Amounts billed for teaching physician services and paid by Medicare carriers were reviewed by the General Accounting Office (GAO) to determine whether such payments had been made only where the physicians had satisfied the requirements of the Social Security Act. Attention was focused on the requirement that teaching physicians must provide a…

Purpose: We identified the types of home-and community-based services (HCBS) that high-risk older adults in Medicare managed care used, and we examined participant characteristics associated with service use in six areas: overall service use, four specific categories of HCBS, and referrals to insured medical services. Design and Methods: We used…

Purpose: The purpose of this work was to, among frail dually eligible older adults, determine risk factors for the likelihood of using Medicare home health and Medicaid home health services and to, among service users, determine correlates of Medicare home health, Medicaid home health, and Medicaid waiver service expenditures. Design and Methods:…

Focuses on the elderly poor and the role of both private and public insurance in supplementing Medicare. Examination revealed that those who depend exclusively on Medicare incur substantial out-of-pocket costs, although they use fewer services than those who also have Medicaid or private insurance. (Author/NRB)

Context: Alzheimer's patients living in rural communities may face significant barriers to effective outpatient medical care. Purpose: We sought to examine rural-urban differences in risk for ambulatory care sensitive hospitalizations (ACSH), an indicator of access to outpatient care, in community-dwelling veterans with dementia. Methods: Medicare…

This article compares three methods for estimating the medical cost burden of intimate partner violence against U.S. adult women (18 years and older), 1 year postvictimization. To compute the estimates, prevalence data from the National Violence Against Women Survey are combined with cost data from the Medical Expenditure Panel Survey, the…

Background: In the mid-1990s, significant gaps existed in the quality of acute myocardial infarction (AMI) care between rural and urban hospitals. Since then, overall AMI care quality has improved. This study uses more recent data to determine whether rural-urban AMI quality gaps have persisted. Methods: Using inpatient records data for 34,776…

The General Accounting Office reviewed the effects of major legislative changes on Medicare and Medicaid program costs and the out-of-pocket costs to the programs' beneficiaries. Of 30 laws that affected Medicare and Medicaid enacted by Congress during the period 1980 through 1986, 5 were estimated to have the greatest effects on the costs of the…

Text of a Congressional hearing examining the plight of aging Americans, still at financial risk despite the help of Medicare and Medicaid, is presented in this document. Testimony or prepared statements are delivered by 17 Congressmen including Representatives Roybal, Jeffords, Renaldo, Hammerschmidt, Pepper, McCain, Manton, Fawell, Robinson,…

This consumer education document is intended to provide a complete description of Medicare's Prospective Payment System (PPS) for hospitals from the consumer's point of view and to provide basic information on how consumers can protect their rights to appropriate hospital care under Medicare. The first section describes the PPS and also explains…

Notes that, lacking objective, comprehensive information about health care coverage options, Medicare beneficiaries rarely understand consequences of alternative purchasing decisions. Describes Illness Episode Approach, method providing information on Medicare, Medigap policies, and Health Maintenance Organizations. Method described presents…

This report details changes and potential changes in Medicare Graduate Medical Education reimbursement, which encompasses both Medicare Direct Graduate Medical Education payments and Medical Indirect Medical Education payments, and reimbursement for residency training costs. Emphasis is placed on the implications for postdoctoral dental education…

Context: Few telemedicine projects have systematically examined provider satisfaction and attitudes. Purpose: To determine the acceptability and perceived impact on primary care providers' (PCP) practices of a randomized clinical trial of the use of telemedicine to electronically deliver health care services to Medicare patients with diabetes in…

Congress created the State Children's Health Insurance Program (SCHIP) to reduce the number of uninsured children in low-income families that do not qualify for Medicaid. States have flexibility in structuring their SCHIP programs, and their income eligibility limits vary. Concerns have been raised that individuals might substitute SCHIP for…

Context: National financial data show that rural referral center (RRC) hospitals have performed well financially. RRC hospitals' median cash flow margin ratio was 10.04% in 2002 and grew to 11.04% in 2004. Purpose: The aim of this study is to compare the ratio analysis of key operational and financial performance measures of for-profit RRCs to…