Ambulatory Patient Group

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Ambulatory Patient Group (APG) is a classification system for outpatient services reimbursement developed for the American Medicare service by the Health Care Financing Administration. [1] It classifies patients into nearly 300 pathology groups rather than the 14,000 of the International Classification of Diseases.

Medicare (United States) United States single-payer national social insurance program

Medicare is a national health insurance program in the United States, begun in 1966 under the Social Security Administration and now administered by the Centers for Medicare and Medicaid Services (CMS). It provides health insurance for Americans aged 65 and older. It also provides health insurance to younger people with some disability status as determined by the Social Security Administration, as well as people with end stage renal disease and amyotrophic lateral sclerosis. Medicare is funded by a combination of a payroll tax, beneficiary premiums and surtaxes from beneficiaries, and general U.S. Treasury revenue.

The APG system is similar to the diagnosis-related groups (DRG), which apply to inpatient care rendered by a hospital.

Diagnosis-related group (DRG) is a system to classify hospital cases into one of originally 467 groups, with the last group being "Ungroupable". This system of classification was developed as a collaborative project by Robert B Fetter, PhD, of the Yale School of Management, and John D. Thompson, MPH, of the Yale School of Public Health. The system is also referred to as "the DRGs", and its intent was to identify the "products" that a hospital provides. One example of a "product" is an appendectomy. The system was developed in anticipation of convincing Congress to use it for reimbursement, to replace "cost based" reimbursement that had been used up to that point. DRGs are assigned by a "grouper" program based on ICD diagnoses, procedures, age, sex, discharge status, and the presence of complications or comorbidities. DRGs have been used in the US since 1982 to determine how much Medicare pays the hospital for each "product", since patients within each category are clinically similar and are expected to use the same level of hospital resources. DRGs may be further grouped into Major Diagnostic Categories (MDCs). DRGs are also standard practice for establishing reimbursements for other Medicare related reimbursements such as to home healthcare providers.

Related Research Articles

APG is an abbreviation with several different meanings:

Health care Prevention of disease and promotion of wellbeing

Health care or healthcare is the maintenance or improvement of health via the prevention, diagnosis, and treatment of disease, illness, injury, and other physical and mental impairments in human beings. Health care is delivered by health professionals in allied health fields. Physicians and physician associates are a part of these health professionals. Dentistry, midwifery, nursing, medicine, optometry, audiology, pharmacy, psychology, occupational therapy, physical therapy and other health professions are all part of health care. It includes work done in providing primary care, secondary care, and tertiary care, as well as in public health.

Ambulatory care

Ambulatory care or outpatient care is medical care provided on an outpatient basis, including diagnosis, observation, consultation, treatment, intervention, and rehabilitation services. This care can include advanced medical technology and procedures even when provided outside of hospitals.

The Angiosperm Phylogeny Group, or APG, refers to an informal international group of systematic botanists who collaborate to establish a consensus on the taxonomy of flowering plants (angiosperms) that reflects new knowledge about plant relationships discovered through phylogenetic studies.

In medicine, performance status is an attempt to quantify cancer patients' general well-being and activities of daily life. This measure is used to determine whether they can receive chemotherapy, whether dose adjustment is necessary, and as a measure for the required intensity of palliative care. It is also used in oncological randomized controlled trials as a measure of quality of life.

Clinic Health care facility, primarily focused on the care of outpatients

A clinic is a healthcare facility that is primarily focused on the care of outpatients. Clinics can be privately operated or publicly managed and funded. They typically cover the primary healthcare needs of populations in local communities, in contrast to larger hospitals which offer specialised treatments and admit inpatients for overnight stays.

Medical classification, or medical coding, is the process of transforming descriptions of medical diagnoses and procedures into universal medical code numbers. The diagnoses and procedures are usually taken from a variety of sources within the health care record, such as the transcription of the physician's notes, laboratory results, radiologic results, and other sources.

North York General Hospital Hospital in Ontario, Canada

North York General Hospital (NYGH) in Toronto, Ontario, Canada, offers acute care, ambulatory and long-term services at multiple sites. Known as North York General, it is one of Canada's leading community academic hospitals and is affiliated with the University of Toronto. The hospital primarily serves north central Toronto and southern York Region. NYGH is one of the three constituent hospitals of the Peters-Boyd Academy of the University of Toronto Faculty of Medicine.

