Redwood Medicare Assignment Program.
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This study examines the degree to which patient characteristics predict physicians' ad hoc decisions regarding acceptance of Medicare assignment. The study is based on a random sample of Medicare Part B enrollees living independently in the Salem, Oregon metropolitan area. Beneficiary characteristics and beneficiary reports of physician behavior are obtained from an hour long face-to-face survey. The findings show that patient characteristics are significant predictors of physician behavior. Those respondents with poor health, no supplementary coverage to Medicare Part B, and who are more sensitive to the cost of health care are significantly more likely to report that their physician accepts assignment than are respondents without these characteristics. Policy and research implications are discussed.
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In a national survey of fellows who had trained in geriatric medicine and psychiatry, the vast majority of former fellows expressed satisfaction with their current work. Satisfaction with a career choice in geriatrics was significantly greater among those physicians who had practices with large numbers of patients over 75, accepted Medicare assignment, spent their time as clinician-researchers, and had a medical school appointment. Physician job satisfaction may have important consequences, and attention to maximizing satisfaction is warranted.
This paper examines the changes in the billing for office visits, hospital visits, and consultations in the Medicare program for the period of 1986 through 1988. The analysis does not correct for changes in beneficiary or provider characteristics over the three-year period. Findings indicate $75 million in additional Medicare expenditures due to change in pattern of physician charges for these three commonly performed groups of procedures.
Physician payment reforms implemented in January 1992 have dramatically changed the way payments for services are determined under the Medicare Part B program. This paper presents new measures of access using physician-level data that provide a baseline for monitoring changes in access that might occur as these payment reforms unfold and that allow us to examine recent access trends. Our results suggest that Medicare beneficiaries as a group currently have a high degree of access to care, and that access generally improved between 1986 and 1990.
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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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.
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.
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.
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.
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