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Linking tumor registry and Medicaid claims to evaluate cancer care delivery. 将肿瘤登记和医疗补助申请联系起来，评估癌症护理服务。
Health Care Financing Review Pub Date : 2009-01-01
Deborah Schrag, Beth A Virnig, Joan L Warren
{"title":"Linking tumor registry and Medicaid claims to evaluate cancer care delivery.","authors":"Deborah Schrag, Beth A Virnig, Joan L Warren","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The utility of Medicaid claims for studying cancer care is not known. Our objective was to evaluate how well Medicaid claims capture diagnostic and treatment information recorded by the California Cancer Registry (CCR). We compared cancer treatment from Medicaid claims with CCR data, using 1988-2000 cases matched with 1997-1998 Medicaid enrollment data. Medicaid claims corroborated diagnoses for 73 percent of breast and 68 percent of colorectal cancers in CCR. Medicaid claims confirmed surgery for 67 percent of CCR's breast cancers. We found that Medicaid claims have moderate sensitivity for identifying cancer diagnoses and surgery. Linked registry-Medicaid data can identify indigent patients and the timing of Medicaid coverage.</p>","PeriodicalId":55071,"journal":{"name":"Health Care Financing Review","volume":"30 4","pages":"61-73"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4195063/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28371519","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}
引用次数: 0
Estimating the costs of potentially preventable hospital acquired complications. 估算潜在可预防的医院并发症的成本。
Health Care Financing Review Pub Date : 2009-01-01
Richard L Fuller, Elizabeth C McCullough, Mona Z Bao, Richard F Averill
{"title":"Estimating the costs of potentially preventable hospital acquired complications.","authors":"Richard L Fuller, Elizabeth C McCullough, Mona Z Bao, Richard F Averill","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>California and Maryland hospital data are used to estimate the incremental cost associated with 64 categories of hospital acquired complications. The reason for admission, severity of illness at admission and the presence of hospital acquired complications are used in a linear regression model to predict incremental per patient cost yielding an adjusted R2 of 0.58 for Maryland data and 0.60 for California data. The estimated incremental cost due to each of the 64 categories of complications was consistent across both databases and accounted for an increase in total short term acute inpatient hospital cost of 9.39 percent in the California data and 9.63 percent in the Maryland data.</p>","PeriodicalId":55071,"journal":{"name":"Health Care Financing Review","volume":"30 4","pages":"17-32"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4195062/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28373698","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}
引用次数: 0
Payment reduction and Medicare private fee-for-service plans. 减少支付和医疗保险私人按服务收费计划。
Health Care Financing Review Pub Date : 2009-01-01
Austin B Frakt, Steven D Pizer, Roger Feldman
{"title":"Payment reduction and Medicare private fee-for-service plans.","authors":"Austin B Frakt,&nbsp;Steven D Pizer,&nbsp;Roger Feldman","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Medicare private fee-for-service (PFFS) plans are paid like other Medicare Advantage (MA) plans but are exempt from many MA requirements. Recently, Congress set average payments well above the costs of traditional fee-for-service (FFS) Medicare, inducing dramatic increases in PFFS plan enrollment. This has significant implications for Medicare's budget, provoking calls for policy change. We predict the effect of proposals to cut PFFS payments on PFFS plan participation and enrollment. We find that small reductions in payment rates would reduce PFFS participation and enrollment; if Congress reduces payments to traditional FFS levels it would cause the vast majority (85 percent) of PFFS plans to exit the market.</p>","PeriodicalId":55071,"journal":{"name":"Health Care Financing Review","volume":"30 3","pages":"15-24"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4195074/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28335210","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}
引用次数: 0
Psychometric properties of an instrument to assess Medicare beneficiaries' prescription drug plan experiences. 一种评估医疗保险受益人处方药计划经历的工具的心理测量特性。
Health Care Financing Review Pub Date : 2009-01-01
Steven C Martino, Marc N Elliott, Paul D Cleary, David E Kanouse, Julie A Brown, Karen L Spritzer, Amy Heller, Ron D Hays
