Title: Extent and Impact of the Use of Observations Stays in the Medicare Program
Institution: NORC
Principal Investigator: Janet Sutton, Ph.D.
Duration: February 2008 – September 2008
Paragraph Summary: The researchers will examine the extent of Medicare observation visits, as well as their implications. Observation visits, as distinct from inpatient visits, are covered under Medicare Part B, rather than Medicare Part A. This has implications for hospital payments, beneficiary copayments, and beneficiary eligibility for SNF coverage. The researchers will examine how observation stays are used in the Medicare program, as well as how they affect beneficiary out-of-pocket liability and hospital payments. The objective of this project is to better understand the extent to which observation visits, rather than inpatient visits, are used, as well as the implications for hospitals and beneficiaries.
Title: The Impact of Pay for Performance on Hospitals that Care for Minorities and the Poor
Institution: Harvard University School of Public Health
Principal Investigator: Ashish Jha, M.D., M.P.H.
Duration: February 2008 – July 2008
Paragraph Summary: The researchers will examine the impact of financial incentives to improve quality on hospitals that care for minority or other underserved populations. The Centers for Medicare and Medicaid Services have implemented pay for performance (P4P) demonstrations, and are considering implementing P4P nationally. However, the impact of P4P has not been widely evaluated. Hospitals that care for underserved populations may have greater potential for quality improvement; conversely these facilities lack the tools and resources to improve quality and compete for the additional resources. The researchers will examine changes in quality for hospitals in the Medicare Premier P4P Demonstration that serve disadvantaged populations (minority and poor); these changes will be compared with changes in hospitals in the demonstration that do not serve disadvantaged populations and with hospitals that serve disadvantaged hospitals not in the demonstration (and not subject to P4P). The objective of the project is to provide more information about the impact of P4P on hospitals that serve disadvantaged populations, and help policymakers to design incentive systems that encourage higher quality care without disproportionately harming hospitals that care for these populations.
Title: Measuring the Costs and Benefits of Medicare Private Fee-for-Service
Institution: Boston VA Research Institute Inc.
Principal Investigator: Steven D. Pizer, Ph.D.
Duration: February 2008 – January 2010
Paragraph Summary: The researchers will explore how private fee-for-service (PFFS) plans and beneficiary choices are affected by Medicare payment policy. PFFS plans cover services from any Medicare-qualified provider and pay physicians by fee-for-service. The researchers will measure the effects of payment changes on PFFS plan decisions regarding market entry, benefit design, and premiums and then analyze the effects of changes in benefits and premiums on enrollment. They will address the following research questions: (1) how would plan availability be affected if payment rates were reduced; (2) how would premiums and benefits be affected by changes in payment rates; and (3) how does the value to beneficiaries of the PFFS option compare to its cost to the taxpayers? The objective of the project is to inform policymakers about the costs and benefits of paying private Medicare health insurance plans.
Title: Medicaid Long-Term Care Programs: Simulating Rate Setting and Cross-Payer Effects
Institution: State of Maryland Department of Health and Mental Hygiene
Principal Investigator: Tricia Roddy
Duration: February 2008 – January 2010
Paragraph Summary: The researchers will examine issues related to setting Medicaid payment rates for capitated long-term care. In particular, they will establish a framework to examine an array of potential factors that affect both the calculation of capitation payment rates and the implications for cross effects between Medicaid and Medicare. Using data from Maryland, the researchers will: 1) examine alternatives for calculating and applying Medicaid payments; 2) integrate estimated and actual acute care expenditures in order to model the full spectrum of public program expenditures for dual eligibles; 3) explore the implications of including chronic conditions and functional status in rate-setting; and 4) examine how and to what extent Medicaid community supports affect Medicare acute care and Medicaid institutional resource use. The objective of this study is to provide administrators and policymakers at the state and federal level a better understanding of the interactive effects between Medicare’s acute care services and Medicaid’s long-term care services, as efforts to improve coordination of this care evolve.
