ࡱ> yx@=@ w82bldž=R41vp> x[klTE>{W vy-KBR"-l%aҊD j@HI䏚D%F1D=ݽk[Mos:39sfYJF#U^v_ ~ B{ޟL) ⻂0 )pS6 EHc[]HMܶ|+oOD ˒ Ò<yžT@u(|I^K`RRE_^T 'NS|EZ*؈=.L@֭ g|5le(;^ZO Ly>_#vJ5 WԆg_B՜R#MyjOٯ,SꧼW#Z{FVq)}/<:^ي?mFhGkc^H5m5uتt|g++=%vKkvbxiL=&ltyȦv/La`/ΣT܂}H?Hj>'5r3_n+]0uU;T6nhX*mXmcM>qz[YN,WT\˹ o~a1Eib`xλ xxpzZc&M*⋺3@K Ƃɥdv^knHi@ڇܹkIzp]7!PX8i/ǰLŒeHb6#fWRLl,e+| vl÷LSW6V6 qy)6 QWٔ)fH'4Úbb,dKFZm2I1Q+SmG6+C:e∤ڎltfɁbbk(; ~bnK}tktsAB12ABzeH 7|ABi|vWxƓ`/ Dz(*)cE bzӈH ϵk.u-Ǜ=DLw+*]t9#>(^&_C_w\ WM>#y_0߈ j|u?"AޣwRG\8Il//@_}\J{}Lk8a y i7̒r!rkp)>\kHB2z?aKYUWof%{/VtaK eܫ$qՌn`2\Z{2}qW>i*^0z,w1ğ]¯IhƯr \=ɋ=lEz 8t{(4hYކdkQRdnyŔA@OV2R6g%ì ~Ν e%+QJ.di*R=Ҍ7u+t(yh uٻ:?臅#B;vѹ8F`$%.>$pUSConstraints on Payment Rates(~Hospitals and other institutional providers Formula for market-basket increases Congressional adjustments Physicians Formula based on the  sustainable growth rate Congressional adjustments `,? I,? IL Constraints on Payment Rates (2)!!(Medicare Advantage Formula in law (2004 = 107% of fee-for-service) Move to bidding system Medicare Part D Bidding system Fixed government share of total costsLH5H5MIncreased Cost Sharing(/Beneficiaries pay a share of their health costs First-day Part A hospital deductible ($912) Part B deductible ($110) 20% coinsurance for Part B services Reduces government costs Encourages cost-conscious purchasing, reducing use of discretionary services But could impede the use of appropriate services60i0iN Modifying the Volume of Services!!(Identifying efficient providers and promoting efficient care patterns Provider profiling Disseminating information to enrollees and providers Creating payment incentives ( pay for performance ) Disease management, care coordination&FFU$Modifying the Volume of Services (2)%%(dPay only for appropriate care, regardless of efficiency Prior authorization of services Coding edits&8-8-O$Influence Price or Costs of Services%%(Bundled payments Pay differentially, e.g., based on site Make more use of hospitalists, intensivists Competitive bidding to establish price Durable medical equipment 6J QPLimit Provider Participation(Competitive bidding to designate winners Durable medical equipment Selective contracting Centers of excellence Demonstration: coronary artery bypass grafts (1991-1996) `),9),9V"Medicare s Future(Continued adjustment of payment systems Innovative approaches to purchasing services in the fee-for-service environment Increased enrollment in managed care  Comparative Cost Adjustment Program Demonstration of premium support system, starting in 2010 (MMA) MMA provision to trigger review of spending if Medicare spending exceeds 45% general revenue@Z@Z]Z@]/       0` ̙33` ` ff3333f` 333MMM` f` f` 3>?" dd@,|?" dd@   " @ ` n?" dd@   @@``PR    @ ` ` p>>L0  p(    6  P   T Click to edit Master title style! !  0N     RClick to edit Master text styles Second level Third level Fourth level Fifth level!     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S @ 6+  `P  ,  P*   @ 6l `  +  R*  H @ 0޽h ? ̙3380___PPT10.$w 0( (>   0L P    X*   0 S     Z*   6W `P   X*   6 [ `   Z* H  0޽h ? ̙3380___PPT10.$y 0L0 Px(  l  C <     l  C  P   XB  0D@pH  0޽h ? 3y___PPT10Y+D=' = @B +  0L0  h(  hx h c $P    h0 BA ?  ; h T ?"6@ NNN?Nk yGSource: Centers for Medicare & Medicaid Services, Office of the ActuaryHHBH h 0޽h ? ̙33___PPT10i.Q̠+D=' = @B +  0L0  (  x  c $ `p   x  c $x ``  XB  0DppH  0޽h ? 