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At least 145 records · Page 8Linked to original sources
PubMed2006

Medicare in interventional pain management: A critical analysis.

Recent years have been quite eventful for interventional pain physicians with numerous changes in the Medicare payment system with a view for the future and what it holds for interventional pain management for 2006 and beyond. On February 8, 2006, President Bush signed the Deficit Reduction Act of 2005, which cuts the federal budget by 39 billion dollars and Medicare and Medicaid by almost 11 billion dollars over five years. The Act contains a number of important provisions that effect physicians in general and interventional pain physicians in particular. This Act provides one year, 0% conversion factor update in payments for physicians services in 2006. Medicare has four programs or parts, namely Medicare Parts A, B, C, and D, and two funds to pay providers for serving beneficiaries in each of these program. Part B helps pay for physician, outpatient hospital, home health, and other services for the aged and disabled who have voluntarily enrolled. Before 1922, the fees that Medicare paid for those services were largely based on physician's historical charges. Despite Congress's actions of freezing or limiting the fee increases, spending continued to rise because of increases in the volume and intensity of physician services. Medicare spending per beneficiary for physician services grew at an average annual rate of 11.6% from 1980 through 1991. Consequently Congress was forced to reform the way that Medicare sets physician fees, due to ineffectiveness of the fee controls and reductions. The sustained growth rate (SGR) system was established because of the concern that the fee schedule itself would not adequately constrain increases in spending for physicians' services. The law specifies a formula for calculating the SGR, based on changes in four factors: (1) estimated changes in fees; (2) estimated change in the average number of Part B enrollees (excluding Medicare Advantage beneficiaries); (3) estimated projected growth in real gross domestic product (GDP) growth per capita; and (4) estimated change in expenditures due to changes in law or regulation. Overall, the frequency of utilization of interventional procedures has increased substantially since 1998. In 2006 and beyond, interventionalists will face a number of evolving economic and policy-related issues, including reimbursement discrepancies, issues related to CPT coding, issues related to utilization, fraud, and abuse.

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PubMed1991

Physician attitudes and behavior in response to changes in Medicare reimbursement policies.

BACKGROUND: Rapidly changing Medicare reimbursement policies since 1983 have affected every primary care physician. This study has attempted to quantify the attitudes and behaviors of Ohio primary care physicians toward these changes. METHODS: In Ohio, 1758 primary care physicians were surveyed by a mailed questionnaire about their attitudes toward recent changes in Medicare reimbursement policies and the resulting changes in their practices. RESULTS: More than 80% of respondents termed most Medicare policies as "objectionable" or "very objectionable." Fifty percent were limiting the number of Medicare patients in their practices. Family physicians and physicians who perceived their income to have decreased and their staff workload to have increased were also more likely to limit the number of Medicare patients in their practices. CONCLUSIONS: Ohio primary care physicians have a negative opinion of Medicare reimbursement policies and have limited their practices significantly as a result.

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PubMed1990

Urban-rural differences in Medicare physician expenditures.

Policymakers have long been concerned with urban-rural disparities in access to health care. These disparities may be particularly severe in the case of the elderly and others covered by Medicare. Descriptive tables show that the total volume of physician services provided to rural beneficiaries is more than 40% lower than the volume of physician services provided to urban beneficiaries. This result is fairly consistent across all types of care and sites of care. In our econometric analysis, we investigate the factors that may explain these differences in utilization. The results indicate that, with prices held constant, variations in demographic and economic characteristics are not the major reasons for the urban-rural gap. Differences in hospital and physician (particularly specialist) availability appear to be the main factors.

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PubMed1990

Volume performance standards: can they control growth in Medicare services?

Congress has adopted volume performance standards (VPSs), a system using collective incentives, as a means to control costs of physicians' services under the Medicare program. Past efforts to curb expenditures failed to focus sufficiently on providing direct incentives to individual providers or consumers, and did not achieve desirable results. West German and Canadian experiences suggest that mechanisms to contain costs may work best when their scope is regional rather than national, prompting the view that the VPS system should operate on a state level. The system's efficacy may also require Medicare officials to analyze utilization patterns assiduously, and states' medical and professional organizations to monitor physicians' practices and formulate due practice guidelines.

Cost Control↗