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At least 613 records · Page 34Linked to original sources
PubMed2000

A comparison of Medicare fee-for-service and a group-model HMO in the inpatient management and long-term survival of elderly individuals with syncope.

OBJECTIVE: To compare the management and survival of elderly patients hospitalized with syncope in 2 healthcare delivery systems. STUDY DESIGN: Retrospective cohort. PATIENTS AND METHODS: Using hospitalization records from Medicare and a group-model health maintenance organization (HMO) in Oregon, we identified individuals with an admission or discharge diagnosis of syncope between 1992 and 1994. Among patients 65 years or older (median age = 79 years), we randomly selected a sample of the standard Medicare patients (primarily fee-for-service; n = 473) and all of the group-model HMO patients (n = 583). Use of inpatient testing and consultation was ascertained by chart review; all-cause mortality was obtained from the National Death Index. RESULTS: Median diagnostic testing and consultation costs were the same (P = .35) in the standard Medicare population ($643) and the HMO population ($619), although the use of specific tests differed. More cardiovascular syncope was identified in the Medicare population (23% vs 18%; P = .02). Inpatient, 30-day, 1-year, and 4-year mortality rates were higher in the Medicare population (1.7%, 3.8%, 16.7%, and 50.6% respectively) than in the HMO population (0.7%, 1.5%, 13.2%, and 41.8%). After adjusting for age, gender, comorbidity, diagnostic testing, and administrative factors, the relative risk (RR) of dying was lower for group-model HMO patients (RR = 0.74; 95% confidence interval = 0.60, 0.91) than for standard Medicare patients (RR = 1.0). CONCLUSIONS: The inpatient management of these elderly patients with syncope was similar in the group-model HMO and standard Medicare settings, but survival was better for the individuals in the HMO. The reason for the differential survival is not obvious and warrants additional study.

Aged↗
PubMed2001

Comparison of cesarean section rates in fee-for-service versus managed care patients in the Ohio Medicaid population, 1992-1997.

OBJECTIVE: To examine changes over time in the cesarean section rates for fee-for-service (FFS) beneficiaries versus enrollees of managed care programs (MCPs) in the Ohio Medicaid population. STUDY DESIGN: Cross-sectional study using linked Ohio birth certificates and Medicaid files. PATIENTS AND METHODS: Study patients were Medicaid-enrolled residents of urban counties who had singleton, live births from 1992 through 1997 (n = 86,459). Changes in primary and repeat cesarean section rates were analyzed in the FFS and MCP groups. The test of homogeneity of odds ratios was used to measure the statistical difference between unadjusted odds ratios. Logistic regression analysis was conducted to adjust for risk factors. RESULTS: From 1992 to 1997, the difference in the rates of primary and repeat cesarean sections between FFS and MCP patients decreased. The unadjusted odds ratio (OR) increased from 0.66 to 0.81 (P = .06) for primary cesarean sections and from 0.67 to 1.04 (P = .03) for repeat cesarean sections; this indicated that the likelihood of undergoing a cesarean section increased over time for MCP enrollees compared with FFS beneficiaries. The results of the multivariate analysis indicated that the interaction term of payment source by year was not significant for primary cesarean sections (adjusted OR = 0.93; 95% confidence interval = 0.83, 1.04), but was highly significant for repeat cesarean sections (adjusted OR = 0.53; 95% confidence interval = 0.44, 0.64). CONCLUSION: We observed a reduction in the difference between the rates of both primary and repeat cesarean sections in FFS and MCP patients over time. The reduction was not statistically significant for primary cesarean sections. For repeat cesarean sections, however, we observed a convergence of the rates for FFS and MCP patients.

Adult↗
PubMed2001

Hospice use in Medicare managed care and fee-for-service systems.

