Medicare Laboratory Payment Policy

Medicare Laboratory Payment Policy
Author: Institute of Medicine
Publisher: National Academies Press
Total Pages: 261
Release: 2000-12-04
Genre: Medical
ISBN: 0309183618

Clinical laboratory tests play an integral role in helping physicians diagnose and treat patients. New developments in laboratory technology offer the prospect of improvements in diagnosis and care, but will place an increased burden on the payment system. Medicare, the federal program providing coverage of health-care services for the elderly and disabled, is the largest payer of clinical laboratory services. Originally designed in the early 1980s, Medicare's payment policy methodology for outpatient laboratory services has not evolved to take into account technology, market, and regulatory changes, and is now outdated. This report examines the current Medicare payment methodology for outpatient clinical laboratory services in the context of environmental and technological trends, evaluates payment policy alternatives, and makes recommendations to improve the system.

Rewarding Provider Performance

Rewarding Provider Performance
Author: Institute of Medicine
Publisher: National Academies Press
Total Pages: 273
Release: 2007-02-17
Genre: Medical
ISBN: 0309102162

The third installment in the Pathways to Quality Health Care series, Rewarding Provider Performance: Aligning Incentives in Medicare, continues to address the timely topic of the quality of health care in America. Each volume in the series effectively evaluates specific policy approaches within the context of improving the current operational framework of the health care system. The theme of this particular book is the staged introduction of pay for performance into Medicare. Pay for performance is a strategy that financially rewards health care providers for delivering high-quality care. Building on the findings and recommendations described in the two companion editions, Performance Measurement and Medicare's Quality Improvement Organization Program, this book offers options for implementing payment incentives to provide better value for America's health care investments. This book features conclusions and recommendations that will be useful to all stakeholders concerned with improving the quality and performance of the nation's health care system in both the public and private sectors.

Cost-Based, Charge-Based, and Contractual Payment Systems

Cost-Based, Charge-Based, and Contractual Payment Systems
Author: Duane C. Abbey
Publisher: CRC Press
Total Pages: 186
Release: 2012-08-07
Genre: Business & Economics
ISBN: 1439872996

The fourth book in the Healthcare Payment System series, Cost-Based, Charge-Based, and Contractual Payment Systems compares cost-based systems, charge-based payment approaches, and contractually-based payment processes with fee-schedule payment systems and prospective payment systems. Supplying readers with a clear understanding of important background material on the different types of healthcare providers, it covers the basics of cost-based, charge-based, and contractual payment systems. The book illustrates essential concepts with a series of simple case studies—making it ideal for anyone interested in learning more about the specific systems and processes used for payment in healthcare services. It discusses Medicare cost-based payment systems, Medicare payment approaches, and includes an appendix that outlines the various Medicare payment systems. Demystifying contractual language, it outlines managed care contracts and also: Delves into the intricacies involved with adjudication of claims Considers capitated payment systems Addresses healthcare costs and cost-based reimbursement systems Examines charge-based and contractual payment systems Describes where healthcare payment systems are headed in the future Since compliance is inherent throughout the process of providing services, filling claims, and receiving payment, the book examines the range of compliance concerns, including statutory, contractual, and overpayment issues. Using numerous examples to illustrate the processes used for capitated contract arrangements, the book includes coverage of claim adjustment, managed care contracts, and the various combinations of payment systems used by third-party administrators.

Paying for Medicare

Paying for Medicare
Author: David G. Smith
Publisher: Routledge
Total Pages: 277
Release: 2017-09-29
Genre: Medical
ISBN: 1351500449

** Paying for Medicare received the American Risk and Insurance Association's Elizur Wright Award for itsoutstanding contribution to risk management and insurance literature.The Prospective Payment System and the Medicare Fee Schedule, two of the most effectively sustained and successful efforts at policy innovation in history continue to shape decisions about Medicare and cost containment efforts.Smith shows how particular policy alternatives were developed; why chosen or rejected; and how provider interests and American political institutions have shaped their design and implementation.

Advances in Patient Safety

Advances in Patient Safety
Author: Kerm Henriksen
Publisher:
Total Pages: 526
Release: 2005
Genre: Medical
ISBN:

v. 1. Research findings -- v. 2. Concepts and methodology -- v. 3. Implementation issues -- v. 4. Programs, tools and products.

The Future of Nursing 2020-2030

The Future of Nursing 2020-2030
Author: National Academies of Sciences Engineering and Medicine
Publisher:
Total Pages:
Release: 2021-09-30
Genre:
ISBN: 9780309685061

The decade ahead will test the nation's nearly 4 million nurses in new and complex ways. Nurses live and work at the intersection of health, education, and communities. Nurses work in a wide array of settings and practice at a range of professional levels. They are often the first and most frequent line of contact with people of all backgrounds and experiences seeking care and they represent the largest of the health care professions. A nation cannot fully thrive until everyone - no matter who they are, where they live, or how much money they make - can live their healthiest possible life, and helping people live their healthiest life is and has always been the essential role of nurses. Nurses have a critical role to play in achieving the goal of health equity, but they need robust education, supportive work environments, and autonomy. Accordingly, at the request of the Robert Wood Johnson Foundation, on behalf of the National Academy of Medicine, an ad hoc committee under the auspices of the National Academies of Sciences, Engineering, and Medicine conducted a study aimed at envisioning and charting a path forward for the nursing profession to help reduce inequities in people's ability to achieve their full health potential. The ultimate goal is the achievement of health equity in the United States built on strengthened nursing capacity and expertise. By leveraging these attributes, nursing will help to create and contribute comprehensively to equitable public health and health care systems that are designed to work for everyone. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity explores how nurses can work to reduce health disparities and promote equity, while keeping costs at bay, utilizing technology, and maintaining patient and family-focused care into 2030. This work builds on the foundation set out by The Future of Nursing: Leading Change, Advancing Health (2011) report.

Drug-Coated Balloons

Drug-Coated Balloons
Author: Bernardo Cortese
Publisher: Springer
Total Pages: 230
Release: 2019-06-19
Genre: Medical
ISBN: 3319926004

This book provides a comprehensive, up-to-date summary of drug-coated balloon (DCB) technology and the role of DCBs in the treatment of coronary and peripheral arterial disease. In addition to clear explanation of how DCBs works, readers will find an enlightening analysis of the mistakes and successes of the past decade and the emergence of the latest delivery systems, which combine a more deliverable device with much improved drug delivery to the vessel wall. The full range of current applications of DCBs are reviewed in detail, drawing on the latest scientific evidence. Due attention is paid to newer devices, with provision of technical insights and documentation of the available clinical data. Ongoing research projects, remaining technical challenges, likely future directions, and reimbursement issues are also carefully considered. This book will be a useful tool for any interventional cardiologist, interventional radiologist, or vascular surgeon who wishes to acquire a deep knowledge of this technology and its application in both coronary and peripheral interventions.