A nice summary on Medicare’s valuation approach to compiling a “price” it pays to a hospital for a stay. If you recall, there are 746 DRG’s CMS tweaks to an infinitely granular level to arrive at a reimbursement total.
As Reinhardt relays, CMS pays for costs, as close as it can approximate, not value.
If you are a hospitalist and have even a hint of skin in the game, i.e., you take care of patients, play with data, or are one of those advanced types who sit behind a desk and tell the rest of us what to do, this one is worth your time.
Take a look!
Also note, as reform advances, DSH payments will be clipped, labor costs will be contested and defended (“the unions are killing us,” “you are missing hidden costs in our city,” and non EBM-based political meddling), and GME dollars will be ratcheted up or down based on residency program performance. The wealth pie is shrinking and institutions will surely fight for every nickel.
Algorithm for a Hospital Episode Price
Public and private payers incentivizing providers (P4P) to coax desired clinical behaviors have failed. Both CMS derived measures and those used by commercial insurers, many of which overlap, fail to pass Good Housekeeping standards and lack the reliable characteristics indicators must possess. Whether those indicators are valid, attributable, or meaningful makes all the difference in […]
You have read constant references about ACOs (accountable care organizations) in every journal you pick up until you are blue in the face, I’m sure. You or your hospital might even be participating in one. Mostly all straight Medicare patients (the two-thirds not in Managed Medicare) are eligible for inclusion. You need two things to […]
Like you, I am focused on care transitions these days. Inpatient providers have gotten closer to mastering the hospital side of things (disease-specific care), but we still have a long way to go on broad-based QI with items such as hand washing, nosocomial infections, and patient communication. Additionally, the patient’s passage back from the wards […]