Effect of Health Insurance Type on Access to Care
|
|
- Kory Dalton
- 8 years ago
- Views:
Transcription
1 Effect of Health Insurance Type on Access to Care John M. Froelich, MD; Ryan Beck, MD; Wendy M. Novicoff, PhD; K.J. Saleh, MD, MSc, FRCSC, MHCM abstract Full article available online at Healio.com/Orthopedics. Search: Growing orthopedic and nonorthopedic literature illustrates the point that having health insurance does not equal having access to care. The goal of this study was to evaluate the burden placed on patients to gain access to outpatient orthopedic care. For this study, burden was quantified as the distance traveled by the patient to be seen in clinic. This study was a retrospective review of all new patient encounters at an adult orthopedic outpatient clinic in an academic tertiary referral center over 1 calendar year. All patients were stratified into 4 categories: commercial/private insurance, Medicaid, Medicare, and uninsured/private pay. The average distance traveled by each patient to the center was then calculated based on the patient s billing zip code. Patient visits were further stratified based on whether the patients were seen by 1 of 3 different categories of providers: general orthopedics/adult reconstruction, spine, and sports/upper extremity. The study group comprised 774 (31.1%) Medicaid patients, 653 (26.2%) Medicare patients, 917 (36.8%) commercial/private insurance patients, and 146 (5.9%) uninsured/private pay patients. The average 1-way distance traveled was 36.2 miles for Medicaid patients, 21.3 miles for Medicare patients, 24.1 miles for commercial/private insurance patients, and 25.3 miles for uninsured/private pay patients (P,.00). Subgroup analysis noted a statistical difference in distance traveled for the general orthopedics/adult reconstruction and sports/upper extremity groups. The study s findings suggest that having insurance does not equal access to outpatient orthopedic care at a single institution. The specific burdens that each group faces to gain access to care are unclear. The authors are from the Department of Orthopaedic Surgery (JMF), University of Colorado, Aurora, Colorado; the Division of Orthopaedic Surgery (RB, KJS), Southern Illinois University, Springfield, Illinois; and the Department of Orthopedic Surgery and Public Health Sciences (WMN), University of Virginia, Charlottesville, Virginia. Dr Froelich is an AAOS Washington Health Policy Fellow. The authors have no relevant financial relationships to disclose. Correspondence should be addressed to: John M. Froelich, MD, Department of Orthopaedic Surgery, University of Colorado, E 17h Ave, Academic Office One, Mail Stop B202, Aurora, CO (john.froelich@ucdenver.edu). doi: / e1272
2 Effect of Health Insurance Type on Access to Care Froelich et al Previous authors have noted a second-tier treatment of patients with Medicaid insurance, requiring them to wait longer for outpatient clinic appointments compared with those patients with private insurance. 1-5 Whatever the outcome of health-care reform may be, the number of people requiring healthcare services will continue to grow, thus increasing the current clinical burden on medical providers. When a provider becomes busier, a patient s insurance status may become a screening tool for clinic access. 6 The goal of the current study was to evaluate the influence of a patient s insurance provider on his or her ability to gain access to orthopedic care as a reflection on the distance traveled by the patient to be seen in clinic. Broadly, the authors hoped to begin addressing the question of whether insurance equals access to care in outpatient orthopedic care. The authors hypothesized that Medicaid patients will travel farther than Medicare and commercially insured patients for an outpatient orthopedic clinic appointment. Materials and Methods This study was a retrospective review of all new patient encounters for an adult orthopedic outpatient clinic at an academic tertiary referral center for 1 calendar year. All patients were filtered into 4 categories based on their insurance provider: commercial/private, public aid/medicaid, Medicare, and uninsured/private pay (referred to as self-pay throughout the text). The average distance traveled for each patient to the clinic was then calculated using Google Maps (Mountain View, California) based on the patient s home billing zip code. Pediatric patients, prisoners, charity cases, students using university insurance, liability cases, and workers compensation patients were excluded from the study because they each represent unique referral and access issues that were believed to potentially bias the data. Patients were further stratified based on the county in which their reported zip code was associated using an online search through the US Census Bureau. Institutional review board approval was obtained for the study. The average 1-way distance traveled in miles was calculated for each of the 4 insurance types. The same comparison of mileage traveled per patient in comparison with insurance type was then completed for visits based on whether the patients were seen by 1 of 3 different categories of providers: general orthopedics/adult reconstruction, spine, and sports/upper extremity. The top 5 referring counties for all new patients were also tabulated. The percentage of adult Medicaid enrollees in the top 5 referring counties was then compared with the percentage of Medicaid enrollees in the county in which the clinic is based. Public 2010 data available from the State Department of Public Health and the federal census were used to tabulate the percentage of adult enrollees in each evaluated county. 7 The county in which the clinic is located served as a control and was not included in the calculations as one of the top 5 referral counties. Analysis of variance was used to compare the groups. Resulting P values less than.05 were considered statistically significant. Figure 1: Graph showing the average distance traveled for all adult outpatient clinic encounters based on insurance type. Results A total of 2596 new patients were evaluated during the collection period, with 106 patients ultimately excluded for the following reasons: incomplete insurance information (n516), prisoners (n514), workers compensation patients (n541), liability cases (n519), student insurance (n57), and local charity aid (n59). Therefore, a total of 2490 individual new patient encounters were evaluated for this study. The study group comprised 774 (31.1%) Medicaid patients, 653 (26.2%) Medicare patients, 917 (36.8%) commercial insurance patients, and 146 (5.9%) selfpay patients. The average 1-way distance traveled was 36.2 miles for Medicaid patients, 21.3 miles for Medicare patients, 24.1 miles for commercial insurance patients, and 25.3 miles for self-pay patients (P<.00) (Figure 1). The distance traveled was quantified into groups of 25-mile increments for a 1-way trip based on insurance type. The percentage of total patients who traveled per 25-mile increment was tabulated for each insurance type (Table 1). These findings were significant, noting that a larger percentage of Medicaid patients traveled more than 50 miles each direction compared with patients from the other insurance groups (P<.00). County-specific calculations found that the percentage of adults with Medicaid insurance in the county in which the clinic is based was 8.4%. The percentage of adult Medicaid enrollees in each of the top 5 referring counties for all new patients was also tabulated and is presented in Table 2. A 0.6% higher average adult enrollment existed based on county populations for the top 5 referring counties, which was statistically significant (P,.00). In the subgroup analysis of patients who saw general orthopedics/adult reconstruction, spine, or sports/upper extremity physicians, it was noted that Medicaid patients seen by general orthopedics/adult reconstruction and sports/upper extremity physicians traveled a significantly greater distance than did those with Medicare insurance, commercial insurance, or selfpay patients. Specifically, Medicaid pa- 1 OCTOBER 2013 Volume 36 Number 10 e1273
3 tients who saw general orthopedics/adult reconstruction physicians traveled an average of miles (P,.00) vs miles for commercial insurance patients, miles for Medicare patients, and miles for self-pay patients (Figure 2A). Medicaid patients who saw sports/ upper extremity physicians traveled an average of miles (P,.00) vs 22.5 miles for commercial insurance patients, miles for Medicare patients, and miles for self-pay patients (Figure 2B). No statistical difference was noted in the spine subgroup (P5.24), with Medicaid patients traveling an average of 34.3 miles, commercial insurance patients traveling an average of miles, Medicare patients traveling an average of miles, and self-pay patients traveling an average of miles (Figure 2C). Discussion In this study, a statistically significant difference was noted in the distance traveled by patients to access adult outpatient orthopedic care in 1 referral area depending on the patient s insurance provider. Further analysis of the data showed that the discrepancy based on distance traveled to clinic was present in the specialty subdivisions of general/adult reconstruction and sports/upper extremity. Interestingly, no statistically significant difference was found in distance traveled by patients seeing spine physicians based on insurance Table 1 Percentage of New Patients per Insurance Type Based on Distance Traveled Insurance Type <25 miles miles >51 miles Total Medicaid a 100 Medicare Commercial Self-pay a P,.00 % provider. When all new patient encounters for 1 calendar year were considered, Medicaid patients traveled 26 more miles round-trip than did Medicare patients and 24 more miles than did commercially insured patients to see either an orthopedic physician or an orthopedic physician extender. Calfee et al 8 recently reported the influence of insurance status on the distance traveled for new patients in a single tertiary center hand practice. The authors found a similar trend of increased distance traveled for patients with Medicaid insurance, as well as a disproportionate rate of Medicaid patients from greater distances that cannot be explained by the density of Medicaid patients from the region. Wolinsky et al 5 evaluated nonurgent operative management of ankle and distal radius fractures in California. The authors found that a statistically significant higher proportion of noninsured or underinsured patients initially evaluated outside of their trauma center ultimately received definitive care at their center, independent of the fracture severity or patient comorbidities compared with insured patients. 5 This recent work investigating the management of nonurgent fractures adds to the existing and growing orthopedic literature describing increased transfer rates of traumatic poorly insured orthopedic injuries, as well as access burdens for outpatient spine clinics based on insurance status Table 2 Percentage of Enrolled Adult Medicaid Recipients by County County Medicaid, % Home Total referring counties Wolinsky et al 5 divided treatment groups by insurance reimbursement levels. Previous authors have also suggested the influence of poor reimbursement on access to care. 6,12-16 It could be hypothesized that lower financial reimbursement played a role in determining how far Medicaid patients in the current study had to travel. According to the state-specific 2010 Medicaid reimbursement schedule for Current Procedural Terminology codes (New Patient Visit Detailed/Level 3) and (Established Patient Visit Detailed/ Level 3), the current authors practice was reimbursed approximately 45% less per Medicaid visit compared with the average commercially insured patient during the data collection period. 3,17 The authors believe the discrepancy in reimbursement for services provided for Medicaid patients vs commercially insured patients contributed substantially to the study s findings, but the authors acknowledge that reimbursement rates are not the sole factors in determining patient access. 16,18 Medicaid patients often have complex social stresses that can complicate the ability to arrange and attend clinical visits and adhere to treatment protocols. Although difficult to quantify, these real and perceived complexities may also lead to physicians limiting the number of Medicaid patients evaluated and cared for in their clinics. 9 e1274
4 Effect of Health Insurance Type on Access to Care Froelich et al 2A 2B 2C Figure 2: Graphs showing the 1-way distance traveled by patients with different insurance types visiting general orthopedic/adult reconstruction (A), sports/ upper extremity (B), and spine (C) physicians. One potential reason for the increased distance traveled by Medicaid patients in the current study could be explained by the perceived lower economic status of rural counties more distant from the authors clinic. The authors attempted to address this potential geographic bias by evaluating the percentage of enrolled Medicaid adults in the top 5 referring counties based on publicly available 2010 enrollment data from the state Department of Public Aid and 2010 US census data (Table 2). Based on the calculations for adult enrollees, a significant difference was found in the percentage of adult Medicaid enrollees between the county in which the study was based and the combined Medicaid enrollment for the top 5 referring counties. The authors acknowledge that these findings demonstrate a statistically significant increase in the concentration of adult Medicaid patients in the surrounding