A DRG, kapena magulu okhudzana ndi magulu, ndi momwe Medicare ndi makampani ena a inshuwalansi amagwiritsira ntchito ndalama zomwe amagwiritsa ntchito kuchipatala ndikupeza momwe angaperekere kuchipatala. M'malo molipira chipatala chifukwa cha zomwe adasamalira wodwala kuchipatala, Medicare amalipira chipatala ndalama zokwanira malinga ndi matenda a DRG kapena matenda.
Ngati chipatala chikugwira wodwalayo pamene akugwiritsira ntchito ndalama zochepa kuposa malipiro a DRG, amapanga phindu. Ngati chipatalacho sichiposa malipiro a DRG omwe amachiza wodwalayo, amataya ndalama.
Chiyambi
Zaka zapitazo, pamene mudakhala m'chipatala, chipatalacho chikanatumiza ndalama kwa Medicare kapena kampani yanu ya inshuwalansi yomwe imakhala ndi milandu ya Band-Aid, X-ray, chipsinjo cha mowa, mphasa, ndi aspirin. tsiku lililonse munali m'chipatala. Izi zinalimbikitsa zipatala kukupatsani chipatala kwa nthawi yaitali ndikutheka kuti ndikuchitireni zochuluka momwe mungathere pamene mudali m'chipatala. Ndipotu, mutakhala m'chipatala nthawi yaitali, ndalama zambiri zomwe chipatala chinapangidwira pazipinda. Kuwonjezera pa njira zomwe mudazichita mukakhala m'chipatala, mabungwe ambiri a Band-Aids, X-rays, ndi swabs omwe mumagwiritsa ntchito.
Pamene ndalama zothandizira zaumoyo zidakwera, boma linayesetsa kupeza njira zowononga ndalama zomwe zimalimbikitsa chipatala kuti chisamalire bwino.
Chotsatira chake chinali DRG.
Kuyambira m'ma 1980, ma CDG anasintha momwe Medicare amapereka zipatala. M'malo molipirira tsiku lililonse muli m'chipatala ndipo aliyense amathandiza, Medicare amalipira ndalama zokhazokha chifukwa cha chipatala chanu chochokera ku DRG yanu, yomwe imayambira pa matenda anu (kuphatikizapo kachilombo kafukufuku, ngati kuli kotheka), opaleshoni iliyonse njira zowonjezera, ndi msinkhu wanu ndi nkhanza.
Lingaliro ndilo kuti DRG iliyonse imaphatikizapo odwala omwe ali ndi matenda omwe ali ndi matenda omwe ali nawo, ndipo omwe akusowa amafunika kuchuluka kwazinthu zofunikira kuti azichiritsira. Kupanga dongosolo lino sikunali kophweka, monga tafotokozera ndi Centers for Medicare ndi Medicaid Services .
Mchitidwe wa DRG cholinga chake ndicho kufanana ndi madera a chipatala, mosasamala kumene chipatala chiri kapena odwala omwe amachitira. Koma zopanda pake zilipobe m'dongosololi, ndikuwongolera zipatala kuti ziganizidwe pazinthu zomwe zimathera ndi mapiri apamwamba, ngakhale kugwiritsa ntchito DGRs.
The Affordable Care Act inayambitsa kusintha kwatsopano kwa Medicare, kuphatikizapo kubweza ndalama ndi Accountable Care Organizations (ACOs). Koma DGRs imapanga maziko a dongosolo la kulipira chipatala cha Medicare.
Momwe Malipoti a Malipiro a DRG Amawerengera
Medicare imayamba powerengera mtengo wapatali wa zinthu zofunika kuti athe kuchiza odwala a Medicare mu DRG yapadera. Cholinga chachitsulocho chimasinthidwa malinga ndi zinthu zosiyanasiyana, kuphatikizapo malipiro a malo omwe amapatsidwa (chipatala ku NYC chimapereka malipiro opambana kuposa chipatala chakumidzi ku Kansas, mwachitsanzo, ndipo chikuwonetsedwa mu chiwerengero cha malipiro omwe chipatala chilichonse chimapeza kwa DRG yemweyo).
Kwa zipatala ku Alaska ndi Hawaii, ngakhale gawo lopanda malipiro a ndalama za boma la DRG zimasinthidwa ndi mtengo wa chinthu chokhala ndi moyo.
