The payment policy for United States physicians was formerly based on determination of customary and prevailing charges from their fee schedules. Rapidly growing health care expenditures in the 1980s led to a fundamental change in payment reimbursement in which the new system was based on the resource costs to the physician for providing health care services. This reform highlights the signific...

This article reviews the history of the productivity adjustment in the fee schedule and the literature on measuring productivity in health care. Measuring physician-specific productivity is challenging, a principal reason why the actual update formula uses an economywide measure of productivity change. A number of the challenges, including adjusting for quality, the use of administered prices, ...

Adjusted for differences in purchasing power and practice expenses, Canadian physician fees are, on average, 59 percent of Medicare fees. The general perception that Medicare fees are low is the result of comparison with U.S. private fees, not to the much lower Canadian fees. In the context of the current U.S. health care system, lowering Medicare fees to Canadian levels could jeopardize access...

The 22 modifier is a Current Procedural Terminology code modifier that allows surgeons to receive additional reimbursement for complex procedures. The goal of this study was to evaluate the rate of, time to, and factors affecting reimbursement for 22-modifier cases filed by orthopedic surgeons. The authors reviewed the charts and billing data of the 150 noncharity spine and total joint replacem...

BACKGROUND In Japan, the revision of the fee schedules in 2006 introduced a new category of general care ward for more advanced care, with a higher staffing standard, a patient-to-nurse ratio of 7:1. Previous studies have suggested that these changes worsened inequalities in the geographic distribution of nurses, but there have been few quantitative studies evaluating this effect. This study ai...

Most provincial governments are considering or introducing changes to hospital funding. Ten years of rapidly increasing expenditures have left them still facing complaints of waiting lists and waiting times. Activity-based funding (ABF) would supplement traditional negotiated global budgets, reimbursing a predetermined amount for each case treated - essentially, a "fee schedule" - thus providin...

Medicare has begun to implement a new payment system for physician services; the system's cornerstone is a resource-based relative value scale (RBRVS) that divides physician services into three components--physician work, practice expense, and malpractice insurance--and calculates a relative value for each component. The relative values for the components are adjusted for geographic differences...

OBJECTIVE To examine how drug therapy patterns for osteoporosis have changed after the Medicare Physician Fee Schedule (MPFS) reimbursement reduction in 2007, in relation to follow-up bone mineral density (BMD) testing status. METHODS We used a retrospective temporal shift design to examine changes in drug therapy patterns before (Phase 1: January 1, 2005-December 31, 2006) and after (Phase 2...

www.aafp.org / fpm ■ F A M I L Y P R A C T I C E M A N A G E M E N T ■ 23 IL LU ST R A TI O N B Y J O H N F R ET Z Nonphysician providers of many stripes now work in family practices. This includes a variety of midlevel providers, nurses and medical assistants, among others. One way Medicare recognizes these individuals for payment purposes is by reimbursing physicians for services provided “in...

The 1989 Omnibus Budget Reconciliation Act (OBRA 89) included physician payment reform, part of which was a limit on balanced billing. The provision limiting charges was implemented in 1991. Under this reform, physicians who did not accept Medicare assignment were prohibited from billing Medicare beneficiaries more than 140 percent of the prevailing charge for evaluation and management services...