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PubMed1980

Influence of a cash fee on outpatient heroin detoxification.

Twenty-eight employed heroin addicts who were admitted to 10-day, outpatient detoxification and paid a modest fee were compared to 28 poverty-level, unemployed patients who received free detoxification. Patients were matched for admission date within +/- 30 days, sex, age within +/- 5 years, total length of heroin use within +/- 3 years, and parole/probation status. At the end of detoxification treatment, 9 of 28 (32.1%) patients who paid a fee, and 11 of 28 (39.3%) patients who were given free treatment had urines which were devoid of heroin derivative (PNS). Three of less patients in each group chose to remain in longer-term treatment (PNS). These results suggest that a patient fee did not favorably influence outcome of outpatient heroin detoxification.

Ambulatory Care↗
PubMedDate not supplied

Quality of care provided to patients with diabetes mellitus in Puerto Rico; managed care versus fee-for-service experience.

OBJECTIVE: To evaluate and compare the quality of diabetes care in a large managed care system and fee-for-service payment system in Puerto Rico. METHODS: This retrospective cross-sectional study assessed the adherence to standards of diabetes care in 1,687,202 subjects--226,210 from a fee-for-service population and 1,460,992 from a managed care group. Patients with diabetes mellitus were identified from insurance claims reports. Type of health-care provider, service location, number of visits, and laboratory utilization were also assessed. RESULTS: From the analysis, we identified 90,616 patients with diabetes (5.4% of the overall study group). Of these, 66,587 (73.5%) were found to have at least one encounter with a physician in a medical visit. Of the 66,586 patients with diabetes who visited a physician, only 4% were treated by an endocrinologist. General laboratory utilization was 34% for the entire population of patients with diabetes studied. In the group of patients with documented laboratory tests, 93% had a documented fasting blood glucose test; in contrast, hemoglobin A lc testing was performed in only 9% of the patients. The fee-for-service group had a higher rate of visits to medical specialists and general laboratory utilization, whereas the managed care group had a higher rate of hospital admissions and emergency department visits. CONCLUSION: The quality of diabetes management and the subsequent outcomes are related to patient and health-care provider adherence to standards of care. In this analysis, we found that patients and physicians are responsible for low compliance with recognized standards of diabetes care in Puerto Rico. The lack of adequate management will lead to increased mortality, development and severity of chronic complications, and increased emergency department utilization. Therefore, health-care providers and payers should find ways to achieve more effective promotion of adherence to accepted standards of care for patients with diabetes.

Aged↗
PubMed1991

Physician payment reform--putting the fee schedule together.

In 1989, Congress enacted sweeping legislation to require that Medicare pay physicians under a single fee schedule beginning in January 1992. Although the law was detailed in specifying the structure of the fee schedule, it left many difficult policy and operational issues to be resolved. This article discusses how the agency charged with implementing the new law will address those issues and describes some of the key steps that will be taken to put the fee schedule together.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1991

Plans' execs mixed on impact of fee schedule.

With Medicare's physician fee schedule set to begin phasing in this January, executives at healthcare plans and medical groups are mixed on the impact of the plan. Because the schedule will lower fees for specialists and raise payments to primary-care providers, many healthcare managers are concerned about cost shifting. Others expect the schedule to have a minimal effect on fees because many prepaid plans already have resource-based payment methodologies.

Attitude of Health Personnel↗
PubMed1991

Determination of fees by professionals: an exploratory investigation of dentists.

Previous research has attempted to infer dentists' pricing practices from aggregate data, such as those derived from insurance claims. In a disaggregated analysis based on a mail survey of 327 dentists in private practice, the authors find the most important influence on dental fees to be cost, followed by fees charged by other dentists and perceptions of patient sensitivity to prices. The relative importance of the various influences on dentists' fees is related to several practice characteristics, including location and gross income.

Chi-Square Distribution↗
PubMed1993

Physician performance standard rates of increase for federal fiscal year 1994 and physician fee schedule update for calendar year 1994--HCFA. Final notice with comment period.

