The kindly physician or the profit maximizer?

In the U.S. physician fees are largely set through regulation or negotiation with insurers. For physicians accepting Medicare or Medicaid patients, fees are set by government entities (i.e., the Centers for Medicare and Medicaid Services for Medicare reimbursement for the former and state Medicaid agencies for the latter). Rates for physicians accepting patients with private…

How does Geisinger Pay its Physicians?

Geisinger Health System is a physician-led, not-for-profit, integrated delivery system serving an area with approximately 2.6 million people in northeastern and central Pennsylvania with innovative products and services designed to drive higher performance. Geisinger is known for providing high quality care at low cost. How do they do it? Is it how they incentivize physicians?…

The Impacts of Managed Competition in Netherlands

Financial incentives matter.  If one had to give economists (and health economists as well) a slogan, this would be it. In 2006, the Netherlands instituted a form of managed competition. According to Van Dijk et al (2012) “Before 2006, inhabitants had either compulsory social (sickness fund, 62%) or voluntarily private (36%) health insurance depending, among others, on income (below a gross…

Medicare Physician Payment Adjustments

The Medicare billing system is complex.  There an alphabet soup of acronyms, (e.g., RVUs, CPT, HCPCS, GPCI) and each of these affects payments in different ways.  In addition to the standard payment terms, Medicare is also creating additional payment incentives.  These payment incentives fall into three broad categories: Quality reporting e-Prescribing (eRx) Electronic Health Records…

Do doctors tailor the care they provide based on the patient’s health plan?

Many studies (including my own) have shown that physicians paid via capitation  perform fewer services than those paid via fee-for-service (FFS).  In the current health care world, however, most physicians treat patients from a variety of different insurance systems (notable exceptions are doctors working at Kaiser and the VA). Two important research questions come to…

“Do Medicare patients have longer waits to see doctors than those with commercial insurance?”

…and three other questions about physician care. Do Medicare patients have shorter waiting times than those with commercial insurance? In the 2010 survey, among those seeking an appointment, most beneficiaries (75 percent) and most privately insured individuals (72 percent) reported “never” having to wait longer than they wanted for an appointment for routine care. Another…

Medicare Doc Paycut Reversed

In 1998, Medicare enacted the sustainable growth rate (SGR) which would slowly bring down Medicare physician compensation.  However, each year, it gets reversed by Congress. Now, instead of a gradual decline, the implementation of SGR would  result in a 21.2% pay cut for Medicare docs. Before the Thanksgiving holiday, however, Congress once again reversed the…