医院协会批评对医疗保健(Medicare)付费的建议(上)
NEW YORK (Reuters Health) - American hospitals expect to receive about $1 billion less next year for Medicare outpatient services, if guidelines established Wednesday by the Centers for Medicare & Medicaid Services (CMS) are approved by Congress.
The CMS, a unit of the US Department of Health and Human Services, recommended that hospitals gain a 2.3% overall increase for Medicare outpatient services effective January 1, 2002. CMS estimates payments for outpatient services will total $17.5 billion in 2002.
However, the CMS recommendations were crafted under the year-old Outpatient Prospective Payment System (OPPS) that will "fold in" and combine two reimbursement programs, according to Carmela Coyle, a senior vice president for policy at the American Hospital Association (AHA). The net effect of the recommendations could be a potential $1 billion shortfall in payments to hospitals, said Coyle.
Hospitals receive most of their payments for outpatient services via base payment rates defined by ambulatory payment classifications (APCs), which cover outpatient services that are clinically similar and require comparable resources.
The OPPS in 2001 also includes pass-through payments for certain high-cost drugs, devices and biological treatments to complement the APCs. The drug and device pass-through payments are temporary, according to the CMS, and were intended to make up the difference between the cost of older technology and the cost of new items which have not yet been incorporated into the APC system.
Another group of services, described as the outpatient "outlier" pool, was part of the 2001 OPPS to cover the cost of treating outpatients who incurred extraordinarily high treatment costs.
CMS has recommended folding in 75% of the drug and device pass-through payments into all of the APC payments in 2002. By the following year, 100% of the costs would be absorbed into the APCs., 百拇医药
The CMS, a unit of the US Department of Health and Human Services, recommended that hospitals gain a 2.3% overall increase for Medicare outpatient services effective January 1, 2002. CMS estimates payments for outpatient services will total $17.5 billion in 2002.
However, the CMS recommendations were crafted under the year-old Outpatient Prospective Payment System (OPPS) that will "fold in" and combine two reimbursement programs, according to Carmela Coyle, a senior vice president for policy at the American Hospital Association (AHA). The net effect of the recommendations could be a potential $1 billion shortfall in payments to hospitals, said Coyle.
Hospitals receive most of their payments for outpatient services via base payment rates defined by ambulatory payment classifications (APCs), which cover outpatient services that are clinically similar and require comparable resources.
The OPPS in 2001 also includes pass-through payments for certain high-cost drugs, devices and biological treatments to complement the APCs. The drug and device pass-through payments are temporary, according to the CMS, and were intended to make up the difference between the cost of older technology and the cost of new items which have not yet been incorporated into the APC system.
Another group of services, described as the outpatient "outlier" pool, was part of the 2001 OPPS to cover the cost of treating outpatients who incurred extraordinarily high treatment costs.
CMS has recommended folding in 75% of the drug and device pass-through payments into all of the APC payments in 2002. By the following year, 100% of the costs would be absorbed into the APCs., 百拇医药