Another VBP fail?

Value-based purchasing is supposed to tie reimbursement to quality of care and costs.  Providers that are high quality and low cost are supposed to get higher reimbursement, those that are low quality and high cost the reverse.  The key question is: does this reimbursement approach work in practice? According to a recent study by Grabowski…

Why don’t payers adopt my technology?

Why don’t payers adopt innovative approaches to treat mental illness? For instance, crisis intervention programs, recovery-focused consumer education programs, telehealth programs, and on-line treatment programs have sometimes have had problems receiving reimbursement from payers. Monica Oss of OpenMinds takes the payers’ perspective: Often, the organization proposing the new program comes to the table with an…

International Strategies for Skilled Nursing Facility Reimbursement

In the past, I have written about how Medicare pays for Skilled Nursing Facilities (SNF).  Medicare uses a case-mix adjusted per diem rate.  This approach, however, isn’t the only manner payers can use to reimburse nursing facilities.  Consider how Australia pays for nursing care under their Australian National Sub-Acute and Non-Acute Patient Classification System (AN-SNAP):…

How Medicare payment policy affects SNF incentives to hospitalize patients

Under Medicare Part A, beneficiaries can receive coverage for care provided by skilled nursing facilities (SNFs), also known as nursing homes.  Between 2000 and 2007, however, the rate of potentially avoidable re-hospitalizations for five key conditions (congestive heart failure, respiratory infection, urinary tract infection, sepsis, and electrolyte imbalance) increased from 13.7% to 18.5%. One potential explanation…