Repricing specialty hospital outpatient services using ambulatory surgery center prices.

This article explores whether Medicare pays more for the same outpatient services provided in an acute specialty hospital than in an ambulatory surgery center (ASC). How financially dependent a specialty hospital is on ASC-eligible services is also investigated. Medicare outpatient claims in 43 orthopedic and 12 surgical specialty hospitals in 2004 were repriced using ASC pricing software.

Alternative comorbidity adjustors for the Medicare inpatient psychiatric facility PPS.

The inpatient psychiatric facility prospective payment system (IPF-PPS), provides per diem payments for psychiatric hospitals and units, including 17 comorbid condition payment adjustors that cover 11 percent of patients. This study identifies an alternative set of 16 adjustors identifying three times as many high-cost patients and evaluates the improved predictive power in log per diem cost regression models. A model using the IPF-PPS adjustors achieved 8.

Prospective payment for Medicare inpatient psychiatric care: assessing the alternatives.

This article reports the findings of an empirical analysis of per case and per diem models of prospective payment for Medicare inpatient psychiatric care. Quantitative measures are presented that show the improvement of a per diem model over a per case model. The research supports the viability of per diem prospective payment and identifies directions for future research that would refine current per diem models.