Medicaid Physician Fees Remained Substantially Below Fees Paid By Medicare In 2019

Zuckerman, Stephen; Skopec, Laura; Aarons, Joshua

doi:10.1377/hlthaff.2020.00611

Cited by 65 publications

(77 citation statements)

References 1 publication

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“…We collected Medicaid professional fees for OUD treatment and related services by building on a survey of fee-for-service physician fees for common procedures in the District of Columbia and fifty state Medicaid programs which has been conducted since 1993 [ 5 ]. In this study, we collected new data to create three indexes related to OUD treatment in state Medicaid programs in 2021, with an emphasis on services related to first-line medication treatments in outpatient settings.…”

Section: Methodsmentioning

confidence: 99%

“…Previous research examining Medicaid physician fees across a variety of types of care found that in 2019, as in prior years, Medicaid reimbursement was below Medicare and private insurance fees [ 5 ]. While no study has examined Medicaid fees related to OUD treatment, several recent changes have affected the use of these services in Medicaid.…”

Section: Introductionmentioning

confidence: 99%

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Medicaid professional fees for treatment of opioid use disorder varied widely across states and were substantially below fees paid by medicare in 2021

Clemans-Cope

Lynch

Payton

et al. 2022

Subst Abuse Treat Prev Policy

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Background As Medicaid is the largest payer for opioid use disorder (OUD) treatment services in the United States, information about Medicaid provider reimbursement is critical, and Medicaid payment policies influence the structure of OUD treatment services for everyone with OUD treatment needs. Methods We collected Medicaid professional fees for OUD treatment and related services for the District of Columbia and fifty state Medicaid programs and the Medicare program in 2021. We create three fee indexes related to OUD treatment, with an emphasis on services related to first-line medication treatments in outpatient settings. We then create Medicaid fee indexes and Medicaid-to-Medicare fee indexes. Results Weekly Medicaid fee bundles for methadone treatment at OTPs in 2021 varied widely, more than 4-fold across states. The Medicaid-to-Medicare fee index shows that the national average Medicaid fee bundle was 56 percent of Medicare fees for regular methadone treatment at OTPs in 2021. For services related to OUD treatment, Medicaid fees varied up to 5-fold and larger across the components of each of the four services, and Medicaid fees were low relative to Medicare for almost all state services examined. The Medicaid-to-Medicare fee index was 64 percent of Medicare fees in 2021, ranging from 52 percent for evaluation & management to 76 percent for toxicology testing. Conclusions There appears to be little justification for such large variation in Medicaid fees across states. In addition, the generally low fees in Medicaid persist despite recent efforts to increase access to opioid use disorder treatment for Medicaid enrollees, and have important implications for access to life-saving treatment during the current opioid overdose crisis.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Medicaid professional fees for treatment of opioid use disorder varied widely across states and were substantially below fees paid by medicare in 2021

Clemans-Cope

Lynch

Payton

et al. 2022

Subst Abuse Treat Prev Policy

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“…Low Medicaid reimbursement rates and high uninsured rates in the Low income group contribute to lower expenditures for all services except prescription medications. 14,15 Given the greater expenditures for those with higher incomes in the US and the poorer health of those with low incomes, resources may not be used where they are most needed. 16,17 Indeed, increased spending on those with high incomes and better health disproportionately benefits them.…”

Section: Discussionmentioning

confidence: 99%

Income and Race-Ethnicity Disparities in Medical Care Utilization and Expenditures in the United States, 2017-2019

Wetzler

Cobb²

2022

Preprint

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BackgroundThe COVID-19 pandemic has focused attention on race and income disparities in SARS-CoV-2 mortality and morbidity. Much less attention has been paid to other socioeconomic factors including income.ObjectiveThe goal of this study was to compare disparities in medical care utilization and related expenditures associated with income to those associated with race and ethnicity in the US for those aged 0 to 64 for four categories of medical services: hospital, emergency room, ambulatory care, and prescription medications.MethodsWe used Medical Expenditure Panel Survey data for years 2017 through 2019. For each of the four medical services, there were three measures. First was the percentage of those aged 0-64 with or without utilization and expenditures. Due to statistical issues related to zero values for utilization and expenditures, the second and third measures were average utilization and expenditures only for those with both utilization and expenditures. Disparities by income and race-ethnicity were measured by calculating the percent difference between the group with the lowest utilization or expenditures and the group with the highest utilization or expenditures.ResultsFor 9 of the 12 separate differences the income differences exceed the corresponding race-ethnicity difference and the income differences are generally much greater in magnitude. Within the income comparisons, those on Medicaid had the greatest utilization in 7 of the 8 comparisons. The High Income group had greatest expenditures for 3 of the 4 medical services. Non-Hispanic Whites had the greatest utilization and expenditures for 9 of the 12 measures and Hispanics had the least utilization and expenditures for 9 of the 12 measures.ConclusionsThese results indicate that income inequalities are more strongly associated with medical care utilization and expenditures than race-ethnicity among those aged 0-64. Although more research should focus on income related health disparities in the United States, it is time to recognize that sound health policy must include reducing socioeconomic inequalities, especially those related to income.

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“…To estimate the cost of outpatient visits, we used the mean cost of a level 3 office visit (the most common type of office visit). 31 We used a level 3 office visit instead of using actual acuity-adjusted outpatient visit levels for simplicity, because outpatient visit acuity levels have a minimal impact on cost.…”

Section: Study Data and Methodsmentioning

confidence: 99%

Evidence-Based Community Health Worker Program Addresses Unmet Social Needs And Generates Positive Return On Investment

et al. 2020

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Interventions that address socioeconomic determinants of health are receiving considerable attention from policy makers and health care executives. The interest is fueled in part by expected returns on investment. However, many current estimates of returns on investment are likely overestimated, because they are based on pre-post study designs that are susceptible to regression to the mean. We present a return-on-investment analysis that is based on a randomized controlled trial of Individualized Management for Patient-Centered Targets (IMPaCT), a standardized community health worker intervention that addresses unmet social needs for disadvantaged people. We found that every dollar invested in the intervention would return $2.47 to an average Medicaid payer within the fiscal year.

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Medicaid Physician Fees Remained Substantially Below Fees Paid By Medicare In 2019

Cited by 65 publications

References 1 publication

Medicaid professional fees for treatment of opioid use disorder varied widely across states and were substantially below fees paid by medicare in 2021

Medicaid professional fees for treatment of opioid use disorder varied widely across states and were substantially below fees paid by medicare in 2021

Income and Race-Ethnicity Disparities in Medical Care Utilization and Expenditures in the United States, 2017-2019

Evidence-Based Community Health Worker Program Addresses Unmet Social Needs And Generates Positive Return On Investment

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