This commentary evaluates the merits of proposals in the United States to create a site-neutral payment system for postacute care for patients with select rehabilitation-related conditions. Under a site-neutral payment system, Medicare would pay providers based on patients' clinical needs, not on the peculiarities of individual postacute settings such as skilled nursing facilities and inpatient rehabilitation facilities. This commentary frames the policy choices by taking into account the research evidence on setting costs and outcomes, the policy tools and preconditions needed for an effective site-neutral payment system, and the overall direction of American health and postacute policy.
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http://dx.doi.org/10.1016/j.apmr.2014.02.018 | DOI Listing |
Health Serv Res
September 2024
Center for Health Policy and Healthcare Research, Northeastern University, Boston, Massachusetts, USA.
Objective: To examine the association between hospital-cardiologist integration and Medicare spending for stable angina patients.
Data Sources And Study Setting: This study used Medicare Standard Analytic Files from 2013 to 2020 and the Centers for Medicare and Medicaid Services National Downloadable File for accompanying physician data.
Study Design: This was a retrospective cohort study of Medicare beneficiaries with a new diagnosis of stable angina between 2013 and 2020.
Inquiry
August 2024
University of Minnesota, Minneapolis, MN, USA.
Site-neutral payment is a policy created by federal rule making and implemented by the Centers for Medicare and Medicaid Services (CMS) that aims to reduce healthcare costs by aligning payment rates for certain services provided in multiple care settings. Site-neutral payments are intended to eliminate the incentive for providers to acquire facilities, such as physician offices or ambulatory surgical centers (ASCs), that Medicare reimburses at the lower non-facility rate and convert those settings into hospital outpatient departments (HOPDs), where Medicare reimburses at the higher facility rate. Although initiated by Congress to address payment disparities in Medicare, similar payment discrepancies can be seen in the commercial market where individual and employer-sponsored health plans often pay more for certain outpatient services depending on their location.
View Article and Find Full Text PDFJCO Oncol Pract
December 2024
Department of Health Policy and Management, Rollins School of Public Health and Winship Cancer Institute, Emory University, Atlanta, GA.
Purpose: Medicare's differential payments for services delivered in physician offices versus hospital outpatient settings incentivize hospital-physician integration (ie, vertical integration) across many specialties, but evidence for oncologists is mixed. We examined the association of Medicare site-based payment policy and physician practice characteristics, including service volume and diversity, with vertical integration among oncologists in 2013-2019.
Methods: Using the Medicare Provider Utilization and Payment Data and Medicare Data on Provider Practice and Specialty in 2013-2019, we extracted nonintegrated medical/hematologic oncologists (hereafter oncologists) in 2013 and followed them through 2019.
Health Serv Res
October 2022
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Objective: To compare prices paid by commercial insurers for ambulatory services in physician office and hospital outpatient settings.
Data Sources: MarketScan Commercial Claims and Encounters database obtained from Truven Health Analytics.
Study Design: We examined ambulatory service claims for a sample of privately insured individuals who were continuously enrolled in a health maintenance organization plan, preferred provider organization plan, high-deductible/consumer-driven health plan, or exclusive provider organization plan in 2018.
Mo Med
August 2021
Missouri Medicine Contributing Editor and the author of numerous books on practice management. He is a retired Internal Medicine physician in St. Louis.
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