referring counties, but they do not believe the numerical difference carries the same clinical significance. Based on a delta of 0.6% of total enrolled Medicaid adults and an absolute lower number of enrolled patients in the top 5 referring counties of 161,032 vs 197,465 people in the authors home county, it is difficult to explain the large disproportionate number of Medicaid patients who travel greater distances for a clinic visit vs Medicare, commercial insurance, or self-pay patients. This study has some limitations. First, the study is a single-year retrospective review. Due to the retrospective nature of the data, the authors were unable to determine the factors that led to individuals traveling large distances to be seen in clinic. The authors clinic is a tertiary referral center, and due to that distinction, it attracts patients from throughout the state. This could increase the distance traveled by patients, but one would expect this increased travel burden to be more equitable in distribution across all insurance types. One could theorize that if an individual drove farther, he or she was more likely to have been turned down by a more local orthopedic surgeon, but it is not known whether that is true for the current study because that information was not available in a retrospective fashion. In addition, the study data were limited and potentially biased because it is not known whether any of the patients had seen a previous orthopedic surgeon and were seeking a second opinion. Finally, the authors did not collect demographic information for associated medical comorbidities for comparison between the groups to delineate whether more medically complex patients were being referred to the tertiary care center. To the authors knowledge, this study is the largest on the travel burden placed on a patient to access outpatient adult orthopedic care based on his or her insurance provider. The study s findings demonstrate that insurance status affects the distance traveled by patients for a new patient visit. The authors acknowledge a statistically significant larger Medicaid population in the surrounding counties that could influence the study findings, but they do not believe that the data can be completely explained by this finding. Access to care has been most classically quantified in measuring clinic appointment availability or wait times. The authors suggest that another way to quantify limited access to care and a subsequent increased burden on a population group is to measure the distance a patient needs to travel to see a physician. Based on the premise that an average individual would not choose to travel farther, incur increased fuel expenses, and have more time away from work or children to receive orthopedic care independent of insurance requirements, the authors believe that the study data demonstrate that simple possession of insurance does not result in equal access to outpatient orthopedic care. A larger review of burdens placed on patients due to their insurance status is necessary to understand the full effect of the disconnect between possessing insurance and having access to care. References 1. Access of Medicaid recipients to outpatient care. N Engl J Med. 1994; 330(20): Asplin BR, Rhodes KV, Levy H, et al. Insurance status and access to urgent ambulatory care follow-up appointments. JAMA. 2005; 294(10): Blanchard J, Ogle K, Thomas O, Lung D, Asplin B, Lurie N. Access to appointments OCTOBER 2013 Volume 36 Number 10 e1275
5 based on insurance status in Washington, D.C. J Health Care Poor Underserved. 2008; 19(3): Resneck J Jr, Pletcher MJ, Lozano N. Medicare, Medicaid, and access to dermatologists: the effect of patient insurance on appointment access and wait times. J Am Acad Dermatol. 2004; 50(1): Wolinsky P, Kim S, Quackenbush M. Does insurance status affect continuity of care for ambulatory patients with operative fractures? J Bone Joint Surg Am. 2011; 93(7): Bisgaier J, Rhodes KV. Auditing access to specialty care for children with public insurance. N Engl J Med. 2011; 364(24): Number of persons enrolled in the medical program by county. SFY Illinois Department of Healthcare and Family Services Web site. Accessed April 1, Calfee RP, Shah CM, Canham CD, Wong AH, Gelberman RH, Goldfarb CA. The influence of insurance status on access to and utilization of a tertiary hand surgery referral center. J Bone Joint Surg Am. 2012; 94(23): Archdeacon MT, Simon PM, Wyrick JD. The influence of insurance status on the transfer of femoral fracture patients to a level-i trauma center. J Bone Joint Surg Am. 2007; 89(12): Koval KJ, Tingey CW, Spratt KF. Are patients being transferred to level-i trauma centers for reasons other than medical necessity? J Bone Joint Surg Am. 2006; 88(10): Decker SL. Medicaid payment levels to dentists and access to dental care among children and adolescents. JAMA. 2011; 306(2): Weiner BK, Black KP, Gish J. Access to spine care for the poor and near poor. Spine J. 2009; 9(3): Decker SL. Medicaid payment levels to dentists and access to dental care among children and adolescents. JAMA. 2011; 306(2): Garber S, Ridgely MS, Bradley M, Chin KW. Payment under public and private insurance and access to cochlear implants. Arch Otolaryngol Head Neck Surg. 2002; 128(10): Skaggs DL, Lehmann CL, Rice C, et al. Access to orthopaedic care for children with medicaid versus private insurance: results of a national survey. J Pediatr Orthop. 2006; 26(3): Berman S, Dolins J, Tang SF, Yudkowsky B. Factors that influence the willingness of private primary care pediatricians to accept more Medicaid patients. Pediatrics. 2005; 110(2 pt 1): Illinois Department of Healthcare and Family Services practitioner fee schedule. Illinois Department of Healthcare and Family Services Web site. Accessed April 1, Cunningham PJ, O Malley AS. Do reimbursement delays discourage Medicaid participation by physicians? Health Aff (Millwood). 2009; 28(1): e1276
URAC Issue Brief: Best Practices in Network Management
1220 L Street, NW, Suite 400 Washington, DC 20005 202.216.9010 Best Practices in Network Management Introduction As consumers enroll in health plans through newly formed Health Insurance Marketplaces,
More informationExtended Stay Recovery Centers: Enhancing the Patient Experience and Lowering Healthcare Costs
Extended Stay Recovery Centers: Enhancing the Patient Experience and Lowering Healthcare Costs Ambulatory Surgery Centers: Less than 24 hours Convalescent Care Centers: Up to 72 hours in Colorado; Proposed
More informationTrends in the Orthopedic Job Market and the Importance of Fellowship Subspecialty Training
Trends in the Orthopedic Job Market and the Importance of Fellowship Subspecialty Training Nathan T. Morrell, MD; Deana M. Mercer, MD; Moheb S. Moneim, MD abstract Full article available online at Healio.com/Orthopedics.
