Medicare Prospective Payment And The Shaping Of U.S. Health Care

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This is the definitive work on Medicare’s prospective payment system (PPS), which had its origins in the 1972 Social Security Amendments, was first applied to hospitals in 1983, and came to fruition with the Balanced Budget Act of 1997. Here, Rick Mayes and Robert A. Berenson, M.D., explain how Medicare’s innovative payment system triggered shifts in power away from the providers (hospitals and doctors) to the payers (government insurers and employers) and how providers have responded to encroachments on their professional and financial autonomy. They conclude with a discussion of the problems with the Medicare Modernization Act of 2003 and offer prescriptions for how policy makers can use Medicare payment policy to drive improvements in the U.S. health care system.Mayes and Berenson draw from interviews with more than sixty-five major policy makers―including former Treasury secretary Robert Rubin, U.S. Representatives Pete Stark and Henry Waxman, former White House chief of staff Leon Panetta, and former administrators of the Health Care Financing Administration Gail Wilensky, Bruce Vladeck, Nancy-Ann DeParle, and Tom Scully―to explore how this payment system worked and its significant effects on the U.S. medical landscape in the past twenty years. They argue that, although managed care was an important agent of change in the 1990s, the private sector has not been the major health care innovator in the United States; rather, Medicare’s transition to PPS both initiated and repeatedly intensified the economic restructuring of the U.S. health care system.

Paperback: 264 pages

Publisher: Johns Hopkins University Press; Reprint edition (May 12, 2008)

Language: English

ISBN-10: 9780801888557

ISBN-13: 978-0801888557

ASIN: 0801888557

Product Dimensions: 6 x 0.6 x 9 inches

Shipping Weight: 15.2 ounces (View shipping rates and policies)

Average Customer Review: 5.0 out of 5 stars  See all reviews (2 customer reviews)

Best Sellers Rank: #1,268,516 in Books (See Top 100 in Books) #50 in Books > Textbooks > Medicine & Health Sciences > Administration & Policy > Medicaid & Medicare #109 in Books > Medical Books > Administration & Medicine Economics > Medicaid & Medicare #334 in Books > Textbooks > Medicine & Health Sciences > Medicine > Clinical > Geriatrics

When asked about health care innovations, especially practices directed at controlling costs, most policymakers and wonks point to private sector solutions, such as the cost-constraining effects of HMOs in the 1990's or today's ideation of consumer-directed health plans. But is this conventional wisdom wrong? What about public sector health policies, most notably in Medicare or Medicaid?In a fascinating new book, two top thought leaders show how a powerful and complex Medicare payment formula led to fundamental changes across the health care system, facilitating a dramatic power shift from providers (hospitals and physicians) to buyers (Medicare, Medicaid, and employers).In Medicare Prospective Payment and the Shaping of U.S. Health Care, Rick Mayes, Ph.D. and Robert A. Berenson, M.D. describe how Medicare's transformation from retrospective, cost-based payment methods to prospective payment systems (PPS) "both initiated and repeatedly intensified the economic restructuring of the U.S. health care system." In addition to providing a thoughtful history of Medicare PPS from a research concept to the single most powerful financial driver in health care, Drs. Mayes and Berenson make the case that the public sector has been the major innovator.In building their case and exploring how PPS works in the real world, they interviewed 65 health financing experts, including several former CMS administrators. Bob Berenson and Rick Mayes do a nice job challenging conventional wisdom, which in health policy is always a good thing.Earlier in my career, I cut my teeth on PPS at the White House Office of Management and Budget (OMB), where my scope included Medicare Part A and hospital reimbursement policy. Therefore, for me, Medicare Prospective Payment and the Shaping of U.S. Health Care made for a particularly intriguing read. But you don't need to be a Medicare wonk to understand and benefit from this crisp, well-written book.- Kip Piper

I concur with the previous detailed reviewer and the book review clipped into the site. Excellent book.

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