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PubMed1985

Trends in physician assignment rates for Medicare services, 1968-85.

This article provides an overview of trends in Medicare assignment rates. It covers changes over time in assignment by demographic characteristics and State and analyzes beneficiary liability. Although assignment rates were rising slowly from 1977 to 1983, beneficiary liability was also rising, primarily because of the rise in physician charges and the reduction on allowed charges. Substantial increases in the assignment rate have coincided with the implementation of provisions in the Deficit Reduction Act of 1984 to encourage assignment, and the assignment rate reached on all time high of 69 percent in 1985.

Aged↗
PubMed1992

Determinants of physician acceptance of assignment: an examination of Medicare beneficiary characteristics.

This study examines the degree to which patient characteristics predict physicians' ad hoc decisions regarding acceptance of Medicare assignment. The study is based on a random sample of Medicare Part B enrollees living independently in the Salem, Oregon metropolitan area. Beneficiary characteristics and beneficiary reports of physician behavior are obtained from an hour long face-to-face survey. The findings show that patient characteristics are significant predictors of physician behavior. Those respondents with poor health, no supplementary coverage to Medicare Part B, and who are more sensitive to the cost of health care are significantly more likely to report that their physician accepts assignment than are respondents without these characteristics. Policy and research implications are discussed.

Aged↗
PubMed1995

Economic viability of a model rural family practice.

BACKGROUND AND OBJECTIVES: A model rural clinic was established by the Quincy Family Practice Residency Program with the financial support of sponsoring local hospitals. The purpose of the study was 1) to determine the financial viability of such a model practice and 2) to determine the practice's financial effect on the sponsoring hospitals. METHODS: The rural practice was established in a medically underserved area 30 miles from the sponsoring hospitals. A cost analysis of months 7-18 of operation was performed, including an analysis of charges generated at the sponsoring hospitals. Theoretical models of practice to enhance economic viability were explored. RESULTS: The 3,051 office visits fell short of expectations. These visits generated a net practice income of $18,596. Had the practice sought full payment for these visits instead of accepting Medicare assignments, the net income potential would have been $39,182. Growth of the practice until it reached the average size of a typical rural family practice (6,000 annual visits) would produce a net income of $67,113 with Medicare assignments and $103,578 if Medicare assignments were not accepted. Had the practice been a federally designated rural health clinic, a mid-level practitioner with physician supervision could have generated a net practice income of $53,640 for 3,051 visits or $138,863 for 6,000 visits. Referrals from the model clinic for laboratory work, radiology, and hospital admissions generated $9.17 in charges for the sponsoring hospitals for each dollar charged by the clinic. CONCLUSIONS: The financial viability of rural practices is adversely affected by the Medicare reimbursement system. Our model clinic had a positive economic effect on the sponsoring hospitals, suggesting that innovative collaborative sponsorship of such clinics may be mutually beneficial.

Costs and Cost Analysis↗
PubMed1982

Medicare program; assignment and reassignment of home health agencies to designated regional intermediaries--HCFA. Final rule.

We are modifying Medicare regulations to require that all freestanding home health agencies serviced by a nominated intermediary be serviced by a regional intermediary designated by HCFA. These regulations implement section 1816(e)(4) of the Social Security Act (as added by section 930(o) of the Omnibus Reconciliation Act of 1980, Pub. L. 96-499), which requires the Secretary to designate regional agencies or organizations to perform intermediary functions for home health agencies.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1982

Medicare program; assignment and reassignment of home health agencies to designated regional intermediaries: Health Care Financing Administration. Proposed rule.

We are proposing to modify Medicare regulations to require that all freestanding home health agencies (HHAs) serviced by a nominated intermediary be serviced by a regional intermediary designated by HCFA. One intermediary would be designated to service freestanding HHA's in each state. These proposed regulations would implement Section 1816(e)(4) of the Social Security Act (as added by Section 930(o) of the Omnibus Reconciliation Act of 1980, Pub L. 96-499), which requires the secretary to designate regional agencies or organizations to perform intermediary functions for home health agencies. The publication of the regulations also complies with a court order. This proposal would improve the administration of the home health benefit under the Medicare program.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1989

Mandatory assignment. What hath it wrought in Massachusetts?

The national precedent set in 1986--when Chapter 475, mandating Medicare assignment in Massachusetts, became law--has spread across the United States as other states seek to control physicians' incomes under the Medicare program. While some form of mandatory assignment is the law in at least a dozen states, the Bay State's law currently remains the most restrictive in the country. The effects of Chapter 475 continue to ripple through the health care system and are sure to intensify as the national debate heats up over the future of the Medicare program. The article explains the theoretical and practical reasons why mandatory Medicare assignment affects access to medical care, jeopardizes the number of physicians who will choose to treat Medicare patients, and ties the professional licensure process not to clinical expertise but to acceptance of a broad social-entitlement program.

Attitude of Health Personnel↗
PubMed1985

Medicare program; assignment and reassignment of home health agencies to designated regional intermediaries--HCFA. Proposed notice.

Section 1816(e)(4) of the Social Security Act (as amended by Section 2326(b) of the Deficit Reduction Act of 1984, Pub. L. 98-369) requires that the number of regional intermediaries designated to service freestanding home health agencies (HHAs) be limited to not more than ten. In accordance with Section 1816(e)(4) of the Act and existing regulations, this notice announces our proposal to designate ten regional intermediaries to process the workload of these HHAs, the States each intermediary would service, the general criteria used to select these intermediaries, and the procedures we plan to use during the change-over period. This notice also announces our tentative selections of designated regional intermediaries. The goal of this notice and the legislation on which it is based is to achieve more consistent and effective administration of the home health benefit under the Medicare program.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1995

Health insurance does not guarantee access to primary care: a national study of physicians' acceptance of publicly insured patients.

The roles of reimbursement and other predictors that affect physicians' willingness to accept publicly insured continuing care patients were examined in a national survey. The response rate was 47%. Eighty-eight percent of the respondents were accepting new patients. Forty-two percent of these physicians were willing to accept new continuing care patients insured by Medicaid, 70% reported accepting those paying by Medicare assignment, and 85% said they accept patients covered by Medicare plus balance-billing payments. Low reimbursement was the strongest predictor for lack of acceptance. The results suggest that systems of multitiered reimbursement are associated with diminished access for patients insured in the lower tiers.

Adult↗
PubMed1983

Factors influencing physician assignment decisions under Medicare.

The factors that influence physician assignment decisions under Medicare are of major importance to Medicare patients, physicians, and the federal government. This study used a unique data base gathered in Colorado during 1979 to examine these factors. The data base coupled information from Medicare claims with detailed survey information on beneficiaries who received the services. Multiple regression analysis was applied to a sample of approximately 6,500 services. It showed that a variety of physician, beneficiary, and service characteristics are statistically significant determinants of whether a Medicare service is provided on assignment.

Colorado↗