Medicare Payment Policy

Recommendations

Info

Context for <strong>Medicare</strong> payment policy C H A p t e R1
Page 1 and 2: RepoRt to the CongRess Medicare Pay
Page 3: RepoRt to tHe CongRess Medicare Pay
Page 6 and 7: with the structure of the payment s
Page 9 and 10: table of contents Acknowledgments .
Page 11: executive summary
Page 14 and 15: of services—and pressure on feder
Page 16 and 17: current Medicare payments are adequ
Page 18 and 19: outpatient dialysis services Outpat
Page 20 and 21: some facilities are willing to acce
Page 22 and 23: coverage for conventional treatment
Page 24 and 25: of care for these conditions should
Page 29 and 30: Context for Medicare payment policy
Page 31 and 32: Share of GDP FIGURE 1-1 FIguRe 1-1
Page 33 and 34: FIGURE FIguRe Percent 1-3 1-3 3500
Page 35 and 36: the level of health care spending a
Page 37 and 38: FIGURE FIguRe Percent 1-5 1-5 100 9
Page 39 and 40: Medicare program spending and fundi
Page 41 and 42: tABLe 1-5 2012). These projections
Page 43 and 44: FIGURE FIguRe 1-10 Number of benefi
Page 45 and 46: effects of growth in health care sp
Page 47 and 48: In 2011, the Commission reported si
Page 49 and 50: endnotes 1 Personal health care is
Page 51 and 52: Docteur, E., and R. Berenson. 2009.
Page 53: C H A p t e R2 Assessing payment ad
Page 56 and 57: 30 Assessing payment adequacy and u
Page 58 and 59: Some measures focus on beneficiarie
Page 60 and 61: together account for more than 90 p
Page 62 and 63: that may affect the distribution of
Page 64 and 65: References Berenson, R. A., P. B. G
Page 66 and 67: R e C o M M e n D A t I o n 3 The C
Page 68 and 69: percent due to two factors. First,
Page 71 and 72: tABLe 3-1 Hospital services 2006 20
Page 73 and 74: Beneficiaries’ access to care: Ac
Page 75 and 76: tABLe 3-2 shares of hospitals offer
Page 77 and 78:
2012). 6 Both the number of deals a
Page 79 and 80:
eadmissions (from 12.3 percent to 9
Page 81 and 82:
ather than from an actual shift tow
Page 83 and 84:
a combination of low-volume and oth
Page 85 and 86:
per admission in 2011 than hospital
Page 87 and 88:
average mortality rates, in part du
Page 89 and 90:
FIguRe FIGURE 3-9 3-8 Given a 20 pe
Page 91 and 92:
2013, 2 percent in 2014, and 3 perc
Page 93 and 94:
law, but this slower pace is necess
Page 95 and 96:
Court decision in the summer of 201
Page 97:
Medicare Payment Advisory Commissio
Page 100 and 101:
R e C o M M e n D A t I o n s (The
Page 102 and 103:
and 84 percent reported that they n
Page 105 and 106:
Background Physicians and other hea
Page 107 and 108:
4-2 FIguRe 4-2 2014 to 2018 2013 to
Page 109 and 110:
have meaningful results on bundling
Page 111 and 112:
appointments for routine care, illn
Page 113 and 114:
physician. Some physicians reported
Page 115 and 116:
professionals are participating pro
Page 117 and 118:
coronary artery bypass grafting has
Page 119 and 120:
• Another study for the Commissio
Page 121 and 122:
costs. The first measure is how Med
Page 123 and 124:
the patient-centered medical home (
Page 125 and 126:
endnotes 1 For further information,
Page 127:
Hendel, R. C., M. Cerqueira, P. S.
Page 130 and 131:
R e C o M M e n D A t I o n 5 The C
Page 132 and 133:
• Capacity and supply of provider
Page 134 and 135:
expense portion of the PFS rate tha
Page 136 and 137:
Differences in types of patients tr
