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Fee-for-Service for Health Care

Research Brief

10Plan, How Would It Affect Health Care Spending by Consumers and the Federal Government

The 10Plan is a self-pay plan for individuals currently uninsured or covered by a private nongroup health insurance plan. The authors built a microsimulation model to estimate health care spending under both the status quo and the 10Plan.

Feb 25, 2021
Journal Article

Trends in Low-Value Health Service Use and Spending in the US Medicare Fee-for-Service Program, 2014–2018

Among individuals with fee-for-service Medicare receiving any of 32 measured services, low-value care use and spending decreased marginally from 2014 to 2018.

Feb 18, 2021
News Release

Low-Value Care Among Medicare Recipients Drops Only Marginally Despite Effort to Curb Practices

Examples of low-value health care include prescribing opioids for acute back pain and antibiotics for upper respiratory infections. Despite efforts to better educate clinicians and discourage wasteful care, spending on such services among Medicare recipients dropped only marginally from 2014 to 2018.

Feb 16, 2021
Journal Article

Patterns of Postoperative Visits Among Medicare Fee-for-service Beneficiaries

To describe patterns of postoperative visits reported for Medicare fee-for-service (FFS) patients.

Feb 12, 2021
Report

The 10Plan: An Alternative Approach to Health Care Financing

The 10Plan would require individuals to pay a copayment for each encounter but no premiums up front. They'd have Medicare rates, and could pay cash or borrow from the government at a low interest rate to pay for services. How would health care spending and federal costs change under the plan?

Jan 25, 2021
Journal Article

Quality Of End-Of-Life Care Is Higher In The VA Compared To Care Paid For By Traditional Medicare

The Medicare-reliant veterans were significantly more likely to receive high-intensity care, in the form of chemotherapy, hospital stays, admission to the intensive care unit, more days spent in the hospital, and death in the hospital. However, they were significantly less likely than VA-reliant patients to have multiple emergency department visits. Higher-intensity end-of-life care may be driven by financial incentives present in fee-for-service Medicare but not in the VA's integrated system.

Aug 5, 2020
Report

Advancing the Development of a Framework to Capture Non–Fee-for-Service Health Care Spending for Primary Care

This report describes work conducted to understand what non-fee-for-service payment data are being collected by states and other stakeholders to support more complete measurement of primary care spending as a proportion of total health care spending.

Jul 30, 2020
Journal Article

High-Price And Low-Price Physician Practices Do Not Differ Significantly On Care Quality Or Efficiency

Higher-priced providers do not necessarily provide higher-quality care.

Jun 6, 2017
Commentary

Paying for Telemedicine

Telehealth, delivering health services and information via technology, holds great promise. But more information is needed to determine what works and what doesn't.

Sep 3, 2015
Journal Article

Medicare's Step Back from Global Payments: Unbundling Postoperative Care

Many experts believe that the U.S. health care system's continued dependence on fee-for-service payments is a key driver of excessive health care spending.

Jul 16, 2015
Report

Specialty Payment Model Opportunities and Assessment: Oncology Simulation Report

This report shares results of a simulation analysis of a payment model for specialty oncology services that is being developed for possible testing by the Center for Medicare and Medicaid Innovation at the Centers for Medicare and Medicaid Services.

Mar 17, 2015
Report

Home Health Care for California's Injured Workers: Options for Implementing a Fee Schedule

The California Department of Industrial Relations/Division of Worker's Compensation asked RAND to help develop a fee schedule for home health services provided to injured workers. The researchers made three sets of recommendations.

Jan 27, 2015
Report

Predictive Model Could Apply to Medicare Physician Fee Schedule

The Centers for Medicare and Medicaid Services uses a resource-based relative value (RBRV) scale to calculate payments for physicians. The values of the scale were validated with predictive modeling, and the result may be helpful in two key applications: flagging codes as potentially misvalued and determining why a code is valued differently than predicted.

Jan 16, 2015
Research Brief

RAND Modeling Offers Support for Transparent and Consistent CMS Physician Fee Schedules

The current process used by the Centers for Medicare & Medicaid Services for valuing physician work is based on physician survey responses. RAND researchers examined the feasibility of developing a model based instead on external data sources.

Jan 16, 2015
Journal Article

Reporting CAHPS and HEDIS Data by Race/Ethnicity for Medicare Beneficiaries

How should ethnic group-specific quality of care data best be reported to Medicare beneficiaries?

Jan 1, 2012
Journal Article

How Do the Experiences of Medicare Beneficiary Subgroups Differ Between Managed Care and Original Medicare?

Quality improvement in Medicare managed care plans should target care for particular subgroups such as beneficiaries who have low incomes, are less healthy, older, female, and who did not complete high school.

Aug 1, 2011
Journal Article

Depression and the Health Care Experiences of Medicare Beneficiaries

Depressed patients report poorer health care experiences and have less confidence that they can recognize their need for care.

Jan 1, 2011
Journal Article

Healthcare Costs Associated with Depression in Medically Ill Fee-for-Service Medicare Participants

Examine the association between depression and healthcare costs in medically ill fee-for-service (FFS) Medicare recipients.

Jan 1, 2009
Journal Article

Partially Capitated Managed Care Versus FFS for Special Needs Children

Little research has examined whether MCPs that incorporate case management are effective in coordinating services for CSHCN.

Jan 1, 2007
Report

Use of Outpatient Mental Health Care: Trial of a Prepaid Group Practice Versus Fee-for-Service

The aim of this study was to determine whether a prepaid group practice delivers less outpatient mental health care than fee-for-service when both serve comparable populations.

Jan 1, 1986

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