Government Payments and Health Policy
1-In the Austin and Kachalia (2020) commentary, what is one challenge with reporting or using quality of care data from a provider’s perspective? What action did CMS take to alleviate the reporting burden of providers during the COVID-19 pandemic?
2-What role does the Relative Value Update Committee (RUC) have on Medicare physician payments? Briefly discuss two potential problems with its operation or representation?
3-How were early hospital payments in Medicare set between 1965 and 1982? Briefly explain why this payment structure created incentives to maximize hospital admissions of Medicare patients and contributed to a “medical arms race” with rapid spending growth?
4-Briefly discuss what happened to Medicare inpatient hospital admissions and average length of stay (ALOS) in the few years after DRGs were implemented in 1983. Why do you think these changes occurred after DRGs were implemented?
5-In the Zuckerman article, which 3 targeted conditions were used to evaluate 30-day hospital readmission rates? What was the maximum penalty rate (%) in the first year of HRRP? since readmission rates dropped between 2010 and 2015 for both targeted AND non-targeted conditions, if the penalties only applied to the 3 targeted conditions?
6-Hospitals agreed to an inpatient prospective payment system (IPPS) in 1983 after changes were made to address the concerns of major teaching hospitals. Discuss how the DRG payment formula is adjusted today to support teaching hospitals?