Application of an Army Prospective Payment Model Structured on the Standards Set Forth by the CHAMPUS Maximum Allowable Charges and the Center for Medicare and Medicaid Services: An Academic Approach

摘要

As new challenges and threats evolve in the 21st century, the Military Health System must understand and respond to these factors to properly resource military treatment facilities from both the patient's and the health care provider's perspectives. The Military Health System is focusing on these quality, access, and cost issues through interrelated initiatives such as the Balanced Scorecard, new TRICARE contractor incentives, corporate-wide strategic plans, and prospective payment systems. As part of the drive to resource the facilities, the corporate leadership began investigating the idea of adopting a prospective payment platform. The purpose of this study was to assess whether the current historical retrospective funding was adequate or whether a prospective budgeting platform was a more cost-effective and feasible alternative. The study specifically analyzed the individual cost components of the Civilian Health and Medical Program of the Uniformed Services reimbursement model as the potential prospective payment chassis. The study used the 10 most common Diagnosis-Related Groups (DRGs) for the year 2002 for the nation with facility-specific information from Brooke Army Medical Center (BAMC).