Under Medicare's prospective payment system (PPS), hospitals are paid on the basis of patient illness and receive predetermined rates for treating patients with the same diagnosis which are combined into diagnosis related groups (DRG). GAO evaluated hospitals' compliance with Medicare guidelines for inpatient treatment of alcohol abuse and examined the effects of PPS rates on the delivery and payment of alcoholism treatment services.
Recommendations for Executive Action
|Health Care Financing Administration||1. The Administrator, HCFA, should refine the study of alcoholism treatment DRG by: (1) verifying, on a sample basis, the data submitted by hospitals; and (2) identifying and accounting for all types of treatments, including detoxification, rehabilitation, combination, and recap or reinforcement treatments.|
|Health Care Financing Administration||2. The Administrator, HCFA, should ensure that PRO intermediaries use alcoholism treatment review criteria that are consistent with and cover all aspects of Medicare guidelines for alcoholism treatments.|