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Results for “Reimbursement, Incentive”

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PubMed1999

Is hospital capitation DOA?

The growth of hospital capitation has been slow because most hospitals have not reached their "capitation threshold." Financial pressure at this threshold compels a hospital to implement cost management methods to allow it to potentially profit from capitation. In addition, most markets have not provided payers with adequate incentives to share risk. Conditions that will drive payers to adopt hospital capitation include true integration of care delivery systems and information systems, sustained medical losses, and strong market position of hospitals.

Capitation Fee↗
PubMed2006

A behavioral model of clinician responses to incentives to improve quality.

The use of pay for performance (P4P) and public reporting of performance (PR) in health care is increasing rapidly worldwide. The rationale for P4P and PR comes from experience in other industries and from theories about incentive use from psychology, economics, and organizational behavior. This paper reviews the major themes from this prior research and considers how they might be applied to health care. The resulting conceptual model addresses the dual nature (combining direct financial and reputational incentives) of the initiatives many policymakers are pursuing. It also includes explicit recognition of the key contextual factors (at the levels of the markets and the provider organization) and provider and patient characteristics that can enhance or mitigate response to incentives. Evaluation of the existing literature (through June 2005) about incentive use in health care in light of the conceptual model highlights important weaknesses in the way that trials have been reported to date and suggests future research topics.

Behavior↗
PubMed1984

Office laboratory tests. Perceptions of profitability.

Theoretic modeling suggests that common office tests as a group are profitable. To determine whether practicing internists perceive this profitability and whether their perceptions differ for different tests or for patients with different types of insurance coverage, the authors surveyed 111 physicians in private office practice. Respondents' estimates of receipts for tests done on patients with Medicare or Blue Cross/Blue Shield coverage were higher than their estimated costs for the testing. Estimates of receipts from Medicaid patients were lower than estimated costs of testing. After standardizing the estimated receipts from patients with different insurance coverages, the authors found that the average estimated profits for different tests on an "average insured patient" varied sixfold, from $5.99 for an electrocardiogram to $1.01 for a urinalysis. The authors suggest that perceived financial incentives are extremely variable by test. Different insurance coverages are perceived as providing varying financial incentives for testing; Medicaid provides a disincentive. Appropriate reform of the existing fee schedules should be selective by test and coverage.

Attitude to Health↗
PubMed1994

Medicaid policies for HIV-related drug therapies: perspectives of the state affiliates of the American Pharmaceutical Association.

OBJECTIVES: To determine how Medicaid prescription drug policies differ by state, and to assess how these policies affect pharmacies and the drug therapies available to Medicaid patients with HIV infection or tuberculosis. EVALUATION PROCESS: The state affiliates of the American Pharmaceutical Association (APhA) were surveyed to learn how state Medicaid policies impact the provision of prescription drugs to Medicaid patients within their state. The survey focused on Medicaid payment level incentives, Medicaid payments compared with private payments, Medicaid utilization policies, and incentives and disincentives in each state's Medicaid payment system. RESULTS: Approximately two-thirds of the APhA affiliates reported that the Medicaid payment levels in their states for drugs used to treat HIV-related illnesses were at least moderately below private payment levels; in 11 states these Medicaid payments were substantially below those of private payers. Many APhA affiliates responding to the survey stated that the Medicaid program in their state limited the number of reimbursed drugs that Medicaid patients can receive. Eight APhA affiliates reporting that these utilization limits created restrictions on the ability of Medicaid patients with AIDS and HIV-related infections to receive needed medications. CONCLUSIONS: With Medicaid programs becoming the major payers of AIDS-related healthcare, federal policies should standardize Medicaid coverage, payment, and utilization policies for prescription drugs needed by Medicaid recipients with HIV-related conditions. This would enable Medicaid patients to receive necessary and adequate drug therapies regardless of their state of residence. These federally mandated policies also would require an increased federal role in financing this expanded Medicaid drug coverage.

HIV Infections↗
PubMedDate not supplied

Comparing the options for universal coverage.

This paper identifies and evaluates eight legislative policy options for achieving universal coverage. These options are reviewed systematically by addressing three distinct, although related, issues: defining the "universe" covered, defining the nature of the coverage to be provided, and providing legal incentives to assure the coverage and financing. In particular, this paper focuses on the obligations of employers and individuals under these proposals and appropriate governmental policies to promote compliance.

Cost Sharing↗
PubMed1995

Capitation: implications for provider cost structures.

Healthcare operating managers understand that capitation has inverted the financial incentives that existed in the fee-for-service environment. However, cost-structure implications of the managed care environment also must be understood if organizations are to prosper as markets evolve into capitation.

Capitation Fee↗
PubMedDate not supplied

The uptake of childhood immunization and financial incentives to general practitioners.

