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Designing and Implementing Health Care Provider Payment Systems

Jack Langenbrunner,Cheryl Cashin,Sheila O'Dougherty

Author : Jack Langenbrunner,Cheryl Cashin,Sheila O'Dougherty
Publisher : World Bank Publications
Page : 348 pages
File Size : 46,8 Mb
Release : 2009-01-01
Category : Medical
ISBN : 9780821378243

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Designing and Implementing Health Care Provider Payment Systems by Jack Langenbrunner,Cheryl Cashin,Sheila O'Dougherty Pdf

Strategic purchasing of health services involves a continuous search for the best ways to maximize health system performance by deciding which interventions should be purchased, from whom these should be purchased, and how to pay for them. In such an arrangement, the passive cashier is replaced by an intelligent purchaser that can focus scarce resources on existing and emerging priorities rather than continuing entrenched historical spending patterns.Having experimented with different ways of paying providers of health care services, countries increasingly want to know not only what to do when paying providers, but also how to do it, particularly how to design, manage, and implement the transition from current to reformed systems. 'Designing and Implementing Health Care Provider Payment Systems: How-To Manuals' addresses this need.The book has chapters on three of the most effective provider payment systems: primary care per capita (capitation) payment, case-based hospital payment, and hospital global budgets. It also includes a primer on a second policy lever used by purchasers, namely, contracting. This primer can be especially useful with one provider payment method: hospital global budgets. The volume's final chapter provides an outline for designing, launching, and running a health management information system, as well as the necessary infrastructure for strategic purchasing.

Healthcare Payment Systems

Duane C. Abbey

Author : Duane C. Abbey
Publisher : CRC Press
Page : 284 pages
File Size : 45,8 Mb
Release : 2010-10-22
Category : Business & Economics
ISBN : 9781439884065

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Healthcare Payment Systems by Duane C. Abbey Pdf

For healthcare providers and patients alike, the ways of private third-party payer payment systems can be mysterious and oftentimes quite frustrating. Payment for hospital, nursing, or homecare services can be subject to a variety of payment systems including cost-based and charge-based or those with payments that are determined in advance. Knowing the specific rules needed to navigate each type of payment system is essential for all healthcare administrators and accountants. Healthcare Payment Systems: Fee Schedule Payment System, the second volume in a series by expert consultant and workshop facilitator Duane Abbey, is dedicated to fee schedule payment systems. Always accessible and entertaining in his approach, Dr. Abbey illustrates the diverse challenges involved with these systems through the discussion of reimbursement claims for several individuals in a fictitious community served by a hospital, a nursing facility, and a hospice among other healthcare providers, Including more than 60 very real scenarios that illustrate best practices for various fee payment challenges, this comprehensive volume — Explores the general concept of usual, customary, and reasonable (UCR) that is often applied by private third-party payers Provides web links to a number of essential resources including various government acts and manuals Discusses in-depth what is arguably the most complex fee schedule system: the Medicare Physician Fee Schedule Defines a comprehensive list of acronyms used in the medical payment industry Conceptually, fee schedule payment systems are one of the simpler approaches; however, even straightforward healthcare payment systems can, and indeed do, become quite complex. No payment system exists in a vacuum. In fact, when services are provided, the reimbursement from multiple payment systems may be required. This guide shows you how all these systems work, as well as how they interface with one another in everyday practical use. Understanding the differences among systems and learning how to navigate them can make a huge difference in whether a claim is accepted or not and how much payment is allowed.

Healthcare Payment Systems

Duane C. Abbey

Author : Duane C. Abbey
Publisher : CRC Press
Page : 168 pages
File Size : 44,7 Mb
Release : 2009-05-20
Category : Business & Economics
ISBN : 9781420092783

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Healthcare Payment Systems by Duane C. Abbey Pdf

Healthcare Payment Systems: An Introduction provides a complete introduction to healthcare payment systems. Written by Duane Abbey, one of the nation‘s leading experts and most sought out consultants on payment systems, this volume makes the monumental task of medical reimbursement approachable and manageable. Covering the fundamentals and terminology needed to understand this discipline, and the strategies needed to master it, Dr. Abbey will help you begin to develop the solid core of skills and knowledge needed to confidently approach payment systems as tools to use rather than hazards to avoid -- tools that will lead to improved revenue cycles and higher levels of profitability.

Healthcare Payment Systems

Duane C. Abbey

Author : Duane C. Abbey
Publisher : CRC Press
Page : 113 pages
File Size : 53,7 Mb
Release : 2009-05-20
Category : Business & Economics
ISBN : 9781040083154

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Healthcare Payment Systems by Duane C. Abbey Pdf

Healthcare Payment Systems: An Introduction provides a complete introduction to healthcare payment systems. Written by Duane Abbey, one of the nation‘s leading experts and most sought out consultants on payment systems, this volume makes the monumental task of medical reimbursement approachable and manageable. Covering the fundamentals and terminology needed to understand this discipline, and the strategies needed to master it, Dr. Abbey will help you begin to develop the solid core of skills and knowledge needed to confidently approach payment systems as tools to use rather than hazards to avoid -- tools that will lead to improved revenue cycles and higher levels of profitability.

