22 CFR 192.12 - Administration of benefits.

Code of Federal Regulations, 2012 CFR

2012-04-01

... payment of these benefits, payment shall be made to the eligible survivors under § 192.51(c) or the estate... pursuant to 5 U.S.C. 5569(b). Interest payments under this section shall be paid out of funds available for... the average rate paid on United States Treasury bills with 3-month maturities issued during the...

42 CFR 413.100 - Special treatment of certain accrued costs.

Code of Federal Regulations, 2012 CFR

2012-10-01

... SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Specific...) If the sick leave plan grants employees the nonforfeitable right to demand cash payment for unused... reporting periods that produce the highest average contribution(s), out of the five most recent Medicare...

42 CFR 413.100 - Special treatment of certain accrued costs.

Code of Federal Regulations, 2013 CFR

2013-10-01

... SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Specific...) If the sick leave plan grants employees the nonforfeitable right to demand cash payment for unused... reporting periods that produce the highest average contribution(s), out of the five most recent Medicare...

42 CFR 413.157 - Return on equity capital of proprietary providers.

Code of Federal Regulations, 2012 CFR

2012-10-01

... RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES... percentage equal to one and one-half times the average of the rates of interest on special issues of public... inpatient hospital services is a percentage of the average of the rates of interest described in paragraph...

42 CFR 413.157 - Return on equity capital of proprietary providers.

Code of Federal Regulations, 2011 CFR

2011-10-01

... RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES... percentage equal to one and one-half times the average of the rates of interest on special issues of public... inpatient hospital services is a percentage of the average of the rates of interest described in paragraph...

42 CFR 413.157 - Return on equity capital of proprietary providers.

Code of Federal Regulations, 2013 CFR

2013-10-01

... RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES... percentage equal to one and one-half times the average of the rates of interest on special issues of public... inpatient hospital services is a percentage of the average of the rates of interest described in paragraph...

Distribution and Determinants of 90-Day Payments for Multilevel Posterior Lumbar Fusion: A Medicare Analysis.

PubMed

Jain, Nikhil; Phillips, Frank M; Khan, Safdar N

2018-04-01

A retrospective, economic analysis. The objective of this article is to analyze the distribution of 90-day payments, sources of variation, and reimbursement for complications and readmissions for primary ≥3-level posterior lumbar fusion (PLF) from Medicare data. A secondary objective was to identify risk factors for complications. Bundled payments represent a single payment system to cover all costs associated with a single episode of care, typically over 90 days. The dollar amount spent on different health service providers and the variation in payments for ≥3-level PLF have not been analyzed from a bundled perspective. Administrative claims data were used to study 90-day Medicare (2005-2012) reimbursements for primary ≥3-level PLF for deformity and degenerative conditions of the lumbar spine. Distribution of payments, sources of variation, and reimbursements for managing complications were studied using linear regression models. Risk factors for complications were studied by stepwise multiple-variable logistic regression analysis. Hospital payments comprised 73.8% share of total 90-day payment. Adjusted analysis identified several factors for variation in index hospital payments. The average 90-day Medicare payment for all multilevel PLFs without complications was $35,878 per patient. The additional average cost of treating complications with/without revision surgery within 90 days period ranged from $17,284 to $68,963. A 90-day bundle for ≥3-level PLF with readmission ranges from $88,648 (3 levels) to $117,215 (8+ levels). Rates and risk factors for complications were also identified. The average 90-day payment per patient from Medicare was $35,878 with several factors such as levels of surgery, comorbidities, and development of complications influencing the cost. The study also identifies the risks and costs associated with complications and readmissions and emphasize the significant effect these would have on bundled payments (additional burden of up to 192% the cost of an average uncomplicated procedure over 90 days). Level 3.

42 CFR 413.100 - Special treatment of certain accrued costs.

Code of Federal Regulations, 2014 CFR

2014-10-01

... SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Specific... nonforfeitable right to demand cash payment for unused sick leave at the end of each year, sick pay is includable... reporting periods that produce the highest average contribution(s), out of the five most recent Medicare...

Cost of practice in a tertiary/quaternary referral center: is it sustainable?

PubMed

Cologne, K G; Hwang, G S; Senagore, A J

2014-11-01

Third-party payers are moving toward a bundled care payment system. This means that there will need to be a warranty cost of care-where the cost of complexity and complication rates is built into the bundled payment. The theoretical benefit of this system is that providers with lower complication rates will be able to provide care with lower warranty costs and lower overall costs. This may also result in referring riskier patients to tertiary or quaternary referral centers. Unless the payment model truly covers the higher cost of managing such referred cases, the economic risk may be unsustainable for these centers. We took the last seven patients that were referred by other surgeons as "too high risk" for colectomy at other centers. A contribution margin was calculated using standard Medicare reimbursement rates at our institution and cost of care based on our administrative database. We then recalculated a contribution margin assuming a 3 % reduction in payment for a higher than average readmission rate, like that which will take effect in 2014. Finally, we took into account the cost of any readmissions. Seven patients with diagnosis related group (DRG) 330 were reviewed with an average age of 66.8 ± 16 years, American Society of Anesthesiologists score 2.3 ± 1.0, body mass index 31.6 ± 9.8 kg/m(2) (range 22-51 kg/m(2)). There was a 57 % readmission rate, 29 % reoperation rate, 10.8 ± 7.7 day average initial length of stay with 14 ± 8.6 day average readmission length of stay. Forty-two percent were discharged to a location other than home. Seventy-one percent of these patients had Medicare insurance. The case mix index was 2.45. Average reimbursement for DRG 330 was $17,084 (based on Medicare data) for our facility in 2012, with the national average being $12,520. The total contribution margin among all cases collectively was -$19,122 ± 13,285 (average per patient -$2,731, range -$21,905-$12,029). Assuming a 3 % reimbursement reduction made the overall contribution margin -$22,122 ± 13,285 (average -$3,244). Including the cost of readmission in the variable cost made the contribution margin -$115,741 ± 16,023 (average -$16,534). Care of high-risk patients at tertiary and quaternary referral centers is a very expensive proposition and can lead to financial ruin under the current reimbursement system.

29 CFR 778.400 - The provisions of section 7(g)(3) of the Act.

Code of Federal Regulations, 2010 CFR

2010-07-01

... COMPENSATION Exceptions From the Regular Rate Principles Computing Overtime Pay on An âestablishedâ Rate § 778... Labor as being substantially equivalent to the average hourly earnings of the employee, exclusive of... average hourly earnings for the workweek exclusive of payments described in paragraphs (1) through (7) of...

7 CFR 1437.11 - Average market price and payment factors.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 10 2010-01-01 2010-01-01 false Average market price and payment factors. 1437.11... ASSISTANCE PROGRAM General Provisions § 1437.11 Average market price and payment factors. (a) An average... average market price by the applicable payment factor (i.e., harvested, unharvested, or prevented planting...

Payment Reduction and Medicare Private Fee-for-Service Plans

PubMed Central

Frakt, Austin B.; Pizer, Steven D.; Feldman, Roger

2009-01-01

Medicare private fee-for-service (PFFS) plans are paid like other Medicare Advantage (MA) plans but are exempt from many MA requirements. Recently, Congress set average payments well above the costs of traditional fee-for-service (FFS) Medicare, inducing dramatic increases in PFFS plan enrollment. This has significant implications for Medicare's budget, provoking calls for policy change. We predict the effect of proposals to cut PFFS payments on PFFS plan participation and enrollment. We find that small reductions in payment rates would reduce PFFS participation and enrollment; if Congress reduces payments to traditional FFS levels it would cause the vast majority (85 percent) of PFFS plans to exit the market. PMID:19544932

Wide variation in hospital and physician payment rates evidence of provider market power.

PubMed

Ginsburg, Paul B

2010-11-01

Wide variation in private insurer payment rates to hospitals and physicians across and within local markets suggests that some providers, particularly hospitals, have significant market power to negotiate higher-than-competitive prices, according to a new study by the Center for Studying Health System Change (HSC). Looking across eight health care markets--Cleveland; Indianapolis; Los Angeles; Miami; Milwaukee; Richmond, Va.; San Francisco; and rural Wisconsin--average inpatient hospital payment rates of four large national insurers ranged from 147 percent of Medicare in Miami to 210 percent in San Francisco. In extreme cases, some hospitals command almost five times what Medicare pays for inpatient services and more than seven times what Medicare pays for outpatient care. Variation within markets was just as dramatic. For example, the hospital with prices at the 25th percentile of Los Angeles hospitals received 84 percent of Medicare rates for inpatient care, while the hospital with prices at the 75th percentile received 184 percent of Medicare rates. The highest-priced Los Angeles hospital with substantial inpatient claims volume received 418 percent of Medicare. While not as pronounced, significant variation in physician payment rates also exists across and within markets and by specialty. Few would characterize the variation in hospital and physician payment rates found in this study to be consistent with a highly competitive market. Purchasers and public policy makers can address provider market power, or the ability to negotiate higher-than-competitive prices, through two distinct approaches. One is to pursue market approaches to strengthen competitive forces, while the other is to constrain payment rates through regulation.

7 CFR 1410.41 - Levels and rates for cost-share payments.

Code of Federal Regulations, 2011 CFR

2011-01-01

... shall not pay more than 50 percent of the actual or average cost of establishing eligible practices.... (b) The average cost of performing a practice may be determined by CCC based on recommendations from the State Technical Committee. Such cost may be the average cost in a State, a county, or a part of a...

7 CFR 1450.213 - Levels and rates for establishment payments.

Code of Federal Regulations, 2011 CFR

2011-01-01

.... (a) CCC will pay not more than 75 percent of the actual or average cost (whichever is lower) of... stewardship plan, or equivalent plan. (b) The average cost of performing a practice may be determined by CCC based on recommendations from the State Technical Committee. Such cost may be the average cost in a...

Effect of Risk Acceptance for Bundled Care Payments on Clinical Outcomes in a High-Volume Total Joint Arthroplasty Practice After Implementation of a Standardized Clinical Pathway.

PubMed

Kee, James R; Edwards, Paul K; Barnes, Charles L

2017-08-01

The Bundled Payments for Care Improvement (BPCI) initiative and the Arkansas Payment Improvement (API) initiative seek to incentivize reduced costs and improved outcomes compared with the previous fee-for-service model. Before participation, our practice initiated a standardized clinical pathway (CP) to reduce length of stay (LOS), readmissions, and discharge to postacute care facilities. This practice implemented a standardized CP focused on patient education, managing patient expectations, and maximizing cost outcomes. We retrospectively reviewed all primary total joint arthroplasty patients during the initial 2-year "at risk" period for both BPCI and API and determined discharge disposition, LOS, and readmission rate. During the "at risk" period, the average LOS decreased in our total joint arthroplasty patients and our patients discharged home >94%. Patients within the BPCI group had a decreased discharge to home and decreased readmission rates after total hip arthroplasty, but also tended to be older than both API and nonbundled payment patients. While participating in the BPCI and API, continued use of a standardized CP in a high-performing, high-volume total joint practice resulted in maintenance of a low-average LOS. In addition, BPCI patients had similar outcomes after total knee arthroplasty, but had decreased rates of discharge to home and readmission after total hip arthroplasty. Copyright © 2017 Elsevier Inc. All rights reserved.

Impact of a function-based payment model on the financial performance of acute inpatient medical rehabilitation providers: a simulation analysis.

PubMed

Sutton, J P; DeJong, G; Song, H; Wilkerson, D

1997-12-01

To operationalize research findings about a medical rehabilitation classification and payment model by building a prototype of a prospective payment system, and to determine whether this prototype model promotes payment equity. This latter objective is accomplished by identifying whether any facility or payment model characteristics are systematically associated with financial performance. This study was conducted in two phases. In Phase 1 the components of a diagnosis-related group (DRG)-like payment system, including a base rate, function-related group (FRG) weights, and adjusters, were identified and estimated using hospital cost functions. Phase 2 consisted of a simulation analysis in which each facility's financial performance was modeled, based on its 1990-1991 case mix. A multivariate regression equation was conducted to assess the extent to which characteristics of 42 rehabilitation facilities contribute toward determining financial performance under the present Medicare payment system as well as under the hypothetical model developed. Phase 1 (model development) included 61 rehabilitation hospitals. Approximately 59% were rehabilitation units within a general hospital and 48% were teaching facilities. The number of rehabilitation beds averaged 52. Phase 2 of the stimulation analysis included 42 rehabilitation facilities, subscribers to UDS in 1990-1991. Of these, 69% were rehabilitation units and 52% were teaching facilities. The number of rehabilitation beds averaged 48. Financial performance, as measured by the ratio of reimbursement to average costs. Case-mix index is the primary determinant of financial performance under the present Medicare payment system. None of the facility characteristics included in this analysis were associated with financial performance under the hypothetical FRG payment model. The most notable impact of an FRG-based payment model would be to create a stronger link between resource intensity and level of reimbursement, resulting in greater equity in the reimbursement of inpatient medical rehabilitation hospitals.

75 FR 45636 - Animal Generic Drug User Fee Rates and Payment Procedures for Fiscal Year 2011

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-03

... . (The Pay.gov payment option is available to you after you submit a cover sheet. Click the ``Pay Now... that the number of applications that will pay fees in FY 2011 will equal 30 percent less than the... average receipts of 14.4 per year over the latest 5 years, including our FY 2010 estimate. Applying a 30...

High Variation of Intravitreal Injection Rates and Medicare Anti-Vascular Endothelial Growth Factor Payments per Injection in the United States.

PubMed

Erie, Jay C; Barkmeier, Andrew J; Hodge, David O; Mahr, Michael A

2016-06-01

To estimate geographic variation of intravitreal injection rates and Medicare anti-vascular endothelial growth factor (VEGF) drug costs per injection in aging Americans. Observational cohort study using 2013 Medicare claims database. United States fee-for-service (FFS) Part B Medicare beneficiaries and their providers. Medicare Provider Utilization and Payment Data furnished by the Centers for Medicare and Medicaid Services was used to identify all intravitreal injection claims and anti-VEGF drug claims among FFS Medicare beneficiaries in all 50 states and the District of Columbia in 2013. The rate of FFS Medicare beneficiaries receiving intravitreal injections and the mean Medicare-allowed drug payment per anti-VEGF injection was calculated nationally and for each state. Geographic variations were evaluated by using extremal quotient, coefficient of variation, and systematic component of variance (SCV). Rate of FFS Medicare Part B beneficiaries receiving intravitreal injections (Current Procedural Terminology [CPT] code, 67028), nationally and by state; mean Medicare-allowed drug payment per anti-VEGF injection (CPT code, 67028; and treatment-specific J-codes, J0178, J2778, J9035, J3490, and J3590) nationally and by state. In 2013, the rate of FFS Medicare beneficiaries receiving intravitreal injections varied widely by 7-fold across states (range by state, 4 per 1000 [Wyoming]-28 per 1000 [Utah]), averaging 19 per 1000 beneficiaries. The mean SCV was 8.5, confirming high nonrandom geographic variation. There were more than 2.1 million anti-VEGF drug claims, totaling more than $2.3 billion in Medicare payments for anti-VEGF agents in 2013. The mean national Medicare drug payment per anti-VEGF injection varied widely by 6.2-fold across states (range by state, $242 [South Carolina]-$1509 [Maine]), averaging $1078 per injection. Nationally, 94% of injections were office based and 6% were facility based. High variation was observed in intravitreal injection rates and in Medicare drug payments per anti-VEGF injection across the United States in 2013. Identifying factors that contribute to high variation may help the ophthalmology community to optimize further the delivery and use of anti-VEGF agents. Copyright © 2016 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

7 CFR 210.4 - Cash and donated food assistance to States.

Code of Federal Regulations, 2010 CFR

2010-01-01

... provisions of this section to each State agency for lunches and meal supplements served to children under the... meal national average payment rate (general cash assistance) and the special assistance national... establish maximum per meal rates of reimbursement within which a State may vary reimbursement rates to...

7 CFR 210.4 - Cash and donated food assistance to States.

Code of Federal Regulations, 2011 CFR

2011-01-01

... provisions of this section to each State agency for lunches and meal supplements served to children under the... meal national average payment rate (general cash assistance) and the special assistance national... establish maximum per meal rates of reimbursement within which a State may vary reimbursement rates to...

42 CFR 412.331 - Determining hospital-specific rates in cases of hospital merger, consolidation, or dissolution.

Code of Federal Regulations, 2010 CFR

2010-10-01

... each hospital's base period data, the intermediary determines a combined average discharge-weighted... payment determination: (1) Revised hospital-specific rate. Using each hospital's base period data, the... hospital-specific rates are determined as follows: (1) Hospital-specific rate—(i) Adequate base year data...

FEE-SCHEDULE INCREASES IN CANADA: IMPLICATION FOR SERVICE VOLUMES AMONG FAMILY AND SPECIALIST PHYSICIANS.

PubMed

Ariste, Ruolz

2015-01-01

Physician spending has substantially increased over the last few years in Canada to reach $27.4 billion in 2010. Total clinical payment to physicians has grown at an average annual rate of 7.6% from 2004 to 2010. The key policy question is whether or not this additional money has bought more physician services. So, the purpose of this study is to understand if we are paying more for the same amount of medical services in Canada or we are getting more bangs for our buck. At the same time, the paper attempts to find out whether or not there is a productivity difference between family physician services and surgical procedures. Using the Baumol theory and data from the National Physician Database for the period 2004-2010, the paper breaks down growth in physician remuneration into growth in unit cost and number of services, both from the physician and the payer perspectives. After removing general inflation and population growth from the 7.6% growth in total clinical payment, we found that real payment per service and volume of services per capita grew at an average annual rate of 3.2% and 1.4% respectively, suggesting that payment per service was the main cost driver of physician remuneration at the national level. Taking the payer perspective, it was found that, for the fee-for-service (FFS) scheme, volume of services per physician decreased at an average annual rate of -0.6%, which is a crude indicator that labour productivity of physicians on FFS has fallen during the period. However, the situation differs for the surgical procedures. Results also vary by province. Overall, our finding is consistent with the Baumol theory, which hypothesizes higher productivity growth in technology-driven sectors.

Medicare: Reasonableness of Health Maintenance Organization Payments Not Assured

DTIC Science & Technology

1989-03-07

diagnosis related group ESRD end stage renal disease FAR Federal Acquisition Regulations GAO General Accounting Office HCFA Health Care Financing...national average per capita Medicare costs for the pay- ment year being developed. 2. Estimates county (or, for end stage renal disease [ESRD] enrollees...intensity adjustments. Although the HMO Page 31 GAO/HRD941 Medicare Payments to HMOs Chapter 2 The Adjusted Coinninity Rate Proema Not Funcioning as

Patient-initiated switching between private and public inpatient hospitalisation in Western Australia 1980 – 2001: An analysis using linked data

PubMed Central

Moorin, Rachael E; Holman, C D'Arcy J

2005-01-01

Background The aim of the study was to identify any distinct behavioural patterns in switching between public and privately insured payment classifications between successive episodes of inpatient care within Western Australia between 1980 and 2001 using a novel 'couplet' method of analysing longitudinal data. Methods The WA Data Linkage System was used to extract all hospital morbidity records from 1980 to 2001. For each individual, episodes of hospitalisation were paired into couplets, which were classified according to the sequential combination of public and privately insured episodes. Behavioural patterns were analysed using the mean intra-couplet interval and proportion of discordant couplets in each year. Results Discordant couplets were consistently associated with the longest intra-couplet intervals (ratio to the average annual mean interval being 1.35), while the shortest intra-couplet intervals were associated with public concordant couplets (0.5). Overall, privately insured patients were more likely to switch payment classification at their next admission compared with public patients (the average rate of loss across all age groups being 0.55% and 2.16% respectively). The rate of loss from the privately insured payment classification was inversely associated with time between episodes (2.49% for intervals of 0 to 13 years and 0.83% for intervals of 14 to 21 years). In all age groups, the average rate of loss from the privately insured payment classification was greater between 1981 and 1990 compared with that between 1991 and 2001 (3.45% and 3.10% per year respectively). Conclusion A small but statistically significant reduction in rate of switching away from PHI over the latter period of observation indicated that health care policies encouraging uptake of PHI implemented in the 1990s by the federal government had some of their intended impact on behaviour. PMID:15978139

12 CFR 327.7 - Payment of interest on assessment underpayments and overpayments.

Code of Federal Regulations, 2010 CFR

2010-01-01

... October, respectively, is the coupon equivalent yield of the average discount rate set on the 3-month... underpayment or overpayment of an assessment shall accrue interest at the relevant interest rate. (ii) Interest... discharged. (iii) The relevant interest rate shall be redetermined for each quarterly assessment interval. A...

Medical Malpractice Reform: Noneconomic Damages Caps Reduced Payments 15 Percent, With Varied Effects By Specialty

PubMed Central

Seabury, Seth A.; Helland, Eric; Jena, Anupam B.

2014-01-01

The impact of medical malpractice reforms on the average size of malpractice payments in specific physician specialties is unknown and subject to debate. We analyzed a national sample of 220,653 malpractice claims from 1985–2010 merged with information on state liability reforms. We estimated the impact of state noneconomic damage caps on average malpractice payment size for physicians overall and for 10 different specialties, and compared how the effects differed according to the restrictiveness of the cap ($250,000 vs. $500,000 cap). We found noneconomic damage caps reduced payments by $42,980 (15%; p<0.001), with a $250,000 cap reducuing average payments by $59,331 (20%; p<0.001), while a $500,000 cap had no significant effect. Effects varied according to specialty and were largest in specialties with high average payments, such as pediatrics. This suggests that the effect of noneconomic damage caps differs by specialty, and only more restrictive caps result in lower average payments. PMID:25339633

29 CFR 548.405 - Representative period.

Code of Federal Regulations, 2011 CFR

2011-07-01

... employee exclusive of overtime premiums over a representative period of time. 21 The basic rate will be... discussion of the exclusion of vacation pay, holiday pay, discretionary bonuses and other payments from the average hourly earnings which comprise the employee's regular rate of pay. (b) The length of time...

29 CFR 548.405 - Representative period.

Code of Federal Regulations, 2010 CFR

2010-07-01

... employee exclusive of overtime premiums over a representative period of time. 21 The basic rate will be... discussion of the exclusion of vacation pay, holiday pay, discretionary bonuses and other payments from the average hourly earnings which comprise the employee's regular rate of pay. (b) The length of time...

You and Foreign Money.

ERIC Educational Resources Information Center

Tucker, James F.

Foreign currency units, exchange rates, the international payments process, and spending money abroad are discussed briefly in this booklet to help teachers explain the international economy. Thirty-two countries are listed with their respective currency units, some of which are illustrated. A chart shows the average yearly exchange rates between…

29 CFR 548.502 - Other payments.

Code of Federal Regulations, 2010 CFR

2010-07-01

... ESTABLISHED BASIC RATES FOR COMPUTING OVERTIME PAY Interpretations Computation of Overtime Pay § 548.502 Other... would have been included in the regular rate of pay. 26 26 Unless specifically excluded by agreement or... employee's daily average hourly earnings, and under the employment agreement he is paid one and one-half...

7 CFR 1450.213 - Levels and rates for establishment payments.

Code of Federal Regulations, 2012 CFR

2012-01-01

... establishing non-woody perennial crops and woody perennial crops specified in the conservation plan, forest stewardship plan, or equivalent plan. (b) The average cost of performing a practice may be determined by CCC...

Do Physicians' Financial Incentives Affect Medical Treatment and Patient Health?†

PubMed Central

Clemens, Jeffrey; Gottlieb, Joshua D.

2014-01-01

We investigate whether physicians' financial incentives influence health care supply, technology diffusion, and resulting patient outcomes. In 1997, Medicare consolidated the geographic regions across which it adjusts physician payments, generating area-specific price shocks. Areas with higher payment shocks experience significant increases in health care supply. On average, a 2 percent increase in payment rates leads to a 3 percent increase in care provision. Elective procedures such as cataract surgery respond much more strongly than less discretionary services. Non-radiologists expand their provision of MRIs, suggesting effects on technology adoption. We estimate economically small health impacts, albeit with limited precision. PMID:25170174

Excluded Facility Financial Status and Options for Payment System Modification

PubMed Central

Schneider, John E.; Cromwell, Jerry; McGuire, Thomas P.

1993-01-01

Psychiatric, rehabilitation, long-term care, and children's facilities have remained under the reimbursement system established under the Tax Equity and Fiscal Responsibility Act (TEFRA) of 1982 (Public Law 97-248). The number of TEFRA facilities and discharges has been increasing while their average profit rates have been steadily declining. Modifying TEFRA would require either rebasing the target amount or adjusting cost sharing for facilities exceeding their cost target. Based on our simulations of alternative payment systems, we recommend rebasing facilities' target amounts using a 50/50 blend of own costs and national average costs. Cost sharing above the target amount could be increased to include more government sharing of losses. PMID:10135345

42 CFR 414.904 - Average sales price as the basis for payment.

Code of Federal Regulations, 2011 CFR

2011-10-01

... for Drugs and Biologicals Under Part B § 414.904 Average sales price as the basis for payment. (a... biologicals furnished in 2005, the payment for such drugs and biologicals, including erythropoietin, furnished...) of this section, the payment for drugs and biologicals, furnished to an end-stage renal disease...

A Comparison of Ambulatory Surgery Center Production Costs and Medicare Payments: Evidence on Colonoscopy and Endoscopy.

PubMed

Mitchell, Jean M; Carey, Kathleen

2016-02-01

Ambulatory surgery centers (ASCs) are freestanding facilities that specialize in surgical and diagnostic procedures that do not require an overnight stay. While it is generally assumed that ASCs are less costly than hospital outpatient surgery departments, there is sparse empirical evidence regarding their relative production costs. To estimate ASC production costs using financial and claims records for procedures performed by surgery centers that specialize in gastroenterology procedures (colonoscopy and endoscopy). We estimate production costs in ASCs that specialize in gastroenterology procedures using financial cost and patient discharge data from Pennsylvania for the time period 2004-2013. We focus on the 2 primary procedures (colonoscopies and endoscopies) performed at each ASC. We use our estimates to predict average costs for each procedure and then compare predicted costs to Medicare ACS payments for these procedures. Comparisons of the costs of each procedure with 2013 national Medicare ASC payment rates suggest that Medicare payments exceed production costs for both colonoscopy and endoscopy. This study demonstrated that it is feasible to estimate production costs for procedures performed in freestanding surgery centers. The procedure-specific cost estimates can then be compared with ASC payment rates to ascertain if payments are aligned with costs. This approach can serve as an evaluation template for CMS and private insurers who are concerned that ASC facility payments for specific procedures may be excessive.

Effects of Medicare payment reform: evidence from the home health interim and prospective payment systems.

PubMed

Huckfeldt, Peter J; Sood, Neeraj; Escarce, José J; Grabowski, David C; Newhouse, Joseph P

2014-03-01

Medicare continues to implement payment reforms that shift reimbursement from fee-for-service toward episode-based payment, affecting average and marginal payment. We contrast the effects of two reforms for home health agencies. The home health interim payment system in 1997 lowered both types of payment; our conceptual model predicts a decline in the likelihood of use and costs, both of which we find. The home health prospective payment system in 2000 raised average but lowered marginal payment with theoretically ambiguous effects; we find a modest increase in use and costs. We find little substantive effect of either policy on readmissions or mortality. Copyright © 2014 Elsevier B.V. All rights reserved.

Effects of Medicare Payment Reform: Evidence from the Home Health Interim and Prospective Payment Systems

PubMed Central

Huckfeldt, Peter J; Sood, Neeraj; Escarce, José J; Grabowski, David C; Newhouse, Joseph P

2014-01-01

Medicare continues to implement payment reforms that shift reimbursement from fee-for-service towards episode-based payment, affecting average and marginal payment. We contrast the effects of two reforms for home health agencies. The Home Health Interim Payment System in 1997 lowered both types of payment; our conceptual model predicts a decline in the likelihood of use and costs, both of which we find. The Home Health Prospective Payment System in 2000 raised average but lowered marginal payment with theoretically ambiguous effects; we find a modest increase in use and costs. We find little substantive effect of either policy on readmissions or mortality. PMID:24395018

42 CFR 495.308 - Net average allowable costs as the basis for determining the incentive payment.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 5 2010-10-01 2010-10-01 false Net average allowable costs as the basis for... Net average allowable costs as the basis for determining the incentive payment. (a) The first year of payment. (1) The incentive is intended to offset the costs associated with the initial adoption...

Payment system reform: one state's journey.

PubMed

Millwee, Billy; Goldfield, Norbert; Averill, Richard; Hughes, John

2013-01-01

In June 2011, Texas enacted Senate Bill 7, which mandates a Medicaid quality-based outcomes payment program on the basis of a common set of outcomes that apply to all types of provider systems including hospitals, managed care plans, medical homes, managed long-term care plans, and Accountable Care Organizations. The quality-based outcome measures focus on potentially preventable events (services) such as preventable admissions and readmissions that result in unnecessary expense, patient inconvenience, and risk of complications. The payment adjustments relate to a provider system's effectiveness in reducing the rate at which potentially preventable events occur. The program envisioned by Texas Medicaid is one that is administratively simple, establishes the right financial incentives to drive delivery system improvement, and does not intrude on the provider practice or the patient. Rather than imposing a series of processes that must be followed or require rigid adherence to standardized protocols, the payment adjustments are based on risk-adjusted comparisons of the rate of potentially preventable events for an individual provider systems to an empirically derived performance standard such as the state average. This article proposes a payment system design that can meet the ambitious objectives of the Texas legislation.

Informal cash payments for birth in Hungary: Are women paying to secure a known provider, respect, or quality of care?

PubMed

Baji, Petra; Rubashkin, Nicholas; Szebik, Imre; Stoll, Kathrin; Vedam, Saraswathi

2017-09-01

In Central and Eastern Europe, many women make informal cash payments to ensure continuity of provider, i.e., to have a "chosen" doctor who provided their prenatal care, be present for birth. High rates of obstetric interventions and disrespectful maternity care are also common to the region. No previous study has examined the associations among informal payments, intervention rates, and quality of maternity care. We distributed an online cross-sectional survey in 2014 to a nationally representative sample of Hungarian internet-using women (N = 600) who had given birth in the last 5 years. The survey included items related to socio-demographics, type of provider, obstetric interventions, and experiences of care. Women reported if they paid informally, and how much. We built a two-part model, where a bivariate probit model was used to estimate conditional probabilities of women paying informally, and a GLM model to explore the amount of payments. We calculated marginal effects of the covariates (provider choice, interventions, respectful care). Many more women (79%) with a chosen doctor paid informally (191 euros on average) compared to 17% of women without a chosen doctor (86 euros). Based on regression analysis, the chosen doctor's presence at birth was the principal determinant of payment. Intervention and procedure rates were significantly higher for women with a chosen doctor versus without (cesareans 45% vs. 33%; inductions 32% vs. 19%; episiotomy 75% vs. 62%; epidural 13% vs. 5%), but had no direct effect on payments. Half of the sample (42% with a chosen doctor, 62% without) reported some form of disrespectful care, but this did not reduce payments. Despite reporting disrespect and higher rates of interventions, women rewarded the presence of a chosen doctor with informal payments. They may be unaware of evidence-based standards, and trust that their chosen doctor provided high quality maternity care. Copyright © 2017 Elsevier Ltd. All rights reserved.

42 CFR 412.503 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-10-01

... from a long-term care hospital based on clinical characteristics and average resource use, for... hospital based on clinical characteristics and average resource use, for prospective payment purposes for... PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Long-Term Care...

42 CFR 412.503 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... from a long-term care hospital based on clinical characteristics and average resource use, for... hospital based on clinical characteristics and average resource use, for prospective payment purposes for... PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Long-Term Care...

42 CFR 412.503 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... from a long-term care hospital based on clinical characteristics and average resource use, for... hospital based on clinical characteristics and average resource use, for prospective payment purposes for... PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Long-Term Care...

42 CFR 412.503 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... from a long-term care hospital based on clinical characteristics and average resource use, for... hospital based on clinical characteristics and average resource use, for prospective payment purposes for... PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Long-Term Care...

Bundled payment initiatives for Medicare and non-Medicare total joint arthroplasty patients at a community hospital: bundles in the real world.

PubMed

Doran, James P; Zabinski, Stephen J

2015-03-01

In the setting of current United States healthcare reform, bundled payment initiatives and episode of care payment models for total joint arthroplasty (TJA) have become increasingly common. The following is a review of our results and experience in a community hospital with bundled payment initiatives for both non-Medicare and Medicare TJA patients since 2011. We have successfully decreased the cost of the TJA episode of care in comparison to our historical averages prior to 2011. This cost-reduction has primarily been achieved through decreased length of inpatient stay, increased discharge to home rather than to skilled nursing or inpatient rehabilitation facilities, reduction in implant cost, improvement in readmission rate and migration of cases to lower cost sites of service. Copyright © 2015 Elsevier Inc. All rights reserved.

34 CFR 682.302 - Payment of special allowance on FFEL loans.

Code of Federal Regulations, 2010 CFR

2010-07-01

... State or non-profit entity's Chief Executive Officer (CEO) which— (1) Includes the name and lender... commercial paper (financial) rates in effect for each of the days in such quarter as reported by the Federal...) Determining the average of the bond equivalent rates of the quotes of the 3-month commercial paper (financial...

29 CFR 778.417 - General requirements of section 7(g).

Code of Federal Regulations, 2010 CFR

2010-07-01

... Exceptions From the Regular Rate Principles Computing Overtime Pay on the Rate Applicable to the Type of Work... overtime pay permitted in this section will not in any circumstances be seized upon as a device for avoiding payment of the minimum wage due for each hour, the requirement must be met that employee's average...

29 CFR 778.417 - General requirements of section 7(g).

Code of Federal Regulations, 2011 CFR

2011-07-01

... Exceptions From the Regular Rate Principles Computing Overtime Pay on the Rate Applicable to the Type of Work... overtime pay permitted in this section will not in any circumstances be seized upon as a device for avoiding payment of the minimum wage due for each hour, the requirement must be met that employee's average...

7 CFR 1786.27 - Definitions and rules of construction.

Code of Federal Regulations, 2014 CFR

2014-01-01

... the RE Act for an FFB loan made on or before July 2, 1986. Fees means any fees, costs or charges... either (1) in default or near default on interest or principal payments due on loans made or guaranteed...) The dollar weighted average interest rate (stated as an annual percentage rate) on a loan; (3) The...

Higher Incentive Payments in Medicare Advantage's Pay-for-Performance Program Did Not Improve Quality But Did Increase Plan Offerings.

PubMed

Layton, Timothy J; Ryan, Andrew M

2015-12-01

To evaluate the effects of the size of financial bonuses on quality of care and the number of plan offerings in the Medicare Advantage Quality Bonus Payment Demonstration. Publicly available data from CMS from 2009 to 2014 on Medicare Advantage plan quality ratings, the counties in the service area of each plan, and the benchmarks used to construct plan payments. The Medicare Advantage Quality Bonus Payment Demonstration began in 2012. Under the Demonstration, all Medicare Advantage plans were eligible to receive bonus payments based on plan-level quality scores (star ratings). In some counties, plans were eligible to receive bonus payments that were twice as large as in other counties. We used this variation in incentives to evaluate the effects of bonus size on star ratings and the number of plan offerings in the Demonstration using a differences-in-differences identification strategy. We used matching to create a comparison group of counties that did not receive double bonuses but had similar levels of the preintervention outcomes. Results from the difference-in-differences analysis suggest that the receipt of double bonuses was not associated with an increase in star ratings. In the matched sample, the receipt of double bonuses was associated with a statistically insignificant increase of +0.034 (approximately 1 percent) in the average star rating (p > .10, 95 percent CI: -0.015, 0.083). In contrast, the receipt of double bonuses was associated with an increase in the number of plans offered. In the matched sample, the receipt of double bonuses was associated with an overall increase of +0.814 plans (approximately 5.8 percent) (p < .05, 95 percent CI: 0.078, 1.549). We estimate that the double bonuses increased payments by $3.43 billion over the first 3 years of the Demonstration. At great expense to Medicare, double bonuses in the Medicare Advantage Quality Bonus Payment Demonstration were not associated with improved quality but were associated with more plan offerings. © Health Research and Educational Trust.

Comparing The Effects Of Reference Pricing And Centers-Of-Excellence Approaches To Value-Based Benefit Design.

PubMed

Zhang, Hui; Cowling, David W; Facer, Matthew

2017-12-01

Various health insurance benefit designs based on value-based purchasing have been promoted to steer patients to high-value providers, but little is known about the designs' relative effectiveness and underlying mechanisms. We compared the impact of two designs implemented by the California Public Employees' Retirement System on inpatient hospital total hip or knee replacement: a reference-based pricing design for preferred provider organizations (PPOs) and a centers-of-excellence design for health maintenance organizations (HMOs). Payment and utilization data for the procedures in the period 2008-13 were evaluated using pre-post and quasi-experimental designs at the system and health plan levels, adjusting for demographic characteristics, case-mix, and other confounders. We found that both designs prompted higher use of designated low-price high-quality facilities and reduced average replacement expenses per member at the plan and system levels. However, the designs used different routes: The reference-based pricing design reduced average replacement payments per case in PPOs by 26.7 percent in the first year, compared to HMOs, but did not lower PPO members' utilization rates. In contrast, the centers-of-excellence design lowered HMO members' utilization rates by 29.2 percent in the first year, compared to PPOs, but did not reduce HMO average replacement payments per case. The reference-based pricing design appears more suitable for reducing price variation, and the centers-of-excellence design for addressing variation in use.

The relationship of California's Medicaid reimbursement system to nurse staffing levels.

PubMed

Mukamel, Dana B; Kang, Taewoon; Collier, Eric; Harrington, Charlene

2012-10-01

Policy initiatives at the Federal and state level are aimed at increasing staffing in nursing homes. These include direct staffing standards, public reporting, and financial incentives. To examine the impact of California's Medicaid reimbursement for nursing homes which includes incentives directed at staffing. Two-stage limited-information maximum-likelihood regressions were used to model the relationship between staffing [registered nurses (RNs), licensed practical nurses, and certified nursing assistants hours per resident day] and the Medicaid payment rate, accounting for the specific structure of the payment system, endogeneity of payment and case-mix, and controlling for facility and market characteristics. A total of 927 California free-standing nursing homes in 2006. The model included facility characteristics (case-mix, size, ownership, and chain affiliation), market competition and excess demand, labor supply and wages, unemployment, and female employment. The instrumental variable for Medicaid reimbursement was the peer group payment rate for 7 geographical market areas, and the instrumental variables for resident case-mix were the average county revenues for professional therapy establishments and the percent of county population aged 65 and over. Consistent with the rate incentives and rational expectation behavior, expected nursing home reimbursement rates in 2008 were associated with increased RN staffing levels in 2006 but had no relationship with licensed practical nurse and certified nursing assistant staffing. The effect was estimated at 2 minutes per $10 increase in rate. The incentives in the Medicaid system impacted only RN staffing suggesting the need to improve the state's rate setting methodology.

7 CFR 760.4 - Normal marketings of milk.

Code of Federal Regulations, 2014 CFR

2014-01-01

... AGRICULTURE SPECIAL PROGRAMS INDEMNITY PAYMENT PROGRAMS Dairy Indemnity Payment Program Payments to Dairy... section are adjusted for any change in the daily average number of cows milked during each pay period the milk is off the market compared with the average number of cows milked daily during the base period. (d...

Financial ratios in diagnostic radiology practices: variability and trends.

PubMed

Hogan, Christopher; Sunshine, Jonathan H

2004-03-01

To evaluate variation in financial ratios for radiology practices nationwide and trends in these ratios and in payments. In 1999, the American College of Radiology surveyed radiology practices by mail. The final response rate was 66%. Weighting was used to make responses representative of all radiology practices in the United States. Self-reported financial ratios (payments, charges, accounts receivable turnover) were analyzed; 449 responses had usable data on these ratios. Comparison with results of a similar 1992 survey and combined analysis with Medicare data on billed charges provided information on trends. All measures of payment collections declined sharply from 1992 to 1999, with the gross collections rate (revenues as percentage of billed charges) decreasing from 71% to 55%. Average payment for a typical radiology service decreased approximately 4% in dollar terms or approximately 19% in inflation-adjusted terms. In 1999, nonmetropolitan practices appeared to fare better than others. Among insurers, Medicaid stood out as a low and slow payer, but neither managed care nor Medicare had a consistent effect on financial ratios. The gross collections rate varied substantially across geographic areas, as did, in an inverse pattern, the level of billed charges. One-quarter of practices had accounts receivable equal to 90 or more days of billings. The opposing geographic pattern of billed charges and gross collection rate suggests that geographic variation in the latter is driven more by variation in billed charges than by variation in payment levels. Radiologists saw a substantial decrease in the real (inflation-adjusted) value of payment per service during the 1990s. The large fraction of practices with accounts receivable of 90 or more days of billings-a level considered potentially imprudent by financial management advisors-suggests that many practices should improve financial management and that state prompt-payment laws have not had a substantial positive effect. Copyright RSNA, 2004

42 CFR 414.904 - Average sales price as the basis for payment.

Code of Federal Regulations, 2010 CFR

2010-10-01

... for Drugs and Biologicals Under Part B § 414.904 Average sales price as the basis for payment. (a... end-stage renal disease patient. (i) Effective for drugs and biologicals furnished in 2005, the payment for such drugs and biologicals, including erythropoietin, furnished to an end-stage renal disease...

77 FR 43232 - National School Lunch, Special Milk, and School Breakfast Programs, National Average Payments...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-24

... ``national average payments,'' the amount of money the Federal Government provides States for lunches... with pricing programs that elect to serve milk free to eligible children continue to receive the... during the second preceding school year were served free or at a reduced price. The higher payment level...

Implications of the Definition of an Episode of Care Used in the Comprehensive Care for Joint Replacement Model.

PubMed

Ellimoottil, Chad; Ryan, Andrew M; Hou, Hechuan; Dupree, James M; Hallstrom, Brian; Miller, David C

2017-01-01

Under the Comprehensive Care for Joint Replacement (CJR) model, hospitals are held accountable for nearly all Medicare payments that occur during the initial hospitalization until 90 days after hospital discharge (ie, the episode of care). It is not known whether unrelated expenditures resulting from this "broad" definition of an episode of care will affect participating hospitals' average episode-of-care payments. To compare the CJR program's broad definition of an episode of care with a clinically narrow definition of an episode of care. We identified Medicare claims for 23 251 patients in Michigan who were Medicare beneficiaries and who underwent joint replacement during the period from 2011 through 2013 at hospitals located in metropolitan statistical areas. Using specifications from the CJR model and the clinically narrow Hospital Compare payment measure, we constructed episodes of care and calculated 90-day episode payments. We then compared hospitals' average 90-day episode payments using the 2 definitions of an episode of care and fit linear regression models to understand whether payment differences were associated with specific hospital characteristics (average Centers for Medicare & Medicaid Services-hierarchical condition categories risk score, rural hospital status, joint replacement volume, percentage of Medicaid discharges, teaching hospital status, number of beds, percentage of joint replacements performed on African American patients, and median income of the hospital's county). We performed analyses from July 1 through October 1, 2015. The correlation and difference between average 90-day episode payments using the broad definition of an episode of care in the CJR model and the clinically narrow Hospital Compare definition of an episode of care. We identified 23 251 joint replacements (ie, episodes of care). The 90-day episode payments using the broad definition of the CJR model ranged from $17 349 to $29 465 (mean [SD] payment, $22 122 [$2600]). Episode payments were slightly lower (mean payment, $21 670) when the Hospital Compare definition was used. Both methods were strongly correlated (r = 0.99, P < .001). The average payment difference between these 2 types of episodes of care was small (mean [SD], $452 [$177]; range, $73-$1006). In our multivariable analysis, we found that the hospital characteristics examined had a minimal impact or no impact on the payment differential. The average 90-day episode payments determined by both definitions of an episode of care were strongly correlated, and there was a small payment differential for most hospitals. In the context of joint replacement bundled payments, these data suggest that hospital performance will be consistent whether a broad or clinically narrow definition of an episode of care is used.

23 CFR 140.906 - Labor costs.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 23 Highways 1 2011-04-01 2011-04-01 false Labor costs. 140.906 Section 140.906 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PAYMENT PROCEDURES REIMBURSEMENT Reimbursement for Railroad Work § 140.906 Labor costs. (a) General. (1) Salaries and wages, at actual or average rates, and...

23 CFR 140.906 - Labor costs.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 23 Highways 1 2014-04-01 2014-04-01 false Labor costs. 140.906 Section 140.906 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PAYMENT PROCEDURES REIMBURSEMENT Reimbursement for Railroad Work § 140.906 Labor costs. (a) General. (1) Salaries and wages, at actual or average rates, and...

