Introduction to Health Care and

Public Health in the U.S.

Financing Health Care, Part 2

Lecture a
This material (Comp 1 Unit 5) was developed by Oregon Health & Science University, funded by the Department
of Health and Human Services, Office of the National Coordinator for Health Information Technology under
Award Number 90WT0001.
This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International
License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/.
 Financing Health Care, Part 2
Learning Objectives - 1
• Describe the revenue cycle and the billing
process undertaken by different health
care enterprises. (Lecture a)
• Explain the billing and coding processes,
and standard code sets used in the claims
process. (Lecture a)

2
 Financing Health Care, Part 2
Learning Objectives - 2
• Identify different fee-for-service and episode-
of-care reimbursement methodologies used
by insurers and health care organizations
(HCOs) in the claims process. (Lecture b)
• Review factors responsible for escalating
health care expenditures in the United States.
(Lecture c)
• Discuss methods of controlling rising medical
costs. (Lecture d)
3
 Health Care Revenue Collection

• Describe the revenue cycle and the billing

process
• Review the use of code sets used in the
claims process

4
 The Business of Health Care - 1

• Health Care Organizations:

– Receive payments from 3rd party
– Payment depends on:
o Codes entered on bill for type of service provided
and diagnosis
o Formula determined by payor
§ Formula is rarely transparent

5
 The Business of Health Care - 2

• Health Care Organizations:

– May receive varying amounts from payor to
payor for identical services
– Receive payment from the government for
approximately 47% of all medical services
rendered

6
 The Revenue Cycle
and Medical Billing
• Revenue Cycle: Standard set of activities
and events that produce revenue or
income for a health care provider.
• Medical Billing: Part of revenue cycle. The
process of submitting claims to insurance
companies in order to receive payment or
reimbursement for services rendered by a
health care provider.

7
 Reimbursement & Claims

• Reimbursement: Compensation or
payment for health care services already
provided
– Fee-For-Service
– Episode-of-Care
• Claim: Itemized statement and request for
payment of the costs of health care
services rendered by a health care
provider or organization sent to third-party
payor 8
 Billing Definitions - 1

• Charge Capture
– The process of documenting medical services
in preparation of a claim
• Charge Description Master
– Database of prices for services provided,
used by HCOs during the billing process

9
 Billing Definitions - 2

• Electronic Data Interchange (EDI)

– Transmission of data between organizations
by electronic means
– Transaction set: an electronic model of a
paper transaction or form

10
 Revenue Cycle Overview

• Appointment • Claim submission:

scheduled paper or electronic
• Registration: • Reimbursement
Demographic and received
insurance info • Final settlement
• Services provided with patient
• Charge capture
• Coding
11
 Registration

• Hospital management software or practice

management software
– Demographic information
– Health insurance information

• Insurance information
– Confirm terms of coverage
– Determine deductibles, copayments, and
coinsurance
– Accurate claim identification by third party payor

12
 Charge Capture

• Process of collecting a list of services,

procedures, supplies, and associated
costs
• Charge description master
– Database used by health care facilities
– Paper based forms
o Superbill, encounter form, or charge ticket

– Electronic capture
o Automatic – improved accuracy

13
 Importance of Charge Capture

• Ensures proper reimbursement for

services provided
• Permits reevaluation of episode of care
reimbursement arrangements

14
 Coding and Code Sets

• Coding: Process of translating the written

diagnosis and procedures relating to a patient
encounter into a numeric classification or
code sets
• Code set: Group of numeric or alphanumeric
codes used to encode descriptive data
elements
– Tables of terms, medical concepts, diagnostic
codes, or procedure codes
– Includes codes and descriptors of the codes
15
 Update to ICD-9

• ICD-10-CM
– Replaces ICD-9-CM Volumes 1 & 2
– Diagnosis codes increased from 14,025 to
69,823.
• ICD-10-PCS
– Replaces ICD-9-CM Volume 3
– Procedure codes increased from 11,000 to
87,000
• Compliance was set for October 1, 2015
16
Code Set Differences
ICD-9 and ICD-10

17
 HIPAA Code Sets
• ICD-10-CM (Diagnosis codes)
• ICD-10-PCS (Procedure codes)
– NCHS & CMS respectively
• Current Procedural Terminology (CPT)
– AMA
• National Drug Codes (NDC)
– FDA and drug manufacturers
• Code on Dental Procedures and
Nomenclature (CDT)
– ADA 18
 Code Sets by Provider

