Medicare Part B reimbursement and the perceived quality of physician care

Abstract

The maximum amount physicians can charge Medicare patients for Part B services depends on Medicare reimbursement rates and on federal and state restrictions regarding balance billing. This study evaluates whether Part B payment rates, state restrictions on balance billing beyond the federal limit, and physician balance billing influence how beneficiaries rate the quality of their doctor's care. Using nationally representative data from the 2001 to 2003 Medicare Current Beneficiary Survey, this paper finds strong evidence that Medicare reimbursement rates, and state balance billing restrictions influence a wide range of perceived care quality measures. Lower Medicare reimbursement and restrictions on physicians' ability to balance bill significantly reduce the perceived quality of care under Part B.

Definition, Practice, Regulations, and Effects of Balance Billing: A Scoping Review

“…As a result, inequitable access across income groups was reported by some studies, 101 while financial hardship to patients became the common impact of the additional bills. 15,19,21,25,31,43,48,49,57,66,72,75,85,97,[100][101][102]105 Balance billing reduced access to care for patients who could not afford to pay. 101 Forgone care and limited access to health services due to extra bills had been reported by studies in Canada, France, and the US especially when the amount of fee was large.…”

Pricing Distortions in Medicare's Physician Fee Schedule and Patient Satisfaction With Care Quality and Access

“…Regarding Medicare payments, with the exception of Brunt and Jensen (2010), previous empirical studies have focused on how Part A reimbursement affects care quality in hospitals. Staiger and Gaumer (1995), Shen (2003), Dafny (2005), Lindrooth et al (2007), and Kaestner and Guardado (2008) all used plausibly exogenous variation in Medicare Part A reimbursement rates to examine how changes in Medicare payments influenced patient mortality subsequent to hospital admission and/or the health outcomes of patients following discharge.…”

“…They found that reduced Medicare payments increased the likelihood of patients developing pressure sores and urinary tract infections in the skilled nursing facility. Brunt and Jensen (2010) examined how Medicare's payment rate for a routine office visit influenced patients' perceptions of the quality of care they received, using data from the 2001-2003 MCBS. They examined 11 different patient-assessed measures of care quality.…”

“…Here, we briefly review empirical studies in this area. See the work of Brunt and Jensen (2010) for a detailed review of theoretical studies. Medicare, Medicaid, and most other insurance plans each set their own rules regarding how they pay providers and the level of their payments.…”

Market power and contract form: evidence from physician group practices

“…However, the literature notes that payment changes, which would create income effects, are associated with increases in physician quality. Decker (2007) found that exogenous changes in Medicaid fees were associated with increases in the length of visits for Medicaid patients, and Brunt and Jensen (2010) found that lower Medicare Part B reimbursement rates significantly reduce the perceived quality of care.…”