Toward a Prospective Payment System for Outpatient Services: Implementation ofAPGs by State Medicaid Agencies and Private Payers

摘要

This report studies a Medicaid outpatient prospective payment system which groupspatients for payment purposes rather than paying on a cost basis. These groups are similar in concept to diagnosis-related groups which form the heart of Medicare's prospective payment system for inpatient care. It involved a case study on Iowa's implementation of the APG system and an analysis of the reimbursement methodology. This report has two components; an in-depth study of three operational APG systems, based on site visits and telephone interviews with other payers than have implemented or planned to implement the system. All six payers that have operational experience tailored their APG systems to their own priorities and markets. They all implemented the system without major incident.