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Acute Care: Trends in Hospital and ASC Payment Policy and Their Impact on the Device Industry

Acute Care: Trends in Hospital and ASC Payment Policy and Their Impact on the Device Industry. Parashar Patel Health Economics & Reimbursement Boston Scientific Medical Device Congress March 29, 2007. The Road Ahead. IPPS. Inpatient payments: the journey continues

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Acute Care: Trends in Hospital and ASC Payment Policy and Their Impact on the Device Industry

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  1. Acute Care: Trends in Hospital and ASC Payment Policy and Their Impact on the Device Industry Parashar Patel Health Economics & Reimbursement Boston Scientific Medical Device Congress March 29, 2007

  2. The Road Ahead IPPS • Inpatient payments: the journey continues • Outpatient payments: the road already traveled? • Ambulatory surgical centers: rest break over? OPPS ASCs

  3. Inpatient: the journey continues • Major Policy Issues • From costs to charges to costs • Transition to cost-based weights, starting FY 2007 • How much variation is too much? • “traditional standardized charges”…HSRV…HSRVcc…??? • Severity versus complexity • CMS-DRGs…APR-DRGs…CSA-DRGs…??? • How well do they recognize current technology? • How well will they recognize future technology? • From IME to P4P • Don’t forget the big (literally!) picture: ….how much is the update…and what should it pay for? • So What? • Manufacturer • Will our customers have ability to provide new treatments? • Hospital • I can use redistribution to squeeze price from my vendors!

  4. Outpatient: the road already traveled? • Major Policy Issues • Cost-based weights since inception (2000) • Spending out of control, again! • Lower growth in services but complexity increases • Cost-based rates not accurate enough? • So What? • Manufacturer • If not inpatient and if not outpatient, then where? • Hospital • I’m getting squeezed on both sides, so what can you do for me? • Do I look elsewhere…maybe ASCs?

  5. ASCs: rest break over? • Major Policy Issues • Costs or equal payments across sites of service? • OPPS=ASC=MD Office? • Should reflect costs…but what is cost? • GAO…MedPAC…FASA…CMS…??? • How well does system recognize current technology? • How will system recognize new technology? • What about quality and P4P? • So What? • Manufacturer • If not in the hospital, then the ASC? • Hospital • Will new ASC system drive services to ASCs? • “Great!!” OR “Why are we left holding the bag??”

  6. ANSWERS?

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