• Bending the Healthcare Cost Curve
    plans or Medicare to require and pay for these services . An additional potential barrier is the current reimbursement policy, which only allows physicians and nurse practitioners to bill directly for services, which could limit reimbursement for and expansion of shared decision making programs that...
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  • Effects of Health Care
    Medicare beneficiaries. 2. The Health Reform Law extends the PQRI program through 2014. For 2011, incentive payments would equal 1.0 percent and 0.5 percent for 2012, 2013, and 2014. 3. The Law also provides an additional 0.5 percent payment bonus to physicians who successfully report...
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  • Leveraging the Synergies of Advanced Placement
    models that include enhanced fees for services, case management fees, and pay-for-performance/incentive payments. • Rationale: On July 1, 2010, the New York State Medicaid program began offering incentive payments to office-based practices recognized by NCQA as Physician Practice Connections...
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  • mission
    (Plan), execute the test (Do), observe and learn from the results (Study), and determine potentialQuality initiatives are large undertakings and require investments in staff, training and technology. Quality improvement programs often do save money, though savings may not appear in the initial...
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  • Costich Final Exam 2012
    demand for PCP training vs. specialty training. 3. Optimal patient compliance with physician guidance could raise or lower medical expenses. Explain both potential outcomes (6) Non-compliant patients tend to continue smoking, eating poorly, and limit exercise. These activities lead to worse...
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  • Healthcare Reform
    participation within the program surround the core concepts to achieve better care for individuals, better health for populations and lower expenditures for Medicare, in other words the Triple Aim. Two payment options are available for shared savings. ACOs can either assume a smaller share of upside gain...
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  • Value Based Insurance Design: Embracing Value over Cost Alone. American Journal of Managed Care. Vol 15, #10. December 2009
    found eligible to participate in a DM program. WellPoint offers this format.38 4. Design by participation. An extension of the third design approach, payment relief is offered to high-risk members who actively participate in a DM or similar incentive program. Gulfstream offered reduced office visit...
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  • Professor Lewer Assignment
    Americans, especially members of disenfranchised groups that have traditionally suffered from poor health outcomes. Do you see any positive/negative incentives being created? Positive. Medicaid and Medicare rewards hispitals that improve patients outcomes under a “Pay for Performance” concept. The...
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  • Dissertation
    consistent with the content of that project but offers some insights into potential cost savings for Medicare from making such investments.) • In the case of self-insured employers, particularly those with a large fee-for-service component, the incentives to implement programs such as the one...
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  • Affordable Health Reforms Act
    the Health Care Delivery System PART 1—LINKING PAYMENT TO QUALITY OUTCOMES UNDER THE MEDICARE PROGRAM Sec. 3001. Hospital Value-Based purchasing program. Sec. 3002. Improvements to the physician quality reporting system. Sec. 3003. Improvements to the physician feedback program. Sec. 3004. Quality...
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  • publication
    encouraging use of IT. By rewarding a quality product, Medicare, in its purchaser role, could provide incentives for providers to adopt the technology necessary to improve quality. Other strategies include increased payment for use of certain forms of health IT and increased reporting on quality...
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  • Ertetet
    patients under the physician’s care. The anti-kickback statute prohibits payments to reward referrals of patients participating in federal health care programs. The Stark laws prevent physicians from referring Medicare and Medicaid patients for health services from entities in which physicians...
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  • Australian Healthcare
    physicians are learning how to participate in the program, extra participation bonus should be provided to encourage the uptake while performance incentives could be modest; however, overtime, performance related components should be increased. ...
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  • Business Administration
    taxes from employers and employees. Medicare Part B (Table 2–3) insures the elderly for physician services and is paid for by federal taxes and monthly premiums from the beneficiaries (http://www.medicare.gov). Medicaid (Table 2–4) is a program run by the states that is funded by federal and state...
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  • Electronic Medical Record Implementation: Costs and Benefits
    program (DHHS, 2009).” In addition, it will be necessary to provide education to eligible participants to facilitate their understanding of all the conditions and guidelines regarding their eligibility, the selection of Medicare or Medicaid incentive programs, the incentive payments, and the...
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  • Healthcare Reform
    result in a 21-percent cut in payments beginning on January 1, 2010. According to a recent survey by the American Medical Association, 60 percent of physicians report that, if Medicare payments are cut by even half that amount (or 10 percent), they will reduce the number of new Medicare patients they...
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  • Long Term Care
    Resource Based Relative Value Scale (RBRVS) developed by researchers from Harvard University for the Health Care Financing Administration, now called CMS. (1) What have been the results of this method of financing to both physicians and to Medicare? (2) What impact does this reimbursement system have...
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  • Health Information Technology
    requires participation in Medicare and Medicaid programs. Slide 17 Stark law is named after Congressman Pete Stark, who introduced the first of the three relevant bills that have been passed. These laws address the concerns that Congress has about physicians referring patients to laboratories and...
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  • Incentives
    physicians to economic incentives inherent in payment mechanisms appears to follow directions expected in theory. Incentive structures are becoming more complex, however, as a result of managed care and blended payment mechanisms. There is insufficient evidence of the effects of incentives on...
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  • Kot Task 2
    continued treatment after discharge due to the patient's condition and was discharged to a skilled nursing facility. To determine what coverage Mrs. Zwick will receive from Medicare Part A, one must look at the coverage requirements. Due to a stroke, the patient was admitted inpatient and needed...
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