Braid-Forbes MJ, Forbes K; AcademyHealth. Meeting (2004 : San Diego, Calif.).
Abstr AcademyHealth Meet. 2004; 21: abstract no. 1449.
The Moran Company, , 1655 N. Fort Myer, Arlington, VA 22209 Tel. 703.841.8402 Fax 703.465.9969
RESEARCH OBJECTIVE: Under the Medicare Hospital Outpatient Prospective Payment System hospitals could receive pass-through payments for pharmaceuticals, calculated at 95 percent of Average Wholesale Price (AWP). Because the statutory limit on pass-through payments was projected to be exceeded, the Centers for Medicare & Medicaid Services (CMS) instituted an across the board pro-rata reduction to these payments in 2002. The following year payment rates fell further as the products came off pass-through status. The objective of this research is to examine whether the reduction in payment for pass-through drugs that were in effect April 1, 2002 through December 31, 2002 reduced utilization of high cost therapies whose reimbursement fell below acquisition cost. Further, we will investigate whether for-profit hospitals exhibited a more sensitive response to the payment change. STUDY DESIGN: Data on actual hospital acquisition costs of pharmaceuticals products separately reimbursed under the Outpatient Prospective Payments System (OPPS) were obtained from hospital pharmacy departments who volunteered their data. We analyzed these data relative to the payment rate effective after the pro-rata reductions went into effect. Utilization trends were calculated from the 2001 and 2002 Medicare Outpatient PPS claims files. An econometric model of the relationship between the ratio of payment rate to acquisition cost and utilization trends was estimated. The effect of the hospitals for-profit status on the model was also estimated. POPULATION STUDIED: Hospital acquisition costs for separately reimbursed pharmaceutical products were obtained from two large hospitals. Quarterly utilization trends were obtained from the Medicare Hospital Outpatient PPS claims files for 2001 and 2002. PRINCIPAL FINDINGS: Because the final 2002 dataset was not available from CMS until late December 2003, preliminary findings are not yet completed. CONCLUSIONS: IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: The hospitals response to reductions in reimbursement for specific therapies has implications for beneficiary access to care. The hospitals response to the pro-rata reductions may foreshadow their response to the larger cuts that occurred in 2003.
Publication Types:
Keywords:
- Costs and Cost Analysis
- Health Expenditures
- Hospitals
- Medicaid
- Medicare
- Outpatient Clinics, Hospital
- Outpatients
- economics
- injuries
- methods
- hsrmtgs
UI: 103624483
From Meeting Abstracts