OBJECTIVE: To examine whether patterns of hospice use by older Medicare beneficiaries are consistent with the differing financial incentives in Medicare managed care (MC) and fee-for-service (FFS) settings. Specifically, are use patterns consistent with incentives that might encourage hospice use for MC enrollees and discourage hospice use for FFS enrollees? STUDY DESIGN: One-year study of hospice use by Medicare beneficiaries dying in 1996. PATIENTS AND METHODS: Medicare enrollment and hospice administrative data were used to examine hospice use before death for all elderly individuals residing in 100 US counties with high MC enrollment in 1996. Age-, sex-, and race-adjusted rate of hospice use and length of stay in hospice are compared between FFS and MC enrollees across and within (when possible) the 100 counties. RESULTS: Rates of hospice use were significantly higher for MC enrollees than for FFS enrollees (26.6 vs 17.0 per 100 deaths; P < .001). These differences persisted within age, sex, and race groups but were not related to area MC enrollment rate or the amount of money paid to managed care organizations. Age-, sex-, and race-adjusted differences were observed in 94 of 100 counties. Length of stay in hospice was marginally longer for MC enrollees than for FFS enrollees (median, 24 vs 21 days; P < .0001). CONCLUSIONS: System of care is an important determinant of hospice use in the elderly Medicare population.

Aged↗
PubMed2002

A comparison of ambulatory services for patients with managed care and fee-for-service insurance.

OBJECTIVES: To determine whether family physicians provide different ambulatory care to patients with health insurance from managed care organization (MCO) versus fee-for-service (FFS) plans. STUDY DESIGN: Multimethod cross-sectional observational study. PATIENTS AND METHODS: A total of 4454 patients made office visits to 138 family physicians in northeastern Ohio. Direct observation with the Davis Observation Code and a structured checklist were used to assess the process of care. Patient satisfaction was measured with the Medical Outcomes Study 9-Item Visit Rating Form. RESULTS: Among 1588 patients with MCO insurance and 876 with FFS insurance, no differences were noted in the number of visits per year, length of visits, percentage of visits for well care, or the percentage of visits in which medicines were prescribed in analyses controlling for patient mix. Visits by patients with MCO insurance were more likely to involve referrals to another physician than visits by patients with FFS insurance. Patient satisfaction and time use during visits were comparable for the 2 groups. CONCLUSIONS: Managed care insurance appears to increase involvement of the primary care provider in the referral process. However, in a healthcare market with moderate managed care penetration in which the same physicians see patients with different types of insurance, the process of care is affected little by type of insurance coverage.

Adult↗
PubMed2002

Medicare program; criteria for submitting supplemental practice expense survey data under the physician fee schedule. Interim final rule with comment period.

This interim final rule revises criteria that we apply to supplemental survey information supplied by physician, non-physician, and supplier groups for use in determining practice expense relative value units under the physician fee schedule. This interim final rule solicits public comments on the revised criteria for supplemental surveys.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2001

A profile of Hawaiians in the Medicaid Fee-For-Service program.

In Hawai'i, the Medicaid Fee-For-Service (FFS) program enrolled approximately 39,000 individuals in fiscal year (FY) 1999. This program specifically provides healthcare services to enrollees classified as aged, blind, disabled, in-state foster children, and children who live out-of-state in subsidized adoptions. The total expenditure associated with this program was over $300 million in FY 1999. Nearly 4,600 enrollees in the Medicaid FFS program were self-identified as Native Hawaiians or part-Hawaiians. Although the proportion of Hawaiians in the Medicaid program was a fair representation of Hawaiians in the state, the distribution by recipient category within the program was in sharp contrast. Aged Hawaiians appeared to be under-represented in the program while disabled Hawaiians were overrepresented. Foster children and children under subsidized adoption accounted for 1% of the total Hawaiian population. Excluding the foster children and children under subsidized adoption, recipients of Hawaiian ancestry in the Medicaid FFS program (aged, blind, and disabled) obtained health care services amounting to approximately $34 million in FY 1999. Females in this population received more services, with total Medicaid payments amounting to $18.7 million. A higher proportion of Hawaiian recipients were on the neighbor islands. In this FFS Hawaiian population, the top three disease-states by dollar volume in FY 1999, were Alzheimer's disease, acute cerebrovascular disease, and profound mental retardation. A total of $3 million in services were provided to recipients with these primary disease-states. The five leading disease-states facing Hawaiians were generally comparable to those confronting the overall FFS population.

