professor naoki ikegami’s “fee-for-service payment – an evil practice that must be stamped out” summarizes many of the failings of alternatives to fee-for-service (ffs) payment systems. his article also offers several suggestions for improving ffs systems. however, even powerful arguments against many of the alternatives to ffs, does not make a convincing argument for ffs systems. in addition, ...

co-opting physicians to regulate fee-for-service (ffs) payment is more feasible and simpler to administer than capitation, diagnosis-related groups (drgs) and pay-for-performance. the key lies in designing and revising the fee schedule, which not only defines and sets the fee for each item, but also the conditions of billing. adherence to these regulations must be strictly audited in order to c...

Professor Naoki Ikegami’s “Fee-for-service payment – an evil practice that must be stamped out” summarizes many of the failings of alternatives to fee-for-service (FFS) payment systems. His article also offers several suggestions for improving FFS systems. However, even powerful arguments against many of the alternatives to FFS, does not make a convincing argument for FFS systems. In addition, ...

ost experts who examine America’s persistent healthcare cost and quality problems identify fee-for-service (FFS) reimbursement as an key contributor to the system’s chronic ills. Under FFS, doctors and hospitals are paid more for doing more, not for delivering better outcomes. The economic incentives under FFS actually discourage quality improvement because care that “gets it right the first ti...

Co-opting physicians to regulate Fee-for-Service (FFS) payment is more feasible and simpler to administer than capitation, Diagnosis-Related Groups (DRGs) and pay-for-performance. The key lies in designing and revising the fee schedule, which not only defines and sets the fee for each item, but also the conditions of billing. Adherence to these regulations must be strictly audited in order to c...

BACKGROUND Medicare managed care enrollees who disenroll to fee-for-service (FFS) historically have worse health and higher costs than continuing enrollees and beneficiaries remaining in FFS. OBJECTIVE To examine disenrollment patterns by analyzing Medicare payments following disenrollment from Medicare Advantage (MA) to FFS in 2007. Recent growth in the MA program, introduction of limits on ...

In this article, case-mix-adjusted outcomes of home health care are found to be superior for Medicare fee-for-service (FFS) patients relative to Medicare health maintenance organization (HMO) patients. The superior outcomes for FFS patients were accompanied by higher utilization and cost of home health services, suggesting a volume-outcome (or dose-response) relationship that was further substa...

Using the Diagnostic Cost Group (DCG) model developed from a national sample, we examine biased selection among one fee-for-service (FFS) plan, one preferred provider organization, and several health maintenance organizations (HMOs) in Massachusetts. The proportions of enrollees in low-risk groups are higher in the HMO plans and lower in the FFS plan. The average age in the FFS plan is 9 years ...

This article examines the differences in mortality measured health status between the Medicare Advantage (MA) program and Fee-for-Service (FFS) program from 1999 to 2007. At the national level, differences in mortality rates were associated with MA market share. In some counties, enrollees in the MA program were 40% less likely to die than their peers in the FFS program, but in other counties, ...