prospective payment system

Summary

Summary: A system wherein reimbursement rates are set, for a given period of time, prior to the circumstances giving rise to actual reimbursement claims.

Top Publications

  1. ncbi Outpatient prospective payment: uses and progress to date
    Carole Cusack
    Treo Solutions, Albany, New York, USA
    J Ambul Care Manage 25:56-62. 2002
  2. ncbi Prospective rates for episodes of home health care
    Paul L Grimaldi
    State Healthcare Division of Affiliated Computer Services, Inc, Rockville, MD, USA
    J Health Care Finance 28:63-75. 2002
  3. pmc Expansion of Medicare's definition of post-acute care transfers
    Jerry Cromwell
    Health Care Financ Rev 24:95-113. 2002
  4. ncbi The origins, development, and passage of Medicare's revolutionary prospective payment system
    Rick Mayes
    University of Richmond Department of Political Science, 28 Westhampton Way, Richmond, VA 23173, USA
    J Hist Med Allied Sci 62:21-55. 2007
  5. ncbi Creaming, skimping and dumping: provider competition on the intensive and extensive margins
    R P Ellis
    Economics Department, Boston University, MA, USA
    J Health Econ 17:537-55. 1998
  6. ncbi Effects of the DRG-based prospective payment system operated by the voluntarily participating providers on the cesarean section rates in Korea
    Kwangsoo Lee
    Department of Hospital Management, College of Medicine, Eulji University, Jung ju Yongdu 2dong 143 5, Daejeon, South Korea
    Health Policy 81:300-8. 2007
  7. ncbi The effect of financial pressure on the quality of care in hospitals
    Yu Chu Shen
    Health Policy Center, The Urban Institute, 2100 M Street NW, Washington, DC 20037, USA
    J Health Econ 22:243-69. 2003
  8. pmc How much do hospitals cost shift? A review of the evidence
    Austin B Frakt
    VA Boston Healthcare System, Boston, MA, USA
    Milbank Q 89:90-130. 2011
  9. ncbi "Quicker and sicker" under Medicare's prospective payment system for hospitals: new evidence on an old issue from a national longitudinal survey
    Xufeng Qian
    Moody s Investors Services, New York
    Bull Econ Res 63:1-27. 2011
  10. ncbi Changes in the status of hospitalized stroke patients since inception of the prospective payment system in 1983
    Susan M Schmidt
    Department of Nursing, Xavier University, Cincinnati, OH 45207 7351, USA
    Arch Phys Med Rehabil 83:894-8. 2002

Detail Information

Publications221 found, 100 shown here

  1. ncbi Outpatient prospective payment: uses and progress to date
    Carole Cusack
    Treo Solutions, Albany, New York, USA
    J Ambul Care Manage 25:56-62. 2002
    ....
  2. ncbi Prospective rates for episodes of home health care
    Paul L Grimaldi
    State Healthcare Division of Affiliated Computer Services, Inc, Rockville, MD, USA
    J Health Care Finance 28:63-75. 2002
    ....
  3. pmc Expansion of Medicare's definition of post-acute care transfers
    Jerry Cromwell
    Health Care Financ Rev 24:95-113. 2002
    In October 1998, the definition of a transfer in Medicare's hospital prospective payment system was expanded to include several post-acute care (PAC) providers in 10 high-volume PAC diagnosis-related groups (DRGs)...
  4. ncbi The origins, development, and passage of Medicare's revolutionary prospective payment system
    Rick Mayes
    University of Richmond Department of Political Science, 28 Westhampton Way, Richmond, VA 23173, USA
    J Hist Med Allied Sci 62:21-55. 2007
    ..and passage of the single most influential postwar innovation in medical financing: Medicare's prospective payment system (PPS)...
  5. ncbi Creaming, skimping and dumping: provider competition on the intensive and extensive margins
    R P Ellis
    Economics Department, Boston University, MA, USA
    J Health Econ 17:537-55. 1998
    ..Prospectively paid providers cream low severity patients and skimp high severity ones. If there is dumping of high severity patients, then there will also be skimping...
  6. ncbi Effects of the DRG-based prospective payment system operated by the voluntarily participating providers on the cesarean section rates in Korea
    Kwangsoo Lee
    Department of Hospital Management, College of Medicine, Eulji University, Jung ju Yongdu 2dong 143 5, Daejeon, South Korea
    Health Policy 81:300-8. 2007
    This study explored the effects of the diagnosis-related group (DRG)-based prospective payment system (PPS) operated by voluntarily participating organizations on the cesarean section (CS) rates, and analyzed whether the participating ..
  7. ncbi The effect of financial pressure on the quality of care in hospitals
    Yu Chu Shen
    Health Policy Center, The Urban Institute, 2100 M Street NW, Washington, DC 20037, USA
    J Health Econ 22:243-69. 2003
    ..The financial pressure variables are: fiscal pressure from the Prospective Payment System (PPS) for inpatient care, and changes in health maintenance organization (HMO) penetration at the county ..
  8. pmc How much do hospitals cost shift? A review of the evidence
    Austin B Frakt
    VA Boston Healthcare System, Boston, MA, USA
    Milbank Q 89:90-130. 2011
    ....
  9. ncbi "Quicker and sicker" under Medicare's prospective payment system for hospitals: new evidence on an old issue from a national longitudinal survey
    Xufeng Qian
    Moody s Investors Services, New York
    Bull Econ Res 63:1-27. 2011
    Medicare's prospective payment system for hospitals (PPS), introduced in the USA in 1983, replaced cost reimbursement with a system of fixed rates which created incentives for hospitals to control costs...
