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Maryland Hospital Payment System
Since the late 1970s, the Maryland hospital payment system has employed an all-payer system for hospital services in which all payers pay the same amount for a given service at a particular hospital. An independent commission establishes the rate structure for each hospital. The system eliminated hospital cost shifting across payers and more equitably spread the costs of uncompensated care and medical education and limited cost growth, but per capita Medicare hospital costs are among the country's highest. Medicare's participation in the system is authorized by the Social Security Act and is tied to a growth limit in payment per admission. The Medicare waiver created incentives to increase the volume of services provided. Medicare pays higher rates for hospital services in Maryland than it does under the national prospective payment systems. 2014 revisions On January 10, 2014, the Centers for Medicare and Medicaid Services (CMS) and the State announced a new model that will ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
All-payer Rate Setting
All-payer rate setting is a price setting mechanism in which all third parties pay the same price for services at a given hospital. It can be used to increase the market power of payers (such as private and/or public insurance companies) versus providers, such as hospital systems, in order to control costs. All-payer characteristics are found in most developed economies with multi-payer healthcare systems, including France, Germany, Japan, and the Netherlands. The U.S. state of Maryland also uses such a model. All-payer rate setting have been proposed in the United States as a healthcare reform measure. The proposal for a public option (a voluntary, publicly sponsored insurance plan similar to Medicare) has been cited as indirectly sharing some of the same goals as all-payer rate-setting systems. Maryland Since the late 1970s, Maryland has operated an all-payer system for hospital services. An independent commission establishes the rate structure for each hospital. That eli ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Per Capita
''Per capita'' is a Latin phrase literally meaning "by heads" or "for each head", and idiomatically used to mean "per person". The term is used in a wide variety of social sciences and statistical research contexts, including government statistics, economic indicators, and built environment studies. It is commonly used in the field of statistics in place of saying "per person" (although ''per caput'' is the Latin for "per head"). It is also used in wills to indicate that each of the named beneficiaries should receive, by devise or bequest, equal shares of the estate. This is in contrast to a '' per stirpes'' division, in which each branch (Latin '' stirps'', plural ''stirpes'') of the inheriting family inherits an equal share of the estate. This is often used with the ‘2-0 rule’, a statistical principle that determines which group is larger per capita. Under the 2-0 rule, a group is the largest per capita if it has both the biggest total size and size of the group of t ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Medicare (United States)
Medicare is a government national health insurance program in the United States, begun in 1965 under the Social Security Administration (SSA) and now administered by the Centers for Medicare and Medicaid Services (CMS). It primarily provides health insurance for Americans aged 65 and older, but also for some younger people with disability status as determined by the SSA, including people with end stage renal disease and amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease). In 2018, according to the 2019 Medicare Trustees Report, Medicare provided health insurance for over 59.9 million individuals—more than 52 million people aged 65 and older and about 8 million younger people. According to annual Medicare Trustees reports and research by the government's MedPAC group, Medicare covers about half of healthcare expenses of those enrolled. Enrollees almost always cover most of the remaining costs by taking additional private insurance and/or by joining a public Part C o ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Social Security Act
The Social Security Act of 1935 is a law enacted by the 74th United States Congress and signed into law by US President Franklin D. Roosevelt. The law created the Social Security program as well as insurance against unemployment. The law was part of Roosevelt's New Deal domestic program. By the 1930s, the United States was the only modern industrial country without any national system of social security. In the midst of the Great Depression, the physician Francis Townsend galvanized support behind a proposal to issue direct payments to the elderly. Responding to that movement, Roosevelt organized a committee led by Secretary of Labor Frances Perkins to develop a major social welfare program proposal. Roosevelt presented the plan in early 1935 and signed the Social Security Act into law on August 14, 1935. The act was upheld by the Supreme Court in two major cases decided in 1937. The law established the Social Security program. The old-age program is funded by payroll tax ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Prospective Payment System
