Who is affected by the IPPS transfer rule regarding DRGs?

The IPPS transfer rule is specifically designed to address situations where patients are transferred from one acute care hospital to another or to a post-acute care setting. This rule primarily affects patients with certain diagnoses that fall under designated Diagnosis-Related Groups (DRGs). These DRGs are typically associated with higher resource use, prompting a closer examination of how hospitals manage costs and reimbursement processes related to patient transfers.

When patients are diagnosed with conditions classified under ten specific DRGs, the receiving facility and the transferring hospital share the reimbursement for the services rendered, rather than allowing an entire DRG payment to go to the original hospital upon discharge. This structure incentivizes hospitals to discharge patients more judiciously and helps to ensure that the payment reflects the actual care provided, considering the potential for overlapping services in cases of transfer.

In this context, the transfer rule seeks to maintain effective care coordination and proper resource allocation while minimizing unnecessary costs. Thus, patients diagnosed with conditions under these specific DRGs are directly impacted by this regulation.