Medicare Payment Differentials across Ambulatory Settings
نویسندگان
چکیده
This product is part of the RAND Health working paper series. RAND working papers are intended to share researchers' latest findings and to solicit informal peer review. They have been approved for circulation by RAND Health but have not been formally edited or peer reviewed. Unless otherwise indicated, working papers can be quoted and cited without permission of the author, provided the source is clearly referred to as a working paper. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors. is a registered trademark. iii PREFACE Separate payment systems are used in each ambulatory setting where care is provided to Medicare beneficiaries: hospital outpatient departments, ambulatory surgical centers and physician offices. For most services, Medicare pays different amounts for the facility-related component of providing comparable services in the different settings. The payment differentials have raised questions about what types of potentially perverse financial incentives exist that could influence a provider's choice of ambulatory setting and whether Medicare is paying a premium for services that could appropriately be provided in a less costly setting (MedPAC, 2004). Department of Health and Human Services asked RAND to analyze issues related to modifying Medicare payment policy for health care services delivered in various ambulatory settings so that payment rates reflect the costs of delivering the services in each setting. This report describes our findings with respect to the payment and cost differentials for a set of high volume procedures provided in multiple ambulatory settings and discusses potential policy options. The study should be of interest to health policymakers.
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