In April 2006, Ontario instituted the Diabetes Management Incentive (DMI) that increased payments to physicians that provided high-quality diabetes care. Did the incentive improve payments quality? According to a paper by Kantarevic and Kralj (2012), it turns out that the answer is yes, but the magnitude of the change depends on the type of physician. [...]
Read the rest of this entry »Archive for the 'Supply of Medical Services' Category
Nursing Home Quality
Typically, Nursing Home quality is measured using metrics from Nursing Home Compare. These metrics are calculated based on survey and certification processes and resident assessments from from the Minimum Data Set (MDS). These, however, are not the only quality metrics one can use. For instance, one can use consumer complaints as a measure of quality [...]
Read the rest of this entry »Medicare Reimbursement for Outpatient Therapy
Today I review Medicare’s approach for paying for outpatient therapy visits. The content draws largely from CMS and MedPAC sources. What is outpatient therapy Outpatient therapy includes physical therapy (PT), occupational therapy (OT), and speech-language pathology (SLP) services. Who can provide outpatient therapy? Institutional Facilities Hospitals Skilled nursing facilities (SNF) Comprehensive outpatient rehabilitation facilities (CORF) [...]
Read the rest of this entry »The Doc Fix and the Fiscal Cliff
President Barack Obama has signed the American Taxpayer Relief Act of 2012, which continues current Medicare payment rates for the nation’s physicians through Dec. 31, 2013. This bill nullifies the Sustainable Growth Rate which, if implemented, would have reduced Medicare payments to physicians by 26.5 percent. The doc fix will cost $10.6 billion in fiscal [...]
Read the rest of this entry »How Medicare Measures Hospital Quality
There are many ways that Medicare evaluates hospital quality. Medicare conducts patient surveys (i.e,. HCAHPS). Medicare has hospitals report a variety of process of care measures through the Inpatient Quality Report (IQR) Program. Medicare uses data that Centers for Disease Control and Prevention (CDC) collects via the National Healthcare Safety Network (NHSN) tool to measure [...]
Read the rest of this entry »P4P for Maryland Hospitals
Maryland is a unique state for Hospitals. Since 1977, Maryland’s Health Services Cost Review Commission sets payment rates for all hospitals regardless of the payer. This approach is only feasible because Maryland receives a federal waiver that exempts its hospitals from national Medicare and state Medicaid fee schedules. Just as Medicare has begun implementing its [...]
Read the rest of this entry »Will Medicare Reduce Your Hospial’s Reimbursement Rates?
Do you work at New York-Presbyterian in Manhattan? Massachusetts General Hospital in Boston? Both these hospitals, with large market shares in their cities, will see their Medicare payments reduced through the Hospital Value-Based Purchasing (HVBP) program. If you work at Cleveland Clinic or Intermountain Medical Center in Utah, on the other hand, Medicare will be [...]
Read the rest of this entry »Appropriate IME and DSH payments
Although Medicare has a set rate schedule, not all hospitals receive the same payment for providing the same service. Among the number of adjustments Medicare makes to its inpatient prospective payments rates are the indirect medical education (IME) and disproportionate share hospital (DSH). The goal of IME is to compensate hospitals for patient care costs [...]
Read the rest of this entry »San Francisco Healthcare Market
Key findings from a CHCF issue brief on Health Care in the San Francisco Bay Area include: Although two hospital systems account for half of inpatient discharges, as a result of geographic barriers, much of health care delivery occurs within local submarkets. Health care providers weathered the economic downturn comparatively well, with hospital systems showing [...]
Read the rest of this entry »Physician Payments in the 1990s
One of my favorite health economists and bloggers is Austin Frakt of the Incidental Economist. In a recent paper, he examines whether new Health Reform provisions have learned from the mistakes in the 1990s from shifting provider reimbursement to a capitation based-system. To find the answer, you’ll need to read his commentary (with Rick Mayes) [...]
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