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At least 631 records · Page 35Linked to original sources
PubMed1991

Impact of the Medicare fee schedule on an academic department of medicine.

OBJECTIVE: To examine the effect of the Medicare Fee Schedule (MFS) on Medicare revenues in the department of medicine at an urban academic medical center after the MFS is fully implemented. METHODS: Department revenues from Medicare were compared with projected revenues using the MFS proposed by the Health Care Financing Administration on June 5, 1991. National Medicare claims data were used to determine differences in service mix between community and academic internists and the impact of the geographic component of the MFS on department revenues. RESULTS: Department revenues from Medicare in 1996 are projected to be 25.5% lower under the MFS than if the current system had continued. Subspecialty sections that perform large numbers of procedures and special tests had the largest decrease in revenues (eg, gastroenterology, -29.8%); however, this did not differ greatly from decreases in sections that mainly provide visits and consultations (eg, general internal medicine, -24.7%). CONCLUSION: The proposed MFS is projected to lead to substantial reductions in department revenues from Medicare. While relative values for services and geographic location will play a role in how individual departments fare under the MFS, the value of the conversion factor used in the final MFS will be the factor of greatest importance.

Academic Medical Centers↗
PubMed1991

New fee schedule tests staff skills. The Health Care Group.

The Medicare Fee Schedule (MFS) picture is quite incomplete, with myriad details unsettled. But one thing is clear: the shift to a new reimbursement system is loaded with significant practice management implications and challenges. Now, before the MFS is implemented, physicians should evaluate their management operations and business systems, to meet the challenges ahead. Most physicians understand that practice viability will depend on increasing their patient base and the scope of services delivered to non-Medicare patients. Yet many do not understand the marketing and management challenges implied in such growth. The issues are these: how can a practice attract more non-Medicare patients? And how can such growth be accommodated without disproportionately increasing costs or inconveniencing patients and staff?

Fees, Medical↗
PubMed1990

[Hemoglobin, sedimentation and community health legislation. Frequency of tests and fees at the Vaga community health center during 1983-87].

On the basis of laboratory records and doctors' list of appointments, we analyzed the number of hemoglobin tests and sedimentation rates performed at Vågå community health centre during the period 1983-87. In 1983 the doctors worked on a "fee for service" basis. Since 1984 they have been paid a fixed salary. Individual doctors showed little variation in their use of tests, but there were considerable differences between doctors. The average number of tests per patient was stable and seemed independent of how the doctors were reimbursed.

Ambulatory Care Facilities↗
PubMed1990

Diagnostic testing and return visits for acute problems in prepaid, case-managed Medicaid plans compared with fee-for-service.

Enrollment of Medicaid recipients into capitated, case-managed systems of health care has been advocated as a means to control costs. We studied the effect of such systems on care for urinary tract infection (UTI), pelvic inflammatory disease, and vaginitis among women enrolled in Aid to Families with Dependent Children in capitated demonstration programs in Santa Barbara County, California, and Jackson County, Missouri (prepaid), compared with similar but fee-for-service (FFS) counties in Ventura County, California, and St Louis, Mo. Structured abstracts were performed on 2382 outpatient charts with one of the three conditions in 1985. The proportion of cases with UTI in which a urine culture was obtained was similar in Santa Barbara (prepaid) and Ventura (FFS), 47% vs 46%, but greater in Jackson County (prepaid) than St Louis (FFS), 58% vs 32%. The proportion of cases with return visits for a UTI was: Santa Barbara (prepaid), 40%; Ventura (FFS), 33%; Jackson (prepaid), 72%; and St Louis (FFS), 53%. The proportion of patients with pelvic inflammatory disease with cervical cultures for gonorrhea as Santa Barbara (prepaid), 81%; Ventura (FFS), 52%; Jackson (prepaid), 86%; and St Louis (FFS), 61%. The proportion of women returning for follow-up after pelvic inflammatory disease was similar across all counties at 40% and 50%. The number of office diagnostic tests performed for vaginitis was greater in both demonstration counties. These data do not demonstrate any diminution in either diagnostic testing or follow-up visits for three common ambulatory problems in a Medicaid population enrolled in a capitated, case-managed system, with some trends for more care in the demonstration sites.

Adult↗
PubMed1989

MA hospitals suffer from physician fee limits.

Massachusetts laws restricting physician fees are creating problems for hospitals as well. The physician shortage that the restrictions have created is resulting in emergency department overloads and rising lengths of stay in hospitals outside the Boston metropolitan area.

Fees, Medical↗
PubMed1989

Detection of depressive disorder for patients receiving prepaid or fee-for-service care. Results from the Medical Outcomes Study.

