Sample records for fr22jy10n medicare program
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2012-04-18
..., 413, and 495 [CMS-0044-CN] RIN 0938-AQ84 Medicare and Medicaid Programs; Electronic Health Record... proposed rule entitled ``Medicare and Medicaid Programs; Electronic Health Record Incentive Program--Stage... (77 FR 13698), the proposed rule entitled ``Medicare and Medicaid Programs; Electronic Health Record...
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2011-09-26
... [CMS-1351-CN] RIN 0938-AQ29 Medicare Program; Prospective Payment System and Consolidated Billing for... rule entitled ``Medicare Program; Prospective Payment System and Consolidated Billing for Skilled... Payment System (PPS) final rule (76 FR 48486, 48540) inadvertently included several technical errors in...
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2012-02-21
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-9069-N] Medicare and Medicaid Programs; Quarterly Listing of Program Issuances--October Through December 2011 AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Notice. SUMMARY: This quarterly...
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2010-02-24
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-1566-CN... 22, 2010 (75 FR 3743), there were a number of technical errors that are identified and corrected in... telephone at the number listed in the FOR FURTHER INFORMATION CONTACT section of this notice by the date...
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2012-07-27
...] Medicare Program; Application by the American Association of Diabetes Educators (AADE) for Continued... Register (77 FR 11130) entitled, ``Application by the American Association of Diabetes Educators (AADE) for... Notice. SUMMARY: This final notice announces the approval of an application from the American Association...
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2013-12-02
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-6051-N] Medicare, Medicaid, and Children's Health Insurance Programs; Provider Enrollment Application Fee Amount... period entitled ``Medicare, Medicaid, and Children's Health Insurance Programs; Additional Screening...
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2011-06-14
..., 413, and 476 [CMS-1518-CN] RIN 0938-AQ24 Medicare Program; Proposed Changes to the Hospital Inpatient...-9644 of May 5, 2011 (76 FR 25788), there were a number of technical and typographical errors that are...) endorsement number for the CMS quality measure, Percent of Residents With Pressure Ulcers That Are New or...
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2012-04-20
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-1442-N... regulatory philosophy and principles identified in Executive Order 12866 and 13563, the RFA, and section 1102.... Kathleen Sebelius, Secretary, Department of Health and Human Services. [FR Doc. 2012-9598 Filed 4-19-12; 8...
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2011-04-15
...] Medicare Program; Solicitation for Proposals for the Medicare Community-Based Care Transitions Program... interested parties of an opportunity to apply to participate in the Medicare Community-based Care Transitions.... 111-148, enacted on March 23, 2010) (Affordable Care Act) authorized the Medicare Community-based Care...
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75 FR 67751 - Medicare Program: Community-Based Care Transitions Program (CCTP) Meeting
2010-11-03
...] Medicare Program: Community-Based Care Transitions Program (CCTP) Meeting AGENCY: Centers for Medicare... guidance and ask questions about the upcoming Community-based Care Transitions Program. The meeting is open... conference will also provide an overview of the Community-based Care Transitions Program (CCTP) and provide...
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2012-05-18
...] Medicare Program; Solicitation for Proposals for the Medicare Graduate Nurse Education Demonstration... participate in the Medicare Graduate Nurse Education (GNE) Demonstration. DATES: Proposals will be considered...--(A) 1 or more applicable schools of nursing; and (B) 2 or more applicable non- hospital community...
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76 FR 19527 - Medicare Program; Medicare Shared Savings Program: Accountable Care Organizations
2011-04-07
...). Under these provisions, providers of services and suppliers can continue to receive traditional Medicare... Plans and Integration of Community Resources 11. ACO Marketing Guidelines 12. Program Integrity... the Institute of Medicine report: Safety, effectiveness, patient-centeredness, timeliness, efficiency...
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76 FR 67801 - Medicare Program; Medicare Shared Savings Program: Accountable Care Organizations
2011-11-02
... Furnished by Non-Physician Practitioners in the Assignment Process c. Assignment of Beneficiaries to ACOs... Insurance Program CMP Civil Monetary Penalties CMS Centers for Medicare & Medicaid Services CNM Certified... the current payment system by rewarding providers for delivering high quality, efficient clinical care...
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2011-08-08
... Medicare and Medicaid Services Medicare and Medicaid Programs; Quarterly Listing of Program Issuances... Centers for Medicare & Medicaid Services [CMS-9066-NC] Medicare and Medicaid Programs; Quarterly Listing... Medicare & Medicaid Services (CMS), HHS. ACTION: Notice with comment period. SUMMARY: This quarterly notice...
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2013-03-07
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 42 CFR Part 412... philosophy and principles identified in Executive Order 12866 and 13563, the RFA, and section 1102(b) of the.... Approved: March 1, 2013. Kathleen Sebelius, Secretary, Department of Health and Human Services. [FR Doc...
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2013-07-22
... and 423 [CMS-4173-CN] RIN 0938-AR69 Medicare Program; Medical Loss Ratio Requirements for the Medicare... number of technical, typographical, and cross-referencing errors that are identified and corrected in the... Minimum Medical Loss Ratio, we made a typographical error in a section number. On page 31311, in Sec. 423...
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2010-11-16
... 0938-AP89 Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal... the July 22, 2010 Federal Register entitled, ``Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2011.'' DATES: Effective Date. This correction is effective for IRF...
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78 FR 75304 - Medicare Program; Medicare Secondary Payer and Certain Civil Money Penalties
2013-12-11
... [CMS-6061-ANPRM] RIN 0938-AR88 Medicare Program; Medicare Secondary Payer and Certain Civil Money... practices for which civil money penalties (CMPs) may or may not be imposed for failure to comply with...-3951. I. Background A. Imposition of Civil Money Penalties (CMPs) In 1981, the Congress added section...
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76 FR 66309 - Pilot Program for Parallel Review of Medical Products; Correction
2011-10-26
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare and Medicaid Services [CMS-3180-N2] Food and Drug Administration [Docket No. FDA-2010-N-0308] Pilot Program for Parallel Review of Medical... 11, 2011 (76 FR 62808). The document announced a pilot program for sponsors of innovative device...
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2012-03-22
...] Medicare Program; Solicitation for Proposals for the Medicare Graduate Nurse Education Demonstration... Education (GNE) Demonstration. The primary goal of the GNE Demonstration is to increase the number of... schools of nursing; and (B) 2 or more applicable non-hospital community-based care settings. The written...
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76 FR 61103 - Medicare Program; Comprehensive Primary Care Initiative
2011-10-03
...] Medicare Program; Comprehensive Primary Care Initiative AGENCY: Centers for Medicare & Medicaid Services... organizations to participate in the Comprehensive Primary Care initiative (CPC), a multipayer model designed to... the Comprehensive Primary Care initiative or the application process. SUPPLEMENTARY INFORMATION: I...
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75 FR 44313 - Medicare and Medicaid Programs; Electronic Health Record Incentive Program
2010-07-28
... Payment Calculation for Eligible Hospitals c. Medicare Share d. Charity Care e. Transition Factor f...), eligible hospitals and critical access hospitals (CAHs) participating in Medicare and Medicaid programs...) technology. This final rule specifies--the initial criteria EPs, eligible hospitals, and CAHs must meet in...
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76 FR 26805 - Medicare Program; Hospice Wage Index for Fiscal Year 2012
2011-05-09
..., and hospices in low-wage index areas are unfairly advantaged. The commenter felt that our not wage... Medicare & Medicaid Services 42 CFR Part 418 Medicare Program; Hospice Wage Index for Fiscal Year 2012... [CMS-1355-P] RIN 0938-AQ31 Medicare Program; Hospice Wage Index for Fiscal Year 2012 AGENCY: Centers...
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75 FR 1843 - Medicare and Medicaid Programs; Electronic Health Record Incentive Program
2010-01-13
... Payment Calculation for Eligible Hospitals c. Medicare Share d. Charity Care e. Transition Factor f...) and eligible hospitals participating in Medicare and Medicaid programs that adopt and meaningfully use... an EP and eligible hospital must meet in order to qualify for the incentive payment; calculation of...
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42 CFR 460.168 - Reinstatement in other Medicare and Medicaid programs.
2010-10-01
... 42 Public Health 4 2010-10-01 2010-10-01 false Reinstatement in other Medicare and Medicaid programs. 460.168 Section 460.168 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF... Reinstatement in other Medicare and Medicaid programs. To facilitate a participant's reinstatement in other...
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2012-04-27
... osteopathy, dentistry, and podiatry, as required in order to become certified by the appropriate specialty...'' (January 23, 2004, 69 FR 3434). A final rule titled ``Medicare, Medicaid, and Children's Health Insurance...
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The distribution of polarized radio sources >15 μJy IN GOODS-N
International Nuclear Information System (INIS)
Rudnick, L.; Owen, F. N.
2014-01-01
We present deep Very Large Array observations of the polarization of radio sources in the GOODS-N field at 1.4 GHz at resolutions of 1.''6 and 10''. At 1.''6, we find that the peak flux cumulative number count distribution is N(> p) ∼ 45*(p/30 μJy) –0.6 per square degree above a detection threshold of 14.5 μJy. This represents a break from the steeper slopes at higher flux densities, resulting in fewer sources predicted for future surveys with the Square Kilometer Array and its precursors. It provides a significant challenge for using background rotation measures (RMs) to study clusters of galaxies or individual galaxies. Most of the polarized sources are well above our detection limit, and they are also radio galaxies that are well-resolved even at 10'', with redshifts from ∼0.2-1.9. We determined a total polarized flux for each source by integrating the 10'' polarized intensity maps, as will be done by upcoming surveys such as POSSUM. These total polarized fluxes are a factor of two higher, on average, than the peak polarized flux at 1.''6; this would increase the number counts by ∼50% at a fixed flux level. The detected sources have RMs with a characteristic rms scatter of ∼11 rad m –2 around the local Galactic value, after eliminating likely outliers. The median fractional polarization from all total intensity sources does not continue the trend of increasing at lower flux densities, as seen for stronger sources. The changes in the polarization characteristics seen at these low fluxes likely represent the increasing dominance of star-forming galaxies.
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76 FR 68011 - Medicare Program; Advanced Payment Model
2011-11-02
...This notice announces the testing of the Advance Payment Model for certain accountable care organizations participating in the Medicare Shared Savings Program scheduled to begin in 2012, and provides information about the model and application process.
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76 FR 39006 - Medicare Program; Hospital Inpatient Value-Based Purchasing Program; Correction
2011-07-05
... and 480 [CMS-3239-CN] RIN 0938-AQ55 Medicare Program; Hospital Inpatient Value-Based Purchasing... Value-Based Purchasing Program.'' DATES: Effective Date: These corrections are effective on July 1, 2011... for the hospital value-based purchasing program. Therefore, in section III. 6. and 7. of this notice...
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2013-03-18
... policy to address the issues raised by the Administrative Law Judge and Medicare Appeals Council... issued by the ALJs and the Medicare Appeals Council do not establish Medicare payment policy, we are... Council decisions previously described, this Ruling establishes a policy that revises the current policy...
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2013-07-31
...] Medicare, Medicaid, and Children's Health Insurance Programs: Announcement of Temporary Moratoria on... combat fraud, waste, and abuse in Medicare, Medicaid, and the Children's Health Insurance Program (CHIP... Health Insurance Programs; Additional Screening Requirements, Application Fees, Temporary Enrollment...
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2010-06-08
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Administration on Aging Funding Opportunity: Affordable Care Act Medicare Beneficiary Outreach and Assistance Program Funding for Title VI Native American Programs Purpose of Notice: Availability of funding opportunity announcement. Funding Opportunity Title/Program Name: Affordable Care Act Medicare...
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2013-07-26
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-3280-FN] Medicare and Medicaid Programs; Initial Approval of Center for Improvement in Healthcare Quality's (CIHQ's) Hospital Accreditation Program AGENCY: Centers for Medicare and Medicaid Services, HHS. ACTION: Final...
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78 FR 8535 - Medicare Program: Comprehensive End-Stage Renal Disease Care Model Announcement
2013-02-06
... develop and test innovative health care payment and service delivery models that show promise of reducing... test innovative payment and service delivery models that reduce spending under Medicare, Medicaid or...] Medicare Program: Comprehensive End-Stage Renal Disease Care Model Announcement AGENCY: Centers for...
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2010-02-03
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-1341-NC] Medicare and Medicaid Programs; Announcement of Applications From Hospitals Requesting Waiver for Organ Procurement Service Area AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Notice with...
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2013-01-03
... (PQRS), the Children's Health Insurance Program (CHIP), and the Pioneer Accountable Care Organization... No. 93.773, Medicare--Hospital Insurance; and Program No. 93.774, Medicare-- Supplementary Medical...
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2011-12-20
... comment period. SUMMARY: This notice with comment period announces a waiver request from Pioneer Community... which the hospital is located: Pioneer Community Hospital (Medicare provider number 25-1302), of... No. 93.773, Medicare--Hospital Insurance; Program No. 93.774, Medicare-- Supplementary Medical...
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2013-09-20
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-3287-PN] Medicare and Medicaid Programs; Application from the Compliance Team for Initial CMS-Approval of its Rural Health Clinic Accreditation Program AGENCY: Centers for Medicare and Medicaid Services, HHS. ACTION...
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76 FR 627 - Medicare Program; End-Stage Renal Disease Quality Incentive Program
2011-01-05
... important components of the Medicare ESRD payment system. In the proposed rule, we described the evolution...) of the Social Security Act (the Act), as the next step in the evolution of the ESRD quality program...-mix (for example, nursing home patients, patients with complex conditions) that may make meeting the...
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2010-01-22
... the Social Security Act (the Act), requiring the Secretary to provide informational materials to..., National Hispanic Council on Aging; Stephen L. Fera, Vice President, Social Mission Programs, Independence.... Medicare Outreach and Education Strategies. Public Comment. Listening Session with CMS Leadership. Next...
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2017-11-15
This major final rule addresses changes to the Medicare physician fee schedule (PFS) and other Medicare Part B payment policies such as changes to the Medicare Shared Savings Program, to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services, as well as changes in the statute. In addition, this final rule includes policies necessary to begin offering the expanded Medicare Diabetes Prevention Program model.
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2013-07-09
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 42 CFR Parts 431 [CMS-1450-CN] RIN 0938-AR52 Medicare and Medicaid Programs; Home Health Prospective Payment System Rate... period titled ``Medicare and Medicaid Programs; Home Health Prospective Payment System Rate Update for CY...
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2016-11-15
This major final rule addresses changes to the physician fee schedule and other Medicare Part B payment policies, such as changes to the Value Modifier, to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services, as well as changes in the statute. This final rule also includes changes related to the Medicare Shared Savings Program, requirements for Medicare Advantage Provider Networks, and provides for the release of certain pricing data from Medicare Advantage bids and of data from medical loss ratio reports submitted by Medicare health and drug plans. In addition, this final rule expands the Medicare Diabetes Prevention Program model.
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76 FR 41260 - Supplemental Funding for the Senior Medicare Patrol (SMP) Program
2011-07-13
... additional funding to double the size of the SMP program. The SMP program expansion has resulted in... DEPARTMENT OF HEALTH AND HUMAN SERVICES Administration on Aging Supplemental Funding for the Senior Medicare Patrol (SMP) Program ACTION: Notice of intent to provide supplemental funding to the...
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2010-09-24
... are imposed by section 1804 of the Social Security Act (the Act), requiring the Secretary to provide... President, Social Mission Programs, Independence Blue Cross; Richard C. Frank, M.D., Director, Cancer... Committee Work Summary. Medicare Outreach and Education Strategies. Public Comment. Listening Session with...
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2013-01-02
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-1456-NC] Medicare and Medicaid Programs; Announcement of Application From a Hospital Requesting Waiver for Organ Procurement Service Area AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Notice with...
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2012-08-24
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-1452-NC] Medicare and Medicaid Programs; Announcement of Application From a Hospital Requesting Waiver for Organ Procurement Service Area AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Notice with...
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2013-03-29
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-1457-NC] Medicare and Medicaid Programs; Announcement of Application From a Hospital Requesting Waiver for Organ Procurement Service Area AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Notice with...
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2011-06-03
..., ``Inpatient Psychiatric Facilities Prospective Payment System--Update for Rate Year Beginning July 1, 2011 (RY... [CMS-1346-CN] RIN 0938-AQ23 Medicare Program; Inpatient Psychiatric Facilities Prospective Payment System--Update for Rate Year Beginning July 1, 2011 (RY 2012); Correction AGENCY: Centers for Medicare...
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2012-10-17
... [CMS-1588-F2] RIN 0938-AR12 Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2013 Rates..., 2012 Federal Register entitled ``Medicare Program; Hospital Inpatient Prospective Payment Systems for...
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2010-12-08
... [CMS-1510-CN] RIN 0938-AP88 Medicare Program; Home Health Prospective Payment System Rate Update for... Health Prospective Payment System Rate Update for Calendar Year 2011; Changes in Certification... effective as if they had been included in the Medicare Program; Home Health Prospective Payment System Rate...
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Can health promotion programs save Medicare money?
Goetzel, Ron Z; Shechter, David; Ozminkowski, Ronald J; Stapleton, David C; Lapin, Pauline J; McGinnis, J Michael; Gordon, Catherine R; Breslow, Lester
2007-01-01
The impact of an aging population on escalating US healthcare costs is influenced largely by the prevalence of chronic disease in this population. Consequently, preventing or postponing disease onset among the elderly has become a crucial public health issue. Fortunately, much of the total burden of disease is attributable to conditions that are preventable. In this paper, we address whether well-designed health promotion programs can prevent illness, reduce disability, and improve the quality of life. Furthermore, we assess evidence that these programs have the potential to reduce healthcare utilization and related expenditures for the Medicare program. We hypothesize that seniors who reduce their modifiable health risks can forestall disability, reduce healthcare utilization, and save Medicare money. We end with a discussion of a new Senior Risk Reduction Demonstration, which will be initiated by the Centers for Medicare and Medicaid Services in 2007, to test whether risk reduction programs developed in the private sector can achieve health improvements among seniors and a positive return on investment for the Medicare program. PMID:18044084
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2010-12-27
... [CMS-1510-CN2] RIN 0938-AP88 Medicare Program; Home Health Prospective Payment System Rate Update for... ``Medicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2011; Changes in... Prospective Payment System Rate Update for Calendar Year 2011; Changes in Certification Requirements for Home...
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2010-11-29
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare and Medicaid Services [CMS-2332-PN] Medicare Program; Application by the American Association for Accreditation of Ambulatory Surgery... Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) for recognition as a national...
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Medicare program; Medicare depreciation, useful life guidelines--HCFA. Final rule.
1983-08-18
These final rules amend Medicare regulations to clarify which useful life guidelines may be used by providers of health care services to determine the useful life of a depreciable asset for Medicare reimbursement purposes. Current regulations state that providers must utilize the Departmental useful life guidelines or, if none have been published by the Department, either the American Hospital Association (AHA) useful life guidelines of 1973 of IRS guidelines. We are eliminating the reference to IRS guidelines because these are now outdated for Medicare purposes since they have been rendered obsolete either by the IRS or by statutory change. We are also deleting the specific reference to the 1973 AHA guidelines since these guidelines are updated by the AHA periodically. In addition, we are clarifying that certain tax legislation on accelerated depreciation, passed by Congress, does not apply to the Medicare program.
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2010-04-01
... 22 Foreign Relations 2 2010-04-01 2010-04-01 true Act. 901.10 Section 901.10 Foreign Relations FOREIGN SERVICE GRIEVANCE BOARD GENERAL Meanings of Terms As Used in This Chapter § 901.10 Act. Act means the Foreign Service Act of 1980 (Pub. L. 96-465, October 17, 1980), as amended. [56 FR 55458, Oct. 28...
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2012-05-16
... Provisions to Promote Program Efficiency, Transparency, and Burden Reduction; Final Rule #0;#0;Federal..., Transparency, and Burden Reduction AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Final... on providers of care. CMS has also identified non-regulatory changes to increase transparency and to...
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Can health promotion programs save Medicare money?
Directory of Open Access Journals (Sweden)
Ron Z Goetzel
2007-04-01
Full Text Available Ron Z Goetzel1, David Shechter2, Ronald J Ozminkowski1, David C Stapleton3, Pauline J Lapin4, J Michael McGinnis5, Catherine R Gordon6, Lester Breslow71Institute for Health and Productivity Studies, Cornell University, Washington, DC; 2Health and Productivity Research, Thomson Medstat, Santa Barbara, CA; 3Cornell Institute for Policy Research, Cornell University, Washington, DC; 4Office of Research, Development, and Information, Centers for Medicare and Medicaid Services, Baltimore, MD; 5National Academy of Sciences, Institute of Medicine, The National Academies, Washington, DC; 6Office of the Director, Centers for Disease Control and Prevention, Washington, DC; 7UCLA School of Public Health, Dept. of Health Services, Los Angeles, CA, USAAbstract: The impact of an aging population on escalating US healthcare costs is influenced largely by the prevalence of chronic disease in this population. Consequently, preventing or postponing disease onset among the elderly has become a crucial public health issue. Fortunately, much of the total burden of disease is attributable to conditions that are preventable. In this paper, we address whether well-designed health promotion programs can prevent illness, reduce disability, and improve the quality of life. Furthermore, we assess evidence that these programs have the potential to reduce healthcare utilization and related expenditures for the Medicare program. We hypothesize that seniors who reduce their modifiable health risks can forestall disability, reduce healthcare utilization, and save Medicare money. We end with a discussion of a new Senior Risk Reduction Demonstration, which will be initiated by the Centers for Medicare and Medicaid Services in 2007, to test whether risk reduction programs developed in the private sector can achieve health improvements among seniors and a positive return on investment for the Medicare program.Keywords: health promotion, return on investment, Medicare, financial
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2010-05-28
... specified list of new Clinical Procedural Terminology (CPT) codes for clinical laboratory tests in calendar... are codified at 42 CFR part 414, subpart G. A newly created Current Procedural Terminology (CPT) code..., Medicare--Hospital Insurance; and Program No. 93.774, Medicare-- Supplementary Medical Insurance Program...
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Results of the Medicare Health Support disease-management pilot program.
McCall, Nancy; Cromwell, Jerry
2011-11-03
In the Medicare Modernization Act of 2003, Congress required the Centers for Medicare and Medicaid Services to test the commercial disease-management model in the Medicare fee-for-service program. The Medicare Health Support Pilot Program was a large, randomized study of eight commercial programs for disease management that used nurse-based call centers. We randomly assigned patients with heart failure, diabetes, or both to the intervention or to usual care (control) and compared them with the use of a difference-in-differences method to evaluate the effects of the commercial programs on the quality of clinical care, acute care utilization, and Medicare expenditures for Medicare fee-for-service beneficiaries. The study included 242,417 patients (163,107 in the intervention group and 79,310 in the control group). The eight commercial disease-management programs did not reduce hospital admissions or emergency room visits, as compared with usual care. We observed only 14 significant improvements in process-of-care measures out of 40 comparisons. These modest improvements came at substantial cost to the Medicare program in fees paid to the disease-management companies ($400 million), with no demonstrable savings in Medicare expenditures. In this large study, commercial disease-management programs using nurse-based call centers achieved only modest improvements in quality-of-care measures, with no demonstrable reduction in the utilization of acute care or the costs of care.
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Evaluation of Medicare Health Support chronic disease pilot program.
Cromwell, Jerry; McCall, Nancy; Burton, Joe
2008-01-01
The Medicare Program is conducting a randomized trial of care management services among fee-for-service (FFS) beneficiaries called the Medicare Health Support (MHS) pilot program. Eight disease management (DM) companies have contracted with CMS to improve clinical quality, increase beneficiary and provider satisfaction, and achieve targeted savings for chronically ill Medicare FFS beneficiaries. In this article, we present 6-month intervention results on beneficiary selection and participation rates, mortality rates, trends in hospitalizations, and success in achieving Medicare cost savings. Results to date indicate limited success in achieving Medicare cost savings or reducing acute care utilization.
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2013-08-28
... the requirements at Sec. 482.41(c)(4), AOA/HFAP revised its standards to include the National Fire... Insurance Program; and No. 93.774, Medicare--Supplementary Medical Insurance Program) Dated: July 19, 2013...
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2010-12-15
...] Medicare Program; Re-Chartering of the Advisory Panel on Ambulatory Payment Classification (APC) Groups... announces the re-chartering of the Advisory Panel on Ambulatory Payment Classification (APC) Groups (the... (APC) groups and their associated weights established under the Medicare hospital Outpatient...
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2010-08-27
...] Medicare Program; Listening Session Regarding the Implementation of Section 10332 of the Patient Protection... of the Patient Protection and Affordable Care Act (the Affordable Care Act), which amended section 1874 of the Social Security Act: Availability of Medicare Data for Performance Measurement. The purpose...
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Medicare Beneficiary Knowledge of the Part D Program
U.S. Department of Health & Human Services — Medicare Beneficiary Knowledge of the Part D Program and Its Relationship with Voluntary Enrollment According to findings appearing in Medicare Beneficiary Knowledge...
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2011-12-19
... Parts 402 and 403 [CMS-5060-P] RIN 0938-AR33 Medicare, Medicaid, Children's Health Insurance Programs...'s Health Insurance Program (CHIP) to report annually to the Secretary certain payments or transfers... State plan under title XIX (Medicaid) or XXI of the Act (the Children's Health Insurance Program, or...
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2011-02-18
... [CMS-1510-F2] RIN 0938-AP88 Medicare Program; Home Health Prospective Payment System Rate Update for... set forth an update to the Home Health Prospective Payment System (HH PPS) rates, including: The... the Medicare prospective payment system for HHAs. This correcting amendment corrects a technical error...
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2012-09-10
..., Medicaid, and CHIP Programs: Research and Analysis on Impact of CMS Programs on the Indian Health Care System AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Notice of Single Source Award. SUMMARY: This notice supports expansion of research on the impact of CMS programs on the Indian health...
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Medicare program; clarification of Medicare's accrual basis of accounting policy--HCFA. Final rule.
1995-06-27
This final rule revises the Medicare regulations to clarify the concept of "accrual basis of accounting" to indicate that expenses must be incurred by a provider of health care services before Medicare will pay its share of those expenses. This rule does not signify a change in policy but, rather, incorporates into the regulations Medicare's longstanding policy regarding the circumstances under which we recognize, for the purposes of program payment, a provider's claim for costs for which it has not actually expended funds during the current cost reporting period.
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2011-06-14
... stakeholders to develop initiatives to test innovative payment and service delivery models to reduce program...] Medicare Program; Pioneer Accountable Care Organization Model; Extension of the Submission Deadlines for... of the Pioneer Accountable Care Organization Model letters of intent to June 30, 2011 and the...
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Single phase semipolar (11 anti 22) GaN on (10 anti 10) sapphire
Energy Technology Data Exchange (ETDEWEB)
Ploch, S.; Stellmach, J.; Schwaner, T.; Frentrup, M.; Wernicke, T.; Pristovsek, M.; Kneissl, M. [Institute of Solid States Physics, (Germany); Park, J.B.; Niermann, T.; Lehmann, M. [Institute of Optics and Atomic Physics, TU Berlin, Hardenbergstr. 36, 10623 Berlin (Germany)
2011-07-01
InGaN quantum well based light emitters grown on (0001) GaN suffer from poor quantum efficiencies with increasing indium mole fraction due to strong polarization fields along the polar crystal orientation. This effect can be greatly reduced by growing on semi- and non-polar GaN orientations. Semipolar (11 anti 22) GaN layers were deposited by metalorganic vapour phase epitaxy on (10 anti 10) sapphire. After sapphire substrate nitridation at 1000 C, a GaN nucleation layer was deposited at high temperature, followed by the deposition of 1.5 nm thick GaN buffer layers. The samples show predominantly (11 anti 22) orientation with a small fraction of (10 anti 13) oriented domains. With increasing nitridation layer thickness the (10 anti 13) phase is suppressed leading to a very smooth surface morphology (rms roughness < 4nm). PL measurements show dominant basel plane stacking fault (BSF) I{sub 1} luminescence without any other defects. Transmission electron microscopy measurements reveal a high BSF density. The FWHM of the X-ray diffraction rocking curve measurements of the (1122) reflection decreases to 1193 arcsec and 739 arcsec along [1 anti 100] and [11 anti 23] respectively with increasing nucleation temperature. Using high temperature nucleation smooth and homogeneous (11 anti 22) phase GaN layers have been obtained.
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2011-08-12
...] Medicare Program; Accountable Care Organization Accelerated Development Learning Sessions; Center for... (CMS). This two-day training session is the second Accelerated Development Learning Session (ADLS.... Through Accelerated Development Learning Sessions (ADLS), the Innovation Center will test whether...
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2011-03-03
...] Medicare, Medicaid, and Children's Health Insurance Programs; Renewal, Expansion, and Renaming of the...'s Health Insurance Program (CHIP) about options for selecting health care coverage under these and... needs are for experts in health disparities, State Health Insurance Assistance Programs (SHIPs), health...
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2011-10-28
...] Medicare Program; Accountable Care Organization Accelerated Development Learning Sessions; Center for... Services (CMS). This two-day training session is the third and final Accelerated Development Learning... the quality of care for beneficiaries. Through Accelerated Development Learning Sessions (ADLS), the...
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2013-02-08
... Parts 402 and 403 [CMS-5060-F] RIN 0938-AR33 Medicare, Medicaid, Children's Health Insurance Programs...'s Health Insurance Program (CHIP) to report annually to the Secretary certain payments or transfers... Vol. 78 Friday, No. 27 February 8, 2013 Part II Department of Health and Human Services Centers...
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2011-05-20
... Affordable Care Act, to test innovative payment and service delivery models that reduce spending under.... This Model will test the effectiveness of a combination of the following: Payment arrangements that...] Medicare Program; Pioneer Accountable Care Organization Model: Request for Applications AGENCY: Centers for...
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2012-02-24
...] Medicare Program; Application by the American Association of Diabetes Educators (AADE) for Continued... American Association of Diabetes Educators' (AADE) request for the Secretary's approval of its... Association of Diabetes Educators for continued recognition as a national accreditation program for...
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78 FR 21610 - Expansion Funds for the Support of the Senior Medicare Patrol (SMP) Program
2013-04-11
... Grants. Announcement Type: Health Care Fraud Prevention Program Expansion Capacity. Funding Opportunity... DEPARTMENT OF HEALTH AND HUMAN SERVICES Administration for Community Living Expansion Funds for the Support of the Senior Medicare Patrol (SMP) Program ACTION: Notice of intent to provide expansion...
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75 FR 46948 - Medicare Program; Listening Session Regarding Confidential Feedback Reports and the...
2010-08-04
...] Medicare Program; Listening Session Regarding Confidential Feedback Reports and the Implementation of a... Services (CMS), HHS. ACTION: Notice of meeting. SUMMARY: This notice announces a listening session being... modifier to the fee- for-service physician fee schedule. The purpose of the listening session is to solicit...
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2010-11-26
...] Medicare Program; Quality Improvement Organization (QIO) Contracts: Solicitation of Proposals From In-State... the Social Security Act (the Act) to provide at least 6 months' advance notice of the expiration dates of contracts with out- of-State Quality Improvement Organizations (QIOs) before renewing any of those...
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48 CFR 22.610 - Contract clause.
2010-10-01
... PROGRAMS APPLICATION OF LABOR LAWS TO GOVERNMENT ACQUISITIONS Walsh-Healey Public Contracts Act 22.610... Contracts Act, in solicitations and contracts covered by the Act (see 22.603, 22.604, and 22.605). [61 FR... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Contract clause. 22.610...
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2010-11-29
...] Medicare Program; Listening Session on Development of Additional Imaging Efficiency Measures for Use in the...), HHS. ACTION: Notice of meeting. SUMMARY: This notice announces a listening session to receive comments... Quality Data Reporting Program (HOP QDRP), which is authorized under section 1833(t)(17) of the Social...
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76 FR 15105 - Medicare and Medicaid Programs; Civil Money Penalties for Nursing Homes
2011-03-18
... Services 42 CFR Part 488 [CMS-2435-F] Medicare and Medicaid Programs; Civil Money Penalties for Nursing... incentives for quality improvement, and to remove uncertainty for nursing homes, we proposed to set the... Vol. 76 Friday, No. 53 March 18, 2011 Part III Department of Health and Human Services Centers for...
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2010-05-05
... including Directors and Board Members of corporations and non-profit organizations and charities. The..., ``Medicare Program; Revisions to Payment Policies, Five-Year Review of Work Relative Value Units, Changes to...
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2012-04-12
... Outcome Survey HPMS Health Plan Management System ICD-9-CM Internal Classification of Disease, 9th..., Improvement, and Modernization Act of 2003 (Pub. L. 108-173) MS-DRG Medicare Severity Diagnosis Related Group...
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2013-09-27
...] Medicare Program; Approval of Accrediting Organization for Suppliers of Advanced Diagnostic Imaging... accredit suppliers seeking to furnish the technical component (TC) of advanced diagnostic imaging services... advanced diagnostic imaging (ADI) service and establish procedures to ensure that the criteria used by an...
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2012-01-04
... lines was not applied correctly. We have corrected our programming logic in the OPPS data process to... made to the programming logic described in the CY 2012 OPPS/ASC final (see 76 FR 74141). The correct...
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2011-09-26
...; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2012; Changes in Size... [CMS-1349-CN] RIN 0938-AQ28 Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2012; Changes in Size and Square Footage of Inpatient Rehabilitation Units...
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Identifying the Transgender Population in the Medicare Program
Proctor, Kimberly; Haffer, Samuel C.; Ewald, Erin; Hodge, Carla; James, Cara V.
2016-01-01
Abstract Purpose: To identify and describe the transgender population in the Medicare program using administrative data. Methods: Using a combination of International Classification of Diseases ninth edition (ICD-9) codes relating to transsexualism and gender identity disorder, we analyzed 100% of the 2013 Centers for Medicare & Medicaid Services (CMS) Medicare Fee-For-Service (FFS) “final action” claims from both institutional and noninstitutional providers (∼1 billion claims) to identify individuals who may be transgender Medicare beneficiaries. To confirm, we developed and applied a multistage validation process. Results: Four thousand ninety-eight transgender beneficiaries were identified, of which ∼90% had confirmatory diagnoses, billing codes, or evidence of a hormone prescription. In general, the racial, ethnic, and geographic distribution of the Medicare transgender population tends to reflect the broader Medicare population. However, age, original entitlement status, and disease burden of the transgender population appear substantially different. Conclusions: Using a variety of claims information, ranging from claims history to additional diagnoses, billing modifiers, and hormone prescriptions, we demonstrate that administrative data provide a valuable resource for identifying a lower bound of the Medicare transgender population. In addition, we provide a baseline description of the diversity and disease burden of the population and a framework for future research. PMID:28861539
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2010-08-27
... outpatient rehabilitation facility (CORF), a home health agency (HHA), or a hospice that has in effect an agreement to participate in Medicare, or a clinic, a rehabilitation agency, or a public health agency that... devices used for reduction of fractures and dislocation'' as one of the ``medical and other health...
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Pre-Medicare Eligible Individuals’ Decision-Making In Medicare Part D: An Interview Study
Directory of Open Access Journals (Sweden)
Tao Jin, B.S. Pharm, Ph.D. Candidate
2010-01-01
Full Text Available ObjectivesThe objective of this study was to elicit salient beliefs among pre-Medicare eligible individuals regarding (1 the outcomes associated with enrolling in the Medicare Part D program; (2 those referents who might influence participants’ decisions about enrolling in the Part D program; and (3 the perceived barriers and facilitators facing those considering enrolling in the Part D program.MethodsFocused interviews were used for collecting data. A sample of 10 persons between 62 and 64 years of age not otherwise enrolled in the Medicare program was recruited. Interviews were audio taped and field notes were taken concurrently. Audio recordings were reviewed to amend field notes until obtaining a thorough reflection of interviews. Field notes were analyzed to elicit a group of beliefs, which were coded into perceived outcomes, the relevant others who might influence Medicare Part D enrollment decisions and perceived facilitators and impediments. By extracting those most frequently mentioned beliefs, modal salient sets of behavioral beliefs, relevant referents, and control beliefs were identified.ResultsAnalyses showed that (1 most pre-Medicare eligible believed that Medicare Part D could “provide drug coverage”, “save money on medications”, and “provide financial and health security in later life”. However, “monthly premiums”, “the formulary with limited drug coverage” and “the complexity of Medicare Part D” were perceived as major disadvantages; (2 immediate family members are most likely to influence pre-Medicare eligible’s decisions about Medicare Part D enrollment; and (3 internet and mailing educational brochures are considered to be most useful resources for Medicare Part D enrollment. Major barriers to enrollment included the complexity and inadequacy of insurance plan information.ConclusionThere are multiple factors related to decision-making surrounding the Medicare Part D enrollment. These factors
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Pre-Medicare Eligible Individuals' Decision-Making In Medicare Part D: An Interview Study
Directory of Open Access Journals (Sweden)
Tao Jin
2010-01-01
Full Text Available Objectives: The objective of this study was to elicit salient beliefs among pre-Medicare eligible individuals regarding (1 the outcomes associated with enrolling in the Medicare Part D program; (2 those referents who might influence participants' decisions about enrolling in the Part D program; and (3 the perceived barriers and facilitators facing those considering enrolling in the Part D program. Methods: Focused interviews were used for collecting data. A sample of 10 persons between 62 and 64 years of age not otherwise enrolled in the Medicare program was recruited. Interviews were audio taped and field notes were taken concurrently. Audio recordings were reviewed to amend field notes until obtaining a thorough reflection of interviews. Field notes were analyzed to elicit a group of beliefs, which were coded into perceived outcomes, the relevant others who might influence Medicare Part D enrollment decisions and perceived facilitators and impediments. By extracting those most frequently mentioned beliefs, modal salient sets of behavioral beliefs, relevant referents, and control beliefs were identified. Results: Analyses showed that (1 most pre-Medicare eligible believed that Medicare Part D could "provide drug coverage", "save money on medications", and "provide financial and health security in later life". However, "monthly premiums", "the formulary with limited drug coverage" and "the complexity of Medicare Part D" were perceived as major disadvantages; (2 immediate family members are most likely to influence pre-Medicare eligible's decisions about Medicare Part D enrollment; and (3 internet and mailing educational brochures are considered to be most useful resources for Medicare Part D enrollment. Major barriers to enrollment included the complexity and inadequacy of insurance plan information. Conclusion: There are multiple factors related to decision-making surrounding the Medicare Part D enrollment. These factors include the advantages
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2011-10-28
...] Medicare and Medicaid Programs; The American Association for Accreditation of Ambulatory Surgery Facilities... receipt of a deeming application from the American Association for Accreditation of Ambulatory Surgery... of Ambulatory Surgery Facilities (AAAASF's) request for deeming authority for RHCs. This notice also...
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2012-06-26
...This notice announces a new opportunity for participation in the Advance Payment Model for certain accountable care organizations participating in the Medicare Shared Savings Program scheduled to begin in January 2013.
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2011-11-30
...This notice announces a new application deadline for participation in the Advance Payment Model for certain accountable care organizations participating in the Medicare Shared Savings Program scheduled to begin in 2012.
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2010-12-23
... [CMS-1350-ANPRM] RIN 0938-AQ51 Medicare Program; Emergency Medical Treatment and Labor Act... Emergency Medical Treatment and Labor Act (EMTALA). Specifically, this document serves as a request for... available to persons without Federal government identification, commenters are encouraged to leave their...
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2012-02-02
... [CMS-1350-NC] RIN 0938-AQ51 Medicare Program; Emergency Medical Treatment and Labor Act (EMTALA... the applicability of the Emergency Medical Treatment and Labor Act (EMTALA) to hospital inpatients... available to persons without Federal government identification, commenters are encouraged to leave their...
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Use of Medicare's Diabetes Self-Management Training Benefit
Strawbridge, Larisa M.; Lloyd, Jennifer T.; Meadow, Ann; Riley, Gerald F.; Howell, Benjamin L.
2015-01-01
Medicare began reimbursing for outpatient diabetes self-management training (DSMT) in 2000; however, little is known about program utilization. Individuals diagnosed with diabetes in 2010 were identified from a 20% random selection of the Medicare fee-for-service population (N = 110,064). Medicare administrative and claims files were used to…
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Effects of a Community-Based Fall Management Program on Medicare Cost Savings.
