For over thirty years researchers have documented significant variation in medical care spending both between geographic regions and across hospitals within regions that does not seem to be related to outcomes. Much of the spending variation in the commercial insurance market is due to differences in prices across providers. Given the current policy focus on reducing medical care costs, these f...

programs to “take into account the situation of hospitals that serve a disproportionate number of low-income patients with special needs” when determining payment rates for inpatient hospital care. This requirement is referred to as the Medicaid disproportionate share hospital (DSH) payment adjustment. Expenditures for DSH have increased significantly in recent years: Between 1990 and 1996, for...

We describe the new technology add-on payment (NTAP) program used by the Centers for Medicare and Medicaid Services (CMS) to provide additional payment for breakthrough technologies in the Medicare hospital inpatient prospective payment system (IPPS). We also evaluate spending under the program. Our findings suggest that the criteria established by the CMS to limit qualifying technologies, comb...

Based on the report of the Central Social Insurance Medical Council concerning the 2002 Revision of the Medical Service Fee Schedule, a new inclusive payment system was introduced in 82 special functioning hospitals (university hospitals, National Cancer Center, National Cardiovascular Center) in Japan in April 2003. Beginning in April 2004, the system was gradually extended to general hospital...

This study assessed the characteristics of beneficiaries of a government-led policy of exemption for payment being provided in a regional hospital in Nepal. In January and February 2012, 9547 patients sought services at the out-patient clinic, the majority (83%) of whom were from the same district although this was a referral hospital for 15 districts. Only 10.8% received exemption from payment...

Medicare's hospital outpatient prospective payment system (HOPPS) was initially developed in response to the rapid rise in Medicare's outpatient expenses between 1980 and 1991. The Balanced Budget Act of 1997 mandated HOPPS, with an implementation date of August 1, 2000. Unlike the Medicare Physician Fee Schedule, the Centers for Medicare and Medicaid Services (CMS) used hospital charge data to...

Assigning a code from any of the diagnosis-related groups to a short-stay hospital discharge covered by Medicare is tantamount to the Medicare payment to the hospital, subject to certain statutory adjustments. Therefore, diagnosis-related groups are the backbone of the prospective payment system implemented October 1, 1983. However, methods employed in the assignment of diagnosis-related groups...

M health care experts believe that primary care is the foundation on which to build a high-performing health care system, with maximized quality and reduced costs.1 The Affordable Care Act (ACA), in an acknowledgment of primary care’s importance, includes a 10% payment bonus for primary care physicians participating in Medicare between 2011 and 2015. This fee-for-service payment incentive does ...