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The authors studied the ratio of costs to charges (RCC) used to estimate the cost of Medicare hospital cases in the formula which sets cost outlier payments. The authors estimate that, under current payment policy, the cost of the average cost outlier case is overestimated by 23 percent. The causes of this overestimate are a secular decline in RCC of between 2 and 3 percent a year and the fact that cost outlier cases typically receive a higher percentage of ancillary charges that have a very low actual RCC. The inaccurate estimate of the cost of cost outlier cases contravenes current policy intent in two important ways. First, it changes the fraction of the excess costs that are insured from the intended 75 percent to 92 percent. Secondly, cases face different cost outlier thresholds, and therefore receive different payment amounts, depending on the mix of ancillary and accommodation services required by the patient. It would be possible to improve the measurement of the cost of cost outlier cases by using separate RCCs for ancillary and accommodation charges. The outcomes of alternative policies are estimated in the report.

Medicare. --- Hospitals --- Outliers, DRG --- Prospective Payment System --- Prospective payment --- economics

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Under the prospective payment system (PPS) introduced in 1983, hospitals are to be paid for each Medicare admission on the basis of a price per case set in advance, thus giving hospitals and other providers incentives for delivering care that are radically different from those of cost-reimbursement financing. This report identifies major issues relating to quality of care, sketches conceptual and practical aspects of carrying out appropriate studies of these issues, and outlines a quality-of-care research agenda. It emphasizes changes in hospital care that are most likely to occur secondary to PPS, those likely to have the most direct impact on patients' outcomes, and changes that can be defined, detected, and measured with relative ease. Certain themes for future research efforts are stressed: (1) the overall research agenda must be strong enough to detect clinically meaningful impacts on patient outcomes and to be able to assign those impacts to PPS; (2) outcomes other than death must be examined; (3) interpreting the impacts of PPS requires understanding the clinical circumstances of Medicare patients; (4) developing better outcome measures is essential; (5) targeting impact studies on high-priority topics will be unavoidable; and (6) a full picture of the effects of PPS requires a long-term perspective, extending beyond FY 1987.

Hospitals --- Older people --- Medical care --- Medicare. --- Health Services Research. --- Quality of Health Care --- Reimbursement, Prospective. --- Prospective payment --- Hospital care --- Quality control. --- economics. --- Health Insurance for Aged and Disabled, Title 18. --- United States. --- Prospective Payment System.

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health care system.

Managed Care Programs --- Health Policy --- Costs and Cost Analysis --- Prospective Payment System --- Medicare --- Hospitals --- Medical care, Cost of --- Medicare. --- Health insurance --- Older people --- Medicaid --- Medigap --- Health care policy --- Health policy --- Medical care --- Medicine and state --- Policy, Medical --- Public health --- Public health policy --- State and medicine --- Science and state --- Social policy --- economics --- economics. --- Prospective payment --- Claims administration --- Government policy

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This report details the analyses that RAND performed to support the Health Care Financing Administration's efforts to design, develop and implement the Prospective Payment System for inpatient rehabilitation.

