What Is A Private Fee For Service Plan
Health Intendance Financ Rev. 2009 Spring; xxx(3): 15–24.
Payment Reduction and Medicare Private Fee-for-Service Plans
Abstruse
Medicare private fee-for-service (PFFS) plans are paid like other Medicare Advantage (MA) plans but are exempt from many MA requirements. Recently, Congress set average payments well to a higher place the costs of traditional fee-for-service (FFS) Medicare, inducing dramatic increases in PFFS plan enrollment. This has significant implications for Medicare's budget, provoking calls for policy change. We predict the effect of proposals to cut PFFS payments on PFFS plan participation and enrollment. We discover that small reductions in payment rates would reduce PFFS participation and enrollment; if Congress reduces payments to traditional FFS levels it would cause the vast majority (85 pct) of PFFS plans to leave the marketplace.
Introduction
MA is the Medicare Programme that pays private plans capitated rates to insure beneficiaries. The most familiar MA plan type is the HMO, but the program too includes preferred provider organizations (PPOs) and PFFS plans. PFFS plans presume adventure similar other MA plans merely do not utilize all the cost command mechanisms required of other MA programme types (Medicare Payment Advisory Commission, 2007b). In particular, they are not required to manage care or establish networks of providers. In addition PFFS plans must pay physicians at least the same rate every bit traditional Medicare (Blum, Brownish, and Frieder, 2007; Miller, 2008). Considering PFFS plans do not build networks, they take been willing to enroll beneficiaries in rural areas that other MA plan types avert due to the high costs of network contracting in those areas.
The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), all-time known for establishing a Medicare outpatient drug do good, too made pregnant changes to the MA program. In the MMA, Congress created weather favorable for rapid growth of MA plans in general and PFFS plans in detail. Between 2005 and 2006, PFFS enrollment increased 932 percent, while overall MA enrollment grew 37 percentage (Gold, 2007a, 2008). The Congressional Upkeep Office (CBO) estimates that Medicare spending on PFFS plans will increment as a proportion of total MA spending from 21 to 30 percent between 2008 and 2017 (Orszag, 2007).
Increases mandated by the MMA and prior legislation have pushed payments to MA plans, including PFFS plans, well to a higher place average per beneficiary costs for traditional FFS Medicare. Payments are specially high relative to FFS expenditures in counties that were subject to the rural floor charge per unit, a minimum payment charge per unit for rural areas established by the Counterbalanced Budget Act of 1997 (BBA) to encourage HMO participation in those areas. The average MA payment was 134 pct of average FFS expenditures in rural floor counties in 2006 (Medicare Payment Advisory Commission, 2007b). Because a greater share of their enrollment is in rural counties, PFFS plans receive greater payment relative to FFS expenditure than other plan types. The Medicare Payment Advisory Commission (MedPAC) reported that payments to MA plans and PFFS plans were 112 per centum and 119 percent of FFS expenditures, respectively, in 2006 (Medicare Payment Advisory Commission, 2007b). CBO estimates were similar (Gronniger and Sunshine, 2007). In 2008, payments to PFFS plans declined slightly but were yet 17 percent above FFS costs (Medicare Payment Informational Commission, 2008).
The electric current state of PFFS differs considerably from the way the plan blazon was conceived. When the PFFS plan type was introduced in 1997 the expectation was that about Medicare beneficiaries would enroll in managed care plans. Beneficiaries who did not want a limited option of providers could select PFFS and pay a higher premium for it. Instead, PFFS has become a vehicle for providing extra benefits to enrollees and at great cost to the Medicare Programme. Part of this price is borne by all Medicare beneficiaries through higher Part B premiums (Medicare Payment Advisory Commission, 2007c).
