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At least 109 records · Page 6Linked to original sources
PubMed1976

Physician fee patterns under medicare: a descriptive analysis.

To describe physician fee patterns under a national program, we analyzed physician reimbursement rates for 39 medical procedures for 292 local Medicare reimbursement areas. The results indicate that the maximum prevailing charge for each procedure generally ranged from three to 10 times the minimum charge. Prevailing charges, however, clustered around the mean (coefficient of variation less than 0.50) in 37 of the 39 fee distributions for general practitioners and specialists. Although differences (P less than 0.05) existed between mean general practitioner and specialist charges for 27 of the 39 procedures, these differences were generally less than 10%.

Clinical Laboratory Techniques↗
PubMed1978

Second opinion elective surgery programs: outcome status over time.

Given the increasing rate of surgery and the escalating costs of hospitalization, it seems appropriate to review the necessity of recommended elective surgery before the surgery is performed. The second opinion elective surgery program is designed to screen patients before they undergo surgery. Findings are based on all not confirmed for surgery cases and an equal number of confirmed for surgery cases who were evaluated one year after their second opinion consultation. Roughly 77.9% of those not confirmed had not had the surgery and, of this, 64.4% reported no medical treatment (potential surplus surgery). Of the 710 not confirmed cases, one third (34.9%) never reported receiving medical treatment. The majority of those individuals confirmed for surgery did have the operation; however, 25.4% had not had surgery one year from their consultation. Thirty-two per cent of the confirmed cases reported never receiving medical treatment. There were 77 individuals (11.1%) who were confirmed for surgery who neither reported having surgery nor any medical treatment (population at risk). Subsequent follow up studies will present a clearer assessment of the ability of the program to screen potential surplus surgery and to realize cost savings.

Female↗
PubMed1982

Impact of a mandatory second-opinion program on medicaid surgery rates.

The effect of the Massachusetts second-opinion program on the volume of elective surgery in the Medicaid population was assessed using two approaches: a study of the program experience and surgery decisions of 2,501 program referrals, and an analysis of Medicaid surgery rates before and after program implementation. Nonconfirmation rates, which averaged 14.5 per cent, varied by procedure from 4 per cent for cholecystectomy to 26 per cent for disc surgery. The patient's surgery decision was related to the outcome of the second-opinion consultation: 85.5 per cent of the confirmed patients had the originally proposed operation, as compared with 31 per cent of the nonconfirmed patients. In the year after program implementation, the program was associated with a 20 per cent reduction in the volume of those procedures covered by the program. The greatest percentage declines were for hysterectomies, meniscectomies, hemorrhoidectomies and tonsillectomies/adenoidectomies. The decline in surgery rates was attributed both to a direct effect on patients referred to the program and to a sentinel effect whereby fewer operations were proposed. We conclude that the mandatory second-opinion program in Massachusetts saved Medicaid $3 to $4 for every dollar spent.

Costs and Cost Analysis↗
PubMedDate not supplied

Lessons for providers from a purchaser's perspective.

On Jan. 1, 1991, the John Hancock National Transplant Program (JHNTP) became operational, matching kidney, heart, liver, and bone marrow transplant patients from a potential pool comprising more than two million covered lives, with organ transplant programs at 14 institutions across the country. Conceptualizing the program and selecting and contracting with the transplant centers took more than 18 months. This article shares some of the insights from that process that are pertinent to providers of transplant services and to others considering entering this or other forms of specialized contracting.

Competitive Bidding↗