• Physician: Inpatient and outpatient

• Diagnosis: ICD-10-CM
• Procedure: CPT
• Hospital Facility: inpatient
– Diagnosis: ICD-10-CM
– Procedure: ICD-10-PCS
• Hospital Facility: Outpatient
– Diagnosis: ICD-10-CM
– Procedure: HCPCS (CPT Level I and HCPCS
Level II)
19
 ICD-10-CM

• Diseases of the circulatory system I00-I99

– I20-I25 Ischemic heart diseases
o I20 Angina pectoris
o I21 ST elevation (STEMI) and non-ST elevation
(NSTEMI) myocardial infarction
o I22 Subsequent ST elevation (STEMI) and non-ST
elevation (NSTEMI) myocardial infarction
o I23 Certain current complications following ST elevation
(STEMI) and non-ST elevation (NSTEMI) myocardial
infarction (within the 28 day period)
o I24 Other acute ischemic heart diseases
o I25 Chronic ischemic heart disease
20
 CPT Examples

• Auditory System
– External Ear
o Incision
o 69000 Drainage external ear, abscess or
hematoma, simple
o 69005 Complicated
o 69020 Drainage external auditory canal, abscess
o 69090 Ear piercing

21
 Coding Examples

• Diagnosis
– Upper respiratory infection = J06.9 (ICD-10-CM)

• Service, procedure or test

– New patient, office visit, level II = 99202 (CPT)
– Biopsy of skin, subcutaneous tissue and/or mucous
membrane(including simple closure), unless
otherwise listed; single lesion = 11100 (CPT)
– Immune globulin 10 mg = J1564 (HCPCS Level II)

22
 Financing Health Care, Part 2
Summary
• Revenue cycle
– Unique process
– Charge capture
o Services & diagnosis

– Claims coded

23
 Financing Health Care Part 2
References – 1 – Lecture a
References
Buck, C. J. (2012). ICD-9-CM, for Physicians. In CPT Current Procedural Terminology
(Professional ed., Vol. 1, 2). Chicago, IL: The American Health Information
Management Association.
Code Sets Overview. (n.d.). Retrieved January 24, 2017, from
https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/Code-
Sets/index.html
Coding & Billing. (n.d.). Retrieved January 24, 2017, from https://www.ama-
assn.org/practice-management/coding-billing
Current Procedural Terminology. (n.d.). Retrieved January 24, 2017, from Wikipedia
website: http://en.wikipedia.org/wiki/Current_Procedural_Terminology.
Definition of Health Insurance Terms. (2010, August 1). Retrieved January 24, 2017, from
Bureau of Labor Statistics website: http://www.bls.gov/ncs/ebs/sp/healthterms.pdf.

24
 Financing Health Care Part 2
References – 2 – Lecture a
References
National Center for Health Statistics. International Classification of Diseases (ICD-10-
CM/PCS) Transition - Background.
http://www.cdc.gov/nchs/icd/icd10cm_pcs_background.htm. Updated October 1,
2015. Accessed January 24, 2017.

25
 Introduction to Health Care and
Public Health in the U.S.
Financing Health Care, Part 2
Lecture a

This material was developed by Oregon

Health & Science University, funded by the
Department of Health and Human Services,
Office of the National Coordinator for Health
Information Technology under Award
Number 90WT0001.
26
 Introduction to Health Care and
Public Health in the U.S.
Financing Health Care, Part 2

Lecture b
This material (Comp 1 Unit 5) was developed by Oregon Health & Science University, funded by the Department
of Health and Human Services, Office of the National Coordinator for Health Information Technology under
Award Number 90WT0001.
This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International
License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/.
 Reimbursement Methodologies

• Revenue Cycle
– Claims submitted and adjusted by payor
• Examine different methodologies used by
payors to reimburse providers.

28
 Claim Submission - 1

• Claim:
– Demographic and insurance information
– Diagnosis and procedure codes
– Time intervals
– Charges
– Provider identifiers

29
 Claim Submission - 2

• Submission:
– Paper
o Physicians – CMS Form 1500
o Facility – CMS Form 1450

– EDI: 837 Transaction

30
 Electronic Claims Transactions

• American National Standards Institute

• Electronic Data Interchange (EDI)
– HIPAA privacy rules/Transactions Rule
o 837 Health care claims or equivalent encounter
information
o 835 Health care payment and remittance advice
o 270/271 Eligibility for a health plan
o 276/277 Health claims status
o 278 Referral certification and authorization