23 CFR 140.906 - Labor costs.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 23 Highways 1 2013-04-01 2013-04-01 false Labor costs. 140.906 Section 140.906 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PAYMENT PROCEDURES REIMBURSEMENT Reimbursement for Railroad Work § 140.906 Labor costs. (a) General. (1) Salaries and wages, at actual or average rates, and...

78 FR 45178 - National School Lunch, Special Milk, and School Breakfast Programs, National Average Payments...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-26

... ``national average payments,'' the amount of money the Federal Government provides States for lunches... institutions with pricing programs that elect to serve milk free to eligible children continue to receive the... during the second preceding school year were served free or at a reduced price. The higher payment level...

76 FR 43256 - National School Lunch, Special Milk, and School Breakfast Programs, National Average Payments...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-20

... ``national average payments,'' the amount of money the Federal Government provides States for lunches... institutions with pricing programs that elect to serve milk free to eligible children continue to receive the... during the second preceding school year were served free or at a reduced price. The higher payment level...

7 CFR 1427.104 - Payment rate.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 10 2012-01-01 2012-01-01 false Payment rate. 1427.104 Section 1427.104 Agriculture... Cotton § 1427.104 Payment rate. (a) Beginning August 1, 2008 and ending July 31, 2012, the payment rate...) Beginning August 1, 2012, the payment rate for purposes of calculating payments as specified in this subpart...

7 CFR 1427.104 - Payment rate.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 10 2014-01-01 2014-01-01 false Payment rate. 1427.104 Section 1427.104 Agriculture... Cotton § 1427.104 Payment rate. (a) Beginning August 1, 2008 and ending July 31, 2012, the payment rate...) Beginning August 1, 2012, the payment rate for purposes of calculating payments as specified in this subpart...

7 CFR 1427.104 - Payment rate.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 10 2011-01-01 2011-01-01 false Payment rate. 1427.104 Section 1427.104 Agriculture... Cotton § 1427.104 Payment rate. (a) Beginning August 1, 2008 and ending July 31, 2012, the payment rate...) Beginning August 1, 2012, the payment rate for purposes of calculating payments as specified in this subpart...

7 CFR 1427.104 - Payment rate.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 10 2010-01-01 2010-01-01 false Payment rate. 1427.104 Section 1427.104 Agriculture... Cotton § 1427.104 Payment rate. (a) Beginning August 1, 2008 and ending July 31, 2012, the payment rate...) Beginning August 1, 2012, the payment rate for purposes of calculating payments as specified in this subpart...

Nonresearch Industry Payments to Radiologists: Characteristics and Associations With Regional Medical Imaging Utilization.

PubMed

Kokabi, Nima; Junn, Jacqueline C; Xing, Minzhi; Hemingway, Jennifer; Hughes, Danny R; Duszak, Richard

2017-03-01

To evaluate characteristics of nonresearch industry payments to radiologists and associations with regional diagnostic imaging utilization. Using 2014 CMS Open Payment data, all disclosed nonresearch-related industry payments to radiologists were identified. Health Resources and Services Administration Area Health Resources Files were used to identify actual and population-weighted numbers of radiologists by state. Utilizing the 5% random beneficiary sample CMS Research Identifiable Files from 2014, average Medicare imaging spending per beneficiary in each state was calculated. Average frequency and dollar amounts of nonresearch nonroyalty payments to radiologists were calculated at the state level. Using the Pearson correlation coefficient, the relationship between frequency and amounts of nonresearch payments to radiologists versus per-beneficiary Medicare imaging spending was evaluated at the state level. Overall, 2,008 radiologists (1,670 diagnostic, 338 interventional) received nonresearch nonroyalty payments from industry, representing 5.2% of all 38,857 radiologists nationwide. A total of 4,975 individual transfers translated to 2.5 ± 1.3 discrete payments per receiving radiologist with a mean of $432 ± $1,976 (median $26; range $1-$34,050). Food and beverage expenses constituted the vast majority of disclosed transfers (4,111; 83%), followed by travel and lodging (444; 9%), consulting fees (279; 6%), and educational expenses (51; 1%). Considerable geographic variation in payments was observed, ranging from 0% of radiologists in Vermont to 12.9% in the District of Columbia. No correlation was identified between average per-beneficiary Medicare imaging spending and the proportion of nonresearch-funded radiologists in each state (r = 0.06). Similarly, no correlation was identified between average per-beneficiary Medicare imaging spending and the average nonresearch transfer amount to radiologists in each state (r = -0.08). In 2014, only a small minority of United States radiologists received nonresearch payments from industry. At the state level, medical imaging utilization does not seem to be influenced by such financial relationships. Copyright © 2016. Published by Elsevier Inc.

42 CFR 447.255 - Related information.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Related information. 447.255 Section 447.255 Public... Facility Services Payment Rates § 447.255 Related information. The Medicaid agency must submit, with the assurances described in § 447.253(a), the following information: (a) The amount of the estimated average...

7 CFR 1430.607 - Rate of payment and limitations on funding.

Code of Federal Regulations, 2010 CFR

2010-01-01

... August 2005 and October 2005 when the hurricane disasters occurred. (2) Louisiana—$16.47 per... August 2005 and September 2005 when the hurricane disasters occurred. (3) Alabama, Arkansas, Georgia and... hurricane-related disaster (not a monthly average for any one month), are greater than 20 percent of the...

7 CFR 1430.607 - Rate of payment and limitations on funding.

Code of Federal Regulations, 2011 CFR

2011-01-01

... August 2005 and October 2005 when the hurricane disasters occurred. (2) Louisiana—$16.47 per... August 2005 and September 2005 when the hurricane disasters occurred. (3) Alabama, Arkansas, Georgia and... hurricane-related disaster (not a monthly average for any one month), are greater than 20 percent of the...

7 CFR 1430.607 - Rate of payment and limitations on funding.

Code of Federal Regulations, 2013 CFR

2013-01-01

... August 2005 and October 2005 when the hurricane disasters occurred. (2) Louisiana—$16.47 per... August 2005 and September 2005 when the hurricane disasters occurred. (3) Alabama, Arkansas, Georgia and... hurricane-related disaster (not a monthly average for any one month), are greater than 20 percent of the...

7 CFR 1430.607 - Rate of payment and limitations on funding.

Code of Federal Regulations, 2012 CFR

2012-01-01

... August 2005 and October 2005 when the hurricane disasters occurred. (2) Louisiana—$16.47 per... August 2005 and September 2005 when the hurricane disasters occurred. (3) Alabama, Arkansas, Georgia and... hurricane-related disaster (not a monthly average for any one month), are greater than 20 percent of the...

7 CFR 1430.607 - Rate of payment and limitations on funding.

Code of Federal Regulations, 2014 CFR

2014-01-01

... August 2005 and October 2005 when the hurricane disasters occurred. (2) Louisiana—$16.47 per... August 2005 and September 2005 when the hurricane disasters occurred. (3) Alabama, Arkansas, Georgia and... hurricane-related disaster (not a monthly average for any one month), are greater than 20 percent of the...

Contrary to cost-shift theory, lower Medicare hospital payment rates for inpatient care lead to lower private payment rates.

PubMed

White, Chapin

2013-05-01

Many policy makers believe that when Medicare constrains its payment rates for hospital inpatient care, private insurers end up paying higher rates as a result. I tested this "cost-shifting" theory using a unique new data set that combines MarketScan private claims data with Medicare hospital cost reports. Contrary to the theory, I found that hospital markets with relatively slow growth in Medicare inpatient hospital payment rates also had relatively slow growth in private hospital payment rates during 1995-2009. Using regression analyses, I found that a 10 percent reduction in Medicare payment rates led to an estimated reduction in private payment rates of 3 percent or 8 percent, depending on the statistical model used. These payment rate spillovers may reflect an effort by hospitals to rein in their operating costs in the face of lower Medicare payment rates. Alternatively, hospitals facing cuts in Medicare payment rates may also cut the payment rates they seek from private payers to attract more privately insured patients. My findings indicate that repealing cuts in Medicare payment rates would not slow the growth in spending on hospital care by private insurers and would in fact be likely to accelerate the growth in private insurers' costs and premiums.

42 CFR 416.172 - Adjustments to national payment rates.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 3 2014-10-01 2014-10-01 false Adjustments to national payment rates. 416.172... Adjustments to national payment rates. (a) General rule. Contractors adjust the payment rates established for...; or (2) The geographically adjusted payment rate determined under this subpart. (c) Geographic...

42 CFR 416.172 - Adjustments to national payment rates.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 3 2012-10-01 2012-10-01 false Adjustments to national payment rates. 416.172... Adjustments to national payment rates. (a) General rule. Contractors adjust the payment rates established for...; or (2) The geographically adjusted payment rate determined under this subpart. (c) Geographic...

Medicaid payment rates, case-mix reimbursement, and nursing home staffing--1996-2004.

PubMed

Feng, Zhanlian; Grabowski, David C; Intrator, Orna; Zinn, Jacqueline; Mor, Vincent

2008-01-01

We examined the impact of state Medicaid payment rates and case-mix reimbursement on direct care staffing levels in US nursing homes. We used a recent time series of national nursing home data from the Online Survey Certification and Reporting system for 1996-2004, merged with annual state Medicaid payment rates and case-mix reimbursement information. A 5-category response measure of total staffing levels was defined according to expert recommended thresholds, and examined in a multinomial logistic regression model. Facility fixed-effects models were estimated separately for Registered Nurse (RN), Licensed Practical Nurse (LPN), and Certified Nurse Aide (CNA) staffing levels measured as average hours per resident day. Higher Medicaid payment rates were associated with increases in total staffing levels to meet a higher recommended threshold. However, these gains in overall staffing were accompanied by a reduction of RN staffing and an increase in both LPN and CNA staffing levels. Under case-mix reimbursement, the likelihood of nursing homes achieving higher recommended staffing thresholds decreased, as did levels of professional staffing. Independent of the effects of state, market, and facility characteristics, there was a significant downward trend in RN staffing and an upward trend in both LPN and CNA staffing. Although overall staffing may increase in response to more generous Medicaid reimbursement, it may not translate into improvements in the skill mix of staff. Adjusting for reimbursement levels and resident acuity, total staffing has not increased after the implementation of case-mix reimbursement.

A risk-based prospective payment system that integrates patient, hospital and national costs.

PubMed

Siegel, C; Jones, K; Laska, E; Meisner, M; Lin, S

1992-05-01

We suggest that a desirable form for prospective payment for inpatient care is hospital average cost plus a linear combination of individual patient and national average cost. When the coefficients are chosen to minimize mean squared error loss between payment and costs, the payment has efficiency and access incentives. The coefficient multiplying patient costs is a hospital specific measure of financial risk of the patient. Access is promoted since providers receive higher reimbursements for risky, high cost patients. Historical cost data can be used to obtain estimates of payment parameters. The method is applied to Medicare data on psychiatric inpatients.

7 CFR 760.1308 - Payment rate.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 7 2012-01-01 2012-01-01 false Payment rate. 760.1308 Section 760.1308 Agriculture... Payment rate. (a) A national per-hundredweight payment rate will be calculated by dividing the available... multiplying the payment rate determined in paragraph (a) of this section by the dairy producer's share in the...

7 CFR 760.1308 - Payment rate.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 7 2011-01-01 2011-01-01 false Payment rate. 760.1308 Section 760.1308 Agriculture... Payment rate. (a) A national per-hundredweight payment rate will be calculated by dividing the available... multiplying the payment rate determined in paragraph (a) of this section by the dairy producer's share in the...

7 CFR 760.1308 - Payment rate.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 7 2014-01-01 2014-01-01 false Payment rate. 760.1308 Section 760.1308 Agriculture... Payment rate. (a) A national per-hundredweight payment rate will be calculated by dividing the available... multiplying the payment rate determined in paragraph (a) of this section by the dairy producer's share in the...

7 CFR 760.1308 - Payment rate.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 7 2010-01-01 2010-01-01 false Payment rate. 760.1308 Section 760.1308 Agriculture... Payment rate. (a) A national per-hundredweight payment rate will be calculated by dividing the available... multiplying the payment rate determined in paragraph (a) of this section by the dairy producer's share in the...

Impact of universal medical insurance system on the accessibility of medical service supply and affordability of patients in China

PubMed Central

Zhang, Zhiguo; Ren, Jing; Zhang, Jie; Pan, Xiaoyun; Zhang, Liang; Jin, Si

2018-01-01

Background China’s universal medical insurance system (UMIS) is designed to promote social fairness through improving access to medical services and reducing out-of-pocket (OOP) costs for all Chinese. However, it is still not known whether UMIS has a significant impact on the accessibility of medical service supply and the affordability, as well as the seeking-care choice, of patients in China. Methods Segmented time-series regression analysis, as a powerful statistical method of interrupted time series design, was used to estimate the changes in the quantity and quality of medical service supply before and after the implementation of UMIS. The rates of catastrophic payments and seeking-care choices for UMIS beneficiaries were selected to measure the affordability and medical service flow of patients after the implementation of UMIS. Results China’s UMIS was established in 2008. After that, the trending increase of the expenditure of the UMIS was higher than that of increase in revenue compared to previous years. Up to 2014, the UMIS had covered 97.5% of the entire population in China. After introduction of the UMIS, there were significant increases in licensed physicians, nurses, and hospital beds per 1000 individuals. In addition, hospital outpatient visits and inpatient visits per year increased compared to the pre-UMIS period. The average fatality rate of inpatients in the overall hospital and general hospital and the average fatality rate due to acute myocardial infarction (AMI) in general hospitals was significantly decreased. In contrast, no significant and prospective changes were observed in rural physicians per 1000 individuals, inpatient visits and inpatient fatality rate in the community centers and township hospitals compared to the pre-UMIS period. After 2008, the rates of catastrophic payments for UMIS inpatients at different income levels were declining at three levels of hospitals. Whichever income level, the rate of catastrophic payments for inpatients of Urban Employee’s Basic Medical Insurance was the lowest. For the low-income patients, a single hospitalization at a tertiary hospital can lead to catastrophic payments. It is needless to say what the economic burden could be if patients required multiple hospitalizations within a year. UMIS beneficiaries showed the intention of growth to seek hospitalization services in tertiary hospitals. Conclusions Introduction of the UMIS contributed to an increase in available medical services and the use thereof, and a decrease in fatality rate. The affordability of UMIS beneficiaries for medical expenses was successfully ameliorated. The differences in patients’ affordability are mainly manifested in different medical insurance schemes and different seeking-care choices. The ability of the poor patients covered by UMIS to resist catastrophic medical payments is still relatively weak. Therefore, the current UMIS should reform the insurance payment model to promote the integration of medical services and the formation of a tiered treatment system. UMIS also should establish supplementary medical insurance packages for the poor. PMID:29513712

Impact of universal medical insurance system on the accessibility of medical service supply and affordability of patients in China.

PubMed

Xiong, Xiaolei; Zhang, Zhiguo; Ren, Jing; Zhang, Jie; Pan, Xiaoyun; Zhang, Liang; Gong, Shiwei; Jin, Si

2018-01-01

China's universal medical insurance system (UMIS) is designed to promote social fairness through improving access to medical services and reducing out-of-pocket (OOP) costs for all Chinese. However, it is still not known whether UMIS has a significant impact on the accessibility of medical service supply and the affordability, as well as the seeking-care choice, of patients in China. Segmented time-series regression analysis, as a powerful statistical method of interrupted time series design, was used to estimate the changes in the quantity and quality of medical service supply before and after the implementation of UMIS. The rates of catastrophic payments and seeking-care choices for UMIS beneficiaries were selected to measure the affordability and medical service flow of patients after the implementation of UMIS. China's UMIS was established in 2008. After that, the trending increase of the expenditure of the UMIS was higher than that of increase in revenue compared to previous years. Up to 2014, the UMIS had covered 97.5% of the entire population in China. After introduction of the UMIS, there were significant increases in licensed physicians, nurses, and hospital beds per 1000 individuals. In addition, hospital outpatient visits and inpatient visits per year increased compared to the pre-UMIS period. The average fatality rate of inpatients in the overall hospital and general hospital and the average fatality rate due to acute myocardial infarction (AMI) in general hospitals was significantly decreased. In contrast, no significant and prospective changes were observed in rural physicians per 1000 individuals, inpatient visits and inpatient fatality rate in the community centers and township hospitals compared to the pre-UMIS period. After 2008, the rates of catastrophic payments for UMIS inpatients at different income levels were declining at three levels of hospitals. Whichever income level, the rate of catastrophic payments for inpatients of Urban Employee's Basic Medical Insurance was the lowest. For the low-income patients, a single hospitalization at a tertiary hospital can lead to catastrophic payments. It is needless to say what the economic burden could be if patients required multiple hospitalizations within a year. UMIS beneficiaries showed the intention of growth to seek hospitalization services in tertiary hospitals. Introduction of the UMIS contributed to an increase in available medical services and the use thereof, and a decrease in fatality rate. The affordability of UMIS beneficiaries for medical expenses was successfully ameliorated. The differences in patients' affordability are mainly manifested in different medical insurance schemes and different seeking-care choices. The ability of the poor patients covered by UMIS to resist catastrophic medical payments is still relatively weak. Therefore, the current UMIS should reform the insurance payment model to promote the integration of medical services and the formation of a tiered treatment system. UMIS also should establish supplementary medical insurance packages for the poor.

A Retrospective, Cost-minimization Analysis of Disposable and Traditional Negative Pressure Wound Therapy Medicare Paid Claims

PubMed

Delhougne, Gary; Hogan, Christopher; Tarka, Kim; Nair, Sunitha

2018-01-01

Traditional negative pressure wound therapy (NPWT) systems are considered durable. The pump is designed for use by numerous patients over a period of several years. Recently developed smaller, disposable devices are designed for single-patient use. A retrospective analysis of 2012-2014 national Medicare claims data was used to examine payments associated with the use of traditional and disposable NPWT systems. Data extracted included NPWT episodes from the Limited Data Set Standard Analytic Files including the 5% sample for traditional NPWT and 100% sample for disposable NPWT. NPWT episodes were identified using claim service dates and billing codes. Mean costs per episode were compared and analyzed using chi-squared tests for comparisons between patients who received traditional and those who used disposable NPWT. For continuous variables, statistical significance was assessed using Mann-Whitney U tests. The data included traditional (n = 2938; mean age 66.6 years) and disposable (n = 3522; mean age 67.6 years) episodes for the 2 NPWT groups. Wound types differed for NPWT groups (P <.0001) and included surgical (1134 [39%] versus 764 [22%]), generic open (850 [29%] versus 342 [10%]), skin ulcers (561 [19%] versus 1301 [37%]), diabetic ulcers (240 [8%] versus 342 [10%]), and circulatory system wounds (105 [4%] versus 563 [16%]). Average payment amounts were $4650 ± $2782 for traditional and $1532 ± $1767 per disposable NPWT episode (P <.0001). Payment differences were not affected by wound or comorbidity characteristics. Using the 2016 rates, average payments were $3501 for traditional and $1564 for disposable NPWT. Considering the rate of NPWT use in the United States and the results of this study suggesting substantial potential cost savings, additional analyses and cost-effectiveness studies are warranted.

Monte Carlo simulation to analyze the cost-benefit of radioactive seed localization versus wire localization for breast-conserving surgery in fee-for-service health care systems compared with accountable care organizations.

PubMed

Loving, Vilert A; Edwards, David B; Roche, Kevin T; Steele, Joseph R; Sapareto, Stephen A; Byrum, Stephanie C; Schomer, Donald F

2014-06-01

In breast-conserving surgery for nonpalpable breast cancers, surgical reexcision rates are lower with radioactive seed localization (RSL) than wire localization. We evaluated the cost-benefit of switching from wire localization to RSL in two competing payment systems: a fee-for-service (FFS) system and a bundled payment system, which is typical for accountable care organizations. A Monte Carlo simulation was developed to compare the cost-benefit of RSL and wire localization. Equipment utilization, procedural workflows, and regulatory overhead differentiate the cost between RSL and wire localization. To define a distribution of possible cost scenarios, the simulation randomly varied cost drivers within fixed ranges determined by hospital data, published literature, and expert input. Each scenario was replicated 1000 times using the pseudorandom number generator within Microsoft Excel, and results were analyzed for convergence. In a bundled payment system, RSL reduced total health care cost per patient relative to wire localization by an average of $115, translating into increased facility margin. In an FFS system, RSL reduced total health care cost per patient relative to wire localization by an average of $595 but resulted in decreased facility margin because of fewer surgeries. In a bundled payment system, RSL results in a modest reduction of cost per patient over wire localization and slightly increased margin. A fee-for-service system suffers moderate loss of revenue per patient with RSL, largely due to lower reexcision rates. The fee-for-service system creates a significant financial disincentive for providers to use RSL, although it improves clinical outcomes and reduces total health care costs.

42 CFR 414.904 - Average sales price as the basis for payment.

Code of Federal Regulations, 2014 CFR

2014-10-01

... subsection (c), the term billing unit means the identifiable quantity associated with a billing and payment code, as established by CMS. (c) Single source drugs—(1) Average sales price. The average sales price... report as required by section 623(c) of the Medicare Prescription Drug, Improvement, and Modernization...

42 CFR 414.904 - Average sales price as the basis for payment.

Code of Federal Regulations, 2012 CFR

2012-10-01

... subsection (c), the term billing unit means the identifiable quantity associated with a billing and payment code, as established by CMS. (c) Single source drugs—(1) Average sales price. The average sales price... report as required by section 623(c) of the Medicare Prescription Drug, Improvement, and Modernization...

7 CFR 634.27 - Cost-share payment.

Code of Federal Regulations, 2010 CFR

2010-01-01

... AGRICULTURE LONG TERM CONTRACTING RURAL CLEAN WATER PROGRAM Participant RCWP Contracts § 634.27 Cost-share... essential for meeting the water quality objectives in the project area. (c) Basis for cost-share payment. (1...) Average cost, or (ii) Actual cost not to exceed average cost. (2) If the average cost at the time of...

7 CFR 634.27 - Cost-share payment.

Code of Federal Regulations, 2014 CFR

2014-01-01

... AGRICULTURE LONG TERM CONTRACTING RURAL CLEAN WATER PROGRAM Participant RCWP Contracts § 634.27 Cost-share... essential for meeting the water quality objectives in the project area. (c) Basis for cost-share payment. (1...) Average cost, or (ii) Actual cost not to exceed average cost. (2) If the average cost at the time of...

7 CFR 634.27 - Cost-share payment.

Code of Federal Regulations, 2013 CFR

2013-01-01

... AGRICULTURE LONG TERM CONTRACTING RURAL CLEAN WATER PROGRAM Participant RCWP Contracts § 634.27 Cost-share... essential for meeting the water quality objectives in the project area. (c) Basis for cost-share payment. (1...) Average cost, or (ii) Actual cost not to exceed average cost. (2) If the average cost at the time of...

7 CFR 634.27 - Cost-share payment.

Code of Federal Regulations, 2011 CFR

2011-01-01

... AGRICULTURE LONG TERM CONTRACTING RURAL CLEAN WATER PROGRAM Participant RCWP Contracts § 634.27 Cost-share... essential for meeting the water quality objectives in the project area. (c) Basis for cost-share payment. (1...) Average cost, or (ii) Actual cost not to exceed average cost. (2) If the average cost at the time of...

7 CFR 634.27 - Cost-share payment.

Code of Federal Regulations, 2012 CFR

2012-01-01

... AGRICULTURE LONG TERM CONTRACTING RURAL CLEAN WATER PROGRAM Participant RCWP Contracts § 634.27 Cost-share... essential for meeting the water quality objectives in the project area. (c) Basis for cost-share payment. (1...) Average cost, or (ii) Actual cost not to exceed average cost. (2) If the average cost at the time of...

Bulgaria health system review.

PubMed

Dimova, Antoniya; Rohova, Maria; Moutafova, Emanuela; Atanasova, Elka; Koeva, Stefka; Panteli, Dimitra; van Ginneken, Ewout

2012-01-01

In the last 20 years, demographic development in Bulgaria has been characterized by population decline, a low crude birth rate, a low fertility rate, a high mortality rate and an ageing population. A stabilizing political situation since the early 2000s and an economic upsurge since the mid-2000s were important factors in the slight increase of the birth and fertility rates and the slight decrease in standardized death rates. In general, Bulgaria lags behind European Union (EU) averages in most mortality and morbidity indicators. Life expectancy at birth reached 73.3 years in 2008 with the main three causes of death being diseases of the circulatory system, malignant neoplasms and diseases of the respiratory system. One of the most important risk factors overall is smoking, and the average standardized death rate for smoking-related causes in 2008 was twice as high as the EU15 average. The Bulgarian health system is characterized by limited statism. The Ministry of Health is responsible for national health policy and the overall organization and functioning of the health system and coordinates with all ministries with relevance to public health. The key players in the insurance system are the insured individuals, the health care providers and the third party payers, comprising the National Health Insurance Fund, the single payer in the social health insurance (SHI) system, and voluntary health insurance companies (VHICs). Health financing consists of a publicprivate mix. Health care is financed from compulsory health insurance contributions, taxes, outofpocket (OOP) payments, voluntary health insurance (VHI) premiums, corporate payments, donations, and external funding. Total health expenditure (THE) as a share of gross domestic product (GDP) increased from 5.3% in 1995 to 7.3% in 2008. At the latter date it consisted of 36.5% OOP payments, 34.8% SHI, 13.6% Ministry of Health expenditure, 9.4% municipality expenditure and 0.3% VHI. Informal payments in the health sector represent a substantial part of total OOP payments (47.1% in 2006). The health system is economically unstable and health care establishments, most notably hospitals, are suffering from underfunding. Planning of outpatient health care is based on a territorial principle. Investment for state and municipal health establishments is financed from the state or municipal share in the establishments capital. In the first quarter of 2009, health workers accounted for 4.9% of the total workforce. Compared to other countries, the relative number of physicians and dentists is particularly high but the relative number of nurses remains well below the EU15, EU12 and EU27 averages. Bulgaria is faced with increased professional mobility, which is becoming particularly challenging. There is an oversupply of acute care beds and an undersupply of longterm care and rehabilitation services. Health care reforms after 1989 focused predominantly on ambulatory care and the restructuring of the hospital sector is still pending on the government agenda. Citizens as well as medical professionals are dissatisfied with the health care system and equity is a challenge not only because of differences in health needs, but also because of socioeconomic disparities and territorial imbalances. The need for further reform is pronounced, particularly in view of the low health status of the population. Structural reforms and increased competitiveness in the system as well as an overall support of reform concepts and measures are prerequisites for successful progress. World Health Organization 2012, on behalf of the European Observatory on health systems and Policies.

38 CFR 21.9640 - Rates of payment of educational assistance.

Code of Federal Regulations, 2010 CFR

2010-07-01

... the institution of higher learning (converted into United States dollars); or (2) The average (i.e... percent) and who— (1) Is enrolled at an institution of higher learning located in the United States, or at... amount for established charges paid directly to the institution of higher learning for the entire quarter...

7 CFR 993.159 - Payments for services performed with respect to reserve tonnage prunes.

Code of Federal Regulations, 2011 CFR

2011-01-01

... (natural condition rate) for necessary services rendered by the handler in connection with such prunes so... year when the Committee recommends a reserve pool (except the Committee may extend this date by not... tonnage prunes. The Committee will compute the average industry cost for holding reserve pool prunes by...

7 CFR 993.159 - Payments for services performed with respect to reserve tonnage prunes.

Code of Federal Regulations, 2010 CFR

2010-01-01

... (natural condition rate) for necessary services rendered by the handler in connection with such prunes so... year when the Committee recommends a reserve pool (except the Committee may extend this date by not... tonnage prunes. The Committee will compute the average industry cost for holding reserve pool prunes by...

75 FR 41796 - National School Lunch, Special Milk, and School Breakfast Programs, National Average Payments...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-19

..., afterschool snacks and breakfasts served to children participating in the National School Lunch and School... Factors and to the maximum Federal reimbursement rates for lunches and afterschool snacks served to... afterschool snacks served under the National School Lunch Program are rounded down to the nearest whole cent...

42 CFR 418.306 - Determination of payment rates.

Code of Federal Regulations, 2011 CFR

2011-10-01

... year 2001, the payment rate is the payment rate in effect during the previous fiscal year increased by... payment rate is effective only for the period April 1, 2001 through September 30, 2001. For the period October 1, 2000 through March 31, 2001, the payment rate is based upon the rule under paragraph (b)(3)(iv...

42 CFR 418.306 - Determination of payment rates.

Code of Federal Regulations, 2010 CFR

2010-10-01

... year 2001, the payment rate is the payment rate in effect during the previous fiscal year increased by... payment rate is effective only for the period April 1, 2001 through September 30, 2001. For the period October 1, 2000 through March 31, 2001, the payment rate is based upon the rule under paragraph (b)(3)(iv...

42 CFR 413.337 - Methodology for calculating the prospective payment rates.

Code of Federal Regulations, 2011 CFR

2011-10-01

... excluded from the data base used to compute the Federal payment rates. In addition, allowable costs related to exceptions payments under § 413.30(f) are excluded from the data base used to compute the Federal... prospective payment rates. (a) Data used. (1) To calculate the prospective payment rates, CMS uses— (i...

42 CFR 413.337 - Methodology for calculating the prospective payment rates.

Code of Federal Regulations, 2014 CFR

2014-10-01

... excluded from the data base used to compute the Federal payment rates. In addition, allowable costs related to exceptions payments under § 413.30(f) are excluded from the data base used to compute the Federal... prospective payment rates. (a) Data used. (1) To calculate the prospective payment rates, CMS uses— (i...

42 CFR 413.337 - Methodology for calculating the prospective payment rates.

Code of Federal Regulations, 2012 CFR

2012-10-01

... excluded from the data base used to compute the Federal payment rates. In addition, allowable costs related to exceptions payments under § 413.30(f) are excluded from the data base used to compute the Federal... prospective payment rates. (a) Data used. (1) To calculate the prospective payment rates, CMS uses— (i...

7 CFR 632.31 - Cost-share payment.

Code of Federal Regulations, 2011 CFR

2011-01-01

... out the contract, the land user is indebted to the United States for the cost of the misused material... contract. The cost-share payment is to be determined by one of the following methods: (1) Average cost. (2) Actual cost but not more than the average cost. (3) Specified maximum cost. If the average cost or the...

7 CFR 632.31 - Cost-share payment.

Code of Federal Regulations, 2010 CFR

2010-01-01

... out the contract, the land user is indebted to the United States for the cost of the misused material... contract. The cost-share payment is to be determined by one of the following methods: (1) Average cost. (2) Actual cost but not more than the average cost. (3) Specified maximum cost. If the average cost or the...

7 CFR 632.31 - Cost-share payment.

Code of Federal Regulations, 2014 CFR

2014-01-01

... out the contract, the land user is indebted to the United States for the cost of the misused material... contract. The cost-share payment is to be determined by one of the following methods: (1) Average cost. (2) Actual cost but not more than the average cost. (3) Specified maximum cost. If the average cost or the...

7 CFR 632.31 - Cost-share payment.

Code of Federal Regulations, 2013 CFR

2013-01-01

... out the contract, the land user is indebted to the United States for the cost of the misused material... contract. The cost-share payment is to be determined by one of the following methods: (1) Average cost. (2) Actual cost but not more than the average cost. (3) Specified maximum cost. If the average cost or the...

7 CFR 632.31 - Cost-share payment.

Code of Federal Regulations, 2012 CFR

2012-01-01

... out the contract, the land user is indebted to the United States for the cost of the misused material... contract. The cost-share payment is to be determined by one of the following methods: (1) Average cost. (2) Actual cost but not more than the average cost. (3) Specified maximum cost. If the average cost or the...

7 CFR 760.6 - Information to be furnished.

Code of Federal Regulations, 2013 CFR

2013-01-01

... AGRICULTURE SPECIAL PROGRAMS INDEMNITY PAYMENT PROGRAMS Dairy Indemnity Payment Program Payments to Dairy... period. (d) The average number of cows milked during the base period and during each pay period in the...

7 CFR 760.6 - Information to be furnished.

Code of Federal Regulations, 2011 CFR

2011-01-01

... AGRICULTURE SPECIAL PROGRAMS INDEMNITY PAYMENT PROGRAMS Dairy Indemnity Payment Program Payments to Dairy... period. (d) The average number of cows milked during the base period and during each pay period in the...

7 CFR 760.6 - Information to be furnished.

Code of Federal Regulations, 2014 CFR

2014-01-01

... AGRICULTURE SPECIAL PROGRAMS INDEMNITY PAYMENT PROGRAMS Dairy Indemnity Payment Program Payments to Dairy... period. (d) The average number of cows milked during the base period and during each pay period in the...

7 CFR 760.6 - Information to be furnished.

Code of Federal Regulations, 2012 CFR

2012-01-01

... AGRICULTURE SPECIAL PROGRAMS INDEMNITY PAYMENT PROGRAMS Dairy Indemnity Payment Program Payments to Dairy... period. (d) The average number of cows milked during the base period and during each pay period in the...

76 FR 13292 - Medicare Program: Changes to the Hospital Outpatient Prospective Payment System and CY 2011...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-11

... Prospective Payment System and CY 2011 Payment Rates; Changes to the Ambulatory Surgical Center Payment System and CY 2011 Payment Rates; Changes to Payments to Hospitals for Graduate Medical Education Costs..., 2010, entitled ``Medicare Program: Hospital Outpatient Prospective Payment System and CY 2011 Payment...

42 CFR 413.345 - Publication of Federal prospective payment rates.

Code of Federal Regulations, 2013 CFR

2013-10-01

... RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Prospective Payment for Skilled Nursing Facilities § 413.345 Publication of Federal prospective payment rates...

42 CFR 413.345 - Publication of Federal prospective payment rates.

Code of Federal Regulations, 2010 CFR

2010-10-01

... RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Prospective Payment for Skilled Nursing Facilities § 413.345 Publication of Federal prospective payment rates...

Determinants of catastrophic health expenditure in iran.

PubMed

Abolhallaje, M; Hasani, Sa; Bastani, P; Ramezanian, M; Kazemian, M

2013-01-01

This study will provide detailed specification of those variables and determinants of unpredictable health expenditure in Iran, and the requirements to reduce extensive effects of the factors affecting households' payments for health and other goods and services inappropriately. This study aims to identify measures of fair financing of health services and determinants of fair financing contribution, regarding the required share of households that prevents their catastrophic payments. In this regard, analysis of shares of households' expenditures on main groups of goods and services in urban and rural areas and in groups of deciles in the statistics from households' expenditure surveys was applied. The growth of spending in nominal values within the years 2002-2008 was considerably high and the rate for out-of-pocket payments is nearly the same or greater than the rate for total health expenditure. In 2008, urban and rural households in average pay 6.4% and 6.35% of their total expenditure on health services. Finally three categories of determinants of unfair and catastrophic payments by households were recognized in terms of households' socio-economic status, equality/inequality conditions of the distribution of risk of financing, and economic aspects of health expenditure distribution. While extending the total share of government and prepayment sources of financing health services are considered as the simplest policy for limiting out-of-pocket payments, indicators and policies introduced in this study could also be considered important and useful for the development of health sector and easing access to health services, irrespective of health financing fairness.

Does €1 Per Prescription Make a Difference? Impact of a Capped Low-Intensity Pharmaceutical Co-Payment.

PubMed

García-Gómez, Pilar; Mora, Toni; Puig-Junoy, Jaume

2018-06-01

Increasing patient contributions and reducing the population exempt from pharmaceutical co-payment and co-insurance rates were one of the most common measures in the reforms adopted in Europe during 2010-2015. We estimated the association between the introduction of a capped co-payment of €1 per prescription and drug consumption of the publicly insured population of Catalonia (Spain). We used administrative data on monthly pharmaceutical consumption (defined daily doses [DDDs]) from January 2012 to December 2014, for a representative sample of 85,000 people. Our results showed that consumption increased in the 2 months previous to the introduction of the measure, and fell with the introduction of the 'Euro per prescription' co-payment. The average net response associated with the reform (including anticipation) was a reduction of 4.1 DDDs per person per month, representing a 6.4% reduction. The decrease in pharmaceutical consumption was larger for those individuals who had free medicines prior to the reform compared with those who already paid a co-insurance rate (9.7 vs. 1.4 DDDs per person per month). The largest reduction in DDDs per person occurred in the following groups: dermatologic drugs, antihypertensives, non-insulin antidiabetic drugs, insulin antidiabetic drugs, and laxatives. A uniform capped low co-payment may give rise to a major reduction in drug consumption to a much greater extent among those who previously had free prescriptions.

Refining Risk Adjustment for the Proposed CMS Surgical Hip and Femur Fracture Treatment Bundled Payment Program.

PubMed

Cairns, Mark A; Ostrum, Robert F; Clement, R Carter

2018-02-21

The U.S. Centers for Medicare & Medicaid Services (CMS) has been considering the implementation of a mandatory bundled payment program, the Surgical Hip and Femur Fracture Treatment (SHFFT) model. However, bundled payments without appropriate risk adjustment may be inequitable to providers and may restrict access to care for certain patients. The SHFFT proposal includes adjustment using the Diagnosis-Related Group (DRG) and geographic location. The goal of the current study was to identify and quantify patient factors that could improve risk adjustment for SHFFT bundled payments. We retrospectively reviewed a 5% random sample of Medicare data from 2008 to 2012. A total of 27,898 patients were identified who met SHFFT inclusion criteria (DRG 480, 481, and 482). Reimbursement was determined for each patient over the bundle period (the surgical hospitalization and 90 days of post-discharge care). Multivariable regression was performed to test demographic factors, comorbidities, geographic location, and specific surgical procedures for associations with reimbursement. The average reimbursement was $23,632 ± $17,587. On average, reimbursements for male patients were $1,213 higher than for female patients (p < 0.01). Younger age was also associated with higher payments; e.g., reimbursement for those ≥85 years of age averaged $2,282 ± $389 less than for those aged 65 to 69 (p < 0.01). Most comorbidities were associated with higher reimbursement, but dementia was associated with lower payments, by an average of $2,354 ± $243 (p < 0.01). Twenty-two procedure codes are included in the bundle, and patients with the 3 most common codes accounted for 98% of the cases, with average reimbursement ranging from $22,527 to $24,033. Less common procedures varied by >$20,000 in average reimbursement (p < 0.01). DRGs also showed significant differences in reimbursement (p < 0.01); e.g., DRG 480 was reimbursed by an average of $10,421 ± $543 more than DRG 482. Payments varied significantly by state (p ≤ 0.01). Risk adjustment incorporating specific comorbidities demonstrated better performance than with use of DRG alone (r = 0.22 versus 0.15). Our results suggest that the proposed SHFFT bundled payment model should use more robust risk-adjustment methods to ensure that providers are reimbursed fairly and that patients retain access to care. At a minimum, payments should be adjusted for age, comorbidities, demographic factors, geographic location, and surgical procedure.

42 CFR 405.2464 - Payment rate.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 2 2014-10-01 2014-10-01 false Payment rate. 405.2464 Section 405.2464 Public... Payment rate. (a) Determination of the payment rate for RHCs and FQHCs that are authorized to bill on the basis of reasonable cost. (1) An all-inclusive rate is determined by the MAC at the beginning of the...

Nursing cost by DRG: nursing intensity weights.

PubMed

Knauf, Robert A; Ballard, Karen; Mossman, Philip N; Lichtig, Leo K

2006-11-01

Although diagnosis-related group (DRG) reimbursement is used for Medicare and many other payors, nursing--the largest portion of hospital costs--is not specifically identified and quantified in deriving payments in any of the DRG reimbursement systems except that of New York State. In New York, nursing costs are allocated to each DRG in payment rate formulation by means of nursing intensity weights (NIWs)--relative values reflecting the quantity and types of nursing services provided to patients in each DRG. In the absence of charges for nursing services, these NIWs are derived from scores for each DRG provided by a representative panel of nurses through a modified Delphi technique. NIWs have been shown to correlate with hospitals' nursing costs per day. They are used to set cost-based payment weights, thereby avoiding compression caused by using flat cost-to-charge or cost-per-day averages for all acute and intensive care patients.

Contrary To Popular Belief, Medicaid Hospital Admissions Are Often Profitable Because Of Additional Medicare Payments.

PubMed

Stensland, Jeffrey; Gaumer, Zachary R; Miller, Mark E

2016-12-01

It is generally believed that most hospitals lose money on Medicaid admissions. The data suggest otherwise. Medicaid admissions are often profitable for hospitals because of payments from both the Medicaid program and the Medicare program, including payments for uncompensated care and from the Medicare disproportionate-share hospital program. On average, adding a single Medicaid patient day in fiscal year 2017 will increase most hospitals' Medicare payments by more than $300. When added to Medicaid payments, these payments often cause Medicaid patients to be profitable for hospitals. In contrast, adding a single charity care day in the same year will decrease overall Medicare payments by about $20 on average. The Centers for Medicare and Medicaid Services recently announced a proposal to shift some Medicare payments from supporting hospitals' costs for Medicaid patients to directly supporting their costs for uncompensated care. If that proposal is adopted, hospitals' profits on Medicaid patients would decrease, but their losses on care for the uninsured would be reduced. Project HOPE—The People-to-People Health Foundation, Inc.

7 CFR 792.4 - Demand for payment of debts.

Code of Federal Regulations, 2010 CFR

2010-01-01

..., applicable interest, costs, and other charges; (2) FSA' intent to establish an account on a debt record 30... that time; (3) The applicable late payment interest rate. (i) If a late payment interest rate is... the date from which the late payment interest has been accruing; (ii) If a late payment interest rate...

Office of the Secretary of Defense Retirement Options

DTIC Science & Technology

2014-09-01

majority of officers are male. Data for life expectancies were extrapolated from the DOD Office of the Actuary Life Expectancy Rate. This rate was...difference between the two policies is that instead of taking the final month of base pay as the retired base, it is now a mathematical average of the final...All the data for annuity payments were based on the DOD Office of the Actuary Statistical Report on the Military Retirement System Fiscal Year 2013

Variation in Payment Rates under Medicare's Inpatient Prospective Payment System.

PubMed

Krinsky, Sam; Ryan, Andrew M; Mijanovich, Tod; Blustein, Jan

2017-04-01

To measure variation in payment rates under Medicare's Inpatient Prospective Payment System (IPPS) and identify the main payment adjustments that drive variation. Medicare cost reports for all Medicare-certified hospitals, 1987-2013, and Dartmouth Atlas geographic files. We measure the Medicare payment rate as a hospital's total acute inpatient Medicare Part A payment, divided by the standard IPPS payment for its geographic area. We assess variation using several measures, both within local markets and nationally. We perform a factor decomposition to identify the share of variation attributable to specific adjustments. We also describe the characteristics of hospitals receiving different payment rates and evaluate changes in the magnitude of the main adjustments over time. Data downloaded from the Centers for Medicare and Medicaid Services, the National Bureau of Economic Research, and the Dartmouth Atlas. In 2013, Medicare paid for acute inpatient discharges at a rate 31 percent above the IPPS base. For the top 10 percent of discharges, the mean rate was double the IPPS base. Variations were driven by adjustments for medical education and care to low-income populations. The magnitude of variation has increased over time. Adjustments are a large and growing share of Medicare hospital payments, and they create significant variation in payment rates. © Health Research and Educational Trust.

Disclosure of industry payments to prescribers: industry payments might be a factor impacting generic drug prescribing.

