BACKGROUND: This study aimed to quantify the direct medical cost of treating inflammatory bowel disease (IBD) in Manitoba in 2005/2006. METHODS: In all, 7375 individuals with IBD recorded in the University of Manitoba IBD Epidemiology Database were matched on age, gender, and geography to up to 10 non-IBD controls. Data ...

BACKGROUND: Hospitals perform root cause analyses (RCA) and implement action plans for sentinel events (SE) to prevent similar adverse events. Dissemination of RCA action plans between hospitals has been limited by an absence of universal definitions of terms and classification frameworks, which have been recently proposed by the World Health ...

Objectives. We examined surveillance data for disparities in pediatric influenza associated hospitalizations according to neighborhood socioeconomic status (SES) measures in New Haven County, Connecticut. Methods. We geocoded influenza-associated hospitalization case data from the past 7 years for children from birth to age 17 years and linked these to US Census ...

BACKGROUND: This study aims to examine factors associated with variation in crash-related hospitalization costs for young adults in New South Wales (NSW), Australia with a particular focus on types of vehicle occupant, rurality of residence and socioeconomic status (SES). METHODS: Data on patients aged 17-25 years, admitted to public hospitals ...

Aiming to align provider incentives toward improving quality and efficiency, the Center for Medicare and Medicaid Services is considering broader bundling of hospital and physician payments around episodes of inpatient surgery. Decisions about bundled payments would benefit from better information about how payments are currently distributed among providers of different ...

This final rule will revise the Medicare conditions of participation for hospitals and critical access hospitals (CAHs) to provide visitation rights to Medicare and Medicaid patients. Specifically, Medicare- and Medicaid-participating hospitals and CAHs will be required to have written policies and procedures regarding the visitation rights of patients, including those ...

BACKGROUND: Several strategies have been proposed to reform physician reimbursement while improving quality of care. Despite much debate, physicians' opinions regarding reimbursement reform proposals have not been objectively assessed. METHODS: We conducted a national survey of randomly selected physicians between June 25 and October 31, 2009. Physicians rated their support ...

The inclusion of the failure to rescue (FTR) measure as one of the Centers for Medicare and Medicaid Services Inpatient Prospective Payment System measures has raised questions about the characteristics of FTR cases and their outcomes. In this study, we validated 75% of the identified FTR complications using medical record ...

The aim of this study was to describe characteristics and trends of radiologic technologist (RT) malpractice payments. National Practitioner Data Bank data files were analyzed for details of RT malpractice payments from 1991 through 2008. Payment amounts, sources, and allegations were all identified and summarized, along with geographic and demographic ...

BACKGROUND: Federal, state, and local governments provide substantial subsidies to so-called "safety-net" hospitals, in part, to offset the loss in revenue associated with providing a disproportionate share (DSH) of care to low-income and uninsured patients, with the goal to improve access to care for uninsured and ensure affordable care for ...

This study aims to analyze mechanisms for facilitating the uptake of new medical devices in the German system of hospital reimbursement, focusing on the example of coronary stents, including (1) trends in their coding, (2) associated diagnosis-related group (DRG) payments, (3) their integration in the German DRG (G-DRG) system, and ...

: We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems and to implement certain provisions of the Affordable Care Act and other legislation. In addition, we describe the ...

OBJECTIVE: To model the effect of excluding payment for eight hospital-acquired conditions (HACs) on hospital payments in Victoria, Australia. DESIGN, SETTING AND PARTICIPANTS: Retrospective ecological study using the Victorian Admitted Episodes Dataset. The analysis involved all acute inpatient admissions to Victorian public and private hospitals between 1 July 2007 and ...

A study of more than 270 hospitals over a four-year period highlighted a number of investments that can reduce hospitals' costs and improve efficiency, including the following: E-procurement systems. Electronic exchange of invoices and payments (and electronic receipt of payments). Human resources IT systems that reduce the need for manual ...

Medicare launched its Provider Enrollment, Chain, and Ownership System in 2003 to get all physicians and nonphysician health professionals who bill Medicare enrolled in one national database. But officials say 25 percent of U.S. Medicare physicians and other health professionals still are not enrolled. Many physicians are asking: Who must ...

Cuts in payments to physicians who treat patients on Medicaid and in the Children's Health Insurance Program (CHIP) appear likely, as state leaders grapple with potential multibillion-dollar budget deficits this year and next.

BACKGROUND: Different types of providers often face differing financial incentives for providing similar types of care. This may have implications for payment systems that target improvements in care requiring multiple types of providers. OBJECTIVES: The objective of this study was to determine how hospitalization influences the anemia of Medicare patients ...

