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RepoRt to the CongRess Medicare Pay
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RepoRt to tHe CongRess Medicare Pay
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with the structure of the payment s
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table of contents Acknowledgments .
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executive summary
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of services—and pressure on feder
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current Medicare payments are adequ
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outpatient dialysis services Outpat
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some facilities are willing to acce
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coverage for conventional treatment
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of care for these conditions should
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Context for Medicare payment policy
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4 Context for Medicare payment poli
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FIguRe FIGURE 1-2 1-2 12% Out of po
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the level of health care spending a
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1-4 FIguRe 1-4 140 120 100 80 60 Do
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FIguRe 1-6 1-6 Growth rate (in perc
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FIGURE FIguRe Share of GDP (in perc
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Share of GDP (in percent) FIGURE 1-
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FIGURE FIguRe 1-10 1-10 8% African
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FIguRe 1-12 1-11 1800 1600 1400 120
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Americans than for other racial and
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References Agency for Healthcare Re
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Medicare Payment Advisory Commissio
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Assessing payment adequacy and upda
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The goal of Medicare payment policy
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may go up when payment rates go dow
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hospitals and that hospitals shift
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individual payment systems but also
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Hospital inpatient and outpatient s
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Hospital inpatient and outpatient s
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covered the fully allocated costs o
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3-1 3-1 FIguRe 100 80 60 40 Number
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Visits or claims per 1,000 benefici
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3-4 3-4 FIguRe 2012 dollars (in bil
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of physicians employed directly by
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FIguRe FIGURE Annual percent change
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FIGURE FIguRe Margin (in percent) 3
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FIGURE FIguRe Margin (in percent) 3
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tABLe 3-5 performance of efficient
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Act, the EHR Incentive Program also
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as Medicaid expands, the new insura
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ates for separately paid drugs resu
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endnotes 1 From 2002 to 2011, 479 h
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References Agency for Healthcare Re
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C H A p t e R4 physician and other
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physician and other health professi
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from the SGR system in its October
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4-1 4-1 FIguRe 40 35 30 25 20 15 10
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tABLe 4-1 Most aged Medicare benefi
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tABLe 4-2 Medicare beneficiaries ha
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payment adjustments for health prof
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tABLe 4-3 Year physicians primary c
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provider’s characteristics, geogr
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tABLe 4-4 type of service Change in
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tABLe 4-5 type of imaging Change in
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the patient-centered medical home T
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FIguRe FIGURE Cumulative percent ch
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References ABIM Foundation. 2012. C
- Page 129 and 130: Ambulatory surgical center services
- Page 131 and 132: Ambulatory surgical center services
- Page 133 and 134: Background An ambulatory surgical c
- Page 135 and 136: Differences in types of patients tr
- Page 137 and 138: Differences in types of patients tr
- Page 139 and 140: number of services grew from 2006 t
- Page 141 and 142: tABLe 5-7 rapidly than nonowning ph
- Page 143 and 144: Creating a value-based purchasing p
- Page 145 and 146: Revisiting the ambulatory surgical
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- Page 149: Medicare Payment Advisory Commissio
- Page 152 and 153: R e C o M M e n D A t I o n 6 The C
- Page 154 and 155: 128 Outpatient dialysis services: A
- Page 156 and 157: tABLe 6-1 Characteristics of FFs di
- Page 158 and 159: Physicians Association has publishe
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- Page 162 and 163: Number of FFS dialysis beneficiarie
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- Page 168 and 169: anticipated under the modernized pa
- Page 170 and 171: endnotes 1 In this chapter, we use
- Page 172 and 173: References ABIM Foundation. 2012. C
- Page 175: C H A p t e R7 post-acute care prov
- Page 178 and 179: encourages more 60-day episodes. Fu
- Page 182 and 183: R e C o M M e n D A t I o n s (The
- Page 184 and 185: • Capacity and supply of provider
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- Page 189 and 190: Description of beneficiaries who us
- Page 191 and 192: CMs’s revisions to the snF pps Al
- Page 193 and 194: tABLe 8-4 SNF volume per FFS benefi
- Page 195 and 196: tABLe 8-5 snF quality measures vary
- Page 197 and 198: care they provide and the arrangeme
- Page 199 and 200: 7-7 8-5 FIguRe 25 20 15 10 Medicare
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- Page 203 and 204: Medicare’s skilled nursing facili
- Page 205 and 206: tABLe 8-8 number of nursing homes t
- Page 207 and 208: endnotes 1 Throughout this chapter,
- Page 209 and 210: References Alliance for Quality Nur
- Page 211 and 212: C H A p t e R9 Home health care ser
- Page 213 and 214: Home health care services Chapter s
- Page 215 and 216: Background Medicare home health car
- Page 217 and 218: 8-1 9-1 FIguRe 24 22 20 18 16 14 Me
- Page 219 and 220: of home health episodes. In additio
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- Page 223 and 224: that they remain in home health car
- Page 225 and 226: Regions or states with utilization
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- Page 229 and 230: The share of episodes qualifying fo
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least one measure (either low cost
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strengthening incentives for effect
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strengthening incentives for effect
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References Benjamin, A. E. 1993. An
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R e C o M M e n D A t I o n 10 The
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1.6 percent, for a total of 1,165 f
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tABLe 10-1 general, IRFs are concen
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Medicare applies additional criteri
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tABLe 10-3 IRF occupancy rates rose
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tABLe 10-6 Compliance rate of Medic
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tABLe 10-9 Distribution of IRF case
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FIguRe FIGURE Cumulative percent ch
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tABLe 10-13 IRFs’ Medicare margin
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endnotes 1 This rule does not take
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C H A p t e R11 Long-term care hosp
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Long-term care hospital services Ch
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Background Patients with chronic cr
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would have lower readmission rates
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short-stay outlier cases in long-te
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Chronically critically ill benefici
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tABLe 11-3 the top 25 Ms-LtC-DRgs m
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from year to year, over time we fou
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volume of patients on average and b
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endnotes 1 The Medicare, Medicaid,
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References Barnato, A. E., D. L. An
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Scheinhorn, D. J., M. S. Hassenpflu
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R e C o M M e n D A t I o n 12 The
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262 Hospice services: Assessing pay
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tABLe 12-1 Category Description amo
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March 2009 Commission recommendatio
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tABLe 12-2 The second, more visible
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tABLe 12-3 We estimate that the sha
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FIguRe 12-1 12-1 250 200 150 100 Le
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tABLe 12-6 Characteristic shortest
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tABLe 12-8 In 2010, 10.1 percent of
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tABLe 12-9 Average Hospice costs pe
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tABLe 12-11 Hospice characteristic
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endnotes 1 If a beneficiary does no
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References Barnato, A. E., D. L. An
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the Medicare Advantage program: sta
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charges no premium (beyond the Medi
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tABLe 13-1 Medicare Advantage enrol
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tABLe 13-2 Access to Medicare Advan
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FIGURE FIguRe 13-2 13-2 MA bids in
- Page 324 and 325:
tABLe 13-4 Distribution of enrollme
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plan are updated using the new 2013
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measures, it is often the case that
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tABLe 13-8 plan performance on the
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tABLe 13-10 plans report a single r
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endnotes 1 Cost plans are technical
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References Centers for Medicare & M
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R e C o M M e n D A t I o n s 14-1
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314 Medicare Advantage special need
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Introduction Special needs plans (S
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previous Commission recommendations
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previous Commission recommendations
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to reduce hospital utilization for
- Page 351 and 352:
RAtIonALe 14-2 This recommendation
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RAtIonALe 14-3 Consistent with the
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endnotes 1 Employer plans are anoth
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C H A p t e R15 status report on pa
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334 Status report on Part D percent
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tABLe 15-1 parameters of the define
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Characteristics of Medicare benefic
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tABLe 15-5 pDp region state(s) of b
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FIguRe FIGURE 15-1 15-1 Enrollment
- Page 371 and 372:
tABLe 15-7 Virginia region, along w
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tABLe 15-8 stand-alone pDps with th
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gradual phase-out of the coverage g
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sponsors (i.e., the direct subsidy
- Page 379 and 380:
use of preferred pharmacy networks
- Page 381 and 382:
premiums) rather than lowering the
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tABLe 15-15 spending—using cost-s
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to formularies, benefit structure,
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with a difference of at least $12 i
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A p p e n D I X Commissioners' voti
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Chapter 5: Ambulatory surgical cent
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14-4 For dual-eligible special need
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The Hono orable Max Baucus Chairman
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ecommend that the Congress offset t
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problematic than access to speciali
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patients in hospitals, nursing faci
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Collecting data to improve payment
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a percentage of fee-schedule spendi
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Within the ACO program, incentives
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ates. Primary care physicians and o
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Appendix 17 Report to the Congress:
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19 Report to the Congress: Medicare
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• Along A with th he recommend da
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Acronyms
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gDR generic dispensing rate gI gast
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More about MedpAC
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Commissioners’ biographies scott
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Herb B. Kuhn is current president a
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Commission staff Mark e. Miller, ph