This report shares results of a simulation analysis of a payment model for specialty oncology services that is being developed for possible testing by the Center for Medicare and Medicaid Innovation at the Centers for Medicare and Medicaid Services.
The California Department of Industrial Relations/Division of Worker's Compensation asked RAND to help develop a fee schedule for home health services provided to injured workers. The researchers made three sets of recommendations.
The current process used by the Centers for Medicare & Medicaid Services for valuing physician work is based on physician survey responses. RAND researchers examined the feasibility of developing a model based instead on external data sources.
The Centers for Medicare and Medicaid Services uses a resource-based relative value (RBRV) scale to calculate payments for physicians. The values of the scale were validated with predictive modeling, and the result may be helpful in two key applications: flagging codes as potentially misvalued and determining why a code is valued differently than predicted.
Quality improvement in Medicare managed care plans should target care for particular subgroups such as beneficiaries who have low incomes, are less healthy, older, female, and who did not complete high school.