Adolescent↗
PubMed2002

FDA user fee and Modernisation Act.

A new law authorises the Food and Drug Administration to collect fees on medical device premarket submissions. The law also introduces important medical device regulatory reforms. This article discusses this new law and comments on the impact that it could have on the medical device industry.

Biotechnology↗
PubMed2003

Difference in the use of preventive services between fee-for-service plans and HMOs: is more better?

OBJECTIVE: Based on the US Preventive Services Task Force recommendations, we studied how health insurance type, ie, fee-for-service (FFS) or health maintenance organization (HMO), affects the utilization of preventive services of differing effectiveness. STUDY DESIGN: Household survey data from the 1993 and 1994 National Health Interview Surveys. METHODS: We compared the use of mammograms, Pap smears, blood pressure measurements, counseling about hormone replacement therapy (HRT), and general physical examinations in FFS plans and HMOs. We used the bivariate probit model to control for selection bias caused by the unobservable factors in the choice of health insurance type. RESULTS: Enrollees in HMOs obtained more Pap smears, blood pressure measurements, mammograms (women 40 to 49 years old), and general physical examinations than enrollees in FFS plans. No significant difference was found between FFS plans and HMOs for the use of mammograms (women aged 30 to 39 years and 50 to 64 years) or HRT counseling. The correlation ratios from bivariate probit estimations indicated no selection bias favoring HMOs; for some preventive services, selection bias favored FFS plans. CONCLUSIONS: Compared with enrollees in FFS plans, persons in HMOs used more preventive services, including less effective ones. Not controlling for selection bias underestimated the HMO effect.

Adult↗
PubMed2003

Medicare program; revisions to payment policies under the physician fee schedule for calendar year 2004. Final rule with comment period.

This final rule will refine the resource-based practice expense relative value units (RVUs) and make other changes to Medicare Part B payment policy. The policy changes concern: Medicare Economic Index, practice expense for professional component services, definition of diabetes for diabetes self-management training, supplemental survey data for practice expense, geographic practice cost indices, and several coding issues. In addition, this rule updates the codes subject to the physician self-referral prohibition. We also make revisions to the sustainable growth rate and the anesthesia conversion factor. These changes will ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services. We are also finalizing the calendar year (CY) 2003 interim RVUs and are issuing interim RVUs for new and revised procedure codes for CY 2004. As required by the statute, we are announcing that the physician fee schedule update for CY 2004 is -4.5 percent, the initial estimate of the sustainable growth rate for CY 2004 is 7.4 percent, and the conversion factor for CY 2004 is $35.1339. We published a proposed rule (68 FR 50428) in the Federal Register on Part B drug payment reform on August 20, 2003. This proposed rule would also make changes to Medicare payment for furnishing or administering certain drugs and biologicals. We have not finalized these proposals to take into account that the Congress is considering legislation that would address these issues. We will continue to monitor legislative activity that would reform the Medicare Part B drug payment system. If legislation is not enacted soon on this issue, we remain committed to completing the regulatory process.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2003

Professionally exempt nurses & the fee basis of payment.

Within the home health industry, per-visit pay has long been used by agencies to compensate nurses. This "fee-based" system of compensation has been subject to scrutiny by the Department of Labor (DOL), which claims that this is not an appropriate method to compensate professional nurses who would qualify as "exempt" employees under the Fair Labor Standards Act. Recent court decisions have disagreed with the DOL's position on the issue, but home health agencies need to be careful about employee compensation statutes at both the federal and state level so as not to open themselves up to potentially devastating penalties.

Community Health Nursing↗
PubMed2004

Medicare program; revisions to payment policies under the physician fee schedule for calendar year 2005. Final rule with comment period.

