The task of controlling healthcare spending has been passed along to state governments, public and private payors and to providers themselves. These professionals are faced with the task of designing and implementing reimbursement rates in an era of managed care. This book aims to provide assistance to healthcare professionals who are responsible for developing and implementing rate setting systems. It features five case studies of states that have successfully implemented different types of rate structures, details methods and admininstration techniques for both hospitals and physicians, discusses the organizational structure of different rate setting systems, and examines how to determine and update hospital payment rates through different techniques.
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Hospital & Physician Rate-Setting Systems is designed to give both payers and providers a conceptual overview of the challenges and methods of hospital and physician rate-setting, complemented by several real world examples of federal and state rate-setting actions. As a systematic guide, this book provides answers to the sequence of questions and issues that need to be resolved in crafting reimbursement rates. It becomes a "consultant-services-in-print" by providing perspective, encouragement and indirect experience to the various rate-setting system approaches. Hospital & Physician Rate-Setting Systems will detail the best practices of five states' rate-setting programs and the issues surrounding implementation; explain how rate-setting can be used to strengthen managed care initiatives; prompt readers to answer the necessary policy and technical questions; describe and lay out the steps for structuring and implementing a rate-setting body; show how to bundle physician with hospital services in a single inpatient global rate, aligning the incentives to promote efficient care delivery; and familiarize readers with the characteristics of the rate-setting bureau and commission and the authorities leading them.
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