OBJECTIVE To assess the effect of differing health insurance coverage of physician office visits on the use of colorectal cancer (CRC) tests among an employed and insured population. METHOD Cohort study of persons ages 50 to 64 years enrolled in fee-for-service (FFS) or preferred provider organization (PPO) health plans, where FFS plan enrollees bear disproportionate share of office visit cov...

CONTEXT Since 2000, the Centers for Medicare & Medicaid Services (CMS) has been collecting information on beneficiaries' experiences with health care for Medicare managed care (MMC) and traditional fee-for-service (FFS) Medicare. OBJECTIVES To compare beneficiary experiences with managed care and FFS arrangements throughout the country and to assess the stability of those differences over tim...

On July 7, 2014, the Centers for Medicare and Medicaid Services (CMS) published the calendar year (CY) 2015 proposed payment rule for the Medicare Home Health Prospective Payment System (HH PPS). The proposed rule reflects the annual update to the Medicare fee-for-service (FFS) HH rates and policies based on regulatory changes put forward by CMS and legislative changes previously adopted by Con...

Little is known about variation in patterns of recovery among patients discharged alive from hospitalizations for pneumonia.The aim of the is observational cohort study was to characterize the variation in patterns of hospital readmission and survival in the year after discharge for pneumonia in 3 different health systems.The 3 cohorts consisted of (1) the Health and Retirement Study participan...

This article has two objectives: to quantify the access and utilization of services received by chronically mentally ill Medicaid recipients, and to compare service utilization and access under prepayment and fee-for-service (FFS) payment. The study setting is Hennepin County (Minneapolis), Minnesota, where 35 percent of Medicaid recipients were randomly assigned to receive services from prepai...

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 r...

OBJECTIVE To prospectively compare inpatient and outpatient utilization rates between prepaid (PPD) and fee-for-service (FFS) insurance coverage for patients with chronic disease. DATA SOURCE/STUDY SETTING Data from the Medical Outcomes Study, a longitudinal observational study of chronic disease patients conducted in Boston, Chicago, and Los Angeles. STUDY DESIGN A four-year prospective st...

Objectives. The purpose of this study was to investigate whether or not there is an association between managed care insurance and the delivery and outcome of care in patients presenting with unstable angina. Background. The proportion of U.S. patients with managed care health insurance is increasing. This may be associated with recent improvements in the control of health care costs. It is unk...

OBJECTIVE Use of physician service claims and other administrative data is increasingly being advocated for chronic disease surveillance. However, such data may be vulnerable to reimbursement policy changes. We sought to determine how non-fee-for-service (non-FFS) primary care affects the detection of diabetes using physician claims data. METHODS Ontarians over age 66 with diabetes and receiv...

BACKGROUND Our aim was to compare access to effective care among elderly Medicare patients in a Staff Model and Group Model HMO and in Fee-for-Service (FFS) care. METHODS We used a retrospective cohort study design, using claims and automated medical record data to compare achievement on quality indicators for elderly Medicare recipients. Secondary data were collected from 1) HMO data sets an...