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PubMed1992

Medicaid prenatal care: a comparison of use and outcomes in fee-for-service and managed care.

BACKGROUND: To control rising costs, state Medicaid agencies are enrolling recipients in managed care health plans (MCPs). We performed this study to assess this policy's impact on accessibility and outcomes of Medicaid-funded prenatal care. METHODS: We performed a retrospective, controlled study with three cohorts: a study group of 1106 Medicaid recipients enrolled in three MCPs, a matched comparison group of 4830 recipients receiving care in the fee-for-service (FFS) system, and a second matched comparison group of 4434 non-Medicaid enrollees of the same MCPs. Data on prenatal care use and birth outcomes were obtained through linkage of claims and discharge files with birth certificate files. RESULTS: Medicaid recipients enrolled in MCPs used prenatal care similarly to those in the FFS system and showed equal or modestly improved birth-weight distributions. However, Medicaid MCP enrollees showed poorer use of prenatal care and birth outcomes compared with non-Medicaid enrollees of the same plans. CONCLUSIONS: Enrollment in MCPs has a neutral or small beneficial effect on the prenatal care received by the Medicaid population. However, providing financial access and modifying the system of care for this population did not result in parity with the general population.

Birth Certificates↗
PubMed1999

The impact of physician bonuses, enhanced fees, and feedback on childhood immunization coverage rates.

OBJECTIVES: The purpose of this study was to examine the effects on immunization coverage of 3 incentives for physicians--a cash bonus for practice--wide increases, enhanced fee for service, and feedback. METHODS: Incentives were applied at 4-month intervals over 1 year among 60 inner-city office-based pediatricians. At each interval, charts of 50 randomly selected children between 3 and 35 months of age were reviewed per physician. RESULTS: The percentage of children who were up to date for diphtheria, tetanus, and pertussis and Haemophilus influenzae type b; polio; and measles-mumps-rubella immunization in the study's bonus group improved by 25.3 percentage points (P < .01). No significant changes occurred in the other groups. However, percentage of immunizations received outside the participating practice also increased significantly in the bonus group (P < .01). Levels of missed opportunities to immunize were high in all groups and did not change over time. Physicians' knowledge of contraindications was low. CONCLUSIONS: Bonuses sharply and rapidly increased immunization cover-age in medical records. However, much of the increase was the result of better documentation. A bonus is a powerful incentive, but more structure or education may be necessary to achieve the desired results.

Child, Preschool↗
PubMed1985

Physicians' acceptance of an alternative to fee-for-service payment: a possible source of change in Quebec medicine.

This article reports on a survey conducted on a sample of Quebec physicians at the end of 1981. The objective of the study was to assess the acceptance by physicians of a possible change in their current mode of remuneration and to identify the consequences of such a change on the physicians' practice and on the attainment of broader health care objectives. The results presented in this article seem to indicate that neither the present fee-for-service mode of payment nor a change to time-based remuneration can reconcile both professional and broader health care objectives. Implications of these findings for health policies are discussed.

Attitude of Health Personnel↗
PubMed1986

The temporal use of diagnostic tests of the colon: some results for fee-for-service medicine in Australia.

In the context of rising health expenditures it is relevant to consider the behavior of those who, in large part, determine what medical procedures are performed on patients. The purpose of this paper is to describe the utilization of diagnostic tests of the colon in Australia. The study is restricted to private medical practitioners operating on a fee-for-service basis. Diagnosis of the gastrointestinal tract is of some interest because the new technology of fiber optic endoscopy has provided an alternative means of diagnosing diseases or conditions. The results presented here indicate rising per capita utilization rates for both the "new" technology and the "old" techniques of barium enema radiology and sigmoidoscopy. There is no evidence of the "new" technology displacing the "old" in terms of per capita use. The data may be consistent with the hypothesis that process innovations in medicine do not displace alternative products: rather they are "added on" to the existing products.

Australia↗
PubMed1996

Revisiting fee policies.

