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Related Experiment Videos

Toward a prospective payment system for ambulatory surgery.

J Lion1, J Vertrees, A Malbon

  • 1Heller School, Brandeis University, Waltham, MA 02254.

Health Care Financing Review
|January 4, 1991
PubMed
Summary

Ambulatory surgery for Medicare patients in 1985 cost $1.8 billion, with cataract procedures dominating. Diagnosis-related groups were unsuitable for prospective payment due to inconsistencies, leading to consideration of newer ambulatory payment systems.

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Area of Science:

  • Health Economics
  • Surgical Services Research
  • Medicare Policy Analysis

Background:

  • In 1985, ambulatory surgery represented a significant expenditure within the Medicare population.
  • Cataract surgeries constituted a substantial portion of the total costs associated with same-day surgical procedures.

Purpose of the Study:

  • To evaluate the financial implications of ambulatory surgery for the elderly Medicare population in 1985.
  • To assess the feasibility of using diagnosis-related groups (DRGs) for a prospective payment system for ambulatory surgery.
  • To explore alternative payment classification systems for ambulatory surgical services.

Main Methods:

  • Analysis of hospital facility charges for ambulatory surgery in 1985.
  • Evaluation of the applicability of diagnosis-related groups (DRGs) for ambulatory procedures.

Related Experiment Videos

  • Review of newly developed ambulatory payment classification systems, including ambulatory visit groups and ambulatory patient groups.

    • Main Results:

    • Total hospital facility charges for ambulatory surgery in 1985 were estimated at $1.8 billion.
    • Diagnosis-related groups (DRGs) were deemed unsuitable for a prospective payment system due to medical DRG inclusion and significant charge variations.
    • The study identified limitations in using existing DRG structures for ambulatory surgery payment models.

    Conclusions:

    • Diagnosis-related groups (DRGs) are not appropriate for a prospective payment system for ambulatory surgery in the Medicare population.
    • The variability in procedure costs within DRGs hinders consistent application for payment purposes.
    • Alternative systems like ambulatory visit groups and ambulatory patient groups warrant further investigation for ambulatory surgery payment.