Fee-for-service is growing--accounting for nearly 95 percent of all physician office visits.
Despite policy interest in moving away from fee-for-service in favor of risk-based payment models, new research shows that fee-for-service remains the dominant payment method for physician visits and, in fact, continues to grow. Samuel H. Zuvekas and Joel W. Cohen of the Agency for Healthcare Research and Quality examined the prevalence of pure capitation--in which a physician receives a fixed monthly payment per patient regardless of services provided--from 1996 to 2013. They found that the overall percentage of physician office visits covered has slowly declined since 2007. In 2013 capitated payments declined to 5.3 percent of all US physician office visits, with 94.7 percent covered under fee-for-service arrangements.
Researchers dispute the notion that retail clinics ultimately save payers money.
Because they are cheaper than physician office and emergency department (ED) visits, retail clinics have been seen as saving money for patients and health plans. To understand whether the use of retail clinics cuts health care costs, J. Scott Ashwood of RAND and coauthors assessed data from a large health plan to understand what fraction of visits to retail clinics replace office or ED visits versus those that represent new utilization. They found that 58 percent of retail clinic visits represented new utilization--cases in which an individual would not otherwise have sought care elsewhere. Because new utilization outweighed replacement, the overall health spending for low-severity conditions (such as sinusitis and urinary tract infections) and preventive services (such as immunizations) increased by $14 per person per year. The findings refute the notion that retail clinics are a means of saving money.
Primary care practices may not be well equipped to manage depression.
Using data from the National Study of Physician Organizations survey, Tara F. Bishop of Weill Cornell Medicine and coauthors assessed care management use across four chronic conditions: asthma, depression, diabetes, and congestive heart failure. When compared against the overall mean score for care management (4.8), depression scored significantly lower (0.8)--meaning that less than one care management process for depression was used across the practices. The authors say the findings suggest that US primary care practices may not be well equipped to manage depression as a chronic illness, despite the fact that more than half of the 8 million ambulatory care visits for depression each year in the US are to a primary care physician.
Without paid sick leave, workers are more likely to work through illness.
Full- and part-time US workers without paid sick leave are three times more likely to forgo medical care for themselves and 1.6 times more likely to forgo medical care for their family, compared to working adults with paid sick leave benefits. LeaAnne DeRigne of Florida Atlantic University and coauthors used data from the National Health Interview Survey to assess the risks associated with not having paid sick leave. Nearly 49 million workers in the US do not have paid sick leave and are more likely to have fair or poor health. Insured working adults with paid sick leave benefits stay home when sick or injured an average of 1.5 more days annually compared to their counterparts without paid leave. The authors also examined income data, finding that low-income workers without paid sick leave are the least likely to address health care concerns in a timely manner.
Also of interest in the March issue: