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HCMG 1010, Exam 2
Hospitals
| Question | Answer |
|---|---|
| What defines a non-profit hospital? | tax exemptions, but to qualify for tax exemptions must provide "community benefit", cannot distribute profit (no shareholders) |
| What defines a for-profit hospial? | no limitation in ability to enjoy their surplus, but no favorable tax status |
| What does a hospital payment include? | facility related, does not include professional fees for physicians |
| How is hospital per diem payment calculated? | variant of FFS, daily fee that includes everything other than professional fee; all procedures have the same base rate, multiply by total number of days |
| How was Medicare reimbursed to hospitals before 1983 (FFS)? | hospitals would submit list of all services provided and Medicare wold provide the hospital with a fee for each |
| How did Medicare change when switching hospitals to prospective payment system after 1983? | every patient assigned a diagnosis-related group, medicare makes a lump sum payment for that patient based on the DRG |
| Who was at risk after medicare switched to prospective payments? | medicare at risk for number of admissions, hospital t risk for LOS and resources consumed per stay |
| What is upcoding? | code patients in more-lucrative DRGs after medicare switched to prospective payments for hospitals |
| What is stinting? | provide too little care |
| How did hospitals respond when medicare switched to prospective payments? | upcoding, stinting, and cream-skinning |
| What is the goal in a hospital annual budget? | cost control and stability rather than maximizing volume |
| How are public hospitals like VA allocated budgets? | federally appropriated funds are internally allocated |
| How are private hospitals allocated budgets? | MD all-payer global budget model, state regulator gives each hospital a fixed annual revenue cap and approved prices. Hospitals bill FFS) |
| What was the goal of bundled payment programs in Medicare's Comprehensive Care for Joint Replacement? | the bundled payment program was for hip and knee replacement, the goal was to make hospital residual claimant on costs to create incentives to provide care efficiently AND coordinate with downstream providers |
| What was the design of the Medicare Comprehensive Care for Joint Replacement bundled payment program? | designed as mandatory, 5-year, MSA-level randomized trial, fixed amount for entire episode of care, hospital stay + downstream payments post discharge |
| What was the program design in the Medicare Comprehensive Care for Joint Replacement bundled payment program? | eligible MSAs randomized into participation, control MSA hospitals continue to be paid under status quo, episode begins with a hospital stay with a discharge diagnosis, ends 90 days after discharge |
| How were the bundled payments for Comprehensive Care for Joint Replacement given to hospitals | At the end of the year, hospitals get shared savings if per episode Medicare spending is below target price AND met minimum quality standard. Or else, pay the difference (to stop loss) |
| What were the results from the Comprehensive Care for Joint Replacement bundled payment program? | initial evaluation shows decrease in discharge to institutional post-acute care, BUT not a decrease in Medicare spending |
| Why are mandatory participation controversial? | CJR was the first AND only mandatory participation APM, politically costly, providers to not like to be forced to change how they do things |
| When is voluntary participation more likely? | for hospitals that can increase revenue without changing behavior, and for hospitals that had large changes in behavior when participation was mandatory |
| How would voluntary designs benefit based on targeted reimbursement to hospitals claim level? | if targeted reimbursement is UNDER fee for service status quo, BUT fewer hospitals would also participatee |
| What are three things to incentivize quality in healthcare? | care about the outcomes, not specific procedures, difficult because outcomes are hard to measure, put money at stake for perfomance/quality measures |
| Why is readmissions a good thing to improve on | any unplanned admission to any hospital within 30 days after discharge regardless of the reason for the new admission. there is now Medicare Hospital Readmissions Reduction Program - penalize hospitals by adjusting down ALL medicare admission payments |
| What are the details of the hospital readmissions reduction program by Medicare? | hospitals penalized if risk-adjusted readmission rate was greater than national average during benchmark setting period |
| What were the results of the hospital readmissions reduction program by Medicae? | readmit lower proportion of own patients returning within 30 days; accounts for 40-45% of the decrease in readmission |
| What is one group of patients that are negatively affected by readmission penalities | socially vulnerable patients because readmission penalties penalize hospitals for caring for them (more likely to be readmitted) |
Created by:
goldengalleon