Payment Discrepancies and Access to Primary Care Physicians for Dual-eligible Medicare-Medicaid Beneficiaries

Fung, Vicki; McCarthy, Stephen; Price, Mary; Hull, Peter; Cook, Benjamin Lê; Hsu, John; Newhouse, Joseph P.

doi:10.1097/mlr.0000000000001525

Cited by 3 publications

(3 citation statements)

References 19 publications

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“…31 Our study, along with others that have found limited impacts of the reimbursement bump on provider participation in Medicaid and use of other preventive care services highlight the importance of policy implementation, such as outreach efforts to increase providers' awareness of the policy and assistance for signing up for the program. 22,23,32 Moreover, it is possible that even with the reimbursement bump Medicaid vaccine administration reimbursements remained lower than those of commercial insurance plans. Most states did not increase vaccine administration reimbursements to Medicare rates and instead opted for lower VFC maximum rates.…”

Section: Discussionmentioning

confidence: 99%

The Impact of the Medicaid Reimbursement Bump on Influenza Vaccination Rates Among US Teens: Evidence from the National Immunization Survey–Teen 2011–2020

Marcondes,

Price,

McDowell

et al. 2023

J Am Board Fam Med

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Background: Many adolescents do not receive basic preventive care such as influenza vaccinations. The Affordable Care Act (ACA) temporarily increased Medicaid reimbursements for primary care services, including vaccine administration, in 2013 to 2014. The objective of this study is to assess the impact of reimbursement increases on influenza vaccination rates among adolescents with Medicaid.Methods: This repeated cross-sectional study used a difference-in-difference approach to compare changes in annual influenza vaccination rates for 20,884 adolescents 13 to 17 years old covered by Medicaid with adequate provider-reported data in 18 states with larger extended (>$5, 2013 to 2019) versus larger temporary (2013 to 2014 only) versus smaller reimbursement changes. We used linear probability models with individual-level random effects, adjusting for state and individual characteristics and annual time trends to assess the impact of a Medicaid vaccine administration reimbursement increase on annual influenza vaccination.Results: Mean Medicaid reimbursements for vaccine administration doubled from 2011 to 2013 to 2014 (eg, from $11 to $22 for CPT 90460). States with smaller reimbursement changes had higher mean reimbursements and higher adjusted vaccination rates at baseline ( 2011) compared with states with larger temporary and extended reimbursement changes. The reimbursement change was not associated with increases in influenza vaccination rates.Discussion: Influenza vaccination rates were low among adolescents with Medicaid throughout the study period, particularly in states with lower Medicaid reimbursement levels before the ACA.Conclusion: That reimbursement increases were not associated with higher vaccination rates suggests additional efforts are needed to improve influenza vaccination rates in this population. ( J Am Board Fam Med 2024;37:137-146.

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Section: Discussionmentioning

confidence: 99%

The Impact of the Medicaid Reimbursement Bump on Influenza Vaccination Rates Among US Teens: Evidence from the National Immunization Survey–Teen 2011–2020

Marcondes,

Price,

McDowell

et al. 2023

J Am Board Fam Med

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“…However, barriers exist that limit dually-enrolled patients from accessing primary care. Most states cap reimbursements for dually-enrolled patients at the Medicaid fee, disincentivizing providers from caring for these patients 9,10 . Socioeconomic constraints, such as a lack of available transportation or unaffordable copays, may also prevent dually-enrolled patients from accessing primary care 1,2 .…”

mentioning

confidence: 99%

“…Socioeconomic constraints, such as a lack of available transportation or unaffordable copays, may also prevent dually-enrolled patients from accessing primary care 1,2 . As a result, dually-enrolled patients may be disproportionately limited from receiving necessary primary care and chronic disease management, potentially contributing to disparities in hospitalizations 9–11 …”

mentioning

confidence: 99%

Better Nurse Practitioner Primary Care Practice Environments Reduce Hospitalization Disparities Among Dually-Enrolled Patients

