Mohr Penny E, Kintala Sreelata
Policy Anal Brief W Ser. 2003 Aug;6(1):1-4.
The transition to Medicare's new prospective payment system for hospital outpatient services has arguable been the most complex and difficult programmatic change in the history of Medicare (Federal Register, 2002). Concern about its adverse effects led to holding rural hospitals with 100 beds or fewer harmless from the financial consequences of the new payment system for the first three years. However, small rural hospitals were not held harmless from implementing the outpatient prospective payment system (OPPS). Many outside observers felt that small rural hospitals would be ill-equipped to handle the immensity of change required, and that claim denials or delays caused by inaccurate claims submissions might have a disproportionate effect on smaller hospitals. There were also reports about difficulties with the interim payment system that had been designed to ensure small hospitals did not lose money during the first three years. This policy brief describes issues that arose in implementing OPPS during the first years of the program, identifies specific implementation concerns for small rural hospitals, and raises issues that may warrant further research or policy action.
向医疗保险针对医院门诊服务的新预期支付系统的转变，可以说是医疗保险历史上最复杂、最艰难的方案变革（《联邦公报》，2002年）。对其负面影响的担忧导致拥有100张或更少床位的农村医院在前三年免受新支付系统的财务影响。然而，小型农村医院在实施门诊预期支付系统（OPPS）方面并未得到豁免。许多外部观察家认为，小型农村医院没有能力应对所需变革的巨大规模，而且不准确的索赔提交导致的索赔拒绝或延误可能对较小医院产生不成比例的影响。也有报告称，旨在确保小型医院在前三年不亏损的临时支付系统存在困难。本政策简报描述了该计划头几年实施OPPS时出现的问题，确定了小型农村医院的具体实施问题，并提出了可能需要进一步研究或政策行动的问题。
