Hospital manipulations in the DRG system: a systematic scoping review

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2. Roger France FH. Case mix use in 25 countries: a migration success but international comparisons failure. Int J Med Inform. 2003; 70:215-9.

3. Rosenberg MA, Browne MJ. The Impact of the Inpatient Prospective Payment System and Diagnosis- Related Groups: A Survey of the Literature. North American Actuarial Journal. 2001; 5:84-94.

4. International Classification of Diseases (ICD). World Health Organization [Internet]. 2008 [cited 2008 Oct 12]. Available from: http://www.who.int/classifications/icd/en/. Search in Google Scholar

5. Vladeck BC. Medicare hospital payment by diagnosisrelated groups. Ann Intern Med. 1984; 100:576-91.

6. Sheingold SH. The first three years of PPS: Impact on medicare costs. Health Affairs. 1989; 8:191-204.

7. McMahon LF, Jr., Smits HL. Can Medicare prospective payment survive the ICD-9-CM disease classification system? Ann Intern Med. 1986; 104:562-6.

8. Iezzoni LI. Risk adjustment for measuring healthcare outcomes. 2nd ed. Chicago, IL: Health Administration Press; 1997. Search in Google Scholar

9. Fisher ES, Whaley FS, Krushat WM, et al. The accuracy of Medicare’s hospital claims data: progress has been made, but problems remain. Am J Public Health. 1992; 82:243-8.

10. Iezzoni LI, Moskowitz MA. Clinical overlap among medical diagnosis-related groups. JAMA. 1986; 255: 927-9. 10.1001/jama.1986.03370070081030 Search in Google Scholar

11. Lloyd SS, Rissing JP. Physician and coding errors in patient records. JAMA. 1985; 254:1330-6. 10.1001/jama.1985.03360100080018 Search in Google Scholar

12. Simborg DW. DRG creep: a new hospital-acquired disease. N Engl J Med. 1981; 304:1602-4. 10.1056/NEJM198106253042611 Search in Google Scholar

13. Psaty BM, Boineau R, Kuller LH, Luepker RV. The potential costs of upcoding for heart failure in the United States. Am J Cardiol. 1999; 84:108-9, A9.

14. Silverman E, Skinner J. Medicare Upcoding and Hospital Ownership. Journal of Health Economics. 2004; 23:369-89.

15. Pongpirul K, Walker DG, Winch PJ, Robinson C. A qualitative study of DRG coding practice in hospitals under the Thai Universal Coverage Scheme. BMC Health Serv Res. 2011;11:71.

16. Korcok M. Will DRG payments creep into all US health insurance plans? Can Med Assoc J. 1984; 130: 912-5. Search in Google Scholar

17. Dranove D. Rate-Setting by Diagnosis Related Groups and Hospital Specialization. RAND Journal of Economics. 1987; 18:417-27.

18. Farley DE, Hogan C. Case-mix specialization in the market for hospital services. Health Serv Res. 1990; 25:757-83. Search in Google Scholar

19. Zuidema GD, Dans PE, Dunlap ED. Documentation of care and prospective payment. One hospital’s experience. Ann Surg. 1984; 199:515-21. 10.1097/00000658-198405000-00004 1353479 6426413 Search in Google Scholar

20. Gollin G, Moores D. Turning whine into wine: the fiscal impact of comprehensive documentation and billing for nonoperative pediatric surgical services. J Pediatr Surg. 2006; 41:1093-5.

21. Brown JG. Improper fiscal year 2000 medicare fee-forservice payments (A-17-00- 02000): Department of Health and Human Services Office of Inspector General; 2001. Search in Google Scholar

22. Kleinmuntz C, Kleinmuntz D, Stephen R, Nordlund D. Measuring and managing risk improves strategic financial planning. Healthcare Financial Management. 1999:51-8. Search in Google Scholar

23. Gottlieb M, Eichenwald K, Barbanel J. Health care’s giant: powerhouse under scrutiny-a special report. New York Times. 1997; 28 March;Sect. 1. Search in Google Scholar

24. Brubaker B. HCA Faces New Fraud Charges; US Says Virginia Hospitals Involved in Medicare Scam. Washington Post 2001 17 March. Search in Google Scholar

25. McNeil BJ. Hospital response to DRG-based prospective payment. Med Decis Making. 1985; 5: 15-21.

26. Lorence DP, Richards M. Variation in coding influence across the USA. Risk and reward in reimbursement optimization. J Manag Med. 2002; 16:422-35.

27. Williams SV. The impact of DRG-based prospective payment on clinical decision making. Med Decis Making. 1985; 5:23-9.