  10. ncbi Changes in the status of hospitalized stroke patients since inception of the prospective payment system in 1983
    Susan M Schmidt
    Department of Nursing, Xavier University, Cincinnati, OH 45207 7351, USA
    Arch Phys Med Rehabil 83:894-8. 2002
    To describe epidemiologically the changes in acute-care delivery services for stroke victims since the inception of the 1983 prospective payment system (PPS).
  11. ncbi Early trends from the Study to Evaluate the Prospective Payment System Impact on Small Dialysis Organizations (STEPPS)
    Steven M Brunelli
    Renal Division and Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women s Hospital and Harvard Medical School, Boston, MA, USA
    Am J Kidney Dis 61:947-56. 2013
    Launched in January 2011, the prospective payment system (PPS) for the US Medicare End-Stage Renal Disease Program bundled payment for services previously reimbursed independently...
  12. ncbi Trends and regional variations in hospital utilization and quality during the first two years of the prospective payment system
    S DesHarnais
    Department of Health Policy and Administration, University of North Carolina, Chapel Hill 27599 7400
    Inquiry 25:374-82. 1988
    ..model, we studied utilization and quality-of-care trends for the years preceding implementation of the prospective payment system (PPS) and the two years following its implementation...
  13. ncbi Cost accounting to determine prices: how well do prices reflect costs in the German DRG-system?
    Jonas Schreyögg
    Department of Health Care Management, Berlin University of Technology, Strasse des 17 Juni 145, 10623 Berlin, Germany
    Health Care Manag Sci 9:269-79. 2006
    ..Although cost data accuracy has improved over the last few years there are still a number of challenges that need to be addressed...
  14. ncbi Association of hospital ownership with patient transfers to outpatient care under a prospective payment system in Taiwan
    Herng Ching Lin
    Taipei Medical University, School of Health Care Administration, 250 Wu Hsing St, Taipei, Taiwan
    Health Policy 69:11-9. 2004
    Case payment, a prospective payment system akin to diagnosis-related groups (DRGs) has in-built incentives for hospitals to transfer inpatients to their own ambulatory care units following early discharge...
  15. pmc The impact of the prospective payment system for skilled nursing facilities on therapy service provision: a transaction cost approach
    Jacqueline S Zinn
    Temple University, Philadelphia, PA 19122, USA
    Health Serv Res 38:1467-85. 2003
    To examine skilled nursing facilities (SNFs) "make-or-buy" decisions with respect to rehabilitation therapy service provision in the 1990s, both before and after implementation of Medicare's Prospective Payment System (PPS) for SNFs.
  16. ncbi Rehabilitation therapy in skilled nursing facilities: effects of Medicare's new prospective payment system
    Chapin White
    Economics of Aging Program, National Bureau of Economic Research, Cambridge, Massachusetts, USA
    Health Aff (Millwood) 22:214-23. 2003
    In 1998 the Centers for Medicare and Medicaid Services (CMS) began phasing in a new prospective payment system (PPS) for Medicare payments to skilled nursing facilities (SNFs)...
  17. pmc Redesigning Medicare inpatient PPS to adjust payment for post-admission complications
    Richard F Averill
    3M Health Information Systems, Wallingford, CT 06492, USA
    Health Care Financ Rev 27:83-93. 2006
    Under the Medicare diagnosis-related group (DRG) based inpatient prospective payment system (IPPS), payments to hospitals can increase when a post-admission complication occurs...
  18. ncbi Case-mix payment in Japanese medical care
    Shinichi Okamura
    Department of Medical Informatics and Decision Sciences, Gunma University Hospital, 3 39 15 Showa Machi, Maebashi, Gunma 371 8511, Japan
    Health Policy 74:282-6. 2005
    ..For the expansion of this system, ongoing program refinement, reflecting the results of data analysis, is indispensable...
  19. ncbi Medicare payment for selected adverse events: building the business case for investing in patient safety
    Chunliu Zhan
    Agency for Healthcare Research and Quality, Rockville, Maryland, USA
    Health Aff (Millwood) 25:1386-93. 2006
    This study estimates that Medicare extra payments under the hospital prospective payment system (PPS) range from about $700 per case of decubitus ulcer to $9,000 per case of postoperative sepsis in the five types of adverse events ..
  20. ncbi Did the introduction of a prospective payment system for nursing home stays reduce the likelihood of pharmacological management of secondary ischaemic stroke?
    Kate L Lapane
    Department of Community Health, Brown Medical School, Providence, Rhode Island, USA
    Drugs Aging 23:61-9. 2006
    Since 1998, a prospective payment system (PPS) for Medicare services provided by nursing homes in the US has been in operation. Concerns have been expressed that the PPS may affect the quality of care delivered to residents...
  21. ncbi Inter-DRG resource dynamics in a prospective payment system: a stochastic kernel approach
    Anurag Sharma
    Centre for Health Economics, Monash University, Clayton 3800, Victoria, Australia
    Health Care Manag Sci 12:38-55. 2009
    ..dynamics across Diagnosis Related Groups (DRGs) of elective surgery patients, in a continuing Prospective Payment System (PPS)...
  22. ncbi Development of a simulation program for estimating hospital incomes under the prospective payment system
    Toshikazu Abe
    Division of Information Science and Biostatistics Niigata University Graduate School of Medical and Dental Sciences, Asahimachi Dori 1, Niigata 951 8520, Japan
    Comput Methods Programs Biomed 80:271-6. 2005
    A prospective payment system based on diagnosis procedure combination (DPC/PPS) was introduced to acute care hospitals in Japan in April 2003...
  23. ncbi Potential impact of the new medicare prospective payment system on reimbursement for traumatic brain injury inpatient rehabilitation
    Jeanne M Hoffman
    Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA
    Arch Phys Med Rehabil 84:1165-72. 2003
    To evaluate the potential impact of the new Medicare prospective payment system (PPS) on traumatic brain injury (TBI) rehabilitation.
