Prospective payment's impact on ancillary services. Pastoral care, social services: role in reducing medical costs.

Under the prospective payment system, costs for medical social services, as well as for other inpatient services, are reimbursed at a fixed rate according to the patient's diagnosis. Thus hospitals, under the incentives to reduce costs by limiting services and increasing patient volume, will examine ancillary services to determine whether the services increase or decrease costs. Social and pastoral care workers will likely play an important role in hospitals' cost reduction efforts in several ways: Begin forming a discharge plan early in a patient's care, especially for patients who are at high risk for delayed discharge. Evaluate patients and their families to detect problems that may impede treatment and recovery and refer patients to community and hospital resources for help. In the emergency room, guide persons who do not need to be hospitalized to community resources. Record patient information that may help health professionals improve treatment and speed discharge. Such data include patients' financial status, use of community agencies, and rehabilitation. Counsel patients and families as they make treatment decisions.