More informationMGMA ACA Exchange Implementation Survey Report. May 2014
MGMA ACA Exchange Implementation Survey Report May 2014 Overview Medical Group Management Association (MGMA) conducted member research in April 2014 to better understand the impact of the Affordable Care
More informationMEDICARE PHYSICAL THERAPY. Self-Referring Providers Generally Referred More Beneficiaries but Fewer Services per Beneficiary
United States Government Accountability Office Report to Congressional Requesters April 2014 MEDICARE PHYSICAL THERAPY Self-Referring Providers Generally Referred More Beneficiaries but Fewer Services
More informationIWCC 50 ILLINOIS ADMINISTRATIVE CODE 7110 7110.90. Section 7110.90 Illinois Workers' Compensation Commission Medical Fee Schedule
Section 7110.90 Illinois Workers' Compensation Commission Medical Fee Schedule a) In accordance with Sections 8(a), 8.2 and 16 of the Workers' Compensation Act [820 ILCS 305/8(a), 8.2 and 16] (the Act),
More informationNurse Practitioners, Certified Nurse Midwives, and Physician Assistants in Physician Offices
Nurse Practitioners, Certified Nurse Midwives, and Physician Assistants in Physician Offices Melissa Park, M.P.H.; Donald Cherry, M.S.; and Sandra L. Decker, Ph.D. Key findings Data from the National Ambulatory
More informationPlease Register by October 3, 2014. Please Join Us
Please Register by October 3, 2014 Orthopaedics Symposium 2014 Please Join Us Information for Physicians, PA s, NP s, Chiropractors, RN s & Therapists Saturday, October 11, 2014 New Location! Hilton Fort
More informationWorking with Colorado s Rural Health Clinics to Support Operations and Quality Improvement
Working with Colorado s Rural Health Clinics to Support Operations and Quality Improvement Jennifer Dunn, Colorado Rural Health Center Abstract The Colorado Rural Health Center s (CRHC) Healthy Clinic
More informationVirtual Mentor American Medical Association Journal of Ethics November 2006, Volume 8, Number 11: 771-775.
Virtual Mentor American Medical Association Journal of Ethics November 2006, Volume 8, Number 11: 771-775. Medicine and society Crowded conditions: coming to an ER near you by Jessamy Taylor Most people
More informationResearch Brief. Majority of Dental-Related Emergency Department Visits Lack Urgency and Can Be Diverted to Dental Offices. Key Messages.
Majority of Dental-Related Emergency Department Visits Lack Urgency and Can Be Diverted to Dental Offices The Health Policy Institute (HPI) is a thought leader and trusted source for policy knowledge on
More informationWhy it is Cost Effective to Use a Physician Search Firm
January 2010 Why it is Cost Effective to Use a Physician Search Firm Guest Author: Thomas Grimes III, FACHE, retired CEO, Good Samaritan Community Healthcare, Puyallup, Washington. Tom currently leads
More informationAccess to Health Services
Ah Access to Health Services Access to Health Services HP 2020 Goal Improve access to comprehensive, quality health care services. HP 2020 Objectives Increase the proportion of persons with a usual primary
More informationPhysician Assistants 2012 Survey
Vermont Department of Health Physician Assistants 2012 Survey Statistical Report 2012 Physician Assistants Survey Statistical Report State of Vermont Peter Shumlin, Governor Agency of Human Services Douglas
More informationSupporting Our Communities COMMUNITY HEALTH. Improvement. Report
Supporting Our Communities COMMUNITY HEALTH Improvement Report 2015 CHIR-FY2015-UMRehab.indd 1 Mission, Vision and Financial Assistance Policy Mission University of Maryland Rehabilitation & Orthopaedic
More informationDRAFT. Network Adequacy Standards for Qualified Health Plans Marketed in the Silver State Health Insurance Exchange
DRAFT Network Adequacy Standards for Qualified Health Plans Marketed in the Silver State Health Insurance Exchange Section I. A carrier that is participating in the Silver State Health Insurance Exchange
More informationPrepared By: Erica Crall & Lucien Wulsin, Jr.
Insure the Uninsured Project San Diego County Counties, Clinics, Hospitals, Managed Care and the Uninsured: Ten-Year Trend Report (1996-2006) Prepared By: Erica Crall & Lucien Wulsin, Jr. COUNTY ECONOMY
More informationDisclaimer. Knowing Your Worth: Calculating Your Productivity. Definitions. Disclosure
Knowing Your Worth: Calculating Your Productivity PAOS 2012 Tricia Marriott, PA-C, MPAS AAPA Director Reimbursement Policy tmarriott@aapa.org @TriciaPAC on Twitter Disclaimer This presentation was current
More informationAccountable Care Organizations: What Are They and Why Should I Care?
Accountable Care Organizations: What Are They and Why Should I Care? Adrienne Green, MD Associate Chief Medical Officer, UCSF Medical Center Ami Parekh, MD, JD Med. Director, Health System Innovation,
More informationALBERT EINSTEIN HEALTHCARE NETWORK POLICY AND PROCEDURE MANUAL. Page 1 of 1. Subject: Charity Care
Page 1 of 1 PURPOSE: Albert Einstein Healthcare Network ( AEHN ) is a system of not-for-profit healthcare institutions that provides inpatient, outpatient, and emergency services whose mission includes
More informationRURAL NURSE PRACTITIONERS: RHAC SURVEY RESULTS. Presentation to Rural Health Advisory Committee & Flex Committee May 19, 2015
RURAL NURSE PRACTITIONERS: RHAC SURVEY RESULTS Presentation to Rural Health Advisory Committee & Flex Committee May 19, 2015 Review: Minnesota regions Review: NPs vs population, by Minnesota region 2015
More informationOrthopedic NPs Exploring Specialty Care Career & Education Opportunities. Jackson Orthopaedic Foundation www.jacksonortho.org
Orthopedic NPs Exploring Specialty Care Career & Education Opportunities Jackson Orthopaedic Foundation A.J. Benham, DNP & Kathleen Geier, DNP Jackson Orthopaedic Foundation 3317 Elm Street, Suit 201 Oakland,
More informationTime From Injury to Treatment in Workers Compensation Preliminary Results
2015 Annual Issues Symposium Time From Injury to Treatment in Workers Compensation Preliminary Results Barry Lipton, FCAS, MAAA Practice Leader and Senior Actuary, NCCI May 14, 2015 Overview Background
More informationTELEMEDICINE REIMBURSEMENT MANDATES BY STATE: Medicaid & Private Payer
TELEMEDICINE REIMBURSEMENT MANDATES BY STATE: Medicaid & Private Payer Unless otherwise noted, this information came from The Center for Telehealth and E-Health Law, and The American Telemedicine Association
