Medicare: Federal program, created by Public Law 89-97, Title XVIII-Health Insurance for the Aged, a 1965 amendment to the Social Security Act, that provides health insurance benefits to persons over the age of 65 and others eligible for Social Security benefits. It consists of two separate but coordinated programs: hospital insurance (MEDICARE PART A) and supplementary medical insurance (MEDICARE PART B). (Hospital Administration Terminology, AHA, 2d ed and A Discursive Dictionary of Health Care, US House of Representatives, 1976)Centers for Medicare and Medicaid Services (U.S.): A component of the Department of Health and Human Services to oversee and direct the Medicare and Medicaid programs and related Federal medical care quality control staffs. Name was changed effective June 14, 2001.Medicare Part B: The voluntary portion of Medicare, known as the Supplementary Medical Insurance (SMI) Program, that includes physician's services, home health care, medical services, outpatient hospital services, and laboratory, pathology, and radiology services. All persons entitled to Medicare Part A may enroll in Medicare Part B on a monthly premium basis.Medicare Part A: The compulsory portion of Medicare that is known as the Hospital Insurance Program. All persons 65 years and older who are entitled to benefits under the Old Age, Survivors, Disability and Health Insurance Program or railroad retirement, persons under the age of 65 who have been eligible for disability for more than two years, and insured workers (and their dependents) requiring renal dialysis or kidney transplantation are automatically enrolled in Medicare Part A.United StatesFee-for-Service Plans: Method of charging whereby a physician or other practitioner bills for each encounter or service rendered. In addition to physicians, other health care professionals are reimbursed via this mechanism. Fee-for-service plans contrast with salary, per capita, and prepayment systems, where the payment does not change with the number of services actually used or if none are used. (From Discursive Dictionary of Health Care, 1976)Insurance, Pharmaceutical Services: Insurance providing for payment of services rendered by the pharmacist. Services include the preparation and distribution of medical products.Reimbursement Mechanisms: Processes or methods of reimbursement for services rendered or equipment.Insurance Benefits: Payments or services provided under stated circumstances under the terms of an insurance policy. In prepayment programs, benefits are the services the programs will provide at defined locations and to the extent needed.Prospective Payment System: A system wherein reimbursement rates are set, for a given period of time, prior to the circumstances giving rise to actual reimbursement claims.Insurance Claim Review: Review of claims by insurance companies to determine liability and amount of payment for various services. The review may also include determination of eligibility of the claimant or beneficiary or of the provider of the benefit; determination that the benefit is covered or not payable under another policy; or determination that the service was necessary and of reasonable cost and quality.Health Expenditures: The amounts spent by individuals, groups, nations, or private or public organizations for total health care and/or its various components. These amounts may or may not be equivalent to the actual costs (HEALTH CARE COSTS) and may or may not be shared among the patient, insurers, and/or employers.Medicare Payment Advisory Commission: The Commission was created by the Balanced Budget Act of 1997 under Title XVIII. It is specifically charged to review the effect of Medicare+Choice under Medicare Part C and to review payment policies under Parts A and B. It is also generally charged to evaluate the effect of prospective payment policies and their impact on health care delivery in the US. The former Prospective Payment Assessment Commission (ProPAC) and the Physician Payment Review Commission (PPRC) were merged to form MEDPAC.Insurance, Medigap: A supplemental health insurance policy sold by private insurance companies and designed to pay for health care costs and services that are not paid for either by Medicare alone or by a combination of Medicare and existing private health insurance benefits. (From Facts on File Dictionary of Health Care Management, 1988)Insurance Coverage: Generally refers to the amount of protection available and the kind of loss which would be paid for under an insurance contract with an insurer. (Slee & Slee, Health Care Terms, 2d ed)Medicaid: Federal program, created by Public Law 89-97, Title XIX, a 1965 amendment to the Social Security Act, administered by the states, that provides health care benefits to indigent and medically indigent persons.Fee Schedules: A listing of established professional service charges, for specified dental and medical procedures.Rate Setting and Review: A method of examining and setting levels of payments.Eligibility Determination: Criteria to determine eligibility of patients for medical care programs and services.Economics, Hospital: Economic aspects related to the management and operation of a hospital.Cost Sharing: Provisions of an insurance policy that require the insured to pay some portion of covered expenses. Several forms of sharing are in use, e.g., deductibles, coinsurance, and copayments. Cost sharing does not refer to or include amounts paid in premiums for the coverage. (From Dictionary of Health Services Management, 2d ed)Skilled Nursing Facilities: Extended care facilities which provide skilled nursing care or rehabilitation services for inpatients on a daily basis.Fraud: Exploitation through misrepresentation of the facts or concealment of the purposes of the exploiter.Patient Protection and Affordable Care Act: An Act prohibiting a health plan from establishing lifetime limits or annual limits on the dollar value of benefits for any participant or beneficiary after January 1, 2014. It permits a restricted annual limit for plan years beginning prior to January 1, 2014. It provides that a health plan shall not be prevented from placing annual or lifetime per-beneficiary limits on covered benefits. The Act sets up a competitive health insurance market.Competitive Bidding: Pricing statements presented by more than one party for the purpose of securing a contract.Insurance Selection Bias: Adverse or favorable selection bias exhibited by insurers or enrollees resulting in disproportionate enrollment of certain groups of people.Insurance Claim Reporting: The design, completion, and filing of forms with the insurer.Capitation Fee: A method of payment for health services in which an individual or institutional provider is paid a fixed, per capita amount without regard to the actual number or nature of services provided to each patient.Cost Savings: Reductions in all or any portion of the costs of providing goods or services. Savings may be incurred by the provider or the consumer.Diagnosis-Related Groups: A system for classifying patient care by relating common characteristics such as diagnosis, treatment, and age to an expected consumption of hospital resources and length of stay. Its purpose is to provide a framework for specifying case mix and to reduce hospital costs and reimbursements and it forms the cornerstone of the prospective payment system.Reimbursement, Incentive: A scheme which provides reimbursement for the health services rendered, generally by an institution, and which provides added financial rewards if certain conditions are met. Such a scheme is intended to promote and reward increased efficiency and cost containment, with better care, or at least without adverse effect on the quality of the care rendered.Managed Care Programs: Health insurance plans intended to reduce unnecessary health care costs through a variety of mechanisms, including: economic incentives for physicians and patients to select less costly forms of care; programs for reviewing the medical necessity of specific services; increased beneficiary cost sharing; controls on inpatient admissions and lengths of stay; the establishment of cost-sharing incentives for outpatient surgery; selective contracting with health care providers; and the intensive management of high-cost health care cases. The programs may be provided in a variety of settings, such as HEALTH MAINTENANCE ORGANIZATIONS and PREFERRED PROVIDER ORGANIZATIONS.Health Care Reform: Innovation and improvement of the health care system by reappraisal, amendment of services, and removal of faults and abuses in providing and distributing health services to patients. It includes a re-alignment of health services and health insurance to maximum demographic elements (the unemployed, indigent, uninsured, elderly, inner cities, rural areas) with reference to coverage, hospitalization, pricing and cost containment, insurers' and employers' costs, pre-existing medical conditions, prescribed drugs, equipment, and services.Health Services Research: The integration of epidemiologic, sociological, economic, and other analytic sciences in the study of health services. Health services research is usually concerned with relationships between need, demand, supply, use, and outcome of health services. The aim of the research is evaluation, particularly in terms of structure, process, output, and outcome. (From Last, Dictionary of Epidemiology, 2d ed)Health Care Costs: The actual costs of providing services related to the delivery of health care, including the costs of procedures, therapies, and medications. It is differentiated from HEALTH EXPENDITURES, which refers to the amount of money paid for the services, and from fees, which refers to the amount charged, regardless of cost.Risk Sharing, Financial: Any system which allows payors to share some of the financial risk associated with a particular patient population with providers. Providers agree to adhere to fixed fee schedules in exchange for an increase in their payor base and a chance to benefit from cost containment measures. Common risk-sharing methods are prospective payment schedules (PROSPECTIVE PAYMENT SYSTEM), capitation (CAPITATION FEES), diagnosis-related fees (DIAGNOSIS-RELATED GROUPS), and pre-negotiated fees.Financing, Personal: Payment by individuals or their family for health care services which are not covered by a third-party