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It has been proposed that Medicare pay for inpatient physicians' services on a per-case basis, giving physicians an incentive to economize on services delivered in the hospital. This report outlines the design of a possible demonstration of a system of per-case payment and considers the following key issues in developing such a design: (1) selecting the options most attractive to demonstrate, (2) participation in the demonstration, (3) setting payment rates, (4) site selection, and (5) evaluation of the demonstration. The demonstration would seek to determine how alternative methods of paying physicians would affect costs, beneficiary access and financial liability, and health status outcomes or quality of care.
Clinical laboratory tests play an integral role in helping physicians diagnose and treat patients. New developments in laboratory technology offer the prospect of improvements in diagnosis and care, but will place an increased burden on the payment system. Medicare, the federal program providing coverage of health-care services for the elderly and disabled, is the largest payer of clinical laboratory services. Originally designed in the early 1980s, Medicare's payment policy methodology for outpatient laboratory services has not evolved to take into account technology, market, and regulatory changes, and is now outdated. This report examines the current Medicare payment methodology for outpatient clinical laboratory services in the context of environmental and technological trends, evaluates payment policy alternatives, and makes recommendations to improve the system.
A panel of recognized authorities comprehensively review the medical, surgical, and pathophysiologic issues relevant to lung volume reduction surgery for emphysema. Topics range from the open technique and video-assisted thoracoscopic approaches to LVRS, to anesthetic management, to perioperative and nursing care of the patient. The experts also detail the selection of candidates for LVRS, the clinical results and clinical trials in LVRS, and the effects of LVRS on survival rates.