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Results for “Rate Setting and Review”

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At least 127 records · Page 7Linked to original sources
PubMed1999

Marketing environment dynamics and implications for pricing strategies: the case of home health care.

This research reviews the factors affecting the pricing or rate schedules of home health care agencies. A large number of factors affect costs and thus rate structures. The major factors include reimbursement structures with accompanying discount structures, administrative burdens, and risks. Channel issues include bargaining power, competition, and size. Staffing issues affect pricing and product through the provider level, productivity, and quality outcomes. Physician and patient issues include quality concerns and choices. These factors are discussed in light of overall marketing strategy and the interaction of pricing with other marketing controllables such as product, place/distribution, and promotion. Economic and accounting principles are also reviewed with consideration to understanding direct and indirect costs in order to enable negotiators to effectively price health care services.

Accounting↗
PubMedDate not supplied

Is a PSO right for you?

The Balanced Budget Act of 1997 established the new Medicare+Choice program which provides a variety of alternatives to traditional Medicare Part A and Part B, including the provider sponsored organization (PSO). Over the next several years, a significant number of organizations will consider becoming a PSO. The decision requires a thorough and detailed review of critical success factors. This articles outlines those factors and defines some components of a successful PSO.

Budgets↗
PubMed1996

ASORN participating in Medicare Fee Schedule review.

ASORN members have the opportunity to influence the new Medicare Fee Schedules by responding to an upcoming Health Care Financing Administration survey. The process used to determine future Medicare reimbursement is one that ophthalmic nurses should understand so that they may increase efficiency and flexibility in their own careers and practices.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1997

Medicare program; adjustment in payment amounts for new technology intraocular lenses--HCFA. Proposed rule.

This proposed rule would establish in regulations a process under which interested parties may request, with respect to a class of new technology intraocular lenses (IOLs), a review of the appropriateness of the current payment amount for IOLs furnished by Medicare-participating ambulatory surgical centers. The rule implements section 141(b) of the Social Security Act Amendments of 1994, which requires us to develop and implement this process.

Ambulatory Surgical Procedures↗
PubMed1990

Refinement and expansion of the Harvard Resource-Based Relative Value Scale: the second phase.

The Harvard resource-based relative value scale (RBRVS) for physician services has assumed a critical role in physician payment reform. We have demonstrated that the relative resource costs of providing physician services can be defined and measured in a rational and systematic way and that the results are reliable and valid. Consequently, the RBRVS is a viable basis for national payment policy and could be used for establishing a national fee schedule for physician services or to identify "mispriced" physician procedures. Since the release of the final report of the first phase of the Harvard RBRVS study in September of 1988, there has been extensive review, discussion, and criticism of the RBRVS. Dr. Laurence F. McMahon, Jr., in the accompanying article, provides a further critique of our research. In this paper, we review the RBRVS study and results and respond to the major criticisms that have been raised by Dr. McMahon and others. We then describe the tasks we are currently undertaking to expand and validate our research and address the important criticisms and limitations.

Data Interpretation, Statistical↗
PubMed1981

Barriers to coordinating health services regulatory programs.

State and federal health services regulatory programs have proliferated over the past ten years, but little attention has been paid to their coordination to ensure that they reinforce rather than obstruct each other. Four approaches taken by states to coordinate certificate-of-need and prospective rate or budget review programs are examined here. Technical, administrative, and political factors are found to impede close working relations between the programs. Some coordination procedure may even exacerbate program weaknesses and diminish regulatory impact. The current configuration of political support for the programs makes policy changes to facilitate program coordination rather unlikely.

Certificate of Need↗
PubMed1983

A theory of organizational response to regulation: the case of hospitals.

This paper presents a general theory of organizational response to regulation, a theory that integrates adaptation and mutual selection perspectives. Two major forms of regulation in the hospital industry, certificate of need and rate review, are examined. Hypotheses are derived concerning the nature and timing of the various adjustments hospitals make both in internal organizational arrangements and in patterns of interorganizational activity in the face of regulatory constraints. Suggestions and data sources for testing the theory are presented.

Certificate of Need↗
PubMed1994

Judicial review of Medicaid hospital and nursing home reimbursement methodologies under the Boren Amendment.

Congress passed the Boren Amendment to allow states to develop and implement alternative reimbursement methodologies that promote the efficient and economical delivery of hospital and nursing facility services. However, courts have interpreted Boren in ways that limit state discretion and impede their ability to meet budgetary constraints.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1994

Hospital wage and price controls: lessons from the Economic Stabilization Program.

The Clinton Administration has implied that short-run failures to control health care costs may cause a reexamination of wage and price controls as elements of comprehensive health care reform. The most recent imposition of mandatory wage and price controls was the Economic Stabilization Program (ESP) of the early 1970s. We analyze trends in hospitals' economic behavior and utilization before, during, and after ESP. We also review the relevant literature to estimate ESP's impact, considering other factors that influence hospital behavior. Noting important changes in the hospital industry since the 1970s, we conclude that ESP had limited effect and that similar controls would have little effect today.

