Hospital payment systems: Will payers like the future better than the past?

Health Affairs

Volumn 25, Issue 1, 2006, Pages 81-93

  Nichols, Len M ^a   O'Malley, Ann S ^b  

^a NEW AMERICA FOUNDATION   (United States)

^b CENTER FOR STUDYING HEALTH SYSTEM CHANGE   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

CONFERENCE PAPER; HEALTH ECONOMICS; HEALTH INSURANCE; REIMBURSEMENT; UNITED STATES;

ECONOMICS, HOSPITAL; INSURANCE, HOSPITALIZATION; REIMBURSEMENT MECHANISMS; UNITED STATES;

EID: 32044456263     PISSN: 02782715     EISSN: 02782715     Source Type: Journal    
DOI: 10.1377/hlthaff.25.1.81     Document Type: Conference Paper

References (33)

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2. Data from the Centers for Medicare and Medicaid Services, National Health Accounts (NHA), 2003, http://www.cras.hhs.gov/statistics/nhe/definitions- sources-methods/default.asp (accessed 13 September 2005). Private insurance pays for 34.4 percent of hospital spending, and we assume that 90 percent of this is from group coverage, since more than 90 percent of private enrollees are in group plans. Medicare, by contrast, pays for 30.3 percent of hospital expenditures.
3. Strunk et al., "Tracking Health Care Costs."
4. Midwest Business Group on Health, with Juran Institute and Severyn Group, Reducing the Costs of Poor-Quality Health Care through Responsible Purchasing Leadership, April 2003, http://www.mbgh.org/templates/User Files/Documents/ CostofPoorQualityReport.pdf (accessed 14 November 2005).
5. See C.P. Tompkins, S.H. Altman, and E. Eilat, "The Precarious Pricing System for Hospital Services," Health Affairs 25, no. 1(2006): 45-56.
6. U.E. Reinhardt, "The Pricing of U.S. Hospital Services: Chaos behind a Veil of Secrecy," Health Affairs 25, no. 1 (2006): 57-69.
7. B.C. Strunk and R.E. Hurley, "Paying for Quality: Health Plans Try Carrots Instead of Sticks," Issue Brief no. 82 (Washington: Center for Studying Health System Change, May 2004).
8. For example, chronic care management expenses associated with diabetes and hypertension can prevent hospitalizations, but not in the one-to-two-year enrollment time frame of the average health plan enrollee.
9. G.P. Mays, R.E. Hurley, and J.M. Grossman, "An Empty Toolbox? Changes in Health Plans' Approaches for Managing Costs and Care," Health Services Research 38, no. 1, Part 2 (2003): 375-393.
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15. In addition to the Exhibit 2 sources, see M.B. Rosenthal et al., "Paying for Quality: Providers' Incentives for Quality Improvement," Health Affairs 23, no. 2 (2004): 127-141. Details on the specific bonuses can be found in a Technical Appendix, online at http://content.healthaffairs.org/cgi/ content/full/25/1/81/DC1.
16. More information on the CMS's Premier Hospital Quality Incentive Demonstration and Hospital Three State Pilot project is at http://www.cms.hhs. gov/quality/hospital (accessed 14 November 2005).
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18. Rosenthal et al., "Paying for Quality";
19. J. Gutman, ed., Case Studies in Health Plan Pay-for-Performance Programs (Washington: Atlantic Information Services Inc., 2004).
20. Rosenthal et al., "Paying for Quality."
21. J. Rivers, Arizona Hospital Association, personal communication, 10 March 2005;
22. G. Rollins, "Management: A Worthy Bonus," Hospitals and Health Networks 78, no. 9 (2004): 32-33.
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25. Leapfrog Compendium, http://www.leapfroggroup.org/leapfrog_compendium (accessed 9 November 2005);
26. Gutman, ed., Case Studies; and individual health plan Web sites.
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28. Authors' calculations based on AHRQ's HCUP online database, http://www.hcup.ahrq.gov/HcupNet.asp (accessed 14 November 2005).
29. Leapfrog Compendium.
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33. P.B. Ginsburg, "Controlling Health Care Costs," New England Journal of Medicine 351, no. 16 (2004): 1591-1593.