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Boston Children's Hospital (formerly known as Children's Hospital Boston until 2013) [1] is the main pediatric training and research hospital of Harvard Medical School, Harvard University. [2] It is a nationally ranked, freestanding acute care children's hospital located at the centre of Harvard Longwood Medical and Academic Area in Boston ...
A prospective payment system (PPS) is a term used to refer to several payment methodologies for which means of determining insurance reimbursement is based on a predetermined payment regardless of the intensity of the actual service provided. It includes a system for paying hospitals based on predetermined prices, from Medicare.
Pay for performance systems link compensation to measures of work quality or goals. Current methods of healthcare payment may actually reward less-safe care, since some insurance companies will not pay for new practices to reduce errors, while physicians and hospitals can bill for additional services that are needed when patients are injured by mistakes. [1]
25 to 30 percent of hospital procedures are wasteful without improving the quality of care. [47] Unlike fee-for-service, bundled payment discourages unnecessary care, encourages coordination across providers, and potentially improves quality. [5] [48] Unlike capitation, bundled payment does not penalize providers for caring for sicker patients. [5]
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About 25% of U.S. healthcare costs relate to administrative costs (e.g., billing and payment, as opposed to direct provision of services, supplies and medicine) versus 10-15% in other countries. For example, Duke University Hospital had 900 hospital beds but 1,300 billing clerks during 2013.
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The Division of Health Care Finance and Policy defined by regulation what contribution level meets the "fair and reasonable" test in the statute. The regulation imposes two tests. First, employers are deemed to have offered "fair and reasonable" coverage if at least 25% of their full-time workers are enrolled in the firm's health plan.