Charging for missed sessions is presented as part of an ethical flexible fee policy that is being challenged and will require continued appraisal.

Appointments and Schedules↗
PubMed1997

The evaluation of fee for service and managed care from the viewpoint of people with disabilities in the USA.

In the literature on managed health care there is little presented from the viewpoint of people with disabilities, but this study looks at what is found. Using a sample of 258 persons with disabilities in Massachusetts obtained through a mail survey, no statistically significant differences between the two groups (fee for service or managed care) on a series of relevant variables was found. An evaluation of their health insurance and their primary care physician was asked for and several regression models of the relevant variables related to these two evaluations were tested. It seems that accessibility of the primary care physicians's office and the physician's level of understanding of the person's disability are related in a statistically significant way to their rating of their health insurance. Also it appears that the ease of obtaining an appointment and the physician's level of understanding of the person's disability are related in a statistically significant way to the evaluation of their primary care physician. The major policy implication of these findings is that managed care may not be the disaster which many foresee it to be.

Attitude to Health↗
PubMedDate not supplied

Physician payment reform. How the new Medicare fee schedule affects you.

Ernst & Young, an Associate Member of AGPA, has prepared an analysis of the Omnibus Budget Reconciliation Act of 1989 (OBRA 89), which contains more than 80 provisions, to explain the timetable and methodology for implementation of new Medicare fee schedules. W. Susan Dempsey, a senior manager with Ernst & Young, prepared the tables and charts for this article in the Group Practice Journal to highlight those provisions that will have the greatest impact on group practices. While all questions may not be answered in one summary of this complex law, hopefully the explanations and illustrations provided by the accounting-health care consulting firm will provide useful enlightenment.

Fee Schedules↗
PubMed1991

Hospital executives anxious over ramifications of final physician fee rules.

The final Medicare physician fee schedule regulations represent the biggest change to the Medicare system since it was enacted 26 years ago. The new rules, which will dramatically change the way physicians are paid, have hospitals scrambling to comprehend their effects while looking for ways to keep delicate relations with their medical staffs from deteriorating.

Fee Schedules↗
PubMed1992

Physician payment reform: how will medical specialties fare under the new Medicare fee schedule?

In 1989, the federal government legislated a major overhaul of the Medicare payment system for physician services, to be implemented beginning in January 1992. Under the new plan, payments will be set according to a national fee schedule based primarily on a "resource-based relative value scale." This article summarizes the development of the new payment system and explores the likely impact of its implementation on medical and surgical specialties.

Economics, Medical↗
PubMed1992

Medicare program; fee schedules for the services of certified registered nurse anesthetists--HCFA. Final rule.

We are revising the Medicare regulations to allow certified registered nurse anesthetists (CRNAs) to receive Medicare payment for the anesthesia services and related care they furnish. In addition, this final rule sets forth the fee schedules under which payment is made for the services of CRNAs, except for the services of CRNAs in certain rural hospitals who are paid on a reasonable cost basis. This rule, which is effective for services furnished on or after January 1, 1989, implements section 9320 of the Omnibus Budget Reconciliation Act of 1986, as amended by section 4084 of the Omnibus Budget Reconciliation Act of 1987, section 411(i)(3) of the Medicare Catastrophic Coverage Act of 1988, section 608(c) of the Family Support Act of 1988, and sections 6106, 6107 and 6132 of the Omnibus Budget Reconciliation Act of 1989. This final rule does not reflect the changes concerning the calculation of payment rates contained in section 1833(1)(4) of the Social Security Act, as enacted by section 4160 of the Omnibus Budget Reconciliation Act of 1990. Those changes apply to services furnished on or after January 1, 1991. Thus, the changes to the payment calculation provisions described and published below are applicable only to services furnished in calendar years 1989 and 1990.

Certification↗
PubMed1992

Should private payers adopt RBRVS fee schedules?

Independent Blue Cross and Blue Shield plans are adopting RBRVS-based fee schedules for reimbursing physicians. Some argue that private payers should follow suit.

