DPC20140314
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This document discusses the implementation of a Diagnosis-Procedure-Combination (DPC) classification system for hospitals in Japan as an alternative to traditional fee-for-service reimbursement. It provides background on Japan's healthcare system and reimbursement structure. It then outlines several feasibility studies conducted in the late 1990s to evaluate different case-based payment models like the US DRG system. This led to the introduction of a DPC-based per diem payment system for participating hospitals in 2003, with the goal of reducing costs. Over time the DPC system was expanded and saw increased adoption among hospitals in Japan.
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For this Dropbox assignment, please read pages 692-716 (Case 14) of the course textbook Strategic Management in Health Care Organizations. In these pages, the Jefferson Hospital System (JHS) is described.
JHS consists of a full-service, acute-care hospital (Cooper Green Hospital), specialty outpatient clinics (Jefferson Outpatient Care), and six satellite, primary care clinics (the Community Care Plan).
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Create a 2- to 3-page report in Microsoft Word document that answers the following questions.
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· What would you do to increase the utilization of these services and attract a greater mix of paying patients? State at least four steps or actions you would take for this.
Support your responses with examples.
Cite any sources in APA format.
Assignment Grading Criteria
Maximum Points
Analyzed the components of the medical system at JHS that were underutilized.
Explained why the components of the medical system were underutilized.
Summarized the steps to increase the utilization of services and attract a greater mix of paying patients at JHS.
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As Dr. Michael entered his office, Martha James was still on his mind. It had been nearly four years since he launched the Community Care Plan, but in many ways it was still struggling. In his heart, he still believed it was a good model to provide access to preventive and routine medical services to the population traditionally served by Cooper Green Hospital: the poor and uninsured of Jefferson County. It placed small outpatient clinics within local neighborhoods.
They were staffed by physician assistants or nurse practitioners, who were supervised by a physician. For a quarterly fee, members could receive routine medical care at the CCP clinics. When needed, they also received care from specialists, and even inpatient hospital care at Cooper Green.
To Dr. Michael it made perfect sense; the CCP offered better access to services, less waiting time, less travel time, and a better atmosphere.
But the numbers did not agree. Although some of the CCP clinics established a reasonably sized patient base, others were struggling to attract members. If Martha James had been a CCP member, she could have been seen and received treatment before the infection had migrated to her lungs and she would not have had such a long waiting time. “For her, and thousands more like her,” Dr. Michael thought, “it's important to keep the CCP running–if at all possible.” But few people knew about the CCP and even fewer had joined.
The five-year funding that enabled the hospital to launch the CCP was about to run out. Dr. Michael knew he was facing a critical decision: .
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For this Dropbox assignment, please read pages 692-716 (Case 14) of the course textbook Strategic Management in Health Care Organizations. In these pages, the Jefferson Hospital System (JHS) is described.
JHS consists of a full-service, acute-care hospital (Cooper Green Hospital), specialty outpatient clinics (Jefferson Outpatient Care), and six satellite, primary care clinics (the Community Care Plan).
With these components, JHS provides a full spectrum of medical care and a choice of two affordable payment options for what is considered to be an underserved population.
Create a 2- to 3-page report in Microsoft Word document that answers the following questions.
· Why do you think the components of this system are underutilized? (Please note that this is not just a problem of poor marketing and communication.)
· What would you do to increase the utilization of these services and attract a greater mix of paying patients? State at least four steps or actions you would take for this.
Support your responses with examples.
Cite any sources in APA format.
Assignment Grading Criteria
Maximum Points
Analyzed the components of the medical system at JHS that were underutilized.
Explained why the components of the medical system were underutilized.
Summarized the steps to increase the utilization of services and attract a greater mix of paying patients at JHS.
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As Dr. Michael entered his office, Martha James was still on his mind. It had been nearly four years since he launched the Community Care Plan, but in many ways it was still struggling. In his heart, he still believed it was a good model to provide access to preventive and routine medical services to the population traditionally served by Cooper Green Hospital: the poor and uninsured of Jefferson County. It placed small outpatient clinics within local neighborhoods.
They were staffed by physician assistants or nurse practitioners, who were supervised by a physician. For a quarterly fee, members could receive routine medical care at the CCP clinics. When needed, they also received care from specialists, and even inpatient hospital care at Cooper Green.
To Dr. Michael it made perfect sense; the CCP offered better access to services, less waiting time, less travel time, and a better atmosphere.
But the numbers did not agree. Although some of the CCP clinics established a reasonably sized patient base, others were struggling to attract members. If Martha James had been a CCP member, she could have been seen and received treatment before the infection had migrated to her lungs and she would not have had such a long waiting time. “For her, and thousands more like her,” Dr. Michael thought, “it's important to keep the CCP running–if at all possible.” But few people knew about the CCP and even fewer had joined.
The five-year funding that enabled the hospital to launch the CCP was about to run out. Dr. Michael knew he was facing a critical decision: .
Hospitals: 10 necessary structural reforms
10 necessary structural reforms proposals in order to improve efficiency, patient safety and clinical effectivenes.
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DPC20140314
- 1. Measuring Q of a hospital Diagnosis-procedure-combination (DPC) classification for acute hospitals in Japan and its application for risk- adjustment for in-hospital mortality Etsuji Okamoto (National Institute of Public Health)
- 4. The world-longest ALOS OECD Health at A Glance 2013
- 5. Good treatment for CVA
- 6. Lowest rescue rate of AMI
- 7. Fee-for-service (FFS): mainstay of Japan’s reimbursement • 1961 Universal coverage • FFS through uniform fee schedule • 1980s rapid increase of geriatric hospitals • notorious for excessive medication, IV as shown below • 1983 “bundling” of inpatient IV • 1990 per diem reimbursement for geriatric hp • 1990s growing interests in fixed payment in acute care and long-term care. • 2000 LTCI (incl:geriatric hps)
- 8. Prelude • Central Social Insurance Health Care Committee (advisory board for the minister on fee schedule setting) proposed “case- payment” to hospitals in February 1996. • MHW proposed a trial of “per-diem” by specialty (not based on patients’ diagnosis) reimbursement to the CSIHCC on 28th August 1996. This proposal was not realized.
- 9. Feasibility study of US DRG to Japanese hospitals • by Institute of Health Economics & Policy (IHEP) in 1997 in collaboration with 3M HIS, inc. • 17 large hospitals, 121543 cases (ICD9) discharged in 1996. • verified HCFA-DRG(elderly, 492 groups), All patient-DRG(including pediatric patients, 641 groups), APR-DRG(refined, 1530 groups, copy- righted by 3M HIS, inc) • Conclusions: feasible with AP-DRG.
- 10. pilot study • MHW proposed a pilot study of “per-case” reimbursement based on ICD9B classification (approximately 100 groups) to public hospitals. • The Committee on the Pilot Study of Fixed- reimbursement for Acute Hospitals (chair: Akira Matsuda, director of National Institute of Hospital Management) convened on 18th July 1997. • Uncertainty about the feasibility and concerns about effects on the quality of care (note: there were concerns on DRG in the U.S.)
- 11. Structure of DPC coding
- 12. DPC-PDPS(perdiem payment system) April 2003 • Officially introduced to participating hospitals • Differentiate it as perdiem payment from US DRG case-payment system • Perdiem cost is reduced in 3 stages
- 13. Getting more complicated MDC17 (psychiatric), MDC18 (others) added in 2008
- 14. Increase of DPC participating hospitals
- 15. Share of DPC in acute care beds
- 17. Shortened ALOS