Allied health professions are health care professions distinct from nursing, medicine, and pharmacy. They work in health care teams to make the health care system function by providing a range of diagnostic, technical, therapeutic and direct patient care and support services that are critical to the other health professionals they work with and the patients they serve.

Outpatient surgery, also known as ambulatory surgery, day surgery, day case surgery, or same-day surgery, is surgery that does not require an overnight hospital stay. The term “outpatient” arises from the fact that surgery patients may enter and leave the facility on the same day. The advantages of outpatient surgery over inpatient surgery include greater convenience and reduced costs.

Asterids major clade of plants (in APG I, II and III)

In the APG IV system (2016) for the classification of flowering plants, the name asterids denotes a clade. Common examples include the forget-me-nots, nightshades, the common sunflower, petunias, morning glory and sweet potato, coffee, lavender, lilac, olive, jasmine, honeysuckle, ash tree, teak, snapdragon, sesame, psyllium, garden sage, table herbs such as mint, basil, and rosemary, and rainforest trees such as Brazil nut.

Commelinids important clade of plants (In APG II and III)

In plant taxonomy, commelinids is a name used by the APG IV system for a clade within the monocots, which in its turn is a clade within the angiosperms. The commelinids are the only clade that the APG has informally named within the monocots. The remaining monocots are a paraphyletic unit. Also known as the commelinid monocots it forms one of three groupings within the monocots, and the final branch, the other two groups being the alismatid monocots and the lilioid monocots.

Los Angeles County Department of Health Services

Los Angeles County Department of Health Services operates the public hospitals and clinics in Los Angeles County, and is United States' second largest municipal health system, after NYC Health + Hospitals.

University of Vermont Medical Center Hospital in Vermont, U.S.

The University of Vermont Medical Center is an academic medical center located in Burlington, Vermont, United States. It is affiliated with the University of Vermont College of Medicine and the University of Vermont College of Nursing and Health Sciences and serves as both a regional referral center and a community hospital.

Acute care is a branch of secondary health care where a patient receives active but short-term treatment for a severe injury or episode of illness, an urgent medical condition, or during recovery from surgery. In medical terms, care for acute health conditions is the opposite from chronic care, or longer term care.

The medical home, also known as the patient-centered medical home (PCMH), is a team-based health care delivery model led by a health care provider to provide comprehensive and continuous medical care to patients with a goal to obtain maximal health outcomes. It is described in the "Joint Principles" as "an approach to providing comprehensive primary care for children, youth and adults."

Cardiac monitoring

Cardiac monitoring generally refers to continuous or intermittent monitoring of heart activity, generally by electrocardiography, with assessment of the patient's condition relative to their cardiac rhythm. It is different from hemodynamic monitoring, which monitors the pressure and flow of blood within the cardiovascular system. The two may be performed simultaneously on critical heart patients. Cardiac monitoring with a small device worn by an ambulatory patient is known as ambulatory electrocardiography. Transmitting data from a monitor to a distant monitoring station is known as telemetry or biotelemetry.

Ambulatory care nursing is the nursing care of patients who receive treatment on an outpatient basis, ie they do not require admission to a hospital for an overnight stay. Ambulatory care includes those clinical, organizational and professional activities engaged in by registered nurses with and for individuals, groups, and populations who seek assistance with improving health and/or seek care for health-related problems. The American Academy of Ambulatory Care Nursing (AAACN) describes ambulatory care nursing as a comprehensive practice which is built on a broad knowledge base of nursing and health sciences, and applies clinical expertise rooted in the nursing process.

A prospective payment system (PPS) is a term used to refer to several payment methodologies for which means of determining insurance reimbursement is based on a predetermined payment regardless of the intensity of the actual service provided.

References

  1. ↑ Abbey, Duane C.; Blount, L. Lamar (October 1996). "Understanding the financial implications of APGs - ambulatory patient groups". Healthcare Financial Management. 50 (10).
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