Unbiased Analysis of Today's Healthcare Issues
That is the topic from a recent study by Hayes et al. (2024): Payments for some diagnostic scans undertaken in outpatient settings were unbundled from Diagnosis Related Group based payments in England in April 2013 to address under-provision. Unbundled scans attracted additional payments of between £45 and £748 directly following the reform. We examined the…
This is the question put forth in a paper by Chen et al. (2017). The authors examine Medicare’s Acute Care Episode (ACE) Demonstration Program, which was a small, voluntary episode-based bundled payment program. According to the CMS website, There were 28 cardiac and 9 orthopedic inpatient surgical services and procedures included in the bundled payment demonstration. These…
What are the best practices for providing care for a specific condition? This question is not easy to answer. Further, the best practices for treating the average patient may differ from the best practice for treating certain other types of patients; particularly when a patient suffers from multiple conditions simultaneously. Despite these challenges, this information…
Implemented on August 1, 2000, Medicare’s Outpatient Prospective Payment System (OPPS) classifies hospital outpatient services into approximately 800 ambulatory payment classifications (APCs) based on clinical and cost similarity. Medicare reimburses the hospital the same amount for each APC–with adjustments for local labor costs, certain hospitals, and outlier cases–regardless of the mix of services provided. How…
Bundled payment has been gaining popularity in the minds of policymakers. In essence, a bundled payment structure gives providers a single lump sum payment to cover all related services for an episode of care. In the private sector, the Texas Heart Institute and Geisinger Health System both charge a single lump sum for certain procedures.…