Chapter 07: Paying for Health Care in America: Rising Costs and Challenges Cherry and Jacob: Contemporary Nursing: Issues, Trends, and Management, 8th Edition

An older adult client was admitted to the hospital with the condition classified as “pneumonia.” Reimbursement for care was based on a predetermined fixed price. What is this classification system referred to as? a. Diagnosis-related groups (DRGs) b. Subjective symptom management c. Acuity classification system d. Organized managed care ANS: A DRGs are used in reimbursement for health care services based on a predetermined fixed price per case or diagnosis in 468 categories. Under DRGs, each Medicare client is assigned to a diagnostic grouping based on his or her primary diagnosis at hospital admission. Medicare limits total payment to the hospital to the amount preestablished for that DRG. DIF: Comprehension 2. The precise classification of clients according to the highest diagnosis-related group (DRG) has created a new role for nurses, known as a _____ nurse. a. case management b. quality assurance c. utilization review d. cost-control ANS: C