Key Findings. (1) Based on analysis of 2009 Medicare claims data, more than 70% of rural primary care physicians (PCP) and non-physician practitioners (NPP) qualify for payments under the Primary Care Incentive Payment Program (PCIP) threshold (i.e., meet the > 60% of allowable Medicare charges). (2) The average incentive payment for qualifying rural PCPs would result in an additional $8,000 in...

The Medicare Program is conducting a randomized trial of care management services among fee-for-service (FFS) beneficiaries called the Medicare Health Support (MHS) pilot program. Eight disease management (DM) companies have contracted with CMS to improve clinical quality, increase beneficiary and provider satisfaction, and achieve targeted savings for chronically ill Medicare FFS beneficiaries...

Between 1989 and 1994 the health maintenance organization (HMO) share of the Medicare market grew rapidly. It is still heavily concentrated geographically, however. The most influential factor in this growth is HMO penetration into an area's general health care market. Medicare payment rates and prior Medicare HMO penetration also have an impact, but their effects are much weaker. Thus, payment...

We estimated the effects of three Health Care Financing Administration (HCFA)-funded case management demonstrations for high-cost Medicare beneficiaries in the fee-for-service (FFS) sector. Participating beneficiaries were randomly assigned to receive case management plus regular Medicare benefits or regular benefits only. None of the demonstrations improved self-care or health or reduced Medic...

As the first step in a pioneering effort by the Health Care Financing Administration (HCFA) to measure interstate border crossing for services used by both Medicare and non-Medicare beneficiaries, the authors study the spending behavior of Medicare beneficiaries for 10 Medicare-covered services. Based on interstate flow-of-expenditure data developed for calendar year 1991, the authors analyze t...

This article is the last in a series of studies concerning Medicare program costs of Social Security Disability Insurance (DI) beneficiaries who were under age 62 at time of entitlement to disabled-worker benefits. The earlier work provided the statistical analysis and mathematical models needed to construct estimates of Medicare costs for those beneficiaries while in the DI program. In this ar...

OBJECTIVE The objectives of this study are to evaluate the development and implementation of Medicare Locals as new primary care organisations and consider the implications of these findings for the wider challenge of strengthening primary healthcare in Australia and internationally. DESIGN National survey of Medicare Locals which involved the use of content analysis and a descriptive survey ...

Managed care has grown dramatically over the years, first among private employers, then in Medicaid programs (Medi-Cal in California) and in the Medicare system. Today, two in five older persons in California (40%) are in Medicare HMOs at any one time. Nationwide, one in six (17%) among the elderly population is in a Medicare HMO. This Policy Brief reports new findings on access to care of elde...

The Department of Health & Human Services’ Centers for Medicare and Medicaid Services (CMS) has approved the continuation of deeming authority for The Joint Commission’s hospital accreditation program through July 15, 2014. The CMS designation means that hospitals accredited by The Joint Commission may choose to be “deemed” as meeting Medicare and Medicaid certification requirements. CMS found ...