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Do hospitals respond to changing incentive structures? Evidence from Medicare’s 2007 DRG restructuring

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  • Cook, Amanda
  • Averett, Susan

Abstract

In 2007, the Centers for Medicare and Medicaid restructured the diagnosis related group (DRG) system by expanding the number of categories within a DRG to account for complications present within certain conditions. This change allows for differential reimbursement depending on the severity of the case. We examine whether this change incentivized hospitals to upcode patients as sicker to increase their reimbursements. Using the National Inpatient Survey data from HCUP from 2005 to 2010 and three methods to detect the presence of upcoding, our most conservative estimate is an additional three percent of reimbursement is attributable to upcoding. We find evidence of upcoding in government, non-profit, and for-profit hospitals. We find spillover effects of upcoding impacting not only Medicare payers, but also private insurance companies as well.

Suggested Citation

  • Cook, Amanda & Averett, Susan, 2020. "Do hospitals respond to changing incentive structures? Evidence from Medicare’s 2007 DRG restructuring," Journal of Health Economics, Elsevier, vol. 73(C).
  • Handle: RePEc:eee:jhecon:v:73:y:2020:i:c:s0167629618309330
    DOI: 10.1016/j.jhealeco.2020.102319
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    As found by EconAcademics.org, the blog aggregator for Economics research:
    1. Chris Sampson’s journal round-up for 5th October 2020
      by Chris Sampson in The Academic Health Economists' Blog on 2020-10-05 11:00:05

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    1. Argys, Laura M. & Averett, Susan L. & Yang, Muzhe, 2020. "Residential noise exposure and health: Evidence from aviation noise and birth outcomes," Journal of Environmental Economics and Management, Elsevier, vol. 103(C).

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    More about this item

    Keywords

    Upcoding; Hospital reimbursement; Health care financing; Health insurance; Diagnosis related group;
    All these keywords.

    JEL classification:

    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private

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