Medicare prospective payment without separate urban and rural rates.

Health Care Financ Rev

Health Care Financing Administration.

Published: August 1993

The elimination of urban-rural differences in the Medicare prospective payment system (PPS) standard rates implies a need to re-examine all the PPS payment adjustments. Refinements for case mix, outliers, and the wage index can make a significant contribution to avoiding payment disparities in a single-rate system. However, changes in the adjustments for teaching and disproportionate-share (DSH) hospitals are also needed. The typically urban location of these hospitals makes it difficult to balance PPS payments and costs among major groups of urban and rural hospitals without some form of higher payment for all hospitals located in large urban areas.

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4193306PMC

Publication Analysis

Top Keywords

medicare prospective
8
prospective payment
8
urban rural
8
payment
5
payment separate
4
urban
4
separate urban
4
rural rates
4
rates elimination
4
elimination urban-rural
4

Similar Publications

Background: Prospective randomized trials have demonstrated noninferior survival between sublobar resection and lobectomy in healthy non-small cell lung cancer (NSCLC) patients with tumors ≤2cm. However, some patient attributes are not well represented in randomized trials and uncertainty remains in the widespread applicability of randomized trial nodal dissection protocols.

Methods: Patients with ≤2cm, node-negative NSCLC (cT1N0) in the Society of Thoracic Surgeons prospective database were linked to Medicare survival data using a probabilistic matching algorithm.

View Article and Find Full Text PDF

Objective: To determine the association between concurrent statin use with immune checkpoint inhibitors (ICIs) and lung cancer-specific and overall mortality in patients with nonsmall cell lung cancer (NSCLC).

Materials And Methods: SEER-Medicare was used to conduct a retrospective study of Medicare beneficiaries ≥65 years of age diagnosed with NSCLC between 2007 and 2017 treated with an ICI. Patients were followed from date of first ICI claim until death, 1 month from last ICI claim, or 12/31/2018, whichever came first.

View Article and Find Full Text PDF

Association of Mobile Stroke Unit Care and Spending, Utilization, and Death in New York City.

J Am Heart Assoc

January 2025

Department of Population Health Sciences Weill Cornell Medicine New York NY.

Background: Transport by mobile stroke units (MSUs), which provide access to computed tomography scanning and intravenous blood pressure medications and thrombolytics, reduces time to treatment and may improve short-term functional outcomes for patients with acute stroke. The longer-term clinical and financial impacts remain incompletely understood. The aim of the study was to determine whether MSU care is associated with better health, utilization, and spending outcomes for patients with suspected acute stroke.

View Article and Find Full Text PDF

Background: The sustainability of community pharmacies in the United States depends, in large part, on policies enacted by the Centers for Medicare and Medicaid Services (CMS). In 2003, CMS policy allowed retrospective direct and indirect remuneration (DIR) fees to manage costs. From 2024, only prospective DIR fees are permitted.

View Article and Find Full Text PDF

Introduction And Hypothesis: The objective was to externally validate and recalibrate a previously developed model for predicting postoperative surgical-site infection (SSI) after pelvic organ prolapse (POP) surgery.

Methods: This study utilized a previously validated model for predicting post-POP surgery SSI within 90 days of surgery using a Medicare population. For this study, the model was externally validated and recalibrated using the Premier Healthcare Database (PHD) and the National Surgical Quality Improvement Project (NSQIP) database.

View Article and Find Full Text PDF

Want AI Summaries of new PubMed Abstracts delivered to your In-box?

Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!