More information2013 Implementation Strategy Report: UC Irvine Health; A valuable asset to Orange County
2013 Implementation Strategy Report: UC Irvine Health; A valuable asset to Orange County UC (University of California) Health is the fourth largest health system in California, and includes the UC Irvine
More informationRural Provider Types and Payment Models
Rural Provider Types and Payment Models Emily Jane Cook, JD, MSPH McDermott Will & Emery LLP American Health Lawyers Association Institute on Medicare and Medicaid Payment Issues Baltimore, MD March 20,
More information206 Capitol Street -3 rd Flr Charleston, WV 25301 P. 304-544-9733 chris@wvemscoalition.com
July 24, 2015 WV Bureau for Medical Services Transportation 350 Capitol Street, Room 251 Charleston, WV 25301 BMS.comments@wv.gov RE: Transportation, Chapter 524, and appendix To Whom It May Concern: The
More informationREIMBURSEMENT, CAPITATION AND RISK ADJUSTMENT
REIMBURSEMENT, CAPITATION AND RISK ADJUSTMENT HIV/AIDS BUREAU HEALTH RESOURCES AND SERVICES ADMINISTRATION HRSA HIV/AIDS Bureau 1 REIMBURSEMENT METHODOLOGIES Retrospective Cost Based Prospective TYPES
More informationHow To Study The Use Of The Emergency Room
Use of the Emergency Room in a Community Hospital H. A. WHITE, M.D., M.P.H., and P. A. O'CONNOR, M.D., M.P.H. AN INCREASING demand for medical care has been noted in hospital emergency rooms across the
More informationInterventional Pain Management 2007 Benchmark Survey
Interventional Pain Management 2007 Benchmark Survey Date Section One: General Information Geographic location (select one) Return Deadline - vember 12, 2007 Eastern: (Connecticut, Delaware, District of
More information2009 Medicaid Transformation Program Review Out-of-State Services
2009 Medicaid Transformation Program Review Out-of-State Services Description Kansas Medicaid maintains an out-of-state program for situations which require a Kansas Medicaid beneficiary to receive services
More informationEssential Hospitals VITAL DATA. Results of America s Essential Hospitals Annual Hospital Characteristics Survey, FY 2012
Essential Hospitals VITAL DATA Results of America s Essential Hospitals Annual Hospital Characteristics Survey, FY 2012 Published: July 2014 1 ABOUT AMERICA S ESSENTIAL HOSPITALS METHODOLOGY America s
More informationHow to Hire International Medical Graduates with Ease by Ann Massey Badmus, Attorney at Law
May 2011 How to Hire International Medical Graduates with Ease by Ann Massey Badmus, Attorney at Law According to an American College of Physicians monograph published in 2008, International Medical Graduates
More informationFinancial Burden of Medical Care: A Family Perspective
NCHS Data Brief No. 14 January 014 Financial Burden of Medical Care: A Family Perspective Robin A. Cohen, Ph.D., and Whitney K. Kirzinger, M.P.H. Key findings Data from the National Health Interview Survey,
More informationGAO HOSPITAL EMERGENCY DEPARTMENTS. Crowding Continues to Occur, and Some Patients Wait Longer than Recommended Time Frames
GAO United States Government Accountability Office Report to the Chairman, Committee on Finance, U.S. Senate April 2009 HOSPITAL EMERGENCY DEPARTMENTS Crowding Continues to Occur, and Some Patients Wait
More informationGENERAL GOVERNMENT ADMINISTRATION EXECUTIVE RECORDS RETENTION AND DISPOSITION SCHEDULES (ERRDS) ERRDS, HEALTH POLICY COMMISSION
TITLE 1 CHAPTER 18 PART 669 GENERAL GOVERNMENT ADMINISTRATION EXECUTIVE RECORDS RETENTION AND DISPOSITION SCHEDULES (ERRDS) ERRDS, HEALTH POLICY COMMISSION 1.18.669.1 ISSUING AGENCY: New Mexico Commission
More informationModify the Institutions for Mental Disease (IMDs) exclusion for capitation payments
July 27, 2015 Centers for Medicare and Medicaid Services Department of Health and Human Services Attention: CMS-2390-P 7500 Security Boulevard Baltimore, MD 21244 SUBMITTED ELECTRONICALLY Re: CMS-2390-P:
More informationSubject: Electronic Health Records: Number and Characteristics of Providers Awarded Medicaid Incentive Payments for 2011
United States Government Accountability Office Washington, DC 20548 December 13, 2012 Congressional Committees Subject: Electronic Health Records: Number and Characteristics of Providers Awarded Medicaid
More informationA Consumer Guide to Understanding Health Plan Networks
A Consumer Guide to Understanding Health Plan Networks Table of Contents steps you can take to understand your health plan s provider network pg 4 What a provider network is pg 8 Many people are now shopping
More informationStatement of Conflicts of Interest
10 th Annual 340B Coalition Winter Conference Expansion of Pharmacy Services Through the 340B Program Binita Patel, PharmD, MS Director of Ambulatory/Retail Services Froedtert & Medical College of Wisconsin
More informationEssential Vocabulary Common Procedural Terminology Relative Value Update Committee Relative Value Units
Billing and Coding Prepared for the AAOS: Business, Policy and Practice Management in Orthopaedics William Beach, MD Orthopaedic Research of Virginia Julie Balch Samora, MD, PhD, MPH The Ohio State University
More informationROGER E. MURKEN, MD. Curriculum Vitae. OrthoColorado Hospital 11650 W. 2 nd Place Lakewood, CO 80228
ROGER E. MURKEN, MD Curriculum Vitae OFFICE ADDRESS: TELEPHONE, FAX AND E-MAIL. Panorama Orthopedics & Spine Center, PC 660 Golden Ridge Rd, Suite 250 Golden, CO 80401 (303) 233-1223 Office (303) 233-8755
More informationThursday May 19 th, 2011 COA 2011 Annual Meeting/ QME Course Ritz-Carlton-Laguna Niguel
Thursday May 19 th, 2011 COA 2011 Annual Meeting/ QME Course Ritz-Carlton-Laguna Niguel -My Disclosure is in the Final Program and the COA Database -I have no potential conflicts with this programs -I
More informationUS Navy Orthopaedic Physician Assistant Fellowship. LT Michael A. Mitchell, PA-C, MPAS Fellowship Program Director
US Navy Orthopaedic Physician Assistant Fellowship LT Michael A. Mitchell, PA-C, MPAS Fellowship Program Director History The US Navy Orthopaedic Physician Assistant Fellowship and Additional Qualification
More informationNo preference is given to New York based companies. The Funding Availability Solicitation (FAS) is a nationwide solicitation.
