Hospital & Physician Rate-Setting Systems: A Reference Manual for Developing and Implementing Rate Structures

Hospital & Physician Rate-Setting Systems is designed to give both payers and providers a conceptual overview of the challenges and methods of hospital and physician rate-setting, complemented by several real world examples of federal and state rate-setting actions. As a systematic guide, this book provides answers to the sequence of questions and issues that need to be resolved in crafting reimbursement rates. It becomes a "consultant-services-in-print" by providing perspective, encouragement and indirect experience to the various rate-setting system approaches. Hospital & Physician Rate-Setting Systems will detail the best practices of five states' rate-setting programs and the issues surrounding implementation; explain how rate-setting can be used to strengthen managed care initiatives; prompt readers to answer the necessary policy and technical questions; describe and lay out the steps for structuring and implementing a rate-setting body; show how to bundle physician with hospital services in a single inpatient global rate, aligning the incentives to promote efficient care delivery; and familiarize readers with the characteristics of the rate-setting bureau and commission and the authorities leading them.