Ghimire, Ekta; Colligan, Erin M; Howell, Benjamin; Perlroth, Daniella; Marrufo, Grecia; Rusev, Emil; Packard, Michael
2015-12-01
Fall-related injuries and health risks associated with reduced mobility or physical inactivity account for significant costs to the U.S. healthcare system. The widely disseminated lay-led A Matter of Balance (MOB) program aims to help older adults reduce their risk of falling and associated activity limitations. This study examined effects of MOB participation on health service utilization and costs for Medicare beneficiaries, as a part of a larger effort to understand the value of community-based prevention and wellness programs for Medicare. A controlled retrospective cohort study was conducted in 2012-2013, using 2007-2011 MOB program data and 2006-2013 Medicare data. It investigated program effects on falls and fall-related fractures, and health service utilization and costs (standardized to 2012 dollars), of 6,136 Medicare beneficiaries enrolled in MOB from 2007 through 2011. A difference-in-differences analysis was employed to compare outcomes of MOB participants with matched controls. MOB participation was associated with total medical cost savings of $938 per person (95% CI=$379, $1,498) at 1 year. Savings per person amounted to $517 (95% CI=$265, $769) for unplanned hospitalizations; $81 for home health care (95% CI=$20, $141); and $234 (95% CI=$55, $413) for skilled nursing facility care. Changes in the incidence of falls or fall-related fractures were not detected, suggesting that cost savings accrue through other mechanisms. This study suggests that MOB and similar prevention programs have the potential to reduce Medicare costs. Further research accounting for program delivery costs would help inform the development of Medicare-covered preventive benefits. Copyright © 2015 American Journal of Preventive Medicine. All rights reserved.
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2012-03-23
... for persons wishing to retain a proof of filing by stamping in and retaining an extra copy of the... accrediting body's approved program would be deemed to have met the Medicare conditions. A national... the national accrediting body making the request, describing the nature of the request, and providing...
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2010-06-17
... Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and Fiscal Year 2010 Rates and to the Long- Term Care Hospital Prospective Payment System and Rate Year 2010 Rates... Prospective Payment Systems for Acute Care Hospitals and Fiscal Year 2010 Rates and to the Long-Term Care...
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42 CFR 403.206 - General standards for Medicare supplemental policies.
2010-10-01
... 42 Public Health 2 2010-10-01 2010-10-01 false General standards for Medicare supplemental policies. 403.206 Section 403.206 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS SPECIAL PROGRAMS AND PROJECTS Medicare Supplemental Policies...
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The Costs of Decedents in the Medicare Program: Implications for Payments to Medicare+Choice Plans
Buntin, Melinda Beeuwkes; Garber, Alan M; McClellan, Mark; Newhouse, Joseph P
2004-01-01
Objective To discuss and quantify the incentives that Medicare managed care plans have to avoid (through selective enrollment or disenrollment) people who are at risk for very high costs, focusing on Medicare beneficiaries in the last year of life—a group that accounts for more than one-quarter of Medicare's annual expenditures. Data Source Medicare administrative claims for 1994 and 1995. Study Design We calculated the payment a plan would have received under three risk-adjustment systems for each beneficiary in our 1995 sample based on his or her age, gender, county of residence, original reason for Medicare entitlement, and principal inpatient diagnoses received during any hospital stays in 1994. We compared these amounts to the actual costs incurred by those beneficiaries. We then looked for clinical categories that were predictive of costs, including costs in a beneficiary's last year of life, not accounted for by the risk adjusters. Data Extraction Methods The analyses were conducted using claims for a 5 percent random sample of Medicare beneficiaries who died in 1995 and a matched group of survivors. Principal Findings Medicare is currently implementing the Principal Inpatient Diagnostic Cost Groups (PIP-DCG) risk adjustment payment system to address the problem of risk selection in the Medicare+Choice program. We quantify the strong financial disincentives to enroll terminally ill beneficiaries that plans still have under this risk adjustment system. We also show that up to one-third of the selection observed between Medicare HMOs and the traditional fee-for-service system could be due to differential enrollment of decedents. A risk adjustment system that incorporated more of the available diagnostic information would attenuate this disincentive; however, plans could still use clinical information (not included in the risk adjustment scheme) to identify beneficiaries whose expected costs exceed expected payments. Conclusions More disaggregated prospective
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2011-04-07
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-1357-N] RIN... document, demonstrates that this notice is consistent with the regulatory philosophy and principles.... Kathleen Sebelius, Secretary, Department of Health and Human Services. Addendum This addendum includes...
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2010-10-01
...; RIN 0938-AP33 Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System Changes and FY 2011 Rates; Provider... Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective...
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2012-02-01
... Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal... the final rule entitled ``Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2012 Rates...
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2011-03-11
... Prospective Payment System and CY 2011 Payment Rates; Changes to the Ambulatory Surgical Center Payment System..., 2010, entitled ``Medicare Program: Hospital Outpatient Prospective Payment System and CY 2011 Payment Rates; Ambulatory Surgical Center Payment System and CY 2011 Payment Rates; Payments to Hospitals for...
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2012-10-29
... Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and... Federal Register entitled ``Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and Fiscal Year 2013 Rates...
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2013-03-13
... Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and... Register entitled ``Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and Fiscal Year 2013 Rates; Hospitals...
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2011-05-16
... partner with States, providers, beneficiaries and their caregivers, and other stakeholders to improve... conflicting Medicaid and Medicare requirements. This document represents the first step. We have compiled what.... We will then determine which issues to address and in what order and timeframe. All areas are...
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2011-10-24
... consequence of increasing health care costs to the Medicare program and limiting the choices of those patients... with information concerning the illness, injury or condition that brought the patient to the ASC, as.../grievances relating, but not limited to, mistreatment, neglect, verbal, mental, sexual, or physical abuse...
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2010-08-03
... Prospective Payment System and CY 2010 Payment Rates; Changes to the Ambulatory Surgical Center Payment System...-1414-CN2] RIN 0938-AP41 Medicare Program: Changes to the Hospital Outpatient Prospective Payment System and CY 2010 Payment Rates; Changes to the Ambulatory Surgical Center Payment System and CY 2010...
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2011-11-04
... Prospective Payment System Rate Update for Calendar Year 2012; Final Rule #0;#0;Federal Register / Vol. 76, No... 0938-AQ30 Medicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2012... sets forth updates to the home health prospective payment system (HH PPS) rates, including: the...
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2012-12-14
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 42 CFR Parts 438, 441, and 447 [CMS-2370-CN] RIN 0938-AQ63 Medicaid Program; Payments for Services Furnished by Certain...-26507 of November 6, 2012 (77 FR 66670), there were a number of technical errors that are identified and...
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The Medicare Health Outcomes Survey program: Overview, context, and near-term prospects
Directory of Open Access Journals (Sweden)
Miller Nancy A
2004-07-01
Full Text Available Abstract In 1996, the Centers for Medicare & Medicaid Services (CMS initiated the development of the Medicare Health Outcomes Survey (HOS. It is the first national survey to measure the quality of life and functional health status of Medicare beneficiaries enrolled in managed care. The program seeks to gather valid and reliable health status data in Medicare managed care for use in quality improvement activities, public reporting, plan accountability and improving health outcomes based on competition. The context that led to the development of the HOS was formed by the convergence of the following factors: 1 a recognized need to monitor the performance of managed care plans, 2 technical expertise and advancement in the areas of quality measurement and health outcomes assessment, 3 the existence of a tested functional health status assessment tool (SF-36®1, which was valid for an elderly population, 4 CMS leadership, and 5 political interest in quality improvement. Since 1998, there have been six baseline surveys and four follow up surveys. CMS, working with its partners, performs the following tasks as part of the HOS program: 1 Supports the technical/scientific development of the HOS measure, 2 Certifies survey vendors, 3 Collects Health Plan Employer Data and Information Set(HEDIS®2 HOS data, 4 Cleans, scores, and disseminates annual rounds of HOS data, public use files and reports to CMS, Quality Improvement Organizations (QIOs, Medicare+Choice Organizations (M+COs, and other stakeholders, 5 Trains M+COs and QIOs in the use of functional status measures and best practices for improving care, 6 Provides technical assistance to CMS, QIOs, M+COs and other data users, and 7 Conducts analyses using HOS data to support CMS and HHS priorities. CMS has recently sponsored an evaluation of the HOS program, which will provide the information necessary to enhance the future administration of the program. Information collected to date reveals that the
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2013-05-31
...] Medicare Program; Notification of Closure of Teaching Hospitals and Opportunity To Apply for Available... announces the closure of two teaching hospitals and the initiation of an application process where hospitals... modifying language at section 1886(d)(5)(B)(v) of the Act, to instruct the Secretary to establish a process...
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Baicker, Katherine; Shepard, Mark; Skinner, Jonathan
2013-05-01
The US Medicare program consumes an ever-rising share of the federal budget. Although this public spending can produce health and social benefits, raising taxes to finance it comes at the cost of slower economic growth. In this article we describe a model incorporating the benefits of public programs and the cost of tax financing. The model implies that the "one-size-fits-all" Medicare program, with everyone covered by the same insurance policy, will be increasingly difficult to sustain. We show that a Medicare program with guaranteed basic benefits and the option to purchase additional coverage could lead to more unequal health spending but slower growth in taxation, greater overall well-being, and more rapid growth of gross domestic product. Our framework highlights the key trade-offs between Medicare spending and economic prosperity.
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2012-06-26
... forth in 42 CFR 414.402 will be used to determine what items will be included in the competitions. These..., regardless of the method of delivery. Non-Mail Order Item--Any item that a beneficiary or caregiver picks up... what Medicare pays for mail order supplies versus non-mail order supplies may encourage fraud and abuse...
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Lessons for the new CMS innovation center from the Medicare health support program.
Barr, Michael S; Foote, Sandra M; Krakauer, Randall; Mattingly, Patrick H
2010-07-01
The Patient Protection and Affordable Care Act establishes a new Center for Medicare and Medicaid Innovation in the Centers for Medicare and Medicaid Services (CMS). The center is intended to enhance the CMS's role in promoting much-needed improvements in payment and service delivery. Lessons from the Medicare Health Support Program, a chronic care pilot program that ran between 2005 and 2008, illustrate the value of drawing on experience in planning for the center and future pilot programs. The lessons include the importance of strong leadership; collaboration and flexibility to foster innovation; receptivity of beneficiaries to care management; and the need for timely data on patients' status. The lessons also highlight pitfalls to be avoided in planning future pilot programs, such as flawed strategies for selecting populations to target when testing payment and service delivery reforms.
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2013-11-20
... DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT [Docket No. FR-5683-N-102] 10-Day Notice of Proposed Information Collection: Generic Customer Satisfaction Surveys; Physical Inspection Pilot Program...
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2014-12-05
This final rule implements various provider enrollment requirements. These include: Expanding the instances in which a felony conviction can serve as a basis for denial or revocation of a provider or supplier's enrollment; if certain criteria are met, enabling us to deny enrollment if the enrolling provider, supplier, or owner thereof had an ownership relationship with a previously enrolled provider or supplier that had a Medicare debt; enabling us to revoke Medicare billing privileges if we determine that the provider or supplier has a pattern or practice of submitting claims that fail to meet Medicare requirements; and limiting the ability of ambulance suppliers to "backbill" for services performed prior to enrollment.
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2010-07-01
... testimony, industry also stated that the changes that were present in NCPDP SCRIPT 10.6 created an environment where long-term care (LTC) facilities could carry out e-prescribing under Medicare Part D. They.... Most hospitals and most other providers and suppliers are small entities, either by nonprofit status or...
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75 FR 8391 - Assisted Living Conversion Program (ALCP) and Emergency Capital Repair Program (ECRP)
2010-02-24
... Conversion Program (ALCP) provides funding for the physical costs of converting some or all the units of an... DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT [Docket No. FR-5376-N-10] Assisted Living Conversion... rehabilitate, modernize, or retrofit aging structure, common areas, or individual dwelling units through the...
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U.S. Department of Health & Human Services — Data set merges information about the Centers for Medicare and Medicaid Services, Medicare and Medicaid EHR Incentive Programs attestations with the Office of the...
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JY1 time scale: a new Kalman-filter time scale designed at NIST
International Nuclear Information System (INIS)
Yao, Jian; Parker, Thomas E; Levine, Judah
2017-01-01
We report on a new Kalman-filter hydrogen-maser time scale (i.e. JY1 time scale) designed at the National Institute of Standards and Technology (NIST). The JY1 time scale is composed of a few hydrogen masers and a commercial Cs clock. The Cs clock is used as a reference clock to ease operations with existing data. Unlike other time scales, the JY1 time scale uses three basic time-scale equations, instead of only one equation. Also, this time scale can detect a clock error (i.e. time error, frequency error, or frequency drift error) automatically. These features make the JY1 time scale stiff and less likely to be affected by an abnormal clock. Tests show that the JY1 time scale deviates from the UTC by less than ±5 ns for ∼100 d, when the time scale is initially aligned to the UTC and then is completely free running. Once the time scale is steered to a Cs fountain, it can maintain the time with little error even if the Cs fountain stops working for tens of days. This can be helpful when we do not have a continuously operated fountain or when the continuously operated fountain accidentally stops, or when optical clocks run occasionally. (paper)
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1992-05-04
This final rule sets forth the procedures to be followed for collection of past-due amounts owed by individuals who breached contracts under certain scholarship and loan programs. The programs that would be affected are the National Health Service Corps Scholarship, the Physician Shortage Area Scholarship, and the Health Education Assistance Loan. These procedures would apply to those individuals who breached contracts under the scholarship and loan programs and who-- Accept Medicare assignment for services; Are employed by or affiliated with a provider, Health Maintenance Organization, or Competitive Medical Plan that receives Medicare payment for services; or Are members of a group practice that receives Medicare payment for services. This regulation implements section 1892 of the Social Security Act, as added by section 4052 of the Omnibus Budget Reconciliation Act of 1987.
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2012-11-21
... of the Actuary in the Centers for Medicare & Medicaid Services. The estimates underlying these determinations are prepared by actuaries meeting the qualification standards and following the actuarial... alternative analysis and financial projection purposes, and the Office of the Actuary has adopted this...
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2011-10-24
... Efficiency, Transparency, and Burden Reduction AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS...-regulatory changes to increase transparency and to become a better business partner. As explained in the plan...
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2011-04-29
... 2012 IRF PPS Federal Prospective Payment Rates A. Proposed Market Basket Increase Factor, Productivity.... Proposed Productivity Adjustment 3. Proposed Calculation of the IRF PPS Market Basket Increase Factor for... Medicare Provider Analysis and Review MFP Multifactor Productivity MMSEA Medicare, Medicaid, and SCHIP...
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2010-09-24
... Administrative Law Judge (ALJ) hearings and judicial review under the Medicare appeals process. The adjustment to the AIC threshold amounts will be effective for requests for ALJ hearings and judicial review filed on... judicial review. DATES: Effective Date: This notice is effective on January 1, 2011. FOR FURTHER...
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Financial Incentives and Physician Practice Participation in Medicare's Value-Based Reforms.
Markovitz, Adam A; Ramsay, Patricia P; Shortell, Stephen M; Ryan, Andrew M
2017-07-26
To evaluate whether greater experience and success with performance incentives among physician practices are related to increased participation in Medicare's voluntary value-based payment reforms. Publicly available data from Medicare's Physician Compare (n = 1,278; January 2012 to November 2013) and nationally representative physician practice data from the National Survey of Physician Organizations 3 (NSPO3; n = 907,538; 2013). We used regression analysis to examine practice-level relationships between prior exposure to performance incentives and participation in key Medicare value-based payment reforms: accountable care organization (ACO) programs, the Physician Quality Reporting System ("Physician Compare"), and the Meaningful Use of Health Information Technology program ("Meaningful Use"). Prior experience and success with financial incentives were measured as (1) the percentage of practices' revenue from financial incentives for quality or efficiency; and (2) practices' exposure to public reporting of quality measures. We linked physician participation data from Medicare's Physician Compare to the NSPO3 survey. There was wide variation in practices' exposure to performance incentives, with 64 percent exposed to financial incentives, 45 percent exposed to public reporting, and 2.2 percent of practice revenue coming from financial incentives. For each percentage-point increase in financial incentives, there was a 0.9 percentage-point increase in the probability of participating in ACOs (standard error [SE], 0.1, p Financial incentives were not associated with participation in Physician Compare. Among ACO participants, a 1 percentage-point increase in incentives was associated with a 0.7 percentage-point increase in the probability of being "very well" prepared to utilize cost and quality data (SE, 0.1, p financial incentives with additional efforts to address the needs of practices with less experience with such incentives to promote value-based payment
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2011-09-23
... Administrative Law Judge (ALJ) hearings and judicial review under the Medicare appeals process. The adjustment to the AIC threshold amounts will be effective for requests for ALJ hearings and judicial review filed on... $1,350 for judicial review. DATES: Effective Date: This notice is effective on January 1, 2012. FOR...
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2013-09-27
... Administrative Law Judge (ALJ) hearings and judicial review under the Medicare appeals process. The adjustment to the AIC threshold amounts will be effective for requests for ALJ hearings and judicial review filed on... ALJ hearings and $1,430 for judicial review. DATES: This notice is effective on January 1, 2014. FOR...
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2012-09-28
... Administrative Law Judge (ALJ) hearings and judicial review under the Medicare appeals process. The adjustment to the AIC threshold amounts will be effective for requests for ALJ hearings and judicial review filed on... $1,400 for judicial review. Effective Date: This notice is effective on January 1, 2013. FOR FURTHER...
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Zeng, Wu; Stason, William B; Fournier, Stephen; Razavi, Moaven; Ritter, Grant; Strickler, Gail K; Bhalotra, Sarita M; Shepard, Donald S
2013-05-01
This study reports outcomes of a Medicare-sponsored demonstration of two intensive lifestyle modification programs (LMPs) in patients with symptomatic coronary heart disease: the Cardiac Wellness Program of the Benson-Henry Mind Body Institute (MBMI) and the Dr Dean Ornish Program for Reversing Heart Disease® (Ornish). This multisite demonstration, conducted between 2000 and 2008, enrolled Medicare beneficiaries who had had an acute myocardial infarction or a cardiac procedure within the preceding 12 months or had stable angina pectoris. Health and economic outcomes are compared with matched controls who had received either traditional or no cardiac rehabilitation following similar cardiac events. Each program included a 1-year active intervention of exercise, diet, small-group support, and stress reduction. Medicare claims were used to examine 3-year outcomes. The analysis includes 461 elderly, fee-for-service, Medicare participants and 1,795 controls. Cardiac and non-cardiac hospitalization rates were lower in participants than controls in each program and were statistically significant in MBMI (P costs of $3,801 and $4,441 per participant for the MBMI and Ornish Programs, respectively, were offset by reduced health care costs yielding non-significant three-year net savings per participant of about $3,500 in MBMI and $1,000 in Ornish. A trend towards lower mortality compared with controls was observed in MBMI participants (P = .07). Intensive, year-long LMPs reduced hospitalization rates and suggest reduced Medicare costs in elderly beneficiaries with symptomatic coronary heart disease. Copyright © 2013 Mosby, Inc. All rights reserved.
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Chollet, D J
1999-05-01
Despite the enactment of significant changes to the Medicare program in 1997, Medicare's Hospital Insurance trust fund is projected to be exhausted just as the baby boom enters retirement. To address Medicare's financial difficulties, a number of reform proposals have been offered, including several to individualize Medicare financing and benefits. These proposals would attempt to increase Medicare revenues and reduce Medicare expenditures by having individuals bear risk--investment market risk before retirement and insurance market risk after retirement. Many fundamental aspects of these proposals have yet to be worked out, including how to guarantee a baseline level of saving for health insurance after retirement, how retirees might finance unanticipated health insurance price increases after retirement, the potential implications for Medicaid of inadequate individual saving, and whether the administrative cost of making the system fair and adequate ultimately would eliminate any rate-of-return advantages from allowing workers to invest their Medicare contributions in corporate stocks and bonds.
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Sivakumar, Haran; Hanoch, Yaniv; Barnes, Andrew J; Federman, Alex D
2016-01-01
Poor Medicare knowledge is associated with worse health outcomes, especially in low-income patients. We examined the association of health literacy and cognition with actual and perceived Medicare knowledge in a sample of inner-city older adults. We conducted a cross-sectional analysis of data on 336 adults ages 65 years and older with Medicare coverage recruited from senior centers and low-income housing facilities in Manhattan, New York. Actual Medicare knowledge was determined by a summary score of 9 true/false questions about the Medicare program and perceived Medicare knowledge with a single item. Validated measures were used to assess health literacy and general cognition. Among respondents, 63.1% had high actual Medicare knowledge, and 36.0% believed that they knew what they needed to know about Medicare. Actual and perceived Medicare knowledge were poorly correlated (r = -.01, p > .05). In multivariable models, low health literacy was significantly associated with actual Medicare knowledge (β = -8.30, SE = 2.71, p information about the Medicare program and diminish their ability to make fully informed choices.
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Social Security Administration — The purpose of this exchange is to identify any Medicare beneficiary who may be eligible for Medicare cost sharing under the Medicaid program, notify these potential...
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2008-06-27
This final rule implements a number of regulatory provisions that are applicable to all providers and suppliers, including durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers. This final rule establishes appeals processes for all providers and suppliers whose enrollment, reenrollment or revalidation application for Medicare billing privileges is denied and whose Medicare billing privileges are revoked. It also establishes timeframes for deciding enrollment appeals by an Administrative Law Judge (ALJ) within the Department of Health and Human Services (DHHS) or the Departmental Appeals Board (DAB), or Board, within the DHHS; and processing timeframes for CMS' Medicare fee-for-service (FFS) contractors. In addition, this final rule allows Medicare FFS contractors to revoke Medicare billing privileges when a provider or supplier submits a claim or claims for services that could not have been furnished to a beneficiary. This final rule also specifies that a Medicare contractor may establish a Medicare enrollment bar for any provider or supplier whose billing privileges have been revoked. Lastly, the final rule requires that all providers and suppliers receive Medicare payments by electronic funds transfer (EFT) if the provider or supplier, is submitting an initial enrollment application to Medicare, changing their enrollment information, revalidating or re-enrolling in the Medicare program.
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Quemaduras por frío: Revisión de 10 Años
EULUFÍ M, ALEX; PIÑEROS B, JOSÉ LUIS; CALDERÓN O, WILFREDO; CUADRA C, ÁLVARO; DANILLA E, STEFAN; LÉNIZ M, PATRICIO; ROCO M, HÉCTOR; ROA G, RICARDO; EULUFÍ M, CHRISTIAN
2006-01-01
La injuria por frío ha sido objeto de estudio desde la década de 1960, Este trabajo entrega los resultados de una revisión retrospectiva de un grupo de 10 pacientes ingresados al Hospital del Trabajador de Santiago (HTS) en un periodo de 10 años producto de accidentes laborales de distintas etiologías. Cabe señalar que solo encontramos reportes aislados de casos en la literatura revisada. Se revisaron retrospectivamente las fichas clínicas de 10 pacientes en el periodo 1993-2003. Las edades f...
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The economic impact of Medicare Part D on congestive heart failure.
Dall, Timothy M; Blanchard, Tericke D; Gallo, Paul D; Semilla, April P
2013-05-01
Medicare Part D has had important implications for patient outcomes and treatment costs among beneficiaries with congestive heart failure (CHF). This study finds that improved medication adherence associated with expansion of drug coverage under Part D led to nearly $2.6 billion in reductions in medical expenditures annually among beneficiaries diagnosed with CHF and without prior comprehensive drug coverage, of which over $2.3 billion was savings to Medicare. Further improvements in adherence could potentially save Medicare another $1.9 billion annually, generating upwards of $22.4 billion in federal savings over 10 years.
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The Topology of Large-Scale Structure in the 1.2 Jy IRAS Redshift Survey
Protogeros, Zacharias A. M.; Weinberg, David H.
1997-11-01
We measure the topology (genus) of isodensity contour surfaces in volume-limited subsets of the 1.2 Jy IRAS redshift survey, for smoothing scales λ = 4, 7, and 12 h-1 Mpc. At 12 h-1 Mpc, the observed genus curve has a symmetric form similar to that predicted for a Gaussian random field. At the shorter smoothing lengths, the observed genus curve shows a modest shift in the direction of an isolated cluster or ``meatball'' topology. We use mock catalogs drawn from cosmological N-body simulations to investigate the systematic biases that affect topology measurements in samples of this size and to determine the full covariance matrix of the expected random errors. We incorporate the error correlations into our evaluations of theoretical models, obtaining both frequentist assessments of absolute goodness of fit and Bayesian assessments of models' relative likelihoods. We compare the observed topology of the 1.2 Jy survey to the predictions of dynamically evolved, unbiased, gravitational instability models that have Gaussian initial conditions. The model with an n = -1 power-law initial power spectrum achieves the best overall agreement with the data, though models with a low-density cold dark matter power spectrum and an n = 0 power-law spectrum are also consistent. The observed topology is inconsistent with an initially Gaussian model that has n = -2, and it is strongly inconsistent with a Voronoi foam model, which has a non-Gaussian, bubble topology.
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22 CFR 92.10 - Specific waiver in notarial certificate.
2010-04-01
... officer has reason to believe that material statements in a document presented for notarization are false... frivolous statements: Provided, That substantial and compelling reasons do not exist which impel restraining...) executed in connection with divorce proceedings. [22 FR 10858, Dec. 27, 1957, as amended at 60 FR 51723...
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2013-10-30
...)(A) of the Act specifies that the premium that these individuals will pay for CY 2014 will be equal... OASDI program or the Railroad Retirement Act and certain others do not have to pay premiums for Medicare...-6390. SUPPLEMENTARY INFORMATION: I. Background Section 1818 of the Social Security Act (the Act...
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2012-11-21
...)(A) of the Act specifies that the premium that these individuals will pay for CY 2013 will be equal... program or the Railroad Retirement Act and certain others do not have to pay premiums for Medicare Part A.... SUPPLEMENTARY INFORMATION: I. Background Section 1818 of the Social Security Act (the Act) provides for...
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2011-11-01
... program or the Railroad Retirement Act and certain others do not have to pay premiums for Medicare Part A... will pay for CY 2012 will be equal to the premium for uninsured aged enrollees reduced by 45 percent.... SUPPLEMENTARY INFORMATION: I. Background Section 1818 of the Social Security Act (the Act) provides for...
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42 CFR 403.322 - Termination of agreements for Medicare recognition of State systems.
2010-10-01
... 42 Public Health 2 2010-10-01 2010-10-01 false Termination of agreements for Medicare recognition of State systems. 403.322 Section 403.322 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS SPECIAL PROGRAMS AND PROJECTS Recognition of State...
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Shih, Terry; Ryan, Andrew M; Gonzalez, Andrew A; Dimick, Justin B
2015-06-01
To project readmission penalties for hospitals performing cardiac surgery and examine how these penalties will affect minority-serving hospitals. The Hospital Readmissions Reduction Program will potentially expand penalties for higher-than-predicted readmission rates to cardiac procedures in the near future. The impact of these penalties on minority-serving hospitals is unknown. We examined national Medicare beneficiaries undergoing coronary artery bypass grafting in 2008 to 2010 (N = 255,250 patients, 1186 hospitals). Using hierarchical logistic regression, we calculated hospital observed-to-expected readmission ratios. Hospital penalties were projected according to the Hospital Readmissions Reduction Program formula using only coronary artery bypass grafting readmissions with a 3% maximum penalty of total Medicare revenue. Hospitals were classified into quintiles according to proportion of black patients treated. Minority-serving hospitals were defined as hospitals in the top quintile whereas non-minority-serving hospitals were those in the bottom quintile. Projected readmission penalties were compared across quintiles. Forty-seven percent of hospitals (559 of 1186) were projected to be assessed a penalty. Twenty-eight percent of hospitals (330 of 1186) would be penalized less than 1% of total Medicare revenue whereas 5% of hospitals (55 of 1186) would receive the maximum 3% penalty. Minority-serving hospitals were almost twice as likely to be penalized than non-minority-serving hospitals (61% vs 32%) and were projected almost triple the reductions in reimbursement ($112 million vs $41 million). Minority-serving hospitals would disproportionately bear the burden of readmission penalties if expanded to include cardiac surgery. Given these hospitals' narrow profit margins, readmission penalties may have a profound impact on these hospitals' ability to care for disadvantaged patients.
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2013-10-03
... calculated by the our Office of the Actuary, to determine both the aggregate amount of empirically justified... Office of the Actuary used the March 2013 update of the Medicare Hospital Cost Report Information System..., as these hospitals do not receive a Medicare DSH payment. The CMS Office of the Actuary's final...
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2011-06-06
.../Kyphoplasty 7. Closed Treatment of Distal Radial Fracture 8. Orthopaedic Surgery--Thigh/Knee 9. Treatment of Ankle Fracture 10. Orthopaedic Surgery/Podiatry 11. Application of Cast and Strapping 12. Cardiothoracic... Immunology MMA Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Pub. L. 108-173) MMSV...
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First-time characterization of JY-1-like sequence in goats
African Journals Online (AJOL)
2015-07-11
Jul 11, 2015 ... Material and Methods. Nine well-recognized .... available, the bovine JY-1 gene sequence (GenBank accession no. .... Since no phenotypes on fecundity and sexual precocity are currently available for goats, it may not be ...
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2012-02-24
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-6034-N] Medicaid Program; Announcement of Medicaid Recovery Audit Contractors (RACs) Contingency Fee Update AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Notice. SUMMARY: This notice announces an...
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Gu, Qian; Koenig, Lane; Faerberg, Jennifer; Steinberg, Caroline Rossi; Vaz, Christopher; Wheatley, Mary P
2014-06-01
To explore the impact of the Hospital Readmissions Reduction Program (HRRP) on hospitals serving vulnerable populations. Medicare inpatient claims to calculate condition-specific readmission rates. Medicare cost reports and other sources to determine a hospital's share of duals, profit margin, and characteristics. Regression analyses and projections were used to estimate risk-adjusted readmission rates and financial penalties under the HRRP. Findings were compared across groups of hospitals, determined based on their share of duals, to assess differential impacts of the HRRP. Both patient dual-eligible status and a hospital's dual-eligible share of Medicare discharges have a positive impact on risk-adjusted hospital readmission rates. Under current Centers for Medicare and Medicaid Service methodology, which does not adjust for socioeconomic status, high-dual hospitals are more likely to have excess readmissions than low-dual hospitals. As a result, HRRP penalties will disproportionately fall on high-dual hospitals, which are more likely to have negative all-payer margins, raising concerns of unintended consequences of the program for vulnerable populations. Policies to reduce hospital readmissions must balance the need to ensure continued access to quality care for vulnerable populations. © Health Research and Educational Trust.
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22 CFR 64.10 - Grant not to constitute a gift.
2010-04-01
... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Grant not to constitute a gift. 64.10 Section... EMPLOYEES IN CULTURAL EXCHANGE PROGRAMS OF FOREIGN COUNTRIES § 64.10 Grant not to constitute a gift. A grant made under an approved program shall not constitute a gift for purposes of 22 CFR 10.735-203 and...
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2010-03-09
... Airworthiness Directives; AeroSpace Technologies of Australia Pty Ltd Models N22B, N22S, and N24A Airplanes... authority for Australia, has issued AD GAF-N22-52, Amendment 1, dated January 2010 (referred to after this... examining the MCAI in the AD docket. Relevant Service Information AeroSpace Technologies of Australia...
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2011-11-04
... Stuart Caplan, (410) 786-8564 Emission Tomography Registry RN, MAS. Sites. XII Medicare-Approved JoAnna... Stuart Caplan, (410) 786-8564 Emission Tomography for RN, MAS. Dementia Trials. All Other Information...
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76 FR 54599 - Medicare Program; Medicare Advantage and Prescription Drug Benefit Programs
2011-09-01
...), prescription drug benefit program (Part D) and section 1876 cost plans including conforming changes to the MA... accounts (MSA) plans, cost-sharing for dual-eligible enrollees in the MA program and prescription drug pricing, coverage, and payment processes in the Part D program, and requirements governing the marketing...
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76 FR 60050 - Medicaid Program: Money Follows the Person Rebalancing Demonstration Program
2011-09-28
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services Medicaid Program: Money Follows the Person Rebalancing Demonstration Program AGENCY: Centers for Medicare & Medicaid... Medicaid beneficiaries with disabling and chronic conditions from institutions into the community. The...
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75 FR 16149 - Medicaid and CHIP Programs; Meeting of the CHIP Working Group-April 26, 2010
2010-03-31
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-2312-N] DEPARTMENT OF LABOR Employee Benefits Security Administration Medicaid and CHIP Programs; Meeting of the CHIP Working Group-- April 26, 2010 AGENCIES: Centers for Medicare & Medicaid Services (CMS), Department of...
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Medicare Non-Utilization Project (MNUP)
Social Security Administration — A program integrity initiative using a data exchange between SSA and the Centers for Medicare and Medicaid Services (CMS).CMS will identify Medicare Part B enrollees...
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Description and outcomes of a Medicare case management program by nurses.
Allen, S A
1999-01-01
During the current environment of cost-cutting and restructuring, case management is viewed as a means of providing comprehensive, coordinated care while reducing costs. Studies of community-based case management have been disappointing. This study evaluates a Medicare service, Management and Evaluation of the Care Plan (MAE), as a model of nurses providing case management in the home. Three groups were compared: MAE (N = 176), non-MAE (N = 187) and newly discharged (N = 93). Utilization data was collected over one year. Overall, subjects were unmarried older women with three functional limitations, four medical diagnoses and averaged 43 home care visits and one hospitalization. MAE patients were older, had more functional and environmental limitations, less ADL independence, and a worse prognosis, yet used significantly less health care than non-MAE recipients did. Regression analysis was performed using group membership and hospital and home care utilization as dependent variables. Although the project was conducted at one site, overall the sample was similar to the national Medicare population.
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Financial Performance of Rural Medicare ACOs.
Nattinger, Matthew C; Mueller, Keith; Ullrich, Fred; Zhu, Xi
2018-12-01
The Centers for Medicare & Medicaid Services (CMS) has facilitated the development of Medicare accountable care organizations (ACOs), mostly through the Medicare Shared Savings Program (MSSP). To inform the operation of the Center for Medicare & Medicaid Innovation's (CMMI) ACO programs, we assess the financial performance of rural ACOs based on different levels of rural presence. We used the 2014 performance data for Medicare ACOs to examine the financial performance of rural ACOs with different levels of rural presence: exclusively rural, mostly rural, and mixed rural/metropolitan. Of the ACOs reporting performance data, we identified 97 ACOs with a measurable rural presence. We found that successful rural ACO financial performance is associated with the ACO's organizational type (eg, physician-based) and that 8 of the 11 rural ACOs participating in the Advanced Payment Program (APP) garnered savings for Medicare. Unlike previous work, we did not find an association between ACO size or experience and rural ACO financial performance. Our findings suggest that rural ACO financial success is likely associated with factors unique to rural environments. Given the emphasis CMS has placed on rural ACO development, further research to identify these factors is warranted. © 2016 National Rural Health Association.
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2013-12-27
... Conditions for Coverage CHAP Community Health Accreditation Program CMHC Community Mental Health Center COI... Pathology Services (Sec. 485.727) N. Emergency Preparedness Regulations for Community Mental Health Centers... Preparedness for Community Mental Health Centers (CMHCs)--Training and Testing (Sec. 485.920(d)) R. Conditions...
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Spectral intensity dependence an isotropy of sources stronger than 0.1 Jy at 2700 MHz
International Nuclear Information System (INIS)
Balonek, T.J.; Broderick, J.J.; Condon, J.J.; Crawford, D.F.; Jauncey, D.L.
1975-01-01
The 1000-foot (305 m) telescope of the National Astronomy and Ionosphere Center was used to measure 430 MHz flux densities of sources stronger than 0.1 Jy at 2700 MHz. Distributions of the resulting two-point spectral indices α (430, 2700) of sources in the intensity range 0.1less than or equal toS<0.35 Jy were compared with α (318, 2700) distributions of sources stronger than 0.35 Jy at 2700 MHz. The median normal-component spectral index and fraction of flat-spectrum sources in the faintest sample do not continue the previously discovered trend toward increased spectral steepening of faint sources. This result differs from the prediction of simple evolutionary cosmological models and therefore favors the alternative explanation that local source-density inhomogeneities are responsible for the observed intensity dependence of spectral indices
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Hallam, K; Gardner, J
1999-11-08
Most Americans know Medicare as the health insurance program that covers the elderly. But to providers it's much more that. The program pays for medical education, finances capital projects and subsidizes care for the indigent. Should Medicare continue making those add-on payments? Is that the program's mission? The debate is intensifying.
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Measuring Coding Intensity in the Medicare Advantage Program
U.S. Department of Health & Human Services — In 2004, Medicare implemented a risk-adjustment system that pays Medicare Advantage (MA) plans based on diagnoses reported for their enrollees, giving the plans an...
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State Policies Influence Medicare Telemedicine Utilization.
Neufeld, Jonathan D; Doarn, Charles R; Aly, Reem
2016-01-01
Medicare policy regarding telemedicine reimbursement has changed little since 2000. Many individual states, however, have added telemedicine reimbursement for either Medicaid and/or commercial payers over the same period. Because telemedicine programs must serve patients from all or most payers, it is likely that these state-level policy changes have significant impacts on telemedicine program viability and utilization of services from all payers, not just those services and payers affected directly by state policy. This report explores the impact of two significant state-level policy changes-one expanding Medicaid telemedicine coverage and the other introducing telemedicine parity for commercial payers-on Medicare utilization in the affected states. Medicare claims data from 2011-2013 were examined for states in the Great Lakes region. All valid claims for live interactive telemedicine professional fees were extracted and linked to their states of origin. Allowed encounters and expenditures were calculated in total and on a per 1,000 members per year basis to standardize against changes in the Medicare population by state and year. Medicare telemedicine encounters and professional fee expenditures grew sharply following changes in state Medicaid and commercial payer policy in the examined states. Medicare utilization in Illinois grew by 173% in 2012 (over 2011) following Medicaid coverage expansion, and Medicare utilization in Michigan grew by 118% in 2013 (over 2012) following adoption of telemedicine parity for commercial payers. By contrast, annual Medicare telemedicine utilization growth in surrounding states (in which there were no significant policy changes during these years) varied somewhat but showed no discernible pattern. Although Medicare telemedicine policy has changed little since its inception, changes in state policies with regard to telemedicine reimbursement appear to have significant impacts on the practical viability of telemedicine programs
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Pre-Enrollment Reimbursement Patterns of Medicare Beneficiaries Enrolled in “At-Risk” HMOs
Eggers, Paul W.; Prihoda, Ronald
1982-01-01
The Health Care Financing Administration (HCFA) has initiated several demonstration projects to encourage HMOs to participate in the Medicare program under a risk mechanism. These demonstrations are designed to test innovative marketing techniques, benefit packages, and reimbursement levels. HCFA's current method for prospective payments to HMOs is based on the Adjusted Average Per Capita Cost (AAPCC). An important issue in prospective reimbursement is the extent to which the AAPCC adequately reflects the risk factors which arise out of the selection process of Medicare beneficiaries into HMOs. This study examines the pre-enrollment reimbursement experience of Medicare beneficiaries who enrolled in the demonstration HMOs to determine whether or not a non-random selection process took place. The three demonstration HMOs included in the study are the Fallon Community Health Plan, the Greater Marshfield Community Health Plan, and the Kaiser-Permanente medical program of Portland, Oregon. The study includes 18,085 aged Medicare beneficiaries who had enrolled in the three plans as of April, 1981. We included comparison groups consisting of a 5 percent random sample of aged Medicare beneficiaries (N = 11,240) living in the same geographic areas as the control groups. The study compares the groups by total Medicare reimbursements for the years 1976 through 1979. Adjustments were made for AAPCC factor differences in the groups (age, sex, institutional status, and welfare status). In two of the HMO areas there was evidence of a selection process among the HMOs enrollees. Enrollees in the Fallon and Kaiser health plans were found to have had 20 percent lower Medicare reimbursements than their respective comparison groups in the four years prior to enrollment. This effect was strongest for inpatient services, but a significant difference also existed for use of physician and outpatient services. In the Marshfield HMO there was no statistically significant difference in pre
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2011-03-14
...' FTE Resident Caps for Graduate Medical Education Payment Purposes AGENCY: Centers for Medicare... education affiliated groups for the purpose of determining possible full-time equivalent resident cap... caps for direct GME under Medicare for certain hospitals, and to authorize the ``redistribution'' of...
