Date of Conferral

2022

Degree

Doctor of Healthcare Administration (D.H.A.)

School

Health Services

Advisor

Sally Willis

Abstract

Healthcare costs have continued to increase in the United States. The Centers for Medicare and Medicaid Services (CMS) have proposed policy changes to reduce inequities between hospital outpatient centers and independent freestanding facilities when reimbursing for the same service. The purpose of this quantitative study was to explore if there was a difference in the payments to the Outpatient Prospective Payment System between the years 2017 and 2018 to assist hospital administrators in preparing for Medicare reimbursement cuts. The study was grounded in the agency theory and aimed to determine the relationship among the provider, payer, and patient. The research questions were designed to determine a statistically significant relationship between the reimbursement of monies for outpatient and inpatient billing between 2017 and 2018. The descriptive quantitative study utilized publicly available secondary data published by CMS to see if there was a change in outpatient and inpatient payments and procedures billed to Medicare between 2017 and 2018. The sample size for this quantitative study was 64 and was limited to New Jersey hospitals. The statistical analysis used for this study was the paired-samples Wilcoxon test to determine whether there was a statistically significant difference between the three variables chosen. The results from this study showed a statistically significant difference in outpatient payments, services, and inpatient hospital volume from 2017 to 2018. There was an increase in outpatient spending and volume and a decrease in inpatient volume. The findings of this study will help hospital administrators create positive social change by closing the healthcare equity gap, increasing transparency in healthcare costs, and promoting patient-centered care.

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