Nikpour,

Brom,

Mason

et al. 2023

Medical Care

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Background: Over 12 million Americans are dually enrolled in Medicare and Medicaid. These individuals experience over twice as many hospitalizations for chronic diseases such as coronary artery disease and diabetes compared with Medicare-only patients. Nurse practitioners (NPs) are well-positioned to address the care needs of dually-enrolled patients, yet NPs often work in unsupportive clinical practice environments. The purpose of this study was to examine the association between the NP primary care practice environment and hospitalization disparities between dually-enrolled and Medicare-only patients with chronic diseases. Methods: Using secondary cross-sectional data from the Nurse Practitioner Primary Care Organizational Climate Questionnaire and Medicare claims files, we examined 135,648 patients with coronary artery disease and/or diabetes (20.0% dually-eligible, 80.0% Medicare-only), cared for in 450 practices employing NPs across 4 states (PA, NJ, CA, FL) in 2015. We compared dually-enrolled patients’ odds of being hospitalized when cared for in practice environments characterized as poor, mixed, and good based on practice-level Nurse Practitioner Primary Care Organizational Climate Questionnaire scores. Results: After adjusting for patient and practice characteristics, dually-enrolled patients in poor practice environments had the highest odds of being hospitalized compared with their Medicare-only counterparts [odds ratio (OR): 1.48, CI: 1.37, 1.60]. In mixed environments, dually-enrolled patients had 27% higher odds of a hospitalization (OR: 1.27, CI: 1.12, 1.45). However, in the best practice environments, hospitalization differences were nonsignificant (OR: 1.02, CI: 0.85, 1.23). Conclusions: As policymakers look to improve outcomes for dually-enrolled patients, addressing a modifiable aspect of care delivery in NPs’ clinical practice environment is a key opportunity to reduce hospitalization disparities.

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Evolving Economics: The Erosion of Medicare Reimbursement in Breast Surgery (2003–2023)

Gao,

HoSang,

Bleicher

et al. 2024

Ann Surg Oncol

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Introduction Medicare significantly influences reimbursement rates, setting a standard that impacts private insurance policies. Despite declining rates in various specialties, the magnitude of these trends has not been examined in breast surgery. This study examines Medicare reimbursement trends for breast surgery operations. Methods Data for 10 breast operations from 2003 to 2023 were collected from the Medicare Physician Fee Look-Up Tool and yearly reimbursement was computed using the conversion factor. The year-to-year percentage change in reimbursement was calculated, and the overall median change was compared with the consumer price index (CPI) for inflation evaluation. All data were adjusted to 2023 United States dollars. The compound annual growth rate (CAGR) was calculated using inflation-adjusted data. Results Over the study period, reimbursement for the 10 breast operations had a mean unadjusted percentage increase of + 25.17%, while the CPI increased by 69.15% (p < 0.001). However, after adjustment, overall reimbursement decreased by − 20.70%. Only two operations (lumpectomy and simple mastectomy) saw increased inflation-adjusted Medicare reimbursement (+ 0.37% and + 3.58%, respectively). The CAGR was − 1.54% overall but remained positive for the same two operations (+ 0.02% and + 0.18%, respectively). Based on these findings, breast surgeons were estimated to be reimbursed $107,605,444 less in 2023 than if rates had kept pace with inflation over the past decade. Conclusion Inflation-adjusted Medicare reimbursement rates for breast surgeries have declined from 2003 to 2023. This downward trend may strain resources, potentially leading to compromises in care quality. Surgeons, administrators, and policymakers must take proactive measures to address these issues and ensure the ongoing accessibility and quality of breast surgery.

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Payment Discrepancies and Access to Primary Care Physicians for Dual-eligible Medicare-Medicaid Beneficiaries

Abstract: Supplemental Digital Content is available in the text.

Cited by 3 publications

References 19 publications

The Impact of the Medicaid Reimbursement Bump on Influenza Vaccination Rates Among US Teens: Evidence from the National Immunization Survey–Teen 2011–2020

The Impact of the Medicaid Reimbursement Bump on Influenza Vaccination Rates Among US Teens: Evidence from the National Immunization Survey–Teen 2011–2020

Better Nurse Practitioner Primary Care Practice Environments Reduce Hospitalization Disparities Among Dually-Enrolled Patients

Evolving Economics: The Erosion of Medicare Reimbursement in Breast Surgery (2003–2023)

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