This notice announces the calendar year (CY) 1994 updates to the Medicare physician fee schedule and the Federal fiscal year (FY) 1994 performance standard rates of increase for expenditures and volume of physicians' services under the Medicare Supplementary Medical Insurance (Part B) program as required by sections 1848 (d) and (f), respectively, of the Social Security Act. The physician performance standard rates of increase for Federal FY 1994 are 8.6 percent for surgical services, 10.5 percent for primary care services, 9.2 percent for other nonsurgical services, and 9.3 percent for all physicians' services. The fee schedule update for CY 1994 is 10.0 percent for surgical services, 7.9 percent for primary care services, and 5.3 percent for other nonsurgical services. This notice also references the surgical and nonsurgical designations for new and revised procedure codes in the Physicians' Current Procedural Terminology, to be used in applying the CY 1994 updates and for establishing and measuring expenditures under the MVPS for FY 1994. These designations appear in Addendum C of the final rule with comment period entitled "Medicare Program; Revisions to Payment Policies and Adjustments to the Relative Value Units under the Physician Fee Schedule for Calendar Year 1994 (BPD-770-FC)," published elsewhere in this Federal Register issue. The new and revised surgical and nonsurgical designations are subject to public comment. In addition, this notice addresses public comments on the "initial" procedure-specific list of surgical services published in our November 25, 1992, notice.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1994

Physician fee schedule update for calendar year 1995 and physician volume performance standard rates of increase for federal fiscal year 1995--HCFA. Final notice.

This final notice announces the calendar year (CY) 1995 updates to the Medicare physician fee schedule and the Federal fiscal year (FY) 1995 volume performance standard rates of increase for expenditures for physicians' services under the Medicare Supplementary Medical Insurance (Part B) program as required by sections 1848(d) and (f), respectively, of the Social Security Act. The fee schedule update for CY 1995 is 12.2 percent for surgical services, 7.9 percent for primary care services, and 5.2 percent for other nonsurgical services. While it does not affect payment, there was a 7.7 percent increase in the update for all physicians' services for 1995. The physician volume performance standard rates of increase for Federal FY 1995 are 9.2 percent for surgical services, 13.8 percent for primary care services, 4.4 percent for other nonsurgical services, and a weighted average of 7.5 percent for all physicians' services. In our December 2, 1993 notice announcing the CY 1994 update to the Medicare physician fee schedule and FY 1994 volume performance standard rates of increase, we invited public comment on the update indicators for surgical and nonsurgical procedures that were new or revised in 1994. There were no public comments on those indicators. We have decided not to establish a public comment period for the codes that are new and revised in 1995 since, although these codes are initially classified as surgical or nonsurgical based on the clinical judgment of our medical staff, that classification ultimately rests on charge data that we use when they become available to determine whether the codes classified as surgical meet the criteria specified in our December 1993 notice.(ABSTRACT TRUNCATED AT 250 WORDS)

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1991

RBRVS: how new physician fee schedules will work.

The Health Care Financing Administration's (HCFA's) new Medicare fee schedule for physicians will break physician services into three components: physician work, practice expenses, and malpractice expenses. HCFA intends the new fee schedule to reduce and more equitably distribute Medicare expenditures for physician services. For healthcare organizations, the new fee schedule may mean changes in revenue collections, revisions to coding and billing systems, and greater competition between physicians and outpatient hospital services.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1998

Does competition by health maintenance organizations affect the adoption of cost-containment measures by fee-for-service plans?

How groups insured by fee-for-service health plans react to increased competition from health maintenance organizations (HMOs) is an unresolved question. We investigated whether groups insured by indemnity plans respond to HMO market competition by changing selected health insurance features, such as deductible amounts, stop loss levels, and coinsurance rates, or by adopting utilization management or preferred provider organization (PPO) benefit options. We collected benefit design data for the years 1985 through 1992 from 95 insured groups in 62 US metropolitan statistical areas. Multivariate hazard analysis showed that groups located in markets with higher rates of change in HMO enrollment were less likely to increase deductibles or stop loss levels. Groups located in markets with higher HMO enrollment were more likely to adopt utilization management or PPO benefit options. A group located in a market with an HMO penetration rate of 20% was 65% more likely to have included a PPO option as part of its insurance benefit plan than a group located in a market with an HMO penetration rate of 15% (p < 0.05). Concern about possible adverse selection effects may deter some fee-for-service groups from changing their health insurance coverage. Under some conditions, however, groups insured under fee-for-service plans do respond to managed care competition by changing their insurance benefits to achieve greater cost containment.

Cost Control↗
PubMedDate not supplied

Controlling and reducing legal fees in the age of fixed reimbursement.

