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Joseph S Ross - One of the best experts on this subject based on the ideXlab platform.
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Laboratory Test Ordering at Physician Offices with and without On-Site Laboratories
Journal of General Internal Medicine, 2010Co-Authors: Tara F Bishop, Alex D Federman, Joseph S RossAbstract:Background Physician Self-Referral, ordering a test or procedure or referring to a facility in which a Physician has a financial interest, has been associated with increased utilization of health care services. Objective To examine the association between on-site laboratories and laboratory test ordering among visits to group-practice Physicians. Design Cross-sectional study using data from the 2005 and 2006 National Ambulatory Medical Care Surveys. Study Population Visits by adults to non-federally-funded, non-hospital-based group practices. Primary analyses focused on visits to Physician owners; secondary analyses focused on visits to non-owners. Main Measures Ordering of five laboratory tests: complete blood count (CBC), electrolytes, glycoslyated hemoglobin A1c (HbA1c), cholesterol, and prostate-specific antigen (PSA). Key Results There were 19,163 visits to group-practice owners with 51.9% to a practice with an on-site laboratory. Visits to primary care Physicians were more likely to be to a practice with an on-site laboratory when compared with visits to specialists (64.4% vs. 34.0%, p
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laboratory test ordering at Physician offices with and without on site laboratories
Journal of General Internal Medicine, 2010Co-Authors: Tara F Bishop, Alex D Federman, Joseph S RossAbstract:Background Physician Self-Referral, ordering a test or procedure or referring to a facility in which a Physician has a financial interest, has been associated with increased utilization of health care services.
Hhs Centers For Medicare Medicaid Services - One of the best experts on this subject based on the ideXlab platform.
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Medicare Program; Final Waivers in Connection With the Shared Savings Program. Final rule.
Federal register, 2015Co-Authors: Hhs Centers For Medicare Medicaid ServicesAbstract:This final rule finalizes waivers of the application of the Physician Self-Referral law, the Federal anti-kickback statute, and the civil monetary penalties (CMP) law provision relating to beneficiary inducements to specified arrangements involving accountable care organizations (ACOs) under section 1899 of the Social Security Act (the Act) (the "Shared Savings Program''), as set forth in the Interim Final Rule with comment period (IFC) dated November 2, 2011. As explained in greater detail below, in light of legislative changes that occurred after publication of the IFC, this final rule does not finalize waivers of the application of the CMP law provision relating to "gainsharing'' arrangements. Section 1899(f) of the Act, as added by the Affordable Care Act, authorizes the Secretary to waive certain fraud and abuse laws as necessary to carry out the provisions of section 1899 of the Act.
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medicare and medicaid programs hospital outpatient prospective payment and ambulatory surgical center payment systems and quality reporting programs Physician owned hospitals data sources for expansion exception Physician certification of inpatient h
Federal Register, 2014Co-Authors: Hhs Centers For Medicare Medicaid ServicesAbstract:: This final rule with comment period revises the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for CY 2015 to implement applicable statutory requirements and changes arising from our continuing experience with these systems. In this final rule with comment period, we describe the changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment system. In addition, this final rule with comment period updates and refines the requirements for the Hospital Outpatient Quality Reporting (OQR) Program and the ASC Quality Reporting (ASCQR) Program. In this document, we also are making changes to the data sources permitted for expansion requests for Physician-owned hospitals under the Physician Self-Referral regulations; changes to the underlying authority for the requirement of an admission order for all hospital inpatient admissions and changes to require Physician certification for hospital inpatient admissions only for long-stay cases and outlier cases; and changes to establish a formal process, including a three-level appeals process, to recoup overpayments that result from the submission of erroneous payment data by Medicare Advantage (MA) organizations and Part D sponsors in the limited circumstances in which the organization or sponsor fails to correct these data.
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Medicare program; Physicians' referrals to health care entities with which they have financial relationships: exception for certain electronic health records arrangements. Final rule.
Federal register, 2013Co-Authors: Hhs Centers For Medicare Medicaid ServicesAbstract:This final rule revises the exception to the Physician Self-Referral law that permits certain arrangements involving the donation of electronic health records items and services. Specifically, this final rule extends the expiration date of the exception to December 31, 2021, excludes laboratory companies from the types of entities that may donate electronic health records items and services, updates the provision under which electronic health records software is deemed interoperable, removes the electronic prescribing capability requirement, and clarifies the requirement prohibiting any action that limits or restricts the use, compatibility, or interoperability of donated items or services.