A study of hospital facility and physician charges relative to payments, as affected by source of payment is provided. Charges relative to payment source are studied for both emergency room visits and inpatient hospital stays using the Medical Expenditure Panel Survey for 2003. We present evidence that hospitals are more ...

The majority of states have enacted price transparency laws to allow patients to shop for care and to prevent price discrimination of the uninsured. In California, hospitals must provide a price estimate to a requesting uninsured patient and cannot bill for an amount greater than the reimbursement the hospital would ...

Inpatient rehabilitation hospitals provide important services to patients to restore physical and cognitive functioning. Historically, these hospitals have been reimbursed by Medicare under a cost-based system; but in 2002, Medicare implemented a rehabilitation prospective payment system (PPS). Despite the implementation of a PPS for rehabilitation, there is limited published research ...

To prepare for payment reform, hospitals should: convene a permanent task force to monitor risk and lead performance improvement in the postreform era; identify the metrics linked to new and emerging incentive payments (e.g., readmission rates, prevention quality indicators); quantify their financial risk exposure and identify all performance improvement areas; ...

Almost one-fourth of Medicare beneficiaries discharged from the hospital to a skilled nursing facility were readmitted to the hospital within thirty days; this cost Medicare $4.34 billion in 2006. Especially in an elderly population, cycling into and out of hospitals can be emotionally upsetting and can increase the likelihood of ...

One potential option of President Obama's proposed health care plan is to change from fee-for-service to episode-of-care payments. These global payments would combine physician and hospital reimbursement from admission to discharge. In an effort to further evaluate this strategy, CMS has initiated a pilot study called the Acute Care Episode ...

CONTEXT: In October 2008, the Centers for Medicare & Medicaid Services reduced payments to hospitals for a group of hospital-acquired conditions (HACs) not documented as present on admission (POA). It is unknown what proportion of Medicare severity diagnosis related group (MS-DRG) assignments will change when the International Classification of Disease, ...

To examine the effects of incentive payment frequency on quality measures in a physician-specific pay-for-performance (P4P) experiment. A multispecialty physician group practice. In 2007, all primary care physicians (n=179) were randomized into two study arms differing by the frequency of incentive payment, either four quarterly bonus checks or a single ...

BACKGROUND: When second-generation antipsychotics (SGAs), also called atypical antipsychotics, were introduced in the 1990s, early research suggested that these drugs offered better tolerability and adherence than first-generation antipsychotics (FGAs), or typical antipsychotics. This presumably would reduce the need for hospital services. However, health research to test this hypothesis has focused ...

In Germany the introduction of a prospective payment system (PPS) is intended for inpatients hospitalised in psychiatric facilities. We investigate the various elements of the Prospective Payment System for Inpatient Psychiatric Facilities (IFP PPS) which was established in the USA in 2005 with respect to their potential to be incorporated ...

BACKGROUND: The recent public reporting of payments made to physicians by manufacturers of orthopedic devices provides an opportunity to assess the accuracy of physicians' conflict-of-interest disclosures. METHODS: We analyzed the reports of payments made to physicians by five manufacturers of total hip and knee prostheses in 2007. For each payment ...

Could your hospital survive on Medicare payments alone? Some forward-looking leaders are asking this question with surprising answers.

Catheter-associated urinary tract infection (CAUTI) is a common and costly problem for hospitalized patients. Policymakers have taken notice of the importance of these infections, and changes to the prospective payment rules of Medicare, Medicaid, and many additional third-party payers have been implemented to hold hospitals accountable for the delivery of ...

We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems, and to implement certain provisions made by the TMA, Abstinence Education, and QI Program Extension Act of 2007, the ...

This paper analyzes hospital cost shifting using a natural experiment generated by the Balanced Budget Act (BBA) of 1997. I find evidence that urban hospitals were able to shift part of the burden of Medicare payment reduction onto private payers. However, the overall estimated degree of cost shifting is small ...

Beginning federal fiscal year (FFY) 2013, value-based purchasing (VBP) would implement a withholding of 2 percent of Medicare reimbursement, which would then increase gradually to 5 percent in FFY16. A hospital's percentile ranking in a VBP performance measurement system would determine the amount of payment, if any, it would receive ...

A recent study has found that U.S. hospitals are apparently shifting the unreimbursed costs of caring for Medicare inpatients to other payers. So far, hospitals have found other sources of revenue to offset negative margins from patient care, but how much longer they can continue to do so is uncertain. ...

Medicare, an important payer for hospitals, reimburses hospitals for inpatient stays using Diagnosis Related Groups (DRGs). Many private insurers also use the DRG methodology to reimburse hospitals for their services. Therefore, those blood service organizations that bill Medicare directly require an understanding of the DRG system of payment to enable ...

