Declining Medicaid Fees and Primary Care Appointment Availability for New Medicaid Patients

Candon, Molly; Zuckerman, Stephen; Wissoker, Douglas; Saloner, Brendan; Kenney, Genevieve M.; Rhodes, Karin V.; Polsky, Daniel

doi:10.1001/jamainternmed.2017.6302

Cited by 31 publications

(25 citation statements)

References 4 publications

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“… 12 - 15 , 27 - 29 The ACA was associated with lower rates of uninsurance but was not associated with differences in wait times, which indicates that the health care system was able to absorb the increased demand for primary care. 30 , 31 We observed increases in physician visits but did not observe any significant changes in ED use. This is likely because insurance lowers the out-of-pocket cost of using the ED and thus leads to increased ED utilization; however, it could also prevent utilization among those who have been using the ED as a substitute for primary care, which could lead to mixed results.…”

Section: Discussionmentioning

confidence: 53%

The Affordable Care Act Attenuates Financial Strain According to Poverty Level

McKenna

Langellier

Alcalá

et al. 2018

INQUIRY

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We use data from the 2011-2016 National Health Interview Survey to examine how the Patient Protection and Affordable Care Act (ACA) has influenced disparities in health care–related financial strain, access to care, and utilization of services by categories of the Federal Poverty Level (FPL). We use multivariable regression analyses to determine the ACA’s effects on these outcome measures, as well as to determine how changes in these measures varied across different FPL levels. We find that the national implementation of the ACA’s insurance expansion provisions in 2014 was associated with improvements in health care–related financial strain, access, and utilization. Relative to adults earning more than 400% of the FPL, the largest effects were observed among those earning between 0% to 124% and 125% to 199% of the FPL after the implementation of the ACA. Both groups experienced reductions in disparities in financial strain and uninsurance relative to the highest FPL group. Overall, the ACA has attenuated health care–related financial strain and improved access to and the utilization of health services for low- and middle-income adults who have traditionally not met income eligibility requirements for public insurance programs. Policy changes that would replace the ACA with less generous age-based tax subsidies and reductions in Medicaid funding could reverse these gains.

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Section: Discussionmentioning

confidence: 53%

The Affordable Care Act Attenuates Financial Strain According to Poverty Level

McKenna

Langellier

Alcalá

et al. 2018

INQUIRY

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“…We also estimate how changes in prices ("reimbursement rates" in medical jargon) affect patient acceptance. This price parameter has been analysts' main focus when studying physicians' reluctance to accept Medicaid (Polsky et al, 2015;Candon et al, 2018;Oostrom et al, 2017;Alexander and Schnell, 2019), but we find that billing hurdles are at least as significant. Section 3 introduces a conceptual framework that tells us how to think about these two factors simultaneously.…”

mentioning

confidence: 73%

The Costs of Payment Uncertainty in Healthcare Markets

Dunn¹,

Gottlieb²,

Shapiro³

et al. 2020

ERWP

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What does it cost healthcare providers to collect payment in the complex U.S. health insurance system? We study this question using rich data on repeated interactions between a large sample of physicians and many different payers, and investigate the consequences when these costs are high. Payment uncertainty is high and variable, with 19% of Medicaid visits not reimbursed after the first claim submission. In such cases, physicians either forgo substantial revenue or incur costs to collect payment. Using physician movers and practices that span state boundaries, we find that providers respond to these costs by refusing to accept Medicaid patients in states with more severe billing hurdles. This supply margin is even more responsive to these costs than to reimbursement rates. Using these supply estimates, we calculate that the costs of billing Medicaid consume one-quarter of the average revenue from a Medicaid visit. We estimate a model of the billing process, and find that the variable costs of billing each visit account for 21 percentage points of this total cost. Analyzing healthcare prices without accounting for billing costs and payment uncertainty may substantially misrepresent differences between private payers and Medicaid.

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“…Several studies suggest that the ACA fee bump raised Medicaid reimbursement rates (Kirby 2017), increased primary care provider participation in Medicaid (Polsky, Richards et al 2015), increased prenatal care utilization among Medicaid enrolled pregnant women (Li, Pesko et al 2018), and increased office visits and improved health outcomes among Medicaid enrollees (Alexander and Schnell 2017). When the federal fee bump policy ended in December 2014, Medicaid appointment availability declined in states that did not maintain the previously mandated higher reimbursement rates (Candon, Zuckerman et al 2018). However, one paper suggests limited effects of the fee bump on physician participation in Medicaid (Decker 2016).…”

Section: Related Literaturementioning

confidence: 99%

“…Medicaid spending across the surveyed procedure. Previous studies have also used the ratio in health and healthcare analyses (Decker 2009, Decker 2012, Polsky, Richards et al 2015, Callison and Nguyen 2018, Candon, Zuckerman et al 2018, Li, Pesko et al 2018). 10 We note the possibility that some respondents may include tobacco cessation treatment with SUD treatment, either because some respondents view tobacco as a substance or because many SUD treatment facilities offer smoking cessation services (Friedmann, Jiang et al 2008).…”

Section: Medicaid-to-medicare Reimbursement Fee Ratiomentioning

confidence: 99%

Reimbursement Rates for Primary Care Services: Evidence of Spillover Effects to Behavioral Health

Maclean¹,

McClellan²,

Polsky³

2018

Self Cite

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We study spillover effects from the largest increase in Medicaid reimbursement rates in the history of the program for primary care services to behavioral health and healthcare outcomes; mental illness, substance use disorders, and tobacco product use. Much of the variation in Medicaid reimbursement rates we leverage is attributable to a large federally mandated increase between 2013 and 2014. We apply differences-indifferences models to survey data specifically designed to measure behavioral health outcomes over the period 2010 to 2016. We find that higher primary care Medicaid reimbursement rates improve behavioral health outcomes among enrollees. We find no evidence that behavioral healthcare service use is altered. Previous economic research shows that the mandated boost increased office visits. Thus our results suggest that primary care providers are efficient in improving behavioral health outcomes among Medicaid enrollees. Given established shortages of behavioral health providers, these findings are important from a healthcare workforce and policy perspective.

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Declining Medicaid Fees and Primary Care Appointment Availability for New Medicaid Patients

Cited by 31 publications

References 4 publications

The Affordable Care Act Attenuates Financial Strain According to Poverty Level

The Affordable Care Act Attenuates Financial Strain According to Poverty Level

The Costs of Payment Uncertainty in Healthcare Markets

Reimbursement Rates for Primary Care Services: Evidence of Spillover Effects to Behavioral Health

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