WordNet

(physical chemistry) a sample of matter in which substances in different phases are in equilibrium; "in a static system oil cannot be replaced by water on a surface"; "a system generating hydrogen peroxide"
instrumentality that combines interrelated interacting artifacts designed to work as a coherent entity; "he bought a new stereo system"; "the system consists of a motor and a small computer"
a group of independent but interrelated elements comprising a unified whole; "a vast system of production and distribution and consumption keep the country going" (同)scheme
a complex of methods or rules governing behavior; "they have to operate under a system they oppose"; "that language has a complex system for indicating gender" (同)system of rules
a group of physiologically or anatomically related organs or parts; "the body has a system of organs for digestion"
a procedure or process for obtaining an objective; "they had to devise a system that did not depend on cooperation"
the living body considered as made up of interdependent components forming a unified whole; "exercise helped him get the alcohol out of his system"
of or concerned with or related to the future; "prospective earnings"; "a prospective mother"; "a prospective bride"; "the statute is solely prospective in operation"
a sum of money paid or a claim discharged
the act of paying money (同)defrayal, defrayment

PrepTutorEJDIC

〈C〉(関連した部分から成る)『体系』,系統,組織[網],装置 / 〈C〉(教育・政治などの)『制度』,機構;《the~》体制 / 〈C〉(思想・学問などの)『体系』,学説 / 〈C〉(…の)『方法』,方式,やり方《+of doing》 / 〈U〉正しい方針(筋道,順序) / 〈U〉《the~》(身体の)組織,系統 / 〈U〉《the~,one's~》身体,全身
未来の,将来の / 予想される,見込みのある
〈U〉(…の)『支払い』,納入《+『for』(『of』)+『名』》 / 〈C〉(…の)『支払金,支払物』《+『for』(『of』)+『名』》 / 〈U〉《時にa payment》(善または悪の)報い,報酬,罰《+『for』+『名』》

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/01/17 02:26:54」(JST)

wiki en

A prospective payment system (PPS) is a term used to refer to several payment methodologies where means of determining insurance reimbursement is based on a pre-determined payment, regardless of the intensity of the actual service provided.

It includes a system for paying hospitals based on predetermined prices, from Medicare. Payments are typically based on codes provided on the insurance claim.^[1] Examples of these codes include:

Diagnosis-related groups – for hospital inpatient claims
Ambulatory Payment Classification – for hospital outpatient claims
Current Procedural Terminology – for other outpatient claims

The PPS was established by the Center for Medicare and Medicaid Services (CMS) in 1983, specifically to address expensive hospital care. Regardless of services provided, payment was of an established fee. The idea was to encourage hospitals to tame increasingly expensive hospital care.

In 2000, CMS changed the reimbursement system for outpatient care at Federally Qualified Health Centers (FQHCs) to include a prospective payment system for Medicaid and Medicare.^[2] Under this system, health centers receive a fixed, per-visit payment for any visit by a patient with Medicaid, regardless of the length or intensity of the visit. The per-visit rate for the Medicaid PPS is specific to the individual health center location. This rate is determined and updated by a financial accounting process conducted by State Medicaid agencies. The FQHC PPS rate for Medicare (previously called the All Inclusive Reimbursement Rate), in contrast, is fixed at the same level across different health centers. ^[3] ^[4]

Aside from FQHCs, other entities that provide outpatient services to Medicaid patients, that are also paid by a PPS methodology include:

"FQHC look-alikes" (Health centers not receiving a federal grant under section 330 of the Public Health Service Act, but otherwise meet the criteria for FQHC-status.)
Indian Health Service Health Centers^[5]
Rural Health Centers (in some states, like California)^[6]

References

^ "Overview Prospective Payment Systems". Centers for Medicare & Medicaid Services.
^ Chris Koppen (January 2001). "Understanding the Medicaid Prospective Payment System for Federally Qualified Health Centers (FQHCs)" (PDF). Retrieved 24 December 2014.
^ National Association of Community Health Centers. "Medicaid Prospective Payment System". Retrieved 24 December 2014.
^ Center for Healthcare Research and Transformation (July 23, 2013). http://www.chrt.org/public-policy/policy-papers/federally-qualified-health-centers-an-overview/. Retrieved 24 December 2014. Missing or empty |title= (help)
^ "Indian Health Service Legislation". Retrieved 24 December 2014.
^ "Securing additional Medi-Cal payments for Clinics in California". Retrieved 24 December 2014.