Among the target-linked services introduced by the 1990 general practitioners' contract, childhood immunization in Scotland is the best suited for GPs to achieve the high target, given a centralized call and recall system and public confidence in the service. Yet over 25% of the practices in the area of the Greater Glasgow Health Board did not qualify for the high target payments in the last quarter of the 1991/92 financial year. Examining indicators of the socioeconomic characteristics of the patient population, practice profiles and the effect of financial incentives, we discuss the reasons for cross-practice variation in the uptake of this service and estimate the probability of practices which missed the high target achieving it in the future.

Appointments and Schedules↗
PubMed1992

Alberta's Acute Care Funding Project.

Alberta initiated the Acute Care Funding Project (ACFP) in 1988, a new hospital funding system that institutes case mix budgeting adjustments to the global budget so that hospitals can be treated more equitably. The initiative is a significant departure in principle from the former method of funding. The ACFP is summarized and critiqued, and focuses on the inpatient side of the picture. The various elements of the project are discussed, such as the hospital performance index, the hospital performance measure, the Refined Diagnostic Related Group, case weights, typical and outlier cases, and the costing mechanisms. Since its implementation, the ACFP has undergone substantial changes; these are discussed, as well as some of the problems that still need to be addressed. Overall, the system offers incentives to reduce length of stay and to increase the efficiency with which inpatient care is provided.

Alberta↗
PubMed2006

Effectiveness of an incentive-based online physical activity intervention on employee health status.

OBJECTIVE: The objective of this study was to test whether a financial incentive integrated with health benefits for an online physical activity program was associated with increased employee participation and improved health status among participants compared with nonparticipants. METHODS: Participation in the Virtual Fitness Center (VFC), an online physical activity program associated with a 150 dollars cash rebate, was assessed. Risk status for 2004 VFC participants and nonparticipants was compared using a health risk appraisal. RESULTS: A total of 53.8% of total eligible employees were VFC participants and reduced their risk for physical inactivity (8.4% points), life dissatisfaction (2.1), low perception of health (1.9), high risk status (1.3), smoking (0.4), and high body weight (0.2). CONCLUSIONS: Providing a cash incentive is one strategy for encouraging VFC participation and eliciting improved health status in an employer-sponsored, web-based physical activity program.

Adult↗
PubMed1997

Providing incentives to control health care costs and remain competitive in the marketplace: a pilot study.

Few marketplaces in the United States have been subject to as much scrutiny, and undergone as much transformation in the 1990s, as has health care. Even based on the slowest growth rates experienced in the 1980s and 1990s, the United States is projected to be spending $3,140,221 per minute on health care by the year 2000. The purpose of this study was to examine how coordination between providers of medical care, and working with their customers (i.e., payors) might reduce costs without compromising quality. Providing incentives to these groups of businesses that form the health systems can be a means for achieving both individual health system objectives. Because of the importance of pharmacists in health care delivery systems, they were considered an excellent group for testing and measuring the impact of incentive programs. The study involved a before and after six month period involving dispensing patterns through a pharmacy benefit manager. Incentives were provided to pharmacies based on percent improvement in generic substitution rates and formulary compliance. A network of 342 independent pharmacies, with their dispensing patterns monitored through a pharmacy benefit manager under its contract program. The results of the study were that generic substitution rates rose from the pre-trial period of 68.5% to 73.7% in the first three months of the trial period, and to 75.6% in the second three months of the trial period. The overall increase in substitution was from 68.5% in the base period to 74.7% over six months. These differences were statistically significant at the 0.05 level. Estimated savings to health plans on an annualized basis would be approximately $3.4 million, and the payout per conversion to pharmacies was $3.23. While not measured directly, no adverse clinical effects were reported due to substitutions. Thus, an incentive system to reward those health care providers can effectively control expenses to achieve mutually desirable goals of all parties. If properly structured, the providers, health systems of which they are a part, and payors can benefit. Using an incentive program like the one designed for this study, health systems may be able to be more competitive in marketing their services to payors.

Cost Control↗
PubMed1994

Cost-benefit analysis of six alternative payment incentives for child therapists.

The outcomes and costs of 6 different methods of motivating therapists to meet service delivery goals at a community mental health center for children and adolescents were evaluated over a 5-year period. The costs and cost-savings benefits of each motivational method were compared with each other and with two baselines. Four incentive interventions generated more cost savings than they required in monetary outlays. Most cost-beneficial were bonuses paid to therapists for each hour of service they delivered over their monthly goals and bonus plans that rewarded therapists for exceeding their goals while also rewarding staff if total department goals were exceeded. The most cost-beneficial system saved $25,542 over 6 months that would have been paid to compensate for therapy hours not delivered, for an incentive investment of $9,726 over the 6 months. This yielded a net benefit of $15,816, or $31,632 annually.

