Download or read book Medicare Outlier Payments to Hospitals written by United States. Congress. Senate. Committee on Appropriations. Subcommittee on Departments of Labor, Health and Human Services, Education, and Related Agencies and published by . This book was released on 2004 with total page 62 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Improving Medicare s Policy for Payment of Unusual Hospital Cases written by Grace M. Carter and published by . This book was released on 1992 with total page 116 pages. Available in PDF, EPUB and Kindle. Book excerpt: 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.
Download or read book Medicare Outlier Payments to Hospitals written by United States Senate and published by . This book was released on 2019-11-23 with total page 58 pages. Available in PDF, EPUB and Kindle. Book excerpt: Medicare outlier payments to hospitals: hearing before a subcommittee of the Committee on Appropriations, United States Senate, One Hundred Eighth Congress, first session, special hearing, March 11, 2003, Washington, DC.
Download or read book Payment Rates for Unusual Medicare Hospital Cases written by Grace M. Carter and published by . This book was released on 1992 with total page 70 pages. Available in PDF, EPUB and Kindle. Book excerpt: 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.
Download or read book Medicare Prospective Payment and the American Health Care System written by and published by . This book was released on 1986 with total page 132 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Medicare Outlier Payments to Hospitals written by United States. Congress. Senate. Committee on Appropriations. Subcommittee on Departments of Labor, Health and Human Services, Education, and Related Agencies and published by . This book was released on 2004 with total page 52 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Cost Estimates for Cost Outlier Cases Under Medicare s Prospective Payment System written by Grace M. Carter and published by . This book was released on 1994 with total page 35 pages. Available in PDF, EPUB and Kindle. Book excerpt: The authors studied the ratio of costs to charges (RCC) used to estimate the cost of Medicare hospital cases in the formula which sets cost outlier payments. The authors estimate that, under current payment policy, the cost of the average cost outlier case is overestimated by 23 percent. The causes of this overestimate are a secular decline in RCC of between 2 and 3 percent a year and the fact that cost outlier cases typically receive a higher percentage of ancillary charges that have a very low actual RCC. The inaccurate estimate of the cost of cost outlier cases contravenes current policy intent in two important ways. First, it changes the fraction of the excess costs that are insured from the intended 75 percent to 92 percent. Secondly, cases face different cost outlier thresholds, and therefore receive different payment amounts, depending on the mix of ancillary and accommodation services required by the patient. It would be possible to improve the measurement of the cost of cost outlier cases by using separate RCCs for ancillary and accommodation charges. The outcomes of alternative policies are estimated in the report.
Download or read book Medicare Hospital Outlier Payments Warrant Increased Scrutiny written by United States. Department of Health and Human Services. Office of Inspector General and published by . This book was released on 2013 with total page 18 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Medicare Inpatient Hospital Payments CMS Has Used External Data for New Technologies in Certain Instances and medicare Remains Primary Data Source written by and published by DIANE Publishing. This book was released on 2007 with total page 28 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Impact of the Medicare Hospital Prospective Payment System written by and published by . This book was released on 1984 with total page 340 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Medicare Prospective Payment and the American Health Care System written by United States. Prospective Payment Assessment Commission and published by . This book was released on 1987 with total page 136 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Monographs written by and published by . This book was released on 1994 with total page 56 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Medicare Hospital Outlier Payments Warrant Increased Scrutiny written by CreateSpace Independent Publishing Platform and published by Createspace Independent Publishing Platform. This book was released on 2018-07-11 with total page 36 pages. Available in PDF, EPUB and Kindle. Book excerpt: Medicare hospital outlier payments warrant increased scrutiny.
Download or read book Insurance Aspects of DRG Outlier Payments written by Emmett B. Keeler and published by . This book was released on 1988 with total page 60 pages. Available in PDF, EPUB and Kindle. Book excerpt: As part of Medicare's prospective payment system, the government pays "outlier" payments for especially long or expensive cases. These payments can be viewed as insurance for the hospital against excessive losses, and mitigate problems of access and underprovision of care for the sickest patients and problems of fairness for the hospitals that take care of them. This Note characterizes the outlier payment formulas that minimize risk for hospitals under any fixed constraints on the sum of outlier payments and minimum hospital coinsurance rate. The authors then simulate per-case payments for a policy that did not include any outlier payments, the current outlier policy, and several other policies that minimize risk subject to different coinsurance constraints. The current outlier policy achieves each of its goals to at least some extent, but more insurance could be provided without lessening attainment of the other goals. The Note also discusses some problems with the implementation of the current policy, such as its reliance on day outliers.
Download or read book Report and Recommendations to the Congress written by United States. Prospective Payment Assessment Commission and published by . This book was released on 1992 with total page 148 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Adjustments to the Medicare Prospective Payment System written by and published by . This book was released on 1988 with total page 296 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Medicare written by United States. Congress. House. Committee on Ways and Means and published by . This book was released on 1986 with total page 84 pages. Available in PDF, EPUB and Kindle. Book excerpt:
