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SEIU-UHW Advocating for Fair Treatment in Prime Healthcare's Record & Prospective Payment

SEIU-UHW is fighting for fair treatment of California hospital workers and integrity in dealings with patients, caregivers, and the public in their labor dispute with Prime Healthcare. This presentation highlights the potential gaming of Prime Hospitals APR-DRGs and the need for caution in reimbursement and disproportionate share.

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SEIU-UHW Advocating for Fair Treatment in Prime Healthcare's Record & Prospective Payment

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  1. Prime Healthcare’s Record& Prospective Payment in California

  2. Background SEIU-UHW is engaged in a labor dispute with Prime Healthcare. Not surprisingly, we often find that the same corporate employers who fail to treat their employees with dignity, respect and fairness are also failing to be responsible corporate citizens in other areas. In this presentation, as always, SEIU-UHW stands up for fair treatment of California hospital workers, and integrity in dealing with patients, caregivers and the public.

  3. Prime Hospitals

  4. APR-DRGs can be gamed • Prospective payment: DRG weights • ICD-9 codes broken into 4 groups corresponding to 4 levels of payment • Similar to CMS MS-DRGs Source: HCUP

  5. Septicemia: Top U.S. Hospitals, 2009

  6. Severe Malnutrition in CA, 2010

  7. Encephalopathy: Top 10 U.S. Hospitals

  8. MS-DRG SeverityTop 10 U.S. Hospitals, 2010

  9. Short Stays for High-Cost Patients This chart compares all 94 health systems with at least 10,000 qualifying Medicare claims in 2009 Prime has the highest average severity, but many short stays

  10. ER Business Model - example

  11. Recap • DRGs can be gamed • Prime’s model may be spreading • Caution needed: • Reimbursement could increase much more than expected • Disproportionate share could go to most aggressive companies • ER business model raises costs and concerns

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