In this report we present newly developed measures of Medicare expenditures at the hospital referral region level for 2003 to 2008. These estimates reflect a larger sample of Medicare beneficiaries than our past estimates: 20% of the fee-for-service population instead of a 5% sample as in the previous data series. These rates rely on the actual Medicare claims files rather than the Continuous M...

OBJECTIVE To identify factors associated with the cost of treating high-cost Medicare beneficiaries. DATA SOURCES A national sample of 1.6 million elderly, Medicare beneficiaries linked to 2004-2005 Community Tracking Study Physician Survey respondents and local market data from secondary sources. STUDY DESIGN Using 12 months of claims data from 2005 to 2006, the sample was divided into pre...

As the first step in a pioneering effort by the Health Care Financing Administration (HCFA) to measure interstate border crossing for services used by both Medicare and non-Medicare beneficiaries, the authors study the spending behavior of Medicare beneficiaries for 10 Medicare-covered services. Based on interstate flow-of-expenditure data developed for calendar year 1991, the authors analyze t...

The Department of Health & Human Services’ Centers for Medicare and Medicaid Services (CMS) has approved the continuation of deeming authority for The Joint Commission’s hospital accreditation program through July 15, 2014. The CMS designation means that hospitals accredited by The Joint Commission may choose to be “deemed” as meeting Medicare and Medicaid certification requirements. CMS found ...

In this article Bruce Vladcck helps Catholic providers get ready for a new era in Medicaremanaged care—and he explains what the Health Care Financing Administration is doing to improve Medicare in the changing healthcare environment. A series of CHA -sponsored regional meetings will also prepare CHA members for changes in Medicare and Medicaid. Sec William J. Cox's companion article on p. 29 an...

In July 2003, Premier, Inc. and the Centers for Medicare and Medicaid Services (CMS) launched the Hospital Quality Incentive Demonstration Project (HQI), a three-year program designed to determine if financial incentives are effective at improving the quality of inpatient care. In the demonstration, CMS will measure performance and pay incentives to participating hospitals that achieve superior...

Marian Gornick is Director, Division of Beneficiary Studies, in the Office of Research, Health Care Financing Administration. She has been involved in research studies relating to Medicare and Medicaid since the programs were first implemented. Jay N. Greenberg is on the faculty of the Heller Graduate School, Brandeis University. Dr. Greenberg serves as the Associate Director for Research of th...

The Emergency Medical Treatment and Active Labor Act (EMTALA) was passed by the US Congress in 1986 as part of the Consolidated Omnibus Reconciliation Act (COBRA), much of which dealt with Medicare issues. The law’s initial intent was to ensure patient access to emergency medical care and to prevent the practice of patient dumping, in which uninsured patients were transferred, solely for financ...

Since publication of the Centers for Medicare and Medicaid Services (CMS) Conditions of Participation Final Rule in 2007, there has been dual regulation of transplant centers by the Organ Procurement and Transplantation Network (OPTN) contractor the United Network for Organ Sharing (UNOS) and CMS. Herein, we summarize the environment leading to the development of the present regulatory framewor...

The Centers for Medicare and Medicaid Services (CMS) has developed a set of regulations that spell out the Conditions of Participation (CoPs) for provider hospitals that wish to be certified (and thus eligible for reimbursement) by Medicare for transplant services. The American Society of Transplant Surgeons (ASTS) Council has played a major role in providing CMS with advice and guidance in the...