28. Harper DL. Critical appraisal of the DRG system: problem areas for DRG reimbursement in the USA. Aust Clin Rev. 1985:5-11. Search in Google Scholar

29. Dafny LS. How Do Hospitals Respond to Price Changes? In: National Bureau of Economic Research, Inc, NBER Working Papers: 9972; 2003. 10.3386/w9972 Search in Google Scholar

30. Lave JR. Hospital reimbursement under Medicare. Milbank Mem Fund Q Health Soc 1984;62:251-68. 10.2307/3349827 Search in Google Scholar

31. McCarthy CM. DRGs-five years later. N Engl J Med. 1988; 318:1683-6. 10.1056/NEJM198806233182510 Search in Google Scholar

32. Hadley J, Swartz K. The impacts on hospital costs between 1980 and 1984 of hospital rate regulation, competition, and changes in health insurance coverage. Inquiry. 1989; 26:35-47. Search in Google Scholar

33. Hadley J, Zuckerman S, Feder J. Profits and fiscal pressure in the prospective payment system: their impacts on hospitals. Inquiry. 1989; 26:354-65. Search in Google Scholar

34. Russell LB, Manning CL. The effect of prospective payment on Medicare expenditures. N Engl J Med. 1989; 320:439-44. 10.1056/NEJM198902163200706 Search in Google Scholar

35. Barbetta GP, Turati G, Zago AM. Behavioral differences between public and private not-for-profit hospitals in the Italian National Health Service. Health Econ. 2007; 16:75-96.

36. Siciliani L. Selection of treatment under prospective payment systems in the hospital sector. J Health Econ. 2006; 25:479-99.

37. Greenberg D, Peiser JG, Peterburg Y, Pliskin JS. Reimbursement policies, incentives and disincentives to perform laparoscopic surgery in Israel. Health Policy. 2001; 56:49-63.

38. Bentley J, Butler P. Describing and paying hospitals: development in patient case mix. Washington, D.C.: Association of American Medical Colleges; 1980. Search in Google Scholar

39. Dranove D, White WD. Medicaid-dependent hospitals and their patients: how have they fared? Health Serv Res. 1998; 33:163-85. Search in Google Scholar

40. Malcomson JM. Supplier discretion over provision: Theory and an application to medical care. RAND Journal of Economics. 2005; 36:412-32. 10.2139/ssrn.668367 Search in Google Scholar

41. Rock RC. Assuring quality of care under DRG-based prospective payment. Med Decis Making. 1985; 5: 31-4.

42. Guterman S, Eggers PW, Riley G, Greene TF, Terrell SA. The first 3 years of Medicare prospective payment: an overview. Health Care Financ Rev. 1988; 9:67-77. Search in Google Scholar

43. Wynia MK, Cummins DS, VanGeest JB, Wilson IB. Physician manipulation of reimbursement rules for patients: between a rock and a hard place. JAMA. 2000; 283:1858-65. 10.1001/jama.283.14.1858 Search in Google Scholar

44. Powell R. Bureaucratic Malpractice. In: Princeton University, Center for the Analysis of Public Issues; 1974. Search in Google Scholar

45. Gilman BH. Hospital response to DRG refinements: the impact of multiple reimbursement incentives on inpatient length of stay. Health Econ. 2000; 9:277-94.

46. Sloan FA, Morrisey MA, Valvona J. Effects of the Medicare prospective payment system on hospital cost containment: an early appraisal. Milbank Q. 1988; 66:191-220.

47. Zhang JL. The impact of a diagnosis-related groupbased prospective payment experiment: the experience of Shanghai. Applied Economics Letters. 2010; 17: 1797-803.

48. Newhouse JP. Do unprofitable patients face access problems? Health Care Financ Rev. 1989; 11:33-42. Search in Google Scholar

49. Sheingold SH. The first three years of PPS: impact on Medicare costs. Health Aff (Millwood). 1989; 8: 191-204. 10.1377/hlthaff.8.3.191 Search in Google Scholar

50. Steinbusch PJ, Oostenbrink JB, Zuurbier JJ, Schaepkens FJ. The risk of upcoding in casemix systems: a comparative study. Health Policy. 2007; 81: 289-99.

51. Lungen M, Lauterbach KW. [Upcoding-a risk for the use of diagnosis-related groups]. Dtsch Med Wochenschr. 2000; 125:852-6. Search in Google Scholar

52. Victorian Government Department of Human Services. Victoria, public hospitals, policy and funding guidelines 1997-1998. Melbourne: Victorian Government Department of Human Services; 1997. Search in Google Scholar

53. Carter GM, Newhouse JP, Relles DA. How Much Change in the Case Mix Index Is DRG Creep? Journal of Health Economics. 1990; 9:411-28.

54. Carter GM, Newhouse JP, Relles DA. Has DRG Creep Crept Up? Decomposing The Case Mix Index Change Between 1987 And 1988. Santa Monica, CA: RAND Corporation; 1991. Search in Google Scholar

55. Serden L, Lindqvist R, Rosen M. Have DRG-based prospective payment systems influenced the number of secondary diagnoses in health care administrative data? Health Policy. 2003; 65:101-7.

56. Hsia DC, Ahern CA, Ritchie BP, Moscoe LM, Krushat WM. Medicare reimbursement accuracy under the prospective payment system, 1985 to 1988. JAMA. 1992; 268:896-9. 10.1001/jama.1992.03490070078046 Search in Google Scholar

57. Rovner J. Providers ‘Downcoding’ Medicare Claims to Avert Investigation. Reuters Health Information 2001. Search in Google Scholar

58. Becker D, Kessler D, McClellan M. Detecting Medicare abuse. J Health Econ. 2005; 24:189-210.

59. Hsia DC. Diagnosis related group coding accuracy of the peer review organizations. J AHIMA . 1992; 63: 56-64. Search in Google Scholar

60. Boadway R, Marchand M, Sato M. An optimal contract approach to hospital financing. J Health Econ. 2004; 23:85-110.