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BACKGROUND Medicare's home health care program, consisting primarily of home visits by nurses and health aides, was conceived as a means to facilitate hospital discharge. Because home health care is now one of the fastest-growing categories of Medicare expenditures, we analyzed Medicare claims data to determine current patterns of use. METHODS We used(More)
  • W P Welch
  • 1985
The literature suggests four basic "facts" about biased selection in PGPs: First, the well disproportionally enroll in PGPs. Second, for a group defined according to low expenditure, expenditure regresses toward the mean. Whether this is applicable to PGPs is unclear. Third, the well disproportionally disenroll from PGPs. Finally, although more evidence is(More)
  • W P Welch
  • 1987
Although teaching hospitals are widely discussed in terms of 115 university teaching hospitals, Medicare's prospective payment system pays about 1,000 teaching hospitals an additional amount per case. This paper investigates two frequent justifications for this add-on payment: 1) teaching hospitals have sicker patients, and 2) they produce medical(More)
This paper develops a geographic index of physician practice costs. A Laspeyres index is derived for each Metropolitan Statistical Area and for the non-metropolitan portion of each state. Relative prices by area are obtained for four practice inputs: physicians' own time, employee wages, office rents, and malpractice insurance. Each input price proxy is(More)
  • W P Welch
  • 1991
Defining geographic areas for the purpose of paying health care providers has been difficult and is an issue that Congress continues to address. Employment-based insurance programs are starting to face this same issue in paying HMOs. Because input prices are related to population density, payment levels could be related to density. This paper offers a new(More)
BACKGROUND The national volume-performance standard recently implemented by Medicare does not account for geographic variation in expenditures for physicians' services. To study this variation, we examined expenditures for physicians' services in all metropolitan areas in the United States. METHODS We used Medicare claims data for 1989 to measure rates of(More)
Concern about certain contractual arrangements between health maintenance organizations (HMOs) and primary care physicians has led policymakers to consider curbing these arrangements; one law has already been passed. However, these arrangements are complex and their impact is neither obvious nor well understood. This article first presents a conceptual(More)
BACKGROUND Physician profiling is a method of cost control that focuses on patterns of care instead of on specific clinical decisions. It is one cost-control method that takes into account physicians' desire to curb the intrusion of administrative mechanisms into the clinical encounter. To provide a concrete example of profiling, we analyzed the inpatient(More)
OBJECTIVE To assess the impact of the electronic health record (EHR) on cost (i.e., payments to providers) and process measures of quality of care. STUDY DESIGN Retrospective before-after-study-control. From the database of a large managed care organization (MCO), we obtained the claims of patients from four community physician practices that implemented(More)
As more Americans choose among insurance plans, the possibility of biased selection increases in importance. Although regression toward the mean is recognized as a common problem in evaluating social programs, it has generally been ignored in studies of biased selection. Suppose that people are included in a group simply because they had expenditures in one(More)