Background This paper explores the association between Medicare costs and quality of care indicators including geographic location. The analysis determines the areas in the US where medical procedures are most affordable and most expensive for Medicare recipients. Methods Analytics is used to explore the association between cost and quality of Medicare. IBM Cognos and Tableau are used for data ...

Medicare claims data are available to Department of Veterans Affairs (VA) researchers to identify veterans with acute stroke. Our study sought to (1) ascertain whether additional acute stroke cases are identified with Medicare data and (2) assess the use of VA and Medicare inpatient automated data for assigning the stroke date. The study population was veterans living in Veterans Integrated Ser...

C urrent discussions of the future of Medicare include proposals to increase the enrollment of beneficiaries in private health insurance plans. These proposals would provide incentives for beneficiaries to join private plans, rely on more loosely structured health plans such as preferred provider organizations (PPOs), change the way health plans are paid, and in some cases create competition be...

IMPORTANCE Instituting widespread measurement of outcomes for cancer hospitals using administrative data is difficult owing to lack of cancer-specific information such as disease stage. OBJECTIVE To evaluate the performance of hospitals that treat patients with cancer using Medicare data for outcome ascertainment and risk adjustment and to assess whether hospital rankings based on these measu...

This article provides a synopsis of the available evidence on the impact of the Medicare prospective payment system (PPS) for hospitals over the first 3 years of its implementation. The impact of PPS on hospitals, Medicare beneficiaries, post-hospital care, other payers for inpatient hospital services, other health care providers, and Medicare program operations and expenditures is examined.

The 2003 Medicare Prescription Drug, Improvement, and Modernization Act (MMA) created Medicare Part D, a voluntary prescription drug benefit program. The benefit is a government subsidized prescription drug benefit within Medicare. This article focuses on the development of the prescription drug risk-adjustment model used to adjust payments to reflect the health status of plan enrollees.

MR. WILLIAM J. LONDON: I am an actuary with the Health Care Financing Administration (HCFA), and we also have Richard Swift from Aetna, and Woody McDonald from Tillinghast. We're going to discuss the Medicare physician fee schedule and the Medicare volume performance standards, which are the expenditure targets for Medicare, and alsothe other part of physician payment reform or balance billing ...

The 1989 Omnibus Budget Reconciliation Act (OBRA 89) included physician payment reform, part of which was a limit on balanced billing. The provision limiting charges was implemented in 1991. Under this reform, physicians who did not accept Medicare assignment were prohibited from billing Medicare beneficiaries more than 140 percent of the prevailing charge for evaluation and management services...

This issue brief provides an overview of Medicare's coverage gaps and the primary sources of supplemental coverage for Medicare beneficiaries. It focuses particularly on the Medigap market: the effects of standardization, recent premium trends and rating practices, and options for reform. It considers Medigap within the context of Medicare prescription drug proposals and efforts to reform the e...

The Medicare Current Beneficiary Survey (MCBS) is a large survey utilizing a nationally representative sample of the Medicare population. The MCBS collects data on a whole host of topics including health status, health insurance coverage and financing, access to care, knowledge and understanding of the Medicare Program, as well as use and effectiveness of new program benefits and changes.