During the past decade, the Health Care Financing Administration (HCFA) has revised the current procedural terminology (CP1) coding guidelines in an effort to clarify the work of physicians. In today's climate of health care regulation, the accuracy of how physicians use CPT coding to define their evaluation and management (ElM) services is receiving more attention. Because coding is tied to re...

By March 2015, 30% of all Medicare beneficiaries were enrolled in Medicare Advantage (MA) plans. Research to date has not explored the impacts of MA market penetration on individual or population health outcomes. The primary objective of this study is to examine the relationships between MA market penetration and the beneficiary's portfolio of cardiometabolic diagnoses. This study uses 2004 to ...

Increases in the Number of Medicare Beneficiaries The proportion of the United States population covered by Medicare has increased over time. This has resulted from the normal eligibility age remaining fixed at 65 combined with the aging of the population. The aging of the population is due to both increased life expectancy and decreased fertility. In 1965, 65-year-old retirees could expect to ...

This article presents a system under consideration by the Health Care Financing Administration (HCFA) for incorporating a measure of severity of illness into the Medicare diagnosis-related groups (DRGs). DRG assignment is one of the main factors in determining the payment made for hospital inpatient services furnished to Medicare beneficiaries. Specifically, the formula used to calculate paymen...

BACKGROUND Inappropriate emergency department (ED) use among Medicaid enrollees is considered a problem because of cost. We developed and evaluated a system change innovation designed to remove system barriers to primary care access for Medicaid patients. METHODS Patients who presented to the ED without an identified primary care provider were randomized to the intervention (n = 72) or compar...

This article presents the results of a pioneering effort by the Health Care Financing Administration (HCFA) to measure interstate border crossing for services used by Medicare and non-Medicare beneficiaries. A major focus is to provide estimates of per capita expenditures by State for individual services. Such estimates are not possible without adjustment for interstate border-crossing flows. T...

measures. This is an important consideration. After all, from the ideals of the patient safety/quality improvement movement, safety is “everyone’s responsibility” and the patient is a member of the team. The inability of the patient to ally with the team’s goals diminishes teamwork and, thereby, increases the risk of errors or adverse outcomes. However, we were disappointed with the dichotomy p...

This report is a summary of Device-associated (DA) Module data collected by hospitals participating in the National Healthcare Safety Network (NHSN) for events occurring from January through December 2011 and reported to the Centers for Disease Control and Prevention (CDC) by August 1, 2012. This report updates previously published DA Module data from NHSN and provides contemporary comparative ...

PURPOSE Diagnosis Related Groups (DRGs) are widely used for a variety of purposes including quality improvement, hospital output measurement and funding. DRGs are a patient classification scheme which provides a means of relating the type of patients a hospital treats (i.e., its casemix) to the costs incurred by the hospital. This is done by classifying patients into mutually exclusive groups b...