The implications of PFFS growth and spending have defenseless the attention of Congress and take raised questions about the value of PFFS relative to its cost (Neuman, 2007). Each boosted dollar in extra PFFS benefits has been estimated to price Medicare $3 (Harrison and Zarabozo, 2008). Recent legislation and proposals take targeted MA payments and regulations favorable to PFFS as ways to reduce spending. On July 15, 2008, Congress overrode a veto of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) (Iglehart, 2008). Beginning in 2010, MIPPA volition remove duplicative payments that MA plans receive for indirect medical didactics expenses. In 2011 MIPPA will rescind the PFFS provider network exemption in areas with at to the lowest degree 2 local network plans (HMOs or PPOs) (Congressional Budget Office, 2008; Biles, Adrion, and Guterman, 2008). CBO estimated that these provisions volition decrease MA enrollment in 2013 past 2.3 million beneficiaries relative to the pre-MIPPA gauge of 14.3 million; Federal spending will fall past $47.5 billion over 2009-2018 (Orszag, 2008).
Since 2005, MedPAC has recommended parity between per beneficiary MA payment and FFS expenditure (Medicare Payment Advisory Commission, 2005). In a pre-MIPPA analysis, CBO estimated parity would salvage $149 billion over 2009-2017. CBO has besides estimated that Medicare would save $43 billion over 2009-2017 by reducing PFFS payments to FFS costs but leaving payments to other plans at current levels (Gronniger and Sunshine, 2007).
This article complements CBO's analysis past estimating the effects of MedPAC and CBO proposals on PFFS availability and enrollment. Nosotros notice that a payment rate cap of 100 percent of FFS costs would reduce PFFS plan participation by 85 percent, potentially affecting about 1.9 million enrollees.
Study Data and Methods
Our principal goal is to predict the effects of payment changes on the decisions of PFFS-offer firms to participate (enter) in Medicare. Our approach is to estimate a model of PFFS entry by firm, canton, and year. Using this model, we simulate the effect of reduced payment rates. To do so, we created a year-canton-firm level file from publicly available data on MA program participation, enrollment, payment rates, system names, benefits (2008 simply), and FFS costs.i To these we merged information on Medigap premiums and variables from the Area Resource File (ARF).2 These variables are used to control for PPFS programme price and accept been employed in prior work for similar purposes (Cawley, Chernew, and McLaughlin, 2005).
Our sample frame included all U.S. counties, all firms that ever offered a PFFS product (excluding employer-simply plans), and years 2001-2008 (2001 was the commencement total yr of PFFS availability) (Gold, 2007b). Except as indicated below, the analytic file contained one record for each combination of year, county, and PFFS-offering firm. We set an entry variable to one for records indicating a twelvemonth and county in which a business firm entered and zero otherwise.
We used a strict notion of entry: while a firm may contract with CMS to offer a program in a county, we consider it to have entered but if information technology enrolled a meaningful number of beneficiaries. Our criteria for entry are enrollment of at to the lowest degree 11 individuals and at least 0.1 pct of beneficiaries in the county. The former is a functional definition: CMS reports enrollment below 11 as missing. The latter is consistent with techniques practical in prior work (Cawley, Chernew, and McLaughlin, 2005; Town and Liu, 2003; Frakt and Pizer, 2009; Pizer and Frakt, 2002).
While some firms offer PFFS products in most counties, others are active only in sure States (e.thou., States where they are licensed). Such sub-national participants should not be considered as potential entrants in every county. Therefore, for each firm, we removed all twelvemonth-county pairs in States in which the firm never entered whatsoever county.
In counties with few beneficiaries, average FFS price is highly influenced by outlier values. Thus, we dropped counties with fewer than 250 beneficiaries (1.5 percent of records). The last file contained 272,580 year-county-house observations, representing 8 years (2001-2008), 3,075 U.S. counties, and 33 firms. In descriptive results, aggregates are weighted by beneficiaries or PFFS enrollees as indicated. The Technical Note describes the multivariate model used to simulate PFFS firm response to payment changes.
Study Results
Effigy one presents PFFS enrollment and boilerplate payment rate caps (as well called benchmarks) as a proportion of FFS cost for 2001-2008 and 2009 estimates of the latter.3 The calculation of benchmarks follows MedPAC'south methodology and complements their analyses of 2006 and 2008 (Biles, Adrion, and Guterman, 2008).