  24. ncbi Hospital case payment systems in Europe
    Reinhard Busse
    Health Care Manag Sci 9:211-3. 2006
    ..The editorial sets the policy scene, and argues that DRG systems must be seen both as a technical reimbursement method and as a fundamental incentive mechanism within the health system...
  25. ncbi Patient casemix classification for medicare psychiatric prospective payment
    Edward M Drozd
    RTI International, 411 Waverley Oaks Rd, Suite 330, Waltham, MA 02452 8414, USA
    Am J Psychiatry 163:724-32. 2006
    For a proposed Medicare prospective payment system for inpatient psychiatric facility treatment, the authors developed a casemix classification to capture differences in patients' real daily resource use.
  26. ncbi A closer look at all-patient refined DRGs
    Richard F Averill
    3M Health Information Systems, Wallingford, CT, USA
    J AHIMA 73:46-50. 2002
  27. ncbi Developing a Medicare prospective payment system for inpatient psychiatric care
    Judith R Lave
    Department of Health Policy and Management, Center for Research on Health Care, University of Pittsburgh, USA
    Health Aff (Millwood) 22:97-109. 2003
    ..Refinement Act (BBRA) of 1999, the secretary of health and human services was mandated to implement a prospective payment system (PPS) for psychiatric inpatient facilities that were exempt from the Medicare inpatient PPS...
  28. ncbi Application of functional independence measure-function related groups and resource utilization groups-version III systems across post acute settings
    T B Eilertsen
    University of Colorado Health Sciences Center, Center on Aging Research Section, Denver 80206, USA
    Med Care 36:695-705. 1998
    ..The present study evaluated alternative patient classification systems for skilled nursing facility and rehabilitation facility patients...
  29. ncbi Medicare prospective payment reforms and hospital utilization. Temporary or lasting effects?
    A Muller
    Department of Health Services Administration, University of Arkansas, Little Rock 72204
    Med Care 31:296-308. 1993
    ..The Medicare reimbursement reforms appear to remain effective in reducing hospital utilization, but at a reduced rate...
  30. ncbi The effect of Medicare's prospective payment system on discharge outcomes of skilled nursing facility residents
    Walter P Wodchis
    Toronto Rehabilitation Institute, Queen Elizabeth Centre, 130 Dunn Ave, Toronto, Ontario M6K 2R7
    Inquiry 41:418-34. 2004
    ..payment method for Medicare (Part A) skilled nursing facility (SNF) care from a cost-based system to a prospective payment system (PPS)...
  31. ncbi Effects of payment incentives, hospital ownership and competition on hospitalization decisions for ambulatory surgical procedures
    Sudha Xirasagar
    University of South Carolina, Department of Health Services Policy and Management, Columbia, SC, USA
    Health Policy 76:26-37. 2006
    ....
  32. ncbi Challenges and opportunities for Medicare's original prospective payment system
    Chantal Worzala
    Medicare Payment Advisory Commission MedPAC, Washington, DC, USA
    Health Aff (Millwood) 22:175-82. 2003
    ..To successfully navigate these issues, policymakers and program administrators need accurate and timely information...
  33. ncbi Trends in inpatient rehabilitation stroke outcomes before and after advent of the prospective payment system: a systematic review
    Suzanne Rinere O'Brien
    University of Rochester Medical Center, School of Nursing, Rochester, New York, USA
    J Neurol Phys Ther 34:17-23. 2010
    ..In order to examine the influence of the prospective payment system (PPS), which was instituted in 2002, particular attention was paid to the pre-PPS to post-PPS period...
  34. ncbi What happened to PEPP? QIOs plan for hospital payment monitoring program
    Renato Estrella
    IPRO, Lake Success, NY, USA
    J AHIMA 74:43-8; quiz 49-50. 2003
  35. ncbi Trends in Medicare home health care use: 1997-2001
    Christopher M Murtaugh
    Center for Home Care Policy and Research, Visiting Nurse Service of New York, USA
    Health Aff (Millwood) 22:146-56. 2003
    ..major overhaul in Medicare payment for home health care with an interim payment system (IPS) preceding a prospective payment system (PPS)...
  36. pdf Overview: Medicare post-acute care since the Balanced Budget Act of 1997
    Philip G Cotterill
    Centers for Medicare and Medicaid Services, Office of Research, Development, and Information, 7500 Security Boulevard, C3 21 28, Baltimore, MD 21244 1850, USA
    Health Care Financ Rev 24:1-6. 2002
  37. pmc Assessing the RUG-III resident classification system for skilled nursing facilities
    Chapin White
    Harvard University, USA
    Health Care Financ Rev 24:7-15. 2002
    ..Receipt of special treatments such as intravenous medications and respiratory therapy is strongly associated with high residual costs (p < 0.01). Modifications to the RUG-III system can increase its variance explanation...
  38. ncbi [Development of classification and payment system of in patient hospital admissions in the United States: introduction of Medicare Severity Diagnosis-Related Groups (MS-DRGs) and the Present On Admission (POA) indicator]
    Massimo Maurici
    Dipartimento di Sanita Pubblica, Universita degli Studi di Roma Tor Vergata
    Ig Sanita Pubbl 63:691-701. 2007
    ..The authors describe the main characteristics of the new MS-DRG system and POA indicator and their potential impact on Italian Public Health system...
  39. ncbi Paying hospitals on the basis of nursing intensity: policy and political considerations
    Paul B Ginsburg
    Center for Studying Health System Change
    Policy Polit Nurs Pract 9:118-20. 2008
    ..the role of nurses in hospitals and the intensity of nursing resources used in care are more likely to be influenced by quality reporting and pay for performance than by incorporating nursing intensity into a prospective payment system.
