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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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- Page 50 and 51: References Agency for Healthcare Re
- Page 52 and 53: Medicare Payment Advisory Commissio
- Page 55 and 56: Assessing payment adequacy and upda
- Page 57 and 58: The goal of Medicare payment policy
- Page 59 and 60: may go up when payment rates go dow
- Page 61 and 62: hospitals and that hospitals shift
- Page 63 and 64: individual payment systems but also
- Page 65 and 66: Hospital inpatient and outpatient s
- Page 67 and 68: Hospital inpatient and outpatient s
- Page 69: covered the fully allocated costs o
- Page 72 and 73: 3-1 3-1 FIguRe 100 80 60 40 Number
- Page 74 and 75: Visits or claims per 1,000 benefici
- Page 76 and 77: 3-4 3-4 FIguRe 2012 dollars (in bil
- Page 78 and 79: of physicians employed directly by
- Page 80 and 81: FIguRe FIGURE Annual percent change
- Page 82 and 83: FIGURE FIguRe Margin (in percent) 3
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- Page 86 and 87: tABLe 3-5 performance of efficient
- Page 88 and 89: Act, the EHR Incentive Program also
- Page 90 and 91: as Medicaid expands, the new insura
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- Page 94 and 95: endnotes 1 From 2002 to 2011, 479 h
- Page 96 and 97: References Agency for Healthcare Re
- 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
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- Page 115 and 116: professionals are participating pro
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- Page 119 and 120: • Another study for the Commissio
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- 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
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- 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
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References Berenson, R. A., P. B. G
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C H A p t e R6 outpatient dialysis
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outpatient dialysis services Chapte
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Dialysis treatment choices Dialysis
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tABLe 6-2 and 2010, compared with a
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percent of their payment is based o
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Medicare, in MA, and not eligible f
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measured utilization in dollars by
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tABLe 6-4 Dialysis clinical indicat
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estimated that these items and serv
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high inpatient admission rate. Such
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implant an AV graft for certain pat
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Seeking Alpha. 2012. Warren Buffett
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post-acute care providers: shortcom
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expanded readmission policies The C
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R e C o M M e n D A t I o n s (The
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• Capacity and supply of provider
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tABLe 8-1 A growing share of fee-fo
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Description of beneficiaries who us
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CMs’s revisions to the snF pps Al
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tABLe 8-4 SNF volume per FFS benefi
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tABLe 8-5 snF quality measures vary
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care they provide and the arrangeme
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7-7 8-5 FIguRe 25 20 15 10 Medicare
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tABLe 8-6 Comparison of Medicare fe
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Medicare’s skilled nursing facili
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tABLe 8-8 number of nursing homes t
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endnotes 1 Throughout this chapter,
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References Alliance for Quality Nur
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C H A p t e R9 Home health care ser
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Home health care services Chapter s
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Background Medicare home health car
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8-1 9-1 FIguRe 24 22 20 18 16 14 Me
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of home health episodes. In additio
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tABLe 9-3 care increased from 7.2 p
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that they remain in home health car
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Regions or states with utilization
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tABLe 9-7 in home health care polic
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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
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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
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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
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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
- Page 425:
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