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PubMed1992

Specialty differentials, limited license practitioners, and Medicare's new fee schedule.

The use of specialty differentials in the newly adopted Medicare fee schedule has been debated over the past 2 years. Arguments supporting the elimination of specialty differentials for optometrists and ophthalmologists are presented. The first recommendations by the Physician Payment Review Commission eliminating specialty differentials represent a victory for optometry in its efforts to achieve parity in the reimbursement of Medicare-covered services. Relative value units and practice costs to be used by the new Medicare fee schedule must be determined for optometry. Estimates of the model fee schedules for eye care procedures have been released by the Department of Health and Human Services.

Economics, Medical↗
PubMed2003

[How do medical facilities cope with a new medical fee system? A case study of the Kumamoto medical area].

In April 2000, a new medical fee system for hospitals designated for specific functions was introduced into the remuneration of medical services. A basic concept of this system is to pay a supplementary fee for hospital treatment during the acute treatment. In this study, in order to clarify the effect of this new system on hospital management, we performed the case study of three hospitals (Kumamoto National Hospital, Saiseikai Kumamoto Hospital and Kumamoto Chuo Hospital) located in Kumamoto medical area. As a result, in this area, the basic qualitative aspects of medical care environment, such as the number of hospital beds and long-term facilities, was found to be well equipped. In addition, three hospitals differ in following points: 1) characteristics of clinical department, 2) management strategy. In conclusion, the case of the Kumamoto medical area was considered to provide an important model of collaboration and co-operation between medical facilities toward the new medical fee system.

Economics, Hospital↗
PubMed1992

[What does the higher concentration of general practitioners mean for fee-for-service reimbursement].

The density of general practitioners has increased steadily in Norway. By the end of 1989, there were 1,339 inhabitants per general practitioner. General practitioners are partly remunerated per item of service, i.e., by reimbursement from the National Insurance Fund and partly by patient co-payment. The article analyses the connection between density of general practitioner and level of fee-for-service reimbursement. The average general practitioner received about 60% higher fee-for-service reimbursement in 1989 than in 1985. This increase is markedly higher than the nominal changes in the tariff. The increase was somewhat higher in areas with a relatively low density of general practitioners. Also, in each of the years 1985-1989, the average fee-for-service reimbursement was slightly higher in areas with a low density of general practitioners. The variations have only a slight impact on the gross revenues of general practitioners. Three models explaining the use of general medical services are outlined. The results can be interpreted in the light of changes in health, changes in health-related behaviour, and supplier-induced demand. Since only aggregate data are available, it is difficult to further explore possible explanations.

Fees, Medical↗
PubMed2005

Establishment of vaccination clinics; user fees for investigational new drug (IND) influenza vaccine services and vaccines. Interim final rule and request for comments.

We are amending 42 CFR part 70 to establish vaccination clinics and a user fee in connection with the administration of vaccination services and vaccine. On December 7, 2004, HHS Secretary Tommy G. Thompson announced the purchase of 1.2 million doses of GlaxoSmithKline (GSK) influenza vaccine, Fluarix, for distribution to areas most in need as determined by State public health authorities. The Fluarix vaccine has been approved in seventy-eight foreign countries, and FDA has recently reviewed extensive manufacturing and summary clinical information and conducted an inspection of the GSK manufacturing facility in Germany to determine that this vaccine, although not licensed in the United States, is suitable for use under an Investigational New Drug application (IND). The Food and Drug Administration (FDA) reviewed GSK's IND application as well as the clinical protocol and manufacturing data. CDC and CDC's Institutional Review Board approved the GSK flu vaccine response protocol including the informed consent document. To ensure that the vaccine is properly administered to individuals identified to be most at risk and facilitate compliance with IND requirements, CDC is establishing vaccination clinics. CDC is proceeding without delay because of the unprecedented nature of this season's influenza vaccine shortage caused by contamination problems with Chiron Corporation's production facility in the United Kingdom, which effectively cut in half the expected United States supply of inactivated influenza vaccine. A user fee is being established in order to recoup the costs associated with administering the vaccine and for the vaccine itself. All individuals, other than those who are enrolled in Medicare Part B, will be required to pay the user fee.