This final rule refines the resource-based practice expense relative value units (RVUs) and makes other changes to Medicare Part B payment policy. These policy changes concern: supplemental survey data for practice expense; updated geographic practice cost indices for physician work and practice expense; updated malpractice RVUs; revised requirements for supervision of therapy assistants; revised payment rules for low osmolar contrast media; changes to payment policies for physicians and practitioners managing dialysis patients; clarification of care plan oversight requirements; revised requirements for supervision of diagnostic psychological testing services; clarifications to the policies affecting therapy services; revised requirements for assignment of Medicare claims; addition to the list of telehealth services; and, several coding issues. We are making these changes to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services. This final rule also addresses the following provisions of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Pub. L. 108-17) (MMA): coverage of an initial preventive physical examination; coverage of cardiovascular (CV) screening blood tests; coverage of diabetes screening tests; incentive payment improvements for physicians in shortage areas; payment for covered outpatient drugs and biologicals; payment for renal dialysis services; coverage of routine costs associated with certain clinical trials of category A devices as defined by the Food and Drug Administration; hospice consultation service; indexing the Part B deductible to inflation; extension of coverage of intravenous immune globulin (IVIG) for the treatment in the home of primary immune deficiency diseases; revisions to reassignment provisions; and, payment for diagnostic mammograms, physicians' services associated with drug administration services and coverage of religious nonmedical health care institution items and services to the beneficiary's home. In addition, this rule updates the codes subject to the physician self-referral prohibition, discusses payment for set-up of portable x-ray equipment, discusses the third five-year refinement of work RVUs, and solicits comments on potentially misvalued work RVUs. We are also finalizing the calendar year (CY) 2004 interim RVUs and are issuing interim RVUs for new and revised procedure codes for CY 2005. As required by the statute, we are announcing that the physician fee schedule update for CY 2005 is 1.5 percent, the initial estimate for the sustainable growth rate for CY 2005 is 4.3, and the conversion factor for CY 2005 is $37.8975.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2004

The impact of fee-for-service and managed care insurance on access to cardiac care in Maryland.

Cardiovascular disease is one of the leading causes of death in the United States. The treatment of acute myocardial infarction (AMI) provides a useful model for studying the impact of fee-for-service and HMO insurance on access to cardiac care. Prior studies provide evidence in support of a disparity in access to cardiac care by insurance type, but no other study has examined the impact of insurance type in a regulated hospital industry. This study is unique because it explores the impact of a regulatory approach that is supplemented by the workings of a competitive market on access to cardiac care for AMI patients. After controlling for age, sex, and race, it was observed that HMO AMI patients were less likely to receive cardiac catheterizations (OR = 0.827 at the 95 percent confidence level) and CABG surgery (OR = 0.852 at 95 percent confidence level) when compared to FFS AMI patients. HMO AMI patients were slightly more likely to receive a PTCA cardiac procedure (OR = 1.067 at the 95 percent confidence level) than FFS AMI patients.

Adult↗
PubMed2005

Utilization of health care services among the near-elderly: a comparison of managed care and fee-for-service enrollees.

This article compares and contrasts the use of health care services among near-elderly adults (55-64 yr) across HMOs, PPOs, and fee-for-service (FFS) plans. Statistical tests are used to examine possible selection bias by type of plan [corrected] Multistage regression methods are implemented whenever the test results indicate the presence of selection bias. The findings show that compared with FFS plans, HMOs and PPOs are associated with a greater use of outpatient services and preventive services among adults in this age range. The rate of hospital admissions and the length of hospital stay are found to be similar across these types of plans.

Fee-for-Service Plans↗
PubMed2005

Inmate fees for health care services. Final rule.

The Bureau of Prisons (Bureau) finalizes rules describing procedures we will follow for charging inmates fees for certain kinds of health services, as required under the Federal Prisoner Health Care Copayment Act of 2000 (Pub. L. 106-294, October 12, 2000, 114 Stat 1038, codified at 18 U.S.C. 4048).

Civil Rights↗