Primer On Medicare Hospital Pricing

By  |  November 26, 2010 | 

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

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About the Author: Bradley Flansbaum

Bradley Flansbaum
Bradley Flansbaum, DO, MPH, MHM works for Geisinger Health System in Danville, PA in both the divisions of hospital medicine and population health. He began working as a hospitalist in 1996, at the inception of the hospital medicine movement. He is a founding member of the Society of Hospital Medicine and served as a board member and officer. He speaks nationally in promoting hospital medicine and has presented at many statewide meetings and conferences. He is also actively involved in house staff education. Currently, he serves on the SHM Public Policy Committee and has an interest in payment policy, healthcare market competition, health disparities, cost-effectiveness analysis, and pain and palliative care. He is SHM’s delegate for the AMA House of Delegates. Dr. Flansbaum received his undergraduate degree from Union College in Schenectady, NY and attended medical school at the New York College of Osteopathic Medicine. He completed his residency and chief residency in Internal Medicine at Long Island Jewish Medical Center in New York. He received his M.P.H. in Health Policy and Management at Columbia University. He is a political junky, and loves to cook, stay fit, read non-fiction, listen to many genres of music, and is a resident of Danville, PA.

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