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physician payment incentive

Amanda N Fader, Tim Xu, Brian J Dunkin, Martin A Makary
BACKGROUND: Surgery is one of the highest priced services in health care, and complications from surgery can be serious and costly. Recently, advances in surgical techniques have allowed surgeons to perform many common operations using minimally invasive methods that result in fewer complications. Despite this, the rates of open surgery remain high across multiple surgical disciplines. METHODS: This is an expert commentary and review of the contemporary literature regarding minimally invasive surgery practices nationwide, the benefits of less invasive approaches, and how minimally invasive compared with open procedures are differentially reimbursed in the United States...
October 17, 2016: Surgical Endoscopy
Zachary M Grinspan, Yuhua Bao, Alison Edwards, Phyllis Johnson, Rainu Kaushal, Lisa M Kern
This was a retrospective cohort study of ambulatory care quality by physicians who received payment for Medicaid Stage 1 Meaningful Use (MU) in 2012 using New York State Medicaid Claims (2010-2013). Eight quality measures were used to compare performance of physicians who received payments to Adopt, Implement, or Use (AIU) an electronic health record in 2011 but not for MU in 2012 (AIU-only group) and physicians who cared for Medicaid patients but received no payments (no-incentive group), using propensity score-weighted difference-in-difference logistic regression analyses, clustering by physician...
October 13, 2016: American Journal of Medical Quality: the Official Journal of the American College of Medical Quality
Mariétou H Ouayogodé, Carrie H Colla, Valerie A Lewis
BACKGROUND: Medicare's Accountable Care Organization (ACO) programs introduced shared savings to traditional Medicare, which allow providers who reduce health care costs for their patients to retain a percentage of the savings they generate. OBJECTIVE: To examine ACO and market factors associated with superior financial performance in Medicare ACO programs. METHODS: We obtained financial performance data from the Centers for Medicare and Medicaid Services (CMS); we derived market-level characteristics from Medicare claims; and we collected ACO characteristics from the National Survey of ACOs for 215 ACOs...
September 27, 2016: Healthcare
Benjamin P Falit, Hubert Y Pan, Benjamin D Smith, Brian M Alexander, Anthony L Zietman
Examinations of the US radiation oncology workforce offer inconsistent conclusions, but recent data raise significant concerns about an oversupply of physicians. Despite these concerns, residency slots continue to expand at an unprecedented pace. Employed radiation oncologists and professional corporations with weak contracts or loose ties to hospital administrators would be expected to suffer the greatest harm from an oversupply. The reduced cost of labor, however, would be expected to increase profitability for equipment owners, technology vendors, and entrenched professional groups...
November 1, 2016: International Journal of Radiation Oncology, Biology, Physics
Laxmaiah Manchikanti, Vijay Singh, Joshua A Hirsch
UNLABELLED: In the face of the progressive implementation of the Affordable Care Act (ACA), a significant regulatory regime, and the Merit-Based Incentive Payment System (MIPS), the Centers for Medicare and Medicaid Services (CMS) released its proposed 2017 hospital outpatient department (HOPD) and ambulatory surgery center (ASC) payment rules on July 14, 2016, and the physician payment schedule was released July 15, 2016. U.S. health care costs continue to increase, occupying 17.5% of the gross domestic product (GDP) in 2014 and surpassing $3 trillion in overall health care expenditure...
September 2016: Pain Physician
Laxmaiah Manchikanti, Alan D Kaye, Joshua A Hirsch
The Centers for Medicare and Medicaid Services (CMS) released the proposed 2017 Medicare physician fee schedule on July 7, 2016, addressing Medicare payments for physicians providing services either in an office or facility setting, which also includes payments for office expenses and quality provisions for physicians. This proposed rule occurs in the context of numerous policy changes, most notably related to the Medicare Access & CHIP Reauthorization Act of 2015 (MACRA) and its Merit-Based Incentive Payment System (MIPS)...