We estimated clinicians' awareness of depression for patients with current depressive disorder (N = 650) who received care in either a single-specialty solo or small group practice, a large multispecialty group practice, or a health maintenance organization in three US sites. Depressive disorder was determined by independent diagnostic assessment shortly after an office visit. Detection and treatment of depression were determined from visit-report forms completed by the treating clinician. Depending on the setting, from 78.2% to 86.9% of depressed patients who visited mental health specialists had their depression detected at the time of the visit, compared with 45.9% to 51.2% of depressed patients who visited medical clinicians, after adjusting for case-mix differences. Among patients of mental health specialists, there were no significant differences by type of payment in the likelihood of depressive disorder being detected or treated. Among patients of medical clinicians, however, those receiving care financed by prepayment were significantly less likely to have their depression detected or treated during the visit than were similar patients receiving fee-for-service care.

Adult↗
PubMed1977

A comparative analysis of the attitudes of dentists toward the advertising of their fees and services.

Restrictions on advertising about services performed by professional groups have recently been questioned by the government and consumers. The purpose of this study was to determine dentists' attitudes about the use of advertising in their profession and to compare the results with responses from physicians, attorneys, and accountants. While a survey of these groups in three metropolitan areas indicates mild support for advertising in general, there was a definite negative reaction to advertising in the respective professions. Participants also reported their attitudes about the effects of advertising on prices and fees, quality of services, and public expectations and governmental regulations.

Accounting↗
PubMed1987

General practitioner fees: the effect of an additional 10% goods and services tax.

The effects of an increase in general practitioner fees on the timing of decisions to seek certain consultations were studied at the time of the introduction of a 10% goods and services tax (GST) on 1 October 1986. Fifty-six general practitioners collected information on 4113 consecutive paediatric consultations over a four week study period. The price rise itself appeared to have little or no effect either on numbers attending, pattern of illness or on the timing of consultations. However, private medical insurance may have influenced decisions on when to seek medical attention.

Child↗
PubMed1979

Charging for hospital pharmaceutical services: computerized system using a markup and a dose fee.

The methods used to determine pharmacy charges for a pricing program in a 940-bed hospital using a computerized on-line pharmacy pricing and inventory control system are described. The program requires input of only four pieces of information: (1) patient number; (2) drug identification number; (3) dose factor; and (4) total number of doses dispensed. In the pricing formula, the charge to the patient is calculated by adding the product of the total cost of medication and the markup factor to the product of the dose fee and the total number of doses received. Advantages of the system are: (1) the patient or third-party payer can be given an itemized bill for all pharmaceutical charges; (2) the system accounts for all medication costs, whether they are charged to the patient or not; (3) the revenue for the department can be projected and adjusted accurately; (4) the charges are fair and equitable; (5) the patient is charged for medication administered only; and (6) the system produces accurate statistical reports for both the pharmacy and the financial services department. The disadvantages is the number of man-hours needed for the pricing function.

Computers↗
PubMed1979

Cost-based fee-setting for therapeutic consulting services.

A method for developing cost-based dietetic consulting fees is presented which can be applied in hospital in-patient and out-patient departments and in private practice. Limitations and advantages of the method are noted. The advantages outweigh the drawbacks.

Dietetics↗
PubMed1982

A longitudinal analysis of dentists' attitudes toward advertising their fees and services.

Over the past five years restrictions on advertising by various categories of professionals have gradually been reduced. A study was conducted in 1976 and replicated in 1981 to provide a basis for comparison of the change in attitudes by dentists toward advertising in general, advertising of fees, advertising of services, and the effect of advertising on various public issues. The attitudes of dentists toward advertising changed significantly during this period, generally becoming more positive.

Advertising↗
PubMed1982

Hospital use in a fee-for-service system.

The population of Olmsted County, Minnesota, receives care virtually exclusively from two fee-for-service group practices: the Mayo Clinic and the Olmsted Medical and Surgical Group. Study of the use of acute-care hospital services by this population in 1976 reveals that the hospital discharge rate per 1,000 population, adjusted for age and sex, was 30% less than the national rate; the age-sex-adjusted rate of hospital days per 1,000 population was 38% less than the national rate. Analysis by length of stay, type of hospital service, frequency of selected diagnoses and surgical procedures, and certain demographic and economic characteristics did not explain the differences from national use rates. These rates are comparable, after age and sex adjustment, with those in larger prepaid group practices. The analysis suggests that the organization of medical care may have an important influence on hospital use.

Catchment Area, Health↗
PubMed1978

Fees for information services to hospitals: a California experience.

