I-DRG, noma ukuhlanganiswa okuhlobene nokuxilongwa, indlela iMedare kanye nezinye izinkampani zomshuwalense wezempilo ezihlukanisa ngayo izindleko zokuhlala esibhedlela futhi kunqume ukuthi zingakanani ukukhokhela ukuhlala esibhedlela. Esikhundleni sokukhokhela esibhedlela lokho okwakuthatha ukunakekelwa kwesiguli esibhedlela, uMedare ukhokha isibhedlela isibalo esilinganiselwe esekelwe i-DRG yesiguli noma ukuxilongwa.
Uma isibhedlela sithatha isiguli ngenkathi sisebenzisa imali engaphansi kwe-DRG yokukhokha, senza inzuzo. Uma isibhedlela singaphezu kokukhokha kwe-DRG okwelapha isiguli, kulahlekelwa yimali.
Ingemuva
Eminyakeni edlule, lapho uhlala esibhedlela, isibhedlela sasizothumela umthamo ku-Medicare noma inkampani yakho yomshuwalense efaka amacala azo zonke izinsizakalo ze-Band-Aid, i-X-ray, i-alcohol swab, i-bedpan ne-aspirin, kanye ne-room room usuku ngalunye owawuse esibhedlela. Lezi zibhedlela zakhuthaza ukuba zigcine esibhedlela isikhathi eside ngangokunokwenzeka futhi zenze okuningi ngangokunokwenzeka ngenkathi usesikhathini esibhedlela. Emva kwakho konke, uma usesikhathi esibhedlela, imali eyengeziwe isibhedlela esenziwe ekamelweni lamacala. Izinqubo eziningi ozenzile ngesikhathi esibhedlela, i-Band-Aids, i-X-rays, ne-alcohol swabs oyisebenzisayo.
Njengoba izindleko zokunakekelwa kwempilo zenyuka, uhulumeni wafuna indlela yokulawula izindleko ngenkathi ekhuthaza izibhedlela ukuba zihlinzeke ngokucophelela.
Umphumela waba yi-DRG.
Kusukela ngawo-1980, i-DRG yashintsha ukuthi i-Medicare ibuyisela kanjani izibhedlela. Esikhundleni sokukhokha usuku ngalunye usesibhedlela futhi u-Band-Aid ngamunye uyayisebenzisa, i-Medicare ikhokhela imali eyodwa esibhedlela sakho esekelwe ku-DRG yakho, esekelwe ekuxilongweni kwakho (kufaka phakathi ukuxilongwa kwesibili, uma kusebenza), noma yikuphi ukuhlinzwa izinqubo ezihilelekile, kanye nobudala bakho nobulili.
Umqondo wukuthi i-DRG ngayinye ihlanganisa iziguli ezinezifo ezifanayo zempilo, futhi ukunakekelwa kwazo kudinga inani elifanayo lemithombo yokwelapha. Ukuthuthukisa lolu hlelo kwakungeyona into elula, njengoba kuchazwa yiCenter for Medicare neMedicaid Services .
Uhlelo lwe-DRG luhloswe ngokuyinhloko ukulinganisa iziqephu zezinzuzo zesibhedlela, kungakhathaliseki ukuthi isibhedlela siphi noma uhlobo luni lweziguli ezithathayo. Kodwa ukungabi namakhono okwamanje kusekhona ohlelweni, kuholele ezinye izibhedlela ukugxilisa izinsiza kumasevisi aphelela ngamaphesenti aphezulu enzuzo, naphezu kokusetshenziswa kwe-DGRs.
I-Care Affordable Act yabhekana nezinguquko ezintsha zokukhokhelwa kweMedare, kufaka phakathi izinkokhelo ezikhokhelwa izinkampani kanye nezinhlangano zokunakekela ezithintekayo (ACOs). Kodwa i-DGRs isakha isisekelo sesimiso sokukhokha esibhedlela saseMedare.
Indlela Amanani Ekhokha E-DRG Abalwa ngayo
I-Medicare iqala ngokubala izindleko ezijwayelekile zemithombo edingekayo ukuphatha iziguli ze-Medicare ku-DRG ethile. Lesi silinganiso sesisekelo sichitshiyelwa ngokusekelwe ezinhlobonhlobo zezici, kufaka phakathi inkomba yomholo wendawo enikeziwe (isibhedlela sase-NYC sikhokhela inkokhelo ephakeme kunesibhedlela zasemaphandleni yaseKansas, isibonelo, futhi kubonakala ngesilinganiso sokukhokha esibhedlela ngasinye for the DRG efanayo).
Izibhedlela zase-Alaska naseHawaii, ngisho nengxenye engekho emthethweni ye-DRG imali yokukhokhwa kwemali ishintshwe izindleko zesici sokuphila.
