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From: eric@milo.UUCP (Eric Bergan)
Newsgroups: net.med
Subject: Re: DRG/HMOs and quality of Patient Care (provocative)
Message-ID: <784@milo.UUCP>
Date: Mon, 17-Dec-84 10:30:33 EST
Article-I.D.: milo.784
Posted: Mon Dec 17 10:30:33 1984
Date-Received: Tue, 18-Dec-84 07:10:36 EST
References: <1011@aecom.UUCP>
Distribution: net
Organization: JHU/Applied Physics Lab, Laurel, MD
Lines: 36

> 
> 	In an effort to bring down the high cost of Health care, there has
> been a spread of HMOs (Health Maintenance Organizations) and reimbursement
> by DRGs (Diagnostic Related Groups).
> 	To oversimplify, these work by Pre-payment by the patient (HMO) or
> a set fee for the diagnosis (DRG), and replace so-called Fee for Service
> arrangements. (Pay for each test, pay for each day in the hospital - the
> more the doctor does, the more he gets paid).

	No sane person that I know currently considers DRGs to be good. For
one thing, they totally ignore the age of the patient. Taking care of a 
broken hip for a 10 year old is significantly different thatn taking
care of a broken hip for a 70 year old. Also, there are currently gaps in 
the codes - last I knew there was only a code for out patient cataract surgery,
not in patient.

	But, there is a reason for the attempt. Hospitals are currently
rewarded for keeping patients longer than medically necessary, they are paid
by the day, not to treat the illness. I am currently involved with an attempt
to overhaul a hospital to bring its office practices into the 20th century.
There is no attempt made currently to optimize the scheduled tests, or the
flow of paper work on the patient. One example that I know of involves the
radiology department treating the in patients as sort of a queue, they fill
in the times between scheduled out patients with in patient tests. While
an in patient is waiting for a radiology test, they can not be scheduled for
any other testing. This can lead to one or two extra hospital days per stay.

	The problem so far does not have any simple solutions. But it is clear
that health care can not continue in its current form, it already accounts
for a staggering amount of the GNP. What the final, humane form of medical
care will be is going to take some trial and error, and there are going to
be some inequities during this time. Wish I had the answer.

-- 
					eric
					...!seismo!umcp-cs!aplvax!milo!eric