The Assistant Secretary for Planning and Evaluation in collaboration with the Centers for Medicare and Medicaid Services contracted with RAND to conduct an environmental scan of hospital outpatient performance measurement for visits, services, and procedures paid under the Medicare Outpatient Prospective Payment System.
Effects of Medicare's Hospital Prospective Payment System (PPS) on Disabled Medicare Beneficiaries: Final Report
The purpose of this study was to determine how PPS has affected the patterns of care received by Medicare beneficiaries with chronic disabling conditions. The study used the 1982 and 1984 National Long-Term Care Surveys to provide an empirical analysis of differences in the utilization patterns of hospital, skilled nursing facility and home health
An analysis was made of the pre and post-patterns of Medicare Part A service use using the samples of the 1982 and 1984 National Long-Term Care Surveys linked to the Medicare Part A bill files and mortality reports. The analysis was conducted both for the total elderly Medicare beneficiary population and for the community resident disabled populat
This study examines the impact of changes in Medicare home health policy mandated by the Balanced Budget Act (BBA) of 1997 on satisfaction with care for disabled Medicare beneficiaries. The BBA mandated major changes in home health payment requiring the implementation of a Prospective Payment System (PPS) and an Interim Payment System (IPS) prior
ACA. 2011. Patient Protection and Affordable Care Act, Public Law 111-148 (March 23, 2010), as modified by the Health Care and Education Reconciliation Act of 2010, Public Law 111-152, Title 2, Subtitle A, Section 2201(a)(4)(B). Karakus, M., Frey, W., Goldman, H., Fields, S., Drake, R. 2011.Federal Financing of Supported Employment and Customize
PeaceHealth Medical Group is a non-profit treatment facility within Eugene, OR. Eugene is the third largest metro area in the state and the largest community served by PeaceHealth. They have operated the only psychiatric inpatient facility in the county for over a decade. Due to financial issues, they started a partnership with Lane County Behavio
This report presents findings from a study of the implementation of coordinated specialty care services provided to individuals who are experiencing the early stages of schizophrenia as part of the National Institute of Mental Health’s (NIMH’s) Recovery After an Initial Schizophrenia Episode (RAISE) initiative. This NIMH initiative is a test o
Understanding the High Prevalence of Low-Prevalence Chronic Disease Combinations: Databases and Methods for Research. 3M Health Information Systems Grouper Systems
All Patient Refined Diagnosis Related Group (APR-DRG) References: 1 3M Health Information Systems. All Patient Refined Diagnosis Related Groups (APR-DRGs) Methodology Overview (2003). http://www.hcup-us.ahrq.gov/db/nation/nis/APR-DRGsV20MethodologyOverview...
Understanding the High Prevalence of Low-Prevalence Chronic Disease Combinations: Databases and Methods for Research. Centers for Medicare & Medicaid Services Grouper Systems
Hierarchical Condition Categories (HCC) References:
Medicaid and Permanent Supportive Housing for Chronically Homeless Individuals: Emerging Practices From the Field. 4.2. Understanding Health Centers and Federally Qualified Health Centers Medicaid Reimbursement
Nationwide, over 1,100 federally funded Health Centers served over 21 million patients in 2012. 35 The majority of Health Center patients have incomes below the federal poverty level. Before 2014, more than one-third of Health Center patients were uninsured, and 40 percent of health center patients were Medicaid beneficiaries. Many patients wh
Medicaid and Permanent Supportive Housing for Chronically Homeless Individuals: Emerging Practices From the Field. Acronyms
The following acronyms are mentioned in this report.
A Primer on Using Medicaid for People Experiencing Chronic Homelessness and Tenants in Permanent Supportive Housing. 7.1. Medicaid Fee-For-Service Payment Mechanisms
Until recently, most people with disabilities who were enrolled in Medicaid, including people experiencing homelessness and those who became tenants of PSH, have received health care and behavioral health services reimbursed through fee-for-service arrangements.
A Primer on Using Medicaid for People Experiencing Chronic Homelessness and Tenants in Permanent Supportive Housing. Acronyms
The following acronyms are mentioned in this report.
The previous sections focus on the service categories that contributed the most to the slowdown in per beneficiary spending growth between 2000-2008 and 2009-2012. For further examination of these trends, we estimated the contributions of price and utilization to the slowdown within each service category. Definitions for each of the utilization me
Impact of Insurance Expansion on Hospital Uncompensated Care Costs in 2014. I. Introduction: Uncompensated Care Costs, Coverage Expansion, and Hospitals
This report summarizes research on the effect of the major health insurance coverage expansion under the Affordable Care Act (ACA) on the drivers of uncompensated care (UCC) and on hospital UCC costs.
Performance Improvement 2011-2012. What Have Been the Changes in Numbers of Skilled Nursing Facilities and Long Term Care Hospitals?
In the years immediately following the introduction of prospective payment systems (PPS) for skilled nursing facilities (SNFs), large numbers of hospital-based SNFs closed. During the same time period, long-term care hospitals (LTCHs) expanded rapidly, especially in certain areas of the country. Some of the increase in LTCH services was provided
This report, Performance Improvement 2011-2012, the 17th in this series, summarizes the key findings from studies completed during the two fiscal-year period ending September 30, 2011.
Studies by Agency Elements of evaluation: Effective programs achieve results. Results derive from good management which requires good decisions. Good decision-making depends on good information. Good information requires good data and careful analysis. Creative project officers, skillful researchers, thoughtful an
Acronyms and Glossary 1915(c) waivers refers to section 1915(c) of the Medicaid program allowing the Secretary of HHS to waive certain program requirements in the law. Waivers permit States greater flexibility to target program eligibility and provide home and community based services for the disabled and/or elderly population