Palinso kusintha kwa malipiro a mgwirizano wa DRG ngati chipatala chikugwira odwala ambiri osatetezedwa, kapena ngati chipatala chophunzitsira.
Momwe DRG Imagwirira ntchito
Lamulo losavuta limaphatikizapo izi: Bambo Koff ndi Bambo Flemm onse adalandira chipatala chomwechi kuti akachire matenda a chibayo . Bambo Koff adachizidwa ndikumasulidwa masiku awiri. Hospitali ya Bambo Flemm inatha masiku khumi.
Popeza Bambo Koff ndi Bambo Flemm ali ndi matenda omwewo, ali ndi DRG yomweyo. Malinga ndi DRG, Medicare amapereka chipatala chomwecho kwa Bambo Koff monga momwe amachitira Bambo Flemm ngakhale kuti chipatalacho chinagwiritsa ntchito ndalama zochulukitsa Bambo Flemm masiku 10 kuposa kupereka masiku awiri kwa Mr. Koff.
Ndi DRG, Medicare imalipira chipatala pogwiritsa ntchito matendawa kuti wodwalayo adziritsidwa kuchipatala kuti asamalire, osati malinga ndi kuchuluka kwa chipatala chochiza wodwalayo, nthawi yayitali kuchipatala, kapena chipatala chomwe amachitira kuchipatala .
Pankhani ya Bambo Koff, chipatalachi chikhoza kukhala phindu lochepa. Kulipira kwa DRG kungakhale kochepa kwambiri kuposa mtengo weniweni wa masiku awiri a Mr. Koff.
Pankhani ya Bambo Flemm, chipatalacho chinataya ndalama. Zinalidipira chipatala kwambiri kuti asamalire Bambo Flemm masiku 10 kuposa malipiro a DRG omwe analandira.
Zotsatira za DRGs
Ndalama za boma la DRG zimalimbikitsa zipatala kuti zikhale zovuta kwambiri pochiza odwala ndipo zimachotsa chiwopsezo kuchipatala kuti azichiritsa odwala . Komabe, uwu ndi lupanga lakuthwa konsekonse pamene zipatala tsopano zikufunitsitsa kulandira odwala posachedwa ndipo nthawi zina amatsutsidwa kuti amachotsa odwala kwawo asanakhale ndi thanzi lokwanira kupita kwawo bwinobwino.
Tsopano Medicare imakhala ndi malamulo pamalo omwe amalanga chipatala ndalama ngati wodwala abwereranso kuchipatala ali ndi matenda omwewo mkati mwa masiku 30 atatha. Izi zikutanthauza kufooketsa zipatala kuti asatengere odwala asanakhale ndi thanzi labwino.
Kuwonjezera apo, m'madera ena a DRG, chipatalachi chiyenera kugawana gawo limodzi la ndalama zowonongeka ndi DRG ndi malo osungirako mankhwala kapena wothandizira odwala pakhomo ngati atulutsa mchipatala kuchipatala kapena kuchipatala.
Popeza wodwala angathe kumasulidwa kuchipatala posakhalitsa ndi thandizo la chipatala chachipatala kapena kuchipatala, chipatala chimafuna kuchita zimenezi chifukwa ndizopindulitsa kwambiri kuchokera ku malipiro a DRG. Komabe, Medicare imafuna chipatala kuti igawire gawo la kubwezera kwa DRG ndi malo osungirako mankhwala kapena wothandizira zaumoyo kunyumba kuti athetse ndalama zowonjezera zogwirizana ndi mautumikiwa.
Onani Mndandanda wa DRGs
Mndandanda wamakono wa DRGs (monga wa 2017) ukupezeka pano.
Phunzirani zambiri za DRGs
Kodi DRG Yanu Imatsimikiza Motani?
Kodi DRG imadziŵa bwanji chipatala chomwe chimaperekedwa?
> Zotsatira:
> Magulu a Medicare ndi Medicaid Services, Odwala Opaleshoni PPS.
> Zopangira za Medicare ndi Medicaid Services, Kupanga ndi Kukula kwa Gulu Lolimbana ndi Magulu . October 2016.
> Zigawo za Medicare ndi Medicaid Services, Dipatimenti Yopewera Kuwerengera Mapemphero. April 2016.
> New England Journal of Medicine Catalyst. Kupititsa patsogolo Zowonjezera za Chipatala ndi Dongosolo Labwino. April 10, 2017.