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October 25, 2010 | Journal Article
Most physicians believe that Medicare reimbursements are inequitable but do not agree on how to reform the payment system. Physicians' views may be helpful in optimizing the design of any reimbursement reforms. The researchers of this study solicited their opinions regarding three reform strategies.
June 1, 2010 | Journal Article
The U.S. system of billing third parties for health care services is complex, expensive and inefficient. This study examines excessive administrative complexity from a focused and potentially practical perspective.
February 21, 2013 | Journal Article
Researchers raise significant questions about the risk adjustment that Medicare and others apply to insurance claims data.
April 1, 2013 | Journal Article
When hospital service line profit goes down, mortality goes up.
March 1, 2010 | Journal Article
This article examines the influence of cost on patient use of behavioral counseling services. Smoking and obesity are two major public health challenges, but few health insurance plans cover counseling services to help individuals lose weight or stop smoking. Little is known about how the cost of behavioral counseling services affects the consumption of such services.
October 1, 2009 | Journal Article
Capitated managed care contracted physicians make treatment decisions that are not inconsistent with profit-maximization. Due to great physician efficiency, halting of unnecessary procedures or skimping on care, this article shows that capitation is affecting the practice of medicine.
September 10, 2009 | Journal Article
The PROMETHEUS Payment approach seeks to promote and reward high-quality, efficient, patient-centered health care by using a novel method to pay hospitals and physicians and other providers. The PROMETHEUS Payment model consists of three components: evidence-informed base payments with patient-specific severity adjustments and an allowance for potentially avoidable complications.
July 1, 2009 | Journal Article
This survey on quality-based payment found that the prevalence of external performance bonuses paid by insurers to large medical groups is larger than the prevalence of performance bonuses paid by the medical groups to the primary care and specialist physicians.
February 1, 2012 | Journal Article
Provisions of the Affordable Care Act offer extraordinary opportunities to insure many more people, reimburse previously unreimbursed services, integrate care using new information technology tools and treatment teams, confront complex chronic comorbidities, and adopt underused evidence-based interventions.
January 10, 2008 | Journal Article
Related websites Subscription required: What We Know and Do Not Know About Tiered Provider Networks Some health care plans in the United States have adopted tiered provider networks (TPNS) to address the escalation of costs and poor quality care in ...