Hospitals. --- Hospitals - Rehabilitation services - Prospective payment - United States. --- Hospitals --- Inpatients --- Prospective Payment System --- Rehabilitation Centers --- Reimbursement Mechanisms --- Health Facilities --- Patients --- Persons --- Health Care Facilities, Manpower, and Services --- Insurance, Health, Reimbursement --- Health Care --- Financing, Organized --- Named Groups --- Economics --- Health Care Economics and Organizations --- Hospitals & Medical Centers --- Public Health --- Health & Biological Sciences --- Rehabilitation services --- Prospective payment --- Healthcare Economics and Organizations --- Capital --- Conditions, Economic --- Consumption --- Cost of Living --- Easterlin Hypothesis --- Economic Conditions --- Economic Factors --- Economic Policies --- Economic Policy --- Economics, Home --- Factors, Economic --- Home Economics --- Household Consumption --- Macroeconomic Factors --- Microeconomic Factors --- Policies, Economic --- Policy, Economic --- Production --- Remittances --- Utility Theory --- Consumer Price Index --- Condition, Economic --- Consumer Price Indices --- Consumption, Household --- Economic Condition --- Economic Factor --- Factor, Economic --- Factor, Macroeconomic --- Factor, Microeconomic --- Factors, Macroeconomic --- Factors, Microeconomic --- Household Consumptions --- Hypothesis, Easterlin --- Index, Consumer Price --- Indices, Consumer Price --- Living Cost --- Living Costs --- Remittance --- Theories, Utility --- Theory, Utility --- Utility Theories --- Community Financing --- Grants --- Organized Financing --- Financing, Community --- Grant --- Community-Based Distribution --- Contraceptive Distribution --- Delivery of Healthcare --- Dental Care Delivery --- Distribution, Non-Clinical --- Distribution, Nonclinical --- Distributional Activities --- Healthcare --- Healthcare Delivery --- Healthcare Systems --- Non-Clinical Distribution --- Nonclinical Distribution --- Delivery of Dental Care --- Health Care Delivery --- Health Care Systems --- Activities, Distributional --- Activity, Distributional --- Care, Health --- Community Based Distribution --- Community-Based Distributions --- Contraceptive Distributions --- Deliveries, Healthcare --- Delivery, Dental Care --- Delivery, Health Care --- Delivery, Healthcare --- Distribution, Community-Based --- Distribution, Contraceptive --- Distribution, Non Clinical --- Distributional Activity --- Distributions, Community-Based --- Distributions, Contraceptive --- Distributions, Non-Clinical --- Distributions, Nonclinical --- Health Care System --- Healthcare Deliveries --- Healthcare System --- Non Clinical Distribution --- Non-Clinical Distributions --- Nonclinical Distributions --- System, Health Care --- System, Healthcare --- Systems, Health Care --- Systems, Healthcare --- Third-Party Payers --- Health Insurance Reimbursement --- Reimbursement, Health Insurance --- Third-Party Payments --- Health Insurance Reimbursements --- Insurance Reimbursement, Health --- Insurance Reimbursements, Health --- Payer, Third-Party --- Payers, Third-Party --- Payment, Third-Party --- Payments, Third-Party --- Reimbursements, Health Insurance --- Third Party Payers --- Third Party Payments --- Third-Party Payer --- Third-Party Payment --- Healthcare Facilities, Manpower, and Services --- Person --- Clients --- Client --- Patient --- Facilities, Health --- Facility, Health --- Health Facility --- Mechanism, Reimbursement --- Mechanisms, Reimbursement --- Reimbursement Mechanism --- Centers, Rehabilitation --- Center, Rehabilitation --- Rehabilitation Center --- Adjustment, Discretionary --- Discretionary Adjustment Factor --- Prospective Pricing --- Prospective Reimbursement --- Reimbursement, Prospective --- Adjustment Factor, Discretionary --- Adjustment Factors, Discretionary --- Adjustments, Discretionary --- Discretionary Adjustment --- Discretionary Adjustment Factors --- Discretionary Adjustments --- Factor, Discretionary Adjustment --- Factors, Discretionary Adjustment --- Payment System, Prospective --- Payment Systems, Prospective --- Pricing, Prospective --- Prospective Payment Systems --- Prospective Reimbursements --- Reimbursements, Prospective --- System, Prospective Payment --- Systems, Prospective Payment --- Inpatient --- Benevolent institutions --- Infirmaries --- Health facilities --- Prospective Payment System. --- Inpatients. --- economics. --- United States.

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This revised edition of Basics of PET Imaging presents an unparalleled text on the basics of PET imaging technology. Distinguished author, Dr. Gopal B. Saha, has updated his previous bestselling work with concise chapters on PET fundamentals, including: Basic physics Instrumentation and data acquisition Production of PET radionuclides Performance characteristics of PET scanners Regulatory and reimbursement issues To maximize understanding, and to help technologists and residents prepare for board exams, chapters include pertinent basic science and equations along with sample problems and practice questions. The remarkable combination of Dr. Saha’s brevity and clarity of content once again makes this edition an ideal reference book for nuclear medicine professionals interested in the basics of PET imaging.

Medicine. --- Nuclear medicine. --- Radiology, Medical. --- Tomography, Emission --- Medical physics --- Allied Health Occupations --- Image Enhancement --- Radionuclide Imaging --- Reimbursement Mechanisms --- Tomography --- Indicators and Reagents --- Image Interpretation, Computer-Assisted --- Investigative Techniques --- Technology --- Tomography, Emission-Computed --- Radiopharmaceuticals --- Technology, Radiologic --- Prospective Payment System --- Diagnostic Techniques, Radioisotope --- Diagnostic Imaging --- Laboratory Chemicals --- Technology, Industry, and Agriculture --- Analytical, Diagnostic and Therapeutic Techniques and Equipment --- Insurance, Health, Reimbursement --- Photography --- Health Occupations --- Diagnostic Techniques and Procedures --- Disciplines and Occupations --- Technology, Industry, Agriculture --- Financing, Organized --- Specialty Uses of Chemicals --- Diagnosis --- Economics --- Chemical Actions and Uses --- Health Care Economics and Organizations --- Chemicals and Drugs --- Health Care --- Medicine --- Radiology, MRI, Ultrasonography & Medical Physics --- Health & Biological Sciences --- Tomography, Emission. --- Medical physics. --- Health physics --- Health radiation physics --- Medical radiation physics --- Radiotherapy physics --- Radiation therapy physics --- Computerized emission tomography --- Emission tomography --- PET (Tomography) --- PET-CT (Tomography) --- Positron emission tomography --- Positron emission transaxial tomography --- Radionuclide tomography --- Scintigraphy, Tomographic --- Tomography, Radionuclide --- Radiology. --- Medicine & Public Health. --- Nuclear Medicine. --- Imaging / Radiology. --- Biophysics --- Physics --- Diagnostic imaging --- Positrons --- Radioisotope scanning --- Data processing --- Emission --- Clinical radiology --- Radiology, Medical --- Radiology (Medicine) --- Atomic medicine --- Radioisotopes in medicine --- Medical radiology --- Radioactive tracers --- Radioactivity --- Physiological effect --- Radiological physics --- Radiation