31
 Remittance

• Reimbursement received
– Reduced amount due to coinsurance,
copayments, or contract
– Challenges
o Non-payment by payor
o Incorrect reimbursement

• Final settlement with patient

– coinsurance

32
 3rd Party reimbursement

• Reimbursement Methodology
– Fee-for-service (FFS): Separate payments
made for each individual service provided
– Episode-of-care: Payment of one sum for
providing all services or care during a illness
or time frame
• Example:
– Patient with cough and fever is treated at
urgent care

33
 Reimbursement Methodology

• Fee-for-service (FFS)
– Traditional retrospective
– Self-pay

• Episode-of-care (EOC)
– Capitation
– Prospective payment
– Global payment

• Managed care may involve either

methodology
34
FFS: Traditional Retrospective - 1

• Payment made after services have been

provided
– Method used by commercial or indemnity
insurance policies
– Fee schedule
o Developed using historical claims data
o Lists allowable services and procedures and
amounts payable for each

35
FFS: Traditional Retrospective - 2

• Resource-Based Relative Value Scale

(RBRVS)
– Used by Medicare and other third-party
payors
– Payments are based on cost of services in
terms of effort, overhead, and malpractice
insurance

36
 FFS: Self-pay

• Self-pay
– Patient responsible for payment for health
care services
o Uninsured subset of self-pay
– May seek reimbursement afterwards
o Self-insured plan: Large employers (ERISA)
o Costs possibly higher

37
 EOC: Capitation - 1

• Health care organization receives fixed sum

per person enrolled in the plan
• Same amount paid regardless of the number
of plan patients requiring care, frequency of
visits, or severity of illness
– PMPM: per member per month
• Payor knows costs in advance
• Provider assumes some risk, but has
guaranteed income
38
 EOC: Capitation - 2

• Group practice agreement with payor

– Payor pays the practice $25 per 100
members per month
o If costs of care are less than $25 per 100, the
practice makes money
o If costs of care are greater than $25 per 100, the
practice loses money
• Provider must balance provision of care
with the costs

39
EOC: Prospective Payment Method

• Payors establish reimbursement rates in

advance for services to be provided over a
specified time
• Based upon average resource use
required to provide a level of care for a
given set of conditions or a disease
• Same amount paid regardless of the costs
incurred

40
 Prospective Payment Types

• Per-diem: Fixed payment made for each

day of hospitalization
– i.e. based on unit of time
• Case-based: Fixed amount for providing
health services for a condition or disease
(case)

41
Diagnosis Related Groups (DRGs)

• Payments to hospitals for inpatient

services for Medicare patients
• Payments based on:
– Diagnosis, procedures, age, sex,
comorbidities, complications, and discharge
status
o Comorbidity: The presence of 2 or more conditions
or diseases in the same patient which complicates
a patient’s hospital stay leading to more resource
use or longer length of stay
42
 EOC: Global Payment

• Payor makes one payment for multiple

providers treating a single episode of care
• Extends the concept of capitation to a
larger group

43
 Managed Care Reimbursement

• Reimbursement
– Contract with providers to limit fees
o Fee-for-service: Discounted fee schedules
o Episode-of-care: Prospective payment

• Patient utilization control through

– Financial incentives to use network resources
o Offer lower in-network costs
o Increase out-of-pocket expenses for non-network
use

44
 Financing Health Care, Part 2
Summary
• Revenue cycle
– Unique process
– Charge capture
o Services & diagnosis

– Claims coded
– Claim submitted and adjusted by payor
• Reimbursement methods
– Fee-for service
– Episode-of-care
45
 Financing Health Care Part 2
References – Lecture b
References
Castro, A. B. and Layman, E (2006). Principles of Healthcare Reimbursement. In CPT
Current Procedural Terminology (Standard ed., Ch. 1 - 3, 8). Chicago, IL: The
American Health Information Management Association.
Code Sets Overview. (n.d.). Retrieved January 24, 2017, from
https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/Code-
Sets/index.html
Current Procedural Terminology. (n.d.). Retrieved March 30, 2016, from Wikipedia
website: http://en.wikipedia.org/wiki/Current_Procedural_Terminology.

