In the new Hospital Value-Based Purchasing (VBP) Program, Medicare rewards hospitals that provide high quality care at competitive costs for their patients. Since October 2012, hospitals nationwide are being paid for inpatient acute care services based on documented quality care measures rather than the volume of services.
Established under the Affordable Care Act, the Hospital VBP Program has implemented a pay-for-performance approach to the payment system that accounts for the largest share of Medicare spending, affecting payment for inpatient stays in over 3,500 hospitals across the country.
“Instead of payment that asks, ‘How much did you do?’ the Affordable Care Act clearly moves us toward payment that asks, ‘How well did you do?’ and more importantly, ‘How well did the patient do?’” according to Dr. Don Berwick, Centers for Medicare and Medicaid Services (CMS) Administrator.
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About 70 percent of people turning age 65 can expect to use some form of long-term care during their lives, according to the U.S. Department of Health and Human Services.
Do you know what Medicare covers?
Medicare covers medically necessary care, such as doctor visits, drugs, and hospital stays. Medicare coverage also includes short-term services for conditions that are expected to improve, such as physical therapy to help you regain your function after a fall or stroke. In addition, Medicare covers a short stay in a skilled nursing facility or for home health care services as long the following conditions are met:
- You have had a recent prior hospital stay of at least three days.
- You are admitted to a Medicare-certified nursing facility within 30 days of your prior hospital stay.
- You need skilled care, such as skilled nursing services, physical therapy, or other types of therapy.
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Medicare released pricing information for more than 3,300 U.S. hospitals on the top 100 procedures and treatments in 2011.
Comparison shopping has taken on a whole new meaning thanks to the release of government data that shows hospitals across the country and within the same geographic region are charging significantly different rates for identical inpatient services.
This data provided by the federal Center for Medicare and Medicaid Services marks the first time information about hospital rates has been released publicly. With increased transparency, consumers (particularly those who are uninsured or have limited coverage) can shop more wisely for health care.
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