Inquiry J Health Car
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Inquiry J Health Car · Jan 1987
An analysis of methods to reform Medicare payment for physician services.
Congress and the administration are changing Medicare's method of paying for physician services, with the intention of reducing the growth in or absolute level of Medicare payment rates. We analyzed the implications of four possible strategies for payment reform: modifications to the present system of paying by customary, prevailing, and reasonable (CPR) charges; payment based on fee schedules; payment for packages of related services; and capitation payment. ⋯ The inherent danger is that constraining program expenditures may impair access to and quality of care to beneficiaries, especially for poor or infirm people, who are more vulnerable. Thus, any payment reform will require careful monitoring to safeguard beneficiaries' quality of care.
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Inquiry J Health Car · Jan 1987
The distributional implications of using relative prices in DRG payment systems.
Decisions by state Medicaid programs and other third-party payers to use DRGs as the basis of hospital payment require the resolution of numerous technical design issues, including determining relative price schedules, that are likely to have important distributional implications for payers and hospitals. At issue is the development of price schedules that reflect average resource use in the populations using DRG reimbursement. An examination of differences between the Medicare relative prices and other relative prices based on different populations in New York State revealed that significant cross-subsidies among payers and hospitals would occur if Medicare relative prices were used as the basis of payment for patients outside the Medicare program. Such unintended cross-subsidies would compromise a major goal of DRG payment: to reduce "inequitable" charge and cost differentials among third-party payers.
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Inquiry J Health Car · Jan 1986
The effect of injecting price competition into the hospital market: the case of preferred provider organizations.
Preferred provider organizations (PPOs) and other discount health care purchasers are injecting price competition into the hospital market, which has hitherto been insulated from price competition by comprehensive and generous insurance coverage. Providing the discounts demanded by PPOs thus poses unaccustomed and difficult problems for hospitals. ⋯ We predict that prices will fall, excess capacity will be reduced, and some hospitals may develop financial problems. In the extreme case, prices will fall substantially, some hospitals will go bankrupt, excess capacity will be eliminated, and an unprecedented price volatility will be introduced into the market.
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In a keynote address before the AHA Conference on Maintaining Services to the Poor, the author expressed his personal concerns and conclusions about what is happening on the "care of the poor" front in this country. This article highlights those concerns, among them: the preemption of concern for equity in the delivery of health care services by other national priorities; the disinclination of the states to assume the burden of caring for the poor forced on them by the Reagan administration; and the moral and financial dilemma this has placed on health care providers. The author concludes that the trend toward increasing the numbers of for-profit hospitals and preferred provider organizations will only worsen the situation, and that equalizing the charity care burden may best be accomplished in states with regulated systems. He concludes that the issue could reach a political explosion point in this election year.
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Hospice care has emerged as a humane, cost-effective method of providing care for terminally ill patients. Although hospices are relatively new to the United States, their number has mushroomed to about 1,000. ⋯ To facilitate the collection of data on hospice care, the NHO and the Joint Commission are collaborating with the American Medical Record Association to create a model medical record. The hospice standards and model record will be instrumental in ensuring nationwide quality assurance and quality assessment for this important new form of medical care.