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https://www.readbyqxmd.com/read/29843017/blended-capitation-and-incentives-fee-codes-inside-and-outside-the-capitated-basket
#1
Xue Zhang, Arthur Sweetman
Blended capitation physician payment models incorporating fee-for-service (FFS), pay-for-performance and/or other payment elements seek to avoid the extremes of both FFS and capitation. However, evidence is limited regarding physicians' responses to blended models, and potential shifts in service provision across payment categories within the practice. We examine the switch from FFS to a blended capitation-FFS model for primary care physicians in group practice. The empirical analysis shows patients experiencing 9-14% reductions in capitated services and simultaneous increases of 10-22% in FFS services from their rostering physicians...
March 22, 2018: Journal of Health Economics
https://www.readbyqxmd.com/read/29794522/medicaid-innovations-and-the-role-of-academic-health-centers
#2
Sheldon M Retchin, Wendy Yi Xu
Although they represent less than 8% of all U.S. hospitals, academic health centers (AHCs) deliver almost 40% of the inpatient care for Medicaid beneficiaries. However, because of low Medicaid reimbursement rates, AHCs have had to rely on supplemental funding sources, such as disproportionate share hospital (DSH) payments and upper payment limit (UPL) payments. Recent legislative efforts and changes to payment structures have made these sources vulnerable to severe reductions. For instance, DSH payments are scheduled to be cut by $8 billion by 2021, and UPL payments are a diminishing resource for many states because the program is based on a fee-for-service model and most states are moving to managed care...
May 22, 2018: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/29618391/provider-payment-to-primary-care-physicians-in-china-background-challenges-and-a-reform-framework
#3
Xiaoying Pu, Yaming Gu, Xiaohe Wang
AIM: To provide a framework for provider payment reform for primary care physicians in China. BACKGROUND: Primary health care is central to health system reform and payment incentives have significant consequences for the equity and efficiency of it. METHODS: This paper describes the special payments system for public primary health institutions and the subsequent internal salary remuneration to primary care physicians in China. Based on an analysis of the major challenges, we suggest a reform framework including the pattern of governance, and payments to primary health institutions and employed physicians...
April 5, 2018: Primary Health Care Research & Development
https://www.readbyqxmd.com/read/29553274/incorporating-value-into-physician-payment-and-patient-cost-sharing
#4
Zirui Song, Amol S Navathe, Ezekiel J Emanuel, Kevin G Volpp
The United States is simultaneously moving toward value-based payments for populations and precision medicine for individuals. During this evolution, innovations in payment and delivery that enhance tailoring of treatments to individuals while improving the value of care are needed. We propose one such innovation that would allow physician payment and patient cost sharing to better reflect the value of care by allowing the appropriateness of a service for a given patient in a given clinical situation to play a more meaningful role in the design of such incentives...
March 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/29537697/hepatology-in-a-changing-health-care-landscape-a-call-for-health-services-research
#5
Lisa B VanWagner, Fasiha Kanwal
With the passage of the Affordable Care Act followed by the physician payment reform, there is an urgent need to better understand the complex relationships between structure (including incentives), processes, and outcomes of health care and, based on this understanding, identify interventions that can ensure delivery of high-value care to patients with liver disease. As hepatologists, how do we systematically address these issues and ensure that we provide high-value care to our patients? These factors combine in the burgeoning field of health services research...
March 14, 2018: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
https://www.readbyqxmd.com/read/29521892/provider-reimbursement-following-the-affordable-care-act
#6
Brandon Bowling, David Newman, Craig White, Ashley Wood, Alberto Coustasse
Decreasing health care expenditures has been one of the main objectives of the Affordable Care Act. To achieve this goal, the Centers for Medicare and Medicaid Services (CMS) has been tasked with experimenting with provider reimbursement methods in an attempt to increase quality, while decreasing costs. The purpose of this research was to study the effects of the Affordable Care Act on physician reimbursement rates from CMS to determine the most cost-effective method of delivering health care services. The CMS has experimented with payment methods in an attempt to increase cost-effectiveness...
April 2018: Health Care Manager
https://www.readbyqxmd.com/read/29517575/variability-in-case-durations-for-common-surgical-procedures
#7
Laurent G Glance, Richard P Dutton, Changyong Feng, Yue Li, Stewart J Lustik, Andrew W Dick
BACKGROUND: Under the Merit-based Incentive Payment System, physician payment will be adjusted using a composite performance score that has 4 components, one of which is resource use. The objective of this exploratory study is to quantify the facility-level variation in surgical case duration for common surgeries to examine the feasibility of using surgical case duration as a performance metric. METHODS: We used data from the National Anesthesia Clinical Outcomes Registry on 404,987 adult patients undergoing one of 6 general surgical or orthopedic procedures: laparoscopic appendectomy, laparoscopic cholecystectomy, laparoscopic cholecystectomy with intraoperative cholangiogram, knee arthroscopy, laminectomy, and total hip replacement...