This article is designed to provide hospital management with three general approaches to control or substantially reduce legal fees yet ensure the receipt of high-quality legal services. The first approach discusses general tactics which can be employed by hospital management for reducing legal fees for services provided by outside counsel on an hourly basis. The second approach involves a determination by the hospital of whether utilization of in-house legal counsel is appropriate, discusses the types of services that can be provided by an in-house legal counsel, and provides advice to the hospital concerning the hiring and retention of in-house legal counsel. The third approach concerns alternative alternative fee arrangements to hourly billing which hospital management can utilize with outside legal counsel when use of in-house legal counsel is not necessary or economically appropriate.

Contract Services↗
PubMed1987

The impact of prepaid medicine on the fee-for-service practice.

It is much more than just a learning process for physicians to understand the benefits offered by a new arrangement. The introduction of capitated medicine into a traditionally fee-for-service medical group is far-reaching, and it will affect even parts of the practice that may have been considered untouchable. The primary consideration of groups discussing prepaid involvement is most often utilization review. While this is very important, there are many other less obvious areas of impact. Quality assurance, practice size and specialty makeup, physician compensation incentives, contract management, data processing demands, fee schedule changes, and patient advocacy are but a few of the many areas that should be taken into consideration by the medical group manager, physicians, and board when making a decision about whether to introduce a prepaid component into a fee-for-service practice.

Fees, Medical↗
PubMed1987

Medicare physician fee schedules: issues and evidence from South Carolina.

Three key research questions are identified and analyzed in this article. First is an investigation of whether Medicare already pays physicians using de facto fee schedules. Evidence from South Carolina suggests not. Second is an evaluation of the physician procedures and specialties likely to be affected by imposition of a Medicare fee schedule. Medical visits are identified as especially susceptible. Third is a report on simulated effects of a charge-based fee schedule on Medicare program payments, physicians' practice revenues, and beneficiaries' liabilities.

Data Collection↗
PubMed1999

Payment by salary or fee-for-service. Effect on health care resource use in the last year of life.

OBJECTIVE: To investigate the effect of physician payment method on use of health care resources. DESIGN: Retrospective analysis of patient health care data collected for 3 years (1994 to 1996) from the Vital Statistics Department of the British Columbia Ministry of Health. Billing numbers identified physician payment method. SETTING: Salaried and fee-for-service primary care practices in the Capital Region District of Victoria, BC. PARTICIPANTS: A total of 582 patients in their last year of life: 106 were attended by salaried family physicians at a community health clinic; 476 were attended by fee-for-service practitioners. Groups were comparable in age, sex, and geographical location. MAIN OUTCOME MEASURES: Number and cost of specialist and diagnostic services and medications, number of days in hospital (acute and extended care), and main causes of death. RESULTS: None of the dependent measures showed any statistically significant differences based on comparisons between many variables for patients in the two groups. Costs of pharmaceutical, specialist, and diagnostic services were not significantly different for the two groups. There were three main causes of death, according to codes on death certificates: heart disease, malignant neoplasms, and cerebrovascular disease. CONCLUSION: Whether physicians were paid by salary or fee-for-service had no empirical effect on health care resource use.

Aged↗
PubMed1999

Medicare program; revisions to payment policies under the physician fee schedule for calendar year 2000. Health Care Financing Administration (HCFA), HHS. Final rule with comment period.

This final rule makes several changes affecting Medicare Part B payment. The changes include: implementation of resource-based malpractice insurance relative value units (RVUs); refinement of resource-based practice expense RVUs; payment for physician pathology and independent laboratory services; discontinuous anesthesia time; diagnostic tests; prostate screening; use of CPT modifier -25; qualifications for nurse practitioners; an increase in the work RVUs for pediatric services; adjustments to the practice expense RVUs for physician interpretation of Pap smears; and revisions to the work RVUs for new and revised CPT codes for calendar year 1999 and a number of other changes relating to coding and payment. Furthermore, we are finalizing the 1999 interim physician work RVUs and are issuing interim RVUs for new and revised codes for 2000. This final rule solicits public comments on the second 5-year refinement of work RVUs for services furnished beginning January 1, 2002 and requests public comments on potentially misvalued work RVUs for all services in the CY 2000 physician fee schedule. This final rule also conforms the regulations to existing law and policy regarding: removal of the x-ray as a prerequisite for chiropractic manipulation; the exclusion of payment for assisted suicide; and optometrist services. This final rule also announces the calendar year 2000 Medicare physician fee schedule conversion factor under the Medicare Supplementary Insurance (Part B) program as required by section 1848(d) of the Social Security Act. The 2000 Medicare physician fee schedule conversion factor is $36.6137.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2000

Forensic psychiatrists' fee agreements: a preliminary empirical survey and discussion.

