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PubMed1992

Ambulatory testing for capitation and fee-for-service patients in the same practice setting: relationship to outcomes.

Previous studies of the impact of varying reimbursement incentives on physician behavior have not explored the simultaneous implications for patients' health outcomes. Using a single group of physicians who provided care for hypertensive patients with either capitation (N = 99) or fee-for-service (N = 66) health insurance plans, physicians' test-ordering behavior and patients' subsequent health outcomes were examined. After controlling for patients' age, severity of hypertension, and level of comorbidity, it was found that patients with capitation health insurance had fewer laboratory tests and lower overall charges than the fee-for-service patients, with no clinical or statistically significant differences in 1-year health outcomes, specifically blood pressure control. The study concludes that capitation can result in reduction in charges associated with management of hypertension, without apparent compromise in proximate health outcomes.

Adult↗

PubMed2007

Caregivers' ratings of access: do children with special health care needs fare better under fee-for-service or partially capitated managed care?

OBJECTIVE: The objective of this study was to evaluate how enrollment in a partially capitated managed care (MC) option versus the fee-for-service (FFS) system affects caregivers' ratings of dimensions of access to services among children with special health care needs (SHCN). SUBJECTS: The data were collected from telephone interviews during the summer and fall of 2002 with a random sample of 1088 caregivers of children with SHCN who qualified for Supplemental Security Income and therefore were enrolled the Medicaid program for children with SHCN in the District of Columbia. RESEARCH DESIGN: We used a 2-step procedure in which we first estimated plan choice and then constructed a selectivity correction to control for the potential selection bias linked to plan choice. We estimated the second stage equations predicting caregiver's ratings of dimensions of access as a function of the selectivity correction, the plan choice dummy variable and other exogenous variables. RESULTS: After controlling for the potential selection bias linked to plan choice and other confounding factors, we find that caregivers of children in FFS are significantly more likely than caregivers of children enrolled in the partially capitated MC plan to rate the following dimensions of access as either fair or poor: "access to specialists' care" (P < 0.01), "access to emergency room care" (P < 0.01), "convenience of the doctor's office" (P < 0.01), and "waiting time between making the appointment actual visit" (P < 0.05). CONCLUSIONS: We attribute these differences in caregivers' ratings of dimensions of access that exist between partially capitated MC and FFS enrollees to case management and care coordination services along with higher fees paid for pediatrician's and specialists' services available under MC option.

Capitation Fee↗

PubMed1995

Fee-for-service versus capitation-based reimbursement: how the payment method affects utilization of echocardiographic services by referring physicians.

Historically, health insurance carriers (HIC) have reimbursed physicians on a fee-for-service basis for echocardiographic studies. With the emergence of managed care, the HIC now may have the option of paying on a capitation basis. To determine whether the method of reimbursement had any bearing on the types of patients referred for echocardiographic services, we conducted a two-phase (retrospective) study. In Phase One, we assessed two groups of ambulatory patients with regard to patient characteristics, medical reason for referral, and echocardiographic results. Group A (4,066 patients) had insurance plans that stipulated reimbursement for echocardiographic services as part of capitation for cardiology services. Group B (3,061 patients) had plans that reimbursed for echocardiographic services on a fee-for-service basis. In Phase Two, we assessed a total of 5,947 patients (3,833 from Group A and 2,114 from Group B) over a period of 40 months to determine the frequency of referral for a second echocardiogram within 2 years of a normal one and the repeat normalcy rate. The results showed that the capitation reimbursement group included younger, predominantly female patients who were referred more often for a more benign reason and who more frequently were diagnosed echocardiographically with less severe disease, higher rates of normalcy, and repeat normalcy. These findings suggest that in our geographic area the capitation method of reimbursement permitted more liberal utilization of echocardiographic services. In this era of cost awareness, the study suggests the need for better screening of patients referred for echocardiographic services.

Capitation Fee↗

PubMed1998

Dental procedure fees 1975 through 1995: how much have they changed?

A shift toward diagnostic and preventive dentistry in the last two decades is evident from the change in the number of dental procedures performed, as well as the change in the percentage of time spent performing different types of procedures. During the period 1975 through 1995, the average nominal fees for selected dental procedures increased. Once inflation was taken into account, however, the increase in the average real fees charged was more modest.

Adult↗

PubMed1996

Increasing revenue through fee review and adjustment.

Medical group practices are under increasing pressure to deliver care more cost-efficiently. To remain competitive, practices must find ways to increase their fee-for-service revenue. One way for medical group practices to increase revenue is to review fees in accordance with industry standards and to adjust them, as needed.