June 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29517056/expanding-incentives-for-coordinated-patient-centered-care-implications-for-neurologists
#8
William G Mantyh, Bruce H Cohen, Luana Ciccarelli, Lindsey M Philpot, Lyell K Jones
Historically, payment for cognitive, nonprocedural care has required provision of face-to-face evaluation and management as part of general ambulatory or inpatient care. Although non-face-to-face patient care (e.g., care via electronic means or telephone) is commonly performed and is integral to patient-centered care, appropriate reimbursement for this type of care is lacking. Beginning in 2017, Centers for Medicare and Medicaid (CMS) has taken a large step forward in reimbursing an increased number of cognitive care and non-face-to-face codes...
February 2018: Neurology. Clinical Practice
https://www.readbyqxmd.com/read/29370425/meaningful-use-s-benefits-and-burdens-for-us-family-physicians
#9
G Talley Holman, Steven E Waldren, John W Beasley, Deborah J Cohen, Lawrence D Dardick, Chester H Fox, Jenna Marquard, Ryan Mullins, Charles Q North, Matt Rafalski, A Joy Rivera, Tosha B Wetterneck
Objective: The federal meaningful use (MU) program was aimed at improving adoption and use of electronic health records, but practicing physicians have criticized it. This study was aimed at quantifying the benefits (ie, usefulness) and burdens (ie, workload) of the MU program for practicing family physicians. Materials and Methods: An interdisciplinary national panel of experts (physicians and engineers) identified the work associated with MU criteria during patient encounters...
January 23, 2018: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/29285865/sorting-into-payment-schemes-and-medical-treatment-a-laboratory-experiment
#10
Jeannette Brosig-Koch, Nadja Kairies-Schwarz, Johanna Kokot
In this study, we introduce the opportunity for physicians to sort into capitation or fee-for-service payment. Using a controlled medically framed laboratory experiment with a sequential within-subject design allows isolating sorting from incentive effects. We observe a strong preference for fee-for-service payment, which does not depend on subjects' prior experience with one of the two payment schemes. Further, we identify a significant sorting effect. Subjects choosing capitation deviate ex ante less from patient-optimal medical treatment than subjects who sort into fee-for-service payment...
December 2017: Health Economics
https://www.readbyqxmd.com/read/29204975/characteristics-and-disparities-among-primary-care-practices-in-the-united-states
#11
David Michael Levine, Jeffrey A Linder, Bruce E Landon
BACKGROUND: Despite new incentives for US primary care, concerns abound that patient-centered practice capabilities are lagging. OBJECTIVE: Describe the practice structure, patient-centered capabilities, and payment relationships of US primary care practices; identify disparities in practice capabilities. DESIGN: Analysis of the 2015 Medical Organizations Survey (MOS), part of the nationally representative Medical Expenditure Panel Survey (MEPS)...
April 2018: Journal of General Internal Medicine
https://www.readbyqxmd.com/read/29200334/performance-and-participation-of-physicians-in-year-one-of-medicare-s-value-based-payment-modifier-program
#12
Karen E Joynt Maddox, Arnold M Epstein, Lok Wong Samson, Lena M Chen
In 2015 Medicare launched the Physician Value-Based Payment Modifier program, the largest US ambulatory care pay-for-performance program to date and a precursor to the forthcoming Merit-based Incentive Payment System. In its first year, the program included practices with a hundred or more clinicians. We found that 1,010 practices met this criterion, 899 of which had at least one attributed beneficiary. Of these latter practices, 263 (29.3 percent) failed to report performance data and received a 1 percent reporting-based penalty...
December 2017: Health Affairs
https://www.readbyqxmd.com/read/29188286/association-of-dermatologist-density-with-the-volume-and-costs-of-dermatology-procedures-among-medicare-beneficiaries
#13
Sally Y Tan, Daphne Tsoucas, Arash Mostaghimi
Importance: The persistent shortage of dermatologists in the United States affects access to care and patient outcomes. Objective: To characterize the effect of geographic variations in dermatologist density on the provision of dermatology procedures within Medicare. Design, Setting, and Participants: This was a cross-sectional study using the 2013 Medicare Provider Utilization and Payment Database. Dermatology-related procedures were defined by the top 50 billing codes accounting for more than 95% of procedures billed by dermatologists...
January 1, 2018: JAMA Dermatology
https://www.readbyqxmd.com/read/29182351/the-influence-of-provider-characteristics-and-market-forces-on-response-to-financial-incentives
#14
Brock O'Neil, Mark Tyson, Amy J Graves, Daniel A Barocas, Sam S Chang, David F Penson, Matthew J Resnick
OBJECTIVES: Alternative payment models, such as accountable care organizations, use financial incentives as levers for change to facilitate the transition from volume to value. However, implementation raises concerns about adverse changes in market competition and the resultant physician response. We sought to identify physician characteristics and market-level factors associated with variation in response to financial incentives for cancer care that may ultimately be leveraged in risk-shared payment models...