payer, either insurance or medical assistance.Cost Allocation: The assignment, to each of several particular cost-centers, of an equitable proportion of the costs of activities that serve all of them. Cost-center usually refers to institutional departments or services.Cost Control: The containment, regulation, or restraint of costs. Costs are said to be contained when the value of resources committed to an activity is not considered excessive. This determination is frequently subjective and dependent upon the specific geographic area of the activity being measured. (From Dictionary of Health Services Management, 2d ed)Economic Competition: The effort of two or more parties to secure the business of a third party by offering, usually under fair or equitable rules of business practice, the most favorable terms.Relative Value Scales: Coded listings of physician or other professional services using units that indicate the relative value of the various services they perform. They take into account time, skill, and overhead cost required for each service, but generally do not consider the relative cost-effectiveness. Appropriate conversion factors can be used to translate the abstract units of the relative value scales into dollar fees for each service based on work expended, practice costs, and training costs.Prescription Fees: The charge levied on the consumer for drugs or therapy prescribed under written order of a physician or other health professional.Risk Adjustment: The use of severity-of-illness measures, such as age, to estimate the risk (measurable or predictable chance of loss, injury or death) to which a patient is subject before receiving some health care intervention. This adjustment allows comparison of performance and quality across organizations, practitioners, and communities. (from JCAHO, Lexikon, 1994)Drug Costs: The amount that a health care institution or organization pays for its drugs. It is one component of the final price that is charged to the consumer (FEES, PHARMACEUTICAL or PRESCRIPTION FEES).Budgets: Detailed financial plans for carrying out specific activities for a certain period of time. They include proposed income and expenditures.Surgicenters: Facilities designed to serve patients who require surgical treatment exceeding the capabilities of usual physician's office yet not of such proportion as to require hospitalization.Quality of Health Care: The levels of excellence which characterize the health service or health care provided based on accepted standards of quality.Hospice Care: Specialized health care, supportive in nature, provided to a dying person. A holistic approach is often taken, providing patients and their families with legal, financial, emotional, or spiritual counseling in addition to meeting patients' immediate physical needs. Care may be provided in the home, in the hospital, in specialized facilities (HOSPICES), or in specially designated areas of long-term care facilities. The concept also includes bereavement care for the family. (From Dictionary of Health Services Management, 2d ed)Fees, Medical: Amounts charged to the patient as payer for medical services.Contract Services: Outside services provided to an institution under a formal financial agreement.Marketing of Health Services: Application of marketing principles and techniques to maximize the use of health care resources.Hospitals: Institutions with an organized medical staff which provide medical care to patients.Current Procedural Terminology: Descriptive terms and identifying codes for reporting medical services and procedures performed by PHYSICIANS. It is produced by the AMERICAN MEDICAL ASSOCIATION and used in insurance claim reporting for MEDICARE; MEDICAID; and private health insurance programs (From CPT 2002).SEER Program: A cancer registry mandated under the National Cancer Act of 1971 to operate and maintain a population-based cancer reporting system, reporting periodically estimates of cancer incidence and mortality in the United States. The Surveillance, Epidemiology, and End Results (SEER) Program is a continuing project of the National Cancer Institute of the National Institutes of Health. Among its goals, in addition to assembling and reporting cancer statistics, are the monitoring of annual cancer incident trends and the promoting of studies designed to identify factors amenable to cancer control interventions. (From National Cancer Institute, NIH Publication No. 91-3074, October 1990)Fees and Charges: Amounts charged to the patient as payer for health care services.Physician Self-Referral: Referral by physicians to testing or treatment facilities in which they have financial interest. The practice is regulated by the Ethics in Patient Referrals Act of 1989.Models, Econometric: The application of mathematical formulas and statistical techniques to the testing and quantifying of economic theories and the solution of economic problems.Health Services Accessibility: The degree to which individuals are inhibited or facilitated in their ability to gain entry to and to receive care and services from the health care system. Factors influencing this ability include geographic, architectural, transportational, and financial considerations, among others.Nursing Homes: Facilities which provide nursing supervision and limited medical care to persons who do not require hospitalization.Health Care Surveys: Statistical measures of utilization and other aspects of the provision of health care services including hospitalization and ambulatory care.Hospitalization: The confinement of a patient in a hospital.Costs and Cost Analysis: Absolute, comparative, or differential costs pertaining to services, institutions, resources, etc., or the analysis and study of these costs.Drug Prescriptions: Directions written for the obtaining and use of DRUGS.Hospital Costs: The expenses incurred by a hospital in providing care. The hospital costs attributed to a particular patient care episode include the direct costs plus an appropriate proportion of the overhead for administration, personnel, building maintenance, equipment, etc. Hospital costs are one of the factors which determine HOSPITAL CHARGES (the price the hospital sets for its services).Legislation, Drug: Laws concerned with manufacturing, dispensing, and marketing of drugs.Fees, Pharmaceutical: Amounts charged to the patient or third-party payer for medication. It includes the pharmacist's professional fee and cost of ingredients, containers, etc.Retrospective Studies: Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons.Financial Management, Hospital: The obtaining and management of funds for hospital needs and responsibility for fiscal affairs.Patient Readmission: Subsequent admissions of a patient to a hospital or other health care institution for treatment.Models, Economic: Statistical models of the production, distribution, and consumption of goods and services, as well as of financial considerations. For the application of statistics to the testing and quantifying of economic theories MODELS, ECONOMETRIC is available.Inflation, Economic: An increase in the volume of money and credit relative to available goods resulting in a substantial and continuing rise in the general price level.Prescription Drugs: Drugs that cannot be sold legally without a prescription.Privatization: Process of shifting publicly controlled services and/or facilities to the private sector.Health Care Sector: Economic sector concerned with the provision, distribution, and consumption of health care services and related products.Home Care Services: Community health and NURSING SERVICES providing coordinated multiple services to the patient at the patient's homes. These home-care services are provided by a visiting nurse, home health agencies, HOSPITALS, or organized community groups using professional staff for care delivery. It differs from HOME NURSING which is provided by non-professionals.Subacute Care: Medical and skilled nursing services provided to patients who are not in an acute phase of an illness but who require a level of care higher than that provided in a long-term care setting. (JCAHO, Lexikon, 1994)Hospices: Facilities or services which are especially devoted to providing palliative and supportive care to the patient with a terminal illness and to the patient's family.Insurance, Health: Insurance providing coverage of medical, surgical, or hospital care in general or for which there is no specific heading.United States Dept. of Health and Human Services: A cabinet department in the Executive Branch of the United States Government concerned with administering those agencies and offices having programs pertaining to health and human services.Health Benefit Plans, Employee: Health insurance plans for employees, and generally including their dependents, usually on a cost-sharing basis with the employer paying a percentage of the premium.Accountable Care Organizations: Organizations of health care providers that agree to be accountable for the quality, cost, and overall care of Medicare beneficiaries who are enrolled in the traditional fee-for-service program who are assigned to it. Assigned means those beneficiaries for whom the professionals in the organization provide the bulk of primary care services. ( CareOrganization.pdf accessed 03/16/2011)Deductibles and Coinsurance: Cost-sharing mechanisms that provide for payment by the insured of some portion of covered expenses. Deductibles are the amounts paid by the insured under a health insurance contract before benefits become payable; coinsurance is the provision under which the insured pays part of the medical bill, usually according to a fixed percentage, when benefits become payable.United States Department of Veterans Affairs: A cabinet department in the Executive Branch of the United States Government concerned with overall planning, promoting, and administering programs pertaining to VETERANS. It was established March 15, 1989 as a Cabinet-level position.Ownership: The legal relation between an entity (individual, group, corporation, or-profit, secular, government) and an object. The object may be corporeal, such as equipment, or completely a creature of law, such as a patent; it may be movable, such as an animal, or immovable, such as a building.Formularies as Topic: Works about lists of drugs or collections of recipes, formulas, and prescriptions for the compounding