A DRG, kana kuenzanisa kuenzanirana kweboka, ndiyo nzira iyo Medicare nemamwe makambani emishuwarisi ehutano anopa zvipatara mari yekurapa uye anoona kuti vangabhadharwa zvakadini nechipatara murwere. Panzvimbo pokubhadhara chipatara kune izvo zvakashandiswa kuchengetedza murwere wepachipatara, Medicare aripa chipatara chiyero chakatarwa zvichienderana neDGG murwere kana kuti kuongororwa.
Kana chipatara chichibata murwere ichi pachinenge chichishanda kudarika chikwereti cheDGG, chinoita purofiti. Kana chipatara ichipfuura zvinopfuura kubhadhara kweDGG kurapa murwere, inorasikirwa nemari.
Background
Makore apfuura, pawakagara muchipatara, chipatara chacho chaizotumira mari kune Medicare kana inshuwarisi yekambani iyo yaisanganisira mhosva yeBan-Aid, X-ray, swab, alcohol, aspirin, pamwe nekamuri zuva rimwe nerimwe waive muchipatara. Izvi zvakakurudzira zvipatara kukuchengetedza iwe kuchipatara kwenguva yakareba sezvazvingaita uye kuita zvakanyanya kwauri sezvaungaita iwe uchiri muchipatara. Mushure mezvose, nguva refu iwe waive muchipatara, mari yakawanda iyo chipatara chakaitwa panzvimbo yemhosva. Iyo yakawanda yawakanga waita munguva yezvipatara, iyo yakanyanya Band-Aids, X-rays, newaini swabs yawakashandisa.
Sezvo mari yekuchengetwa kwehutano yakakwira, hurumende yakatsvaka nzira yekudzivirira mari iyo ichikurudzira zvipatara kuti zvive nehanya zvakanyanya.
Chii chakakonzerwa neDGG.
Kutanga muma1980, DRG dzakashandura kuti Medicare inopa sei zvipatara. Panzvimbo yekubhadhara zuva rega rega uri muchipatara uye rimwe nerimwe reBhuku-Rubatsiro raunoshandisa, Medicare inobhadhara mari imwe chete yeimba yako yekuchengetedza maererano neDGG yako, iyo inobva pakuongorora kwako (kusanganisira yechipiri yekuongorora, kana zvichibvira), chero upi zvake mitemo inobatanidzwa, uye makore ako uye zvepabonde.
Pfungwa iyi ndeyokuti DRC imwe neimwe inosanganisira varwere vane zvirwere zvakafanana zvekurapwa, uye avo vane hanya vanoda zvimwe zvakafanana zvekushandisa kubata. Kuvandudza urongwa uhwu kwaisava nyore, sezvakatsanangurwa neCenters for Medicare neMedicaid Services .
Izvo chirongwa cheDGG chinotarisirwa kunyanya kuenzanisa zvipatara zvitsva, pasinei nokuti chipatara chiri chei kana kuti varwere vorudzii rwavanobata. Asi kusava nehutano kunenge kuchiripo muhurongwa, kutungamirira zvimwe zvipatara kuti zviongorore zvishandiswa pamabasa anoguma nepamusoro pemiganhu yemiganhu, pasinei nekushandiswa kweDGRs.
Iko kusingakwanisi Kutarisira Mutemo yakatanga mune dzimwe shanduko itsva dzekubhadhara kweMedare, kusanganisira bundled kubhadhara uye Accountable Care Organizations (ACOs). Asi DGRs ichiri kuumba hwaro hweMurengeti weHIV.
Nzira yekubhadharwa kweDGG Inowanikwa sei
Medicare inotanga nokuverenga mavhareji emari yezvinhu zvakakosha kurapa varwere veMedare mune imwe DRG. Nhamba yepamusoro iyo inogadziriswa zvichibva kune zvakasiyana-siyana zvezvinhu, kusanganisira mubairo webhadharo kune nzvimbo inopiwa (chipatara muNewC inopa mari yakakwirira kupfuura chipatara mumaruwa eKansas, somuenzaniso, uye inoratidzwa mubhadharo yekubhadhara apo chipatara chimwe nechimwe chinowana nokuda kweDGG imwe chete).
Kune zvipatara muAlaska neHawaii, kunyange chikamu chisingawaniki cheDGG chebhadharo chekubhadhara chechigodhi chinoshandiswa nehutengo hwehupenyu huno.
