Health Care Financing Review

Publication covering business and finance issues in the health care industry.

Articles from Vol. 24, No. 4, Summer

Administrator's Decisions
Under Section 1878(f) of the Social Security Act, as amended, a Provider Reimbursement Review Board (PRRB) decision is final unless the Secretary of Health and Human Services, on his own motion, and within 60 days after the provider is notified of...
End Stage Renal Disease and Medicare
INTRODUCTION Since 1972 all persons with end stage renal disease (ESRD) eligible for Social Security are entitled to all Medicare benefits, regardless of age. ESRD patients need continual renal replacement therapy to survive. Although only 1 percent...
ESRD Managed Care Demonstration: Financial Implications
INTRODUCTION The intent of the ESRD demonstration was to determine whether an extension of an integrated, capitated system of care to ESRD beneficiaries would be operationally feasible, efficient, and able to produce outcomes comparable to the current...
Evaluation of the ESRD Managed Care Demonstration Operations
INTRODUCTION The ESRD population in the U.S. represents the only outright disease-specific form of Medicare eligibility. (1) All persons with ESRD, subject to Social Security requirements, are eligible for Medicare regardless of age. ESRD patients,...
Growth in Residential Alternatives to Nursing Homes: 2001
INTRODUCTION Demographic projections made in the 1980s suggested that the aging of the population would produce a surge in the number of persons needing long-term facility care as we approached the year 2000. Based on the existing stock of nursing...
Improving the Care of ESRD Patients: A Success Story
INTRODUCTION The adequacy of hemodialysis and the management of anemia in the U.S. ESRD population have improved dramatically in the last decade, partially in response to a program initiated by the Federal Government in collaboration with physicians...
Is Case-Mix Adjustment Necessary for an Expanded Dialysis Bundle?
INTRODUCTION Currently, the Medicare outpatient PPS pays a fixed amount for a limited bundle of routine, dialysis-related services, known as the composite rate (CR). Dialysis facilities are allowed to bill Medicare separately for other covered services...
Measuring Beneficiary Knowledge of the Medicare Program: A Psychometric Analysis
INTRODUCTION Given the increasing variety of health insurance options available to Medicare beneficiaries, it is of vital importance that beneficiaries sufficiently understand the tradeoffs associated with their different insurance options so they...
Patient Selection in the ESRD Managed Care Demonstration
INTRODUCTION The notion of preferable or favorable patient selection into Medicare HMOs is not new. Indeed, abundant evidence accumulated over the past two decades has helped illuminate the phenomenon whereby those Medicare beneficiaries who choose...
Potential Organ-Donor Supply and Efficiency of Organ Procurement Organizations
INTRODUCTION Although over 70,000 Americans awaited a solid organ transplant in 2000, only 22,953 transplants were performed (United Network for Organ Sharing, 2003). It is generally believed that this disparity is due to the inability of the organ...
Prescription Drug Use in the Elderly: A Descriptive Analysis
BACKGROUND Payment for pharmaceutical therapy in the elderly has become a central policy debate but has been poorly informed by data on actual drug use in this population. The research literature has focused almost exclusively on cost and payment...
Quality of Life and Patient Satisfaction: ESRD Managed Care Demonstration
INTRODUCTION It has been postulated that an MCP can provide better and more comprehensive health care at a lower cost (Starr, 2000). However, it has also been stated that the main disadvantage of MCPs is the restrictive nature of their health care...