Ambulatory Care Services and the Prospective Payment System

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Jones & Bartlett Learning, 1999 - Health & Fitness - 292 pages
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Aspen's Prospective Payment for Ambulatory Services will provide the reader with an overview of the development of the APC prospective payment system, An understanding of the importance of case mix for managed care practice And The ambulatory case mix systems. Fundamentals of APCs, including both the financial and clinical aspects, will be covered along with challenges to implementation of the system and principles of coding for outpatient prospective payment. Managerial approaches to dealing with outpatient prospective payment will be included.
 

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Contents

Preparing for Outpatient Prospective Payment
15
Coding and the Medicare Outpatient Prospective
43
An Opportunity
53
The Development of Outpatient Prospective
65
Development of a Prospective Payment System
75
Outpatient Prospective Payment Systems
145
Blue Shield of California Outpatient Payment
153
Chapter 10The Design and Implementation of
161
Chapter 11Preparing for Outpatient Prospective
171
Chapter 12The Incremental Cost of Second and Third
187
Chapter 13A Quality Improvement Process for Ambulatory
195
Chapter 14Payment for Packages of Outpatient
211
Chapter 15The Development of a Physician Prospective
253
Index
287
Copyright

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About the author (1999)

Norbert Goldfield, M.D. is Medical Director for 3M Health Information Systems. In this capacity, he has worked on a number of projects including development of an outpatient visit-based prospective payment system, development of risk adjusters for capitation payment/ retrospective analyses of episodes of care, refinement of DRGs adjusted for severity/mortality used for quality (internal management/or public disclosure) and payment purposes, and new methods of measuring quality of care such as a tool to avoid readmissions and a tool to not reimburse hospitals extra for patients incurring avoidable complications during their hospital stay. Many countries throughout the world use these tools for quality management purposes. He has presented many papers on topics ranging from quality of care measurement to history of efforts to enact national health reform. He has published extensively and is editor of the peer-reviewed Journal of Ambulatory Care Management. Dr. Goldfield is a practicing internist with a subspecialty in adolescent medicine. He works two days a week at a community health center and has introduced new coordinated care programs for patients with chronic illness. Dr. Goldfield has helped form several volunteer organizations including Hampshire Health Access (providing access to care for the uninsured in Hampshire County, Mass where the author lives) and the Palestinian Medical Access Partnership (providing major surgeries to Palestinian children living in the West Bank and Gaza). He is also on the board of Health Care For All based in Boston, Massachusetts.

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