Unbiased Analysis of Today's Healthcare Issues

Skilled Nursing Facilities

Today I summarize recent trends in skilled nursing facilities (SNFs) as outlined in MedPAC’s 2011 Report to Congress. SNFs furnish short-term skilled nursing and rehabilitation services to beneficiaries after a stay in an acute care hospital. These services include physical and occupational therapy and speech–language pathology services. Examples of SNF patients include those recovering from […]

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New Legislation affecting Medicare Hospital Payments

Recent Legislation CMS completed its implementation of Medicare severity–diagnosis related groups (MS–DRGs) and cost-based relative weights in FY 2009. TMA, Abstinence Education, and QI Programs Extension Act of 2007 (TMA), the Congress mandated payment reductions of 0.6 percent in 2008 and an additional 0.9 percent in 2009 to offset the effects of documentation and coding […]

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MedPAC’s Home Health Recommendations

In their latest 2011, MedPAC made four recommendations to alter payment policy in the home health setting.  These include the following: The Secretary, with the Office of Inspector General, should conduct medical review activities in counties that have aberrant home health utilization.  The Secretary should implement the new authorities to suspend payment and the enrollment […]

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Medicare Payment Adequacy

How do policymakers  determine if Medicare payment levels are adequate?  The Medicare Payment Advisory Commission (MedPAC) uses the following criteria: Access to care determined by the number of providers and volume of services. Quality of care Provider access to capital Provider margins. Although these measures do provide valuable information, they are far from perfect.  Access […]

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MedPAC’s Analysis of Inpatient Rehabilitation Facilities

Inpatient Rehabilitation Facilities (IRF) provide rehabilitation to invidiuals recovering from serious illnesses such as strokes or hip replacements.  Today I review MedPAC’s analysis of Medicare payment policies for IRFs. In 2002, expenditures on IRF totaled nearly $5.7 billion. This figure grew at an annual rate of 6.7 percent to $6.4 billion in 2004. Between 2005 […]

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MedPAC’s 2011 Home Health Reform Recommendations

In 2009, 3.3 million Medicare beneficiaries used home health.  In the past few years, the home health expenditure growth rate has outpaced Medicare spending in all other areas.  This finding is likely correlated with the 9.7% increase in the number of home health agencies between 2008 and 2009.  How should Medicare reform home health to […]

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Medicare Regional Variation in Service Use may be Exaggerated

Regional differences in the cost of health care are due to differences in both the price and volume of medical care.  Since, Medicare sets prices, there should be little variation in prices…right? Actually, Medicare payments have geographic adjustments based on a number of factors.  For instances, the hospital wage index gives pay hospitals more in […]

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Medicare Reimbursement Information III

Today, we will focus on hospital care outside of the traditional Inpatient hospital care setting. Again, this information is culled from MedPAC reports. Outpatient Hospital Services Outpatient hospital care, from injections to complex procedures, accounted for $19 billion of total Medicare spending in 2007 Originally, outpatient reimbursement was cost based and copayments amounted to about […]

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