Medical services rates (51 - 60 of 111 items)
Medicare: Referrals to Physician-Owned Imaging Facilities Warrant HCFA's Scrutiny
HEHS-95-2: Published: Oct 20, 1994. Publicly Released: Nov 22, 1994.
Pursuant to a congressional request, GAO compared physicians' referral rates for diagnostic imaging services, focusing on: (1) referrals by physicians with a financial interest in joint-venture imaging service facilities; and (2) whether the Department of Health and Human Services' (HHS) procedures and policies are effective in monitoring and identifying abusive self-referral practices.GAO found t...
Medicare: Changes to HMO Rate Setting Method Are Needed to Reduce Program Costs
HEHS-94-119: Published: Sep 2, 1994. Publicly Released: Sep 2, 1994.
Pursuant to a legislative requirement, GAO reviewed: (1) Medicare's rate setting methodology for health maintenance organizations (HMO); and (2) the ability of the Medicare risk contract program to achieve cost savings.GAO found that: (1) the Medicare risk contract program has not reduced Medicare costs because the Health Care Financing Administration's (HCFA) rate setting methodology and administ...
Primary Care Physicians: Managing Supply in Canada, Germany, Sweden, and the United Kingdom
HEHS-94-111: Published: May 18, 1994. Publicly Released: Jun 20, 1994.
Pursuant to a congressional request, GAO examined the methods other countries use to manage their physician supply and specialty distribution, focusing on how other countries: (1) ensure that they have an adequate supply of primary care physicians; and (2) encourage physicians to practice medicine in medically underserved areas.GAO found that: (1) Canada and Great Britain have established primary...
Medicare: Graduate Medical Education Payment Policy Needs to Be Reexamined
HEHS-94-33: Published: May 4, 1994. Publicly Released: May 12, 1994.
Pursuant to a congressional request, GAO reviewed Medicare financing for graduate medical education (GME), focusing on: (1) how Medicare compensates hospitals for GME costs; and (2) the extent of Medicare's support for primary care and nonprimary care physicians' GME.GAO found that: (1) Medicare pays for about 29 percent of total GME direct costs, which totalled $1.46 billion in 1992; (2) although...
Health Care: Antitrust Enforcement Under Maryland's Hospital All-Payer System
HEHS-94-81: Published: Apr 27, 1994. Publicly Released: May 9, 1994.
Pursuant to a congressional request, GAO reviewed Maryland's hospital antitrust enforcement actions, focusing on: (1) the effect of Maryland's all-payer rate-setting and certificate of need (CON) programs on the state's antitrust enforcement actions; and (2) whether these programs render state antitrust enforcement for hospitals unnecessary.GAO found that: (1) Maryland regulates hospital prices, m...
Medicare: Impact of OBRA-90's Dialysis Provisions on Providers and Beneficiaries
HEHS-94-65: Published: Apr 25, 1994. Publicly Released: Apr 25, 1994.
Pursuant to a legislative requirement, GAO provided information on how Medicare End-Stage Renal Disease Program (ESRD) patients are affected by provisions requiring employer-sponsored health care plans to pay for dialysis before Medicare does, focusing on the: (1) amount of money dialysis providers receive; and (2) out-of-pocket payments that Medicare beneficiaries make.GAO found that: (1) dialysi...
Medicare: Greater Investment in Claims Review Would Save Millions
HEHS-94-35: Published: Mar 2, 1994. Publicly Released: Mar 11, 1994.
Pursuant to a congressional request, GAO reviewed the Health Care Financing Administration's (HCFA) Medicare claims medical review process to determine whether: (1) the improved medical review activities at the demonstration carriers produced measurable savings or benefits to the claims process; (2) additional medical review funding for other carriers would be cost-effective; and (3) HCFA medical...
Managed Health Care: Effect on Employers' Costs Difficult to Measure
HRD-94-3: Published: Oct 19, 1993. Publicly Released: Oct 19, 1993.
Pursuant to a congressional request, GAO reviewed employers' recent experiences with managed health care, focusing on cost control and enrollee perspectives.GAO found that: (1) the proportion of private-sector employees enrolled in managed care plans increased from 5 percent in 1980 to 55 percent in 1992; (2) managed care cost control efforts involve alternative financing methods and limitations o...
HCFA Payment Rate for Erythropoietin
HRD-94-1R: Published: Oct 13, 1993. Publicly Released: Oct 13, 1993.
Pursuant to a congressional request, GAO reviewed the methodology the Health Care Financing Administration (HCFA) used to establish Medicare's payment rate for erythropoietin (EPO). GAO found that the: (1) model HCFA used to set the initial payment rate for EPO contained the necessary cost components for establishing a reasonable Medicare payment rate; (2) estimates used to set the initial payment...
Nonprofit Hospitals: For-Profit Ventures Pose Access and Capacity Problems
HRD-93-124: Published: Jul 22, 1993. Publicly Released: Aug 3, 1993.
Pursuant to a congressional request, GAO provided information about joint ventures between nonprofit hospitals and physicians, focusing on the: (1) rate at which nonprofit hospitals participate in joint ventures; (2) extent to which these ventures serve the poor; (3) extent that joint ventures can contribute to excess capacity for community medical services; and (4) effect of recent federal and st...