A. General 1. Is preference given to New York based companies? No preference is given to New York based companies. The Funding Availability Solicitation (FAS) is a nationwide solicitation. 2. Is the coordination
More informationResidency Selection Criteria: What Medical Students Perceive as Important
Residency Selection Criteria: What Medical Students Perceive as Important Suzanne Brandenburg, MD *, Tracy Kruzick, MD *, C.T. Lin, MD *, Andrew Robinson, MD, Lorraine J. Adams, MSW * * University of Colorado
More informationProfile of Pediatric Visits
Profile of Pediatric Visits Annualized Estimates by Source of Payment Patient Age Physician Specialty Well vs Sick Visit Office Setting Practice Ownership Physician Employment Status & Geopgraphic Location
More informationSTATE STANDARDS FOR ACCESS TO CARE IN MEDICAID MANAGED CARE
Department of Health and Human Services OFFICE OF INSPECTOR GENERAL STATE STANDARDS FOR ACCESS TO CARE IN MEDICAID MANAGED CARE Suzanne Murrin Deputy Inspector General for Evaluation and Inspections September
More informationModels to Identify and Support Clinical Trial Participants
Models to Identify and Support Clinical Trial Participants Income Disparities in Cancer Clinical Trial Enrollment: Evidence and Models for Patient Support Joseph Unger, Ph.D. SWOG Statistical Center Fred
More informationDAVID CHARLES JOHNSON, MD
DAVID CHARLES JOHNSON, MD 19455 Deerfield Ave Suite 312 Lansdowne, VA 20176 (703) 729-5010 dcjmd@nationalsportsmed.com Biographical Experience Date of Birth 07/05/69 Rockville Centre, NY 2006 2009 The
More informationPolicy Holder Name Relationship to Patient SSN DOB
Orthopedic Today s Date Patient s SSN# Legal First Name Last Name M.I. DOB Gender Parent/Guardian Name (for pediatrics) DOB Address City State Zip Home Phone Cell Phone Work Phone Email Have any members
More informationMedicare Acceptance by Oregon Physicians
Medicare Acceptance by Oregon Physicians Snapshot of Trends from the 2006 Oregon Physician Workforce Survey Office for Oregon Health Policy and Research 100 90 80 70 60 50 40 30 20 10 0 Percent 74 67 Access
More informationInternational Medical Workforce Conference. The U.S. Physician Workforce The Impact of Education and Training
International Medical Workforce Conference The U.S. Physician Workforce The Impact of Education and Training Michael E. Whitcomb, M.D. Senior Vice President for Medical Education Association of American
More informationTelehealth Services Billing Overview. Kathy J. Chorba California Telehealth Resource Center kchorba@caltelehealth.org
Telehealth Services Billing Overview Kathy J. Chorba California Telehealth Resource Center kchorba@caltelehealth.org Senate Bill 1665 Telemedicine Development Act of 1996 Mandated all payers develop a
More informationHealth Services - A Review of the Ontario Medical Referral System
Centre for Studies in Family Medicine Patterns of Specialty Medical Referral Analysis of a Primary Health Care Electronic Medical Record Database Joshua Shadd, MD CCFP Bridget Ryan PhD Moira Stewart PhD
More informationBlue Care Network Physical & Occupational Therapy Utilization Management Guide Published 11/13/2012
Blue Care Network Physical & Occupational Therapy Utilization Management Guide Published 11/13/2012 Landmark Healthcare, Inc., oversees outpatient physical, occupational and speech services for BCN members
More informationUndergraduate Student Health Insurance Plan (USHIP) Benefits 2015-2016
Undergraduate Student Health Insurance Plan (USHIP) Benefits 2015-2016 For your insurance ID card or additional information on this plan, visit: www.4studenthealth.com/uci How USHIP Works For UC Irvine
More informationEssential Hospitals VITAL DATA. Results of America s Essential Hospitals Annual Hospital Characteristics Report, FY 2013
Essential Hospitals VITAL DATA Results of America s Essential Hospitals Annual Hospital Characteristics Report, FY 2013 Published: March 2015 1 ABOUT AMERICA S ESSENTIAL HOSPITALS METHODOLOGY America s
More informationCopyright 2014, AORN, Inc. Page 1 of 5
AORN Position Statement on One Perioperative Registered Nurse Circulator Dedicated to Every Patient Undergoing an Operative or Other Invasive Procedure POSITION STATEMENT The goal of perioperative nursing
More informationWORKERS COMPENSATION AND GROUP HEALTH HOSPITAL OUTPATIENT PAYMENTS: A COMPARISON
WORKERS COMPENSATION AND GROUP HEALTH HOSPITAL OUTPATIENT PAYMENTS: A COMPARISON By Dr. Richard Victor and Dr. Olesya Fomenko Workers Compensation Research Institute (WCRI) Rising hospital payments have
More informationPhysician Assistants as Providers for Simple Industrial Injury Claims in the Washington State Workers Compensation System (SB 6356)
Physician Assistants as Providers for Simple Industrial Injury Claims in the Washington State Workers Compensation System (SB 6356) Report to the Washington State Legislature As required by SB 6356 (Chapter
More informationCURRICULUM VITAE TIMOTHY J. BIRNEY, M.D. University of Pittsburgh, School of Medicine M.D. Degree, Cum Laude 1983
CURRICULUM VITAE TIMOTHY J. BIRNEY, M.D. EDUCATION: Undergraduate: Dartmouth College, Hanover, NH B.A. Degree, Cum Laude 1979 Medical: University of Pittsburgh, School of Medicine M.D. Degree, Cum Laude
More informationThe Effect of a Carve-out Advanced Access Scheduling System on No-show Rates
Practice Management Vol. 41, No. 1 51 The Effect of a Carve-out Advanced Access Scheduling System on No-show Rates Kevin J. Bennett, PhD; Elizabeth G. Baxley, MD Background and Objectives: The relationship
More informationMaster of Science Degree in Psychiatric Nursing Family Psychiatric Nurse Practitioner Certificate. Certificate Family Psychiatric Nurse Practitioner
Binghamton University Letter of Intent A. Program Identity A1 Proposed Title A2 Proposed Award Master of Science Degree in Psychiatric Nursing Family Psychiatric Nurse Practitioner Certificate Master of
More informationResearch Brief. Are Medicaid and Private Dental Insurance Payment Rates for Pediatric Dental Care Services Keeping up with Inflation?