of medicinal preparations. Formularies differ from PHARMACOPOEIAS in that they are less complete, lacking full descriptions of the drugs, their formulations, analytic composition, chemical properties, etc. In hospitals, formularies list all drugs commonly stocked in the hospital pharmacy.Health Services for the Aged: Services for the diagnosis and treatment of diseases in the aged and the maintenance of health in the elderly.Long-Term Care: Care over an extended period, usually for a chronic condition or disability, requiring periodic, intermittent, or continuous care.Quality Indicators, Health Care: Norms, criteria, standards, and other direct qualitative and quantitative measures used in determining the quality of health care.Rehabilitation Nursing: A nursing specialty involved in the diagnosis and treatment of human responses of individuals and groups to actual or potential health problems with the characteristics of altered functional ability and altered life-style.Hospitals, Rural: Hospitals located in a rural area.Outcome Assessment (Health Care): Research aimed at assessing the quality and effectiveness of health care as measured by the attainment of a specified end result or outcome. Measures include parameters such as improved health, lowered morbidity or mortality, and improvement of abnormal states (such as elevated blood pressure).Logistic Models: Statistical models which describe the relationship between a qualitative dependent variable (that is, one which can take only certain discrete values, such as the presence or absence of a disease) and an independent variable. A common application is in epidemiology for estimating an individual's risk (probability of a disease) as a function of a given risk factor.Episode of Care: An interval of care by a health care facility or provider for a specific medical problem or condition. It may be continuous or it may consist of a series of intervals marked by one or more brief separations from care, and can also identify the sequence of care (e.g., emergency, inpatient, outpatient), thus serving as one measure of health care provided.Outliers, DRG: In health care reimbursement, especially in the prospective payment system, those patients who require an unusually long hospital stay or whose stay generates unusually high costs.Utilization Review: An organized procedure carried out through committees to review admissions, duration of stay, professional services furnished, and to evaluate the medical necessity of those services and promote their most efficient use.Health Policy: Decisions, usually developed by government policymakers, for determining present and future objectives pertaining to the health care system.Cohort Studies: Studies in which subsets of a defined population are identified. These groups may or may not be exposed to factors hypothesized to influence the probability of the occurrence of a particular disease or other outcome. Cohorts are defined populations which, as a whole, are followed in an attempt to determine distinguishing subgroup characteristics.Quality Assurance, Health Care: Activities and programs intended to assure or improve the quality of care in either a defined medical setting or a program. The concept includes the assessment or evaluation of the quality of care; identification of problems or shortcomings in the delivery of care; designing activities to overcome these deficiencies; and follow-up monitoring to ensure effectiveness of corrective steps.Politics: Activities concerned with governmental policies, functions, etc.Ambulatory Care: Health care services provided to patients on an ambulatory basis, rather than by admission to a hospital or other health care facility. The services may be a part of a hospital, augmenting its inpatient services, or may be provided at a free-standing facility.Physician's Practice Patterns: Patterns of practice related to diagnosis and treatment as especially influenced by cost of the service requested and provided.Technology, High-Cost: Advanced technology that is costly, requires highly skilled personnel, and is unique in its particular application. Includes innovative, specialized medical/surgical procedures as well as advanced diagnostic and therapeutic equipment.Inpatients: Persons admitted to health facilities which provide board and room, for the purpose of observation, care, diagnosis or treatment.Patient Discharge: The administrative process of discharging the patient, alive or dead, from hospitals or other health facilities.Data Collection: Systematic gathering of data for a particular purpose from various sources, including questionnaires, interviews, observation, existing records, and electronic devices. The process is usually preliminary to statistical analysis of the data.Managed Competition: A strategy for purchasing health care in a manner which will obtain maximum value for the price for the purchasers of the health care and the recipients. The concept was developed primarily by Alain Enthoven of Stanford University and promulgated by the Jackson Hole Group. The strategy depends on sponsors for groups of the population to be insured. The sponsor, in some cases a health alliance, acts as an intermediary between the group and competing provider groups (accountable health plans). The competition is price-based among annual premiums for a defined, standardized benefit package. (From Slee and Slee, Health Care Reform Terms, 1993)Health Services: Services for the diagnosis and treatment of disease and the maintenance of health.Home Care Agencies: Public or private organizations that provide, either directly or through arrangements with other organizations, home health services in the patient's home. (Hospital Administration Terminology, 2d ed)Social Security: Government sponsored social insurance programs.Drugs, Generic: Drugs whose drug name is not protected by a trademark. They may be manufactured by several companies.Healthcare Disparities: Differences in access to or availability of medical facilities and services.Manipulation, Chiropractic: Procedures used by chiropractors to treat neuromusculoskeletal complaints.Age Factors: Age as a constituent element or influence contributing to the production of a result. It may be applicable to the cause or the effect of a circumstance. It is used with human or animal concepts but should be differentiated from AGING, a physiological process, and TIME FACTORS which refers only to the passage of time.Accounts Payable and Receivable: Short-term debt obligations and assets occurring in the regular course of operational transactions.Medication Therapy Management: Assistance in managing and monitoring drug therapy for patients receiving treatment for cancer or chronic conditions such as asthma and diabetes, consulting with patients and their families on the proper use of medication; conducting wellness and disease prevention programs to improve public health; overseeing medication use in a variety of settings.Professional Review Organizations: Organizations representing designated geographic areas which have contracts under the PRO program to review the medical necessity, appropriateness, quality, and cost-effectiveness of care received by Medicare beneficiaries. Peer Review Improvement Act, PL 97-248, 1982.Value-Based Purchasing: Purchasers are provided information on the quality of health care, including patient outcomes and health status, with data on the dollar outlays going towards health. The focus is on managing the use of the health care system to reduce inappropriate care and to identify and reward the best-performing providers. (from accessed 11/25/2011)Drug Utilization: The utilization of drugs as reported in individual hospital studies, FDA studies, marketing, or consumption, etc. This includes drug stockpiling, and patient drug profiles.Length of Stay: The period of confinement of a patient to a hospital or other health facility.Comorbidity: The presence of co-existing or additional diseases with reference to an initial diagnosis or with reference to the index condition that is the subject of study. Comorbidity may affect the ability of affected individuals to function and also their survival; it may be used as a prognostic indicator for length of hospital stay, cost factors, and outcome or survival.Consumer Satisfaction: Customer satisfaction or dissatisfaction with a benefit or service received.Policy Making: The decision process by which individuals, groups or institutions establish policies pertaining to plans, programs or procedures.Income: Revenues or receipts accruing from business enterprise, labor, or invested capital.Economics, Medical: Economic aspects of the field of medicine, the medical profession, and health care. It includes the economic and financial impact of disease in general on the patient, the physician, society, or government.Personal Health Services: Health care provided to individuals.Hospitals, Proprietary: Hospitals owned and operated by a corporation or an individual that operate on a for-profit basis, also referred to as investor-owned hospitals.Blue Cross Blue Shield Insurance Plans: Prepaid health and hospital insurance plan.Cost-Benefit Analysis: A method of comparing the cost of a program with its expected benefits in dollars (or other currency). The benefit-to-cost ratio is a measure of total return expected per unit of money spent. This analysis generally excludes consideration of factors that are not measured ultimately in economic terms. Cost effectiveness compares alternative ways to achieve a specific set of results.European Continental Ancestry Group: Individuals whose ancestral origins are in the continent of Europe.Private Sector: That distinct portion of the institutional, industrial, or economic structure of a country that is controlled or owned by non-governmental, private interests.Financing, Government: Federal, state, or local government organized methods of financial assistance.FloridaHospitals, Veterans: Hospitals providing medical care to veterans of wars.Tax Equity and Fiscal Responsibility Act: PL97-248. Title II of the Act specifies "provisions relating to savings in health and income security programs." This includes changes in payment for services, benefits and premiums of Medicare as well as changes in provisions under Medicaid and other specific programs covered by Social Security. Title II includes various revenue measures.

