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Essay / Research Paper Abstract
This 5 page paper discusses the PPS system and argues that it is only partially effective; and that rising costs are forcing some patients out of the system entirely. Bibliography lists 4 sources.
Page Count:
5 pages (~225 words per page)
File: D0_HVProPay.rtf
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Unformatted sample text from the term paper:
weaknesses. Discussion The Prospective Payment System (PPS) pays for "inpatient and outpatient services, as well as skilled nursing facilities, rehabilitation hospitals, and home health services" (Medicare inpatient hospital prospective payments
system). The system works by setting payment levels "prospectively," meaning ahead of time; the pay rate depends on the service provided and is established by finding out what hospitals across
the country charge, and taking an average (Medicare inpatient hospital prospective payment system). This means of course that hospitals will be reimbursed for more than the services are worth while
other institutions will lose money on the procedure. Researching the topic found nothing to indicate the systems strengths, per se, but there were many to criticize it. One of the
biggest complaints, probably not surprisingly, is the time it takes to doctors to get paid; or finding that when they are paid, the reimbursement is short of the actual money
spent. One source tells us that "[A]s a nonprofit institution, we deal with a whole variety of issues--Medicaid in particular is not reimbursing even close to what our actual costs
are, putting a burden on our practice. Medicaid reimbursement has not increased--in fact, its gone down in the 13 years that Ive been here, but my costs continue to rise"
(Moore, 2006, p. 10). The result is that this practice is losing so much money on Medicaid patients that they are beginning to restrict the number of such patients they
see, something they are not happy about doing (Moore, 2006). There is also the problem of doctors not receiving reimbursement for specialized equipment such as hearing aids (Moore, 2006).
A physician in a small practice in Dallas reports that there has been "an increase in the denials of reimbursement for children with developmental delays" (Moore, 2006, p. 10). This
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