{"title":"Psychometric properties of an instrument to assess Medicare beneficiaries' prescription drug plan experiences.","authors":"Steven C Martino,&nbsp;Marc N Elliott,&nbsp;Paul D Cleary,&nbsp;David E Kanouse,&nbsp;Julie A Brown,&nbsp;Karen L Spritzer,&nbsp;Amy Heller,&nbsp;Ron D Hays","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Using data from 335,249 Medicare beneficiaries who responded to the 2007 Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey, along with data from 22 cognitive interviews, we investigated the reliability and validity of an instrument designed to assess beneficiaries' experiences with their prescription drug plans. Composite measures derived from the instrument had acceptable internal consistency and sufficient plan-level reliability to inform consumer choice, quality improvement, and payor oversight. These measures were positively associated with members' overall rating of the plan and their willingness to recommend the plan. Moreover, each was independently useful in predicting beneficiaries' global ratings of their plan. This instrument can be an important tool for helping beneficiaries to choose a plan that best meets their needs.</p>","PeriodicalId":55071,"journal":{"name":"Health Care Financing Review","volume":"30 3","pages":"41-53"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4195071/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28335212","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}
引用次数: 0
The Medicare hospice payment system: a consideration of potential refinements. 医疗保险临终关怀支付系统:对潜在改进的考虑。
Health Care Financing Review Pub Date : 2009-01-01
Nancy Nicosia, Elaine Reardon, Karl Lorenz, Joanne Lynn, Melinda Beeuwkes Buntin
{"title":"The Medicare hospice payment system: a consideration of potential refinements.","authors":"Nancy Nicosia,&nbsp;Elaine Reardon,&nbsp;Karl Lorenz,&nbsp;Joanne Lynn,&nbsp;Melinda Beeuwkes Buntin","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The purpose of this article is to examine variation in resource utilization across and within patient stays in the context of Medicare's per diem payment system for hospice. Visit-level resource utilization data were linked to patient-level diagnosis and demographics covering more than 68,000 Medicare patients admitted in 2002 and 2003. Our findings suggest that case mix adjustment based on diagnosis and demographics does not improve our ability to explain variation in resource utilization across stays. However, we do find that there is substantial variation in resource utilization within stays that may not be captured in the current per diem payment system.</p>","PeriodicalId":55071,"journal":{"name":"Health Care Financing Review","volume":"30 4","pages":"47-59"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4195059/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28371518","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}
引用次数: 0
Developing financial benchmarks for critical access hospitals. 制定关键医院的财务基准。
Health Care Financing Review Pub Date : 2009-01-01
George H Pink, George M Holmes, Rebecca T Slifkin, Roger E Thompson
{"title":"Developing financial benchmarks for critical access hospitals.","authors":"George H Pink,&nbsp;George M Holmes,&nbsp;Rebecca T Slifkin,&nbsp;Roger E Thompson","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>This study developed and applied benchmarks for five indicators included in the CAH Financial Indicators Report, an annual, hospital-specific report distributed to all critical access hospitals (CAHs). An online survey of Chief Executive Officers and Chief Financial Officers was used to establish benchmarks. Indicator values for 2004, 2005, and 2006 were calculated for 421 CAHs and hospital performance was compared to the benchmarks. Although many hospitals performed better than benchmark on one indicator in 1 year, very few performed better than benchmark on all five indicators in all 3 years. The probability of performing better than benchmark differed among peer groups.</p>","PeriodicalId":55071,"journal":{"name":"Health Care Financing Review","volume":"30 3","pages":"55-69"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4195075/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28335213","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}
引用次数: 0
Use and knowledge of the new enrollee "welcome to Medicare" physical examination benefit. 使用和了解新参保人“欢迎医保”体检的好处。
Health Care Financing Review Pub Date : 2009-01-01
Cara A Petroski, Joseph F Regan
{"title":"Use and knowledge of the new enrollee \"welcome to Medicare\" physical examination benefit.","authors":"Cara A Petroski,&nbsp;Joseph F Regan","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The Medicare Current Beneficiary Survey (MCBS) is a large survey utilizing a nationally representative sample of the Medicare population. The MCBS collects data on a whole host of topics including health status, health insurance coverage and financing, access to care, knowledge and understanding of the Medicare Program, as well as use and effectiveness of new program benefits and changes.</p>","PeriodicalId":55071,"journal":{"name":"Health Care Financing Review","volume":"30 3","pages":"71-6"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4195073/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28257892","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}
引用次数: 0
Medicare financial status, budget impact, and sustainability--which concept is which? 医疗保险的财务状况、预算影响和可持续性——哪个概念是哪个?
