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Secondary capitation is a relationship arranged by a managed care organization between a physician and a secondary or specialist provider, such as an X-ray facility or ancillary facility such as a durable medical equipment supplier whose secondary provider is also paid capitation based on that PCP's enrolled membership.
The Sunshine Act requires manufacturers of drugs, medical devices, biological and medical supplies covered by the three federal health care programs Medicare, Medicaid, and State Children's Health Insurance Program (SCHIP) to collect and track all financial relationships with physicians and teaching hospitals and to report these data to the Centers for Medicare and Medicaid Services (CMS).
HHN (Hospitals & Health Networks) Magazine. Archived from the original on 2011-07-11; Pham HH, Ginsburg PB, Lake TK, Maxfield MM (January 2010). "Episode-based payments: charting a course for health care payment reform" (PDF). Washington, DC: National Institute for Health Care Reform. Archived from the original (PDF) on 2010-08-19
Bundled payment is the reimbursement of health care providers on the basis of expected costs for episodes of care. It has been portrayed as a middle ground between fee-for-service reimbursement and capitation (in which providers are paid a "lump sum" per patient regardless of how many services the patient receives), given that risk is shared ...
National Inpatient Sample (NIS) (formerly the Nationwide Inpatient Sample): A 20 percent stratified sample of all-payer, inpatient discharges from U.S. community hospitals (excluding rehabilitation and long-term acute-care hospitals). The NIS is available from 1988 forward, and a new database is released annually, approximately 18 months after ...
The Bundled Payment for Care Improvement (BPCI) Initiative Pilot Program [19] gives healthcare providers a bundled payment for all of the care done at the inpatient facility, post-acute care facility, and other outpatient services. [20] The range of time for this care varies but the bundling time can start 3 days prior to the acute care. [20]
Delays in transfers can put people at higher risk of complications and derail day-to-day life for patients. 'We're at a standstill': Patients can face agonizing waits for hospital transfers Skip ...
Medicare's new prospective payment system with DRGs triggered a shift in the balance of political and economic power between the providers of medical care (hospitals and physicians) and those who paid for it - power that providers had successfully accumulated for more than half a century. [15]