Review of Private Sector Payment Methodologies for Hospital Outpatient Services

摘要

The project: gathers information on the types of private sector prospective payment systems that have been developed or are under development for outpatient hospital or ambulatory surgery center (ASC) services; and discusses the contributions that private sector prospective payment systems could make toward the design of a prospective system under Medicare. The report concludes that, at the present time, there are not likely to be any major components of private payer systems that could substantially contribute toward the design of a system under Medicare. Private payers are still looking to Medicare to play a leading role in this area. Despite the operational difficulties involved in the development of a prospective pricing system for outpatient services, Medicare may be better situated to develop a successful system because of both better access to better data and greater buying power.