Private Fee-For-Service Enrollment and Benchmark/Fee-For-Service Toll Ratio, 2001-20091
1 "Benchmark" is the maximum allowable payment charge per unit. Since 2006, the bodily rate paid to plans is a function of bids simply is no higher than the benchmark. PFFS enrollment is not still bachelor for 2009; estimates of benchmark/FFS for 2009 are based on 2009 criterion rates and 2008 enrollment figures.
SOURCE: Frakt, A. B., Pizer, Southward. D., VA Boston Healthcare System and BU School of Public Wellness, Feldman, R., University of Minnesota School of Public Health, 2009.
In Figure 1, the benchmark to FFS cost ratio is weighted by canton-level counts of all Medicare beneficiaries and by PFFS enrollees. The former is what Medicare offers an MA plan on average to enroll a casher. The latter reflects PFFS enrollment patterns. Both measures are above 1.0 in every year, and since 2004, PFFS enrollment-weighted values are higher than casher-weighted values revealing that PFFS enrollment is disproportionately drawn from highly paid counties relative to FFS.
Table 1 reports the 2008 entry, enrollment, and non-drug benefits patterns for the top 10 PFFS-offering firms (enrollment ranked) and, in aggregate, all other firms. Because our assay excludes employer-only plans, the ranking differs from that reported elsewhere.4 By our definition of entry (meaningful enrollment), no firm offers plans in all counties, iii firms (Humana, Coventry, and Universal American) offering plans in over half the counties, and nigh are decidedly sub-national players (Table 1).
Table i
Entry and Enrollment for the Summit x Individual Fee-For-Service-Offering Firms, 2008
| Entry | Enrollment | Benefits | ||||
|---|---|---|---|---|---|---|
| | | | ||||
| Number of Counties Entered | Percent of Counties Entered westward/o Rx Benefit | National Enrollment1 | Per centum of Enrollment in Rural Counties2 | Monthly Boilerplate Net Premiumiii | Boilerplate Medico Visit Co-Payiv | |
| Humana | 2,595 | 0 | 684,087 | 35.60 | $20.45 | $22.39 |
| BC/BS of MI | 262 | 0 | 243,745 | 25.twenty | $114.08 | $13.06 |
| Coventry | ane,732 | 98 | 230,498 | 36.10 | $31.47 | $24.43 |
| WellPoint | 1,154 | two | 189,500 | 38.90 | $xv.84 | $xiii.39 |
| Aetna | one,000 | 0 | 188,480 | xviii.20 | $89.75 | $8.35 |
| Universal American | 1,664 | 100 | 176,250 | 38.threescore | $28.xv | $26.14 |
| Aon | 715 | 100 | 97,930 | 36.60 | $twenty.28 | $10.00 |
| WellCare | 840 | 0 | 94,833 | xx.twenty | $i.87 | $xiv.54 |
| UnitedHealth | 913 | 92 | 90,739 | 28.thirty | $i.71 | $29.57 |
| Universal Wellness Care | 314 | 0 | 31,021 | fourteen.20 | -$5.50 | $10.25 |
| All Other Firms | 1,194 | 73 | 134,516 | 17.30 | $53.48 | $12.71 |
| National Total/Boilerplate | 12,383 | 47 | ii,161,599 | 31.10 | $38.52 | $xviii.47 |
National PFFS enrollment in 2008 of 2.2 1000000 was full-bodied amidst Humana with 0.7 meg enrollees (Table 1), and Blue Cantankerous/Blue Shield of Michigan, Coventry, and Wellpoint, which collectively captured one-tertiary of the market. PFFS enrollment in rural counties was a larger share of total enrollment than is common for MA plans in full general: 31 percent for PFFS (Table i) and 11 per centum for MA plans (Gold, 2008).
In contrast to other MA plan types, which must offer at least i product with a drug benefit, PFFS-offering firms are not required to offer a drug benefit (Table 1). Overall, 47 percent of county-programme pairs do non include a drug benefit. Simply this masks considerable variation by firm. Some firms never or rarely offer a drug benefit (Coventry, Universal American, Aon, and UnitedHealth), while others ofttimes or always do so. Firms that exercise non offer a drug benefit may have made a strategic decision to provide drug options only through stand-alone prescription drug plans (PDPs).
