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Health Care Payment Approaches

Journal Article

Quality Of End-Of-Life Care Is Higher In The VA Compared To Care Paid For By Traditional Medicare

The Medicare-reliant veterans were significantly more likely to receive high-intensity care, in the form of chemotherapy, hospital stays, admission to the intensive care unit, more days spent in the hospital, and death in the hospital. However, they were significantly less likely than VA-reliant patients to have multiple emergency department visits. Higher-intensity end-of-life care may be driven by financial incentives present in fee-for-service Medicare but not in the VA's integrated system.

Aug 5, 2020
Journal Article

CMS Reimbursement Reform and the Incidence of Hospital-Acquired Pulmonary Embolism or Deep Vein Thrombosis

CMS's refusal to pay for hospital-acquired conditions resulted in a lower incidence of hospital-acquired pulmonary embolism or deep vein thrombosis after hip or knee replacement surgery.

Aug 5, 2020
Report

Practice Expense Methodology and Data Collection Research and Analysis: Interim Phase II Report

In this report, the authors address how the Centers for Medicare and Medicaid Services can improve the methodology or update data used for setting practice expense payment rates under the Medicare Physician Fee Schedule.

Aug 4, 2020
Report

Advancing the Development of a Framework to Capture Non–Fee-for-Service Health Care Spending for Primary Care

This report describes work conducted to understand what non-fee-for-service payment data are being collected by states and other stakeholders to support more complete measurement of primary care spending as a proportion of total health care spending.

Jul 30, 2020
Dissertation

Three Essays In Health Policy and Economics: Surprise Out-of-Network Medical Bills and Out-of-Network Health Care Provider Payment in the United States

Three essays addressing surprise out-of-network medical bills and out-of-network health care provider payment.

Jul 16, 2020
Commentary

Why States' 'Netflix Model' Prescription Drug Arrangements Are No Silver Bullet

Despite the buzz and catchy notion that subscription models are "Netflix for drugs," it's hard to come up with a theoretical case that supports subscription models over traditional price negotiation between payers and manufacturers over a per-dose or per-unit price.

Jul 1, 2020
Journal Article

Accounting for the Burden and Redistribution of Health Care Costs: Who Uses Care and Who Pays for It

The dollar value of health care received declines as income rises as does health care received as a percent of income.

Jun 25, 2020
Blog

COVID-19, Out-of-Network Hospital Payments, Russia's Economy: RAND Weekly Recap

This weekly recap focuses on COVID-19, limiting out-of-network hospital payments, Russia's sluggish economy, RAND's largest-ever fundraising campaign, and more.

Mar 13, 2020
News Release

Limiting Out-of-Network Payments to Hospitals Could Produce Cost Savings Similar to Single-Payer Options

Placing limits on what hospitals can collect for out-of-network care could yield savings similar to more-sweeping proposals such as Medicare for All or setting global health spending caps. Because such an approach has the possibility to sharply cut hospital revenues, any cap would need to be set carefully as to not overly disrupt hospital operations.

Mar 12, 2020
Report

The Effects of Limiting Payments to Hospitals for Out-of-Network Care

There is growing interest among U.S. policymakers to use out-of-network payment limits to curb surprise medical bills and as a tool to control rising health care costs. How might such limits affect negotiated in-network prices and total payments for hospital care?

Mar 12, 2020
Report

RAND Medicare Advantage (MA) and Part D Contract Star Ratings Technical Expert Panel November 7th, 2019 Meeting

On November 7, 2019, the RAND Corporation convened a Technical Expert Panel (TEP) web meeting to gather input on analyses that could be conducted to further enhance the Medicare Advantage (MA) and Part D Contract Star Ratings program.

Feb 7, 2020
Journal Article

Payment for Services Rendered: Updating Medicare's Valuation of Procedures

Medicare appears to be overpaying surgeons for post-operative care associated many medical procedures. Federal officials should incorporate ways to more objectively measure the amount of postoperative care surgeons provide to patients

Jan 24, 2020
Journal Article

The Challenge of Determining Appropriate Care in the Era of Patient-Centered Care and Rising Health Care Costs

The goal of health care is to ensure that patients receive the right care for the right patient for the right problem at the right time from the right provider. Inappropriate care is costly. The challenge is to define and increase delivery of appropriate care.

Dec 12, 2019
Report

Options for Reinvesting Savings from Restored Federal Cost-Sharing Reduction Payments: Examining the Effects of Two Policy Alternatives on Spending and Enrollment in the Individual Health Insurance Market

The authors of this report examine the impact of providing additional health insurance subsidies or financing reinsurance from the savings resulting from restored federal cost-sharing reduction payments to insurers under the Affordable Care Act.

Sep 10, 2019
Report

RAND Medicare Advantage (MA) and Part D Contract Star Ratings Technical Expert Panel April 30, 2019 Meeting

On April 30, 2019, the RAND Corporation convened a Technical Expert Panel (TEP) web meeting to gather input on analyses that could be conducted to further enhance the Medicare Advantage (MA) and Part D Contract Star Ratings program.

Sep 6, 2019
Report

Evaluation of California's Global Payment Program: Final Report

The Global Payment Program seeks to improve health care for California's uninsured by using federal funds to make prospective payments for inpatient, outpatient, and nontraditional services. This report presents the final evaluation of the program.

Aug 22, 2019
Journal Article

Medical Practice Consolidation and Physician Shared Patient Network Size, Strength, and Stability

Practice consolidation can increase the stability of physician networks, which may have positive implications for organizational effectiveness.

Aug 20, 2019
Report

Survey-Based Reporting of Post-Operative Visits for Select Procedures with 10- or 90-Day Global Periods: Final Report

For many surgeries and procedures, Medicare and most other insurers cover a bundle of services, including post-operative visits, during the global period. This survey was designed to capture the level of post-operative visits during this period.

Jul 31, 2019
Journal Article

How Are Medical Groups Identified as High Performing? The Effect of Different Approaches to Classification of Performance

To accurately identify "high-performing providers", a standard definition of high-performance and an agreed-upon approach to measurement are necessary.

Jul 24, 2019
Report

Effects of Alternative Insurer Responses to Discontinued Federal Cost-Sharing Reduction Payments: Broad Loading as an Alternative to Silver Loading

In this report, the authors assess the effects of disallowing the current practice of increasing only the premiums of silver-tiered individual market plans in response to discontinued federal payments of cost-sharing reductions (silver loading).

Jun 3, 2019

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