A
recently published report helps smack down a few common myths
and misstatements concerning Medicare payments to hospitals. It is
available as free full text here.
Myth # 1: Medicare is a
fee-for-service system of reimbursement.
This is true only
for part B Medicare. For part A, under which hospitals are
reimbursed, the payment is a lump sum based on the diagnosis.
Although that payment can be modified based on certain severity
indicators there is no direct payment for services rendered. If
Medicare paid hospitals for the services rendered it would be a
retrospective, rather than a prospective payment.
Myth # 2: The wildly popular use of
cardiac stents is driving health care costs out of control.
Not for acute
coronary syndrome, which accounts for about two thirds of stents,
according to the article. Following an uptick attributable to the
shift from bare metal to drug eluting stents costs stabilized and,
when adjusted for inflation, decreased slightly according to the
report. To stretch the point a bit further just go back to the days
before the reperfusion era of double digit mortality and two week
lengths of stay. Scientific advancement, not external pressure, has
driven the improvements in emergency cardiac care.
Myth # 3: The use of cardiac stents
has been a big money maker for hospitals.
It's really quite
the opposite. Cardiac stents have been a money loser. According to
the report, Medicare payments fall short of estimated costs for
patients hospitalized for ACS who receive emergency PCI.
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