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Author: Grace M. Carter
Publisher:
ISBN:
Category : Diagnosis related groups
Languages : en
Pages : 116
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Book Description
In FY 1989, the Health Care Financing Agency (HCFA) changed the amount it would pay for extremely long or costly Medicare hospital stays called outliers. Based on a 20% sample of Medicare hospitalizations as recorded in the Medicare Provider Analysis and Review (MEDPAR) file, the authors compared the distribution of outlier payments under the FY 1989 policy with the FY 1988 distribution under the previous policy; described the extent to which each policy provided reimbursement to the most costly cases and examined the distribution of outlier payments among other patient groups and among hospital groups; and estimated the effect of outlier payments on hospitals' financial risk using the methodology developed in Keeler et al. (1988). The authors examined three characteristics of stays that hospitals might have changed in response to the incentives inherent in outlier policy: (1) the resources provided to long-staying patients, (2) the discharge rate near the old outlier threshold, and (3) the concentration of very expensive cases in public hospitals in large urban areas. The outlier policy appears to have accomplished several goals. In particular, the new policy succeeded in: concentrating outlier funds on the costliest cases; providing more funds to hospitals with cases that are more costly than average for their Diagnosis Related Group (DRG); and decreasing risk by 5% from what it would have been if the policy had not changed. The study also identified two problems with existing outlier policy: (1) day outlier payments frequently exceed the cost of the services delivered; and (2) the formula for setting cost outlier thresholds produces less than optimum protection from risk. Although the changes were not large, the authors found some evidence that hospitals responded to the outlier policy change both by increasing length of stay and increasing the services delivered to the most costly patients. They judge that this analysis increases the strength of the argument for using case-based rather than hospital-based outlier payments.
Author: Grace M. Carter
Publisher:
ISBN:
Category : Diagnosis related groups
Languages : en
Pages : 116
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Book Description
In FY 1989, the Health Care Financing Agency (HCFA) changed the amount it would pay for extremely long or costly Medicare hospital stays called outliers. Based on a 20% sample of Medicare hospitalizations as recorded in the Medicare Provider Analysis and Review (MEDPAR) file, the authors compared the distribution of outlier payments under the FY 1989 policy with the FY 1988 distribution under the previous policy; described the extent to which each policy provided reimbursement to the most costly cases and examined the distribution of outlier payments among other patient groups and among hospital groups; and estimated the effect of outlier payments on hospitals' financial risk using the methodology developed in Keeler et al. (1988). The authors examined three characteristics of stays that hospitals might have changed in response to the incentives inherent in outlier policy: (1) the resources provided to long-staying patients, (2) the discharge rate near the old outlier threshold, and (3) the concentration of very expensive cases in public hospitals in large urban areas. The outlier policy appears to have accomplished several goals. In particular, the new policy succeeded in: concentrating outlier funds on the costliest cases; providing more funds to hospitals with cases that are more costly than average for their Diagnosis Related Group (DRG); and decreasing risk by 5% from what it would have been if the policy had not changed. The study also identified two problems with existing outlier policy: (1) day outlier payments frequently exceed the cost of the services delivered; and (2) the formula for setting cost outlier thresholds produces less than optimum protection from risk. Although the changes were not large, the authors found some evidence that hospitals responded to the outlier policy change both by increasing length of stay and increasing the services delivered to the most costly patients. They judge that this analysis increases the strength of the argument for using case-based rather than hospital-based outlier payments.
Author: Grace M. Carter
Publisher:
ISBN:
Category : Medical
Languages : en
Pages : 70
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Book Description
This report examines the formulas that the Health Care Financing Administration (HCFA) uses to pay for the extra expenses incurred by unusual hospital cases (outliers) and recommends changes in these formulas. Outlier payments are those made in addition to the regular diagnosis-related-group payment and are designed to reduce hospitals' financial risks and their financial incentives to refuse to serve, or to underserve, exceptionally costly cases. There are two kinds of outliers--day outliers (cases that remain in the hospital beyond a certain number of days) and cost outliers (cases whose standardized charges exceed a cost threshold). The authors describe how the average cost of day outlier cases increases as a function of length of stay. They also consider the forms of the day outlier per diem and the cost outlier threshold, which determines which cases will be paid as outliers and the amount of the payment. The authors find a large percentage of day outlier payments go to profitable cases, which is contrary to policy intent. They recommend a reduction in the day outlier per diem to the level that would provide the same coinsurance to day and cost outliers. They suggest replacing the current formula for the cost outlier threshold with a fixed loss cost outlier threshold.
Author:
Publisher:
ISBN:
Category : Health insurance
Languages : en
Pages : 48
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Book Description
Author: Medicare Payment Advisory Commission (U.S.)
