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PubMedDate not supplied

Improving glycemic control: can techniques used in a managed care setting be successfully adapted to a rural fee-for-service practice?

The objective of this work was to improve glycemic control using case management supported by electronic diabetes care monitoring. Information for patients with diagnosed diabetes in a rural community was maintained in the Diabetes Care Monitoring System. In September 1998, counseling and medication management for glycemic control was intensified during individual office visits. And, from September 1998 to February 1999, 2-hour cluster visits modeled after a successful urban program were offered for groups of patients with elevated HbA1c values. The median (and 75th percentile) HbA1c values for the patient population decreased from 8.7% (10.9%) in March 1998 (N = 173) to 7.5% (9.3%) in March 1999 (N = 182) and was maintained at 7.5% (9.1%) through March 2000 (N = 182). Case management, including cluster visits, can be accomplished in a rural physician's office with the support of an electronic diabetes care monitoring system. This intensified approach decreased and sustained the HbA1c level by more than a percentage point for the patient population.

Adolescent↗
PubMed2002

Costs of treatment for elderly women with early-stage breast cancer in fee-for-service settings.

PURPOSE: This study provides population-based estimates of the treatment costs for elderly women with early-stage breast cancer, with emphasis on costs of modified radical mastectomy (MRM) compared with breast-conserving surgery (BCS) and radiation therapy (RT). PATIENTS AND METHODS: Women with breast cancer from the Surveillance, Epidemiology, and End Results cancer registries were linked with their Medicare claims, 1990 through 1998. Each claim was assigned to an initial, continuing, or terminal care phase after a cancer diagnosis. Mean monthly phase-specific costs were determined for all health care and for treatment related only to cancer. Cumulative long-term costs of care that accrue during a women's remaining lifetime were calculated by treatment group. RESULTS: Initial care costs for the 6 months after diagnosis for women who underwent BCS with RT were approximately $450 per month higher than for women with MRM. During the continuing-care phase, costs for women undergoing BCS with RT were significantly less expensive than for MRM cases. The two groups had similar costs in the terminal-care phase. Assuming the same survival distributions, long-term costs for women undergoing BCS with RT were not statistically different than for women undergoing MRM. CONCLUSION: Although mastectomy was less costly in the initial phase, the lifetime costs of BCS with RT and mastectomy were equivalent. Thus, women's preferences, resources to cover out-of-pocket costs, and life situations should be the major factors addressed in shared decision making about treatment options.

Aged↗
PubMed1997

Medicare's resource-based relative value scale, a de facto national fee schedule: its implications and uses for neurologists.

The institution of the RBRVS as a basis of Medicare reimbursement corrects some long-standing inequities. First, it corrects the magnitude of reimbursement of procedures compared with cognitive services. Second, it corrects unexplained geographical variations in reimbursement. The RBRVS continues to go through refinement. The 5-year review and HCFA's practice expense project are likely to further improve reimbursement for cognitive services. Furthermore, because of the strengths of the scale, the RBRVS is now employed by most payors and is a useful practice management tool. Relative to other specialties, particularly the surgical specialties, neurology has in general benefited from these changes. Yet the RBRVS only addresses the rate of reimbursement; the proliferation of plans and insurance products with different coverage and payment policies and different procedures vastly complicates medical practice management. Understanding the development and evolution of the RBRVS is one necessary element of competent practice management.

Fee Schedules↗
PubMed2005

Impact of prescription-term deregulation with revised medical service fees on drug therapy management.

The proclamation of April 2002 of a Ministry of Health, Labor and Welfare ordinance has enabled doctors to prescribe drugs for an outpatient without a limit on the length of prescription terms except for a few drugs. There is a concern that the prescription-term deregulation could cause careless drug therapy management in order to extend the interval between patient hospital visits. The purpose of this study is to make pre- and post-deregulation comparisons of two items, prescription terms and implementation of clinical examination that complied with package-insert precautions, and to discuss the approaches to increase safety. Prescription terms have lengthened progressively. In the pre-regulation period of January to March 2002, the mean prescription term was 19.9 days; in the post-regulation period of July to September 2002, it was 24.9 days; and in July to September 2003, 28.6 days. Even for anti-tumor agents, there were prescriptions over 90 days after deregulation. There was no significant difference between the pre- and post-deregulation compliance ratios for the package-insert precautions in eight drugs of investigated nine. However, one case had a delay in detection of liver dysfunction, which was caused by deviation from the once-a-month testing indicated in the package-insert precautions for prolonged prescription terms. The evidence suggested that the deregulation led to negligent drug therapy management. To assure safe therapy, the following should be addressed: first, sufficient function of a computerized prescriber order entry system and second, creation of a new framework with pharmacists' active involvement such as collaborative therapy management with physicians.

Ambulatory Care↗
PubMed2006

Supporting older people: care needs and care fees.

In this article, brought to you in association with Help the Aged, Phillip Spiers discusses the different options for older people who are not coping at home, and directs carers to sources of financial support with care.

Aged↗
PubMed1997

The treatment of women with mental health disorders under HMO and fee-for-service insurance.

The expansion of managed care may have significant implications for the treatment of women with mental health problems seen in primary care and by specialty mental health practitioners. Using data on office visits by women with mental health problems from the 1990-1994 annual National Ambulatory Medical Care Survey, we examine characteristics of office visits by payment type. We find that women with HMO-paid visits are much more likely to see a primary care practitioner rather than a specialist. While treatment patterns in primary care do not differ by payment type, treatment patterns in specialty care differ substantially. Women in HMOs are more likely to receive medications and less likely to receive psychotherapy, particularly longer duration psychotherapy, than are those with FFS payment.

Adolescent↗
PubMed2001

Utilization, costs, and access to primary care in fee-for-service and managed care plans.

This study compares access to primary care, utilization, and costs among enrollees in four forms of managed care and an indemnity plan. We use 1996 data from a commercial insurer. Most managed care enrollees had better access to primary care services than indemnity enrollees. This access was associated with a generally lower rate of preventable hospitalization. Per capita inpatient costs were notably lower in managed care plans than in the indemnity plan. We describe how health care managers can use readily available administrative data and straightforward statistical techniques to enhance routine monitoring for quality and costs. Policy makers can use this approach to identify health services trends, and to evaluate access to health services for individuals enrolled in various benefit plan types.

Fee-for-Service Plans↗