Medicare Prospective Payment System (PPS)

Publications

Alphabetical list. You can also view by publication date.

• Area Wage Index of the Medicare Inpatient Hospital Prospective Payment System: Perspectives, Policies, and Choices
  Author(s): Anthony Wellever, Andrew Coburn, Charles Fluharty, J. Patrick Hart, A. Clinton MacKinney, Timothy McBride, Keith Mueller, Rebecca Slifkin
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Health care financing, Legislation and regulation, Medicare Prospective Payment System (PPS), Medicare Wage Index
  Date: 08 / 2000
  This Policy Paper summarizes the positions of various rural health advocates and recording the actions taken by Congress and the Health Care Financing Administration (HCFA) to improve the wage index. Finally, it outlines the research needed to energize the policy discussion of the uses and methods of calculating the hospital wage index. Report produced by the RUPRI Rural Health Panel.
• At-Risk Hospitals: The Role of Critical Access Hospital Status in Mitigating the Effects of New Prospective Payment Systems Under Medicare
  Author(s): Kathleen Dalton, Rebecca Slifkin, Hilda Howard
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Medicare Prospective Payment System (PPS)
  Date: 02 / 2000
  This report examines not-for-profit hospitals that potentially qualify as Critical Access Hospitals and identifies those facilities that are at risk as a result of Medicare's PPS to non-acute care settings.
• Calculating and Using the Area Wage Index of the Medicare Inpatient Hospital Prospective Payment System
  Author(s): Anthony Wellever
  Research center: Rural Policy Research Institute (RUPRI) Center for Rural Health Policy Analysis
  Topics: Medicare Prospective Payment System (PPS), Medicare Wage Index
  Date: 06 / 2000
  This policy brief explains how the area wage index is calculated and used, and identifies the major unresolved issues related to its calculation and use. Report produced by the RUPRI Rural Health Panel.
• Financially Distressed Rural Hospitals In Four States
  Research center: Walsh Center for Rural Health Analysis
  Topics: Health care financing, Hospitals and clinics, Medicare Prospective Payment System (PPS)
  Report Number: Policy Analysis Brief W Series No. 2
  Date: 01 / 2004
  The effect of the outpatient prospective payment system (OPPS) on the financial performance of rural hospitals was simulated in four states-Iowa, Texas, Washington, and West Virginia. Findings suggest that the profitability and cash position of small, government-owned, and Medicare-dependent hospitals will be adversely impacted by the OPPS. Results also suggest that the number of financially distressed rural hospitals will increase significantly. The small rural hospitals currently protected by the hold harmless provision are those most likely to be hardest hit by OPPS.
• How Will Elimination of Hospital Bad Debt Reimbursement Affect Rural PPS Hospitals?
  Author(s): Janet P. Sutton, Alene Kennedy, Lucia Hammer, Grace Yang
  Research center: Walsh Center for Rural Health Analysis
  Topics: Health care financing, Hospitals and clinics, Medicare Prospective Payment System (PPS)
  Report Number: Walsh W Series No. 11
  Date: 07 / 2007
  Policy brief examining the financial effect that changes in current Medicare bad debt payment policy, as proposed in the FY2007 budget, might have on rural hospitals.
• PPS Inpatient Payment and the Area Wage Index
  Author(s): Kathleen Dalton, Rebecca T. Slifkin
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Hospitals and clinics, Medicare Prospective Payment System (PPS), Medicare Wage Index
  Date: 01 / 2001
  Discusses how inpatient rates are calculated, the role of the wage index, and issues surrounding the wage index and reimbursement to rural hospitals by Medicare under the Prospective Payment System (PPS).
• Primer on the Occupational Mix Adjustment to the Medicare Hospital Wage Index
  Author(s): Kristin Reiter, Rebecca Slifkin, Mark Holmes
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Medicare Prospective Payment System (PPS), Medicare Wage Index
  Report Number: Working Paper No. 86
  Date: 09 / 2006
  Focuses on the occupational mix adjustment (OMA) to the labor-related share in the hospital inpatient prospective payment system. The Primer explains what the OMA is, why it is needed and how it has been calculated. In addition, reasons why the effect of the OMA has been less than some rural advocates anticipated are discussed.
• Quality of Medicare Outpatient Claims Data and Its Implications for Rural Outpatient Payment Policy
  Author(s): Penny E. Mohr
  Research center: Walsh Center for Rural Health Analysis
  Topic: Medicare Prospective Payment System (PPS)
  Date: 12 / 2001
  Analyzes Medicare outpatient claims to see if relatively poor quality of small rural hospitals' claims data have amplified the negative effects of the new payment system on small hospitals. Compares three indicators of quality across urban, rural, and small rural hospitals: 1) proportion of claims with missing procedure codes, 2) proportion of claims with multiple procedures codes, and 3) proportion of "low-intensity" versus higher intensity evaluation and management or emergency room services. Finds no significant differences among urban, rural, and low-volume rural hospitals with respect to missing codes; urban hospitals were more likely to have multiple codes; and small rural hospitals were substantially more likely to submit low intensity claims. Study does not refute the possibility that undercoding played a role in CMS's forecasts of negative impact of the outpatient PPS for small rural hospitals. Report available on request.
• Role of CAH Status in Mitigating the Effects of New Prospective Payment Systems Under Medicare
  Author(s): Kathleen Dalton, Rebecca T. Slifkin, Hilda A. Howard
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Critical Access Hospitals and Rural Hospital Flexibility Program, Health care financing, Medicare Prospective Payment System (PPS)
  Date: 01 / 2000
  Examines rural hospitals that potentially qualify as Critical Access Hospitals (CAH), and identifies facilities at substantial financial risk as a result of Medicare?s expansion of prospective payment systems (PPS) to non-acute settings.
• Rural Home Health Agencies: The Impact of the Balanced Budget Act
  Author(s): Sheila J. Franco, Joel Leon
  Research center: Walsh Center for Rural Health Analysis
  Topics: Home health, Medicare Prospective Payment System (PPS)
  Date: 04 / 2000
  This policy analysis brief examines how the characteristics of rural and urban Medicare-certified home health agencies differ, estimates the impact of interim payment system (IPS) on these agencies, and discusses policy implications for a Medicare home health prospective payment system (PPS). For a print copy of publications prior to 2004, please contact the Walsh Center at 301-951-5070.
• Rural Hospital Area Wages and the PPS Wage Index: 1900-1997
  Author(s): Kathleen Dalton, Rebecca Slifkin, Hilda Howard
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Medicare Prospective Payment System (PPS), Medicare Wage Index
  Date: 10 / 2000
  