  40. ncbi Hospital inpatient prospective payment system: incorporating new technology
    Jeffrey M Durthaler
    Outcomes Research Group, US Medical Division, Eli Lilly and Company, Indianapolis, IN 46285, USA
    Am J Health Syst Pharm 60:S15-20. 2003
    New technologies in the impatient prospective payment system are discussed...
  41. ncbi Medicare changes to the hospital inpatient prospective payment systems: commentary on the implications for the hospital-based wound care clinician
    Lee Ann Krapfl
    Mercy Medical Center, Dubuque, IA 52001, USA
    J Wound Ostomy Continence Nurs 35:61-2. 2008
  42. ncbi The ABCs of PPS and LTACHs
    Cherilyn G Murer
    Murer Group, Joliet, Ill, USA
    Rehab Manag 15:52-3. 2002
  43. ncbi Straight talk. New approaches in healthcare. Be aware: Medicare's Ambulatory Payment Classification poses significant risks in both lost revenue and noncompliance
    Adriana van der Graf
    Mod Healthc 33:41-4. 2003
  44. pmc Measuring function for Medicare inpatient rehabilitation payment
    Grace M Carter
    Health Care Financ Rev 24:25-44. 2003
    ..present the rules used to construct administratively simple, homogeneous, resource use groups that provide reasonable incentives for access and quality care and that determine payments under the new IRF prospective payment system (PPS).
  45. ncbi Medicare's big changes
    Martin Sipkoff
    Manag Care 17:29-30, 35-6. 2008
  46. ncbi 2008 refinements to the Medicare Home Health Prospective Payment System
    Pamela Teenier
    Medicare Operations, Gentiva Health Services, Corpus Christi, TX 78418, USA
    Home Healthc Nurse 26:181-4. 2008
    On January 1, 2008, Centers for Medicare and Medicaid Services (CMS) implemented refinements to the Prospective Payment System (PPS)...
  47. ncbi Transfer trauma. Hospitals oppose CMS plan to include more DRGs in controversial policy
    Jeff Tieman
    Mod Healthc 33:24-5. 2003
  48. ncbi Hospital-based and freestanding skilled nursing facilities: any cause for differential Medicare payments?
    Korbin Liu
    Urban Institute, Washington, DC 20037, USA
    Inquiry 40:94-104. 2003
    ..for hospital-based and freestanding skilled nursing facilities (SNFs) were eliminated by the SNF prospective payment system initiated in 1998...
  49. ncbi Room for improvement: gastrointestinal disorders and payment errors
    Kathy M Terry
    Federal Health Care Assessment, IPRO, Lake Success, NY 11042 1002, USA
    J Community Health 33:111-6. 2008
    ....
  50. ncbi The clinician's role in Medicare prospective payment: Part 1--Basic terms
    Pamela Teenier
    Medicare Operations, Gentiva Health Services, Corpus Christi, TX, USA
    Home Healthc Nurse 22:526-8. 2004
  51. ncbi Prospective per diem rates for skilled nursing care
    Paul L Grimaldi
    State Healthcare Division of Affiliated Computer Services, Inc, Rockville, MD, USA
    J Health Care Finance 28:49-62. 2002
    ..1998, Medicare's cost-related reimbursement method for skilled nursing facility care was replaced with a prospective payment system that includes a case-mix adjustment based on the Resource Utilization Groups to which Medicare residents ..
  52. ncbi Prospective payments in a regional trauma center: the case for recognition of the transfer patient in diagnostic related groups
    Jason A London
    Division of Trauma General Surgery, Harborview Medical Center, Department of Surgery, University of Washington, Seattle, Washington 98104, USA
    J Trauma 60:390-5; discussion 395-6. 2006
    ....
  53. ncbi Is your organization's wage index accurate?
    Thomas M Schuhmann
    Cost Report Data Resources, LLC, Louisville, KY, USA
    Healthc Financ Manage 61:74-80. 2007
    ....
  54. ncbi Proposed PPS favors rurals. Specialty hospitals expected to take hit in new system
    Jennifer Lubell
    Mod Healthc 36:8-9. 2006
  55. ncbi PPS to draw more attention
    Jennifer Lubell
    Mod Healthc 37:29-30. 2007
  56. ncbi The devil's in the dollars. Opposition to new DRGs, coding system based on financial winners, losers
    Todd Sloane
    Mod Healthc 36:33. 2006
  57. ncbi Adjustment of inpatient care reimbursement for nursing intensity
    John M Welton
    College of Nursing, Medical University of South Carolina, Charleston, SC, USA
    Policy Polit Nurs Pract 7:270-80. 2006
    The Centers for Medicare and Medicaid Services has begun an ambitious recalibration of the inpatient prospective payment system, the first since its introduction in 1983...
  58. ncbi CMS releases inpatient payment rule for fiscal year 2007
    Kate Traynor
    Am J Health Syst Pharm 63:1678-81. 2006
  59. ncbi Nursing intensity and hospital payment
    David M Keepnews
    Policy Polit Nurs Pract 7:237-9. 2006
  60. ncbi Staying ahead in a changing regulatory environment
    Paul Allen
    Johns Hopkins Health System, Baltimore, USA
    Healthc Financ Manage 60:109-10. 2006
  61. ncbi Did recent changes in Medicare reimbursement hit teaching hospitals harder?
    R Tamara Konetzka
    The University of Chicago, Department of Health Studies, 5841 S Maryland Avenue, MC2007, Chicago IL 60637, USA
    Acad Med 80:1069-74. 2005
    ....