Page 138 and 139:
tABLe 5-4 Most Medicare-certified A
Page 140 and 141:
tABLe 5-6 surgical service of outpa
Page 142 and 143:
Creating a value-based purchasing p
Page 144 and 145:
Revisiting the ambulatory surgical
Page 146 and 147:
• keep providers under financial
Page 148 and 149:
References Berenson, R. A., P. B. G
Page 151 and 152:
C H A p t e R6 outpatient dialysis
Page 153 and 154:
outpatient dialysis services Chapte
Page 155 and 156:
Dialysis treatment choices Dialysis
Page 157 and 158:
tABLe 6-2 and 2010, compared with a
Page 159 and 160:
percent of their payment is based o
Page 161 and 162:
Medicare, in MA, and not eligible f
Page 163 and 164:
measured utilization in dollars by
Page 165 and 166:
tABLe 6-4 Dialysis clinical indicat
Page 167 and 168:
estimated that these items and serv
Page 169 and 170:
high inpatient admission rate. Such
Page 171 and 172:
implant an AV graft for certain pat
Page 173:
Seeking Alpha. 2012. Warren Buffett
Page 177 and 178:
post-acute care providers: shortcom
Page 179:
expanded readmission policies The C
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
Page 187 and 188:
tABLe 8-1 A growing share of fee-fo
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
Page 201 and 202:
tABLe 8-6 Comparison of Medicare fe
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
Page 221 and 222:
tABLe 9-3 care increased from 7.2 p
Page 223 and 224:
that they remain in home health car
Page 225 and 226:
Regions or states with utilization
Page 227 and 228:
tABLe 9-7 in home health care polic
Page 229 and 230:
The share of episodes qualifying fo
Page 231 and 232:
least one measure (either low cost
Page 233 and 234:
strengthening incentives for effect
Page 235 and 236:
strengthening incentives for effect
Page 237:
References Benjamin, A. E. 1993. An
Page 240 and 241:
R e C o M M e n D A t I o n 10 The
Page 242 and 243:
1.6 percent, for a total of 1,165 f
Page 244 and 245:
tABLe 10-1 general, IRFs are concen
Page 246 and 247:
Medicare applies additional criteri
Page 248 and 249:
tABLe 10-3 IRF occupancy rates rose
Page 250 and 251:
tABLe 10-6 Compliance rate of Medic
Page 252 and 253:
tABLe 10-9 Distribution of IRF case
Page 254 and 255:
FIguRe FIGURE Cumulative percent ch
Page 256 and 257:
tABLe 10-13 IRFs’ Medicare margin
Page 258 and 259:
endnotes 1 This rule does not take
Page 261 and 262:
C H A p t e R11 Long-term care hosp
Page 263 and 264:
Long-term care hospital services Ch
Page 265 and 266:
Background Patients with chronic cr
Page 267 and 268:
would have lower readmission rates
Page 269 and 270:
short-stay outlier cases in long-te
Page 271 and 272:
Chronically critically ill benefici
Page 273 and 274:
tABLe 11-3 the top 25 Ms-LtC-DRgs m
Page 275 and 276:
from year to year, over time we fou
Page 277 and 278:
volume of patients on average and b
Page 279 and 280:
endnotes 1 The Medicare, Medicaid,
Page 281 and 282:
References Barnato, A. E., D. L. An
Page 283:
Scheinhorn, D. J., M. S. Hassenpflu
Page 286 and 287:
R e C o M M e n D A t I o n 12 The
Page 288 and 289:
262 Hospice services: Assessing pay
Page 290 and 291:
tABLe 12-1 Category Description amo
Page 292 and 293:
March 2009 Commission recommendatio
Page 294 and 295:
tABLe 12-2 The second, more visible
Page 296 and 297:
tABLe 12-3 We estimate that the sha
Page 298 and 299:
FIguRe 12-1 12-1 250 200 150 100 Le
