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HRD-85-109 1 (1985-09-12)

handle is hein.gao/gaobabntv0001 and id is 1 raw text is: W4z. Fogel UNITED STATES GENERAL ACCOUNTING OFFICEM .N,-sio, _ _ WASHINGTON, D.C. 20548 X- Ccdae- ES rOURCP.S L e ,,SON September 12, C. McClain Haddow Acting Administrator, Health Care Financing Administration Department of Health and Human Services Dear Mr. Haddow: Subject: Additional Changes to the Medicare Reimbursement Rates for Major Joint Procedures Are Needed (GAO/HRD-85-109) In a June 10, 1985, Notice of Proposed Rulemaking, the Health Care Financing Administration (HCFA) recommended an increase in the Medicare payment rate for bilateral or multiple joint replacements currently included in Diagnosis Related Group (DRG) 209. We stated our tentative support for this increase in a letter to the former Administrator dated April 17, 1985, prior to completing our analysis of Medicare payment rates for major joint procedures. The proposed change was finalized in the September 3, 1985 regulation. The results of our completed work reinforce the need for this change to provide more equitable reimbursement to providers, reduce the risk to beneficiaries that results from multiple surgeries where one would be appropriate, and prevent an unnecessary rise in Medicare costs. Our analysis also confirms the need for the other changes to the reimbursement rates for major joint procedures discussed in our April letter. Specifically, --all procedures to correct problems or complications with joint replacements (revisions) should be reimbursed under DRG 209, rather than under DRGs 209, 442, and 443 as is currently the case; and --reimbursement for a certain joint repair procedure (femoral head replacement) currently included under DRG 209 should be included under DRGs 210 and 211 with other similar repair procedures. These additional changes would be more consistent with the principles of the Medicare prospective payment system and would provide more equitable reimbursement to providers. (106270) 11111111III 128136 oC) - HUMAN F DIV I 72.-r 6.

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