The right-about columns of Table 1 report 2008 monthly average net premium (accounting for any Part B premium rebate), and boilerplate doctor visit co-payment. The national average premium, $38.52, is lower than the $45 reported elsewhere for 2006 (Gold, 2007a).5 The considerable variation in firm-level cyberspace premium is likely due to variations in Office B rebates, differences in benefit design (principally whether or not plans are bundled with a drug do good), and variation in the geographic area over which unlike firms operate, which corresponds to variation in average per-beneficiary payment rate. Boilerplate doc co-payments are consistent with those reported elsewhere (Aureate, 2007a).
Figure 2 presents our simulations of the effects of changes in payment rates. The simulations were conducted using 2008 data based on the entry model described in the Technical Note. In each successive simulation, nosotros capped the county payment rate at a lower level, starting at 115 pct and ending at 95 percent of canton FFS cost, the rate prior to the passage of the 1997 BBA. Since the actual enrollee-weighted average 2008 benchmark/FFS value is 119 percent (Effigy 1), all simulations reduce PFFS entry relative to current police force. In particular, MedPAC'southward proposal to pay 100 per centum of FFS cost would reduce entry by 85 per centum. Bold a proportional reduction in enrollment, about ane.9 million current PFFS enrollees would have to select another MA plan or switch to traditional FFS Medicare.
Estimated Effect of Payment Rate Caps on Private Fee-For-Service Entry, 2008ane
1 Pct changes relative to 2008 benchmark payment rate levels.
SOURCE: Frakt, A. B., Pizer, S. D., VA Boston Healthcare System and BU School of Public Wellness, Feldman, R., University of Minnesota School of Public Wellness, 2009.
Discussion
Recent congressionally mandated payment charge per unit increases have stimulated PFFS enrollment and provoked calls for policy change. In contempo annual reports to Congress, MedPAC has cautioned that higher payments to MA plans, including PFFS plans, increase Medicare costs and casher Part B premiums. MedPAC has recommended parity between MA payment rates and FFS cost, and CBO has evaluated the budgetary implications of cutting payments to PFFS plans. With the passage of MIPPA, Congress signaled an intention to reverse some of the furnishings of earlier rate-setting statutes while standing to consider further measures.
This commodity makes two empirical contributions to this debate. First, we provide the outset time series (2001-2009) of benchmark payment rates as a proportion of FFS toll for PFFS plans. In the existing literature, this number is only available for 2006 and 2008. Second, we evaluate the impact of payment charge per unit cuts on PFFS entry and enrollment, complementing the CBO'due south budgetary assay. We predict that a 100 per centum FFS cap would reduce PFFS entry by 85 percent, potentially affecting i.9 million beneficiaries. Those beneficiaries would have to enroll in another MA plan (if available) or receive coverage from FFS Medicare. CBO estimates that achieving payment parity between FFS and PFFS would save Medicare $43 billion over 2009-2017 (Gronniger and Sunshine, 2007).
PFFS plans do have other options in the face of payment cuts. They could reduce benefits. This, as opposed to exit, is more probable for modest reductions in the benchmark relative to FFS price. Nevertheless, at the margin in that location will be exits with any size cut in payment. Reducing payments to or near FFS cost essentially returns to rates offered at a time when PFFS was a permitted plan type simply actual PFFS entry was tiny. This descriptive evidence strongly suggests that plan go out and non benefits changes will be the ascendant response to big changes in payment.
While our assay is express to PFFS, it is unlikely Congress would cutting payments to PFFS plans while leaving payments to other MA plans intact. Therefore, parity between payment rates and FFS toll would have larger implications for Medicare, MA plans, and beneficiaries than nosotros take described.
Of course, the provision of MIPPA scheduled for 2011 that volition remove the PFFS provider network exemption in areas with at least 2 local network plans volition accept a large impact on PFFS without affecting other MA plans. Using our written report data and CBO methodology, we estimate that had the network exemption repeal occurred in 2008, it would take caused virtually one-half of PFFS plans to exit the market, affecting ane.iv million enrollees (Bradley, 2008). Our results suggest that a cut in payments to 100 percent of FFS cost implemented earlier MIPPA's adjustment of the PFFS network exemption (i.east., in 2010) would render MIPPA'southward affect moot. On the other paw, if payments are cutting afterwards MIPPA is in consequence they would induce a further reduction in the number of PFFS plans and enrollees beyond what would be acquired by MIPPA alone.
