235.013 DRG Payment System

235.013

DRG Payment System: The Texas Medical Association voted to actively seek to resolve the problems of rural hospital reimbursement under DRGs.

TMA acknowledges the need for hospital management to develop a data base so that practice patterns, caseload characteristics, and hospital resource utilization information can be shared; reemphasizes the need for physicians to be aware of hospital costs and pricing as an aid to implementation of efficient patient care, and urges that hospitals provide this information; agrees that diagnoses which are developed by record and business departments for billing under the DRG system must be made known to physicians so that these diagnoses and those developed by physicians can be confirmed to be congruent; and agrees that hospital management be reminded of the new demands on physicians' time as a result of DRGs.

TMA voted to recommend to its members and other physicians in Texas that they actively work for the repeal of DRG validation through physician attestation.

TMA voted to express strenuous opposition to extending Prospective Payment System and the diagnostic related groups reimbursement mechanisms to physicians' payments under any system of insurance, public or private; and to voice strenuous opposition to application of this system of payment for hospital services by private insurance carriers (CSE, p 143, A-93; reaffirmed CSE Rep. 6-A-03; reaffirmed CSE Rep. 1-A-13).

Last Updated On

October 07, 2016