Question

How has Medicare hospital payment changed over time? Discuss one of the new forms of Medicare payment for hospitals and how it would affect cost and quality.

Answer 1

• Medicare is a health insurance programme for people age 65 or older
• aged under 65 with disabilities
• People of all ages with ESRD ( Permanent kidney damage)
• It is divided into 3 parts. One is Hospital insurance ( Inpatients care), Medical Insurance ( doctors services and outpatient cares), Prescription drug coverage.
• Medicare also involves in physician self referral, Physician value based payment modifier, Self referral disclosure protocol and medicare shared savings program
• A new payment system is prospective payment system ( PPS)
• The payment in this system is fixed regardless of the intensity of actual service provided
• PPS will activate only if the patient consult with a physician or other doctors. A patient who consulted a nurse in the ER and left without consulting a physician is not eligible for PPS payment
• PPS service is divided according to the classification of the system
• The seperate fixed system for PPS are given below
• Acute inpatient PPS
• Home health PPS
• Hospice center
• Inpatient Psychiatric facility PPS
• Inpatient rehabilitation facility PPS
• Long term care hospital PPS
• Skilled Nursing facility PPS
• All Fee-For-Service providers
• Inpatient PPS PC Pricer
• FQHC PPS