  62. ncbi A primer for understanding diagnosis-related groups and inpatient hospital reimbursement with nursing implications
    Laura Beaty
    Memorial Hermann Southwest Hospital, Houston, TX 77074, USA
    Crit Care Nurs Q 28:360-9. 2005
    ..Nurses can play roles that greatly impact the final DRG for each inpatient medical record...
  63. ncbi CMS ruling targets home health
    Jennifer Lubell
    Mod Healthc 37:14. 2007
  64. pmc Physical rehabilitation following medicare prospective payment for skilled nursing facilities
    Walter P Wodchis
    Toronto Rehabilitation Institute, Queen Elizabeth Centre, 130 Dunn Ave, Toronto, Ontario, M6K 2R7
    Health Serv Res 39:1299-318. 2004
    To examine the effect of the Medicare prospective payment system (PPS) for skilled nursing facilities (SNF) on the delivery of rehabilitation therapy to residents.
  65. ncbi The use of ambulatory patient groups for regulation of hospital ambulatory surgery revenue in Maryland
    Graham Atkinson
    J Ambul Care Manage 31:17-23. 2008
    ..This article describes the policy rationale for this system, the analysis that was performed, and the methods that will be used to control the revenue per case and compare the relative charges of the hospitals...
  66. ncbi Extra training needed for DRGs. Concerns arise on coding, payment issues for system
    Jennifer Lubell
    Mod Healthc 37:8-9. 2007
  67. ncbi Rural implications of Medicare's post-acute-care transfer payment policy
    Julie A Schoenman
    NORC Walsh Center for Rural Health Analysis, NORC at the University of Chicago, Bethesda, MD 20814, USA
    J Rural Health 21:122-30. 2005
    ..from selected diagnosis-related groups (DRGs) to a skilled nursing facility, home health care, or a prospective payment system (PPS)-excluded facility...
  68. ncbi Variation in patient routine costliness in U.S. psychiatric facilities
    Jerry Cromwell
    RTI, 411 Waverley Oaks Road, Suite 330, Waltham, Massachusetts 02452 8414, USA
    J Ment Health Policy Econ 8:15-28. 2005
    ..Budget Refinement Act of 1999 included a Congressional mandate to develop a patient-level case mix prospective payment system (PPS) for all Medicare beneficiaries treated in PPS-exempt psychiatric facilities...
  69. ncbi The clinician's role in Medicare prospective payment: part 4--Medicare adjustments
    Pamela Teenier
    Medicare Operations, Gentiva Health Services, Corpus Christi, TX, USA
    Home Healthc Nurse 23:331-4. 2005
  70. ncbi Reshuffling the DRG deck. New cardiac DRGs praised for more equitable reimbursements while post-acute-transfer changes are generating some worries
    Matthew DoBias
    Mod Healthc 35:6-7, 16, 1. 2005
    ..Tom Watson, left, a partner with accounting firm BKD, which specializes in healthcare reimbursement, says it's unlikely the changes will put any hospitals out of business, but they will feel a pinch...
  71. ncbi Cost containment and infusion services
    Kathy Kokotis
    Resources, Inc, Crown Point, Indiana 46307, USA
    J Infus Nurs 28:S22-32; quiz S33-6. 2005
    The implementation of the Medicare Prospective Payment System (MPPS) has placed pressure on healthcare organizations to decrease patient length of stay without adversely affecting outcomes...
  72. ncbi Counter intelligence?
    Barbara Straub Williams
    Powers, Pyles, Sutter and Verville, PC, Washington, DC, USA
    Healthc Financ Manage 59:42-4, 46. 2005
    ..Providers should: Pay particular attention to the period in which the bed count is applied. Not rely solely on the definition of available beds in the Provider Reimbursement Manual...
  73. ncbi The codes to watch: identifying the DRGs most prone to payment error
    Kimberly Hrehor
    Texas Medical Foundation, Austin, TX, USA
    J AHIMA 76:36-40. 2005
  74. ncbi Recalibrating Medicare payments for inpatient care
    Paul B Ginsburg
    Center for Studying Health System Change, Washington, DC, USA
    N Engl J Med 355:2061-4. 2006
  75. ncbi The problem with diagnosis related group 475
    Douglas R Gracey
    Mayo Clinic, Rochester, MN 55905, USA
    Chest 122:299-301. 2002
    The reimbursement of hospital Part A cost by Medicare under the original prospective payment system (PPS) created serious financial problems for hospitals in many areas but was especially serious in patients receiving mechanical ..
  76. ncbi Medicare's fee schedule for hospital outpatient care
    Paul L Grimaldi
    State Healthcare Division of Affiliated Computer Science Services, Inc, Rockville, MD, USA
    J Health Care Finance 28:14-31. 2002
    Medicare's hospital outpatient prospective payment system (OPPS) went live on August 1, 2000, after a decade of developmental work...
  77. ncbi Evaluating the organizational effectiveness of APC implementation efforts
    Rajan Patel
    Ernst and Young, LLP, Boston, Massachusetts, USA
    Healthc Financ Manage 56:suppl 34-6, 38, 40. 2002
    To optimize revenue under the Medicare outpatient prospective payment system's new coding-based ambulatory payment classifications (APCs), healthcare providers need to ensure several key steps are taken at the organizational level...
  78. ncbi Prospective payment for nursing homes increased therapy provision without improving community discharge rates
    E Hutt
    Center on Aging Research Section, University of Colorado Health Sciences Center, Denver, Colorado 80206, USA
    J Am Geriatr Soc 49:1071-9. 2001
    OBJECTIVES: To determine the impact of the prospective payment system (PPS) for skilled nursing facilities (SNFs) on therapy use and community discharge rates...
