Citation URL: http://www.urban.org/DianaKVerrilli

This study used data from 1986 through 1992 to estimate the “volume offset” that may occur when payment rates for Medicare physician services are changed. Although policymakers assume that 50 percent of all fee reductions are offset by volume increases and that this occurs across all type of services, this analysis does not support that position. There is a “volume offset,” but it is generally smaller than 50 percent. For evaluation and management and imaging services, an offset of about 25 percent would seem appropriate. Although the 50 percent assumption for procedures is consistent with this study, our analysis suggests that an offset occurs in response to fee increases as well as decreases. (Medical Care Research and Review 1998 December; 55(4):457-458).

The spread of managed care organizations' (MCOs’) selective networks reduced patient access to services, along with provider access to paying patients, so many providers have lobbied for laws to force plans to contract with "any willing provider" and give patients "freedom of choice." In opposition are MCOs, which want full freedom to contract selectively to control prices and utilization. This article comprehensively described laws in all 51 jurisdictions, classified by relative strength, and assessed the policy implications. Most enactments are relatively weak, and all are limited in application by ERISA and the Federal HMO Act. An associative multivariate analysis also showed that states with laws also have higher HMO penetration and higher physician density, but smaller rural populations. This paper concluded that the strongest laws overly restrict the management of care, to the likely detriment of cost control. But where market power is rapidly concentrating, unrestrained selective contracting could diminish patient access to care and long-term competition. In the face of uncertainty about the impact of these laws, an intermediate approach may be better than all or nothing. States should consider mandating that plans offer point-of-service options, for a separate premium. This option guarantees patient choice of plans at the time of enrollment and of providers at the time of care, yet maintains plan ability to control core providers. (Journal of Health Politics, Policy and Law 1997 October; 22(5): 1133-1189).

This report focuses on the possible effects of establishing a payment structure for physician services that could be used in conjunction with various approaches to cost containment. It explores a fee schedule based on the Medicare relative value scale (RVS), the impact of conversion factors (CFs) on all payers, the difference between CFs set by private payers and CFs currently used by Medicare, and how Medicare payments would change under an RVS system. The authors also investigate how much of a gap exists between Medicaid fees and fees established under the Medicare fee schedule.

Preferred provider organizations represent a form of managed care in which providers agree to accept discounted fee in exchange for the expectation that their patient volume will be maintained or increased. Between 1981 and 1994, the number of PPOs increased from about 10 plans to over 700. Using data from two large national insurers, this study shows that discounts of between 10 and 20 percent were achieved relative to their indemnity plans. However, it was still the case that the PPO rates remained substantially above rates paid under the Medicare fee schedule. (Health Care Financing Review 1996 Spring; 17(6):161-170)

The objective of this report was to study the extent to which Ontario residents use physician services in the United States. The Ontario Ministry of Health provided data on out-of-country expenditures for 1987–94 and physician claims submitted to the Ministry for services provided in 1992 and 1993. Physician services provided to Ontario residents were classified into 16 broad categories of medical services, and expenditures were classified by service date, age group, and type of medical service. Conclusions were drawn about how much Ontario residents spent for physician services in the United States and the types of services that they sought.

This report compares service volume and intensity for elderly patients receiving all types of cardiovascular procedures, noninvasive tests, and diagnostic imaging in the three most populous Canadian provinces and the United States in 1992. Specific comparisons were made by type of cardiovascular service and patient age. Volume and intensity were measured directly using Medicare Relative Value Units. The report's findings provide a stimulus for further research to clarify the effects of service-use differences on access and associated health outcomes.

To learn more about the determinants of end-of-life costs, this study compares decedents' and survivors' use of physician services in the United States and two major Canadian provinces, Quebec and British Columbia. It is based on physician claims data for 1992 from the U.S. Health Care Financing Administration, the Quebec Ministry of Health, the British Columbia Ministry of Health, and a 1 percent random sample of Medicare beneficiaries. Physician service utilization for persons in their last six months of life, aggregated into relative value units, is compared by type of service with that of survivors. The authors also briefly discuss the differences in resources, values, and practice style between the two countries.

The goal of this report was to assess the relative volume and price of physician services in Canada and the United States through a comparative analysis of 1992 claims data from Canadian provincial ministries of health and from the U.S. Health Care Financing Administration. The study groups consisted of all the elderly in the three largest Canadian provinces and a 1 percent random sample of U.S. elderly Medicare beneficiaries. Patterns of use of physician services and procedures are described, and several possible explanations for differences between the patterns in the United States and Canada are suggested.

In the absence of federal health care reform legislation, states are designing their own reforms to the way health care is financed and delivered. This databook presents detailed data on the utilization of physician services by state and by metropolitan statistical area for Medicare. Beyond offering background information, these data can provide states with the means of investigating which services are under- or over-supplied in certain areas of the state.

Only recently have studies on Medicare use rates incorporated estimates of person-level randomness. Physician profiling studies, in which physicians are given information on the services that they delivered, should incorporate standard errors of the mean. This report estimates the mean volume and intensity of physician services per Medicare beneficiary and the standard errors associated with such measurements. Several estimators are discussed because 12 percent of Medicare beneficiaries are eligible for only part of a year.

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