La tarification à l'activité en SSR : impasse ou opportunité de réforme ?

The target model of prospective payment system (PPS) in French post-acute care (SSR) is still unknown. While PPS in French acute care Hospitals is modelled on the Diagnosis Related Groups (DRG) of Fetter, the case-mix classification system in post-acute care (PMSI-SSR) is a French invention based on the model of Resource Utilization Groups (RUG). The disappearance of the segmentation between rehabilitation facilities and sub-acute care facilities, as desired by the decrees of 2008, leads to a profound re-engineering of SSR by category of acute care. The new case-mix groups built according to these categories by French agency for information on hospitalization (ATIH) suggests that case-mix categories could not be organized by clinical problems and expected resource needs. The imposed choice in the context of the PPS between a per diem system of payment or weighted case is facing the international literature. Faced with the risk of loss of opportunity in the context of managed competition established at all stages of the chain of care, rehabilitation and supportive access will only be maintained by a classification of patient groups identifying complex medical care programs and required expected resource consumption. Under the PPS, discharges are assigned to case-mix categories organized by clinical problems and expected resource needs. Each case-mix category has a national relative weight reflecting the expected relative costliness of treatment for patients in that category compared with that for the average Medicare inpatient rehabilitation patient.