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Transportation safety, tobacco restriction and other vital issues such as mandatory Medicare assignment are IMS priorities for the upcoming session of the Iowa Legislature. The author, chairman of the IMS Committee on Legislation, discusses the 1990 IMS legislative agenda.
BACKGROUND: The changing scope of optometric practice has had a large impact on the profession. Optometry has gone from a drugless profession to a profession that can use diagnostic pharmaceutical agents (DPAs) in every state and therapeutic pharmaceutical agents (TPAs) in 46 states. The intent of this study was to determine the influence that these legal variables exert on the scope of practice for optometrists in different states. METHODS: Optometrists in three states with varying statutes regulating the scope of practice were surveyed to determine if there were practice differences related to these state laws. RESULTS: In states with TPA usage, more optometrists accepted Medicare assignment and had hospital and nursing home privileges. Optometrists with TPA certification had, as a group, graduated more recently. Travel times for patients with conditions requiring treatment with therapeutic drugs were shorter in the states with TPA legislation. CONCLUSIONS: Access to care is enhanced for citizens of a state with optometric usage of therapeutic pharmaceutical agents.
This paper updates previous research on physician-based measures of access to care for Medicare beneficiaries following the implementation of Medicare payment reform in 1992. Using data collected in spring 1993, the results show that the majority of physician-based access indicators did not change significantly from 1992 levels. Those indicators that did change generally offset reductions in access identified immediately after the implementation of Medicare physician payment reform.
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The Omnibus Budget Reconciliation Act of 1989 (OBRA89) established volume performance standards (VPSs) as a key element in Medicare physician reform. This policy requires making choices along three dimensions: the risk pool, the scope and nature of the standard, and the application of the standard. VPSs have most effectively controlled expenditures and changed physician behavior when they use states as the risk pool, are composed entirely of Medicare Part B services, and establish per capita utilization targets. The institution of separate standards for voluntarily formed physician groups would pose substantial administrative challenges and has the potential to effect adverse outcomes. Instead, Congress should continue to encourage prepaid plans for the purpose of lowering health care use. Under current law, VPSs will be used to adjust future price increases. Congress may not wish to emulate the example of countries that have imposed expenditure ceilings to control costs unless the current method of using VPSs proves unsuccessful.
This paper examines the impact of Medicare physician payment reform on access to care by comparing several physician-based access measures in the pre- and post-reform periods. The results suggest that the broad goals of payment reform may have been at least partially achieved: the proportion of physician revenues derived from Medicare increased for primary care physicians and decreased for nonprimary care MDs; there was little change in the absolute or relative number of visits provided to Medicare patients; and an increasing number of physicians charged no more than the Medicare payment amount. Some signs of deteriorating access were found, however. Fewer physicians were willing to treat all new Medicare patients and more physicians accepted no new Medicare patients. Furthermore, there was an increase in the proportion of physicians who reduced or stopped providing to Medicare patients certain types of services that they continued to provide to other patients.
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The prospect of budget cuts in Medicare is likely to result in less generous reimbursements from Medicare and thus affects physicians' willingness to accept Medicare patients with the reduced payments. This study examines physicians' decisions about case-by-case assignment and participation in Medicare in relation to Medicare reimbursement generosity. A two-part model is applied to a database from a national survey of physicians. The results indicate that reimbursement generosity from private insurance relative to that from Medicare negatively affects physicians' assignment rates, implying that the elderly's access to health care and/or the financial burden is likely to be jeopardized by further reductions in Medicare reimbursements.
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In this paper I examine the access, quality, and cost trade-offs of assignment under Part B of the Medicare program for both participating and nonparticipating practices, and discuss the impact of assignment on both physician and patient choices. I also discuss the assignment options, or variants of assignment, that have been pursued and that might be considered for future implementation to curb increases in physician costs. Although one frequently suggested alternative--mandatory assignment--would reduce much of the uncertainty surrounding physician costs and reduce some of the out-of-pocket costs of the elderly, it could promote a two-tier system of care by reducing quality for Medicare beneficiaries, and may produce increases in government expenditures.
This rule establishes in regulations the circumstances in which a nonparticipating physician who does not accept Medicare assignment of a claim is required to refund to the beneficiary any amounts collected for physician services determined to be not reasonable and necessary. Its purpose is to extend limitation of liability protection to beneficiaries with non-assigned claims when the physician knew or could reasonably have been expected to know that Medicare would deny payment for the services. Physician appeal rights are also specified. This rule conforms our regulations to section 9332(c) of the Omnibus Budget Reconciliation Act of 1986.
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