PubMed

Qian, Jingjing; Hansen, Richard A; Surry, Daniel; Howard, Jennifer; Kiptanui, Zippora; Harris, Ilene

2017-07-01

Pharmaceutical companies paid at least $3.91bn to prescribers in 2013, yet evidence indicating whether industry payments shift prescribing away from generics is limited. This study examined the association between amount of industry payments to prescribers and generic drug prescribing rates among Medicare Part D prescribers. A cross-sectional analysis was conducted among 770 095 Medicare Part D prescribers after linking the 2013 national Open Payments data with 2013 Medicare Provider Utilization and Payment data. The exposure variable was the categorized amount of total industry payments to prescribers (i.e., meals, travel, research, and ownership). The outcome was prescriber's annual generic drug prescribing rate. Multivariable generalized linear regression models were used to examine the association between the amount of industry payments and prescriber's annual generic drug prescribing rates, controlling for prescriber's demographic and practice characteristics. In this sample, over one-third (38.0%) of Medicare Part D prescribers received industry payments in 2013. The mean annual generic drug prescribing rate was highest among prescribers receiving no payments and lowest among those receiving more than $500 of industry payments (77.5% vs. 71.3%, respectively; p < 0.001). The receipt of industry payments was independently associated with prescribers' generic drug prescribing rate; higher payments corresponded with lower generic drug prescribing rates. Other prescriber characteristics associated with higher annual generic drug prescribing rate included male sex, non-northeast region, specialty, and patient volume. Receipt of industry payments was associated with a decreased rate of generic drug prescribing. How this affects patient care and total medical costs warrants further study. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

Exploring the market for third-party-owned residential photovoltaic systems: insights from lease and power-purchase agreement contract structures and costs in California

DOE PAGES

Davidson, Carolyn; Steinberg, Daniel; Margolis, Robert

2015-02-04

We report that over the past several years, third-party-ownership (TPO) structures for residential photovoltaic (PV) systems have become the predominant ownership model in the US residential market. Under a TPO contract, the PV system host typically makes payments to the third-party owner of the system. Anecdotal evidence suggests that the total TPO contract payments made by the customer can differ significantly from payments in which the system host directly purchases the system. Furthermore, payments can vary depending on TPO contract structure. To date, a paucity of data on TPO contracts has precluded studies evaluating trends in TPO contract cost. Thismore » study relies on a sample of 1113 contracts for residential PV systems installed in 2010–2012 under the California Solar Initiative to evaluate how the timing of payments under a TPO contract impacts the ultimate cost of the system to the customer. Furthermore, we evaluate how the total cost of TPO systems to customers has changed through time, and the degree to which contract costs have tracked trends in the installed costs of a PV system. We find that the structure of the contract and the timing of the payments have financial implications for the customer: (1) power-purchase contracts, on average, cost more than leases, (2) no-money-down contracts are more costly than prepaid contracts, assuming a customer's discount rate is lower than 17% and (3) contracts that include escalator clauses cost more, for both power-purchase agreements and leases, at most plausible discount rates. Additionally, all contract costs exhibit a wide range, and do not parallel trends in installed costs over time.« less

Exploring the market for third-party-owned residential photovoltaic systems: insights from lease and power-purchase agreement contract structures and costs in California

NASA Astrophysics Data System (ADS)

Davidson, Carolyn; Steinberg, Daniel; Margolis, Robert

2015-02-01

Over the past several years, third-party-ownership (TPO) structures for residential photovoltaic (PV) systems have become the predominant ownership model in the US residential market. Under a TPO contract, the PV system host typically makes payments to the third-party owner of the system. Anecdotal evidence suggests that the total TPO contract payments made by the customer can differ significantly from payments in which the system host directly purchases the system. Furthermore, payments can vary depending on TPO contract structure. To date, a paucity of data on TPO contracts has precluded studies evaluating trends in TPO contract cost. This study relies on a sample of 1113 contracts for residential PV systems installed in 2010-2012 under the California Solar Initiative to evaluate how the timing of payments under a TPO contract impacts the ultimate cost of the system to the customer. Furthermore, we evaluate how the total cost of TPO systems to customers has changed through time, and the degree to which contract costs have tracked trends in the installed costs of a PV system. We find that the structure of the contract and the timing of the payments have financial implications for the customer: (1) power-purchase contracts, on average, cost more than leases, (2) no-money-down contracts are more costly than prepaid contracts, assuming a customer’s discount rate is lower than 17% and (3) contracts that include escalator clauses cost more, for both power-purchase agreements and leases, at most plausible discount rates. In addition, all contract costs exhibit a wide range, and do not parallel trends in installed costs over time.

Exploring the market for third-party-owned residential photovoltaic systems: insights from lease and power-purchase agreement contract structures and costs in California

DOE Office of Scientific and Technical Information (OSTI.GOV)

Davidson, Carolyn; Steinberg, Daniel; Margolis, Robert

We report that over the past several years, third-party-ownership (TPO) structures for residential photovoltaic (PV) systems have become the predominant ownership model in the US residential market. Under a TPO contract, the PV system host typically makes payments to the third-party owner of the system. Anecdotal evidence suggests that the total TPO contract payments made by the customer can differ significantly from payments in which the system host directly purchases the system. Furthermore, payments can vary depending on TPO contract structure. To date, a paucity of data on TPO contracts has precluded studies evaluating trends in TPO contract cost. Thismore » study relies on a sample of 1113 contracts for residential PV systems installed in 2010–2012 under the California Solar Initiative to evaluate how the timing of payments under a TPO contract impacts the ultimate cost of the system to the customer. Furthermore, we evaluate how the total cost of TPO systems to customers has changed through time, and the degree to which contract costs have tracked trends in the installed costs of a PV system. We find that the structure of the contract and the timing of the payments have financial implications for the customer: (1) power-purchase contracts, on average, cost more than leases, (2) no-money-down contracts are more costly than prepaid contracts, assuming a customer's discount rate is lower than 17% and (3) contracts that include escalator clauses cost more, for both power-purchase agreements and leases, at most plausible discount rates. Additionally, all contract costs exhibit a wide range, and do not parallel trends in installed costs over time.« less

42 CFR 416.171 - Determination of payment rates for ASC services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Determination of payment rates for ASC services... Determination of payment rates for ASC services. (a) Standard methodology. The standard methodology for determining the national unadjusted payment rate for ASC services is to calculate the product of the...

The Economics of Skin Cancer: An Analysis of Medicare Payment Data.

PubMed

Chen, Jenny T; Kempton, Steven J; Rao, Venkat K

2016-09-01

The incidence and cost of nonmelanoma skin cancers are skyrocketing. Five million cases cost $8.1 billion in 2011. The average cost of treatment per patient increased from $1000 in 2006 to $1600 in 2011. We present a study of the economics and costs of skin cancer management in Medicare patients. We studied data released by the Centers for Medicare and Medicaid Services in 2014. Treatment modalities for the management of skin cancer were reviewed, and costs of treatment were quantified for a sample of 880,000 providers. Review of Medicare payment records related to the management of skin cancer yielded data from over 880,000 health care providers who received $77 billion in Medicare payments in 2012. From 1992 to 2009, the rate of Mohs micrographic surgery (MMS) has increased by 700%, and these procedures typically have Medicare payments 120% to 370% more than surgical excision, even when including pathology fees. From 1992 to 2009, MMS increased by 700%, whereas surgical excisions increased by only 20%. In 2009, 1800 providers billed Medicare for MMS; in 2012, that number increased to 3209. On average, 1 in 4 cases of skin cancer is treated with MMS. Mohs excision is more expensive than surgical excision in an office setting. Procedures requiring the operating room are much more expensive than office procedures. In an era of high deductible health plans, patients' financial burden is much less with simple excisions of skin cancers done in a clinic when compared with Mohs surgery or operative interventions.

42 CFR 422.252 - Terminology.

Code of Federal Regulations, 2011 CFR

2011-10-01

... a nationally average risk profile for the factors described in § 422.308(c), and this amount is... risk profile for the risk factors CMS applies to payment calculations as set forth at § 422.308(c) of... eligible beneficiary with a nationally average risk profile for the risk factors CMS applies to payment...

38 CFR 21.9675 - Conditions that result in reduced rates or no payment.

Code of Federal Regulations, 2010 CFR

2010-07-01

... reduced rates or no payment. 21.9675 Section 21.9675 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF... Assistance § 21.9675 Conditions that result in reduced rates or no payment. The payment rates as established... the requirements for graduation. VA may pay educational assistance for a course from which the...

78 FR 39063 - Prompt Payment Interest Rate; Contract Disputes Act

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-28

... DEPARTMENT OF THE TREASURY Fiscal Service Prompt Payment Interest Rate; Contract Disputes Act..., 2013, and ending on December 31, 2013, the prompt payment interest rate is 1\\3/4\\ per centum per annum... authority to specify the rate by which the interest shall be computed for interest payments under section 12...

42 CFR 412.523 - Methodology for calculating the Federal prospective payment rates.

Code of Federal Regulations, 2010 CFR

2010-10-01

.... (4) Determining the Federal prospective payment rate for each LTC-DRG. The Federal prospective payment rate for each LTC-DRG is the product of the weighting factors described in § 412.515 and the... payment rate multiplied by the relative weight of the LTC-DRG assigned for that discharge. A hospital's...

Informal payments for healthcare services and short-term effects of the introduction of visit fee on these payments in Hungary.

PubMed

Baji, Petra; Pavlova, Milena; Gulácsi, László; Zsófia, Homolyáné Csete; Groot, Wim

2012-01-01

The objective of this paper is to study the short-term effects of the introduction of the visit fee in Hungary in 2007 on informal patient payments. We present the pattern of informal payments in primary, out-patient specialist and in in-patient care in the period before and shortly after the visit fee was introduced. We also analyse whether in the short run, the introduction of visit fee decreased the probability of paying informally. For the analysis, we use a dataset for a representative sample of 2500 respondents collected in 2007 shortly after the introduction of the visit fee, which contains data on informal payments for healthcare services. According to our results, 9% of the patients paid informally during their last visit to GP (2 Euros on average), 14% paid informally for specialist care (35 Euros on average) and 50% paid informally for hospitalisation (58 Euros on average). We find a significant reduction in the probability of paying informally only for elderly patients in case of in-patient care. Our results suggest that informal payments are widely spread in Hungary, especially in in-patient care. The short run potential of the introduction of the visit fee to reduce informal payments seems to be minor. Copyright © 2011 John Wiley & Sons, Ltd.

Medicare payment reform and provider entry and exit in the post-acute care market.

PubMed

Huckfeldt, Peter J; Sood, Neeraj; Romley, John A; Malchiodi, Alessandro; Escarce, José J

2013-10-01

To understand the impacts of Medicare payment reform on the entry and exit of post-acute providers. Medicare Provider of Services data, Cost Reports, and Census data from 1991 through 2010. We examined market-level changes in entry and exit after payment reforms relative to a preexisting time trend. We also compared changes in high Medicare share markets relative to lower Medicare share markets and for freestanding relative to hospital-based facilities. We calculated market-level entry, exit, and total stock of home health agencies, skilled nursing facilities, and inpatient rehabilitation facilities from Provider of Services files between 1992 and 2010. We linked these measures with demographic information from the Census and American Community Survey, information on Certificate of Need laws, and Medicare share of facilities in each market drawn from Cost Report data. Payment reforms reducing average and marginal payments reduced entries and increased exits from the market. Entry effects were larger and more persistent than exit effects. Entry and exit rates fluctuated more for home health agencies than skilled nursing facilities. Effects on number of providers were consistent with entry and exit effects. Payment reform affects market entry and exit, which in turn may affect market structure, access to care, quality and cost of care, and patient outcomes. Policy makers should consider potential impacts of payment reforms on post-acute care market structure when implementing these reforms. © Health Research and Educational Trust.

Medicare Payment Reform and Provider Entry and Exit in the Post-Acute Care Market

PubMed Central

Huckfeldt, Peter J; Sood, Neeraj; Romley, John A; Malchiodi, Alessandro; Escarce, José J

2013-01-01

Objective To understand the impacts of Medicare payment reform on the entry and exit of post-acute providers. Data Sources Medicare Provider of Services data, Cost Reports, and Census data from 1991 through 2010. Study Design We examined market-level changes in entry and exit after payment reforms relative to a preexisting time trend. We also compared changes in high Medicare share markets relative to lower Medicare share markets and for freestanding relative to hospital-based facilities. Data Extraction Methods We calculated market-level entry, exit, and total stock of home health agencies, skilled nursing facilities, and inpatient rehabilitation facilities from Provider of Services files between 1992 and 2010. We linked these measures with demographic information from the Census and American Community Survey, information on Certificate of Need laws, and Medicare share of facilities in each market drawn from Cost Report data. Principal Findings Payment reforms reducing average and marginal payments reduced entries and increased exits from the market. Entry effects were larger and more persistent than exit effects. Entry and exit rates fluctuated more for home health agencies than skilled nursing facilities. Effects on number of providers were consistent with entry and exit effects. Conclusions Payment reform affects market entry and exit, which in turn may affect market structure, access to care, quality and cost of care, and patient outcomes. Policy makers should consider potential impacts of payment reforms on post-acute care market structure when implementing these reforms. PMID:23557215

Medical Malpractice Claims in Radiation Oncology: A Population-Based Study 1985-2012

DOE Office of Scientific and Technical Information (OSTI.GOV)

Marshall, Deborah C.; Punglia, Rinaa S.; Fox, Dov

Purpose: The purpose of this study was to determine trends in radiation oncology malpractice claims and expenses during the last 28 years and to compare radiation oncology malpractice claims to those of other specialties. Methods and Materials: We performed a retrospective analysis of closed malpractice claims filed from 1985 to 2012, collected by a nationwide medical liability insurance trade association. We analyzed characteristics and trends among closed claims, indemnity payments (payments to plaintiff), and litigation expenses. We also compared radiation oncology malpractice claims to those of 21 other medical specialties. Time series dollar amounts were adjusted for inflation (2012 was themore » index year). Results: There were 1517 closed claims involving radiation oncology, of which 342 (22.5%) were paid. Average and median indemnity payments were $276,792 and $122,500, respectively, ranking fifth and eighth, respectively, among the 22 specialty groups. Linear regression modeling of time trends showed decreasing total numbers of claims (β = −1.96 annually, P=.003), increasing average litigation expenses paid (β = +$1472 annually, P≤.001), and no significant changes in average indemnity payments (β = −$681, P=.89). Conclusions: Medical professional liability claims filed against radiation oncologists are not common and have declined in recent years. However, indemnity payments in radiation oncology are large relative to those of many other specialties. In recent years, the average indemnity payment has been stable, whereas litigation expenses have increased.« less

42 CFR 412.332 - Payment based on the hospital-specific rate.

Code of Federal Regulations, 2010 CFR

2010-10-01

... HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Inpatient Hospital Capital Costs Determination of Transition Period Payment Rates for... (f) is determined by multiplying the applicable hospital-specific rate by the DRG weighting factor...

Adjusting health expenditure for military spending and interest payment: Israel and the OECD countries.

PubMed

Shmueli, Amir; Israeli, Avi

2013-02-20

Compared to OECD countries, Israel has a remarkably low percentage of GDP and of government expenditure spent on health, which are not reflected in worse national outcomes. Israel is also characterized by a relatively high share of GDP spent on security expenses and payment of public debt. To determine to what extent differences between Israel and the OECD countries in security expenses and payment of the public debt might account for the gaps in the percentage of GDP and of government expenditures spent on health. We compare the percentages of GDP and of government expenditures spent on health in the OECD countries with the respective percentages when using primary civilian GDP and government expenditures (i.e., when security expenses and interest payment are deducted). We compared Israel with the OECD average and examined the ranking of the OECD countries under the two measures over time. While as a percentage of GDP, the national expenditure on health in Israel was well below the average of the OECD countries, as a percentage of primary civilian GDP it was above the average until 2003 and below the average thereafter. When the OECD countries were ranked according to decreasing percent of GDP and of government expenditure spent on health, adjusting for security and debt payment expenditures changed the Israeli rank from 23rd to 17th and from 27th to 25th, respectively. Adjusting for security expenditures and interest payment, Israel's low spending on health as a percentage of GDP and as a percentage of government's spending increases and is closer to the OECD average. Further analysis should explore the effect of additional population and macroeconomic differences on the remaining gaps.

Adjusting health expenditure for military spending and interest payment: Israel and the OECD countries

PubMed Central

2013-01-01

Background Compared to OECD countries, Israel has a remarkably low percentage of GDP and of government expenditure spent on health, which are not reflected in worse national outcomes. Israel is also characterized by a relatively high share of GDP spent on security expenses and payment of public debt. Objectives To determine to what extent differences between Israel and the OECD countries in security expenses and payment of the public debt might account for the gaps in the percentage of GDP and of government expenditures spent on health. Methods We compare the percentages of GDP and of government expenditures spent on health in the OECD countries with the respective percentages when using primary civilian GDP and government expenditures (i.e., when security expenses and interest payment are deducted). We compared Israel with the OECD average and examined the ranking of the OECD countries under the two measures over time. Results While as a percentage of GDP, the national expenditure on health in Israel was well below the average of the OECD countries, as a percentage of primary civilian GDP it was above the average until 2003 and below the average thereafter. When the OECD countries were ranked according to decreasing percent of GDP and of government expenditure spent on health, adjusting for security and debt payment expenditures changed the Israeli rank from 23rd to 17th and from 27th to 25th, respectively. Conclusions Adjusting for security expenditures and interest payment, Israel's low spending on health as a percentage of GDP and as a percentage of government's spending increases and is closer to the OECD average. Further analysis should explore the effect of additional population and macroeconomic differences on the remaining gaps. PMID:23425013

A model to determine payments associated with radiology procedures.

PubMed

Mabotuwana, Thusitha; Hall, Christopher S; Thomas, Shiby; Wald, Christoph

2017-12-01

Across the United States, there is a growing number of patients in Accountable Care Organizations and under risk contracts with commercial insurance. This is due to proliferation of new value-based payment models and care delivery reform efforts. In this context, the business model of radiology within a hospital or health system context is shifting from a primary profit-center to a cost-center with a goal of cost savings. Radiology departments need to increasingly understand how the transactional nature of the business relates to financial rewards. The main challenge with current reporting systems is that the information is presented only at an aggregated level, and often not broken down further, for instance, by type of exam. As such, the primary objective of this research is to provide better visibility into payments associated with individual radiology procedures in order to better calibrate expense/capital structure of the imaging enterprise to the actual revenue or value-add to the organization it belongs to. We propose a methodology that can be used to determine technical payments at a procedure level. We use a proportion based model to allocate payments to individual radiology procedures based on total charges (which also includes non-radiology related charges). Using a production dataset containing 424,250 radiology exams we calculated the overall average technical charge for Radiology to be $873.08 per procedure and the corresponding average payment to be $326.43 (range: $48.27 for XR and $2750.11 for PET/CT) resulting in an average payment percentage of 37.39% across all exams. We describe how charges associated with a procedure can be used to approximate technical payments at a more granular level with a focus on Radiology. The methodology is generalizable to approximate payment for other services as well. Understanding payments associated with each procedure can be useful during strategic practice planning. Charge-to-total charge ratio can be used to approximate radiology payments at a procedure level. Copyright © 2017 Elsevier B.V. All rights reserved.

77 FR 76624 - Prompt Payment Interest Rate; Contract Disputes Act

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-28

... DEPARTMENT OF THE TREASURY Fiscal Service Prompt Payment Interest Rate; Contract Disputes Act... beginning January 1, 2013, and ending on June 30, 2013, the prompt payment interest rate is 1-3/8 per centum... Prompt Payment Act, 31 U.S.C. 3902(a), provide for the calculation of interest due on claims at the rate...

Financial gains and risks in pay-for-performance bonus algorithms.

PubMed

Cromwell, Jerry; Drozd, Edward M; Smith, Kevin; Trisolini, Michael

2007-01-01

Considerable attention has been given to evidence-based process indicators associated with quality of care, while much less attention has been given to the structure and key parameters of the various pay-for-performance (P4P) bonus and penalty arrangements using such measures. In this article we develop a general model of quality payment arrangements and discuss the advantages and disadvantages of the key parameters. We then conduct simulation analyses of four general P4P payment algorithms by varying seven parameters, including indicator weights, indicator intercorrelation, degree of uncertainty regarding intervention effectiveness, and initial baseline rates. Bonuses averaged over several indicators appear insensitive to weighting, correlation, and the number of indicators. The bonuses are sensitive to disease manager perceptions of intervention effectiveness, facing challenging targets, and the use of actual-to-target quality levels versus rates of improvement over baseline.

Medicare physician payment systems: impact of 2011 schedule on interventional pain management.

PubMed

Manchikanti, Laxmaiah; Singh, Vijay; Caraway, David L; Benyamin, Ramsin M; Hirsch, Joshua A

2011-01-01

Physicians in the United States have been affected by significant changes in the patterns of medical practice evolving over the last several decades. The recently passed affordable health care law, termed the Patient Protection and Affordable Care Act of 2010 (the ACA, for short) affects physicians more than any other law. Physician services are an integral part of health care. Physicians are paid in the United States for their personal services. This payment also includes the overhead expenses for maintaining an office and providing services. The payment system is highly variable in the private insurance market; however, governmental systems have a formula-based payment, mostly based on the Medicare payment system. Physician services are billed under Part B. Since the inception of the Medicare program in 1965, several methods have been used to determine the amounts paid to physicians for each covered service. Initially, the payment systems compensated physicians on the basis of their charges. In 1975, just over 10 years after the inception of the Medicare program, payments changed so as not to exceed the increase in the Medical Economic Index (MEI). Nevertheless, the policy failed to curb increases in costs, leading to the determination of a yearly change in fees by legislation from 1984 to 1991. In 1992, the fee schedule essentially replaced the prior payment system that was based on the physician's charges, which also failed to live up to expectations for operational success. Then, in 1998, the sustainable growth rate (SGR) system was introduced. In 2009, multiple attempts were made by Congress to repeal the formula - rather unsuccessfully. Consequently, the SGR formula continues to hamper physician payments. The mechanism of the SGR includes 3 components that are incorporated into a statutory formula: expenditure targets, growth rate period, and annual adjustments of payment rates for physician services. Further, the relative value of a physician fee schedule is based on 3 components: physician work, practice expense (PE), and malpractice expense that are used to determine a value ranking for each service to which it is applied. On average, the work component represents 53.5% of a service's relative value, the fee component represents 43.6%, and the malpractice component represents 3.9%. The final schedule for physician payment was issued on November 24, 2010. This was based on a total cut of 30.8% with 24.9% of the cut attributed to SGR. However, as usual, with patchwork efficiency, Congress passed a one-year extension of the 0% update, effective through December 2011. Consequently, CMS issued an emergency update of the 2011 Medicare fee schedule, with multiple revisions, resulting in a reduction of the conversion factor of $36.8729 from December 2010 to $33.9764 for 2011.

Lessons learned from the reimbursement profile of a mature private medical toxicology practice: office-based practice pays.

PubMed

Thompson, Trevonne M; Leikin, Jerrold B

2015-03-01

We previously reported the financial data for the first 5 years of one of the author's medical toxicology practice. The practice has matured; changes have been made. The practice is increasing its focus on office-based encounters and reducing hospital-based acute care encounters. We report the reimbursement rates and other financial metrics of the current practice. Financial records from October 2009 through September 2013 were reviewed. This is a period of 4 fiscal years and represents the currently available financial data. Charges, payments, and reimbursement rates were recorded according to the type and setting of the medical toxicology encounter: forensic consultations, outpatient clinic encounters, nonpsychiatric inpatient consultations, emergency department (ED) consultations, and inpatient psychiatric consultations. All patients were seen regardless of ability to pay or insurance status. The number of billed Current Procedural Terminology (CPT) codes for office-based encounters increased over the study period; the number of billed CPT codes for inpatient and ED consultations reduced. Office-based encounters demonstrate a higher reimbursement rate and higher payments. In the fiscal year (FY) of 2012, office-based revenue exceeded hospital-based acute care revenue by over $140,000 despite a higher number of billed CPT encounters in acute care settings, and outpatient payments were 2.39 times higher than inpatient, inpatient psychiatry, observation unit, and ED payments combined. The average payment per CPT code was higher for outpatient clinic encounters than inpatient encounters for each fiscal year studied. There was an overall reduction in CPT billing volume between FY 2010 and FY 2013. Despite this, there was an increase in total practice revenue. There was no change in payor mix, practice logistics, or billing/collection service company. In this medical toxicology practice, office-based encounters demonstrate higher reimbursement rates and overall payments compared to inpatient and ED consultations. While consistent with our previous studies, these differences have been accentuated. This study demonstrates the results of changes to the practice--reduced inpatient/ED consultations and increased outpatient encounters. These practice changes resulted in higher overall revenue despite a lower patient volume. In this analysis, the office-based practice of medical toxicology has higher reimbursement rates, nearly 2.5 times higher, when compared to hospital-based acute care consultations.

42 CFR 412.2 - Basis of payment.

Code of Federal Regulations, 2011 CFR

2011-10-01

... services furnished to Medicare beneficiaries. The prospective payment rate for each discharge (as defined... the election in § 405.521 of this chapter. (4) The acquisition costs of hearts, kidneys, livers, lungs... payments to hospitals. In addition to payments based on the prospective payment system rates for inpatient...

42 CFR 412.2 - Basis of payment.

Code of Federal Regulations, 2014 CFR

2014-10-01

... services furnished to Medicare beneficiaries. The prospective payment rate for each discharge (as defined... the election in § 405.521 of this chapter. (4) The acquisition costs of hearts, kidneys, livers, lungs... payments to hospitals. In addition to payments based on the prospective payment system rates for inpatient...

42 CFR 412.2 - Basis of payment.

Code of Federal Regulations, 2013 CFR

2013-10-01

... services furnished to Medicare beneficiaries. The prospective payment rate for each discharge (as defined... the election in § 405.521 of this chapter. (4) The acquisition costs of hearts, kidneys, livers, lungs... payments to hospitals. In addition to payments based on the prospective payment system rates for inpatient...

42 CFR 412.2 - Basis of payment.

Code of Federal Regulations, 2012 CFR

2012-10-01

... services furnished to Medicare beneficiaries. The prospective payment rate for each discharge (as defined... the election in § 405.521 of this chapter. (4) The acquisition costs of hearts, kidneys, livers, lungs... payments to hospitals. In addition to payments based on the prospective payment system rates for inpatient...

42 CFR 412.2 - Basis of payment.

Code of Federal Regulations, 2010 CFR

2010-10-01

... services furnished to Medicare beneficiaries. The prospective payment rate for each discharge (as defined... the election in § 405.521 of this chapter. (4) The acquisition costs of hearts, kidneys, livers, lungs... payments to hospitals. In addition to payments based on the prospective payment system rates for inpatient...

42 CFR 413.304 - Eligibility for prospectively determined payment rates.

Code of Federal Regulations, 2013 CFR

2013-10-01

...-STAGE RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Prospectively Determined Payment Rates for Low-Volume Skilled Nursing Facilities, for Cost...

42 CFR 413.304 - Eligibility for prospectively determined payment rates.

Code of Federal Regulations, 2010 CFR

2010-10-01

...-STAGE RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Prospectively Determined Payment Rates for Low-Volume Skilled Nursing Facilities, for Cost...

Patient out-of-pocket spending in cranial neurosurgery: single-institution analysis of 6569 consecutive cases and literature review.

PubMed

Yoon, Seungwon; Mooney, Michael A; Bohl, Michael A; Sheehy, John P; Nakaji, Peter; Little, Andrew S; Lawton, Michael T

2018-05-01

OBJECTIVE With drastic changes to the health insurance market, patient cost sharing has significantly increased in recent years. However, the patient financial burden, or out-of-pocket (OOP) costs, for surgical procedures is poorly understood. The goal of this study was to analyze patient OOP spending in cranial neurosurgery and identify drivers of OOP spending growth. METHODS For 6569 consecutive patients who underwent cranial neurosurgery from 2013 to 2016 at the authors' institution, the authors created univariate and multivariate mixed-effects models to investigate the effect of patient demographic and clinical factors on patient OOP spending. The authors examined OOP payments stratified into 10 subsets of case categories and created a generalized linear model to study the growth of OOP spending over time. RESULTS In the multivariate model, case categories (craniotomy for pain, tumor, and vascular lesions), commercial insurance, and out-of-network plans were significant predictors of higher OOP payments for patients (all p < 0.05). Patient spending varied substantially across procedure types, with patients undergoing craniotomy for pain ($1151 ± $209) having the highest mean OOP payments. On average, commercially insured patients spent nearly twice as much in OOP payments as the overall population. From 2013 to 2016, the mean patient OOP spending increased 17%, from $598 to $698 per patient encounter. Commercially insured patients experienced more significant growth in OOP spending, with a cumulative rate of growth of 42% ($991 in 2013 to $1403 in 2016). CONCLUSIONS Even after controlling for inflation, case-mix differences, and partial fiscal periods, OOP spending for cranial neurosurgery patients significantly increased from 2013 to 2016. The mean OOP spending for commercially insured neurosurgical patients exceeded $1400 in 2016, with an average annual growth rate of 13%. As patient cost sharing in health insurance plans becomes more prevalent, patients and providers must consider the potential financial burden for patients receiving specialized neurosurgical care.

Possible consequences of regionally based bundled payments for diabetic amputations for safety net hospitals in Texas.

PubMed

Newhall, Karina; Stone, David; Svoboda, Ryan; Goodney, Philip

2016-12-01

Ongoing health reform in the United States encourages quality-based reimbursement methods such as bundled payments for surgery. The effect of such changes on high-risk procedures is unknown, especially at safety net hospitals. This study quantified the burden of diabetes-related amputation and the potential financial effect of bundled payments at safety net hospitals in Texas. We performed a cross-sectional analysis of diabetic amputation burden and charges using publically available data from Centers for Medicare and Medicaid and the Texas Department of Health from 2008 to 2012. Using hospital referral region (HRR)-level analysis, we categorized the proportion of safety net hospitals within each region as very low (0%-9%), low (10%-20%), average (20%-33%), and high (>33%) and compared amputation rates across regions using nonparametric tests of trend. We then used charge data to create reimbursement rates based on HRR to estimate financial losses. We identified 51 adult hospitals as safety nets in Texas. Regions varied in the proportion of safety net hospitals from 0% in Victoria to 65% in Harlingen. Among beneficiaries aged >65, amputation rates correlated to the proportion of safety net hospitals in each region; for example, patients in the lowest quartile of safety net had a yearly rate of 300 amputations per 100,000 beneficiaries, whereas those in the highest quartile had a yearly rate of 472 per 100,000 (P = .007). Charges for diabetic amputation-related admissions varied almost 200-fold, from $5000 to $1.4 million. Using reimbursement based on HRR to estimate a bundled payment, we noted net losses would be higher at safety net vs nonsafety net hospitals ($180 million vs $163 million), representing a per-hospital loss of $1.6 million at safety nets vs $700,000 at nonsafety nets (P < .001). Regions with a high proportion of safety net hospitals perform almost half of the diabetic amputations in Texas. Changes to traditional payment models should account for the disproportionate burden of high-risk procedures performed by these hospitals. Copyright © 2016. Published by Elsevier Inc.

42 CFR 413.314 - Determining payment amounts: Routine per diem rate.

Code of Federal Regulations, 2013 CFR

2013-10-01

... RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Prospectively Determined Payment Rates for Low-Volume Skilled Nursing Facilities, for Cost Reporting Periods...

42 CFR 413.314 - Determining payment amounts: Routine per diem rate.

Code of Federal Regulations, 2010 CFR

2010-10-01

... RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Prospectively Determined Payment Rates for Low-Volume Skilled Nursing Facilities, for Cost Reporting Periods...

Application of total care time and payment per unit time model for physician reimbursement for common general surgery operations.

PubMed

Chatterjee, Abhishek; Holubar, Stefan D; Figy, Sean; Chen, Lilian; Montagne, Shirley A; Rosen, Joseph M; Desimone, Joseph P

2012-06-01

The relative value unit system relies on subjective measures of physician input in the care of patients. A payment per unit time model incorporates surgeon reimbursement to the total care time spent in the operating room, postoperative in-house, and clinic time to define payment per unit time. We aimed to compare common general surgery operations by using the total care time and payment per unit time method in order to demonstrate a more objective measurement for physician reimbursement. Average total physician payment per case was obtained for 5 outpatient operations and 4 inpatient operations in general surgery. Total care time was defined as the sum of operative time, 30 minutes per hospital day, and 30 minutes per office visit for each operation. Payment per unit time was calculated by dividing the physician reimbursement per case by the total care time. Total care time, physician payment per case, and payment per unit time for each type of operation demonstrated that an average payment per time spent for inpatient operations was $455.73 and slightly more at $467.51 for outpatient operations. Partial colectomy with primary anastomosis had the longest total care time (8.98 hours) and the least payment per unit time ($188.52). Laparoscopic gastric bypass had the highest payment per time ($707.30). The total care time and payment per unit time method can be used as an adjunct to compare reimbursement among different operations on an institutional level as well as on a national level. Although many operations have similar payment trends based on time spent by the surgeon, payment differences using this methodology are seen and may be in need of further review. Copyright © 2012 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Malpractice in otology.

PubMed

Blake, Danielle M; Svider, Peter F; Carniol, Eric T; Mauro, Andrew C; Eloy, Jean Anderson; Jyung, Robert W

2013-10-01

(1) Analyze otologic procedural malpractice litigation in the United States of America. (2) Discuss ways to prevent future malpractice litigation. Case series with record review. The study is a case series with review of court records pertaining to otologic procedures using the Westlaw legal database. The phrase medical malpractice was searched with terms related to otology and neurotology obtained from the AAO-HNS website. Of the 47 claims that met inclusion criteria, 63.8% were decided in the physician's favor, 25.5% were decided in the plaintiff's favor (average payment $446,697), and 10.6% were settled out of court (average payment $372,607). Cerumen removal was the most common procedure leading to complaint (21.3%) and the most likely procedure to lead to payment (50.0%). Hearing loss was the most common injury claimed among all cases (53.2%) and resulted in a high proportion of cases that led to payment (40.0%). Other common alleged injuries were facial nerve injury (27.7%), tympanic membrane perforation (23.4%), need for additional surgery (42.6%), and lack of informed consent (31.9%). In addition, cases resulting from acoustic neuroma or stapedectomy resulted in higher payments to the plaintiffs (average $3,498,597 and $2,733,000, respectively). Malpractice trials were resolved in the defendant's favor in the majority of cases. Cerumen removal was the most common procedure leading to complaint and the procedure most likely to result in payment. Hearing loss was the most common injury cited. Payment was highest in acoustic neuroma and stapedectomy cases.

7 CFR 1403.4 - Demand for payment of debts.

Code of Federal Regulations, 2010 CFR

2010-01-01

... payment interest rate set out in § 1403.9. (4) CCC's intent, if applicable, to collect the debt 30 days... for and the amount of the debt determined to be due CCC, including the principal, applicable interest...) The applicable late payment interest rate. (i) If a late payment interest rate is specified in the...

24 CFR 213.255 - Premiums where first principal payment one year or less after initial endorsement.

Code of Federal Regulations, 2011 CFR

2011-04-01

... insurance endorsement, the mortgagee, upon such first principal payment date, shall pay a second premium equal to one-half of one percent of the average outstanding principal obligation of the mortgage for the... and second premiums shall equal the sum of (i) One percent per annum of the average outstanding...

Medicare program: changes to the hospital outpatient prospective payment system and CY 2008 payment rates, the ambulatory surgical center payment system and CY 2008 payment rates, the hospital inpatient prospective payment system and FY 2008 payment rates; and payments for graduate medical education for affiliated teaching hospitals in certain emergency situations Medicare and Medicaid programs: hospital conditions of participation; necessary provider designations of critical access hospitals. Interim and final rule with comment period.

PubMed

2007-11-27

This final rule with comment period revises the Medicare hospital outpatient prospective payment system to implement applicable statutory requirements and changes arising from our continuing experience with this system. We describe the changes to the amounts and factors used to determine the payment rates for Medicare hospital outpatient services paid under the prospective payment system. These changes are applicable to services furnished on or after January 1, 2008. In addition, the rule sets forth the applicable relative payment weights and amounts for services furnished in ASCs, specific HCPCS codes to which the final policies of the ASC payment system apply, and other pertinent rate setting information for the CY 2008 ASC payment system. Furthermore, this final rule with comment period will make changes to the policies relating to the necessary provider designations of critical access hospitals and changes to several of the current conditions of participation requirements. The attached document also incorporates the changes to the FY 2008 hospital inpatient prospective payment system (IPPS) payment rates made as a result of the enactment of the TMA, Abstinence Education, and QI Programs Extension Act of 2007, Public Law 110-90. In addition, we are changing the provisions in our previously issued FY 2008 IPPS final rule and are establishing a new policy, retroactive to October 1, 2007, of not applying the documentation and coding adjustment to the FY 2008 hospital-specific rates for Medicare-dependent, small rural hospitals (MDHs) and sole community hospitals (SCHs). In the interim final rule with comment period in this document, we are modifying our regulations relating to graduate medical education (GME) payments made to teaching hospitals that have Medicare affiliation agreements for certain emergency situations.

7 CFR 1421.304 - Payment amount.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 2012 Crop of Wheat, Barley, Oats, and Triticale § 1421.304 Payment amount. (a) The grazing payment rate... payment rate in effect for the predominant class of wheat in the county where the farm is located as of... three (3) similar farms. For triticale, the payment yield shall be the yield for wheat from three (3...

Variation in Bariatric Surgery Episode Costs in the Commercially Insured: Implications for Bundled Payments in the Private Sector.

PubMed

Kelsall, Alexander C; Cassidy, Ruth; Ghaferi, Amir A

2017-08-01

To describe hospital-level variation in roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) in Michigan. Bariatric surgery is an increasingly prevalent elective surgical procedure that will likely be considered for future bundled payment programs, both public and private. Past research in the Medicare population found that the index hospitalization is responsible for the majority of payment variation among hospitals. However, this research largely excluded SG, now the most commonly performed bariatric surgery procedure nationally. We used data from a state-wide quality collaborative to calculate the average risk and price-adjusted 30-day episode payment for patients undergoing RYGB and SG procedures at Michigan hospitals between January 2009 and October 2014. We organized hospitals into quintiles and compared the variation in payments between highest and lowest-cost quintiles, and also the payment categories that drove this variation. We identified 9035 patients undergoing RYGB (n = 4194) or SG (n = 4841) procedures at 31 hospitals. The average price and risk-adjusted episode payment ranged from $11,874 in the lowest hospital quintile to $13,394 in the highest quintile, representing a difference of $1519 (12.8%). Payments for the index hospitalization accounted for the largest share of total episode costs for both procedure types. Despite representing 2.7% to 6.0% of payments across quintiles, postdischarge payments explained 22.6% of hospital variation in SG. Similarly, readmissions explained 24.5% of payment variation for SG episodes, despite representing between 1.2% and 4.4% of payments. Collectively, our findings suggest that there are previously underappreciated differences in episode payment variation between bariatric surgery procedures. SG may be more amenable to cost containment under bundled payment initiatives by virtue of the greater share of variation explained by readmission and postdischarge payments, components of episode payment more likely to be influenced by provider discretion.

Patient Perception of Value in Bundled Payments for Total Joint Arthroplasty.

PubMed

Schwartz, Adam J; Fraser, James F; Shannon, Allison M; Jackson, Nikki T; Raghu, T S

2016-12-01

A central concern for providers in a bundled payment model is determining how the bundle is distributed. Prior studies have shown that current reimbursement rates are often not aligned with patients' values. While willingness-to-pay (WTP) surveys are perhaps useful in a fee-for-service arrangement to determine overall reimbursement, the percentage of payment distribution might be as or more important in a bundled payment model. All patients undergoing primary total joint arthroplasty by a single surgeon were offered participation in a preoperative WTP survey. At a minimum 3 months postoperatively, patients were mailed instructions for an online follow-up survey asking how they would allocate a hypothetical bonus payment. From January through December 2014, 45 patients agreed to participate in the preoperative WTP survey. Twenty patients who were minimum 3 months postoperative also completed the follow-up survey. Patients valued total knee and hip arthroplasty at $28,438 (95% confidence interval [CI]: $20,551-36,324) and $39,479 (95% CI: $27,848-$51,112), respectively. At 3 months postoperatively, patients distributed a hypothetical bonus payment 55.5% to the surgeon (95% CI: 47.8%-63.1%), 38% to the hospital (95% CI: 30.3%-45.7%), and 6.5% (95% CI: -1.2% to 14.2%) to the implant manufacturer (P < .001). The data suggest that total joint arthroplasty patients have vastly different perceptions of payment distributions than what actually exists. In contrast to the findings of this study, the true distribution of payments for an episode of care averages 65% to the hospital, 27% to the implant manufacturer, and 8% to the surgeon. While many drivers of payment distribution exist, this study suggests that patients would allocate a larger proportion of a bundled payment to surgeons than is currently disbursed. This finding may also provide a plausible explanation for patients' consistent overestimation of surgeon reimbursements. Copyright © 2016 Elsevier Inc. All rights reserved.

7 CFR 1416.504 - Payment calculation.

Code of Federal Regulations, 2010 CFR

2010-01-01

... payment rate for insured or NAP covered tropical fruit is a flat rate of $5000 per acre. The rate for uninsured or acreage without NAP coverage is $4750 per acre. The total payment is subject to the limitations...

Expediting Tax Deposits Can Increase the Government’s Interest Earnings.

DTIC Science & Technology

1983-11-21

the FTD system. These deposits included such tax receipts as withheld personal income tax, corporate income tax , and social security, excise...Greater than or 159,500 2,733 4.2 571,000 222,000 equal to $25,000 Total $1,279,000 Corporate Income Tax Payments Projected Sampling Average Number...than or 130,600 2,215 2.7 292,000 80,000 equal to $25,000 Total $779,000 Corporate Income Tax Payments Projected Sampling Average Number Average

Standardization of Type 2 Diabetes Outpatient Expenditure with Bundled Payment Method in China.

PubMed

Xu, Guo-Chao; Luo, Yun; Li, Qian; Wu, Meng-Fan; Zhou, Zi-Jun

2016-04-20

In recent years, the prevalence of type 2 diabetes among Chinese population has been increasing by years, directly leading to an average annual growth rate of 19.90% of medical expenditure. Therefore, it is urgent to work on strategies to control the growth of medical expenditure on type 2 diabetes on the basis of the reality of China. Therefore, in this study, we explored the feasibility of implementing bundled payment in China through analyzing bundled payment standards of type 2 diabetes outpatient services. This study analyzed the outpatient expenditure on type 2 diabetes with Beijing Urban Employee's Basic Medical Insurance from 2010 to 2012. Based on the analysis of outpatient expenditure and its influential factors, we adopted decision tree approach to conduct a case-mix analysis. In the end, we built a case-mix model to calculate the standard expenditure and the upper limit of each combination. We found that age, job status, and whether with complication were significant factors that influence outpatient expenditure for type 2 diabetes. Through the analysis of the decision tree, we used six variables (complication, age, diabetic foot, diabetic nephropathy, cardiac-cerebrovascular disease, and neuropathy) to group the cases, and obtained 11 case-mix groups. We argued that it is feasible to implement bundled payment on type 2 diabetes outpatient services. Bundled payment is effective to control the increase of outpatient expenditure. Further improvements are needed for the implementation of bundled payment reimbursement standards, together with relevant policies and measures.

42 CFR 422.304 - Monthly payments.

Code of Federal Regulations, 2014 CFR

2014-10-01

... makes advance monthly payments of the amounts determined under paragraphs (a)(1) and (a)(2) of this... month. (1) Payment of bid for plans with bids below benchmark. For MA plans that have average per capita... benchmarks. The rebate amount under paragraph (a)(1)(ii) of this section is the amount of the monthly rebate...

42 CFR 422.304 - Monthly payments.

Code of Federal Regulations, 2013 CFR

2013-10-01

... makes advance monthly payments of the amounts determined under paragraphs (a)(1) and (a)(2) of this... month. (1) Payment of bid for plans with bids below benchmark. For MA plans that have average per capita... benchmarks. The rebate amount under paragraph (a)(1)(ii) of this section is the amount of the monthly rebate...

42 CFR 422.304 - Monthly payments.

Code of Federal Regulations, 2012 CFR

2012-10-01

... makes advance monthly payments of the amounts determined under paragraphs (a)(1) and (a)(2) of this... month. (1) Payment of bid for plans with bids below benchmark. For MA plans that have average per capita... benchmarks. The rebate amount under paragraph (a)(1)(ii) of this section is the amount of the monthly rebate...

The impact of DRGs on the cost and quality of health care in the United States.

PubMed

Davis, C; Rhodes, D J

1988-01-01

The prospective Payment System (PPS) represents a fundamental change in the way the United States government reimburses hospitals for medical services covered under Medicare, a federal health care insurance program for the elderly and disabled. PPS replaced the retrospective cost-based system of payment for Medicare services with a prospective payment system. Under PPS, a predetermined specific rate for each discharge dictates payment according to the diagnosis related group (DRG) in which the discharge is classified. The PPS was intended to create financial incentives that encourage hospitals to restrain the use of resources while providing high-quality inpatient care. Both objectives appear to have been met under PPS. Hospital utilization has declined, average length of stay has fallen, and the locus of care has shifted from the inpatient setting to less costly outpatient settings. The growth in inpatient hospital benefits has slowed and the impending insolvency of the Medicare trust fund has been forestalled. Studies have found no deterioration in the quality of care rendered to Medicare beneficiaries. Neither the mortality rate nor the rate of re-admission (presumably related to premature discharge) increased under PPS. Indeed, PPS appears to have enhanced the quality of inpatient care by discouraging unnecessary and potentially harmful procedures, and by encouraging the concentration of complex procedures in facilities in which the high frequency of these procedures promotes efficiency. Incentive-based reimbursement also appears to have contributed to the growth in alternative delivery systems, such as HMOs and PPOs, which contain costs by maintaining a high volume of a limited range of services. The success of the PPS/DRG system in controlling costs and promoting quality in this country suggests its application in other countries, either as a method of reimbursement or as a product line management tool.

