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This notice announces that the inpatient hospital deductible for calendar year 1990 under Medicare's hospital insurance program (Part A) is +592. The Medicare statute specifies the formula to be used to determine this amount.
OBJECTIVE: To determine the costs for 1000 randomized interventional angiographic procedures. METHODS: An 9-page paper form was used to manually record the consumables, technologist time, room occupancy time and recovery room time for 80 different procedures collected over a 2-year period. The average cost for expendables per procedure was calculated for procedures that occurred 5 or more times. RESULTS: Of the 1000 procedures surveyed, there were 20 that had 10 or more occurrences, 9 that occurred 5-9 times and 51 that occurred less than 5 times, of which 32 had only a single occurrence. The total expendables used were $514,008. The total examination time was 1158 hours. The total technologist time was 2493 hours, and the total recovery room time was 1806 hours. Examples of the average cost per procedure are: cerebral angiogram (n = 249), avg. cost $441.24, and transvenous liver biopsy (n = 30), avg. cost $642.89. The coefficient of variation for procedure costs ranged from 15% to 139%. There were no correlations of technician time or procedure technical cost with the date of scan, indicating that there was no systematic increase or decrease in costs over the survey period. There were moderate correlations of the technical cost of a procedure with technologist time (Pearson r = 0.69) and the duration of a procedure (Pearson r = 0.73). The technical costs of interventional procedures were significantly underfunded; the reimbursement from the Ontario Hospital Insurance Plan was $278,446, or 54% of the actual costs. Fourteen procedures were reimbursed at below 50% of their costs. CONCLUSION: This shortfall in funding has serious consequences for the types and numbers of procedures that are possible in radiology departments. Funds must be diverted from other places to prevent serious rationing of these services.
Prospective cost and reimbursement data were collected from 10 centers in various parts of the United States on 566 patients undergoing lower extremity arterial reconstructions for limb salvage and nonlimb salvage indications. Information for each patient was available on indication and type of procedure, length of stay, the type of hospital insurance, and hospital costs/charges. Diagnosis related group payments from each center were used to determine net gain or loss for each patient. Patients were classified as having claudication or critical ischemia (limb salvage). Reimbursements matched costs/charges for the claudication group; overall mean loss in this group was only $915 per patient. However, all centers had important losses in the limb salvage group. Reimbursements averaged 60% of costs/charges, with a mean loss of $8158 per patient and an overall loss for all 10 centers of $3,653,918. An effort to remedy this inequity is progressing via a dialogue between representatives of the Society for Vascular Surgery, the North American Chapter of the International Society for Cardiovascular Surgery, and the federal government.
The recent proposal to to roll back the recent increase in the Social Security payroll tax has some health care executives worried. The Hospital Insurance Trust Fund is closely linked to the Social Security fund, and what affects one will surely affect the other. However, analysts say that the question of whether the trust funds should or should not be part of the federal budget masks a much bigger question. Are the Administration, Congress, and the American public ready to raise taxes to adequately fund Medicare?
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It is believed by many that the cost of the Social Security program currently is considerably higher than it had been estimated that it would be when the program was enacted in 1935. The analysis in this article indicates that the cost of the Old-Age and Survivors Insurance program in 1980, when expressed as a percentage of taxable payroll, was almost exactly the same as it was estimated initially to be then. Such cost, however, does not include the Disability Insurance and Hospital Insurance programs and, moreover, is estimated to increase by about 50 percent over the next 50 years, whereas the initial estimates showed no cost increases after 1980.
This paper examines two components of the hospital insurance market structure-market share and the absolute number of enrollees in Blue Cross plans-to ascertain whether market structure affects the willingness of Blue Cross plans to use cost control measure. Empirical estimates show that larger plans are more likely to use prospective reimbursement, pre-admission testing, and concurrent review. Market share, however, has a positive effect only on concurrent review. We suggest that there are economies of scale to cost control efforts, but that high market share generally does not lead to increased cost-consciousness.
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In this study, the operating performances of not-for-profit community hospitals are compared among groups partitioned by bond ratings, level of debt insurance coverage, and number of bond rating services. The analysis indicates that the performances of hospitals with full debt insurance coverage resulting in AAA ratings are significantly lower than those of hospitals with partial debt insurance and with AA ratings or better. Indeed, the hospitals with full debt insurance resemble those with partial insurance that are rated BBB to A. These findings have implications for managerial action choices. Hospitals seeking external funding to improve their operating performance may consider the costs and benefits of full insurance coverage.
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This first part of a two-part article on how tax laws and Medicare regulations affect hospital malpractice insurance discusses self-insurance mechanisms, particularly trust funds. Relationships among tax exemptions, Medicare and other intermediaries' reimbursements, investment income from such funds, and payments to and from the funds are examined.
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This notice announces the hospital insurance premium for the uninsured aged for calendar year 1989 under Medicare's hospital insurance program (Part A). The monthly Medicare Part A premium for the 12 months beginning January 1, 1989 (for individuals who are not insured under the Social Security or Railroad Retirement Acts and do not otherwise meet the requirements for entitlement to Part A) is $156. The Medicare statute specifies the method to be used to determine this amount.