As the struggle to halt healthcare costs continues, Maryland has uniquely managed to contain hospital reimbursement.
The Center for Studying Health System Change's visits to 12 metropolitan communities found that hospitals are using their clout to command high payment rate increases from private insurers.
Provider consolidation, lower Medicare and Medicaid reimbursements, and post-recession stress will combine to increase healthcare costs by 8.5% in 2012, according to a new study.
Comparative effectiveness research will take a more prominent role in payer policies as the Patient-Centered Outcomes Research Institute drives research efforts.
Real-time, on-site claims processing will become as common as point-of-service transactions in other industries.
There's a large gap in private insurer inpatient payment rates among regions, with Miami-South Florida averaging 147% of Medicare rates, while San Francisco came in at 210%
The goal of Comparative Effectiveness Research appears to be something that everyone can agree on
Controversy continues to swirl around Medicare's two-year-old policy of not paying for what it considers preventable hospital-acquired condtions. CMS has decided for now not to expand its list of 12 serious adverse events for which it does not reimburse hospitals.
There seems to be a growing consensus among healthcare stakeholders that despite new reforms, something still has to give in the way care is delivered. Episode-based payment may be a viable solution. It is an intermediate step between fee-for-service, which historically leads to overuse or underuse of services depending on reimbursement, and capitalization, which moves all the risk to the provider.
In a move toward accountable care, the Blue Cross and Blue Shield Assn. (BCBSA) has established a policy that denies acute care hospitals reimbursement for certain never events.