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Unformatted text preview: actice costs Attempt to remedy disparity between spet and primarycare physician reimbursement Implications of PPS Implications of PPS Who benefits from PPS relative to feeforservice reimbursement? How will quality of care and provider behavior change? Providers with low cost patients and most efficient care Why is setting of RBRVS and DRG reimbursement so contentious? Reduced duration of hospital stays Shift toward lower cost treatments Increased coding of diagnoses Other Effects of PPS Other Effects of PPS How does modification to reimbursement affect new technology adoption? Difficult to measure impact since policy was implemented across entire country at same time How are DRG reimbursement rates determined? Need capital subsidization to compensate? If everyone’s cost are above reimbursement rate, how long before change? Hospital Payment-to-Cost Ratios
140% 130% Payment to Cost Ratio 120% 110% 100% 90% 80% 70% 60%
19 80 19 82 19 84 6 19 88 19 90 19 92 19 94 19 96 19 98 20 00 20 02 20 04 20 06 20 08 19 8 Medicare Medicaid Private Payer Source:Trendwatch Chartbook 2009, Trends Affecting Hospitals and Health Systems, Table 4.4, p. A35, at http://www.aha.org/aha/trendwatch/chartbook/2009/appendix4.pdf. Medicaid Today
Health Insurance Coverage
29 million children & 15 million adults in lowincome families; 14 million elderly and persons with disabilities Assistance to Medicare Beneficiaries
8.8 million aged and disabled — 21% of Medicare beneficiaries LongTerm Care Assistance
1 million nursing home residents; 2.8 million communitybased residents MEDICAID
Support for Health Care System and Safetynet
16% of national health spending; 41% of longterm care services
SOURCE: Kaiser Commission on Medicaid and the Uninsu...
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- Spring '11