Economies of scale, physician volume for urology patients, and DRG prospective hospital payment system

Urology ◽  
1990 ◽  
Vol 36 (5) ◽  
pp. 471-476 ◽  
Author(s):  
Eric Munoz ◽  
Richard Boiardo ◽  
Katherine Mulloy ◽  
Jonathan Goldstein ◽  
Jeffrey G. Brewster ◽  
...  
Neurosurgery ◽  
1990 ◽  
Vol 26 (1) ◽  
pp. 156-161 ◽  
Author(s):  
Eric Munoz ◽  
Richard Boiardo ◽  
Katherine Mulloy ◽  
Jonathan Goldstein ◽  
Noel Tenenbaum ◽  
...  

Orthopedics ◽  
1990 ◽  
Vol 13 (1) ◽  
pp. 39-44
Author(s):  
Eric Munoz ◽  
Richard Boiardo ◽  
Katherine Mulloy ◽  
Jonathan Goldstein ◽  
Jeffrey G Brewster ◽  
...  

BMJ ◽  
2010 ◽  
Vol 340 (mar10 2) ◽  
pp. c1306-c1306
Author(s):  
Z. Kmietowicz

ILR Review ◽  
1991 ◽  
Vol 44 (4) ◽  
pp. 765
Author(s):  
William G. Johnson ◽  
Louise B. Russell

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Simon B. Spika ◽  
Peter Zweifel

Abstract Background With DRG payments, hospitals can game the system by ’upcoding’ true patient’s severity of illness. This paper takes into account that upcoding can be performed by the chief physician and hospital management, with the extent of the distortion depending on hospital’s internal decision-making process. The internal decision making can be of the principal-agent type with the management as the principal and the chief physician as the agent, but the chief physicians may be able to engage in negotiations with management resulting in a bargaining solution. Results In case of the principal-agent mechanism, the distortion due to upcoding is shown to accumulate, whereas in the bargaining case it is avoided at the level of the chief physician. Conclusion In the presence of upcoding it may be appropriate for the sponsor to design a payment system that fosters bargaining to avoid additional distortions even if this requires extra funding.


2015 ◽  
Vol 72 (3) ◽  
pp. 251-257 ◽  
Author(s):  
Uros Babic ◽  
Ivan Soldatovic ◽  
Dejana Vukovic ◽  
Milena Santric-Milicevic ◽  
Mihailo Stjepanovic ◽  
...  

Background/Aim. Global budget per calendar year is a traditional method of funding hospitals in Serbia. Diagnose related groups (DGR) is a method of hospital payment based on classification of patients into groups with clinically similar problems and similar utilization of hospital resources. The aim of this study was to compare current methods of hospital services payment with the projected costs by DRG payment method in urology. Methods. The data were obtained from the information system used in the Clinical Hospital Center ?Dr. Dragisa Misovic? - Dedinje in Belgrade, Serbia. The implemented hospital information system was the main criterion for selection of healthcare institutions. The study included 994 randomly selected patients treated surgically and conservatively in 2012. Results. Average costs under the current payment method were slightly higher than those projected by DRG, however, the variability was twice as high (54,111 ? 69,789 compared to 53,434 ? 32,509, p < 0,001) respectively. The univariate analysis showed that the highest correlation with the current payment method as well as with the projected one by DRG was observed in relation to the number of days of hospitalization (? = 0.842, p < 0.001, and ? = 0.637, p < 0.001, respectively). Multivariate regression models confirmed the influence of the number of hospitalization days to costs under the current payment system (? = 0.843, p < 0.001) as well as under the projected DRG payment system (? = 0.737, p < 0.001). The same predictor was crucial for the difference in the current payment method and the projected DRG payment methods (? = 0.501, p <0.001). Conclusion. Payment under the DRG system is administratively more complex because it requires detailed and standardized coding of diagnoses and procedures, as well as the information on the average consumption of resources (costs) per DRG. Given that aggregate costs of treatment under two hospital payment methods compared in the study are not significantly different, the focus on minor surgeries both under the current hospital payment method and under the introduced DRG system would be far more cost-effective for a hospital as great variations in treatment performance (reduction of days of hospitalization and complications), and consequently invoiced amounts would be reduced.


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