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Toil and trouble over outpatient prospective payment
Health Cost Management
|December 11, 1987
Summary
Healthcare Financial Administration (HCFA) is exploring a Medicare outpatient prospective payment system (PPS). Other payers are developing similar systems to control ambulatory care costs.
Area of Science:
- Health policy and administration
- Healthcare economics
- Ambulatory care management
Background:
- Healthcare payers are facing increasing ambulatory care costs.
- Existing payment models may not adequately control outpatient expenditures.
- The Centers for Medicare & Medicaid Services (CMS) is evaluating new payment structures.
Purpose of the Study:
- To report on the status and timing of proposed outpatient prospective payment systems (PPS).
- To analyze the implications of potential Medicare outpatient PPS mandates.
- To examine the development of non-Medicare outpatient PPS by third-party payers.
Main Methods:
- Review of current policy considerations by the Health Care Financing Administration (HCFA).
- Analysis of initiatives by third-party payers for non-Medicare enrollees.
- Compilation of perspectives from various participants and observers in the healthcare industry.
Main Results:
- HCFA is considering a mandatory Medicare outpatient PPS.
- Several third-party payers are independently developing outpatient PPS models.
- These initiatives aim to reduce overall ambulatory care spending.
Conclusions:
- The healthcare landscape is evolving with new outpatient payment models.
- Anticipated changes in payment systems could significantly impact healthcare providers.
- Cost containment in ambulatory care remains a key focus for payers.