Strategic Options in Capital Budgeting and Program Selection under Fee-For-Service and Managed Care

1996 ◽  
Vol 21 (4) ◽  
pp. 7-17
Author(s):  
Frank T. Magiera ◽  
Robert A. McLean
Keyword(s):  
Managed Care ◽  
Capital Budgeting ◽  
Fee For Service ◽  
Program Selection ◽  
Strategic Options

"DR UNNECESSARY"

PEDIATRICS ◽  
1996 ◽  
Vol 97 (2) ◽  
pp. A30-A30
Author(s):  
J. F. L.
Keyword(s):  
Managed Care ◽  
Private Practice ◽  
Psychiatric Treatment ◽  
Health Maintenance Organizations ◽  
Case Managers ◽  
Fee For Service ◽  
Health Maintenance ◽  
Insurance Costs ◽  
Treatment Plans

The old reality for many psychiatrists was a private practice filled with long-term patients who paid $100 or more for 50 minutes of talk. The new reality? Managing medication for up to 30 new patients a week for half the hourly fee—and answering to case managers who aren't even doctors. No wonder the number of U.S. medical school graduates in psychiatric residencies dropped nearly 12%—to 3909 from 4447—between 1988 and 1994. The blame—or the credit—goes to managed care, the catchall term for the revolution that has swept through both the medical and mental health care fields in recent years. Desperate to cut runaway health insurance costs, most companies have axed longstanding fee-for-service plans and instead steer employees seeking psychiatric treatment to health maintenance organizations or specialized managed-care firms. These organizations decide the type and amount of care patients receive. Psychiatrists have to get with the program—and agree to its treatment plans and fee schedules—or watch the bulk of their practices disappear. Only the rare psychiatrist can attract private patients wealthy enough to pay for traditional psychotherapy without the benefit of insurance.

A Fee-for-Service Practice Cannot Survive

2019 ◽  
pp. 47-51
Author(s):  
Jeffrey E. Barnett ◽  
Jeffrey Zimmerman
Keyword(s):  
Mental Health ◽  
Managed Care ◽  
Private Practice ◽  
Clinical Skills ◽  
Disposable Income ◽  
Fee For Service ◽  
Health Practice ◽  
Mental Health Practice ◽  
Community Needs ◽  
Goods And Services

During fiscally challenging times and given the prevalence of managed care, it is easy to think that a fee-for-service private mental health practice is no longer possible. This chapter clearly demonstrates how wrong this myth is. Many individuals use their disposable income to purchase goods and services that are of value to them. How to develop and maintain a financially successful fee-for-service private practice is explained. Specific strategies are provided to determine community needs, to develop clinical skills that meet these needs, and to demonstrate the value of these services to prospective clients. Recommendations are made for structuring one’s practice so that clients will be more likely to pay for needed services out-of-pocket and for developing a successful fee-for-service private mental health practice.

Home care reimbursement for intravenous ganciclovir therapy

1996 ◽  
Vol 53 (2) ◽  
pp. 161-163 ◽  
Author(s):  
Essy Mozaffari ◽  
Sean D. Sullivan
Keyword(s):  
Health Care ◽  
Managed Care ◽  
Home Care ◽  
Home Health Care ◽  
Home Health ◽  
Fee For Service ◽  
Geographic Variations ◽  
Intravenous Ganciclovir ◽  
Ganciclovir Therapy ◽  
Nursing Services

Variability in reimbursement for home i.v. ganciclovir therapy among three types of payers was investigated. A survey was developed to estimate reimbursement for drug and medical supplies and nursing services associated with preparing i.v. ganciclovir and administering it to persons with cytomegalovirus (CMV)-associated retinitis in the home care setting. The questionnaire was mailed to 45 home health care agencies and 11 nursing agencies. Of the 56 surveys mailed, 26 (46%) were returned and considered usable. Of the 26 respondents, 22 were home health care companies, 4 were nursing ageiicies, 22 served patients covered by managed care or state assistance that reimbursed on a per diem trasis, and 9 did not provide care to fee-for-service patients. The mean total daily-reimbursement rate (for ganciclovir, supplies, and nursing services) from managed care per diem plans was $137.69 per patient, compared with $I29.18 from fee-for-service plans and $72.68 from state assistance per diem plans. The dissimilarity may have been due to geographic variations in reimbursement and different mechanisms of reimbursement. Providers of home i.v. ganciclovir therapy for persons with CMV retinitis received the highest tnean total daily reimbursement from managed care per diem plans, followed by fee-for-service plans and state assistance per diem plans.

