Unbiased Analysis of Today's Healthcare Issues
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…
“From 2004 through 2009, the volume of Medicare outpatient services per FFS beneficiary increased at roughly a 4.3 percent annual rate for a cumulative increase of 23 percent over the six-year period. During the same period, Medicare inpatient discharge volume declined at roughly a 0.9 percent annual rate, and inpatient discharges per FFS Part A…
Hospitals in Sacramento were concerned about the large number of nusring home transfers to its facility. Were many of these tranfers unnecessary? Did patients with little chance of recovery benefit from these hospital stays? To reduce end-of-life tranfers to hospitals from nursing homes, 3 Sacramento-area hospital systems and 18 nursing homes instuted the Preparing Residents…
On Monday I attended a talk at AcademyHealth on the impact of market consolidation on the cost of health care. Particularly interesting was Robert (Bob) Berenson’s analysis of the effect of provider consolidation on negotiating power and health care prices. Particularly, provider have been gaining market power of late, according to recent CTS site visits.…
The Healthcare Economist has already commented on the impending Medicare implementation of a hospital value-based purchased (VBP) system. Now, Medicare’s hospital VBP program has garnered the attention of the popular press. According to the New York Times: “The administration plans to establish ‘Medicare spending per beneficiary’ as a new measure of hospital performance…Hospitals could be…
One large insurer is planning to begin paying hospitals based on quality. “WellPoint is replacing the system it uses to help offset rising medical and other costs at hospitals in 14 states that serve its Blue Cross Blue Shield plans, which cover 34 million people. In recent years, it has raised its payments to those…
Is health reform coming to the UK? Since the middle of the decade, the NHS has used a tariff system which pays a fixed price per procedure. Now, however, the Financial Times, reports that the UK plans for “public and private hospitals to compete on price for the treatment of NHS patients.” The reform calls…
The Health Reform (ACA) legislation mandated Medicare establish a hospital value-based purchasing (VBP) program by 2012. In fact, the Deficit Reduction Act of 2005 already authorized Medicare to develop a plan to implement VBP for 2009. How will they do this? A CMS report from 2007 sheds some light on the topic. Since 2005,…
From what areas does a hospital draw on to fill its beds? There have been many attempts to define a hospital’s catchment area. The Dartmouth Atlas Group uses hospital referral regions (HRRs) and hospital service areas (HSAs). One method is to determine a minimum admission rate for a given geographic unit (e.g., county, census tract,…
Why are hospitalization rates so high for Medicare beneficiaries living in long-term care facilities (i.e., skilled nursing facilities, nursing facilities, and assisted living facilities)? The first reason is obvious: they are sick. If they weren’t, they wouldn’t need to be living in these facilities in the first place. Hospitalizing sick patients is often necessary. Unnecessary…