Current fiscal constraints will likely mean less money for private Medicare plans (Krugman, 2008). As the fastest growing and most costly plan type, PFFS plans already are viewed as a potential source for savings. As we take illustrated, payment cuts have the potential to effectively shut downwards the PFFS market, making PFFS a specially brilliant illustration of the consequences of managing markets through congressional rate-setting. Subsequently creating explosive growth in PFFS enrollment, members of Congress will have to weigh the likely disruption and lost benefits for beneficiaries against predicted savings as they consider reversing course.
Technical Note
Nosotros estimated a logit model of PFFS entry with clustering on firm to adjust standard errors for firm-specific heteroscedasticity. Because lagged payment-to-FFS toll ratios are included in the model, 2001 data are omitted, reducing the sample to 238,358 year-county-firm observations. Lags are included in the model because plans did not reply to payment incentives instantaneously (Figure one). Simulations assume that payment caps are set permanently and then lags and electric current values are equal. Variables are defined in Tabular array 2; mean values, model coefficients and marginal effects are provided in Table 3.
Table 2
Definition of Variables
| Variable | Definition |
|---|---|
| Benchmark/FFS | Twelvemonth-county specific benchmark payment rates as a proportion of per-beneficiary FFS costs. |
| Average Non-Rx Medigap Premium | Year-state specific average of non-drug Medigap premiums from a large insurer. |
| County Risk Score | Year 2000 canton-level CMS diagnosis-based risk score. |
| Urban Adjacent Indicator | County-level indicator of urban status. |
| Rural Indicator | County-level indicator of rural status. |
| Proportion Elderly in Poverty | Year 2000 proportion of elderly population with income below Federal Poverty Level. |
| Per Majuscule Inc. (in 000) | Year 2000 canton per capital income in thousands. |
| Proportion due west/Col. Deg. | Twelvemonth 2000 proportion of individuals in county with college degree. |
| Proportion w/H.South. Diploma | Year 2000 proportion of individuals in county with high schoolhouse diploma. |
| Proportion Elderly 75+ | Yr 2000 proportion of elderly in county that are at least 75 years sometime. |
| General Practitioner Density | Yr 2000 canton-level number of general practitioners per square mile. |
| Hospital Density | Yr 2000 canton-level number of hospitals per square mile. |
| Proportion White Collar | Year 2000 proportion of workers in county in white neckband jobs. |
| Proportion Manufacturing | Year 2000 proportion of workers in county in manufacturing jobs. |
| Proportion Construction | Year 2000 proportion of workers in county in structure jobs. |
Tabular array 3
Logit Entry Model (Dependent Variable Is an Indicator of House-County Entry)
| Variable | Sample Mean | Coefficient (Standard Error) | Marginal Effect |
|---|---|---|---|
| Criterion/FFS | ane.14 | 22.11 (6.25)*** | 1.78 |
| 1-Yr Lag Benchmark/FFS | 1.14 | 23.78 (7.34)*** | 1.91 |
| two-Yr Lag Benchmark/FFS | i.14 | 24.15 (vii.41)*** | 1.94 |
| (Benchmark/FFS) | i.32 | -8.25 (two.45)*** | -0.66 |
| 1-Yr Lag (Criterion/FFS) | 1.33 | -viii.92 (2.97)** | -0.72 |
| 2-Yr Lag (Criterion/FFS) | one.32 | -10.12 (ii.91)*** | -0.81 |
| Average Non-Rx Medigap Premium | 117.79 | 0.01 (0.00)*** | 0 |
| Canton Risk Score | 0.99 | -0.3 -i.11 | -0.02 |
