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March 1989

Prospective Reimbursement and Pediatric Services

Author Affiliations

Chief Operating Officer University of Arizona Health Sciences Center 1501 N Campbell Tucson, AZ 85724

Am J Dis Child. 1989;143(3):292-293. doi:10.1001/archpedi.1989.02150150046015

The findings described by Munoz and colleagues1 in this issue of AJDC are important for planning pediatric services. It should be remembered that diagnosis related groups (DRGS) were originally intended to be a management tool to compare utilization and costs of treatment in similar disease categories. In 1984, the federal government first applied DRGs as a reimbursement methodology for Medicare beneficiaries. Pediatric facilities were excluded along with other specific services. The exclusion from DRG reimbursement was based primarily on the DRG's lack of experience and their consequent inability to establish reasonable reimbursement.

Reasonable reimbursement for pediatric services is the key issue. The popularity of prospective payment among federal and state governments as well as other payers has placed greater pressure to include pediatric services under the same reimbursement scheme as services for adult patients. This practice, particularly in "all-payer" states, poses immediate problems for institutions

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