{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T16:01:19Z","timestamp":1791475279250,"version":"4.3.4"},"reference-count":19,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:00:00Z","timestamp":1790208000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100014848","name":"Arnold Ventures","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100014848","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Medicare is the largest payer of hospital services in the United States. Under the inpatient prospective payment system, hospitals receive \u201cbase\u201d and \u201cadd-on\u201d payments that are adjusted for geographic and hospital-specific factors to reflect differences in costs. Variation in Medicare payments has received little attention, as research has primarily focused on commercial price variation. The relationship between Medicare and commercial payment variation is also not well understood and a topic of considerable controversy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We used 2023 data from the Centers for Medicare and Medicaid Services' Inpatient Prospective Payment System Impact File to estimate standardized Medicare base and final payments to inpatient prospective payment system hospitals in the United States.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We found that Medicare final payments vary more than base rates across both hospitals and states due largely to add-on payments. Commercial prices are positively correlated with Medicare add-on payments.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our study highlights the importance of add-ons in driving variation in Medicare payments, potentially influencing variation in commercial prices.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/haschl\/qxag258","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T11:55:28Z","timestamp":1790164528000},"source":"Crossref","is-referenced-by-count":0,"title":["Hospital add-on payments are associated with variation in Medicare and commercial payments"],"prefix":"10.1093","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2651-8639","authenticated-orcid":false,"given":"Roslyn C","family":"Murray","sequence":"first","affiliation":[{"name":"Brown University School of Public Health Department of Health Services, Policy and Practice, , Providence, RI 02903 \u00a0","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-0154-1756","authenticated-orcid":false,"given":"Andrew M","family":"Ryan","sequence":"additional","affiliation":[{"name":"Brown University School of Public Health Department of Health Services, Policy and Practice, , Providence, RI 02903 \u00a0","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9405-1989","authenticated-orcid":false,"given":"Christopher M","family":"Whaley","sequence":"additional","affiliation":[{"name":"Brown University School of Public Health Department of Health Services, Policy and Practice, , Providence, RI 02903 \u00a0","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,9,24]]},"reference":[{"key":"2026100811410837700_qxag258-B1","author":"Centers for Medicare and Medicaid Services"},{"key":"2026100811410837700_qxag258-B2","author":"Medicare Payment Advisory Commission"},{"key":"2026100811410837700_qxag258-B3","author":"Medicare Payment Advisory Commission"},{"key":"2026100811410837700_qxag258-B4","author":"Medicare Payment Advisory Commission"},{"issue":"2","key":"2026100811410837700_qxag258-B5","doi-asserted-by":"publisher","first-page":"676","DOI":"10.1111\/1475-6773.12490","article-title":"Variation in payment rates under Medicare's inpatient prospective payment system","volume":"52","author":"Krinsky","year":"2017","journal-title":"Health Serv Res."},{"issue":"5","key":"2026100811410837700_qxag258-B6","doi-asserted-by":"publisher","first-page":"935","DOI":"10.1377\/hlthaff.2012.0332","article-title":"Contrary to cost-shift theory, lower Medicare hospital payment rates for inpatient care lead to lower private payment rates","volume":"32","author":"White","year":"2013","journal-title":"Health Aff (Milwood)"},{"issue":"1","key":"2026100811410837700_qxag258-B7","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1111\/1475-6773.12101","article-title":"How do hospitals cope with sustained slow growth in Medicare prices?","volume":"49","author":"White","year":"2014","journal-title":"Health Serv Res."},{"issue":"5","key":"2026100811410837700_qxag258-B8","doi-asserted-by":"publisher","first-page":"1045","DOI":"10.1377\/hlthaff.2009.0599","article-title":"Private-payer profits can induce negative Medicare margins","volume":"29","author":"Stensland","year":"2010","journal-title":"Health Aff (Millwood)"},{"issue":"1","key":"2026100811410837700_qxag258-B9","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1111\/j.1468-0009.2011.00621.x","article-title":"How much do hospitals cost shift? A review of the evidence","volume":"89","author":"Frakt","year":"2011","journal-title":"Milbank Q."},{"key":"2026100811410837700_qxag258-B10","author":"Baker"},{"issue":"1","key":"2026100811410837700_qxag258-B11","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1093\/qje\/qjy020","article-title":"The price ain\u2019t right? Hospital prices and health spending on the privately insured","volume":"134","author":"Cooper","year":"2019","journal-title":"Q J Econ."},{"key":"2026100811410837700_qxag258-B12","article-title":"State spotlight: the use of provider-based reference pricing in Oklahoma and South Carolina","author":"Corlette","year":"2025","journal-title":"Health Aff Forefront"},{"issue":"12","key":"2026100811410837700_qxag258-B13","doi-asserted-by":"publisher","first-page":"1680","DOI":"10.1377\/hlthaff.2024.00691","article-title":"Hospital payment caps could save state employee health plans millions while keeping hospital operating margins healthy","volume":"43","author":"Murray","year":"2024","journal-title":"Health Aff (Millwood)"},{"key":"2026100811410837700_qxag258-B14","author":"Whaley"},{"key":"2026100811410837700_qxag258-B15","author":"CMS.gov"},{"issue":"11","key":"2026100811410837700_qxag258-B16","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.40328","article-title":"Structural racial disparities in the allocation of disproportionate share hospital payments","volume":"5","author":"Schpero","year":"2022","journal-title":"JAMA Netw Open"},{"key":"2026100811410837700_qxag258-B17","author":"Cecil G. Sheps Center for Health Services Research"},{"issue":"8","key":"2026100811410837700_qxag258-B18","doi-asserted-by":"publisher","first-page":"963","DOI":"10.1377\/hlthaff.2025.00019","article-title":"Sharp rise in urban hospitals with rural status in Medicare, 2017\u201323: article examines growing number of urban hospitals that also have rural status for Medicare non-billing benefits","volume":"44","author":"Wang","year":"2025","journal-title":"Health Aff."},{"key":"2026100811410837700_qxag258-B19","author":"Oregon State Legislature"}],"container-title":["Health Affairs Scholar"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/healthaffairsscholar\/advance-article-pdf\/doi\/10.1093\/haschl\/qxag258\/71370215\/qxag258.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/healthaffairsscholar\/article-pdf\/4\/10\/qxag258\/71370215\/qxag258.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/healthaffairsscholar\/article-pdf\/4\/10\/qxag258\/71370215\/qxag258.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T15:41:16Z","timestamp":1791474076000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/healthaffairsscholar\/article\/doi\/10.1093\/haschl\/qxag258\/8833205"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,24]]},"references-count":19,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,10,5]]}},"URL":"https:\/\/doi.org\/10.1093\/haschl\/qxag258","relation":{},"ISSN":["2976-5390"],"issn-type":[{"value":"2976-5390","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,10]]},"published":{"date-parts":[[2026,9,24]]},"article-number":"qxag258"}}