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…
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.…
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,…
Currently, Medicare and private insurers are attempting to put in place incentives to reduce the number of readmissions. Visits to the hospital are costly and reducing the frequency of hospital visits is the best means to reduce medical costs. In particular, if readmissions are the fault of the care the patients receive during the initial…
Should Medicare pay hospitals located in New York City more for the same care as hospitals in Montana? Prima facie, one might believe that New York hospitals should receive higher wages since the costs of operating a hospital are much higher in New York. Labor (i.e., nurses, doctors, etc.) may prefer to live in an…
The HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) is a standardized survey instrument and data collection methodology for measuring patients’ perceptions of their hospital experience. HCAPHS is the first national standard for collecting and reporting hospitals quality data. The survey asks discharged patients 27 questions about their recent hospital stay. The survey is…
Kolstad and Kowalski (2010) examine how the Massachusetts individual mandate affected uninsurance rates, hospital and outpatient utilization, and preventive care: “Among the population discharged from the hospital in Massachusetts, the reform decreased uninsurance by 28% relative to its initial level. Increased coverage affected utilization patterns by decreasing length of stay and the number of inpatient…
Some press on a report I worked on at Acumen, LLC. “The hospital wage index used to adjust Medicare inpatient prospective payment system (IPPS) payments to reflect the geographic differences in labor costs has created payment problems through its use of metropolitan statistical areas (MSAs) and “rest of state” areas to define hospital labor markets.…