Additional Changes to the Medicare Reimbursement Rates for Major Joint Procedures Are Needed
HRD-85-109
Published: Sep 12, 1985. Publicly Released: Sep 12, 1985.
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Highlights
GAO reviewed the increase in the Medicare payment rate for bilateral or multiple joint replacement procedures in light of the resources used by the providers program costs.
Recommendations
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Health Care Financing Administration | The Administrator of the Health Care Financing Administration (HCFA) should include all revisions of prior joint replacements under DRG 209. |
Closed – Not Implemented
HCFA stated that the recommended change might provide a remedy for surgical procedures. HCFA stated that such a change would affect other DRG and, therefore, would require substantial study. Such a study has not been undertaken or planned. The data GAO developed demonstrated that the recommended change was needed.
|
| Health Care Financing Administration | The Administrator, HCFA, should include the repair of the femoral head in DRG 210 and 211 with other similar hip repair procedures. |
Closed – Not Implemented
HCFA disagreed with the recommendation based on the payment of averages theory of the prospective payment system. GAO believes that it has shown that the applicable procedure distorts the averages and the recommendation is valid.
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Topics
Disease detection or diagnosisHealth care cost controlHealth care costsMedicareMedical services ratesPatient care servicesPaymentsSurgeryDiagnosis related groupsHospitals