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PubMed Journals Articles About "Requires Hospitals Post Prices Medicare Patients Useful Step" RSS

17:43 EST 14th November 2018 | BioPortfolio

Requires Hospitals Post Prices Medicare Patients Useful Step PubMed articles on BioPortfolio. Our PubMed references draw on over 21 million records from the medical literature. Here you can see the latest Requires Hospitals Post Prices Medicare Patients Useful Step articles that have been published worldwide.

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Showing "Requires Hospitals Post Prices Medicare Patients Useful Step" PubMed Articles 1–25 of 45,000+

Market Power: Price Variation Among Commercial Insurers For Hospital Services.

Much research has focused on differences in hospital prices paid by private (commercial) versus public (Medicare and Medicaid) health insurers. Far less is known about price differences across commercial payers-health maintenance organizations (HMOs) or preferred provider organizations (PPOs) versus other payers, such as casualty (automobile), workers' compensation, and travel insurers. We found that other insurers had far less negotiating power with hospitals than commercial HMO/PPO insurers did. In the pe...


Prices for physician services in Medicare Advantage versus traditional Medicare.

To compare the prices paid to physicians by employer-sponsored Medicare Advantage (MA) plans with those paid by traditional Medicare (TM) and to determine whether the relationship between MA and TM prices is affected by the generosity of MA benchmarks.

Variation in Prostaglandin Analog Prices Paid for Through Medicare Part D.

Determine the prices and price variation of the prostaglandin analogs (PGAs) used in the United States and examine their trends from 2013-2016 using Medicare Part D data.


They think you earn too much, but they probably don't care.

A survey of patients and physicians in southern California indicates that patients overestimate Medicare payments to hospitals for elective coronary stenting several-fold and overestimate Medicare payments to physicians for coronary stenting over 15-fold. Patients think payments should be less than they erroneously think hospitals and physicians are paid but should be much more than hospitals and physicians are paid. The authors hypothesize that patients' view of physician payments may interfere with the ph...

Comparing post-acute rehabilitation use, length of stay, and outcomes experienced by Medicare fee-for-service and Medicare Advantage beneficiaries with hip fracture in the United States: A secondary analysis of administrative data.

Medicare Advantage (MA) and Medicare fee-for-service (FFS) plans have different financial incentives. Medicare pays predetermined rates per beneficiary to MA plans for providing care throughout the year, while providers serving FFS patients are reimbursed per utilization event. It is unknown how these incentives affect post-acute care in skilled nursing facilities (SNFs). The objective of this study was to examine differences in rehabilitation service use, length of stay, and outcomes for patients following...

Quality disclosure and the timing of insurers' adjustments: Evidence from medicare advantage.

Mandatory quality disclosure often includes a period over which the quality of new entrants is unreported. This provides the opportunity for forward-looking firms to adjust product characteristics in advance of disclosure. Using comprehensive data on Medicare Advantage (MA) from 2007 to 2015, I exploit the design of the MA Star Rating program to examine the presence of forward-looking behavior among insurers. I find that high-quality insurers reduce prices leading up to quality disclosure, while low-quality...

The Importance of Rural Hospitals: Transfers and 30-day Readmissions Among Rural Residents and Patients Presenting at Rural Hospitals.

The purpose was to examine factors associated with transfers and readmissions among Medicare patients initially presenting at rural facilities. Data from the 2013 Medicare Claims file were used to identify fee-for-service patients with a hospital admission (n = 298,783) or an emergency department visit immediately followed by a hospital admission (117,416), for a total of 416,199. Transfers were defined as hospitalization at a different facility within 1 day of a discharge from a prior inpatient or emer...

Does a Reduction in Readmissions Result in Net Savings for Most Hospitals? An Examination of Medicare's Hospital Readmissions Reduction Program.

This study aimed (1) to estimate the impact of an incremental reduction in excess readmissions on a hospital's Medicare reimbursement revenue, for hospitals subject to penalties under the Medicare's Hospital Readmissions Reduction Program and (2) to evaluate the economic case for an investment in a readmission reduction program. For 2,465 hospitals with excess readmissions in the Fiscal Year 2016 Hospital Compare data set, we (1) used the Hospital Readmissions Reduction Program statute to estimate hospital-...