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Menz, Hylton B
2009-10-30
In 2004, as an extension of the Enhanced Primary Care (EPC) program, the Australian Government introduced a policy of providing Medicare rebates for allied health services provided to patients with chronic or complex health conditions. The objective of this study was to evaluate the utilisation of podiatry services provided under this scheme between 2004 and 2008. Data pertaining to the Medicare item 10962 for the calendar years 2004-2008 were extracted from the Australian Medicare Benefits Schedule (MBS) database and cross-tabulated by sex and age. Descriptive analyses were undertaken to assess sex and age differences in the number of consultations provided and to assess for temporal trends over the five-year assessment period. The total cost to Medicare over this period was also determined. During the 2004-2008 period, a total of 1,338,044 EPC consultations were provided by podiatrists in Australia. Females exhibited higher utilisation than males (63 versus 37%), and those aged over 65 years accounted for 75% of consultations. There was a marked increase in the number of consultations provided from 2004 to 2008, and the total cost of providing EPC podiatry services during this period was $62.9 M. Podiatry services have been extensively utilised under the EPC program by primary care patients, particularly older women, and the number of services provided has increased dramatically between 2004 and 2008. Further research is required to determine whether the EPC program enhances clinical outcomes compared to standard practice.
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Energy Technology Data Exchange (ETDEWEB)
Kim, Ki-Wook; Choi, Nak-Jung [Department of Nano-Optical Engineering, Korea Polytechnic University, Siheung, Gyeonggi-do, 429-839 (Korea, Republic of); Kim, Kyoung-Bo [Department of Metallurgical and Materials Engineering, Inha Technical College, Incheon, 402-752 (Korea, Republic of); Kim, Moojin [Department of Renewable Energy, Jungwon University, 85, Munmu-ro, Goesan-eup, Goesan-gun, Chungbuk, 367-805 (Korea, Republic of); Lee, Sung-Nam, E-mail: snlee@kpu.ac.kr [Department of Nano-Optical Engineering, Korea Polytechnic University, Siheung, Gyeonggi-do, 429-839 (Korea, Republic of)
2016-05-05
We have grown thin films of nonpolar m-plane (10-10) ZnO on a semipolar (11–22) GaN template by atomic layer deposition (ALD) at low growth temperatures (<200 °C). The surface morphology of the ZnO film is found to be an arrowhead-like structure, which is a typical surface structure of the semipolar (11–22) GaN films. On increasing the growth temperature of the ZnO films, the concentration and mobility of the charge carriers in the ZnO film are increased. However, the optical transmittance decreases with an increase in the growth temperature. Based on these results, we have fabricated semipolar (11–22) GaN-based light-emitting diodes (LEDs) with nonpolar m-plane ZnO film as a transparent conductive oxide (TCO) to improve the light extraction efficiency. In spite of a decrease in the optical transmittance, the operation voltage of semipolar (11–22) GaN-based LEDs is found to decrease with an increase in the growth temperature, which might be due to the improvements in the electrical properties and current spreading effect, resulting in an increase in the optical output power. - Highlights: • Polarity control of ZnO film grown in m-/c-sapphire and semipolar GaN template. • Achievement of high quality nonpolar m-plane ZnO flims on semipolar (11–22) GaN template. • The simultaneous improvements of carrier concentration and mobility in the nonpolar ZnO TCO flims. • Nonpolar ZnO TCO increases current spreading length and light output power of semipolar GaN-LED.
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2010-03-26
... under Medicare. This notice also includes listings of all approval numbers from the Office of Management... stent facilities. Included in this notice is a list of the American College of Cardiology's National Cardiovascular Data registry sites, active CMS coverage-related guidance documents, and special one-time notices...
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48 CFR 22.1303 - Applicability.
2010-10-01
... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Applicability. 22.1303 Section 22.1303 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION SOCIOECONOMIC... organizations where the workers are recruited outside of the United States. [66 FR 53488, Oct. 22, 2001, as...
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Opioid Prescribing Practices of Neurosurgeons: Analysis of Medicare Part D.
Khalid, Syed I; Adogwa, Owoicho; Lilly, Daniel T; Desai, Shyam A; Vuong, Victoria D; Mehta, Ankit I; Cheng, Joseph
2018-04-01
The Centers for Disease Control have declared that the United States is amidst a continuing opioid epidemic, with drug overdose-related death tripling between 1999 and 2014. Among the 47,055 overdose-related deaths that occurred in 2014, 28,647 (60.9%) of them involved an opioid. The Part D Prescriber Public Use File, which is based on beneficiaries enrolled in the Medicare Part D prescription drug program, was used to query information on prescription drug events incurred by Medicare beneficiaries with a Part D prescription drug plan from 31 June 2014 to 30 June 2015. Only those providers with the specialty description of neurosurgeon, as reported on the provider's Part B claims, were included in this study. A total of 271,502 beneficiaries, accounting for 971,581 claims and 22,152,689 day supplies of medication, accounted for the $52,956,428.40 paid by the Centers for Medicare and Medicaid Services for medication that the 4085 neurosurgeons submitted to the Centers for Medicare and Medicaid Services Part D program in the 2014 calendar year. During the same year, 402,767 (41.45%) claims for 158,749 (58.47%) beneficiaries accounted for 6,458,624 (29.16%) of the day supplies of medications and $13,962,630.11 (26.37%) of the total money spent by the Centers for Medicare and Medicaid Services Part D that year. Nationwide, the ratio of opioid claims to total Medicare Part D beneficiaries was 1.48. No statistically significant regional differences were found. The opioid misuse epidemic is a complex and national issue with patterns of prescription not significantly different between regions. All neurosurgeons must be cognizant of their prescribing practices so as to best support the resolution of this public health crisis. Copyright © 2017. Published by Elsevier Inc.
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2011-07-18
...) 786-4533, and Jana Lindquist, (410) 786-4533, Partial hospitalization and community mental health... Laboratory Fee Schedule CMHC Community Mental Health Center CMS Centers for Medicare & Medicaid Services CPT... community mental health centers (CMHCs)) and hospital outpatient services that are furnished to inpatients...
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2011-11-25
... recommendations to the Medicare Trustees on how the Trustees might more accurately estimate health spending in the long run. The Panel's discussion is expected to be very technical in nature and will focus on the... making recommendations to the Medicare Trustees on how the Trustees might more accurately project health...
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2010-09-24
... Office of Management and Budget for collections of information in CMS regulations and a list of Medicare- approved carotid stent facilities. Included in this notice is a list of the American College of Cardiology... special one-time notices regarding national coverage provisions. Also included in this notice is a list of...
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Squitieri, Lee; Chung, Kevin C
2017-07-01
In 2015, the U.S. Congress passed the Medicare Access and Children's Health Insurance Program Reauthorization Act, which effectively repealed the Centers for Medicare and Medicaid Services sustainable growth rate formula and established the Centers for Medicare and Medicaid Services Quality Payment Program. The Medicare Access and Children's Health Insurance Program Reauthorization Act represents an unparalleled acceleration toward value-based payment models and a departure from traditional volume-driven fee-for-service reimbursement. The Quality Payment Program includes two paths for provider participation: the Merit-Based Incentive Payment System and Advanced Alternative Payment Models. The Merit-Based Incentive Payment System pathway replaces existing quality reporting programs and adds several new measures to create a composite performance score for each provider (or provider group) that will be used to adjust reimbursed payment. The advanced alternative payment model pathway is available to providers who participate in qualifying Advanced Alternative Payment Models and is associated with an initial 5 percent payment incentive. The first performance period for the Merit-Based Incentive Payment System opens January 1, 2017, and closes on December 31, 2017, and is associated with payment adjustments in January of 2019. The Centers for Medicare and Medicaid Services estimates that the majority of providers will begin participation in 2017 through the Merit-Based Incentive Payment System pathway, but aims to have 50 percent of payments tied to quality or value through Advanced Alternative Payment Models by 2018. In this article, the authors describe key components of the Medicare Access and Children's Health Insurance Program Reauthorization Act to providers navigating through the Quality Payment Program and discuss how plastic surgeons may optimize their performance in this new value-based payment program.
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2010-04-23
... within a reasonable distance of the facility; Assures that an adequate environment exists for operating... final rule on these operational issues, we will work with all interested stakeholders to develop the..., Health Records, Medicaid, Medicare, Nursing [[Page 21179
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Directory of Open Access Journals (Sweden)
Menz Hylton B
2009-10-01
Full Text Available Abstract Background In 2004, as an extension of the Enhanced Primary Care (EPC program, the Australian Government introduced a policy of providing Medicare rebates for allied health services provided to patients with chronic or complex health conditions. The objective of this study was to evaluate the utilisation of podiatry services provided under this scheme between 2004 and 2008. Methods Data pertaining to the Medicare item 10962 for the calendar years 2004-2008 were extracted from the Australian Medicare Benefits Schedule (MBS database and cross-tabulated by sex and age. Descriptive analyses were undertaken to assess sex and age differences in the number of consultations provided and to assess for temporal trends over the five-year assessment period. The total cost to Medicare over this period was also determined. Results During the 2004-2008 period, a total of 1,338,044 EPC consultations were provided by podiatrists in Australia. Females exhibited higher utilisation than males (63 versus 37%, and those aged over 65 years accounted for 75% of consultations. There was a marked increase in the number of consultations provided from 2004 to 2008, and the total cost of providing EPC podiatry services during this period was $62.9 M. Conclusion Podiatry services have been extensively utilised under the EPC program by primary care patients, particularly older women, and the number of services provided has increased dramatically between 2004 and 2008. Further research is required to determine whether the EPC program enhances clinical outcomes compared to standard practice.
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75 FR 39641 - Medicare and Medicaid Programs; Civil Money Penalties for Nursing Homes
2010-07-12
... law judge (ALJ) reverses the civil money penalty determination in whole or in part, the escrowed..., widespread harm, or resulting in a resident's death is not eligible for the civil money penalty reduction... Penalties for Nursing Homes AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Proposed...
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10 CFR 10.22 - Notice to individual.
2010-01-01
... 10 Energy 1 2010-01-01 2010-01-01 false Notice to individual. 10.22 Section 10.22 Energy NUCLEAR... NATIONAL SECURITY INFORMATION OR AN EMPLOYMENT CLEARANCE Procedures § 10.22 Notice to individual. A... Counsel, and signed by the Director, Office of Administration, must be presented to each individual whose...
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2011-02-02
... Improvement Protection Act of 2000 (Pub. L. 106-544) CAH Critical access hospital CAP Competitive acquisition... corporations and non-profit organizations and charities. The ``Report to Congress on Steps Taken to Assure... primarily payable under Part A of Medicare, such as hospitals, home health agencies (including home health...
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How Successful Is Medicare Advantage?
Newhouse, Joseph P; McGuire, Thomas G
2014-01-01
Context Medicare Part C, or Medicare Advantage (MA), now almost 30 years old, has generally been viewed as a policy disappointment. Enrollment has vacillated but has never come close to the penetration of managed care plans in the commercial insurance market or in Medicaid, and because of payment policy decisions and selection, the MA program is viewed as having added to cost rather than saving funds for the Medicare program. Recent changes in Medicare policy, including improved risk adjustment, however, may have changed this picture. Methods This article summarizes findings from our group's work evaluating MA's recent performance and investigating payment options for improving its performance even more. We studied the behavior of both beneficiaries and plans, as well as the effects of Medicare policy. Findings Beneficiaries make “mistakes” in their choice of MA plan options that can be explained by behavioral economics. Few beneficiaries make an active choice after they enroll in Medicare. The high prevalence of “zero-premium” plans signals inefficiency in plan design and in the market's functioning. That is, Medicare premium policies interfere with economically efficient choices. The adverse selection problem, in which healthier, lower-cost beneficiaries tend to join MA, appears much diminished. The available measures, while limited, suggest that, on average, MA plans offer care of equal or higher quality and for less cost than traditional Medicare (TM). In counties, greater MA penetration appears to improve TM's performance. Conclusions Medicare policies regarding lock-in provisions and risk adjustment that were adopted in the mid-2000s have mitigated the adverse selection problem previously plaguing MA. On average, MA plans appear to offer higher value than TM, and positive spillovers from MA into TM imply that reimbursement should not necessarily be neutral. Policy changes in Medicare that reform the way that beneficiaries are charged for MA plan
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Medication adherence and Medicare expenditure among beneficiaries with heart failure.
Lopert, Ruth; Shoemaker, J Samantha; Davidoff, Amy; Shaffer, Thomas; Abdulhalim, Abdulla M; Lloyd, Jennifer; Stuart, Bruce
2012-09-01
To (1) measure utilization of and adherence to heart failure medications and (2) assess whether better adherence is associated with lower Medicare spending. Pooled cross-sectional design using six 3-year cohorts of Medicare beneficiaries with congestive heart failure (CHF) from 1997 through 2005 (N = 2204). Adherence to treatment was measured using average daily pill counts. Bivariate and multivariate methods were used to examine the relationship between medication adherence and Medicare spending. Multivariate analyses included extensive variables to control for confounding, including healthy adherer bias. Approximately 58% of the cohort were taking an angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB), 72% a diuretic, 37% a beta-blocker, and 34% a cardiac glycoside. Unadjusted results showed that a 10% increase in average daily pill count for ACE inhibitors or ARBs, beta-blockers, diuretics, or cardiac glycosides was associated with reductions in Medicare spending of $508 (not significant [NS]), $608 (NS), $250 (NS), and $1244 (P <.05), respectively. Estimated adjusted marginal effects of a 10% increase in daily pill counts for beta-blockers and cardiac glycosides were reductions in cumulative 3-year Medicare spending of $510 to $561 and $750 to $923, respectively (P <.05). Higher levels of medication adherence among Medicare beneficiaries with CHF were associated with lower cumulative Medicare spending over 3 years, with savings generally exceeding the costs of the drugs in question.
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Corazzini, Kirsten
2003-01-01
Objective To examine how case managers in a state-funded home care program allocate home care services in response to information about a client's Medicare home health care status, with particular attention to the influence of work environment. Data Sources/Study Setting Primary data collected on 355 case managers and 26 agency directors employed in June 1999 by 26 of the 27 regional agencies administering the Massachusetts Home Care Program for low-income elders. Study Design Data were collected in a cross-sectional survey study design. A case manager survey included measures of work environment, demographics, and factorial survey vignette clients (N=2,054), for which case managers assessed service eligibility levels. An agency director survey included measures of management practices. Data Collection/Extraction Methods Hierarchical linear models estimated the effects of work environment on the relationship between client receipt of Medicare home health care and care plan levels while controlling for case-mix differences in agencies' clients. Principal Findings Case managers did not supplement extant Medicare home health services, but did allocate more generous service plans to clients who have had Medicare home health care services recently terminated. This finding persisted when controlling for case mix and did not vary by work environment. Work environment affected overall care plan levels. Conclusions Study findings indicate systematic patterns of frontline resource allocation shaping the relationships among community-based long-term care payment sources. Further, results illustrate how nonuniform implementation of upper-level initiatives may be partially attributed to work environment characteristics. PMID:14596390
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2013-08-06
.... Accounting Statement 7. Conclusion B. Regulatory Flexibility Act Analysis C. Unfunded Mandates Reform Act...-eligible beneficiaries would receive their drugs through the Medicare Part D benefit, which would work... rate than higher-skilled occupations, using the [[Page 47943
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Effect of medicare payment on rural health care systems.
McBride, Timothy D; Mueller, Keith J
2002-01-01
Medicare payments constitute a significant share of patient-generated revenues for rural providers, more so than for urban providers. Therefore, Medicare payment policies influence the behavior of rural providers and determine their financial viability. Health services researchers need to contribute to the understanding of the implications of changes in fee-for-service payment policy, prospects for change because of the payment to Medicare+Choice risk plans, and implications for rural providers inherent in any restructuring of the Medicare program. This article outlines the basic policy choices, implications for rural providers and Medicare beneficiaries, impacts of existing research, and suggestions for further research. Topics for further research include implications of the Critical Access Hospital program, understanding how changes in payment to rural hospitals affect patient care, developing improved formulas for paying rural hospitals, determining the payment-to-cost ratio for physicians, measuring the impact of changes in the payment methodology used to pay for services delivered by rural health clinics and federally qualified health centers, accounting for the reasons for differences in historical Medicare expenditures across rural counties and between rural and urban counties, explicating all reasons for Medicare+Choice plans withdrawing from some rural areas and entering others, measuring the rural impact of proposals to add a prescription drug benefit to the Medicare program, and measuring the impact of Medicare payment policies on rural economies.
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42 CFR 423.800 - Administration of subsidy program.
2010-10-01
... 42 Public Health 3 2010-10-01 2010-10-01 false Administration of subsidy program. 423.800 Section 423.800 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT Premiums and Cost...
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42 CFR 423.159 - Electronic prescription drug program.
2010-10-01
... 42 Public Health 3 2010-10-01 2010-10-01 false Electronic prescription drug program. 423.159 Section 423.159 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT Cost Control and Quality...
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Medicare FFS Jurisdiction Error Rate Contribution Data
U.S. Department of Health & Human Services — The Centers for Medicare and Medicaid Services CMS is dedicated to continually strengthening and improving the Medicare program, which provides vital services to...
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Medicare and Medicaid fraud and abuse regulations.
Liang, F Z; Black, B L
1991-11-01
Specific business arrangements that are protected under legislation and regulations governing parties doing business with Medicare or Medicaid are discussed. Regulations implementing the Medicare and Medicaid Patient Protection Act of 1987 specify practices and activities that are not subject to criminal penalties under the antikickback provisions of the Social Security Act or to exclusion from Medicare or state health-care programs. As of July 29, 1991, all organized health-care settings that receive payments from either Medicare or state health-care programs must comply with these regulations. The final rule sets forth "safe harbors"--exceptions to prohibitions against (1) kickbacks, bribes, rebates, and other illegal activities involving remunerations for patient referrals and (2) inducements to purchase or lease goods paid for by Medicare or state health-care programs. The safe harbors comprise 11 broad categories--investment interests, space rental, equipment rental, personal services and management contracts, purchase of a medical practice, referral services, warranties, discounts, employees, group purchasing organizations, and waiver of deductibles and coinsurance. Implications for pharmacy are discussed. These regulations will affect the purchase of pharmaceuticals by institutional pharmacies. Each institution should review its current practices to determine whether they are within the safe harbors.
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Statistical Uncertainty in the Medicare Shared Savings...
U.S. Department of Health & Human Services — According to analysis reported in Statistical Uncertainty in the Medicare Shared Savings Program published in Volume 2, Issue 4 of the Medicare and Medicaid Research...
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Bellinger, Adam S; Elliott, Sean P; Yang, Liu; Wei, John T; Saigal, Christopher S; Smith, Alexandria; Wilt, Timothy J; Strope, Seth A
2012-05-01
Benign prostatic hyperplasia creates significant expenses for the Medicare program. We determined expenditure trends for benign prostatic hyperplasia evaluative testing after urologist consultation and placed these trends in the context of overall Medicare expenditures. Using a 5% national sample of Medicare beneficiaries from 2000 to 2007 we developed a cohort of 40,253 with claims for new visits to urologists for diagnoses consistent with symptomatic benign prostatic hyperplasia. We assessed trends in initial inflation and geography adjusted expenditures within 12 months of diagnosis by evaluative test categories derived from the 2003 American Urological Association guideline on the management of benign prostatic hyperplasia. Using governmental reports on Medicare expenditure trends for benign prostatic hyperplasia we compared expenditures to overall and imaging specific Medicare expenditures. Comparisons were assessed by the Z-test and regression analysis for linear trends, as appropriate. Between 2000 and 2007 inflation adjusted total Medicare expenditures per patient for the initial evaluation of patients with benign prostatic hyperplasia seen by urologists increased from $255.44 to $343.98 (p inflation adjusted expenditures increased for benign prostatic hyperplasia related evaluations. This growth was slower than the overall growth in Medicare expenditures. The increase in BPH related imaging expenditures was restrained compared to that of the Medicare program as a whole. Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
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75 FR 46833 - 45th Anniversary of Medicare and Medicaid
2010-08-03
... Part III The President Proclamation 8544--45th Anniversary of Medicare and Medicaid #0; #0; #0..., 2010 45th Anniversary of Medicare and Medicaid By the President of the United States of America A Proclamation When President Lyndon B. Johnson signed Medicare and Medicaid into law on July 30, 1965, millions...
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Disease management for chronically ill beneficiaries in traditional Medicare.
Bott, David M; Kapp, Mary C; Johnson, Lorraine B; Magno, Linda M
2009-01-01
We summarize the Centers for Medicare and Medicaid Services' (CMS's) experience with disease management (DM) in fee-for-service Medicare. Since 1999, the CMS has conducted seven DM demonstrations involving some 300,000 beneficiaries in thirty-five programs. Programs include provider-based, third-party, and hybrid models. Reducing costs sufficient to cover program fees has proved particularly challenging. Final evaluations on twenty programs found three with evidence of quality improvement at or near budget-neutrality, net of fees. Interim monitoring covering at least twenty-one months on the remaining fifteen programs suggests that four are close to covering their fees. Characteristics of the traditional Medicare program present a challenge to these DM models.
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77 FR 26827 - Medicaid Program; Community First Choice Option
2012-05-07
... Medicare & Medicaid Services 42 CFR Part 441 Medicaid Program; Community First Choice Option; Final Rule #0... [CMS-2337-F] RIN 0938-AQ35 Medicaid Program; Community First Choice Option AGENCY: Centers for Medicare... Affordable Care Act, which establishes a new State option to provide home and community-based attendant...
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Xu, Peng; Burgess, James F; Cabral, Howard; Soria-Saucedo, Rene; Kazis, Lewis E
2015-03-03
The Centers for Medicare & Medicaid Services (CMS) publishes star ratings on Medicare Advantage (MA) contracts to measure plan quality of care with implications for reimbursement and bonuses. To investigate whether MA contract characteristics are associated with quality of care through the Medicare plan star ratings. Retrospective study of MA star ratings in 2010. Unadjusted and adjusted multivariable linear regression models assessed the relationship between 5-star rating summary scores and plan characteristics. CMS MA contracts nationally. 409 (71%) of a total of 575 MA contracts, covering 10.56 million Medicare beneficiaries (90% of the MA population) in the United States in 2010. The MA quality ratings summary score (stars range from 1 to 5) is a quality measure based on 36 indicators related to processes of care, health outcomes, access to care, and beneficiary satisfaction. Nonprofit, larger, and older MA contracts were more likely to receive higher star ratings. Star ratings ranged from 2 to 5. Nonprofit contracts received an average 0.55 (95% CI, 0.42 to 0.67) higher star ratings than for-profit contracts (P star ratings than for-profit contracts. When comparing health plans in the future, the CMS should give increasing attention to for-profit plans with lower quality ratings and consider developing programs to assist newer and smaller plans in improving their care for Medicare beneficiaries. None.
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Mittler, Jessica N; Landon, Bruce E; Zaslavsky, Alan M; Cleary, Paul D
2011-10-14
Medicare beneficiaries' awareness of Medicare managed care plans is critical for realizing the potential benefits of coverage choices. To assess the relationships of the number of Medicare risk plans, managed care penetration, and stability of plans in an area with traditional Medicare beneficiaries' awareness of the program. Cross-sectional analysis of Medicare Current Beneficiary Survey data about beneficiaries' awareness and knowledge of Medicare managed care plan availability. Logistic regression models used to assess the relationships between awareness and market characteristics. Traditional Medicare beneficiaries (n = 3,597) who had never been enrolled in Medicare managed care, but had at least one plan available in their area in 2002, and excluding beneficiaries under 65, receiving Medicaid, or with end stage renal disease. Traditional Medicare beneficiaries' knowledge of Medicare managed care plans in general and in their area. Having more Medicare risk plans available was significantly associated with greater awareness, and having an intermediate number of plans (2-4) was significantly associated with more accurate knowledge of Medicare risk plan availability than was having fewer or more plans. Medicare may have more success engaging consumers in choice and capturing the benefits of plan competition by more actively selecting and managing the plan choice set. Public Domain.
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Béthermin, M.; Dole, H.; Beelen, A.; Aussel, H.
2010-03-01
Aims: We aim to place stronger lower limits on the cosmic infrared background (CIB) brightness at 24 μm, 70 μm and 160 μm and measure the extragalactic number counts at these wavelengths in a homogeneous way from various surveys. Methods: Using Spitzer legacy data over 53.6 deg2 of various depths, we build catalogs with the same extraction method at each wavelength. Completeness and photometric accuracy are estimated with Monte-Carlo simulations. Number count uncertainties are estimated with a counts-in-cells moment method to take galaxy clustering into account. Furthermore, we use a stacking analysis to estimate number counts of sources not detected at 70 μm and 160 μm. This method is validated by simulations. The integration of the number counts gives new CIB lower limits. Results: Number counts reach 35 μJy, 3.5 mJy and 40 mJy at 24 μm, 70 μm, and 160 μm, respectively. We reach deeper flux densities of 0.38 mJy at 70, and 3.1 at 160 μm with a stacking analysis. We confirm the number count turnover at 24 μm and 70 μm, and observe it for the first time at 160 μm at about 20 mJy, together with a power-law behavior below 10 mJy. These mid- and far-infrared counts: 1) are homogeneously built by combining fields of different depths and sizes, providing a legacy over about three orders of magnitude in flux density; 2) are the deepest to date at 70 μm and 160 μm; 3) agree with previously published results in the common measured flux density range; 4) globally agree with the Lagache et al. (2004) model, except at 160 μm, where the model slightly overestimates the counts around 20 and 200 mJy. Conclusions: These counts are integrated to estimate new CIB firm lower limits of 2.29-0.09+0.09 nW m-2 sr-1, 5.4-0.4+0.4 nW m-2 sr-1, and 8.9-1.1+1.1 nW m-2 sr-1 at 24 μm, 70 μm, and 160 μm, respectively, and extrapolated to give new estimates of the CIB due to galaxies of 2.86-0.16+0.19 nW m-2 sr-1, 6.6-0.6+0.7 nW m-2 sr-1, and 14.6-2.9+7.1 nW m-2 sr-1
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Measuring coding intensity in the Medicare Advantage program.
Kronick, Richard; Welch, W Pete
2014-01-01
In 2004, Medicare implemented a system of paying Medicare Advantage (MA) plans that gave them greater incentive than fee-for-service (FFS) providers to report diagnoses. Risk scores for all Medicare beneficiaries 2004-2013 and Medicare Current Beneficiary Survey (MCBS) data, 2006-2011. Change in average risk score for all enrollees and for stayers (beneficiaries who were in either FFS or MA for two consecutive years). Prevalence rates by Hierarchical Condition Category (HCC). Each year the average MA risk score increased faster than the average FFS score. Using the risk adjustment model in place in 2004, the average MA score as a ratio of the average FFS score would have increased from 90% in 2004 to 109% in 2013. Using the model partially implemented in 2014, the ratio would have increased from 88% to 102%. The increase in relative MA scores appears to largely reflect changes in diagnostic coding, not real increases in the morbidity of MA enrollees. In survey-based data for 2006-2011, the MA-FFS ratio of risk scores remained roughly constant at 96%. Intensity of coding varies widely by contract, with some contracts coding very similarly to FFS and others coding much more intensely than the MA average. Underpinning this relative growth in scores is particularly rapid relative growth in a subset of HCCs. Medicare has taken significant steps to mitigate the effects of coding intensity in MA, including implementing a 3.4% coding intensity adjustment in 2010 and revising the risk adjustment model in 2013 and 2014. Given the continuous relative increase in the average MA risk score, further policy changes will likely be necessary.
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2013-09-06
... millions) (2) change (3) Total $3,625 1% Eye and ocular adnexa 1,496 -3 Digestive system 743 8 Nervous... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 42 CFR Parts 405...: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality...
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VizieR Online Data Catalog: Orion Integral Filament ALMA+IRAM30m N2H+(1-0) data (Hacar+, 2018)
Hacar, A.; Tafalla, M.; Forbrich, J.; Alves, J.; Meingast, S.; Grossschedl, J.; Teixeira, P. S.
2018-01-01
Combined ALMA+IRAM30m large-scale N2H+(1-0) emission in the Orion ISF. Two datasets are presented here in FITS format: 1.- Full data cube: spectral resolution = 0.1 kms-1 2.- Total integrated line intensity (moment 0) map Units are in Jy/beam See also: https://sites.google.com/site/orion4dproject/home (2 data files).
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Percolation Analysis of a Wiener Reconstruction of the IRAS 1.2 Jy Redshift Catalog
Yess, Capp; Shandarin, Sergei F.; Fisher, Karl B.
1997-01-01
We present percolation analyses of Wiener reconstructions of the IRAS 1.2 Jy redshift survey. There are 10 reconstructions of galaxy density fields in real space spanning the range β = 0.1-1.0, where β = Ω0.6/b, Ω is the present dimensionless density, and b is the bias factor. Our method uses the growth of the largest cluster statistic to characterize the topology of a density field, where Gaussian randomized versions of the reconstructions are used as standards for analysis. For the reconstruction volume of radius R ~ 100 h-1 Mpc, percolation analysis reveals a slight ``meatball'' topology for the real space, galaxy distribution of the IRAS survey.
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Reforming funding for chronic illness: Medicare-CDM.
Swerissen, Hal; Taylor, Michael J
2008-02-01
Chronic diseases are a major challenge for the Australian health care system in terms of both the provision of quality care and expenditure, and these challenges will only increase in the future. Various programs have been instituted under the Medicare system to provide increased funding for chronic care, but essentially these programs still follow the traditional fee-for-service model. This paper proposes a realignment and extension of current Medicare chronic disease management programs into a framework that provides general practitioners and other health professionals with the necessary "tools" for high quality care planning and ongoing management, and incorporating international models of outcome-linked funding. The integration of social support services with the Medicare system is also a necessary step in providing high quality care for patients with complex needs requiring additional support.
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Multi-source self-calibration: Unveiling the microJy population of compact radio sources
Radcliffe, J. F.; Garrett, M. A.; Beswick, R. J.; Muxlow, T. W. B.; Barthel, P. D.; Deller, A. T.; Middelberg, E.
2016-01-01
Context. Very long baseline interferometry (VLBI) data are extremely sensitive to the phase stability of the VLBI array. This is especially important when we reach μJy rms sensitivities. Calibration using standard phase-referencing techniques is often used to improve the phase stability of VLBI
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2013-04-29
.... ACTION: Proposed rule. SUMMARY: This proposed rule would revise the Incentive Reward Program provisions... significant of these revisions include: changing the Incentive Reward Program potential reward amount for... related to the Incentive Reward Program. Frank Whelan, (410) 786-1302, for issues related to provider...
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The Impact of Hospital-Acquired Conditions on Medicare..
U.S. Department of Health & Human Services — According to findings reported in The Impact of Hospital-Acquired Conditions on Medicare Program Payments, published in Volume 4, Issue 4 of the Medicare and...
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42 CFR 460.90 - PACE benefits under Medicare and Medicaid.
2010-10-01
... 42 Public Health 4 2010-10-01 2010-10-01 false PACE benefits under Medicare and Medicaid. 460.90 Section 460.90 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... FOR THE ELDERLY (PACE) PACE Services § 460.90 PACE benefits under Medicare and Medicaid. If a Medicare...
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PACE and the Medicare+Choice risk-adjusted payment model.
Temkin-Greener, H; Meiners, M R; Gruenberg, L
2001-01-01
This paper investigates the impact of the Medicare principal inpatient diagnostic cost group (PIP-DCG) payment model on the Program of All-Inclusive Care for the Elderly (PACE). Currently, more than 6,000 Medicare beneficiaries who are nursing home certifiable receive care from PACE, a program poised for expansion under the Balanced Budget Act of 1997. Overall, our analysis suggests that the application of the PIP-DCG model to the PACE program would reduce Medicare payments to PACE, on average, by 38%. The PIP-DCG payment model bases its risk adjustment on inpatient diagnoses and does not capture adequately the risk of caring for a population with functional impairments.
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Changes in Postacute Care in the Medicare Shared Savings Program.
McWilliams, J Michael; Gilstrap, Lauren G; Stevenson, David G; Chernew, Michael E; Huskamp, Haiden A; Grabowski, David C
2017-04-01
Postacute care is thought to be a major source of wasteful spending. The extent to which accountable care organizations (ACOs) can limit postacute care spending has implications for the importance and design of other payment models that include postacute care. To assess changes in postacute care spending and use of postacute care associated with provider participation as ACOs in the Medicare Shared Savings Program (MSSP) and the pathways by which they occurred. With the use of fee-for-service Medicare claims from a random 20% sample of beneficiaries with 25 544 650 patient-years, 8 395 426 hospital admissions, and 1 595 352 stays in skilled nursing facilities (SNFs) from January 1, 2009, to December 31, 2014, difference-in-difference comparisons of beneficiaries served by ACOs with beneficiaries served by local non-ACO health care professionals (control group) were performed before vs after entry into the MSSP. Differential changes were estimated separately for cohorts of ACOs entering the MSSP in 2012, 2013, and 2014. Patient attribution to an ACO in the MSSP. Postacute spending, discharge to a facility, length of SNF stays, readmissions, use of highly rated SNFs, and mortality, adjusted for patient characteristics. For the 2012 cohort of 114 ACOs, participation in the MSSP was associated with an overall reduction in postacute spending (differential change in 2014 for ACOs vs control group, -$106 per beneficiary [95% CI, -$176 to -$35], or -9.0% of the precontract unadjusted mean of $1172; P = .003) that was driven by differential reductions in acute inpatient care, discharges to facilities rather than home (-0.6 percentage points [95% CI, -1.1 to 0.0], or -2.7% of the unadjusted precontract mean of 22.6%; P = .03), and length of SNF stays (-0.60 days per stay [95% CI, -0.99 to -0.22], or -2.2% of the precontract unadjusted mean of 27.07 days; P = .002). Reductions in use of SNFs and length of stay were largely due to within-hospital or
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75 FR 69037 - Medicaid Program; Recovery Audit Contractors
2010-11-10
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 42 CFR Part 455 [CMS-6034-P] RIN 0938-AQ19 Medicaid Program; Recovery Audit Contractors AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Proposed rule. SUMMARY: This proposed rule would provide guidance to...
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2010-10-22
.... Palliative care in an LTC facility involves addressing physical, intellectual, emotional, social, and... Disability, Aging and Long-Term Care Policy and the Urban Institute; ``Synthesis and Analysis of Medicare..., mental, social, or emotional status; clinical complications that suggested a need to alter the care plan...
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2010-09-27
... in which the hospital is located: War Memorial Hospital (Medicare provider number 51-1309), of..., Virginia Beach, VA 23453. The Hospital's Designated OPO is: Center for Organ Recovery and Education, RIDC...
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Vertical integration strategies: revenue effects in hospital and Medicare markets.
Cody, M
1996-01-01
The purpose of this study was to evaluate the revenue effects of seven vertically integrated strategies on California hospitals. The strategies investigated were managed care contracts, physician affiliations, ambulatory care, ambulatory surgery, home health services, inpatient rehabilitation, and skilled nursing care. The study population included 242 not-for-profit hospitals in continuous operation from 1983 to 1990. Many hospitals developed vertically integrated programs in the 1980s as inpatient utilization fell in response to the Medicare Prospective Payment program. Net revenue rose on average by $2,080 from 1983 to 1990, but fell by $2,421 from the Medicare program. On the whole, the more physicians affiliated with a hospital, the higher the net revenue. However, in the Medicare population, the number of managed care contracts was significant. The pre-hospital strategies generated significant revenue, while the post-hospital strategies did not. In the Medicare program, inpatient rehabilitation significantly reduced revenue.
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... get about Medicare Lost/incorrect Medicare card Report fraud & abuse File a complaint Identity theft: protect yourself ... the U.S. Centers for Medicare & Medicaid Services. 7500 Security Boulevard, Baltimore, MD 21244 Sign Up / Change Plans ...
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2015-08-17
We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital related costs of acute care hospitals to implement changes arising from our continuing experience with these systems for FY 2016. Some of these changes implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act), the Pathway for Sustainable Growth Reform(SGR) Act of 2013, the Protecting Access to Medicare Act of 2014, the Improving Medicare Post-Acute Care Transformation Act of 2014, the Medicare Access and CHIP Reauthorization Act of 2015, and other legislation. We also are addressing the update of the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits for FY 2016.As an interim final rule with comment period, we are implementing the statutory extensions of the Medicare dependent,small rural hospital (MDH)Program and changes to the payment adjustment for low-volume hospitals under the IPPS.We also are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) for FY 2016 and implementing certain statutory changes to the LTCH PPS under the Affordable Care Act and the Pathway for Sustainable Growth Rate (SGR) Reform Act of 2013 and the Protecting Access to Medicare Act of 2014.In addition, we are establishing new requirements or revising existing requirements for quality reporting by specific providers (acute care hospitals,PPS-exempt cancer hospitals, and LTCHs) that are participating in Medicare, including related provisions for eligible hospitals and critical access hospitals participating in the Medicare Electronic Health Record (EHR)Incentive Program. We also are updating policies relating to the
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Veilleux, Jean Wright
2012-01-01
This Article argues that the current approach of the Department of Health and Human Services and the Centers for Medicare and Medicaid Services (CMS) to enforcement of the Ethics in Patient Referrals Act (the "Stark Law") is unnecessarily punitive and discourages health-care providers from self-disclosing even very minor violations of the Stark Law. This Article suggests a number of specific changes to encourage provider self-disclosure and proposes that CMS create a demonstration project under the authority of the Patient Protection and Affordable Care Act to test the reforms. A demonstration project provides the perfect vehicle to prove that increased self-disclosure protocols for the Stark Law can decrease the government's costs of enforcement, improve program integrity, and encourage providers to deal responsibly with the inevitable minor lapses in compliance that arise in such an enormous government program as Medicare.
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49 CFR Appendix B to Part 599 - Engine Disablement Procedures for the CARS Program
2010-10-01
... 49 Transportation 7 2010-10-01 2010-10-01 false Engine Disablement Procedures for the CARS Program B Appendix B to Part 599 Transportation Other Regulations Relating to Transportation (Continued...—Engine Disablement Procedures for the CARS Program ER29JY09.006 ...
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Semilla, April P; Chen, Fang; Dall, Timothy M
2015-07-01
Medicare Part D is a prescription drug program that provides seniors and disabled individuals enrolled in Medicare with outpatient drug coverage benefits. Part D has been shown to increase access to medicines and improve medication adherence; however, the effect of Part D on health outcomes has not yet been extensively studied. In this study, we used a published and validated Markov-based microsimulation model to quantify the relationships among medication use, disease incidence and severity, and mortality. Based on the simulation results, we estimate that since the implementation of Part D in 2006, nearly 200,000 Medicare beneficiaries have lived at least 1 year longer. Reductions in mortality have occurred because of fewer deaths associated with medication-sensitive conditions such as diabetes, congestive heart failure, stroke, and myocardial infarction. Improved access to medication through Medicare Part D helps patients improve blood pressure, cholesterol, and blood glucose levels, which in turn can prevent or delay the onset of disease and the incidence of adverse health events, thus reducing mortality.
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2013-12-10
... MFP Multi-Factor Productivity MGMA Medical Group Management Association MIEA-TRHCA The Medicare... 69624), we revised the methodology for calculating direct PE RVUs from the top- down to the bottom-up... Based on RVUs To calculate the payment for each physicians' service, the components of the fee schedule...
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77 FR 17143 - Medicaid Program; Eligiblity Changes Under the Affordable Care Act of 2010
2012-03-23
... Medicare and Medicaid Services 42 CFR Parts 431, 435 and 457 Medicaid Program; Eligibility Changes Under... for Medicare & Medicaid Services 42 CFR Parts 431, 435, and 457 [CMS-2349-F] RIN 0938-AQ62 Medicaid Program; Eligiblity Changes Under the Affordable Care Act of 2010 AGENCY: Centers for Medicare & Medicaid...
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78 FR 6272 - Rules Relating to Additional Medicare Tax; Correction
2013-01-30
... Rules Relating to Additional Medicare Tax; Correction AGENCY: Internal Revenue Service (IRS), Treasury... regulations are relating to Additional Hospital Insurance Tax on income above threshold amounts (``Additional Medicare Tax''), as added by the Affordable Care Act. Specifically, these proposed regulations provide...
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2017-08-14
We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems for FY 2018. Some of these changes implement certain statutory provisions contained in the Pathway for Sustainable Growth Rate (SGR) Reform Act of 2013, the Improving Medicare Post-Acute Care Transformation Act of 2014, the Medicare Access and CHIP Reauthorization Act of 2015, the 21st Century Cures Act, and other legislation. We also are making changes relating to the provider-based status of Indian Health Service (IHS) and Tribal facilities and organizations and to the low-volume hospital payment adjustment for hospitals operated by the IHS or a Tribe. In addition, we are providing the market basket update that will apply to the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits for FY 2018. We are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) for FY 2018. In addition, we are establishing new requirements or revising existing requirements for quality reporting by specific Medicare providers (acute care hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric facilities). We also are establishing new requirements or revising existing requirements for eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) participating in the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. We are updating policies relating to the Hospital Value-Based Purchasing (VBP) Program, the Hospital Readmissions Reduction Program, and the Hospital-Acquired Condition (HAC) Reduction Program. We also are making changes relating to transparency of accrediting organization survey
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2011-06-17
... Community Mental Health Centers; Proposed Rule #0;#0;Federal Register / Vol. 76 , No. 117 / Friday June 17... (CoPs) for Community Mental Health Centers AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS... participation (CoPs) that community mental health centers (CMHCs) would have to meet in order to participate in...
