Hirth Richard A, Wolfe Robert A, Wheeler John R, Roys Erik C, Tedeschi Philip J, Pozniak Alyssa S, Wright Glenn T
University of Michigan, School of Public Health, Department of Health Management and Policy, 109 S. Observatory, Ann Arbor, MI 48109-2029, USA.
Health Care Financ Rev. 2003 Summer;24(4):77-88.
Congress has required CMS to expand the Medicare outpatient prospective payment system (PPS) for dialysis services to include as many drugs and diagnostic procedures provided to end stage renal disease (ESRD) patients as possible. One important implementation question is whether dialysis facility case mix should be reflected in payment. We use fiscal year (FY) 2000 cost report and patient billing and clinical data to determine the relationship between costs and case mix, as represented by several patient demographic, diagnostic, and clinical characteristics. Results indicate considerable variability in costs and case mix across facilities and a significant and substantial relationship between case mix and facility cost, suggesting case mix payment adjustment may be important.
国会已要求医疗保险和医疗补助服务中心（CMS）扩大针对透析服务的医疗保险门诊预付费系统（PPS），以尽可能多地纳入提供给终末期肾病（ESRD）患者的药物和诊断程序。一个重要的实施问题是，透析机构的病例组合是否应在支付中得到体现。我们使用2000财年成本报告、患者计费和临床数据，来确定成本与病例组合之间的关系，病例组合由若干患者人口统计学、诊断和临床特征来表示。结果表明，各机构之间在成本和病例组合方面存在很大差异，病例组合与机构成本之间存在显著且实质性的关系，这表明病例组合支付调整可能很重要。