Adolescent↗
PubMed2006

[Doctors' use and assessment of a fee-for-service life-style advice scheme].

BACKGROUND: Fee-for-service life-style advice, a "green prescription" was introduced in Norway in 2003 as an alternative to the prescription of drugs to patients with moderate hypertension or risk of type 2 diabetes. The prescription includes an assessment of diet and/or physical activity, and an individual plan for change with systematic follow up from the GP. Material was provided by the Directorate of Health and Social Affairs, and a special fee of NOK 200 was established. The Research Institute of the Norwegian Medical Association has evaluated GPs' attitudes to and use of this scheme. MATERIAL AND METHODS: A representative sample of 1134 Norwegian GPs, of whom 59% responded. Ten of the respondents were also interviewed comprehensively over the telephone. RESULTS AND INTERPRETATION: Green prescriptions has low legitimacy among Norwegian GPs. Advise on lifestyle to patients with moderate hypertension or risk of type 2 diabetes is already an integral and natural component of GP work and calls for no extra fee or bureaucratic procedures. There is a risk of medicalisation in that non-patients become patients. On the other hand, patients who already are on drugs, but who may be able to reduce or eliminate these if they change their lifestyle, are not included in the scheme. Further development of the concept should to a larger degree include collaboration with the GPs.

Attitude of Health Personnel↗
PubMedDate not supplied

Comparison of examination fees and availability of routine vision care by optometrists and ophthalmologists.

A national telephone survey of eye care practitioners shows that the average fee for routine eye examinations was less among optometrists than ophthalmologists. The average wait for the earliest appointment was 5 days for optometrists and 20 days for ophthalmologists. Weekend and evening appointments were also more obtainable among optometrists. The study did not determine what tests were included in the routine examination of each practitioner. Optometrists are licensed to use diagnostic drugs in all 50 States and prescribe therapeutic drugs for the treatment of ocular diseases in 25 States. Legislation that would update State laws permitting doctors of optometry to prescribe and use pharmaceutical agents for the treatment of eye diseases has been introduced in many of the remaining States. Supporters of bills permitting therapeutic pharmaceutical optometry contend that these changes would ensure the availability of quality eye care at significant savings, since optometric fees are generally lower than ophthalmological fees. In addition, it has been argued that optometrists are equitably distributed geographically and are more likely to have weekend and evening office hours, thus enabling increased patient access to eye care. When considering cost-effectiveness and accessibility, this study may provide information to those States considering changes in the scope of optometric licensure.

Appointments and Schedules↗
PubMed1991

Online access to MEDLINE in clinical settings: impact of user fees.

The effect of introducing user fees on the frequency and quality of MEDLINE searching with GRATEFUL MED by physicians in clinical settings was tested. After training and free use (prior study), consenting participants were randomly allocated to pay searching costs (pay group) or continue without fees (no pay group). Fifty-nine physicians participated. Among the prior study's frequent searchers, the pay group searched at less than one third of the rate of those assigned to no pay. For less frequent searchers in the prior study, only 48% of those assigned to pay did any searches, compared with 85% for the no pay group (P = 0.006), and for those who did search, their frequency was almost half. However, there was no significant difference in the quality of searches; both groups demonstrated about equivalent recall (P = 0.77), but significantly lower precision (P = 0.03) than for the librarian's independent searches. Similarly, there was no difference in the proportion of searches affecting clinical decisions for the two groups. Thus, imposing user charges for online searching in clinical settings after a period of free use adversely affects searching quantity, but not quality. MEDLINE providers should consider whether user fees will undermine its benefits.

Fees and Charges↗
PubMed1990

Medicare surgical global fees: the relationship between included services and payment.

This paper documents how extensively the component services Medicare carriers include in their global fees vary for four common operations. Although payment for each of the operations also varies substantially among Medicare carrier areas, differences in the extent of services included in the surgical global fee do not contribute to explaining the variations in payment. The recently enacted Medicare fee schedule based on resources can rationalize the current pattern of payments, but only if a uniform global service policy is implemented.