The author performed a preliminary empirical study of forensic fee agreements. A survey of forensic psychiatrists produced samples of fee agreements used for expert witness work. The samples were analyzed to determine patterns of usage, critical elements, styles of agreement design, and other observations. Despite uncertainties of payment in this field, a surprising number of experts do not use formal fee agreements. This and other results are discussed.

Contract Services↗
PubMed2001

Medicare program; revisions to payment policies and five-year review of and adjustments to the relative value units under the physician fee schedule for calendar year 2002. Final rule with comment period.

This final rule with comment period makes several changes affecting Medicare Part B payment. The changes affect: refinement of resource-based practice expense relative value units (RVUs); services and supplies incident to a physician's professional service;anesthesia base unit variations;recognition of CPT tracking codes; and nurse practitioners, physician assistants, and clinical nurse specialists performing screening sigmoidoscopies. It also addresses comments received on the June 8, 2001 proposed notice for the 5-year review of work RVUs and finalizes these work RVUs. In addition,we acknowledge comments received on our request for information on our policy for CPT modifier 62 that is used to report the work of co-surgeons. The rule also updates the list of certain services subject to the physician self-referral prohibitions to reflect changes to CPT codes and Healthcare Common Procedure Coding System codes effective January 1, 2002. These refinements and changes will ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services. The Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 modernizes the mammography screening benefit and authorizes payment under the physician fee schedule effective January 1, 2002; provides for biennial screening pelvic examinations for certain beneficiaries effective July 1, 2001; provides for annual glaucoma screenings for high-risk beneficiaries effective January 1,2002; expands coverage for screening colonoscopies to all beneficiaries effective July 1, 2001; establishes coverage for medical nutrition therapy services for certain beneficiaries effective January 1, 2002; expands payment for telehealth services effective October 1, 2001; requires certain Indian Health Service providers to be paid for some services under the physician fee schedule effective July 1, 2001; and revises the payment for certain physician pathology services effective January 1, 2001. This final rule will conform our regulations to reflect these statutory provisions. In addition, we are finalizing the calendar year (CY) 2001 interim RVUs and are issuing interim RVUs for new and revised procedure codes for calendar year (CY) 2002. As required by the statute, we are announcing that the physician fee schedule update for CY2002 is -4.8 percent, the initial estimate of the Sustainable Growth Rate (SGR) for CY 2002 is 5.6 percent, and the conversion factor for CY 2002 is $36.1992.

Fee Schedules↗
PubMed2002

Acute care service utilisation and the possible impacts of a user-fee policy in Hong Kong.

OBJECTIVES: To examine the utilisation pattern of accident and emergency services and to study the possible impact of a user-fee policy on non-emergency attendances in Hong Kong. DESIGN: Retrospective study. METHODS: Four different scenarios are postulated to examine the impact on the number of accident and emergency attendances of a user-fee policy from 2000 to 2029. Patient volume data of accident and emergency attendances for 2000 were made available by the Hospital Authority of Hong Kong. RESULTS: Non-emergency use of the accident and emergency services is the main cause of over-utilisation and contributes to more than 70.0% of its use. Only 22.0% of patients attending accident and emergency departments were admitted to a ward for further treatment. By 2029, the number of accident and emergency attendances would increase by more than 47.0% if the present utilisation pattern prevails. However, if patients at triage levels 3, 4, and 5 were discouraged from using the accident and emergency services, the number of attendances would decrease by 76.4%. CONCLUSION: The proposed user-fee policy would act as a deterrent by preventing unnecessary use of accident and emergency services. However, the use of out-patient services may be increased as a result and attendance should be carefully monitored. Community health education and civic education relating to abuse of accident and emergency services would be effective in reducing over-utilisation of these services.

Accidents↗
PubMed2003

Medicare program; physician fee schedule update for calendar year 2003. Final rule.

This final rule revises the estimates used to establish the sustainable growth rates (SGRs) for fiscal years 1998 and 1999 for the purposes of determining future updates to the physician fee schedule and announces a 1.6 percent increase in the calendar year (CY) 2003 physician fee schedule conversion factor (CF) for March 1 to December 31, 2003. The physician fee schedule CF from March 1 to December 31, 2003, will be $36.7856. The anesthesia CF for this period will be $17.05. Any information contained in this final rule related to the CY 2003 physician or anesthesia CFs takes the place of the information contained in the December 31, 2002, final rule. All other provisions of the December 31, 2002, final rule are unchanged by this final rule.

Fee Schedules↗