The researchers construct a measure of prospective payment
use for 300 metropolitan statistical areas for the years 2008-12, using data from the Health Care Cost Institute on over five million claims from 1,300 hospitals.
Under the Home Health Prospective Payment
System, implemented in 2000, facilities received a 60-day prospective payment
based on patients' health characteristics, functional status, and service use, which reduced marginal payment.
The creators of the prospective payment
system hoped that it would eliminate unnecessary hospital care by penalizing hospitals for longer than average hospital stays.
This is the period from one year before to one year after the implementation of prospective payment
Congress directed HCFA to develop a complementary prospective payment
system for all outpatient care following the successful--from the Federal viewpoint--implementation of the DRG-based prospective payment
system for inpatient care, begun in 1984.
To help healthcare executives sort through the numerous changes found in the new CMS regulations a special audio webcast Reimbursement Briefing: 2011 Final Medicare Inpatient Prospective Payment
System Rule was presented on September 14, 2010.
MedPAC (2003a, b) examined changes before and after implementation of the prospective payment
systems for SNFs and home health care and found substantial declines in the use of home health care but increases in the use of skilled nursing and other postacute care providers, indicating that, for some diagnoses, skilled nursing may be partly replacing home health care.
Having attended a few of those seminars and read a number of articles, I find that most experts agree on certain activities that today's lab manager and supervisor should be performing to function effectively under prospective payment
Inpatient Psychiatric Facility Prospective Payment
System (IPF PPS)
The audit of 147 claims revealed that 50 claims had been paid by both Part A through the prospective payment
and by Part B as individually filed claims.
Although recent data suggest that the growth rate in nursing home expenditures has moderated (Cohen and Dubay 1990), important policy questions remain regarding the role of prospective payment
in containing costs and its impact on equally important considerations of access to nursing home care and quality of care.
This first column summarizes Competitive Prospective Payment
and Managed Competition, both of which have received attention in Washington, D.