Adolescent↗
PubMed2000

Payment systems and considerations of case mix--are diagnosis-related groups applicable in Japan?

OBJECTIVE: Cost containment is a large concern. Japanese medical institutions operate on a fee-for-service basis, giving few incentives for healthcare providers to control the number of procedures performed or to save the healthcare costs. Thus, the objective of this study was to determine the feasibility of applying diagnosis-related groups (DRGs) in Japan, since systems that employ DRGs provide these incentives. DESIGN AND SETTING: Three types of data (patient discharge, hospital cost and hospital characteristics data) were collected from 17 acute general hospitals in Japan. These data were used to calculate variance (R2) for length of stay for each of 3 US-based DRG systems [health care financing administration (HCFA)-DRG, all-patient (AP)-DRG, all-patient refined (APR)-DRG] in order to determine which of the systems is most appropriate for use in Japan to classify patients. We also examined the financial impact for hospitals through budget simulations when DRG is used as a payment tool. MAIN OUTCOME MEASURES AND RESULTS: Of the DRG alternatives examined, we have found that the AP-DRGs are the preferred alternative. The data in Japan are not sufficiently complete to support the APR-DRGs, and we believe that the HCFA-DRGs are not as clinically sophisticated as the AP-DRGs and may not be as well accepted by the medical community. As there is a clear intention in Japan of developing Japanese-specific DRGs, the AP-DRGs represent a sound starting point for this effort. Our work demonstrates that basing payments on DRGs is partially feasible for Japan. This means that the treated case was found to be feasible as the unit of payment. CONCLUSION: Changing to a prospective payment system in Japan will give hospitals powerful incentives to become more efficient. This, in turn, will open hospital capacity, which should assist Japan in providing the care needed by an aging population in a cost-effective way.

Diagnosis-Related Groups↗
PubMed1993

Payment mechanisms, nonprice incentives, and organizational innovation in health care.

Health care organizational structures support alternative combinations of payment and nonprice incentives for physicians, hospitals, and other providers. Changing perceptions among purchasers of the relative effectiveness of particular mechanisms lead to changes in the market shares held by particular organizational structures. This paper uses principal-agent and transactions cost economics to develop a conceptual matrix for understanding organizational innovation in the health care system. It contrasts the differing incentives in retrospective versus prospective payment mechanisms, arms-length review versus peer review mechanisms for controlling inappropriate utilization, and "free choice of physician" versus selective contracting mechanisms for structuring the basic insurer-provider relationship.

Delivery of Health Care↗
PubMedDate not supplied

Realigning incentives in fee-for-service Medicare.

This paper proposes Medicare payment reform built on the fee-for-service system, with incentive payments to eligible provider organizations determined by their rate of increase in cost per patient compared to the overall growth rate in the community. By planning and monitoring how care patterns are altered to achieve greater efficiency, policy-makers can align the incentives of Medicare and the provider organization better than using either fee-for-service or capitation alone. This reform, unlike capitation, maintains Medicare's historical role as insurer and focuses providers on managing care.

Aged↗
PubMed2002

Quality incentives for Medicare+Choice plans.

The Medicare program should be a leader in national efforts to improve quality of care. This paper proposes a new system of quality bonuses for Medicare+Choice plans and lays out a framework of key issues and options to promote discussion about such an initiative.

Humans↗
PubMedDate not supplied

Competition and prospective payment: a new way to control health costs.

Health care costs must be controlled to finance the expanded eligibility and coverage promised during the Presidential campaign. As a practical reality, reforming the existing fee-for-service system is the only way that significant cost control can be achieved during the next four years. The expansion of the basic Medicare prospective payment system to all health care settings and to all payers, combined with price discounting and consumer incentives to use providers that discount, can form the basis of a competitive prospective payment system (PPS). A competitive PPS can bring down costs and complement managed competition and other ongoing cost-containment initiatives.

Cost Control↗
PubMedDate not supplied

Successful techniques for retaining a cohort of infants and children born to HIV-infected women: the prospective P2C2 HIV study.

Retaining subjects from disadvantaged populations in long-term studies is necessary to obtain high-quality data. This article presents cumulative retention rates from a 5-year prospective cohort study, the Pediatric Pulmonary and Cardiovascular Complications of Vertically Transmitted HIV Infection study. It also presents results of a cross-sectional qualitative survey about factors that induced caregivers to stay in the study. Although the repeated study visits were long and uncomfortable, cumulative retention among the 298 HIV-infected children was 80%. Incentives considered important by the caregivers included phone contact with nurse coordinators, nurse coordinators accompanying the caregiver and child during visits, phone reminders for appointments, help with scheduling, meals and transportation, access to health care, and relationships with staff. Thus, the high follow-up rate was in part due to nurses' efforts to reduce the study's burden on the families, provide tangible and intangible incentives, and establish personal relationships with families.

Adult↗