| Urban Adjacent Indicator | 0.36 | -0.11 (.05)* | -0.01 |
| Rural Indicator | 0.27 | -0.44 (.17)** | -0.03 |
| Proportion Elderly in Poverty | 0.12 | -1.08 -ane.34 | -0.09 |
| Per Capital letter Inc. (in 000) | 22.44 | -0.01 -0.01 | 0 |
| Proportion w/Col. Deg. | 0.16 | 0.26 -0.39 | 0.02 |
| Proportion w/H.Southward. Diploma | 0.77 | -0.16 -0.76 | -0.01 |
| Proportion Elderly 75+ | 0.47 | -1.42 -1.12 | -0.11 |
| Full general Practitioner Density | 0.06 | -0.29 (.07)*** | -0.02 |
| Hospital Density | 0.01 | -1.39 (.42)*** | -0.xi |
| Proportion White Collar | 0.51 | i.08 (.five)* | 0.09 |
| Proportion Manufacturing | 0.17 | ane.09 (.43)* | 0.09 |
| Proportion Construction | 0.08 | -0.49 -0.9 | -0.04 |
| Constant | -46.62 (xi.84)*** |
Footnotes
Austin B. Frakt and Steven D. Pizer are with the VA Boston Healthcare System and BU Schoolhouse of Public Wellness. Roger Feldman is with the University of Minnesota School of Public Health. The inquiry in this article was supported by Grant Number 63744 from the Robert Wood Johnson Foundation's Changes in Wellness Care Financing and Organisation Initiative. The statements expressed in this article are those of the authors and do non necessarily reflect the views or policies of the VA Boston Healthcare Organization and BU School of Public Health, Academy of Minnesota School of Public Health, the Robert Forest Johnson Foundation, or the Centers for Medicare & Medicaid Services (CMS).
1MA and FFS files are available from CMS at the following Internet sites: MA programme participation www.cms.hhs.gov/Health-PlanRepFileData/03_Geo.asp and world wide web.cms.hhs.gov/MCRAdvPartDEnrolData/MACSASC/list.asp; MA enrollment www.cms.hhs.gov/MCRAdvPartDEnrolData/MMAESCC/list.asp; MA payment rates world wide web.cms.hhs.gov/MedicareAdvtgSpecRateStats/RSD/list.asp; MA organization names www.cms.hhs.gov/MCRAdvPartDEnrolData/PDMCPDO/listing.asp; MA drug benefits world wide web.cms.hhs.gov/PrescriptionDrugCovGenIn/; MA non-drug benefits www.medicare.gov/download/downloaddb.asp; and FFS costs world wide web.cms.hhs.gov/MedicareAdvtgSpecRateStats/05_FFS_Data.asp.
2Medigap premium data were provided by a large insurer. ARF data are bachelor from Quality Resource Systems, Inc. (world wide web.arfsys.com/).
3Earlier 2006, plans were paid an administratively set payment rate. Since 2006, plans are paid a value no college than a criterion. Plans that bid below the benchmark are paid the benchmark less 25 percentage of the benchmark-bid deviation. For simplicity, we use the term benchmark to refer to the actual payment rate (prior to 2006) and maximum payment rate (2006 and later) (Medicare Payment Informational Commission, 2007a).
4In particular, UnitedHealth is ranked second or third when employer-only plans are included (Gold, 2007b; Blum, Brown, and Frieder, 2007).
5It is not clear if the 2006 estimates in Gold (2007a) are net of Part B rebates. Aureate (2007a) also reports that the average 2006 PFFS premium was $5 below the average HMO premium.
Reprint Requests: Austin B. Frakt, Ph.D., VA Boston Healthcare Organization and BU School of Public Health, 150 S. Huntington Avenue (152H), Boston, MA 02130. E-mail: ude.ub@tkarf
References
- Biles B, Adrion East, Guterman S. The Continuing Cost of Privatization: Extra Payments to Medicare Advantage Plans in 2008. Vol. 42. The Republic Fund; Sep, 2008. Issue Cursory No. 1169. [PubMed] [Google Scholar]
- Bradley T. Congressional Budget Part. Personal communication. Sep eleven, 2008.