5 CFR 532.801 - Payment of unrestricted rates for recruitment or retention purposes.

Code of Federal Regulations, 2010 CFR

2010-01-01

... recruitment or retention purposes. 532.801 Section 532.801 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PREVAILING RATE SYSTEMS Payment of Unrestricted Rates for Recruitment or Retention Purposes § 532.801 Payment of unrestricted rates for recruitment or retention purposes. (a) When...

42 CFR 413.316 - Determining payment amounts: Ancillary services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Prospectively Determined Payment Rates for Low-Volume Skilled Nursing Facilities, for Cost Reporting Periods...

42 CFR 413.316 - Determining payment amounts: Ancillary services.

Code of Federal Regulations, 2013 CFR

2013-10-01

... RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Prospectively Determined Payment Rates for Low-Volume Skilled Nursing Facilities, for Cost Reporting Periods...

42 CFR 413.310 - Basis of payment.

Code of Federal Regulations, 2010 CFR

2010-10-01

... PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Prospectively Determined Payment Rates for Low-Volume Skilled Nursing Facilities, for Cost Reporting Periods Beginning Prior to July 1, 1998...

42 CFR 413.310 - Basis of payment.

Code of Federal Regulations, 2013 CFR

2013-10-01

... PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Prospectively Determined Payment Rates for Low-Volume Skilled Nursing Facilities, for Cost Reporting Periods Beginning Prior to July 1, 1998...

Care-Seeking Patterns and Direct Economic Burden of Injuries in Bangladesh.

PubMed

Alfonso, Natalia Y; Alonge, Olakunle; Hoque, Dewan Md Emdadul; Baset, Kamran Ul; Hyder, Adnan A; Bishai, David

2017-04-29

This study provides a comprehensive review of the care-seeking patterns and direct economic burden of injuries from the victims' perspective in rural Bangladesh using a 2013 household survey covering 1.17 million people. Descriptive statistics and bivariate analyses were used to derive rates and test the association between variables. An analytic model was used to estimate total injury out-of-pocket (OOP) payments and a multivariate probit regression model assessed the relationship between financial distress and injury type. Results show non-fatal injuries occur to 1 in 5 people in our sample per year. With average household size of 4.5 in Bangladesh--every household has an injury every year. Most non-fatally injured patients sought healthcare from drug sellers. Less than half of fatal injuries sought healthcare and half of those with care were hospitalized. Average OOP payments varied significantly (range: $8-$830) by injury type and outcome (fatal vs. non-fatal). Total injury OOP expenditure was $$355,795 and $5000 for non-fatal and fatal injuries, respectively, per 100,000 people. The majority of household heads with injuries reported financial distress. This study can inform injury prevention advocates on disparities in healthcare usage, OOP costs and financial distress. Reallocation of resources to the most at risk populations can accelerate reduction of preventable injuries and prevent injury related catastrophic payments and impoverishment.

Care-Seeking Patterns and Direct Economic Burden of Injuries in Bangladesh

PubMed Central

Alfonso, Yira Natalia; Alonge, Olakunle; Hoque, Dewan Md Emdadul; Ul Baset, Md Kamran; Hyder, Adnan A.; Bishai, David

2017-01-01

This study provides a comprehensive review of the care-seeking patterns and direct economic burden of injuries from the victims’ perspective in rural Bangladesh using a 2013 household survey covering 1.17 million people. Descriptive statistics and bivariate analyses were used to derive rates and test the association between variables. An analytic model was used to estimate total injury out-of-pocket (OOP) payments and a multivariate probit regression model assessed the relationship between financial distress and injury type. Results show non-fatal injuries occur to 1 in 5 people in our sample per year. With average household size of 4.5 in Bangladesh--every household has an injury every year. Most non-fatally injured patients sought healthcare from drug sellers. Less than half of fatal injuries sought healthcare and half of those with care were hospitalized. Average OOP payments varied significantly (range: $8–$830) by injury type and outcome (fatal vs. non-fatal). Total injury OOP expenditure was $355,795 and $5000 for non-fatal and fatal injuries, respectively, per 100,000 people. The majority of household heads with injuries reported financial distress. This study can inform injury prevention advocates on disparities in healthcare usage, OOP costs and financial distress. Reallocation of resources to the most at risk populations can accelerate reduction of preventable injuries and prevent injury related catastrophic payments and impoverishment. PMID:28468240

26 CFR 25.2701-4 - Accumulated qualified payments.

Code of Federal Regulations, 2010 CFR

2010-04-01

... compound interest from the due date of the payment at a rate not less than the appropriate discount rate is... retained interest conferring a distribution right that was previously valued as a qualified payment right (a “qualified payment interest”), the taxable estate or taxable gifts of the individual holding the...

Determinants of willingness to pay for a new therapy in a sample of menopausal-aged women.

PubMed

Rasch, Andrej; Hodek, Jan-Marc; Runge, Claus; Greiner, Wolfgang

2009-01-01

Menopause is a natural physiological event that usually begins in women between the ages of 48 and 55 years. In many cases, this event is associated with unpleasant somatic-vegetative, urogenital or psychological symptoms. To test the health and social demographic factors (especially household income level) that influence willingness to pay (WTP) for a new hormone-free treatment in women of menopausal age. 1365 women between the ages of 45 and 73 years were surveyed about their health and WTP for the new treatment. WTP was evaluated with a closed-ended binary questionnaire (four groups with different levels of co-payment between euro15 and euro60), using the contingent valuation method. The average WTP was calculated according to the area under the demand function. Factors contributing to payment readiness were examined by means of binary logistic regression. WTP was significantly affected by women's opinion of the new medication, the level of co-payment required, net household income, whether currently in treatment for menopausal symptoms, and Menopause Rating Scale (MRS) values. Compared with other factors, the level of co-payment was predicted to have a negative impact on WTP. Income level is an important factor in WTP and correlates highly with several other health-related variables (WHO-5 index, MRS value, receipt of other menopause medicines and existing co-morbidity). The average co-payment that our group of women was willing to pay was between euro17 and euro35 per month, or euro24 to euro42 for women who were currently receiving treatment for symptoms of menopause. While interpreting the results, it should be considered that the hypothetical therapy was assumed to be a new non-reimbursable alternative to conventional therapy offered under the existing statutory framework for health insurance in Germany. Despite some methodological limitations, these results are useful for examining the factors affecting WTP and incremental utilities for future medicine dealing with menopause.

System-Level Health-Care Integration and the Costs of Cancer Care Across the Disease Continuum.

PubMed

Kaye, Deborah R; Min, Hye Sung; Norton, Edward C; Ye, Zaojun; Li, Jonathan; Dupree, James M; Ellimoottil, Chad; Miller, David C; Herrel, Lindsey A

2018-03-01

Policy reforms in the Affordable Care Act encourage health care integration to improve quality and lower costs. We examined the association between system-level integration and longitudinal costs of cancer care. We used linked SEER-Medicare data to identify patients age 66 to 99 years diagnosed with prostate, bladder, esophageal, pancreatic, lung, liver, kidney, colorectal, breast, or ovarian cancer from 2007 to 2012. We attributed each patient to one or more phases of care (ie, initial, continuing, and end of life) according to time from diagnosis until death or end of study interval. For each phase, we aggregated all claims with the primary cancer diagnosis and identified patients treated in an integrated delivery network (IDN), as defined by the Becker Hospital Review list of the top 100 most integrated health delivery systems. We then determined if care provided in an IDN was associated with decreased payments across cancers and for each individual cancer by phase and across phases. We identified 428,300 patients diagnosed with one of 10 common cancers. Overall, there were no differences in phase-based payments between IDNs and non-IDNs. Average adjusted annual payments by phase for IDN versus non-IDNs were as follows: initial, $14,194 versus $14,421, respectively ( P = .672); continuing, $2,051 versus $2,099 ( P = .566); and end of life, $16,257 versus $16,232 ( P = .948). However, in select cancers, we observed lower payments in IDNs. For bladder cancer, payments at the end of life were lower for IDNs ($11,041 v $12,331; P = .008). Of the four cancers with the lowest 5-year survival rates (ie, pancreatic, lung, esophageal, and liver), average expenditures during the initial and continuing-care phases were lower for patients with liver cancer treated in IDNs. For patients with one of 10 common malignancies, treatment in an IDN generally is not associated with lower costs during any phase of cancer care.

Early Lessons on Bundled Payment at an Academic Medical Center.

PubMed

Jubelt, Lindsay E; Goldfeld, Keith S; Blecker, Saul B; Chung, Wei-Yi; Bendo, John A; Bosco, Joseph A; Errico, Thomas J; Frempong-Boadu, Anthony K; Iorio, Richard; Slover, James D; Horwitz, Leora I

2017-09-01

Orthopaedic care is shifting to alternative payment models. We examined whether New York University Langone Medical Center achieved savings under the Centers for Medicare and Medicaid Services Bundled Payments for Care Improvement initiative. This study was a difference-in-differences study of Medicare fee-for-service patients hospitalized from April 2011 to June 2012 and October 2013 to December 2014 for lower extremity joint arthroplasty, cardiac valve procedures, or spine surgery (intervention groups), or for congestive heart failure, major bowel procedures, medical peripheral vascular disorders, medical noninfectious orthopaedic care, or stroke (control group). We examined total episode costs and costs by service category. We included 2,940 intervention episodes and 1,474 control episodes. Relative to the trend in the control group, lower extremity joint arthroplasty episodes achieved the greatest savings: adjusted average episode cost during the intervention period decreased by $3,017 (95% confidence interval [CI], -$6,066 to $31). For cardiac procedures, the adjusted average episode cost decreased by $2,999 (95% CI, -$8,103 to $2,105), and for spinal fusion, it increased by $8,291 (95% CI, $2,879 to $13,703). Savings were driven predominantly by shifting postdischarge care from inpatient rehabilitation facilities to home. Spinal fusion index admission costs increased because of changes in surgical technique. Under bundled payment, New York University Langone Medical Center decreased total episode costs in patients undergoing lower extremity joint arthroplasty. For patients undergoing cardiac valve procedures, evidence of savings was not as strong, and for patients undergoing spinal fusion, total episode costs increased. For all three conditions, the proportion of patients referred to inpatient rehabilitation facilities upon discharge decreased. These changes were not associated with an increase in index hospital length of stay or readmission rate. Opportunities for savings under bundled payment may be greater for lower extremity joint arthroplasty than for other conditions.

76 FR 38742 - Prompt Payment Interest Rate; Contract Disputes Act

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-01

... DEPARTMENT OF THE TREASURY Fiscal Service Prompt Payment Interest Rate; Contract Disputes Act... beginning July 1, 2011, and ending on December 31, 2011, the prompt payment interest rate is 2\\1/2\\ per.... 3902(a), provide for the calculation of interest due on claims at the rate established by the Secretary...

76 FR 82350 - Prompt Payment Interest Rate; Contract Disputes Act

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-30

... DEPARTMENT OF THE TREASURY Fiscal Service Prompt Payment Interest Rate; Contract Disputes Act... beginning January 1, 2012, and ending on June 30, 2012, the prompt payment interest rate is 2 per centum per... of interest due on claims at the rate established by the Secretary of the Treasury. The Secretary of...

77 FR 38888 - Prompt Payment Interest Rate; Contract Disputes Act

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-29

... DEPARTMENT OF THE TREASURY Fiscal Service Prompt Payment Interest Rate; Contract Disputes Act... beginning July 1, 2012, and ending on December 31, 2012, the prompt payment interest rate is 1\\3/4\\ per... interest due on claims at the rate established by the Secretary of the Treasury. The Secretary of the...

75 FR 82146 - Prompt Payment Interest Rate; Contract Disputes Act

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-29

... DEPARTMENT OF THE TREASURY Fiscal Service Prompt Payment Interest Rate; Contract Disputes Act... beginning January 1, 2011, and ending on June 30, 2011, the prompt payment interest rate is 2\\5/8\\ per... calculation of interest due on claims at the rate established by the Secretary of the Treasury. The Secretary...

75 FR 37881 - Prompt Payment Interest Rate; Contract Disputes Act

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-30

... DEPARTMENT OF THE TREASURY Fiscal Service Prompt Payment Interest Rate; Contract Disputes Act... beginning July 1, 2010, and ending on December 31, 2010, the prompt payment interest rate is 3\\1/8\\ per... of interest due on claims at the rate established by the Secretary of the Treasury. The Secretary of...

12 CFR 226.19 - Certain mortgage and variable-rate transactions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... frequency of interest rate and payment changes. (vii) Any rules relating to changes in the index, interest... that the interest rate, payment, or term of the loan can change. (ii) The index or formula used in..., illustrating how payments and the loan balance would have been affected by interest rate changes implemented...

Changes in health expenditures in China in 2000s: has the health system reform improved affordability.

PubMed

Long, Qian; Xu, Ling; Bekedam, Henk; Tang, Shenglan

2013-06-13

China's health system reform launched in early 2000s has achieved better coverage of health insurance and significantly increased the use of healthcare for vast majority of Chinese population. This study was to examine changes in the structure of total health expenditures in China in 2000-2011, and to investigate the financial burden of healthcare placed on its population, particularly between urban and rural areas and across different socio-economic development regions. Health expenditures data came from the China National Health Accounts study in 1990-2011, and other data used to calculate the financial burden of healthcare were from China Statistical Yearbook and China Population Statistical Yearbook. Total health expenditures were divided into government and social expenditure, and out-of-pocket payment. The financial burden of healthcare was estimated as out-of-pocket payment per capita as a percentage of annual household living consumption expenditure per capita. Between 2000 and 2011, total health expenditures in China increased from Chinese yuan 319 to 1888 (United States dollars 51 to 305), with average annual increase of 17.4%. Government and social health expenditure increased rapidly being 22.9% and 18.8% of average annual growth rate, respectively. The share of out-of-pocket payment in total health expenditure for the urban population declined from 53% in 2005 to 36% in 2011, but had only a slight decrease for the rural population from 53% to 50%. Out-of-pocket payment, as a percentage of annual household living consumption, has continued to rise, particularly in the rural population from the less developed region (6.1% in 2000 to 8.8% in 2011). The rapid increase of public funding to subsidize health insurance in China, as part of the reform strategy, did not mitigate the out-of-pocket payment for healthcare over the past decade. Financial burden of healthcare on the rural population increased. Affordability among the rural households with sick members, particularly in the less developed region, is getting worse. It needs effective measures on cost control including healthcare provider payment reform and well developed health insurance schemes to offer better financial protection for the vulnerable Chinese seeking essential healthcare.

26 CFR 16A.126-1 - Certain cost-sharing payments-in general.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 26 Internal Revenue 14 2012-04-01 2012-04-01 false Certain cost-sharing payments-in general. 16A... CERTAIN CONSERVATION COST-SHARING PAYMENTS § 16A.126-1 Certain cost-sharing payments—in general. (a... average annual income derived from the affected property prior to receipt of the improvement or an amount...

26 CFR 16A.126-1 - Certain cost-sharing payments-in general.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 26 Internal Revenue 14 2013-04-01 2013-04-01 false Certain cost-sharing payments-in general. 16A... CERTAIN CONSERVATION COST-SHARING PAYMENTS § 16A.126-1 Certain cost-sharing payments—in general. (a... average annual income derived from the affected property prior to receipt of the improvement or an amount...

26 CFR 16A.126-1 - Certain cost-sharing payments-in general.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 26 Internal Revenue 14 2014-04-01 2013-04-01 true Certain cost-sharing payments-in general. 16A... CERTAIN CONSERVATION COST-SHARING PAYMENTS § 16A.126-1 Certain cost-sharing payments—in general. (a... average annual income derived from the affected property prior to receipt of the improvement or an amount...

42 CFR 413.337 - Methodology for calculating the prospective payment rates.

Code of Federal Regulations, 2013 CFR

2013-10-01

...-STAGE RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Prospective Payment for Skilled Nursing Facilities § 413.337 Methodology for calculating the...

42 CFR 413.337 - Methodology for calculating the prospective payment rates.

Code of Federal Regulations, 2010 CFR

2010-10-01

...-STAGE RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Prospective Payment for Skilled Nursing Facilities § 413.337 Methodology for calculating the...

The impact of profitability of hospital admissions on mortality.

PubMed

Lindrooth, Richard C; Konetzka, R Tamara; Navathe, Amol S; Zhu, Jingsan; Chen, Wei; Volpp, Kevin

2013-04-01

Fiscal constraints faced by Medicare are leading to policies designed to reduce expenditures. Evidence of the effect of reduced reimbursement on the mortality of Medicare patients discharged from all major hospital service lines is limited. We modeled risk-adjusted 30-day mortality of patients discharged from 21 hospital service lines as a function of service line profitability, service line time trends, and hospital service line and year-fixed effects. We simulated the effect of alternative revenue-neutral reimbursement policies on mortality. Our sample included all Medicare discharges from PPS-eligible hospitals (1997, 2001, and 2005). The results reveal a statistically significant inverse relationship between changes in profitability and mortality. A $0.19 average reduction in profit per $1.00 of costs led to a 0.010-0.020 percentage-point increase in mortality rates (p < .001). Mortality in newly unprofitable service lines is significantly more sensitive to reduced payment generosity than in service lines that remain profitable. Policy simulations that target service line inequities in payment generosity result in lower mortality rates, roughly 700-13,000 fewer deaths nationally. The policy simulations raise questions about the trade-offs implicit in universal reductions in reimbursement. The effect of reduced payment generosity on mortality could be mitigated by targeting highly profitable services only for lower reimbursement. © Health Research and Educational Trust.

The Impact of Profitability of Hospital Admissions on Mortality

PubMed Central

Lindrooth, Richard C; Konetzka, R Tamara; Navathe, Amol S; Zhu, Jingsan; Chen, Wei; Volpp, Kevin

2013-01-01

Background Fiscal constraints faced by Medicare are leading to policies designed to reduce expenditures. Evidence of the effect of reduced reimbursement on the mortality of Medicare patients discharged from all major hospital service lines is limited. Methods We modeled risk-adjusted 30-day mortality of patients discharged from 21 hospital service lines as a function of service line profitability, service line time trends, and hospital service line and year-fixed effects. We simulated the effect of alternative revenue-neutral reimbursement policies on mortality. Our sample included all Medicare discharges from PPS-eligible hospitals (1997, 2001, and 2005). Results The results reveal a statistically significant inverse relationship between changes in profitability and mortality. A $0.19 average reduction in profit per $1.00 of costs led to a 0.010–0.020 percentage-point increase in mortality rates (p < .001). Mortality in newly unprofitable service lines is significantly more sensitive to reduced payment generosity than in service lines that remain profitable. Policy simulations that target service line inequities in payment generosity result in lower mortality rates, roughly 700–13,000 fewer deaths nationally. Conclusions The policy simulations raise questions about the trade-offs implicit in universal reductions in reimbursement. The effect of reduced payment generosity on mortality could be mitigated by targeting highly profitable services only for lower reimbursement. PMID:23346946

Racial Earnings Differentials and Performance Pay

ERIC Educational Resources Information Center

Heywood, John S.; O'Halloran, Patrick L.

2005-01-01

A comparative analysis between output-based payment and time rates payment is presented. It is observed that racial or gender earnings discrimination is more likely in time rates payment and supervisory evaluations.

Specialty Payment Model Opportunities and Assessment: Oncology Simulation Report.

PubMed

White, Chapin; Chan, Chris; Huckfeldt, Peter J; Kofner, Aaron; Mulcahy, Andrew W; Pollak, Julia; Popescu, Ioana; Timbie, Justin W; Hussey, Peter S

2015-07-15

This article describes the results of a simulation analysis of a payment model for specialty oncology services that is being developed for possible testing by the Center for Medicare and Medicaid Innovation at the Centers for Medicare & Medicaid Services (CMS). CMS asked MITRE and RAND to conduct simulation analyses to preview some of the possible impacts of the payment model and to inform design decisions related to the model. The simulation analysis used an episode-level dataset based on Medicare fee-for-service (FFS) claims for historical oncology episodes provided to Medicare FFS beneficiaries in 2010. Under the proposed model, participating practices would continue to receive FFS payments, would also receive per-beneficiary per-month care management payments for episodes lasting up to six months, and would be eligible for performance-based payments based on per-episode spending for attributed episodes relative to a per-episode spending target. The simulation offers several insights into the proposed payment model for oncology: (1) The care management payments used in the simulation analysis-$960 total per six-month episode-represent only 4 percent of projected average total spending per episode (around $27,000 in 2016), but they are large relative to the FFS revenues of participating oncology practices, which are projected to be around $2,000 per oncology episode. By themselves, the care management payments would increase physician practices' Medicare revenues by roughly 50 percent on average. This represents a substantial new outlay for the Medicare program and a substantial new source of revenues for oncology practices. (2) For the Medicare program to break even, participating oncology practices would have to reduce utilization and intensity by roughly 4 percent. (3) The break-even point can be reduced if the care management payments are reduced or if the performance-based payments are reduced.

Specialty Payment Model Opportunities and Assessment

PubMed Central

White, Chapin; Chan, Chris; Huckfeldt, Peter J.; Kofner, Aaron; Mulcahy, Andrew W.; Pollak, Julia; Popescu, Ioana; Timbie, Justin W.; Hussey, Peter S.

2015-01-01

Abstract This article describes the results of a simulation analysis of a payment model for specialty oncology services that is being developed for possible testing by the Center for Medicare and Medicaid Innovation at the Centers for Medicare & Medicaid Services (CMS). CMS asked MITRE and RAND to conduct simulation analyses to preview some of the possible impacts of the payment model and to inform design decisions related to the model. The simulation analysis used an episode-level dataset based on Medicare fee-for-service (FFS) claims for historical oncology episodes provided to Medicare FFS beneficiaries in 2010. Under the proposed model, participating practices would continue to receive FFS payments, would also receive per-beneficiary per-month care management payments for episodes lasting up to six months, and would be eligible for performance-based payments based on per-episode spending for attributed episodes relative to a per-episode spending target. The simulation offers several insights into the proposed payment model for oncology: (1) The care management payments used in the simulation analysis—$960 total per six-month episode—represent only 4 percent of projected average total spending per episode (around $27,000 in 2016), but they are large relative to the FFS revenues of participating oncology practices, which are projected to be around $2,000 per oncology episode. By themselves, the care management payments would increase physician practices’ Medicare revenues by roughly 50 percent on average. This represents a substantial new outlay for the Medicare program and a substantial new source of revenues for oncology practices. (2) For the Medicare program to break even, participating oncology practices would have to reduce utilization and intensity by roughly 4 percent. (3) The break-even point can be reduced if the care management payments are reduced or if the performance-based payments are reduced. PMID:28083365

Potential effects of the new Medicare Prospective Payment System on drug prescription in end-stage renal disease care.

PubMed

Winkelmayer, Wolfgang C

2011-01-01

The Centers for Medicaid and Medicare Services have announced a new Prospective Payment System to reimburse the care furnished by dialysis centers to patients with end-stage renal disease (ESRD). As of January 2011, most aspects of the outpatient treatment of patients with ESRD will be included in a single payment. In addition to the items previously included in the Composite Rate, injectable drugs and their oral equivalents will be included in this new capitation payment, as will the laboratory tests required for monitoring maintenance dialysis. As of January 2014, oral-only medications will also be included. Physician payments and payments for inpatient care, as well as for care not directly related to ESRD care will continue to be reimbursed separately. Patterns of medication treatment of ESRD patients will likely be revisited, and one can expect pronounced adjustments. Treatment of anemia will likely shift towards less use of erythropoiesis-stimulating agents and somewhat towards higher use of intravenous iron supplements. Average hemoglobin concentrations will decline. Use of intravenous vitamin D analogues will likely be reduced and substituted with their oral equivalents in many patients. One can also expect a temporary trend towards higher use of calcimetics, since their inclusion in the payment bundle is deferred until 2014. Treatment of problems with vascular access patency and of access infections will likely shift to the inpatient setting, and there may be reluctance to quickly accept recovering patients back to the outpatient setting after vascular access intervention. On aggregate, these changes have the potential to alter patient outcomes, but it is currently unclear how these will be and can be monitored. Copyright © 2011 S. Karger AG, Basel.

Do heart failure disease management programs make financial sense under a bundled payment system?

PubMed

Eapen, Zubin J; Reed, Shelby D; Curtis, Lesley H; Hernandez, Adrian F; Peterson, Eric D

2011-05-01

Policy makers have proposed bundling payments for all heart failure (HF) care within 30 days of an HF hospitalization in an effort to reduce costs. Disease management (DM) programs can reduce costly HF readmissions but have not been economically attractive for caregivers under existing fee-for-service payment. Whether a bundled payment approach can address the negative financial impact of DM programs is unknown. Our study determined the cost-neutral point for the typical DM program and examined whether published HF DM programs can be cost saving under bundled payment programs. We used a decision analytic model using data from retrospective cohort studies, meta-analyses, 5 randomized trials evaluating DM programs, and inpatient claims for all Medicare beneficiaries discharged with an HF diagnosis from 2001 to 2004. We determined the costs of DM programs and inpatient care over 30 and 180 days. With a baseline readmission rate of 22.9%, the average cost for readmissions over 30 days was $2,272 per patient. Under base-case assumptions, a DM program that reduced readmissions by 21% would need to cost $477 per patient to be cost neutral. Among evaluated published DM programs, 2 of the 5 would increase provider costs (+$15 to $283 per patient), whereas 3 programs would be cost saving (-$241 to $347 per patient). If bundled payments were broadened to include care over 180 days, then program saving estimates would increase, ranging from $419 to $1,706 per patient. Proposed bundled payments for HF admissions provide hospitals with a potential financial incentive to implement DM programs that efficiently reduce readmissions. Copyright © 2011 Mosby, Inc. All rights reserved.

Effect of Medicaid Payment on Rehabilitation Care for Nursing Home Residents

PubMed Central

Wodchis, Walter P.; Hirth, Richard A.; Fries, Brant E.

2007-01-01

There is considerable interest in examining how Medicaid payment affects nursing home care. This study examines the effect of Medicaid payment methods and reimbursement rates on the delivery of rehabilitation therapy to Medicaid nursing home residents in six States from 1992-1995. In States that changed payment from prospective facility-specific to prospective case-mix adjusted payment methods, Medicaid residents received more rehabilitation therapy after the change. While residents in States using case-mix adjusted payment rates for Medicaid payment were more likely to receive rehabilitation than residents in States using prospective facility-specific Medicaid payment, the differences were general and not specific to Medicaid residents. Retrospective payment for Medicaid resident care was associated with greater use of therapy for Medicaid residents. PMID:17645160

Effect of Medicaid payment on rehabilitation care for nursing home residents.

PubMed

Wodchis, Walter P; Hirth, Richard A; Fries, Brant E

2007-01-01

There is considerable interest in examining how Medicaid payment affects nursing home care. This study examines the effect of Medicaid payment methods and reimbursement rates on the delivery of rehabilitation therapy to Medicaid nursing home residents in six States from 1992-1995. In States that changed payment from prospective facility-specific to prospective case-mix adjusted payment methods, Medicaid residents received more rehabilitation therapy after the change. While residents in States using case-mix adjusted payment rates for Medicaid payment were more likely to receive rehabilitation than residents in States using prospective facility-specific Medicaid payment, the differences were general and not specific to Medicaid residents. Retrospective payment for Medicaid resident care was associated with greater use of therapy for Medicaid residents.

Association of Industry Payments to Physicians With the Prescribing of Brand-name Statins in Massachusetts.

PubMed

Yeh, James S; Franklin, Jessica M; Avorn, Jerry; Landon, Joan; Kesselheim, Aaron S

2016-06-01

Pharmaceutical industry payments to physicians may affect prescribing practices and increase costs if more expensive medications are prescribed. Determine the association between industry payments to physicians and the prescribing of brand-name as compared with generic statins for lowering cholesterol. Cross-sectional linkage of the Part D Medicare prescriptions claims data with the Massachusetts physicians payment database including all licensed Massachusetts physicians who wrote prescriptions for statins paid for under the Medicare drug benefit in 2011. The exposure variable was a physician's industry payments as listed in the Massachusetts database. The outcome was the physician's rate of prescribing brand-name statins. We used linear regression to analyze the association between the intensity of physicians' industry relationships (as measured by total payments) and their prescribing practices, as well as the effects of specific types of payments. Among the 2444 Massachusetts physicians in the Medicare prescribing database in 2011, 899 (36.8%) received industry payments. The most frequent payment was for company-sponsored meals (n = 639 [71.1%]). Statins accounted for 1 559 003 prescription claims; 356 807 (22.8%) were for brand-name drugs. For physicians with no industry payments listed, the median brand-name statin prescribing rate was 17.8% (95% CI, 17.2%-18.4%). For every $1000 in total payments received, the brand-name statin prescribing rate increased by 0.1% (95% CI, 0.06%-0.13%; P < .001). Payments for educational training were associated with a 4.8% increase in the rate of brand-name prescribing (P = .004); other forms of payments were not. Industry payments to physicians are associated with higher rates of prescribing brand-name statins. As the United States seeks to rein in the costs of prescription drugs and make them less expensive for patients, our findings are concerning.

38 CFR 21.7139 - Conditions which result in reduced rates or no payment.

Code of Federal Regulations, 2010 CFR

2010-07-01

... in reduced rates or no payment. 21.7139 Section 21.7139 Pensions, Bonuses, and Veterans' Relief... Conditions which result in reduced rates or no payment. The monthly rates established in §§ 21.7136, 21.7137... nonpunitive grade which is not used in computing requirements for graduation unless the provisions of this...

Higher Magnitude Cash Payments Improve Research Follow-up Rates Without Increasing Drug Use or Perceived Coercion

PubMed Central

Festinger, David S.; Marlowe, Douglas B.; Dugosh, Karen L.; Croft, Jason R.; Arabia, Patricia L.

2008-01-01

In a prior study (Festinger et al., 2005) we found that neither the mode (cash vs. gift card) nor magnitude ($10, $40, or $70) of research follow-up payments increased rates of new drug use or perceptions of coercion. However, higher payments and payments in cash were associated with better follow-up attendance, reduced tracking efforts, and improved participant satisfaction with the study. The present study extended those findings to higher payment magnitudes. Participants from an urban outpatient substance abuse treatment program were randomly assigned to receive $70, $100, $130, or $160 in either cash or a gift card for completing a follow-up assessment at 6 months post-admission (n ≅ 50 per cell). Apart from the payment incentives, all participants received a standardized, minimal platform of follow-up efforts. Findings revealed that neither the magnitude nor mode of payment had a significant effect on new drug use or perceived coercion. Consistent with our previous findings, higher payments and cash payments resulted in significantly higher follow-up rates and fewer tracking calls. In addition participants receiving cash vs. gift cards were more likely to use their payments for essential, non-luxury purchases. Follow-up rates for participants receiving cash payments of $100, $130, and $160 approached or exceeded the FDA required minimum of 70% for studies to be considered in evaluations of new medications. This suggests that the use of higher magnitude payments and cash payments may be effective strategies for obtaining more representative follow-up samples without increasing new drug use or perceptions of coercion. PMID:18395365

Nursing home costs, Medicaid rates, and profits under alternative Medicaid payment systems.

PubMed Central

Schlenker, R E

1991-01-01

This analysis compares nursing home costs, Medicaid payment rates, and profits under three Medicaid nursing home payment systems: case-mix, facility-specific, and class-rate systems. Data used were collected from 135 nursing homes in seven states. The association of case mix with costs, rates, and profits under the three payment systems was of particular interest. Case mix was more strongly associated (positively) with patient care cost and the Medicaid rate for the case-mix systems than for the other systems, particularly the class-rate systems. In contrast, case mix and profits were not associated in the case-mix or facility-specific systems, but were negatively associated in the class rate systems. Overall, the results suggest that case-mix systems have some important advantages over other payment systems, but further research is needed on larger samples and involving the newer case-mix systems. PMID:1743972

Do Case Rates Affect Physicians' Clinical Practice in Radiation Oncology?: An Observational Study

PubMed Central

Loy, Bryan A.; Shkedy, Clive I.; Powell, Adam C.; Happe, Laura E.; Royalty, Julie A.; Miao, Michael T.; Smith, Gary L.; Long, James W.; Gupta, Amit K.

2016-01-01

Case rate payments combined with utilization monitoring may have the potential to improve the quality of care by reducing over and under-treatment. Thus, a national managed care organization introduced case rate payments at one multi-site radiation oncology provider while maintaining only fee-for-service payments at others. This study examined whether the introduction of the payment method had an effect on radiation fractions administered when compared to clinical guidelines. The number of fractions of radiation therapy delivered to patients with bone metastases, breast, lung, prostate, and skin cancer was assessed for concordance with clinical guidelines. The proportion of guideline-based care ascertained from the payer's claims database was compared before (2011) and after (2013) the payment method introduction using relative risks (RR). After the introduction of case rates, there were no significant changes in guideline-based care in breast, lung, and skin cancer; however, patients with bone metastases and prostate cancer were significantly more likely to have received guideline-based care (RR = 2.0 and 1.1, respectively, p<0.05). For the aggregate of all cancers, the under-treatment rate significantly declined (p = 0.008) from 4% to 0% after the introduction of case rate payments, while the over-treatment rate remained steady at 9%, with no significant change (p = 0.20). These findings suggest that the introduction of case rate payments did not adversely affect the rate of guideline-based care at the provider examined. Additional research is needed to isolate the effect of the payment model and assess implications in other populations. PMID:26870963

Do Case Rates Affect Physicians' Clinical Practice in Radiation Oncology?: An Observational Study.

PubMed

Loy, Bryan A; Shkedy, Clive I; Powell, Adam C; Happe, Laura E; Royalty, Julie A; Miao, Michael T; Smith, Gary L; Long, James W; Gupta, Amit K

2016-01-01

Case rate payments combined with utilization monitoring may have the potential to improve the quality of care by reducing over and under-treatment. Thus, a national managed care organization introduced case rate payments at one multi-site radiation oncology provider while maintaining only fee-for-service payments at others. This study examined whether the introduction of the payment method had an effect on radiation fractions administered when compared to clinical guidelines. The number of fractions of radiation therapy delivered to patients with bone metastases, breast, lung, prostate, and skin cancer was assessed for concordance with clinical guidelines. The proportion of guideline-based care ascertained from the payer's claims database was compared before (2011) and after (2013) the payment method introduction using relative risks (RR). After the introduction of case rates, there were no significant changes in guideline-based care in breast, lung, and skin cancer; however, patients with bone metastases and prostate cancer were significantly more likely to have received guideline-based care (RR = 2.0 and 1.1, respectively, p<0.05). For the aggregate of all cancers, the under-treatment rate significantly declined (p = 0.008) from 4% to 0% after the introduction of case rate payments, while the over-treatment rate remained steady at 9%, with no significant change (p = 0.20). These findings suggest that the introduction of case rate payments did not adversely affect the rate of guideline-based care at the provider examined. Additional research is needed to isolate the effect of the payment model and assess implications in other populations.

12 CFR Appendix H to Part 226 - Closed-End Model Forms and Clauses

Code of Federal Regulations, 2010 CFR

2018-01-01

... Payment Summary Model Clause (§ 226.18(s)) H-4(F)—Adjustable-Rate Mortgage or Step-Rate Mortgage Interest Rate and Payment Summary Model Clause (§ 226.18(s)) H-4(G)—Mortgage with Negative Amortization Interest Rate and Payment Summary Model Clause (§ 226.18(s)) H-4(H)—Fixed-Rate Mortgage with Interest-Only...

42 CFR 416.171 - Determination of payment rates for ASC services.

Code of Federal Regulations, 2013 CFR

2013-10-01

... services. (d) Limitation on payment rates for office-based surgical procedures and covered ancillary... nonfacility practice expense relative value units under § 414.22(b)(5)(i)(B) of this subchapter multiplied by... payment rate for covered ancillary radiology services that involve certain nuclear medicine procedures...

42 CFR 416.171 - Determination of payment rates for ASC services.

Code of Federal Regulations, 2014 CFR

2014-10-01

... services. (d) Limitation on payment rates for office-based surgical procedures and covered ancillary... nonfacility practice expense relative value units under § 414.22(b)(5)(i)(B) of this subchapter multiplied by... payment rate for covered ancillary radiology services that involve certain nuclear medicine procedures...

Comparison of Medicaid Payments Relative to Medicare Using Inpatient Acute Care Claims from the Medicaid Program: Fiscal Year 2010-Fiscal Year 2011.

PubMed

Stone, Devin A; Dickensheets, Bridget A; Poisal, John A

2018-02-01

To compare Medicaid fee-for-service (FFS) inpatient hospital payments to expected Medicare payments. Medicaid and Medicare claims data, Medicare's MS-DRG grouper and inpatient prospective payment system pricer (IPPS pricer). Medicaid FFS inpatient hospital claims were run through Medicare's MS-DRG grouper and IPPS pricer to compare Medicaid's actual payment against what Medicare would have paid for the same claim. Average inpatient hospital claim payments for Medicaid were 68.8 percent of what Medicare would have paid in fiscal year 2010, and 69.8 percent in fiscal year 2011. Including Medicaid disproportionate share hospital (DSH), graduate medical education (GME), and supplemental payments reduces a substantial proportion of the gap between Medicaid and Medicare payments. Medicaid payments relative to expected Medicare payments tend to be lower and vary by state Medicaid program, length of stay, and whether payments made outside of the Medicaid claims process are included. © Health Research and Educational Trust.

Review of Diagnosis-Related Group-Based Financing of Hospital Care

PubMed Central

Kocic, Sanja; Jakovljevic, Mihajlo

2016-01-01

Since the 1990s, diagnosis-related group (DRG)-based payment systems were gradually introduced in many countries. The main design characteristics of a DRG-based payment system are an exhaustive patient case classification system (ie, the system of diagnosis-related groupings) and the payment formula, which is based on the base rate multiplied by a relative cost weight specific for each DRG. Cases within the same DRG code group are expected to undergo similar clinical evolution. Consecutively, they should incur the costs of diagnostics and treatment within a predefined scale. Such predictability was proven in a number of cost-of-illness studies conducted on major prosperity diseases alongside clinical trials on efficiency. This was the case with risky pregnancies, chronic obstructive pulmonary disease, diabetes, depression, alcohol addiction, hepatitis, and cancer. This article presents experience of introduced DRG-based payments in countries of western and eastern Europe, Scandinavia, United States, Canada, and Australia. This article presents the results of few selected reviews and systematic reviews of the following evidence: published reports on health system reforms by World Health Organization, World Bank, Organization for Economic Co-operation and Development, Canadian Institute for Health Information, Canadian Health Services Research Foundation, and Centre for Health Economics University of York. Diverse payment systems have different strengths and weaknesses in relation to the various objectives. The advantages of the DRG payment system are reflected in the increased efficiency and transparency and reduced average length of stay. The disadvantage of DRG is creating financial incentives toward earlier hospital discharges. Occasionally, such polices are not in full accordance with the clinical benefit priorities. PMID:28462278

Standardization of Type 2 Diabetes Outpatient Expenditure with Bundled Payment Method in China

PubMed Central

Xu, Guo-Chao; Luo, Yun; Li, Qian; Wu, Meng-Fan; Zhou, Zi-Jun

2016-01-01

Background: In recent years, the prevalence of type 2 diabetes among Chinese population has been increasing by years, directly leading to an average annual growth rate of 19.90% of medical expenditure. Therefore, it is urgent to work on strategies to control the growth of medical expenditure on type 2 diabetes on the basis of the reality of China. Therefore, in this study, we explored the feasibility of implementing bundled payment in China through analyzing bundled payment standards of type 2 diabetes outpatient services. Methods: This study analyzed the outpatient expenditure on type 2 diabetes with Beijing Urban Employee's Basic Medical Insurance from 2010 to 2012. Based on the analysis of outpatient expenditure and its influential factors, we adopted decision tree approach to conduct a case-mix analysis. In the end, we built a case-mix model to calculate the standard expenditure and the upper limit of each combination. Results: We found that age, job status, and whether with complication were significant factors that influence outpatient expenditure for type 2 diabetes. Through the analysis of the decision tree, we used six variables (complication, age, diabetic foot, diabetic nephropathy, cardiac-cerebrovascular disease, and neuropathy) to group the cases, and obtained 11 case-mix groups. Conclusions: We argued that it is feasible to implement bundled payment on type 2 diabetes outpatient services. Bundled payment is effective to control the increase of outpatient expenditure. Further improvements are needed for the implementation of bundled payment reimbursement standards, together with relevant policies and measures. PMID:27064041

Child support and alimony: 1985 (supplemental report).

PubMed

Hanlon, R A

1989-03-01

This report on child support and alimony is based on data from the 1987 and 1986 US Current Population Surveys. As of spring 1986, 8.8 million mothers were living with children under 21 years of age whose fathers were not living in the household; 61%, or about 5.4 million, of these women were awarded or had an agreement to receive child support payments for their children as of the survey date. Of the 5.4 million women awarded child support, 4.4 million were supposed to receive child support for their children in 1985. Of those due payment, about half received the full amount they were due. Of the remaining women, there was no evidence of a difference between the proportion receiving partial payment and those receiving no payment at all--about 26% each. Of the 5.4 million women with awards for their children, 45% had health insurance included as part of the award. Of the 3.4 million women without child support awards, about half (48%) wanted but could not obtain awards for their children. The child support award rate reported in 1986 showed a slight increase from that of 1984 (up 2.2% to 58%). The proportion of women awarded child support payments in 1986 was higher for Whites (71%) than for Blacks (36%) or Hispanics (42%). Women with 4 or more years of college were more likely to have been awarded support payments (77%) than women with 4 years of high school (63%). The average (mean) amount of child support received in 1985 was $2200.

Improvement in Total Joint Replacement Quality Metrics: Year One Versus Year Three of the Bundled Payments for Care Improvement Initiative.

PubMed

Dundon, John M; Bosco, Joseph; Slover, James; Yu, Stephen; Sayeed, Yousuf; Iorio, Richard

2016-12-07

In January 2013, a large, tertiary, urban academic medical center began participation in the Bundled Payments for Care Improvement (BPCI) initiative for total joint arthroplasty, a program implemented by the Centers for Medicare & Medicaid Services (CMS) in 2011. Medicare Severity-Diagnosis Related Groups (MS-DRGs) 469 and 470 were included. We participated in BPCI Model 2, by which an episode of care includes the inpatient and all post-acute care costs through 90 days following discharge. The goal for this initiative is to improve patient care and quality through a patient-centered approach with increased care coordination supported through payment innovation. Length of stay (LOS), readmissions, discharge disposition, and cost per episode of care were analyzed for year 3 compared with year 1 of the initiative. Multiple programs were implemented after the first year to improve performance metrics: a surgeon-directed preoperative risk-factor optimization program, enhanced care coordination and home services, a change in venous thromboembolic disease (VTED) prophylaxis to a risk-stratified protocol, infection-prevention measures, a continued emphasis on discharge to home rather than to an inpatient facility, and a quality-dependent gain-sharing program among surgeons. There were 721 Medicare primary total joint arthroplasty patients in year 1 and 785 in year 3; their data were compared. The average hospital LOS decreased from 3.58 to 2.96 days. The rate of discharge to an inpatient facility decreased from 44% to 28%. The 30-day all-cause readmission rate decreased from 7% to 5%; the 60-day all-cause readmission rate decreased from 11% to 6%; and the 90-day all-cause readmission rate decreased from 13% to 8%. The average 90-day cost per episode decreased by 20%. Mid-term results from the implementation of Medicare BPCI Model 2 for primary total joint arthroplasty demonstrated decreased LOS, decreased discharges to inpatient facilities, decreased readmissions, and decreased cost of the episode of care in year 3 compared with year 1, resulting in increased value to all stakeholders involved in this initiative and suggesting that continued improvement over initial gains is possible.

Month-wise variation and prediction of bulk tank somatic cell count in Brazilian dairy herds and its impact on payment based on milk quality.

PubMed

Busanello, Marcos; de Freitas, Larissa Nazareth; Winckler, João Pedro Pereira; Farias, Hiron Pereira; Dos Santos Dias, Carlos Tadeu; Cassoli, Laerte Dagher; Machado, Paulo Fernando

2017-01-01

Payment programs based on milk quality (PPBMQ) are used in several countries around the world as an incentive to improve milk quality. One of the principal milk parameters used in such programs is the bulk tank somatic cell count (BTSCC). In this study, using data from an average of 37,000 farms per month in Brazil where milk was analyzed, BTSCC data were divided into different payment classes based on milk quality. Then, descriptive and graphical analyses were performed. The probability of a change to a worse payment class was calculated, future BTSCC values were predicted using time series models, and financial losses due to the failure to reach the maximum bonus for the payment based on milk quality were simulated. In Brazil, the mean BTSCC has remained high in recent years, without a tendency to improve. The probability of changing to a worse payment class was strongly affected by both the BTSCC average and BTSCC standard deviation for classes 1 and 2 (1000-200,000 and 201,000-400,000 cells/mL, respectively) and only by the BTSCC average for classes 3 and 4 (401,000-500,000 and 501,000-800,000 cells/mL, respectively). The time series models indicated that at some point in the year, farms would not remain in their current class and would accrue financial losses due to payments based on milk quality. The BTSCC for Brazilian dairy farms has not recently improved. The probability of a class change to a worse class is a metric that can aid in decision-making and stimulate farmers to improve milk quality. A time series model can be used to predict the future value of the BTSCC, making it possible to estimate financial losses and to show, moreover, that financial losses occur in all classes of the PPBMQ because the farmers do not remain in the best payment class in all months.