46
 Introduction to Health Care and
Public Health in the U.S.
Financing Health Care, Part 2

Lecture c
This material (Comp 1 Unit 5) was developed by Oregon Health & Science University, funded by the Department
of Health and Human Services, Office of the National Coordinator for Health Information Technology under
Award Number 90WT0001.
This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International
License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/.
 What’s Driving the High Cost of
Health Care in the U.S.
• Review U.S. health care expenditures and
medical inflation
• Examine the factors contributing to the
increase in health care expenditures in the
United States
• Describe the Emergency Medical
Treatment and Active Labor Act (EMTALA)
• Discuss the cost of care to the uninsured

48
 Factors Contributing to High
Health Care Expenditures
• Technology
• Increased demand and utilization
– Chronic disease
– Aging population
• Administrative costs
– 7% of health care expenditures in the U.S.
– Twice the average of other industrialized
countries

49
 Technology and National
Health Care Expenditures
• Congressional Budget Office Estimates
– 40-50% of total expenditures
• Technology in health care
– Procedures
– Equipment
– Processes by which medical care is delivered

50
 Technology - 1

• Previously untreatable conditions

– Arthritis in hips and knees
• New medical and surgical procedures
– Angioplasty
– Joint repairs/replacements

51
 Technology - 2

• Medical devices
– Computerized Tomography (CT) scanners
– MRI imaging
– Implantable defibrillators
• Health Information Technology (HIT)
– Electronic medical records
– Telemedicine

52
 Pharmaceutical Costs

• Estimated 10% of total health care expenditures

– $298 billion in 2014; $40.3 billion 1990
– Average ~12% increase over the last 10 years
– Drug costs inflated above Consumer Price Index
(CPI)/other health care sectors
• Increased availability
– Medications for chronic disease
o e.g. cholesterol, diabetes
• Increased demand
– Cancer chemotherapy

53
 Administrative Costs

• Approximately 7% of annual U.S. health

care expenditures
• Administrative costs more than twice
average of other western industrialized
nations
• Estimated excess expense = $91 billion

54
 Physician/Hospital Costs

• Increased demand
– Utilization
o Positron emission tomography (PET)
o Magnetic resonance imaging (MRI)

– Techniques
o Minimally invasive surgery
§ da Vinci robotic surgery
o Imaging techniques

55
 Chronic Disease - 1

• Ongoing, generally incurable, illness or

condition
– Heart disease – Cancer
– Obesity – Diabetes

• Preventable/Manageable through:
– Early detection – Exercise
– Diet – Medical treatment

56
 Chronic Disease - 2

• Affects 1 of 2 adults in the U.S.

• Accounts for 7 of 10 deaths
• Daily activity limitations for 1 in 4 with
chronic disease
• Obesity major concern and contributor
– 1 in 3 adults
– 1 in 5 children between ages 2 and 19

57
 Chronic Disease and
Health Risk Behaviors
• CDC: Four health risk behaviors
– Lack of physical activity
– Poor nutrition and obesity
– Tobacco use
– Excessive alcohol consumption

58
 Prevalent Chronic Diseases

• Asthma
• Chronic obstructive pulmonary disease
• Chronic renal failure
• Congestive heart failure
• Coronary artery disease
• Diabetes
• Mood disorders/senility
• Cancer
• Hypertension
59
 Chronic Disease and Increased
Demand for Services
• Increased Utilization of Services
– Management/treatment to decrease risk of
complications
o For example, aggressive treatment of diabetes to
avoid such complications as heart disease, kidney
failure, or blindness
– Early intervention at risk groups
o For example, weight loss, smoking cessation

60
 Early Detection and Prevention

• Increased Preventive Services

– Detection
o Screening mammograms
o Colonoscopy

– Prevention
o Immunizations

61
 Increased Demand: Aging

• Increased utilization of services for chronic

illness above age 64
• 1946-1964: 66 million children
• Medicare eligibility beginning in 2011
– Additional 10 million enrollees by 2018
– Projected costs > $13,000 per capita with
comparable increase in Medicare costs

62
 The Uninsured

• Receive
– Less preventive care
– Diagnosed at more advanced disease states
– Once diagnosed, received less therapeutic
care
– Have higher mortality rates
• Cost of care is twice as much for
uninsured vs. insured

63
 The Uninsured 2014

• Enrollment in ACA coverage corresponds

with large declines in the uninsured rate
– Uninsured rate dropped from 16.2%, last
quarter of 2013 to 12.1%, last quarter of 2014
• Barriers:
– 48% coverage too expensive
– 12% unemployed or not offered through work
– 13% ineligible

64
 Financing Health Care, Part 2
Summary – Lecture c
• U.S. health care expenditures highest
worldwide
– Both per capita and % GDP
• Factors
– Increase demand and utilization
o Aging and chronic disease

