The effect of Medicare's payment system for rehabilitation hospitals on length of stay, charges, and total payments.
Background Medicare's system for the payment of rehabilitation hospitals is based on limits derived from a hospital's average allowable charges per patient discharged during a base year.
Thereafter, payments are capped, but hospitals receive incentive payments if charges per patient are reduced in succeeding years.
We hypothesized that per-patient charges would increase during the base year and then decrease in subsequent years.
Hospitals would thus have higher reimbursement limits and receive incentive payments for reducing their charges.
Methods We analyzed Medicare claims data for 190,921 discharges from 69 rehabilitation hospitals from 1987 through 1994.
We compared total charges, length of stay, and interim payments before, during, and after each hospital's base year.
Results After we controlled for inflation and temporal and seasonal trends, mean charges per patient discharged increased from $25,131 for patients discharged before the base year to $32,167 for patients discharged in the base year (a 28 percent increase, P<0.001) and the mean length of stay increased from 22.1 to 26.7 days (a 21 percent increase, P<0.001).
After the base year, mean charges decreased to $29,307 (a 9 percent decrease) and the mean length of stay decreased to 24.0 days (a 10 percent decrease) (P<0.001 for both comparisons). (...)
Mots-clés Pascal : Réhabilitation, Hôpital, Paiement, Economie santé, Etats Unis, Amérique du Nord, Amérique, Analyse coût, Homme, Remboursement
Mots-clés Pascal anglais : Rehabilitation, Hospital, Payment, Health economy, United States, North America, America, Cost analysis, Human
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 97-0515474
Code Inist : 002B30A04B. Création : 13/02/1998.