Problem
Health care organizations such as Choice Hospital must keep up to date with new initiatives related to reimbursement by third-party payers for services provided. This is especially true for Medicare reimbursement and initiatives tied to legislation such as the Affordable Care Act and the 21st Century Cures Act.
You are working with the chief financial officer and his team on two types of statistics related to Medicare reimbursement initiatives:
• Medicare spending per beneficiary (MSPB)
• Hospital readmission rates
You will be working with the finance team to prepare a presentation for the CEO and executive leadership team to help them understand these requirements. Cite at least 2 scholarly reference articles or government publications that were published within the last 3-5 years.
A. Describe what the Medicare program or initiative that uses the statistic?
B. Is it an incentive- or penalty-type program related to the rate of Medicare reimbursement?
C. Are the statistics and the program or initiative tied to performance, for example improving quality of care? If so, how?
D. Which legislation is authorizing the Centers for Medicare and Medicaid Services (CMS) to initiate these programs?
- what is the statistic and how is it calculated?
What are some examples of these statistics from publications or government sites?
For many of the CMS initiatives, data for health care institutions is made available through the CMS Hospital Compare Web site.