ABSTRACT
The Federal Register is used as a historical record documenting the interaction between the Health Care Financing Administration (HCFA) and health care providers in the regulation of outpatient surgery services to Medicare patients. A content analysis of the Federal Register reveals that HCFA is more likely to accommodate requests for clarification, for shifting services among payment levels, and for adding or deleting services from coverage than for altering payment methods. These findings can be used by health care providers to develop strategies for coping with the expansion of prospective payment to all outpatient services.
Subject(s)
Centers for Medicare and Medicaid Services, U.S. , Government Publications as Topic , Medicare/legislation & jurisprudence , Outpatient Clinics, Hospital/economics , Outpatient Clinics, Hospital/legislation & jurisprudence , Prospective Payment System/legislation & jurisprudence , Ambulatory Care/classification , Ambulatory Care/economics , Facility Regulation and Control , Humans , Interinstitutional Relations , United StatesABSTRACT
Two generalized game theory models are developed to explain observed management decisions between two large hospitals in Shelby County Tennessee within the regulatory context of competition for an advanced radiological technology pursued through the certificate-of-need process. The first model rationalizes each hospital's decision to submit competing certificate-of-need applications. The second model rationalizes the eventual joint venture agreement between the two hospitals and offers an explanation as to why the technology has yet to be acquired. The models are tested through interviews with the hospital administrators responsible for negotiating the joint venture agreement. The interviews confirm a preemptive motive behind each hospital's decision to compete and that the certificate-of-need requirement contributed to the eventual joint venture agreement.
Subject(s)
Certificate of Need/legislation & jurisprudence , Decision Making, Organizational , Economic Competition , Hospital Planning/legislation & jurisprudence , Tomography, Emission-Computed/economics , Certificate of Need/economics , Cooperative Behavior , Costs and Cost Analysis , Game Theory , Hospital Planning/economics , Hospital Shared Services , Interinstitutional Relations , Negotiating , Radiology Department, Hospital/economics , TennesseeABSTRACT
Using multivariate analysis, this study evaluates the relationship between socioeconomic status and hospital resource utilization as measured by length of stay for elderly Medicare patients, age 65 and older, within Shelby County, Tennessee. Variations in length of stay are compared across income groupings for seven different Diagnosis Related Groups (DRGs) and relative effects are measured for socioeconomic status, age, race, gender, discharge status, and severity of illness. Despite the lack of provider specific and patient specific information, the analysis does suggest that, once patients access the medical care system, socioeconomic status has a limited effect on discharge decisions. The results also indicate that the effect of administratively necessary days on length of stay needs further policy review.