Practice patterns, case mix, Medicare payment policy, and dialysis facility costs. (1/2846)

OBJECTIVE: To evaluate the effects of case mix, practice patterns, features of the payment system, and facility characteristics on the cost of dialysis. DATA SOURCES/STUDY SETTING: The nationally representative sample of dialysis units in the 1991 U.S. Renal Data System's Case Mix Adequacy (CMA) Study. The CMA data were merged with data from Medicare Cost Reports, HCFA facility surveys, and HCFA's end-stage renal disease patient registry. STUDY DESIGN: We estimated a statistical cost function to examine the determinants of costs at the dialysis unit level. PRINCIPAL FINDINGS: The relationship between case mix and costs was generally weak. However, dialysis practices (type of dialysis membrane, membrane reuse policy, and treatment duration) did have a significant effect on costs. Further, facilities whose payment was constrained by HCFA's ceiling on the adjustment for area wage rates incurred higher costs than unconstrained facilities. The costs of hospital-based units were considerably higher than those of freestanding units. Among chain units, only members of one of the largest national chains exhibited significant cost savings relative to independent facilities. CONCLUSIONS: Little evidence showed that adjusting dialysis payment to account for differences in case mix across facilities would be necessary to ensure access to care for high-cost patients or to reimburse facilities equitably for their costs. However, current efforts to increase dose of dialysis may require higher payments. Longer treatments appear to be the most economical method of increasing the dose of dialysis. Switching to more expensive types of dialysis membranes was a more costly means of increasing dose and hence must be justified by benefits beyond those of higher dose. Reusing membranes saved money, but the savings were insufficient to offset the costs associated with using more expensive membranes. Most, but not all, of the higher costs observed in hospital-based units appear to reflect overhead cost allocation rather than a difference in real resources devoted to treatment. The economies experienced by the largest chains may provide an explanation for their recent growth in market share. The heterogeneity of results by chain size implies that characterizing units using a simple chain status indicator variable is inadequate. Cost differences by facility type and the effects of the ongoing growth of large chains are worthy of continued monitoring to inform both payment policy and antitrust enforcement.  (+info)