Blue Cross Blue Shield Insurance Plans↗
PubMed1993

Medicare, Medicaid and CLIA programs; CLIA program fee collection; correction--HCFA. Correcting amendments.

This rule corrects a technical error in a rule entitled, "Regulations Implementing the Clinical Laboratory Improvement Amendments of 1988 (CLIA)" which inadvertently deleted some content of another rule entitled, "CLIA Program Fee Collection." Both rules were published in the Federal Register on February 28, 1992. We are restoring, without change, the content of sections 493.602 through 493.634, which was incorrectly removed effective September 1, 1992.

Certification↗
PubMedDate not supplied

Americans compare managed care, Medicare, and fee-for-service.

Are all health plans created equal? A recent survey of 1,000 adults queried Americans about their experiences with managed care, the Medicare program, and traditional fee-for-service medicine. Most Americans said they generally are content with their arrangements, but Medicare patients reported the highest level of satisfaction. Managed care consumers said they are generally pleased with their care, but they reported some problems with their specialist care. Overall most Americans are not looking for a completely new health care system.

Attitude to Health↗
PubMed1994

Medicare Program; physician performance standard rates of increase for fiscal year 1994 and physician fee schedule update for calendar year 1994--HCFA. Correction of final notice with comment period.

This document corrects an error that occurred in the calculation of the fiscal year 1994 Medicare volume performance standard for surgical services and that appeared in the final notice with comment period published in the Federal Register on December 2, 1993 (58 FR 63856) entitled "Medicare Program; Physician Performance Standard Rates of Increase for Fiscal Year 1994 and Physician Fee Schedule Update for Calendar Year 1994." This notice also corrects a typographical error in a date.

Fee Schedules↗
PubMed1994

Fee-for-service lives--in this managed care firm.

A medical group management firm in California is turning conventional managed care wisdom on its ear. It pays primary care physicians on a fee-for-service basis, while putting specialists on salary.

California↗
PubMed1995

Practice expenses in the MFS (Medicare fee schedule): the service-class approach.

The practice expense component of the Medicare fee schedule (MFS), which is currently based on historical charges and rewards physician procedures at the expense of cognitive services, is due to be changed by January 1, 1998. The Physician Payment Review Commission (PPRC) and others have proposed microcosting direct costs and allocating all indirect costs on a common basis, such as physician time or work plus direct costs. Without altering the treatment of direct costs, the service-class approach disaggregates indirect costs into six practice function costs. The practice function costs are then allocated to classes of services using cost-accounting and statistical methods. This approach would make the practice expense component more resource-based than other proposed alternatives.

Cost Allocation↗
PubMed1995

National Practitioner Data Bank for Adverse Information on Physicians and Other Health Care Practitioners; payment of fees--HRSA. Final rule.

This final rule amends the existing regulations governing the National Practitioner Data Bank for Adverse Information on Physicians and Other Health Care Practitioners (the Data Bank) authorizing the reporting and release of information concerning: Payments made for the benefit of physicians, dentists, and other health care practitioners as a result of medical malpractice actions or claims; and certain adverse actions taken regarding the licenses and clinical privileges of physicians and dentists. This final rule removes restrictions on allowed methods of payment for Data Bank fees.

Dentists↗
PubMed1995

Using Medicaid fee-for-service data to develop community health center policy.

This article presents an analysis of fee-for-service Medicaid data for King County, Washington. This analysis was conducted using Department of Social and Health Services billing records for patients of the community health centers of Seattle-King County (14 primary care sites), the Seattle-King County Department of Public Health (9 primary care sites), and Harborview Medical Center (a large tertiary facility with a primary care outpatient clinic associated with the University of Washington) from January through June, 1992. The complete billing records of all patients who utilized any one of the 24 sites were made available. These records were used to review utilization patterns and patient costs. The implications for community health centers regarding Medicaid managed care, health care reform, and population-based management are discussed.

Aid to Families with Dependent Children↗