Maryland hospital payment system
This article relies largely or entirely on a single source. (February 2014) |
Since the late 1970s, the Maryland hospital payment system has employed an all-payer system for hospital services in which all payers pay the same amount for a given service at a particular hospital. An independent commission establishes the rate structure for each hospital. The system eliminated hospital cost shifting across payers and more equitably spread the costs of uncompensated care and medical education and limited cost growth, but per capita Medicare hospital costs are among the country's highest.[1]
Medicare's participation in the system is authorized by the Social Security Act and is tied to a growth limit in payment per admission. The Medicare waiver created incentives to increase the volume of services provided. Medicare pays higher rates for hospital services in Maryland than it does under the national prospective payment systems.[1]
2014 revisions
On January 10, 2014, the
Separately, Maryland plans to reduce its unadjusted all-cause, all-site
Maryland's rate-setting commission, known as the Health Services Cost Review Commission, will change its annual rate-setting procedures. The update is based on multiple factors, and it intended to reduce the incentive for increased volume. Hospitals receive only a fraction of the standard rate for providing services above a calculated-but-adjustable annual limit, while receiving bonuses for keeping services under the limit. The commission will seek to shift to population-based payment models that reward providers for improving health outcomes, enhancing quality and controlling costs.[1]
Rural hospitals
Maryland already operates a "Total Patient Revenue" model that establishes fixed global budgets for certain rural hospitals on the basis of their historical cost trends.[1]
Global and capitated payments are expected to encourage coordinated care, emphasis on care transitions, and focus on prevention.[1]
References
- ^ PMID 24410022.
- ^ "Equalizing Health Provider Rates: All-Payer Rate Setting". National Conference of State Legislatures.
External links
- "Maryland's Dr. Joshua M. Sharfstein discusses move to cap hospital payments". Modern Healthcare. Retrieved 2014-01-29.