Fee Schedules↗
PubMed1990

Impact of the Medicare fee schedule on payments to physicians.

Beginning in 1992, the Medicare program will pay physicians by the Medicare Fee Schedule, a system of geographically adjusted standardized payment rates based in part on the Resource-Based Relative Value Scale developed by Hsaio et al and in part on current Medicare payments. In our simulations of the Medicare Fee Schedule, we find that (1) redistributions of Medicare-allowed charges across specialities will be substantial but approximately only half the size projected by Hsaio, (2) there will be large redistributions among geographic areas that tend to compound the specialty redistributions, and (3) there will be wide variation within specialties as to how individual providers are affected. The majority of the redistributive impact of the Medicare Fee Schedule is attributable to implementation of a geographically adjusted system of standardized payments rather than to the particular work values developed by Hsiao et al in the Resource-Based Relative Value Scale.

Costs and Cost Analysis↗
PubMed1988

Does the computerisation of a general practice increase doctor's fees?

While few Auckland general practitioners had inpractice computers before 1981-2, many installed computers after 1981-2. In order to assess some of the determinants of the computerisation of practices and the outcomes of computerisation, data was collected on a random sample of Auckland urban area general practitioners for the financial years 1981-2 and 1984-5. The characteristics of those installing computers and the effect of computerisation on practice costs, fees and workloads was explored. No significant difference in fees was seen between computerised and noncomputerised general practitioners, but differences were observed in practice costs and practice workstyles. The cost of the purchase of a computer by a practice does not appear to be directly passed on to the consumer in higher patient fees.

Costs and Cost Analysis↗
PubMed1986

Day hospital fees and accessibility of essential health services.

Day hospital fee increases in April 1984 were followed by a fall in hypertensive, diabetic and asthmatic patients' attendances at the Bishop Lavis Day Hospital. The majority of the patients attending less often for treatment were not receiving medical care elsewhere, which resulted in a large number of hospital admissions with increased financial and long-term health costs for the patients. Increases in patient fees at the day hospitals have been far in excess of the inflation rate over the past 10 years, and a review of the tariff structure is required to bring fees to levels which are affordable by low-income patients.

Asthma↗
PubMedDate not supplied

The payment of fees for psychotherapy.

Several specific effects of third party payment of fees for psychoanalysis and psychotherapy are demonstrated. Using some of the criteria for listening that have been set out by Langs (1981, 1982), case illustrations from several sources are reviewed and discussed. Some of the examples have been selected from detailed accounts found in the psychotherapeutic literature, which should permit the reader to turn to the original source for verification and review in greater detail. Others have considered the effects of third party payment or reduced fees on the course and outcome of psychoanalysis and psychotherapy (Eissler 1974, Gray 1973, Halpert 1972a, Langs 1979, Lorand and Console 1958). With the exception of Langs, none of these has looked at how the therapist's compensation or activity around the fee payment is represented in the derivative material of the patient. In Langs' assessment of the derivatives in a case where insurance was used, the effects appeared detrimental to the therapeutic course.

Communication↗
PubMed1995

Psychoanalytic technique and the creation of analysands: on beginning analysis with patients who are reluctant to pay the analyst's fee.

This paper discusses prospective analysands who are able but reluctant to pay analysts' fees. The author presents analytic data in which analysts decided to gratify their reluctant analysands by reducing their fees in order to facilitate the subsequent analysis of their reluctance. These examples are employed to discuss the general question of fee reduction.

Adult↗
PubMed1995

Mental health care utilization in prepaid and fee-for-service plans among depressed patients in the Medical Outcomes Study.