November 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/29153847/effect-of-incentive-payments-on-chronic-disease-management-and-health-services-use-in-british-columbia-canada-interrupted-time-series-analysis
#15
M Ruth Lavergne, Michael R Law, Sandra Peterson, Scott Garrison, Jeremiah Hurley, Lucy Cheng, Kimberlyn McGrail
We studied the effects of incentive payments to primary care physicians for the care of patients with diabetes, hypertension, and Chronic Obstructive Pulmonary Disease (COPD) in British Columbia, Canada. We used linked administrative health data to examine monthly primary care visits, continuity of care, laboratory testing, pharmaceutical dispensing, hospitalizations, and total h ealth care spending. We examined periods two years before and two years after each incentive was introduced, and used segmented regression to assess whether there were changes in level or trend of outcome measures across all eligible patients following incentive introduction, relative to pre-intervention periods...
February 2018: Health Policy
https://www.readbyqxmd.com/read/29135661/reconsidering-the-affordable-care-act-s-restrictions-on-physician-owned-hospitals-analysis-of-cms-data-on-total-hip-and-knee-arthroplasty
#16
P Maxwell Courtney, Brian Darrith, Daniel D Bohl, Nicholas B Frisch, Craig J Della Valle
BACKGROUND: Concerns about financial incentives and increased costs prompted legislation limiting the expansion of physician-owned hospitals in 2010. Supporters of physician-owned hospitals argue that they improve the value of care by improving quality and reducing costs. The purpose of the present study was to determine whether physician-owned and non-physician-owned hospitals differ in terms of costs, outcomes, and patient satisfaction in the setting of total hip arthroplasty (THA) and total knee arthroplasty (TKA)...
November 15, 2017: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/29133491/exploring-attributes-of-high-value-primary-care
#17
Melora Simon, Niteesh K Choudhry, Jim Frankfort, David Margolius, Julia Murphy, Luis Paita, Thomas Wang, Arnold Milstein
PURPOSE: Medicare's merit-based incentive payment system and narrowing of physician networks by health insurers will stoke clinicians' and policy makers' interest in care delivery attributes associated with value as defined by payers. METHODS: To help define these attributes, we analyzed 2009 to 2011 commercial health insurance claims data for more than 40 million preferred provider organization patients attributed to over 53,000 primary care practice sites. We identified sites ranking favorably on both quality and low total annual per capita health care spending ("high-value") and sites ranking near the median ("average-value")...
November 2017: Annals of Family Medicine
https://www.readbyqxmd.com/read/29126109/do-prospective-payment-systems-ppss-lead-to-desirable-providers-incentives-and-patients-outcomes-a-systematic-review-of-evidence-from-developing-countries
#18
Si Ying Tan, G J Melendez-Torres
The reform of provider payment systems, from retrospective to prospective payment, has been heralded as the right move to contain costs in the light of rising health expenditures in many countries. However, there are concerns on quality trade-off. The heightened attention given to prospective payment system (PPS) reforms and the rise of empirical evidence regarding PPS interventions among developing countries suggest that a systematic review is necessary to understand the effects of PPS reforms in developing countries...
January 1, 2018: Health Policy and Planning
https://www.readbyqxmd.com/read/29116661/complying-with-the-emergency-medical-treatment-and-labor-act-emtala-challenges-and-solutions
#19
Charleen Hsuan, Jill R Horwitz, Ninez A Ponce, Renee Y Hsia, Jack Needleman
The Emergency Medical Treatment and Labor Act (EMTALA), which requires Medicare-participating hospitals to provide emergency care to patients regardless of their ability to pay, plays an important role in protecting the uninsured. Yet many hospitals do not comply. This study examines the reasons for noncompliance and proposes solutions. We conducted 11 semistructured key informant interviews with hospitals, hospital associations, and patient safety organizations in the Centers for Medicare and Medicaid Services region with the highest number of EMTALA complaints filed...
January 2018: Journal of Healthcare Risk Management: the Journal of the American Society for Healthcare Risk Management
https://www.readbyqxmd.com/read/29075552/patient-copayments-provider-incentives-and-income-effects-theory-and-evidence-from-the-essential-medications-list-under-china-s-2009-healthcare-reform
#20
Brian K Chen, Y Tony Yang, Karen Eggleston
Expanding access through insurance expansion can increase healthcare utilization through moral hazard. Reforming provider incentives to introduce more supply-side cost sharing is increasingly viewed as crucial for affordable, sustainable access. Using both difference-in-differences and segmented regression analyses on a panel of 1,466 hypertensive and diabetic patients, we empirically examine Shandong province's initial implementation of China's 2009 Essential Medications List policy. The policy reduced drug sale markups to providers but also increased drug coverage benefits for patients...
March 2017: World Medical & Health Policy
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