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Payment Policies (payment + policy)
Selected AbstractsChanges in Regional Variation of Medicare Home Health Care Utilization and Service Mix for Patients Undergoing Major Orthopedic Procedures in Response to Changes in Reimbursement PolicyHEALTH SERVICES RESEARCH, Issue 4 2009John D. FitzGerald Background. Significant variation in regional utilization of home health (HH) services has been documented. Under Medicare's Home Health Interim and Prospective Payment Systems, reimbursement policies designed to curb expenditure growth and reduce regional variation were instituted. Objective. To examine the impact of Medicare reimbursement policy on regional variation in HH care utilization and type of HH services delivered. Research Design. We postulated that the reimbursement changes would reduce regional variation in HH services and that HH agencies would respond by reducing less skilled HH aide visits disproportionately compared with physical therapy or nursing visits. An interrupted time-series analysis was conducted to examine regional variation in the month-to-month probability of HH selection, and the number of and type of visits among HH users. Subjects. A 100 percent sample of all Medicare recipients undergoing either elective joint replacement (1.6 million hospital discharges) or surgical management of hip fracture (1.2 million hospital discharges) between January 1996 and December 2001 was selected. Results. Before the reimbursement changes, there was great variability in the probability of HH selection and the number of HH visits provided across regions. In response to the reimbursement changes, though there was little change in the variation of probability of HH utilization, there were marked reductions in the number and variation of HH visits, with greatest reductions in regions with highest baseline utilization. HH aide visits were the source of the baseline variation and accounted for the majority of the reductions in utilization after implementation. Conclusions. The HH interim and prospective payment policies were effective in reducing regional variation in HH utilization. [source] The Effect of State Medicaid Case-Mix Payment on Nursing Home Resident AcuityHEALTH SERVICES RESEARCH, Issue 4p1 2006Zhanlian Feng Objective. To examine the relationship between Medicaid case-mix payment and nursing home resident acuity. Data Sources. Longitudinal Minimum Data Set (MDS) resident assessments from 1999 to 2002 and Online Survey Certification and Reporting (OSCAR) data from 1996 to 2002, for all freestanding nursing homes in the 48 contiguous U.S. states. Study Design. We used a facility fixed-effects model to examine the effect of introducing state case-mix payment on changes in nursing home case-mix acuity. Facility acuity was measured by aggregating the nursing case-mix index (NCMI) from the MDS using the Resource Utilization Group (Version III) resident classification system, separately for new admits and long-stay residents, and by an OSCAR-derived index combining a range of activity of daily living dependencies and special treatment measures. Data Collection/Extraction Methods. We followed facilities over the study period to create a longitudinal data file based on the MDS and OSCAR, respectively, and linked facilities with longitudinal data on state case-mix payment policies for the same period. Principal Findings. Across three acuity measures and two data sources, we found that states shifting to case-mix payment increased nursing home acuity levels over the study period. Specifically, we observed a 2.5 percent increase in the average acuity of new admits and a 1.3 to 1.4 percent increase in the acuity of long-stay residents, following the introduction of case-mix payment. Conclusions. The adoption of case-mix payment increased access to care for higher acuity Medicaid residents. [source] The Effect of Medicaid Payment Generosity on Access and Use among BeneficiariesHEALTH SERVICES RESEARCH, Issue 3 2005Yu-Chu Shen Objective. This study examines the effects of Medicaid payment generosity on access and care for adult and child Medicaid beneficiaries. Data Source. Three years of the National Surveys of America's Families (1997, 1999, 2002) are linked to the Urban Institute Medicaid capitation rate surveys, the Area Resource File, and the American Hospital Association survey files. Study Design. In order to identify the effect of payment generosity apart from unmeasured differences across areas, we compare the experiences of Medicaid beneficiaries with groups that should not be affected by Medicaid payment policies. To assure that these groups are comparable to Medicaid beneficiaries, we reweight the data using propensity score methods. We use a difference-in-differences model to assess the effects of Medicaid payment generosity on four categories of access and use measures (continuity of care, preventive care, visits, and perceptions of provider communication and quality of care). Principal Findings. Higher payments increase the probability of having a usual source of care and the probability of having at least one visit to a doctor and other health professional for Medicaid adults, and produce more positive assessments of the health care received by adults and children. However, payment generosity has no effect on the other measures that we examined, such as the probability of receiving preventive care or the probability of having unmet needs. Conclusions. Higher payment rates can improve some aspects of access and use for Medicaid beneficiaries, but the effects are not dramatic. [source] Do Rural Elders Have Limited Access to Medicare Hospice Services?JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2004Beth A. Virnig PhD Objectives:, To examine whether there are urban-rural differences in use of the Medicare hospice benefit before death and whether those differences suggest that there is a problem with access to hospice care for rural Medicare beneficiaries. Design:, Observational