BACKGROUND Case payment for cataract surgery with Government Employee Insurance (GEI) was implemented at Chang Gung Memorial Hospital (CGMH) in March 1994, and fee-for-service (FFS) was retained for cataract inpatients with or without other health insurance. We examined the impact of this change in the reimbursement policy from FFS to case payment on the health care provider's practice behavior...

Despite its size and immense influence over health care in America, Medicare today is no monolith. It is comprised of three distinct payment programs though which it provides services to beneficiaries: “traditional,” fee-for-service (FFS) Medicare; Medicare Advantage (MA); and the Medicare Shared Savings and Pioneer accountable care organizations (ACO) programs. These models, which strongly inf...

PRINCETON, NJ ANN ARBOR, MI CAMBRIDGE, MA CHICAGO, IL OAKLAND, CA WASHINGTON, DC Controlling health care’s rising cost, while simultaneously expanding its availability and quality, is a top priority for policymakers at all levels of government. Increasingly, both private and public payers are experimenting with alternative payment models designed to improve care and slow spending. The U.S. Depa...

This is the first study to focus on Medicare mammography rescreening using a relatively large population of older women over a long followup period. To assess correlates of regular mammography, we followed all women age 65 or over enrolled continuously in Medicare fee-for-service (FFS) (n = 515,746) over a 7-year period. Data were drawn from the CMS claims data for the period 1992-1998. Irregul...

Currently, relative value units for practice expense are determined under the Medicare fee schedule (MFS) using historical physician charges. This seems inconsistent with the goal of a resource-based fee schedule. A specialty resource-based method of determining practice expense payments is presented and simulated here. The method assumes that, for each service, the payment for practice expense...

In fiscal year 2017, Medicaid is projected to finance the health care coverage for an estimated 74 million beneficiaries with estimated expenditures of $596 billion.1 State Medicaid directors oversee the day-to-day operations of their state Medicaid programs, and are responsible for a wide array of activities including benefit and payment determinations; procurement of services; and processing ...

background equity of access to health and provider payment mechanism in healthcare is a worldwide debated. healthcare reforms are primarily designed to improve productivity, economic efficiency and quality of care; however, an appropriate reimbursement of healthcare providers for services offered to patients and marinating a robust payment mechanism are not elucidated yet. conclusions no single...

This issue focuses on selected developments in the Medicare fee-for-service program. Two of the articles provide new estimates of the effect of Medicare supplemental insurance on total Medicare utilization and costs: One addresses utilization differences under alternative forms of supplemental insurance, and the other reports on utilization experience under the Medicare SELECT Demonstration. Tw...

Survey (MCBS) is a powerful tool for analyzing the Medicare population. Using MCBS data from the 2000 Access to Care File, differences in the composition of the population enrolled in Medicare risk HMOs and of those in the same geographic areas who remained in fee-for-service (FFS) were examined. The results show that differences in the population reflect different rates of managed care enrollm...

Direct primary care (DPC) is an emerging practice alternative that (1) eliminates traditional third-party fee-for-service billing and (2) charges patients a periodic fee for primary care services. We describe the DPC model by identifying DPC practices across the United States; distinguish it from other practice arrangements, such as the "concierge" practice; and describe the model's pricing usi...