Une \u00e9tude de la RAND Corporation analyse le ph\u00e9nom\u00e8ne de \u00ab upcoding \u00bb dans les h\u00f4pitaux pour des s\u00e9jours en hospitalisation compl\u00e8te, \u00e0 partir des donn\u00e9es du Health Care Payments Database de l\u2019\u00c9tat de Californie (\u00c9tats-Unis). Le upcoding correspond \u00e0 une facturation de s\u00e9jours en utilisant des cat\u00e9gories de s\u00e9v\u00e9rit\u00e9 ou de diagnostic plus r\u00e9mun\u00e9ratrices que celles qui seraient normalement applicables.<\/p>\n
Les auteurs estiment que, pour l\u2019ann\u00e9e 2023, le upcoding a contribu\u00e9 \u00e0 une augmentation des paiements pouvant atteindre 554 millions de dollars en faveur des h\u00f4pitaux pour les s\u00e9jours financ\u00e9s par des assureurs commerciaux, par rapport au niveau des paiements observ\u00e9s en 2018. Cette progression des d\u00e9penses est donc attribu\u00e9e en partie \u00e0 une modification des pratiques de codage hospitalier plut\u00f4t qu\u2019\u00e0 une seule \u00e9volution des besoins de sant\u00e9 ou des tarifs.<\/p>\n
L\u2019analyse montre que le ph\u00e9nom\u00e8ne est concentr\u00e9 sur un nombre limit\u00e9 de groupes de diagnostics hospitaliers tr\u00e8s utilis\u00e9s, les Medicare Severity Diagnosis Related Groups (MS-DRG). Ces groupes sont au c\u0153ur des m\u00e9canismes de tarification \u00e0 l\u2019activit\u00e9 aux \u00c9tats-Unis. L\u2019\u00e9tude indique \u00e9galement que ce upcoding a probablement entra\u00een\u00e9 une hausse des restes \u00e0 charge pour certains patients couverts par des contrats Medicare Advantage, c\u2019est-\u00e0-dire des assurances priv\u00e9es g\u00e9rant des prestations de type Medicare.<\/p>\n
Ce travail s\u2019inscrit dans la s\u00e9rie des \u00ab research reports \u00bb de RAND Health, branche de la RAND Corporation sp\u00e9cialis\u00e9e dans la recherche en sant\u00e9. Les rapports de RAND sont soumis \u00e0 un processus de revue par les pairs afin de garantir la qualit\u00e9 m\u00e9thodologique et l\u2019objectivit\u00e9. RAND est une institution \u00e0 but non lucratif sp\u00e9cialis\u00e9e dans l\u2019analyse des politiques publiques, mais ses publications ne refl\u00e8tent pas n\u00e9cessairement les positions de ses commanditaires ou clients.<\/p>\n
Pour le suivi des politiques publiques, cette \u00e9tude fournit un exemple chiffr\u00e9 et r\u00e9cent des effets potentiels du codage hospitalier sur les d\u00e9penses de sant\u00e9 et sur le reste \u00e0 charge des assur\u00e9s, dans un contexte de tarification \u00e0 l\u2019activit\u00e9 et de concurrence entre assureurs, sans toutefois d\u00e9tailler les m\u00e9canismes de contr\u00f4le ou de r\u00e9gulation mis en place. Elle met en \u00e9vidence l\u2019importance de la surveillance des pratiques de codage et des incitations \u00e9conomiques qui p\u00e8sent sur les \u00e9tablissements de sant\u00e9 et les financeurs.(contenu r\u00e9sum\u00e9 en fran\u00e7ais par l’IA)\u00a0Lire la Suite<\/a><\/p>","protected":false},"excerpt":{"rendered":" Une \u00e9tude de la RAND Corporation analyse le ph\u00e9nom\u00e8ne de \u00ab upcoding \u00bb dans les h\u00f4pitaux pour des s\u00e9jours en hospitalisation compl\u00e8te, \u00e0 partir des donn\u00e9es du Health Care Payments […]<\/p>\n","protected":false},"author":1,"featured_media":10675,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[26],"tags":[234,227,226],"class_list":["post-20055","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-donnees-etudes-evaluation-et-prospective","tag-rand","tag-ia","tag-sources-etrangeres"],"_links":{"self":[{"href":"https:\/\/veilles-affaires-sociales.fr\/index.php?rest_route=\/wp\/v2\/posts\/20055","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/veilles-affaires-sociales.fr\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/veilles-affaires-sociales.fr\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/veilles-affaires-sociales.fr\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/veilles-affaires-sociales.fr\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=20055"}],"version-history":[{"count":0,"href":"https:\/\/veilles-affaires-sociales.fr\/index.php?rest_route=\/wp\/v2\/posts\/20055\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/veilles-affaires-sociales.fr\/index.php?rest_route=\/wp\/v2\/media\/10675"}],"wp:attachment":[{"href":"https:\/\/veilles-affaires-sociales.fr\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=20055"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/veilles-affaires-sociales.fr\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=20055"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/veilles-affaires-sociales.fr\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=20055"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}