– Technology
– Pharmaceutical costs
– Administration costs
65
 Financing Health Care, Part 2
References – 1 – Lecture c
References
Adapted from: DeLia, D., Cantor, J., Emergency department utilization and capacity; The
Synthesis Project, Robert Wood Johnson Foundation. Research Synthesis Report 17,
July 2009.
California Healthcare Foundation. Health care costs 101: reaching a spending plateau?
http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/PDF%20H/PDF%20
HealthCareCosts15.pdf November 2015. Accessed January 24, 2017.
Callahan, D. (n.d.). The Hastings Center Bioethics Briefing Book. Retrieved January 24,
2017, from
http://www.thehastingscenter.org/uploadedFiles/Publications/Briefing_Book/health%2
0care%20costs%20chapter.pdf
Centers for Medicare and Medicaid Services. National health expenditure accounts.
https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-
Reports/NationalHealthExpendData/NHE-Fact-Sheet.html. Updated December 2,
2015. Accessed January 24, 2017.

66
 Financing Health Care, Part 2
References – 2 – Lecture c
References
Fisher E, Bynum J, Skinner J. The Policy Implications of Variations in Medicare Spending
Growth. The Dartmouth Atlas: The Dartmouth Institute for Health Policy and Clinical
Practice Center for Health Policy Research, February 27, 2009. Available at:
http://www.dartmouthatlas.org/downloads/reports/Policy_Implications_Brief_022709.p
df. Accessed January 24, 2017.
Robert Wood Johnson Foundation. Available at: http://www.rwjf.org/. Source for health
issue research and health policy. Accessed January 24, 2017.
The Congress of the United States Congressional Budget Office. Washington DC: 2008
[cited July 31, 2010]. Technological Change And The Growth Of Health Care
Spending. Available at: http://www.cbo.gov/ftpdocs/89xx/doc8947/01-31-
TechHealth.pdf. Accessed January 24, 2017.

67
 Financing Health Care, Part 2
References – 3 – Lecture c
References
The Peterson Center on Healthcare and the Kaiser Family Foundation. Menlo Park, CA
(2016) Health costs. Available from: http://www.healthsystemtracker.org/. Provides
background information, links to key data and policy information on US healthcare
costs. Last accessed January 24, 2017.
Weber EJ, Showstack JA, Hunt KA, et al. “Are the Uninsured Responsible for the
Increase in Emergency Department Visits in the United States?” Annals of
Emergency Medicine 52(2): 108–115, 2008.

68
 Introduction to Health Care and
Public Health in the U.S.
Financing Health Care, Part 2

Lecture d
This material (Comp 1 Unit 5) was developed by Oregon Health & Science University, funded by the Department
of Health and Human Services, Office of the National Coordinator for Health Information Technology under
Award Number 90WT0001.
This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International
License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/.
 Controlling Health Care Costs - 1

• Review some potential methods of

controlling rising costs in medicine
– Examine the role of health information
technology in reducing and limiting costs
o Use of electronic health records and evidence-
based medicine (EBM)
o Clinical decision support
o Clinical practice guidelines

70
 Controlling Health Care Costs - 2

• Examine delivery models for reducing

health care expenditures
– Retail clinics/Urgent care
– Extenders/Doctors of Nursing Practice (DNP)
– Patient-Centered Medical Home
o Direct primary care

– Concierge medicine

71
 Cost Drivers: Technology

• 50 % of total annual expenditures

• Devices advance diagnosis and care
– Imaging: CT, MRI
– Artificial devices: Hips, knees, pacemakers
• New procedures treat the untreatable,
minimize risk, improve outcomes
– Surgery: da Vinci robot

72
Cost Drivers: Increased Utilization

• Physician and Hospital Utilization

– Aging
o Increasing number >65 y.o.
o Increasing cost >65 y.o.