September 2016: Pain Physician
Laxmaiah Manchikanti, Standiford Helm Ii, Ramsin M Benyamin, Joshua A Hirsch
UNLABELLED: The Merit-based Incentive Payment System (MIPS) was created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) to improve the health of all Americans by providing incentives and policies to improve patient health outcomes. MIPS combines 3 existing programs, Meaningful Use (MU), now called Advancing Care Information (ACI), contributing 25% of the composite score; Physician Quality Reporting System (PQRS), changed to Quality, contributing 50% of the composite score; and Value-based Payment (VBP) system to Resource Use or cost, contributing 10% of the composite score...
September 2016: Pain Physician
Bijan J Borah, Yang Qiu, Nilay D Shah, Patrick P Gleason
BACKGROUND: The Medicare 5-Star Rating System measures and provides incentive for improving Medicare Part D plans through a quality-based payment program. Adherence to medications for chronic conditions is key to the Star ratings. Our objective was to assess the impact of direct-to-provider letters on improving medication adherence. METHODS: Members of a large US pharmacy benefits manager (PBM) who did not adhere to prescription of oral diabetes (antidiabetics), cholesterol-reducing (statins), or hypertension (renin angiotensin system [RAS] antagonists) drug therapy were identified from the prescriptions claims data of>600,000 continuously enrolled Medicare members...
September 2016: Healthcare
Sanjay Basu, Russell S Phillips, Zirui Song, Bruce E Landon, Asaf Bitton
PURPOSE: We assess the financial implications for primary care practices of participating in patient-centered medical home (PCMH) funding initiatives. METHODS: We estimated practices' changes in net revenue under 3 PCMH funding initiatives: increased fee-for-service (FFS) payments, traditional FFS with additional per-member-per-month (PMPM) payments, or traditional FFS with PMPM and pay-for-performance (P4P) payments. Net revenue estimates were based on a validated microsimulation model utilizing national practice surveys...
September 2016: Annals of Family Medicine
Hui Zhang, Christian Wernz, Danny R Hughes
Payment innovations that better align incentives in health care are a promising approach to reduce health care costs and improve quality of care. Designing effective payment systems, however, is challenging due to the complexity of the health care system with its many stakeholders and their often conflicting objectives. There is a lack of mathematical models that can comprehensively capture and efficiently analyze the complex, multi-level interactions and thereby predict the effect of new payment systems on stakeholder decisions and system-wide outcomes...
September 1, 2016: Health Care Management Science
Ciara Pendrith, Amardeep Thind, Gregory S Zaric, Sisira Sarma
OBJECTIVES: The primary objective of this paper is to compare cervical cancer screening rates of family physicians in Ontario's two dominant reformed practice models, Family Health Group (FHG) and Family Health Organization (FHO), and traditional fee-for-service (FFS) model. Both reformed models formally enrol patients and offer extensive pay-for-performance incentives; however, they differ by remuneration for core services (FHG is FFS; FHO is capitated). The secondary objective is to estimate the average and marginal costs of screening in each model...
August 2016: Healthcare Policy, Politiques de Santé
Rachelle Ashcroft, Jose Silveira, Kwame Mckenzie
BACKGROUND: An opportunity to address the needs of patients with common mental disorders (CMDs) resides in primary care. Barriers are restricting availability of treatment for CMDs in primary care. By understanding the incentives that promote and the disincentives that deter treatment for CMDs in a collaborative primary care context, this study aims to help contribute to goals of greater access to mental healthcare. METHOD: A qualitative pilot study using semi-structured interviews with thematic analysis...
August 2016: Healthcare Policy, Politiques de Santé
Chloe de Grood, Aida Raissi, Yoojin Kwon, Maria Jose Santana
OBJECTIVE: The goal of this scoping review was to summarize the current literature identifying barriers and opportunities that facilitate adoption of e-health technology by physicians. DESIGN: Scoping review. SETTING: MEDLINE, EMBASE, and PsycINFO databases as provided by Ovid were searched from their inception to July 2015. Studies captured by the search strategy were screened by two reviewers and included if the focus was on barriers and facilitators of e-health technology adoption by physicians...
