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March 6, 1991

The Prospective Payment System: A Civic Good, Not a Civil War-Reply

Author Affiliations

Harborview Medical Center Seattle, Wash

Harborview Medical Center Seattle, Wash

JAMA. 1991;265(9):1113. doi:10.1001/jama.1991.03460090060030

In Reply.—  Dr Haruda has made a very serious error in interpreting the article by Keeler et al,1 which deals with development of a sickness at admission score and its use to predict death rates. The predictions were made only to give readers an estimate of whether patients were more or less severely ill at admission during the post-PPS period. Keeler et al applied the severity of illness score to the patient populations and projected an expectation of an increased mortality of 1.6 percentage points. Their adjuster equation predicted a 180-day mortality of 28.5%, pre-PPS, and the actual was 29.6%; and they predicted a rate of 30.1% post-PPS, but the rate was only 29%. From these data, it can be concluded that patients were sicker in the post-PPS period and that the death rate should have gone up, but in actuality, it fell.However, the actual rates experienced by