Computer Simulation Model To Evaluate Management Strategies To Face Medicare'S Prospective Payment System.

Abstract

The Tax Equity and Fiscal Responsibility Act (TEFRA) of 1982 limits Medicare's reimbursement per patient to a fixed amount depending on the patient's particular type of disease. The reimbursement is based on a set of diagnosis-related groups (DRGs), which categorizes patients into disease classifications. As a result, hospitals must make efficiency gains and managers must look for new ways to provide quality care while containing cost. A simulation model was developed to evaluate the financial effects of particular administrative policies. Patient billing data were collected over a three-month period and analyzed for the purpose of simulating length of stay and resource consumption per cost center. Regression analyses were used to approximate departmental cost as a function of length of stay and to estimate total cost as a function of certain departmental costs. Distribution-fitting techniques were used to determine the method of random generation for independent variables. Two runs are presented to illustrate how policies are simulated and results interpreted.

Publication Date

12-1-1985

Publication Title

Proceedings - Annual Symposium on Computer Applications in Medical Care

Number of Pages

901-905

Document Type

Article; Proceedings Paper

Personal Identifier

scopus

Socpus ID

0022307349 (Scopus)

Source API URL

https://api.elsevier.com/content/abstract/scopus_id/0022307349

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