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J Health Polit Policy Law 8970838.
Published: 22 January 2021
... Medicare Advantage plans successfully compete with TM only because their payment rates are tied by regulation to those in the traditional Medicare program. However, Medicare has not succeeded in implementing new, value-based payment approaches that also would serve as models for other payers, nor has...
J Health Polit Policy Law (2018) 43 (5): 739–765.
Published: 01 October 2018
... productive inefficiency is a more tractable concept than waste. We then review the literature on the efficiency of health providers. We discuss the evidence on whether supply- and demand-side policies, such as value-based payment and cost sharing, can raise efficiency, finding that many of these policies...
J Health Polit Policy Law (2016) 41 (5): 1033–1045.
Published: 01 October 2016
...-based purchasing may not be to patients or even payers, but to policy makers seeking a morally justifiable alternative to politically contested regulatory policies. Copyright © 2016 by Duke University Press 2016 value-based purchasing pay-for-performance payment reform Medicare Value...
J Health Polit Policy Law (2018) 43 (3): 401–425.
Published: 01 June 2018
... has increasingly moved toward value-based purchasing, in which fee-for-service payments are supplemented to incentivize higher-quality and lower-cost care. The transition of Medicare from a payment system largely based on quantity to a system that holds plans and providers financially accountable for...
J Health Polit Policy Law (2018) 43 (6): 1025–1040.
Published: 01 December 2018
... 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...
J Health Polit Policy Law (1990) 15 (1): 69–99.
Published: 01 February 1990
...-governmental advisory body. Aspects of this structure could be adopted by Medicare in order to determine conversion factors for resource-based relative value scales or to create expenditure control and incentive structures for Medicare-participating physicians. Physician Payment and Cost- Containment...
J Health Polit Policy Law (2018) 43 (2): 305–323.
Published: 01 April 2018
... community partners. One of the key ideals involved in this process for the finance teams was to ensure alignment of the funds flow methodology and contracting process with the goals of the New York State Value-Based Roadmap, which focuses on shifting 80–90 percent of managed care payments into a value-based...
J Health Polit Policy Law (2018) 43 (1): 5–18.
Published: 01 February 2018
.... Copyright © 2018 by Duke University Press 2018 Medicaid best-price rule pharmaceutical pricing value-based payment outcome-based pricing Even in today's polarized political landscape, a consensus has emerged: Americans deserve better value for their health care dollars. The focus on value...
J Health Polit Policy Law (2016) 41 (4): 743–762.
Published: 01 August 2016
...-policy-commission/annual-cost-trends-hearing/2014/testimony/ . Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds . 2015 . Annual Report. Washington, DC . Burwell Sylvia M. 2015 . “ Setting Value-Based Payment Goals — HHS Efforts...
J Health Polit Policy Law (1982) 7 (2): 407–420.
Published: 01 April 1982
... Administration, Duke University Press 1982 Cost-Based Reimbursement and Prospective Payment: Reassessing the Incentives Richard W. Foster, University of Chicago Abstract. Prospective payment is distinguished from the imposition of a regula- tory ceiling on hospital costs. While a regulatory...
J Health Polit Policy Law (2015) 40 (4): 839–846.
Published: 01 August 2015
... potentially undermine the changes that are introduced, through a process of policy drift. These conclusions are based on comparisons with Medicare's last major payment policy reform, when Congress passed legislation requiring Medicare's use of the Resource-Based Relative Value Scale (RBRVS) in 1989. Of course...
J Health Polit Policy Law (1984) 9 (1): 81–101.
Published: 01 February 1984
... empirical findings are described, structural analysis of this particular PP program’s strengths and weaknesses is presented. Finally, the implications of that analysis for present prospective payment programs, particularly those based on the methodology of diagnosis-related groups (DRGs), are...
J Health Polit Policy Law (1987) 12 (4): 683–702.
Published: 01 August 1987
... Research and Health Care Technology Assessment. Kane , R. L. 1986 . Outcome-Based Payment: A New Beginning? Health Progress ( April ): 36 -70. Kane , R. L. , R. M. Bell, and S. Z. Riegler. 1986 . Value Preferences for Nursing Home Outcomes. The Gerontologist 26 ( 3 ): 303 -308...
J Health Polit Policy Law (1992) 17 (3): 483–508.
Published: 01 June 1992
... . Hospital Payment Effects on Acute Inpatient Care for Mental Disorders. Archives of General Psychiatry 42 : 552 -55. Siegel , Carole , K. Jones, E. Laska, M. Meisner, and S. Lin. 1992 . A Risk-based Prospective Payment System That Integrates Patient, Hospital and National Costs. Journal of...
J Health Polit Policy Law (1993) 18 (1): 113–174.
Published: 01 February 1993
... Health and Human Services regarding the development of a resource-based relative value scale for physician services (PPRC 1991a: 407). 124 Journal of Health Politics, Policy and Law Table 3 Stages in Physician Payment Reform, 1984-1996...
J Health Polit Policy Law (1984) 8 (4): 660–685.
Published: 01 August 1984
... discounts than without them. Therefore, based on coefficients from the regressions presented in Table 2, we estimate that if the discounts in effect in 1979 would have somehow disappeared, total payments to hospitals would have risen by up to 5 percent. Using DIS coefficients from profit regres...
J Health Polit Policy Law (1994) 19 (4): 729–751.
Published: 01 August 1994
... may receive windfall profits. Thus the impact of severity of illness on hospital profitability is important as long as prospective, case- based payment methods, including Medicare’s, fail to adjust for differ- ences in illness severity. Although consequential policy implications exist...
J Health Polit Policy Law (2018) 43 (3): 483–510.
Published: 01 June 2018
... Medicare spending: DRGs (Diagnosis-Related Groups), RBRVS (Resource-Based Relative Value Scale), and the SGR (Sustainable Growth Rate). They promised to set prospective limits on Medicare spending (DRGs), base program payments on expert judgment of relative costs (RBRVS), and create spending growth targets...
J Health Polit Policy Law (1985) 10 (3): 513–532.
Published: 01 June 1985
... nothing wrong with PPS that cannot be fixed, if we want to fix it. As a penultimate point on PPS, it is necessary to address the concern that DRG- based payments will encourage hospitals to avoid admitting relatively sicker pa- tients, to discharge patients too early, to underprovide needed...
J Health Polit Policy Law (2017) 42 (6): 1113–1125.
Published: 01 December 2017
... , Latkovic Tom , Tsai Daniel , and Ward Tim . 2015 . “ Risk Adjustment for Retrospective Episode-Based Payment .” February . NY : McKinsey on Healthcare Center for US Health System Reform . Hanlon Carrie . 2012 . “ Minnesota and Ohio: Advancing Health Equity through Delivery...