Fee Schedules↗

PubMed1992

Clinical Laboratory Improvement Act program fee collection--HCFA. Final rule with comment.

This rule implements provisions of section 353 of Public Health Service Act (as amended by the Clinical Laboratory Improvement Amendments of 1988). Those provisions require laboratories to pay fees for issuance of registration certificates, certificates of waiver, certificates of accreditation, or certificates and to fund activities to determine compliance with the requirements established by the Department of Health and Human Services for laboratory testing. It also establishes the policy that laboratories licensed by and located in States with licensure programs approved by HHS may be exempt from the requirements of the Clinical Laboratory Improvement Amendments of 1988 (CLIA). This rule also establishes the methodology used to determine the amount of the fees charged for certificates of waiver, registration certificates, certificates of accreditation, or certificates and activities to establish application procedures and determine compliance with applicable certification requirements.

Accreditation↗

PubMedDate not supplied

Creating a sustainable physician compensation plan. Serving both fee-for-service and capitated populations.

A large, integrated health system in St. Louis acquired a primary care, health maintenance organization staff model group practice with 55 physicians. Health system leadership positioned the acquired physician group to diversify and expand its fee-for-service patient base to increase revenue and support the expansive fixed cost structure of the health centers. With interim managers, the leaders developed a new physician compensation plan that put a greater portion of the physicians' compensation at risk and provided incentives for enhanced productivity in both the capitated and fee-for-service lines of business. This article explores the key characteristics, benefits and potential areas for improvement associated with the new incentive compensation model and describes the centers' improved operating performance and gains in physician productivity.

Capitation Fee↗

PubMed2002

Alcohol and juvenile justice contacts: a comparison of fee-for-service and capitated medicaid mental health services.

OBJECTIVE: This study examines whether youth with alcohol problems are especially vulnerable to juvenile justice contact when receiving public mental health services in fee-for-service versus capitated managed-care agencies. Capitation is a payment method often accompanying managed care; a fixed fee is paid per person enrolled, for a specific time period and range of services. METHOD: Youth services were studied in a statewide, quasi-experimental design from July 1994 to June 1997; subjects were 13,365 Medicaid-eligible youth (52% female) aged 10-17. Alcohol problems were measured using a clinician-generated psychiatric diagnosis and a subjective indicator of alcohol symptoms obtained from a psychometrically tested mental health treatment intake form. Analysis methods were hazard/survival rates, log-rank tests and Cox proportional hazards models. RESULTS: As measured by the presence of symptoms, alcohol-involved youth in capitated managed care were significantly less likely to have contact with the juvenile justice system, in uncontrolled analysis. In controlled analysis, they were also less likely; however, only at the level of a trend. CONCLUSIONS: Concerns regarding capitated managed mental health care (e.g., substitution of care or "cost-shifting") found no support. There was no evidence of a shifting of alcohol-involved youth receiving mental health services under capitated managed care to the juvenile justice system. If anything, such youth saw their likelihood of juvenile justice involvement decrease.

Adolescent↗

PubMedDate not supplied

Freestanding abortion clinics: services, structure, fees.

In 1981, The Alan Guttmacher Institute (AGI), in collaboration with the National Abortion Federation (NAF), conducted a survey of 240 abortion clinics to update information about clinic structure and the relationship of structural characteristics to services, policies and fees. The clinics surveyed were a stratified random sample of all non-hospital abortion facilities that provided 400 or more abortions in the United States in 1980. Among the findings are the following: Thirty-one percent of the clinics reported that they are nonprofit or tax-exempt corporations. The nonprofit clinics are not significantly different from for-profit clinics in either the number of patients they serve or the region of the country in which they are located. Twenty percent of facilities, although regarded as clinics by the AGI for research purposes, define themselves as physicians' offices. These offices are more often located in the West and have smaller caseloads than other clinics. They are also disproportionately located in states with high abortion rates, which suggests that private physicians in these states are more willing than doctors in other states to provide relatively large numbers of abortions in their offices. Two-thirds of the clinics are licensed, most of them by states, but some by cities and counties. Licensed clinics have larger caseloads than nonlicensed facilities, but they are no different in terms of the other characteristics measured in the study, including services offered and fee structure. Fifty-four percent of clinics provide abortions after 12 weeks since the last menstrual period (LMP), and 24 percent, past 14 weeks.(ABSTRACT TRUNCATED AT 250 WORDS)

Abortion, Legal↗

PubMed1982

Therapeugenic factors in psychotherapy: the effects of fee and title on credibility and attraction.