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2013-07-19
... Index MFP Multi-Factor Productivity MIEA-TRHCA The Medicare Improvements and Extension Act, Division B... calculating direct PE RVUs from the top- down to the bottom-up methodology beginning in CY 2007. We adopted a... $20 million. 2. Calculation of Payments Based on RVUs To calculate the payment for each physicians...
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2010-12-27
... Director.) Specific conflict of interest rules that should apply to RACs for the Medicare Parts C and D... Remuneration (DIR). The DIR information reported by plans includes rebates paid by pharmaceutical manufacturers, as well as other remuneration received by the plan that has the effect of reducing their drug costs...
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Plenary III–04: Responses to Drug Costs: Year Three of the Medicare Part D Program
Fung, Vicki; Reed, Mary; Hsu, John
2010-01-01
Background/Aims: Many Medicare Part D beneficiaries face substantial prescription drug cost-sharing. In the first year of the program, many beneficiaries reported substantial drug use changes in response to the coverage gap. In response, an increasing number of plans offer generic drug coverage during the gap. We compared responses to Part D costs among beneficiaries with generic-only gap coverage and full gap coverage in 2008, the third year of the Part D program.
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Disease prevention policy under Medicare: a historical and political analysis.
Schauffler, H H
1993-01-01
I review the history and politics of Medicare disease prevention policy and identify factors associated with the success or failure of legislative initiatives to add preventive services benefits to Medicare. Between 1965 and 1990, 453 bills for Medicare preventive services were introduced in the U.S. Congress, but not until 1980, after 350 bills had failed, was the first preventive service added to the Medicare program. Medicare currently pays for only four of the 44 preventive services recommended for the elderly by the U.S. Preventive Services Task Force (pneumococcal and hepatitis B vaccinations, Pap smears, and mammography). In addition, Congress has funded demonstration programs for the influenza vaccine and comprehensive preventive services. The preventive services added to Medicare reflect the bias of the biomedical model toward screening and immunizations. Counseling services have received the least legislative attention. Factors associated with successful enactment include single-benefit bills, incorporation into budget-deficit reduction legislation, documented evidence of cost-effectiveness, public hearings, sponsorship by chairs of key congressional committees, and persistent congressional leadership. Factors associated with failure include lack of support from Medicare beneficiaries, lack of professional support, impact on total Medicare expenditures, disagreement over or failure to address payment and financing mechanisms, and competing congressional priorities.
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Jeong, Erwin W; Feger, Erin; Noble, Harmony K; Kmiec, Magdalen; Prayaga, Ram S
2018-01-01
Background Nonadherence is a major concern in the management of chronic conditions such as hypertension, cardiovascular disease, and diabetes where patients may discontinue or interrupt their medication for a variety of reasons. Text message reminders have been used to improve adherence. However, few programs or studies have explored the benefits of text messaging with older populations and at scale. In this paper, we present a program design using tailored and interactive text messaging to improve refill rates of partially adherent or nonadherent Medicare members of a large integrated health plan. Objective The aim of this 3-month program was to gain an understanding of whether tailored interactive text message dialogues could be used to improve medication refills in Medicare patients with one or more chronic diseases. Methods We used the mPulse Mobile interactive text messaging solution with partially adherent and nonadherent Medicare patients (ie, over age 65 years or younger with disabilities) of Kaiser Permanente Southern California (KP), a large integrated health plan, and compared refill rates of the text messaging group (n=12,272) to a group of partially adherent or nonadherent Medicare patients at KP who did not receive text messages (nontext messaging group, n=76,068). Both groups were exposed to other forms of refill and adherence outreach including phone calls, secure emails, and robo-calls from December 2016 to February 2017. Results The text messaging group and nontext messaging group were compared using an independent samples t test to test difference in group average of refill rates. There was a significant difference in medication refill rates between the 2 groups, with a 14.07 percentage points higher refill rate in the text messaging group (Pimprove medication refill rates among Medicare patients. These findings also support using interactive text messaging as a cost-effective, convenient, and user-friendly solution for patient engagement
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Medicare-Medicaid Enrollee Profiles (State and National)
U.S. Department of Health & Human Services — Today there are over 10 million Medicare-Medicaid enrollees in the United States.To provide a greater understanding of the Medicare-Medicaid enrollee population, the...
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2010-08-03
... hospitalization and community mental health center issues. James Poyer, (410) 786-2261, Reporting of quality data... Community mental health center CMS Centers for Medicare & Medicaid Services CoP Conditions of Participation... (which includes partial hospitalization services furnished by community mental health centers (CMHCs...
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2012-07-13
... national standardized 60- day episode rates, the national per-visit rates, the low-utilization payment... Care Hospital LUPA Low Utilization Payment Amount MEPS Medical Expenditures Panel Survey MMA Medicare... units of services, adjustments for geographic differences in wage levels, outlier payments, the...
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2012-06-11
... identify outlier cases for both inpatient operating and inpatient capital related payments, which is... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 42 CFR Parts 412... Fiscal Year 2013 Rates; Hospitals' Resident Caps for Graduate Medical Education Payment Purposes; Quality...
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1995-09-01
This rule clarifies and updates portions of the HCFA regulations that pertain to the following: The conditions that an HMO or CMP must meet to qualify for a Medicare contract (Subpart J). The contract requirements (Subpart L). The rules for enrollment, entitlement, and disenrollment of Medicare beneficiaries in a contracting HMO or CMP (Subpart K). How a Medicare contract is affected when there is change of ownership or leasing of facilities of a contracting HMO or CMP (Subpart M). These are technical and editorial changes that do not affect the substance of the regulations. They are intended to make it easier to find particular provisions, to provide overviews of the different program aspects, and to better ensure uniform understanding of the rules.
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Reforming Access: Trends in Medicaid Enrollment for New Medicare Beneficiaries, 2008-2011.
Keohane, Laura M; Rahman, Momotazur; Mor, Vincent
2016-04-01
To evaluate whether aligning the Part D low-income subsidy and Medicaid program enrollment pathways in 2010 increased Medicaid participation among new Medicare beneficiaries. Medicare enrollment records for years 2007-2011. We used a multinomial logistic model with state fixed effects to examine the annual change in limited and full Medicaid enrollment among new Medicare beneficiaries for 2 years before and after the reforms (2008-2011). We identified new Medicare beneficiaries in the years 2008-2011 and their participation in Medicaid based on Medicare enrollment records. The percentage of beneficiaries enrolling in limited Medicaid at the start of Medicare coverage increased in 2010 by 0.3 percentage points for individuals aging into Medicare and by 1.3 percentage points for those qualifying due to disability (p < .001). There was no significant difference in the size of enrollment increases between states with and without concurrent limited Medicaid eligibility expansions. Our findings suggest that streamlining financial assistance programs may improve Medicare beneficiaries' access to benefits. © Health Research and Educational Trust.
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Harewood, Gavin C; Alsaffar, Omar
2015-03-01
The Centers for Medicare and Medicaid Services recently published data on Medicare payments to physicians for 2012. We investigated regional variations in payments to gastroenterologists and evaluated whether payments correlated with the number of Medicare patients in each state. We found that the mean payment per gastroenterologist in each state ranged from $35,293 in Minnesota to $175,028 in Mississippi. Adjusted per-physician payments ranged from $11 per patient in Hawaii to $62 per patient in Washington, DC. There was no correlation between the mean per-physician payment and the mean number of Medicare patients per physician (r = 0.09), there also was no correlation between the mean per-physician payment and the overall mean per-capita health care costs for each state (r = -0.22). There was a 5.6-fold difference between the states with the lowest and highest adjusted Medicare payments to gastroenterologists. Therefore, the Centers for Medicare and Medicaid Services payments do not appear to be associated with the volume of Medicare beneficiaries or overall per-capita health care costs for each state. Copyright © 2015 AGA Institute. Published by Elsevier Inc. All rights reserved.
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Competitive pricing and the challenge of cost control in medicare.
Coulam, Robert F; Feldman, Roger D; Dowd, Bryan E
2011-08-01
The Medicare program faces a serious challenge: it must find ways to control costs but must do so through a system of congressional oversight that necessarily limits its choices. We look at one approach to prudent purchasing - competitive pricing - that Medicare has attempted many times and in various ways since the beginning of the program, and in all but one case unsuccessfully due to the politics of provider opposition working through Congress and the courts. We look at some related efforts to change Medicare pricing to explore when the program has been successful in making dramatic changes in how it pays for health care. A set of recommendations emerges for ways to respond to the impediments of law and politics that have obstructed change to more efficient payment methods. Except in unusual cases, competitive pricing threatens too many stakeholders in too many ways for key political actors to support it. But an unusual case may arise in the coming Medicare fiscal crisis, a crisis related in part to the prices Medicare pays. At that point, competitive pricing may look less like a problem and more like a solution coming at a time when the system badly needs one.
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2011-04-06
... Payment System Transition Budget-Neutrality Adjustment AGENCY: Centers for Medicare & Medicaid Services... in the CY 2011 ESRD Prospective Payment System (PPS) final rule for renal dialysis services provided...-Stage Renal Disease Prospective Payment System'', hereinafter, referred to as the CY 2011 ESRD PPS final...
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42 CFR 411.204 - Medicare benefits secondary to LGHP benefits.
2010-10-01
... 42 Public Health 2 2010-10-01 2010-10-01 false Medicare benefits secondary to LGHP benefits. 411... benefits secondary to LGHP benefits. (a) Medicare benefits are secondary to benefits payable by an LGHP for services furnished during any month in which the individual— (1) Is entitled to Medicare Part A benefits...
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Predictors of regional Medicare expenditures for otolaryngology physician services.
Smith, Alden; Handorf, Elizabeth; Arjmand, Ellis; Lango, Miriam N
2017-06-01
To describe geographic variation in spending and evaluate regional Medicare expenditures for otolaryngologist services with population- and beneficiary-related factors, physician supply, and hospital system factors. Cross-sectional study. The average regional expenditures for otolaryngology physician services were defined as the total work relative value units (wRVUs) collected by otolaryngologists in a hospital referral region (HRR) per thousand Medicare beneficiaries in the HRR. A multivariable linear regression model tested associations with regional sociodemographics (age, sex, race, income, education), the physician and hospital bed supply, and the presence of an otolaryngology residency program. In 2012, the mean Medicare expenditure for otolaryngology provider services across HRRs was 224 wRVUs per thousand Medicare beneficiaries (standard deviation [SD] 104), ranging from 31 to 604 wRVUs per thousand Medicare beneficiaries. In 2013, the average Medicare expenditures for each HRR was highly correlated with expenditures collected in 2012 (Pearson correlation coefficient .997, P = .0001). Regional Medicare expenditures were independently and positively associated with otolaryngology, medical specialist, and hospital bed supply in the region, and were negatively associated with the supply of primary care physicians and presence of an otolaryngology residency program after adjusting for other factors. The magnitude of associations with physician supply and hospital factors was stronger than any population or Medicare beneficiary factor. Wide variations in regional Medicare expenditures for otolaryngology physician services, highly stable over 2 years, were strongly associated with regional health system factors. Changes in health policy for otolaryngology care may require coordination with other physician specialties and integrated hospital systems. NA. Laryngoscope, 127:1312-1317, 2017. © 2016 The American Laryngological, Rhinological and Otological Society
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2015-11-13
This final rule with comment period revises the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for CY 2016 to implement applicable statutory requirements and changes arising from our continuing experience with these systems. In this final rule with comment period, we describe the changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment system. In addition, this final rule with comment period updates and refines the requirements for the Hospital Outpatient Quality Reporting (OQR) Program and the ASC Quality Reporting (ASCQR) Program. Further, this document includes certain finalized policies relating to the hospital inpatient prospective payment system: Changes to the 2-midnight rule under the short inpatient hospital stay policy; and a payment transition for hospitals that lost their status as a Medicare-dependent, small rural hospital (MDH) because they are no longer in a rural area due to the implementation of the new Office of Management and Budget delineations in FY 2015 and have not reclassified from urban to rural before January 1, 2016. In addition, this document contains a final rule that finalizes certain 2015 proposals, and addresses public comments received, relating to the changes in the Medicare regulations governing provider administrative appeals and judicial review relating to appropriate claims in provider cost reports.
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Chen, Lena M; Epstein, Arnold M; Orav, E John; Filice, Clara E; Samson, Lok Wong; Joynt Maddox, Karen E
2017-08-01
Medicare recently launched the Physician Value-Based Payment Modifier (PVBM) Program, a mandatory pay-for-performance program for physician practices. Little is known about performance by practices that serve socially or medically high-risk patients. To compare performance in the PVBM Program by practice characteristics. Cross-sectional observational study using PVBM Program data for payments made in 2015 based on performance of large US physician practices caring for fee-for-service Medicare beneficiaries in 2013. High social risk (defined as practices in the top quartile of proportion of patients dually eligible for Medicare and Medicaid) and high medical risk (defined as practices in the top quartile of mean Hierarchical Condition Category risk score among fee-for-service beneficiaries). Quality and cost z scores based on a composite of individual measures. Higher z scores reflect better performance on quality; lower scores, better performance on costs. Among 899 physician practices with 5 189 880 beneficiaries, 547 practices were categorized as low risk (neither high social nor high medical risk) (mean, 7909 beneficiaries; mean, 320 clinicians), 128 were high medical risk only (mean, 3675 beneficiaries; mean, 370 clinicians), 102 were high social risk only (mean, 1635 beneficiaries; mean, 284 clinicians), and 122 were high medical and social risk (mean, 1858 beneficiaries; mean, 269 clinicians). Practices categorized as low risk performed the best on the composite quality score (z score, 0.18 [95% CI, 0.09 to 0.28]) compared with each of the practices categorized as high risk (high medical risk only: z score, -0.55 [95% CI, -0.77 to -0.32]; high social risk only: z score, -0.86 [95% CI, -1.17 to -0.54]; and high medical and social risk: -0.78 [95% CI, -1.04 to -0.51]) (P risk only performed the best on the composite cost score (z score, -0.52 [95% CI, -0.71 to -0.33]), low risk had the next best cost score (z score, -0.18 [95% CI, -0.25 to -0.10]), then
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27 CFR 10.22 - Employee associations.
2010-04-01
... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Employee associations. 10.22 Section 10.22 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT OF THE TREASURY LIQUORS COMMERCIAL BRIBERY Commercial Bribery § 10.22 Employee associations. Gifts...
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2013-05-31
... health coverage options available. The Advisory Panel on Outreach and Education allows us to consider a... Education (APOE) and Request for Nominations AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS... Education (APOE) has been renewed. It also requests nominations for individuals to serve on the APOE. DATES...
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2010-07-01
... 40 Protection of Environment 1 2010-07-01 2010-07-01 false Appearances. 22.10 Section 22.10 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GENERAL CONSOLIDATED RULES OF PRACTICE GOVERNING... and ethics required of practitioners before the courts of the United States. ...
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Bernhardt, Antonia K; Lynn, Joanne; Berger, Gregory; Lee, James A; Reuter, Kevin; Davanzo, Joan; Montgomery, Anne; Dobson, Allen
2016-09-01
At age 65, the average man and woman can respectively expect 1.5 years and 2.5 years of requiring daily help with "activities of daily living." Available services fail to match frail elders' needs, thereby routinely generating errors, unreliability, unwanted services, unmet needs, and high costs. The number of elderly Medicare beneficiaries likely to be frail will triple between 2000 and 2050. Low retirement savings, rising medical and long-term care costs, and declining family caregiver availability portend gaps in badly needed services. The financial simulation reported here for 4 diverse MediCaring Communities shows lower per capita costs. Program savings are substantial and can improve coverage and function of local supportive services within current overall Medicare spending levels. The Altarum Institute Center for Elder Care and Advanced Illness has developed a reform model, MediCaring Communities, to improve services for frail elderly Medicare beneficiaries through longitudinal care planning, better-coordinated and more desirable medical and social services, and local monitoring and management of a community's quality and supply of services. This study uses financial simulation to determine whether communities could implement the model within current Medicare and Medicaid spending levels, an important consideration to enable development and broad implementation. The financial simulation for MediCaring Communities uses 4 diverse communities chosen for adequate size, varying health care delivery systems, and ability to implement reforms and generate data rapidly: Akron, Ohio; Milwaukie, Oregon; northeastern Queens, New York; and Williamsburg, Virginia. For each community, leaders contributed baseline population and program effect estimates that reflected projections from reported research to build the model. The simulation projected third-year savings between $269 and $537 per beneficiary per month and cumulative returns on investment between 75% and 165%. The
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75 FR 75693 - Tax Credit Assistance Program-Reallocation of Funds
2010-12-06
... DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT [Docket No. FR-5448-N-01] Tax Credit Assistance... the Reallocation of Tax Credit Assistance Program (TCAP) funds. This funding opportunity makes approximately $16 million available to assist housing projects that received Low Income Housing Tax Credit...
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2-(2-Pyridylpyridinium (2,2′-bipyridine-κ2N,N′tetrakis(nitrato-κ2O,O′bismuthate(III
Directory of Open Access Journals (Sweden)
Shu-Shen Zhang
2011-10-01
Full Text Available The structure of the title compound, (C10H9N2[Bi(NO34(C10H8N2], consists of 2-(2-pyridylpyridinium cations and anions [Bi(NO34(C10H8N2]−. The Bi3+ ion lies on the twofold axis. It is coordinated by two nitrogen atoms from one 2,2′-bipyridine ligand and eight oxygen atoms from four NO3− anions. The disordered cation is positioned at the inversion centre. The [Bi(NO34(C10H8N2]− anions and 2-(2-pyridylpyridinium cations are connected via N—H...O hydrogen bonds into chains. Moreover, these chains are further linked into a two-dimensional layered structure through π–π stacking interactions between bipyridine ligands along the c axis [centroid–centroid distance = 2.868 (4 Å].
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Recent Health Care Use and Medicaid Entry of Medicare Beneficiaries.
Keohane, Laura M; Trivedi, Amal N; Mor, Vincent
2017-10-01
To examine the relationship between Medicaid entry and recent health care use among Medicare beneficiaries. We identified Medicare beneficiaries without full Medicaid or use of hospital or nursing home services in 2008 (N = 2,163,387). A discrete survival analysis estimated beneficiaries' monthly likelihood of entry into the full Medicaid program between January 2009 and June 2010. During the 18-month study period, Medicaid entry occurred for 1.1% and 3.7% of beneficiaries who aged into Medicare or originally qualified for Medicare due to disability, respectively. Among beneficiaries who aged into Medicare, 49% of new Medicaid participants had no use of inpatient, skilled nursing facility, or nursing home services during the study period. Individuals who recently used inpatient, skilled nursing facility or nursing home services had monthly rates of 1.9, 14.0, and 38.1 new Medicaid participants per 1,000 beneficiaries, respectively, compared with 0.4 new Medicaid participants per 1,000 beneficiaries with no recent use of these services. Although recent health care use predicted greater likelihood of Medicaid entry, half of new Medicaid participants used no hospital or nursing home care during the study period. These patterns should be considered when designing and evaluating interventions to reform health care delivery for dual-eligible beneficiaries. © The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
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2010-11-24
...The final rule with comment period in this document revises the Medicare hospital outpatient prospective payment system (OPPS) to implement applicable statutory requirements and changes arising from our continuing experience with this system and to implement certain provisions of the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010 (Affordable Care Act). In this final rule with comment period, we describe the changes to the amounts and factors used to determine the payment rates for Medicare hospital outpatient services paid under the prospective payment system. These changes are applicable to services furnished on or after January 1, 2011. In addition, this final rule with comment period updates the revised Medicare ambulatory surgical center (ASC) payment system to implement applicable statutory requirements and changes arising from our continuing experience with this system and to implement certain provisions of the Affordable Care Act. In this final rule with comment period, we set forth the applicable relative payment weights and amounts for services furnished in ASCs, specific HCPCS codes to which these changes apply, and other pertinent ratesetting information for the CY 2011 ASC payment system. These changes are applicable to services furnished on or after January 1, 2011. In this document, we also are including two final rules that implement provisions of the Affordable Care Act relating to payments to hospitals for direct graduate medical education (GME) and indirect medical education (IME) costs; and new limitations on certain physician referrals to hospitals in which they have an ownership or investment interest. In the interim final rule with comment period that is included in this document, we are changing the effective date for otherwise eligible hospitals and critical access hospitals that have been reclassified from urban to rural under section 1886(d)(8)(E) of the Social Security
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2010-04-23
... includes payment for premiums for Medicare Part B. Section 4732 of the Balanced Budget Act of 1997 (BBA... formula for determining State allotments. However, since certain States projected a deficit in their... minimize the impact on States with FY QI allotments that might be greater than their QI expenditures for...
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75 FR 38748 - Medicaid Program; Premiums and Cost Sharing; Correction
2010-07-06
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 42 CFR Parts 447 and 457 [CMS-2244-CN] RIN 0938-AP73 Medicaid Program; Premiums and Cost Sharing; Correction AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS ACTION: Correction of final rule with comment period...
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Medicare and Medicaid programs; advance directives--HCFA. Final rule.
1995-06-27
This final rule responds to public comments on the March 6, 1992 interim final rule with comment period that amended the Medicare and Medicaid regulations governing provider agreements and contracts to establish requirements for States, hospitals, nursing facilities, skilled nursing facilities, providers of home health care or personal care services, hospice programs and managed care plans concerning advance directives. An advance directive is a written instruction, such as a living will or durable power of attorney for health care, recognized under State law, relating to the provision of health care when an individual's condition makes him or her unable to express his or her wishes. The intent of the advance directives provisions is to enhance an adult individual's control over medical treatment decisions. This rule confirms the interim final rule with several minor changes based on our review and consideration of public comments.
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2011-11-18
... a diagnosis affects the management of the patient. Use of the device significantly improves clinical... Payments Under the Hospital Inpatient Prospective Payment System AGENCY: Centers for Medicare & Medicaid... and technologies under the hospital inpatient prospective payment system (IPPS). Interested parties...
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Energy Technology Data Exchange (ETDEWEB)
Mehnke, Frank; Stellmach, Joachim; Frentrup, Martin; Kusch, Gunnar; Wernicke, Tim; Pristovsek, Markus; Kneissl, Michael [Technische Universitaet Berlin, Institut fuer Festkoerperphysik, Hardenbergstr. 36, 10623 Berlin (Germany)
2011-07-01
The energy gap of AlGaN varies between 3.4 eV and 6.2 eV and allows light emitting diodes (LED) in the ultraviolet spectral region. The authors studied semipolar (11 anti 22) AlGaN layers that were deposited on (10 anti 10) m-plane sapphire using MOVPE (metalorganic vapor phase epitaxy) without nucleation layer with a substrate temperature below 1100 C in H2 atmosphere. The layers are preferably (11 anti 22) oriented. The sample show a surface roughness between 15 and 2 nm. The Al content of the smoothest samples is about 60% determined by transmission experiments. Below 60% Al content a triangular morphology was observed, the opening angle increased with decreasing Al content. The absorption edge was 0.05 eV (GaN) to 0.35 eV (AlN) below the band edge of (0001) oriented AlGaN layers. Further investigations of semipolar AlGaN layers to study the applicability for UV LEDs are under preparation.
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42 CFR 411.53 - Basis for conditional Medicare payment in no-fault cases.
2010-10-01
... 42 Public Health 2 2010-10-01 2010-10-01 false Basis for conditional Medicare payment in no-fault... Limitations on Medicare Payment for Services Covered Under Liability or No-Fault Insurance § 411.53 Basis for conditional Medicare payment in no-fault cases. (a) A conditional Medicare payment may be made in no-fault...
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Looking at CER from Medicare's perspective.
Mohr, Penny
2012-05-01
Comparative effectiveness research (CER) is rapidly adding to the amount of data available to health care coverage and payment decision makers. Medicare's decisions have a large effect on coverage and reimbursement policies throughout the health insurance industry and will likely influence the entire U.S. health care system; thus, examining its role in integrating CER into policy is crucial. To describe the potential benefits of CER to support payment and coverage decisions in the Medicare program, limitations on its use,the role of the Centers for Medicare & Medicaid Services (CMS) in improving the infrastructure for CER, and to discuss challenges that must be addressed to integrate CER into CMS's decision-making process. A defining feature of CER is that it provides the type of evidence that will help decision makers, such as patients, clinicians, and payers,make more informed treatment and policy decisions. Because CMS is responsible for more than 47 million elderly and disabled beneficiaries, the way that Medicare uses CER has the potential to have a large impact on public and individual health. Currently many critical payment and coverage decisions within the Medicare program are made on the basis of poor quality evidence, and CER has the potential to greatly improve the quality of decision making. Despite common misconceptions, CMS is not prohibited by law from using CER apart from some reasonable limitations. CMS is,however, required to support the development of the CER infrastructure by making their data more readily available to researchers. While CER has substantial potential to improve the quality of the agency's policy decisions,challenges remain to integrate CER into Medicare's processes. These challenges include statutory ambiguities, lack of sufficient staff and internal resources to take advantage of CER, and the lack of an active voice in setting priorities for CER and study design. Although challenges exist, CER has the potential to greatly
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Directory of Open Access Journals (Sweden)
López Jesús Edgardo
2006-12-01
Full Text Available
10.0pt; font-family: ";Cambria";,";serif";; mso-ascii-theme-font: major-latin; mso-fareast-font-family: Baskerville; mso-hansi-theme-font: major-latin; mso-bidi-font-family: Baskerville;">El fríjol común (10.0pt; font-family: ";Cambria";,";serif";; mso-ascii-theme-font: major-latin; mso-fareast-font-family: Baskerville-Italic; mso-hansi-theme-font: major-latin; mso-bidi-font-family: Baskerville-Italic;">Phaseolus vulgaris 10.0pt; font-family: ";Cambria";,";serif";; mso-ascii-theme-font: major-latin; mso-fareast-font-family: Baskerville; mso-hansi-theme-font: major-latin; mso-bidi-font-family: Baskerville;">L. es un alimento básico en la región Andina por ser una fuente rica en proteína y de bajo costo. La investigación para incrementar rendimientos en esta leguminosa es una opción para mejorar la competitividad en el mercado mundial. El objetivo principal de este trabajo fue evaluar por rendimiento los genotipos promisorios de fríjol voluble, tipos Bola roja y Reventón, para las zonas frías de Colombia mediante el análisis de sendero. Se realizó un diseño de bloques completos al azar con tres réplicas para evaluar 10 genotipos promisorios de fríjol voluble. El análisis de sendero para el rendimiento por planta y las correlaciones entre el rendimiento y sus componentes mostraron que el carácter número de vainas por planta es el de mayor importancia sobre la determinación del rendimiento, en comparación con los caracteres peso de 100 semillas y número de semillas por vaina, tanto en los genotipos de fríjol voluble tipo Bola roja como tipo Reventón.
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34 CFR 300.22 - Individualized education program.
2010-07-01
... CHILDREN WITH DISABILITIES General Definitions Used in This Part § 300.22 Individualized education program. Individualized education program or IEP means a written statement for a child with a disability that is developed... 34 Education 2 2010-07-01 2010-07-01 false Individualized education program. 300.22 Section 300.22...
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2012-11-23
... evidence that use of the device to make a diagnosis affects the management of the patient. Use of the... the device. ++ Decreased pain, bleeding or other quantifiable symptoms. ++ Reduced recovery time. In... technology that substantially improves the diagnosis or treatment of Medicare beneficiaries before...
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2013-11-29
... evidence that use of the device to make a diagnosis affects the management of the patient. Use of the... the device. ++ Decreased pain, bleeding or other quantifiable symptoms. ++ Reduced recovery time. In... technology that substantially improves the diagnosis or treatment of Medicare beneficiaries before...
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Frakt, Austin B; Pizer, Steven D; Hendricks, Ann M
2008-12-01
Medicare and the Veterans Health Administration (VA) both finance large outpatient prescription drug programs, though in very different ways. In the ongoing debate on how to control Medicare spending, some suggest that Medicare should negotiate directly with drug manufacturers, as the VA does. In this article we relate the role of interest groups to policy differences between Medicare and the VA and, in doing so, explain why such a large change to the Medicare drug program is unlikely. We argue that key policy differences are attributable to stable differences in interest group involvement. While this stability makes major changes in Medicare unlikely, it suggests the possibility of leveraging VA drug purchasing to achieve savings in Medicare. This could be done through a VA-administered drug-only benefit for Medicare-enrolled veterans. Such a partnership could incorporate key elements of both programs: capacity to accept large numbers of enrollees (like Medicare) and leverage to negotiate prescription drug prices (like the VA). Moreover, it could be implemented at no cost to the VA while achieving savings for Medicare and beneficiaries.
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78 FR 28551 - Medicaid Program; State Disproportionate Share Hospital Allotment Reductions
2013-05-15
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 42 CFR Part 447 [CMS-2367-P] RIN 0938-AR31 Medicaid Program; State Disproportionate Share Hospital Allotment Reductions AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Proposed rule. SUMMARY: The statute...
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78 FR 57293 - Medicaid Program; State Disproportionate Share Hospital Allotment Reductions
2013-09-18
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 42 CFR Part 447 [CMS-2367-F] RIN 0938-AR31 Medicaid Program; State Disproportionate Share Hospital Allotment Reductions AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Final rule. SUMMARY: The statute, as...
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Medicare Prescription Drug Coverage - General Information
U.S. Department of Health & Human Services — The MMA legislation provides seniors and people with disabilities with the first comprehensive prescription drug benefit ever offered under the Medicare program, the...
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Medicare depreciation; useful life guidelines--HCFA. Proposed rule.
1982-09-30
We are proposing to amend Medicare regulations to clarify which useful life guidelines providers of health care services may use to determine the useful life of a depreciable asset for Medicare reimbursement purposes. Current regulations state that providers must utilize HHS useful life guidelines or, if none have been published by HHS, the American Hospital Association (AHA) useful life guidelines of 1973 or IRS guidelines. We are proposing to eliminate the reference to IRS guidelines because those previously acceptable for Medicare purposes are outdated and have been made obsolete by the IRS or by statutory change. We would also delete the specific reference to the 1973 AHA guidelines. In addition, we intend this amendment to clarify that certain tax legislation on accelerated depreciation, recently passed by Congress, does not apply to the Medicare program.
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2012-11-15
This final rule with comment period revises the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for CY 2013 to implement applicable statutory requirements and changes arising from our continuing experience with these systems. In this final rule with comment period, we describe the changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment system. In addition, this final rule with comment period updates and refines the requirements for the Hospital Outpatient Quality Reporting (OQR) Program, the ASC Quality Reporting (ASCQR) Program, and the Inpatient Rehabilitation Facility (IRF) Quality Reporting Program. We are continuing the electronic reporting pilot for the Electronic Health Record (EHR) Incentive Program, and revising the various regulations governing Quality Improvement Organizations (QIOs), including the secure transmittal of electronic medical information, beneficiary complaint resolution and notification processes, and technical changes. The technical changes to the QIO regulations reflect CMS' commitment to the general principles of the President's Executive Order on Regulatory Reform, Executive Order 13563 (January 18, 2011).
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42 CFR 424.540 - Deactivation of Medicare billing privileges.
2010-10-01
... change in practice location, a change of any managing employee, and a change in billing services. A... 42 Public Health 3 2010-10-01 2010-10-01 false Deactivation of Medicare billing privileges. 424.540 Section 424.540 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND...
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75 FR 76987 - Agency Information Collection Activities: Submission for OMB Review; Comment Request
2010-12-10
... office or Medicare carrier. Frequency: Reporting--On occasion; Affected Public: State, Local, or Tribal Government, Business or other-for-profit, Not-for-profit institutions; Number of Respondents: 1,048,243... Strategic Operations and Regulatory Affairs. [FR Doc. 2010-31075 Filed 12-9-10; 8:45 am] BILLING CODE 4120...
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77 FR 71609 - Self-Help Homeownership Opportunity Program (SHOP) Grant Monitoring
2012-12-03
... DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT [Docket No. FR-5603-N-89] Self-Help Homeownership Opportunity Program (SHOP) Grant Monitoring AGENCY: Office of the Chief Information Officer, HUD. ACTION... electronic submission of responses. This notice also lists the following information: Title of Proposed: Self...
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Medicare Data to Calculate Your Primary Service Areas
U.S. Department of Health & Human Services — The following data is being made available to applicants to the Medicare Shared Savings Program (Shared Savings Program), in order to allow them to calculate their...
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Medicare Modernization Act (MMA) IRS Medicare Part D
Social Security Administration — SSA uses the Internal Revenue Service (IRS) information in determing the eligibility of Medicare recipients to receive subsidy payments for Medicare premiums. SSA...
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Collision course? Donald Trump, Paul Ryan, and the fate of Medicare.
Oberlander, Jonathan
2018-04-10
The election of Donald Trump as president of the United States raises questions about the future of Medicare. How will Medicare fare under Republican-led government? There are several compelling reasons that the Trump administration and Congressional Republicans might avoid Medicare reform, including the political risks of taking on a popular program, the difficulties the party has encountered in trying to dismantle the Patient Protection and Affordable Care Act (ACA), the importance of older Americans to the GOP coalition, and President Trump's views about Medicare. However, because of fiscal pressures and the commitment of Speaker of the House Paul Ryan and other Republicans to entitlement reform, the GOP nonetheless could end up attempting to make major changes in Medicare. Alternatively, Republican efforts to repeal and undermine the ACA could unintentionally enhance the political fortunes of proposals to expand Medicare. Consequently, the fate of Medicare during the Trump administration remains highly uncertain.
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An Analysis of Medicare Reimbursement to Ophthalmologists: Years 2012 to 2013.
Han, Everett; Baisiwala, Shivani; Jain, Atul; Bundorf, M Kate; Pershing, Suzann
2017-10-01
To analyze trends in utilization and payment of ophthalmic services in the Medicare population for years 2012 and 2013. Retrospective, cross-sectional study. A retrospective cross-sectional observational analysis was performed using publicly available Medicare Physician and Other Supplier aggregate file and the Physician and Other Supplier Public Use File. Variables analyzed included aggregate beneficiary demographics, Medicare payments to ophthalmologists, ophthalmic medical services provided, and the most common Medicare-reimbursed ophthalmic services. In 2013, total Medicare Part B reimbursement for ophthalmology was $5.8 billion, an increase of 3.6% from the previous year. From 2012 to 2013, the total number of ophthalmology services rendered increased by 2.2%, while average dollar amount reimbursed per ophthalmic service decreased by 5.4%. The top 5 highest reimbursed services accounted for 85% of total ophthalmic Medicare payments in 2013, an 11% increase from 2012. During 2013, drug reimbursement represented 32.8% of the total Medicare payments to ophthalmologists. Ranibizumab and aflibercept alone accounted for 95% of the entire $1.9 billion in drug reimbursements ophthalmologists in 2013. Medicare Part B reimbursement for ophthalmologists was primarily driven by use of anti-vascular endothelial growth factor (anti-VEGF) injections from 2012 to 2013. Of the total drug payments to ophthalmologists, biologic anti-VEGF agents ranibizumab and aflibercept accounted for 95% of all drug reimbursement. This is in contrast to other specialties, in which drug reimbursement represented only a small portion of Medicare reimbursement. Published by Elsevier Inc.
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CENTERS for MEDICARE & MEDICAID SERVICES Medicare Hospice Benefits This official government booklet includes information about Medicare hospice benefits: Who’s eligible for hospice care What services are included in hospice care How ...
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Health care utilization among Medicare-Medicaid dual eligibles: a count data analysis
Directory of Open Access Journals (Sweden)
Shin Jaeun
2006-04-01
Full Text Available Abstract Background Medicare-Medicaid dual eligibles are the beneficiaries of both Medicare and Medicaid. Dual eligibles satisfy the eligibility conditions for Medicare benefit. Dual eligibles also qualify for Medicaid because they are aged, blind, or disabled and meet the income and asset requirements for receiving Supplement Security Income (SSI assistance. The objective of this study is to explore the relationship between dual eligibility and health care utilization among Medicare beneficiaries. Methods The household component of the nationally representative Medical Expenditure Panel Survey (MEPS 1996–2000 is used for the analysis. Total 8,262 Medicare beneficiaries are selected from the MEPS data. The Medicare beneficiary sample includes individuals who are covered by Medicare and do not have private health insurance during a given year. Zero-inflated negative binomial (ZINB regression model is used to analyse the count data regarding health care utilization: office-based physician visits, hospital inpatient nights, agency-sponsored home health provider days, and total dental visits. Results Dual eligibility is positively correlated with the likelihood of using hospital inpatient care and agency-sponsored home health services and the frequency of agency-sponsored home health days. Frequency of dental visits is inversely associated with dual eligibility. With respect to racial differences, dually eligible Afro-Americans use more office-based physician and dental services than white duals. Asian duals use more home health services than white duals at the 5% statistical significance level. The dual eligibility programs seem particularly beneficial to Afro-American duals. Conclusion Dual eligibility has varied impact on health care utilization across service types. More utilization of home healthcare among dual eligibles appears to be the result of delayed realization of their unmet healthcare needs under the traditional Medicare-only program
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Reforming Medicare through 'version 2.0' of accountable care.
Lieberman, Steven M
2013-07-01
Medicare needs fundamental reform to achieve fiscal sustainability, improve value and quality, and preserve beneficiaries' access to physicians. Physician fees will fall by one-quarter in 2014 under current law, and the dire federal budget outlook virtually precludes increasing Medicare spending. There is a growing consensus among policy makers that reforming fee-for-service payment, which has long served as the backbone of Medicare, is unavoidable. Accountable care organizations (ACOs) provide a new payment alternative but currently have limited tools to control cost growth or engage and reward beneficiaries and providers. To fundamentally reform Medicare, this article proposes an enhanced version of ACOs that would eliminate the scheduled physician fee cuts, allow fees to increase with inflation, and enhance ACOs' ability to manage care. In exchange, the proposal would require modest reductions in overall Medicare spending and require ACOs to accept increased accountability and financial risk. It would cause per beneficiary Medicare spending by 2023 to fall 4.2 percent below current Congressional Budget Office projections and help the program achieve fiscal sustainability.
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Pauly, Nathan J; Talbert, Jeffery C; Brown, Joshua
2016-06-01
Administrative claims data are used for a wide variety of research and quality assurance purposes; however, they are prone to medication exposure misclassification if medications are purchased without using an insurance benefit. Low-cost generic drug programs (LCGPs) offered at major chain pharmacies are a relatively new and sparsely investigated source of exposure misclassification. LCGP medications are often purchased out of pocket; thus, a pharmacy claim may never be submitted, and the exposure may go unobserved in claims data. As heavy users of medications, Medicare beneficiaries have much to gain from the affordable medications offered through LCGPs. This use may put them at increased risk of exposure misclassification in claims data. Many high-risk medications (HRMs) and medications tracked for adherence and utilization quality metrics are available through LCGPs, and exposure misclassification of these medications may impact the quality assurance efforts reliant on administrative claims data. Presently, there is little information regarding the use of these programs among a geriatric population. To (a) quantify the prevalence of LCGP users in a nationally representative population of Medicare beneficiaries; (b) compare clinical and demographic characteristics of LCGP users and nonusers; (c) assess determinants of LCGP use and medications acquired through these programs; and (d) analyze patterns of LCGP use during the years 2007-2012. This study relied on data from the Medical Expenditure Panel Survey (MEPS) from 2007 to 2012. The first 3 objectives were completed with a cohort of individuals in the most recent MEPS panel, while the fourth objective was completed with a separate cohort composed of individuals who participated in MEPS from 2007 to 2012. Inclusion in either study cohort required that individuals were Medicare beneficiaries aged 65 years or greater, used at least 1 prescription drug during their 2-year panel period, and participated in all 5
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Lehmann, C U; Longhurst, C A; Hersh, W; Mohan, V; Levy, B P; Embi, P J; Finnell, J T; Turner, A M; Martin, R; Williamson, J; Munger, B
2015-01-01
In the US, the new subspecialty of Clinical Informatics focuses on systems-level improvements in care delivery through the use of health information technology (HIT), data analytics, clinical decision support, data visualization and related tools. Clinical informatics is one of the first subspecialties in medicine open to physicians trained in any primary specialty. Clinical Informatics benefits patients and payers such as Medicare and Medicaid through its potential to reduce errors, increase safety, reduce costs, and improve care coordination and efficiency. Even though Clinical Informatics benefits patients and payers, because GME funding from the Centers for Medicare and Medicaid Services (CMS) has not grown at the same rate as training programs, the majority of the cost of training new Clinical Informaticians is currently paid by academic health science centers, which is unsustainable. To maintain the value of HIT investments by the government and health care organizations, we must train sufficient leaders in Clinical Informatics. In the best interest of patients, payers, and the US society, it is therefore critical to find viable financial models for Clinical Informatics fellowship programs. To support the development of adequate training programs in Clinical Informatics, we request that the Centers for Medicare and Medicaid Services (CMS) issue clarifying guidance that would allow accredited ACGME institutions to bill for clinical services delivered by fellows at the fellowship program site within their primary specialty.
