Possible Influence of the Prospective Payment System on the Assignment of Discharge Diagnoses for Coronary Heart Disease

When it enacted the Tax Equity and Fiscal Responsibility Act of 1982, Congress modified the system by which hospitals are reimbursed for the care of Medicare patients 1 . The prospective payment system instituted was based on diagnosis-related groups (DRGs). Whereas in the past hospital reimbursement had been based on a fee-for-service method of payment, the DRG concept provided a fixed sum based on the usual nature and severity of the illness of patients in a diagnostic grouping. Thus, for example, discharging a patient with a diagnosis of stable angina pectoris resulted in a smaller payment to hospitals than discharging a . . .