The Medicare home health interim payment system (IPS) implemented in fiscal year 1998 provided very strong incentives for home health agencies (HHAs) to reduce the number of visits provided to each Medicare user and to avoid those beneficiaries whose Medicare plan of care was likely to exceed the average beneficiary cost limit. We analyzed multiple years of data from the Medicare Current Benefi...

Medicare beneficiaries do not have to pay for screening colonoscopies but must pay coinsurance if a polyp is removed via polypectomy. Likewise, beneficiaries do not have to pay for fecal occult blood tests but are liable for cost-sharing for diagnostic colonoscopies after a positive test. Legislative and regulatory requirements related to colorectal cancer screening are described, and on the ba...

In this article, an overview of the Medicare hospice benefit is presented and selected preliminary findings from the Medicare hospice benefit program evaluation are provided. By mid-1987, about one-half of all community home health agency-based hospices were Medicare certified, compared with about one-fifth of all independent/freestanding hospices and one-seventh of hospital and skilled nursing...

Policymakers seeking to slow the growth in Medicare spending are increasingly exploring interventions involving beneficiaries with multiple chronic conditions. These beneficiaries tend to have high rates of hospital admissions and readmissions, making them a key driver of total Medicare spending. Several factors appear to contribute to the high rates of hospitalizations among these patients, in...

This article reviews the history of capitation in the Medicare program and examines issues and research findings related to Medicare capitation. Specific capitation issues and related research findings reviewed include: the feasibility and extent of health maintenance organization participation in Medicare; plan marketing; beneficiary choice behavior; quality of care; and the use and cost of se...

Presented are 1986 data and trend data (1974-86) on the use and cost of home health agency services rendered to aged and disabled Medicare beneficiaries. Since 1974, reimbursements for these services have grown more rapidly than overall Medicare expenditures. From 1974 to 1986, Medicare expenditures for these services increased from $141 million to $1.8 billion, an average annual rate of 24 per...

Medicare policy making now deals mostly with price-setting issues. However, as Warren Buffet has noted: "Price is what you pay. Value is what you get." Victor Fuchs's studies raise fundamental issues for a value-oriented Medicare program. Florida offers one of many regional patterns of Medicare mortality that are not yet adequately explained. Valued-oriented, evidence-based Medicare policies wo...

This article describes some of the available evidence on the impact of the Medicare prospective payment system (PPS) for hospitals during its first year, on hospitals, other payers for inpatient hospital services, other providers of health care, and Medicare beneficiaries. In addition, because the impetus for the enactment of the new system stemmed from concern over the financial status of the ...

This study linked the Iowa Women’s Health Study cohort to Medicare administrative data and assessed the value of using Medicare and survey-based sources to study hip fracture incidence. The authors used Social Security number to combine the Iowa Women’s Health Study cohort Medicare enrollment and claims data for 1986–2004. Hip fractures were identified from Medicare and follow-up-mail, survey-b...

OBJECTIVE To examine the long-term impact of Medicare payment reductions on patient outcomes for Medicare acute myocardial infarction (AMI) patients. DATA SOURCES Analysis of secondary data compiled from 100 percent Medicare Provider Analysis and Review between 1995 and 2005, Medicare hospital cost reports, Inpatient Prospective Payment System Payment Impact Files, American Hospital Associati...