UpToDate Contents

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1. 家庭での血液透析プログラムの構成および要素 organization and elements of a home hemodialysis program
2. 長期酸素補充療法 long term supplemental oxygen therapy
3. 神経系のライム病 nervous system lyme disease
4. 供血者スクリーニング：血液のレシピエントとドナーの安全性を高めるための手順とプロセス blood donor screening procedures and processes to enhance safety for the blood recipient and the blood donor
5. 小児における中枢神経系の急性脱髄の鑑別診断 differential diagnosis of acute central nervous system demyelination in children

English Journal

The Medicare physician-data release--context and rationale.

Brennan N1, Conway PH, Tavenner M.
The New England journal of medicine.N Engl J Med.2014 Jul 10;371(2):99-101. doi: 10.1056/NEJMp1405026. Epub 2014 May 28.
PMID 24869599

Caution advised: Medicare's physician-payment data release.

O'Gara PT.
The New England journal of medicine.N Engl J Med.2014 Jul 10;371(2):101-3. doi: 10.1056/NEJMp1405322. Epub 2014 May 28.
PMID 24869596

Development and Evaluation of the CAHPS (Consumer Assessment of Healthcare Providers and Systems) Survey for In-Center Hemodialysis Patients.

Weidmer BA1, Cleary PD2, Keller S3, Evensen C3, Hurtado MP4, Kosiak B5, Gallagher PM6, Levine R7, Hays RD8.
American journal of kidney diseases : the official journal of the National Kidney Foundation.Am J Kidney Dis.2014 Jul 3. pii: S0272-6386(14)00805-1. doi: 10.1053/j.ajkd.2014.04.021. [Epub ahead of print]
BACKGROUND: The US Centers for Medicare & Medicaid Services assess patient experiences of care as part of the end-stage renal disease prospective payment system and Quality Incentive Program. This article describes the development and evaluation of the Consumer Assessment of Healthcare Providers
PMID 24998035

Japanese Journal

アンケート結果のまとめ

諏訪部章
臨床病理 59(5), 496-501, 2011-05-25
NAID 10029427438

DPC導入の影響評価に係る調査データに関するセキュリティ考察

山上浩志,廣川博之
医療情報学 30(4), 241-250, 2010
2003年4月に始まったDPC（Diagnosis Procedure Combination）に基づく包括評価による入院医療費の定額支払い制度は，2010年7月1日時点で一般病院全体の18.0%に相当する1,391施設に適用されている．厚生労働省はこれら施設を対象にした「DPC導入の影響評価に係る調査」を通じて，DPC分類の精緻化，DPCごとの診療報酬点数の決定や病院係数の決定等を行うためのデ …
NAID 130005058874

経皮的内視鏡椎間板ヘルニア摘出の現状(<特集>他科のエキスパートに学ぶ)

出沢明,金民世
脳神経外科ジャーナル 18(12), 875-881, 2009-12-20
… 影響を可及的に少なくする.そして,日帰り手術(DS;day surgery,outpatient surgery,same day surgery,ambulatory surgery)により,早期の社会復帰を目指す.米国では,1983年のMedicareの入院医療の包括支払い(prospective payment system)の導入により,外来での手術に移行する割合が多くなっている.腰椎椎間板ヘルニア摘出術は,高位や横断面での発生部位によっては,直接神経根周囲の椎間板を切除し根を圧排する病 …
NAID 110007483413