Publisher:
ISBN:
Category : Hospitals
Languages : en
Pages : 200
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Book Description
Author: Institute of Medicine
Publisher: National Academies Press
ISBN: 0309083435
Category : Medical
Languages : en
Pages : 213
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Book Description
Many Americans believe that people who lack health insurance somehow get the care they really need. Care Without Coverage examines the real consequences for adults who lack health insurance. The study presents findings in the areas of prevention and screening, cancer, chronic illness, hospital-based care, and general health status. The committee looked at the consequences of being uninsured for people suffering from cancer, diabetes, HIV infection and AIDS, heart and kidney disease, mental illness, traumatic injuries, and heart attacks. It focused on the roughly 30 million-one in seven-working-age Americans without health insurance. This group does not include the population over 65 that is covered by Medicare or the nearly 10 million children who are uninsured in this country. The main findings of the report are that working-age Americans without health insurance are more likely to receive too little medical care and receive it too late; be sicker and die sooner; and receive poorer care when they are in the hospital, even for acute situations like a motor vehicle crash.
Author: Institute of Medicine
Publisher: National Academies Press
ISBN: 030904491X
Category : Medical
Languages : en
Pages : 225
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Book Description
Americans praise medical technology for saving lives and improving health. Yet, new technology is often cited as a key factor in skyrocketing medical costs. This volume, second in the Medical Innovation at the Crossroads series, examines how economic incentives for innovation are changing and what that means for the future of health care. Up-to-date with a wide variety of examples and case studies, this book explores how payment, patent, and regulatory policiesâ€"as well as the involvement of numerous government agenciesâ€"affect the introduction and use of new pharmaceuticals, medical devices, and surgical procedures. The volume also includes detailed comparisons of policies and patterns of technological innovation in Western Europe and Japan. This fact-filled and practical book will be of interest to economists, policymakers, health administrators, health care practitioners, and the concerned public.
Author:
Publisher:
ISBN:
Category : Medical care, Cost of
Languages : en
Pages : 184
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Author:
Publisher:
ISBN:
Category : Medical care
Languages : en
Pages : 636
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Author: National Research Council
Publisher: National Academies Press
ISBN: 0309156297
Category : Medical
Languages : en
Pages : 322
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Book Description
The rapid growth of home health care has raised many unsolved issues and will have consequences that are far too broad for any one group to analyze in their entirety. Yet a major influence on the safety, quality, and effectiveness of home health care will be the set of issues encompassed by the field of human factors research-the discipline of applying what is known about human capabilities and limitations to the design of products, processes, systems, and work environments. To address these challenges, the National Research Council began a multidisciplinary study to examine a diverse range of behavioral and human factors issues resulting from the increasing migration of medical devices, technologies, and care practices into the home. Its goal is to lay the groundwork for a thorough integration of human factors research with the design and implementation of home health care devices, technologies, and practices. On October 1 and 2, 2009, a group of human factors and other experts met to consider a diverse range of behavioral and human factors issues associated with the increasing migration of medical devices, technologies, and care practices into the home. This book is a summary of that workshop, representing the culmination of the first phase of the study.
Author: National Academies of Sciences Engineering and Medicine
Publisher:
ISBN: 9780309685061
Category :
Languages : en
Pages :
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Book Description
The decade ahead will test the nation's nearly 4 million nurses in new and complex ways. Nurses live and work at the intersection of health, education, and communities. Nurses work in a wide array of settings and practice at a range of professional levels. They are often the first and most frequent line of contact with people of all backgrounds and experiences seeking care and they represent the largest of the health care professions. A nation cannot fully thrive until everyone - no matter who they are, where they live, or how much money they make - can live their healthiest possible life, and helping people live their healthiest life is and has always been the essential role of nurses. Nurses have a critical role to play in achieving the goal of health equity, but they need robust education, supportive work environments, and autonomy. Accordingly, at the request of the Robert Wood Johnson Foundation, on behalf of the National Academy of Medicine, an ad hoc committee under the auspices of the National Academies of Sciences, Engineering, and Medicine conducted a study aimed at envisioning and charting a path forward for the nursing profession to help reduce inequities in people's ability to achieve their full health potential. The ultimate goal is the achievement of health equity in the United States built on strengthened nursing capacity and expertise. By leveraging these attributes, nursing will help to create and contribute comprehensively to equitable public health and health care systems that are designed to work for everyone. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity explores how nurses can work to reduce health disparities and promote equity, while keeping costs at bay, utilizing technology, and maintaining patient and family-focused care into 2030. This work builds on the foundation set out by The Future of Nursing: Leading Change, Advancing Health (2011) report.
