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Outpatient prospective payment.

Administrative Radiology : AR

|July 8, 1991

Summary

This summary is machine-generated.

Medicare

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Area of Science:

Health Care Policy
Medical Economics

Background:

The Health Care Financing Administration (HCFA) is proposing a prospective payment system for Medicare outpatient services.
This system will significantly alter outpatient service management and reimbursement, particularly for radiology.
Providers are already facing reduced reimbursements due to earlier payment adjustments.

Purpose of the Study:

To analyze the anticipated impact of a prospective payment system on Medicare outpatient services.
To understand the financial implications for healthcare providers, including radiology.

Main Methods:

Analysis of proposed Medicare outpatient prospective payment system.
Comparison with the impact of inpatient prospective payment systems (DRGs) and resource-based relative value scale (RBRVS).

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Main Results:

The prospective payment system is expected to lead to significant financial shifts among providers, creating 'winners and losers'.
Payments for outpatient services may be reduced and vary considerably between providers.
This policy initiative is predicted to have a greater impact than DRGs and RBRVS combined.

Conclusions:

A prospective payment system for outpatients will likely cap payments across the entire hospital service continuum.
Healthcare providers must prepare for substantial changes in financial structures and operational management.