Cost-Based, Charge-Based, and Contractual Payment Systems

Duane C. Abbey

Author : Duane C. Abbey
Publisher : CRC Press
Page : 186 pages
File Size : 52,6 Mb
Release : 2018-06-28
Category : Business & Economics
ISBN : 9781040084045

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Cost-Based, Charge-Based, and Contractual Payment Systems by Duane C. Abbey Pdf

The fourth book in the Healthcare Payment System series, Cost-Based, Charge-Based, and Contractual Payment Systems compares cost-based systems, charge-based payment approaches, and contractually-based payment processes with fee-schedule payment systems and prospective payment systems. Supplying readers with a clear understanding of important backgr

The Future of Nursing 2020-2030

National Academies of Sciences Engineering and Medicine,Committee on the Future of Nursing 2020-2030

Author : National Academies of Sciences Engineering and Medicine,Committee on the Future of Nursing 2020-2030
Publisher : Unknown
Page : 128 pages
File Size : 45,7 Mb
Release : 2021-09-30
Category : Electronic
ISBN : 0309685060

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The Future of Nursing 2020-2030 by National Academies of Sciences Engineering and Medicine,Committee on the Future of Nursing 2020-2030 Pdf

The decade ahead will test the nation's nearly 4 million nurses in new and complex ways. Nurses live and work at the intersection of health, education, and communities. Nurses work in a wide array of settings and practice at a range of professional levels. They are often the first and most frequent line of contact with people of all backgrounds and experiences seeking care and they represent the largest of the health care professions. A nation cannot fully thrive until everyone - no matter who they are, where they live, or how much money they make - can live their healthiest possible life, and helping people live their healthiest life is and has always been the essential role of nurses. Nurses have a critical role to play in achieving the goal of health equity, but they need robust education, supportive work environments, and autonomy. Accordingly, at the request of the Robert Wood Johnson Foundation, on behalf of the National Academy of Medicine, an ad hoc committee under the auspices of the National Academies of Sciences, Engineering, and Medicine conducted a study aimed at envisioning and charting a path forward for the nursing profession to help reduce inequities in people's ability to achieve their full health potential. The ultimate goal is the achievement of health equity in the United States built on strengthened nursing capacity and expertise. By leveraging these attributes, nursing will help to create and contribute comprehensively to equitable public health and health care systems that are designed to work for everyone. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity explores how nurses can work to reduce health disparities and promote equity, while keeping costs at bay, utilizing technology, and maintaining patient and family-focused care into 2030. This work builds on the foundation set out by The Future of Nursing: Leading Change, Advancing Health (2011) report.

Crossing the Quality Chasm

Institute of Medicine,Committee on Quality of Health Care in America

Author : Institute of Medicine,Committee on Quality of Health Care in America
Publisher : National Academies Press
Page : 360 pages
File Size : 55,9 Mb
Release : 2001-08-19
Category : Medical
ISBN : 9780309072809

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Crossing the Quality Chasm by Institute of Medicine,Committee on Quality of Health Care in America Pdf

Second in a series of publications from the Institute of Medicine's Quality of Health Care in America project Today's health care providers have more research findings and more technology available to them than ever before. Yet recent reports have raised serious doubts about the quality of health care in America. Crossing the Quality Chasm makes an urgent call for fundamental change to close the quality gap. This book recommends a sweeping redesign of the American health care system and provides overarching principles for specific direction for policymakers, health care leaders, clinicians, regulators, purchasers, and others. In this comprehensive volume the committee offers: A set of performance expectations for the 21st century health care system. A set of 10 new rules to guide patient-clinician relationships. A suggested organizing framework to better align the incentives inherent in payment and accountability with improvements in quality. Key steps to promote evidence-based practice and strengthen clinical information systems. Analyzing health care organizations as complex systems, Crossing the Quality Chasm also documents the causes of the quality gap, identifies current practices that impede quality care, and explores how systems approaches can be used to implement change.