The Effect Of The Hospital Readmissions Reduction Program On Readmission And Observation Stay Rates For Heart Failure.

The Hospital Readmissions Reduction Program reduces Medicare prospective payments for hospitals with excess readmissions for selected diagnoses. By comparing data for patients who were readmitted or placed on observation status immediately before and immediately after the thirty-day cutoff for penalties, we sought to determine whether hospitals have responded to the program by shifting readmissions for heart failure to observation status. We used regression discontinuity, taking advantage of the cutoff to g...

Comparison Of Hospitals Participating In Medicare's Voluntary And Mandatory Orthopedic Bundle Programs.

We analyzed data from Medicare and the American Hospital Association Annual Survey to compare characteristics and baseline performance among hospitals in Medicare's voluntary (Bundled Payments for Care Improvement initiative, or BPCI) and mandatory (Comprehensive Care for Joint Replacement Model, or CJR) joint replacement bundled payment programs. BPCI hospitals had higher mean patient volume and were larger and more teaching intensive than were CJR hospitals, but the two groups had similar risk exposure an...

Strategic Patient Discharge: the Case of Long-Term Care Hospitals.

Medicare's prospective payment system for long-term acute-care hospitals (LTCHs) provides modest reimbursements at the beginning of a patient's stay before jumping discontinuously to a large lump-sum payment after a prespecified number of days. We show that LTCHs respond to the financial incentives of this system by disproportionately discharging patients after they cross the large-payment threshold. We find this occurs more often at for-profit facilities, facilities acquired by leading LTCH chains, and fac...

Generic Drug Price Hikes And Out-Of-Pocket Spending For Medicare Beneficiaries.

Recent increases in prices of longtime generic drugs have focused attention on competition in generic markets. We used Medicare Part D data for the period 2006-15 to examine sudden large price increases in generic drugs in the context of their base prices, duration, and accompanying changes in patients' out-of-pocket spending. The fraction of drugs that at least doubled in price increased from 1.00 percent of generic products in 2007 to 4.39 percent in 2013. Almost all were initially low- or medium-price ...

Prices For Cardiac Implant Devices May Be Up To Six Times Higher In The US Than In Some European Countries.

Medical devices are estimated to account for 6 percent of health expenditures in the US and 7 percent in European Union (EU) countries. Cardiac implants are a large segment of the market, but little is known about their prices. Using 2006-14 data from a large hospital panel survey, this article provides a systematic comparison of prices of cardiac implants between the US and four EU countries. The data reveal that prices were two to six times higher in the US than in Germany, where cardiac implants were g...

Strategy and risk sharing in hospital-postacute care integration.

Postacute care has been identified as a primary area for cost containment. The continued shift of payment structures from volume to value has often put hospitals at the forefront of addressing postacute care cost containment. However, hospitals continue to struggle with models to manage patients in postacute care institutions, such as skilled nursing facilities or in home health agencies. Recent research has identified postacute care network development as one mechanism to improve outcomes for patients sent...

Impact of Event Severity on Hospital Rankings Based on Heart Failure Readmission Rates.

The Medicare Readmissions Reduction Program penalizes hospitals with higher than expected readmission rates after discharge for congestive heart failure (CHF). This exploratory study analyzed whether categorizing readmissions by event severity might have implications for the program. The authors used the 5% MedPAR (Medicare Provider and Analysis Review) data for 2008 to 2014 and ranked 1820 hospitals based on all readmissions, readmissions for CHF, short-stay CHF readmissions, and readmissions for severe CH...

Factors associated with treatment outcome of acute post streptococcal glomerulonephritis among patients less than 18 years in Mekelle City, Public Hospitals, North Ethiopia.

To assess factors associated treatment outcomes of acute post streptococcal glomerular nephritis among patients less than 18 years old in Mekelle City Public Hospitals.

