Survival and Treatment for Colorectal Cancer Medicare Patients in Two Group/Staff Health Maintenance Organizations and the Fee-for-Service Setting

1999 ◽  
Vol 56 (2) ◽  
pp. 177-196 ◽  
Author(s):  
Ray M. Merrill ◽  
Martin L. Brown ◽  
Arnold L. Potosky ◽  
Gerald Riley ◽  
Stephen H. Taplin ◽  
...  
PEDIATRICS ◽  
1996 ◽  
Vol 97 (2) ◽  
pp. A30-A30
Author(s):  
J. F. L.

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.


PEDIATRICS ◽  
1995 ◽  
Vol 96 (2) ◽  
pp. 378-378
Author(s):  
J. F. L.

The quality of American health care—unarguably the best in the world—is under siege. Republicans released budget plans last week that would cut subsidies to teaching hospitals that train doctors and perform clinical research. Meanwhile, the private market, whose reform Congress bungled last year, has been doing the same. The two-pronged assault is alarming. American physicians provide innovative, technically advanced care whose quality can be traced in part to generous subsidies for basic research that Congress has provided through the National Institutes for Health (NIH). The NIH estimates that the Senate budget plan could reduce these subsidies for non-AIDS research over the next seven years by as much as 25%; the cut is deeper if inflation is taken into account. The proposed NIH cuts are easily identified and will be subject to public scrutiny. Two other threats are harder to spot. The Federal Government, when reimbursing hospitals for treating Medicare patients, pays an average of 30% extra if treatment is provided in a teaching hospital. The extra payments cover costs associated with training doctors and translating basic research into clinical practice ... Under the GOP budgets, these payments could fall between 30 and 60%. The other dagger aimed at teaching hospitals comes from the private sector. Private insurers have also paid more for patients treated in teaching hospitals. That practice is ending. Wielding new-found market power, health maintenance organizations and other managed-care groups are driving down hospital rates. They refuse to pay for training or research that does not directly benefit their enrollees.


Author(s):  
Thomas M. Kozak ◽  
Andrea Kozak Miller

This chapter examines billing for psychological services through an ethical and procedural lens. Types of billing are reviewed, including fee-for-service and various types of insurance. The usual and customary rate for billing as compared to the amount paid by various types of insurance companies is explored, as is the insurance coverage related to psychological testing. Patient-centered medical homes are discussed, including their relationship to managed care and health maintenance organizations. Capitated systems are reviewed, including how to plan for services and ethical concerns in this model. Other types of billing, including Medicare and Medicaid, are discussed as is the use of a sliding fee scale and collection agencies. This chapter offers a general overview of billing and collecting for psychological services while exploring ethical and real-world considerations.


1992 ◽  
Vol 1992 (1) ◽  
pp. 91-95
Author(s):  
Chris Girard ◽  
Rockwell Schulz ◽  
James O'Leary ◽  
James Greenley ◽  
William Scheckler

1996 ◽  
Vol 53 (1_suppl) ◽  
pp. 44-64 ◽  
Author(s):  
Thomas Rice ◽  
Jon Gabel

As health maintenance organizations (HMOs) emerge as the dominant delivery system, the value of research on the fee-for-service sector will diminish. Health services researchers, purchasers, and HMOs will turn their attention to what makes some HMOs more effective than others. To understand this, researchers should take advantage of natural experiments that occur within an individual HMO. This strategy capitalizes on the diversity within an HMO; a single HMO offers different benefit packages, uses different methods for paying providers, and uses different utilization management programs with different employer groups. The authors reviewed the relatively few studies that take advantage of natural experiments. Findings indicate that patients and physicians respond to economic incentives, but no study has examined the relationship between changes in cost sharing or physician payment and quality of care. To achieve external validity, the authors recommend that funding organizations support consortia that replicate similar natural experiments at different HMOs.


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