  79. ncbi Déjà vu. When it comes to prospective payment, home health agencies can learn from the experiences of acute care hospitals with DRGs
    Patricia B Dray
    3M Health Information Systems, Wallingford, CT, USA
    Health Manag Technol 23:44-6, 50. 2002
  80. ncbi How DRGs hurt academic health systems
    P A Taheri
    Division of Trauma Burn and Emergency Surgery, University of Michigan Health System, Ann Arbor, USA
    J Am Coll Surg 193:1-8; discussion 8-11. 2001
    ..The application of our proposed reimbursement methodology better distributes risk between payers and providers, and reduces adverse selection and incentive problems ("moral hazard")...
  81. ncbi The effects of a low-cost intervention program on hospital costs
    J E Billi
    Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
    J Gen Intern Med 7:411-7. 1992
    ..Audits of quality of care detected no significant difference between groups. CONCLUSION: This low-intensity intervention reduced length of stay and charges, even under the cost-constrained context of the prospective payment system.
  82. ncbi Clinical laboratory employment and workload patterns
    K R Karni
    Department of Laboratory Medicine and Pathology, Medical School, University of Minnesota, USA
    Clin Lab Sci 10:250-7. 1997
    ..The impact of managed care together with the Prospective Payment System, a government initiative of 1983, profoundly affected health care institutions and their personnel...
  83. ncbi The impact of esophageal candidiasis on hospital charges and costs across patient subgroups
    Kuo B Tong
    Quorum Consulting, Inc, San Francisco, CA 94108, USA
    Curr Med Res Opin 24:167-74. 2008
    ..Assess the impact of esophageal candidiasis on US hospital inpatient charges, length of stay (LOS), and costs across clinically relevant subgroups...
  84. ncbi Hospital-physician arrangements and hospital financial performance
    T L Mark
    Project HOPE Center for Health Affairs, Bethesda, MD, USA
    Med Care 36:67-78. 1998
    The introduction of the Medicare Prospective Payment System and the more recent rise of managed care plans have greatly increased the importance of effective hospital financial management...
  85. ncbi Taiwan's 1995 health care reform
    T L Chiang
    Institute of Public Health and Center for Health Policy Research, National Taiwan University, Taipei
    Health Policy 39:225-39. 1997
    ..health services, the scheme enters contracts with health care providers and has been developing a prospective payment system. Meanwhile, the scheme uses a uniform fee schedule and makes all payments through a public single-payer ..
  86. ncbi [DRGs in psychiatric hospital financing exemplified by Hungary. A model for Germany?]
    E Maylath
    Medizinischer Dienst, Krankenversicherung Hamburg
    Gesundheitswesen 62:633-45. 2000
    ..incorporated in the reform of the German health sector has been the introduction of a per case prospective payment system for hospitals with the exception of admissions to psychiatric care...
  87. ncbi Determinants of hospital length of stay
    L R Lutjens
    Kirkhof School of Nursing, Grand Valley State University, Allendale, MI
    J Nurs Adm 23:14-8. 1993
    ..To correct these variations, the Tax Equity and Fiscal Responsibility Act and its concomitant prospective payment system based on DRGs was implemented...
  88. pmc Restructuring in response to case mix reimbursement in nursing homes: a contingency approach
    Jacqueline Zinn
    Department of Risk, Insurance and Healthcare Management, Temple University, Philadelphia, PA, USA
    Health Care Manage Rev 33:113-23. 2008
    ..nursing facility reimbursement changed from cost-based to case mix adjusted payments under the Medicare Prospective Payment System for the costs of all skilled nursing facility care provided to Medicare recipients...
  89. ncbi Performance of freestanding inpatient rehabilitation hospitals before and after the rehabilitation prospective payment system
    Jon M Thompson
    Health Services Administration Program, James Madison University, Harrisonburg, Virginia, USA
    Health Care Manage Rev 35:36-45. 2010
    ..reimbursed by Medicare under a cost-based system; but in 2002, Medicare implemented a rehabilitation prospective payment system (PPS)...
  90. ncbi Reimbursement trends for outpatient interventional radiology procedures: comparison of hospital and freestanding physician office sites of service
    Adam D Talenfeld
    Section of Vascular and Interventional Radiology, Mount Sinai Medical Center, New York, NY, USA
    J Am Coll Radiol 6:417-27. 2009
    ..The aim of this study was to compare trends in reimbursement rates between hospital outpatient departments and freestanding physician offices for commonly performed interventional radiology procedures from 2006 through 2010...
  91. ncbi Impact of prospective payment and discharge location on the outcome of hip fracture
    M B Gerety
    University of Texas Health Sciences Center, San Antonio
    J Gen Intern Med 4:388-91. 1989
    ..review of a consecutive series of cases before and after the reference date of implementation of the prospective payment system (PPS). SETTING: Academic, tertiary-care hospital...
  92. ncbi Components of Medicare reimbursement
    William Malatestinic
    U S Medical Division, Eli Lilly and Company, Indianapolis, IN 46285, USA
    Am J Health Syst Pharm 60:S3-7. 2003
    ..The statutory charge of Medicare is to ensure adequate reimbursement through a Prospective Payment System (PPS) to cover the costs for providing a given service to Medicare beneficiaries...
  93. ncbi Effect of locale on health status and direct care time of rural versus urban home health patients
    C E Adams
    College of Nursing, Home Care Department, Medical University of South Carolina, Charleston, South Carolina, USA
    J Nurs Adm 31:244-51. 2001
    ..The study purpose was to determine if health status differed between rural versus urban home health patients and to identify if locale was a significant predictor of home health direct care time...