The project was directed toward planning, developing, and implementing a subregional biomedical information network among the forty-three health care facilities (hospitals) of the four-county area served by Loma Linda University's health sciences library. The project coordinator contacted administrators and health care professionals in the forty-three institutions to present a plan for the network. The health care facilities were encouraged to support the continuation of the network through contract fees. The availability of specific information services was assured through contractual agreements. It was anticipated that the subregional network would be self-supporting after the twelve-month project period (December 1, 1976-November 30, 1977). The working territory (40,429 square miles) encompassed Mono, Inyo, Riverside, and San Bernardino counties. The project resulted in nine of the forty-three hospitals signing annual contracts for library services. It is recommended that projects of this kind extend beyond a year's duration in order to educate health professionals concerning the value of access to biomedical literature in improving patient care.

California↗
PubMedDate not supplied

Frame disturbances in no-fee psychotherapy.

The frame of psychotherapy shows both universality and social relativity. Since the intrapsychic world is permeable to social reality, the meaning of insurance in psychotherapy depends on context. Experience with Canadian National Health Insurance suggests that when no-fee psychotherapy in normative, it is absorbed in the frame. There are still trouble spots in the Canadian system, particularly the management of missed sessions. Depending on the needs of the patient, charging for missed sessions can disrupt therapy entirely or be constructive for the treatment.

Adult↗
PubMed1994

Primary care performance in fee-for-service and prepaid health care systems. Results from the Medical Outcomes Study.

OBJECTIVE: To examine differences in the quality of primary care delivered in prepaid and fee-for-service (FFS) health care systems. STUDY DESIGN: Longitudinal study of 1208 adult patients with chronic disease whose health insurance was through a traditional indemnity (FFS) plan, an independent practice association (IPA), or a health maintenance organization (HMO). Both IPA and HMO represent prepaid care systems. Patient- and physician-provided information was obtained by self-administered questionnaires. SETTING: A total of 303 physician offices (family medicine, general internal medicine, endocrinology, or cardiology) in solo and group practices in three US cities. OUTCOMES MEASURES: Seven indicators of primary care quality--accessibility (financial and organizational), continuity, comprehensiveness, coordination, and accountability (interpersonal and technical) of care. Performance on each was evaluated in FFS, IPA, and HMO settings. Analyses controlled for patient and physician characteristics. RESULTS: Financial access was highest in prepaid systems. Organizational access, continuity, and accountability were highest in the FFS system. Coordination was highest and comprehensiveness was lowest in HMOs. CONCLUSIONS: The results mark notable differences in core dimensions of primary care quality in each of three payment systems and raise questions regarding the associated cost inefficiencies and outcomes of care. In the current health care delivery reform climate, these findings call for consideration of the relative strengths and weaknesses of each system. We suggest strategies for elevating performance in each.

Adult↗
PubMedDate not supplied

Impact of a Resource-Based Relative Value Scale fee schedule on reimbursements to neonatologists.

We investigated the possible effect of the Resource-Based Relative Value Scale (RBRVS) fee schedule on reimbursements for neonatologists. This payment system may prove attractive to most third-party payers and is predicted to result in lower procedural reimbursement, which is a significant component of neonatal care. We studied the charges and reimbursements for the portion of our intensive care nursery patient population covered by Medicaid for a 1-year period. Total, procedural, and nonprocedural reimbursements under three current systems and the RBRVS were compared. The RBRVS system produced overall improved reimbursement compared with Medicaid, but decreased reimbursement compared with the other two systems. Nonprocedural services were relatively better reimbursed than procedural services. The impact of RBRVS will depend on the population mix of third-party payers, the proportion of nonprocedural charges in a particular neonatal intensive care unit, and the conversion factor used by the third-party payer.

Fees, Medical↗
PubMed1993

[Strategics of medical centers and regional hospitals in response to new labour insurance fee schedule].

The purpose of this paper is to evaluate the medical centers and regional hospitals, strategic response to the implementation of new labour insurance fee schedule. This survey selects fifty-one medical centers and regional hospitals, with the response rate of 92.73%. This questionnaire was developed and evaluated by the authors and mailed to the questionnaire response by hospital's director or relative department director. We have selected Shortell et al. (1985) theory as the framework for evaluating and explaining hospital response to regulation environment (ex: change in the reimbursement system) at institutional-level response (ex: hospital association activity aimed at influencing regulation), managerial-level response (ex: increased physician participation in hospital-wide decision making; starting or expanding a planning department) and technical-level response (ex: shared clinical services such as lab., X-ray, pharmacy). The result found that hospitals with the characteristics as non-public ownership, medical centers, bigger size, and more administrative staff are more inclined to adopt institutional-level response. And a technical-level response occurs to hospital when market competibility becomes more intense which leads to higher reimbursement resource dependency.

Fee Schedules↗