Led male (N = 69) and female (N = 75) Ss to believe that they were rating the accuracy of a description of a mental health professional used to help clients choose their therapist. Ss were exposed to descriptions that were identical in content, with exception of the level of fee, high vs. low, and the title of the therapist, psychiatrist vs. clinical psychologist vs. counselor. Ss were asked to rate the individual in the description on various dimensions of credibility and attraction. The results indicate that Ss were not affected by the level of fee charged except on their willingness to seek therapy from the therapist. Ss consistently rated the psychiatrist higher than the counselor, who in turn was rated higher than the clinical psychologist. Explanations for this and the implications of these findings are discussed.

Adolescent↗

PubMed2006

Horizontal equity in utilisation of care and fairness of health financing: a comparison of micro-health insurance and user fees in Rwanda.

This paper uses two methods to compare the impact of health care payments under insurance and user fees. Concentration indices for insured and uninsured groups are computed following the indirect standardisation method to evaluate horizontal inequity in utilisation of basic health care services. The minimum standard approach analyses the extent to which out-of-pocket health spending contributed to increased poverty. The analysis uses cross-sectional household survey data collected in Rwanda in 2000 in the context of the introduction of community-based health insurance. Results indicate that health spending had a small impact on the socio-economic situation of uninsured and insured households; however, this is at the expense of horizontal inequity in utilisation of care for user-fee paying individuals who reported significantly lower visit rates than the insured.

Cost Sharing↗

PubMedDate not supplied

The impact of user fee exemption on service utilization and treatment seeking behaviour: the case of malaria in Sudan.

This experimental study was undertaken to assess the effect of different levels of exemption, 25%, 50% and 75%, from health centre user fees on health service utilization and treatment seeking behaviour for malaria by a high risk group of pregnant women and children under 5 years. These are groups in need of special medical attention to prevent progression of the disease into complicated or severe malaria. Sinnar State, one of Sudan's highly endemic malaria regions, was selected to be the experimental area. Exemptions were introduced for one year in six health centres. Two centres for each exemption level, and a further two health centres without exemptions were studied. At the beginning and the end of the trial year, households surveys were conducted in the catchment areas of the health centres, and focus group discussions with pregnant women and mothers of children under 5 years were conducted. Routine data were reviewed for malaria cases in the health centres and six studies on malaria cases were done upon exit from the health centres. In-depth interviews with health staff of the health centres were conducted. Exemption from user fees increased health services utilization, improved treatment-seeking behaviour and promoted early diagnosis. The changes during the experimental year were the largest in the centres with the largest exemption. Therefore, policy changes towards exemptions are necessary to facilitate early diagnosis and treatment of malaria.

Fees and Charges↗

PubMed1999

Scattering of primary care: doctor switching and utilization of health care by children on fee-for-service Medicaid.

OBJECTIVE: To determine whether children on fee-for-service Medicaid who switch primary care doctors use less health care and are less up to date with preventive care visits than children who do not switch primary care doctors. DESIGN: Retrospective cohort study using Medicaid claims data. SETTING: 51,027 children enrolled on Medicaid in Monroe County, New York. PATIENTS: 14,187 children enrolled continuously on fee-for-service Medicaid between January 1992 and December 1994. MAIN OUTCOME MEASURES: Utilization of primary care, emergency department (ED) services, and specialty care and proportion up to date with preventive care visits according to American Academy of Pediatrics guidelines. RESULTS: During the 2-year study period, 22% of children switched primary care doctors. Compared with children who did not switch primary care doctors, those who switched had more primary care visits (4.7 vs. 3.2 visits/year, P < .01), age-adjusted preventive care visits (1.2 vs. 1.0 visits/year), ED visits (0.72 vs. 0.47 visits/year, P < .01), and specialist visits (0.99 vs. 0.31, P < .01). On multivariate analysis, doctor switching was associated with increased odds of being up to date with preventive care visits (odds ratio [OR] = 1.7; 95% confidence interval [CI] 1.3 to 2.1). However, on multivariate analysis stratified by age, the association was significant only for older children (ages 11 to 14). Altogether, 68% of all children and 44% of infants less than 1 year old made the recommended number of preventive care visits during the study period. CONCLUSIONS: All groups of children received less preventive care than recommended by the American Academy of Pediatrics. Children who switched primary care doctors had higher utilization of health care, including primary care, ED, and specialty care. Contrary to expectations, they were more likely to be up to date with preventive care visits. The heavy utilization of health services by doctor switchers indicates that this subgroup of children on Medicaid may not be at risk for poor access to health care, but additional research is needed to determine whether the quality of care is related to doctor switching.