OBJECTIVE: Improving patient safety was a strong motivation behind duty hour regulations implemented by Accreditation Council for Graduate Medical Education on July 1, 2003. We investigated whether rates of patient safety indicators (PSIs) changed after these reforms. RESEARCH DESIGN: Observational study of patients admitted to Veterans Health Administration (VA) (N ...

Medicare's Recovery Audit Contractor (RAC) program is being rolled out nationwide in 2009. To successfully manage the RAC appeals process, hospital revenue cycle leaders require accurate and timely tracking of all RAC-related events, deadlines, findings, and costs. These leaders also need to take steps to avoid Medicare overpayments, including establishing ...

In 2002, several hospitals in the Tenet system were accused of overbilling Medicare for cardiac surgery. This led to increased scrutiny of so-called outlier payments, which are used to compensate hospitals when actual costs far exceed those anticipated under prospective payment. Since then, the overall proportion of coronary artery bypass ...

PURPOSE: The aim of this study was to examine the effects of self-referral by comparing recent trends in payments and utilization rates for radionuclide myocardial perfusion imaging (MPI) among radiologists and cardiologists between 1998 and 2006. MATERIALS AND METHODS: Nationwide Medicare Part B claims databases for 1998 through 2006 were ...

PURPOSE: The aim of this study was to compare trends in reimbursement rates between hospital outpatient departments and freestanding physician offices for commonly performed interventional radiology procedures from 2006 through 2010. METHODS: Using final rules data from the 2006 and 2008 Hospital Outpatient Prospective Payment System for Medicare and Medicare ...

Medicare has introduced a number of new payment initiatives that will have a profound effect on hospital reimbursement and quality and safety ratings. The new medical severity diagnosis-related group (MS-DRG) payment system adds a number of new DRG categories to more adequately account for patient severity. The new present-on-admission (POA) ...

The Medicare incentives begin in fiscal 2011, so many hospitals and physician groups will likely accelerate their EHR implementations. Medicare incentives may help CIOs make return-on-in-vestment cases. The goal is to get physicians and hospitals using EHRs by 2014, so the definition of meaningful use may evolve to allow them ...

Virtual business offices are a key part of many hospitals' web strategies. Patients are ready and willing to pay their hospital bills online. Web-based payment centers can help cut self-pay days in A/R and increase collections. Proper marketing is essential to attract patients to a hospital's online business office.

Effective October 1, 2007, the Centers for Medicare and Medicaid Services has changed its methodology for determining the diagnosis-related group for hospitalized patients. In an effort to more accurately reflect severity of illness, the 538 diagnosis-related groups have been converted to 745 new Medicare severity diagnosis-related groups. In addition, selected ...

Dozens of hospitals find themselves a combined $5 million in the hole on payments because Medicare determined the healthcare facilities didn't properly submit quality data. But hospitals say the process is confusing and that Medicare is unhelpful. "The hospital may have made every effort to do everything correctly and still ...

OBJECTIVE: To assess the relationship between annual fills for antidiabetes medications, ACE inhibitors, angiotensin II receptor blockers (ARBs), and lipid-lowering agents on hospitalization and Medicare spending for beneficiaries with diabetes. RESEARCH DESIGN AND METHODS: Using Medicare Current Beneficiary Survey data from 1997 to 2004, we identified 7,441 community-dwelling beneficiaries with ...

Prospective payment schemes in health care often include supply-side insurance for cost outliers. In hospital reimbursement, prospective payments for patient discharges, based on their classification into diagnosis related group (DRGs), are complemented by outlier payments for long stay patients. The outlier scheme fixes the length of stay (LOS) threshold, constraining ...

This final rule sets forth the data elements necessary to comply with the requirements of Section 1923(j) of the Social Security Act (Act) related to auditing and reporting of disproportionate share hospital payments under State Medicaid programs. These requirements were added by Section 1001(d) of the Medicare Prescription Drug, Improvement, ...

With an increased focus on payment and productivity measurement in health care, it is essential to understand the genesis and principles behind the Medicare Resource-Based Relative Value Scale (RBRVS) physician fee schedule. The majority of third-party payers, including a growing number of Medicaid programs and commercial payers, use variations of ...

Policymakers have focused primarily on increasing Medicaid reimbursement rates to increase physicians' participation in Medicaid, although physicians often complain of payment delays and other administrative burdens associated with Medicaid. Linking state-level data on average reimbursement times to the 2004-05 Community Tracking Study Physician Survey, this study examines how Medicaid reimbursement ...