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Fee-for-Service for Health Care

Journal Article
The Impact of Nurse Practitioner-Led Primary Care on Quality and Cost for Medicaid-Enrolled Patients in States With Pay Parity
This retrospective cohort study evaluated the quality and cost implications of receiving primary care from nurse practitioners (NPs) compared to physicians in 14 states that reimburse NPs at the Medicaid fee-for-service physician rate (pay parity).
May 16, 2023
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

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