  94. ncbi From the emergency department to the general hospital: hospital ownership and market factors in the admission of the seriously mentally ill
    Jay J Shen
    Department of Health Care Administration and Policy, School of Public Health, University of Nevada at Las Vegas, USA
    J Healthc Manag 53:268-79; discussion 279-80. 2008
    ..care system, making private health insurance coverage of the SMI more equitable, revising Medicare prospective payment system to better reimburse the treatment of the SMI, and allowing not-for-profit hospitals to count care of the ..
  95. ncbi Impact of an all-inclusive diagnosis-related group payment system on inpatient utilization
    T J Menke
    Center for Quality of Care and Utilization Studies, Veterans Affairs Medical Center, Houston, TX 77030, USA
    Med Care 36:1126-37. 1998
    ..This study estimates the effect of a prospective payment system based on diagnosis-related groups (DRGs) nationwide in the Department of Veterans Affairs.
  96. ncbi Have procompetitive changes altered hospital provision of indigent care?
    E S Campbell
    Department of Economics, East Carolina University, Greenville, NC 27858 4353
    Health Econ 2:281-9. 1993
    ..Some examples include the advent of Medicare's Prospective Payment System, growth in managed care options, relaxation of states' Certificate of Need (CON) regulations, and court ..
  97. ncbi The occupational mix adjustment to the Medicare hospital wage index: why the rural impact is less than expected
    Kristin L Reiter
    North Carolina Rural Health Research and Policy Analysis Center, Cecil G Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 7411, USA
    J Rural Health 24:148-54. 2008
    ..A recent change to Medicare prospective payment system reimbursement--the occupational mix adjustment (OMA) to the wage index--has attracted a great deal of ..
  98. ncbi Medicare-the development of publicly financed health insurance: Medicare's impact on the nation's health care system
    Robert R Kulesher
    Department of Health Services and Information Management, School of Allied Health Sciences, East Carolina University, Greenville, NC 27858 4353, USA
    Health Care Manag (Frederick) 24:320-9. 2005
    ..The prospective payment system, imposed on hospitals in 1987 and later on nursing homes, home health agencies, and other services, has ..
  99. pmc Vulnerability of rural hospitals to Medicare outpatient payment reform
    P E Mohr
    Project HOPE Center for Health Affairs, 7500 Old Georgetown Road, Suite 600, Bethesda, MD 20814, USA
    Health Care Financ Rev 21:1-18. 1999
    Because the Balanced Budget Act (BBA) of 1997 requires implementation of a Medicare prospective payment system (PPS) for hospital outpatient services, the authors evaluated the potential impact of outpatient PPS on rural hospitals...
  100. ncbi Finding relief from TEFRA cost limits
    C J Fletcher
    Arthur Anderson, Miami, FL, USA
    Healthc Financ Manage 50:22-5. 1996
    ..rate increases for inpatient care delivered by healthcare providers excluded from Medicare's prospective payment system. Costs beyond these limits normally are not reimbursed...
  101. ncbi IMRT (intensity modulated radiation therapy): progress in technology and reimbursement
    R Young
    Martin Memorial Cancer Center, Martin Memorial Health Systems, Stuart, Florida, USA
    Radiol Manage 23:20-6, 28, 30 passim; quiz 33-5. 2001
    ..New IMRT reimbursement codes have been issued under the pass-through provisions of Medicare's Outpatient Prospective Payment System (OPPS), which authorize special or increased reimbursement levels for promising new developments in ..

Research Grants35

  1. Improving Inpatient Psychiatric Payment: Cost and Quality Implications
    DONALD MICHAEL STEINWACHS; Fiscal Year: 2010
    DESCRIPTION (provided by applicant): Medicare Prospective Payment System (PPS) for inpatient hospital care has used Diagnostic Related Groups (DRG) to pay "per case" since its implementation in 1983, except for psychiatric disorders...
  2. Evaluating Payment Reform and Provider Practices to Improve Health Outcomes in Ch
    Marc Turenne; Fiscal Year: 2013
    ..This may be especially true in a prospective payment system (PPS), involving a "bundled" payment to providers for a relatively broad set of services, that may not ..
  3. Cost of an Evidence Based Depression Care Management Intervention in Home Health
    Yuhua Bao; Fiscal Year: 2010
    ..incremental payments associated with the CAREPATH intervention under the current Medicare home health prospective payment system (PPS) and compare these payments to the cost of the intervention...
  4. ECONOMICS OF HOSPITAL CAPITAL EXPENDITURES
    JOHN SILVERS; Fiscal Year: 1993
    ..So far capital costs have not responded to Medicare Prospective Payment System [PPS] to the degree shown by operating costs...
  5. RESOURCE USE AND PATIENT OUTCOMES IN MEDICARE HOME CARE
    Richard Fortinsky; Fiscal Year: 2006
    ..Medicare home care reimbursement today is governed by a prospective payment system (PPS), and quality of Medicare home care is increasingly focused on maximizing patient outcomes through ..
  6. TAMI: Technology Assisted Management of Incontinence
    David Boone; Fiscal Year: 2009
    ..the public may demand that nursing homes provide high quality of care to elder residents, the current prospective payment system does not sufficiently reimburse facilities to hire and retain appropriate staffing levels...
  7. TIMING PROPHYLACTIC SURGERY FOR DIVERTICULITIS
    Robert Richards; Fiscal Year: 2000
    ..This study will consider only direct medical costs. Hospital costs will be estimated using the Prospective Payment System. Physician costs will be assessed using the Medicare Fee Schedule...
  8. Outcomes of the Nursing Home Prospective Payment System
    Patrick Murray; Fiscal Year: 2002
    ..services to newly admitted nursing home patients following the implementation of the Nursing Home (NH) Prospective Payment System (PPS) 2...
