Hospital reimbursement incentives: is there a more effective option?--Part II

As discussed in Part I of this article, hospital executives in Canada, Germany, and the United States manage their facilities' resources to maximize the incentives inherent in their respective reimbursement system and thereby increase their bottom line. It was also discussed that an additional supply of available hospitals, physicians, and other services will generate increased utilization. Part II discusses how the Patient Protection and Affordable Care Act of 2010 will eventually fail since it neither controls prices nor utilization (e.g., imaging, procedures, ambulatory surgery, discretionary spending). This article concludes with the discussion of the German multipayer approach with universal access and global budgets that might well be a model for U.S. healthcare in the future. Although the German healthcare system has a number of shortfalls, its paradigm could offer the most appropriate compromise when selecting the economic incentives to reduce the percentage of the U.S. gross domestic product expenditure for healthcare from 17.4% to roughly 12.0%.

Estimating the effects of the Balanced Budget act of 1997 on the home health care use of the dually eligible: a natural experiments approach

This research examines the use of home health agency services used by older adults after the implementation of changes to Medicare's payment scheme mandated by the Balanced Budget Act (BBA) of 1997. The objective of this study is to identify differential effects the BBA may have had on home health service use between dually eligible and Medicare-only beneficiaries. The results of this study suggest that although dually eligible and Medicare-only beneficiaries experienced a substantial decline in home health service use, the dually eligible had a relatively larger decline. Following the BBA, the dually eligible had more office-based physician visits but fewer inpatient hospital days, relative to the Medicare-only population. Finally, the author estimates cost savings to Medicare due to the BBA to be $1 billion in the 2 years following the legislation, whereas Medicaid programs shouldered a larger percentage of the home health service bill.

The Budget Control Act implications for Medicare

The Budget Control Act of 2011 created a 12-member bipartisan congressional committee to develop proposed legislation aimed at reducing the federal deficit. When the committee failed to produce a bill, automatic across-the-board cuts were triggered that include cuts to Medicare. The Medicare cuts would be covered by reduced reimbursements to hospitals. If Congress does not vote to override the automatic cuts, they will take effect on Jan. 2, 2013.

Using third-party financing to help today's patient pay for treatment and care

Patients walking into your practice today are different than the ones you saw a few years ago. Larger deductibles and out-of-pocket costs may cause many of them to put off recommended treatment. What can you do to ease patients' cost concerns and help them move forward with the care they want and need? Creating a comprehensive financial policy that includes a third-party patient financing program is a good place to start. Here's how to ensure that you select the best program for you.