The Australian baby bonus maternity payment and birth characteristics in Western Australia.

PubMed

Einarsdóttir, Kristjana; Langridge, Amanda; Hammond, Geoffrey; Gunnell, Anthony S; Haggar, Fatima A; Stanley, Fiona J

2012-01-01

The Australian baby bonus maternity payment introduced in 2004 has been reported to have successfully increased fertility rates in Australia. We aimed to investigate the influence of the baby bonus on maternal demographics and birth characteristics in Western Australia (WA). This study included 200,659 birth admissions from WA during 2001-2008, identified from administrative birth and hospital data-systems held by the WA Department of Health. We estimated average quarterly birth rates after the baby bonus introduction and compared them with expected rates had the policy not occurred. Rate and percentage differences (including 95% confidence intervals) were estimated separately by maternal demographics and birth characteristics. WA birth rates increased by 12.8% following the baby bonus implementation with the greatest increase being in mothers aged 20-24 years (26.3%, 95%CI = 22.0,30.6), mothers having their third (1.6%, 95%CI = 0.9,2.4) or fourth child (2.2%, 95%CI = 2.1,2.4), mothers living in outer regional and remote areas (32.4%, 95%CI = 30.2,34.6), mothers giving birth as public patients (1.5%, 95%CI = 1.3,1.8), and mothers giving birth in public hospitals (3.5%, 95%CI = 2.6,4.5). Interestingly, births to private patients (-4.3%, 95%CI = -4.8,-3.7) and births in private hospitals (-6.3%, 95%CI = -6.8,-5.8) decreased following the policy implementation. The introduction of the baby bonus maternity payment may have served as an incentive for women in their early twenties and mothers having their third or fourth child and may have contributed to the ongoing pressure and staff shortages in Australian public hospitals, particularly those in outer regional and remote areas.

75 FR 81138 - Medicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2011...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-27

... [CMS-1510-CN2] RIN 0938-AP88 Medicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2011; Changes in Certification Requirements for Home Health Agencies and Hospices AGENCY... ``Medicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2011; Changes in...

42 CFR 412.79 - Determination of the hospital-specific rate for inpatient operating costs for Medicare-dependent...

Code of Federal Regulations, 2010 CFR

2010-10-01

... OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Determination of Transition Period Payment Rates for the Prospective Payment System for Inpatient... 42 Public Health 2 2010-10-01 2010-10-01 false Determination of the hospital-specific rate for...

7 CFR 275.23 - Determination of State agency program performance.

Code of Federal Regulations, 2011 CFR

2011-01-01

... NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE FOOD STAMP AND FOOD DISTRIBUTION PROGRAM PERFORMANCE REPORTING... section, the adjusted regressed payment error rate shall be calculated to yield the State agency's payment error rate. The adjusted regressed payment error rate is given by r 1″ + r 2″. (ii) If FNS determines...

7 CFR 1410.41 - Levels and rates for cost-share payments.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 10 2010-01-01 2010-01-01 false Levels and rates for cost-share payments. 1410.41... CORPORATION, DEPARTMENT OF AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS CONSERVATION RESERVE PROGRAM § 1410.41 Levels and rates for cost-share payments. (a) As determined by the Deputy Administrator, CCC...

Evaluating agricultural nonpoint-source pollution programs in two Lake Erie tributaries.

PubMed

Forster, D Lynn; Rausch, Jonathan N

2002-01-01

During the past three decades, numerous government programs have encouraged Lake Erie basin farmers to adopt practices that reduce water pollution. The first section of this paper summarizes these state and federal government agricultural pollution abatement programs in watersheds of two prominent Lake Erie tributaries, the Maumee River and Sandusky River. Expenditures are summarized for each program, total expenditures in each county are estimated, and cost effectiveness of program expenditures (i.e., cost per metric ton of soil saved) are analyzed. Farmers received nearly $143 million as incentive payments to implement agricultural nonpoint source pollution abatement programs in the Maumee and Sandusky River watersheds from 1987 to 1997. About 95% of these funds was from federal sources. On average, these payments totaled about $7000 per farm or about $30 per farm acre (annualized equivalent of $2 per acre) within the watersheds. Our analysis raises questions about how efficiently these incentive payments were allocated. The majority of Agricultural Conservation Program (ACP) funds appear to have been spent on less cost-effective practices. Also, geographic areas with relatively low (high) soil erosion rates received relatively large (small) funding.

24 CFR 221.256 - Interest rate increase and payment of mortgage insurance premiums on mortgages under § 221.60 and...

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Interest rate increase and payment... Interest rate increase and payment of mortgage insurance premiums on mortgages under § 221.60 and § 221.65... continuation of a below market interest rate, interest on such mortgage shall be computed by the mortgagee at...

The impact of out-of-pocket payments on health care inequity: the case of national health insurance in South Korea.

PubMed

Lee, Weon-Young; Shaw, Ian

2014-07-18

The global financial crisis of 2008 has led to the reinforcement of patient cost sharing in health care policy. This study aimed to explore the impact of direct out-of pocket payments (OOPs) on health care utilization and the resulting financial burden across income groups under the South Korean National Health Insurance (NHI) program with universal population coverage. We used the fourth Korean National Health and Nutrition Examination Survey (KNHNES-IV) and the Korean Household Income and Expenditure Survey (KHIES) of 2007, 2008 and 2009. The Horizontal Inequity Index (HIwv) and the average unit OOPs were used to measure income-related inequity in the quantitative and qualitative aspects of health care utilization, respectively. For financial burden, the incidence rates of catastrophic health expenditure (CHE) were compared across income groups. For outpatient and hospital visits, there was neither pro-poor or pro-rich inequality. The average unit OOPs of the poorest quintile was approximately 75% and 60% of each counterpart in the richest quintile in the outpatient and inpatient services. For the CHE threshold of 40%, the incidence rates were 5.7%, 1.67%, 0.72%, 0.33% and 0.27% in quintiles I (the poorest quintile), II, III, IV and V, respectively. Substantial OOPs under the NHI are disadvantageous, particularly for the lowest income group in terms of health care quality and financial burden.

42 CFR 413.350 - Periodic interim payments for skilled nursing facilities receiving payment under the skilled...

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 2 2013-10-01 2013-10-01 false Periodic interim payments for skilled nursing facilities receiving payment under the skilled nursing facility prospective payment system for Part A...-STAGE RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING...

42 CFR 413.350 - Periodic interim payments for skilled nursing facilities receiving payment under the skilled...

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 2 2012-10-01 2012-10-01 false Periodic interim payments for skilled nursing facilities receiving payment under the skilled nursing facility prospective payment system for Part A...-STAGE RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING...

42 CFR 413.350 - Periodic interim payments for skilled nursing facilities receiving payment under the skilled...

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Periodic interim payments for skilled nursing facilities receiving payment under the skilled nursing facility prospective payment system for Part A...-STAGE RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING...

42 CFR 413.350 - Periodic interim payments for skilled nursing facilities receiving payment under the skilled...

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 2 2011-10-01 2011-10-01 false Periodic interim payments for skilled nursing facilities receiving payment under the skilled nursing facility prospective payment system for Part A...-STAGE RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING...

42 CFR 413.350 - Periodic interim payments for skilled nursing facilities receiving payment under the skilled...

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 2 2014-10-01 2014-10-01 false Periodic interim payments for skilled nursing facilities receiving payment under the skilled nursing facility prospective payment system for Part A...-STAGE RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING...

78 FR 41013 - Medicare and Medicaid Programs; Home Health Prospective Payment System Rate Update for CY 2014...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-09

... [CMS-1450-CN] RIN 0938-AR52 Medicare and Medicaid Programs; Home Health Prospective Payment System Rate Update for CY 2014, Home Health Quality Reporting Requirements, and Cost Allocation of Home Health Survey... period titled ``Medicare and Medicaid Programs; Home Health Prospective Payment System Rate Update for CY...

76 FR 9502 - Medicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2011...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-18

... [CMS-1510-F2] RIN 0938-AP88 Medicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2011; Changes in Certification Requirements for Home Health Agencies and Hospices; Correction... set forth an update to the Home Health Prospective Payment System (HH PPS) rates, including: The...

78 FR 46955 - Animal Drug User Fee Rates and Payment Procedures for Fiscal Year 2014

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-02

...] Animal Drug User Fee Rates and Payment Procedures for Fiscal Year 2014 AGENCY: Food and Drug... payment procedures for fiscal year (FY) 2014 animal drug user fees. The Federal Food, Drug, and Cosmetic... submissions. This notice establishes the fee rates for FY 2014. FOR FURTHER INFORMATION CONTACT: Visit FDA's...

29 CFR Appendix C to Part 4022 - Lump Sum Interest Rates for Private-Sector Payments

Code of Federal Regulations, 2010 CFR

2010-07-01

... 29 Labor 9 2010-07-01 2010-07-01 false Lump Sum Interest Rates for Private-Sector Payments C... Appendix C to Part 4022—Lump Sum Interest Rates for Private-Sector Payments [In using this table: (1) For... (where y is an integer and 0 n 1 + n 2), interest rate i 3 shall apply from the valuation date for a...

29 CFR Appendix B to Part 4022 - Lump Sum Interest Rates for PBGC Payments

Code of Federal Regulations, 2010 CFR

2010-07-01

... 29 Labor 9 2010-07-01 2010-07-01 false Lump Sum Interest Rates for PBGC Payments B Appendix B to... 4022—Lump Sum Interest Rates for PBGC Payments [In using this table: (1) For benefits for which the... + n2), interest rate i3 shall apply from the valuation date for a period of y−n1−n2 years; interest...

42 CFR 413.312 - Methodology for calculating rates.

Code of Federal Regulations, 2013 CFR

2013-10-01

... SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Prospectively Determined Payment Rates for Low-Volume Skilled Nursing Facilities, for Cost Reporting Periods Beginning...

42 CFR 413.312 - Methodology for calculating rates.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Prospectively Determined Payment Rates for Low-Volume Skilled Nursing Facilities, for Cost Reporting Periods Beginning...

42 CFR 413.210 - Conditions for payment under the end-stage renal disease (ESRD) prospective payment system.

Code of Federal Regulations, 2011 CFR

2011-10-01

... disease (ESRD) prospective payment system. 413.210 Section 413.210 Public Health CENTERS FOR MEDICARE... REIMBURSEMENT; PAYMENT FOR END-STAGE RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Payment for End-Stage Renal Disease (ESRD) Services and Organ Procurement Costs...

42 CFR 413.210 - Conditions for payment under the end-stage renal disease (ESRD) prospective payment system.

Code of Federal Regulations, 2010 CFR

2010-10-01

... disease (ESRD) prospective payment system. 413.210 Section 413.210 Public Health CENTERS FOR MEDICARE... REIMBURSEMENT; PAYMENT FOR END-STAGE RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Payment for End-Stage Renal Disease (ESRD) Services and Organ Procurement Costs...

42 CFR 413.210 - Conditions for payment under the end-stage renal disease (ESRD) prospective payment system.

Code of Federal Regulations, 2012 CFR

2012-10-01

... disease (ESRD) prospective payment system. 413.210 Section 413.210 Public Health CENTERS FOR MEDICARE... REIMBURSEMENT; PAYMENT FOR END-STAGE RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Payment for End-Stage Renal Disease (ESRD) Services and Organ Procurement Costs...

42 CFR 413.210 - Conditions for payment under the end-stage renal disease (ESRD) prospective payment system.

Code of Federal Regulations, 2013 CFR

2013-10-01

... disease (ESRD) prospective payment system. 413.210 Section 413.210 Public Health CENTERS FOR MEDICARE... REIMBURSEMENT; PAYMENT FOR END-STAGE RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Payment for End-Stage Renal Disease (ESRD) Services and Organ Procurement Costs...

42 CFR 413.210 - Conditions for payment under the end-stage renal disease (ESRD) prospective payment system.

Code of Federal Regulations, 2014 CFR

2014-10-01

... disease (ESRD) prospective payment system. 413.210 Section 413.210 Public Health CENTERS FOR MEDICARE... REIMBURSEMENT; PAYMENT FOR END-STAGE RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Payment for End-Stage Renal Disease (ESRD) Services and Organ Procurement Costs...

42 CFR 413.83 - Direct GME payments: Adjustment of a hospital's target amount or prospective payment hospital...

Code of Federal Regulations, 2010 CFR

2010-10-01

... target amount or prospective payment hospital-specific rate. 413.83 Section 413.83 Public Health CENTERS... Direct GME payments: Adjustment of a hospital's target amount or prospective payment hospital-specific...-increase ceiling or prospective payment base year for purposes of adjusting the hospital's target amount or...

42 CFR 413.83 - Direct GME payments: Adjustment of a hospital's target amount or prospective payment hospital...

Code of Federal Regulations, 2011 CFR

2011-10-01

... target amount or prospective payment hospital-specific rate. 413.83 Section 413.83 Public Health CENTERS... Direct GME payments: Adjustment of a hospital's target amount or prospective payment hospital-specific...-increase ceiling or prospective payment base year for purposes of adjusting the hospital's target amount or...

Impact of Medicare Advantage Prescription Drug Plan Star Ratings on Enrollment before and after Implementation of Quality-Related Bonus Payments in 2012

PubMed Central

Li, Pengxiang; Doshi, Jalpa A.

2016-01-01

Objective Since 2007, the Centers for Medicare and Medicaid Services have published 5-star quality rating measures to aid consumers in choosing Medicare Advantage Prescription Drug Plans (MAPDs). We examined the impact of these star ratings on Medicare Advantage Prescription Drug (MAPD) enrollment before and after 2012, when star ratings became tied to bonus payments for MAPDs that could be used to improve plan benefits and/or reduce premiums in the subsequent year. Methods A longitudinal design and multivariable hybrid models were used to assess whether star ratings had a direct impact on concurrent year MAPD contract enrollment (by influencing beneficiary choice) and/or an indirect impact on subsequent year MAPD contract enrollment (because ratings were linked to bonus payments). The main analysis was based on contract-year level data from 2009–2015. We compared effects of star ratings in the pre-bonus payment period (2009–2011) and post-bonus payment period (2012–2015). Extensive sensitivity analyses varied the analytic techniques, unit of analysis, and sample inclusion criteria. Similar analyses were conducted separately using stand-alone PDP contract-year data; since PDPs were not eligible for bonus payments, they served as an external comparison group. Result The main analysis included 3,866 MAPD contract-years. A change of star rating had no statistically significant effect on concurrent year enrollment in any of the pre-, post-, or pre-post combined periods. On the other hand, star rating increase was associated with a statistically significant increase in the subsequent year enrollment (a 1-star increase associated with +11,337 enrollees, p<0.001) in the post-bonus payment period but had a very small and statistically non-significant effect on subsequent year enrollment in the pre-bonus payment period. Further, the difference in effects on subsequent year enrollment was statistically significant between the pre- and post-periods (p = 0.011). Sensitivity analyses indicated that the findings were robust. No statistically significant effect of star ratings was found on concurrent or subsequent year enrollment in the pre- or post-period in the external comparison group of stand-alone PDP contracts. Conclusion Star ratings had no direct impact on concurrent year MAPD enrollment before or after the introduction of bonus payments tied to star ratings. However, after the introduction of these bonus payments, MAPD star ratings had a significant indirect impact of increasing subsequent year enrollment, likely via the reinvestment of bonuses to provide lower premiums and/or additional member benefits in the following year. PMID:27149092

Impact of Medicare Advantage Prescription Drug Plan Star Ratings on Enrollment before and after Implementation of Quality-Related Bonus Payments in 2012.

PubMed

Li, Pengxiang; Doshi, Jalpa A

2016-01-01

Since 2007, the Centers for Medicare and Medicaid Services have published 5-star quality rating measures to aid consumers in choosing Medicare Advantage Prescription Drug Plans (MAPDs). We examined the impact of these star ratings on Medicare Advantage Prescription Drug (MAPD) enrollment before and after 2012, when star ratings became tied to bonus payments for MAPDs that could be used to improve plan benefits and/or reduce premiums in the subsequent year. A longitudinal design and multivariable hybrid models were used to assess whether star ratings had a direct impact on concurrent year MAPD contract enrollment (by influencing beneficiary choice) and/or an indirect impact on subsequent year MAPD contract enrollment (because ratings were linked to bonus payments). The main analysis was based on contract-year level data from 2009-2015. We compared effects of star ratings in the pre-bonus payment period (2009-2011) and post-bonus payment period (2012-2015). Extensive sensitivity analyses varied the analytic techniques, unit of analysis, and sample inclusion criteria. Similar analyses were conducted separately using stand-alone PDP contract-year data; since PDPs were not eligible for bonus payments, they served as an external comparison group. The main analysis included 3,866 MAPD contract-years. A change of star rating had no statistically significant effect on concurrent year enrollment in any of the pre-, post-, or pre-post combined periods. On the other hand, star rating increase was associated with a statistically significant increase in the subsequent year enrollment (a 1-star increase associated with +11,337 enrollees, p<0.001) in the post-bonus payment period but had a very small and statistically non-significant effect on subsequent year enrollment in the pre-bonus payment period. Further, the difference in effects on subsequent year enrollment was statistically significant between the pre- and post-periods (p = 0.011). Sensitivity analyses indicated that the findings were robust. No statistically significant effect of star ratings was found on concurrent or subsequent year enrollment in the pre- or post-period in the external comparison group of stand-alone PDP contracts. Star ratings had no direct impact on concurrent year MAPD enrollment before or after the introduction of bonus payments tied to star ratings. However, after the introduction of these bonus payments, MAPD star ratings had a significant indirect impact of increasing subsequent year enrollment, likely via the reinvestment of bonuses to provide lower premiums and/or additional member benefits in the following year.

37 CFR 253.8 - Terms and rates of royalty payments for the use of published pictorial, graphic, and sculptural...

Code of Federal Regulations, 2010 CFR

2010-07-01

... payments for the use of published pictorial, graphic, and sculptural works. 253.8 Section 253.8 Patents... BROADCASTING § 253.8 Terms and rates of royalty payments for the use of published pictorial, graphic, and sculptural works. (a) Scope. This section establishes rates and terms for the use of published pictorial...

37 CFR 381.8 - Terms and rates of royalty payments for the use of published pictorial, graphic, and sculptural...

Code of Federal Regulations, 2010 CFR

2010-07-01

... payments for the use of published pictorial, graphic, and sculptural works. 381.8 Section 381.8 Patents... Terms and rates of royalty payments for the use of published pictorial, graphic, and sculptural works. (a) Scope. This section establishes rates and terms for the use of published pictorial, graphic, and...

76 FR 26431 - Medicare Program; Inpatient Psychiatric Facilities Prospective Payment System-Update for Rate...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-06

...This final rule updates the prospective payment rates for Medicare inpatient hospital services provided by inpatient psychiatric facilities (IPFs) for discharges occurring during the rate year (RY) beginning July 1, 2011 through September 30, 2012. The final rule also changes the IPF prospective payment system (PPS) payment rate update period to a RY that coincides with a fiscal year (FY). In addition, the rule implements policy changes affecting the IPF PPS teaching adjustment. It also rebases and revises the Rehabilitation, Psychiatric, and Long-Term Care (RPL) market basket, and makes some clarifications and corrections to terminology and regulations text.

Risk-adjusted capitation funding models for chronic disease in Australia: alternatives to casemix funding.

PubMed

Antioch, K M; Walsh, M K

2002-01-01

Under Australian casemix funding arrangements that use Diagnosis-Related Groups (DRGs) the average price is policy based, not benchmarked. Cost weights are too low for State-wide chronic disease services. Risk-adjusted Capitation Funding Models (RACFM) are feasible alternatives. A RACFM was developed for public patients with cystic fibrosis treated by an Australian Health Maintenance Organization (AHMO). Adverse selection is of limited concern since patients pay solidarity contributions via Medicare levy with no premium contributions to the AHMO. Sponsors paying premium subsidies are the State of Victoria and the Federal Government. Cost per patient is the dependent variable in the multiple regression. Data on DRG 173 (cystic fibrosis) patients were assessed for heteroskedasticity, multicollinearity, structural stability and functional form. Stepwise linear regression excluded non-significant variables. Significant variables were 'emergency' (1276.9), 'outlier' (6377.1), 'complexity' (3043.5), 'procedures' (317.4) and the constant (4492.7) (R(2)=0.21, SE=3598.3, F=14.39, Prob<0.0001. Regression coefficients represent the additional per patient costs summed to the base payment (constant). The model explained 21% of the variance in cost per patient. The payment rate is adjusted by a best practice annual admission rate per patient. The model is a blended RACFM for in-patient, out-patient, Hospital In The Home, Fee-For-Service Federal payments for drugs and medical services; lump sum lung transplant payments and risk sharing through cost (loss) outlier payments. State and Federally funded home and palliative services are 'carved out'. The model, which has national application via Coordinated Care Trials and by Australian States for RACFMs may be instructive for Germany, which plans to use Australian DRGs for casemix funding. The capitation alternative for chronic disease can improve equity, allocative efficiency and distributional justice. The use of Diagnostic Cost Groups (DCGs) is a promising alternative classification system for capitation arrangements.

Promoting universal financial protection: evidence from the Rashtriya Swasthya Bima Yojana (RSBY) in Gujarat, India.

PubMed

Devadasan, Narayanan; Seshadri, Tanya; Trivedi, Mayur; Criel, Bart

2013-08-20

India's health expenditure is met mostly by households through out-of-pocket (OOP) payments at the time of illness. To protect poor families, the Indian government launched a national health insurance scheme (RSBY). Those below the national poverty line (BPL) are eligible to join the RSBY. The premium is heavily subsidised by the government. The enrolled members receive a card and can avail of free hospitalisation care up to a maximum of US$ 600 per family per year. The hospitals are reimbursed by the insurance companies. The objective of our study was to analyse the extent to which RSBY contributes to universal health coverage by protecting families from making OOP payments. A two-stage stratified sampling technique was used to identify eligible BPL families in Patan district of Gujarat, India. Initially, all 517 villages were listed and 78 were selected randomly. From each of these villages, 40 BPL households were randomly selected and a structured questionnaire was administered. Interviews and discussions were also conducted among key stakeholders. Our sample contained 2,920 households who had enrolled in the RSBY; most were from the poorer sections of society. The average hospital admission rate for the period 2010-2011 was 40/1,000 enrolled. Women, elderly and those belonging to the lowest caste had a higher hospitalisation rate. Forty four per cent of patients who had enrolled in RSBY and had used the RSBY card still faced OOP payments at the time of hospitalisation. The median OOP payment for the above patients was US$ 80 (interquartile range, $16-$200) and was similar in both government and private hospitals. Patients incurred OOP payments mainly because they were asked to purchase medicines and diagnostics, though the same were included in the benefit package. While the RSBY has managed to include the poor under its umbrella, it has provided only partial financial coverage. Nearly 60% of insured and admitted patients made OOP payments. We plea for better monitoring of the scheme and speculate that it is possible to enhance effective financial coverage of the RSBY if the nodal agency at state level would strengthen its stewardship and oversight functions.

5 CFR 550.162 - Payment provisions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... leave without pay period occurs during the employee's high-3 average salary period.) (g) Notwithstanding....162 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PAY ADMINISTRATION (GENERAL) Premium Pay General Rules Governing Payments of Premium Pay on An Annual Basis § 550.162...

5 CFR 550.162 - Payment provisions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... leave without pay period occurs during the employee's high-3 average salary period.) (g) Notwithstanding....162 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PAY ADMINISTRATION (GENERAL) Premium Pay General Rules Governing Payments of Premium Pay on An Annual Basis § 550.162...

12 CFR 27.3 - Recordkeeping requirements.

Code of Federal Regulations, 2012 CFR

2012-01-01

... average or normal monthly income. Include alimony, separate maintenance and child support income... any alimony, child support or separate maintenance payments. Exclude any payments on liabilities which...) Date of application. The date on which a signed application is received by the bank. (xix) Sex of...

48 CFR 32.503-6 - Suspension or reduction of payments.

Code of Federal Regulations, 2011 CFR

2011-10-01

... GENERAL CONTRACTING REQUIREMENTS CONTRACT FINANCING Progress Payments Based on Costs 32.503-6 Suspension or reduction of payments. (a) General. The Progress Payments clause provides a Government right to reduce or suspend progress payments, or to increase the liquidation rate, under specified conditions...

The effect of timing of incentive payments on response rates for cohort study telephone interviews in primary care setting with cost-minimization analysis, a randomized controlled trial.

PubMed

Chin, Weng-Yee; Choi, Edmond P H; Lam, Cindy L K

2015-10-06

The effect of timing of incentive payments on the response rate of telephone surveys is unknown. This study examined whether up-front or delayed incentive payments were associated with higher response rates for participation in a telephone interview administered longitudinal cohort study amongst primary care patients with lower urinary tract symptoms, and to compare the costs between the two timing methods. This study was conducted as part of a naturalistic observation study on the health-related quality of life and health outcomes of Chinese primary care patients with lower urinary tract symptoms. The incentive payment was in the form of a supermarket gift voucher to the value of HD$50 (US$6.50) and could be used in lieu of cash at a major supermarket chain.720 subjects with lower urinary tract symptoms were randomly assigned into two groups. One group was offered an incentive of supermarket cash voucher at time of recruitment ('up-front' payment). The other group was told that the voucher would be sent to them after the complete of their 1-year follow-up telephone interview ('delayed' payment). Primary outcomes were the baseline and 1-year follow-up telephone survey response rates. There was no statistical difference in response rates at baseline (p-value = 0.938) or at the 1-year follow-up (p-value = 0.751) between groups. Cost per completed subject interviews for the up-front payment method was USD16.64, whilst cost for the delayed payment was USD 13.85. It appears the timing of incentive payments does not affect response rates for telephone interview surveys conducted on primary care patients in Hong Kong at baseline or at 1-year follow-up. Delayed incentive payments can reduce the overall cost per successful case. ClinicalTrials.gov Identifier: NCT02307929 Registered 28 August 2013.

[The co-payment of the dependence from the structural reform of 2012 in Spain].

PubMed

Del Pozo-Rubio, Raúl; Pardo-García, Isabel; Escribano-Sotos, Francisco

The objective of this piece of work is to establish the cost of dependency and the cost of financing it. Specifically, we will determine the cost of co-payment for individual users following the modification introduced by the 13th of July 2012 Resolution as well as its allocation by the autonomous regions. The degree and level of dependency was established using the Survey on Disability, Personal Autonomy and Dependency Situations, 2008. The cost of dependency according to degree and level and autonomous regions was established with information from the System for Personal Autonomy and Care of Dependent Persons. The co-payment was established according to applicants' purchasing power. The rating of these services, and the contribution of individual users were done in agreement with 2012 legislation and with common indicators and benchmarks for the whole national territory. The total estimated cost is 10,598.8 million euros (1.03% of GDP), and Andalusia, the Valencian Community and Catalonia are those regions with the greatest costs. The average national co-payment per individual user is 53.54%, with differences due to degrees and levels of disability and autonomous regions, although, generally speaking, all of the users fund more than half of the care they receive. This change in legislation has meant that co-payment is higher than the 33% established by this law and that co-payments prior to 2012 were about 20%. If we add to this the differences in autonomous regions, it would be useful to reflect on the uneven application of the law. Copyright © 2016 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

48 CFR 52.216-7 - Allowable Cost and Payment.

Code of Federal Regulations, 2010 CFR

2010-10-01

... written understanding setting forth the final indirect cost rates. The understanding shall specify (i) the... special terms and the applicable rates. The understanding shall not change any monetary ceiling, contract... not subject to the interest penalty provisions of the Prompt Payment Act. Interim payments made prior...

7 CFR 81.6 - Rate of payment; total payments.

Code of Federal Regulations, 2010 CFR

2010-01-01

... for each eligible prune-plum tree removed will be $8.50 per tree. (b) Payment under paragraph (a) of this section will be made after tree removal has been verified by the staff of the Committee. (c) The $8.50 per tree payment shall be the total payment. USDA will make no other payment with respect to...

7 CFR 760.307 - Payment calculation.

Code of Federal Regulations, 2012 CFR

2012-01-01

... qualifying drought as specified in § 760.305(a) equal to one, two, or three times the monthly payment rate... a calendar year for grazing losses due to qualifying drought will not exceed three monthly payments... to drought, payments will be made only as a “one month” payment, a “two month” payment, or a “three...

7 CFR 760.307 - Payment calculation.

Code of Federal Regulations, 2010 CFR

2010-01-01

... qualifying drought as specified in § 760.305(a) equal to one, two, or three times the monthly payment rate... a calendar year for grazing losses due to qualifying drought will not exceed three monthly payments... to drought, payments will be made only as a “one month” payment, a “two month” payment, or a “three...

7 CFR 760.307 - Payment calculation.

Code of Federal Regulations, 2014 CFR

2014-01-01

... qualifying drought as specified in § 760.305(a) equal to one, two, or three times the monthly payment rate... a calendar year for grazing losses due to qualifying drought will not exceed three monthly payments... to drought, payments will be made only as a “one month” payment, a “two month” payment, or a “three...

7 CFR 760.307 - Payment calculation.

Code of Federal Regulations, 2013 CFR

2013-01-01

... qualifying drought as specified in § 760.305(a) equal to one, two, or three times the monthly payment rate... a calendar year for grazing losses due to qualifying drought will not exceed three monthly payments... to drought, payments will be made only as a “one month” payment, a “two month” payment, or a “three...

7 CFR 760.307 - Payment calculation.

Code of Federal Regulations, 2011 CFR

2011-01-01

... qualifying drought as specified in § 760.305(a) equal to one, two, or three times the monthly payment rate... a calendar year for grazing losses due to qualifying drought will not exceed three monthly payments... to drought, payments will be made only as a “one month” payment, a “two month” payment, or a “three...

7 CFR 81.6 - Rate of payment; total payments.

Code of Federal Regulations, 2012 CFR

2012-01-01

... for each eligible prune-plum tree removed will be $8.50 per tree. (b) Payment under paragraph (a) of this section will be made after tree removal has been verified by the staff of the Committee. (c) The $8.50 per tree payment shall be the total payment. USDA will make no other payment with respect to...

7 CFR 81.6 - Rate of payment; total payments.

Code of Federal Regulations, 2014 CFR

2014-01-01

... for each eligible prune-plum tree removed will be $8.50 per tree. (b) Payment under paragraph (a) of this section will be made after tree removal has been verified by the staff of the Committee. (c) The $8.50 per tree payment shall be the total payment. USDA will make no other payment with respect to...

7 CFR 81.6 - Rate of payment; total payments.

Code of Federal Regulations, 2013 CFR

2013-01-01

... for each eligible prune-plum tree removed will be $8.50 per tree. (b) Payment under paragraph (a) of this section will be made after tree removal has been verified by the staff of the Committee. (c) The $8.50 per tree payment shall be the total payment. USDA will make no other payment with respect to...

7 CFR 81.6 - Rate of payment; total payments.

Code of Federal Regulations, 2011 CFR

2011-01-01

... for each eligible prune-plum tree removed will be $8.50 per tree. (b) Payment under paragraph (a) of this section will be made after tree removal has been verified by the staff of the Committee. (c) The $8.50 per tree payment shall be the total payment. USDA will make no other payment with respect to...

42 CFR 484.220 - Calculation of the adjusted national prospective 60-day episode payment rate for case-mix and...

Code of Federal Regulations, 2014 CFR

2014-10-01

...-day episode payment rate for case-mix and area wage levels. 484.220 Section 484.220 Public Health... Calculation of the adjusted national prospective 60-day episode payment rate for case-mix and area wage levels... case-mix using a case-mix index to explain the relative resource utilization of different patients. To...

42 CFR 484.220 - Calculation of the adjusted national prospective 60-day episode payment rate for case-mix and...

Code of Federal Regulations, 2013 CFR

2013-10-01

...-day episode payment rate for case-mix and area wage levels. 484.220 Section 484.220 Public Health... Calculation of the adjusted national prospective 60-day episode payment rate for case-mix and area wage levels... case-mix using a case-mix index to explain the relative resource utilization of different patients. To...

42 CFR 484.220 - Calculation of the adjusted national prospective 60-day episode payment rate for case-mix and...

Code of Federal Regulations, 2011 CFR

2011-10-01

...-day episode payment rate for case-mix and area wage levels. 484.220 Section 484.220 Public Health... Calculation of the adjusted national prospective 60-day episode payment rate for case-mix and area wage levels... case-mix using a case-mix index to explain the relative resource utilization of different patients. To...

42 CFR 484.220 - Calculation of the adjusted national prospective 60-day episode payment rate for case-mix and...

Code of Federal Regulations, 2012 CFR

2012-10-01

...-day episode payment rate for case-mix and area wage levels. 484.220 Section 484.220 Public Health... Calculation of the adjusted national prospective 60-day episode payment rate for case-mix and area wage levels... case-mix using a case-mix index to explain the relative resource utilization of different patients. To...

42 CFR 484.220 - Calculation of the adjusted national prospective 60-day episode payment rate for case-mix and...

Code of Federal Regulations, 2010 CFR

2010-10-01

... address changes to the case-mix that are a result of changes in the coding or classification of different...-day episode payment rate for case-mix and area wage levels. 484.220 Section 484.220 Public Health... Calculation of the adjusted national prospective 60-day episode payment rate for case-mix and area wage levels...

42 CFR 413.335 - Basis of payment.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Facilities § 413.335 Basis of payment. (a) Method of payment. Under the prospective payment system, SNFs... and, during a transition period, on the basis of a blend of the Federal rate and the facility-specific...

42 CFR 416.125 - ASC facility services payment rate.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 3 2011-10-01 2011-10-01 false ASC facility services payment rate. 416.125 Section 416.125 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... connection with the performance of that procedure. (b) The payment must be substantially less than would have...

42 CFR 416.125 - ASC facility services payment rate.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false ASC facility services payment rate. 416.125 Section 416.125 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... connection with the performance of that procedure. (b) The payment must be substantially less than would have...

42 CFR 422.308 - Adjustments to capitation rates, benchmarks, bids, and payments.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 3 2011-10-01 2011-10-01 false Adjustments to capitation rates, benchmarks, bids, and payments. 422.308 Section 422.308 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM MEDICARE ADVANTAGE PROGRAM Payments to...

26 CFR 1.7519-0T - Table of contents (temporary).

Code of Federal Regulations, 2010 CFR

2010-04-01

... 1987. (iii) Example. (2) Adjusted highest section 1 rate. (i) General rule. (ii) Period for determining highest section rate. Base year. (4) Special rules for certain applicable election years. (i) First...) Special rules for certain payments. (1) Certain indirect payments. (2) Payments by a downstream controlled...

42 CFR 412.8 - Publication of schedules for determining prospective payment rates.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Publication of schedules for determining prospective payment rates. 412.8 Section 412.8 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL...

42 CFR 412.312 - Payment based on the Federal rate.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Capital-Related Costs § 412.312 Payment based on the Federal rate. (a) General. The payment amount for... disproportionate share adjustment factor + capital indirect medical education adjustment factor)×(for hospitals... capital-related and operating-related costs exceed the cost outlier threshold as provided for in § 412.84...

Payments and quality of care in private for-profit and public hospitals in Greece.

PubMed

Kondilis, Elias; Gavana, Magda; Giannakopoulos, Stathis; Smyrnakis, Emmanouil; Dombros, Nikolaos; Benos, Alexis

2011-09-23

Empirical evidence on how ownership type affects the quality and cost of medical care is growing, and debate on these topics is ongoing. Despite the fact that the private sector is a major provider of hospital services in Greece, little comparative information on private versus public sector hospitals is available. The aim of the present study was to describe and compare the operation and performance of private for-profit (PFP) and public hospitals in Greece, focusing on differences in nurse staffing rates, average lengths of stay (ALoS), and Social Health Insurance (SHI) payments for hospital care per patient discharged. Five different datasets were prepared and analyzed, two of which were derived from information provided by the National Statistical Service (NSS) of Greece and the other three from data held by the three largest SHI schemes in the country. All data referred to the 3-year period from 2001 to 2003. PFP hospitals in Greece are smaller than public hospitals, with lower patient occupancy, and have lower staffing rates of all types of nurses and highly qualified nurses compared with public hospitals. Calculation of ALoS using NSS data yielded mixed results, whereas calculations of ALoS and SHI payments using SHI data gave results clearly favoring the public hospital sector in terms of cost-efficiency; in all years examined, over all specialties and all SHI schemes included in our study, unweighted ALoS and SHI payments for hospital care per discharge were higher for PFP facilities. In a mixed healthcare system, such as that in Greece, significant performance differences were observed between PFP and public hospitals. Close monitoring of healthcare provision by hospital ownership type will be essential to permit evidence-based decisions on the future of the public/private mix in terms of healthcare provision.

Payment rates for personal care assistants and the use of long-term services and supports among those dually eligible for Medicare and Medicaid.

PubMed

Ko, Michelle; Newcomer, Robert; Kang, Taewoon; Hulett, Denis; Chu, Philip; Bindman, Andrew B

2014-12-01

To examine the association between payment rates for personal care assistants and use of long-term services and supports (LTSS) following hospital discharge among dual eligible Medicare and Medicaid beneficiaries. State hospital discharge, Medicaid and Medicare claims, and assessment data on California Medicaid LTSS users from 2006 to 2008. Cross-sectional study. We used multinomial logistic regression to analyze county personal care assistant payment rates and postdischarge LTSS use, and estimate marginal probabilities of each outcome across the range of rates paid in California. We identified dual eligible Medicare and Medicaid adult beneficiaries discharged from an acute care hospital with no hospitalizations or LTSS use in the preceding 12 months. Personal care assistant payment rates were modestly associated with home and community-based services (HCBS) use versus nursing facility entry following hospital discharge (RRR 1.2, 95 percent CI: 1.0-1.4). For a rate of $6.75 per hour, the probability of HCBS use was 5.6 percent (95 percent CI: 4.2-7.1); at $11.75 per hour, 18.0 percent (95 percent CI: 12.5-23.4). Payment rate was not associated with the probability of nursing facility entry. Higher payment rates for personal care assistants may increase utilization of HCBS, but with limited substitution for nursing facility care. © Health Research and Educational Trust.

Inpatient care expenditure of the elderly with chronic diseases who use public health insurance: Disparity in their last year of life.

PubMed

Chandoevwit, Worawan; Phatchana, Phasith

2018-06-01

The Thai elderly are eligible for the Civil Servant Medical Benefit Scheme (CS) or Universal Coverage Scheme (UCS) depending on their pre-retirement or their children work status. This study aimed to investigate the disparity in inpatient care expenditures in the last year of life among Thai elderly individuals who used the two public health insurance schemes. Using death registration and inpatient administrative data from 2007 to 2011, our subpopulation group included the elderly with four chronic disease groups: diabetes mellitus, hypertension and cardiovascular disease, heart disease, and cancer. Among 1,242,150 elderly decedents, about 40% of them had at least one of the four chronic disease conditions and were hospitalized in their last year of life. The results showed that the means of inpatient care expenditures in the last year of life paid by CS and UCS per decedent were 99,672 Thai Baht and 52,472 Thai Baht, respectively. On average, UCS used higher healthcare resources by diagnosis-related group relative weight measure per decedent compared with CS. In all cases, the rates of payment for inpatient treatment per diagnosis-related group adjusted relative weight were higher for CS than UCS. This study found that the disparities in inpatient care expenditures in the last year of life stemmed mainly from the difference in payment rates. To mitigate this disparity, unified payment rates for various types of treatment that reflect costs of hospital care across insurance schemes were recommended. Copyright © 2018 Elsevier Ltd. All rights reserved.

Impact of the Japanese Diagnosis Procedure Combination-based Payment System on cardiovascular medicine-related costs.

PubMed

Yasunaga, Hideo; Ide, Hiroo; Imamura, Tomoaki; Ohe, Kazuhiko

2005-09-01

In 2003, a lump-sum payment system based on Diagnosis Procedure Combinations (DPC) was introduced to 82 specific function hospitals in Japan. While the US DRG/PPS system is a "per case payment" system, the DPC based payment system adopts a "per day payment." It is generally believed that the Japanese system provides as much of an incentive as the DRG/PPS system to shorten the average length of stay (LOS). We performed an empirical analysis of the effect of LOS shortening on hospital revenue and expenditure under the DPC-based payment system, particularly in cardiovascular diseases. We also point out fundamentally controversial aspects of the current system. A total 109 cases were selected from patients hospitalized at the University of Tokyo Hospital from May to July, 2003 and classified into one of three categories: (1) cardiac catheter interventions, (2) cardiac catheter examinations, and (3) other conservative treatments. We analyzed the changes in profit per day in cases of a reduction in average LOS and an increase in the number of cases. In category (1) profit increased significantly in conjunction with reduced LOS. In category (2) profit increased only minimally. In category (3), profit increased rarely and sometimes decreased. In cases of conservative treatment, profits sometimes decreased because an increase in material costs exceeded the increase in revenue. It therefore became clear that the DPC-based payment system does not decisively provide an economic incentive to reduce LOS in cardiovascular medicine.

The Effects of Public Disclosure of Industry Payments to Physicians on Patient Trust: A Randomized Experiment.

PubMed

Hwong, Alison R; Sah, Sunita; Lehmann, Lisa Soleymani

2017-11-01

Financial ties between physicians and the pharmaceutical and medical device industry are common, but little is known about how patient trust is affected by these ties. The purpose of this study was to evaluate how viewing online public disclosure of industry payments affects patients' trust ratings for physicians, the medical profession, and the pharmaceutical and medical device industry. This was a randomized experimental evaluation. There were 278 English-speaking participants over age 18 who had seen a healthcare provider in the previous 12 months who took part in the study. Participants searched for physicians on an online disclosure database, viewed payments from industry to the physicians, and assigned trust ratings. Participants were randomized to view physicians who received no payment ($0), low payment ($250-300), or high payment (>$13,000) from industry, or to a control arm in which they did not view the disclosure website. They also were asked to search for and then rate trust in their own physician. Primary outcomes were trust in individual physician, medical profession, and industry. These scales measure trust as a composite of honesty, fidelity, competence, and global trust. Compared to physicians who received no payments, physicians who received payments over $13,000 received lower ratings for honesty [mean (SD): 3.36 (0.86) vs. 2.75 (0.95), p < 0.001] and fidelity [3.19 (0.65) vs. 2.89 (0.68), p = 0.01]. Among the 7.9% of participants who found their own physician on the website, ratings for honesty and fidelity decreased as the industry payment to the physician increased (honesty: Spearman's ρ = -0.52, p = 0.02; fidelity: Spearman's ρ = -0.55, p = 0.01). Viewing the disclosure website did not affect trust ratings for the medical profession or industry. Disclosure of industry payments to physicians affected perceptions of individual physician honesty and fidelity, but not perceptions of competence. Disclosure did not affect trust ratings for the medical profession or the pharmaceutical and medical device industry. ClinicalTrials.gov identifier: NCT02179632 ( https://clinicaltrials.gov/ct2/show/NCT02179632 ).

42 CFR 413.355 - Additional payment: QIO photocopy and mailing costs.

Code of Federal Regulations, 2013 CFR

2013-10-01

... RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Prospective Payment for Skilled Nursing Facilities § 413.355 Additional payment: QIO photocopy and mailing costs. An additional payment is made to a skilled nursing facility in accordance with § 476.78 of this...

75 FR 55801 - Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-14

... 0938-AP87 Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing... Payment System and Consolidated Billing for Skilled Nursing Facilities for FY 2011.'' DATES: Effective... illustrate the skilled nursing facility (SNF) prospective payment system (PPS) payment rate computations for...

42 CFR 413.355 - Additional payment: QIO photocopy and mailing costs.

Code of Federal Regulations, 2010 CFR

2010-10-01

... RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Prospective Payment for Skilled Nursing Facilities § 413.355 Additional payment: QIO photocopy and mailing costs. An additional payment is made to a skilled nursing facility in accordance with § 476.78 of this...

77 FR 60315 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-03

... Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2013 Rates; Hospitals' Resident Caps for Graduate Medical Education Payment Purposes; Quality... entitled ``Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and...

