Health Care Financing Review最新文献

{"title":"Overview","authors":"N. Miller, William D. Saunders","doi":"10.4324/9780429348433-12","DOIUrl":"https://doi.org/10.4324/9780429348433-12","url":null,"abstract":"The Cisco HyperFlex SD-WAN solution is a major technology inflection which integrates Edge Computing, hyperconverged infrastructure, machine learning, and SD-WAN technologies. Cisco SD-WANvEdge Routers are routing components of the architecture that deliver the essential WAN, security and multi-cloud capability of the Cisco SD-WAN solution. Cisco HyperFlex Edge brings the simplicity of hyperconvergence to remote and branch office (ROBO) and edge environments.","PeriodicalId":55071,"journal":{"name":"Health Care Financing Review","volume":"14 1","pages":"1 - 4"},"PeriodicalIF":0.0,"publicationDate":"2020-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70615012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Overview","authors":"J. P. Hadley","doi":"10.1787/9789264301085-3-en","DOIUrl":"https://doi.org/10.1787/9789264301085-3-en","url":null,"abstract":"Today in the United States, national health expenditures total more than $700 billion and make up over 13 percent of the gross domestic product (GDP). By 1995, they are projected to rise above $1 trillion and to comprise 15.6 percent of the GDP (Burner, Waldo, and McKusick, 1992). In spite of this level of expenditure, 15 percent of Americans are still without any form of health insurance and an additional 10 percent are inadequately insured. The President's proposed approach to health care reform and virtually all other national health care reform proposals under consideration rely on health maintenance organizations (HMOs) and other forms of managed care to reduce the rate of health care cost increases while expanding coverage. The focus of this issue of the Health Care Financing Review is on recent empirical evidence from studies of Medicare and Medicaid managed care programs, including an examination of some new methods for setting payment rates to maximize the impact of managed care. As an introduction to these articles, it may be useful to briefly review the history of managed care, with an emphasis on programs financed by the Federal Government.","PeriodicalId":55071,"journal":{"name":"Health Care Financing Review","volume":"15 1","pages":"1 - 5"},"PeriodicalIF":0.0,"publicationDate":"2018-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44133342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Overview","authors":"William D. Saunders","doi":"10.1142/9789813238640_0001","DOIUrl":"https://doi.org/10.1142/9789813238640_0001","url":null,"abstract":"The Medicare prospective payment system (PPS) for hospitals, implemented in 1983, has motivated major changes in the hospital industry and the way hospital services are used by physicians and their patients. By paying hospitals a fixed rate for each inpatient stay based on the patient's diagnosis-related group (DRG) classification, PPS gave hospitals new incentives to provide services economically. Because Medicare's PPS concentrated on inpatient services provided in acute hospital settings, this system did not apply to all hospitals and all services. Certain specialized facilities—psychiatric, rehabilitation, long-term care, and children's hospitals—were excluded from PPS. These types of facilities were excluded because DRGs did not readily apply to the types of care provided by these facilities, or the settings for this care were otherwise unsuited to the PPS. These hospitals have remained under the payment system established by the Tax Equity and Fiscal Responsibility Act (TEFRA) of 1982. Medicare payments to TEFRA facilities are related to the hospitals' actual allowable costs, limited by a facility-specific cost-based target amount. As a group, the number of Medicare cases treated at excluded hospitals and units grew from 439,454 in fiscal year (FY) 1989 to 570,694 in FY 1991, a 30-percent increase. Children's hospitals treated the fewest cases (2,671 in FY 1991), with little change from year to year. Rehabilitation facilities experienced the greatest percentage increase in the number of cases during this period, rising from 144,252 in FY 1989 to 204,213 in FY 1991, a 42percent increase. Psychiatric facilities treated the most cases in FY 1991, 343,912, up from 276,209 in FY 1989. Payments to excluded facilities grew by 39 percent during this period, from $2.8 billion in FY 1989to$3.9 billion in FY 1991. Classification schemes such as the DRG system, which describe case mix and form the basis for payments to health care providers, are often a key to the development of new payment policies. Systems with greater precision can ultimately play an important role in measuring utilization and costs and in resource management. More precise systems will be increasingly important whether the country moves toward a more competitive managed care environment or toward increased constraints on health care budgets, as providers and payers need to project future costs and negotiate contracts based on patient needs and characteristics and manage util ization and costs. The theme of this issue of the Review is \"Hospital Payment: Beyond the Prospective Payment System.\" Three articles present authors' ideas on how current payment methods for excluded hospitals might be modified in the future.","PeriodicalId":55071,"journal":{"name":"Health Care Financing Review","volume":"15 1","pages":"1 - 5"},"PeriodicalIF":0.0,"publicationDate":"2015-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64058611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Colon cancer treatment costs for Medicare and dually eligible beneficiaries.","authors":"Zhehui Luo,&nbsp;Cathy J Bradley,&nbsp;Bassam A Dahman,&nbsp;Joseph C Gardiner","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>To estimate the cost attributable to colon cancer treatment 1 year after diagnosis by cancer stage, comorbidity, treatment regimen, and Medicaid eligibility, we extracted an inception cohort of colon cancer patients aged 66 and older diagnosed between 1997 and 2000 from the Michigan Tumor Registry. Patients were matched to non-cancer control subjects in the Medicare Denominator file. We used the difference-in-differences method to estimate costs attributable to cancer, controlling for costs prior to diagnosis. The mean total colon cancer cost per Medicare patient was $29,196. The method can be applied to longitudinal data to estimate long term costs of cancer from inception where incident patients are identified from a tumor registry.</p>","PeriodicalId":55071,"journal":{"name":"Health Care Financing Review","volume":"31 1","pages":"35-50"},"PeriodicalIF":0.0,"publicationDate":"2010-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2832226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28743287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medicaid expansions and the insurance coverage of poor teenagers.","authors":"Lindsey Jeanne Leininger","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>This article employs a comparison group research design to examine the effects of the Medicaid expansions of the late 1990s on the insurance coverage of poor teenagers. Results suggest that the expansions were associated with a decrease in the likelihood of poor teens experiencing uninsured spells over the course of a calendar year, as measured by spending any part of the prior year uninsured and spending over half of the prior year uninsured. While the expansions were successful in increasing coverage among poor adolescents, they fell far short of facilitating near-universal coverage for this population.