DRG (Diagnosis Related Group)-Based Payment for Radiology, Anesthesia, and Pathology Services

摘要

The report focuses on physician radiology, anesthesiology, and pathology (RAP) services provided to hospital inpatients that potentially could be bundled into a single diagnosis related group (DRG) based payment. The innovative approach would be similar to the method of paying for hospital services under Medicare's hospital prospective payment system and might be a way to help control costs for physician services because both prices and the number of services could be controlled simultaneously. The report uses merged Medicare Part A and Part B claims data from four States (Alabama, Connecticut, Washington and Wisconsin) to provide descriptive and multivariate analyses of RAP charges by DRG and to simulate potential redistributive effects. Major findings indicate that: (1) DRGs account for over one-half of the variation in physician RAP charges for inpatients; (2) surgical DRGs are quite homogeneous whereas medical DRGs vary dramatically; (3) RAP DRG cost weights are consistent across States; (4) over one-half of all hospitals would receive windfall gains of $15 or more per admission, while 16% of hospitals would lose this much or more per case; and (5) the groups of hospitals most likely to win and lose are rural hospitals and teaching hospitals respectively. Analyses that attempt to account for these gains and losses are also included.