Organizational and environmental factors associated with nursing home participation in managed care. (2/2846)

OBJECTIVE: To develop and test a model, based on resource dependence theory, that identifies the organizational and environmental characteristics associated with nursing home participation in managed care. DATA SOURCES AND STUDY SETTING: Data for statistical analysis derived from a survey of Directors of Nursing in a sample of nursing homes in eight states (n = 308). These data were merged with data from the On-line Survey Certification and Reporting System, the Medicare Managed Care State/County Data File, and the 1995 Area Resource File. STUDY DESIGN: Since the dependent variable is dichotomous, the logistic procedure was used to fit the regression. The analysis was weighted using SUDAAN. FINDINGS: Participation in a provider network, higher proportions of resident care covered by Medicare, providing IV therapy, greater availability of RNs and physical therapists, and Medicare HMO market penetration are associated with a greater likelihood of having a managed care contract. CONCLUSION: As more Medicare recipients enroll in HMOs, nursing home involvement in managed care is likely to increase. Interorganizational linkages enhance the likelihood of managed care participation. Nursing homes interested in managed care should consider upgrading staffing and providing at least some subacute services.  (+info)

Use of out-of-plan services by Medicare members of HIP. (3/2846)

Use of out-of-plan services in 1972 by Medicare members of the Health Insurance Plan of Greater New York (HIP) is examined in terms of the demographic and enrollment characteristics of out-of-plan users, types of services received outside the plan, and the relationship of out-of-plan to in-plan use. Users of services outside the plan tended to be more seriously ill and more frequently hospitalized than those receiving all of their services within the plan. The costs to the SSA of providing medical care to HIP enrollees are compared with analogous costs for non-HIP beneficiaries, and the implications for the organization and financing of health services for the aged are discussed.  (+info)

The changing elderly population and future health care needs. (4/2846)

The impending growth of the elderly population requires both fiscal and substantive changes in Medicare and Medicaid that are responsive to cost issues and to changing patterns of need. More emphasis is required on chronic disease management, on meaningful integration between acute and long-term care services, and on improved coordination between Medicare and Medicaid initiatives. This paper reviews various trends, including the growth in managed-care approaches, experience with social health maintenance organizations and Program of All-Inclusive Care for the Elderly demonstrations, and the need for a coherent long-term care policy. Such policies, however, transcend health care and require a broad range of community initiatives.  (+info)

Hospitals and managed care: catching up with the networks. (5/2846)

Although the growth of managed care is having a significant impact on hospitals, organizational response to managed care remains fragmented. We conducted a survey of 83 hospitals nationwide that indicated that most hospitals now have at least one person devoted to managed care initiatives. These individuals, however, often spend most of their time on current issues, such as contracting with managed care organizations and physician relations. Concerns for the future, such as network development and marketing, although important, receive less immediate attention form these individuals. Hospital managed care executives must take a more proactive role in long range managed care planning by collaborating with managed care organizations and pharmaceutical companies.  (+info)

Differences in physician compensation for cardiovascular services by age, sex, and race. (6/2846)

The purpose was to determine whether physicians receive substantially less compensation from patient groups (women, older patients, and nonwhite patients) that are reported to have low rates of utilization of cardiovascular services. Over an 18-month period we collected information on payments to physicians by 3,194 consecutive patients who underwent stress testing an 833 consecutive patients who underwent percutaneous coronary angioplasty at the Yale University Cardiology Practice. Although the charges for procedures were not related to patient characteristics, there were large and significant differences in payment to physicians based on age, sex, and race. For example, physicians who performed percutaneous transluminal coronary angioplasty received at least $2,500 from, or on behalf of, 72% of the patients 40 to 64 years old, 22% of the patients 65 to 74 years old, and 3% of the patients 75 years and older (P < 0.001); from 49% of the men and 28% of the women (P < 0.001); and 42% of the whites and 31% of the nonwhites (P < 0.001). Similar differences were observed for stress testing. These associations were largely explained by differences in insurance status.  (+info)

Use of ineffective or unsafe medications among members of a Medicare HMO compared to individuals in a Medicare fee-for-service program. (7/2846)

Adverse drug reactions and inappropriate prescribing practices are an important cause of hospitalization, morbidity, and mortality in the elderly. This study compares prescribing practices within a Medicare risk contract health maintenance organization (HMO) in 1993 and 1994 with prescribing practices for two nationally representative samples of elderly individuals predominantly receiving medical care within the Medicare fee-for-service sector. Information on prescriptions in the fee-for-service sector came from the 1987 National Medical Expenditures Survey (NMES) and the 1992 Medicare Current Beneficiary Survey (MCBS). A total of 20 drugs were studied; these drugs were deemed inappropriate for the elderly because their risk of causing adverse events exceeded their health benefits, according to a consensus panel of experts in geriatrics and pharmacology. One or more of the 20 potentially inappropriate drugs was prescribed to 11.53% of the Medicare HMO members in 1994. These medications were prescribed significantly less often to HMO members in 1994 than to individuals in the fee-for-service sector, based on information from both the 1987 NMES and the 1992 MCBS. Utilization of unsafe or ineffective medications actually decreased with increasing age in the HMO sample, with lowest rates in individuals over the age of 85. However, no relationship between age and medication use was seen in the NMES study, except for individuals over the age of 90 years. The study data support the conclusion that ineffective or unsafe medications were prescribed less often in the Medicare HMO than in national comparison groups. In fact, for the very old, who are most at risk, the use of these medications was much lower in the Medicare HMO than in the Medicare fee-for-service sector. Nevertheless, in 1994, approximately one of every nine members of this Medicare HMO received at least one such medication. Continued efforts and innovative strategies to further reduce the use of unsafe and ineffective drugs among elderly Medicare HMO members are needed.  (+info)

Medicare HMOs: who joins and who leaves? (8/2846)

Medicare risk health maintenance organizations (HMOs) are an increasingly common alternative to fee-for-service Medicare. To date, there has been no examination of whether the HMO program is preferentially used by blacks or by persons living in lower-income areas or whether race and income are associated with reversing Medicare HMO selection. This question is important because evidence suggests that these beneficiaries receive poorer care under the fee-for-service-system than do whites and persons from wealthier areas. Medicare enrollment data from South Florida were examined for 1990 to 1993. Four overlapping groups of enrollees were examined: all age-eligible (age 65 and over) beneficiaries in 1990; all age-eligible beneficiaries in 1993; all age-eligible beneficiaries residing in South Florida during the period 1990 to 1993; and all beneficiaries who became age-eligible for Medicare benefits between 1990 and 1993. The associations between race or income and choice of Medicare option were examined by logistic regression. The association between the demographic characteristics and time staying with a particular option was examined with Kaplan-Meier methods and Cox Proportional Hazards modeling. Enrollment in Medicare risk HMOs steadily increased over the 4-year study period. In the overall Medicare population, the following statistically significant patterns of enrollment in Medicare HMOs were seen: enrollment of blacks was two times higher than that of non-blacks; enrollment decreased with age; and enrollment decreased as income level increased. For the newly eligible population, initial selection of Medicare option was strongly linked to income; race effects were weak but statistically significant. The data for disenrollment from an HMO revealed a similar demographic pattern. At 6 months, higher percentages of blacks, older beneficiaries (older than 85), and individuals from the lowest income area (less than $15,000 per year) had disenrolled. A small percentage of beneficiaries moved between HMOs and FFS plans multiple times. These data on Medicare HMO populations in South Florida, an area with a high concentration of elderly individuals and with one of the highest HMO enrollment rates in the country, indicate that enrollment into and disenrollment from Medicare risk HMOs are associated with certain demographic characteristics, specifically, black race or residence in a low-income area.  (+info)