Racial and Income Differences in Use of the Hospice Benefit between the Medicare Managed Care and Medicare Fee-for-Service

1999 ◽  
Vol 2 (1) ◽  
pp. 23-31 ◽  
Author(s):  
Beth A. Virnig ◽  
Robert O. Morgan ◽  
Nancy A. Persily ◽  
Carolee A. DeVito
Keyword(s):  
Managed Care ◽  
Fee For Service ◽  
Income Differences

Plan Choice and Changes in Access to Care over Time for SSI-Eligible Children with Disabilities

2005 ◽  
Vol 42 (2) ◽  
pp. 145-159 ◽  
Author(s):  
Pamela N. Roberto ◽  
Jean M. Mitchell ◽  
Darrell J. Gaskin
Keyword(s):  
Managed Care ◽  
Access To Care ◽  
Estimation Procedure ◽  
Care Plan ◽  
Care Hospital ◽  
Fee For Service ◽  
Special Needs Children ◽  
Plan Choice ◽  
Two Step Estimation ◽  
Over Time

This paper analyzes how voluntary enrollment in the fee-for-service (FFS) system versus a partially capitated managed care plan affects changes in access to care over time for special needs children who receive Supplemental Security Income (SSI) due to a disability. Four indicators of access are evaluated, including specialty care, hospital care, emergency care, and access to a regular doctor. We employ the Heckman two-step estimation procedure to correct for the potential nonrandom selection bias linked to plan choice. The findings show that relative to their counterparts in the partially capitated managed care plan, SSI children enrolled in the FFS plan are significantly more likely to encounter an access problem during either of the time periods studied. Similarly, FFS enrollees are significantly more likely than partially capitated managed care participants to experience persistent access problems across three of the four dimensions of care. Possible explanations for the deterioration in access associated with FFS include the lack of case management services, lower reimbursement relative to the partially capitated managed care plan, and provider availability.

Usability of encounter data for Medicaid comprehensive managed care vs traditional Medicaid fee‐for‐service claims among pregnant women

2019 ◽  
Vol 29 (1) ◽  
pp. 30-38
Author(s):  
Yoonyoung Choi ◽  
Haesuk Park ◽  
Christian Hampp ◽  
Babette Brumback ◽  
H. Cody Meissner ◽  
...  
Keyword(s):  
Managed Care ◽  
Pregnant Women ◽  
Fee For Service

Federal reimbursement to laboratories

1996 ◽  
Vol 42 (5) ◽  
pp. 817-821
Author(s):  
J Logue
Keyword(s):  
Managed Care ◽  
Payment System ◽  
Regulatory Change ◽  
Fee For Service ◽  
Medicare Payment ◽  
Laboratory Cost ◽  
Federal Laboratory ◽  
Clinical Laboratories ◽  
Private And Public ◽  
The Cost

Abstract The change from a predominately fee-for-service payment environment to managed care has significantly reduced revenues for many clinical laboratories. Medicare is rapidly becoming the most favorable payor in areas with high managed-care penetration. This trend has not gone unnoticed by Congress, and congressional and regulatory initiatives are rapidly moving to reduce federal laboratory reimbursement. The efforts by both the private and public payors to further restrict payments could have a profound effect on the scope of testing offered by hospital-based laboratories. On-site nonemergent testing capability will be dependent on the cost to provide the service and the level of reimbursement. Laboratory providers have an opportunity to influence the extent of laboratory cost-reducing initiatives. To effect congressional or regulatory change requires an understanding of the federal Medicare payment system and a well-organized effort.

scholarly journals State Medicaid Programs Bring Managed Care Tenets to Fee for Service

2016 ◽  
Vol 22 (2) ◽  
pp. 145-148 ◽  
Author(s):  
Shellie L. Keast ◽  
Grant Skrepnek ◽  
Nancy Nesser
Keyword(s):  
Managed Care ◽  
Fee For Service
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