Healthcare Payment Systems

Duane C. Abbey

Author : Duane C. Abbey
Publisher : CRC Press
Page : 152 pages
File Size : 40,7 Mb
Release : 2010-10-25
Category : Business & Economics
ISBN : 9781439840252

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Healthcare Payment Systems by Duane C. Abbey Pdf

For healthcare providers and patients alike, the ways of private third-party payer payment systems can be mysterious and oftentimes quite frustrating. Payment for hospital, nursing, or homecare services can be subject to a variety of payment systems including cost-based and charge-based or those with payments that are determined in advance. Knowing

Case-based Payment Systems for Hospital Funding in Asia An Investigation of Current Status and Future Directions

OECD,World Health Organization

Author : OECD,World Health Organization
Publisher : OECD Publishing
Page : 132 pages
File Size : 53,6 Mb
Release : 2015-11-02
Category : Electronic
ISBN : 9789290617327

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Case-based Payment Systems for Hospital Funding in Asia An Investigation of Current Status and Future Directions by OECD,World Health Organization Pdf

The report focuses on a review of the implementation experience of case-based and DRG mechanisms in the Asia and Pacific region, drawing particularly on research in Australia, Japan, New Zealand, the Republic of Korea, Singapore and Thailand.

The Healthcare Imperative

Institute of Medicine,Roundtable on Evidence-Based Medicine

Author : Institute of Medicine,Roundtable on Evidence-Based Medicine
Publisher : National Academies Press
Page : 852 pages
File Size : 53,5 Mb
Release : 2011-01-17
Category : Medical
ISBN : 9780309144339

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The Healthcare Imperative by Institute of Medicine,Roundtable on Evidence-Based Medicine Pdf

The United States has the highest per capita spending on health care of any industrialized nation but continually lags behind other nations in health care outcomes including life expectancy and infant mortality. National health expenditures are projected to exceed $2.5 trillion in 2009. Given healthcare's direct impact on the economy, there is a critical need to control health care spending. According to The Health Imperative: Lowering Costs and Improving Outcomes, the costs of health care have strained the federal budget, and negatively affected state governments, the private sector and individuals. Healthcare expenditures have restricted the ability of state and local governments to fund other priorities and have contributed to slowing growth in wages and jobs in the private sector. Moreover, the number of uninsured has risen from 45.7 million in 2007 to 46.3 million in 2008. The Health Imperative: Lowering Costs and Improving Outcomes identifies a number of factors driving expenditure growth including scientific uncertainty, perverse economic and practice incentives, system fragmentation, lack of patient involvement, and under-investment in population health. Experts discussed key levers for catalyzing transformation of the delivery system. A few included streamlined health insurance regulation, administrative simplification and clarification and quality and consistency in treatment. The book is an excellent guide for policymakers at all levels of government, as well as private sector healthcare workers.

Paying for Performance in Healthcare: Implications for Health System Performance and Accountability

Cheryl Cashin,Y-Ling Chi,Michael Borowitz,Sarah Thompson

Author : Cheryl Cashin,Y-Ling Chi,Michael Borowitz,Sarah Thompson
Publisher : McGraw-Hill Education (UK)
Page : 338 pages
File Size : 43,7 Mb
Release : 2014-09-16
Category : Medical
ISBN : 9780335264391

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Paying for Performance in Healthcare: Implications for Health System Performance and Accountability by Cheryl Cashin,Y-Ling Chi,Michael Borowitz,Sarah Thompson Pdf

Health spending continues to grow faster than the economy in most OECD countries. In 2010, the OECD published a study of strategies to increase value for money in health care, in which pay for performance (P4P) was identified as an innovative tool to improve health system efficiency in several OECD countries. However, evidence that P4P increases value for money, boosts quality of processes in health care, or improves health outcomes is limited.This book explores the many questions surrounding P4P such as whether the potential power of P4P has been over-sold, or whether the disappointing results to date are more likely rooted in problems of design and implementation or inadequate monitoring and evaluation. The book also examines the supporting systems and process, in addition to incentives, that are necessary for P4P to improve provider performance and to drive and sustain improvement. The book utilises a substantial set of case studies from 12 OECD countries to shed light on P4P programs in practice.Featuring both high and middle income countries, cases from primary and acute care settings, and a range of both national and pilot programmes, each case study features: Analysis of the design and implementationdecisions, including the role of stakeholders Critical assessment of objectives versus results Examination of the of 'net' impacts, includingpositive spillover effects and unintended consequences The detailed analysis of these 12 case studies together with the rest of this critical text highlight the realities of P4P programs and their potential impact on the performance of health systems in a diversity of settings. As a result, this book provides critical insights into the experience to date with P4P and how this tool may be better leveraged to improve health system performance and accountability. This title is in the European Observatory on Health Systems and Policies Series.

Prospective Payment Systems

Duane C. Abbey

Author : Duane C. Abbey
Publisher : CRC Press
Page : 219 pages
File Size : 43,5 Mb
Release : 2018-06-28
Category : Business & Economics
ISBN : 9781439873021

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Prospective Payment Systems by Duane C. Abbey Pdf

The third book in the Healthcare Payment Systems series, Prospective Payment Systems examines the various types of prospective payment systems (PPS) used by healthcare providers and third-party payers. Emphasizing the basic elements of PPS, it considers the many variations of payment for hospital inpatient and outpatient services, skilled nursing f

Germany Healthcare Sector Organization, Management and Payment Systems Handbook Volume 1 Strategic Information and Basic Laws

IBP, Inc.

