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Date of Graduation

8-2004

Degree Type

Capstone Project (On-Campus Access Only)

Degree Name

Master of Science in Physician Assistant Studies

First Advisor

H."Randy" Randolph, PA-C

Abstract

Context The number of uninsured Americans continues to rise, is of alarming concern, and requires that other options and avenues be sought out.

Objective To find the cost effectiveness of implementing a fee-at-time-of-service plan for a rural family practice clinic in Oregon.

Design A randomized retrospective chart review from 1/1/03 to 5/1/04 comparing the reimbursement rates of private insurance, government insurance, and a fee-at-time-of service plan considering overhead billing costs.

Setting The study will take place at Family Tree Healthcare, a rural family practice clinic in Carlton, Oregon, where many patients, mostly uninsured, use the fee-at-time-of-service plan.

Patients and other Participants Those patients seen from 1/1/03 to 5/1/04, randomly selected, having either an ICD-9 code of 845.0,465.9,461.0, 724.5 or diagnoses in the chart of sprain/strain, upper respiratory infection/pharyngitis, back pain, or sinusitis.

Main outcome Measures Reimbursement rates of fee-at-time-of-service visits compared to private and government insurance reimbursements.

Results Although reimbursement rates were higher per service from the private insurance, FATOS patients out-paid public insurance by an average of $4.72 for a 99213 code. The average payment for a 456.9/URI code was $58.31 for private insurance, $33.28 for public insurance, and $ 38.00 for FATOS patients. For a code of 845.0/sprain-strain average payment was $ 60.83 for private insurance, $33.28 for public insurance, and $38.00 for FATOS patients. Payment for 461.0/sinusitis code averaged $57.45 from private insurance, $33.28 from public insurance, and $38.00 from FATOS patients. Payment for 724.5/back pain was $63.53 from private insurance, $33.28 from public insurance, and $38.00 from FATOS patients.

Conclusions Based on these results at the Family Tree Healthcare clinic it would appear that this a fee at- time-of-service plan provides sufficient financial compensation to encourage providers to implement this type of plan into their own practices.

Comments

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