study using 100% of Medicare enrollment, hospice, and hospital claims data. Setting:, Inpatient hospitals and hospices. Participants:, Persons aged 65 and older in the Medicare program who died in 1999. Measurements:, Rates of hospice use before death and in-hospital death rates were calculated. Results:, In 1999, there were 1.76 million deaths of Medicare beneficiaries aged 65 and older. Hospice services were used by 365,700 of these beneficiaries. Rates of hospice care before death were negatively associated with degree of rurality. The lowest rate of hospice use, 15.2% of deaths, was seen in rural areas not adjacent to an urban area. The highest rate of use, 22.2% of deaths, was seen in urban areas. Rural areas adjacent to urban areas had an intermediate level of hospice use (17.0% of deaths). Hospices based in rural areas had a smaller number of elderly patients each year than hospices based in urban areas (P<.001) and were more likely to have very low volumes (average daily census of three patients or less). Conclusion:, The consistently lower use of Medicare hospice services before death and smaller sizes of rural hospices suggest that the combination of Medicare hospice payment policies and hospice volumes are problematic for rural hospices. Adjusting Medicare payment policies might be a critical step to assure availability of hospice services forterminally ill beneficiaries regardless of where they live. [source] Policy issues related to the rehabilitation of the surgical cancer patient,JOURNAL OF SURGICAL ONCOLOGY, Issue 5 2007Maria Hewitt DrPH Abstract Four policy challenges that face the rehabilitation community in providing services to surgical cancer patients are reviewed: (1) achieving capacity to meet the complex rehabilitation needs of a growing population of cancer patients and long-term survivors; (2) identifying effective models for delivering cancer rehabilitation services; (3) understanding complex insurance coverage and payment policies and determining their effects on access to rehabilitation services; and (4) investing in clinical and health services research to guide rehabilitation practice. Recommendations are made to increase the recognition of cancer rehabilitation as an essential component of cancer survivors' care, improve access to appropriate rehabilitation services, and accelerate the pace of cancer rehabilitation research. J. Surg. Oncol. 95:370,385. © 2007 Wiley-Liss, Inc. [source] Understanding the Impacts of the Medicare Modernization Act: Concerns of Congressional StaffTHE JOURNAL OF RURAL HEALTH, Issue 3 2005Keith J. Mueller PhD ABSTRACT: Sweeping changes to the Medicare program embodied in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), including a new prescription drug benefit, changes in payment policies, and reform of the Medicare managed-care program, have major implications for rural health care. The most efficient mechanism for research to affect policy is to provide policy makers with information on issues about which they have voiced concern. The Rural Policy Research Institute's Health Panel conducted 2 focus groups with 16 congressional staff in September 2004 to identify a set of researchable questions concerning the impact of the MMA on rural health care. This paper presents research questions in the following areas that staff identified as having the highest priority: access to health plans and pharmacy services, beneficiary outreach and enrollment, technology capacity, provider payment policy, and demonstration projects. [source] Rewarding Excellence and Efficiency in Medicare PaymentsTHE MILBANK QUARTERLY, Issue 3 2007KAREN DAVIS Medicare could become an innovative leader in using financial incentives to reward health care providers for providing excellent and efficient care throughout a patient's illness. This article examines the variations in cost and quality in the provision of episodes of care and describes how a pay-for-performance payment system could be designed to narrow those variations and serve as a transition to a new Medicare payment policy that would align physicians' incentives with improvements in both quality and efficiency. In particular, Medicare could stimulate greater efficiency by developing new payment methods that are neither pure fee-for-service nor pure capitation, beginning with a pay-for-performance payment system that rewards quality and efficiency and moving to a blended fee-for-service and case-rate system. [source] The Profitability of Medicare Admissions Based on Source of AdmissionACADEMIC EMERGENCY MEDICINE, Issue 10 2008Megan McHugh PhD Abstract Objectives:, This study investigates whether admissions from the emergency department (ED) have lower dollar margins than elective admissions under Medicare and explores two possible reasons for differences in margins. Methods:, The authors developed patient-level Medicare dollar margins (calculated as patient revenue minus cost) for 1,159,243 Medicare admissions from 321 hospitals using data from the 2003 Nationwide Inpatient Sample (NIS) and the Medicare Impact File. Differences in margins between ED and elective admissions were explored across a number of diagnosis-related groups (DRGs) using t-tests. Chi-square tests were used explore whether ED admission was more common among patients in low-profit DRGs and/or patients with greater severity of illness. Results:, The average Medicare dollar margins were ,$712 (95% confidence interval [CI] = ,$729 to ,$695) for ED admissions and $22 (95% CI = ,$2 to $47) for elective admissions. Medicare dollar margins for ED admissions were lower than those of elective admission for the most common DRGs. ED admission was associated with greater patient severity of illness. Conclusions:, Source of admission is a financially meaningful classification. Because Medicare payment policy does not recognize differences in cost based on patients' route of admission, hospitals may have a financial incentive to favor elective admissions over ED admissions. [source] | ||||||||||