Effective in 2000, Medicare's Outpatient Prospective Payment System (OPPS) sets pre-determined reimbursement rates for hospital outpatient services, replacing the prior cost-based methods of reimbursement. Using Florida outpatient discharge data, we study the effect of OPPS on hospital outpatient volume. We find that on average Medicare rate cuts either decreased or had no significant effect on...

There have been no published empirical studies comparing the experiences of terminally ill patients in managed care organizations (MCOs) and those in fee for service (FFS). This investigation represents the first empirical study to systematically compare substantive outcomes between populations of terminally ill patients enrolled in MCO and FFS healthcare delivery systems. The investigators int...

Although it is well known theoretically that physicians respond to financial incentives, the empirical evidence is quite mixed. Using the 2004 Canadian National Physician Survey, we analyze the number of patient visits per week provided by family physicians in alternative forms of remuneration schemes. Overwhelmingly, fee-for-service (FFS) physicians conduct more patient visits relative to four...

BACKGROUND Many uninsured people living with HIV/AIDS (PLWHA) will obtain managed health insurance coverage when the Affordable Care Act (ACA) is implemented in January 2014. Since 2011, California has transitioned PLWHA to Medicaid managed care (MMC) and to the Low-Income Health Program (LIHP). OBJECTIVES To draw lessons for the ACA implementation from the transitions into MMC and the LIHP. ...

OBJECTIVE To demonstrate cost-effectiveness analysis (CEA) for evaluating different reimbursement models. DATA SOURCES/STUDY SETTING The CEA used an observational study comparing fee for service (FFS) versus capitation for Medicaid cases with severe mental illness (n=522). Under capitation, services were provided either directly (direct capitation [DC]) by not-for-profit community mental heal...

Medicare Advantage (MA) has grown rapidly since the Affordable Care Act; nearly one-third of Medicare beneficiaries now choose MA. An assessment of the comparative value of the 2 options is confounded by an apparent selection bias favoring MA, as reflected in mortality differences. Previous assessments have been hampered by lack of access to claims diagnosis data for the MA population. An indir...

Healthcare reimbursements in the US have been traditionally based upon a fee-for-service (FFS) scheme, providing incentives for high volume of care, rather than efficient care. The new healthcare legislation tests new payment models that remove such incentives, such as the bundled payment (BP) system. We consider a population of patients (beneficiaries). The provider may reject patients based o...

CMS recently assumed responsibility for estimating the Medicare fee-for-service (FFS) error rate from the Office of the Inspector General (OIG). Here, the method used to calculate national, by State, and by error type, estimates for the inpatient acute care portion of this rate is presented. For fiscal years (FYs) 1998 and 2000 discharges, national estimates for the net error rate were 2.6 and ...