– Chronic disease
o Diagnostic tests
o Management of disease
o Prevention of progression and complications

73
Cost Drivers: Administrative Costs
and Reimbursement Methods
• Administrative Costs
– Billing Procedures
o Rules
o Process

• Reimbursement Methods
– Fee-for-service encourage utilization
– Disparities within and among insurance plans

74
 Cost Drivers: Defensive
Medicine & Patient Preference
• Defensive medicine
– Overutilization of services
– Tort reform
• Patient preference
– Request for specific test or medication
– Direct to consumer advertising

75
 Fixing a Broken System?

• Limit resource availability

– Rationing
• Incentives to change utilization
– Increase patient cost
– Wellness and prevention
• Increase in efficiency
– Health Information Technology (HIT)
– Evidence-based medicine (EBM)
– Clinical Practice Guidelines
76
 Health Information Technology

• Health Information Technology for Economic and

Clinical Health Act (HITECH)
– Reward ($$$) for meaningful use of EHR
• EHR Facilitates
– Coordination of care
– Support providers
o Clinical decision support (CDS)
o Clinical practice guidelines/EBM
o Shared information (health information exchange)
o Error avoidance

77
 Evidence-Based Medicine

• Systematic Review of Published Research

• Clinical Practice Guidelines
• Standard of Care
– Lower costs
– End defensive medicine
– Cookbook medicine?
• Evaluating Technology

78
 The Medical Home

• Provides comprehensive medical care

– Personal physician = director
– Practice team
o Collective responsibility

– Enhanced access
o Same day appointments

79
 Concierge Medicine - 1

• Also called direct primary care or retainer practice

• Patient pays fee or retainer
– Monthly or annual
– Receives special service
– Enhanced access
• Multiple models
– Practice size limited
– Limited or no insurance billing
– Should maintain private health insurance for
emergencies

80
 Concierge Medicine - 2

• Typical features
– Same day urgent care appointments
– Next day non-urgent care appointments
– 24-hour telephone access
– Extended office visits
– Preventive care physicals/screenings

81
 Concierge Medicine - 3

• Other features
– Patient’s home or workplace consultations
– Wellness and nutrition planning
– Mental health counseling
– Stress reduction counseling
– Smoking cessation support
– Coordination of medical needs during travel

82
 Concierge Medicine - 4

• Practice costs lower

– Lower staff costs
o Fewer patients = fewer administration/nursing

– Lower overhead costs

o Rent smaller office
o Lower utility costs

• Perception of improved quality

– No difference from traditional primary care

83
 Concierge Medicine - 5

• Challenges
– Health insurance for specialty services, high-
cost procedures, emergency treatments, and
hospitalization.
– No data on how model affects overall health
care costs
– Employers evaluating model for savings
– Could exacerbate the shortage of primary
care providers

84
 Financing Health Care, Part 2
Summary – 1 – Lecture d
• Improved efficiency
– Health information technology
– Evidence-based medicine
• Medical home model
– Lower costs 5.6%
– Comprehensive care
• Concierge medicine or Retainer
– Enhanced services
– No research to support cost containment
85
 Financing Health Care, Part 2
References – 1 – Lecture d
References
Callahan, D. (n.d.). The Hastings Center Bioethics Briefing Book. Retrieved January 24,
2017, from
http://www.thehastingscenter.org/uploadedFiles/Publications/Briefing_Book/health%2
0care%20costs%20chapter.pdf
Centers for Disease Control and Prevention. Meaningful Use.
http://www.cdc.gov/ehrmeaningfuluse/introduction.html. Updated October 11, 2012.
Accessed January 24, 2017.
The Congress of the United States Congressional Budget Office. Washington DC: 2008
[cited July 31, 2010]. Technological Change And The Growth Of Health Care
Spending. Available at: http://www.cbo.gov/ftpdocs/89xx/doc8947/01-31-
TechHealth.pdf. Accessed January 24, 2017.
Fisher E, Bynum J, Skinner J. The Policy Implications of Variations in Medicare Spending
Growth. The Dartmouth Atlas: The Dartmouth Institute for Health Policy and Clinical
Practice Center for Health Policy Research, February 27, 2009. [cited 2010 July 31].
Available at:
http://www.dartmouthatlas.org/downloads/reports/Policy_Implications_Brief_022709.p
df. Accessed January 24, 2017.

86
 Financing Health Care, Part 2
References – 2 – Lecture d
References
Jackson, G. L., Powers, B. J., Chatterjee, R., & Prvu Bettger, J. (n.d.). The Patient-
Centered Medical Home: A Systematic Review. Annals of Internal Medicine. doi:
10.7326/0003-4819-158-3-201302050-00579
Robert Wood Johnson Foundation. Source for health issue research and health policy.
Available at: http://www.rwjf.org/. Last accessed: Mach 30, 2016.
The Peterson Center on Healthcare and the Kaiser Family Foundation. Menlo Park, CA
(2016) Health costs. Available from: http://www.healthsystemtracker.org/. Provides
background information, links to key data and policy information on US healthcare
costs. Last accessed January 24, 2017.

87