To contain costs and increase incentives for efficient provision of care, prospective payment methods are being proposed for Medicare home health services. Although a shift to per episode payment is much discussed, the methods rely on the home health visit as a fundamental building block in setting rates and ceilings. Some propose setting fixed per visit prices in the interim until episode paym...

Payment reform is a tool to improve the quality and consistency of patient care while also reducing unnecessary costs. Cardiovascular disease draws attention for new payment models primarily because it accounts for >$200 billion in annual spending.1 One such model, Advancing Care Coordination through Episode Payment Models (EPM), was an initiative of the Centers for Medicare and Medicaid Servic...

On October 1, 2015, the United States Centers for Medicare and Medicaid Services (CMS) issued a core measure addressing the care of septic patients. These core measures are controversial among healthcare providers. This article will address that there is no gold standard definition for sepsis, severe sepsis or septic shock and the CMS-assigned definitions for severe sepsis and septic shock are ...

The recent regulatory changes enacted by the Centers for Medicare and Medicaid Services (CMS) have identified hospital readmission rates as a critical healthcare quality metric. This research focuses on the utilization of pay-for-performance (P4P) mechanisms to cost effectively reduce hospital readmission rates and meet the regulatory standards set by CMS. Using the experimental economics labor...

Since 1984 the Centers for Medicare & Medicaid Services (CMS) has sponsored a series of conferences to discuss improvements to national health expenditure account (NHEA) activities. This article summarizes the 2005 conference and highlights changes made since the previous conference, commissioned papers on future directions for NHEA projects, and participant recommendations.

O ur Economists' Voice column summarized the severe problems with the current and proposed Medicare auctions. The column was based on a careful reading and analysis of the auction rules. Since that time we and other auction experts have studied the Medicare auctions with theory, experiment, and the limited amount of field data that the Centers for Medicare and Medicaid Services (CMS) has made a...

IMPORTANCE Starting in 2006, the Centers for Medicare & Medicaid Services (CMS) has restricted coverage of bariatric surgery to hospitals designated as centers of excellence (COE) by 2 major professional organizations. OBJECTIVE To evaluate whether the implementation of the COE component of the national coverage decision was associated with improved bariatric surgery outcomes in Medicare pati...

Medicare's databases provide a rich source of information about the program's 43 million beneficiaries. These data have played an important role in documenting racial, ethnic, and socioeconomic disparities in health and health care. Because they derive largely from administrative records that have been collected over many years using varying standards, however, they are not fully adequate for m...

Gastroenterology and cardiology services are common and costly among Medicare beneficiaries. Episode-based payment, which aims to create incentives for high-quality, low-cost care, has been identified as a promising alternative payment model. This article describes research related to the design of episode-based payment models for ambulatory gastroenterology and cardiology services for possible...

A physician’s role in health care should be to promote affordable quality care for the patient. The importance of this role was exemplified in the final Centers for Medicare and Medicaid Services (CMS) regulation that repealed the requirement for local hospital boards but – to help offset concerns regarding "the importance of physician input at the governing body level" – inserted a requirement...