How nurses can survive under DRGs

In an attempt to arrest spiralling health care costs, the US in April 1983 took the bold step of changing the method of payment for government-paid inpatient services from a cost-based retrospective reimbursement system to a prospective payment system (PPS) based on diagnosis related groups (DRGs). Since then Medicare payments to hospitals have been based on a fixed predetermined payment per case, discharge or per diem, or an overall revenue limitation, regardless of costs actually incurred. Naturally, this method has fostered fundamental changes throughout the US health care system, particularly for nursing: among them, the reduction of nursing staff and nurses resuming some functions previously taken over by ancillary staff. While the pros and cons of DRGs continue to create controversy, their use in planning and management of hospitals is being seriously explored in at least seven other countries, including Australia. "Should Australia adopt DRGs, what will be the effects on the health care services?" asks Vera F. Irurita, the author of the following article. But in the meantime, she places a call to nurses to start now to prepare for the future challenge...for their own survival.