A prospective payment system (PPS) is a term used to refer to several payment methodologies for which means of determining insurance reimbursement is based on a predetermined payment regardless of the intensity of the actual service provided. It includes a system for paying hospitals based on predetermined prices, from Medicare. Payments are typically based on codes provided on the insurance claim such as these: * Diagnosis-related groups for hospital inpatient claims * Ambulatory Payment Classification for hospital outpatient claims * Current Procedural Terminology for other outpatient claims The PPS was established by the Centers for Medicare and Medicaid Services (CMS), as a result of the Social Security Amendments Act of 1983, specifically to address expensive hospital care. Regardless of services provided, payment was of an established fee. The idea was to encourage hospitals to lower their prices for expensive hospital care. In 2000, CMS changed the reimbursement syste ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Centers For Medicare And Medicaid Services
The Centers for Medicare & Medicaid Services (CMS), is a federal agency within the United States Department of Health and Human Services (HHS) that administers the Medicare (United States), Medicare program and works in partnership with state governments to administer Medicaid, the Children's Health Insurance Program (CHIP), and health insurance portability standards. In addition to these programs, CMS has other responsibilities, including the administrative simplification standards from the Health Insurance Portability and Accountability Act of 1996 (HIPAA), quality standards in long-term care facilities (more commonly referred to as nursing homes) through its survey and certification process, clinical laboratory quality standards under the Clinical Laboratory Improvement Amendments, and oversight of HealthCare.gov. CMS was previously known as the Health Care Financing Administration (HCFA) until 2001. CMS actively inspects and reports on every nursing home in the United States. ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Hospital Readmission
A hospital readmission is an episode when a patient who had been discharged from a hospital is admitted again within a specified time interval. Readmission rates have increasingly been used as an outcome measure in health services research and as a quality benchmark for health systems. Generally, higher readmission rate indicates ineffectiveness of treatment during past hospitalizations. Hospital readmission rates were formally included in reimbursement decisions for the Centers for Medicare and Medicaid Services (CMS) as part of the Patient Protection and Affordable Care Act (ACA) of 2010, which penalizes health systems with higher than expected readmission rates through the Hospital Readmission Reduction Program. Since the inception of this penalty, there have been other programs that have been introduced, with the aim to decrease hospital readmission. The Community Based Care Transition Program, Independence At Home Demonstration Program, and Bundled Payments for Care Improvemen ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Mean
There are several kinds of mean in mathematics, especially in statistics. Each mean serves to summarize a given group of data, often to better understand the overall value ( magnitude and sign) of a given data set. For a data set, the '' arithmetic mean'', also known as "arithmetic average", is a measure of central tendency of a finite set of numbers: specifically, the sum of the values divided by the number of values. The arithmetic mean of a set of numbers ''x''1, ''x''2, ..., x''n'' is typically denoted using an overhead bar, \bar. If the data set were based on a series of observations obtained by sampling from a statistical population, the arithmetic mean is the '' sample mean'' (\bar) to distinguish it from the mean, or expected value, of the underlying distribution, the '' population mean'' (denoted \mu or \mu_x).Underhill, L.G.; Bradfield d. (1998) ''Introstat'', Juta and Company Ltd.p. 181/ref> Outside probability and statistics, a wide range of other notions of m ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Health Economics
Health economics is a branch of economics concerned with issues related to efficiency, effectiveness, value and behavior in the production and consumption of health and healthcare. Health economics is important in determining how to improve health outcomes and lifestyle patterns through interactions between individuals, healthcare providers and clinical settings. In broad terms, health economists study the functioning of healthcare systems and health-affecting behaviors such as smoking, diabetes, and obesity. One of the biggest difficulties regarding healthcare economics is that it does not follow normal rules for economics. Price and Quality are often hidden by the third-party payer system of insurance companies and employers. Additionally, QALY (Quality Adjusted Life Years), one of the most commonly used measurements for treatments, is very difficult to measure and relies upon assumptions that are often unreasonable. A seminal 1963 article by Kenneth Arrow is often ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
