Publications

In 2000, CMS introduced the Outpatient Prospective Payment System (OPPS), which reimbursed hospitals at a predetermined rate rather than at their actual costs. This study examined whether the OPPS caused outpatient care to shift towards the inpatient setting for inguinal hernia repair surgery, one of the most commonly-performed surgical procedures in the U.S.

Americans today are living longer than at any point in the nation’s history.  In a recent article in The Washington Post, Ezra Klein notes how this phenomenon and the prevalence of chronic illnesses is both challenging the U.S. health care system.

The Medicare Outpatient Prospective Payment System (OPPS) was established by the Balanced Budget Act of 1997 as an attempt to simplify and reduce Medicare payments for hospital outpatient services by creating a new fee schedule. HCFO researchers studied the effects of the OPPS on how much outpatient care is provided by Florida hospitals and who pays for it.

Over the past two decades, a wave of hospital mergers and acquisitions has resulted in many highly concentrated hospital markets across the United States.  This phenomenon has raised concerns that consolidated hospitals are using their increased bargaining power to secure higher prices from health plans, thereby adding to the nation’s already unmanageable health care costs.

Reducing health care costs dominates current health policy discussions, raising important questions about who is responsible for bending the cost curve. A recent article in The Boston Globe explores the challenges providers face in becoming better stewards of health care resources.

Millions of uninsured Americans are potentially one major illness away from financial catastrophe. When faced with a major illness, individuals without health insurance may need to draw on multiple financial resources, including retirement savings, to cover medical bills.

Medicaid bed-hold policies may increase the likelihood of hospitalization of long-stay nursing home residents and increase costs for the federal Medicare program.

The cost of providing employer-sponsored insurance coverage continues to rise, and new legislation requires employers with at least 50 employees to offer affordable coverage or face a financial penalty. Employers are responding in a variety of ways to rein in their health expenditures while complying with these new regulations.

Medication adherence is critical to the management of chronic conditions. Yet, many patients forgo medication when confronted with unmanageable or rising medication costs, a phenomenon termed cost-related nonadherence.

Substituting generics in place of more costly brand-name alternatives has the potential to lower drug spending for health plans. This study examined benefit and formulary design in Medicare Part D plans to determine their impact on generic drug use for cholesterol medication (statins) and to estimate potential savings to Medicare from generic substitution.