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Diagnosis-Related Groups for Physician Reimbursement? FREE

Mark J. Segal, PhD
JAMA. 1985;254(18):2639-2640. doi:10.1001/jama.1985.03360180143045
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Diagnosis-related groups (DRGs) are being considered by policymakers as a basis of physician reimbursement for care provided to Medicare inpatients. Under such a system, all physicians' care associated with a hospital admission, classified into one of over 400 DRGs, would be paid for by Medicare in one lump sum. The attractiveness of aggregating the unit of payment, from the individual service to a "package" of services, here the hospital case, lies in the anticipation of new incentives for greater physician cost consciousness. The report by Lowenstein and colleagues1 in this issue of The JOURNAL is one product of an intensive effort, launched by the Department of Health and Human Services and its Health Care Financing Administration, to fulfill a congressional mandate to explore the "advisability and feasibility" of extending Medicare DRG payment, already in place for hospitals, to physicians. The conclusions from this research are to be presented in

REFERENCES

Lowenstein SR, Iezzoni LI, Moskowitz MA:  Prospective payment for physician services: Impact on medical consultation practices . JAMA 1985;;254:2632-2637.
Reinhardt UE: The Compensation of Physicians: Approaches Used in Other Countries , final report submitted to the Health Care Financing Administration. US Dept of Health and Human Services, grant No. 95-P-97030912, 1985;.
Luft HS: Health Maintenance Organizations: Dimensions of Performance . New York, John Wiley & Sons Inc, 1981;.
Brown LD: Politics and Health Care Organizations: HMOs as Federal Policy . Washington, DC, The Brooking Institution, 1983;.
Jencks SF, Dobson A:  Strategies for reforming Medicare's physician payments: Physician diagnosis-related groups and other approaches . N Engl J Med 1985;;312:1492-1499.
Mitchell JB:  Physician DRGs . N Engl J Med 1985;;313:670-675.
Markel GA: Per-Case Reimbursement for Medical Care , research report 77-5. Camp Hill, Pennsylvania Blue Shield, 1977;.
Horn SD, Balkley G, Sharkey PD, et al:  Interhospital differences in severity of illness: Problems for prospective payment based on diagnosis-related groups (DRGs) . N Engl J Med 1985;;313:20-24.
Wennberg JE, McPherson K, Caper P:  Will payment based on diagnosis-related groups control hospital costs? N Engl J Med 1984;;311:295-300.
Morrisey MA, Conrad DA, Shortell SM, et al:  Hospital rate review: A theory and empirical review . J Health Economics 1984;;3:25-47.

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Lowenstein SR, Iezzoni LI, Moskowitz MA:  Prospective payment for physician services: Impact on medical consultation practices . JAMA 1985;;254:2632-2637.
Reinhardt UE: The Compensation of Physicians: Approaches Used in Other Countries , final report submitted to the Health Care Financing Administration. US Dept of Health and Human Services, grant No. 95-P-97030912, 1985;.
Luft HS: Health Maintenance Organizations: Dimensions of Performance . New York, John Wiley & Sons Inc, 1981;.
Brown LD: Politics and Health Care Organizations: HMOs as Federal Policy . Washington, DC, The Brooking Institution, 1983;.
Jencks SF, Dobson A:  Strategies for reforming Medicare's physician payments: Physician diagnosis-related groups and other approaches . N Engl J Med 1985;;312:1492-1499.
Mitchell JB:  Physician DRGs . N Engl J Med 1985;;313:670-675.
Markel GA: Per-Case Reimbursement for Medical Care , research report 77-5. Camp Hill, Pennsylvania Blue Shield, 1977;.
Horn SD, Balkley G, Sharkey PD, et al:  Interhospital differences in severity of illness: Problems for prospective payment based on diagnosis-related groups (DRGs) . N Engl J Med 1985;;313:20-24.
Wennberg JE, McPherson K, Caper P:  Will payment based on diagnosis-related groups control hospital costs? N Engl J Med 1984;;311:295-300.
Morrisey MA, Conrad DA, Shortell SM, et al:  Hospital rate review: A theory and empirical review . J Health Economics 1984;;3:25-47.
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