Step 4- If the hospital is an approved teaching hospital it receives a percentage add-on payment for indirect medical education (IME) for each case paid through the PPS. This percentage varies depending on the ratio of residents-to-beds.
Step 5- A hospital can receive an additional payment for those cases that include technologies that meet the new technology add-on payment criteria.
Step 6- Next, the costs incurred by the hospital for the case are evaluated to determine whether it is eligible for an additional payment as an outlier case. This additional payment is designed to protect the hospital from large financial losses due to unusually expensive cases. Any outlier payment due is added onto the MS-DRG-adjusted base payment rate.
ABOUT OXFORD OUTCOMES
Oxford Outcomes, Inc. is an international outcomes research agency specializing in health economics, health outcomes research, and policy analysis. Founded in 1997, Oxford Outcomes has provided consulting services to pharmaceuticals, medical devices, professional associations, hospitals and health systems, and all levels of government in the U.S., Canada, and the United Kingdom. The Health Economics practice consists of leading experts based in Morristown NJ, Vancouver BC, Toronto ON, and Oxford UK. Many of our experts are academic based, and the majority of Oxford Outcomes research projects result in publications in peer-reviewed medical, economics, and policy journals.
(1) Refer to TITLE IV--TRANSPARENCY AND PROGRAM INTEGRITY Subtitle A--Limitation on Medicare Exception to the Prohibition on Certain Physician Referrals for Hospitals
(2) J.E. Schneider et al., "The Effects of Physician-Owned Hospitals on Medicare Expenditures Per Capita: An Instrumental Variable Approach to Endogenous Market
|SOURCE Physician Hospitals of America|
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