  • One alternative to traditional Medicare is to enroll into a Medicare Part C plan, often called a "Medicare Advantage" plan. (
  • Clinical trials are the gold standard for evaluating treatment interventions, but the patients they enroll tend to be younger and healthier than the average Medicare patient," Jalbert said. (
  • 4. Undermine Medicare 's popular support by requiring higher income seniors to pay higher premiums (means testing). (
  • Seniors need to decide between the many options offered by government-run Medicare and other private health insurance programs," says Louis Hogrefe, MD , a family medicine physician with Scripps Coastal Medical Center. (
  • Seniors who are already enrolled in Medicare should track changes in their plans, specifically whether the cost of the plan has changed, or whether prescription drugs have been added or subtracted from the formulary of the current health plan," suggests Dr. Hogrefe. (
  • While Democrats hail the sweeping legislation as the greatest expansion of the social safety net since Medicare, they also fear that seniors won't see it that way for this fall's elections. (
  • Change will come slowly to Medicare, which covers 46 million seniors and disabled people. (
  • The law strengthens traditional Medicare, which covers about three-fourths of seniors, by improving preventive care and increasing payments to frontline primary care doctors and nurses serving as medical coordinators. (
  • Her one major caveat: Many seniors in private insurance plans under Medicare Advantage will face higher premiums and reduced benefits as subsidies are scaled back over three to six years to bring the private plans' costs in line with those of traditional Medicare. (
  • Physicians in traditional Medicare would be subject to onerous new documentation requirements for payment and financial incentives to avoid complex patients under the proposed "Merit-based Incentive Payment System. (
  • The additional paperwork burden will push physicians to stop seeing patients with traditional Medicare , retire, avoid older and sicker patients, or go to work for large organizations using "alternative payment models" (which are exempt from the requirement and more likely to have contracts with private Medicare plans). (
  • 3. Raise Medicare 's costs by driving more patients into private Medicare Advantage plans. (
  • Mandatory deductibles and reduced access to physicians in traditional Medicare will drive more patients into private Medicare Advantage plans, which are more costly than the cost of caring for patients in the traditional fee-for-service program. (
  • 6. The GOP sees this bill as a step towards their longer-term goal of turning Medicare into a voucher program for private plans, shifting more costs onto patients. (
  • AHRQ-funded researchers analyzed Medicare data of approximately 1.6 million patients per year with cardiovascular disease (heart attacks, atrial fibrillation, congestive heart failure and ischemic heart disease). (
  • For the new study, published April 26, 2016, ahead of print in Circulation: Cardiovascular Quality and Outcomes , Jalbert and colleagues looked at Medicare patients treated with CAS or CEA whose outcomes were tracked in the Vascular Quality Initiative Registry (n = 5,254) and the National Cardiovascular Data Registry's defunct CARE registry (n = 4,055). (
  • Private plans have already cost Medicare an excess of more than $282 billion since 1985. (
  • Although Obamacare was supposed to reduce the amount the private plans are overpaid (the " Medicare cuts" in Obamacare), these have been mostly offset by "adjustments" and "quality awards" by the Department of Health and Human Services. (
  • When Medicare was created in 1965, it was modeled after the old Blue Cross/Blue Shield employer group plans in effect at that time, which were really created to cover the cost of hospital care, not outpatient care. (
  • Now, the benefits in private health plans have grown considerably over the last 35 years to keep pace with evidence of medical effectiveness, new technology, and an emphasis on prevention, but Medicare has not kept pace with them. (
  • and Medicare special needs plans. (
  • In addition, Medicare Advantage Plans now have an annual cap on how much you pay for Part A and Part B services during the year. (
  • But it gradually reduces generous government subsidies to private insurance plans, Medicare alternatives that have lately gained popularity. (
  • It does this through a variety of plans offered by private companies that have been approved by Medicare. (
  • Medicare drug plans are offered by insurance companies and other private companies approved by Medicare. (
  • Medicare drug plans will cover generic and brand name drugs. (
  • According to Bruce Vladeck, a former top administrator at Medicare , "Since the Sustainable Growth Rate ( SGR ) was implemented in 1998, total Medicare physician expenditures have exceeded the allowed amounts by only $20 billion (on a total of almost $1 trillion). (
  • It can often be used to fill in the payment gaps not covered by traditional Medicare. (
  • What, in your opinion, needs changing about the current Medicare system? (
  • To be covered by Medicare, a drug must be available only by prescription, approved by the Food and Drug Administration, used and sold in the United States and used for a medically accepted indication. (
  • But a new study linking Medicare data to two large registries suggests that accounting for disparate patient factors such as age, disease severity, and comorbidities, as well as procedural and operator characteristics, results in a leveling of the playing field between the two interventions in the Medicare population. (
  • A major problem when it comes to evaluating Medicare data is the lack of detailed information available in the administrative database, noted Jay S. Giri, MD, MPH (Hospital of the University of Pennsylvania, Philadelphia, PA), in an interview with TCTMD. (
  • Last week, President Obama signed long-awaited legislation that will put an end to periodic panic at the prospect of massive, sudden cuts to Medicare physician payments. (
  • There weren't many surprises in the budgets each party released this week, but here was one: Sen. Patty Murray's Democratic proposal had more than double the cuts to the biggest health entitlement, Medicare, as Rep. Paul Ryan's Republican proposal did. (
  • If Congress and the president ever achieve a grand bargain, the Medicare cuts are likely to be much deeper than the figures in either Ryan's or Murray's budget That would be a hard pill for lawmakers on both sides to swallow. (
  • But looked at in the terms the White House uses today, Clinton was proposing cuts in Medicare spending beyond the $270 billion Republicans dared propose. (
  • At one point, Clinton warned that the GOP cuts were "more than was necessary to repair the Medicare trust fund. (
  • The implied political point was that Medicare cuts were going to pay for tax cuts for the rich. (
  • Even with its meager benefits package and even after significant spending cuts mandated by the Balanced Budget Act of 1997, Medicare faces a long-term budget crunch. (
  • The 1997 budget agreement mandated deep cuts in projected Medicare spending over 10 years mainly through the usual price-control mechanisms. (
  • Nowhere is this more true than in its proposed cuts to Medicare. (
  • The administration's intent to make $36 billion in cuts over five years to Medicare (practically speaking, a reduction in the program's annual growth rate by about three-tenths of one percent) has been blasted from all quarters, particularly from hospital executives and medical lobbyists. (
  • Many of the proposed cuts in provider payments proposed in the budget are reasonable, especially those recommended by the respected and non-partisan Medicare Payment Advisory Commission. (
