Posts categorized as: Costs and Competition

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What to Ask (About) a Hospital

Through a collection of fact-sheets on hospital payment streams, various designations, and key sources of information, this guide offers a starting point to understand the organizational and financial differences across hospitals in the United States. This document provides key questions to ask a hospital – about ownership, type of care, location, type of patients, teaching status, and alternative payment – the answers to which can help better understand the regulations under which a hospital operates, the funding streams it may have available, and other factors that influence its business practices and financial status. This document overviews key terms, concepts, and measures related to hospital revenue from three payment types: Medicare, Medicaid, and commercial insurance. This series of fact sheets describe how a hospital’s organization form influences its business and financial operations, eligibility for federal programs, and level of government oversight and public reporting requirements. This series of fact sheets overviews subsection (d) hospitals (“general acute care hospitals”) and Medicare-recognized specialty hospitals, explains how these hospitals are treated under Medicare and 340B, and provides descriptive statistics for each hospital type. This series of fact sheets explain how a hospital’s location influences how and what it gets paid by Medicare, as well as explains how each type of rural hospital is treated under Medicare and 340B, and provides descriptive statistics for each rural hospital type. This series of fact sheets describe how “safety-net hospitals” – Medicare and Medicaid disproportionate share hospitals (DSH) and 340B hospitals – quality and are paid under their respective federal programs, and provides descriptive statistics for each program. This series of fact sheets define graduate medical education and describe U.S. teaching hospitals with key descriptive statistics on institutional characteristics. This series of fact sheets defines the goals of alternative payment models and describes the Medicare Shared Savings Program as well as a range of Centers for Medicare & Medicaid Services Innovation Center models. This document identifies key sources for understanding an individual hospital’s ownership, regulatory and payment classification, and its financial, operational, and quality performance beyond what is covered in the What to Ask (About) a Hospital guide.

Corporatization of Health Care, Costs and Competition, Provider Costs and Billing Reform, Transparency

The Complex Web of Health Care Financial Interests and Their Implications for Ever Higher Spending: An Expert Perspective

Achieving cost containment in healthcare requires an understanding of the complex, often opaque, financial relationships now systemically connecting private insurers, providers, and middlemen businesses, and which are characterized by cost increasing incentives, conflicts of interests, and money flows unrelated to value or quality of care for patients.

Corporatization of Health Care, Costs and Competition

Insulin-Requiring Diabetes Coverage, Affordability, and Access in State-Regulated Private Health Insurance

This issue brief focuses on how cost-sharing requirements affect access to insulin-requiring diabetes care and examines state policy options to improve the affordability of diabetes medications, devices, and supplies in the private insurance market. This issue brief focuses on how prior authorization practices affect access to insulin-requiring diabetes care and outlines state policy options to improve the use of utilization management for clinically appropriate diabetes treatment. This state spotlight examines how Colorado and the District of Columbia used standardized plan design and stakeholder engagement to reduce cost-sharing and expand access to clinically recommended diabetes care.

Costs and Competition, Health Insurance Coverage, Provider Costs and Billing Reform

Outpatient Facility Fee Reform Strategies: A Cheat Sheet on Key Goals and Strategies for Policymakers

This cheat sheet outlines state-level policy options—such as site-neutral payment caps, facility fee billing prohibitions, billing and ownership transparency requirements, outpatient facility fee reporting requirements, coverage and cost-sharing protections, and consumer disclosures—to reform outpatient billing practices by protecting consumers, reducing health care costs, and increasing transparency.

Costs and Competition, Provider Costs and Billing Reform, Transparency

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