2016: Journal of Multidisciplinary Healthcare
M Ruth Lavergne, Michael R Law, Sandra Peterson, Scott Garrison, Jeremiah Hurley, Lucy Cheng, Kimberlyn McGrail
BACKGROUND: In 2007, the province of British Columbia implemented incentive payments to primary care physicians for the provision of comprehensive, continuous, guideline-informed care for patients with 2 or more chronic conditions. We examined the impact of this program on primary care access and continuity, rates of hospital admission and costs. METHODS: We analyzed all BC patients who qualified for the incentive based on their diagnostic profile. We tracked primary care contacts and continuity, hospital admissions (total, via the emergency department and for targeted conditions), and cost of physician services, hospital care and pharmaceuticals, for 24 months before and 24 months after the intervention...
October 18, 2016: CMAJ: Canadian Medical Association Journal, Journal de L'Association Medicale Canadienne
Joyce C West, Diana E Clarke, Farifteh Firoozmand Duffy, Keila D Barber, Eve K Mościcki, Ramin Mojtabai, Kristin Kroeger Ptakowski, Saul Levin
OBJECTIVE: This study sought to describe the extent to which psychiatrists, prior to insurance expansions under the Affordable Care Act (ACA), reported currently participating or being likely to participate in integrated services delivery models, to assume new roles, to accept new reimbursement structures, and to use electronic health records (EHRs). METHODS: A cross-sectional probability survey of U.S. psychiatrists was fielded from September to December 2013. In total, 2,800 psychiatrists were randomly selected from the AMA Physician Masterfile, and 45% responded...
August 15, 2016: Psychiatric Services: a Journal of the American Psychiatric Association
Renee Carter, Bruno Riverin, Jean-Frédéric Levesque, Geneviève Gariepy, Amélie Quesnel-Vallée
BACKGROUND: We aimed to synthesize the evidence of a causal effect and draw inferences about whether Canadian primary care reforms improved health system performance based on measures of health service utilization, processes of care, and physician productivity. METHODS: We searched the Embase, PubMed and Web of Science databases for records from 2000 to September 2015. We based our risk of bias assessment on the Grading of Recommendations Assessment, Development and Evaluation guidelines...
2016: BMC Health Services Research
Joshua M Liao, Ezekiel J Emanuel, Amol S Navathe
Six trends - movement towards value-based payment, rapid adoption of digital health technology, care delivery in non-traditional settings, development of individualized clinical guidelines, increased transparency, and growing cultural awareness about the harms of medical overuse - are driving the US health care system towards a future defined by quality- and patient-centric care. Health care organizations are responding to these changes by implementing provider and workforce changes, pursuing stronger payer-provider integration, and accelerating the use of digital technology and data...
September 2016: Healthcare
Robert E Mechanic, Darren Zinner
OBJECTIVES: Little is known about the scope of alternative payment models outside of Medicare. This study measures the full complement of public and private payment arrangements in large, multi-specialty group practices as a barometer of payment reform among advanced organizations. STUDY DESIGN AND METHODS: We collected information from 33 large, multi-specialty group practices about the proportion of their total revenue in 7 payment models, physician compensation strategies, and the implementation of selected performance management initiatives...
June 2016: American Journal of Managed Care
Funda Gulay Kadioglu
In 2003 Turkey introduced the Health Transition Program to develop easily accessible, high-quality, and effective healthcare services for the population. This program, like other health reforms, has three primary goals: to improve health status, to enhance financial protection, and to ensure patients' satisfaction. Although there is considerable literature on the anticipated positive results of such health reforms, little evidence exists on their current effectiveness. One of the main initiatives of this health reform is a performance-based supplementary payment system, an additional payment healthcare professionals receive each month in addition to their regular salaries...
July 2016: Cambridge Quarterly of Healthcare Ethics: CQ: the International Journal of Healthcare Ethics Committees
Shivani Baisiwala, M Kate Bundorf, Suzann Pershing
BACKGROUND AND OBJECTIVE: To evaluate variation in physician use of vascular endothelial growth factor (VEGF) inhibitors. PATIENTS AND METHODS: Population-based analysis of comprehensive, publicly available 2012 Medicare claims, aggregated by physician specialty and service type - including intravitreal injections of bevacizumab (Avastin; Genentech, South San Francisco, CA), ranibizumab (Lucentis; Genetech, South San Francisco, CA), and aflibercept (Eylea; Regeneron, Tarrytown, NY)...
June 1, 2016: Ophthalmic Surgery, Lasers & Imaging Retina
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