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The Health Care Manager 2019The cost of health care within the United States has continued to increase, whereas the quality of patient care has generally decreased in some areas. With the continued... (Review)
Review
The cost of health care within the United States has continued to increase, whereas the quality of patient care has generally decreased in some areas. With the continued use of Medicare's former physician reimbursement algorithm, termed sustainable growth rate, national expenditures within the United States have been expected to increase 5.6% annually. To modernize the delivery and financing of care, Congress has introduced the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which has permanently eliminated and replaced the sustainable growth rate. The purpose of this study was to review MACRA and its implementation to determine how it would financially impact rural hospitals. Two reimbursement pathways have been created for physicians under the MACRA. In addition, the financing and competition among facilities created by the act have been expected to impact physicians and health care organizations. Rural hospitals have been set to receive reduced government reimbursements and have been predicted to compete poorly with larger hospitals and health care corporations. Furthermore, the payment tracks available through the act have been projected to impact solo and small practice physicians negatively.
Topics: Hospitals, Rural; Humans; Medicare; Medicare Access and CHIP Reauthorization Act of 2015; Physicians; Reimbursement Mechanisms; United States
PubMed: 31344000
DOI: 10.1097/HCM.0000000000000267 -
JAMA Sep 2022
Topics: Aged; Humans; Medicare; Patient Care Bundles; Reimbursement Mechanisms; United States
PubMed: 36098731
DOI: 10.1001/jama.2022.11712 -
JAMA Sep 2022
Topics: Aged; Humans; Medicare; Models, Economic; Patient Care Bundles; Reimbursement Mechanisms; United States
PubMed: 36098727
DOI: 10.1001/jama.2022.11715 -
JAMA May 2022
Topics: Aged; Humans; Medicare; Patient Care Bundles; Reimbursement Mechanisms; United States
PubMed: 35452088
DOI: 10.1001/jama.2022.6402 -
JAMA Surgery Feb 2017
Review
Topics: Health Expenditures; Humans; Medicare; Prospective Payment System; Surgeons; United States
PubMed: 27893025
DOI: 10.1001/jamasurg.2016.4005 -
JAMA Nov 2023
Topics: Drug Costs; Medicare; Negotiating; Prescription Drugs; Prescriptions; United States
PubMed: 37728954
DOI: 10.1001/jama.2023.19506 -
Annual Review of Public Health Apr 2020Over the past decade, the Centers for Medicare and Medicaid Services (CMS) have led the nationwide shift toward value-based payment. A major strategy for achieving this... (Review)
Review
Over the past decade, the Centers for Medicare and Medicaid Services (CMS) have led the nationwide shift toward value-based payment. A major strategy for achieving this goal has been to implement alternative payment models (APMs) that encourage high-value care by holding providers financially accountable for both the quality and the costs of care. In particular, the CMS has implemented and scaled up two types of APMs: population-based models that emphasize accountability for overall quality and costs for defined patient populations, and episode-based payment models that emphasize accountability for quality and costs for discrete care. Both APM types have been associated with modest reductions in Medicare spending without apparent compromises in quality. However, concerns about the unintended consequences of these APMs remain, and more work is needed in several important areas. Nonetheless, both APM types represent steps to build on along the path toward a higher-value national health care system.
Topics: Aged; Aged, 80 and over; Delivery of Health Care; Female; Humans; Male; Medicare; Reimbursement Mechanisms; United States; Value-Based Health Insurance
PubMed: 32237986
DOI: 10.1146/annurev-publhealth-040119-094327 -
JAMA Health Forum Oct 2021
Topics: Delivery of Health Care; Health Facilities; Medicare; United States
PubMed: 36218896
DOI: 10.1001/jamahealthforum.2021.3017 -
The Journal of Medicine and Philosophy Feb 1988At its inception, the Medicare program was seen as a way to bring the elderly into the mainstream of American medicine. The program after twenty years is increasingly... (Review)
Review
At its inception, the Medicare program was seen as a way to bring the elderly into the mainstream of American medicine. The program after twenty years is increasingly viewed as an instrumentality to influence the nature and costs of American medicine. The first part of this article reviews the origins, history, and evolution of the Medicare program in order to explain how and why this change has come about. In the concluding section, the article explores further the implications of the program's concentration on the aged, its uncertain notion of entitlement, and the bewildering character of the current claims of generational inequity allegedly imposed by Medicare's present outlays of +70 billion and its persistingly high rate of cost increases.
Topics: Aged; Cost Control; Health Services for the Aged; Humans; Medicare; United States
PubMed: 3283284
DOI: 10.1093/jmp/13.1.5 -
The American Journal of Hospice &... Aug 2019As the Medicare program struggles to control expenditures, there is increased focus on opportunities to manage patient populations more efficiently and at a lower cost....
As the Medicare program struggles to control expenditures, there is increased focus on opportunities to manage patient populations more efficiently and at a lower cost. A major source of expense for the Medicare program is beneficiaries at end of life. Estimates of the percentage of Medicare costs that arise from patients in the last year of life differ, ranging from 13% to 25%, depending on methods and assumptions. We analyze the most recently available Medicare Limited Data Set to update prior studies of end-of-life costs and examine different methods of performing this calculation. Based upon these findings, we conclude that higher estimates that take into account the spending over the 12 months leading up to death more accurately reflect the full cost of a patient's last year of life. Comparing current year costs of decedents with Medicare's current year costs understates the full budgetary impact of end-of-life patients. Because risk-taking entities such as Medicare Advantage plans and Accountable Care Organizations (ACOs) need to reduce costs while improving the quality of care, they should initiate programs to better manage the care of patients with serious or advanced illness. We also calculate costs for beneficiaries dying in different settings and conclude that more effective use of palliative care and hospice benefits offers a lower cost, higher quality alternative for patients at end of life.
Topics: Accountable Care Organizations; Centers for Medicare and Medicaid Services, U.S.; Female; Health Expenditures; Hospice Care; Humans; Male; Medicare; Medicare Part C; Models, Economic; Terminal Care; United States
PubMed: 30884954
DOI: 10.1177/1049909119836204