...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...

...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...

...Bruce C. Vladeck The basic thesis of this paper is that, in the short to medium term (that is to say, the politically relevant term), fee-for-service payment will be the dominant form of Medicare transaction–and that is not such a bad thing. Capitated arrangements will grow, and should be...

...Barbara Janowitz; Sylvia Wallace; Galba Araujo; Lorena Araujo This paper examines factors associated with the cesarean birth rate, including medical condition and method of payment, in the largest maternity hospital of Fortaleza. Brazil. Data were collected on 5996 women who delivered at the...

... evidence suggests that there was cost-shifting in response to this program, which regulated payment for only Blue Cross and Medicaid patients. Structural features of this program and its successor, the New Jersey DRG program, are analyzed; and implications for the Medicare prospective payment system are...

...George D. Greenberg Rick Mayes and Robert A. Berenson. Medicare Prospective Payment and the Shaping of U.S. Health Care. Baltimore: Johns Hopkins University Press, 2006. 245 pp. $48.95 cloth. Duke University Press 2007 Fisher, E., and J. Wennberg. 2006 . The Care of Patients with Chronic...

...Judith Feder; William Scanlon Even before Medicare adopted case-based payments for hospitals, some state Medicaid programs employed case-mix payment systems for nursing home care. Their purpose was less to promote cost containment than to improve access to nursing homes for the most costly patients...

...Richard G. Frank; Judith R. Lave Psychiatric hospitals and clinics are exempted from the Medicare prospective payment system. In this paper we examine the appropriateness of the DRG classification system for psychiatric patients and argue that, using this system as the basis of payment, two types...

... severity; however the relationship between severity and net revenue per admission was not significant. The results suggest that hospitals with a more severe case mix may not recover the full costs of providing services. Thus payment reform should include adjustments for severity of illness. Copyright...

...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...

...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...

...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...

...Robert Newcomer; Juanita Wood; Andrea Sankar The switch to prospective payment for hospitals under Medicare is expected to have ramifications in a number of different areas. This paper addresses a select number of those areas: hospital organization and management, other community agencies, and...

...Harvey M. Sapolsky Prospective payment promises improvement for a health care system plagued by inefficiency and rising costs, but is likely to disappoint. Serious efforts to control costs threaten the system's access and quality objectives and will be resisted. Moreover, serious cost containment...

...Michael D. Rosko; Robert W. Broyles; William E. Aaronson This article evaluates the potential efficacy of implementing a prospective payment system based on case mix in the nursing home industry. The analysis of structural differences between the nursing home and hospital industries suggests that...

...Ellen M. Immergut C. David Naylor, Private Practice, Public Payment: Canadian Medicine and the Politics of Health Insurance, 1911–1966 (Kingston and Montreal: McGill-Queen's University Press, 1986), 324 pp., $35.00 cloth, $ 15.95 paper. Copyright © 1988 by Duke University Press 1988 References...

... . ____. 2005b. Medicare Demonstration Shows Hospital Quality of Care Improves with Payments Tied to Quality. Press release issued by the CMS Office of Public Affairs, November 14. www.cms.hhs.gov/apps/media/press/release.asp?Counter=1729 . Conrad, D. A., and J. B. Christianson. 2004 . Penetrating the...

...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...