- Blum J, Brownish R, Frieder M. An Examination of Medicare Private Fee-for-Service Plans. The Henry J. Kaiser Family Foundation; Mar, 2007. Medicare Effect Cursory. [Google Scholar]
- Cawley J, Chernew M, McLaughlin C. HMO Participation in Medicare+Choice. Journal of Economics & Management Strategy. 2005 Fall;14(3):543–574. [Google Scholar]
- Congressional Budget Part. Hour 6331: Medicare Improvements for Patients and Providers Act of 2008, Cost Judge. Jul 23, 2008.
- Frakt A, Pizer Southward. Casher Price Sensitivity in the Medicare Prescription Drug Plan Market. Health Economic science. Net address: http://www3.interscience.wiley.com/journal/121673428/abstract (Accessed 2009.) [PubMed]
- Gold M. Medicare Advantage in 2006-2007: What Congress Intended? Health Diplomacy. 2007a Jul-Aug;26(4):w445–w455. [PubMed] [Google Scholar]
- Gold 1000. Medicare Advantage in 2008. The Henry J. Kaiser Family unit Foundation; Jun, 2008. Medicare Event Brief. [Google Scholar]
- Gold Yard. Private Plans in Medicare: A 2007 Update. The Henry J. Kaiser Family Foundation; Mar, 2007b. Medicare Issue Brief. [Google Scholar]
- Gronniger J, Sunshine R. Medicare Advantage: Individual Health Plans in Medicare. Congressional Budget Office; Jun 28, 2007. Economic and Budget Upshot Cursory. [Google Scholar]
- Harrison S, Zarabozo C. The Medicare Advantage Program. Medicare Payment Advisory Committee Public Coming together; December 5, 2008; Internet address: http://www.medpac.gov/tran-scripts/MA1208presentation%20final%20NO%20NOTES.pdf (Accessed 2009.) [Google Scholar]
- Iglehart J. Medicare Showdown. The New England Journal of Medicine. 2008 Aug 7;359(6):556–558. [PubMed] [Google Scholar]
- Krugman P. Kennedy's Large 24-hour interval. NY Times. 2008 Jul eleven; [Google Scholar]
- Medicare Payment Advisory Commission. Medicare Advantage Programme Payment Organisation. Oct, 2007a.
- Medicare Payment Advisory Commission. Report to the Congress: Issues in a Modernized Medicare Plan. Jun, 2005.
- Medicare Payment Advisory Commission. Written report to the Congress: Medicare Payment Policy. Mar, 2007b. Chapter 4.
- Medicare Payment Informational Committee. Study to the Congress: Promoting Greater Efficiency in Medicare. Jun, 2007c.
- Medicare Payment Informational Committee. Report to the Congress: Medicare Payment Policy. Mar, 2008. Affiliate iii.
- Miller Thousand. Individual Fee-for-Service Plans in Medicare Advantage. U.S. Senate; Jan thirty, 2008. Medicare Payment Advisory Commission. Argument before the Committee on Finance. [Google Scholar]
- Neuman P. Private Fee-For-Service Plans in Medicare: Rapid Growth and Future Implications. U.Southward. House of Representatives; May 22, 2007. Testimony before the Subcommittee on Health, Committee on Means and Ways. [Google Scholar]
- Orszag P. Congressional Upkeep Office letter to Judd Gregg, Ranking Member, Committee on the Upkeep. U.S. Senate; Jul 8, 2008. [Google Scholar]
- Orszag P. The Medicare Advantage Program. U.S. Firm of Representatives; Jun 28, 2007. Congressional Upkeep Part.Testimony earlier the Committee on the Budget. [Google Scholar]
- Pizer S, Frakt A. Payment Policy and Competition in the Medicare+Selection Program. Health Care Financing Review. 2002 Autumn;24(1):83–94. [PMC gratis article] [PubMed] [Google Scholar]
- Town R, Liu S. The Welfare Touch of Medicare HMOs. Rand Journal of Economics. 2003;34(4):719–736. [PubMed] [Google Scholar]
Manufactures from Health Intendance Financing Review are provided here courtesy of Centers for Medicare and Medicaid Services
Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4195074/
Posted by: eppsdiesequan49.blogspot.com
0 Response to "What Is A Private Fee For Service Plan"
Post a Comment