Drg Agreement

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Cost control is obviously only one of the criteria for evaluating a financial mechanism. Equally important is access to care and quality of care. We believe that DRGs do not diminish access to hospital care. Most states that use DRGs provide payment to all public hospitals. BCBSA affiliates use DRGs in the full variety of their agreements with hospitals. Our interviewees, although sometimes encountered resistance, generally managed to reach a DRG agreement with all the hospitals they wanted. In 1987, New York State passed a law that introduced DRG-based payments for all non-Medicare patients. This legislation required the New York State Department of Health (NYS DOH) to assess the applicability of Medicare DRGs to a non-Medicare population. This evaluation concluded that Medicare DRGs were insufficient for a non-Medicare population. Based on this assessment, the NYS DOH has entered into an agreement with 3M to study and develop any necessary DRG modifications. The changes led to the initial APDRG, which distinguished itself from Medicare`s DRG by offering support for transplants, high-risk obstetric care, nutritional and pediatric disorders, as well as support for other populations. One of the challenges in working with APDRG consolidators is that there is no common data set/formulas shared across all countries, as is the case with CMSs. Each state manages its own information.

[Citation required] Hospital adjustment factors explain the differences between hospitals in input prices, indirect costs of medical training and care for a disproportionate proportion of poor patients. Operating adjustments are calculated as follows: If you`re a patient, understanding the basics of the impact of your DRG assignment can help you better understand your hospital bill for what your health or Medicare fund paid you, or why a particular DRG was assigned to you. If you are a physician who receives questions from the programmer or compliance department, many of these questions are aimed at determining whether the patient was treated for CC or MCC during hospitalization, in addition to treatment for the primary diagnosis. Instead of simply taking over Medicare weights and flows, DRG users have developed very different diagnoses for the non-Medicare population, by layoff, by prospective payment system. . . .

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