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42 CFR 421.304 - Medicare integrity program contractor functions.
2010-10-01
... services for which Medicare payment may be made either directly or indirectly. (b) Auditing, settling and... and benefit quality assurance issues. (e) Developing, and periodically updating, a list of items of...
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77 FR 5317 - Medicaid Program; Covered Outpatient Drugs
2012-02-02
... for Medicare & Medicaid Services 42 CFR Part 447 Medicaid Program; Covered Outpatient Drugs; Proposed... Part 447 [CMS-2345-P] RIN 0938-AQ41 Medicaid Program; Covered Outpatient Drugs AGENCY: Centers for... requirements pertaining to Medicaid reimbursement for covered outpatient drugs to implement provisions of the...
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Fitzpatrick, Stephanie L; Wilson, Dawn K; Pagoto, Sherry L
2017-06-01
Beginning in January 2018, the Centers for Medicare and Medicaid Services (CMS) plans to cover the Diabetes Prevention Program (DPP), also referred to as Medicare DPP. The American Psychological Association Society for Health Psychology (SfHP) and the Society for Behavioral Medicine (SBM) reviewed the proposed plan. SfHP and SBM are in support of the CMS decision to cover DPP for Medicare beneficiaries but have a significant concern that aspects of the proposal will limit the public health impact. Concerns include the emphasis on weight outcomes to determine continued coverage and the lack of details regarding requirements for coaches. SfHP and SBM are in strong support of modifications to the proposal that would remove the minimum weight loss stipulation to determine coverage and to specify type and qualifications of "coaches."
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Medicare Update: Annual Wellness Visit
... counseling services or programs, designed to reduce risk factors, such as for weight loss, smoking cessation, fall prevention, and nutrition. • Review of the responses to the Health Risk Assessment Prepared by Leslie Fried, Alzheimer’s Association Medicare Advocacy Project. Rev. Feb 1, 2012 ...
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2010-12-08
... recommendations to the Medicare Trustees on how the Trustees might more accurately estimate health spending in the long run. The Panel's discussion is expected to be very technical in nature and will focus on the... Trustees on how the Trustees might more accurately estimate the long term rate of health spending in the...
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2010-05-10
... DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Toxicology Program (NTP) Interagency Center for the Evaluation of Alternative Toxicological Methods (NICEATM.... Bucher, Associate Director, National Toxicology Program. [FR Doc. 2010-10958 Filed 5-7-10; 8:45 am...
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2012-05-25
... Organization Under the Clinical Laboratory Improvement Amendments of 1988 AGENCY: Centers for Medicare... Commission for re-approval as an accreditation organization for clinical laboratories under the Clinical... On October 31, 1988, the Congress enacted the Clinical Laboratory Improvement Amendments of 1988...
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U.S. Department of Health & Human Services — The "Medicare hospital spending per patient (Medicare Spending per Beneficiary)" measure shows whether Medicare spends more, less or about the same per Medicare...
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Saleh, Shadi S; Freire, Chris; Morris-Dickinson, Gwendolyn; Shannon, Trip
2012-06-01
To investigate the business case of postdischarge care transition (PDCT) among Medicare beneficiaries by conducting a cost-benefit analysis. Randomized controlled trial. A general hospital in upstate New York State. Elderly Medicare beneficiaries being treated from October 2008 through December 2009 were randomly selected to receive services as part of a comprehensive PDCT program (intervention--173 patients) or regular discharge process (control--160 patients) and followed for 12 months. The intervention comprised five activities: development of a patient-centered health record, a structured discharge preparation checklist of critical activities, delivery of patient self-activation and management sessions, follow-up appointments, and coordination of data flow. Cost-benefit ratio of the PDCT program; self-management skills and abilities. The 1-year readmission analysis revealed that control participants were more likely to be readmitted than intervention participants (58.2% vs 48.2%; P = .08); with most of that difference observed in the 91 to 365 days after discharge. Findings from the cost-benefit analysis revealed a cost-benefit ratio of 1.09, which indicates that, for every $1 spent on the program, a saving of $1.09 was realized. In addition, participating in a care transition program significantly enhanced self-management skills and abilities. Postdischarge care transition programs have a dual benefit of enhancing elderly adults' self-management skills and abilities and producing cost savings. This study builds a case for the inclusion of PDCT programs as a reimbursable service in benefit packages. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.
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Structure of $^{22}$N and the N=14 subshell
Rodriguez-Tajes, C.; Alvarez-Pol, H.; Aumann, T.; Benjamim, E.; Benlliure, J.; Borge, M.J.G.; Caamano, M.; Casarejos, E.; Chatillon, A.; Chulkov, L.V.; Eppinger, K.; Faestermann, T.; Gascon, M.; Geissel, H.; Gernhauser, R.; Jonson, B.; Kanungo, R.; Krucken, R.; Kurtukian, T.; Larsson, K.; Maierbeck, P.; Nilsson, T.; Nociforo, C.; Parfenova, Yu.; Pascual-Izarra, C.; Perea, A.; Perez-Loureiro, D.; Prochazka, A.; Schwertel, S.; Simon, H.; Summerer, K.; Tengblad, O.; Weick, H.; Winkler, M.; Zhukov, M.V.
2011-01-01
One-neutron knockout data for (18-22)N are analyzed in the eikonal approximation of the Glauber model. The role of the s-d shell and the crossing of the N = 14 neutron subshell are discussed. Of particular interest is the nucleus (22)N, where the knockout data provide a sensitive experimental test for a possible halo structure of its ground state. The observation of a narrow momentum distribution of the (21)N fragments, together with an essential 1s(1/2) contribution needed to describe the observed longitudinal-momentum distribution, allow the firm conclusion that the ground state of (22)N is a well-developed nuclear halo. The results also show that the N = 14 subshell in (22)N is somewhat reduced as compared to that of (23)O.
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50 CFR 10.22 - Law enforcement offices.
2010-10-01
... 50 Wildlife and Fisheries 1 2010-10-01 2010-10-01 false Law enforcement offices. 10.22 Section 10... GENERAL PROVISIONS Addresses § 10.22 Law enforcement offices. Service law enforcement offices and their areas of responsibility follow. Mail should be addressed: “Assistant Regional Director, Division of Law...
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76 FR 2453 - Medicare Program; Hospital Inpatient Value-Based Purchasing Program
2011-01-13
... program based on conditions for coverage. This new program will necessarily be a fluid model, subject to... rewarding better value, outcomes, and innovations instead of merely volume. Use of Measures: Public....hospitalcompare.hhs.gov , after a 30-day preview period. An interactive Web tool, this Web site assists...
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... schedule a lung cancer screening counseling and shared decision making visit with your doctor to discuss the benefits ... when they’re available in your MyMedicare.gov account. 58 Section 3: For more information Visit Medicare. gov for general information about Medicare ...
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2001-12-03
This interim final rule with comment period delays for 1 year the effective date of the last sentence of 42 CFR 411.354(d)(1). Section 411.354(d)(1) was promulgated in the final rule entitled "Medicare and Medicaid Programs; Physicians' Referrals to Health Care Entities With Which They Have Financial Relationships," published in the Federal Register on January 4, 2001 (66 FR 856). A 1-year delay in the effective date of the last sentence in Section 411.354(d)(1) will give Department officials the opportunity to reconsider the definition of compensation that is "set in advance" as it relates to percentage compensation methodologies in order to avoid unnecessarily disrupting existing contractual arrangements for physician services. Accordingly, the last sentence of Section 411.354(d)(1), which would have become effective January 4, 2002, will not become effective until January 6,2003.
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Trish, Erin; Ginsburg, Paul; Gascue, Laura; Joyce, Geoffrey
2017-09-01
(HCPCS code E0143; 95% CI, 66.3%-68.5%) to 75.8% for a complete blood cell count (CPT 85025; 95% CI, 75.0%-76.6%). Traditional Medicare's administratively set rates act as a strong anchor for physician reimbursement in the MA market, although MA plans succeed in negotiating lower prices for other health care services for which TM overpays. Reforms that transition the Medicare program toward some premium support models could substantially affect how physicians and other clinicians are paid.
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Bis(2,2'-bipyridyl-κN,N')(carbonato-κO,O')cobalt(III) bromide trihydrate.
Ma, Peng-Tao; Wang, Yu-Xia; Zhang, Guo-Qian; Li, Ming-Xue
2007-12-06
The title complex, [Co(CO(3))(C(10)H(8)N(2))(2)]Br·3H(2)O, is isostructural with the chloride analogue. The six-coordinated octahedral [Co(2,2'-bipy)(2)CO(3)](+) cation (2,2'-bipy is 2,2'-bipyrid-yl), bromide ion and water mol-ecules are linked together via O-H⋯Br and O-H⋯O hydrogen bonds, generating a one-dimensional chain.
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Directory of Open Access Journals (Sweden)
Emmanuel Aubert
2016-11-01
Full Text Available The coordination polymer {[Cu(SiF6(C10H8N22]·2C10H8N2·5H2O}n, systematic name: poly[[bis(μ2-4,4′-bipyridine(μ2-hexafluoridosilicatocopper(II] 4,4′-bipyridine disolvate pentahydrate], contains pores which are filled with water and 4,4′-bipyridine molecules. As a result of the presence of these ordered species, the framework changes its symmetry from P4/mmm to P21/c. The 4,4′-bipyridine guest molecules form chains inside the 6.5 × 6.9 Å pores parallel to [100] in which the molecules interact through π–π stacking. Ordered water molecules form infinite hydrogen-bonded chains inside a second pore system (1.6 × 5.3 Å free aperture perpendicular to the 4,4′-bipyridine channels.
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Arslan, Hakan; Mansuroglu, Demet Sezgin; VanDerveer, Don; Binzet, Gun
2009-04-01
N-(2,2-Diphenylacetyl)- N'-(naphthalen-1yl)-thiourea (PANT) has been synthesized and characterized by elemental analysis, IR spectroscopy and 1H NMR spectroscopy. The crystal and molecular structure of the title compound has been determined from single crystal X-ray diffraction data. It crystallizes in the triclinic space group P-1, Z = 2 with a = 10.284(2) Å, b = 10.790(2) Å, c = 11.305(2) Å, α = 64.92(3)°, β = 89.88(3)°, γ = 62.99(3)°, V = 983.7(3) Å 3 and Dcalc = 1.339 Mg/m 3. The molecular structure, vibrational frequencies and infrared intensities of PANT were calculated by the Hartree-Fock and density functional theory methods (BLYP and B3LYP) using the 6-31G* basis set. The calculated geometric parameters were compared to the corresponding X-ray structure of the title compound. We obtained 22 stable conformers for the title compound; however Conformer 1 is approximately 9.53 kcal/mol more stable than Conformer 22. The comparison of the theoretical and experimental geometry of the title compound shows that the X-ray parameters fairly well reproduce the geometry of Conformer 17. The harmonic vibrations computed for this compound by the B3LYP/6-31G* method are in good agreement with the observed IR spectral data. Theoretical vibrational spectra of the title compound were interpreted by means of PEDs using the VEDA 4 program. A general better performance of the investigated methods was calculated by PAVF 1.0 program.
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22 CFR 127.10 - Civil penalty.
2010-04-01
... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Civil penalty. 127.10 Section 127.10 Foreign... Civil penalty. (a) The Assistant Secretary of State for Political-Military Affairs is authorized to impose a civil penalty in an amount not to exceed that authorized by 22 U.S.C. 2778, 2779a and 2780 for...
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2011-10-11
... (Sec. 423.2300) b. Definitions (Sec. 423.2305) (1) Applicable Beneficiary (2) Applicable Drug (3... marketing, including agent/broker training; payments to MA organizations based on quality ratings; standards... program; payment rules for non-contract health care providers; extending current network adequacy...
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Improving the design of competitive bidding in Medicare Advantage.
Cawley, John H; Whitford, Andrew B
2007-04-01
In 2003, Congress passed the Medicare Prescription Drug, Improvement, and Modernization Act, which required that in 2006 the Centers for Medicare and Medicaid Services (CMS) implement a system of competitive bids to set payments for the Medicare Advantage program. Managed care plans now bid for the right to enroll Medicare beneficiaries. Data from the first year of bidding suggest that imperfect competition is limiting the success of the bidding system. This article offers suggestions to improve this system based on findings from auction theory and previous government-run auctions. In particular, CMS can benefit by adjusting its system of competitive bids in four ways: credibly committing to regulations governing bidding; limiting the scope for collusion, entry deterrence, and predatory behavior among bidders; adjusting how benchmark reimbursement rates are set; and accounting for asymmetric information among bidders.
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Model citizens. Outsourcing helps start-up Medicare HMO.
Slavic, B; Adami, S
1999-04-01
Health Plans of Pennsylvania (HPP), the managed care arm of Crozer-Keystone Health System, in Media, Pa. Selecting the information systems and building the infrastructure to support the start-up of a new Medicare HMO product. HPP chose to outsource the information systems needed to integrate all the components of managed care administration into a cost-effective and cohesive program. Because of its aggressive programming and start-up of the MedCarePlus product offering, HPP became the first plan in the country to submit Medicare claims data electronically for encounter reporting to the Health Care Financing Administration (HCFA). "Through an integrated team approach, an organization truly can benefit from the economies of scale gained through outsourcing."
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75 FR 56946 - Medicaid Program; Review and Approval Process for Section 1115 Demonstrations
2010-09-17
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 42 CFR Part 431 [CMS-2325-P] RIN 0938-AQ46 Medicaid Program; Review and Approval Process for Section 1115 Demonstrations AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Proposed rule. SUMMARY: This...
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2010-09-17
... DEPARTMENT OF HEALTH AND HUMAN SERVICES National Toxicology Program (NTP); NTP Interagency Center for the Evaluation of Alternative Toxicological Methods (NICEATM); Availability of Interagency..., Associate Director, National Toxicology Program. [FR Doc. 2010-23262 Filed 9-16-10; 8:45 am] BILLING CODE...
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2010-06-10
... DEPARTMENT OF HEALTH AND HUMAN SERVICES National Toxicology Program (NTP); NTP Interagency Center for the Evaluation of Alternative Toxicological Methods (NICEATM): Availability of the Biennial... Toxicology Program. [FR Doc. 2010-13952 Filed 6-9-10; 8:45 am] BILLING CODE 4140-01-P ...
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2010-04-01
... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Purpose. 226.10 Section 226.10 Foreign Relations AGENCY FOR INTERNATIONAL DEVELOPMENT ADMINISTRATION OF ASSISTANCE AWARDS TO U.S. NON-GOVERNMENTAL ORGANIZATIONS Pre-award Requirements § 226.10 Purpose. Sections 226.11 through 226.17 prescribe forms and...
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2010-04-01
... 22 Foreign Relations 2 2010-04-01 2010-04-01 true Reports. 1003.10 Section 1003.10 Foreign Relations INTER-AMERICAN FOUNDATION RULES SAFEGUARDING PERSONAL INFORMATION IN IAF RECORDS § 1003.10 Reports... or systems will be separately listed and reported to the Office of Management and Budget in...
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7 CFR 3405.22 - Evaluation of program.
2010-01-01
... 7 Agriculture 15 2010-01-01 2010-01-01 false Evaluation of program. 3405.22 Section 3405.22 Agriculture Regulations of the Department of Agriculture (Continued) COOPERATIVE STATE RESEARCH, EDUCATION, AND EXTENSION SERVICE, DEPARTMENT OF AGRICULTURE HIGHER EDUCATION CHALLENGE GRANTS PROGRAM...
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2010-03-31
... City 410 E. Washington Street. Iowa City IA 52240 160,520 35 Boise City Housing Authority 1276 River... Authority. 101. Mason City Housing Authority 22 N. Georgia-- 214. Boise City Housing Authority 1276 River... DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT [Docket No. FR-5213-FA-02] Announcement of Funding...
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Medicare Appeals Council Decisions
U.S. Department of Health & Human Services — Decisions of the Departmental Appeals Board's Medicare Appeals Council involving claims for entitlement to Medicare and individual claims for Medicare coverage and...
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10 CFR 75.22 - Accounting records.
2010-01-01
... 10 Energy 2 2010-01-01 2010-01-01 false Accounting records. 75.22 Section 75.22 Energy NUCLEAR... Accounting and Control for Facilities § 75.22 Accounting records. (a) The accounting records required by § 75... determination of the book inventory at any time; (2) All measurement results that are used for determination of...
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The Role of Medicare's Inpatient Cost-Sharing in Medicaid Entry.
Keohane, Laura M; Trivedi, Amal N; Mor, Vincent
2018-04-01
To isolate the effect of greater inpatient cost-sharing on Medicaid entry among Medicare beneficiaries. Medicare administrative data (years 2007-2010) were linked to nursing home assessments and area-level socioeconomic indicators. Medicare beneficiaries who are readmitted to a hospital must pay an additional deductible ($1,100 in 2010) if their readmission occurs more than 59 days following discharge. In a regression discontinuity analysis, we take advantage of this Medicare benefit feature to test whether beneficiaries with greater cost-sharing have higher rates of Medicaid enrollment. We identified 221,248 Medicare beneficiaries with an initial hospital stay and a readmission 53-59 days later (no deductible) or 60-66 days later (charged a deductible). Among beneficiaries in low-socioeconomic areas with two hospitalizations, those readmitted 60-66 days after discharge were 21 percent more likely to join Medicaid compared with those readmitted 53-59 days following their initial hospitalization (absolute difference in adjusted risk of Medicaid entry: 3.7 percent vs. 3.1 percent, p = .01). Increasing Medicare cost-sharing requirements may promote Medicaid enrollment among low-income beneficiaries. Potential savings from an increased cost-sharing in the Medicare program may be offset by increased Medicaid participation. © Health Research and Educational Trust.
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Chambers, James D; May, Katherine E; Neumann, Peter J
2013-06-01
The Food and Drug Administration (FDA) and Medicare use different standards to determine, first, whether a new drug or medical device can be marketed to the public and, second, if the federal health insurance program will pay for use of the drug or device. This discrepancy creates hurdles and uncertainty for drug and device manufacturers. We analyzed discrepancies between FDA approval and Medicare national coverage determinations for sixty-nine devices and Part B drugs approved during 1999-2011. We found that Medicare covered FDA-approved drugs or devices 80 percent of the time. However, Medicare often added conditions beyond FDA approval, particularly for devices and most often restricting coverage to patients with the most severe disease. In some instances, Medicare was less restrictive than the FDA. Our findings highlight the importance for drug and device makers of anticipating Medicare's needs when conducting clinical studies to support their products. Our findings also provide important insights for the FDA's and Medicare's pilot parallel review program.
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2010-06-29
... DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT [Docket No. FR-5376-N-55] Green Retrofit Program of... Affordable Housing Preservation must collect certain data to administer the Green Retrofit Program (GRP... Title of Proposal: Green Retrofit Program of Title XII of the American Recovery and Reinvestment Act of...
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7 CFR 22.304 - Multiyear planning and programming.
2010-01-01
... 7 Agriculture 1 2010-01-01 2010-01-01 false Multiyear planning and programming. 22.304 Section 22.304 Agriculture Office of the Secretary of Agriculture RURAL DEVELOPMENT COORDINATION Roles and Responsibilities of State Governments § 22.304 Multiyear planning and programming. State and multicounty...
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42 CFR 460.124 - Additional appeal rights under Medicare or Medicaid.
2010-10-01
... 42 Public Health 4 2010-10-01 2010-10-01 false Additional appeal rights under Medicare or Medicaid. 460.124 Section 460.124 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH... or Medicaid. A PACE organization must inform a participant in writing of his or her appeal rights...
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Die maak van ’n kies-jou-eie-avontuur-boek
Directory of Open Access Journals (Sweden)
M. Preller
2000-04-01
Full Text Available ’n Kies-jou-eie-avontuur-boek het nie ’n hoofkarakter nie. Jy die leser, is die hoofkarakter in die boek. Die boek is dus in die tweede persoon geskryf. Alles wat gebeur, gebeur met jou. Jy, die leser, word op spesifieke plekke in die boek voor ’n keuse gestel.
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MEDICARE PAYMENTS AND SYSTEM-LEVEL HEALTH-CARE USE
ROBBINS, JACOB A.
2015-01-01
The rapid growth of Medicare managed care over the past decade has the potential to increase the efficiency of health-care delivery. Improvements in care management for some may improve efficiency system-wide, with implications for optimal payment policy in public insurance programs. These system-level effects may depend on local health-care market structure and vary based on patient characteristics. We use exogenous variation in the Medicare payment schedule to isolate the effects of market-level managed care enrollment on the quantity and quality of care delivered. We find that in areas with greater enrollment of Medicare beneficiaries in managed care, the non–managed care beneficiaries have fewer days in the hospital but more outpatient visits, consistent with a substitution of less expensive outpatient care for more expensive inpatient care, particularly at high levels of managed care. We find no evidence that care is of lower quality. Optimal payment policies for Medicare managed care enrollees that account for system-level spillovers may thus be higher than those that do not. PMID:27042687
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Preparación y caracterización de la zeolita MCM-22 y de su precursor laminar
Directory of Open Access Journals (Sweden)
Pergher Sibele B. C.
2003-01-01
Full Text Available The layered precursor of MCM-22 was prepared with different Si/Al ratios: 15, 25, 50, 100 and ¥. Upon heat treatment these precursors form MCM-22 zeolite. Both layered precursor and MCM-22 zeolite were characterized by several techniques: Chemical Analysis by Atomic Absorption Spectroscopy (AAS, X-Ray Diffraction (XRD, Thermo-gravimetric Analysis (TGA, Pore Analysis by N2 and Ar adsorption, Scanning Electron Microscopy (SEM, Infrared Spectroscopy (IR and Temperature Programmed Desorption of ammonium (TPD.
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2011-10-31
... DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health Proposed National Toxicology... Session AGENCY: Division of the National Toxicology Program (DNTP), National Institute of Environmental.... Bucher, Associate Director, National Toxicology Program. [FR Doc. 2011-28132 Filed 10-28-11; 8:45 am...
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76 FR 10735 - Medicaid Program; Community First Choice Option
2011-02-25
... for Medicare & Medicaid Services 42 CFR Part 441 Medicaid Program; Community First Choice Option... Part 441 [CMS-2337-P] RIN 0938-AQ35 Medicaid Program; Community First Choice Option AGENCY: Centers for... Section 2401 of the Affordable Care Act (ACA) which establishes a new State option to provide home and...
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2013-06-03
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 42 CFR Part 433 [CMS-2327-CN] RIN 0938-AR38 Medicaid Program; Increased Federal Medical Assistance Percentage Changes Under the Affordable Care Act of 2010; Correction AGENCY: Centers for Medicare & Medicaid Services (CMS...
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Li, Rui; Gregg, Edward W; Barker, Lawrence E; Zhang, Ping; Zhang, Fang; Zhuo, Xiaohui; Williams, Desmond E; Soumerai, Steven B
2013-10-01
Medicare Part D, implemented in 2006, provided coverage for prescription drugs to all Medicare beneficiaries. To examine the effect of Part D on the financial burden of persons with diagnosed diabetes. We conducted an interrupted time-series analysis using data from the 1996 to 2008 Medical Expenditure Panel Survey (11,178 persons with diabetes who were covered by Medicare, and 8953 persons aged 45-64 y with diabetes who were not eligible for Medicare coverage). We then compared changes in 4 outcomes: (1) annual individual out-of-pocket expenditure (OOPE) for prescription drugs; (2) annual individual total OOPE for all health care services; (3) annual total family OOPE for all health care services; and (4) percentage of persons with high family financial burden (OOPE ≥10% of income). For Medicare beneficiaries with diabetes, Part D was associated with a 28% ($530) decrease in individual annual OOPE for prescription drugs, a 23% ($560) reduction in individual OOPE for all health care, a 23% ($863) reduction in family OOPE for all health care, and a 24% reduction in the percentage of families with high financial burden in 2006. There were similar reductions in 2007 and 2008. By 2008, the percentage of Medicare beneficiaries with diabetes living in high financial burden families was 37% lower than it would have been had Part D not been in place. Introduction of Part D coverage was associated with a substantial reduction in the financial burden of Medicare beneficiaries with diabetes and their families.
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75 FR 30043 - Medicare Program; Meeting of the Advisory Panel on Medicare Education
2010-05-28
... imposed * * * by law.'' Such duties are imposed by section 1804 of the Social Security Act (the Act...; Stephen P. Fera, M.B.A., Vice President, Social Mission Programs, Independence Blue Cross; Nan-Kirsten... Education Strategies. Public Comment. Listening Session with CMS Leadership. Next Steps. Individuals or...
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22 CFR 518.24 - Program income.
2010-04-01
... 22 Foreign Relations 2 2010-04-01 2010-04-01 true Program income. 518.24 Section 518.24 Foreign... Financial and Program Management § 518.24 Program income. (a) Federal awarding agencies shall apply the standards set forth in this section in requiring recipient organizations to account for program income...
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County-Level Population Economic Status and Medicare Imaging Resource Consumption.
Rosenkrantz, Andrew B; Hughes, Danny R; Prabhakar, Anand M; Duszak, Richard
2017-06-01
The aim of this study was to assess relationships between county-level variation in Medicare beneficiary imaging resource consumption and measures of population economic status. The 2013 CMS Geographic Variation Public Use File was used to identify county-level per capita Medicare fee-for-service imaging utilization and nationally standardized costs to the Medicare program. The County Health Rankings public data set was used to identify county-level measures of population economic status. Regional variation was assessed, and multivariate regressions were performed. Imaging events per 1,000 Medicare beneficiaries varied 1.8-fold (range, 2,723-4,843) at the state level and 5.3-fold (range, 1,228-6,455) at the county level. Per capita nationally standardized imaging costs to Medicare varied 4.2-fold (range, $84-$353) at the state level and 14.1-fold (range, $33-$471) at the county level. Within individual states, county-level utilization varied on average 2.0-fold (range, 1.1- to 3.1-fold), and costs varied 2.8-fold (range, 1.1- to 6.4-fold). For both large urban populations and small rural states, Medicare imaging resource consumption was heterogeneously variable at the county level. Adjusting for county-level gender, ethnicity, rural status, and population density, countywide unemployment rates showed strong independent positive associations with Medicare imaging events (β = 26.96) and costs (β = 4.37), whereas uninsured rates showed strong independent positive associations with Medicare imaging costs (β = 2.68). Medicare imaging utilization and costs both vary far more at the county than at the state level. Unfavorable measures of county-level population economic status in the non-Medicare population are independently associated with greater Medicare imaging resource consumption. Future efforts to optimize Medicare imaging use should consider the influence of local indigenous socioeconomic factors outside the scope of traditional beneficiary-focused policy
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Examining Measures of Income and Poverty in Medicare Administrative Data.
Samson, Lok Wong; Finegold, Kenneth; Ahmed, Azeem; Jensen, Matthew; Filice, Clara E; Joynt, Karen E
2017-12-01
Disparities by economic status are observed in the health status and health outcomes of Medicare beneficiaries. For health services and health policy researchers, one barrier to addressing these disparities is the ability to use Medicare data to ascertain information about an individual's income level or poverty, because Medicare administrative data contains limited information about individual economic status. Information gleaned from other sources-such as the Medicaid and Supplemental Security Income programs-can be used in some cases to approximate the income of Medicare beneficiaries. However, such information is limited in its availability and applicability to all beneficiaries. Neighborhood-level measures of income can be used to infer individual-level income, but level of neighborhood aggregation impacts accuracy and usability of the data. Community-level composite measures of economic status have been shown to be associated with health and health outcomes of Medicare beneficiaries and may capture neighborhood effects that are separate from individual effects, but are not readily available in Medicare data and do not serve to replace information about individual economic status. There is no single best method of obtaining income data from Medicare files, but understanding strengths and limitations of different approaches to identifying economic status will help researchers choose the best method for their particular purpose, and help policymakers interpret studies using measures of income.
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Paying Medicare Advantage plans: To level or tilt the playing field.
Glazer, Jacob; McGuire, Thomas G
2017-12-01
Medicare beneficiaries are eligible for health insurance through the public option of traditional Medicare (TM) or may join a private Medicare Advantage (MA) plan. Both are highly subsidized but in different ways. Medicare pays for most of costs directly in TM, and subsidizes MA plans based on a "benchmark" for each beneficiary choosing a private plan. The level of this benchmark is arguably the most important policy decision Medicare makes about the MA program. Many analysts recommend equalizing Medicare's subsidy across the options - referred to in policy circles as a "level playing field." This paper studies the normative question of how to set the level of the benchmark, applying the versatile model developed by Einav and Finkelstein (EF) to Medicare. The EF framework implies unequal subsidies to counteract risk selection across plan types. We also study other reasons to tilt the field: the relative efficiency of MA vs. TM, market power of MA plans, and institutional features of the way Medicare determines subsidies and premiums. After review of the empirical and policy literature, we conclude that in areas where the MA market is competitive, the benchmark should be set below average costs in TM, but in areas characterized by imperfect competition in MA, it should be raised in order to offset output (enrollment) restrictions by plans with market power. We also recommend specific modifications of Medicare rules to make demand for MA more price elastic. Copyright © 2016. Published by Elsevier B.V.
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Westrick, Salisa C; Hastings, Tessa J; McFarland, Stuart J; Hohmann, Lindsey A; Hohmann, Natalie S
2016-09-01
Many Medicare beneficiaries have limited income and report problems paying for their medications. Programs are available to assist these low-income individuals. However, these programs are underused because of lack of general awareness and perceived complexity of program applications. To (a) determine the frequency of encounters by pharmacists with Medicare beneficiaries who cannot afford prescription drugs; (b) identify strategies that pharmacists use to assist Medicare beneficiaries who cannot afford prescription drugs; and (c) explore what pharmacists know about programs for Medicare beneficiaries with limited income. This study used a mixed-mode survey of 350 randomly sampled community pharmacies located in 32 counties in Alabama with a high proportion of Medicare beneficiaries who were potentially eligible for low-income subsidy programs. Measures included frequency of encounters by pharmacists with Medicare beneficiaries who could not afford their medications, strategies used to assist Medicare beneficiaries, and pharmacists' knowledge of programs for Medicare beneficiaries with limited income. Of 350 surveys sent, 12 were nondeliverable, and 151 were completed (response rate=44.6%). About 50% of respondents reported encountering Medicare beneficiaries who could not afford their medications at least weekly. Various strategies were reported, including refiling claims that were previously denied every day (40.7%), contacting insurance companies at least once per week (43.2%), and loaning medications at least 2-3 times per month (29.1%). Only 12.6% reported referring beneficiaries to the Aging and Disability Resource Centers (ADRCs) to assess eligibility for limited-income programs. When asked about programs for beneficiaries with limited income, the answers were predominantly "don't know for sure." Several strategies were used by pharmacists in an attempt to help limited-income Medicare beneficiaries obtain their medications. Lack of knowledge about financial
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MEDICARE: Improvements Needed in Provider Communications and Contracting Procedures
National Research Council Canada - National Science Library
Aronovitz, Leslie
2001-01-01
.... Under Medicare's fee-for-service system-which accounts for over 80 percent of program beneficiaries physicians, hospitals, and other providers submit claims to receive reimbursement for services...
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Menger, Richard P; Wolf, Michael E; Kukreja, Sunil; Sin, Anthony; Nanda, Anil
2015-01-01
Medicare data showing physician-specific reimbursement for 2012 were recently made public in the mainstream media. Given the ongoing interest in containing healthcare costs, we analyze these data in the context of the delivery of spinal surgery. Demographics of 206 leading surgeons were extracted including state, geographic area, residency training program, fellowship training, and academic affiliation. Using current procedural terminology (CPT) codes, information was evaluated regarding the number of lumbar laminectomies, lumbar fusions, add-on laminectomy levels, and anterior cervical fusions reimbursed by Medicare in 2012. In 2012 Medicare reimbursed the average neurosurgeon slightly more than an orthopedic surgeon for all procedures ($142,075 vs. $110,920), but this was not found to be statistically significant (P = 0.218). Orthopedic surgeons had a statistical trend illustrating increased reimbursement for lumbar fusions specifically, $1187 versus $1073 (P = 0.07). Fellowship trained spinal surgeons also, on average, received more from Medicare ($125,407 vs. $76,551), but again this was not statistically significant (P = 0.112). A surgeon in private practice, on average, was reimbursed $137,495 while their academic counterparts were reimbursed $103,144 (P = 0.127). Surgeons performing cervical fusions in the Centers for Disease Control West Region did receive statistically significantly less reimbursement for that procedure then those surgeons in other parts of the country (P = 0.015). Surgeons in the West were reimbursed on average $849 for CPT code 22,551 while those in the Midwest received $1475 per procedure. Medicare reimbursement data are fundamentally flawed in determining healthcare expenditure as it shows a bias toward delivery of care in specific patient demographics. However, neurosurgeons, not just policy makers, must take ownership to analyze, investigate, and interpret these data as it will affect healthcare reimbursement and delivery moving
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Ryan, Andrew M; Damberg, Cheryl L
2013-06-01
The Medicare program has implemented pay-for-performance (P4P), or Value-Based Purchasing, for inpatient care and for Medicare Advantage plans, and plans to implement a program for physicians in 2015. In this paper, we review evidence on the effectiveness of P4P and identify design criteria deemed to be best practice in P4P. We then assess the extent to which Medicare's existing and planned Value-Based Purchasing programs align with these best practices. Of the seven identified best practices in P4P program design, the Hospital Value-Based Purchasing program is strongly aligned with two of the best practices, moderately aligned with three, weakly aligned with one, and has unclear alignment with one best practice. The Physician Value-Based Purchasing Modifier is strongly aligned with two of the best practices, moderately aligned with one, weakly aligned with three, and has unclear alignment with one of the best practices. The Medicare Advantage Quality Bonus Program is strongly aligned with four of the best practices, moderately aligned with two, and weakly aligned with one of the best practices. We identify enduring gaps in P4P literature as it relates to Medicare's plans for Value-Based Purchasing and discuss important issues in the future of these implementations in Medicare. Copyright © 2013 Elsevier Inc. All rights reserved.
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Sjoding, Michael W; Valley, Thomas S; Prescott, Hallie C; Wunsch, Hannah; Iwashyna, Theodore J; Cooke, Colin R
2016-01-15
Intermediate care (i.e., step-down or progressive care) is an alternative to the intensive care unit (ICU) for patients with moderate severity of illness. The adoption and current use of intermediate care is unknown. To characterize trends in intermediate care use among U.S. hospitals. We examined 135 million acute care hospitalizations among elderly individuals (≥65 yr) enrolled in fee-for-service Medicare (U.S. federal health insurance program) from 1996 to 2010. We identified patients receiving intermediate care as those with intensive care or coronary care room and board charges labeled intermediate ICU. In 1996, a total of 960 of the 3,425 hospitals providing critical care billed for intermediate care (28%), and this increased to 1,643 of 2,783 hospitals (59%) in 2010 (P billed for intermediate care, but billing steadily increased to 22.8% by 2010 (P billed for ICU care and ward-only care declined. Patients billed for intermediate care had more acute organ failures diagnoses codes compared with general ward patients (22.4% vs. 15.8%). When compared with patients billed for ICU care, those billed for intermediate care had fewer organ failures (22.4% vs. 43.4%), less mechanical ventilation (0.9% vs. 16.7%), lower mean Medicare spending ($8,514 vs. $18,150), and lower 30-day mortality (5.6% vs. 16.5%) (P billing increased markedly between 1996 and 2010. These findings highlight the need to better define the value, specific practices, and effective use of intermediate care for patients and hospitals.
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Canadian Medicare: prognosis guarded.
Naylor, C D; Fooks, C; Williams, J I
1995-01-01
Beset by unprecedented fiscal pressures, Canadian medicare has reached a crossroads. The authors review the impact of recent cuts in federal transfer payments on provincial health care programs and offer seven suggestions to policymakers trying to accommodate these reductions. (1) Go slowly: public health care spending is no longer rising and few provinces have the necessary systems in place to manage major reductions. (2) Target reductions, rewarding quality and efficiency instead of making ...
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75 FR 14454 - National Protection and Programs Directorate; National Infrastructure Advisory Council
2010-03-25
..., National Infrastructure Advisory Council. [FR Doc. 2010-6633 Filed 3-24-10; 8:45 am] BILLING CODE 9110-9P-P ... Directorate; National Infrastructure Advisory Council AGENCY: National Protection and Programs Directorate... Infrastructure Advisory Council (NIAC) will meet on Tuesday, April 13, 2010, at the National Press Club's...
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U.S. Department of Health & Human Services — Medicare certified institutional providers are required to submit an annual cost report to a Medicare Administrative Contractor. The cost report contains provider...
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The bribery statute: a new weapon against Medicare fraud.
Cozort, L A
2001-03-01
A May 2000 U.S. Supreme Court decision determining when a Federal bribery statute can be used to fight Medicare fraud has ramifications for healthcare providers. In Fischer v. United States, the Court concluded that healthcare providers that participate in Medicare are considered to receive benefits as set forth in the bribery statute and thus can be prosecuted for fraudulent activities against the government under the statute. The statute mandates a fine, imprisonment for up to 10 years, or both for anyone convicted under it. Provider organizations that receive Medicare payments and business associates of such organizations should be aware that the government may step up its use of the bribery law in prosecuting fraudulent activity. In addition, although the case pertained specifically to healthcare providers that participate in Medicare, providers that do not participate in Medicare may wish to evaluate the advisability of accepting other Federal funding because of the possible reach of the bribery statute.
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31 CFR 10.22 - Diligence as to accuracy.
2010-07-01
... 31 Money and Finance: Treasury 1 2010-07-01 2010-07-01 false Diligence as to accuracy. 10.22... § 10.22 Diligence as to accuracy. (a) In general. A practitioner must exercise due diligence— (1) In... provided in §§ 10.34, 10.35, and 10.37, a practitioner will be presumed to have exercised due diligence for...
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Directory of Open Access Journals (Sweden)
Bryan B Brimhall
Full Text Available Colonoscopy is performed on patients across a broad spectrum of demographic characteristics. These characteristics may aggregate by patient insurance provider and influence bowel preparation quality and the prevalence of adenomas. The purpose of this study was to evaluate the association of insurance status and suboptimal bowel preparation, recommendation for an early repeat colonoscopy due to suboptimal bowel preparation, adenoma detection rate (ADR, and advanced ADR (AADR.This is a cohort study of outpatient colonoscopies (n = 3113 at a single academic medical center. Patient insurance status was categorized into five groups: 1 Medicare < 65y; 2 Medicare ≥ 65y; 3 Tricare/VA; 4 Medicaid/Colorado Indigent Care Program (CICP; and 5 commercial insurance. We used multivariable logistic or linear regression modeling to estimate the risks for the association between patient insurance and suboptimal bowel preparation, recommendation for an early repeat colonoscopy due to suboptimal bowel preparation, ADR, and AADR. Models were adjusted for appropriate covariates.Medicare patients < 65y (OR 4.91; 95% CI: 3.25-7.43 and Medicaid/CICP patients (OR 4.23; 95% CI: 2.65-7.65 were more likely to have a suboptimal preparation compared to commercial insurance patients. Medicare patients < 65y (OR 5.58; 95% CI: 2.85-10.92 and Medicaid/CICP patients (OR 3.64; CI: 1.60-8.28 were more likely to receive a recommendation for an early repeat colonoscopy compared to commercial insurance patients. Medicare patients < 65y had a significantly higher adjusted ADR (OR 1.50; 95% CI: 1.03-2.18 and adjusted AADR (OR 1.99; 95% CI: 1.15-3.44 compared to commercial insurance patients.Understanding the reasons for the higher rate of a suboptimal bowel preparation in Medicare < 65y and Medicaid/CICP patients and reducing this rate is critical to improving colonoscopy outcomes and reducing healthcare costs in these populations.
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Chen, Elizabeth Edmiston; Miller, Edward Alan
2017-09-01
This study assessed the odds of dying in hospital associated with enrollment in Medicare Advantage (M-A) versus conventional Medicare Fee-for-Service (M-FFS). Data were derived from the 2008 and 2010 waves of the Health and Retirement Study ( n = 1,030). The sample consisted of elderly Medicare beneficiaries who died in 2008-2010 (34% died in hospital, and 66% died at home, in long-term senior care, a hospice facility, or other setting). Logistic regression estimated the odds of dying in hospital for those continuously enrolled in M-A from 2008 until death compared to those continuously enrolled in M-FFS and those switching between the two plans. Results indicate that decedents continuously enrolled in M-A had 43% lower odds of dying in hospital compared to those continuously enrolled in M-FFS. Financial incentives in M-A contracts may reduce the odds of dying in hospital.
