Medicare and Beneficiaries Pay More for Preadmission Services at Affiliated Hospitals Than at Wholly Owned Settings
Provides an overview of the Medicare diagnosis-related group (DRG) window policy. Examines how much Medicare and Medicare beneficiaries paid affiliated settings, including Critical Access Hospitals, for admission-related outpatient services in 2019 that would have otherwise been covered by the DRG policy at wholly-owned hospitals. Offers recommendations to the Centers for Medicare & Medicaid Services (CMS) for updating the DRG policy.
Date: 12/2021 Type: Document Sponsoring organization: Office of Inspector General (HHS) view details
Overview of Major Ambulatory Surgeries Performed in Hospital-Owned Facilities, 2019
Presents data on major ambulatory surgeries performed in hospital-owned facilities using the 2019 Nationwide Ambulatory Surgery Sample (NASS). Includes statistics on ambulatory surgeries by patient and hospital characteristics, including age, community income, patient and hospital location, and primary expected payer.
Date: 12/2021 Type: Document Sponsoring organization: Agency for Healthcare Research and Quality view details
December 2021 MedPAC Meeting Transcript
Transcript from the Medicare Payment Advisory Commission's (MedPAC) December 2021 meeting. Covers payment adequacy and updates for hospital
inpatient and outpatient services and the mandated report on changes to the low-volume
hospital payment adjustment, physician and other health professional services, ambulatory surgical center services, outpatient dialysis services, and hospice services. Highlights the effect of COVID-19 relief funding on rural hospital margins, rural hospital bypass, and rural hospice payment utilization, among other rural references.
Date: 12/2021 Type: Document Sponsoring organization: Medicare Payment Advisory Commission view details
Examining Rural Hospital Bypass for Outpatient Services
Explores the drivers of rural hospital bypass for outpatient services and the relationship between hospital outpatient services and inpatient utilization. Examines demographic and market characteristics associated with bypass for outpatient services before and after inpatient admissions. Also analyzes how utilization for common outpatient services differs between Critical Access Hospitals (CAHs) and rural prospective payment system (PPS) hospitals.
Date: 11/2021 Type: Document Sponsoring organization: Centers for Medicare and Medicaid Services view details
Medicare Payment Basics: Outpatient Dialysis Services Payment System
Overview of Medicare payment methods for outpatient dialysis services of beneficiaries with end-stage renal disease (ESRD). Describes the base payment rate for freestanding and hospital-based facilities and identifies facility-level adjustments, including facilities located in rural areas.
Date: 11/2021 Type: Document Sponsoring organization: Medicare Payment Advisory Commission view details
Trends in Outpatient Telemedicine Utilization Among Rural Medicare Beneficiaries, 2010 to 2019
Examines the growth of telehealth utilization among rural Medicare beneficiaries between 2010-2019. Compares telehealth use across beneficiaries with a severe mental illness diagnosis, other mental health diagnoses, and with no mental health diagnoses. Describes trends for mental health versus non-mental health visits and across clinician specialties. Presents data on rural Medicare beneficiary characteristics with and without a telemedicine visit in 2019, including age, race and ethnicity, sex, U.S. Census division, and more.
Author(s): Michael L. Barnett, Haiden A. Huskamp, Alisa B. Bush, et al. Citation: JAMA Health Forum, 2(10), e213282 Date: 10/2021 Type: Document view details
Medicare Covers a Lower Percentage of Outpatient Costs in Hospitals Located in Rural Areas
Policy brief describing differences in Medicare Outpatient Prospective Payment System (OPPS) payments between urban and rural hospitals. Features statistics on OPPS payments as a percent of total net patient revenue, as a percent of Medicare outpatient cost by hospital payment classification, and as a percent of Medicare outpatient cost by number of acute beds, with breakdowns by urban and rural location.
Author(s): Pranathi Sana, George H. Pink Date: 09/2021 Type: Document Sponsoring organization: North Carolina Rural Health Research Program view details