<30 days
How long is the length of stay for acute care hospitals?
>30 days
How long is the length of stay for long-term hospitals?
General hospital
-provide a variety of services including general medical and surgical services, obstetric services, etc.
Specialty hospitals
-concentrate on one disease like psychiatric diseases, cancer, or tubuerculosis, or one segment of the population such as children or veterans.
For-profit
have to distribute some of their profits to investors
Non-profit
have no investors that they must pay dividends to; get to enjoy the income and property tax exemptions
Community Hospitals
-all nonfederal, short-term general or specialty hospitals
-can be teaching hospitals as well; must be nonfederal tho
teaching hospital
-may be expressly associated with a medical school or have an affiliation
-must offer physician training in order to be considered this
Multi-hospital system
-when a hospital is either leased under contract by another hospital or are legally incorporated by or under the direction of a board that determines the control of 2 or more hospitals
-ex: baptist
Retrospective Payment System (RPS)
-reimbursement on the basis of cost or charges
-this causes hospitals to: perform more procedures, increase LOS for patients, reduce efficiency in hospital management
Patient mix
-accounts for loss due to non-paying patients or less payments made by insurers than actual cost
Cost
-the price that is negotiated between the hospital and third-party payers. (cost < charges)
-usually ends up being less
wage index application, teaching status, disproportionate share payments, severity
factors that influence reimbursement amount
Balanced Budget Act (BBA)
-introduced prospective payment systems
-reduced medicare reimbursements by $115 billion
decrease in no. of inpatient admissions and shortened LOS, increase in post-hospital use of services like NH, unbundled services, reclassification of patients in higher weighted DRGs, shift severely ill patients to other institutions
What are the 5 biggest impacts of PPS?
Diagnosis-related groups (DRGs)
-places patients into groups based on their diagnosis; each with an assigned weight
-depends on condition, severity, comorbidities
-this is all based on the average resources used to treat medicare patients in that treatment group