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MACRA, MIPS, and the New Medicare Quality Payment Program: An Update for Radiologists.
Rosenkrantz, Andrew B; Nicola, Gregory N; Allen, Bibb; Hughes, Danny R; Hirsch, Joshua A
2017-03-01
The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 advances the goal of tying Medicare payments to quality and value. In April 2016, CMS published an initial proposed rule for MACRA, renaming it the Quality Payment Program (QPP). Under QPP, clinicians receive payments through either advanced alternative payment models or the Merit-Based Incentive Payment System (MIPS), a consolidation of existing federal performance programs that applies positive or negative adjustments to fee-for-service payments. Most physicians will participate in MIPS. This review highlights implications of the QPP and MIPS for radiologists. Although MIPS incorporates radiology-specific quality measures, radiologists will also be required to participate in other practice improvement activities, including patient engagement. Recognizing physicians' unique practice patterns, MIPS will provide special considerations in performance evaluation for physicians with limited face-to-face patient interaction. Although such considerations will affect radiologists' likelihood of success under QPP, many practitioners will be ineligible for the considerations under currently proposed criteria. Reporting using qualified clinical data registries will benefit radiologists' performance by allowing expanded arrays of MIPS and non-MIPS specialty-specific measures. A group practice reporting option will substantially reduce administrative burden but introduce new challenges by requiring uniform determination of patient-facing status and performance measurement for all of the group's physicians (diagnostic radiologists, interventional radiologists, and nonradiologists) under the same taxpayer identification number. Given that the initial MIPS performance period begins in 2017, radiologists must begin preparing for QPP and taking actions to ensure their future success under this new quality-based payment system. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights
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Variation in Payment Rates under Medicare's Inpatient Prospective Payment System.
Krinsky, Sam; Ryan, Andrew M; Mijanovich, Tod; Blustein, Jan
2017-04-01
To measure variation in payment rates under Medicare's Inpatient Prospective Payment System (IPPS) and identify the main payment adjustments that drive variation. Medicare cost reports for all Medicare-certified hospitals, 1987-2013, and Dartmouth Atlas geographic files. We measure the Medicare payment rate as a hospital's total acute inpatient Medicare Part A payment, divided by the standard IPPS payment for its geographic area. We assess variation using several measures, both within local markets and nationally. We perform a factor decomposition to identify the share of variation attributable to specific adjustments. We also describe the characteristics of hospitals receiving different payment rates and evaluate changes in the magnitude of the main adjustments over time. Data downloaded from the Centers for Medicare and Medicaid Services, the National Bureau of Economic Research, and the Dartmouth Atlas. In 2013, Medicare paid for acute inpatient discharges at a rate 31 percent above the IPPS base. For the top 10 percent of discharges, the mean rate was double the IPPS base. Variations were driven by adjustments for medical education and care to low-income populations. The magnitude of variation has increased over time. Adjustments are a large and growing share of Medicare hospital payments, and they create significant variation in payment rates. © Health Research and Educational Trust.
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2010-05-12
... DEPARTMENT OF HEALTH AND HUMAN SERVICES National Toxicology Program (NTP); Office of Liaison, Policy and Review; Meeting of the Scientific Advisory Committee on Alternative Toxicological Methods... Director, National Toxicology Program. [FR Doc. 2010-11318 Filed 5-11-10; 8:45 am] BILLING CODE 4140-01-P ...
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75 FR 37971 - Providing Stability and Security for Medicare Reimbursements
2010-06-30
... Part IV The President Memorandum of June 25, 2010--Providing Stability and Security for Medicare Reimbursements #0; #0; #0; Presidential Documents #0; #0; #0;#0;Federal Register / Vol. 75, No. 125 / Wednesday...
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International Nuclear Information System (INIS)
Kim, Doo Soo; Kim, Deuk Young; Seo, Yong Gon; Kim, Ji Hoon; Hwang, Sung Min; Baik, Kwang Hyeon
2012-01-01
Semipolar (11-22) GaN films were grown on m-plane (1-100) sapphire substrates by using metalorganic chemical vapor deposition. The line widths of the omega rocking curves of the semipolar GaN films were 498 arcsec along the [11-23] GaN direction and 908 arcsec along the [10-10] GaN direction. The properties of the Ti/Al/Ni/Au metal contact were investigated using transmission-line-method patterns oriented in both the [11-23] GaN and the [10-10] GaN directions of semipolar (11-22) GaN. The minimum specific contact resistance of ∼3.6 x 10 -4 Ω·cm -2 was obtained on as-deposited metal contacts. The Ohmic contact properties of semipolar (11-22) GaN became degraded with increasing annealing temperature above 400 .deg. C. The thermal degradation of the metal contacts may be attributed to the surface property of N-polarity on the semipolar (11-22) GaN films. Also, the semipolar (11-22) GaN films did not show clear anisotropic behavior of the electrical properties for different azimuthal angles.
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12 CFR 22.10 - Notice of servicer's identity.
2010-01-01
... 12 Banks and Banking 1 2010-01-01 2010-01-01 false Notice of servicer's identity. 22.10 Section 22... SPECIAL FLOOD HAZARDS § 22.10 Notice of servicer's identity. (a) Notice requirement. When a bank makes... designee) in writing of the identity of the servicer of the loan. The Director of FEMA has designated the...
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Competitive bidding in Medicare Advantage: effect of benchmark changes on plan bids.
Song, Zirui; Landrum, Mary Beth; Chernew, Michael E
2013-12-01
Bidding has been proposed to replace or complement the administered prices that Medicare pays to hospitals and health plans. In 2006, the Medicare Advantage program implemented a competitive bidding system to determine plan payments. In perfectly competitive models, plans bid their costs and thus bids are insensitive to the benchmark. Under many other models of competition, bids respond to changes in the benchmark. We conceptualize the bidding system and use an instrumental variable approach to study the effect of benchmark changes on bids. We use 2006-2010 plan payment data from the Centers for Medicare and Medicaid Services, published county benchmarks, actual realized fee-for-service costs, and Medicare Advantage enrollment. We find that a $1 increase in the benchmark leads to about a $0.53 increase in bids, suggesting that plans in the Medicare Advantage market have meaningful market power. Copyright © 2013 Elsevier B.V. All rights reserved.
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COMPETITIVE BIDDING IN MEDICARE ADVANTAGE: EFFECT OF BENCHMARK CHANGES ON PLAN BIDS
Song, Zirui; Landrum, Mary Beth; Chernew, Michael E.
2013-01-01
Bidding has been proposed to replace or complement the administered prices in Medicare pays to hospitals and health plans. In 2006, the Medicare Advantage program implemented a competitive bidding system to determine plan payments. In perfectly competitive models, plans bid their costs and thus bids are insensitive to the benchmark. Under many other models of competition, bids respond to changes in the benchmark. We conceptualize the bidding system and use an instrumental variable approach to study the effect of benchmark changes on bids. We use 2006–2010 plan payment data from the Centers for Medicare and Medicaid Services, published county benchmarks, actual realized fee-for-service costs, and Medicare Advantage enrollment. We find that a $1 increase in the benchmark leads to about a $0.53 increase in bids, suggesting that plans in the Medicare Advantage market have meaningful market power. PMID:24308881
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22 CFR 145.24 - Program income.
2010-04-01
... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Program income. 145.24 Section 145.24 Foreign....24 Program income. (a) The Department shall apply the standards set forth in this section in requiring recipient organizations to account for program income related to projects financed in whole or in...
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22 CFR 135.25 - Program income.
2010-04-01
... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Program income. 135.25 Section 135.25 Foreign... income. (a) General. Grantees are encouraged to earn income to defray program costs. Program income includes income from fees for services performed, from the use or rental of real or personal property...
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Physician trainees' decision making and information processing: choice size and Medicare Part D.
Barnes, Andrew J; Hanoch, Yaniv; Martynenko, Melissa; Wood, Stacey; Rice, Thomas; Federman, Alex D
2013-01-01
Many patients expect their doctor to help them choose a Medicare prescription drug plan. Whether the size of the choice set affects clinicians' decision processes and strategy selection, and the quality of their choice, as it does their older patients, is an important question with serious financial consequences. Seventy medical students and internal medicine residents completed a within-subject design using Mouselab, a computer program that allows the information-acquisition process to be examined. We examined highly numerate physician trainees' decision processes, strategy, and their ability to pick the cheapest drug plan-as price was deemed the most important factor in Medicare beneficiaries' plan choice-from either 3 or 9 drug plans. Before adjustment, participants were significantly more likely to identify the lowest cost plan when facing three versus nine choices (67.3% vs. 32.8%, pinformation on each attribute (pdecision strategies focusing on comparing alternate plans across a single attribute (search pattern, pdecision process and strategy, numeracy, and amount of medical training, the odds were 10.75 times higher that trainees would choose the lowest cost Medicare Part D drug plan when facing 3 versus 9 drug plans (pdecision environment are needed and suggest physicians' role in their patients' Part D choices may be most productive when assisting seniors with forecasting their expected medication needs and then referring them to the Medicare website or helpline.
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2010-11-29
... DEPARTMENT OF HEALTH AND HUMAN SERVICES National Toxicology Program (NTP): Office of Liaison... Materials The agenda topic is the peer review of the findings and conclusions of draft NTP TRs of toxicology.... Bucher, Associate Director, National Toxicology Program. [FR Doc. 2010-29945 Filed 11-26-10; 8:45 am...
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Medicare Hospital Spending Per Patient - National
U.S. Department of Health & Human Services — The "Medicare hospital spending per patient (Medicare Spending per Beneficiary)" measure shows whether Medicare spends more, less or about the same per Medicare...
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Medicare Hospital Spending Per Patient - Hospital
U.S. Department of Health & Human Services — The "Medicare hospital spending per patient (Medicare Spending per Beneficiary)" measure shows whether Medicare spends more, less or about the same per Medicare...
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Medicare Hospital Spending Per Patient - State
U.S. Department of Health & Human Services — The "Medicare hospital spending per patient (Medicare Spending per Beneficiary)" measure shows whether Medicare spends more, less or about the same per Medicare...
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78 FR 6273 - Rules Relating to Additional Medicare Tax
2013-01-30
... DEPARTMENT OF THE TREASURY Internal Revenue Service 26 CFR Parts 1 and 31 [REG-130074-11] RIN 1545-BK54 Rules Relating to Additional Medicare Tax Correction In proposed rule document 2012-29237, appearing on pages 72268- 72277 in the issue of Wednesday, December 5, 2012, make the following correction...
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76 FR 36879 - Minnesota: Final Authorization of State Hazardous Waste Management Program Revision
2011-06-23
... Treatment Subcategories for Radioactively Contaminated Cadmium-, Mercury-, and Silver- Containing Batteries..., 1998 (63 FR 28556) Land Disposal Restrictions Phase IV; Hazardous Soils Treatment Standards and..., October 22, 1998 (63 FR 56710) Hazardous Remediation Waste Management Requirements (HWIR-Media), Checklist...
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2010-11-09
... Retirement Act and certain others do not have to pay premiums for Medicare Part A.) Section 1818A of the Act... specifies that the premium that these individuals will pay for CY 2011 will be equal to the premium for... consequential effect on State, local, or tribal governments or on the private sector. However, States are...
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Disease management and the Medicare Modernization Act: "It's the insurance, stupid".
Sidorov, Jaan; Schlosberg, Claudia
2005-12-01
While definitions of "disease management" (DM) emphasize quality of care for populations with chronic illness, proponents argue it reduces healthcare costs. Buyers may find disease management organizations' (DMOs') use of clinical guidelines, physician collaboration, and promotion of patient self-management intuitively sound, but it is performance guarantees, combined with retrospective effectiveness cost studies, that have driven DMOs' penetration of the commercial insurance market with revenues that exceed $500 million per year. The success of DMOs contributed to the creation of the Chronic Care Improvement Program (CCIP), which is designed to prospectively test the impact of DM on both the quality and cost of care for fee-for-service Medicare beneficiaries with chronic illness. This may lead to an expansion of DM in Medicare, and even greater opportunities for DMOs beyond the $10 billion in 10- year projected growth. For community-based physicians caring for patients with chronic illness, the sharpened focus on chronic care and the growth of DMOs creates some potential advantages. These include more time to treat more patients with acute illness, lower practice costs, opportunities to collaborate over quality, and a greater ability to achieve quality targets set by pay-for-performance arrangements.
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10 CFR 1045.22 - No comment policy.
2010-01-01
... 10 Energy 4 2010-01-01 2010-01-01 false No comment policy. 1045.22 Section 1045.22 Energy DEPARTMENT OF ENERGY (GENERAL PROVISIONS) NUCLEAR CLASSIFICATION AND DECLASSIFICATION Identification of Restricted Data and Formerly Restricted Data Information § 1045.22 No comment policy. (a) Authorized holders of RD and FRD shall not confirm or expand...
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Applying the 2003 Beers Update to Elderly Medicare Enr...
U.S. Department of Health & Human Services — Applying the 2003 Beers Update to Elderly Medicare Enrollees in the Part D Program Inappropriate prescribing of certain medications known as Beers drugs may be...
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Funding a Health Disparities Research Agenda: The Case of Medicare Home Health Care
Davitt, Joan K.
2014-01-01
Medicare home health care provides critical skilled nursing and therapy services to patients in their homes, generally after a period in an inpatient facility or nursing home. Disparities in access to, or outcomes of, home health care can result in patient deterioration and increased cost to the Medicare program if patient care needs intensify.…
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Rahman, Momotazur; Keohane, Laura; Trivedi, Amal N; Mor, Vincent
2015-10-01
Medicare Advantage payment regulations include risk-adjusted capitated reimbursement, which was implemented to discourage favorable risk selection and encourage the retention of members who incur high costs. However, the extent to which risk-adjusted capitation has succeeded is not clear, especially for members using high-cost services not previously considered in assessments of risk selection. We examined the rates at which participants who used three high-cost services switched between Medicare Advantage and traditional Medicare. We found that the switching rate from 2010 to 2011 away from Medicare Advantage and to traditional Medicare exceeded the switching rate in the opposite direction for participants who used long-term nursing home care (17 percent versus 3 percent), short-term nursing home care (9 percent versus 4 percent), and home health care (8 percent versus 3 percent). These results were magnified among people who were enrolled in both Medicare and Medicaid. Our findings raise questions about the role of Medicare Advantage plans in serving high-cost patients with complex care needs, who account for a disproportionately high amount of total health care spending. Project HOPE—The People-to-People Health Foundation, Inc.
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Setifi, Zouaoui; Domasevitch, Konstantin V; Setifi, Fatima; Mach, Pavel; Ng, Seik Weng; Petříček, Vaclav; Dušek, Michal
2013-11-01
In the ionic structure of the title compound, [Fe(C12H8N2)3](C9H5N4O2)2·H2O, the octahedral tris-chelate [Fe(phen)3](2+) dications [Fe-N = 1.9647 (14)-1.9769 (14) Å; phen is 1,10-phenathroline] afford one-dimensional chains by a series of slipped π-π stacking interactions [centroid-to-centroid distances = 3.792 (3) and 3.939 (3) Å]. The 1,1,3,3-tetracyano-2-(2-hydroxyethyl)propenide anions, denoted tcnoetOH(-), reveal an appreciable delocalization of π-electron density, involving the central propenide [C-C = 1.383 (3)-1.401 (2) Å] fragment and four nitrile groups, and this is also supported by density functional theory (DFT) calculations at the B97D/6-311+G(2d,2p) level. Primary noncovalent inter-moiety interactions comprise conventional O-H...O(N) and weak C-H...O(N) hydrogen bonding [O...O(N) = 2.833 (2)-3.289 (5) Å and C...O(N) = 3.132 (2)-3.439 (2) Å]. The double anion...π interaction involving a nitrile group of tcnoetOH(-) and two cis-positioned pyridine rings (`π-pocket') of [Fe(phen)3](2+) [N...centroid = 3.212 (2) and 3.418 (2) Å] suggest the relevance of anion...π stackings for charge-diffuse polycyanoanions and common M-chelate species.
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Paying Medicare Advantage Plans: To Level or Tilt the Playing Field
Glazer, Jacob; McGuire, Thomas G.
2017-01-01
Medicare beneficiaries are eligible for health insurance through the public option of traditional Medicare (TM) or may join a private Medicare Advantage (MA) plan. Both are highly subsidized but in different ways. Medicare pays for most of costs directly in TM, and makes a subsidy payment to an MA plan based on a “benchmark” for each beneficiary choosing a private plan. The level of this benchmark is arguably the most important policy decision Medicare makes about the MA program. Presently, about 30% of beneficiaries are in MA, and Medicare subsidizes MA plans more on average than TM. Many analysts recommend equalizing Medicare’s subsidy across the options – referred to in policy circles as a “level playing field.” This paper studies the normative question of how to set the level of the benchmark, applying the versatile model of plan choice developed by Einav and Finkelstein (EF) to Medicare. The EF framework implies unequal subsidies to counteract risk selection across plan types. We also study other reasons to tilt the field: the relative efficiency of MA vs. TM, market power of MA plans, and institutional features of the way Medicare determines subsidies and premiums. After review of the empirical and policy literature, we conclude that in areas where the MA market is competitive, the benchmark should be set below average costs in TM, but in areas characterized by imperfect competition in MA, it should be raised in order to offset output (enrollment) restrictions by plans with market power. We also recommend specific modifications of Medicare rules to make demand for MA more price elastic. PMID:28318667
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Energy Technology Data Exchange (ETDEWEB)
Lee, Sang-Sung; Wajima, Kiyoaki; Algaba, Juan-Carlos; Zhao, Guang-Yao; Hodgson, Jeffrey A.; Byun, Do-Young; Kang, Sincheol; Kim, Soon-Wook; Kino, Motoki [Korea Astronomy and Space Science Institute, 776 Daedeok-daero, Yuseong-gu, Daejeon 34055 (Korea, Republic of); Kim, Dae-Won; Park, Jongho; Kim, Jae-Young; Trippe, Sascha [Department of Physics and Astronomy, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826 (Korea, Republic of); Miyazaki, Atsushi [Japan Space Forum, 3-2-1, Kandasurugadai, Chiyoda-ku, Tokyo 101-0062 Japan (Japan); Kim, Jeong-Sook, E-mail: sslee@kasi.re.kr [National Astronomical Observatory of Japan, 2211 Osawa, Mitaka, Tokyo 1818588 (Japan)
2016-11-01
We present results of single-epoch very long baseline interferometry (VLBI) observations of gamma-ray bright active galactic nuclei (AGNs) using the Korean VLBI Network (KVN) at the 22, 43, 86, and 129 GHz bands, which are part of a KVN key science program, Interferometric Monitoring of Gamma-Ray Bright AGNs. We selected a total of 34 radio-loud AGNs of which 30 sources are gamma-ray bright AGNs with flux densities of >6 × 10{sup −10} ph cm{sup −2} s{sup −1}. Single-epoch multifrequency VLBI observations of the target sources were conducted during a 24 hr session on 2013 November 19 and 20. All observed sources were detected and imaged at all frequency bands, with or without a frequency phase transfer technique, which enabled the imaging of 12 faint sources at 129 GHz, except for one source. Many of the target sources are resolved on milliarcsecond scales, yielding a core-jet structure, with the VLBI core dominating the synchrotron emission on a milliarcsecond scale. CLEAN flux densities of the target sources are 0.43–28 Jy, 0.32–21 Jy, 0.18–11 Jy, and 0.35–8.0 Jy in the 22, 43, 86, and 129 GHz bands, respectively. Spectra of the target sources become steeper at higher frequency, with spectral index means of −0.40, −0.62, and −1.00 in the 22–43 GHz, 43–86 GHz and 86–129 GHz bands, respectively, implying that the target sources become optically thin at higher frequencies (e.g., 86–129 GHz).
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22 CFR 120.10 - Technical data.
2010-04-01
... information in the public domain as defined in § 120.11. It also does not include basic marketing information... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Technical data. 120.10 Section 120.10 Foreign Relations DEPARTMENT OF STATE INTERNATIONAL TRAFFIC IN ARMS REGULATIONS PURPOSE AND DEFINITIONS § 120.10...
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Recovery of renal function among ESRD patients in the US medicare program.
Directory of Open Access Journals (Sweden)
Sumit Mohan
Full Text Available BACKGROUND: Patients started on long term hemodialysis have typically had low rates of reported renal recovery with recent estimates ranging from 0.9-2.4% while higher rates of recovery have been reported in cohorts with higher percentages of patients with acute renal failure requiring dialysis. STUDY DESIGN: Our analysis followed approximately 194,000 patients who were initiated on hemodialysis during a 2-year period (2008 & 2009 with CMS-2728 forms submitted to CMS by dialysis facilities, cross-referenced with patient record updates through the end of 2010, and tracked through December 2010 in the CMS SIMS registry. RESULTS: We report a sustained renal recovery (i.e no return to ESRD during the available follow up period rate among Medicare ESRD patients of > 5% - much higher than previously reported. Recovery occurred primarily in the first 2 months post incident dialysis, and was more likely in cases with renal failure secondary to etiologies associated with acute kidney injury. Patients experiencing sustained recovery were markedly less likely than true long-term ESRD patients to have permanent vascular accesses in place at incident hemodialysis, while non-White patients, and patients with any prior nephrology care appeared to have significantly lower rates of renal recovery. We also found widespread geographic variation in the rates of renal recovery across the United States. CONCLUSIONS: Renal recovery rates in the US Medicare ESRD program are higher than previously reported and appear to have significant geographic variation. Patients with diagnoses associated with acute kidney injury who are initiated on long-term hemodialysis have significantly higher rates of renal recovery than the general ESRD population and lower rates of permanent access placement.
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42 CFR 455.232 - Medicaid integrity audit program contractor functions.
2010-10-01
... 42 Public Health 4 2010-10-01 2010-10-01 false Medicaid integrity audit program contractor functions. 455.232 Section 455.232 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS PROGRAM INTEGRITY: MEDICAID Medicaid...
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75 FR 61101 - Closed Captioning of Video Programming
2010-10-04
... Captioning of Video Programming AGENCY: Federal Communications Commission. ACTION: Final rule; waiver of... (Bureau), waives in part the requirement that video programming distributors (VPDs) place contact... (2), published at 74 FR 1594, January 13, 2009, requiring video programming distributors to place...
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Medicare's post-acute care payment: a review of the issues and policy proposals.
Linehan, Kathryn
2012-12-07
Medicare spending on post-acute care provided by skilled nursing facility providers, home health providers, inpatient rehabilitation facility providers, and long-term care hospitals has grown rapidly in the past several years. The Medicare Payment Advisory Commission and others have noted several long-standing problems with the payment systems for post-acute care and have suggested refinements to Medicare's post-acute care payment systems that are intended to encourage the delivery of appropriate care in the right setting for a patient's condition. The Patient Protection and Affordable Care Act of 2010 contained several provisions that affect the Medicare program's post-acute care payment systems and also includes broader payment reforms, such as bundled payment models. This issue brief describes Medicare's payment systems for post-acute care providers, evidence of problems that have been identified with the payment systems, and policies that have been proposed or enacted to remedy those problems.
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Out-of-pocket health spending by poor and near-poor elderly Medicare beneficiaries.
Gross, D J; Alecxih, L; Gibson, M J; Corea, J; Caplan, C; Brangan, N
1999-04-01
To estimate out-of-pocket health care spending by lower-income Medicare beneficiaries, and to examine spending variations between those who receive Medicaid assistance and those who do not receive such aid. DATA SOURCES AND COLLECTION: 1993 Medicare Current Beneficiary Survey (MCBS) Cost and Use files, supplemented with data from the Bureau of the Census (Current Population Survey); the Congressional Budget Office; the Health Care Financing Administration, Office of the Actuary (National Health Accounts); and the Social Security Administration. We analyzed out-of-pocket spending through a Medicare Benefits Simulation model, which projects out-of-pocket health care spending from the 1993 MCBS to 1997. Out-of-pocket health care spending is defined to include Medicare deductibles and coinsurance; premiums for private insurance, Medicare Part B, and Medicare HMOs; payments for non-covered goods and services; and balance billing by physicians. It excludes the costs of home care and nursing facility services, as well as indirect tax payments toward health care financing. Almost 60 percent of beneficiaries with incomes below the poverty level did not receive Medicaid assistance in 1997. We estimate that these beneficiaries spent, on average, about half their income out-of-pocket for health care, whether they were enrolled in a Medicare HMO or in the traditional fee-for-service program. The 75 percent of beneficiaries with incomes between 100 and 125 percent of the poverty level who were not enrolled in Medicaid spent an estimated 30 percent of their income out-of-pocket on health care if they were in the traditional program and about 23 percent of their income if they were enrolled in a Medicare HMO. Average out-of-pocket spending among fee-for-service beneficiaries varied depending on whether beneficiaries had Medigap policies, employer-provided supplemental insurance, or no supplemental coverage. Those without supplemental coverage spent more on health care goods and
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77 FR 31486 - Virginia Regulatory Program
2012-05-29
... United States Court of Appeals for the District of Columbia Circuit in Nat'l Mining Ass'n v. Kempthorne... Federal VER regulations promulgated by OSM on December 17, 1999 (64 FR 70766-70838). Nat'l Mining Ass'n v...
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77 FR 6619 - Community Advantage Pilot Program
2012-02-08
... access to capital for small businesses and entrepreneurs in underserved markets, SBA is issuing this... (``CA Pilot Program'') (76 FR 9626). The CA Pilot Program was introduced to increase SBA-guaranteed... small businesses and entrepreneurs in underserved markets, SBA is issuing this Notice to revise several...
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Medicare Current Beneficiary Survey
U.S. Department of Health & Human Services — The Characteristics and Perceptions of the Medicare Population Data from the 2010 Medicare Current Beneficiary Survey is a series of source books based on the...
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2016-11-04
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) repeals the Medicare sustainable growth rate (SGR) methodology for updates to the physician fee schedule (PFS) and replaces it with a new approach to payment called the Quality Payment Program that rewards the delivery of high-quality patient care through two avenues: Advanced Alternative Payment Models (Advanced APMs) and the Merit-based Incentive Payment System (MIPS) for eligible clinicians or groups under the PFS. This final rule with comment period establishes incentives for participation in certain alternative payment models (APMs) and includes the criteria for use by the Physician-Focused Payment Model Technical Advisory Committee (PTAC) in making comments and recommendations on physician-focused payment models (PFPMs). Alternative Payment Models are payment approaches, developed in partnership with the clinician community, that provide added incentives to deliver high-quality and cost-efficient care. APMs can apply to a specific clinical condition, a care episode, or a population. This final rule with comment period also establishes the MIPS, a new program for certain Medicare-enrolled practitioners. MIPS will consolidate components of three existing programs, the Physician Quality Reporting System (PQRS), the Physician Value-based Payment Modifier (VM), and the Medicare Electronic Health Record (EHR) Incentive Program for Eligible Professionals (EPs), and will continue the focus on quality, cost, and use of certified EHR technology (CEHRT) in a cohesive program that avoids redundancies. In this final rule with comment period we have rebranded key terminology based on feedback from stakeholders, with the goal of selecting terms that will be more easily identified and understood by our stakeholders.
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75 FR 58328 - Nebraska: Final Authorization of State Hazardous Waste Management Program Revisions
2010-09-24
... (67 FR 48393). Specifically, the commenter argued that the Phase IV Land Disposal Restriction (LDR... Significantly Affect Energy Supply, Distribution, or Use'' (66 FR 28355, May 22, 2001), because it is not a... inconsistent with applicable law for EPA, when it reviews a State authorization application, to require the use...
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50 CFR Figure 4 to Part 223 - Georgia TED
2010-10-01
... 50 Wildlife and Fisheries 7 2010-10-01 2010-10-01 false Georgia TED 4 Figure 4 to Part 223 Wildlife and Fisheries NATIONAL MARINE FISHERIES SERVICE, NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION, DEPARTMENT OF COMMERCE MARINE MAMMALS THREATENED MARINE AND ANADROMOUS SPECIES Pt. 223, Fig. 4 Figure 4 to Part 223—Georgia TED EC01JY91.048 [52 FR...
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77 FR 15966 - Ohio: Final Authorization of State Hazardous Waste Management Program Revision
2012-03-19
... Hazardous Waste Management Program Revision AGENCY: Environmental Protection Agency (EPA). ACTION: Final..., 1989 (54 FR 27170) to implement the RCRA hazardous waste management program. We granted authorization... Combustors; Final Rule, Checklist 198, February 14, 2002 (67 FR 6968); Hazardous Waste Management System...
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22 CFR 34.10 - Collection methods.
2010-04-01
... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Collection methods. 34.10 Section 34.10 Foreign... Collection methods. Upon completion of notice and provision of all due process rights as listed in 34.8(b) of... collect the debt by one or more of the following methods: (a) Administrative offset. (1) Payments...
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Hot-Fire Testing of 5N and 22N HPGP Thrusters
Burnside, Christopher G.; Pedersen, Kevin W.; Pierce, Charles W.
2015-01-01
This hot-fire test continues NASA investigation of green propellant technologies for future missions. To show the potential for green propellants to replace some hydrazine systems in future spacecraft, NASA Marshall Space Flight Center (MSFC) is continuing to embark on hot-fire test campaigns with various green propellant blends.NASA completed hot-fire testing of 5N and 22N HPGP thrusters at the Marshall Space Flight Center’s Component Development Area altitude test stand in April 2015. Both thrusters are ground test articles and not flight ready units, but are representative of potential flight hardware with a known path towards flight application. The purpose of the 5N testing was to perform facility check-outs and generate a small set of data for comparison to ECAPS and Orbital ATK data sets. The 5N thruster performed as expected with thrust and propellant flow-rate data generated that are similar to previous testing at Orbital ATK. Immediately following the 5N testing, and using the same facility, the 22N testing was conducted on the same test stand with the purpose of demonstrating the 22N performance. The results of 22N testing indicate it performed as expected.The results of the hot-fire testing are presented in this paper and presentation.
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10 CFR 473.22 - Initial review by manager.
2010-01-01
... 10 Energy 3 2010-01-01 2010-01-01 false Initial review by manager. 473.22 Section 473.22 Energy... Certification of Grants, Cooperative Agreements, Contracts, and Projects § 473.22 Initial review by manager. (a) Upon expiration of the time for filing information under these regulations, the manager shall— (1...
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Saitone, T L; Sexton, R J; Sexton Ward, A
2018-01-01
The Affordable Care Act (ACA) established the Hospital-Acquired Condition (HAC) Reduction Program. The Centers for Medicare and Medicaid Services (CMS) established a total HAC scoring methodology to rank hospitals based upon their HAC performance. Hospitals that rank in the lowest quartile based on their HAC score are subject to a 1% reduction in their total Medicare reimbursements. In FY 2017, 769 hospitals incurred payment reductions totaling $430 million. This study analyzes how improvements in the rate of catheter-associated urinary tract infections (CAUTI), based on the implementation of a cranberry-treatment regimen, impact hospitals' HAC scores and likelihood of avoiding the Medicare-reimbursement penalty. A simulation model is developed and implemented using public data from the CMS' Hospital Compare website to determine how hospitals' unilateral and simultaneous adoption of cranberry to improve CAUTI outcomes can affect HAC scores and the likelihood of a hospital incurring the Medicare payment reduction, given results on cranberry effectiveness in preventing CAUTI based on scientific trials. The simulation framework can be adapted to consider other initiatives to improve hospitals' HAC scores. Nearly all simulated hospitals improved their overall HAC score by adopting cranberry as a CAUTI preventative, assuming mean effectiveness from scientific trials. Many hospitals with HAC scores in the lowest quartile of the HAC-score distribution and subject to Medicare reimbursement reductions can improve their scores sufficiently through adopting a cranberry-treatment regimen to avoid payment reduction. The study was unable to replicate exactly the data used by CMS to establish HAC scores for FY 2018. The study assumes that hospitals subject to the Medicare payment reduction were not using cranberry as a prophylactic treatment for their catheterized patients, but is unable to confirm that this is true in all cases. The study also assumes that hospitalized catheter
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2012-03-13
... MILLENNIUM CHALLENGE CORPORATION [MCC FR 12-03] Sunshine Act Meeting; Millennium Challenge Corporation Board of Directors; March 22, 2012 AGENCY: Millennium Challenge Corporation. TIME AND DATE: 3 p.m... CONSIDERED: The Board of Directors (the ``Board'') of the Millennium Challenge Corporation (``MCC'') will...
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... community has a significant impact on the local economy. In rural areas, Medicare reimbursement is a critical source of that healthcare spending, particularly since the higher percentage of elderly population in rural areas mean that Medicare accounts for ...
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Functional impairment and hospital readmission in Medicare seniors.
Greysen, S Ryan; Stijacic Cenzer, Irena; Auerbach, Andrew D; Covinsky, Kenneth E
2015-04-01
Medicare currently penalizes hospitals for high readmission rates for seniors but does not account for common age-related syndromes, such as functional impairment. To assess the effects of functional impairment on Medicare hospital readmissions given the high prevalence of functional impairments in community-dwelling seniors. We created a nationally representative cohort of 7854 community-dwelling seniors in the Health and Retirement Study, with 22,289 Medicare hospitalizations from January 1, 2000, through December 31, 2010. Outcome was 30-day readmission assessed by Medicare claims. The main predictor was functional impairment determined from the Health and Retirement Study interview preceding hospitalization, stratified into the following 5 levels: no functional impairments, difficulty with 1 or more instrumental activities of daily living, difficulty with 1 or more activities of daily living (ADL), dependency (need for help) in 1 to 2 ADLs, and dependency in 3 or more ADLs. Adjustment variables included age, race/ethnicity, sex, annual income, net worth, comorbid conditions (Elixhauser score from Medicare claims), and prior admission. We performed multivariable logistic regression to adjust for clustering at the patient level to characterize the association of functional impairments and readmission. Patients had a mean (SD) age of 78.5 (7.7) years (range, 65-105 years); 58.4% were female, 84.9% were white, 89.6% reported 3 or more comorbidities, and 86.0% had 1 or more hospitalizations in the previous year. Overall, 48.3% had some level of functional impairment before admission, and 15.5% of hospitalizations were followed by readmission within 30 days. We found a progressive increase in the adjusted risk of readmission as the degree of functional impairment increased: 13.5% with no functional impairment, 14.3% with difficulty with 1 or more instrumental activities of daily living (odds ratio [OR], 1.06; 95% CI, 0.94-1.20), 14.4% with difficulty with 1 or more
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76 FR 34541 - Child and Adult Care Food Program Improving Management and Program Integrity
2011-06-13
... 7 CFR Parts 210, 215, 220 et al. Child and Adult Care Food Program Improving Management and Program..., 220, 225, and 226 RIN 0584-AC24 Child and Adult Care Food Program Improving Management and Program... management and integrity in the Child and Adult Care Food Program (CACFP), at 67 FR 43447 (June 27, 2002) and...
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Directory of Open Access Journals (Sweden)
Songwuit Chanthee
2016-05-01
Full Text Available The crystal structures of the building block tetramethylammonium (2,2′-bipyridine-κ2N,N′tetracyanidoferrate(III trihydrate, [N(CH34][Fe(CN4(C10H8N2]·3H2O, (I, and a new two-dimensional cyanide-bridged bimetallic coordination polymer, poly[[(2,2′-bipyridine-κ2N,N′di-μ2-cyanido-dicyanido(μ-ethylenediamine-κ2N:N′(ethylenediamine-κ2N,N′cadmium(IIiron(II] monohydrate], [CdFe(CN4(C10H8N2(C2H8N22]·H2O, (II, are reported. In the crystal of (I, pairs of [Fe(2,2′-bipy(CN4]− units (2,2′-bipy is 2,2′-bipyridine are linked together through π–π stacking between the pyridyl rings of the 2,2′-bipy ligands to form a graphite-like structure parallel to the ab plane. The three independent water molecules are hydrogen-bonded alternately with each other, forming a ladder chain structure with R44(8 and R66(12 graph-set ring motifs, while the disordered [N(CH34]+ cations lie above and below the water chains, and the packing is stabilized by weak C—H...O hydrogen bonds. The water chains are further linked with adjacent sheets into a three-dimensional network via O—H...O hydrogen bonds involving the lattice water molecules and the N atoms of terminal cyanide groups of the [Fe(2,2′-bipy(CN4]− building blocks, forming an R44(12 ring motif. Compound (II features a two-dimensional {[Fe(2,2′-bipy(CN4Cd(en2]}n layer structure (en is ethylenediamine extending parallel to (010 and constructed from {[Fe(2,2′-bipy(CN4Cd(en]}n chains interlinked by bridging en ligands at the Cd atoms. Classical O—H...N and N—H...O hydrogen bonds involving the lattice water molecule and N atoms of terminal cyanide groups and the N—H groups of the en ligands are observed within the layers. The layers are further connected via π–π stacking interactions between adjacent pyridine rings of the 2,2′-bipy ligands, completing a three-dimensional supramolecular structure.
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22 CFR 216.10 - Records and reports.
2010-04-01
... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Records and reports. 216.10 Section 216.10 Foreign Relations AGENCY FOR INTERNATIONAL DEVELOPMENT ENVIRONMENTAL PROCEDURES § 216.10 Records and... statements, Determinations and Declarations which will be available to the public under the Freedom of...
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Resource Use and Medicare Costs During Lay Navigation for Geriatric Patients With Cancer.
Rocque, Gabrielle B; Pisu, Maria; Jackson, Bradford E; Kvale, Elizabeth A; Demark-Wahnefried, Wendy; Martin, Michelle Y; Meneses, Karen; Li, Yufeng; Taylor, Richard A; Acemgil, Aras; Williams, Courtney P; Lisovicz, Nedra; Fouad, Mona; Kenzik, Kelly M; Partridge, Edward E
2017-06-01
Lay navigators in the Patient Care Connect Program support patients with cancer from diagnosis through survivorship to end of life. They empower patients to engage in their health care and navigate them through the increasingly complex health care system. Navigation programs can improve access to care, enhance coordination of care, and overcome barriers to timely, high-quality health care. However, few data exist regarding the financial implications of implementing a lay navigation program. To examine the influence of lay navigation on health care spending and resource use among geriatric patients with cancer within The University of Alabama at Birmingham Health System Cancer Community Network. This observational study from January 1, 2012, through December 31, 2015, used propensity score-matched regression analysis to compare quarterly changes in the mean total Medicare costs and resource use between navigated patients and nonnavigated, matched comparison patients. The setting was The University of Alabama at Birmingham Health System Cancer Community Network, which includes 2 academic and 10 community cancer centers across Alabama, Georgia, Florida, Mississippi, and Tennessee. Participants were Medicare beneficiaries with cancer who received care at participating institutions from 2012 through 2015. The primary exposure was contact with a patient navigator. Navigated patients were matched to nonnavigated patients on age, race, sex, cancer acuity (high vs low), comorbidity score, and preenrollment characteristics (costs, emergency department visits, hospitalizations, intensive care unit admissions, and chemotherapy in the preenrollment quarter). Total costs to Medicare, components of cost, and resource use (emergency department visits, hospitalizations, and intensive care unit admissions). In total, 12 428 patients (mean (SD) age at cancer diagnosis, 75 (7) years; 52.0% female) were propensity score matched, including 6214 patients in the navigated group and 6214
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42 CFR 1000.20 - Definitions specific to Medicare.
2010-10-01
... 42 Public Health 5 2010-10-01 2010-10-01 false Definitions specific to Medicare. 1000.20 Section 1000.20 Public Health OFFICE OF INSPECTOR GENERAL-HEALTH CARE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS INTRODUCTION; GENERAL DEFINITIONS Definitions § 1000.20 Definitions specific to...
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2010-10-01
... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Policy. 22.1802 Section 22.1802 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION SOCIOECONOMIC PROGRAMS...-Verify program provides an Internet-based means of verifying employment eligibility of workers employed...
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2010-07-30
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-2480-NC] Medicaid Program; Request for Comments on Legislative Changes To Provide Quality of Care to Children AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Notice with Comments. SUMMARY: This notice...
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22 CFR 229.400 - Education programs or activities.
2010-04-01
... SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 229.400 Education programs or activities... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Education programs or activities. 229.400...
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76 FR 42536 - Real-Time System Management Information Program
2011-07-19
...-Time System Management Information Program AGENCY: Federal Highway Administration (FHWA), DOT. ACTION... Real-Time System Management Information Program and general information about current and planned... establishing requirements for the Real-Time System Management Information Program on November 8, 2010, at 75 FR...
