<div class="description">
<dl><dd>"Supported by the Health Care Financing Administration, U.S. Department of Health and Human Services."</dd>
<dd>"Rand library collection"--Label on cover</dd>
<dd>Includes bibliographical references (p. 37-41)</dd>
<dd>"The Omnibus Budget Reconciliation Act of 1989 (OBRA89) provides for the establishment of Medicare volume performance standards (VPSs) beginning in 1990. Under the VPS policy, payment updates for physicians' fees may depend on the difference between the actual rate of growth in expenditures for physicians' services and a performance standard established for the year. The goal of this study is to provide a framework for analyzing the strengths and weknesses of a range of different VPSs. Establishing a VPS policy requires making choices along three dimensions: the risk pool, the scope and nature of standard, and the application of the standard. ...The likely effectiveness of each choice in providing incentives to control cost and consider possible adverse outcomes and administrative problems [was evaluated]."--p. v</dd>
<dd>"Beginning in 1990, Medicare set volume standards, and subsequent payment updates for physician fees depend on the difference between actual volume and the standard. Establishing a VPS (volume performance standard) policy requires choices along three dimensions: the risk pool, the scope and nature of the standard, and the application of the standard. This study reviews the literature and the experience of other countries to analyze the strengths and weaknesses of these alternative choices. The authors conclude that VPSs will be most effective in controlling expenditures and changing physician behavior if they are defined using subnational geographic units, all Medicare services (Part A and Part B), and per-capita utilization targets. Other countries have successfully controlled costs with expenditure ceilings, though there is limited evidence as to how practice patterns have responded to these ceilings. However, capitated payment systems have been demonstrated to be effective in lowering health care use, and the Health Care Financing Administration should continue to encourage prepaid plans."--publisher's description</dd>
<dd>The research described in this report was supported by the Health Care Financing Administration, U.S. Department of Health and Human Services, Cooperative Agreement 99-C-98489/9-07</dd></dl><br>Subjects: Medical fees; Medicare; Medicare Part B; Fee Schedules; Health Expenditures; Medical fees Government policy United States; Medicare</div>
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<dl><dd>Marquis, M. Susan</dd>
<dd>Kominski, Gerald F</dd></dl></div>
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