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The Prospective Payment System: A Civic Good, Not a Civil War-Reply FREE

James P. LoGerfo, MD
JAMA. 1991;265(9):1113-1113. doi:10.1001/jama.1991.03460090060030
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In Reply.—  Dr Haruda has made a very serious error in interpreting the article by Keeler et al,1 which deals with development of a sickness at admission score and its use to predict death rates. The predictions were made only to give readers an estimate of whether patients were more or less severely ill at admission during the post-PPS period. Keeler et al applied the severity of illness score to the patient populations and projected an expectation of an increased mortality of 1.6 percentage points. Their adjuster equation predicted a 180-day mortality of 28.5%, pre-PPS, and the actual was 29.6%; and they predicted a rate of 30.1% post-PPS, but the rate was only 29%. From these data, it can be concluded that patients were sicker in the post-PPS period and that the death rate should have gone up, but in actuality, it fell.However, the actual rates experienced by

REFERENCES

Keeler EB, Kahn KL, Draper D, et al.  Changes in sickness at admission following the introduction of the prospective payment system . JAMA. 1990;;264:1962-1968.
Kahn KL, Keeler EB, Sherwood MJ, et al.  Comparing outcomes of care before and after implementation of the DRG-based prospective payment system . JAMA. 1990;; 264:1984-1988.

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Keeler EB, Kahn KL, Draper D, et al.  Changes in sickness at admission following the introduction of the prospective payment system . JAMA. 1990;;264:1962-1968.
Kahn KL, Keeler EB, Sherwood MJ, et al.  Comparing outcomes of care before and after implementation of the DRG-based prospective payment system . JAMA. 1990;; 264:1984-1988.
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