Adolescent↗

PubMed2006

[Marginal case of a practice fee for psychiatric emergency service].

Since 1 January 2004, the German Act for the Modernisation of Health Insurance (GMG) has regulated collection of a so-called practice fee-a charge to patients for their first outpatient health care in any given quarter. We report the case of a slightly inebriated patient who, against his will, was taken to a psychiatric outpatient department by local authorities, where he had to pay the quarterly charge of 10 EUR. Considering that he was forced and therefore had to pay the fee against his will, the present regulation is being discussed with respect to legal and moral implications in psychiatric emergency cases.

Alcoholic Intoxication↗

PubMed2005

Child behavioral health service use and caregiver strain: comparison of managed care and fee-for-service Medicaid systems.

This study compares behavioral health service utilization patterns and their determinants among Medicaid-enrolled children, ages 5-17 (N = 676) who were being served under managed care in Tennessee or a traditional fee-for-service system in Mississippi. Children in the fee-for-service program were significantly more likely than their counterparts in the managed care Medicaid program to receive behavioral health services (i.e., any service, support services, traditional outpatient services, day treatment, inpatient/residential care) and to receive more services overall. This finding held after controlling for the influence of other factors. Although child, family, and community variables were related to service use patterns, the relationships differed across systems. Caregiver strain was associated with several service use variables, but its influence was more pronounced in Tennessee. These findings support continued focus on the multi-level factors that shape behavioral health service use among children.

Adolescent↗

PubMed1982

Fetal monitoring in a community hospital: analysis of health maintenance organization, fee-for-service, and clinic populations.

This paper was a review of 2,210 deliveries in a community hospital in which electronic fetal monitoring was used. Patients were evaluated from three different types of group practices-health maintenance organization, fee-for-service, and clinic populations. Electronic fetal monitoring was used in 48%, 41%, and 70% of these groups, respectively. The respective cesarean section rates were 13%, 20%, and 10%. Monitored and nonmonitored, high- and low-risk groups were identified. A higher cesarean section rate for cephalopelvic disproportion was found in the monitored groups. However, this difference was most marked in the fee-for-service group. Perinatal morbidity and mortality results did not differ significantly among the three groups despite differences in electronic fetal monitoring use and cesarean section rates. The use of electronic fetal monitoring did not correlate with the cesarean section rate. Reasonable perinatal morbidity and mortality are compatible with relatively high electronic fetal monitoring rates (70%) and low cesarean section rates (10%). Within certain groups, use of electronic fetal monitoring may increase the cesarean section rate because of an increased diagnosis of cephalopelvic disproportion.

Attitude of Health Personnel↗

PubMed1992

The Medicare Fee Schedule unveiled: an account of physician payment reform.

On January 1, 1992, the Medicare program unveiled a new method for paying physicians known as the Medicare Fee Schedule (MFS). The new fee schedule is a complex system of administrative pricing based on the resource inputs used in producing physician services. The MFS consists of three parts: (1) a Relative Value Scale (RVS) which assigns to each medical service a value relative to all other services; (2) a Conversion Factor (CF) which converts the relative values into dollars; and (3) a Geographic Adjustment Factor (GAF) which adjusts payments based on geographic differences in the cost of producing physician services. In the paper we explain: how the relative values were determined; how the GAF was constructed; and how the CF was calculated. In addition, we explain balancing billing limits and the Medicare Volume Performance Standards (MVPS). We then present computer simulations of the impact of the MFS on payments to physicians. We find that the MFS will: (1) redistribute payments away from surgeons, radiologists, and other procedure-based specialties toward the primary care specialties, (2) redistribute payment away from urban areas toward rural areas, (3) redistribute payments away from invasive procedures and diagnostic tests toward evaluation and management services. We conclude with a discussion of the future refinements of the MFS, its applicability to other payors, and whether it will accomplish its intended purposes.

Computer Simulation↗

PubMed1995

User fees, demand for children's health care and access across income groups: the Philippine case.

This paper examines the potential effects of user fees on the demand for child health care across income groups. A mixed/conditional logit model of provider choice is estimated using national data from the Philippines. The model explicitly allows for price elasticity to be dependent upon income. The results indicate that price plays a significant role in the demand for child health care and that medical care demand for poorer children is substantially more price sensitive than it is for richer children. The notion that user fees are regressive is therefore supported.

Adolescent↗