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Journal of Parenteral and Enteral Nutrition
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Impact of Medicare Prospective Reimbursement System on Nutritional Support Service Patients: The Importance of Pass Throughs

Terry P. Clemmer, M.D.

Nutritional Support Service and the Division of Critical Care Medicine, Department of Medicine, LDS Hospital, Divisions of Respiratory, Critical Care, and Occupational (Pulmonary) Medicine, University of Utah College of Medicine, Salt Lake City, Utah

James F. Orme, JR, M.D.

Nutritional Support Service and the Division of Critical Care Medicine, Department of Medicine, LDS Hospital, Divisions of Respiratory, Critical Care, and Occupational (Pulmonary) Medicine, University of Utah College of Medicine, Salt Lake City, Utah

Frank O. Thomas, M.D.

Nutritional Support Service and the Division of Critical Care Medicine, Department of Medicine, LDS Hospital, Divisions of Respiratory, Critical Care, and Occupational (Pulmonary) Medicine, University of Utah College of Medicine, Salt Lake City, Utah

Marilee Peterson, R.N.

Nutritional Support Service and the Division of Critical Care Medicine, Department of Medicine, LDS Hospital, Divisions of Respiratory, Critical Care, and Occupational (Pulmonary) Medicine, University of Utah College of Medicine, Salt Lake City, Utah

Linde Merrow, R.N.

Nutritional Support Service and the Division of Critical Care Medicine, Department of Medicine, LDS Hospital, Divisions of Respiratory, Critical Care, and Occupational (Pulmonary) Medicine, University of Utah College of Medicine, Salt Lake City, Utah

Helene Peterson, R.D.

Nutritional Support Service and the Division of Critical Care Medicine, Department of Medicine, LDS Hospital, Divisions of Respiratory, Critical Care, and Occupational (Pulmonary) Medicine, University of Utah College of Medicine, Salt Lake City, Utah

The financial data of all patients (535) admitted to the Nutritional Support Service (NSS) during 1985, including charges, true care costs, and actual reimbursement including pass-through payments (which are Medicare funds given directly to hospitals for education and capital equipment, and vary significantly from hospital to hospital), were analyzed. The NSS Medicare patients fell into 98 diagnostic related groups (DRGs). All 3,939 Medicare patients admitted in 1985 with the same DRGs as the NSS patients were also identified and their financial data analyzed. The NSS patients lost $999,643 because the 266 medicare reimbursed NSS patients sustained high losses which overwhelmed the modest profits of the 269 non-Medicare patients. When data from all Medicare patients (which includes both NSS and non-NSS patients) with the same DRGs are analyzed, large profits are realized. These profits are totally due to pass-through payments received. Without pass throughs the loss for all 3,939 Medicare patients in these 98 DRGs would have been $1,641,273. The impact of eliminating pass throughs in the next few years needs to be determined. NSS patients represent a group that generates high financial losses under the federal prospective reimbursement system. However, present Medicare reimbursement of other less seriously ill patients with similar DRGs more than compensate these losses if pass throughs are used in determining reimbursements. (Journal of Parenteral and Enteral Nutrition 13:71-76, 1989)

Journal of Parenteral and Enteral Nutrition, Vol. 13, No. 1, 71-76 (1989)
DOI: 10.1177/014860718901300171
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