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Impact of Medicare Prospective Reimbursement System on Nutritional Support Service Patients: The Importance of Pass Throughs
Author(s) -
Clemmer Terry P.,
Orme James F.,
Thomas Frank O.,
Peterson Marilee,
Merrow Linde,
Peterson Helene
Publication year - 1989
Publication title -
journal of parenteral and enteral nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.935
H-Index - 98
eISSN - 1941-2444
pISSN - 0148-6071
DOI - 10.1177/014860718901300171
Subject(s) - reimbursement , service (business) , intensive care medicine , prospective payment system , medicine , medical emergency , business , emergency medicine , health care , finance , marketing , political science , payment , law
The financial data of all patients (535) admitted to the Nutritional Support Service (NSS) during 1985, including charges, true care costs, and actual reimbursement including pass‐through payments (which are Medicare funds given directly to hospitals for education and capital equipment, and vary significantly from hospital to hospital), were analyzed. The NSS Medicare patients fell into 98 diagnostic related groups (DRGs). All 3,939 Medicare patients admitted in 1985 with the same DRGs as the NSS patients were also identified and their financial data analyzed. The NSS patients lost $999,643 because the 266 medicare reimbursed NSS patients sustained high losses which overwhelmed the modest profits of the 269 non‐Medicare patients. When data from all Medicare patients (which includes both NSS and non‐NSS patients) with the same DRGs are analyzed, large profits are realized. These profits are totally due to pass‐through payments received. Without pass throughs the loss for all 3,939 Medicare patients in these 98 DRGs would have been $1,641,273. The impact of eliminating pass throughs in the next few years needs to be determined. NSS patients represent a group that generates high financial losses under the federal prospective reimbursement system. However, present Medicare reimbursement of other less seriously ill patients with similar DRGs more than compensate these losses if pass throughs are used in determining reimbursements. (Journal of Parenteral and Enteral Nutrition 13:71–76, 1989)