75 FR 70371 - Medicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2011...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-17

...This final rule sets forth an update to the Home Health Prospective Payment System (HH PPS) rates, including: the national standardized 60-day episode rates, the national per-visit rates, the nonroutine medical supply (NRS) conversion factors, and the low utilization payment amount (LUPA) add-on payment amounts, under the Medicare prospective payment system for HHAs effective January 1, 2011. This rule also updates the wage index used under the HH PPS and, in accordance with the Patient Protection and Affordable Care Act of 2010 (Affordable Care Act), updates the HH PPS outlier policy. In addition, this rule revises the home health agency (HHA) capitalization requirements. This rule further adds clarifying language to the ``skilled services'' section. The rule finalizes a 3.79 percent reduction to rates for CY 2011 to account for changes in case-mix, which are unrelated to real changes in patient acuity. Finally, this rule incorporates new legislative requirements regarding face-to-face encounters with providers related to home health and hospice care.

Medicaid nursing home payment and the role of provider taxes.

PubMed

Grabowski, David C; Zhanlian Feng; Mor, Vincent

2008-08-01

In the context of recent state budget shortfalls and the repeal of the Boren Amendment, state Medicaid expenditures for nursing home care were considered a potential target for payment cuts. The authors examine this issue using data from a survey of state nursing home payment policies. Results indicate that aggregate inflation-adjusted Medicaid payment rates steadily increased through 2004, and this growth is partly attributable to the adoption of nursing home provider taxes in many states. A recent proposal to cap provider taxes, if enacted, may lead to a decrease in Medicaid payment rates for nursing home care.

Medicaid Nursing Home Payment and the Role of Provider Taxes

PubMed Central

Feng, Zhanlian; Intrator, Orna; Mor, Vincent

2009-01-01

In the context of recent state budget shortfalls and the repeal of the Boren amendment, state Medicaid expenditures for nursing home care were considered a potential target for payment cuts. We examine this issue using data from a survey of state nursing home payment policies. Our results indicate aggregate inflation-adjusted Medicaid payment rates increased steadily through 2004, and this growth was partly attributable to the adoption of nursing home provider taxes in many states. A recent proposal to cap provider taxes, if enacted, may lead to a decrease in Medicaid payment rates for nursing home care. PMID:18369236

Medicare and Medicaid programs; Home Health Prospective Payment System rate update for CY 2014, home health quality reporting requirements, and cost allocation of home health survey expenses. Final rule.

PubMed

2013-12-02

This final rule will update the Home Health Prospective Payment System (HH PPS) rates, including the national, standardized 60-day episode payment rates, the national per-visit rates, the low-utilization payment adjustment (LUPA) add-on, and the non-routine medical supply (NRS) conversion factor under the Medicare prospective payment system for home health agencies (HHAs), effective January 1, 2014. As required by the Affordable Care Act, this rule establishes rebasing adjustments, with a 4-year phase-in, to the national, standardized 60-day episode payment rates; the national per-visit rates; and the NRS conversion factor. In addition, this final rule will remove 170 diagnosis codes from assignment to diagnosis groups within the HH PPS Grouper, effective January 1, 2014. Finally, this rule will establish home health quality reporting requirements for CY 2014 payment and subsequent years and will clarify that a state Medicaid program must provide that, in certifying HHAs, the state's designated survey agency carry out certain other responsibilities that already apply to surveys of nursing facilities and Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF-IID), including sharing in the cost of HHA surveys. For that portion of costs attributable to Medicare and Medicaid, we will assign 50 percent to Medicare and 50 percent to Medicaid, the standard method that CMS and states use in the allocation of expenses related to surveys of nursing homes.

Are cost differences between specialist and general hospitals compensated by the prospective payment system?

PubMed

Longo, Francesco; Siciliani, Luigi; Street, Andrew

2017-10-23

Prospective payment systems fund hospitals based on a fixed-price regime that does not directly distinguish between specialist and general hospitals. We investigate whether current prospective payments in England compensate for differences in costs between specialist orthopaedic hospitals and trauma and orthopaedics departments in general hospitals. We employ reference cost data for a sample of hospitals providing services in the trauma and orthopaedics specialty. Our regression results suggest that specialist orthopaedic hospitals have on average 13% lower profit margins. Under the assumption of break-even for the average trauma and orthopaedics department, two of the three specialist orthopaedic hospitals appear to make a loss on their activity. The same holds true for 33% of departments in our sample. Patient age and severity are the main drivers of such differences.

75 FR 19185 - Direct and Counter-Cyclical Program and Average Crop Revenue Election Program, Disaster...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-14

... Program, Disaster Assistance Programs, Marketing Assistance Loans and Loan Deficiency Payments Program... Disaster Program (LFP), the Supplemental Revenue Assistance Payments Program (SURE) and the Marketing... losses, unless the loss has already been reported for the Noninsured Crop Disaster Assistance Program...

Private-sector vaccine purchase costs and insurer payments: a disincentive for using combination vaccines?

PubMed

Clark, Sarah J; Cowan, Anne E; Freed, Gary L

2011-04-01

Combination vaccines have been endorsed as a means to decrease the number of injections needed to complete the childhood immunization schedule, yet anecdotal reports suggest that private providers lose money on combination vaccines. The objective of this study was to determine whether practices purchasing combination vaccines had significantly different vaccine costs and reimbursement compared to practices that were not purchasing combination vaccines. Using cross-sectional purchase and insurer payment data collected from a targeted sample of private practices in five US states, we calculated the average total vaccine cost and reimbursement across the childhood immunization schedule. The average vaccine purchase cost across the childhood schedule was significantly higher for practices using a combined vaccine with diphtheria, tetanus, acellular pertussis vaccine, inactivated polio vaccine, and Hepatitis B vaccine (DTaP-IPV-HepB) than for practices using either separate vaccine products or a combined vaccine with Haemophilus influenzae, type b vaccine and Hepatitis B vaccine (Hib-HepB). The average insurer payment for vaccine administration across the childhood schedule was significantly lower for practices using DTaP-IPV-HepB combination vaccine than for practices using separate vaccine products. This study appears to validate anecdotal reports that vaccine purchase costs and insurer payment for combination vaccines can have a negative financial impact for practices that purchase childhood vaccines.

Comparative analysis of the current payment system for hospital services in Serbia and projected payments under diagnostic related groups system in urology.

PubMed

Babić, Uroš; Soldatović, Ivan; Vuković, Dejana; Milićević, Milena Šantrić; Stjepanović, Mihailo; Kojić, Dejan; Argirović, Aleksandar; Vukotić, Vinka

2015-03-01

Global budget per calendar year is a traditional method of funding hospitals in Serbia. Diagnose related groups (DGR) is a method of hospital payment based on classification of patients into groups with clinically similar problems and similar utilization of hospital resources. The aim of this study was to compare current methods of hospital services payment with the projected costs by DRG payment method in urology. The data were obtained from the information system used in the Clinical Hospital Center "Dr. Dragiša Mišović"--Dedinje in Belgrade, Serbia. The implemented hospital information system was the main criterion for selection of healthcare institutions. The study included 994 randomly selected patients treated surgically and conservatively in 2012. Average costs under the current payment method were slightly higher than those projected by DRG, however, the variability was twice as high (54,111 ± 69,789 compared to 53,434 ± 32,509, p < 0.001) respectively. The univariate analysis showed that the highest correlation with the current payment method as well as with the projected one by DRG was observed in relation to the number of days of hospitalization (ρ = 0.842, p < 0.001, and ρ = 0.637, p < 0.001, respectively). Multivariate regression models confirmed the influence of the number of hospitalization days to costs under the current payment system (β = 0.843, p < 0.001) as well as under the projected DRG payment system (β = 0.737, p < 0.001). The same predictor was crucial for the difference in the current payment method and the pro- jected DRG payment methods (β = 0.501, p < 0.001). Payment under the DRG system is administratively more complex because it requires detailed and standardized coding of diagnoses and procedures, as well as the information on the average consumption of resources (costs) per DRG. Given that aggregate costs of treatment under two hospital payment methods compared in the study are not significantly different, the focus on minor surgeries both under the current hospital payment method and under the introduced DRG system would be far more cost-effective for a hospital as great variations in treatment performance (reductions of days of hospitalization and complications), and consequently invoiced amounts would be reduced.

Policy Makers Will Need A Way To Update Bundled Payments That Reflects Highly Skewed Spending Growth Of Various Care Episodes

PubMed Central

Rosen, Allison B.; Aizcorbe, Ana; Ryu, Alexander J.; Nestoriak, Nicole; Cutler, David M.; Chernew, Michael E.

2015-01-01

Bundled payment entails paying a single price for all services delivered as part of an episode of care for a specific condition. It is seen as a promising way to slow the growth of health care spending while maintaining or improving the quality of care. To implement bundled payment, policy makers must set base payment rates for episodes of care and update the rates over time to reflect changes in the costs of delivering care and the components of care. Adopting the fee-for-service paradigm of adjusting payments with uniform update rates would be fair and accurate if costs increased at a uniform rate across episodes. But our analysis of 2003 and 2007 US commercial claims data showed spending growth to be highly skewed across episodes: 10 percent of episodes accounted for 82.5 percent of spending growth, and within-episode spending growth ranged from a decline of 75 percent to an increase of 323 percent. Given that spending growth was much faster for some episodes than for others, a situation known as skewness, policy makers should not update episode payments using uniform update rates. Rather, they should explore ways to address variations in spending growth, such as updating episode payments one by one, at least at the outset. PMID:23650329

7 CFR 792.10 - Late payment interest, penalty and administrative charges.

Code of Federal Regulations, 2010 CFR

2010-01-01

... State and local governments. Interest on debts owed by such entities shall be charged to the extent... debts. The late payment interest rate shall be equal to the higher of the Treasury Department's current... Prompt Payment Act was chosen as an alternative rate to ensure that the Government would recoup interest...

Assessing quality of maternity care in Hungary: expert validation and testing of the mother-centered prenatal care (MCPC) survey instrument.

PubMed

Rubashkin, Nicholas; Szebik, Imre; Baji, Petra; Szántó, Zsuzsa; Susánszky, Éva; Vedam, Saraswathi

2017-11-16

Instruments to assess quality of maternity care in Central and Eastern European (CEE) region are scarce, despite reports of poor doctor-patient communication, non-evidence-based care, and informal cash payments. We validated and tested an online questionnaire to study maternity care experiences among Hungarian women. Following literature review, we collated validated items and scales from two previous English-language surveys and adapted them to the Hungarian context. An expert panel assessed items for clarity and relevance on a 4-point ordinal scale. We calculated item-level Content Validation Index (CVI) scores. We designed 9 new items concerning informal cash payments, as well as 7 new "model of care" categories based on mode of payment. The final questionnaire (N = 111 items) was tested in two samples of Hungarian women, representative (N = 600) and convenience (N = 657). We conducted bivariate analysis and thematic analysis of open-ended responses. Experts rated pre-existing English-language items as clear and relevant to Hungarian women's maternity care experiences with an average CVI for included questions of 0.97. Significant differences emerged across the model of care categories in terms of informal payments, informed consent practices, and women's perceptions of autonomy. Thematic analysis (N = 1015) of women's responses identified 13 priority areas of the maternity care experience, 9 of which were addressed by the questionnaire. We developed and validated a comprehensive questionnaire that can be used to evaluate respectful maternity care, evidence-based practice, and informal cash payments in CEE region and beyond.

26 CFR 1.483-4 - Contingent payments.

Code of Federal Regulations, 2010 CFR

2010-04-01

... present value of the payment ($156,705), calculated using the test rate of 5 percent, compounded annually... section, the $20,000 payment is treated as a payment of principal of $19,231 (the present value, as of the..., 1999) over $266,699 (the present value of $300,000, determined by discounting the payment at the test...

42 CFR 413.76 - Direct GME payments: Calculation of payments for GME costs.

Code of Federal Regulations, 2010 CFR

2010-10-01

...-STAGE RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING... nursing and allied health payment “pool” for the current calendar year as described at § 413.87(f), to the projected total Medicare+Choice direct GME payments made to all hospitals for the current calendar year. (e...

42 CFR 413.76 - Direct GME payments: Calculation of payments for GME costs.

Code of Federal Regulations, 2012 CFR

2012-10-01

...-STAGE RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING... nursing and allied health payment “pool” for the current calendar year as described at § 413.87(f), to the projected total Medicare+Choice direct GME payments made to all hospitals for the current calendar year. (e...

42 CFR 413.76 - Direct GME payments: Calculation of payments for GME costs.

Code of Federal Regulations, 2013 CFR

2013-10-01

...-STAGE RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING... nursing and allied health payment “pool” for the current calendar year as described at § 413.87(f), to the projected total Medicare+Choice direct GME payments made to all hospitals for the current calendar year. (e...

42 CFR 413.76 - Direct GME payments: Calculation of payments for GME costs.

Code of Federal Regulations, 2011 CFR

2011-10-01

...-STAGE RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING... nursing and allied health payment “pool” for the current calendar year as described at § 413.87(f), to the projected total Medicare+Choice direct GME payments made to all hospitals for the current calendar year. (e...

42 CFR 413.76 - Direct GME payments: Calculation of payments for GME costs.

Code of Federal Regulations, 2014 CFR

2014-10-01

...-STAGE RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING... nursing and allied health payment “pool” for the current calendar year as described at § 413.87(f), to the projected total Medicare+Choice direct GME payments made to all hospitals for the current calendar year. (e...

42 CFR 403.770 - Payments for home services.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 2 2013-10-01 2013-10-01 false Payments for home services. 403.770 Section 403.770... of Participation, and Payment § 403.770 Payments for home services. (a) The RNHCI nursing visits are paid at the modified low utilization payment adjusted (LUPA) rate used under the home health...

42 CFR 403.770 - Payments for home services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Payments for home services. 403.770 Section 403.770... of Participation, and Payment § 403.770 Payments for home services. (a) The RNHCI nursing visits are paid at the modified low utilization payment adjusted (LUPA) rate used under the home health...

42 CFR 403.770 - Payments for home services.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 2 2014-10-01 2014-10-01 false Payments for home services. 403.770 Section 403.770... of Participation, and Payment § 403.770 Payments for home services. (a) The RNHCI nursing visits are paid at the modified low utilization payment adjusted (LUPA) rate used under the home health...

42 CFR 403.770 - Payments for home services.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 2 2011-10-01 2011-10-01 false Payments for home services. 403.770 Section 403.770... of Participation, and Payment § 403.770 Payments for home services. (a) The RNHCI nursing visits are paid at the modified low utilization payment adjusted (LUPA) rate used under the home health...

42 CFR 403.770 - Payments for home services.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 2 2012-10-01 2012-10-01 false Payments for home services. 403.770 Section 403.770... of Participation, and Payment § 403.770 Payments for home services. (a) The RNHCI nursing visits are paid at the modified low utilization payment adjusted (LUPA) rate used under the home health...

Will Changes to Medicare Payment Rates Alter Hospice's Cost-Saving Ability?

PubMed

Taylor, Donald H; Bhavsar, Nrupen A; Bull, Janet H; Kassner, Cordt T; Olson, Andrew; Boucher, Nathan A

2018-05-01

On January 1, 2016, Medicare implemented a new "two-tiered" model for hospice services, with per diem rates increased for days 1 through 60, decreased for days 61 and greater, and service intensity add-on payments made retrospectively for the last seven days of life. To estimate whether the Medicare hospice benefit's potential for cost savings will change as a result of the January 2016 change in payment structure. Analysis of decedents' claims records using propensity score matching, logistic regression, and sensitivity analysis. All age-eligible Medicare decedents who received care and died in North Carolina in calendar years 2009 and 2010. Costs to Medicare for hospice and other healthcare services. Medicare costs were reduced from hospice election until death using both 2009-2010 and new 2016 payment structures and rates. Mean cost savings were $1,527 with actual payment rates, and would have been $2,105 with the new payment rates (p < 0.001). Cost savings were confirmed by reducing the number of days used for cost comparison by three days for those with hospice stays of at least four days ($4,318 using 2009-2010 rates, $3,138 for 2016 rates: p < 0.001). Cost savings were greater for males ($3,393) versus females ($1,051) and greatest in cancer ($6,706) followed by debility and failure to thrive ($5,636) and congestive heart failure ($1,309); dementia patients had higher costs (+$1,880) (p < 0.001). When adding 3 days to the comparison period, hospice increased costs to Medicare. Medicare savings could continue with the 2016 payment rate change. Cost savings were found for all primary diagnoses analyzed except dementia.

Prediction of Change in Prescription Ingredient Costs and Co-payment Rates under a Reference Pricing System in South Korea.

PubMed

Heo, Ji Haeng; Rascati, Karen L; Lee, Eui-Kyung

2017-05-01

The reference pricing system (RPS) establishes reference prices within interchangeable reference groupings. For drugs priced higher than the reference point, patients pay the difference between the reference price and the total price. To predict potential changes in prescription ingredient costs and co-payment rates after implementation of an RPS in South Korea. Korean National Health Insurance claims data were used as a baseline to develop possible RPS models. Five components of a potential RPS policy were varied: reference groupings, reference pricing methods, co-pay reduction programs, manufacturer price reductions, and increased drug substitutions. The potential changes for prescription ingredient costs and co-payment rates were predicted for the various scenarios. It was predicted that transferring the difference (total price minus reference price) from the insurer to patients would reduce ingredient costs from 1.4% to 22.8% for the third-party payer (government), but patient co-payment rates would increase from a baseline of 20.4% to 22.0% using chemical groupings and to 25.0% using therapeutic groupings. Savings rates in prescription ingredient costs (government and patient combined) were predicted to range from 1.6% to 13.7% depending on various scenarios. Although the co-payment rate would increase, a 15% price reduction by manufacturers coupled with a substitution rate of 30% would result in a decrease in the co-payment amount (change in absolute dollars vs. change in rates). Our models predicted that the implementation of RPS in South Korea would lead to savings in ingredient costs for the third-party payer and co-payments for patients with potential scenarios. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Final inpatient rehabilitation PPS rule improves on proposed rule.

PubMed

Reynolds, M

2001-10-01

On August 7, 2001, the Centers for Medicare and Medicaid Services (CMS--formerly HCFA) released the final rule for a new prospective payment system (PPS) for inpatient rehabilitation services describing the process that must be used to receive payment for such services provided to Medicare beneficiaries. The process consists of five steps: First, a clinician performs assessments of the patient upon admission and at discharge. Second, the patient is classified into a case-mix group (CMG) with an assigned relative-value weight within that CMG. Third, the Federal prospective payment rate is determined by multiplying the relative-value weight by an annually updated, budget-neutral conversion factor. Fourth, the Federal prospective payment rate is adjusted to account for facility-specific factors. Finally, the facility-adjusted payment rate may be adjusted for case-specific factors. The final rule eliminates three deficiencies in the proposed rule by providing increased payment for treating any comorbidities documented prior to the second day before discharge, providing more appropriate payment for transfer cases, and minimizing the paperwork associated with patient assessment.

Under Pressure: Financial Impact of the Hospital-Acquired Conditions Initiative. A Statewide Analysis of Pressure Ulcer Development and Payment

PubMed Central

Meddings, Jennifer A.; Reichert, Heidi; Rogers, Mary A. M.; Hofer, Timothy P.; McMahon, Laurence F.; Grazier, Kyle L.

2017-01-01

OBJECTIVE To assess the financial impact of the 2008 Hospital-Acquired Conditions Initiative’s pressure ulcer payment changes on Medicare and other payors. DESIGN, SETTING AND PARTICIPANTS Retrospective before-and-after study of all-payor statewide administrative data for >2.4 million annual adult discharges from 311 nonfederal acute-care California hospitals in 2007 and 2009, using the Healthcare Cost and Utilization Project State Inpatient Datasets. We assessed how often and by how much the 2008 payment changes for pressure ulcers affected hospital payment. MEASUREMENTS Pressure ulcer rates and hospital payment changes RESULTS Hospital-acquired pressure ulcer rates were very low (0.28%) in 2007 and 2009; present-on-admission pressure ulcer rates increased from 2.35% in 2007 to 3.00% in 2009. By clinical stage of pressure ulcer (available in 2009), hospital-acquired stage III–IV ulcers occurred in 603 discharges (0.02%); 60,244 discharges (2.42%) contained other pressure ulcer diagnoses. Payment removal for stage III–IV hospital-acquired ulcers reduced payment in 75 (0.003%) discharges for a statewide payment decrease of $310,444 (0.001%) for all payors and $199,238 (0.001%) for Medicare. For all other pressure ulcers, the Hospital-Acquired Conditions Initiative reduced hospital payment in 20,246 (0.81%) cases (including 18,953 cases with present-on-admission ulcers) reducing statewide payment by $62,538,586 (0.21%) for all payors and $47,237,984 (0.32%) for Medicare. CONCLUSION The total financial impact of the 2008 payment changes for pressure ulcers was negligible. Most payment decreases occurred by removal of comorbidity payments for present-on-admission pressure ulcers other than stages III–IV. The removal of payment for hospital-acquired stage III–IV ulcers was more than 200 times less than the removal of payment for other types of pressure ulcers that occurred in implementation of the Hospital-Acquired Conditions Initiative. PMID:26140454

7 CFR 1469.23 - Program payments.

Code of Federal Regulations, 2013 CFR

2013-01-01

... AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS CONSERVATION SECURITY PROGRAM Contracts and Payments § 1469.23 Program payments. (a) Stewardship component of CSP payments. (1) The conservation stewardship plan... Agriculture Statistics Service (NASS) land rental data, and Conservation Reserve Program (CRP) rental rates...

42 CFR 413.170 - Scope.

Code of Federal Regulations, 2010 CFR

2010-10-01

... PRINCIPLES OF REASONABLE COST REIMBURSEMENT; PAYMENT FOR END-STAGE RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Payment for End-Stage Renal Disease (ESRD... the principles and authorities under which CMS is authorized to establish a prospective payment system...

Medicare and Medicaid Programs; CY 2017 Home Health Prospective Payment System Rate Update; Home Health Value-Based Purchasing Model; and Home Health Quality Reporting Requirements. Final rule.

PubMed

2016-11-03

This final rule updates the Home Health Prospective Payment System (HH PPS) payment rates, including the national, standardized 60-day episode payment rates, the national per-visit rates, and the non-routine medical supply (NRS) conversion factor; effective for home health episodes of care ending on or after January 1, 2017. This rule also: Implements the last year of the 4-year phase-in of the rebasing adjustments to the HH PPS payment rates; updates the HH PPS case-mix weights using the most current, complete data available at the time of rulemaking; implements the 2nd-year of a 3-year phase-in of a reduction to the national, standardized 60-day episode payment to account for estimated case-mix growth unrelated to increases in patient acuity (that is, nominal case-mix growth) between CY 2012 and CY 2014; finalizes changes to the methodology used to calculate payments made under the HH PPS for high-cost "outlier" episodes of care; implements changes in payment for furnishing Negative Pressure Wound Therapy (NPWT) using a disposable device for patients under a home health plan of care; discusses our efforts to monitor the potential impacts of the rebasing adjustments; includes an update on subsequent research and analysis as a result of the findings from the home health study; and finalizes changes to the Home Health Value-Based Purchasing (HHVBP) Model, which was implemented on January 1, 2016; and updates to the Home Health Quality Reporting Program (HH QRP).

75 FR 79000 - Agency Information Collection Activities: Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-17

... States submit pricing information for the 50 most widely prescribed drugs so that the States' prices can be compared to the national average prices obtained from the survey. The States pricing information... health care payment and remittance advices, transmit health plan premium payments, determine health care...

78 FR 19690 - Submission for OMB Review; Prompt Payment

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-02

... collected. B. Annual Reporting & Recordkeeping Burden Data from the Federal Procurement Data System (FPDS.... Based on the data, an estimated 2,679 contractors or respondents will provide an average of 18.27... withholding and others will have to provide their payment certification. This estimate also assumes automation...

20 CFR 411.500 - Definitions of terms used in this subpart.

Code of Federal Regulations, 2010 CFR

2010-04-01

.... 411.500 Section 411.500 Employees' Benefits SOCIAL SECURITY ADMINISTRATION THE TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM Employment Network Payment Systems § 411.500 Definitions of terms used in this subpart. (a...), the average monthly payment of Supplemental Security Income (SSI) benefits based on disability payable...

20 CFR 411.500 - Definitions of terms used in this subpart.

Code of Federal Regulations, 2014 CFR

2014-04-01

.... 411.500 Section 411.500 Employees' Benefits SOCIAL SECURITY ADMINISTRATION THE TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM Employment Network Payment Systems § 411.500 Definitions of terms used in this subpart. (a...), the average monthly payment of Supplemental Security Income (SSI) benefits based on disability payable...

20 CFR 411.500 - Definitions of terms used in this subpart.

Code of Federal Regulations, 2013 CFR

2013-04-01

.... 411.500 Section 411.500 Employees' Benefits SOCIAL SECURITY ADMINISTRATION THE TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM Employment Network Payment Systems § 411.500 Definitions of terms used in this subpart. (a...), the average monthly payment of Supplemental Security Income (SSI) benefits based on disability payable...

20 CFR 411.500 - Definitions of terms used in this subpart.

Code of Federal Regulations, 2012 CFR

2012-04-01

.... 411.500 Section 411.500 Employees' Benefits SOCIAL SECURITY ADMINISTRATION THE TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM Employment Network Payment Systems § 411.500 Definitions of terms used in this subpart. (a...), the average monthly payment of Supplemental Security Income (SSI) benefits based on disability payable...

20 CFR 411.500 - Definitions of terms used in this subpart.

Code of Federal Regulations, 2011 CFR

2011-04-01

.... 411.500 Section 411.500 Employees' Benefits SOCIAL SECURITY ADMINISTRATION THE TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM Employment Network Payment Systems § 411.500 Definitions of terms used in this subpart. (a...), the average monthly payment of Supplemental Security Income (SSI) benefits based on disability payable...

7 CFR 623.12 - Payments to landowners by NRCS.

Code of Federal Regulations, 2014 CFR

2014-01-01

... the practices specified in the WRPO; or pay the average cost of establishing the practices specified..., DEPARTMENT OF AGRICULTURE WATER RESOURCES EMERGENCY WETLANDS RESERVE PROGRAM § 623.12 Payments to landowners by NRCS. (a) NRCS will share the cost with landowners of rehabilitating the enrolled land in the EWRP...

7 CFR 623.12 - Payments to landowners by NRCS.

Code of Federal Regulations, 2013 CFR

2013-01-01

... the practices specified in the WRPO; or pay the average cost of establishing the practices specified..., DEPARTMENT OF AGRICULTURE WATER RESOURCES EMERGENCY WETLANDS RESERVE PROGRAM § 623.12 Payments to landowners by NRCS. (a) NRCS will share the cost with landowners of rehabilitating the enrolled land in the EWRP...

7 CFR 623.12 - Payments to landowners by NRCS.

Code of Federal Regulations, 2012 CFR

2012-01-01

... the practices specified in the WRPO; or pay the average cost of establishing the practices specified..., DEPARTMENT OF AGRICULTURE WATER RESOURCES EMERGENCY WETLANDS RESERVE PROGRAM § 623.12 Payments to landowners by NRCS. (a) NRCS will share the cost with landowners of rehabilitating the enrolled land in the EWRP...

Child support and alimony: 1983 (supplemental report).

PubMed

Sanders, R A

1986-10-01

The concern has continued over the financial situation of US women and their children after divorce and separation and over the situation of never-married mothers, in part due to the low average incomes and accompanying high incidence of poverty among families with family householders and no husband present. This report presents information on both the award and actual receipt of child support to women on behalf of their children and on alimony for their own support. Additional data concerning receipt and type of property settlement following divorce is provided for ever-divorced women. As of spring 1984, 8.7 million mothers were living with children under 21 years of age whose fathers were not living in the household; 58% or about 5 million of these women were awarded or had an agreement to receive child support payments for their children as of the survey date. Of the 5 million women awarded child support, 4 million were supposed to receive child support for their children in 1983. Of those due payment, about half received the full amount they were due. The child support award rate reported in 1984 (58%) was not significantly different from that of 1982; however, the proportion of women receiving payments in 1983 (76%) increased slightly over that of the previous survey (72%). The average (mean) amount of child support received in 1983 was $2340. About 43% of the 2.9 million women below the poverty level were awarded child support. Whites and college-educated women were more likely to be awarded child support. Only about 14% of the 17.4 million ever-divorced or currently separated women as of spring 1984 were awarded or had an agreement to receive alimony or maintenance payments In spring 1984, about 37% of the 14.8 million women who had ever been divorced reported receiving some form of property settlement.

Payment Rates for Personal Care Assistants and the Use of Long-Term Services and Supports among Those Dually Eligible for Medicare and Medicaid

PubMed Central

Ko, Michelle; Newcomer, Robert; Kang, Taewoon; Hulett, Denis; Chu, Philip; Bindman, Andrew B

2014-01-01

Objective To examine the association between payment rates for personal care assistants and use of long-term services and supports (LTSS) following hospital discharge among dual eligible Medicare and Medicaid beneficiaries. Data Sources State hospital discharge, Medicaid and Medicare claims, and assessment data on California Medicaid LTSS users from 2006 to 2008. Study Design Cross-sectional study. We used multinomial logistic regression to analyze county personal care assistant payment rates and postdischarge LTSS use, and estimate marginal probabilities of each outcome across the range of rates paid in California. Data Extraction Methods We identified dual eligible Medicare and Medicaid adult beneficiaries discharged from an acute care hospital with no hospitalizations or LTSS use in the preceding 12 months. Principal Findings Personal care assistant payment rates were modestly associated with home and community-based services (HCBS) use versus nursing facility entry following hospital discharge (RRR 1.2, 95 percent CI: 1.0–1.4). For a rate of $6.75 per hour, the probability of HCBS use was 5.6 percent (95 percent CI: 4.2–7.1); at $11.75 per hour, 18.0 percent (95 percent CI: 12.5–23.4). Payment rate was not associated with the probability of nursing facility entry. Conclusions Higher payment rates for personal care assistants may increase utilization of HCBS, but with limited substitution for nursing facility care. PMID:25327166

Measuring hospital input price increases: The rebased hospital market basket

PubMed Central

Freeland, Mark S.; Chulis, George S.; Brown, Aaron P.; Skellan, David; Maple, Brenda T.; Singer, Naphtale; Lemieux, Jeffrey; Arnett, Ross H.

1991-01-01

The input prices indexes used in part to set payment rates for Medicare inpatient hospital services in both prospective payment system (PPS) and PPS-excluded hospitals were rebased from 1982 to 1987 beginning with payments for fiscal year 1991. In this article, the issues and evidence used to determine the composition of the revised hospital input price indexes are discussed. One issue is the need for a separate market basket for PPS-excluded hospitals. Also, the payment implications of using hospital-industry versus economywide measures of wage rates as price proxies for the growth in hospital wage rates are addressed. PMID:10113610

7 CFR 1400.501 - Determination of average adjusted gross income.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 10 2011-01-01 2011-01-01 false Determination of average adjusted gross income. 1400... PAYMENT ELIGIBILITY FOR 2009 AND SUBSEQUENT CROP, PROGRAM, OR FISCAL YEARS Average Adjusted Gross Income Limitation § 1400.501 Determination of average adjusted gross income. (a) Except as otherwise provided in...

42 CFR 484.225 - Annual update of the unadjusted national prospective 60-day episode payment rate.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 5 2014-10-01 2014-10-01 false Annual update of the unadjusted national... SERVICES Prospective Payment System for Home Health Agencies § 484.225 Annual update of the unadjusted national prospective 60-day episode payment rate. (a) CMS updates the unadjusted national 60-day episode...

42 CFR 484.225 - Annual update of the unadjusted national prospective 60-day episode payment rate.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 5 2012-10-01 2012-10-01 false Annual update of the unadjusted national... SERVICES Prospective Payment System for Home Health Agencies § 484.225 Annual update of the unadjusted national prospective 60-day episode payment rate. (a) CMS updates the unadjusted national 60-day episode...

42 CFR 484.225 - Annual update of the unadjusted national prospective 60-day episode payment rate.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 5 2010-10-01 2010-10-01 false Annual update of the unadjusted national... SERVICES Prospective Payment System for Home Health Agencies § 484.225 Annual update of the unadjusted national prospective 60-day episode payment rate. (a) CMS updates the unadjusted national 60-day episode...

42 CFR 484.225 - Annual update of the unadjusted national prospective 60-day episode payment rate.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 5 2013-10-01 2013-10-01 false Annual update of the unadjusted national... SERVICES Prospective Payment System for Home Health Agencies § 484.225 Annual update of the unadjusted national prospective 60-day episode payment rate. (a) CMS updates the unadjusted national 60-day episode...

42 CFR 484.225 - Annual update of the unadjusted national prospective 60-day episode payment rate.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 5 2011-10-01 2011-10-01 false Annual update of the unadjusted national... SERVICES Prospective Payment System for Home Health Agencies § 484.225 Annual update of the unadjusted national prospective 60-day episode payment rate. (a) CMS updates the unadjusted national 60-day episode...

42 CFR 422.216 - Special rules for MA private fee-for-service plans.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 3 2013-10-01 2013-10-01 false Special rules for MA private fee-for-service plans... With Providers § 422.216 Special rules for MA private fee-for-service plans. (a) Payment to providers—(1) Payment rate. (i) The MA organization must establish payment rates for plan covered items and...

42 CFR 422.216 - Special rules for MA private fee-for-service plans.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 3 2014-10-01 2014-10-01 false Special rules for MA private fee-for-service plans... With Providers § 422.216 Special rules for MA private fee-for-service plans. (a) Payment to providers—(1) Payment rate. (i) The MA organization must establish payment rates for plan covered items and...

42 CFR 422.216 - Special rules for MA private fee-for-service plans.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 3 2012-10-01 2012-10-01 false Special rules for MA private fee-for-service plans... With Providers § 422.216 Special rules for MA private fee-for-service plans. (a) Payment to providers—(1) Payment rate. (i) The MA organization must establish payment rates for plan covered items and...

12 CFR 714.8 - Are the early payment provisions, or interest rate provisions, applicable in leasing arrangements?

Code of Federal Regulations, 2011 CFR

2011-01-01

... 12 Banks and Banking 6 2011-01-01 2011-01-01 false Are the early payment provisions, or interest... CREDIT UNION ADMINISTRATION REGULATIONS AFFECTING CREDIT UNIONS LEASING § 714.8 Are the early payment provisions, or interest rate provisions, applicable in leasing arrangements? You are not subject to the early...

42 CFR 413.196 - Notification of changes in rate-setting methodologies and payment rates.

Code of Federal Regulations, 2010 CFR

2010-10-01

... payment system described in § 413.220 by the ESRD bundled market basket percentage increase factor. (d... composite payment system described in § 413.220 by the ESRD bundled market basket percentage increase factor minus a productivity adjustment factor. (2) The wage index using the most current hospital wage data. (3...

42 CFR 419.2 - Basis of payment.

Code of Federal Regulations, 2013 CFR

2013-10-01

... prospective payment system establishes a national payment rate, standardized for geographic wage differences... X-ray tests, diagnostic laboratory tests, and other diagnostic tests; (10) Durable medical equipment...

Predictors of negotiated NIH indirect rates at US institutions.

PubMed

Johnston, S Claiborne; Desmond-Hellmann, Susan; Hauser, Stewart; Vermillion, Eric; Mia, Nilo

2015-01-01

The United States (US) Department of Health and Human Services and the Office of Naval Research negotiate institutional rates for payments of overhead costs associated with administration and space usage, commonly known as indirect rates. Such payments account for a large proportion of spending by the National Institutes of Health (NIH). Little has been published about differences in rates and their predictors. Negotiated indirect rates for on-campus research grants were requested from the Council on Governmental Relations for the 100 institutions with greatest NIH funding in 2010. NIH funding, cost of living (ACCRA Index for 2008), public vs. private status, negotiating governmental organization (Department of Health and Human Services or Office of Naval Research), US Census Region, and year were assessed as predictors of institutional indirect rates using generalized estimating equations with all variables included in the model. Overall, 72 institutions participated, with 207 reported indirect rates for the years 2006, 2008, and 2010. Indirect rates ranged from 36.3% to 78%, with an average of 54.5%. Mean rates increased from 53.6% in 2006 to 55.4% in 2010 (p<0.001). In multivariable models, private institutions had 6.2% (95% CI 3.7%-8.7%; p<0.001) higher indirect rates than public institutions. Rates in the Northeast were highest (Midwest 4.0% lower; West 4.9% lower; South 5.2% lower). Greater NIH funding (p = 0.025) and cost of living (p = 0.034) also predicted indirect rates while negotiating governmental organization did not (p = 0.414). Negotiated indirect rates for governmental research grants to academic centers vary widely. Although the association between indirect rates and cost of living may be justified, the cause of variation in rates by region, public-private status, and NIH funding levels is unclear.

Industry Funding Among Leadership in Medical Oncology and Radiation Oncology in 2015.

PubMed

Yoo, Stella K; Ahmed, Awad A; Ileto, Jan; Zaorsky, Nicholas G; Deville, Curtiland; Holliday, Emma B; Wilson, Lynn D; Jagsi, Reshma; Thomas, Charles R

2017-10-01

To quantify and determine the relationship between oncology departmental/division heads and private industry vis-à-vis potential financial conflict of interests (FCOIs) as publicly reported by the Centers for Medicare and Medicaid Services Open Payments database. We extracted the names of the chairs/chiefs in medical oncology (MO) and chairs of radiation oncology (RO) for 81 different institutions with both RO and MO training programs as reported by the Association of American Medical Colleges. For each leader, the amount of consulting fees and research payments received in 2015 was determined. Logistic modeling was used to assess associations between the 2 endpoints of receiving a consulting fee and receiving a research payment with various institution-specific and practitioner-specific variables included as covariates: specialty, sex, National Cancer Institute designation, PhD status, and geographic region. The majority of leaders in MO were reported to have received consulting fees or research payments (69.5%) compared with a minority of RO chairs (27.2%). Among those receiving payments, the average (range) consulting fee was $13,413 ($200-$70,423) for MO leaders and $6463 ($837-$16,205) for RO chairs; the average research payment for MO leaders receiving payments was $240,446 ($156-$1,234,762) and $295,089 ($160-$1,219,564) for RO chairs. On multivariable regression when the endpoint was receipt of a research payment, those receiving a consulting fee (odds ratio [OR]: 5.34; 95% confidence interval [CI]: 2.22-13.65) and MO leaders (OR: 5.54; 95% CI: 2.62-12.18) were more likely to receive research payments. Examination of the receipt of consulting fees as the endpoint showed that those receiving a research payment (OR: 5.41; 95% CI: 2.23-13.99) and MO leaders (OR: 3.06; 95% CI: 1.21-8.13) were more likely to receive a consulting fee. Leaders in academic oncology receive consulting or research payments from industry. Relationships between oncology leaders and industry can be beneficial, but guidance is needed to develop consistent institutional policies to manage FCOIs. Copyright © 2017 Elsevier Inc. All rights reserved.

42 CFR 413.321 - Simplified cost report for SNFs.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Prospectively Determined Payment Rates for Low-Volume Skilled Nursing Facilities, for Cost Reporting Periods Beginning...

42 CFR 413.321 - Simplified cost report for SNFs.

Code of Federal Regulations, 2013 CFR

2013-10-01

... SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Prospectively Determined Payment Rates for Low-Volume Skilled Nursing Facilities, for Cost Reporting Periods Beginning...

Association of a Bundled-Payment Program With Cost and Outcomes in Full-Cycle Breast Cancer Care.

PubMed

Wang, C Jason; Cheng, Skye H; Wu, Jen-You; Lin, Yi-Ping; Kao, Wen-Hsin; Lin, Chia-Li; Chen, Yin-Jou; Tsai, Shu-Ling; Kao, Feng-Yu; Huang, Andrew T

2017-03-01

Value-driven payment system reform is a potential tool for aligning economic incentives with the improvement of quality and efficiency of health care and containment of cost. Such a payment system has not been researched satisfactorily in full-cycle cancer care. To examine the association of outcomes and medical expenditures with a bundled-payment pay-for-performance program for breast cancer in Taiwan compared with a fee-for-service (FFS) program. Data were obtained from the Taiwan Cancer Database, National Health Insurance Claims Data, the National Death Registry, and the bundled-payment enrollment file. Women with newly diagnosed breast cancer and a documented first cancer treatment from January 1, 2004, to December 31, 2008, were selected from the Taiwan Cancer Database and followed up for 5 years, with the last follow-up data available on December 31, 2013. Patients in the bundled-payment program were matched at a ratio of 1:3 with control individuals in an FFS program using a propensity score method. The final sample of 17 940 patients included 4485 (25%) in the bundled-payment group and 13 455 (75%) in the FFS group. Rates of adherence to quality indicators, survival rates, and medical payments (excluding bonuses paid in the bundled-payment group). The Kaplan-Meier method was used to calculate 5-year overall and event-free survival rates by cancer stage, and the Cox proportional hazards regression model was used to examine the effect of the bundled-payment program on overall and event-free survival. Sensitivity analysis for bonus payments in the bundled-payment group was also performed. The study population included 17 940 women (mean [SD] age, 52.2 [10.3] years). In the bundled-payment group, 1473 of 4215 patients (34.9%) with applicable quality indicators had full (100%) adherence to quality indicators compared with 3438 of 12 506 patients (27.5%) with applicable quality indicators in the FFS group (P < .001). The 5-year event-free survival rates for patients with stages 0 to III breast cancer were 84.48% for the bundled-payment group and 80.88% for the FFS group (P < .01). Although the 5-year medical payments of the bundled-payment group remained stable, the cumulative medical payments for the FFS group steadily increased from $16 000 to $19 230 and exceeded pay-for-performance bundled payments starting in 2008. In Taiwan, compared with the regular FFS program, bundled payment may lead to better adherence to quality indicators, better outcomes, and more effective cost-control over time.

PACE and the Medicare+Choice risk-adjusted payment model.

PubMed

Temkin-Greener, H; Meiners, M R; Gruenberg, L

2001-01-01

This paper investigates the impact of the Medicare principal inpatient diagnostic cost group (PIP-DCG) payment model on the Program of All-Inclusive Care for the Elderly (PACE). Currently, more than 6,000 Medicare beneficiaries who are nursing home certifiable receive care from PACE, a program poised for expansion under the Balanced Budget Act of 1997. Overall, our analysis suggests that the application of the PIP-DCG model to the PACE program would reduce Medicare payments to PACE, on average, by 38%. The PIP-DCG payment model bases its risk adjustment on inpatient diagnoses and does not capture adequately the risk of caring for a population with functional impairments.

42 CFR 413.239 - Transition period.

Code of Federal Regulations, 2010 CFR

2010-10-01

... PRINCIPLES OF REASONABLE COST REIMBURSEMENT; PAYMENT FOR END-STAGE RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Payment for End-Stage Renal Disease (ESRD...-treatment payment amount for renal dialysis services (as defined in § 413.171 of this part) and home...

42 CFR 413.300 - Basis and scope.

Code of Federal Regulations, 2013 CFR

2013-10-01

... PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Prospectively Determined Payment Rates for Low-Volume Skilled Nursing Facilities, for Cost Reporting Periods Beginning Prior to July 1, 1998...

42 CFR 413.300 - Basis and scope.

Code of Federal Regulations, 2010 CFR

2010-10-01

... PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Prospectively Determined Payment Rates for Low-Volume Skilled Nursing Facilities, for Cost Reporting Periods Beginning Prior to July 1, 1998...

42 CFR 413.300 - Basis and scope.

Code of Federal Regulations, 2011 CFR

2011-10-01

... PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Prospectively Determined Payment Rates for Low-Volume Skilled Nursing Facilities, for Cost Reporting Periods Beginning Prior to July 1, 1998...

Standardizing Care and Improving Quality under a Bundled Payment Initiative for Total Joint Arthroplasty.

PubMed

Froemke, Cecily C; Wang, Lian; DeHart, Matthew L; Williamson, Ronda K; Ko, Laura Matsen; Duwelius, Paul J

2015-10-01

Increasing demands for episodic bundled payments in total hip and knee arthroplasty are motivating providers to wring out inefficiencies and coordinate services. This study describes a care pathway and gainshare arrangement as the mechanism by which improvements in efficiency were realized under a bundled payment pilot. Analysis of cut-to-close time, LOS, discharge destination, implant cost, and total allowed claims between pre-pilot and pilot cohorts showed an 18% reduction in average LOS (70.8 to 58.2 hours) and a shift from home health and skilled nursing facility discharge to home self-care (54.1% to 63.7%). No significant differences were observed for cut-to-close time and implant cost. Improvements resulted in a 6% reduction in the average total allowed claims per case. Copyright © 2015 Elsevier Inc. All rights reserved.

Evaluation of Industrial Compensation to Cardiologists in 2015.

