New Jersey has had many calls from outside the State from agencies and individuals concerned about DRGs and Medicare. The level of knowledge ranged from some familiarity to total ignorance of even simple data requirements. The second issue is the importance of monitoring quality of care. Quality of care is very difficult to measure. Can quality be measured by a criterion such as outcome alive/dead? In New Jersey, we believe that peer review is an important component in monitoring quality of care, and the PSROs serve this function. The value of an independent organization to monitor the utilization of hospital care cannot be refuted. c. NEW TECHNOLOGY Third, there should be a mechanism for addressing new technology. In New Jersey, the Rate Setting Commission hears testimony from a hospital (or hospitals), the Department of Health, and the Commissioner's Physician Advisory Committee. If evidence is available that a new technological advance is worthwhile, then the hospital is awarded additional reimbursement. The hospital can also obtain additional reimbursement for new technology through the appeals process for those approved certificate of need projects. It is important to note that while the problems of rising hospital costs may be similar nationally, a prospective payment system may not have identical results in Idaho as in Pennsylvania. In those instances where a state can implement their own system, designed to meet the federal objective, then flexibility or waivers for state initiatives should be allowed. SUMMARY In conclusion, we in New Jersey have been working with DRGS since 1976. We feel very strongly that DRGs have a great benefit in terms of allowing hospitals to use available resources wisely and to help contain health care costs for payers and consumers. Now that all New Jersey acute care general hospitals are finally billing by DRGs, we should be in a position to see exactly how much of an impact DRGs can have on a state's health care expenditures and clinical management. Material from Report to Congress Hospital Prospective Payment for Medicare December 1982 Richard S. Schweiker Secretary 0.S. COROCNTTT HOSPITALS 1975-1980 man INCULASZ POLISZ PLI ADJUSTID ADMISSION LANK TATZ 1 LISTA 10 12 13 15 16 17 10 20 22 23 26 27 28 29 30 149.67 .37 ONTARA T! TOCXY CHICAS ATTACHMENT A ANNUAL ORT". 20.00 2.23 DATORY. 0.s. Average 79.60 12.42 Those programs wich require hospitals born to participate and comply. |