Provided below are brief descriptions of recent projects in the areas of:
Managed Care and Provider Payment System Evaluation
Completed a “Multiplan” project concerning payment methodology and comparative payment rates for hospital outpatient services.
Ten health plans participated in a 2006 study that examined payment methodology and comparative plan payment rates for hospital outpatient services. The project included identification of industry best practices for hospital outpatient payment and a comparative analysis of payment methodology and payment rates used by Medicare and study plans. Claims data was used to determine each plan’s payment rates as a proportion of Medicare payment rates under Medicare’s Ambulatory Payment Classification (APC) payment methodology.
Completed a “Multiplan” project of physician fees, utilization and cost.
This 2004 project for a group of 18 health plans included a comparative analysis of physician fees and per member physician utilization and claims cost. In addition, we provided assessments of the health plans physician payment methodology and payment practices and identified industry best practices.
Assisted health plans evaluate and redesign their physician payment systems.
We worked with several health plans to update and improve the competitiveness, reasonableness, and provider acceptance of their physician payment systems. This work was done for HMO, PPO, and indemnity-type plans, and for payment of participating and non-participating providers.
Designed and helped implement an RBRVS physician payment system for a New England Blue Cross Blue Shield plan.
We modeled the financial impact of payment system alternatives and helped the Plan select specific fee schedules for its different benefit plans. In addition, we presented the recommended payment system changes to the Plan's Board, state regulatory officials and physician groups, and helped prepare provider and public relations materials concerning the payment system changes.
Prepared a report, which evaluated the performance of St. Louis managed care plans, for the St. Louis Area Business Coalition.
We used quality, cost, utilization, and access measures to compare St. Louis plan performance with that of managed care plans in other metropolitan areas. Findings were presented to the St. Louis business and managed care communities in order to identify performance differences and to develop approaches to improve healthcare quality and cost-effectiveness.
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Health Policy Analysis
Coordinated and chaired conference on physician productivity.
Dr. Dyckman served as panel chairman and an expert reviewer for a 2006 conference designed to help better understand the data and conceptual issues relating to use of alternative measures of physician’s productivity in updating Medicare physician fees. The conference was jointly sponsored by the Department of Health and Human Services (DHHS) Office of the Assistant Secretary for Planning and Evaluation (ASPE) and Centers for Medicare & Medicaid Services (CMS) Office of the Actuary (OACT). Dr. Dyckman’s review was published in Health Care Financing Review, Winter 2007-2008.
Analysis and report regarding proposed auto insurer fee schedule.
Prepared a report in 2007 that was presented to legislative committee and regulatory authorities in New Jersey on analysis of a proposed auto insurer physician fee schedule. Dr. Dyckman also testified before the legislative committee on proposed legislation related to the PIP fee schedule.
Analyzed geographic variation in physician fees for GAO study.
Conducted supporting analysis of private health plan physician fees for a United States Government Accountability Office (GAO) study of Medicare physician payment; the analysis of geographic variation in physician fees was used in the March 2005 GAO Report to Congress.
Conducted a study of private health plan physician and drug payment practices that was published by the Medicare Payment Advisory Commission (MedPAC).
Interviews were conducted, with more than 30 health plans, relating to physician payment methodology, changing dynamics in physician service markets, payment for physician-administered drugs, and factors that influence health plan physician fee change decisions. Physician fee patterns were analyzed by geographic region, area demographics and payment system characteristics. The project report, Survey of Health Plans Concerning Physician Fees and Payment Methodology, and an additional report on drug pricing were published by MedPAC in August 2003 and are available on their web site.
Testified before the Rhode Island State Senate and before regulatory authorities on health insurance regulatory issues.
Dr. Zachary Dyckman testified on the likely impact on cost and access to health insurance coverage in Rhode Island of proposed legislation to regulate provider payment and other health insurance operational activities. He provided testimony before the Rhode Island Senate Health & Human Services Committee in May 2004. In 2006, Dr. Dyckman testified before Rhode Island regulatory authorities on initiatives to improve health insurance affordability.
Conducted a study and prepared testimony on cost-impact of legislation to provide antitrust exemption for provider joint bargaining.
A northeastern health plan requested a study of the issues surrounding physician antitrust exemption and an assessment of the likely cost implications for healthcare consumers of antitrust exemption legislation. The report included an assessment of experience in states in which such legislation has been enacted. We prepared testimony for the state legislature that demonstrated there is no evidence that this legislation will improve quality of care, but it will raise healthcare costs, increase health insurance premiums, and increase the number of uninsured in the state.
Prepared a report on the cost-effectiveness of organ transplants based on a review of the health economics literature on behalf of the Richard and Helen DeVos Foundation.
The paper focused on the cost-effectiveness of kidney and liver transplants, which combine to represent three-fourths of all transplant procedures performed. We found that kidney and liver transplants have proved to be highly cost-effective. In addition to reducing cost, organ transplants result in improved quality of life and increased patient survival rates. Based on our findings, we concluded there is strong justification for considering well-designed incentives to promote an increase in the number of organ donors.
Conducted a study on The Impact of Cost-Sharing on Pharmaceutical Utilization of Senior Medicare Enrollees (by Jack A. Meyer, Ph.D., Emily K. Waldman, and Zachary Dyckman, Ph.D., April 2000).
The report assessed the likely impact of different cost-sharing features of a Medicare drug benefit on total drug spending by Medicare enrollees and by Medicare. The report illustrated how Medicare enrollees might respond to the drug benefit plan proposed by President Clinton as well as plans with alternative cost-sharing approaches. (An earlier report, prepared by Dr. Dyckman on the cost of a Medicare pharmacy benefit, was cited by President Clinton.)
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Provided health care expert witness and other litigation support services over the past several years.
Dr. Zachary Dyckman and colleagues have provided expert witness and analytical support in litigation relating to health antitrust, health plan-provider payment disputes, provider network exclusion, payment for non-participating providers, government-provider pricing disputes, alleged fraudulent billing practices, and provider-provider contract disputes. These cases have related to physician services, prescription drugs, hospital care, and other health care services.
Several specific examples are cases involving:
Prepared reports regarding class certification for national managed care and other class action cases.
- Payment rates for emergency room (ER) physicians and other hospital-based physicians
- Development and insurance coverage of new biologics
- Interpretation of hospital outlier payment rules
- Payment rates for non-participating (Non-Par) provider services
- Payment for the “professional component of clinical laboratory services”
- Alleged fraudulent billing practices under Medicare and Medicaid
Numerous health plan subscriber and provider suits were consolidated into two classes, subscriber and provider track cases, and were brought before federal court in Miami for class certification and other preliminary legal issues before possible trials. Dr. Zachary Dyckman prepared a report for the subscriber track cases on behalf of a national managed care company. The report included the identification and assessment of differences among health plans in managed care program characteristics, provider payment methodologies, and extent of information regarding program features made available to health plan purchasers and subscribers. Findings from the report were used by health plans in their successful effort against class certification. A second report for the provider track litigation estimated medical care market shares for the defendant managed care plans nationally and in each of the fifty states.
Dr. Dyckman prepared (or is preparing) reports relating to class certification issues in several additional cases during the 2004-2008 period. These have included cases involving:
- Average wholesale pricing (AWP) for physician-administered drugs
- Payment for hospital outpatient services
- Billing and collection practices for clinical laboratory services
- Payment for Non-Par provider services
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|Select projects were conducted by Dyckman & Associates or by Dyckman & Associates staff
prior to 2002 while employed by CHPS Consulting.