• Rural-Urban Issues In The Wage Index Adjustment For Prospective Payment In Skilled Nursing Facilities (Brief Report)
  Author(s): Kathleen Dalton, Rebecca Slifkin
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Long term care, Medicare Prospective Payment System (PPS), Medicare Wage Index
  Report Number: Findings Brief
  Date: 01 / 2004
  The hourly wage data collected from Medicare-participating nursing homes were used to examine urban and rural patterns in average hourly nursing home wages and patterns of wage variation within the statewide rural labor markets defined by CMS. The data were also used to examine the adequacy of the hospital wage index as an adjuster for skilled nursing facility rates. Working Paper No. 78 also addresses this topic.
• Rural-Urban Issues In The Wage Index Adjustment For Prospective Payment In Skilled Nursing Facilities (Full Report)
  Author(s): Kathleen Dalton, Rebecca Slifkin
  Research center: North Carolina Rural Health Research and Policy Analysis Center
  Topics: Long term care, Medicare Prospective Payment System (PPS), Medicare Wage Index
  Report Number: Working Paper No. 78
  Date: 11 / 2003
  The hourly wage data collected from Medicare-participating nursing homes were used to examine urban and rural patterns in average hourly nursing home wages and patterns of wage variation within the statewide rural labor markets defined by CMS. The data were also used to examine the adequacy of the hospital wage index as an adjuster for skilled nursing facility rates. A findings brief on this topic is also available.
• Utilization of Home Health Services Among Rural Medicare Beneficiaries Before and After the PPS
  Author(s): Janet P. Sutton
  Research center: Walsh Center for Rural Health Analysis
  Topics: Home health, Medicare Prospective Payment System (PPS), Rural statistics and demographics
  Date: 08 / 2005
  Describes a study conducted to gather information on the rural effects of the PPS, including whether the PPS contributed to changes in: (1) the demographic and clinical characteristics of home care users; (2) the likelihood of using each of six home care disciplines (aide, skilled nursing, physical therapy, occupational therapy, speech therapy and medical social work); and (3) the intensity of services. A total of 99,367 home health episodes were represented in the two years of Medicare data examined. In both study years, urban residents accounted for three-quarters of episodes, while residents of large rural counties and those of remote rural counties accounted for approximately 21 percent and 3 percent of episodes, respectively. Findings suggest that the PPS has had a mixed effect on access to home care in rural counties. Study results indicated an association between implementation of the PPS and admitting home health diagnoses, utilization and intensity of home care episodes and, for the subset of home health users admitted from an acute hospital, readmission rates.
• Will the Outpatient Prospective Payment System Increase the Number of Distressed Rural Hospitals in Iowa, Texas, Washington, and West Virginia?
  Research center: Walsh Center for Rural Health Analysis
  Topics: Health care financing, Hospitals and clinics, Medicare Prospective Payment System (PPS)
  Date: 01 / 2001
  Simulates the financial impact of the outpatient prospective payment system rates and estimates the number and type of rural hospitals in the five states likely to become financially distressed as a result of its implementation. Results clearly suggest that the outpatient PPS will have a significant negative impact on the profitability and cash position of many rural hospitals, especially those that are small, government owned, and classified as Medicare dependent. The results also suggest that this negative impact may lead to a significant increase in the number of financially distressed rural hospitals. Given these findings, a permanent exemption to outpatient prospective payment to small hospitals may be a policy alternative that would benefit rural communities and cost the Medicare program relatively little. Report available on request.

Related Topics

These related topics also list publications:

• Medicare (65 items)