Are Medicaid and Private Dental Insurance Payment Rates for Pediatric Dental Care Services Keeping up with Inflation? Authors: Kamyar Nasseh, Ph.D.; Marko Vujicic, Ph.D. The Health Policy Institute (HPI)
More informationTelehealth: Today & Tomorrow National Health Policy Forum
Telehealth: Today & Tomorrow National Health Policy Forum April 11, 2014 Karen E. Edison, MD Philip Anderson Prof. & Chair, Dept. of Dermatology Medical Director, Missouri Telehealth Network Director,
More informationHEALTH CARE IN the United States is now engaged in a second quality revolution,
SUPPLEMENT ARTICLE Health Information Systems and Physician Quality: Role of the American Board of Pediatrics Maintenance of Certification in Improving Children s Health Care Paul Miles, MD American Board
More informationTwenty-first century radiology requires rapid and. Radiology by Nonradiologists: Is Report Documentation Adequate? CLINICAL. Shelley Nan Weiner, MD
CLINICAL Radiology by Nonradiologists: Is Report Documentation Adequate? Shelley Nan Weiner, MD Objective: To determine if the quality of medical imaging reports differs significantly between radiologists
More informationThe U.S. Congress expects increased enrollment in capitated health plans (riskcontract
PATTERNS OF PRACTICE DOROTHY A. BAZOS, RN, MS PhD Student Center for the Evaluative Clinical Sciences Dartmouth Medical School Hanover, NH ELLIOTT S. FISHER, MD, MPH Co-Director VA Outcomes Group White
More informationGrowth of Home Health Services and Disparities in California, 2001-2010
Growth of Home Health Services and Disparities in California, 2001-2010 Vivian Y. Wu Background This policy brief describes the recent expansion in the supply of home health (HH) services in California,
More informationAvenues for Expanding Telehealth for Mental Health Services
Avenues for Expanding Telehealth for Mental Health Services September 17, 2013 During 2012, Dr. Karen Rheuban, President of the Virginia Telehealth Network, addressed the Healthy Living/Health Services
More informationEHR Incentive Payments Medicare and Medicaid Indiana
EHR Incentive Payments Medicare and Medicaid Indiana OPTIMIZING EHR PAYMENTS William Rees, CPA Director 317-713-7942 brees@blueandco.com EHR Regulations EHR Incentive Legislation: American Recovery and
More informationHealth Care Utilization and Costs of Full-Pay and Subsidized Enrollees in the Florida KidCare Program: MediKids
Health Care Utilization and Costs of Full-Pay and Subsidized Enrollees in the Florida KidCare Program: MediKids Prepared for the Florida Healthy Kids Corporation Prepared by Jill Boylston Herndon, Ph.D.
More informationCalifornia Children s Services Program Analysis Final Report
California Children s Services Program Analysis Final Report Paul H. Wise, MD, MPH Vandana Sundaram, MPH Lisa Chamberlain, MD, MPH Ewen Wang, MD Olga Saynina, MS Jia Chan, MS Kristen Chan, MASc Beate Danielsen,
More informationInsurance Intake Form, Authorization and Assignment of Benefits
Recipient Information Insurance Intake Form, Authorization and Assignment of Benefits Return completed and signed form with copies of insurance card(s), front and back, to: Fax: (303) 200-5441 E-mail:
More informationThe Emergency Department. Fear of Malpractice and Defensive Medicine in the Emergency Department. ED-Based Malpractice Claims
Fear of Malpractice and in the Emergency Department Darren P. Mareiniss, MD, JD Instructor Department of Emergency Medicine University of Maryland School of Medicine The Emergency Department Emergency
More informationSurgery Pricing Secrets: The Challenges Patients Face
Surgery Pricing Secrets: The Challenges Patients Face Date: February 2010 HEALTHCARE BLUE BOOK AUTHORED BY: CAREOPERATIVE, LLC www.healthcarebluebook.com Page 2 Is it Possible to Find Out What Surgery
More informationWhat Are Ambulatory Surgery Centers?