  • Washington - House Democrats pressed President Obama on Thursday not to cave in budget talks with Republicans, especially by yielding on cuts to Medicare. (
  • 2. I infer he understands that most other plans for Medicare cuts won't get through Congress, and that it will only get tougher to pass such plans each year. (
  • WASHINGTON (AP) -- President Barack Obama's new budget offers Medicare cuts to entice Republicans into tax negotiations, while plowing ahead to cover the uninsured next year under the health care law the GOP has bitterly fought to repeal. (
  • Obama has previously offered most of the Medicare cuts, but failed to gain political traction. (
  • But most of the Medicare cuts would fall on service providers such as hospitals and nursing homes. (
  • The proposed tobacco tax increase isn't likely to generate as much political heat as Medicare cuts or so-called "Obamacare," but it could have a huge effect on public health. (
  • Doctors have complained for years that the federal Medicare program's reimbursements to them are too low, and deep cuts in pay are coming in July unless Congress takes action. (
  • So the Urban Institute's biggest reform would cap the amount seniors could be asked to spend-making Medicare a better insurer of catastrophic care. (
  • President Clinton took his Medicare reform proposals on the road, telling cheering senior citizens that "no American should have to choose between fighting infection and fighting hunger. (
  • Social Security and/or Medicare "reform" along Paul Ryan-esque lines. (
  • The bipartisan "doc fix" bill repeals the Sustainable Growth Rate formula that aimed, but failed, to control growth in Medicare physician payments (Medicare Part B). When it was first adopted in 1997, the SGR probably seemed like a good idea for controlling spending growth. (
  • A draft summary of the Health Security Act, released in September of 1993, contained a chart showing projected growth for Medicare slowing to less than 6 percent by 1997, and less than 5 percent by 1999. (
  • Such Medicare reforms resemble those made under the 1997 Balanced Budget Act that helped create a short-lived surplus. (
  • He meant those dastardly Democrats who've dared to tell the public about his proposal to replace Medicare with a privatized voucher scheme. (
  • Many Republicans had hoped the Medicare changes would help the president and his party score points on an issue where Democrats have long enjoyed an advantage, especially among older voters. (
  • He should try to tell that, for openers, to millions who stand to lose not only Obamacare but also the private insurance plans that are threatened with extinction if the 'Medicare For All' scheme some Democrats favor somehow becomes law. (
  • If you share our content on Facebook, Twitter, or other social media accounts, we may track what content you share. (
  • At least some of their popularity stemmed from the fact that hospitals and clinics made lots of money using them: The spread between what they paid for a dose and what Medicare paid them to administer one reached as high as 30 percent, according to the Medicare Payment Advisory Commission. (
  • Nationally, 17 percent of Medicare-age consumers last year had a 'big problem' finding a new primary care doctor and another 12 percent had a 'small problem,' according to a survey sponsored by the Medicare Payment Advisory Commission. (
  • One of those ACA efforts is the Hospital Readmissions Reduction Program, which reduces Medicare payments to hospitals with relatively high rates of often-preventable hospital readmissions. (
  • Surprisingly, the liberal Washington Post admitted August 8 that Medicare-for-all could shut down rural hospitals, reducing access and care for their regions. (
  • That is why more and more hospitals and physicians are declining Medicare. (
  • Hospitals are limited to what Medicare approves and doctors are not allowed to bill more than 15 percent over what Medicare approves. (
  • New Medicare reimbursement rules provide some relief to safety-net hospitals, shifting the burden of financial penalties toward hospitals serving wealthier patient populations, according to a new study led by Washington University School of Medicine in St. Louis. (
  • For the second time in 6 months, Medicare has erred in calculating hospital readmission penalties for more than 1,000 of the nation's hospitals, says a Kaiser Health News article. (
  • As a result, Medicare has slightly lessened its readmissions penalties for 1,246 hospitals as part of its Hospital Readmissions Reduction Program. (
  • Medicare also modestly increased the penalties for 226 hospitals. (
  • The overpayment to hospitals and clinics arises because Medicare reimburses them based on estimates rather than the actual use of the drug. (
  • Do your doctors and hospitals participate in Tufts Medicare Preferred? (
  • It amounted to single-digit percentage points trimmed from Medicare spending, but for seniors individually and for businesses like hospitals and drug companies, there could be substantial consequences. (
  • Privately run hospitals are also part of the Medicare scheme. (
  • Medicare is a government-funded health insurance program. (
  • In July 1965, under the leadership of President Lyndon Johnson , Congress enacted Medicare under Title XVIII of the Social Security Act to provide health insurance to people age 65 and older, regardless of income or medical history. (
  • When Medicare was established in 1965, many of its supporters believed that insuring persons age sixty-five and over was a precursor to a national system of health insurance . (
  • But instead, Medicare has become the largest public program of health insurance , and universal health insurance is a reality only for older adults and some persons with disabilities. (
  • Before enactment of Medicare in 1965, few elderly persons had reliable health insurance. (
  • As a reliable source of basic health insurance for the elderly, the Medicare program has been a tremendous success. (
  • The CMS administers Medicare, the nations' largest health insurance program, which covers nearly 40 million Americans. (
  • Medicare, the federal health insurance program for older adults and disabled people of all ages, has the capacity to leverage major change in U.S. health care. (
  • Medicare is a federal health insurance program that you qualify for at age 65 or with certain health problems or disabilities. (
  • Health insurance characteristics shift at age 65 as most people become eligi- ble for Medicare. (
  • As is true for health insurance more generally (see Levy and Meltzer ), it has proven more difficult to identify the health impacts of Medicare.9 Most existing studies have focused on mor- tality as an indicator of health.10 An early study by Lichtenberg (2001) used Social Security Administration (SSA) life table data to test for a trend-break in the age profile of mortality at age 65. (
  • Second, we consider the insurance value of Medicare in providing a missing market for health insurance. (
  • While much of the nation is preoccupied with Obamacare and picking new health insurance at work, older Americans have deadlines of their own coming up - involving Medicare. (
  • Another good resource is your State Health Insurance Assistance Program, which provides free Medicare counseling. (
  • Established by a health insurance bill in 1965, as part of President Lyndon Johnson's Great Society , the Medicare program made a significant step for social welfare legislation and helped establish the growing population of the elderly as a pressure group . (
  • The financial future of the part of Medicare that pays older Americans' hospital bills has deteriorated significantly, according to an annual government report. (
  • Over 39 million persons, nearly one in every eight Americans, were enrolled in Medicare in 2000, up from 19 million in 1966. (
