...Katharina Janus; Lawrence D. Brown Commentary Medicare as Incubator for Innovation in Payment Policy Katharina Janus Lawrence D...

...Naoki Ikegami Case-mix-based payment was developed for hospital chronic care units in Japan to replace the flat per diem rate and encourage the admission of patients with higher medical acuity and was part of a policy initiative to make the tariff more evidence based. However, although the criteria...

... aim, that is, to improve health care and population health while containing cost. These include Maryland's Global Revenue Budget model, bundled payments, and ACOs, and they highlight the extent to which this version of integration is underwritten by savings achieved by providers for the Medicare...

...Judy Feder; Alan R. Weil; Robert Berenson; Rachel Dolan; Nicole Lallemand; Emily Hayes Abstract States' role in payment as well as coverage will be subject to debate as the administration and the Congress decide how to address the Affordable Care Act (ACA) and otherwise reshape the nation's health...

...Jonathan Oberlander; Steven B. Spivack Abstract Enacted as part of the 2010 Patient Protection and Affordable Care Act, the Independent Payment Advisory Board (IPAB) was hailed by many analysts as a major innovation in US health policy making and cost control. The board promised to put a brake on...

... Reauthorization Act (MACRA). MACRA established value-based metrics for physician payment and financial incentives for doctors to join alternative delivery models like patient-centered medical homes. Throughout the law's initial implementation, the politics of accommodation prevailed, with federal officials...

...Dylan H. Roby; Christopher J. Louis; Mallory M. Johnson Cole; Natalie Chau; Bridgette Wiefling; David C. Salsberry; Evan King; Allen Miller Abstract The New York Delivery System Reform Incentive Payment (DSRIP) waiver was viewed as a prototype for Medicaid and safety net redesign waivers in the...

...Roger Feldman Abstract A remarkable consensus has developed that the fee-for-service (FFS) approach for paying medical providers must be replaced. This payment approach is said to increase the volume of services without improving care coordination. In response to these calls, Medicare and private...

... payments rewarding outcomes and evidence-based practice; increased transparency; and greater community engagement. The CCO model faces several implementation challenges. If successful, it will provide improved health care delivery, better health outcomes, and overall savings. Copyright © 2015 by Duke...

...Miriam J. Laugesen Copyright © 2015 by Duke University Press 2015 Among practitioners and proponents, the accountable care organization (ACO) model is usually characterized as a disruptive innovation in US health care that reflects over two decades of calls for quality-based payments within...

...Judith Feder; Bruce Spitz This paper analyzes the politics of hospital payment over the last decade. The authors explain how provider interests and judgments became a standard for appropriate hospital payment; the impact of that standard on hospital costs; and the political obstacles to imposing an...

...Richard W. Foster Prospective payment is distinguished from the imposition of a regulatory ceiling on hospital costs. While a regulatory ceiling could potentially be effective in controlling expenditure growth, its success depends upon the political climate. Prospective payment, as a distinct...

...Lawrence D. Brown Copyright © 1983 by the Department of Health Administration, Duke University 1983 Washington Report The Prospects for Prospective Payment Lawrence D. Brown In Washington the word is out that costs are dead. Since the Tax Equity and Fiscal...

...Maqbool Dada; William D. White; Houston H. Stokes; Paul Kurzeja The Medicare prospective payment system (PPS) was designed to create financial incentives for providers to contain costs, but it also places them at financial risk. The system includes provisions to mitigate the risk, but, because they...

...Lee R. Chartock; Robert A. Dorwart References Christianson , J. B. , and M. S. Linehan. 1989 . Capitated Payments for Mental Health Care: The Rhode Island Programs. Community Mental Health Journal 25 : 121 -31. Cromwell , J. , B. Harrow, T. G. McGuire, and R. P. Ellis. 1991...

.... , George J. Schieber, Martha A. Blaxall, and Jon R. Gabel. 1978 . Geographic Variation in Physicians' Fees. Journal of the American Medical Association 240 ( 13 ): 1368 -71. Caldwell , Jacques R. 1989 . Physician Payment Reform: A Practicing Physician's Perspective. Frontiers 6 ( 1...

...Thomas R. Oliver In 1985, Congress established the Physician Payment Review Commission (PPRC) to help formulate changes in the system used by Medicare to pay for physician services. The recommendations of the PPRC and subsequent legislative action led to fundamental reform. As a new type of...

...Harvey M. Sapolsky Louise B. Russell, Medicare's New Hospital Payment System: Is It Working? Washington, DC: Brookings Institution, 1989. 114 pp. Copyright © 1990 by Duke University Press 1990 932 Journal of Health Politics, Policy and Law Louise B. Russell. Medicare’sNew...

...Robert T. Kauer; J. B. Silvers; Jill Teplensky New Medicare regulations have replaced the cost-based system of reimbursement of capital expenditures by hospitals with a fixed payment per case based on assigned diagnostic-related groups. For the first time, hospitals must pay the governmental share...

...Robert E. Mechanic Abstract Policy makers and private health plans are expanding their efforts to implement new payment models that will encourage providers to improve quality and deliver health care more efficiently. Over the past five years, payment reforms have progressed faster in Massachusetts...