PubMed

Khan, Muhammad Shahzeb; Siddiqi, Tariq Jamal; Fatima, Kaneez; Riaz, Haris; Khosa, Faisal; Manning, Warren J; Krasuski, Richard

2017-12-15

The categorization and characterization of pharmaceutical and device manufacturers or group purchasing organization payments to clinicians is an important step toward assessing conflicts of interest and the potential impact of these payments on practice patterns. Payments have not previously been compared among the subspecialties of cardiology. This is a retrospective analysis of the Open Payments database, including all installments and payments made to doctors in the calendar year 2015 by pharmaceutical and device manufacturers or group purchasing organization. Total payments to individual physicians were then aggregated based on specialty, geographic region, and payment type. The Gini Index was further employed to calculate within each specialty to measure income disparity. In 2015, a total of $166,089,335 was paid in 943,744 payments (average $175.00 per payment) to cardiologists, including 23,372 general cardiologists, 7,530 interventional cardiologists, and 2,293 cardiac electro-physiologists. Payments were mal-distributed across the 3 subspecialties of cardiology (p <0.01), with general cardiology receiving the largest number (73.5%) and total payments (62.6%) and cardiac electrophysiologists receiving significantly higher median payments ($1,662 vs $361 for all cardiologists; p <0.01). The Medtronic Company was the largest single payer for all 3 subspecialties. In conclusion, pharmaceutical and device manufacturers or group purchasing organizations continue to make substantial payments to cardiac practitioners with a significant variation in payments made to different cardiology subspecialists. The largest number and total payments are to general cardiologists, whereas the highest median payments are made to cardiac electrophysiologists. The impact of these payments on practice patterns remains to be examined. Copyright © 2017 Elsevier Inc. All rights reserved.

Medicare program; home health prospective payment system rate update for calendar year 2011; changes in certification requirements for home health agencies and hospices. Final rule.

PubMed

2010-11-17

This final rule sets forth an update to the Home Health Prospective Payment System (HH PPS) rates, including: the national standardized 60-day episode rates, the national per-visit rates, the nonroutine medical supply (NRS) conversion factors, and the low utilization payment amount (LUPA) add-on payment amounts, under the Medicare prospective payment system for HHAs effective January 1, 2011. This rule also updates the wage index used under the HH PPS and, in accordance with the Patient Protection and Affordable Care Act of 2010 (Affordable Care Act), updates the HH PPS outlier policy. In addition, this rule revises the home health agency (HHA) capitalization requirements. This rule further adds clarifying language to the "skilled services" section. The rule finalizes a 3.79 percent reduction to rates for CY 2011 to account for changes in case-mix, which are unrelated to real changes in patient acuity. Finally, this rule incorporates new legislative requirements regarding face-to-face encounters with providers related to home health and hospice care.

The Australian Baby Bonus Maternity Payment and Birth Characteristics in Western Australia

PubMed Central

Einarsdóttir, Kristjana; Langridge, Amanda; Hammond, Geoffrey; Gunnell, Anthony S.; Haggar, Fatima A.; Stanley, Fiona J.

2012-01-01

Background The Australian baby bonus maternity payment introduced in 2004 has been reported to have successfully increased fertility rates in Australia. We aimed to investigate the influence of the baby bonus on maternal demographics and birth characteristics in Western Australia (WA). Methods and Findings This study included 200,659 birth admissions from WA during 2001–2008, identified from administrative birth and hospital data-systems held by the WA Department of Health. We estimated average quarterly birth rates after the baby bonus introduction and compared them with expected rates had the policy not occurred. Rate and percentage differences (including 95% confidence intervals) were estimated separately by maternal demographics and birth characteristics. WA birth rates increased by 12.8% following the baby bonus implementation with the greatest increase being in mothers aged 20–24 years (26.3%, 95%CI = 22.0,30.6), mothers having their third (1.6%, 95%CI = 0.9,2.4) or fourth child (2.2%, 95%CI = 2.1,2.4), mothers living in outer regional and remote areas (32.4%, 95%CI = 30.2,34.6), mothers giving birth as public patients (1.5%, 95%CI = 1.3,1.8), and mothers giving birth in public hospitals (3.5%, 95%CI = 2.6,4.5). Interestingly, births to private patients (−4.3%, 95%CI = −4.8,−3.7) and births in private hospitals (−6.3%, 95%CI = −6.8,−5.8) decreased following the policy implementation. Conclusions The introduction of the baby bonus maternity payment may have served as an incentive for women in their early twenties and mothers having their third or fourth child and may have contributed to the ongoing pressure and staff shortages in Australian public hospitals, particularly those in outer regional and remote areas. PMID:23145010

Community financing of local ivermectin distribution in Nigeria: potential payment and cost-recovery outlook.

PubMed

Onwujekwe, O E; Shu, E N; Okonkwo, P O

2000-04-01

The preferred payment mechanism in a community financing scheme for local ivermectin distribution was elicited from randomly selected household heads from three communities in Nigeria using interviewer-administered structured questionnaires. The majority of the respondents in the three communities were prepared to pay for local ivermectin distribution. Additionally, the average amounts the respondents were prepared to pay per person treated ($0.28, $0.30 and $0.38 in Nike, Achi and Toro, respectively) were all more than the $0.20 ceiling recommended by the partners of the African Programme on Onchocerciasis Control (APOC). Thus, the cost-recovery outlook is bright in these communities. However, the preferred payment modality varied. Fee-for-service was the predominant payment modality in the Achi and Nike communities, while the Toro community preferred pre-payment. This study demonstrates that many communities have different payment preferences for endemic disease control efforts. This knowledge will help in developing acceptable and sustainable schemes. The imposition of unacceptable payment mechanisms will lead to an unwillingness to pay.

Financial Incentives and Cervical Cancer Screening Participation in Ontario's Primary Care Practice Models.

PubMed

Pendrith, Ciara; Thind, Amardeep; Zaric, Gregory S; Sarma, Sisira

2016-08-01

The primary objective of this paper is to compare cervical cancer screening rates of family physicians in Ontario's two dominant reformed practice models, Family Health Group (FHG) and Family Health Organization (FHO), and traditional fee-for-service (FFS) model. Both reformed models formally enrol patients and offer extensive pay-for-performance incentives; however, they differ by remuneration for core services (FHG is FFS; FHO is capitated). The secondary objective is to estimate the average and marginal costs of screening in each model. Using administrative data on 7,298 family physicians and their 2,083,633 female patients aged 35-69 eligible for cervical cancer screening in 2011, we assessed screening rates after adjusting for patient and physician characteristics. Predicted screening rates, fees and bonus payments were used to estimate the average and marginal costs of cervical cancer screening. Adjusted screening rates were highest in the FHG (81.9%), followed by the FHO (79.6%), and then the traditional FFS model (74.2%). The cost of a cervical cancer screening was $18.30 in the FFS model. The estimated average cost of screening in the FHGs and FHOs were $29.71 and $35.02, respectively, while the corresponding marginal costs were $33.05 and $39.06. We found significant differences in cervical cancer screening rates across Ontario's primary care practice models. Cervical screening rates were significantly higher in practice models eligible for incentives (FHGs and FHOs) than the traditional FFS model. However, the average and marginal cost of screening were lowest in the traditional FFS model and highest in the FHOs. Copyright © 2016 Longwoods Publishing.

29 CFR 5.31 - Meeting wage determination obligations.

Code of Federal Regulations, 2011 CFR

2011-07-01

... obligations for the payment of both straight time wages and fringe benefits by paying in cash, making payments... “painters” will be met by the payment of a straight time hourly rate of not less than $3.90 and by... for pensions, and 20 cents an hour for vacations; or (2) By paying not less than the basic hourly rate...

42 CFR 422.216 - Special rules for MA private fee-for-service plans.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Special rules for MA private fee-for-service plans... Providers § 422.216 Special rules for MA private fee-for-service plans. (a) Payment to providers—(1) Payment rate. (i) The MA organization must establish payment rates for plan covered items and services that...

42 CFR 422.216 - Special rules for MA private fee-for-service plans.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 3 2011-10-01 2011-10-01 false Special rules for MA private fee-for-service plans... Providers § 422.216 Special rules for MA private fee-for-service plans. (a) Payment to providers—(1) Payment rate. (i) The MA organization must establish payment rates for plan covered items and services that...

77 FR 67449 - Medicare Program; End-Stage Renal Disease Prospective Payment System, Quality Incentive Program...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-09

... Blended Payment a. Update to the Drug Add-on to the Composite Rate Portion of the ESRD Blended Payment Rate i. Estimating Growth in Expenditures for Drugs and Biologicals in CY 2013 ii. Estimating Per Patient Growth iii. Applying the Growth Update to the Drug Add-On Adjustment iv. Update to the Drug Add-On...

78 FR 46958 - Animal Generic Drug User Fee Rates and Payment Procedures for Fiscal Year 2014

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-02

...] Animal Generic Drug User Fee Rates and Payment Procedures for Fiscal Year 2014 AGENCY: Food and Drug... and payment procedures for fiscal year (FY) 2014 generic new animal drug user fees. The Federal Food... for FY 2014. FOR FURTHER INFORMATION CONTACT: Visit FDA's Web site at http://www.fda.gov/ForIndustry...

42 CFR 412.535 - Publication of the Federal prospective payment rates.

Code of Federal Regulations, 2010 CFR

2010-10-01

... HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Long-Term Care Hospitals § 412.535 Publication of the Federal prospective... care hospital prospective payment system effective for each annual update in the Federal Register. (a...

Prescription drugs: issues of cost, coverage, and quality.

PubMed

Copeland, C

1999-04-01

This Issue Brief closely examines expenditures on prescription drugs, and discusses their potential to substitute for other types of health care services. In addition, it describes employer coverage of prescription drugs, direct-to-consumer advertising of prescription drugs, and potential legislation affecting the prescription drug market. Prescription drug expenditures grew at double-digit rates during almost every year since 1980, accelerating to 14.1 percent in 1997. In contrast, total national health expenditures, hospital service expenditures, and physician service expenditures growth rates decreased from approximately 13 percent in 1980 to less than 5 percent in 1997. Private insurance payments for prescription drugs increased 17.7 percent in 1997, after growing 22.1 percent in 1995 and 18.3 percent in 1996. This growth in prescription drug payments compares with 4 percent or less overall annual growth in private insurance payments for each of those three years. From 1993 to 1997, the overwhelming majority of the increases in expenditures on prescription drugs were attributable to increased volume, mix, and availability of pharmaceutical products. In 1997, these factors accounted for more than 80 percent of the growth in prescription drug expenditures. A leading explanation for the sharp growth in drug expenditures is that prescription drugs are a substitute for other forms of health care. While it is difficult to determine the extent to which this substitution occurs, various studies have associated cost savings with the use of pharmaceutical products in treating specific diseases. Evidence suggests that more appropriate utilization of prescription drugs has the potential to lower total expenditures and improve the quality of care. Also, some studies indicate the U.S. health care system needs to improve the way patients use and physicians prescribe current medications. Prescription drug plans offered by employers are likely to undergo changes to ensure that only the most efficacious drugs are covered. Anecdotal evidence suggests that copayments for prescriptions are going to increase. Some health plans are including prescription drug costs in their capitated payments to physicians. Furthermore, prescription drug plans are expected to use formularies more aggressively. In 1996, an average 5.47 outpatient prescriptions were written for those ages 55-64, compared with more than eight for those age 65 and older. Inevitably, this translated to significantly more spending for prescription drugs by the elderly. In 1994-1995, the average elderly individual (age 65 or older) spent $558 on prescription drugs, while the average 55-64-year-old spent $355. While prescription drugs are showing sharp price increases, they are also becoming more important in the treatment of many diseases. Consequently, both employers and policymakers must carefully balance the design and cost of a drug benefit so that continual innovation is preserved and the benefit can remain affordable and effective.

77 FR 21775 - Risk Adjustment Meeting-May 7, 2012 and May 8, 2012

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-11

... notice announces a meeting on the risk adjustment program, which is open to the public. The purpose of... plan average actuarial risk, calculation of payments and charges, data collection approach, and the..., calculation of payments and charges, data collection approach, and the schedule for running risk adjustment...

42 CFR 412.212 - National rate.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 2 2011-10-01 2011-10-01 false National rate. 412.212 Section 412.212 Public... Costs for Hospitals Located in Puerto Rico § 412.212 National rate. (a) General rule. For purposes of payment to hospitals located in Puerto Rico, the national prospective payment rate for inpatient operating...

42 CFR 412.212 - National rate.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 2 2013-10-01 2013-10-01 false National rate. 412.212 Section 412.212 Public... Costs for Hospitals Located in Puerto Rico § 412.212 National rate. (a) General rule. For purposes of payment to hospitals located in Puerto Rico, the national prospective payment rate for inpatient operating...

42 CFR 412.212 - National rate.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 2 2012-10-01 2012-10-01 false National rate. 412.212 Section 412.212 Public... Costs for Hospitals Located in Puerto Rico § 412.212 National rate. (a) General rule. For purposes of payment to hospitals located in Puerto Rico, the national prospective payment rate for inpatient operating...

42 CFR 412.212 - National rate.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 2 2014-10-01 2014-10-01 false National rate. 412.212 Section 412.212 Public... Costs for Hospitals Located in Puerto Rico § 412.212 National rate. (a) General rule. For purposes of payment to hospitals located in Puerto Rico, the national prospective payment rate for inpatient operating...

The importance of assessing out-of-pocket payments when the financing of antiretroviral therapy is transitioned to domestic funding: findings from Vietnam.

PubMed

Johns, Benjamin; Chau, Le Bao; Hanh, Kieu Huu; Huong, Nguyen Thuy; Do, Hoa Mai; Duong, Anh Thuy; Nguyen, Long Hoang

2017-07-01

To assess out-of-pocket payments and catastrophic health expenditures among antiretroviral therapy (ART) patients in Vietnam, and to model catastrophic payments under different copayment scenarios when the primary financing of ART changes to social health insurance. Cross-sectional facility-based survey of 843 patients at 42 health facilities representative of 87% of ART patients in 2015. Because of donor and government funding, no payments were made for antiretroviral drugs. Other health expenditures were about $66 per person per year (95% CI: $30-$102), of which $15 ($7-$22) were directly for HIV-related health services, largely laboratory tests. These payments resulted in a 4.9% (95% CI: 3.1-6.8%) catastrophic payment rate and 2.5% (95% CI: 0.9-4.1%) catastrophic payment rate for HIV-related health services. About 32% of respondents reported, they were eligible for SHI without copayments. If patients had to pay 20% of costs of ART under social health insurance, the catastrophic payment rate would increase to 8% (95% CI: 5.5-10.0%), and if patients without health insurance had to pay the full costs of ART, the catastrophic payment rate among all patients would be 24% (95% CI: 21.1-27.4%). Health and catastrophic expenditures were substantially lower than in previous studies, although different methods may explain some of the discrepancy. The 20% copayments required by social health insurance would present a financial burden to an additional 0.6% to 5.1% of ART patients. Ensuring access to health insurance for all ART patients will prevent an even higher level of financial hardship. © 2017 John Wiley & Sons Ltd.

Effects of diagnosis-related group payment system on appendectomy outcomes.

PubMed

Kim, Tae Hyun; Park, Eun-Cheol; Jang, Sung-In; Jang, Suk-Yong; Lee, Sang Ah; Choi, Jae Woo

2016-12-01

The voluntary diagnosis-related group (DRG) payment system was introduced in 2002. Since July 2013, the Korean government has mandated DRG participation for all hospitals. The main purpose of this study was to examine the effects of mandatory DRG participation on various outcome metrics for appendectomy patients. We collected inpatient DRG data for 280,062 appendectomy patients between 2007 and 2014 using the Health Insurance Review and Assessment database. We examined patient outcome metrics such as length of stay (LOS), total medical cost, spillover, and readmission rate, according to hospital size. As a result of DRG participation, the average LOS for patients decreased (adjusted ratio: 0.83 [large hospitals], 0.83 [small hospitals]; 95% confidence interval [CI]: 0.82-0.84, 0.82-0.84), the total medical costs of patients increased (adjusted ratio: 1.23 [large hospitals], 1.35 [small hospitals]; 95% CI: 1.22-1.24, 1.34-1.36), the spillover of patients increased (adjusted ratio: 2.10 [large hospitals], 2.30 [small hospitals]; 95% CI: 2.03-2.18, 2.16-2.45), and the readmission rates of appendectomy patients decreased (adjusted ratio: 0.85 [large hospitals], 0.49 [small hospitals]; 95% CI: 0.77-0.94, 0.42-0.57). The mandatory implementation of the DRG payment system in South Korea has led to significant reductions in LOS and readmission rates for appendectomy patients. However, any resulting expansion of outpatient services may result in unnecessary resource usage rather than improving medical quality. Policy makers should consider the various implications reflected by these results when considering DRGs for other diseases. Copyright © 2016 Elsevier Inc. All rights reserved.

Alternatives for using multivariate regression to adjust prospective payment rates

PubMed Central

Sheingold, Steven H.

1990-01-01

Multivariate regression analysis has been used in structuring three of the adjustments to Medicare's prospective payment rates. Because the indirect-teaching adjustment, the disproportionate-share adjustment, and the adjustment for large cities are responsible for distributing approximately $3 billion in payments each year, the specification of regression models for these adjustments is of critical importance. In this article, the application of regression for adjusting Medicare's prospective rates is discussed, and the implications that differing specifications could have for these adjustments are demonstrated. PMID:10113271

Using Medical Claims for Policy Effectiveness Surveillance: Reimbursement and Utilization of Abdomen/Pelvis Computed Tomography Scans.

PubMed

Horný, Michal; Morgan, Jake R; Merker, Vanessa L

2015-12-01

To quantify changes in private insurance payments for and utilization of abdominal/pelvic computed tomography scans (CTs) after 2011 changes in CPT coding and Medicare reimbursement rates, which were designed to reduce costs stemming from misvalued procedures. TruvenHealth Analytics MarketScan Commercial Claims and Encounters database. We used difference-in-differences models to compare combined CTs of the abdomen/pelvis to CTs of the abdomen or pelvis only. Our main outcomes were inflation-adjusted log payments per procedure, daily utilization rates, and total annual payments. Claims data were extracted for all abdominal/pelvic CTs performed in 2009-2011 within noncapitated, employer-sponsored private plans. Adjusted payments per combined CTs of the abdomen/pelvis dropped by 23.8 percent (p < .0001), and their adjusted daily utilization rate accelerated by 0.36 percent (p = .034) per month after January 2011. Utilization rate of abdominal-only or pelvic-only CTs dropped by 5.0 percent (p < .0001). Total annual payments for combined CTs of the abdomen/pelvis decreased in 2011 despite the increased utilization. Private insurance payments for combined CTs of the abdomen/pelvis declined and utilization accelerated significantly after 2011 policy changes. While growth in total annual payments was contained in 2011, it may not be sustained if 2011 utilization trends persist. © Health Research and Educational Trust.

42 CFR 419.40 - Payment concepts.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Payment concepts. 419.40 Section 419.40 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... Hospitals § 419.40 Payment concepts. (a) In addition to the payment rate described in § 419.32, for each APC...

7 CFR 920.112 - Late payments.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Miscellaneous Provisions § 920.112 Late payments. Pursuant to § 920.41(a), interest will be charged at a 1.5 percent monthly simple interest rate. Assessments for kiwifruit shall be deemed late if not received... late charge will be assessed when payment becomes 30 days late. Interest and late payment charges shall...

1984 Defense Financial and Investment Review (DFAIR). Survey of Defense Procurement Personnel Results and Findings

DTIC Science & Technology

1984-12-01

to be neither too high, nor too low. They agreed that the flexible progress payment model is too complex to administer, Very few agreed that the flow...Progress Payment Rate ....................... 133 Flexible Progress Payment Model ................... 146 Flow Down of Financing Provisions...Flexible Progress Payment Model A plurality (45%) of all respondents agreed that the flexible progress payment model is too

Under Pressure: Financial Effect of the Hospital-Acquired Conditions Initiative-A Statewide Analysis of Pressure Ulcer Development and Payment.

PubMed

Meddings, Jennifer; Reichert, Heidi; Rogers, Mary A M; Hofer, Timothy P; McMahon, Laurence F; Grazier, Kyle L

2015-07-01

To assess the financial effect of the 2008 Hospital-Acquired Conditions Initiative (HACI) pressure ulcer payment changes on Medicare, other payers, and hospitals. Retrospective before-and-after study of all-payer statewide administrative data for more than 2.4 million annual adult discharges in 2007 and 2009 using the Healthcare Cost and Utilization Project State Inpatient Datasets for California. How often and by how much the 2008 payment changes for pressure ulcers affected hospital payment was assessed. Nonfederal acute care California hospitals (N = 311). Adults discharged from acute-care hospitals. Pressure ulcer rates and hospital payment changes. Hospital-acquired pressure ulcer rates were low in 2007 (0.28%) and 2009 (0.27%); present-on-admission pressure ulcer rates increased from 2.3% in 2007 to 3.0% in 2009. According to clinical stage of pressure ulcer (available in 2009), hospital-acquired Stage III and IV ulcers occurred in 603 discharges (0.02%); 60,244 discharges (2.42%) contained other pressure ulcer diagnoses. Payment removal for Stage III and IV hospital-acquired ulcers reduced payment in 75 (0.003%) discharges, for a statewide payment decrease of $310,444 (0.001%) for all payers and $199,238 (0.001%) for Medicare. For all other pressure ulcers, the Hospital-Acquired Conditions Initiative reduced hospital payment in 20,246 (0.81%) cases (including 18,953 cases with present-on-admission ulcers), reducing statewide payment by $62,538,586 (0.21%) for all payers and $47,237,984 (0.32%) for Medicare. The total financial effect of the 2008 payment changes for pressure ulcers was negligible. Most payment decreases occurred by removal of comorbidity payments for present-on-admission pressure ulcers other than Stages III and IV. The removal of payment for hospital-acquired Stage III and IV ulcers by implementation of the HACI policy was 1/200th that of the removal of payment for other types of pressure ulcers that occurred in implementation of the Hospital-Acquired Conditions Initiative. © 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.

Interest rate swaps: financial tool of the '90s.

PubMed

Woodard, M A

1993-11-01

The implementation of prospective payment for capital costs makes it more necessary than ever for healthcare financial managers to be able to creatively balance capital costs with risk. A new financial management tool--the interest rate swap (a contractual agreement in which one party with a fixed interest rate payment liability and another party with a variable interest payment liability agree to trade those obligations)--is proving to be a solution for a growing number of hospital managers. This article describes the uses of interest rate swaps and discusses the variables to be considered when evaluating whether the benefits of an interest rate swap offset the additional risk.

12 CFR Appendix F to Part 226 - Annual Percentage Rate Computations for Certain Open-End Credit Plans

Code of Federal Regulations, 2010 CFR

2010-01-01

... adjusted balance (previous balance less payments and credits) and the consumer made a payment of $50 at the... convenience of the user, the revised text is set forth as follows: Pt. 226, App. F, Nt. Appendix F to Part 226... rate applies only to an adjusted balance (previous balance less payments and credits) and the consumer...

26 CFR 19.3-1 - Interest on certain deferred payments; interest rate for use in determining whether there is...

Code of Federal Regulations, 2010 CFR

2010-04-01

... annum simple interest shall be used. As an illustration of the meaning of simple interest, if a contract provides for payments of $6,000 in 3 equal installments of $2,000 plus 4 percent per annum simple interest... provides for discounting payments at a 4 percent per annum simple interest rate, shall be used for...

Evaluation of the Effectiveness of a Surgical Checklist in Medicare Patients.

PubMed

Reames, Bradley N; Scally, Christopher P; Thumma, Jyothi R; Dimick, Justin B

2015-01-01

Surgical checklists are increasingly used to improve compliance with evidence-based processes in the perioperative period. Although enthusiasm exists for using checklists to improve outcomes, recent studies have questioned their effectiveness in large populations. We sought to examine the association of Keystone Surgery, a statewide implementation of an evidence-based checklist and Comprehensive Unit-based Safety Program, on surgical outcomes and health care costs. We performed a study using national Medicare claims data for patients undergoing general and vascular surgery (n=1,002,241) from 2006 to 2011. A difference-in-differences approach was used to evaluate whether implementation was associated with improved surgical outcomes and decreased costs when compared with a national cohort of nonparticipating hospitals. Propensity score matching was used to select 10 control hospitals for each participating hospital. Costs were assessed using price-standardized 30-day Medicare payments for acute hospitalizations, readmissions, and high-cost outliers. Keystone Surgery implementation in participating centers (N=95 hospitals) was not associated with improved outcomes. Difference-in-differences analysis accounting for trends in nonparticipating hospitals (N=950 hospitals) revealed no differences in adjusted rates of 30-day mortality [relative risk (RR)=1.03; 95% confidence intervals (CI), 0.97-1.10], any complication (RR=1.03; 95% CI, 0.99-1.07), reoperations (RR=0.89; 95% CI, 0.56-1.22), or readmissions (RR=1.01; 95% CI, 0.97-1.05). Medicare payments for the index admission increased following implementation ($516 average increase in payments; 95% CI, $210-$823 increase), as did readmission payments ($564 increase; 95% CI, $89-$1040 increase). High-outlier payments ($965 increase; 95% CI, $974decrease to $2904 increase) did not change. Implementation of Keystone Surgery in Michigan was not associated with improved outcomes or decreased costs in Medicare patients.

Industry Financial Relationships in Neurosurgery in 2015: Analysis of the Sunshine Act Open Payments Database.

PubMed

de Lotbiniere-Bassett, Madeleine P; McDonald, Patrick J

2018-06-01

The 2013 Physician Payments Sunshine Act mandates that all U.S. drug and device manufacturers disclose payments to physicians. All payments are made available annually in the Open Payments Database (OPD). Our aim was to determine prevalence, magnitude, and nature of these payments to physicians performing neurologic surgery in 2015 and to discuss the role that financial conflicts of interest play in neurosurgery. All records of industry financial relationships with physicians identified by the neurological surgery taxonomy code in 2015 were accessed via the OPD. Data were analyzed in terms of type and amounts of payments, companies making payments, and comparison with previous studies. In 2015, 83,690 payments (totaling $99,048,607) were made to 7613 physicians by 330 companies. Of these, 0.01% were >$1 million, and 73.2% were <$100. The mean payment ($13,010) was substantially greater than the median ($114). Royalties and licensing accounted for the largest monetary value of payments (74.2%) but only 1.7% of the total number. Food and beverage payments were the most commonly reported transaction (75%) but accounted for only 2.5% of total reported monetary value. Neurologic surgery had the second highest average total payment per physician of any specialty. The neurological surgery specialty receives substantial annual payments from industry in the United States. The overall value is driven by a small number of payments of high monetary value. The OPD provides a unique opportunity for increased transparency in industry-physician relationships facilitating disclosure of financial conflicts of interest. Copyright © 2018 Elsevier Inc. All rights reserved.

Medicare and Medicaid Programs; CY 2016 Home Health Prospective Payment System Rate Update; Home Health Value-Based Purchasing Model; and Home Health Quality Reporting Requirements. Final rule.

PubMed

2015-11-05

This final rule will update Home Health Prospective Payment System (HH PPS) rates, including the national, standardized 60-day episode payment rates, the national per-visit rates, and the non-routine medical supply (NRS) conversion factor under the Medicare prospective payment system for home health agencies (HHAs), effective for episodes ending on or after January 1, 2016. As required by the Affordable Care Act, this rule implements the 3rd year of the 4-year phase-in of the rebasing adjustments to the HH PPS payment rates. This rule updates the HH PPS case-mix weights using the most current, complete data available at the time of rulemaking and provides a clarification regarding the use of the "initial encounter'' seventh character applicable to certain ICD-10-CM code categories. This final rule will also finalize reductions to the national, standardized 60-day episode payment rate in CY 2016, CY 2017, and CY 2018 of 0.97 percent in each year to account for estimated case-mix growth unrelated to increases in patient acuity (nominal case-mix growth) between CY 2012 and CY 2014. In addition, this rule implements a HH value-based purchasing (HHVBP) model, beginning January 1, 2016, in which all Medicare-certified HHAs in selected states will be required to participate. Finally, this rule finalizes minor changes to the home health quality reporting program and minor technical regulations text changes.

7 CFR 755.7 - Transportation rates.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 7 2014-01-01 2014-01-01 false Transportation rates. 755.7 Section 755.7 Agriculture... SPECIAL PROGRAMS REIMBURSEMENT TRANSPORTATION COST PAYMENT PROGRAM FOR GEOGRAPHICALLY DISADVANTAGED FARMERS AND RANCHERS § 755.7 Transportation rates. (a) Payments may be based on fixed, set, or actual...

7 CFR 755.7 - Transportation rates.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 7 2011-01-01 2011-01-01 false Transportation rates. 755.7 Section 755.7 Agriculture... SPECIAL PROGRAMS REIMBURSEMENT TRANSPORTATION COST PAYMENT PROGRAM FOR GEOGRAPHICALLY DISADVANTAGED FARMERS AND RANCHERS § 755.7 Transportation rates. (a) Payments may be based on fixed, set, or actual...

7 CFR 755.7 - Transportation rates.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 7 2012-01-01 2012-01-01 false Transportation rates. 755.7 Section 755.7 Agriculture... SPECIAL PROGRAMS REIMBURSEMENT TRANSPORTATION COST PAYMENT PROGRAM FOR GEOGRAPHICALLY DISADVANTAGED FARMERS AND RANCHERS § 755.7 Transportation rates. (a) Payments may be based on fixed, set, or actual...

7 CFR 755.7 - Transportation rates.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 7 2013-01-01 2013-01-01 false Transportation rates. 755.7 Section 755.7 Agriculture... SPECIAL PROGRAMS REIMBURSEMENT TRANSPORTATION COST PAYMENT PROGRAM FOR GEOGRAPHICALLY DISADVANTAGED FARMERS AND RANCHERS § 755.7 Transportation rates. (a) Payments may be based on fixed, set, or actual...

77 FR 44059 - Federal Acquisition Regulation; Payments Under Time-and-Materials and Labor-Hour Contracts

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-26

...) Payments of this clause, but the ``hourly rate'' for labor hours expended in furnishing work not delivered...] RIN 9000-AM01 Federal Acquisition Regulation; Payments Under Time-and-Materials and Labor-Hour... the authorization to use time-and-materials and labor-hour contract payment requirements. DATES...

29 CFR 5.11 - Disputes concerning payment of wages.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 29 Labor 1 2010-07-01 2010-07-01 true Disputes concerning payment of wages. 5.11 Section 5.11... Provisions and Procedures § 5.11 Disputes concerning payment of wages. (a) This section sets forth the procedure for resolution of disputes of fact or law concerning payment of prevailing wage rates, overtime...

77 FR 63751 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-17

... [CMS-1588-F2] RIN 0938-AR12 Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2013 Rates; Hospitals' Resident Caps for Graduate Medical Education Payment Purposes; Quality Reporting Requirements for...

75 FR 31118 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-02

...This notice contains the final wage indices, hospital reclassifications, payment rates, impacts, and other related tables effective for the fiscal year (FY) 2010 hospital inpatient prospective payment systems (IPPS) and rate year 2010 long-term care hospital (LTCH) prospective payment system (PPS). The rates, tables, and impacts included in this notice reflect changes required by or resulting from the implementation of several provisions of the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010. These provisions require the extension of the expiration date for certain geographic reclassifications and special exception wage indices through September 30, 2010; and certain market basket updates for the IPPS and LTCH PPS.

24 CFR 213.254 - Premiums where first principal payment more than one year after initial endorsement.

Code of Federal Regulations, 2011 CFR

2011-04-01

... initial insurance endorsement, the mortgagee, upon the anniversary of such insurance date, shall pay a... of the first principal payment, the mortgagee shall pay a third premium equal to one-half of one percent of the average outstanding principal obligation of the mortgage for the following year which shall...

75 FR 60170 - Proposed Information Collection (Claim for Payment of Cost of Unauthorized Medical Services...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-29

.... Request for Payment of Beneficiary Travel After the Date of Service--417. Estimated Average Burden per... information will have practical utility; (2) the accuracy of VHA's estimate of the burden of the proposed... collected; and (4) ways to minimize the burden of the collection of information on respondents, including...

26 CFR 16A.126-1 - Certain cost-sharing payments-in general.

Code of Federal Regulations, 2011 CFR

2011-04-01

... improvement. An increase in annual income is substantial if it exceeds the greater of 10 percent of the average annual income derived from the affected property prior to receipt of the improvement or an amount... upon the receipt of a section 126 payment is the value of the section 126 improvement, reduced by the...

Diagnosis-Based Risk Adjustment for Medicare Capitation Payments

PubMed Central

Ellis, Randall P.; Pope, Gregory C.; Iezzoni, Lisa I.; Ayanian, John Z.; Bates, David W.; Burstin, Helen; Ash, Arlene S.

1996-01-01

Using 1991-92 data for a 5-percent Medicare sample, we develop, estimate, and evaluate risk-adjustment models that utilize diagnostic information from both inpatient and ambulatory claims to adjust payments for aged and disabled Medicare enrollees. Hierarchical coexisting conditions (HCC) models achieve greater explanatory power than diagnostic cost group (DCG) models by taking account of multiple coexisting medical conditions. Prospective models predict average costs of individuals with chronic conditions nearly as well as concurrent models. All models predict medical costs far more accurately than the current health maintenance organization (HMO) payment formula. PMID:10172666

Geographic classification of hospitals: Alternative labor market areas

PubMed Central

De Lew, Nancy

1992-01-01

Medicare hospital payments are adjusted to reflect variation in hospital wages across geographic areas by grouping hospitals into labor market areas. By only recognizing the average wage in an area, Medicare encourages hospitals to contain costs. Labor market area definitions have recently received renewed attention because of their impact on hospital payments. Alternative labor market areas were evaluated using several criteria, including ability to explain wage variation and impact on payment equity. Rural labor market areas can be improved using county population size; however, further research on urban labor market areas is needed. PMID:10127453

43 CFR Appendix C to Part 2 - Fee Schedule

Code of Federal Regulations, 2011 CFR

2011-10-01

... requesters only). Fees are based on: the average hourly salary (base salary plus DC locality payment), plus 16 percent for benefits, of employees in the following three categories. The average grade was established by surveying the bureaus to obtain the average grade of employees conducting FOIA searches and...

7 CFR 760.209 - Livestock payment calculations.

Code of Federal Regulations, 2011 CFR

2011-01-01

... of the relevant average income loss sustained by the contract grower, with respect to the dead... the Secretary that represents the average number of pounds of corn per day necessary to feed that...) of this section equals the quotient obtained by dividing: (1) The higher of: (i) The national average...

7 CFR 1400.500 - Applicability.

Code of Federal Regulations, 2010 CFR

2010-01-01

... SUBSEQUENT CROP, PROGRAM, OR FISCAL YEARS Average Adjusted Gross Income Limitation § 1400.500 Applicability... program payments or benefits described in § 1400.1 if the average adjusted gross income of the person or... average adjusted gross nonfarm income as defined in § 1400.3 that exceeds $500,000 will not be eligible to...

7 CFR 1400.500 - Applicability.

Code of Federal Regulations, 2011 CFR

2011-01-01

... SUBSEQUENT CROP, PROGRAM, OR FISCAL YEARS Average Adjusted Gross Income Limitation § 1400.500 Applicability... program payments or benefits described in § 1400.1 if the average adjusted gross income of the person or... average adjusted gross nonfarm income as defined in § 1400.3 that exceeds $500,000 will not be eligible to...

7 CFR 760.209 - Livestock payment calculations.

Code of Federal Regulations, 2010 CFR

2010-01-01

... of the relevant average income loss sustained by the contract grower, with respect to the dead... the Secretary that represents the average number of pounds of corn per day necessary to feed that...) of this section equals the quotient obtained by dividing: (1) The higher of: (i) The national average...

24 CFR 221.256 - Interest rate increase and payment of mortgage insurance premiums on mortgages under § 221.60 and...

Code of Federal Regulations, 2011 CFR

2011-04-01

... of mortgage insurance premiums on mortgages under § 221.60 and § 221.65. 221.256 Section 221.256... Interest rate increase and payment of mortgage insurance premiums on mortgages under § 221.60 and § 221.65.... (c) The liability for payment of mortgage insurance premiums shall begin on and be computed from the...

United States Marine Corps Personal Discount Rates: As Evidenced from Voluntary Separation Payment Programs

DTIC Science & Technology

2006-03-01

1995. The Personal Discount Rate: Evidence from Air Force Loss Programs. Mankiw , N.G. 2004. Principles of Economics : Third Edition. Mason, OH...study also determined those personal, professional, and economic traits that had a significant influence on Marines during their separation payment...study also determined those personal, professional, and economic traits that had a significant influence on Marines during their separation payment

Hospitalization of nursing home residents: the effects of states' Medicaid payment and bed-hold policies.

PubMed

Intrator, Orna; Grabowski, David C; Zinn, Jacqueline; Schleinitz, Mark; Feng, Zhanlian; Miller, Susan; Mor, Vince

2007-08-01

Hospitalizations of nursing home residents are costly and expose residents to iatrogenic disease and social and psychological harm. Economic constraints imposed by payers of care, predominantly Medicaid policies, are hypothesized to impact hospitalizations. Federally mandated resident assessments were merged with Medicare claims and eligibility files to determine hospitalizations and death within 150 days of baseline assessment. Nursing home and market characteristics were obtained from the Online Survey Certification and Reporting, and the Area Resource File, respectively. States' average daily Medicaid nursing home payments and bed-hold policies were obtained independently. Prospective cohort study of 570,614 older (> or =65-year-old), non-MCO (Medicare Managed Care), long-stay (> or =90 days) residents in 8,997 urban, freestanding nursing homes assessed between April and June 2000, using multilevel models to test the impact of state policies on hospitalizations controlling for resident, nursing home, and market characteristics. Overall, 99,379 (17.4 percent) residents were hospitalized with rates varying from 8.4 percent in Utah to 24.9 percent in Louisiana. Higher Medicaid per diem was associated with lower odds of hospitalizations (5 percent lower for each $10 above average $103.5, confidence intervals [CI] 0.91-0.99). Hospitalization odds were higher by 36 percent in states with bed-hold policies (CI: 1.12-1.63). State Medicaid bed-hold policy and per-diem payment have important implications for nursing home hospitalizations, which are predominantly financed by Medicare. This study emphasizes the importance of properly aligning state Medicaid and federal Medicare policies in regards to the subsidy of acute, maintenance, and preventive care in the nursing home setting.

Hospitalization of Nursing Home Residents: The Effects of States' Medicaid Payment and Bed-Hold Policies

PubMed Central

Intrator, Orna; Grabowski, David C; Zinn, Jacqueline; Schleinitz, Mark; Feng, Zhanlian; Miller, Susan; Mor, Vince

2007-01-01

Objective Hospitalizations of nursing home residents are costly and expose residents to iatrogenic disease and social and psychological harm. Economic constraints imposed by payers of care, predominantly Medicaid policies, are hypothesized to impact hospitalizations. Data Sources/Study Setting Federally mandated resident assessments were merged with Medicare claims and eligibility files to determine hospitalizations and death within 150 days of baseline assessment. Nursing home and market characteristics were obtained from the Online Survey Certification and Reporting, and the Area Resource File, respectively. States' average daily Medicaid nursing home payments and bed-hold policies were obtained independently. Study Design Prospective cohort study of 570,614 older (≥65-year-old), non-MCO (Medicare Managed Care), long-stay (≥90 days) residents in 8,997 urban, freestanding nursing homes assessed between April and June 2000, using multilevel models to test the impact of state policies on hospitalizations controlling for resident, nursing home, and market characteristics. Principal Findings Overall, 99,379 (17.4 percent) residents were hospitalized with rates varying from 8.4 percent in Utah to 24.9 percent in Louisiana. Higher Medicaid per diem was associated with lower odds of hospitalizations (5 percent lower for each $10 above average $103.5, confidence intervals [CI] 0.91–0.99). Hospitalization odds were higher by 36 percent in states with bed-hold policies (CI: 1.12–1.63). Conclusions State Medicaid bed-hold policy and per-diem payment have important implications for nursing home hospitalizations, which are predominantly financed by Medicare. This study emphasizes the importance of properly aligning state Medicaid and federal Medicare policies in regards to the subsidy of acute, maintenance, and preventive care in the nursing home setting. PMID:17610442

7 CFR 784.6 - Rate of payment and limitations on funding.

Code of Federal Regulations, 2010 CFR

2010-01-01

..., DEPARTMENT OF AGRICULTURE SPECIAL PROGRAMS 2004 EWE LAMB REPLACEMENT AND RETENTION PAYMENT PROGRAM § 784.6... proration provisions of § 784.7, payments for qualifying operations shall be $18 for each qualifying ewe...

Individual payments as a longer-term incentive in online panels.

PubMed

Göritz, Anja S; Wolff, Hans-Georg; Goldstein, Daniel G

2008-11-01

Does it pay to pay online panel members? A three-wave longitudinal experiment was conducted with an online panel to examine whether per person payments, paid through an online intermediary, influence response and retention rates. In the payment condition, participants were promised payment for participation at each wave, whereas control participants were not offered any payment. The promise of a payment had a negative effect on response in Wave 1, but a positive effect on response in Wave 2. Payment had no significant effect on retention. Completing a given wave was an indicator for responding to a subsequent invitation.

Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and FY 2012 rates; hospitals' FTE resident caps for graduate medical education payment. Final rules.

PubMed

2011-08-18

We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems and to implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act) and other legislation. We also are setting forth the update to the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits. We are updating the payment policy and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) and implementing certain statutory changes made by the Affordable Care Act. In addition, we are finalizing an interim final rule with comment period that implements section 203 of the Medicare and Medicaid Extenders Act of 2010 relating to the treatment of teaching hospitals that are members of the same Medicare graduate medical education affiliated groups for the purpose of determining possible full-time equivalent (FTE) resident cap reductions.

7 CFR 226.9 - Assignment of rates of reimbursement for centers.

Code of Federal Regulations, 2010 CFR

2010-01-01

... participating in the Program in that State. These methods are: (1) Meals times rates payment, which involves... comparison to the costs incurred by the institution for the meal service; and, (2) Meals times rates or... where the State agency has chosen the option to implement a meals times rates payment system State-wide...

7 CFR 226.9 - Assignment of rates of reimbursement for centers.

Code of Federal Regulations, 2011 CFR

2011-01-01

... participating in the Program in that State. These methods are: (1) Meals times rates payment, which involves... comparison to the costs incurred by the institution for the meal service; and, (2) Meals times rates or... where the State agency has chosen the option to implement a meals times rates payment system State-wide...

42 CFR 422.252 - Terminology.

Code of Federal Regulations, 2010 CFR

2010-10-01

... § 422.252 Terminology. Annual MA capitation rate means a county payment rate for an MA local area... to refer to the annual MA capitation rate. MA local area means a payment area consisting of county or equivalent area specified by CMS. MA monthly basic beneficiary premium means the premium amount an MA plan...

26 CFR 1.1274-4 - Test rate.

Code of Federal Regulations, 2010 CFR

2010-04-01

... any possible payment schedule. (d) Foreign currency loans. If all of the payments of a debt instrument are denominated in, or determined by reference to, a currency other than the U.S. dollar, the applicable Federal rate for the debt instrument is a foreign currency rate of interest that is analogous to...

45 CFR 98.102 - Content of Error Rate Reports.

Code of Federal Regulations, 2013 CFR

2013-10-01

....102 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CHILD CARE AND DEVELOPMENT FUND Error Rate Reporting § 98.102 Content of Error Rate Reports. (a) Baseline Submission Report... payments by the total dollar amount of child care payments that the State, the District of Columbia or...

45 CFR 98.102 - Content of Error Rate Reports.

Code of Federal Regulations, 2014 CFR

2014-10-01

....102 Public Welfare Department of Health and Human Services GENERAL ADMINISTRATION CHILD CARE AND DEVELOPMENT FUND Error Rate Reporting § 98.102 Content of Error Rate Reports. (a) Baseline Submission Report... payments by the total dollar amount of child care payments that the State, the District of Columbia or...

45 CFR 98.102 - Content of Error Rate Reports.

Code of Federal Regulations, 2012 CFR

2012-10-01

....102 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CHILD CARE AND DEVELOPMENT FUND Error Rate Reporting § 98.102 Content of Error Rate Reports. (a) Baseline Submission Report... payments by the total dollar amount of child care payments that the State, the District of Columbia or...

45 CFR 98.102 - Content of Error Rate Reports.

Code of Federal Regulations, 2011 CFR

2011-10-01

....102 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CHILD CARE AND DEVELOPMENT FUND Error Rate Reporting § 98.102 Content of Error Rate Reports. (a) Baseline Submission Report... payments by the total dollar amount of child care payments that the State, the District of Columbia or...

Cost of high prevalence mental disorders: Findings from the 2007 Australian National Survey of Mental Health and Wellbeing.

