Inquiry J Health Car
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Inquiry J Health Car · Jan 1993
Amending the National Practitioner Data Bank reporting requirements: are small claims predictive of large claims?
This study addresses whether a physician incurring small malpractice claims is predictive of large claims. This is one consideration behind reevaluating whether all claims that result in an indemnity payment should continue to be reported to the National Practitioner Data Bank, or whether claims with payments below some "floor" should be excluded. Using a claims database from 3,098 physicians for 1977-1986, both cross-sectional and longitudinal analyses show that an individual having a small claim (under $30,000) is indicative of a propensity to incur large claims. This finding is robust to the cutpoint between large and small claims.
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Inquiry J Health Car · Jan 1993
Comparative StudyPhysician responses to Medicare physician payment reform: preliminary results on access to care.
This paper examines the impact of Medicare physician payment reform on access to care by comparing several physician-based access measures in the pre- and post-reform periods. The results suggest that the broad goals of payment reform may have been at least partially achieved: the proportion of physician revenues derived from Medicare increased for primary care physicians and decreased for nonprimary care MDs; there was little change in the absolute or relative number of visits provided to Medicare patients; and an increasing number of physicians charged no more than the Medicare payment amount. ⋯ Fewer physicians were willing to treat all new Medicare patients and more physicians accepted no new Medicare patients. Furthermore, there was an increase in the proportion of physicians who reduced or stopped providing to Medicare patients certain types of services that they continued to provide to other patients.
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Inquiry J Health Car · Jan 1992
Comparative StudyRural and urban hospital closures, 1985-1988: operating and environmental characteristics that affect risk.
Due to congressional concern that rural hospitals were particularly disadvantaged by Medicare's Prospective Payment System, the U. S. ⋯ When hospital operating and environmental characteristics were held constant, the odds of closure in rural and urban areas differed significantly only for private nonprofit hospitals. Although a number of factors were associated with hospitals' higher risk of closure, we did not find evidence that Medicare was a major factor associated with financial distress or closure during the 1985 to 1988 period.
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This paper examines the implications of using a Medical Staff Payment System (MSPS) for reimbursing physicians for services provided to inpatients. Inpatient episodes are defined to include seven days before admission and 30 days postdischarge. ⋯ DRGs are strong predictors of expenditures on physician services during the inpatient episode, achieving an R2 of .61. Gains and losses for various types of facilities are simulated, and the characteristics of winning and losing hospitals under an MSPS are identified.
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Inquiry J Health Car · Jan 1991
Trends in length of stay and rates of readmission in Massachusetts: implications for monitoring quality of care.
In this study, we examined lengths of stay and readmission rates for all Medicare patients discharged from Massachusetts acute care hospitals from October 1982 through September 1986. Using multivariate time series models, we controlled for case mix and assessed trends over time and the impact of prospective payment on lengths of stay and rates of readmission within 7, 14, and 30 days of discharge. We examined patterns for patients overall and for those admitted initially with one of several specific medical conditions or for a surgical procedure. ⋯ Overall readmission rates within 7 and 14 days increased by approximately 10% (p less than .05), although the increase was not statistically associated with prospective payment. Readmission rates for individual medical and surgical conditions were not significantly changed. Further study should assess whether the change in overall rates reflects lower quality care.