Page 300 and 301:
tABLe 12-6 Characteristic shortest
Page 302 and 303:
tABLe 12-8 In 2010, 10.1 percent of
Page 304 and 305:
tABLe 12-9 Average Hospice costs pe
Page 306 and 307:
tABLe 12-11 Hospice characteristic
Page 308 and 309:
endnotes 1 If a beneficiary does no
Page 310 and 311:
References Barnato, A. E., D. L. An
Page 313 and 314:
the Medicare Advantage program: sta
Page 315:
charges no premium (beyond the Medi
Page 318 and 319:
tABLe 13-1 Medicare Advantage enrol
Page 320 and 321:
tABLe 13-2 Access to Medicare Advan
Page 322 and 323:
FIGURE FIguRe 13-2 13-2 MA bids in
Page 324 and 325:
tABLe 13-4 Distribution of enrollme
Page 326 and 327:
plan are updated using the new 2013
Page 328 and 329:
measures, it is often the case that
Page 330 and 331:
tABLe 13-8 plan performance on the
Page 332 and 333:
tABLe 13-10 plans report a single r
Page 334 and 335:
endnotes 1 Cost plans are technical
Page 336 and 337:
References Centers for Medicare & M
Page 338 and 339:
R e C o M M e n D A t I o n s 14-1
Page 340 and 341:
314 Medicare Advantage special need
Page 343 and 344:
Introduction Special needs plans (S
Page 345 and 346:
previous Commission recommendations
Page 347 and 348:
previous Commission recommendations
Page 349 and 350:
to reduce hospital utilization for
Page 351 and 352:
RAtIonALe 14-2 This recommendation
Page 353 and 354:
RAtIonALe 14-3 Consistent with the
Page 355 and 356:
endnotes 1 Employer plans are anoth
Page 357:
C H A p t e R15 status report on pa
Page 360 and 361:
334 Status report on Part D percent
Page 363 and 364:
tABLe 15-1 parameters of the define
Page 365 and 366:
Characteristics of Medicare benefic
Page 367 and 368:
tABLe 15-5 pDp region state(s) of b
Page 369 and 370:
FIguRe FIGURE 15-1 15-1 Enrollment
Page 371 and 372:
tABLe 15-7 Virginia region, along w
Page 373 and 374:
tABLe 15-8 stand-alone pDps with th
Page 375 and 376:
gradual phase-out of the coverage g
Page 377 and 378:
sponsors (i.e., the direct subsidy
Page 379 and 380:
use of preferred pharmacy networks
Page 381 and 382:
premiums) rather than lowering the
Page 383 and 384:
tABLe 15-15 spending—using cost-s
Page 385 and 386:
to formularies, benefit structure,
Page 387 and 388:
with a difference of at least $12 i
Page 389:
A p p e n D I X Commissioners' voti
Page 392 and 393:
Chapter 5: Ambulatory surgical cent
Page 394 and 395:
14-4 For dual-eligible special need
Page 397 and 398:
The Hono orable Max Baucus Chairman
Page 399 and 400:
ecommend that the Congress offset t
Page 401 and 402:
problematic than access to speciali
Page 403 and 404:
patients in hospitals, nursing faci
Page 405 and 406:
Collecting data to improve payment
Page 407 and 408:
a percentage of fee-schedule spendi
Page 409 and 410:
Within the ACO program, incentives
Page 411 and 412:
ates. Primary care physicians and o
Page 413 and 414:
Appendix 17 Report to the Congress:
Page 415 and 416:
19 Report to the Congress: Medicare
Page 417 and 418:
• Along A with th he recommend da
Page 419:
Acronyms
Page 422 and 423:
gDR generic dispensing rate gI gast
Page 425:
More about MedpAC
Page 429 and 430:
Commissioners’ biographies scott
Page 431 and 432:
Herb B. Kuhn is current president a
Page 433:
Commission staff Mark e. Miller, ph
show all

Medicare Payment Policy

Create successful ePaper yourself

Delete template?

Save as template?