Medicare's Challenges in Paying Providers

Medicare's two systems for paying providers.

The lessons of Medicare's prospective payment system show that the bundled payment program faces challenges.

Policy makers have been trying to replace Medicare's fee-for-service payment system for years with approaches that pay one price for an aggregation of services. The intent is to reward providers for offering needed care in the most appropriate and cost-effective manner. Medicare's first payment change designed to accomplish such a change was the hospital prospective payment system, introduced d...

Paying Hospitals Under Medicare's Prospective Payment System: Another Perspective

Paying for value: replacing Medicare's sustainable growth rate formula with incentives to improve care.

This brief sets forth a set of policy options to improve the way health care providers are paid by Medicare. The authors suggest repealing Medicare's sustain­able growth rate (SGR) formula for physician fees and replacing it with a pay-for-value approach that would: 1) increase payments over time only for physicians and other provid­ers who participate in innovative care arrangements; 2) streng...

Challenges of Payment System to Primary Health Care Providers in Iranian Comprehensive Health Centers

Background and purpose: The primary health care program for the suburbs is being implemented in Iran after the Health Transformation Plan where services are delivered with the priority of outsourcing and purchasing services from non-governmental sectors. In this program, different payment methods have been used. This study aimed at addressing the challenges associated with payments made to urba...