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medicare and medicaid programs hospital outpatient prospective payment ambulatory surgical center payment hospital value based purchasing program Physician self referral and patient notification requirements in provider agreements final rule with com
Federal Register, 2011Co-Authors: Hhs Centers For Medicare Medicaid ServicesAbstract:This final rule with comment period revises the Medicare hospital outpatient prospective payment system (OPPS) for CY 2012 to implement applicable statutory requirements and changes arising from our continuing experience with this system. In this final rule with comment period, we describe the changes to the amounts and factors used to determine the payment rates for Medicare hospital outpatient services paid under the OPPS. In addition, this final rule with comment period updates the revised Medicare ambulatory surgical center (ASC) payment system to implement applicable statutory requirements and changes arising from our continuing experience with this system. In this final rule with comment period, we set forth the relative payment weights and payment amounts for services furnished in ASCs, specific HCPCS codes to which these changes apply, and other ratesetting information for the CY 2012 ASC payment system. We are revising the requirements for the Hospital Outpatient Quality Reporting (OQR) Program, adding new requirements for ASC Quality Reporting System, and making additional changes to provisions of the Hospital Inpatient Value-Based Purchasing (VBP) Program. We also are allowing eligible hospitals and CAHs participating in the Medicare Electronic Health Record (EHR) Incentive Program to meet the clinical quality measure reporting requirement of the EHR Incentive Program for payment year 2012 by participating in the 2012 Medicare EHR Incentive Program Electronic Reporting Pilot. Finally, we are making changes to the rules governing the whole hospital and rural provider exceptions to the Physician Self-Referral prohibition for expansion of facility capacity and changes to provider agreement regulations on patient notification requirements.
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medicare program hospital outpatient prospective payment system and cy 2011 payment rates ambulatory surgical center payment system and cy 2011 payment rates payments to hospitals for graduate medical education costs Physician self referral rules and
Federal Register, 2010Co-Authors: Hhs Centers For Medicare Medicaid ServicesAbstract:: The final rule with comment period in this document revises the Medicare hospital outpatient prospective payment system (OPPS) to implement applicable statutory requirements and changes arising from our continuing experience with this system and to implement certain provisions of the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010 (Affordable Care Act). In this final rule with comment period, we describe the changes to the amounts and factors used to determine the payment rates for Medicare hospital outpatient services paid under the prospective payment system. These changes are applicable to services furnished on or after January 1, 2011. In addition, this final rule with comment period updates the revised Medicare ambulatory surgical center (ASC) payment system to implement applicable statutory requirements and changes arising from our continuing experience with this system and to implement certain provisions of the Affordable Care Act. In this final rule with comment period, we set forth the applicable relative payment weights and amounts for services furnished in ASCs, specific HCPCS codes to which these changes apply, and other pertinent ratesetting information for the CY 2011 ASC payment system. These changes are applicable to services furnished on or after January 1, 2011. In this document, we also are including two final rules that implement provisions of the Affordable Care Act relating to payments to hospitals for direct graduate medical education (GME) and indirect medical education (IME) costs; and new limitations on certain Physician referrals to hospitals in which they have an ownership or investment interest. In the interim final rule with comment period that is included in this document, we are changing the effective date for otherwise eligible hospitals and critical access hospitals that have been reclassified from urban to rural under section 1886(d)(8)(E) of the Social Security Act and 42 CFR 412.103 to receive reasonable cost payments for anesthesia services and related care furnished by nonPhysician anesthetists from cost reporting periods beginning on or after October 1, 2010, to December 2, 2010.
Kori J. Kingsbury - One of the best experts on this subject based on the ideXlab platform.
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Impact of System and Physician Factors on the Detection of Obstructive Coronary Disease With Diagnostic Angiography in Stable Ischemic Heart Disease
Circulation. Cardiovascular quality and outcomes, 2014Co-Authors: Harindra C. Wijeysundera, Feng Qiu, Maria C. Bennell, Madhu K. Natarajan, Warren J. Cantor, Stuart Smith, Kori J. KingsburyAbstract:Background—Wide variation exists in the detection rate of obstructive coronary artery disease (CAD) with elective coronary angiography for suspected stable ischemic heart disease. We sought to understand the incremental impact of nonclinical factors on this variation. Methods and Results—We included all patients who underwent coronary angiography for possible suspected stable ischemic heart disease, from October 1, 2008, to September 30, 2011, in Ontario, Canada. Nonclinical factors of interest included Physician Self-Referral for angiography, the Physician type (invasive or interventional), and hospital type. Hospitals were categorized into diagnostic angiogram only centers, stand-alone percutaneous coronary intervention centers, or full service centers with coronary artery bypass surgery available. Multivariable hierarchical logistic models were developed to identify system and Physician-level predictors of obstructive CAD, after adjustment for patient factors. Our cohort consisted of 60 986 patients, o...
