This report, Medicare’s Quality Improvement Organization Program:
Maximizing Potential, is the second in the Institute of Medicine’s (IOM)
Pathways to Quality Health Care series and was authored by the IOM’s
Committee on Redesigning Health Insurance Performance Measures, Pay-
ment, and Performance Improvement Programs.
Poor nutrition is a major problem in older Americans. Inadequate
intake affects approximately 37 to 40 percent of community-dwelling individuals
over 65 years of age (Ryan et al., 1992). In addition, the vast
majority of older Americans have chronic conditions in which nutrition
interventions have been demonstrated to be effective in improving health
and quality-of-life outcomes. Eighty-seven percent of older Americans
have either diabetes, hypertension, dyslipidemia, or a combination of
these chronic diseases (NCHS, 1997).
The most important element in implementation of the program is not the initial training event or the
amount of the content, but rather, the ongoing management and coaching of the participants and
those people that the participants are expected to supervise. Further, we must work with your
managers to ensure that they learn how to have those difficult, but necessary, conversations with
their subordinates who are dragging their feet, engaging in subterfuge or just not performing to
With increasing recognition of the environmental impact of food and drink, future food policy and
dietary advice need to go beyond the traditional focus on nutrient recommendations for health to
include wider issues of sustainability. The task should not be underestimated, not least because the
issue of sustainability is complex with multiple dimensions, including environmental, economic and
social aspects. Current dietary advice is based on nutrient recommendations for health.
Medicare only covers durable medical equipment if you get it
from a supplier enrolled in the Medicare Program. This means
that the supplier has been approved by Medicare and has a
Medicare supplier number.
To find a supplier that is enrolled in the Medicare Program, visit
www.medicare.gov and select “Find Suppliers of Medical
Equipment in Your Area.” You can also call 1-800-MEDICARE
(1-800-633-4227) to get this information. TTY users should call
A supplier enrolled in the Medicare Program must meet strict
standards to qualify for a Medicare supplier number.
Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành y học dành cho các bạn tham khảo đề tài: Utilisation of podiatry services in Australia under the Medicare Enhanced Primary Care program, 2004-2008...
Medical costs have become the fastest-growing component of the California workers' compensation program, increasing from 45 percent of benefit costs in the mid-1990s to an estimated 55 percent of benefit costs in 2003. In response to concerns about these rapidly increasing costs, the California Commission on Health and
Chapter 22 - Medicare. After studying this chapter you will be able to: Describe Medicare as a public insurance program for the elderly, distinguish Medicaid from Medicare and understand their relationship, describe the Child Health Insurance Program as one that serves the children of the working poor.
Texas operates a family planning program for more than one hundred thousand low-
income women called the Women’s Health Program (WHP); it is currently administered under a
waiver from the Medicaid program. Earlier this year, the state adopted a policy to exclude
family planning clinics that are Planned Parenthood affiliates from participating in the WHP.
The costs of uncompensated care are estimated to be about $41 billion in 2004. Projected
government spending available to pay for the care of the uninsured in 2004 is $34.6 billion—about 85%
of the total uncompensated care bill. More than half of all funds for uncompensated care come from
the federal government, with the majority (70%) of federal dollars flowing through Medicare and
Medicaid. Most government dollars for uncompensated care goes for hospital care—which is paid
indirectly to hospitals based partly on the share of uncompensated care they provide.
In response to Texas’s affiliate rule, the federal Centers for Medicare and Medicaid
Services (CMS) announced that it would no longer provide federal matching funds for the
program because the rule denies beneficiaries the freedom to choose providers, as assured under
federal policy and stated that the waiver and federal funding would terminate after six months.
Two lawsuits are now in progress as a result of these decisions.
By 1945 Blue Cross had captured 59% of the health insurance market. The idea of prepaid health insurance was
solidified on the American landscape in 1954, when the Internal Revenue Code codified the deductibility of health
insurance payments. The employer deduction significantly reduced the cost of health insurance for consumers eligi-
ble for an employer-provided group plan.
The federal government cast the Blue Cross Blue Shield approach in regulatory concrete in 1965 when Congress
passed the Medicare and Medicaid programs.
Several community health centers operate a PACE program, a home and community based service that
allows severely disabled elders who are eligible for nursing home placement to remain in the community.
PACE is usually based in adult day health centers and operates as a small Medicare Advantage capitated
managed care plan at risk for providing all Medicare and Medicaid covered services including long
term care and acute hospital care. Primary care services are also provided by the PACE program in a
clinic setting utilizing employed or contracted medical providers.
Localism and decentralisation can only work if central government is prepared to trust local bodies, communities and citizens. We have aimed to design a local audit system which provides the rigour needed for Parliament, but allows local public bodies to take more responsibility in the way they procure audit services. These changes go hand in hand with the Government’s actions to increase transparency in local government and will help enable local people and local organisations to hold their local public bodies to account for the way that their money is spent....
Health and Quality of Life Outcomes
Using multiple survey vendors to collect health outcomes information: How accurate are the data?
Samuel C Haffer*
Address: Quality Measurement and Health Assessment Group, U.S. Centers for Medicare & Medicaid Services, MS: S3-02-01, 7500 Security Boulevard, Baltimore, Maryland 21244, USA and Policy Sciences Graduate Program, University of Maryland Baltimore County, Baltimore, Maryland USA Email: Samuel C Haffer* - firstname.lastname@example.org.
This includes being at risk for all medical and long term care costs. A health center taking on this
program must be comfortable assuming significant financial risk as well as be able to assume the significant
regulatory requirements for PACE that parallel much larger Medicare Advantage health plans. Despite the
risk, PACE is one of the few accepted models for fully integrating health and long term care services for
disabled elders and is a very significant resource for communities that have the programs.
PACE began as a Medicare waiver program but is now a full Medicare benefit.
There are no right or wrong answers regarding a company’s choice of
functional focus for its internal audit department. Where stakeholders choose
to position the function on the Internal Audit Continuum is a direct reflection
of their risk appetite and corresponding assurance needs as expressed in the
The mission statement must be tailored to the organisation and the value
drivers identified in Step 1 of the framework.
Herbert Simon’s work on bounded rationality has had little impact on health
policy discourse, despite numerous supportive findings. This is particularly sur-
prising in regard to the elderly, a group marked by a decline in higher cognitive
functions. Elders’ cognitive capacity to make decisions will be challenged even
further with the introduction of the new Medicare prescription drug benefit
program, mainly because of the many options available. At the same time, a
growing body of evidence points to the perils of having too many choices.
Chapter 21 - Medicaid. In this chapter, you will learn: Describe Medicaid as a program that covers medical expenses for many of this nation’s poor, distinguish Medicaid from Medicare and understand their relationship.
Chapter 17 - Insurance and billing. In this chapter you will learn: Define Medicare and Medicaid, discuss TRICARE and CHAMPVA health-care benefits programs, distinguish between HMOs and PPOs, explain how to manage a workers’ compensation case, explain how payers set fees, complete a Centers for Medicare and Medicaid Service (CMS-1500) claim form, identify three ways to transmit electronic claims.