  9. Payment Systems, Market Factors and Long-term Care Hospitals
    EMILY SHELTON; Fiscal Year: 2007
    ..care (PAC) and how their practices have changed in recent years in response to Medicare's prospective payment system (the LTCH-PPS)...
  10. AMBULATORY CARE RISK INDEX
    HERBERT FILLMORE; Fiscal Year: 1992
    ..the APGS, which are the most likely candidate for a Congressionally mandated outpatient Medicare prospective payment system, use only the principal diagnosis and occasionally, a pediatric/adult split to classify medical visits...
  11. New Evidence on the Persistence of High Health Spending
    Richard Hirth; Fiscal Year: 2009
    ..We will provide an example of how such estimates can inform the evaluation of risk-adjustment and reinsurance as mechanisms to improve the functioning of small group health insurance markets. ..
  12. HOSPITALIZATION OF NURSING FACILITY RESIDENTS
    Joan Buchanan; Fiscal Year: 2002
    ..The validity of our profiling tool will be assessed through Comparison with other NT quality indicators (from the MDS) thought to be related to hospitalization and by an analysis of mortality rates. ..
  13. Effectiveness of TEACH Research
    David Meltzer; Fiscal Year: 2008
    ..unreadable] [unreadable] [unreadable]..
  14. 19th Annual Health Economics Conference
    David Meltzer; Fiscal Year: 2008
    ..The 19th annual Health Economics conference hopes to build upon the rich tradition established by the preceding Annual Health Economics Conferences. [unreadable] [unreadable] [unreadable]..
  15. Safety Net Hospitals and Minority Access to Health Care
    Gloria Bazzoli; Fiscal Year: 2009
    ..It is important for policy makers, the public, and the health industry to know what this might mean for access to care if the loss of financial support results in further safety net contraction. ..
  16. HEALTH PLAN RESPONSES TO MEDICARE HMO PREMIUM PAYMENTS
    RANDALL ELLIS; Fiscal Year: 2001
    ..Results will also be useful to policy makers in understanding how recent Medicare reforms have altered HMO premiums, competition, benefit features and the resulting Medicare enrollments. ..
  17. Hospital Finances and the Quality of Hospital Care
    Gloria Bazzoli; Fiscal Year: 2004
    ..does public policy that affects hospital payments, especially the 1997 Balanced Budget Act and its revisions, influence hospital decisions about quality-related resources and processes and the care their patients receive? ..
  18. Leveraging Medicare Payment & Reporting Policies to Improve Nursing Home Quality
    David C Grabowski; Fiscal Year: 2010
    ..Thus, the information derived from this study has the potential to make important research and policy-relevant contributions aimed at improving the quality of care for all nursing home residents. ..
  19. A MULTI-CENTER TRIAL OF ACADEMIC HOSPITALISTS
    David Meltzer; Fiscal Year: 2003
    ..Specific Aim number 3- To assess the effects of hospitalists on housestaff and medical student education and satisfaction. This will be accomplished by surveys administered to medical students and housestaff. ..
  20. Virtual Recovery Simulation
    Margaret Stineman; Fiscal Year: 2006
    ..abstract_text> ..
  21. Selection and the Quality Impact of Nursing Home Ownership
    David C Grabowski; Fiscal Year: 2010
    ..By examining this relationship using a novel empirical strategy, this study provides an opportunity to improve the quality of care for the millions of Americans receiving care in the nursing home setting. ..
  22. Do amputees benefit from comprehensive rehabilitation services?
    Margaret Stineman; Fiscal Year: 2008
    ..abstract_text> ..
  23. Cost-Effectiveness of Prostate Cancer Screen/Treatment
    David Meltzer; Fiscal Year: 2003
    ..3. To assess how the cost-effectiveness of prostate cancer screening and treatment will be affected by the appropriate inclusion of future medical and non-medical costs in cost- effectiveness analysis. ..
  24. Effects of Hospitalists in Medicare Data
    David Meltzer; Fiscal Year: 2008
    ..unreadable] [unreadable] [unreadable]..
  25. Collaborative Clinical Culture and Quality of Care
    Sheldon Greenfield; Fiscal Year: 2003
    ..The results of this study will provide insight into whether HCTs are associated with high staff morale and high quality of care. ..
  26. Harmonizing Data Standards for Primary Care
    Robert Phillips; Fiscal Year: 2007
    ..unreadable] [unreadable] [unreadable] [unreadable]..
  27. A Pilot Survey to Measure Disability in the Elderly Population
    David Cutler; Fiscal Year: 2006
    ..This research is critical for researchers, and for policy-makers who seek to understand why disability is changing and what implications those changes will have for longevity and medical spending. ..
  28. CONTROLLED TRIAL OF SERTRALINE FOR DEPRESSION AFTER TBI
    Charles Bombardier; Fiscal Year: 2004
    ..Secondary hypotheses to be tested include whether sertraline leads to greater improvement in neuropsychological test performance, post-concussive symptoms and self-reported health status as measured by the SF 36. ..
  29. Impact of Depression & Function on Healthcare Use & Cost
    Bruce Friedman; Fiscal Year: 2006
    ....
  30. Understanding Disability Among The Elderly
    David Cutler; Fiscal Year: 2005
    ....
  31. Measurement & Use of Utilities in Ovarian Cancer CEA
    Deborah Dobrez; Fiscal Year: 2003
    ..abstract_text> ..
  32. UTILIZATION AND COST OF HEALTH SERVICES BY CDUs
    W Bradford; Fiscal Year: 2003
    ....
  33. QUALITY OF LIFE AND TREATMENT FOR BRAIN TRAUMA
    Jason Doctor; Fiscal Year: 2003
    ....