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Abstract 342: Impact Of System And Physician Factors On The Diagnostic Yield Of Coronary Angiography In Stable Ischemic Heart Disease: A Population Based Study
Circulation-cardiovascular Quality and Outcomes, 2014Co-Authors: Harindra C. Wijeysundera, Feng Qiu, Maria C. Bennell, Madhu K. Natarajan, Warren J. Cantor, Stuart Smith, Kori J. KingsburyAbstract:Background: Wide variation exists in the diagnostic yield of coronary angiography in stable ischemic heart disease (IHD). Previous work has primarily focused on patient factors for this variation. We sought to understand if system and Physician factors, specifically hospital and Physician type, as well as Physician Self-Referral, have incremental impacts on the yield of coronary angiography, above and beyond that of patient factors alone. Methods: All patients who underwent a diagnostic coronary angiogram for possible stable IHD, at the 18 cardiac centers in Ontario, Canada were identified from October 1st, 2008 to September 30th, 2011. Obstructive coronary artery disease was defined as stenosis greater than 70% in the main coronary arteries or greater than 50% in the left main artery. Physicians were classified as either invasive or interventional. Hospitals were categorized into cath only, stand-alone PCI and full service centers. Multi-variable hierarchical logistic models were developed to identify sy...
Jean M. Mitchell - One of the best experts on this subject based on the ideXlab platform.
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Examining Drivers of Health Care Spending: Evidence on Self-Referral Among a Privately Insured Population
Medical care, 2017Co-Authors: Jean M. Mitchell, James D. Reschovsky, Roy J. Film, Luisa FranziniAbstract:Background: Despite the enactment of laws to restrict the practice of Self-Referral, exceptions in these prohibitions have enabled these arrangements to persist and proliferate. Most research documenting the effects of Self-Referral arrangements analyzed claims records from Medicare beneficiaries. Empirical evidence documenting the effects of Self-Referral on use of services and spending incurred by persons with private insurance is sparse. Objectives: We analyzed health insurance claims records from a large private insurer in Texas to evaluate the effects of Physician Self-Referral arrangements involving physical therapy on the treatment of patients with frozen shoulder syndrome, elbow tendinopathy or tendinitis, and patellofemoral pain syndrome. Study Design: We used regression analysis to evaluate the effects of episode Self-Referral status on: (1) initiation of physical therapy; (2) physical therapy visits and services for those who had at least 1 visit; and (3) total condition-related insurer allowed amounts per episode. Results: For all 3 conditions, we found that patients treated by Physician owners were much more likely to be referred for a course of physical therapy when compared with patients seen by Physician nonowners. A consistent pattern emerged among patients who had at least 1 physical therapy visit; non–self-referred episodes included more physical therapy visits, and more physical therapy services per episode in comparison with episodes classified as Self-Referral. Most self-referred episodes were short and the initial visit did not include an evaluation. Conclusion: Physician owners of physical therapy services refer significantly higher percentages of patients to physical therapy and many are equivocal cases.
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Physician Self-Referral of Physical Therapy Services for Patients with Low Back Pain: Implications for Use, Types of Treatments Received and Expenditures.
Forum for health economics & policy, 2016Co-Authors: Jean M. Mitchell, James D. Reschovsky, Luisa Franzini, Elizabeth Anne ReicherterAbstract:Prior research on treatment of low back pain has documented large increases in use of spinal surgery, MRIs and lumbosacral injections linked to Physician Self-Referral arrangements. No recent research has examined whether Physician ownership of physical therapy services results in greater use of physical therapy to treat low back pain. The objective of this study is to investigate whether Physician ownership of physical therapy services affects frequency of use, visits and types of physical therapy services received by patients with low back pain. Using claims records from insured patients covered by Blue Cross Blue Shield of Texas (2008-2011) we compared several metrics of use of physical therapy services for low back pain episodes controlling for Self-Referral status. We identified 158,151 low back pain episodes, 27% met the criteria to be classified as "Self-Referral." Only 10% of "non-Self-Referral" episodes received physical therapy compared to 26% of Self-Referral episodes (p
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Use of Physical Therapy Following Total Knee Replacement Surgery: Implications of Orthopedic Surgeons' Ownership of Physical Therapy Services.
Health services research, 2016Co-Authors: Jean M. Mitchell, James D. Reschovsky, Elizabeth Anne ReicherterAbstract:Objective To examine whether the course of physical therapy treatments received by patients who undergo total knee replacement (TKR) surgery differs depending on whether the orthopedic surgeon has a financial stake in physical therapy services. Data Sample of Medicare beneficiaries who underwent TKR surgery during the years 2007–2009. Study Design We used regression analysis to evaluate the effect of Physician Self-Referral on the following outcomes: (1) time from discharge to first physical therapy visit; (2) episode length; (3) number of physical therapy visits per episode; (4) number of physical therapy service units per episode; and (5) number of physical therapy services per episode expressed in relative value units. Principal Findings TKR patients who underwent physical therapy treatment at a Physician-owned clinic received on average twice as many physical therapy visits (8.3 more) than patients whose TKR surgery was performed by a orthopedic surgeon who did not self-refer physical therapy services (p
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Linkages between utilization of prostate surgical pathology services and Physician Self-Referral.
Medicare & medicaid research review, 2012Co-Authors: Jean M. MitchellAbstract:OBJECTIVE Federal law prohibits a Physician from referring Medicare patients for procedures or services to health care entities in which the Physician has a financial relationship. This law has exceptions which enable Physicians to self-refer under certain conditions. This study evaluates the effects of Self-Referral on use rates of surgical pathology services performed in conjunction with prostate biopsies and whether such changes are linked to urologist Self-Referral arrangements. DATA AND SAMPLE A targeted market area case study design was employed to identify the sample from Medicare claims data. The sample included male beneficiaries who resided in geographically dispersed counties; were continuously enrolled in Medicare fee-for-service (FFS) during 2005-2007; and who met the criteria to be a potential candidate to undergo a prostate biopsy. OUTCOMES Prostate biopsy procedures per 1000 male Medicare beneficiaries in each county; counts of surgical pathology specimens (jars) associated with prostate biopsy procedures per 1000 male Medicare beneficiaries in each county. FINDINGS Regression analysis shows the Self-Referral share (percentage) of total utilization was associated with significant increases in the use rate of prostate surgical pathology specimens (p
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Urologists’ Self-Referral For Pathology Of Biopsy Specimens Linked To Increased Use And Lower Prostate Cancer Detection
Health affairs (Project Hope), 2012Co-Authors: Jean M. MitchellAbstract:Federal law allows Physicians in some circumstances to refer patients for additional services to a facility in which the Physician has a financial interest. The practice of Physician Self-Referral for imaging and pathology services has been criticized because it can lead to increased use and escalating health care expenditures, with little or no benefit to patients. This study examined Medicare claims for men in a set of geographically dispersed counties to determine how the “in-office ancillary services” exception affected the use of surgical pathology services and cancer detection rates associated with prostate biopsies. I found that self-referring urologists billed Medicare for 4.3 more specimens per prostate biopsy than the adjusted mean of 6 specimens per biopsy that non-self-referring urologists sent to independent pathology providers, a difference of almost 72 percent. Additionally, the regression-adjusted cancer detection rate in 2007 was twelve percentage points higher for men treated by urologis...
Harindra C. Wijeysundera - One of the best experts on this subject based on the ideXlab platform.
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Impact of System and Physician Factors on the Detection of Obstructive Coronary Disease With Diagnostic Angiography in Stable Ischemic Heart Disease
Circulation. Cardiovascular quality and outcomes, 2014Co-Authors: Harindra C. Wijeysundera, Feng Qiu, Maria C. Bennell, Madhu K. Natarajan, Warren J. Cantor, Stuart Smith, Kori J. KingsburyAbstract:Background—Wide variation exists in the detection rate of obstructive coronary artery disease (CAD) with elective coronary angiography for suspected stable ischemic heart disease. We sought to understand the incremental impact of nonclinical factors on this variation. Methods and Results—We included all patients who underwent coronary angiography for possible suspected stable ischemic heart disease, from October 1, 2008, to September 30, 2011, in Ontario, Canada. Nonclinical factors of interest included Physician Self-Referral for angiography, the Physician type (invasive or interventional), and hospital type. Hospitals were categorized into diagnostic angiogram only centers, stand-alone percutaneous coronary intervention centers, or full service centers with coronary artery bypass surgery available. Multivariable hierarchical logistic models were developed to identify system and Physician-level predictors of obstructive CAD, after adjustment for patient factors. Our cohort consisted of 60 986 patients, o...
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Abstract 342: Impact Of System And Physician Factors On The Diagnostic Yield Of Coronary Angiography In Stable Ischemic Heart Disease: A Population Based Study
Circulation-cardiovascular Quality and Outcomes, 2014Co-Authors: Harindra C. Wijeysundera, Feng Qiu, Maria C. Bennell, Madhu K. Natarajan, Warren J. Cantor, Stuart Smith, Kori J. KingsburyAbstract:Background: Wide variation exists in the diagnostic yield of coronary angiography in stable ischemic heart disease (IHD). Previous work has primarily focused on patient factors for this variation. We sought to understand if system and Physician factors, specifically hospital and Physician type, as well as Physician Self-Referral, have incremental impacts on the yield of coronary angiography, above and beyond that of patient factors alone. Methods: All patients who underwent a diagnostic coronary angiogram for possible stable IHD, at the 18 cardiac centers in Ontario, Canada were identified from October 1st, 2008 to September 30th, 2011. Obstructive coronary artery disease was defined as stenosis greater than 70% in the main coronary arteries or greater than 50% in the left main artery. Physicians were classified as either invasive or interventional. Hospitals were categorized into cath only, stand-alone PCI and full service centers. Multi-variable hierarchical logistic models were developed to identify sy...