Government-instituted programs designed to control health care costs include (Select all that apply.)
a. Professional standards review organizations (PSROs).
b. Prospective payment systems (PPSs).
c. Diagnosis-related groups (DRGs).
d. "Never events."
e. Third-party payers.
A, B, C
The federal government, the biggest consumer of health care, which pays for Medicare and Medicaid, has created professional standards review organizations (PSROs) to review the quality, quantity, and costs of hospital care. One of the most significant factors that influenced payment for health care was the prospective payment system (PPS). Established by Congress in 1983, the PPS eliminated cost-based reimbursement. Hospitals serving patients who received Medicare benefits were no longer able to charge whatever a patient's care cost. Instead, the PPS grouped inpatient hospital services for Medicare patients into diagnosis-related groups (DRGs). In 2006, the National Quality Forum (not a government agency) defined a list of 28 "never events" that are devastating and preventable. Through most of the twentieth century, few incentives existed for controlling health care costs. Insurers or third-party payers paid for whatever health care providers ordered for a patient's care and treatment.
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