OBJECTIVE: We compare mental health utilization in prepaid and fee-for-service plans and analyze selection biases. DATA SOURCE: Primary data were collected every six months over a two-year interval for a panel of depressed patients participating in the Medical Outcomes Study, an observational study of adults in competing systems of care in three urban areas (Boston, Chicago, and Los Angeles). STUDY DESIGN: Patients visiting a participating clinician at baseline were screened for depression, followed by a telephone interview, which included the depression section of the NIMH Diagnostic Interview Schedule. Patients with current or past lifetime depressive disorder and those with depressed mood and three other lifetime symptoms were eligible for this analysis. We analyze mental health utilization based on periodic patient self-report. ANALYTIC METHODS: We use two-part models because of the presence of both nonuse and skewness of use. Standard errors are corrected nonparametrically for correlations across observations due to clustered sampling within participating physicians and repeated observations on the same individual. PRINCIPAL FINDINGS: The average number of mental health visits was 35-40 percent lower in the prepaid system, adjusted and unadjusted for observed differences in patient characteristics, including health status. Utilization differences were concentrated among patients of psychiatrists, with only minor differences among patients of general medical providers. Analyzing the effect of switches that patients make between payment systems over time, we found some evidence of adverse selection into fee-for-service plans based on baseline utilization, but not based on utilization at the end of the study. In particular, after adjusting for observed patient characteristics and health status, patients switching out of prepaid plans had higher baseline use than predicted, whereas patients switching out of fee-for-service had lower use than predicted. Switching itself appears to be related to an immediate decline in utilization and was not followed by an increase or "catch-up" effect. CONCLUSIONS: The absence of the commonly found "catch-up" effect following switching and the significant decrease in utilization during the switching period suggests an interruption in care that does not occur for patients staying within a payment system. This finding emphasizes the need for integrating new patients quickly into a system, an issue that should not be neglected in the current policy discussion.

Boston↗
PubMed1993

Dental fees.

Traditional economic theories impact on the viability of a practice. Yet the relationships between revenues generated and dental service fees are more complex than traditionally envisaged. Whereas long-term fee strategies and short term tactics may be instituted to stimulate service demands, the significance of non-fee determinants (e.g. professional skills) cannot be underestimated.

Fees, Dental↗
PubMed1994

[Fee for physician services in completing a life insurance examination].

The question if reports and examinations by medical doctors in the completion of a life insurance policy must be charged according to the official German schedule of fees for medical doctors (GOA) is answered differently in the literature. As the GOA has legal force, an account according to the GOA is prescribed if there is no other conclusion between insurance company and medical doctor. Indisputably an account according to the GOA must be made for additional medical achievements such as laboratory examinations, electrocardiography and x-ray examinations. Insurance companies that offer for the medical report or the examination a fee within the regular limits of the GOA-numbers cannot be blamed to offer an inadequate fee.

Fees, Medical↗
PubMed1993

Comments of Connecticut State Medical Society concerning proposed practitioner fee schedule regulations before the Workers' Compensation Commission 23 September 1993.

The Connecticut General Assembly passed legislation last session reforming the workers' compensation system. One provision of that legislation mandated the establishment of a medical fee schedule for the workers' compensation system by 1 October 1993. In response to that mandate, Workers' Compensation Commission Chairman Jesse Frankl relied upon the work and advice of his Medical Fee Advisory Group, of which the Connecticut State Medical Society was a member, and published proposed regulations for a medical fee schedule in the 31 August 1993 Connecticut Law Journal. A public hearing on those regulations was held on 23 September 1993. The following is testimony submitted by the Connecticut State Medical Society at that public hearing in support of those regulations.

Connecticut↗
PubMed1993

Medicaid physician fees and use of physician and hospital services.

This paper examines how physician fees affect use of physician and hospital services under the Medicaid program. Using data from the 1987 National Medical Expenditure Survey (NMES), it examines how Medicaid physician fee levels affect beneficiaries' probability of using ambulatory physician services, the site at which ambulatory physician care is usually received, and how that site affects level of use and probability of hospital admission. The results indicate that low Medicaid fees hamper access to office-based physicians and encourage use of hospital outpatient departments and emergency rooms. They also indicate that having an office-based doctor as a usual source of ambulatory physician care is associated with a higher frequency of visits and a lower probability of having an inpatient hospitalization.

Ambulatory Care↗