What Are Ambulatory Surgery Centers? Ambulatory surgery centers, or ASCs, are facilities where surgeries that do not require hospital admission are performed. ASCs provide cost-effective services and a
More informationGEORGIA MEDICAID TELEMEDICINE HANDBOOK
GEORGIA MEDICAID TELEMEDICINE HANDBOOK CONNECTING GEORGIA OVERVIEW The Department of Community Health s (DCH) Telemedicine and Telehealth policies are slated to improve and increase access and efficiency
More informationPhysical Therapy Self-Referral ( Direct Access )
Physical Therapy Self-Referral ( Direct Access ) Summary of Statutes and Regulations by State December 2007 The American Association of Orthopaedic Surgeons (AAOS) supports a patient-centered approach
More informationINDUSTRY PERSPECTIVES. Knowing your demographic: Exploring the utilization of locums physicians to expand business
INDUSTRY PERSPECTIVES Knowing your demographic: Exploring the utilization of locums physicians to expand business Justin Roark, Recruiting Principal, Delta Locum Tenens the Offering services appropriate
More informationNON-EMERGENCY MEDICAL TRANSPORTATION
NON-EMERGENCY MEDICAL TRANSPORTATION Brief Coverage Statement Non-Emergency Medical Transportation (NEMT) is provided as an administrative service for Colorado Medical Assistance Program (Colorado Medicaid)
More informationDiffering Surgical Times and Efficiency between Inpatient and Ambulatory Surgery Centers that are Both Hospital Owned
Differing Surgical Times and Efficiency between Inpatient and Ambulatory Surgery Centers that are Both Hospital Owned Theodore Ganley, MD Muayad Kadhim, MD, Itai Gans, MD, Joseph Yellin, BA, Keith Baldwin,
More informationAll University Employees. Workers Compensation Manager WORK-RELATED INJURY PROCEDURES
TO: FROM: SUBJECT: All University Employees Diane Biddle Workers Compensation Manager WORK-RELATED INJURY PROCEDURES The procedure involving work-related injuries requires the injured employee to select
More informationHCUP Methods Series HCUP External Cause of Injury (E Code) Evaluation Report (2001 HCUP Data) Report # 2004-06
HCUP Methods Series Contact Information: Healthcare Cost and Utilization Project (HCUP) Agency for Healthcare Research and Quality 540 Gaither Road Rockville, MD 20850 http://www.hcup-us.ahrq.gov For Technical
More informationMedical Care Costs for Diabetes Associated with Health Disparities Among Adults Enrolled in Medicaid in North Carolina
No. 160 August 2009 Among Adults Enrolled in Medicaid in North Carolina by Paul A. Buescher, Ph.D. J. Timothy Whitmire, Ph.D. Barbara Pullen-Smith, M.P.H. A Joint Report from the and the Office of Minority
More informationSubtitle 09 WORKERS' COMPENSATION COMMISSION. 14.09.03 Guide of Medical and Surgical Fees
Subtitle 09 WORKERS' COMPENSATION COMMISSION 14.09.03 Guide of Medical and Surgical Fees Authority: Labor and Employment Article, 9-309, 9-663 and 9-731, Annotated Code of Maryland Notice of Proposed Action
More informationFlorida Medicaid. Anesthesia Services Coverage Policy. Agency for Health Care Administration. Draft Rule
Florida Medicaid Agency for Health Care Administration Draft Rule Table of Contents 1.0 Introduction... 1 1.1 Description... 1 1.2 Legal Authority... 1 1.3 Definitions... 1 2.0 Eligible Recipient... 2
More informationExpanding Health Coverage in the District of Colombia
Expanding Health Coverage in the District of Colombia Washington, DC s shift from providing to purchasing services, 1999-2009 Gina Lagomarsino Results for Development Institute The Private Sector in Health,
More informationHealth Workforce Trends and Policy in Nevada and the United States
Health Workforce Trends and Policy in Nevada and the United States Tabor Griswold, PhD Health Services Research Analyst Office of Statewide Initiatives University of Nevada School of Medicine CHS Fall
More information230 S. Bemiston; Suite 900 Clayton, MO 63105 (314)727-5522 FAX (314)727-5568 www.mrctbenefitsplus.com www.mrctquote.com
Life & Health Insurance Advisor MRCT Benefits Plus is a comprehensive employee benefits, wellness and Human Resources consulting firm offering a variety of financial services to businesses and individuals
More informationPhysical Medicine and Rehabilitation
Physical Medicine and Rehabilitation Chapter.1 Enrollment..................................................................... -2.2 Benefits, Limitations, and Authorization Requirements...........................
More informationFEE SCHEDULE NEW YORK STATE MEDICAID TRANSPORTATION
FEE SCHEDULE NEW YORK STATE MEDICAID TRANSPORTATION NYS Medicaid Transportation Schedule Ambulance A0422 A0420 A0424 A0425 A0426 A0427 A0428 A0429 A0430 A0431 A0432 A0433 A0434 A0435 A0436 A0999 Advanced
More information2014 SURVEY. Physician Appointment Wait Times and Medicaid and Medicare Acceptance Rates
SURVEY Physician Appointment Wait Times and Medicaid and Medicare Acceptance Rates A survey examining the time needed to schedule a new patient appointment with a physician in major metropolitan markets
More informationNational Quality Management
National Quality Management National Approval Date: Effective Date: 02/24/2015 Subject Practitioner and Provider Availability: Network Composition and Contracting Plan Originating Dept. National Quality
More informationFinancial Assistance Programs State Incentive Grant Information Overview: Board:
South Carolina AHEC Rural Physician Program Financial Assistance Programs 19 Hagood Avenue, Suite 802 Incentive Grant Information MSC 814 Charleston, South Carolina 29425-8140 August 2015 The Legislature
More informationQuantifying Opportunities for Hospital Cost Control: Medical Device Purchasing and Patient Discharge Planning
Quantifying Opportunities for Hospital Cost Control: Medical Device Purchasing and Patient Discharge Planning James C. Robinson, PhD, and Timothy T. Brown, PhD I n the past decade, many hospitals have
More informationOHIO STATE MEDICAL ASSOCIATION HOUSE OF DELEGATES
Addressing Safety & Regulation in Medical Spas WHEREAS, Medical spas, which are facilities that offer cosmetic procedures such as laser hair removal, dermal fillers, and botulinum toxin injections in a
More informationPayment Policy. Evaluation and Management
Purpose Payment Policy Evaluation and Management The purpose of this payment policy is to define how Health New England (HNE) reimburses for Evaluation and Management Services. Applicable Plans Definitions
More informationColorado Small Business Enrollment Guide A BETTER WAY to take care of business
2015 SMALL BUSINESS HEALTH Colorado Small Business Enrollment Guide A BETTER WAY to take care of business Choose BETTER. 31 Important deadline Open enrollment begins on November 15, 2014 for coverage beginning
More information