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42 CFR 447.10 - Prohibition against reassignment of provider claims.
2010-10-01
..., if the agent's compensation for this service is— (1) Related to the cost of processing the billing.... 447.10 Section 447.10 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS PAYMENTS FOR SERVICES Payments: General...
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Zheng, Nan Tracy; Haber, Susan; Hoover, Sonja; Feng, Zhanlian
2017-12-01
Medicaid programs are not required to pay the full Medicare coinsurance and deductibles for Medicare-Medicaid dually eligible beneficiaries. We examined the association between the percentage of Medicare cost sharing paid by Medicaid and the likelihood that a dually eligible beneficiary used evaluation and management (E&M) services and safety net provider services. Medicare and Medicaid Analytic eXtract enrollment and claims data for 2009. Multivariate analyses used fee-for-service dually eligible and Medicare-only beneficiaries in 20 states. A comparison group of Medicare-only beneficiaries controlled for state factors that might influence utilization. Paying 100 percent of the Medicare cost sharing compared to 20 percent increased the likelihood (relative to Medicare-only) that a dually eligible beneficiary had any E&M visit by 6.4 percent. This difference in the percentage of cost sharing paid decreased the likelihood of using safety net providers, by 37.7 percent for federally qualified health centers and rural health centers, and by 19.8 percent for hospital outpatient departments. Reimbursing the full Medicare cost-sharing amount would improve access for dually eligible beneficiaries, although the magnitude of the effect will vary by state and type of service. © Health Research and Educational Trust.
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Plan selection in Medicare Part D: Evidence from administrative data
Heiss, Florian; Leive, Adam; McFadden, Daniel; Winter, Joachim
2014-01-01
We study the Medicare Part D prescription drug insurance program as a bellwether for designs of private, non-mandatory health insurance markets, focusing on the ability of consumers to evaluate and optimize their choices of plans. Our analysis of administrative data on medical claims in Medicare Part D suggests that fewer than 25 percent of individuals enroll in plans that are ex ante as good as the least cost plan specified by the Plan Finder tool made available to seniors by the Medicare administration, and that consumers on average have expected excess spending of about $300 per year, or about 15 percent of expected total out-of-pocket cost for drugs and Part D insurance. These numbers are hard to reconcile with decision costs alone; it appears that unless a sizeable fraction of consumers place large values on plan features other than cost, they are not optimizing effectively. PMID:24308882
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Utilization of substance abuse treatment services under Medicare, 2001-2002.
Vandivort, Rita; Teich, Judith L; Cowell, Alexander J; Chen, Hong
2009-06-01
In 2006, the Medicare program covered 37 million elderly persons and 7 million persons younger than 65 years, but little is known about substance abuse (SA) service utilization. Using the 5% Sample of Medicare claims data, the study examines individuals who used SA detoxification ("detox") and/or rehabilitation ("rehab") services under Medicare in 2001 and 2002. SA claimants less than 65 years of age (disabled) were compared to claimants more than 65 years of age (elderly). The disabled were more likely to have a co-occurring mental disorder than elderly claimants (50% vs. 14%) and more likely to have serious mental illness (21% vs. 2.3%). Disabled claimants were more than three times as likely to receive any detox service as elderly claimants (17% vs. 6%). The rate of claimants receiving rehab services within 30 days of detox is about one third for disabled claimants and one quarter for elderly claimants.
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Directory of Open Access Journals (Sweden)
Jorge Lerman
2010-01-01
Full Text Available La disfunción endotelial es la primera alteración conocida que interviene en el desarrollo de la cardiopatía isquémica. La falta de metodologías adecuadamente desarrolladas que permitan reconocer en la etapa preclínica de la enfermedad a los pacientes en riesgo de padecer un evento cardiovascular alertan sobre la necesidad de adoptar métodos adicionales de diagnóstico para su identificación precoz. La función endotelial en las arterias coronarias fue evaluada con perfusión miocárdica SPECT y la prueba del frío.ObjetivosDeterminar la prevalencia de la prueba del frío en 511 pacientes sin cardiopatía isquémica demostrada, como también de los factores de riesgo coronario asociados en aquellos con resultado positivo y analizar la incidencia de eventos cardiovasculares en un seguimiento de cincuenta meses.Material y métodosEn un servicio de medicina nuclear se realizó en 511 pacientes un estudio tomográfico de perfusión miocárdica (SPECT, cuyo resultado ante el ejercicio reveló una captación uniforme del radiotrazador. Ningún paciente tenía antecedentes de revascularización miocárdica ni de infarto previo. Entre los dos y los cinco días posteriores al ingreso en el protocolo se efectuó la prueba del frío. Se considera que ésta es positiva cuando se observa hipocaptación del radioisótopo en algún segmento que no existía en el estudio del esfuerzo y negativo cuando no hay cambios en la captación entre ambos estudios.El seguimiento promedio fue de 24 ± 13 meses, el cual pudo completarse en el 95% de los participantes. Se analizaron los eventos mortalidad cardíaca, infarto de miocardio, accidente cerebrovascular y procedimientos de revascularización.ResultadosLa edad media fue de 58,7 años con una prevalencia del sexo masculino del 52,6%. Prevalencia de factores de riesgo: diabetes 10,3%, dislipidemia 69,3%, hipertensión arterial 63,4%, obesidad 25,2% y tabaquismo 22,3%.En el 32,4% de los pacientes la prueba fue
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22 CFR 9.10 - Mandatory declassification review.
2010-04-01
... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Mandatory declassification review. 9.10 Section 9.10 Foreign Relations DEPARTMENT OF STATE GENERAL SECURITY INFORMATION REGULATIONS § 9.10 Mandatory declassification review. All requests to the Department by a member of the public, a government employee, or an...
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Raising awareness of Medicare member rights among seniors and caregivers in California.
Olson, Rebecca; Grossman, Ruth M; Fu, Patricia L; Sabogal, Fabio
2010-01-01
Many Medicare recipients do not understand their health care rights. Lumetra, formerly California's Medicare quality improvement organization, developed a multifaceted outreach program to increase beneficiary awareness of its services and of the right to file quality-of-care complaints and discharge appeals. Layered outreach activities to Medicare members and their caregivers in 2 targeted counties consisted of paid media, direct mailings, community outreach, and online marketing. Calls to Lumetra's helpline and visits to its Web site--measures of beneficiary awareness of case review services--increased by 106% and 1214%, respectively, in the targeted counties during the 4-month outreach period. Only small increases occurred in nontargeted counties. Increases in quality-of-care complaints and discharge appeal rates were detected during a longer follow-up period.
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2013-01-30
... Medicaid, Children's Health Insurance Programs, and Exchanges: Essential Health Benefits in Alternative...'s Health Insurance Programs, and Exchanges: Essential Health Benefits in Alternative Benefit Plans... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 42 CFR Parts 430...
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New 2,2'-bipyridine and 1,10-phenanthroline oxohalide complexes of technetium(VII) and -(V)
International Nuclear Information System (INIS)
Davison, A.; Jones, A.G.; Abrams, M.J.
1981-01-01
Novel complexes of heptavalent technetium with the formulation TcO 3 XL (L = 2,2'-bipyridine, X = Cl, Br; L = 1,10-phenanthroline, X = Cl) have been prepared and characterized by elemental analysis and optical and vbrational spectroscopy. These complexes can be reduced to the pentavalent species, TcOX 3 L, by heating in ethanolic aqueous HX. TcOX 3 (2,2'-bipyridine) (X = Cl, Br) can be synthesized independently from n-Bu 4 NTcOX 4 and 2,2'-bipyridine in ethanolic aqueous HX
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48 CFR 970.5223-2 - Affirmative procurement program.
2010-10-01
... for Management and Operating Contracts 970.5223-2 Affirmative procurement program. Link to an amendment published at 75 FR 57695, Sept. 22, 2010. As prescribed in 48 CFR (DEAR) 970.2304-2, insert the...
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Medicare Cancer Screening in the Context of Clinical Guidelines: 2000 to 2012.
Maroongroge, Sean; Yu, James B
2018-04-01
Cancer screening is a ubiquitous and controversial public health issue, particularly in the elderly population. Despite extensive evidence-based guidelines for screening, it is unclear how cancer screening has changed in the Medicare population over time. We characterize trends in cancer screening for the most common cancer types in the Medicare fee-for-service (FFS) program in the context of conflicting guidelines from 2000 to 2012. We performed a descriptive analysis of retrospective claims data from the Medicare FFS program based on billing codes. Our data include all claims for Medicare part B beneficiaries who received breast, colorectal (CRC), or prostate cancer screening from 2000 to 2012 based on billing codes. We utilize a Monte Carlo permutation method to detect changes in screening trends. In total, 231,416,732 screening tests were analyzed from 2000 to 2012, representing an average of 436.8 tests per 1000 beneficiaries per year. Mammography rates declined 7.4%, with digital mammography extensively replacing film. CRC cancer screening rates declined overall. As a percentage of all CRC screening tests, colonoscopy grew from 32% to 71%. Prostate screening rates increased 16% from 2000 to 2007, and then declined to 7% less than its 2000 rate by 2012. Both the aggressiveness of screening guidelines and screening rates for the Medicare FFS population peaked and then declined from 2000 to 2012. However, guideline publications did not consistently precede utilization trend shifts. Technology adoption, practical and financial concerns, and patient preferences may have also contributed to the observed trends. Further research should be performed on the impact of multiple, conflicting guidelines in cancer screening.
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76 FR 14566 - Federal Acquisition Regulation; Socioeconomic Program Parity
2011-03-16
... businesses and their relationship to the other small business programs. FAR Case 2010- 015, Women-Owned Small... Women- owned Small Business (WOSB) Federal Contract Program final rule, (75 FR 62258, October 7, 2010...-disabled veteran-owned small business concerns participation. * * * * * PART 19--SMALL BUSINESS PROGRAMS 19...
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22 CFR 62.8 - General program requirements.
2010-04-01
... 22 Foreign Relations 1 2010-04-01 2010-04-01 false General program requirements. 62.8 Section 62.8 Foreign Relations DEPARTMENT OF STATE PUBLIC DIPLOMACY AND EXCHANGES EXCHANGE VISITOR PROGRAM General... purpose of sharing the language, culture, or history of their home country with Americans, provided such...
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2016-08-22
We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems for FY 2017. Some of these changes will implement certain statutory provisions contained in the Pathway for Sustainable Growth Reform Act of 2013, the Improving Medicare Post-Acute Care Transformation Act of 2014, the Notice of Observation Treatment and Implications for Care Eligibility Act of 2015, and other legislation. We also are providing the estimated market basket update to apply to the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits for FY 2017. We are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) for FY 2017. In addition, we are making changes relating to direct graduate medical education (GME) and indirect medical education payments; establishing new requirements or revising existing requirements for quality reporting by specific Medicare providers (acute care hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric facilities), including related provisions for eligible hospitals and critical access hospitals (CAHs) participating in the Electronic Health Record Incentive Program; updating policies relating to the Hospital Value-Based Purchasing Program, the Hospital Readmissions Reduction Program, and the Hospital-Acquired Condition Reduction Program; implementing statutory provisions that require hospitals and CAHs to furnish notification to Medicare beneficiaries, including Medicare Advantage enrollees, when the beneficiaries receive outpatient observation services for more than 24 hours; announcing the implementation of the Frontier Community Health Integration Project Demonstration; and
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... Mariana Islands, Guam, American Samoa, or the U.S. Virgin Islands, we’ll automatically enroll you in Medicare ... enrollment period for people covered under an employer group health plan If you’re 65 or older ...
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Medicare Administrative Contractor Performance Evaluation
U.S. Department of Health & Human Services — The Centers for Medicare and Medicaid Services (CMS) has compiled a summary of overall Medicare Administrative Contractor (MAC) performance information as measured...
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Trends in laboratory test volumes for Medicare Part B reimbursements, 2000-2010.
Shahangian, Shahram; Alspach, Todd D; Astles, J Rex; Yesupriya, Ajay; Dettwyler, William K
2014-02-01
Changes in reimbursements for clinical laboratory testing may help us assess the effect of various variables, such as testing recommendations, market forces, changes in testing technology, and changes in clinical or laboratory practices, and provide information that can influence health care and public health policy decisions. To date, however, there has been no report, to our knowledge, of longitudinal trends in national laboratory test use. To evaluate Medicare Part B-reimbursed volumes of selected laboratory tests per 10,000 enrollees from 2000 through 2010. Laboratory test reimbursement volumes per 10,000 enrollees in Medicare Part B were obtained from the Centers for Medicare & Medicaid Services (Baltimore, Maryland). The ratio of the most recent (2010) reimbursed test volume per 10,000 Medicare enrollees, divided by the oldest data (usually 2000) during this decade, called the volume ratio, was used to measure trends in test reimbursement. Laboratory tests with a reimbursement claim frequency of at least 10 per 10,000 Medicare enrollees in 2010 were selected, provided there was more than a 50% change in test reimbursement volume during the 2000-2010 decade. We combined the reimbursed test volumes for the few tests that were listed under more than one code in the Current Procedural Terminology (American Medical Association, Chicago, Illinois). A 2-sided Poisson regression, adjusted for potential overdispersion, was used to determine P values for the trend; trends were considered significant at P reimbursement volumes were electrolytes, digoxin, carbamazepine, phenytoin, and lithium, with volume ratios ranging from 0.27 to 0.64 (P reimbursement volumes were meprobamate, opiates, methadone, phencyclidine, amphetamines, cocaine, and vitamin D, with volume ratios ranging from 83 to 1510 (P reimbursement volumes increased for most of the selected tests, other tests exhibited statistically significant downward trends in annual reimbursement volumes. The observed
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International Nuclear Information System (INIS)
Remy, Sophie
1991-01-01
Astronomical observations in the 10 micron atmospheric window provide very important information for many of astrophysical topics. But because of the very large terrestrial photon background at that wavelength, ground based observations have been impeded. On the other band, the ground based telescopes offer a greater angular resolution than the spatially based telescopes. The recent development of detector arrays for the mid infrared range made easier the development of infrared cameras with optimized detectors for astronomical observations from the ground. The CAMIRAS infrared camera, built by the 'Service d'Astrophysique' in Saclay is the instrument we have studied and we present its performances. Its sensitivity, given for an integration time of one minute on source and a signal to noise ratio of 3, is 0.15 Jy for punctual sources, and 20 mJy arcs"-"2 for extended sources. But we need to get rid of the enormous photon background so we have to find a better way of observation based on modulation techniques as 'chopping' or 'nodding'. Thus we show that a modulation about 1 Hz is satisfactory with our detectors arrays without perturbing the signal to noise ratio. As we have a good instrument and because we are able to get rid of the photon background, we can study astronomical objects. Results from a comet, dusty stellar disks, and an ultra-luminous galaxy are presented. (author) [fr
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2012-01-11
..., Grant programs, Social programs, Indians, Reporting and recordkeeping requirements, Surplus agricultural... retroactive Social Security payments. The amendment would remove the language that provides these payments are... beneficiary is disabled; (e) Medicare premiums related to coverage under Title XVIII of the Social Security...
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Is expanding Medicare coverage cost-effective?
Directory of Open Access Journals (Sweden)
Muennig Peter
2005-03-01
Full Text Available Abstract Background Proposals to expand Medicare coverage tend to be expensive, but the value of services purchased is not known. This study evaluates the efficiency of the average private supplemental insurance plan for Medicare recipients. Methods Data from the National Health Interview Survey, the National Death Index, and the Medical Expenditure Panel Survey were analyzed to estimate the costs, changes in life expectancy, and health-related quality of life gains associated with providing private supplemental insurance coverage for Medicare beneficiaries. Model inputs included socio-demographic, health, and health behavior characteristics. Parameter estimates from regression models were used to predict quality-adjusted life years (QALYs and costs associated with private supplemental insurance relative to Medicare only. Markov decision analysis modeling was then employed to calculate incremental cost-effectiveness ratios. Results Medicare supplemental insurance is associated with increased health care utilization, but the additional costs associated with this utilization are offset by gains in quality-adjusted life expectancy. The incremental cost-effectiveness of private supplemental insurance is approximately $24,000 per QALY gained relative to Medicare alone. Conclusion Supplemental insurance for Medicare beneficiaries is a good value, with an incremental cost-effectiveness ratio comparable to medical interventions commonly deemed worthwhile.
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Medicare and Medicaid Linked Files
U.S. Department of Health & Human Services — The Medicare-Medicaid Linked Enrollee Analytic Data Source (MMLEADS) has been developed to allow for the examination of all Medicare and Medicaid enrollment and...
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Medicare and Medicaid Research Review
U.S. Department of Health & Human Services — The Centers for Medicare and Medicaid Services (CMS), Office of Information Products and Data Analysis (OIPDA), is pleased to present our journal, Medicare and...
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Medicare Managed Care plan Performance, A Comparison...
U.S. Department of Health & Human Services — The study evaluates the performance of Medicare managed care, Medicare Advantage, Plans in comparison to Medicare fee-for-service Plans in three states with...
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Barbieri, John S; Miller, Jeffrey J; Nguyen, Harrison P; Forman, Howard P; Bolognia, Jean L; VanBeek, Marta J
2017-06-01
As the implementation of the Medicare Access and Children's Health Insurance Program Reauthorization Act begins, many dermatologists who provide Medicare Part B services will be subject to the reporting requirements of the Merit-based Incentive Payment System (MIPS). Clinicians subject to MIPS will receive a composite score based on performance across 4 categories: quality, advancing care information, improvement activities, and cost. Depending on their overall MIPS score, clinicians will be eligible for a positive or negative payment adjustment. Quality will replace the Physician Quality Reporting System and clinicians will report on 6 measures from a list of over 250 options. Advancing care information will replace meaningful use and will assess clinicians on activities related to integration of electronic health record technology into their practice. Improvement activities will require clinicians to attest to completion of activities focused on improvements in care coordination, beneficiary engagement, and patient safety. Finally, cost will be determined automatically from Medicare claims data. In this article, we will provide a detailed review of the Medicare Access and Children's Health Insurance Program Reauthorization Act with a focus on MIPS and briefly discuss the potential implications for dermatologists. Copyright © 2017 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.
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75 FR 35652 - Safety Zone; Fourth of July Fireworks, City of Vallejo, Vallejo, CA
2010-06-23
... located on Mare Island adjacent to the dry docks in position 38[deg]05'54.83'' N. 122[deg]16'01.69'' W... Local Notice to Mariners. If the Captain of the Port determines that the regulated area need not be.... Coast Guard, Captain of the Port, Sector San Francisco. [FR Doc. 2010-15199 Filed 6-22-10; 8:45 am...
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1998-10-01
This notice reopens the comment period for a proposed rule affecting Medicare payments to ambulatory surgical centers (ASCs) that was originally published in the Federal Register on June 12, 1998 (63 FR 32290). This document gives notice of a delay in the adoption of the provisions of the June 12, 1998 ASC proposed rule as a final rule to be concurrent with the adoption as final of the hospital outpatient prospective payment system (PPS) that is the subject of a proposed rule published in the Federal Register on September 8, 1998 (63 FR 47551). In addition this document confirms that the current ASC payment rates that are effective for services furnished on or after October 1, 1998, will remain in effect until rebased ASC rates and the provisions of the June 12, 1998 ASC proposed rule are adopted as final to be concurrent with the adoption as final of the Medicare hospital PPS.
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Medicare Utilization for Part B
U.S. Department of Health & Human Services — This link takes you to the Medicare utilization statistics for Part B (Supplementary Medical Insurance SMI) which includes the Medicare Part B Physician and Supplier...
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22 CFR 146.400 - Education programs or activities.
2010-04-01
... Basis of Sex in Education Programs or Activities Prohibited § 146.400 Education programs or activities... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Education programs or activities. 146.400 Section 146.400 Foreign Relations DEPARTMENT OF STATE CIVIL RIGHTS NONDISCRIMINATION ON THE BASIS OF SEX...
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Medicare Utilization for Part A
U.S. Department of Health & Human Services — This link takes you to the Medicare utilization statistics for Part A (Hospital Insurance HI) which include the Medicare Ranking for all Short-Stay Hospitals by...
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2010-10-01
... 50 Wildlife and Fisheries 9 2010-10-01 2010-10-01 false 2009-2010 Trip Limits for Open Access Gears South of 40°10â² N. Lat. 5 Table 5 (South) to Part 660, Subpart G Wildlife and Fisheries FISHERY... Trip Limits for Open Access Gears South of 40°10′ N. Lat. Link to an amendment published at 75 FR 60995...
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2010-10-01
... 50 Wildlife and Fisheries 9 2010-10-01 2010-10-01 false 2009-2010 Trip Limits for Open Access Gears North of 40°10â² N. Lat. 5 Table 5 (North) to Part 660, Subpart G Wildlife and Fisheries FISHERY... Trip Limits for Open Access Gears North of 40°10′ N. Lat. Link to an amendment published at 75 FR 60995...
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2010-10-01
... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Definitions. 22.801 Section 22.801 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION SOCIOECONOMIC PROGRAMS APPLICATION OF LABOR LAWS TO GOVERNMENT ACQUISITIONS Equal Employment Opportunity 22.801...
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Lippincott, Christine; Foronda, Cynthia; Zdanowicz, Martin; McCabe, Brian E; Ambrosia, Todd
2017-08-01
The objective of this study was to examine the relationship between nursing excellence and electronic health record adoption. Of 6582 US hospitals, 4939 were eligible for the Medicare Electronic Health Record Incentive Program, and 6419 were eligible for evaluation on the HIMSS Analytics Electronic Medical Record Adoption Model. Of 399 Magnet hospitals, 330 were eligible for the Medicare Electronic Health Record Incentive Program, and 393 were eligible for evaluation in the HIMSS Analytics Electronic Medical Record Adoption Model. Meaningful use attestation was defined as receipt of a Medicare Electronic Health Record Incentive Program payment. The adoption electronic health record was defined as Level 6 and/or 7 on the HIMSS Analytics Electronic Medical Record Adoption Model. Logistic regression showed that Magnet-designated hospitals were more likely attest to Meaningful Use than non-Magnet hospitals (odds ratio = 3.58, P electronic health records than non-Magnet hospitals (Level 6 only: odds ratio = 3.68, P electronic health record use, which involves earning financial incentives for successful adoption. Continued investigation is needed to examine the relationships between the quality of nursing care, electronic health record usage, financial implications, and patient outcomes.
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42 CFR 414.406 - Implementation of programs.
2010-10-01
... 42 Public Health 3 2010-10-01 2010-10-01 false Implementation of programs. 414.406 Section 414.406 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) § 414.406 Implementation...
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2010-01-01
... 10 Energy 4 2010-01-01 2010-01-01 false What process does the Office of Hearings and Appeals use to conduct an investigation of the complaint? 708.22 Section 708.22 Energy DEPARTMENT OF ENERGY DOE CONTRACTOR EMPLOYEE PROTECTION PROGRAM Investigation, Hearing and Decision Process § 708.22 What process does the Office of Hearings and Appeals use t...
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Will Medicare Advantage payment reforms impact plan rebates and enrollment?
Nicholas, Lauren Hersch
2014-01-01
To assess the relationship between Medicare Advantage (MA) plan rebates and enrollment and simulate the effects of Affordable Care Act (ACA) payment reforms. First difference regressions of county-level MA payment and enrollment data from CMS from 2006 to 2010. A $10 decrease in the per member/per month rebate to MA plans was associated with a 0.20 percentage point (0.9%) decrease in MA penetration (P penetration and a 10% decrease in risk score. ACA reforms are predicted to reduce the level of rebates in lower-spending counties, leading to enrollment decreases of 1.7 to 1.9 percentage points in the lowest-spending counties. The simulation predicts that the disenrollment would come from MA enrollees with higher risk scores. MA enrollment responds to availability of supplemental benefits supported by rebates. ACA provisions designed to lower MA spending will predominantly affect Medicare beneficiaries living in counties where MA plans may be unable to offer a comparable product at a price similar to that of traditional Medicare.
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Pomey, Marie-Pascale; Forest, Pierre-Gerlier; Palley, Howard A; Martin, Elisabeth
2007-09-01
In January 1997, the government of Quebec, Canada, implemented a public/private prescription drug program that covered the entire population of the province. Under this program, the public sector collaborates with private insurers to protect all Quebecers from the high cost of drugs. This article outlines the principal features and history of the Quebec plan and draws parallels between the factors that led to its emergence and those that led to the passage of the Medicare Prescription Drug, Improvement and Modernization Act (MMA) in the United States. It also discusses the challenges and similarities of both programs and analyzes Quebec's ten years of experience to identify adjustments that may help U.S. policymakers optimize the MMA.
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78 FR 27284 - Public Transportation on Indian Reservations Program; Tribal Transit Program
2013-05-09
... DEPARTMENT OF TRANSPORTATION Federal Transit Administration Public Transportation on Indian... Federal Register Notice (77 FR 67439) Fiscal Year 2013 Public Transportation on Indian Reservation Program... formula apportionment to eligible Indian tribes providing public transportation on tribal lands. FTA...
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Understanding Trends in Medicare Spending, 2007-2014.
Keohane, Laura M; Gambrel, Robert J; Freed, Salama S; Stevenson, David; Buntin, Melinda B
2018-03-06
To analyze the sources of per-beneficiary Medicare spending growth between 2007 and 2014, including the role of demographic characteristics, attributes of Medicare coverage, and chronic conditions. Individual-level Medicare spending and enrollment data. Using an Oaxaca-Blinder decomposition model, we analyzed whether changes in price-standardized, per-beneficiary Medicare Part A and B spending reflected changes in the composition of the Medicare population or changes in relative spending levels per person. We identified a 5 percent sample of fee-for-service Medicare beneficiaries age 65 and above from years 2007 to 2014. Mean payment-adjusted Medicare per-beneficiary spending decreased by $180 between the 2007-2010 and 2011-2014 time periods. This decline was almost entirely attributable to lower spending levels for beneficiaries. Notably, declines in marginal spending levels for beneficiaries with chronic conditions were associated with a $175 reduction in per-beneficiary spending. The decline was partially offset by the increasing prevalence of certain chronic diseases. Still, we are unable to attribute a large share of the decline in spending levels to observable beneficiary characteristics or chronic conditions. Declines in spending levels for Medicare beneficiaries with chronic conditions suggest that changing patterns of care use may be moderating spending growth. © Health Research and Educational Trust.
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2010-10-01
... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Policy. 22.1401 Section 22.1401 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION SOCIOECONOMIC PROGRAMS APPLICATION OF LABOR LAWS TO GOVERNMENT ACQUISITIONS Employment of Workers with Disabilities 22.1401 Policy...
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Dicken, D.; Tadhunter, C.; Axon, D.; Morganti, R.; Inskip, K. J.; Holt, J.; Delgado, R. Gonzalez; Groves, B.
2009-01-01
We present an analysis of deep mid- to far-infrared (MFIR) Spitzer photometric observations of the southern 2Jy sample of powerful radio sources (0.05
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2012-03-01
... Retiree Health Care Board of Actuaries; Federal Advisory Committee Meeting AGENCY: DoD. ACTION: Meeting... DoD Medicare-Eligible Retiree Health Care Board of Actuaries will take place. DATES: Friday, August 3... Contact: Persons desiring to attend the DoD Medicare- Eligible Retiree Health Care Board of Actuaries...
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22 CFR 1101.10 - Accounting for disclosures.
2010-04-01
... 22 Foreign Relations 2 2010-04-01 2010-04-01 true Accounting for disclosures. 1101.10 Section 1101... STATES SECTION PRIVACY ACT OF 1974 § 1101.10 Accounting for disclosures. (a) Each system manager shall establish a system of accounting for all disclosures of records, either orally or in writing made outside...
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Full Text Available ... Issues Stop Overregulating My OR EHR Incentive Program Global Codes and Data Collection New Medicare Card Project Medicare Enrollment and Participation Medicare Payment Rules Physician Quality Reporting System (PQRS) Value-Based Payment Modifier Third Party ...
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Gong, Dan; Jun, Lin; Tsai, James C
2017-08-01
To calculate the associations between Medicare payment and service volume for complex and noncomplex cataract surgeries. The 2005-2009 CMS Part B National Summary Data Files, CMS Part B Carrier Summary Data Files, and the Medicare Physician Fee Schedule. Conducting a retrospective, longitudinal analysis using a fixed-effects model of Medicare Part B carriers representing all 50 states and the District of Columbia from 2005 to 2009, we calculated the Medicare payment-service volume elasticities for noncomplex (CPT 66984) and complex (CPT 66982) cataract surgeries. Service volume data were extracted from the CMS Part B National Summary and Carrier Summary Data Files. Payment data were extracted from the Medicare Physician Fee Schedule. From 2005 to 2009, the proportion of total cataract services billed as complex increased from 3.2 to 6.7 percent. Every 1 percent decrease in Medicare payment was associated with a nonsignificant change in noncomplex cataract service volume (elasticity = 0.15, 95 percent CI [-0.09, 0.38]) but a statistically significant increase in complex cataract service volume (elasticity = -1.12, 95 percent CI [-1.60, -0.63]). Reduced Medicare payment was associated with a significant increase in complex cataract service volume but not in noncomplex cataract service volume, resulting in a shift toward performing a greater proportion of complex cataract surgeries from 2005 to 2009. © Health Research and Educational Trust.
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The Use of Ambulatory Blood Pressure Monitoring Among Medicare Beneficiaries in 2007-2010
Shimbo, Daichi; Kent, Shia T; Diaz, Keith M; Huang, Lei; Viera, Anthony J; Kilgore, Meredith; Oparil, Suzanne; Muntner, Paul
2014-01-01
The US Centers for Medicaid and Medicare Services reimburses ambulatory blood pressure monitoring (ABPM) for suspected white coat hypertension. We estimated ABPM use between 2007 and 2010 among a 5% random sample of Medicare beneficiaries (≥ 65 years). In 2007, 2008, 2009 and 2010, the percentage of beneficiaries with ABPM claims was 0.10%, 0.11%, 0.10%, and 0.09% respectively. A prior diagnosis of hypertension was more common among those with versus without an ABPM claim (77.7% versus 47.0%)...
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Full Text Available ... My OR EHR Incentive Program Global Codes and Data Collection Patient Opioid Use New Medicare Card Project Medicare ... self-care checklist Evaluation (Complete the Ostomy Patient Survey . We need your opinion!) Program outcomes The ACS ...
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Energy Technology Data Exchange (ETDEWEB)
Sanchez Zapat, J. D.; Sainero, J.
2014-10-01
The Safety Instruction IS-22 is mainly based on the License Renewal rule (10CFR54), unlike the 10 CFR54, the IS-22 is a continued process to be met in the current operation as well as in the long term operation period. Key elements of the aging management according to the IS-22 are the Aging Management Program (AMPs). The AMPs implementation as part of the current Plant Life Management in Cofrentes NPP provides a new approach to the plant maintenance and a solid support for the long term operation. (Author)
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Iorio, Richard; Clair, Andrew J; Inneh, Ifeoma A; Slover, James D; Bosco, Joseph A; Zuckerman, Joseph D
2016-02-01
In 2011 Medicare initiated a Bundled Payment for Care Improvement (BPCI) program with the goal of introducing a payment model that would "lead to higher quality, more coordinated care at a lower cost to Medicare." A Model 2 bundled payment initiative for Total Joint Replacement (TJR) was implemented at a large, tertiary, urban academic medical center. The episode of care includes all costs through 90 days following discharge. After one year, data on 721 Medicare primary TJR patients were available for analysis. Average length of stay (LOS) was decreased from 4.27 days to 3.58 days (Median LOS 3 days). Discharges to inpatient facilities decreased from 71% to 44%. Readmissions occurred in 80 patients (11%), which is slightly lower than before implementation. The hospital has seen cost reduction in the inpatient component over baseline. Early results from the implementation of a Medicare BPCI Model 2 primary TJR program at this medical center demonstrate cost-savings. IV economic and decision analyses-developing an economic or decision model. Copyright © 2016 Elsevier Inc. All rights reserved.
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Jansen, Sarah; Ball, Lauren; Lowe, Catherine
2015-04-01
This study explored private practice dietitians' perceptions of the impact of the Australian Chronic Disease Management (CDM) program on the conduct of their private practice, and the care provided to patients. Twenty-five accredited practising dietitians working in primary care participated in an individual semistructured telephone interview. Interview questions focussed on dietitians' perceptions of the proportion of patients receiving care through the CDM program, fee structures, adhering to reporting requirements and auditing. Transcript data were thematically analysed using a process of open coding. Half of the dietitians (12/25) reported that most of their patients (>75%) received care through the CDM program. Many dietitians (19/25) reported providing identical care to patients using the CDM program and private patients, but most (17/25) described spending substantially longer on administrative tasks for CDM patients. Dietitians experienced pressure from doctors and patients to keep their fees low or to bulk-bill patients using the CDM program. One-third of interviewed dietitians (8/25) expressed concern about the potential to be audited by Medicare. Recommendations to improve the CDM program included increasing the consultation length and subsequent rebate available for dietetic consultations, and increasing the number of consultations to align with dietetic best-practice guidelines. The CDM program creates challenges for dietitians working in primary care, including how to sustain the quality of patient-centred care and yet maintain equitable business practices. To ensure the CDM program appropriately assists patients to receive optimal care, further review of the CDM program within the scope of dietetics is required.
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Medicare managed care. How physicians can make it better.
Roggin, G M
1997-12-01
The federal government is attempting to control anticipated, increased Medicare health care costs by providing the senior population with incentives to encourage their movement into managed care programs. For-profit corporate HMOs that currently dominate the managed care arena are coming under increased competitive pressure at a time when their perception of profiteering is undergoing increased public scrutiny. If physicians are to take advantage of this window of opportunity and successfully enter the Medicare managed care marketplace, they must identify the major deficiencies existing in the current model, and fashion a new product that divests itself of the profit orientation of current corporate HMOs. A nonprofit version of a highly integrated, multispecialty provider service organization (PSO) provides an appropriate model to effectively compete with the corporate HMO. The ideal physician-controlled managed care model must: develop a responsive policy board structure; create practice guidelines that decrease variation in physician practice; achieve an appropriate balance between primary and specialty medical care; and adopt a quality-assurance program that effectively addresses both process and outcome data.
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2010-05-11
... Table 44 concerning the CY 2010 CF budget neutrality adjustment and CY 2010 CF to reflect the net impact... PFS CF CY 2010 CF Budget Neutrality 0.0347 percent Adjustment. (1.000347). CY 2010 Conversion Factor... PFS final rule with comment period (74 FR 61955). We are also correcting the budget neutrality factor...
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Spillover effects of Medicare fee reductions: evidence from ophthalmology.
Mitchell, Jean M; Hadley, Jack; Gaskin, Darrell J
2002-09-01
Relatively little research has examined physicians' supply responses to Medicare fee cuts especially whether fee reductions for specific procedures have "spillover" effects that cause physicians to increase the supply of other services they provide. In this study we investigate whether ophthalmologist changed their provision of non-cataract services to Medicare patients over the time period 1992-1994, when the Medicare Fee Schedule (MFS) resulted in a 17.4% reduction in the average fee paid for a cataract extraction. Following the McGuire-Pauly model of physician behavior (McGuire and Pauly, 1991), we estimated a supply function for non-cataract procedures that included three price variables (own-price, a Medicare cross-price and a private cross-price) and an income effect. The Medicare cross-price and income variables capture spillover effects. Consistent with the model's predictions, we found that the Medicare cross-price is significant and negative, implying that a 10% reduction in the fee for a cataract extraction will cause ophthalmologists to supply about 5% more non-cataract services. Second, the income variable is highly significant, but its impact on the supply of non-cataract services is trivial. The suggests that physicians behave more like profit maximizing firms than target income seekers. We also found that the own-price and the private cross-price variables are highly significant and have the expected positive and negative effects on the volume of non-cataract services respectively. Our results demonstrate the importance of evaluating volume responses to fee changes for the array of services the physician performs, not just the procedure whose fee has been reduced. Focusing only on the procedure whose fee has been cut will yield an incomplete picture of how fee reductions for specific procedures affect physician supply decisions.
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Werner, Brian C; Cancienne, Jourdan M; Burrus, M Tyrrell; Park, Joseph S; Perumal, Venkat; Cooper, M Truitt
2016-02-01
To employ a national database to evaluate the association between intraoperative corticosteroid injection at the time of ankle arthroscopy and postoperative infection rates in Medicare patients. A national insurance database was queried for Medicare patients who underwent ankle arthroscopy, including arthroscopic removal of loose body, synovectomy, and limited or extensive debridement. Two groups were created: ankle arthroscopy with concomitant local steroid injection (n = 459) and a control group of patients who underwent ankle arthroscopy without intraoperative local steroid injection (n = 9,327). The demographics and Charlson Comorbidity Index of each group were compared. Infection rates within 6 months postoperatively were assessed using International Classification of Diseases, 9th revision, and Current Procedural Terminology codes and compared between groups using χ(2)-tests. A total of 9,786 unique patients who underwent ankle arthroscopy were included in the study. There were no statistically significant differences between the steroid injection study group and controls for the assessed infection-related variables, including gender, age group, obesity, smoking, and average Charlson Comorbidity Index. The infection rate for patients who had a local steroid injection at the time of surgery was 3.9% (18/459 patients), compared with 1.8% (168/9,327 patients) in the control group (odds ratio, 2.2; 95% confidence interval, 1.4 to 3.7; P = .002.) The majority of this difference was noted between the 65 and 79 years age groups. The use of intraoperative intraarticular corticosteroid injection at the time of ankle arthroscopy in Medicare patients is associated with significantly increased rates of postoperative infection compared with controls without intraoperative steroid injections. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
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Public Health Spending and Medicare Resource Use: A Longitudinal Analysis of U.S. Communities.
Mays, Glen P; Mamaril, Cezar B
2017-12-01
To examine whether local expenditures for public health activities influence area-level medical spending for Medicare beneficiaries. Six census surveys of the nation's 2,900 local public health agencies were conducted between 1993 and 2013, linked with contemporaneous information on population demographics, socioeconomic characteristics, and area-level Medicare spending estimates from the Dartmouth Atlas of Health Care. Measures derive from agency survey data and aggregated Medicare claims. A longitudinal cohort design follows the geographic areas served by local public health agencies. Multivariate, fixed-effects, and instrumental-variables regression models estimate how area-level Medicare spending changes in response to shifts in local public health spending, controlling for observed and unmeasured confounders. A 10 percent increase in local public health spending per capita was associated with 0.8 percent reduction in adjusted Medicare expenditures per person after 1 year (p health insurance coverage, and health professional shortages. Expanded financing for public health activities may provide an effective way of constraining Medicare spending, particularly in low-resource communities. © Health Research and Educational Trust.
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International Nuclear Information System (INIS)
Nieto, J.M.; Salagre, P.; Medina, F.; Sueiras, J.E.; Solans, X.
1993-01-01
The crystal structure of hydrated strontium decavanadate, Sr 3 V 10 O 28 .22H 2 O, has been determined. It contains two types of strontium ions: the first is coordinated to seven water molecules which define a pentagonal bipyramid; the second bonds to five molecules of water and three O atoms of different decavanadate ions, thereby bridging between decavanadate ions to produce layers of formula [Sr 2 V 10 O 38 H 20 ] n on the crystallographic plane (100). The heptacoordinated Sr and the five molecules of water associated with it are located between the different layers. (orig.)
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77 FR 47375 - Applications for New Awards; Assistive Technology Alternative Financing Program
2012-08-08
... (AT) they need. In addition, programs such as Medicaid, Medicare, and vocational rehabilitation cannot... sources. Competitive Preference Priorities: Within this absolute priority, we give competitive preference... comment on the proposed absolute and competitive preference priorities under section 437(d)(1)of GEPA. The...
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2MASS extended sources in the zone of avoidance
Jarrett, T.; Chester, T.; Cutri, R.; Schneider, S.; Rosenberg, J.; Huchra, J.; Mader, J.
2000-01-01
A new high-resolution near-infrared mapping effort, the Two Micron All Sky Survey (2MASS), is now underway and will provide a complete census of galaxies as faint as 13.5 mag (3 mJy) at 2.2 mu m for most of the sky, and similar to 12.1 mag (10 mJy) for regions veiled by the Milky Way.
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Radio Continuum and Far-infrared Emission from the Galaxies in the ...
Indian Academy of Sciences (India)
R. Narasimhan (Krishtel eMaging) 1461 1996 Oct 15 13:05:22
. Stotal. Galaxy. (mJy/bm). (arc sec). (mJy). Morph. NGC 1407. 0.50. 6 × 6. 99 ± 10. Diffuse. NGC 1371. 0.22. 15 × 15. 19.7 ± 2. Linear. NGC 1415. 0.12. 4 × 4. 27 ± 3. Linear. NGC 1482. 0.81. 8 × 8. 280 ± 30. Diffuse. NGC 1385. 0.41. 15 × 15.
