What is a Medicare inpatient PPS system?
Except for acute care hospital settings, Medicare inpatient PPS systems are in their infancy and will be experiencing gradual revisions. Prepayment amounts cover defined periods (per diem, per stay, or 60-day episodes). The payment amount is based on a unique assessment classification of each patient.
Do CON laws increase or decrease Medicare spending?
While they found some evidence that CON implementation produced a small decrease in spending on acute care, removing CON laws did not lead to an increase in these areas’ costs. Indeed, the researchers found that CON laws may have increased Medicare expenditures.
How is Medicare hospital outpatient PPS (Opps) determined?
(Part B payments for evaluation and treatment visits are determined by the Medicare Physician Fee Schedule .) Medicare Hospital Outpatient PPS (OPPS) is not a "pure" PPS methodology consistent within the characteristics listed above because payment is made for individual evaluation and treatment visits.
What are the Medicare Part A prospective payment systems?
Following are summaries of Medicare Part A prospective payment systems for six provider settings. The DRG payment rate is adjusted based on age, sex, secondary diagnosis and major procedures performed. DRG payment is per stay.
Introduction
The United States spends more on health care as a share of the economy than any other country. In 2018, health spending accounted for 17.7 percent of the U.S. gross domestic product (GDP) — nearly twice as much as the average OECD country despite scant evidence of better outcomes.
Part I. Strategies for Controlling Health Spending
Health care spending is determined by prices and utilization and both of those, in turn, reflect a wide range of market features, such as the extent of provider and insurer competition and local practice patterns. Premiums reflect that spending and any insurer markup, which also reflects insurer competition (Exhibit 1).
Part II. Implementing Policy Goals
To understand trends in spending and implement many of the strategies discussed, states need data. States with the proper regulatory authority can compel organizations, particularly payers, to report data.
Conclusion
Given barriers to significant federal action, substantial policy changes to control spending growth are likely to be limited to state policy. States can pursue many different strategies, ranging from efforts to promote competition, reduce prices, or decrease utilization of low-value care to broader strategies that address overall spending.
How does a certificate of need affect healthcare?
Indeed, Certificate of Need may prove to become a burden on healthcare reform efforts by restricting the growth of new facilities to match the demand generated by the newly insured. With an explosion of new demand, Certificate of Need would presumably raise costs by delaying the needed increase in supply.
What is the CON law?
“The fundamental premise of the CON law is that increasing health care costs may be controlled by governmental restrictions on the unnecessary duplication of medical facilities.” #N#-NC Division of Health Service Regulation website.
Can a physician accept a pro-rata share of indigent care?
If lawmakers wish to ensure indigent access to care, they can legislate requirements for physician-owned facilities to accept a pro-rata share of indigent care, impose taxes, expand Medicaid rolls, or use other means to directly subsidize indigent care losses. The CON process is a faulty answer to an outdated question.
Zipcode to Carrier Locality File
This file is primarily intended to map Zip Codes to CMS carriers and localities. This file will also map Zip Codes to their State. In addition, this file contains an urban, rural or a low density (qualified) area Zip Code indicator.
Provider Center
For a one-stop resource web page focused on the informational needs and interests of Medicare Fee-for-Service (FFS) providers, including physicians, other practitioners and suppliers, go to the Provider Center (see under "Related Links" below).
How many states have CON programs?
The following are state examples of legislative actions impacting CON programs: 35 states currently maintain some form of CON program. Puerto Rico, the US Virgin Islands and the District of Columbia also have CON programs. States retaining CON laws often regulate outpatient facilities and long-term care.
Why are CON programs important?
While the effectiveness of CON programs continues to be a heavily debated topic, many states consider CON programs as one way to control health care costs and increase access to care. Below is a list of both arguments in favor and against CON laws.
What is the assumption of CON regulation?
The basic assumption underlying CON regulation is that excess health care facility capacity results in health care price inflation. Price inflation can occur when a hospital cannot fill its beds and fixed costs must be met through higher charges for the beds that are used.
What is a CON program?
Health Program. Certificate of Need ( CON) laws are state regulatory mechanisms for establishing or expanding health care facilities and services in a given area. In a state with a CON program, a state health planning agency must approve major capital expenditures for certain health care facilities. CON programs aim to control health care costs by ...
Why do hospitals raise their prices?
Larger institutions generally have larger costs, so hospitals and other health facilities may raise prices in order to pay for new, underused medical services or empty beds. CON programs require a health care facility to seek a health planning agency’s approval based on a set of criteria and community need. Once a health facility has applied ...
Is health care a typical economic product?
Health care cannot be considered as a “typical” economic product. Most health services (like lab tests) are ordered by physicians, not patients. Patients do not shop around as they do for other goods and services.