Joint Senate and Assembly Health Committee Hearing on Hospital Reimbursement Mechanisms to be Held this Friday
Where: Broad CIRM Seminar Room Keck School of Medicine of USC 1425 San Pablo Street, Los Angeles, CA 90089 February 24th, 2012 10am - 1pm Rob Charles (626) 806-8761

When: Contact:

Background: Reimbursement mechanisms for hospitals are complex, and practices for dealing with reimbursements
can vary greatly depending on the payor. Effective and efficient reimbursement mechanisms that incentivize good behavior can go a long way towards helping control costs in the healthcare industry and protecting against predatory practices that only serve to increase the burden on taxpayers, patients and the system at large. This is an issue that will become even more vital as federal health care reform is phased in over the coming years. The hearing will explain how hospitals are reimbursed by insurers and health plans, as well as the two major government health care programs, Medicare and Medi-Cal. Differences in reimbursements for contract and non-contract private hospitals will be discussed, as will areas of dispute between hospitals and health plans over hospital reimbursement rates and practices. There will also be an assessment of how these practices impact patients, and a status update on the implementation of paying hospitals through a diagnosis-related group (DRG) methodology in Medi-Cal. This issue has received widespread recognition recently following the Polk Award winning expose done by the Center for Investigative Reporting’s California Watch on various practices at Prime Healthcare Services.


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