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Economic burden of hospitalizations of Medicare beneficiaries with heart failure
Directory of Open Access Journals (Sweden)
Kilgore M
2017-05-01
Full Text Available Meredith Kilgore,1 Harshali K Patel,2 Adrian Kielhorn,2 Juan F Maya,2 Pradeep Sharma1 1Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, 2Amgen, Inc., Thousand Oaks, CA, USA Objective: The objective of this study was to assess the costs associated with the hospitalization and the cumulative 30-, 60-, and 90-day readmission rates in a cohort of Medicare beneficiaries with heart failure (HF.Methods: This was a retrospective, observational study based on data from the national 5% sample of Medicare beneficiaries. Inpatient data were gathered for Medicare beneficiaries with at least one HF-related hospitalization between July 1, 2005, and December 31, 2011. The primary end point was the average per-patient cost of hospitalization for individuals with HF. Secondary end points included the cumulative rate of hospitalization, the average length of hospital stay, and the cumulative 30-, 60-, and 90-day readmission rates.Results: Data from 63,678 patients with a mean age of 81.8 years were included in the analysis. All costs were inflated to $2,015 based on the medical care component of the Consumer Price Index. The mean per-patient cost of an HF-related hospitalization was $14,631. The mean per-patient cost of a cardiovascular (CV-related or all-cause hospitalization was $16,000 and $15,924, respectively. The cumulative rate of all-cause hospitalization was 218.8 admissions per 100 person-years, and the median length of stay for HF-related, CV-related, and all-cause hospitalizations was 5 days. Also, 22.3% of patients were readmitted within 30 days, 33.3% were readmitted within 60 days, and 40.2% were readmitted within 90 days.Conclusion: The costs associated with hospitalization for Medicare beneficiaries with HF are substantial and are compounded by a high rate of readmission. Keywords: heart failure, Medicare, health economics, hospitalization, costs
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Assessing Measurement Error in Medicare Coverage
U.S. Department of Health & Human Services — Assessing Measurement Error in Medicare Coverage From the National Health Interview Survey Using linked administrative data, to validate Medicare coverage estimates...
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Directory of Open Access Journals (Sweden)
Fang Chen
Full Text Available Type 2 diabetes and cardiovascular disease impose substantial clinical and economic burdens for seniors (age 65 and above and the Medicare program. Intensive Behavioral Counseling (IBC interventions like the National Diabetes Prevention Program (NDPP, have demonstrated effectiveness in reducing excess body weight and lowering or delaying morbidity onset. This paper estimated the potential health implications and medical savings of a digital version of IBC modeled after the NDPP.Participants in this digital IBC intervention, the Omada program, include 1,121 overweight or obese seniors with additional risk factors for diabetes or heart disease. Weight changes were objectively measured via participant use of a networked weight scale. Participants averaged 6.8% reduction in body weight within 26 weeks, and 89% of participants completed 9 or more of the 16 core phase lessons. We used a Markov-based microsimulation model to simulate the impact of weight loss on future health states and medical expenditures over 10 years. Cumulative per capita medical expenditure savings over 3, 5 and 10 years ranged from $1,720 to 1,770 (3 years, $3,840 to $4,240 (5 years and $11,550 to $14,200 (10 years. The range reflects assumptions of weight re-gain similar to that seen in the DPP clinical trial (lower bound or minimal weight re-gain aligned with age-adjusted national averages (upper bound. The estimated net economic benefit after IBC costs is $10,250 to $12,840 cumulative over 10 years. Simulation outcomes suggest reduced incidence of diabetes by 27-41% for participants with prediabetes, and stroke by approximately 15% over 5 years.A digital, remotely-delivered IBC program can help seniors at risk for diabetes and cardiovascular disease achieve significant weight loss, reduces risk for diabetes and cardiovascular disease, and achieve meaningful medical cost savings. These findings affirm recommendations for IBC coverage by the U.S. Preventive Services Task Force.
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Competitive bidding in Medicare: who benefits from competition?
Song, Zirui; Landrum, Mary Beth; Chernew, Michael E
2012-09-01
To conduct the first empirical study of competitive bidding in Medicare. We analyzed 2006-2010 Medicare Advantage data from the Centers for Medicare and Medicaid Services using longitudinal models adjusted for market and plan characteristics. A $1 increase in Medicare's payment to health maintenance organization (HMO) plans led to a $0.49 (P service plans included, higher Medicare payments increased bids less ($0.33 per dollar), suggesting more competition among these latter plans. As a market-based alternative to cost control through administrative pricing, competitive bidding relies on private insurance plans proposing prices they are willing to accept for insuring a beneficiary. However, competition is imperfect in the Medicare bidding market. As much as half of every dollar in increased plan payment went to higher bids rather than to beneficiaries. While having more insurers in a market lowered bids, the design of any bidding system for Medicare should recognize this shortcoming of competition.
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77 FR 11677 - Medicaid Program; Review and Approval Process for Section 1115 Demonstrations
2012-02-27
... for Medicare & Medicaid Services 42 CFR Part 431 Department of the Treasury 31 CFR Part 33 Department of Health and Human Services 45 CFR Part 155 Medicaid Program; Review and Approval Process for... Regulations#0;#0; [[Page 11678
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78 FR 59706 - Secure Supply Chain Pilot Program; Correction
2013-09-27
...] Secure Supply Chain Pilot Program; Correction AGENCY: Food and Drug Administration, HHS. ACTION: Notice... Federal Register of August 20, 2013 (78 FR 51192). The document announced the start of the Secure Supply Chain Pilot Program (SSCPP). The document was published with an incorrect email address for the SSCPP...
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Shrank, William
2013-04-01
The Affordable Care Act established the Center for Medicare and Medicaid Innovation to test innovative payment and service delivery models. The goal is to reduce program expenditures while preserving or improving the quality of care provided to beneficiaries of Medicare, Medicaid, and the Children's Health Insurance Program. Central to the success of the Innovation Center is a new, rapid-cycle approach to evaluation. This article describes that approach--setting forth how the Rapid Cycle Evaluation Group aims to deliver frequent feedback to providers in support of continuous quality improvement, while rigorously evaluating the outcomes of each model tested. This article also describes the relationship between the group's work and that of the Office of the Actuary at the Centers for Medicare and Medicaid Services, which plays a central role in the assessment of new models.
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Medicares Physician Quality Reporting System (PQRS)...
U.S. Department of Health & Human Services — Medicares Physician Quality Reporting System (PQRS) allows providers to report measures of process quality and health outcomes. The authors of Medicares Physician...
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Katz, B M; Lundquist, L J; Walsh, D A; Glass, D B
1989-06-01
PKI(6-22)amide is a 17 residue peptide corresponding to the active portion of the heat-stable inhibitor of cAMP-dependent protein kinase. The peptide is a potent (Ki = 1.6 nM), competitive inhibitor of the enzyme. The photoreactive peptide analog (4-azidophenylalanine10)PKI(6-22)amide was synthesized in both its non-radiolabeled and tritiated forms by chemical modification of precursor peptides that were prepared by stepwise solid-phase synthesis. (4-Amino[3,5-3H]phenylalanine10)PKI(6-22)amide, the precursor for the radiolabeled arylazide peptide, was obtained by catalytic reduction of the corresponding peptide containing the 3,5-diiodo-4-aminophenylalanine residue at position 10. The purified PKI peptides were analyzed by HPLC, amino acid analysis, and u.v. spectra. In the dark, (4-azidophenylalanine10)PKI(6-22)amide inhibited the catalytic subunit of cAMP-dependent protein kinase with a Ki value of 2.8 nM. The photoreactivity of the arylazide peptide was demonstrated by time-dependent u.v. spectral changes on exposure to light. Photolysis of the catalytic subunit (4-azido[3,5-3H]phenylalanine10)PKI(6-22)amide complex resulted in specific covalent labeling of the enzyme. The data indicate that this peptide is a useful photoaffinity labeling reagent for the active site of the protein kinase.
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Directory of Open Access Journals (Sweden)
Andrii I. Buvailo
2012-12-01
Full Text Available The reaction between copper(II nitrate and (E-N-(3-amino-2,2-dimethylpropyl-2-(hydroxyiminopropanamide led to the formation of the dinuclear centrosymmetric copper(II title complex, (C8H18N3O22[Cu2(C8H15N3O22(C8H17N3O22](C9H16N3O42·2CH3CN, in which an inversion center is located at the midpoint of the Cu2 unit in the center of the neutral [Cu2(C8H15N3O22(C8H17N3O22] complex fragment. The Cu2+ ions are connected by two N—O bridging groups [Cu...Cu separation = 4.0608 (5 Å] while the CuII ions are five-coordinated in a square-pyramidal N4O coordination environment. The complex molecule co-crystallizes with two molecules of acetonitrile, two molecules of the protonated ligand (E-3-[2-(hydroxyiminopropanamido]-2,2-dimethylpropan-1-aminium and two negatively charged (E-{3-[2-(hydroxyiminopropanamido]-2,2-dimethylpropyl}carbamate anions, which were probably formed as a result of condensation between (E-N-(3-amino-2,2-dimethylpropyl-2-(hydroxyiminopropanamide and hydrogencarbonate anions. In the crystal, the complex fragment [Cu2(C8H15N3O22(C8H17N3O22] and the ion pair C8H18N3O2+.C9H16N3O4− are connected via an extended system of hydrogen bonds.
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Barbieri, John S; Miller, Jeffrey J; Nguyen, Harrison P; Forman, Howard P; Bolognia, Jean L; VanBeek, Marta J
2017-06-01
With the introduction of the Medicare Access and Children's Health Insurance Program Reauthorization Act, clinicians who are not eligible for an exemption must choose to participate in 1 of 2 new reimbursement models: the Merit-based Incentive Payment System or Alternative Payment Models (APMs). Although most dermatologists are expected to default into the Merit-based Incentive Payment System, some may have an interest in exploring APMs, which have associated financial incentives. However, for dermatologists interested in the APM pathway, there are currently no options other than joining a qualifying Accountable Care Organization, which make up only a small subset of Accountable Care Organizations overall. As a result, additional APMs relevant to dermatologists are needed to allow those interested in the APMs to explore this pathway. Fortunately, the Medicare Access and Children's Health Insurance Program Reauthorization Act establishes a process for new APMs to be approved and the creation of bundled payments for skin diseases may represent an opportunity to increase the number of APMs available to dermatologists. In this article, we will provide a detailed review of APMs under the Medicare Access and Children's Health Insurance Program Reauthorization Act and discuss the development and introduction of APMs as they pertain to dermatology. Copyright © 2017 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.
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Beneficiary Activation in the Medicare Population
U.S. Department of Health & Human Services — According to findings reported in Beneficiary Activation in the Medicare Population, published in Volume 4, Issue 4 of the Medicare and Medicaid Research Review,...
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2010-10-01
... 49 Transportation 1 2010-10-01 2010-10-01 false Purpose. 22.1 Section 22.1 Transportation Office of the Secretary of Transportation SHORT-TERM LENDING PROGRAM (STLP) General § 22.1 Purpose. The purpose of the DOT OSDBU STLP is to provide financial assistance in the form of short-term loans from...
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Canadian Medicare: prognosis guarded.
Naylor, C D; Fooks, C; Williams, J I
1995-08-01
Beset by unprecedented fiscal pressures, Canadian medicare has reached a crossroads. The authors review the impact of recent cuts in federal transfer payments on provincial health care programs and offer seven suggestions to policymakers trying to accommodate these reductions. (1) Go slowly: public health care spending is no longer rising and few provinces have the necessary systems in place to manage major reductions. (2) Target reductions, rewarding quality and efficiency instead of making across-the-board cuts. (3) Replace blame with praise:give health care professionals and institutions credit for their contributions. (4) Learn from the successful programs and policies already in place across the country. (5) Foster horizontal and vertical integration of services. (6) Promote physician leadership by rewarding efforts to promote the efficient use of resources. (7) Monitor the effects of cutbacks: physician groups should cooperate with government in maintaining a national "report card" on services, costs and the health status of Canadians.
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How Medicare Could Provide Dental, Vision, and Hearing Care for Beneficiaries.
Willink, Amber; Shoen, Cathy; Davis, Karen
2018-01-01
The Medicare program specifically excludes coverage of dental, vision, and hearing services. As a result, many beneficiaries do not receive necessary care. Those that do are subject to high out-of-pocket costs. Examine gaps in access to dental, vision, and hearing services for Medicare beneficiaries and design a voluntary dental, vision, and hearing benefit plan with cost estimates. Uses the Medicare Current Beneficiary Survey, Cost and Use File, 2012, with population and costs projected to 2016 values. Among Medicare beneficiaries, 75 percent of people who needed a hearing aid did not have one; 70 percent of people who had trouble eating because of their teeth did not go to the dentist in the past year; and 43 percent of people who had trouble seeing did not have an eye exam in the past year. Lack of access was particularly acute for poor beneficiaries. Because few people have supplemental insurance covering these additional services, among people who received care, three-fourths of their costs of dental and hearing services and 60 percent of their costs of vision services were paid out of pocket. We propose a basic benefit package for dental, vision, and hearing services offered as a premium-financed voluntary insurance option under Medicare. Assuming the benefit package could be offered for $25 per month, we estimate the total coverage costs would be $1.924 billion per year, paid for by premiums. Subsidies to reach low-income beneficiaries would follow the same design as the Part D subsidy.
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Cataract surgery among Medicare beneficiaries.
Schein, Oliver D; Cassard, Sandra D; Tielsch, James M; Gower, Emily W
2012-10-01
To present descriptive epidemiology of cataract surgery among Medicare recipients in the United States. Cataract surgery performed on Medicare beneficiaries in 2003 and 2004. Medicare claims data were used to identify all cataract surgery claims for procedures performed in the United States in 2003-2004. Standard assumptions were used to limit the claims to actual cataract surgery procedures performed. Summary statistics were created to determine the number of procedures performed for each outcome of interest: cataract surgery rates by age, sex, race and state; surgical volume by facility type and surgeon characteristics; time interval between first- and second-eye cataract surgery. The national cataract surgery rate for 2003-2004 was 61.8 per 1000 Medicare beneficiary person-years. The rate was significantly higher for females and for those aged 75-84 years. After adjustment for age and sex, blacks had approximately a 30% lower rate of surgery than whites. While only 5% of cataract surgeons performed more than 500 cataract surgeries annually, these surgeons performed 26% of the total cataract surgeries. Increasing surgical volume was found to be highly correlated with use of ambulatory surgical centers and reduced time interval between first- and second-eye surgery in the same patient. The epidemiology of cataract surgery in the United States Medicare population documents substantial variation in surgical rates by race, sex, age, and by certain provider characteristics.
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UGC galaxies stronger than 25 mJy at 4.85 GHz
International Nuclear Information System (INIS)
Condon, J.J.; Frayer, D.T.; Broderick, J.J.
1991-01-01
UGC galaxies in the declination band +5 to +75 deg were identified by position coincidence with radio sources stronger than 25 mJy on the Green Bank 4.85 GHz sky maps. Candidate identifications were confirmed or rejected with the aid of published aperture-synthesis maps and new 4.86 GHz VLA maps having 15 or 18 arcsec resolution, resulting in a sample of 347 nearby radio galaxies plus five new quasar-galaxy pairs. The radio energy sources in UGC galaxies were classified as starbursts or monsters on the basis of their infrared-radio flux ratios, infrared spectral indices, and radio morphologies. The rms scatter in the logarithmic infrared-radio ratio q is not more than 0.16 for starburst galaxies selected at 4.85 GHz. Radio spectral indices were obtained for nearly all of the UGC galaxies, and S0 galaxies account for a disproportionate share of the compact flat-spectrum (alpha less than 0.5) radio sources. The extended radio jets and lobes produced by monsters are preferentially, but not exclusively, aligned within about 30 deg of the optical minor axes of their host galaxies. The tendency toward minor-axis ejection appears to be independent of radio-source size and is strongest for elliptical galaxies. 230 refs
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Center for Medicare & Medicaid Services (CMS) , Medicare Claims data
U.S. Department of Health & Human Services — 2003 forward. CMS compiles claims data for Medicare and Medicaid patients across a variety of categories and years. This includes Inpatient and Outpatient claims,...
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Bazzoli, Gloria J; Thompson, Michael P; Waters, Teresa M
2018-02-08
To examine relationships between penalties assessed by Medicare's Hospital Readmission Reduction Program and Value-Based Purchasing Program and hospital financial condition. Centers for Medicare and Medicaid Services, American Hospital Association, and Area Health Resource File data for 4,824 hospital-year observations. Bivariate and multivariate analysis of pooled cross-sectional data. Safety net hospitals have significantly higher HRRP/VBP penalties, but, unlike nonsafety net hospitals, increases in their penalty rate did not significantly affect their total margins. Safety net hospitals appear to rely on nonpatient care revenues to offset higher penalties for the years studied. While reassuring, these funding streams are volatile and may not be able to compensate for cumulative losses over time. © Health Research and Educational Trust.
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Specialty Drug Spending Trends Among Medicare And Medicare Advantage Enrollees, 2007–11
Trish, Erin; Joyce, Geoffrey; Goldman, Dana P.
2014-01-01
Specialty pharmaceuticals include most injectable and biologic agents used to treat complex conditions such as rheumatoid arthritis, multiple sclerosis, and cancer. We analyzed trends in specialty drug spending among Medicare beneficiaries ages sixty-five and older using 2007–11 pharmacy claims data from a 20 percent sample of Medicare beneficiaries. Annual specialty drug spending per beneficiary who used specialty drugs increased considerably during the study period, from $2,641 to $8,976. H...
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1994-07-15
This final rule implements sections 9312(c)(2), 9312(f), and 9434(b) of Public Law 99-509, section 7 of Public Law 100-93, section 4014 of Public Law 100-203, sections 224 and 411(k)(12) of Public Law 100-360, and section 6411(d)(3) of Public Law 101-239. These provisions broaden the Secretary's authority to impose intermediate sanctions and civil money penalties on health maintenance organizations (HMOs), competitive medical plans, and other prepaid health plans contracting under Medicare or Medicaid that (1) substantially fail to provide an enrolled individual with required medically necessary items and services; (2) engage in certain marketing, enrollment, reporting, or claims payment abuses; or (3) in the case of Medicare risk-contracting plans, employ or contract with, either directly or indirectly, an individual or entity excluded from participation in Medicare. The provisions also condition Federal financial participation in certain State payments on the State's exclusion of certain prohibited entities from participation in HMO contracts and waiver programs. This final rule is intended to significantly enhance the protections for Medicare beneficiaries and Medicaid recipients enrolled in a HMO, competitive medical plan, or other contracting organization under titles XVIII and XIX of the Social Security Act.
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77 FR 18767 - Boating Infrastructure Grant Program
2012-03-28
... the availability of the grants themselves as well as the jobs created to construct facilities... satisfaction. The Service published the BIG final rule in the Federal Register [66 FR 5282] on January 18, 2001... also state the consequences of unauthorized use. Section 86.78 How must I treat program income? This...
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Chung, Sukyung; Lesser, Lenard I; Lauderdale, Diane S; Johns, Nicole E; Palaniappan, Latha P; Luft, Harold S
2015-01-01
Under the Affordable Care Act (ACA), Medicare coverage expanded in 2011 to fully cover annual preventive care visits. We assessed the impact of coverage expansion, using 2007-13 data from primary care patients of Medicare-eligible age at the Palo Alto Medical Foundation (204,388 patient-years), which serves people in four counties near San Francisco, California. We compared trends in preventive visits and recommended preventive services among Medicare fee-for-service and Medicare health maintenance organization (HMO) patients as well as non-Medicare patients ages 65-75 who were covered by private fee-for-service and private HMO plans. Among Medicare fee-for-service patients, the annual use of preventive visits rose from 1.4 percent before the implementation of the ACA to 27.5 percent afterward. This increase was significantly larger than was seen for patients in the other insurance groups. Nevertheless, rates of annual preventive care visit use among Medicare fee-for-service patients remained 10-20 percentage points lower than was the case for people with private coverage (43-44 percent) or those in a Medicare HMO (53 percent). ACA policy changes led to increased preventive service use by Medicare fee-for-service beneficiaries, which suggests that Medicare coverage expansion is an effective way to increase seniors' use of preventive services. Project HOPE—The People-to-People Health Foundation, Inc.
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Cline, Richard R; Mott, David A
2003-01-01
Several proposals for adding a prescription drug benefit to the Medicare program rely on consumer choice and market forces to promote efficiency. However, little information exists regarding: 1) the extent of price sensitivity for such plans among Medicare beneficiaries, or 2) the extent to which drug-only insurance plans using various cost-control mechanisms might experience adverse selection. Using data from a survey of elderly Wisconsin residents regarding their likely choices from a menu of hypothetical drug plans, we show that respondents are likely to be price sensitive with respect to both premiums and out-of-pocket costs but that selection problems may arise in these markets. Outside intervention may be necessary to ensure the feasibility of a market-based approach to a Medicare drug benefit.
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Medicare managed care plan performance: a comparison across hospitalization types.
Basu, Jayasree; Mobley, Lee Rivers
2012-01-01
The study evaluates the performance of Medicare managed care (Medicare Advantage [MA]) Plans in comparison to Medicare fee-for-service (FFS) Plans in three states with historically high Medicare managed care penetration (New York, California, Florida), in terms of lowering the risks of preventable or ambulatory care sensitive conditions (ACSC) hospital admissions and providing increased referrals for admissions for specialty procedures. Using 2004 hospital discharge files from the Healthcare Cost and Utilization Project (HCUP-SID) of the Agency for Healthcare Research and Quality, ACSC admissions are compared with 'marker' admissions and 'referral-sensitive' admissions, using a multinomial logistic regression approach. The year 2004 represents a strategic time to test the impact of MA on preventable hospitalizations, because the HMOs dominated the market composition in that time period. MA enrollees in California experienced 22% lower relative risk (RRR= 0.78, p<0.01), those in Florida experienced 16% lower relative risk (RRR= 0.84, p<0.01), while those in New York experienced 9% lower relative risk (RRR=0.91, p<0.01) of preventable (versus marker) admissions compared to their FFS counterparts. MA enrollees in New York experienced 37% higher relative risk (RRR=1.37, p<0.01) and those in Florida had 41% higher relative risk (RRR=1.41, p<0.01)-while MA enrollees in California had 13% lower relative risk (RRR=0.87, p<0.01)-of referral-sensitive (versus marker) admissions compared to their FFS counterparts. While MA plans were associated with reductions in preventable hospitalizations in all three states, the effects on referral-sensitive admissions varied, with California experiencing lower relative risk of referral-sensitive admissions for MA plan enrollees. The lower relative risk of preventable admissions for MA plan enrollees in New York and Florida became more pronounced after accounting for selection bias.
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Organizational Attributes Associated With Medicare ACO Quality Performance.
Zhu, Xi; Mueller, Keith; Huang, Huang; Ullrich, Fred; Vaughn, Thomas; MacKinney, A Clinton
2018-05-08
To evaluate associations between geographic, structural, and service-provision attributes of Accountable Care Organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP) and the ACOs' quality performance. We conducted cross-sectional and longitudinal analyses of ACO quality performance using data from the Centers for Medicare and Medicaid Services and additional sources. The sample included 322 and 385 MSSP ACOs that had successfully reported quality measures in 2014 and 2015, respectively. Results show that after adjusting for other organizational factors, rural ACOs' average quality score was comparable to that of ACOs serving other geographic categories. ACOs with hospital-system sponsorship, larger beneficiary panels, and higher posthospitalization follow-up rates achieved better quality performance. There is no significant difference in average quality performance between rural ACOs and other ACOs after adjusting for structural and service-provision factors. MSSP ACO quality performance is positively associated with hospital-system sponsorship, beneficiary panel size, and posthospitalization follow-up rate. © 2018 National Rural Health Association.
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Hospice utilization of Medicare beneficiaries in Hawai‘i compared to other states
Directory of Open Access Journals (Sweden)
Deborah Taira
2017-11-01
Full Text Available The objective is to examine hospice utilization among Medicare beneficiaries in Hawai‘i compared to other states. Data were from the 2014 Medicare Hospice Utilization and Payment Public Use File, which included information on 4,025 hospice providers, more than 1.3 million hospice beneficiaries, and over $15 billion in Medicare payments. Multivariable linear regression models were estimated to compare hospice utilization in Hawai‘i to that of other states. Control variables included age, gender, and type of Medicare coverage. Medicare beneficiaries using hospice in Hawai‘i differed significantly from beneficiaries in other states in several ways. Hawai‘i beneficiaries were more likely to be Asian (57% vs. 1%, p < .001 and “other race” (10% vs. 0.1%, p < .001, and less likely to be White (28% vs. 84%, p < .001. Hawai‘i beneficiaries were also more likely to have Medicare Advantage (55% vs. 30%, p = .05. Regarding primary diagnoses, hospice users in Hawai‘i were significantly more likely to have a primary diagnosis of stroke (11% vs. 8%, p = .03 and less likely to have respiratory disease (5% vs. 11%, p = .003. In addition, hospice users in Hawai‘i were more likely to use services in their homes (74% vs. 52%, p = .03. Hawai‘i hospice users were also less likely to die while in hospice (42% vs. 47%, p = .002. Characteristics of Medicare beneficiaries in Hawai‘i differ from those in other states, regarding demographic characteristics, type of coverage, primary diagnoses, likelihood of using services in their homes, and death rates. Further research is needed to better understand factors affecting these differences and whether these differences warrant changes in policy or practice.
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Modifier 22 for acetabular fractures in morbidly obese patients: does it affect reimbursement?
Bergin, Patrick F; Kneip, Christopher; Pierce, Christine; Hendrix, Stephen T; Porter, Scott E; Graves, Matthew L; Russell, George V
2014-11-01
Modifier 22 in the American Medical Association's Current Procedural Terminology (CPT®) book is a billing code for professional fees used to reflect an increased amount of skill, time, and work required to complete a procedure. There is little disagreement that using this code in the setting of surgery for acetabulum fractures in the obese patient is appropriate; however, to our knowledge, the degree to which payers value this additional level of complexity has not been determined. We asked whether (1) the use of Modifier 22 increased reimbursements in morbidly obese patients and (2) there was any difference between private insurance and governmental payer sources in treatment of Modifier 22. Over a 4-year period, we requested immediate adjudication with payers when using Modifier 22 for morbidly obese patients with acetabular fractures. We provided payers with evidence of the increased time and effort required in treating this population. Reimbursements were calculated for morbidly obese and nonmorbidly obese patients. Of the 346 patients we reviewed, 57 had additional CPT® codes or modifiers appended to their charges and were excluded, leaving 289 patients. Thirty (10%) were morbidly obese and were billed with Modifier 22. Fifty-three (18%) were insured by our largest private insurer and 69 (24%) by governmental programs (Medicare/Medicaid). Eight privately insured patients (15%) and seven governmentally insured patients (10%) were morbidly obese and were billed with Modifier 22. For our primary question, we compared reimbursement rates between patients with and without Modifier 22 for obesity within the 289 patients. We then performed the same comparison for the 53 privately insured patients and the 69 governmentally insured patients. Overall, there was no change in mean reimbursement when using Modifier 22 in morbidly obese patients, compared to nonmorbidly obese patients (USD 2126 versus USD 2149, p Level IV, economic and decision analyses. See Instructions
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2012-05-29
... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 42 CFR Parts 430, 433, 447, and 457 [CMS-2292-F] RIN 0938-AQ32 Medicaid and Children's Health Insurance Programs... Children's Health Insurance Program (CHIP) disallowance process to allow States the option to retain...
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2010-10-01
... 49 Transportation 1 2010-10-01 2010-10-01 false Claim process. 22.69 Section 22.69 Transportation Office of the Secretary of Transportation SHORT-TERM LENDING PROGRAM (STLP) Loan Administration § 22.69 Claim process. After reasonable efforts have been exhausted to collect on a delinquent debt, the...
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Limits to source counts and cosmic microwave background fluctuations at 10.6 GHz
International Nuclear Information System (INIS)
Seielstad, G.A.; Masson, C.R.; Berge, G.L.
1981-01-01
We have determined the distribution of deflections due to sky temperature fluctuations at 10.6 GHz. If all the deflections are due to fine structure in the cosmic microwave background, we limit these fluctuations to ΔT/T -4 on an angular scale of 11 arcmin. If, on the other hand, all the deflections are due to confusion among discrete radio sources, the areal density of these sources is calculated for various slopes of the differential source count relationship and for various cutoff flux densities. If, for example, the slope is 2.1 and the cutoff is 10 mJy, we find (0.25--3.3) 10 6 sources sr -1 Jy -1
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The Use of Ambulatory Blood Pressure Monitoring Among Medicare Beneficiaries in 2007-2010
Shimbo, Daichi; Kent, Shia T; Diaz, Keith M; Huang, Lei; Viera, Anthony J; Kilgore, Meredith; Oparil, Suzanne; Muntner, Paul
2014-01-01
The US Centers for Medicaid and Medicare Services reimburses ambulatory blood pressure monitoring (ABPM) for suspected white coat hypertension. We estimated ABPM use between 2007 and 2010 among a 5% random sample of Medicare beneficiaries (≥ 65 years). In 2007, 2008, 2009 and 2010, the percentage of beneficiaries with ABPM claims was 0.10%, 0.11%, 0.10%, and 0.09% respectively. A prior diagnosis of hypertension was more common among those with versus without an ABPM claim (77.7% versus 47.0%). Among hypertensive beneficiaries, 95.2% of those with an ABPM claim were taking antihypertensive medication. Age 75-84 versus 65-74 years, having coronary heart disease, chronic kidney disease, multiple prior hypertension diagnoses, and having filled multiple classes of antihypertensive medication were associated with an increased odds for an ABPM claim among hypertensive beneficiaries. ABPM use was very low among Medicare beneficiaries and was not primarily used for diagnosing white coat hypertension in untreated individuals. PMID:25492832
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Medicare, physicians, and patients.
Hacker, Joseph F
2004-05-01
There are many other provisions to the MMA. It is important to remind our patients that these changes are voluntary. If patients are satisfied with their current Medicare benefits and plan, they need not change to these new plans. However, as physicians we should familiarize ourselves with these new Medicare options so as to better advise our patients. For more information, visit www.ama-assn.org. The Medical Society of Delaware will strive to keep you informed as these new changes are implemented.
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22 CFR 19.10-3 - Marriage after retirement.
2010-04-01
... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Marriage after retirement. 19.10-3 Section 19... PARTICIPANTS IN THE FOREIGN SERVICE RETIREMENT AND DISABILITY SYSTEM § 19.10-3 Marriage after retirement. If an... marriage irrevocably elect to receive a reduced annuity and to provide, subject to any obligation to...
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22 CFR 126.10 - Disclosure of information.
2010-04-01
....10 Foreign Relations DEPARTMENT OF STATE INTERNATIONAL TRAFFIC IN ARMS REGULATIONS GENERAL POLICIES... Trade Controls. (b) Determinations required by law. Section 38(e) of the Arms Export Control Act (22 U.S... contrary to the national interest. Registration with the Directorate of Defense Trade Controls is required...
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Influence of pharmaceutical marketing on Medicare prescriptions in the District of Columbia.
Wood, Susan F; Podrasky, Joanna; McMonagle, Meghan A; Raveendran, Janani; Bysshe, Tyler; Hogenmiller, Alycia; Fugh-Berman, Adriane
2017-01-01
Gifts from pharmaceutical companies are believed to influence prescribing behavior, but few studies have addressed the association between industry gifts to physicians and drug costs, prescription volume, or preference for generic drugs. Even less research addresses the effect of gifts on the prescribing behavior of nurse practitioners (NPs), physician assistants (PAs), and podiatrists. To analyze the association between gifts provided by pharmaceutical companies to individual prescribers in Washington DC and the number of prescriptions, cost of prescriptions, and proportion of branded prescriptions for each prescriber. Gifts data from the District of Columbia's (DC) AccessRx program and the federal Center for Medicare and Medicaid Services (CMS) Open Payments program were analyzed with claims data from the CMS 2013 Medicare Provider Utilization and Payment Data. Washington DC, 2013. Physicians, nurse practitioners, physician assistants, podiatrists, and other licensed Medicare Part D prescribers who participated in Medicare Part D (a Federal prescription drug program that covers patients over age 65 or who are disabled). Gifts to healthcare prescribers (including cash, meals, and ownership interests) from pharmaceutical companies. Average number of Medicare Part D claims per prescriber, number of claims per patient, cost per claim, and proportion of branded claims. In 2013, 1,122 (39.1%) of 2,873 Medicare Part D prescribers received gifts from pharmaceutical companies totaling $3.9 million in 2013. Compared to non-gift recipients, gift recipients prescribed 2.3 more claims per patient, prescribed medications costing $50 more per claim, and prescribed 7.8% more branded drugs. In six specialties (General Internal Medicine, Family Medicine, Obstetrics/Gynecology, Urology, Ophthalmology, and Dermatology), gifts were associated with a significantly increased average cost of claims. For Internal Medicine, Family Medicine, and Ophthalmology, gifts were associated with
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2010-10-01
... 50 Wildlife and Fisheries 7 2010-10-01 2010-10-01 false Civil rights. 401.22 Section 401.22..., DEVELOPMENT AND ENHANCEMENT § 401.22 Civil rights. Each application for Federal assistance, grant-in-aid award... Assisted Programs of the Civil Rights Act of 1964 and with the Secretary's regulations promulgated...
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45 CFR 605.22 - Existing facilities.
2010-10-01
... 45 Public Welfare 3 2010-10-01 2010-10-01 false Existing facilities. 605.22 Section 605.22 Public... Accessibility § 605.22 Existing facilities. (a) Accessibility. A recipient shall operate each program or... existing facilities or every part of a facility accessible to and usable by qualified handicapped persons...
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45 CFR 1151.22 - Existing facilities.
2010-10-01
... 45 Public Welfare 3 2010-10-01 2010-10-01 false Existing facilities. 1151.22 Section 1151.22... Prohibited Accessibility § 1151.22 Existing facilities. (a) A recipient shall operate each program or... make each of its existing facilities or every part of a facility accessible to and usable by...
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Potassium (2,2'-bipyridine-κN,N')bis-(carbonato-κO,O')cobaltate(III) dihydrate.
Wang, Jian-Fei; Lin, Jian-Li
2010-09-30
In the title compound, K[Co(CO(3))(2)(C(10)H(8)N(2))]·2H(2)O, the Co(III) atom is coordinated by two bipyridine N atoms and four O atoms from two bidentate chelating carbonate anions, and thus adopts a distorted octa-hedral N(2)O(4) environment. The [Co(bipy)(CO(3))(2)](-) (bipy is 2,2'-bipyridine) -units are stacked along [100] via π-π stacking inter-actions, with inter-planar distances between the bipyridine rings of 3.36 (4) and 3.44 (6) Å, forming chains. Classical O-H⋯O hydrogen-bonding inter-actions link the chains, forming channels along (100) in which the K(+) ions reside and leading to a three-dimensional supra-molecular architecture.
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10C survey of radio sources at 15.7 GHz - II. First results
AMI Consortium; Davies, Mathhew L.; Franzen, Thomas M. O.; Waldram, Elizabeth M.; Grainge, Keith J. B.; Hobson, Michael P.; Hurley-Walker, Natasha; Lasenby, Anthony; Olamaie, Malak; Pooley, Guy G.; Riley, Julia M.; Rodríguez-Gonzálvez, Carmen; Saunders, Richard D. E.; Scaife, Anna M. M.; Schammel, Michel P.; Scott, Paul F.; Shimwell, Timothy W.; Titterington, David J.; Zwart, Jonathan T. L.
2011-08-01
In a previous paper (Paper I), the observational, mapping and source-extraction techniques used for the Tenth Cambridge (10C) Survey of Radio Sources were described. Here, the first results from the survey, carried out using the Arcminute Microkelvin Imager Large Array (LA) at an observing frequency of 15.7 GHz, are presented. The survey fields cover an area of ≈27 deg2 to a flux-density completeness of 1 mJy. Results for some deeper areas, covering ≈12 deg2, wholly contained within the total areas and complete to 0.5 mJy, are also presented. The completeness for both areas is estimated to be at least 93 per cent. The 10C survey is the deepest radio survey of any significant extent (≳0.2 deg2) above 1.4 GHz. The 10C source catalogue contains 1897 entries and is available online. The source catalogue has been combined with that of the Ninth Cambridge Survey to calculate the 15.7-GHz source counts. A broken power law is found to provide a good parametrization of the differential count between 0.5 mJy and 1 Jy. The measured source count has been compared with that predicted by de Zotti et al. - the model is found to display good agreement with the data at the highest flux densities. However, over the entire flux-density range of the measured count (0.5 mJy to 1 Jy), the model is found to underpredict the integrated count by ≈30 per cent. Entries from the source catalogue have been matched with those contained in the catalogues of the NRAO VLA Sky Survey and the Faint Images of the Radio Sky at Twenty-cm survey (both of which have observing frequencies of 1.4 GHz). This matching provides evidence for a shift in the typical 1.4-GHz spectral index to 15.7-GHz spectral index of the 15.7-GHz-selected source population with decreasing flux density towards sub-mJy levels - the spectra tend to become less steep. Automated methods for detecting extended sources, developed in Paper I, have been applied to the data; ≈5 per cent of the sources are found to be extended
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50 CFR Figure 10 to Part 223 - Flounder TED
2010-10-01
... 50 Wildlife and Fisheries 7 2010-10-01 2010-10-01 false Flounder TED 10 Figure 10 to Part 223 Wildlife and Fisheries NATIONAL MARINE FISHERIES SERVICE, NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION, DEPARTMENT OF COMMERCE MARINE MAMMALS THREATENED MARINE AND ANADROMOUS SPECIES Pt. 223, Fig. 10 Figure 10 to Part 223—Flounder TED EC01JY91.056 [5...
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21 CFR 1306.22 - Refilling of prescriptions.
2010-04-01
... 21 Food and Drugs 9 2010-04-01 2010-04-01 false Refilling of prescriptions. 1306.22 Section 1306.22 Food and Drugs DRUG ENFORCEMENT ADMINISTRATION, DEPARTMENT OF JUSTICE PRESCRIPTIONS Controlled... 75 FR 16308, Mar. 31, 2010, § 1306.22 was revised, effective June 1, 2010. For the convenience of the...
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2013-03-20
...), EPA revised the procedures for IBR'ing Federally-approved SIPs, as a result of consultations between... Violations--Notices 9/8/93 2/22/95, 60 FR 9778 132 Criminal Penalty 11/13/94 10/24/95, 60 FR 54439 133 Civil............ Regulatory Actions & Civil 9/21/95 2/26/97, 62 FR 8624......... Penalties. 400-240......... Criminal...
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48 CFR 22.1400 - Scope of subpart.
2010-10-01
... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Scope of subpart. 22.1400 Section 22.1400 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION SOCIOECONOMIC PROGRAMS APPLICATION OF LABOR LAWS TO GOVERNMENT ACQUISITIONS Employment of Workers with Disabilities 22...
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Lee, David W; Duszak, Richard; Hughes, Danny R
2013-12-01
The purpose of this study was to assess trends in Medicare spending growth for medical imaging relative to other services and the Deficit Reduction Act (DRA). We calculated per-beneficiary Part B Medicare medical imaging expenditures for three-digit Berenson-Eggers Type of Service (BETOS) categories using Physician Supplier Procedure Summary Master Files for 32 million beneficiaries from 2000 to 2011. We adjusted BETOS categories to address changes in coding and payment policy and excluded categories with 2011 aggregate spending less than $500 million. We computed and ranked compound annual growth rates over three periods: pre-DRA (2000-2005), DRA transition period (2005-2007), and post-DRA (2007-2011). Forty-four modified BETOS categories fulfilled the inclusion criteria. Between 2000 and 2006, Medicare outlays for nonimaging services grew by 6.8% versus 12.0% for imaging services. In the ensuing 5 years, annual growth in spending for nonimaging continued at 3.6% versus a decline of 3.5% for imaging. Spending growth for all services during the pre-DRA, DRA, and post-DRA periods were 7.8%, 3.8%, and 2.9 compared with 15.0%, -3.4%, and -2.2% for advanced imaging services. Advanced imaging was among the fastest growing categories of Medicare services in the early 2000s but was in the bottom 2% of spending categories in 2011. Between 2007 and 2011, the fastest growing service categories were evaluation and management services with other specialists (29.1%), nursing home visits (11.2%), anesthesia (9.1%), and other ambulatory procedures (9.0%). Slowing volume growth and massive Medicare payment cuts have left medical imaging near the bottom of all service categories contributing to growth in Medicare spending.