Kukhona futhi izinguquko ekukhokhweni kwezizinda ze-DRG uma isibhedlela sithatha isibalo esikhulu seziguli ezingaqinisekisiwe, noma ngabe siyisibhedlela sokufundisa.
Indlela i-DRG isebenza ngayo
Inguqulo elula ihamba kanje: UMnu. Koff noMnu. Flemm bobabili bavunyelwe esibhedlela esifanayo ukwelashwa kwe- pneumonia . UMnu Koff waphathwa futhi wakhululwa ezinsukwini ezimbili. Ukuvakasha kukaMnu. Flemm kwahlala izinsuku ezingu-10.
Njengoba uMnu. Koff noMnu. Flemm benesifo esifanayo, bane-DRG efanayo. Ngokwe-DRG, uMedare ukhokha isibhedlela esifanayo noMnu Koff njengoba kwenza uMnu. Flemm yize isibhedlela sichitha imali eningi ehlinzeka uMnuz Flemm izinsuku eziningana kunokuhlinzeka uMnu Koff izinsuku ezimbili zokunakekelwa.
Njengoba i-DRG, i-Medicare ikhokhela esibhedlela ngenxa yokuxilongwa kwesiguli esitholwe esibhedlela ukuze siphathe, hhayi ngokuthi ingakanani isibhedlela esenza ukuphatha isiguli, isikhathi esingakanani isiguli esibhedlela, noma ukuthi isibhedlela sichitha sinakekele isiguli .
Endabeni kaMnu Koff, isibhedlela kungenzeka ukuthi senze inzuzo encane. Ukukhokha okusekelwe e-DRG cishe kwakukhudlwana kakhulu kunezindleko zangempela zokuhlala kukaMnu Koff izinsuku ezimbili.
Endabeni kaMnu. Flemm, lesi sibhedlela cishe sabulala imali. Ngokuqinisekile yabiza isibhedlela ukuze sikhathalele uMnu. Flemm izinsuku ezingu-10 kunalokho okukhokhwa yi-DRG.
Impembelelo ye-DRG
Uhlelo lokukhokha lwe-DRG lukhuthaza izibhedlela ukuba zisebenze ngokuphumelelayo ekwelapheni iziguli futhi zisusa isikhuthazo esibhedlela ukuze siphathe ngokweqile iziguli . Kodwa-ke, lokhu kuyinkemba ehlangene kabili njengoba izibhedlela manje zizimisele ukukhipha iziguli ngokushesha ngangokunokwenzeka kanti ngezinye izikhathi zisolwa ngokukhipha iziguli ekhaya ngaphambi kokuba ziphile ngokwanele ukuya ekhaya ngokuphepha.
Manje i-Medicare inemithetho endaweni ejezisa esibhedlela uma ngabe isiguli singeniswa esibhedlela ngesifo esifanayo phakathi nezinsuku ezingu-30 zokukhishwa. Lokhu kusho ukudikibala izibhedlela ekukhipha iziguli ngaphambi kokuba ziphile ngokwanele ukuthi zikhishwe.
Ukwengeza, kwezinye i-DRG, isibhedlela kufanele sabelane ngenxenye yokukhokha kwe-DRG nensizakalo yokuvuselela noma umhlinzeki wezempilo wezempilo ekhaya uma ikhishwa isiguli esibhedlela sokuthola iziguli noma ngokusekelwa kwezempilo ekhaya.
Njengoba isiguli singasuswa esibhedlela ngokushesha ngezinsiza zesikhungo sokuvuselela iziguli noma ukunakekelwa kwezempilo ekhaya, isibhedlela sifisa ukwenza kanjalo ngoba kungenzeka ukuthi inzuzo evela ekukhokhweni kwe-DRG. Kodwa-ke, i-Medicare idinga isibhedlela ukuthi sihlanganyele ingxenye yenkokhelo ye-DRG nensizakalo yokuvuselela noma umhlinzeki wezempilo ukunakekelwa kwezempilo ukuze akhiphe izindleko ezengeziwe ezihambisana nalawo masevisi.
Bheka Uhlu lwe-DRG
Uhla lwamanje lwe-DRG (njengango-2017) lutholakala lapha.
Funda kabanzi mayelana ne-DRGs
I-DRG yakho izimisele kanjani?
I-DRG Inquma Kanjani Isibhedlela Esithola Ukukhokha?
> Imithombo:
> Amasevisi e-Medicare naseMedicaid Services, i-PPS ephuthumayo yeziguli.
> Amasevisi weMediare and Medicaid Services, Design and Development of Group Diagnostic Group . Okthoba 2016.
> Amasevisi we-Medicare neMediicaid Services, Uhlelo lokunciphisa izifunda zeBhedlela. April 2016.
> I-New England Journal of Medicine Catalyst. Ukwenza ngcono iziNzuzo zeZibhedlela ngeDatha yezindleko ezingcono. Ngo-Ephreli 10, 2017.