Health Information Technology : How Can Cms Maintain Regulatory Cost Control?

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What is your opinion of detecting small variations via HIT Medicare databases? How can CMS maintain regulatory cost control to manage these outliers? Health Information Technology (HIT) Medicare databases are useful tools to obtain health information. Medicare collects information on all its beneficiaries and those providers that receive payments from Medicare. The data that Medicare collects can be used to recognize the variations in healthcare cost and the use of services. Spending for Medicare beneficiaries should be the same throughout the country but, it is not. Numerous studies have shown there are differences in cost and the quality of health care with Medicare beneficiaries, with the biggest spending difference being post-acute …show more content…

According to CMS, “Medicare created analytic files that exclude certain categories of Medicare beneficiaries to make those comparisons as meaningful as possible (CMS, 2016). Medicare also has a way to track variations in spending and use of services in different regions called Hospital Referral Region (HRR). HRR looks at where the beneficiary lives not where they go to get care. As stated by McCurdy “HRR’s generally have populations that are large enough to generate stable averages for comparisons of cost and utilization, even for narrowly defined combinations of conditions and services”. The information that Medicare collects on its beneficiaries is broad, comprehensive and from a wide-range of sources, hence, providing insight into the utilization of resources and cost differences in healthcare. Therefore, I believe it to be a reliable and valid tool to detect small variations. Medicare has instituted policies to help regulate cost on these outliers which includes standardized payments, risk adjustments and bundle payments. CMS uses standardized payment rates to determine its Medicare spending per beneficiary (MSPB) .Medicare standardizes the allowed amount for the MSPB. This method looks at the different Fee for Service (FFS) payments and identifies the factors to adjust. Once you remove the differences this should help even out the variability in payments and give a more accurate picture of how resources

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