Access to Office-Based Physicians Under Capitation Reimbursement and Medicaid Case Management

Hohlen, Mina M.; Manheim, Larry M.; Fleming, Gretchen V.; Davidson, Stephen M.; Yudkowsky, Beth K.; Werner, Stephen M.; Wheatley, George M.

doi:10.1097/00005650-199001000-00007

Cited by 16 publications

(6 citation statements)

References 7 publications

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“…Under PCCM, they may continue to limit Medicaid patients or stop accepting them altogether. Many early PCCM programs were implemented with compromises, including fee increases, the inclusion of outpatient departments and other established sites as primary care providers, and less than vigorous enforcement of gate-keeping requirements in order to avoid disrupting existing Medicaid delivery systems (Hohlen et al 1990;Hurley, Freund, and Paul 1993;Schoenman, Evans, and Schur 1997). States implementing PCCM have been urged to carefully recruit and make attempts to retain physicians, and to maintain or increase physician reimbursement rates in order to avoid the loss of participating physicians (Smith, Des Jardins, and Peterson 2000;Norton and Zuckerman 2000).…”

Section: Earlier Workmentioning

confidence: 99%

The Impact of Medicaid Primary Care Case Management on Office-Based Physician Supply in Alabama and Georgia

Adams

Bronstein

Florence³

2003

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The success of the ''primary care case management (PCCM)'' form of managed care implemented in many state Medicaid programs over the past several years depends in part on the expanded availability of primary care physician sites to substitute for hospital-based outpatient care and to provide a medical home for enrollees. However, the PCCM requirement for physicians to accept assignment of a caseload of patients and to provide all of their primary care likely conflicts with the approach of limited Medicaid participation favored by many Medicaid physician participants. This study examines the early impact of PCCM implementation, in the absence of physician reimbursement level increases, on the patterns of Medicaid participation by physicians in communities in Georgia and Alabama. We find that the implementation of PCCM under these conditions often was associated with reductions in the proportion of physicians participating in Medicaid, reductions in the number of very small Medicaid practices, and declines in Medicaid visit volumes across all participating physicians. We also find evidence of an overall reduction in the number of primary care visits per Medicaid enrollee, but an increase in the proportion of these visits that were for preventive care services associated with initial PCCM implementation.

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Section: Earlier Workmentioning

confidence: 99%

The Impact of Medicaid Primary Care Case Management on Office-Based Physician Supply in Alabama and Georgia

Adams

Bronstein

Florence³

2003

INQUIRY

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“…17 Numerous studies suggest that resource use is lower for HMO enrollees, 18 even when the same doctors care for HMO and fee-for-service patients; few studies suggest, however, that these decreases have been imprudent or have caused the health status of patients to worsen. 19,20 Several strong studies suggest that preventive services, such as immunization 21 and screening tests, 7 have been delivered more reliably in managed-care organizations than in feefor-service systems. The strongest negative finding to date about the performance of HMOs has been the observation in the Medical Outcomes Study that fee-for-service patients were more satisfied than HMO patients with their visits to physicians' offices.…”

Section: What the Data Showmentioning

confidence: 99%

Payment by Capitation and the Quality of Care

Berwick

1996

N Engl J Med

132

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Section: What the Data Showmentioning

confidence: 99%

DNA-Triplet Repeats and Neurologic Disease

Rosenberg¹

1996

N Engl J Med

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A The New England Journal of Medicine Downloaded from nejm.org on August 12, 2015. For personal use only. No other uses without permission. We are indebted to the Milbank Memorial Fund for its strong support in creating the diagnosis code for palliative care; to Pat Brooks, The New England Journal of Medicine Downloaded from nejm.org on August 12, 2015. For personal use only. No other uses without permission.

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Access to Office-Based Physicians Under Capitation Reimbursement and Medicaid Case Management

Cited by 16 publications

References 7 publications

The Impact of Medicaid Primary Care Case Management on Office-Based Physician Supply in Alabama and Georgia

The Impact of Medicaid Primary Care Case Management on Office-Based Physician Supply in Alabama and Georgia

Payment by Capitation and the Quality of Care

DNA-Triplet Repeats and Neurologic Disease

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