economic status, 17

geographic distribution, 17

health status, 17

impact of geographic adjustment determinations, 2

nonelderly, 1, 17

Benefits valuation

in Bureau of Labor Statistics data, 75, 82

in hospital wage index, 71–72, 75, 82

Blum, Jonathan, 19b

Braley, Bruce, 28b

Budget neutrality adjustments, 29, 89, 90b

GPCI, 115–117

Bureau of Labor Statistics, 12

health care sector data, recommendations for use of, 8, 12, 58–59, 81–82, 141

labor market smoothing with data from, 89

See also Occupational Employment Statistics

C

Capital as factor of production in health care system, 37–38, 81

Care transitions, 58

Center for Studying Health System Change, 122

Centers for Medicare and Medicaid Services

administrative costs, 55–56, 58, 73, 77, 82

perception of geographic adjustment policy recommendations and implementation, 19b

recommendations for, 8, 9, 10, 12, 13, 82, 83, 139–140, 141

use of statistical areas, 43–45, 44b

See also Medicare

Combined statistical areas, 44b

Commuting, 7

consideration of, in current adjustment and classification system, 93–94

data sources, 94

hospital wage index adjustments, 22, 86–87

labor market smoothing based on, 88, 93–102, 107–109

modeling techniques, 9

patterns, 95, 96t

recommendations for smoothing labor market borders and payment areas, 9–10, 109–110

Section 505 adjustment for, 87

significance of, in setting labor market boundaries, 42

wage index smoothing, 53

Congress, U.S., 2, 16, 29–30

recommendations for, 8, 81–82

Contiguous-county smoothing

implementation, 91b

results of simulations, 91–93, 92t, 93t

shortcomings, 109

technical development, 89

Contract wages

in hospital wage index, 72, 75–76

as percent of hospital personnel expenses, 75–76

Conversion factor, 115

Core-based statistical areas, 44b, 85, 93–94

Cost-share weights, 10, 25, 118–119, 139

Cost Survey for Single Specialty Practices, 135

Critical access hospitals, 62

Current Procedural Terminology, 23, 25, 114

Customary, prevailing, and reasonable, 118

D

Dartmouth Atlas Project, 30, 52

Data sources

access to, 12, 117, 128

commuting patterns, 94

current concerns and criticisms, 4, 16, 31

for geographic variation in physician income, 121–122

for GPCI cost-share weights, 119

for input price determinations, 2, 4

on labor market conditions, 4–5, 32

for labor market smoothing, 89

physician office rent, 13, 132–135, 136t, 141–142

physician salary, 11–12

for physician work adjustment, 4, 124–129

for practice expenses GPCI adjustments, 130, 132

professional liability insurance premiums, 137–138

proxies for physician income calculation, 10–11

quality of current hospital wage index data, 70–74

recommendations for CMS access to BLS data, 12, 141

recommendations for GPCI construction, 8, 12–13, 58–59, 141–142

recommendations for hospital wage index construction, 8, 58–59, 81–82

research framework, 2–3, 33–34

strategies for improving hospital data, 73–74

study goals, 2, 4, 16–17, 18b, 31, 147

See also Accuracy of data

Department of Defense, 13

Department of Health and Human Services, 2, 8, 13, 16

E

Employee compensation

data sources, 130, 132

geographic adjustment rationale, 1–2

health sector-level wages, 130

occupational mix, 130



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