Author : IBP, Inc.
Publisher : Lulu.com
Page : 355 pages
File Size : 47,8 Mb
Release : 2015-04-29
Category : Business & Economics
ISBN : 9781433085857

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Germany Healthcare Sector Organization, Management and Payment Systems Handbook Volume 1 Strategic Information and Basic Laws by IBP, Inc. Pdf

France Healthcare Sector Organization, Management and Payment Systems Handbook - Strategic Information, Programs and Regulations

Medicare Prospective Payment and the Shaping of U.S. Health Care

Rick Mayes,Robert A. Berenson

Author : Rick Mayes,Robert A. Berenson
Publisher : JHU Press
Page : 274 pages
File Size : 40,7 Mb
Release : 2006-12-20
Category : Medical
ISBN : 9780801888878

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Medicare Prospective Payment and the Shaping of U.S. Health Care by Rick Mayes,Robert A. Berenson Pdf

This is the definitive work on Medicare’s prospective payment system (PPS), which had its origins in the 1972 Social Security Amendments, was first applied to hospitals in 1983, and came to fruition with the Balanced Budget Act of 1997. Here, Rick Mayes and Robert A. Berenson, M.D., explain how Medicare’s innovative payment system triggered shifts in power away from the providers (hospitals and doctors) to the payers (government insurers and employers) and how providers have responded to encroachments on their professional and financial autonomy. They conclude with a discussion of the problems with the Medicare Modernization Act of 2003 and offer prescriptions for how policy makers can use Medicare payment policy to drive improvements in the U.S. health care system. Mayes and Berenson draw from interviews with more than sixty-five major policy makers—including former Treasury secretary Robert Rubin, U.S. Representatives Pete Stark and Henry Waxman, former White House chief of staff Leon Panetta, and former administrators of the Health Care Financing Administration Gail Wilensky, Bruce Vladeck, Nancy-Ann DeParle, and Tom Scully—to explore how this payment system worked and its significant effects on the U.S. medical landscape in the past twenty years. They argue that, although managed care was an important agent of change in the 1990s, the private sector has not been the major health care innovator in the United States; rather, Medicare’s transition to PPS both initiated and repeatedly intensified the economic restructuring of the U.S. health care system.

Cost-Based, Charge-Based, and Contractual Payment Systems

Duane C. Abbey

Author : Duane C. Abbey
Publisher : CRC Press
Page : 179 pages
File Size : 50,7 Mb
Release : 2018-06-28
Category : Business & Economics
ISBN : 9781439873007

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Cost-Based, Charge-Based, and Contractual Payment Systems by Duane C. Abbey Pdf

The fourth book in the Healthcare Payment System series, Cost-Based, Charge-Based, and Contractual Payment Systems compares cost-based systems, charge-based payment approaches, and contractually-based payment processes with fee-schedule payment systems and prospective payment systems. Supplying readers with a clear understanding of important backgr

Healthcare Payment Systems

Designing and Implementing Health Care Provider Payment Systems by Jack Langenbrunner,Cheryl Cashin,Sheila O'Dougherty Pdf

Healthcare Payment Systems by Duane C. Abbey Pdf

Healthcare Payment Systems by Duane C. Abbey Pdf

Healthcare Payment Systems by Duane C. Abbey Pdf

Cost-Based, Charge-Based, and Contractual Payment Systems by Duane C. Abbey Pdf

The Future of Nursing 2020-2030 by National Academies of Sciences Engineering and Medicine,Committee on the Future of Nursing 2020-2030 Pdf

Crossing the Quality Chasm by Institute of Medicine,Committee on Quality of Health Care in America Pdf

Healthcare Payment Systems by Duane C. Abbey Pdf

Case-based Payment Systems for Hospital Funding in Asia An Investigation of Current Status and Future Directions by OECD,World Health Organization Pdf

The Healthcare Imperative by Institute of Medicine,Roundtable on Evidence-Based Medicine Pdf

Paying for Performance in Healthcare: Implications for Health System Performance and Accountability by Cheryl Cashin,Y-Ling Chi,Michael Borowitz,Sarah Thompson Pdf

Prospective Payment Systems by Duane C. Abbey Pdf

Germany Healthcare Sector Organization, Management and Payment Systems Handbook Volume 1 Strategic Information and Basic Laws by IBP, Inc. Pdf

Medicare Prospective Payment and the Shaping of U.S. Health Care by Rick Mayes,Robert A. Berenson Pdf

Cost-Based, Charge-Based, and Contractual Payment Systems by Duane C. Abbey Pdf

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