History of Prospective Payment Systems. Although our study focused on chronically disabled persons in the total elderly population, it is important to view the service use and mortality of this subgroup in the context of all major components of the total Medicare population. Sager and his colleagues reviewed hospitalization and mortality data on Wisconsin's elderly Medicaid nursing home population. Relative to the entire population of disabled Medicare beneficiaries, Type I individuals are young, with only 10 percent being over 85 years of age. This document and trademark(s) contained herein are protected by law. Despite these challenges, PPS in healthcare can still be an effective tool for creating cost savings and promoting quality care. The life tables for the total population can be derived by employing the case-mix weights (i.e., the gik) actually calculated for each person. In conjunction with the Grade of Membership analysis employed to develop the case-mix groups, we used cause elimination life table methodologies to analyze the duration data in service episodes. Process-of-care measures included overall quality of care as judged by implicit physician review and explicit measures related to diagnosis and treatment. The Outpatient Prospective Payment System (OPPS) is the system through which Medicare decides how much money a hospital or community mental health center will get for outpatient care to patients with Medicare. Despite the challenges associated with implementation, a prospective payment system can be effectively implemented with the right best practices in place. This file is primarily intended to map Zip Codes to CMS carriers and localities. For example, use of the PAS data precluded measurement of post-discharge mortality figures. Hospital readmission rates were expected to increase after PPS in light of the incentives of PPS for hospitals to discharge patients as quickly as possible. A Prospective Payment System (PPS) is a method of reimbursement in which Medicare payment is made based on a predetermined, fixed amount.

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