33g___PPT10i.Hp@\+D=' = @B +  0L0 0 (  x  c $( `p   x  c $(``  XB  0DppH  0޽h ? 33g___PPT10i.Hp@\+D=' = @B +  0L0 (  x  c $Ђ `p   x  c $  XB  0DppH  0޽h ? 33g___PPT10i.Hp@\+D=' = @B +   0L0  P (  ~  s *hp   ~  s *@  XB  0DppH  0޽h ? f [f f3̙y___PPT10Y+D=' = @B +   0L0  l(  lx l c $ `p   x l c $  XB l 0DppH l 0޽h ? 33g___PPT10i.Hp@\+D=' = @B +   0L0 @ (  x  c $| `p   x  c $T  XB  0DppH  0޽h ? 33g___PPT10i.Hp@\+D=' = @B +   0L0  p(  px p c $ `p   x p c $x``  XB p 0DppH p 0޽h ? 33g___PPT10i.Hp@\+D=' = @B +   0L0  t(  tx t c $$ `p   x t c $``  XB t 0DppH t 0޽h ? 33g___PPT10i.Hp@\+D=' = @B +  0L0  x(  xx x c $7 `p   x x c $8``  XB x 0DppH x 0޽h ? 33g___PPT10i.Hp@\+D=' = @B +  0L0 ` (  x  c $ `p   x  c $x``  XB  0DppH  0޽h ? 33g___PPT10i.Hp@\+D=' = @B +  0L0  |(  |x | c $ `p   x | c $`  XB | 0DppH | 0޽h ? 33g___PPT10i.Hp@\+D=' = @B +  0L0  (  x  c $2 `p   x  c $pE``  XB  0DppH  0޽h ? 33g___PPT10i.Hp@\+D=' = @B +  0L0 p (  x  c $d  `p    x  c $t ``   XB  0DppH  0޽h ? 33g___PPT10i.Hp@\+D=' = @B +v 0 6.( L_dw0Ut R  3 @   * 4  C w@ @   Public Sector Initiatives to Control Costs: Controlling Costs in Medicare: Jack Hoadley, Research Professor, Georgetown University, Health Policy Institute, Presentation to Citizens Health Care Working Group, May 13, 2005.H  0޽h ? ̙33J 0   (  X  C @     S hѐ@ @   Except for 1993-1997, Medicare spending per enrollee during the past 30 years grew at a slower rate than private health insurance spending.H  0޽h ? ̙3380___PPT10.WQ 0 }u  (  X  C @   u  S ڐ@ @   Medicare is different from other programs: it is restricted from practicing medicine, administrative resources come out of the actual service expenditures, the program is huge, and there are great potentials for market-wide effect from policy changes.H  0޽h ? ̙3380___PPT10.WR 0 G? (  X  C @   ?  S @ @   Other factors that make Medicare different are the political environment, beneficiary freedom of choice, its unique patient population (more disabled and elderly), and its unique benefit structure.H  0޽h ? ̙3380___PPT10.W5I 0 )! (  X  C @   !  S @ @   Medicare seeks to control costs by: constraining payment rates, increasing beneficiary cost sharing, modifying the volume of services and other administrative changes.H  0޽h ? ̙3380___PPT10.W}ibT 0 (  (  X  C @      S @ @   Principles of Medicare Payment: ensure access, incentives for provider efficiency, similar payment for services irrespective of setting; and control program spending.H  0޽h ? ̙3380___PPT10.WyoK 0  (  X  C @     S l@ @   mPayment systems include: traditional cost-based, prospective payment systems, and fee schedules (physicians).H  0޽h ? ̙3380___PPT10.W JS 0  Z(  X  C @     S T@ @   \HConstraints on payment rates include: hospital formulas for market-basked increases, Congressional adjustments, and physician formula for  sustainable growth rate. H  0޽h ? ̙3380___PPT10.W,L 0   (  X  C @     S @ @   Additional constraints on payment rates  formulas may be doing  too good a job so Congress then has to make statutory changes to adjust the mandated methods for payment rates. Medicare Advantage has a formula in law (about 107% of fee-for-service), is moving to a bidding system to constrain prices. For Part D, prescription drugs, there is also a bidding system with fixed government share of total costs hoping that the market will keep prices down.H  0޽h ? ̙3380___PPT10.W0VM 0  f(  X  C @     S  ~@ @   hTBeneficiaries share in costs. Increased cost sharing is a device to control costs. H  0޽h ? ̙3380___PPT10.W\jN 0  z(  X  C @     S @ @   |hAnother cost control mechanism is to modify the volume of services by promoting efficient care patterns.H  0޽h ? ̙3380___PPT10.WPqUU 0 0 e(  X  C @     S @ @   gS Coding edits and requiring prior authorization of services can help control costs.H  0޽h ? ̙3380___PPT10.W2,O 0 LD@ (  X  C @   D  S \@ @   Other cost control methods include: payments can be bundled; there can be differential payment levels; certain lower cost settings can be encouraged; there can be competitive bidding to establish price.H  0޽h ? ̙3380___PPT10.WmP 0 2*P (  X  C @   *  S @ @   Provider participation can be limited through competitive bidding, selective contracting, and recognizing and utilizing centers of excellence. jH  0޽h ? ̙3380___PPT10.WV 0 6.` (  X  C @   .  S B@ @   Medicare s future: continued adjustment of payment systems; innovative approaches to purchasing services in fee-for-service; increased enrollment in managed care; in 2010, the  comparative cost adjustment program to compete for fee-for-service, and MMA provision to trigger review of spending if Medicare spending exceeds 45% of general revenue.H  0޽h ? ̙3380___PPT10.W@^ jxml\qvg\ @iePZ G| 98G 䪨AJQd $*\*ď6|U⣔TMKE!w>|6{3s#qՊzmH)&k {q&''I|J7 8`= sM5XsNIUv ܴaD i/% l.>5?C(pG)]l?~oBp'ys: ?2Au] cR?u+Be8N+l`B…M0~YLZP]xK/xQ|oߔ"H3]LR j.ga1Ba B] #\p !K sty~sigdt d_5z2?c=B!ߤ'߂ a5 wz(DY*?勒O(չ_ q({7mÃ;{ Ñ}8{ Wb'qW2NΤ.u%+, /۲,XW3`7X[dEGtPErI ]u?ey{1[=&7MS[PMנWB߳Ls2DWʭ5Nm9uKң ]ג)ْh6mm у6ژ /}߂IRܿ dDx!&1T[uuI!&=30"R؂>lw֣ BJkrJ ~+D^r1l4qD<)̗AѴչE?F5磶zt똸5 ­pwLܸp,\YN1#YA}#n{Z:qC7ܵ/e A.ƛR:y>ʙQ dQULELN!^{MfRumF t_rUBLZ/}IR|@|%3:^=|2I8xQUIir;|bI 13}I{'ybؚ` ={@"\׌0ƀfr1@~LЌ>,5$. LfCpoD :][ׄW66+4̈́]. 붰+aPatD{E.<3P}kn9ܦPP(yqr8w5M}|۪mn<7kZG"hhdG/q`ÑmP*/>Q /)3l+#/g E(fxh_^n2Po>8RT+]{]EAj2HԁbDݼ҃k^lUWçUbQJC ~D\pґ݆qUuw/G'#9[oKO׏*=r#\ġ6W wc/ے9L]M:\o@Jeyv4|:Xt=jMmօV6>ţ3AۓFZlݠt= Gi25PqtFN GjҬwn% YF-پ@/Z2ބ8,2.5cY$:qy똮q|}6vIjusFU#I:.3hWjGp-l4fwAeڊc&fj12gA=$Qb̃J.lK,AfYrxQv;K&P"o+FZ%췧Nę'b/{! W_6 dqD[E6ށzorIe8ߗe?%KGfHVHu_Ҹ uiimΛ H|!1-+MH0Bk6~tj9tZч=WfdP]$(CNfA~C\R四Yh5X\C\&||(.ωF/L>rWM,蛠G1?E҆nTqf!e{wƣ16v;}cH+lH&U.Bl!gw^fJ\  <[+\npO?b\3CV&,L^Œ-=Cp!&`* [u.q!&cUn40ĄKR&ǥNhUDȤq/ 1q˪kaqCL0-D8ch I:CL40LGsgyscr4̕3vmgi8y|Oՙ4•[r wLq0qnp,\pA pT vq%Lz#܇C (+fjl( fa{zVMr1>RBb6<~AաUH*fYFej?:J9nffZ`{46RkڹPk"|9h7?ny̚ ׬ sل{xH7ʹ1446,OYjsЩW^x3*/^8$vX;ݜ'.皦l7*b):e@ k6TsQ\GW]ad#j,m@KNTZg5pvQyV|%ցOA®1Oh+'0 px  NASI conferenceJFHWhyde243Microsoft PowerPoint@PV@dI@վj@/nlPG g  F  y--$xx--'--% nn--'@Times New Roman-.  2 t1."System-@Times New Roman-. 32 Controlling Costs in Medicare.-@Times New Roman-. 2 0? Jack Hoadley.-@Times New Roman-. "2 7:Research Professor.-@Times New Roman-. '2 ?4Georgetown Universityt.-@Times New Roman-. *2 F5Health Policy Institute.-@Times New Roman-. 2 UCitizens.-@Times New Roman-.  2 U3.-@Times New Roman-. -2 U7Health Care Working Groupc.-@Times New Roman-. F2 \*Public Sector Initiatives to Control Costs.-@Times New Roman-. 2 d@ May 13, 2005.---%!!--'0՜.+,0     On-screen Show Georgetownt Times New RomanArialDefault DesignMicrosoft Graph ChartControlling Costs in MedicareGSpending Growth Per Enrollee, Medicare versus Private Health InsuranceWhat Makes Medicare Different?#What Makes Medicare Different? 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