Treatment at safety-net hospitals is associated with delays in coil embolization in patients with subarachnoid hemorrhage.

Successful endovascular management of aneurysmal subarachnoid hemorrhage (aSAH) requires timely access to significant resources. Prior studies suggest an association between time to treatment and patient outcome. Patients treated at safety-net hospitals are thought to be particularly vulnerable to disparities in access to interventions that require substantial technological resources. We hypothesize that patients treated at safety-net hospitals are at greater risk for delayed access to endovascular treatmen...

Greater Reductions in Readmission Rates Achieved by Urban Hospitals Participating in the Medicare Shared Savings Program.

Accountable Care Organizations in the Medicare Shared Savings Program (MSSP) have financial incentives to reduce the cost and improve the quality of care delivered to Medicare beneficiaries that they serve. However, previous research about the impact of the MSSP on readmissions is limited and mixed.

Association of Hospital Participation in a Medicare Bundled Payment Program With Volume and Case Mix of Lower Extremity Joint Replacement Episodes.

Medicare's Bundled Payments for Care Improvement (BPCI) initiative for lower extremity joint replacement (LEJR) surgery has been associated with a reduction in episode spending and stable-to-improved quality. However, BPCI may create unintended effects by prompting participating hospitals to increase the overall volume of episodes paid for by Medicare, which could potentially eliminate program-related savings or prompt them to shift case mix to lower-risk patients.

Readmission Patterns Over 90-Day Episodes of Care Among Medicare Fee-for-Service Beneficiaries Discharged to Post-acute Care.

Examine readmission patterns over 90-day episodes of care in persons discharged from hospitals to post-acute settings.

Regional Variations: The Use Of Hospitals, Home Health, And Skilled Nursing In Traditional Medicare And Medicare Advantage.

In the traditional Medicare program, the use of health care services-particularly postacute care-varies substantially across geographic regions. Less is known about such variations in Medicare Advantage (MA), which is growing rapidly. Insurers that are paid on a risk basis, as in MA, may have incentives and tools to restrain the use of services, which could attenuate geographic variations. In this study of fifty-four million Medicare beneficiaries in the period 2007-13, we found that geographic variations i...

Medicare for the Plastic and Reconstructive Surgeon.

Medicare, a federally funded insurance program in the United States, is a complex program about which many physicians may not receive formal training or education. Plastic surgeons, residents, and advanced practitioners may benefit from at least a basic understanding of Medicare, its components, reimbursement methods, and upcoming health care trends. Medicare consists of Parts A through D, each responsible for a different form of insurance coverage. Medicare pays hospitals, physicians, and graduate medical ...

Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2019 Rates; Quality Reporting Requirements for Specific Providers; Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs (Promoting Interoperability Programs) Requirements for Eligible Hospitals, Cr

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 for FY 2019. Some of these changes implement certain statutory provisions contained in the 21st Century Cures Act and the Bipartisan Budget Act of 2018, and other legislation. We also are making changes relating to Medicare graduate medical education (GME) affiliation agreements for ne...

Racial and Ethnic Composition of Hospitals' Service Areas and the Likelihood of Being Penalized for Excess Readmissions by the Medicare Program.

The Hospital Readmission Reduction Program (HRRP) disproportionately penalizes hospitals serving minority communities. The National Academy of Science, Engineering, and Medicine has recommended that the Centers for Medicare and Medicaid Services (CMS) consider adjusting for social risk factors in their risk adjustment methodology. This study examines the association between the racial and ethnic composition of a hospital market and the impact of other social risk factors on the probability of a hospital bei...

Hypothetical Network Adequacy Schemes For Children Fail To Ensure Patients' Access To In-Network Children's Hospital.

Insurers are increasingly adopting narrow network strategies. Little is known about how these strategies may affect children's access to needed specialty care. We examined the percentage of pediatric specialty hospitalizations that would be beyond existing Medicare Advantage network adequacy distance requirements for adult hospital care and, as a secondary analysis, a pediatric adaptation of the Medicare Advantage requirements. We examined 748,920 hospitalizations at eighty-one children's hospitals that sub...


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