Physician Self-Referral and Physician-Owned Specialty Facilities

Outlines issues of self-referral -- physicians referring patients to a group or facility in which they have a financial interest -- and the prevalence of physician-owned facilities, as well as the effects on healthcare quality, cost, and access

Doing Better by Doing Less: Approaches to Tackle Overuse of Services

Experts have projected that as much as a third of U.S. health care spending is unnecessary and wasteful. Of the estimated $765 billion of health care dollars wasted in 2009, a quarter --$210 billion -- was spent on the overuse of services, which includes services that are provided more frequently than necessary or services that are higher-cost, but no more beneficial than lower-cost alternatives.This paper provides a summary of the problem of overuse in the U.S. health care system. The analysis gives an overview of the provision of medically inappropriate and unnecessary services that drive up health care spending without making a positive impact on patients' health outcomes. It also describes approaches that have already been used to address overuse of health care services and outlines the broader payment reforms needed to minimize incentives to overdiagnose and overtreat.This overuse of services has implications for both health care costs and outcomes. There is substantial variation in the level of inappropriate use across different health care services. Research shows that the rates at which particular procedures, tests, and medications were performed or prescribed when clinically inappropriate ranged from a low of 1 percent to a high of 89 percent

The Impact of Managed Care Payer Contracts on the Subspecialty Medical Provider: Policy Implications that Impact on the Care of Disabled Children

This Note explores the impact of current managed care contractual practices on the subspecialty provider\u27s ability to deliver health care to chronically ill and disabled children. In doing so, it delves into the historical events giving rise to the development of health care reform. It then reviews various physician agreements with several managed care organizations ( MCOs ) to demonstrate how contract conditions affect compensation for pediatric neurosurgical services. This Note then details the impact of managed care on the management of the chronic health problems of such children and proposes alternative solutions for affordable health care delivery systems for poor, medically fragile groups with complex health problems

Introducing activity-based financing: a review of experience in Australia, Denmark, Norway and Sweden

We review and evaluate the international literature on activity-based funding of health services, focussing especially on experience in Australia (Victoria), Denmark, Norway and Sweden. In evaluating this literature we summarise the differences and pros and cons of three different funding arrangements, namely cost-based reimbursement, global budgeting and activity-based financing. The institutional structures of the four jurisdictions that are the main focus of the review are described, and an outline is provided about how activity-based funding has been introduced in each. We then turn to the mechanics of activity-based funding and discuss in detail how patients are classified, how prices are set and how other services are funded. Although concentrating on the four jurisdictions, we draw on wider international experience to inform this discussion. We review evidence of the impact of activity-based funding in the four jurisdictions on efficiency, activity rates, waiting times, quality and overall expenditure. Finally we conclude with a brief commentary of some of the challenges that would have to be faced if implementing activity-based funding.

Vermont Price Variation Analysis

This analysis documents price variations across the state and suggests a process and methodology that the Vermont Green Mountain Care Board could use to set standard rates. The report determined that inpatient prices among Vermont\u27s 14 hospitals and Dartmouth-Hitchcock Medical Center in New Hampshire vary from 71 to 130 percent of the state average. The analysis identified a number of factors that explain some variation in professional prices among providers and also showed there is no consistency in the share of variation explained by each factor across health services

Focal Spot, Spring 2005

https://digitalcommons.wustl.edu/focal_spot_archives/1099/thumbnail.jp

Transaction Prices and Managed Care Discounting for Selected Medical Technologies: A Bargaining Approach

It is generally assumed that managed care has been successful at capturing discounts from medical providers, but the implications have been a matter of debate. Critics argue that managed care organizations attain savings by reducing intensity of services, while others have argued that savings are 'real' and are a consequence of discounts per unit of care. To address this, we obtain separate transaction prices for hospital episodes (treatment) and for the narrowly defined surgical procedure, using the example of heart bypass surgery. Both sets of prices were drawn from a database of insurance claims of self-insured firms that offer a menu of insurance options. We use a Nash-Bargaining framework to obtain price discounts by type of insurance. Adjusting for product and patient heterogeneity, the per-procedure prices yield the anticipated pattern of discounts: Relative to traditional fee for service, point-of-service HMOs exhibited the largest discounts followed by Preferred-Provider-Organizations (18 and 12 percent, respectively). While reductions in intensity of services are not directly observable from the data, combining the results from the per-procedure and per-episode analysis yields a range of intensity reduction of 20-6 percent, with a corresponding per-unit price discount of 4-18 percent for the entire episode. We conclude that a large share cost savings by managed care organizations are due to per-unit price reductions.

Estimating the Economic Impact of Telemedicine in a Rural Community

One commonly discussed benefit of broadband access in rural America is the potential for telemedicine visits that allow rural residents to take advantage of urbanized medical services. While the primary benefit of telemedicine is often viewed as improved health care access, the availability of these services also offers significant economic contributions to the local community. Site visits to 24 rural hospitals of varying size over a four-state area in the Midwest provide information to develop a methodology for estimating telemedicine’s economic impact. Using this technique, telemedicine services contribute between $20,000 and$1.3M annually to these local economies, with an average of $522,000.telemedicine, economic impact, teleradiology, telepsychiatry, Community/Rural/Urban Development, Health Economics and Policy,

Essays on radiology services utilization in the United States

This dissertation investigates how policies and financial incentives may affect the use of services within the United States health care system. The research consists of two distinct parts: Part I comprises two studies examining the impact of recently enacted state legislation regarding dense breast tissue on the use of downstream imaging; Part II delves into changes in physician reimbursement and their effect on health care delivery. Dense breast tissue is a common finding that decreases the sensitivity of mammography in detecting cancer. Some states have passed legislation requiring health care providers to notify patients with dense breast tissue that identification of early cancers may be compromised. Others have also aimed to increase access to supplemental screening tests by requiring health plans to include such follow-up options in covered benefits. The legislation has been controversial because supplemental imaging following a negative screening mammogram for patients with no other risk factors provides little benefit compared to its substantial cost. In the first study, we analyzed whether the dense breast tissue notification laws affected the probability of screening mammography follow-up by ultrasound and magnetic resonance imaging (MRI). We found strong evidence that implementing the notification legislation led to an increase in the probability of downstream breast ultrasound imaging in most states, and to an increase in the probability of downstream breast MRI in some states. In the second study, we identified specific characteristics of various state-level dense breast policies that were associated with increased use of downstream breast ultrasound imaging. In Part II of the dissertation, we assessed the extent to which changes in health care prices affect the provision of health services by physicians in various medical and surgical specialties in both Medicare and the private sector. We exploited the considerable changes in the Medicare Physician Fee schedule due to procedural code bundling that happened between 2010 and 2014 as the source of variation in health care prices. Our results showed that volume responses to changes in health care prices are inelastic and vary in both direction and magnitude by specialty and sector.2019-10-31T00:00:00