This is the definitive work on Medicare's prospective payment system (PPS), which had its origins in the 1972 Social Security Amendments, was first applied to hospitals in 1983, and came to fruition with the Balanced Budget Act of 1997. Here, Rick Mayes and Robert A. Berenson, M.D., explain how Medicare's innovative payment system triggered shifts in power away from the providers (hospitals and doctors) to the payers (government insurers and employers) and how providers have responded to encroachments on their professional and financial autonomy. They conclude with a discussion of the problems with the Medicare Modernization Act of 2003 and offer prescriptions for how policy makers can use Medicare payment policy to drive improvements in the U.S. health care system.Mayes and Berenson draw from interviews with more than sixty-five major policy makers -- including former Treasury secretary Robert Rubin, U.S. Representatives Pete Stark and Henry Waxman, former White House chief of staff Leon Panetta, and former administrators of the Health Care Financing Administration Gail Wilensky, Bruce Vladeck, Nancy-Ann DeParle, and Tom Scully -- to explore how this payment system worked and its significant effects on the U.S. medical landscape in the past twenty years. They argue that, although managed care was an important agent of change in the 1990s, the private sector has not been the major health care innovator in the United States; rather, Medicare's transition to PPS both initiated and repeatedly intensified the economic restructuring of the U.S. health care system.
AcknowledgmentsList of AcronymsIntroduction1. Origins and Policy Gestation2. Development, Growing Appeal, and Passage of Prospective Payment3. The Phase-In Years and Beginning of ""Rough Justice"" for Hospitals4. Medicare Policy's Subordination to Budget Policy, Increased Hospital Cost Shifting, and the Rise of Managed Care5. The Resource-Based Relative-Value Scale Reforms for Physician Payment6. The Calm before the Storm7. The Reckoning and ReversalConclusion: How Medicare Does and Should Shape U.S. Health CareAppendix: InterviewsNotesReferencesIndex
""Mayes and Berenson offer an admirable product in this book, one that we should use to improve our own studies of the state and the agents who help define it.""