Kunewo kuchinjwa kwebhadharo yeBDCG kana chipatara chikabata nhamba yakawanda yevasina kuvimbiswa, kana kuti iri chipatara chokudzidzisa.
Maitiro eDDRG Anoshanda sei
Shanduro yakareruka inofanana neizvi: VaKoff naVaFlemm vose vakabvumirwa kuchipatara chimwe chete kuti vashandise chirwere chepineumonia . VaKoff vakabatwa uye vakasunungurwa mumazuva maviri. Mushandirapamwe waVaFlemm vakapedza mazuva gumi.
Sezvo VaKoff naVaFlemm vaine chirwere chakafanana, vane DGG imwecheteyo. Kubva pane iyo DRG, Medicare inokweretesa chipatara chakafanana naVaKoff sezvinoita kuna Mr. Flemm kunyange zvazvo chipatara ichipedza mari yakawanda inopa mazuva gumi ekutarisira kuna Flemm kupfuura kupa mazuva maviri ekutarisira kuna Koff.
NeDGG, Medicare inokweretesa chirwere chechipatara zvichienderana nekuongorora kuti murwere akapfigirwa muchipatara kuti apore, kwete zvichienderana nehuwandu hwechipatara chakaita kurapa murwere, nguva yakareba sei murwere ari muchipatara, kana kuti yakawanda sei chipatara chakapedza kutarisira murwere .
Muzvakaitika naVaKoff, chipatara chacho chingave chakaita purofisi duku. Iko kupiwa kweDGG kwaive kwakanyanya kuduku kudarika mari chaiyo yaVaKoff yekugara kwemazuva maviri.
Mune zvakaitika kuna Mr. Flemm, chipatara ichida mari. Izvozvo zvakadhura chipatara ichi kuti chichengetedze Bwana Flemm kwemazuva gumi kupfuura kubhadhara kweDGG yakagamuchira.
The Impact of DRGs
IroGG yenzira yekubhadhara inokurudzira zvipatara kuti zvive zvakanyatsoshanda mukurapa varwere uye kubvisa chikonzero chezvipatara kuti vape kupfuura varwere . Zvisinei, iyi ibakatwa rakapetwa kaviri sezvo zvipatara zvino zvinoda kubudisa varwere nokukurumidza sezvinobvira uye dzimwe nguva vanopomerwa kubudisa varwere kumba vasati vaine utano hwakakwana hwokuenda kumba vakachengeteka.
Iye zvino Medicare ine mitemo munzvimbo inoranga chipatara chemari kana murwere achidzokidzwazve kuchipatara ane hutano hwakafanana mumazuva makumi matatu ekubudiswa. Izvi zvinoreva kuvhiringidza zvipatara kubva pakubudisa varwere vasati vaine hutano hwakakwana kuti vasunungurwe.
Uyezve, kune dzimwe DDRG, chipatara chinofanira kugovera chikamu chekubhadhara kweDGG nebazi rekugara pakatarisana kana mutapi wehutano hwepamusha kana ichibudisa murwere kune chiremba chekugarisa varwere kana kuti nehutano hwehutano hwemusha.
Sezvo murwere achigona kusunungurwa kubva kuchipatara nokukurumidza pamwe nemishandira yezvipatara zvekugarisa varwere kana kutarisira utano hwepamusha, chipatara chinoda kuita kudaro nokuti zvinowanzoita purogiramu kubva kuRGG kubhadhara. Zvisinei, Medicare inoda chipatara kuti igovere chikamu chekubhadhara kweDGG nebazi rekugara patsva kana kuti mutarisiri wehutano hwepamusha kuti abvise mari yakawedzerwa inobatanidzwa nemabasa iwayo.
Ona Rongedzo rweDDRG
Rwendo rwezvino rwe DRGs (sa20177) rinowanikwa pano.
Dzidza Zvakawanda Pamusoro peDDRG
Mutoo weDDG Anogadzirisa Sei Chipatara Chinowanikwa?
> Sources:
> Centres for Medicare neMedicaid Services, Yakanyanya Inpatient PPS.
> Centers for Medicare neMedicaid Services, Zvakarongwa uye Kuvandudzwa kweGwara Rinobatana Neboka . October 2016.
> Centres for Medicare neMedicaid Services, Hospital Revenue Reduction Program. April 2016.
> New England Journal of Medicine Catalyst. Kuvandudza Chipatara Chinobatsira Nehuwandu Dhadharo Data. April 10, 2017.