</p>","PeriodicalId":55071,"journal":{"name":"Health Care Financing Review","volume":"31 1","pages":"23-34"},"PeriodicalIF":0.0,"publicationDate":"2010-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4195066/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28743286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ventilator-associated pneumonia among elderly Medicare beneficiaries in long-term care hospitals.","authors":"William Buczko","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Ventilator-associated pneumonia (VAP) is a complication of ventilator care that produces excess, avoidable resource use and treatment costs. Control of VAP is an important aspect of quality of care improvement for long-term care hospitals (LTCHs) since they provide post-acute ventilator care for many Medicare beneficiaries. Data for Medicare patients discharged from LTCHs during CY 2004 who received continuous mechanical ventilation are examined (N=13,759). Nearly 25% of Medicare LTCH ventilator patients acquired VARP Despite having lower mortality and less co-morbidity than non-VAP patients, length of stay (LOS) and total charges were both higher for VAP patients. Some of this excess is avoidable.</p>","PeriodicalId":55071,"journal":{"name":"Health Care Financing Review","volume":"31 1","pages":"1-10"},"PeriodicalIF":0.0,"publicationDate":"2010-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4195065/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28743281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Toward understanding EHR use in small physician practices.","authors":"Suzanne Felt-Lisk,&nbsp;Lorraine Johnson,&nbsp;Christopher Fleming,&nbsp;Rachel Shapiro,&nbsp;Brenda Natzke","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>This article presents insights into the use of electronic health records (EHRs) by small physician practices participating in a CMS pay-for-performance demonstration. Site visits to four States reveal slow movement toward improved EHR use. Factors facilitating use of EHRs include customization of EHR products and being owned by a larger organization. Factors limiting use of EHRs include system limitations, cost, and lack of strong incentives to improve. Practices in one State were moving more vigorously toward improved EHR use than those in the other States. Many practices also increased use of medical assistants after implementing EHRs.</p>","PeriodicalId":55071,"journal":{"name":"Health Care Financing Review","volume":"31 1","pages":"11-22"},"PeriodicalIF":0.0,"publicationDate":"2010-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4195064/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28743284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinician feedback on using episode groupers with Medicare claims data.","authors":"Fred Thomas,&nbsp;Craig Caplan,&nbsp;Jesse M Levy,&nbsp;Marty Cohen,&nbsp;James Leonard,&nbsp;Todd Caldis,&nbsp;Curt Mueller","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>CMS is investigating techniques that might help identify costly physician practice patterns. One method presently under evaluation is to compare resource use for certain episodes of care using commercially available episode grouping software. Although this software has been used by the private sector to classify insured individuals' medical claims into episodes of care, it has never been used with fee-for-service Medicare claims except in the studies by the Medicare Payment Advisory Commission (MedPAC) and CMS. This study reviews and reports on clinician feedback on the most obvious and important decisions that must be faced by Medicare to use grouped claims data as the foundation for a physician performance measurement system. The panel reactions show the importance of bringing persons with clinical knowledge into the development process. The clinician feedback confirms that additional research is needed.</p>","PeriodicalId":55071,"journal":{"name":"Health Care Financing Review","volume":"31 1","pages":"51-61"},"PeriodicalIF":0.0,"publicationDate":"2010-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4195067/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28743288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Redesigning the Medicare inpatient PPS to reduce payments to hospitals with high readmission rates.","authors":"Richard F Averill, Elizabeth C McCullough, John S Hughes, Norbert I Goldfield, James C Vertrees, Richard L Fuller","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>A redesign of the Medicare inpatient prospective payment system (IPPS) that reduces payments to hospitals that have high-risk adjusted readmission rates is proposed. The redesigned IPPS uses a readmission performance standard from best practice hospitals to determine the risk-adjusted number of excess readmissions in a hospital and determines the payment reduction for a hospital based on its excess number of readmissions. Extrapolating from Florida Medicare 2004-2005 discharge data, the redesigned IPPS is estimated to reduce overall annual Medicare inpatient expenditures nationally by $1.25, 1.92, and 2.58 billion for readmission windows of 7, 15, and 30 days, respectively.</p>","PeriodicalId":55071,"journal":{"name":"Health Care Financing Review","volume":"30 4","pages":"1-15"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4195060/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28373697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medicaid consumers and informed decisionmaking.","authors":"Jessica Greene,&nbsp;Ellen Peters","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>In 2006, Florida's Medicaid reform required some Medicaid consumers to enroll in health plans that differed in terms of cost-sharing requirements and benefit limitations. In focus groups we found enthusiasm among Medicaid consumers for having choices among health plans; however, enthusiasm did not translate into comparison shopping for health plans. Survey findings suggested that Medicaid consumers had difficulty comprehending Medicaid health-plan comparison information, particularly if they were lower in numeracy or literacy skills. Given the number of plans offered and the numerous ways they differed, our efforts to simplify the comparison chart resulted in slightly higher comprehension, but only among those with higher skill levels. Our study suggests that policymakers should seek to simplify Medicaid Program information and design to encourage informed decisionmaking.</p>","PeriodicalId":55071,"journal":{"name":"Health Care Financing Review","volume":"30 3","pages":"25-40"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4195072/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28335211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}