Medical fees (1 - 10 of 118 items) in Custom Date Range
Medicare Value-Based Payment Models: Participation Challenges and Available Assistance for Small and Rural Practices
GAO-17-55: Published: Dec 9, 2016. Publicly Released: Dec 9, 2016.
Based on a review of literature and interviews with 38 stakeholders, GAO identified challenges faced by small and rural physician practices when participating in Medicare's new payment models. These models, known as value-based payment models, are intended to reward health care providers for resource use and quality, rather than volume, of services. The challenges identified are in five key topic...
Medicare: Increasing Hospital-Physician Consolidation Highlights Need for Payment Reform
GAO-16-189: Published: Dec 18, 2015. Publicly Released: Dec 18, 2015.
Vertical consolidation is a financial arrangement that occurs when a hospital acquires a physician practice and/or hires physicians to work as salaried employees. The number of vertically consolidated hospitals and physicians increased from 2007 through 2013. Specifically, the number of vertically consolidated hospitals increased from about 1,400 to 1,700, while the number of vertically consolidat...
End-Stage Renal Disease: Medicare Payment Refinements Could Promote Increased Use of Home Dialysis
GAO-16-125: Published: Oct 15, 2015. Publicly Released: Nov 16, 2015.
The percentage of dialysis patients who received home dialysis generally declined between 1988 and 2008 and then slightly increased thereafter through 2012, and stakeholder estimates suggest that future increases in the use of home dialysis are possible. Dialysis patients can receive treatments at home or in a facility. In 1988, 16 percent of 104,200 dialysis patients received home dialysis. Home...
Workers' Compensation: Health Benefit Programs for Returned Peace Corps Volunteers and for Employees of U.S. Agency for International Development Contractors
GAO-16-28R: Published: Oct 30, 2015. Publicly Released: Oct 30, 2015.
Peace Corps and the U.S. Agency for International Development (USAID) both provide health benefits through workers' compensation programs. Peace Corps provides benefits to returned Peace Corps volunteers who sustain illnesses or injuries connected to their Peace Corps service under the Federal Employees' Compensation Act (FECA) program administered by the Department of Labor (DOL). USAID provides...
Medicare Physician Payment Rates: Better Data and Greater Transparency Could Improve Accuracy
GAO-15-434: Published: May 21, 2015. Publicly Released: May 21, 2015.
The American Medical Association/Specialty Society Relative Value Scale Update Committee (RUC) has a process in place to regularly review Medicare physicians' services' work relative values (which reflect the time and intensity needed to perform a service). Its recommendations to the Centers for Medicare & Medicaid Services (CMS), the agency within the Department of Health and Human Services (HHS)...
Medicare: Nurse Anesthetists Billed for Few Chronic Pain Procedures; Implementation of CMS Payment Policy Inconsistent
GAO-14-153: Published: Feb 7, 2014. Publicly Released: Mar 10, 2014.
From 2009 through 2012, certified registered nurse anesthetists (CRNA)—a type of advanced-practice nurse specializing in anesthesia care—billed Medicare fee-for-service (FFS) for a minimal share of selected chronic pain procedures, less than ½ of 1 percent of these procedures in each year. Physicians without board certification in pain medicine billed for the majority of selected procedures e...
Medicare Advantage: 2011 Profits Similar to Projections for Most Plans, but Higher for Plans with Specific Eligibility Requirements
GAO-14-148: Published: Dec 19, 2013. Publicly Released: Jan 22, 2014.
Medicare Advantage (MA) organizations' actual medical expenses, nonmedical expenses (such as marketing, sales, and administration) and profits as a percentage of total revenue were, on average, similar to projected values for plans available to all beneficiaries in 2011, the most recent year for which data were available at the time of the request for this work. MA organizations' actual medical ex...
Medicare Advantage: Special Needs Plans Were More Profitable, on Average, than Plans Available to All Beneficiaries in 2011
GAO-14-210R: Published: Dec 19, 2013. Publicly Released: Jan 22, 2014.
Special needs plans (SNP) reported having higher profit margins and spending a lower percentage of total revenues on medical expenses, on average, than Medicare Advantage (MA) plans available to all beneficiaries in 2011. For instance, SNPs' average profit margin was 4.0 percentage points higher than plans available to all beneficiaries--8.6 percent vs. 4.6 percent. SNPs also had a higher plan-lev...
National Preparedness: HHS Is Monitoring the Progress of Its Medical Countermeasure Efforts but Has Not Provided Previously Recommended Spending Estimates
GAO-14-90: Published: Dec 27, 2013. Publicly Released: Dec 27, 2013.
The Department of Health and Human Services (HHS) has established timelines and milestones for the 72 Public Health Emergency Medical Countermeasures Enterprise (PHEMCE) priorities--33 activities, 25 threat-based approaches, and 14 capabilities--that HHS selected as key to fulfilling PHEMCE strategic goals. However, HHS has not made spending estimates for its medical countermeasure development or...
Medicare: Higher Use of Costly Prostate Cancer Treatment by Providers Who Self-Refer Warrants Scrutiny
GAO-13-525: Published: Jul 19, 2013. Publicly Released: Aug 1, 2013.
The number of Medicare prostate cancer-related intensity-modulated radiation therapy (IMRT) services performed by self-referring groups increased rapidly, while declining for non-self-referring groups from 2006 to 2010. Over this period, the number of prostate cancer-related IMRT services performed by self-referring groups increased from about 80,000 to 366,000. Consistent with that growth, expend...