  • President Clinton is abandoning plans to call for a fundamental change to Medicare that would have for the first time charged 39 million elderly and disabled Americans different amounts for their health care depending on their income. (
  • Medicare was designed according to the medical and insurance practices of the mid-1960s. (
  • We pay into Medicare all of our working lives, and when it is time to receive this insurance our providers are shortchanged. (
  • When you consider the cost of the office, paying the staff and the malpractice insurance, doctors are barely getting by or going in the hole with each Medicare patient they see. (
  • Medicare works with insurance companies and other private companies to offer many options for buying prescription medicines. (
  • Eddie Lovelace, 78, a long-serving judge, was still working at the time of his death and Medicare was not his primary insurance. (
  • For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub . (
  • Medicare Part D is administered through private insurance companies. (
  • Imposing a permanent "doc fix" (that is, nixing a constantly deferred pay cut for physicians) would cost some $133 billion-more than all of Ryan's Medicare savings. (
  • I am sympathetic to the mountainous paperwork, strain and excess demands that practicing modern medicine in the United States today seems to entail, but I don't think the current Medicare scales are going to drive any physicians into poverty. (
  • In 1966, Medicare spurred the racial integration of thousands of waiting rooms, hospital floors, and physician practices by making payments to health care providers conditional on desegregation . (
  • Nevertheless, the hospital was forced by Medicare to write off two-thirds of the expense incurred. (
  • Be aware: Over your lifetime, Medicare will only help pay for a total of 60 days beyond the 90-day limit, called "lifetime reserve days," and thereafter you'll pay the full hospital cost. (
  • Medicare aims to ensure that all Australians have access to free or low-cost medical, optometry, midwifery and hospital care and in special circumstances, allied health. (
  • For example, Medicare Part A, which covers hospital stays, will pay for vision care related to medical emergencies or traumatic injuries. (
  • Medicare hospital cost reports are listed by their Medicare ID, fiscal year (mmyy) format, city, and facility name. (
  • Requests for Medicare hospital reports not listed on this Web site should be submitted directly to Federal CMS . (
  • President Clinton's announcement of his plans to devote an ever-expanding surplus to Social Security and the one on his plans for overhauling Medicare made plain his desire to finish his presidency with a grand flourish. (
  • Some private companies also contract with the Medicare program to offer Medicare health plans. (
  • These are called Medicare Plus Choice (MPC) plans. (
  • Comparing Medicare plans can help you choose the best options for your individual situation. (
  • In Los Angeles County, Medicare participants will have 31 plans from which to choose for 2015, down from 34 this year. (
  • If you don't have a computer to compare plans, or if you don't feel comfortable working through this information on you own, you can get help by calling Medicare at 800-633-4227. (
  • Typically, Medicare pays these plans a fixed monthly fee per patient. (
  • Medicare also measures quality and safety for both MA plans and fee for service providers. (
  • Starting in 2012, Medicare began paying high quality MA plans a bonus. (
  • Medicare uses a star rating for MA plans (1 is the lowest, 5 is the highest). (
  • For now, MA plans do not necessarily save Medicare money. (
  • In fact, for several years MA plans have been getting higher Medicare subsidies than fee for service providers. (
  • The 2010 health law will gradually reduce the level of these subsidies and plans will have to find ways to provide high quality care for less money-the challenge that fee for service Medicare providers already face. (
  • Some patient advocates said Medicare has not done enough to require drug plans to disclose detailed information to prospective members. (
  • All Part D prescriptions plans must be Medicare-approved. (
  • The bottom line is that plans are allowed to provide them and will have to provide them," said a Medicare official who asked not to be identified. (
  • Medicare is counting on competition among the private drug plans to keep prices in check for all drugs. (
  • Hall had hoped his mother would qualify for financial assistance so he sent a letter to Medicare. (
  • Mr. CHARLES HALL (Having a Difficult Time with Medicare): The letter that I received from the Medicare prescription drug assistance explains why they believe that she does not qualify based on income. (
  • This is a very, very confusing benefit,' said Patricia Nemore of the Center for Medicare Advocacy, a consumer group. (
  • Three years ago Clinton himself proposed basically the same package of reforms for Medicare--a fact everyone seems to have forgotten since it was embedded in his massive, ill-fated Health Security Act. (
  • Moreover, it perpetuates a regrettable annual Washington ritual: approving Medicare payment hikes in lieu of discussing other critical health care issues, including overdue major health reforms. (
  • The government for years has tried to rein in spending on the prescription drug, Epogen, which had ranked some years as the most expensive drug to taxpayers through the Medicare system. (
  • A proposed Medicare prescription benefit would have markedly different effects on consumers depending on their income and circumstances, defying easy generalizations about whether it's a good deal. (
  • The biggest problem with Medicare isn't inefficiency, waste, or fraud. (
  • That book has a section called, "Medicare Part D: The Always‐​Pouring Pitcher of Drug Fraud. (
  • Price controls also produce a strong inducement for fraud among Medicare suppliers. (
  • Errors, waste, and fraud in the Medicare system was the topic of conversation before the House Ways and Means Subcommittees on Health and Oversight today. (
  • What does Medicare generally cost? (
  • The diabetes initiative is the first to go nationwide - and Blum said it should put an end to unscrupulous practices such as shipping cartons of supplies to diabetics who haven't run out yet and billing Medicare for the cost. (
  • The CARES Act states that a person with Medicare will not have to pay any cost-sharing for the vaccines. (
  • The cost for vaccines depends on which portion of Medicare is paying and what the vaccine is. (
  • For years, Epogen was one of a trio of anemia drugs - all manufactured by Amgen, a California biotech firm - that cost Medicare as much as $3 billion annually. (
  • Keep in mind that in all of these cases, you'll still generally be responsible for 20% of the Medicare-approved amount of each treatment or procedure, but the bulk of the cost will be absorbed by Medicare. (
  • Joshua Roth of the Fred Hutchinson Cancer Research Center in Seattle said the researchers merely were tallying the cost of screening, and were not "judging value" or saying whether Medicare should pay it. (
  • The cost "seems like a pretty good use of resources" compared to many other things Medicare pays for, said Dr. Peter Bach, a health policy expert at Memorial Sloan Kettering Cancer Center in New York and a former adviser to Medicare. (
  • While pushing the Medicare bill on Capitol Hill, the White House estimated the new drug benefit would cost $400 billion over the next 10 years. (
  • Conservative ire might have been an acceptable political cost if, as some strategists had expected, the Medicare bill boosted support for Mr. Bush and the Republican Party among older voters. (
  • Medicare , the program for the elderly and disabled, lifted its ban on covering sex reassignment surgery earlier this year. (
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