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Government funded health care: Medicare and Medicaid
Medicare and Medicaid ,[object Object],[object Object],[object Object]
Differences in MCare & MCaid ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Other differences ,[object Object],[object Object],[object Object]
Medicare
How does Medicare work ,[object Object],[object Object],[object Object],[object Object]
Two parts to Medicare: Part A ,[object Object],[object Object],[object Object],[object Object]
Part B ,[object Object],[object Object],[object Object],[object Object]
Part C ,[object Object],[object Object],[object Object],[object Object],[object Object]
Part D ,[object Object],[object Object],[object Object],[object Object]
Part D  ,[object Object],[object Object],[object Object],[object Object]
Medicare growth: 1970-97 (enrollees in millions; costs in billions) Cost: $381/ person Cost: $5,631/ person
Life expectancy at age 65
Where does Medicare money go? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Where does Medicare money go? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
What do you get? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
What do you get? ,[object Object],[object Object],[object Object],[object Object],[object Object]
Medicare payments ,[object Object],[object Object],[object Object],[object Object],[object Object]
Who decides what is “medically necessary”? ,[object Object],[object Object],[object Object],[object Object],[object Object]
What does Medicare pay? ,[object Object],[object Object],[object Object],[object Object]
What if your fee is more than the “Medicare allowable” ,[object Object],[object Object],[object Object]
Medicare reimbursement ,[object Object],[object Object],[object Object],[object Object],[object Object]
Medicare reimbursement reform ,[object Object],[object Object],[object Object]
RBRVS ,[object Object],[object Object],[object Object]
Payment reform ,[object Object],[object Object]
Examples of RVUs ,[object Object],[object Object],[object Object],[object Object],[object Object]
Other RVUs ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
So how does this work? ,[object Object],[object Object],[object Object]
Upcoming changes in RVUs ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Hospital payment: Prospective payment (DRG) system ,[object Object],[object Object],[object Object],[object Object],[object Object]
What is a DRG? ,[object Object],[object Object],[object Object],[object Object]
Example DRGS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
How are DRG costs set? ,[object Object],[object Object],[object Object],[object Object],[object Object]
Might get reports like this 127 HEART FAILURE & SHOCK Number of DRG 24     Total LOS 66     Average  LOS 2.8     Total Charges $105,164.00     Average Total Charge $4,381.83     Total Cost (78% of charges) $82,027.92     Average  Total Cost (78% of total charges) $3,417.83     Medicare Average National Payment $4,154.00     Medicare Average LOS 5.5
Shift in Medicare concerns ,[object Object],[object Object],[object Object]
Other feature of Medicare: GME ,[object Object],[object Object],[object Object],[object Object]
Future of Medicare ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Report cards ,[object Object],[object Object],[object Object]
Medicaid
Medicaid ,[object Object],[object Object],[object Object],[object Object]
Program available for M’caid ,[object Object],[object Object],[object Object],[object Object],[object Object]
Medicaid Payments (1997) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Medicaid funding ,[object Object],[object Object],[object Object]
Dealing with lack of MCaid funds ,[object Object],[object Object],[object Object],[object Object]
Eligibility requirements ,[object Object],[object Object],[object Object],[object Object],[object Object]
Medicaid payments ,[object Object],[object Object],[object Object]
How do states stack up ,[object Object]
Oregon Health Plan ,[object Object],[object Object],[object Object]
The Oregon Plan ,[object Object],[object Object],[object Object]
Example of the list ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Legislature provides $200 million ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Legislature provides $210 million ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Other key component of plan ,[object Object],[object Object]
Future of Medicaid ,[object Object],[object Object],[object Object],[object Object]

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Medicare and medicaid

  • 1. Government funded health care: Medicare and Medicaid
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  • 12. Medicare growth: 1970-97 (enrollees in millions; costs in billions) Cost: $381/ person Cost: $5,631/ person
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  • 34. Might get reports like this 127 HEART FAILURE & SHOCK Number of DRG 24     Total LOS 66     Average LOS 2.8     Total Charges $105,164.00     Average Total Charge $4,381.83     Total Cost (78% of charges) $82,027.92     Average Total Cost (78% of total charges) $3,417.83     Medicare Average National Payment $4,154.00     Medicare Average LOS 5.5
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