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PubMed1990

Criteria and standards for evaluating intermediary and carrier performance--HCFA. General notice with comment period.

This notice describes the criteria and standards to be used for evaluating the performance of fiscal intermediaries and carriers in the administration of the Medicare program beginning June 1, 1990. The results of these evaluations are considered whenever HCFA enters into, renews, or terminates an intermediary or carrier agreement or takes other contract actions; assigns or reassigns providers of services to an intermediary; or designates regional or national intermediaries. This notice is published in accordance with sections 1816(f) and 1842(b)(2) of the Social Security Act, which requires us to publish for public comment in the Federal Register those criteria and standards against which we evaluate intermediaries and carriers.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1990

Subsidizing screening mammography through induced revenues and profits.

By segregating asymptomatic from symptomatic patients and realizing the significance of induced revenue and profits created by screening mammography, community hospitals and physicians can make this screening procedure affordable to women in their community. Induced revenue is the total gross revenue produced by subsequent exams due to equivocal results of the initial exam. Profits result from this induced revenue less insurance adjustments and costs incurred by the institution in performing subsequent exams.

Breast Neoplasms↗
PubMed1991

Specialty providers getting paid sooner.

A recent revision in Medicare payment policy is leading to more prompt payment for specialty providers, which are reimbursed differently than most acute-care hospitals under an incentive/penalty system. The providers often face a wait of 12 to 14 months for some money due, a practice they have complained about for years. The revisions are the result of a lawsuit against HHS.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1990

Financing health care.

This article reviews the causes of growth in health care costs and concludes that only changes in the rate of growth in intensity of care are likely to be effective. It proposes a model of consumer choice (with advice) among health plans, and competition among plans on the basis of the rate at which new technology is introduced, as a solution to the problem of picking the appropriate rate. It argues that the existence of the uninsured is evidence of government failure.

Community Participation↗
PubMed1991

Physician fee schedule update for calendar year 1992 and physician performance standard rates of increase for federal fiscal year 1992--HCFA. Notice.

This notice announces the calendar year 1992 update to the Medicare physician fee schedule and the Federal fiscal year 1992 performance standard rates of increase for expenditures and volume of physician services under the Medicare Supplementary Medical Insurance (Part B) program as required by sections 1848 (d) and (f) respectively of the Social Security Act. The fee schedule update for calendar year 1992 is 1.9 percent. The physician performance standard rates of increase for Federal fiscal year 1992 are 10.0 percent for all physician services, 6.5 percent for surgical services, and 11.2 percent for nonsurgical services.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1992

The transition to regional networks. Changes in reimbursement and approaches to care favor cooperative arrangements among providers.

As costs escalate and the delivery system becomes more fragmented, organizations throughout the United States have begun to call for basic reform of the healthcare system. Several national organizations, including the American Hospital Association and the Catholic Health Association, have presented working proposals advocating coordinated regional healthcare delivery systems. The proposed networks would provide a full continuum of services from prevention through aftercare and long-term care, and from primary through tertiary care. In the past few years, providers themselves have begun to see the value of cooperative efforts. Collaborative ventures such as group purchasing and sharing mobile equipment have increased as hospitals look for ways to reduce costs and control overhead. Mergers and affiliations are also becoming more common. As they develop, different networks will allow for various kinds of interrelationships among components. In general, these systems will provide high-volume, low-cost services at a number of sites and low-volume, high-cost services at a central location. Secondary and tertiary campuses will focus increasingly on specialty care, and as volume increases at primary campuses, secondary and tertiary organizations will establish more primary affiliations. To make the transition from a competitive to a cooperative healthcare delivery system, providers will have to reexamine their mission and values and, in many cases, refocus their vision of the future.

Comprehensive Health Care↗