Tanglaw Spring 1998

The MEDICARE Saga Continues by Charley Hughes Manager, Social Services Liberty Hospital The Balanced Budget Act of 1997 that was recently signed into a law by President Clinton is a five year plan to balance the federal budget and reduce Medicare spending by $115 billion. In an effort to begin containing the cost of health care, Medicare , in the early 1980's began the Prospective Payment System (PPS) for in- patient hospitalization when they began using the Diagnosis Related Groups (DRG's) to determine the amount a hospital would be paid to provide a patient's care. The payment was based on the diagnosis of the patient . Under the Balanced Budget Act, Prospective Payment System ( PPS ) is being expanded as the payment mechanism for Skilled Nursing Units, and Home Health. In Skilled Nursing Units the PPS payment will be based on Resource Utilization Groups (RUG's). RUG's reflect the resources the facility uses to care for a patient. The end result is Skilled Nursing Units will be paid less to provide care to residents. This will affect nurses as organizations begin to ask and answer for themselves these questions; does a resident need this service and what is the appropriate skill level for the person providing a particular service? In Home Health the PPS is still being developed. It will result in patients receiving fewer visits and being discharged from home health care sooner. This mean nurses and therapists must, even more, emphasize their role in teaching patients and their families to assume responsibility for their own health care.

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