Health care financing administration's new regulations for financial incentives in medicaid and medicare managed care: One step forward?

American Journal of Medicine

Volumn 105, Issue 5, 1998, Pages 409-415

  Gallagher, Thomas H ^a   Alpers, Ann ^b   Lo, Bernard ^b  

^a WASHINGTON UNIVERSITY SCHOOL OF MEDICINE   (United States)

^b UNIVERSITY OF CALIFORNIA   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; CONSUMER; HEALTH CARE COST; HEALTH CARE FINANCING; HEALTH CARE PLANNING; HEALTH CARE UTILIZATION; HEALTH INSURANCE; MANAGED CARE; MARKETING; MEDICAID; MEDICAL CARE; MEDICARE; PATIENT SATISFACTION; PRIORITY JOURNAL;

HEALTH SERVICES ACCESSIBILITY; HUMANS; MANAGED CARE PROGRAMS; MEDICAID; MEDICARE; PATIENT ADVOCACY; PHYSICIAN INCENTIVE PLANS; RISK SHARING, FINANCIAL; UNITED STATES; UNITED STATES CENTERS FOR MEDICARE AND MEDICAID SERVICES;

EID: 0032213595     PISSN: 00029343     EISSN: None     Source Type: Journal    
DOI: 10.1016/S0002-9343(98)00295-2     Document Type: Article

References (34)

1. 1. Gold M, Hurley R, Lake T, et al. A national survey of the arrangements managed-care plans make with physicians. NEJM. 1995;333: 1678-1683.
2. 2. American Medical Association Council on Ethical and Judicial Affairs. Ethical issues in managed care. JAMA. 1995;273:330-335.
3. 3. Hillman AL. Health maintenance organizations, financial incentives, and physicians' judgments. Ann Intern Med. 1990;112:891-893.
4. 4. Pear R. HMOs fend off restrictions: can reward cost-cutting doctors. New York Times. July 8, 1996:A1.
5. 5. Health Care Financing Administration. Medicare and Medicaid programs: requirements for physician incentive plans in prepaid health care organizations. Federal Register. 1996:13430-13450.
6. 6. Krecke K. Abusing the patient: Medicare fraud and abuse and hospital-physician incentive plans. J Law Reform. 1986;20:279-304.
7. 7. Rodwin MA. Medicine, Money, and Morals: Physicians' Conflicts of Interest. New York Oxford University Press; 1993.
8. 8. Health Care Financing Administration. Proposed rule: Medicare and Medicaid Programs; requirements for physician incentive plans in prepaid health care organizations. Federal Register. 1992: 59024-59041.
9. 9. Group Health Association of America. Comment letter to the Health Care Financing Administration; April 13, 1993.
10. 10. American Medical Association. Comment letter to Health Care Financing Administration; May 28, 1996.
11. 11. American Association of Health Plans. Comment letter to Health Care Financing Administration; May 28, 1996.
12. 12. Health Care Financing Administration. Final rule correction; notice of changes in compliance dates. Federal Register. 1996:46384-46385.
13. 13. Health Care Financing Administration. Amendment to final rule: Medicare and Medicaid programs; requirements for physician incentive plans in prepaid health care organizations. Federal Register. 1996:69034-69050.
14. 14. Conrad DA, Maynard C, Cheadle A, et al. Primary care physician compensation method in medical groups: does it influence the use and cost of health services for enrollees in managed care organizations? JAMA. 1998;279:8563-8858.
15. 15. Hillman AL, Pauly MV, Kerstein JK. How do financial incentives affect physicians' clinical decisions and the financial performance of health maintenance organizations? NEJM. 1989;321:86-92.
16. 16. Miller RH, Luft HS. Does managed care lead to better or worse quality of care? Health Affairs. 1997;16:7-25.
17. 17. Health Care Financing Administration. New reporting requirements for Medicare health plans in 1997: HEDIS 3.0 measures and the Medicare beneficiary satisfaction survey. April 14, 1997.
18. 18. Fried B. Statement before the Senate Committee on Appropriations, Subcommittee on labor, health and human services, and education. November 13, 1996.
19. 19. Consumer Assessment of Health Plans Study. CAHPS survey and reporting kit. Westat, Inc., 1997.
20. 20. National Coalition on Health Care. How Americans perceive the health care system; a report on a national survey. January 1997.
21. 21. Hillman A, Pauly M, Kerman K, Martinek C. HMO managers' views on financial incentives and quality. Data Watch. 1991;Winter: 207-219.
22. 22. Lathan S. Regulation of managed care financial incentive payments to physicians. Am J Law Med. 1997;22:399-432.
23. 23. Hanchak N, Schlackman N, Harmon-Weiss S. U.S. Healthcare's quality-based compensation model. Health Care Financ Rev. 1996; 17:143-159.
24. 24. Reagan M. Towards full disclosure of referral restrictions and financial incentives by prepaid health plans. NEJM. 1987;317:1729-1734.
25. 25. Health Care Financing Administration. Guidance on disclosure of physician incentive plan information to beneficiaries. December 17, 1996.
26. 26. Rodwin MA. Physicians' conflicts of interest: the limits of disclosure. NEJM. 1989;321:1205-1208.
27. 27. Nattinger A, Hoffmann R, Shapiro R, et al. The effect of legislative requirements on the use of breast-conserving surgery. NEJM. 1996; 335:1035-1040.
28. 28. Hillman BJ, Joseph CA, Mabry MR, et al. Frequency and costs of diagnostic imaging in office practice - a comparison of self-referring and radiologist-referring physicians. NEJM. 1990;323:1604-1608.
29. 29. US Department of Human Services. Financial Arrangements between Physicians and Health Care Businesses. Washington, DC: Office of the Inspector General, US Dept Health and Human Services; 1989.
30. 30. Voelker R. HCFA focuses on new plans for quality care. JAMA. 1997;278:1559.
31. 31. Jones S, Lewin M. Improving the Medicare Market: Adding Choice and Protections. Washington, DC: National Academy Press; 1996: 72-74.
32. 32. Edgman-Levitan S, Cleary P. What information do consumers want and need? Health Affairs. 1996;15:42-56.
33. 33. Cronon C. Reading and educating Medicare beneficiaries about choice. In: Jones S, Lewis M, eds. Improving the Medicare Market: Adding Choice and Protections. Washington, DC: National Academy Press; 1996:236-267.
34. 34. Mechanic D, Schlesinger M. The impact of managed care on patients' trust in medical care and their physicians. JAMA. 1996;275: 1693-1697.