Health care cost control (51 - 60 of 648 items)
Medicare Advantage: Increased Spending Relative to Medicare Fee-for-Service May Not Always Reduce Beneficiary Out-of-Pocket Costs
GAO-08-359: Published: Feb 22, 2008. Publicly Released: Feb 28, 2008.
In 2006, the federal government spent about $59 billion on Medicare Advantage (MA) plans, an alternative to the original Medicare fee-for-service (FFS) program. Although health plans were originally envisioned in the 1980s as a potential source of Medicare savings, such plans have generally increased program spending. Payments to MA plans have been estimated to be 12 percent greater than what Medi...
Medicare Physician Payment: Care Coordination Programs Used in Demonstration Show Promise, but Wider Use of Payment Approach May Be Limited
GAO-08-65: Published: Feb 15, 2008. Publicly Released: Feb 15, 2008.
Congress mandated in 2000 that the Centers for Medicare & Medicaid Services (CMS) conduct the Physician Group Practice (PGP) Demonstration to test a hybrid payment methodology for physician groups that combines Medicare fee-for-service payments with new incentive payments. The 10 participants, with 200 or more physicians each, may earn annual bonus incentive payments by achieving cost savings and...
DOD Pharmacy Benefits Program: Reduced Pharmacy Costs Resulting from the Uniform Formulary and Manufacturer Rebates
GAO-08-172R: Published: Oct 31, 2007. Publicly Released: Oct 31, 2007.
Rising pharmacy costs have been a long-standing issue for the Department of Defense (DOD). In 1998, we reported that DOD's fiscal year 1997 total pharmacy costs were $1.3 billion--a 13 percent increase from fiscal year 1995. In fiscal year 2006, DOD dispensed 115 million prescriptions to about 6.5 million beneficiaries at a cost of about $6 billion. One effort to control pharmacy costs is through...
Medicare Inpatient Hospital Payments: CMS Has Used External Data for New Technologies in Certain Instances and Medicare Remains Primary Data Source
GAO-07-46: Published: Sep 26, 2007. Publicly Released: Sep 26, 2007.
Under Medicare, hospitals generally receive fixed payments for inpatient stays based on diagnosis-related groups (DRG), a system that classifies stays by patient diagnoses and procedures. The Centers for Medicare & Medicaid Services (CMS) annually uses its own data to reclassify DRGs. CMS also makes add-on payments for stays involving new technologies that meet three eligibility criteria. Stakehol...
Highlights of a Forum: Health Care 20 Years From Now--Taking Steps Today to Meet Tomorrow's Challenges
GAO-07-1155SP: Published: Sep 7, 2007. Publicly Released: Sep 7, 2007.
"Unless we fix our health care system--in both the public and private sectors--rising health care costs will have severe, adverse consequences for the federal budget as well as the U.S. economy in the future." This is one of the key messages that Comptroller General David M. Walker has been delivering across the country in town-hall style meetings, in speeches, and on radio and television programs...
Medicaid Long-Term Care: Few Transferred Assets before Applying for Nursing Home Coverage; Impact of Deficit Reduction Act on Eligibility Is Uncertain
GAO-07-280: Published: Mar 26, 2007. Publicly Released: Apr 25, 2007.
The Medicaid program paid for nearly one-half of the nation's total long-term care expenditures in 2004. To be eligible for Medicaid long-term care, individuals may transfer assets (income and resources) to others to ensure that their assets fall below certain limits. Individuals who make transfers for less than fair market value (FMV) can be subject to a penalty that may delay Medicaid coverage....
Health Care Spending: Public Payers Face Burden of Entitlement Program Growth, While All Payers Face Rising Prices and Increasing Use of Services
GAO-07-497T: Published: Feb 15, 2007. Publicly Released: Feb 15, 2007.
GAO testified about the challenges involved in financing health care. GAO has been particularly concerned about the federal government's long-term fiscal sustainability and the contribution of health care spending to this troubling picture. For the past several years, we have consistently reported that in just a few decades, the government will face a serious fiscal imbalance driven by known demog...
Medicare: CMS's Proposed Approach to Set Hospital Inpatient Payment Appears Promising
GAO-06-880: Published: Jul 28, 2006. Publicly Released: Jul 28, 2006.
Under Medicare's inpatient prospective payment system (IPPS), hospitals generally receive fixed payments for hospital stays based on diagnosis-related groups (DRG), a system that classifies stays by patient diagnosis and procedures. CMS is required to at least annually update DRG payments to address changes in the cost of inpatient care. CMS uses charge-based weights to update these payments. Cost...
Medicare Physician Services: Use of Services Increasing Nationwide and Relatively Few Beneficiaries Report Major Access Problems
GAO-06-704: Published: Jul 21, 2006. Publicly Released: Jul 21, 2006.
Congress, policy analysts, and groups representing physicians have periodically raised concerns that Medicare's efforts to control spending on physician services by limiting annual updates to physician fees could have an adverse impact on beneficiaries' access to physician services. These concerns were heightened in 2002 when Medicare's formula for setting physician fees required a 5.4 percent red...
Medicare: Sponsors' Management of the Prescription Drug Discount Card and Transitional Assistance Benefit
GAO-06-299R: Published: Jan 13, 2006. Publicly Released: Feb 21, 2006.
The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) added a prescription drug benefit to the Medicare program, which became effective January 1, 2006. To assist Medicare beneficiaries with their prescription drug costs until the new benefit became available, the MMA also required the establishment of a temporary program, the Medicare Prescription Drug Discount Card and...