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PubMed2006

Medicare program; Medicare secondary payer amendments. Interim final rule with comment period.

This interim final rule with comment period implements amendments to the Medicare Secondary Payer (MSP) provisions under Title III of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). The MMA amendments clarify the MSP provisions regarding the obligations of primary plans and primary payers, the nature of the insurance arrangements subject to the MSP rules, the circumstances under which Medicare may make conditional payments, and the obligations of primary payers to reimburse Medicare.

Humans↗
PubMed1979

HCFA's trapped.

Explore the source record for details and available documents.

Costs and Cost Analysis↗
PubMed2003

Drug reimbursement in Finland-a case of explicit prioritizing in special categories.

Increased drug expenses have created challenges for drug reimbursement systems in many industrialised countries, including Finland. Prioritization of drugs could be one solution to this problem. This paper examines stakeholders' perspectives on the prioritization decisions made in the Finnish drug reimbursement system, particularly concerning drugs in the higher reimbursement categories. The analysis was based on 18 interviews with key stakeholders. The results revealed that authorities directly influencing the decisions tried to keep them as technical and non-political as possible. However, doing so was not easy, and there appeared to be hidden non-technical rationales behind many decisions. Stakeholders outside public administration had few opportunities to openly participate in decision-making because of the lack of transparency of the process. Despite this, they tried to influence decisions concerning their interests by using several means, such as lobbying the media, Parliament or other stakeholders. Transparent decision-making and better methods of open discussion on competing interests could promote democracy in the prioritization of drugs and perhaps reduce the harmful effects of indirect and unequal participation by different stakeholders.

Decision Making, Organizational↗
PubMed2003

Hospital economics of the hospitalist.

OBJECTIVE: To determine the economic impact on the hospital of a hospitalist program and to develop insights into the relative economic importance of variables such as reductions in mean length of stay and cost, improvements in throughput (patients discharged per unit time), payer methods of reimbursement, and the cost of the hospitalist program. DATA SOURCES: The primary data source was Tufts-New England Medical Center in Boston. Patient demographics, utilization, cost, and revenue data were obtained from the hospital's cost accounting system and medical records. STUDY DESIGN: The hospitalist admitted and managed all patients during a six-week period on the general medical unit of Tufts-New England Medical Center. Reimbursement, cost, length of stay, and throughput outcomes during this period were contrasted with patients admitted to the unit in the same period in the prior year, in the preceding period, and in the following period. PRINCIPAL FINDINGS: The hospitalist group compared with the control group demonstrated: length of stay reduced to 2.19 days from 3.45 days (p<.001); total hospital costs per admission reduced to 1,775 dollars from 2,332 dollars (p<.001); costs per day increased to 811 dollars from 679 dollars (p<.001); no differences for readmission within 30 days of discharge to extended care facilities. The hospital's expected incremental profitability with the hospitalist was -1.44 dollars per admission excluding incremental throughput effects, and it was most sensitive to changes in the ratio of per diem to case rate reimbursement. Incremental throughput with the hospitalist was estimated at 266 patients annually with an associated incremental profitability of 1.3 million dollars. CONCLUSION: Hospital interventions designed to reduce length of stay, such as the hospitalist, should be evaluated in terms of cost, throughput, and reimbursement effects. Excluding throughput effects, the hospitalist program was not economically viable due to the influence of per diem reimbursement. Throughput improvements occasioned by the hospitalist program with high baseline occupancy levels are substantial and tend to favor a hospitalist program.

Bed Occupancy↗