PubMed

Lee, Yu-Chen; Chatterton, Mary Lou; Magnus, Anne; Mohebbi, Mohammadreza; Le, Long Khanh-Dao; Mihalopoulos, Cathrine

2017-12-01

The aim of this project was to detail the costs associated with the high prevalence mental disorders (depression, anxiety-related and substance use) in Australia, using community-based, nationally representative survey data. Respondents diagnosed, within the preceding 12 months, with high prevalence mental disorders using the Confidentialised Unit Record Files of the 2007 National Survey of Mental Health and Wellbeing were analysed. The use of healthcare resources (hospitalisations, consultations and medications), productivity loss, income tax loss and welfare benefits were estimated. Unit costs of healthcare services were obtained from the Independent Hospital Pricing Authority, Medicare and Pharmaceutical Benefits Scheme. Labour participation rates and unemployment rates were determined from the National Survey of Mental Health and Wellbeing. Daily wage rates adjusted by age and sex were obtained from Australian Bureau of Statistics and used to estimate productivity losses. Income tax loss was estimated based on the Australian Taxation Office rates. The average cost of commonly received Government welfare benefits adjusted by age was used to estimate welfare payments. All estimates were expressed in 2013-2014 AUD and presented from multiple perspectives including public sector, individuals, private insurers, health sector and societal. The average annual treatment cost for people seeking treatment was AUD660 (public), AUD195 (individual), AUD1058 (private) and AUD845 from the health sector's perspective. The total annual healthcare cost was estimated at AUD974m, consisting of AUD700m to the public sector, AUD168m to individuals, and AUD107m to the private sector. The total annual productivity loss attributed to the population with high prevalence mental disorders was estimated at AUD11.8b, coupled with the yearly income tax loss at AUD1.23b and welfare payments at AUD12.9b. The population with high prevalence mental disorders not only incurs substantial cost to the Australian healthcare system but also large economic losses to society.

7 CFR 82.6 - Rate of payment; total payments.

Code of Federal Regulations, 2010 CFR

2010-01-01

... actual 2005 deliveries of clingstone peaches to processors from those acres of clingstone peach trees... will only be made after tree removal has been verified by the staff of the CCPA. (c) The $100 per ton payment is intended to cover the costs of tree removal. USDA will not make any other payment with respect...

Child support and alimony: 1981.

PubMed

Sanders, R A

1985-02-01

This report presents information (including 13 tables) as of spring 1982 on payments made to mothers for child support by fathers not living in the same household, and information on support payments and property settlement awards for women involved in marital dissolution. As of spring 1982, 8.4 million mothers were living with a child under 21 years of age whose father was not living with them; 59% of these women were or would be awarded child support payments than black women (34%) or those of Spanish origin (44%). College educated women were more likely to be awarded and to receive child support payments than women with only a high school education. The average amount of child support received in 1981 was $2,110, a decrease of about 16% from the 1978 level of $2,510. Of the 2.6 million women below the poverty level with children present from an absent father, about 40% received child support. Among the poor, 806,000 women were due child support in 1981 but only 61% received some amount of payment. As of spring 1982, only about 15% of the 17 million divorced or separated women received alimony. In 1981 alimony averaged $3,000, a 25% decrease from the 1978 level of $3,980. In spring 1982, about 42% of the 14.2 million divorced women reported receiving some form of property settlement.

42 CFR 413.149 - Depreciation: Allowance for depreciation on assets financed with Federal or public funds.

Code of Federal Regulations, 2010 CFR

2010-10-01

... REIMBURSEMENT; PAYMENT FOR END-STAGE RENAL DISEASE SERVICES; OPTIONAL PROSPECTIVELY DETERMINED PAYMENT RATES FOR... function of payment of depreciation to provide funds that make it possible to maintain the assets and...

Association of authorized generic marketing with prescription drug spending on antidepressants from 2000 to 2011.

PubMed

Cheng, Ning; Banerjee, Tannista; Qian, Jingjing; Hansen, Richard A

Prior research suggests that authorized generic drugs increase competition and decrease prices, but little empirical evidence supports this conclusion. This study evaluated the impact of authorized generic marketing on brand and generic prices. Longitudinal analysis of the household component of the Medical Expenditure Panel Survey. Interview panels over 12 years, with a new panel each year. For each panel, 5 rounds of household interviews were conducted over 30 months. Nationally representative sample of the U.S. civilian noninstitutionalized population, focusing on people using 1 of 5 antidepressant drugs that became generically available between 2000 to 2011. Drugs and dose/formulations with versus without an authorized generic drug marketed. Multiple linear regression models with lagged variables evaluated the effect of an authorized generic on average inflation-adjusted brand and generic price, adjusting for payment sources, generic entry time, competitor price, and year. During 2000-2011, annual brand antidepressant utilization decreased from 51.47 to 7.52 million prescriptions, and generic antidepressant utilization increased from 0 to 88.83 million prescriptions. Over time, payment per prescription for brand prescriptions increased 25% overall, and generic payments decreased 70% for all payer types. With unadjusted data, after generic entry the average brand price decreased $0.59 per year with and $3.62 per year without an authorized generic in the market. Average generic prices decreased $10.30 per year with and $8.47 per year without an authorized generic in the market. In multiple regression models with lagged variables adjusted for heteroscedasticity, payer source, time since generic entry, competitor price, and year, authorized generics significantly reduced average payment for generic (-$3.03) and brand (-$60.64) prescriptions, and over time this price change slowly diminished. Availability of an authorized generic was associated with reduced average generic and brand price in the antidepressant market, supporting prior evidences. Copyright © 2017 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

Health policies for the reduction of obstetric interventions in singleton full-term births in Catalonia.

PubMed

Pueyo, Maria-Jesus; Escuriet, Ramon; Pérez-Botella, M; de Molina, I; Ruíz-Berdun, D; Albert, S; Díaz, S; Torres-Capcha, P; Ortún, V

2018-04-01

To explore the effect of hospital's characteristics in the proportion of obstetric interventions (OI) performed in singleton fullterm births (SFTB) in Catalonia (2010-2014), while incentives were employed to reduce C-sections. Data about SFTB assisted at 42 public hospitals were extracted from the dataset of hospital discharges. Hospitals were classified according to the level of complexity, the volume of births attended, and the adoption of a non-medicalized delivery (NMD) strategy. The annual average change in the percentage for OI was calculated based on Poisson regression models. The rate of OI (35% of all SFTB) including C-sections (20.6%) remained stable through the period. Hospitals attending less complex cases had a lower average of OI, while hospitals attending lower volumes had the highest average. Higher levels of complexity increased the use of C-sections (+4% yearly) and forceps (+16%). The adoption of the NMD strategy decreased the rate of C-sections. The proportion of OI, including C-sections, remained stable in spite of public incentives to reduce them. The adoption of the NMD strategy could help in decreasing the rate of OI. To reduce the OI rate, new strategies should be launched as the development of low-risk pregnancies units, alignment of incentives and hospital payment, increased value of incentives and encouragement of a cultural shift towards non-medicalized births. Copyright © 2018 Elsevier B.V. All rights reserved.

Do adjusted clinical groups eliminate incentives for HMOs to avoid substance abusers? Evidence from the Maryland Medicaid HealthChoice program.

PubMed

Ettner, Susan L; Johnson, Steven

2003-01-01

The adequacy of risk adjustment to eliminate incentives for managed care organizations (MCOs) to avoid enrolling costly patients had been questioned. This study explored systematic differences in expenditures between beneficiaries with and without substance disorders assigned to the same capitation rate group under the Maryland Medicaid HealthChoice program. The investigators used fiscal year (FY) 1995 to 1997 Medicaid data to assign beneficiaries to rate cells based on FY 1995 diagnoses and compared the distribution of expenditures for beneficiaries with and without substance disorders, defined using FY 1997 and FY 1995 diagnoses. Results showed that differences in FY 1997 expenditures between beneficiaries with and without FY 1995 substance disorders were negligible. However, MCOs could expect greater average losses and lower average profits on beneficiaries with FY 1997 substance disorders. Thus, the adjusted clinical groups methodology used to adjust capitation payments in the HealthChoice program attenuated, but did not eliminate, financial incentives for MCOs to avoid substance abusers.

Payments and quality of care in private for-profit and public hospitals in Greece

PubMed Central

2011-01-01

Background Empirical evidence on how ownership type affects the quality and cost of medical care is growing, and debate on these topics is ongoing. Despite the fact that the private sector is a major provider of hospital services in Greece, little comparative information on private versus public sector hospitals is available. The aim of the present study was to describe and compare the operation and performance of private for-profit (PFP) and public hospitals in Greece, focusing on differences in nurse staffing rates, average lengths of stay (ALoS), and Social Health Insurance (SHI) payments for hospital care per patient discharged. Methods Five different datasets were prepared and analyzed, two of which were derived from information provided by the National Statistical Service (NSS) of Greece and the other three from data held by the three largest SHI schemes in the country. All data referred to the 3-year period from 2001 to 2003. Results PFP hospitals in Greece are smaller than public hospitals, with lower patient occupancy, and have lower staffing rates of all types of nurses and highly qualified nurses compared with public hospitals. Calculation of ALoS using NSS data yielded mixed results, whereas calculations of ALoS and SHI payments using SHI data gave results clearly favoring the public hospital sector in terms of cost-efficiency; in all years examined, over all specialties and all SHI schemes included in our study, unweighted ALoS and SHI payments for hospital care per discharge were higher for PFP facilities. Conclusions In a mixed healthcare system, such as that in Greece, significant performance differences were observed between PFP and public hospitals. Close monitoring of healthcare provision by hospital ownership type will be essential to permit evidence-based decisions on the future of the public/private mix in terms of healthcare provision. PMID:21943020

Economic Analysis of Cleft Palate Repair in International Adoptees.

PubMed

Tomlinson-Hansen, Sandra; Paliga, J Thomas; Tahiri, Youssef; Paine, Kaitlyn M; Bartlett, Scott P; Taylor, Jesse A

2016-09-01

Retrospective cohort study. Major international tertiary care referral center for cleft palate repair. One hundred thirty-eight patients at the Children's Hospital of Philadelphia who had palate repair performed between 2010 and 2013, excluding syndromic patients, patients undergoing palate revision, and patients with incomplete payment information. None. Fees and charges for procedures. Surgeon payment was significantly higher for international adoptees (Δ = $2047.51 [$128.35 to $3966.66], P = .038). Medicaid-adjusted surgeon payments averaged $1006 more for adoptees ([-$394.19 to $2406.98], P = .158). Hospital and anesthesiology costs for adoptee palate repair were highly variable but did not differ significantly from those for nonadoptees. Partly due to payer mix, surgeon reimbursement was somewhat higher for international adoptees. No difference in total payment was found.

Medical malpractice in urology, 1985 to 2004: 469 consecutive cases closed with indemnity payment.

PubMed

Perrotti, Michael; Badger, William; Prader, Susan; Moran, Michael E

2006-11-01

Malpractice premiums have increased by up to 57% for urologists in the last 3 years, for which the reasons are not clearly reported. We sought to better understand factors contributing to the current medical malpractice crisis in urology. Working with the Medical Liability Mutual Insurance Company of New York State we evaluated malpractice claims in urology that were closed with indemnity payment between 1985 and 2004. Individual claims were assessed for the purported negligent act, the procedure when applicable and the expense incurred. We also evaluated the impact of new technologies, eg laparoscopic nephrectomy, on reported claims. A total of 469 urology malpractice claims were closed with indemnity payment during the period evaluated for a total loss indemnity of Dollars 99,335,431. The number of files closed with indemnity payment yearly remained relatively constant at an average of 22 claims. The average indemnity payment increased each year and after correcting for inflation a 191% increase was observed for the period evaluated. The greatest number of claims was related to postoperative events (total of 101), followed by intraoperative events (96), failure to diagnose a given condition (60), medication administration error (21) and a foreign body left following surgery (20). In the area of new technologies laparoscopic surgery accounted for 4 claims and transurethral needle ablation accounted for 1. Vasectomy accounted for 8 claims. In the current study surgical procedures were the greatest generator of claims with the most common being oncological. Emerging and new technologies, eg laparoscopy and robotics, did not account for the increase in indemnity payments observed to date. Only further investigation will determine whether this is secondary to a lag time in the closure of suits related to these emerging technologies or to a lack of such suits. The actual number of claims closed with indemnity payment yearly remained relatively constant. However, the indemnity payment per claim far outpaced that expected for inflation. The observed increase in indemnity payment per claim would appear to be a significant contributing factor to the current malpractice crisis in urology.

42 CFR 419.2 - Basis of payment.

Code of Federal Regulations, 2014 CFR

2014-10-01

... part. (b) Determination of hospital outpatient prospective payment rates: Packaged costs. The..., that includes operating and capital-related costs that are integral, ancillary, supportive, dependent..., these packaged costs may include, but are not limited to, the following items and services, the payment...

42 CFR 419.2 - Basis of payment.

Code of Federal Regulations, 2012 CFR

2012-10-01

... prospective payment system establishes a national payment rate, standardized for geographic wage differences...) Capital-related costs; (9) Implantable items used in connection with diagnostic X-ray tests, diagnostic laboratory tests, and other diagnostic tests; (10) Durable medical equipment that is implantable; (11...

48 CFR 9904.415-60 - Illustrations.

Code of Federal Regulations, 2010 CFR

2010-10-01

... in 9904.415-50(a) are met. Year Amount of future payment × discount rate 8-percent present value... future payment×Discount rate present value factor for 2 yr at 8 pct=Assignable cost $2,000×0.8573=$1,714... was used as the discount rate at the time the cost was assigned. The IRS rate in effect at the date of...

9 CFR 54.6 - Amount of indemnity payments.

Code of Federal Regulations, 2011 CFR

2011-01-01

... will be used. The AMS reports from the most recent week or month prior to the date APHIS offers to pay... weighted average Choice/Prime slaughter lamb price per pound at Greeley, CO; (2) The weekly weighted average Utility slaughter ewe price per pound at San Angelo, TX; (3) The monthly weighted average...

7 CFR 701.117 - Average adjusted gross income limitation.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 7 2011-01-01 2011-01-01 false Average adjusted gross income limitation. 701.117... Conservation Program § 701.117 Average adjusted gross income limitation. To be eligible for payments issued... the provisions of the Adjusted Gross Income Limitations at 7 CFR part 1400 subpart G. [72 FR 45880...

7 CFR 993.159 - Payments for services performed with respect to reserve tonnage prunes.

Code of Federal Regulations, 2012 CFR

2012-01-01

... overhead costs, which include those for supervision, indirect labor, fuel, power and water, taxes and... tonnage prunes. The Committee will compute the average industry cost for holding reserve pool prunes by... choose to exclude the high and low data in computing an industry average. The industry average costs may...

7 CFR 993.159 - Payments for services performed with respect to reserve tonnage prunes.

Code of Federal Regulations, 2013 CFR

2013-01-01

... overhead costs, which include those for supervision, indirect labor, fuel, power and water, taxes and... tonnage prunes. The Committee will compute the average industry cost for holding reserve pool prunes by... choose to exclude the high and low data in computing an industry average. The industry average costs may...

7 CFR 993.159 - Payments for services performed with respect to reserve tonnage prunes.

Code of Federal Regulations, 2014 CFR

2014-01-01

... overhead costs, which include those for supervision, indirect labor, fuel, power and water, taxes and... tonnage prunes. The Committee will compute the average industry cost for holding reserve pool prunes by... choose to exclude the high and low data in computing an industry average. The industry average costs may...

Trends in hospital labor and total factor productivity, 1981-86

PubMed Central

Cromwell, Jerry; Pope, Gregory C.

1989-01-01

The per-case payment rates of Medicare's prospective payment system are annually updated. As one element of the update factor, Congress required consideration of changes in hospital productivity. In this article, calculations of annual changes in labor and total factor productivity during 1981-86 of hospitals eligible for prospective payment are presented using several output and input variants. Generally, productivity has declined since 1980, although the rates of decline have slowed since prospective payment implementation. According to the series of analyses most relevant for policy, significant hospital productivity gains occurred during 1983-86. This may justify a lower update factor. PMID:10313278

The Medicare Access And CHIP Reauthorization Act: Effects On Medicare Payment Policy And Spending.

PubMed

Hussey, Peter S; Liu, Jodi L; White, Chapin

2017-04-01

In 2015, Congress repealed the Sustainable Growth Rate formula for Medicare physician payment, eliminating mandatory payment cuts when spending exceeded what was budgeted. In its place, Congress enacted the Medicare Access and CHIP Reauthorization Act (MACRA), which established a two-track performance-based payment system that encourages physicians to participate in alternative payment models. MACRA could have huge effects on health care delivery, but the nature of those effects is highly uncertain. Using the RAND Corporation's Health Care Payment and Delivery Simulation Model, we estimated the effects of MACRA on Medicare spending and utilization and examined how effects would differ under various scenarios. We estimate that MACRA will decrease Medicare spending on physician services by -$35 to -$106 billion (-2.3 percent to -7.1 percent) and change spending on hospital services by $32 to -$250 billion (0.7 percent to -5.1 percent) in 2015-30. The spending effects are critically dependent on the strength of incentives in the alternative payment models, particularly the incentives for physicians to reduce hospital spending and physician responses to MACRA payment rates. Project HOPE—The People-to-People Health Foundation, Inc.

78 FR 41857 - Simplified Cost Accounting and Other Actions To Reduce Paperwork in the Summer Food Service...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-12

... of the number of meals served to eligible children times the operating payment rate. For... meals served to eligible children times the administrative payment rate, or the amount specified in the... maximum ``meals times rates'' combined operating and administrative reimbursement without regard to their...

An analysis of secondary road maintenance payments to Henrico and Arlington counties with the December 2001 update.

DOT National Transportation Integrated Search

2002-01-01

In 1986, 33.1-23.5:1 of the Code of Virginia established new rates for payments to Henrico and Arlington counties to maintain their secondary roads and specified how the rates were to be adjusted annually. The rates specified for 1986 maintenance pay...

42 CFR 412.75 - Determination of the hospital-specific rate for inpatient operating costs based on a Federal...

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Determination of the hospital-specific rate for... Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Determination of Transition Period Payment Rates...

7 CFR 1427.1207 - Payment rate.

Code of Federal Regulations, 2011 CFR

2011-01-01

..., or if none of the LFQ, LFQc, or LFQf is available, the payment rate shall be zero and shall remain zero unless and until sufficient USPFE prices or the LFQ again becomes available, the USPFE, USPFEc, or..., shall be based on a percentage of the basic rate for baled lint, as specified in the ELS Cotton Domestic...

Rationale for the new GP deprivation payment scheme in England: effects of moving from electoral ward to enumeration district underprivileged area scores.

PubMed Central

Bajekal, M; Alves, B; Jarman, B; Hurwitz, B

2001-01-01

BACKGROUND: The Department of Health introduced a new deprivation payments system for general practitioners (GPs) on 1 April 1999. Following a three-year phasing-in process, registered patients will attract deprivation payments based on the underprivileged area (UPA) score of their enumeration district (ED) of residence, rather than their electoral ward, changing the pattern and distribution of payments throughout England. AIM: To assess the rationale behind the changed deprivation payments system for GPs in England and to examine its impact on GP and practice payments. DESIGN OF STUDY: A quantitative study modelling practice-based deprivation payments. SETTING: A total of 25,450 unrestricted principal GPs in 8919 practices in England. METHOD: The effect of three new components in the system were examined: changes in the ED score ranges attracting payment, the percentage increase in the size of successive payment bands, and the total budget. The relationship between consultation rates (used as a proxy for workload) and UPA score was examined, together with changes in GP payments calculated nationally and by geographical area. RESULTS: A total of 11.6% of the population of England live in wards with a UPA score of 30 or more, qualifying for deprivation payments, and a similar proportion (11.4%) live in EDs with a UPA score of 20 or more. The larger percentage increases in the size of payments in successive ED UPA bands is supported by the modelled relationship between consultation rate and UPA score. Financially, under the new deprivations payment system, entitlement widens with 88% of practices receiving a payment. Overall, 74% of GPs gain and 13% lose (3% losing more than 1500 Pounds), with 13% receiving no payment. CONCLUSION: The new ED system maps onto the previous system well. Moreover, it more finely discriminates between smaller areas of different relative deprivation and, thereby, targets payments more accurately. PMID:11407049

Rationale for the new GP deprivation payment scheme in England: effects of moving from electoral ward to enumeration district underprivileged area scores.

PubMed

Bajekal, M; Alves, B; Jarman, B; Hurwitz, B

2001-06-01

The Department of Health introduced a new deprivation payments system for general practitioners (GPs) on 1 April 1999. Following a three-year phasing-in process, registered patients will attract deprivation payments based on the underprivileged area (UPA) score of their enumeration district (ED) of residence, rather than their electoral ward, changing the pattern and distribution of payments throughout England. To assess the rationale behind the changed deprivation payments system for GPs in England and to examine its impact on GP and practice payments. A quantitative study modelling practice-based deprivation payments. A total of 25,450 unrestricted principal GPs in 8919 practices in England. The effect of three new components in the system were examined: changes in the ED score ranges attracting payment, the percentage increase in the size of successive payment bands, and the total budget. The relationship between consultation rates (used as a proxy for workload) and UPA score was examined, together with changes in GP payments calculated nationally and by geographical area. A total of 11.6% of the population of England live in wards with a UPA score of 30 or more, qualifying for deprivation payments, and a similar proportion (11.4%) live in EDs with a UPA score of 20 or more. The larger percentage increases in the size of payments in successive ED UPA bands is supported by the modelled relationship between consultation rate and UPA score. Financially, under the new deprivations payment system, entitlement widens with 88% of practices receiving a payment. Overall, 74% of GPs gain and 13% lose (3% losing more than 1500 Pounds), with 13% receiving no payment. The new ED system maps onto the previous system well. Moreover, it more finely discriminates between smaller areas of different relative deprivation and, thereby, targets payments more accurately.

42 CFR 413.302 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Prospectively Determined Payment Rates for Low-Volume Skilled Nursing Facilities, for Cost Reporting Periods Beginning Prior to July 1, 1998... Medicare cost report. Routine operating costs means the cost of regular room, dietary, and nursing services...

42 CFR 413.302 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Prospectively Determined Payment Rates for Low-Volume Skilled Nursing Facilities, for Cost Reporting Periods Beginning Prior to July 1, 1998... Medicare cost report. Routine operating costs means the cost of regular room, dietary, and nursing services...

42 CFR 413.302 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Prospectively Determined Payment Rates for Low-Volume Skilled Nursing Facilities, for Cost Reporting Periods Beginning Prior to July 1, 1998... Medicare cost report. Routine operating costs means the cost of regular room, dietary, and nursing services...

7 CFR 1412.78 - Violations.

Code of Federal Regulations, 2010 CFR

2010-01-01

... AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS DIRECT AND COUNTER-CYCLICAL PROGRAM AND AVERAGE CROP REVENUE ELECTION PROGRAM FOR THE 2008 AND SUBSEQUENT CROP YEARS Average Crop Revenue Election (ACRE... contract and refund all payments previously received together with interest; (ii) Pay liquidated damages to...

The impact of payment source and hospital type on rising cesarean section rates in Brazil, 1998 to 2008.

PubMed

Hopkins, Kristine; de Lima Amaral, Ernesto Friedrich; Mourão, Aline Nogueira Menezes

2014-06-01

High cesarean section rates in Brazilian public hospitals and higher rates in private hospitals are well established. Less is known about the relationship between payment source and cesarean section rates within public and private hospitals. We analyzed the 1998, 2003, and 2008 rounds of a nationally representative household survey (PNAD), which includes type of delivery, where it took place, and who paid for it. We construct cesarean section rates for various categories, and perform logistic regression to determine the relative importance of independent variables on cesarean section rates for all births and first births only. Brazilian cesarean section rates were 42 percent in 1998 and 53 percent in 2008. Women who delivered publicly funded births in either public or private hospitals had lower cesarean section rates than those who delivered privately financed deliveries in public or private hospitals. Multivariate models suggest that older age, higher education, and living outside the Northeast region all positively affect the odds of delivering by cesarean section; effects are attenuated by the payment source-hospital type variable for all women and even more so among first births. Cesarean section rates have risen substantially in Brazil. It is important to distinguish payment source for the delivery to have a better understanding of those rates. © 2014 Wiley Periodicals, Inc.

42 CFR 422.300 - Basis and scope.

Code of Federal Regulations, 2010 CFR

2010-10-01

... for making payments to Medicare Advantage (MA) organizations offering local and regional MA plans, including calculation of MA capitation rates and benchmarks, conditions under which payment is based on plan....458 in subpart J for rules on risk sharing payments to MA regional organizations. ...

Malpractice suits in chest radiology: an evaluation of the histories of 8265 radiologists.

PubMed

Baker, Stephen R; Patel, Ronak H; Yang, Lily; Lelkes, Valdis M; Castro, Alejandro

2013-11-01

The aim of this study was to present rates of claims, causes of error, percentage of cases resulting in a judgment, and average payments made by radiologists in chest-related malpractice cases in a survey of 8265 radiologists. The malpractice histories of 8265 radiologists were evaluated from the credentialing files of One-Call Medical Inc., a preferred provider organization for computed tomography/magnetic resonance imaging in workers' compensation cases. Of the 8265 radiologists, 2680 (32.4%) had at least 1 malpractice suit. Of those who were sued, the rate of claims was 55.1 per 1000 person years. The rate of thorax-related suits was 6.6 claims per 1000 radiology practice years (95% confidence interval, 6.0-7.2). There were 496 suits encompassing 48 different causes. Errors in diagnosis comprised 78.0% of the causes. Failure to diagnose lung cancer was by far the most frequent diagnostic error, representing 211 cases or 42.5%. Of the 496 cases, an outcome was known in 417. Sixty-one percent of these were settled in favor of the plaintiff, with a mean payment of $277,230 (95% confidence interval, 226,967-338,614). Errors in diagnosis, and among them failure to diagnose lung cancer, were by far the most common reasons for initiating a malpractice suit against radiologists related to the thorax and its contents.

Do benefits in kind or refunds affect health service utilization and health outcomes? A natural experiment from Japan.

PubMed

Takaku, Reo; Bessho, S

2017-05-01

Although the payment systems of public health insurance vary greatly across countries, we still have limited knowledge of their effects. To quantify the changes from a benefits in kind system to a refund system, we exploit the largest physician strike in Japan since the Second World War. During the strike in 1971 led by the Japan Medical Association (JMA), JMA physicians resigned as health insurance doctors, but continued to provide medical care and even health insurance treatment in some areas. This study uses the regional differences in resignation rates as a natural experiment to examine the effect of the payment method of health insurance on medical service utilization and health outcomes. In the main analysis, aggregated monthly prefectural data are used (N=46). Our estimation results indicate that if the participation rate of the strike had increased by 1% point and proxy claims were refused completely, the number of cases of insurance benefits and the total amount of insurance benefits would have decreased by 0.78% and 0.58%, respectively compared with the same month in the previous year. Moreover, the average amount of insurance benefits per claim increased since patients with relatively less serious diseases might have sought health care less often. Finally, our results suggest that the mass of resignations did not affect death rates. Copyright © 2017 Elsevier B.V. All rights reserved.

Impact of Private Health Insurance on Lengths of Hospitalization and Healthcare Expenditure in India: Evidences from a Quasi-Experiment Study.

PubMed

Vellakkal, Sukumar

2013-01-01

The health insurers administer retrospectively package rates for various inpatient procedures as a provider payment mechanism to empanelled hospitals in Indian healthcare market. This study analyzed the impact of private health insurance on healthcare utilization in terms of both lengths of hospitalization and per-day hospitalization expenditure in Indian healthcare market where package rates are retrospectively defined as healthcare provider payment mechanism. The claim records of 94443 insured individuals and the hospitalisation data of 32665 uninsured individuals were used. By applying stepwise and propensity score matching method, the sample of uninsured individual was matched with insured and 'average treatment effect on treated' (ATT) was estimated. Overall, the strategies of hospitals, insured and insurers for maximizing their utility were competing with each other. However, two aligning co-operative strategies between insurer and hospitals were significant with dominant role of hospitals. The hospitals maximize their utility by providing high cost healthcare in par with pre-defined package rates but align with the interest of insurers by reducing the number (length) of hospitalisation days. The empirical results show that private health insurance coverage leads to i) reduction in length of hospitalization, and ii) increase in per day hospital (health) expenditure. It is necessary to regulate and develop a competent healthcare market in the country with proper monitoring mechanism on healthcare utilization and benchmarks for pricing and provision of healthcare services.

Association of Medicare's Bundled Payment Reform With Changes in Use of Vitamin D Among Patients Receiving Maintenance Hemodialysis: An Interrupted Time-Series Analysis.

PubMed

Spoendlin, Julia; Schneeweiss, Sebastian; Tsacogianis, Theodore; Paik, Julie M; Fischer, Michael A; Kim, Seoyoung C; Desai, Rishi J

2018-06-08

Medicare's 2011 prospective payment system (PPS) was introduced to curb overuse of separately billable injectable drugs. After epoietin, intravenous (IV) vitamin D analogues are the biggest drug cost drivers in hemodialysis (HD) patients, but the association between PPS introduction and vitamin D therapy has been scarcely investigated. Interrupted time-series analyses. Adult US HD patients represented in the US Renal Data System between 2008 and 2013. PPS implementation. The cumulative dose of IV vitamin D analogues (paricalcitol equivalents) per patient per calendar quarter in prevalent HD patients. The average starting dose of IV vitamin D analogues and quarterly rates of new vitamin D use (initiations/100 person-months) in incident HD patients within 90 days of beginning HD therapy. Segmented linear regression models of the immediate change and slope change over time of vitamin D use after PPS implementation. Among 359,600 prevalent HD patients, IV vitamin D analogues accounted for 99% of the total use, and this trend was unchanged over time. PPS resulted in an immediate 7% decline in the average dose of IV vitamin D analogues (average baseline dose = 186.5 μg per quarter; immediate change = -13.5 μg [P < 0.001]; slope change = 0.43 per quarter [P = 0.3]) and in the starting dose of IV vitamin D analogues in incident HD patients (average baseline starting dose = 5.22 μg; immediate change = -0.40 μg [P < 0.001]; slope change = -0.03 per quarter [P = 0.03]). The baseline rate of vitamin D therapy initiation among 99,970 incident HD patients was 44.9/100 person-months and decreased over time, even before PPS implementation (pre-PPS β = -0.46/100 person-months [P < 0.001]; slope change = -0.19/100 person-months [P = 0.2]). PPS implementation was associated with an immediate change in initiation levels (by -4.5/100 person-months; P < 0.001). Incident HD patients were restricted to those 65 years or older. PPS implementation was associated with a 7% reduction in the average dose and starting dose of IV vitamin D analogues and a 10% reduction in the rate of vitamin D therapy initiation. Copyright © 2018 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Sorting Out the Health Risk in California's State-Based Marketplace.

PubMed

Bindman, Andrew B; Hulett, Denis; Gilmer, Todd P; Bertko, John

2016-02-01

To characterize the health risk of enrollees in California's state-based insurance marketplace (Covered California) by metal tier, region, month of enrollment, and plan. 2014 Open-enrollment data from Covered California linked with 2012 hospitalization and emergency department (ED) visit records from statewide all-payer administrative databases. Chronic Illness and Disability Payment System (CDPS) health risk scores derived from an individual's age and sex from the enrollment file and the diagnoses captured in the hospitalization and ED records. CDPS scores were standardized by setting the average to 1.00. Among the 1,286,089 enrollees, 120,573 (9.4 percent) had at least one ED visit and/or a hospitalization in 2012. Higher risk enrollees chose plans with greater actuarial value. The standardized CDPS health risk score was 11 percent higher in the first month of enrollment (1.08; 99 percent CI: 1.07-1.09) than the last month (0.97; 99 percent CI: 0.97-0.97). Four of the 12 plans enrolled 91 percent of individuals; their average health risk scores were each within 3 percent of the marketplace's statewide average. Providing health plans with a means to assess the health risk of their year 1 enrollees allowed them to anticipate whether they would receive or contribute payments to a risk-adjustment pool. After receiving these findings as a part of their negotiations with Covered California, health plans covering the majority of enrollees decreased their initially proposed 2015 rates, saving consumers tens of millions of dollars in potential premiums. © Health Research and Educational Trust.

12 CFR 714.8 - Are the early payment provisions, or interest rate provisions, applicable in leasing arrangements?

Code of Federal Regulations, 2010 CFR

2010-01-01

... provisions, or interest rate provisions, applicable in leasing arrangements? You are not subject to the early... 12 Banks and Banking 6 2010-01-01 2010-01-01 false Are the early payment provisions, or interest rate provisions, applicable in leasing arrangements? 714.8 Section 714.8 Banks and Banking NATIONAL...

78 FR 55120 - Proposed Submission of Information Collections for OMB Review; Comment Request; Payment of...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-09

... their controlled groups, determined on the day before the plan termination date. Interest on late... addition to the flat-rate and variable-rate premiums under section 4006(a)(3) and (8) of ERISA) that is... on Premium Rates (29 CFR part 4006) and Payment of Premiums (29 CFR part 4007) implement the...

42 CFR 412.77 - Determination of the hospital-specific rate for inpatient operating costs for sole community...

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Determination of the hospital-specific rate for....77 Section 412.77 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND... Determination of Transition Period Payment Rates for the Prospective Payment System for Inpatient Operating...

42 CFR 412.78 - Determination of the hospital-specific rate for inpatient operating costs for sole community...

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Determination of the hospital-specific rate for....78 Section 412.78 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND... Determination of Transition Period Payment Rates for the Prospective Payment System for Inpatient Operating...

76 FR 45814 - Animal Generic Drug User Fee Rates and Payment Procedures for Fiscal Year 2012

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-01

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2011-N-0547] Animal Generic Drug User Fee Rates and Payment Procedures for Fiscal Year 2012 AGENCY: Food and Drug Administration, HHS. ACTION: Notice. SUMMARY: The Food and Drug Administration (FDA) is announcing the rates and...

The Type of Payment and Working Conditions.

PubMed

Rhee, Kyung Yong; Kim, Young Sun; Cho, Yoon Ho

2015-12-01

The type of payment is one of the important factors that has an effect on the health of employees, as a basic working condition. In the conventional research field of occupational safety and health, only the physical, chemical, biological, and ergonomic factors are treated as the main hazardous factors. Managerial factors and basic working conditions such as working hours and the type of payment are neglected. This paper aimed to investigate the association of the type of payment and the exposure to the various hazardous factors as an heuristic study. The third Korean Working Conditions Survey (KWCS) by the Occupational Safety and Health Research Institute in 2011 was used for this study. Among the total sample of 50,032 economically active persons, 34,788 employees were considered for analysis. This study examined the relation between the three types of payment such as basic fixed salary and wage, piece rate, and extra payment for bad and dangerous working conditions and exposure to hazardous factors like vibration, noise, temperature, chemical contact, and working at very high speeds. Multivariate regression analysis was used to measure the effect of the type of payment on working hours exposed to hazards. The result showed that the proportion of employees with a basic fixed salary was 94.5%, the proportion with piece rates was 38.6%, and the proportion who received extra payment for hazardous working conditions was 11.7%. The piece rate was associated with exposure to working with tight deadlines and stressful jobs. This study had some limitations because KWCS was a cross-sectional survey.

The health economic burden that acute and chronic wounds impose on an average clinical commissioning group/health board in the UK.

PubMed

Guest, J F; Vowden, K; Vowden, P

2017-06-02

To estimate the patterns of care and related resource use attributable to managing acute and chronic wounds among a catchment population of a typical clinical commissioning group (CCG)/health board and corresponding National Health Service (NHS) costs in the UK. This was a sub-analysis of a retrospective cohort analysis of the records of 2000 patients in The Health Improvement Network (THIN) database. Patients' characteristics, wound-related health outcomes and health-care resource use were quantified for an average CCG/health board with a catchment population of 250,000 adults ≥18 years of age, and the corresponding NHS cost of patient management was estimated at 2013/2014 prices. An average CCG/health board was estimated to be managing 11,200 wounds in 2012/2013. Of these, 40% were considered to be acute wounds, 48% chronic and 12% lacking any specific diagnosis. The prevalence of acute, chronic and unspecified wounds was estimated to be growing at the rate of 9%, 12% and 13% per annum respectively. Our analysis indicated that the current rate of wound healing must increase by an average of at least 1% per annum across all wound types in order to slow down the increasing prevalence. Otherwise, an average CCG/health board is predicted to manage ~23,200 wounds per annum by 2019/2020 and is predicted to spend a discounted (the process of determining the present value of a payment that is to be received in the future) £50 million on managing these wounds and associated comorbidities. Real-world evidence highlights the substantial burden that acute and chronic wounds impose on an average CCG/health board. Strategies are required to improve the accuracy of diagnosis and healing rates.

Fully Capitated Payment Breakeven Rate for a Mid-Size Pediatric Practice.

PubMed

Farmer, Steven A; Shalowitz, Joel; George, Meaghan; McStay, Frank; Patel, Kavita; Perrin, James; Moghtaderi, Ali; McClellan, Mark

2016-08-01

Payers are implementing alternative payment models that attempt to align payment with high-value care. This study calculates the breakeven capitated payment rate for a midsize pediatric practice and explores how several different staffing scenarios affect the rate. We supplemented a literature review and data from >200 practices with interviews of practice administrators, physicians, and payers to construct an income statement for a hypothetical, independent, midsize pediatric practice in fee-for-service. The practice was transitioned to full capitation to calculate the breakeven capitated rate, holding all practice parameters constant. Panel size, overhead, physician salary, and staffing ratios were varied to assess their impact on the breakeven per-member per-month (PMPM) rate. Finally, payment rates from an existing health plan were applied to the practice. The calculated breakeven PMPM was $24.10. When an economic simulation allowed core practice parameters to vary across a broad range, 80% of practices broke even with a PMPM of $35.00. The breakeven PMPM increased by 12% ($3.00) when the staffing ratio increased by 25% and increased by 23% ($5.50) when the staffing ratio increased by 38%. The practice was viable, even with primary care medical home staffing ratios, when rates from a real-world payer were applied. Practices are more likely to succeed in capitated models if pediatricians understand how these models alter practice finances. Staffing changes that are common in patient-centered medical home models increased the breakeven capitated rate. The degree to which team-based care will increase panel size and offset increased cost is unknown. Copyright © 2016 by the American Academy of Pediatrics.

48 CFR 1652.232-71 - Payments-experience-rated contracts.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 6 2014-10-01 2014-10-01 false Payments-experience-rated contracts. 1652.232-71 Section 1652.232-71 Federal Acquisition Regulations System OFFICE OF PERSONNEL MANAGEMENT FEDERAL EMPLOYEES HEALTH BENEFITS ACQUISITION REGULATION CLAUSES AND FORMS CONTRACT CLAUSES Texts...

48 CFR 1652.232-70 - Payments-community-rated contracts.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 6 2014-10-01 2014-10-01 false Payments-community-rated contracts. 1652.232-70 Section 1652.232-70 Federal Acquisition Regulations System OFFICE OF PERSONNEL MANAGEMENT FEDERAL EMPLOYEES HEALTH BENEFITS ACQUISITION REGULATION CLAUSES AND FORMS CONTRACT CLAUSES Texts...

42 CFR 413.340 - Transition period.

Code of Federal Regulations, 2014 CFR

2014-10-01

... PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Prospective Payment for Skilled Nursing... the facility-specific rate. Allowable costs associated with exemptions, as described in § 413.30(e)(2... minus 1 percentage point. (c) SNFs participating in the Multistate Nursing Home Case-Mix and Quality...

42 CFR 413.340 - Transition period.

Code of Federal Regulations, 2012 CFR

2012-10-01

... PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Prospective Payment for Skilled Nursing... the facility-specific rate. Allowable costs associated with exemptions, as described in § 413.30(e)(2... minus 1 percentage point. (c) SNFs participating in the Multistate Nursing Home Case-Mix and Quality...

42 CFR 413.340 - Transition period.

Code of Federal Regulations, 2011 CFR

2011-10-01

... PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES Prospective Payment for Skilled Nursing... the facility-specific rate. Allowable costs associated with exemptions, as described in § 413.30(e)(2... minus 1 percentage point. (c) SNFs participating in the Multistate Nursing Home Case-Mix and Quality...

37 CFR 382.15 - Verification of royalty payments.

Code of Federal Regulations, 2014 CFR

2014-07-01

... payments. 382.15 Section 382.15 Patents, Trademarks, and Copyrights COPYRIGHT ROYALTY BOARD, LIBRARY OF CONGRESS RATES AND TERMS FOR STATUTORY LICENSES RATES AND TERMS FOR DIGITAL TRANSMISSIONS OF SOUND... SATELLITE DIGITAL AUDIO RADIO SERVICES Preexisting Satellite Digital Audio Radio Services § 382.15...

37 CFR 382.15 - Verification of royalty payments.

Code of Federal Regulations, 2011 CFR

2011-07-01

... payments. 382.15 Section 382.15 Patents, Trademarks, and Copyrights COPYRIGHT ROYALTY BOARD, LIBRARY OF CONGRESS RATES AND TERMS FOR STATUTORY LICENSES RATES AND TERMS FOR DIGITAL TRANSMISSIONS OF SOUND... SATELLITE DIGITAL AUDIO RADIO SERVICES Preexisting Satellite Digital Audio Radio Services § 382.15...

37 CFR 382.7 - Verification of royalty payments.

Code of Federal Regulations, 2014 CFR

2014-07-01

... payments. 382.7 Section 382.7 Patents, Trademarks, and Copyrights COPYRIGHT ROYALTY BOARD, LIBRARY OF CONGRESS RATES AND TERMS FOR STATUTORY LICENSES RATES AND TERMS FOR DIGITAL TRANSMISSIONS OF SOUND... SATELLITE DIGITAL AUDIO RADIO SERVICES Preexisting Subscription Services § 382.7 Verification of royalty...

37 CFR 382.6 - Verification of royalty payments.

Code of Federal Regulations, 2011 CFR

2011-07-01

... payments. 382.6 Section 382.6 Patents, Trademarks, and Copyrights COPYRIGHT ROYALTY BOARD, LIBRARY OF CONGRESS RATES AND TERMS FOR STATUTORY LICENSES RATES AND TERMS FOR DIGITAL TRANSMISSIONS OF SOUND... SATELLITE DIGITAL AUDIO RADIO SERVICES Preexisting Subscription Services § 382.6 Verification of royalty...

37 CFR 382.7 - Verification of royalty payments.

Code of Federal Regulations, 2013 CFR

2013-07-01

... payments. 382.7 Section 382.7 Patents, Trademarks, and Copyrights COPYRIGHT ROYALTY BOARD, LIBRARY OF CONGRESS RATES AND TERMS FOR STATUTORY LICENSES RATES AND TERMS FOR DIGITAL TRANSMISSIONS OF SOUND... SATELLITE DIGITAL AUDIO RADIO SERVICES Preexisting Subscription Services § 382.7 Verification of royalty...

37 CFR 382.15 - Verification of royalty payments.

Code of Federal Regulations, 2010 CFR

2010-07-01

... payments. 382.15 Section 382.15 Patents, Trademarks, and Copyrights COPYRIGHT ROYALTY BOARD, LIBRARY OF CONGRESS RATES AND TERMS FOR STATUTORY LICENSES RATES AND TERMS FOR DIGITAL TRANSMISSIONS OF SOUND... SATELLITE DIGITAL AUDIO RADIO SERVICES Preexisting Satellite Digital Audio Radio Services § 382.15...

37 CFR 382.6 - Verification of royalty payments.

Code of Federal Regulations, 2010 CFR

2010-07-01

... payments. 382.6 Section 382.6 Patents, Trademarks, and Copyrights COPYRIGHT ROYALTY BOARD, LIBRARY OF CONGRESS RATES AND TERMS FOR STATUTORY LICENSES RATES AND TERMS FOR DIGITAL TRANSMISSIONS OF SOUND... SATELLITE DIGITAL AUDIO RADIO SERVICES Preexisting Subscription Services § 382.6 Verification of royalty...

37 CFR 382.6 - Verification of royalty payments.

Code of Federal Regulations, 2012 CFR

2012-07-01

... payments. 382.6 Section 382.6 Patents, Trademarks, and Copyrights COPYRIGHT ROYALTY BOARD, LIBRARY OF CONGRESS RATES AND TERMS FOR STATUTORY LICENSES RATES AND TERMS FOR DIGITAL TRANSMISSIONS OF SOUND... SATELLITE DIGITAL AUDIO RADIO SERVICES Preexisting Subscription Services § 382.6 Verification of royalty...

37 CFR 382.15 - Verification of royalty payments.

Code of Federal Regulations, 2013 CFR

2013-07-01

... payments. 382.15 Section 382.15 Patents, Trademarks, and Copyrights COPYRIGHT ROYALTY BOARD, LIBRARY OF CONGRESS RATES AND TERMS FOR STATUTORY LICENSES RATES AND TERMS FOR DIGITAL TRANSMISSIONS OF SOUND... SATELLITE DIGITAL AUDIO RADIO SERVICES Preexisting Satellite Digital Audio Radio Services § 382.15...