Cost Control↗
PubMed2002

Identifying and validating managed care data.

In a managed care organization, data can be the key to facilitating high-quality care and to managing patient care delivery systems effectively, in addition to monitoring costs. Reviewing electronic data requests before contacting data producers, asking the right questions about data, and knowing how to identify good data can help financial managers use data effectively to provide information. In the managed care environment, information is only as good as the steps taken to obtain and validate the data.

Accounting↗
PubMed1993

Methodological aspects of international drug price comparisons.

Drug prices have become an important issue in the last few years as concerns about constrained healthcare resources have increased. Healthcare authorities in all industrialised countries are questioning whether their country is carrying a heavier burden than others in paying for drugs. In view of this discussion, several price comparison studies have been conducted. However, there is no generally accepted methodology on how to conduct price comparisons, and many methodological issues remain unresolved. The results of most published studies are affected by moderately serious methodological flaws, which are never properly addressed. The purpose of this study is to discuss the methodological issue of international drug price comparison, in terms of 6 points that appear to this author to be necessary to conduct a methodologically sound study. A previous review of a large number of drug price comparisons revealed that they all fail to take into account some or all of these 6 basic methodological points. Studies that fulfil the methodological criteria outlined in this paper are therefore urgently needed before drug pricing studies can be fully utilised as a basis for important policy decisions in the healthcare arena.

Drug Costs↗
PubMedDate not supplied

Developing a Medicare prospective payment system for inpatient psychiatric care.

Under the Balanced Budget Refinement Act (BBRA) of 1999, the secretary of health and human services was mandated to implement a prospective payment system (PPS) for psychiatric inpatient facilities that were exempt from the Medicare inpatient PPS. This paper reviews the reason for the initial "distinct-part" exemption, describes research that has been conducted to inform the development of a psychiatric inpatient PPS, and examines some of the issues that must be addressed as a PPS is designed. In addition, some changes in the overall inpatient psychiatric hospital sector are discussed.

Aged↗
PubMed1991

Medicaid payment policies for nursing home care: a national survey.

This research gives a comprehensive overview of the nursing home payment methodologies used by each State Medicaid program. To present this comprehensive overview, 1988 data were collected by survey from 49 States and the District of Columbia. The literature was reviewed and integrated into the study to provide a theoretical framework to analyze the collected data. The data are organized and presented as follows: payment levels, payment methods, payment of capital-related costs, and incentives in nursing home payment. We conclude with a discussion of the impact these different methodologies have on program cost containment, quality, and recipient access.

Capital Expenditures↗
PubMed1984

Prospective payment for psychiatric hospitalization: questions and issues.

Can prospective payment control the cost of Medicare treatment without seriously affecting the quality of care? The authors pose this question and then explore the new system's implications for the mental health field. Because psychiatric diagnoses do not adequately describe the reasons for hospitalization, and because treatment of mental disorders is not standardized throughout the country, the authors posit that psychiatric hospitals will have difficulty adjusting to a reimbursement system based on diagnosis alone. They also review four major aspects of the prospective payment system: efficiency, equity and access for patients, quality of care, and practicality. Other issues, such as prospective payment's financial impact on medical research and technology development, are also discussed.

Cost Control↗
PubMed1988

A review of Ontario's revised drug cost programs.

Ontario's PARCOST program was introduced in 1970. This paper examines the changes wrought in the program since its inception and the economic and political reasons for those changes. It describes the components of the pharmacist's claim, the nature of price controls, and the problems with formulary decisions. The authors suggest that the driving force behind budget restraints is cost containment through lower drug prices with little emphasis on therapeutic considerations.

Cost Control↗
PubMed1996

Ambulatory patient groups and redefining the roles of health care providers' delivery services in the USA.

Provides a review and analysis of the ambulatory patient groups classification system. Discusses a review of the history, development and implementation process. Concludes that in the ongoing efforts to move towards full-managed care in the not-so-distant future, ambulatory patients groups are another potential cost-cutting remedy for current health care providers and that future research into this issue is a must for public policy makers.

Ambulatory Care↗
PubMed1994

The Canadian Patented Medicine Prices Review Board. New rules and new status.

The influence of the Patented Medicine Prices Review Board in restraining the prices of patented drugs has been established over the past 6 years. Recent legislative and policy changes now in place may result in the Board assuming a more influential, public, and activist posture. This article reviews the way in which the Board carries out its mandate to ensure that patented medicines sold in Canada are not 'excessive'. The Board represents one segment of Canada's ongoing effort to balance what often appear to be irreconcilable tasks-the promotion of an increased domestic research and development investment by the pharmaceutical industry, and the control of expenditures for pharmaceuticals in response to the escalating concerns of the provincial health authorities and consumers.

Canada↗