Health Care Financing Review Pub Date : 2009-01-01
Richard S Foster, M Kent Clemens
{"title":"Medicare financial status, budget impact, and sustainability--which concept is which?","authors":"Richard S Foster,&nbsp;M Kent Clemens","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Medicare is continually undergoing change, as it must in order to reflect advances in medical technology, new health care delivery systems, financial pressures, and other developments. Modifications to the program are debated by policymakers in Congress and the administration, together with academic experts and others. These debates would be improved if policymakers and the public had a clearer understanding of Medicare and certain commonly cited views of the program's overall status. Three such concepts--the financial status of the Medicare trust funds, the impact of Medicare on the Federal budget, and the long-run sustainability of Medicare-are often confused with each other and are sometimes used interchangeably. Each concept is important but needs to be used for its own purpose. This article clarifies the differences among these three views of Medicare and provides examples of each.</p>","PeriodicalId":55071,"journal":{"name":"Health Care Financing Review","volume":"30 3","pages":"77-90"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4195070/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28257893","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}
引用次数: 0
Need for risk adjustment in adapting episode grouping software to Medicare data. 需要风险调整的插曲分组软件适应医疗保险数据。
Health Care Financing Review Pub Date : 2009-01-01
Thomas MaCurdy, Jason Kerwin, Nick Theobald
{"title":"Need for risk adjustment in adapting episode grouping software to Medicare data.","authors":"Thomas MaCurdy,&nbsp;Jason Kerwin,&nbsp;Nick Theobald","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Episode grouper software offers a potential framework for developing important components of a pay-for-performance system for healthcare providers. If the costs for treating health conditions can be computed, then policymakers can in principle benchmark different providers' cost distributions and reward the most efficient. This article applies two of the most prominent commercial groupers and examines the properties of the cost distributions calculated for their constructed episodes. The analysis reveals that episode cost distributions exhibit substantial variation and skewness, suggesting the need for innovative risk adjustment methods prior to utilizing groupers for the purpose of physician profiling.</p>","PeriodicalId":55071,"journal":{"name":"Health Care Financing Review","volume":"30 4","pages":"33-46"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4195061/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28373699","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}
引用次数: 0
Pay-for-performance in nursing homes. 疗养院的绩效工资。
Health Care Financing Review Pub Date : 2009-01-01
Becky A Briesacher, Terry S Field, Joann Baril, Jerry H Gurwitz
{"title":"Pay-for-performance in nursing homes.","authors":"Becky A Briesacher,&nbsp;Terry S Field,&nbsp;Joann Baril,&nbsp;Jerry H Gurwitz","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Information on the impact of pay-for-performance programs is lacking in the nursing home setting. This literature review (1980-2007) identified 13 prior examples of pay-for-performance programs in the nursing home setting: 7 programs were active as of 2007, while 6 had been terminated. The programs were mostly short-lived, varied considerably in the choice of performance measures and pay incentives, and evaluations of the impact were rare.</p>","PeriodicalId":55071,"journal":{"name":"Health Care Financing Review","volume":"30 3","pages":"1-13"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2758526/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28335209","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}
引用次数: 0
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