Physician Reimbursement Levels and Adherence to American Academy of Pediatrics Well-Visit and Immunization Recommendations

McInerny, Thomas K.; Cull, William L.; Yudkowsky, Beth K.

doi:10.1542/peds.2004-1510

Cited by 64 publications

(50 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The rate of preventive health care visits, as determined on the basis of diagnostic and procedure codes in health care databases (eg, International Classification of Diseases, Ninth Revision, codes) rather than adolescent or parent reports, was lower. 42 According to 2002 Health Plan Employer Data and Information Set (HEDIS) data, 34% of US adolescents made 1 or more preventive health care visits during the study year. 42 The extent to which the difference in rates of preventive health care visits between HEDIS and selfreported adolescent and parent data that reflect undercoding of preventive visits versus adolescent/parent overreporting is not clear.…”

Section: Adolescent Health Care Visits and Cps Deliverymentioning

confidence: 99%

“…42 According to 2002 Health Plan Employer Data and Information Set (HEDIS) data, 34% of US adolescents made 1 or more preventive health care visits during the study year. 42 The extent to which the difference in rates of preventive health care visits between HEDIS and selfreported adolescent and parent data that reflect undercoding of preventive visits versus adolescent/parent overreporting is not clear. Despite the observation that adolescents are more likely to receive CPSs during preventive care visits, rather than acute-care visits, national and state-based surveys of adolescents and providers have shown that adolescents frequently do not receive recommended CPSs during either type of visit.…”

Section: Adolescent Health Care Visits and Cps Deliverymentioning

confidence: 99%

“…In fact, it is possible that vaccination outside the medical home could decrease preventive visits to a provider's office or clinic. Schoolbased vaccination has been proposed as 1 strategy to achieve high coverage levels, particularly for influenza 46,47 Insufficient compensation 30,42,47 Absence of clear practice guidelines 47 Intrusion into patient's privacy 47 Lack of training 47 Lack of self-efficacy 48 Older age of adolescent 46 Confidential services 94 Medically emancipated conditions 94 Parent-and adolescent-reported barriers…”

Section: Challengesmentioning

confidence: 99%

See 2 more Smart Citations

Adolescent Immunizations and Other Clinical Preventive Services: A Needle and a Hook?

et al. 2008

View full text Add to dashboard Cite

Advances in technology have led to development of new vaccines for adolescents, but these vaccines will be added to a crowded schedule of recommended adolescent clinical preventive services. We reviewed adolescent clinical preventive health care guidelines and patterns of adolescent clinical preventive service delivery and assessed how new adolescent vaccines might affect health care visits and the delivery of other clinical preventive services. Our analysis suggests that new adolescent immunization recommendations are likely to improve adolescent health, both as a "needle" and a "hook." As a needle, the immunization will enhance an adolescent's health by preventing vaccine-preventable diseases during adolescence and adulthood. It also will likely be a hook to bring adolescents (and their parents) into the clinic for adolescent health care visits, during which other clinical preventive services can be provided. We also speculate that new adolescent immunization recommendations might increase the proportion and quality of other clinical preventive services delivered during health care visits. The factor most likely to diminish the positive influence of immunizations on delivery of other clinical preventive services is the additional visit time required for vaccine counseling and administration. Immunizations may "crowd out" delivery of other clinical preventive services during visits or reduce the quality of the clinical preventive service delivery. Complementary strategies to mitigate these effects might include prioritizing clinical preventive services with a strong evidence base for effectiveness, spreading clinical preventive services out over several visits, and withholding selected clinical preventive services during a visit if the prevention activity is effectively covered at the community level. Studies are needed to evaluate the effect of new immunizations on adolescent preventive health care visits, delivery of clinical preventive services, and health outcomes. Pediatricians have a unique opportunity to influence adolescents and their families by helping young people build a strong foundation of good health that will continue into their adult lives.American Academy of Pediatrics (AAP) 1 D ELIVERING PREVENTIVE services to US adolescents* is a public health priority. 2,3 Although most US adolescents are healthy, millions of adolescents initiate behaviors and lifestyles that can adversely affect their immediate and long-term health. 4 Potentially modifiable adolescent behaviors include failure to use seat belts, unsafe operation of motor vehicles, carrying weapons, using alcohol and other drugs, unprotected sex, inactivity, and overeating. These behaviors are directly linked to injuries and death, as well as to sexually transmitted infections (STIs), unintended *The definition of "adolescent" differs across studies and organizations; in this report, an adolescent is a person aged 11 to 18 years, unless otherwise specified.www.pediatrics.org/cgi

show abstract

Section: Adolescent Health Care Visits and Cps Deliverymentioning

confidence: 99%

Section: Adolescent Health Care Visits and Cps Deliverymentioning

confidence: 99%

Section: Challengesmentioning

confidence: 99%

See 1 more Smart Citation

Adolescent Immunizations and Other Clinical Preventive Services: A Needle and a Hook?

et al. 2008

View full text Add to dashboard Cite

show abstract

“…Public programs often reimburse physicians and dentists at lower rates than commercial insurers (Berman et al 2002;Zuckerman et al 2004), and other payment issues (such as delays in reimbursement) may make providers less willing to provide services to children covered under these programs (Cunningham and O'Malley 2009). The literature suggests that higher Medicaid reimbursement rates can increase receipt of preventive care but that such an effect is not assured (Mayer et al 2000;Hughes et al 2005;McInerny, Cull, and Yudkowsky 2005;Shen and Zuckerman 2005).…”

mentioning

confidence: 99%

The Effects of Medicaid and CHIP Policy Changes on Receipt of Preventive Care among Children

Kenney

Marton

Klein³

et al. 2010

Health Services Research

View full text Add to dashboard Cite

Objective. To examine changes in children's receipt of well‐child and preventive dental care in Medicaid/Children's Health Insurance Program (CHIP) in two states that adopted policies aimed at promoting greater preventive care receipt. Data Sources. The 2004–2008 Medicaid/CHIP claims and enrollment data from Idaho and Kentucky. Study Design. Logistic and hazard pre–post regression models, controlling for age, gender, race/ethnicity, and eligibility category. Data Extraction Methods. Claims and enrollment data were de‐identified and merged. Principal Findings. Increased reimbursement had a small, positive association with well‐child care in Idaho, but no consistent effects were found in Kentucky. A premium forgiveness program in Idaho was associated with a substantial increase (between 20 and 113 percent) in receipt of any well‐child care and quicker receipt of well‐child care following enrollment. In Kentucky, children saw modest increases in receipt of preventive dental care and received such care more quickly following increased dental reimbursement, while the move to managed care in Idaho was associated with a small increase in receipt of preventive dental care. Conclusions. Policy changes such as reimbursement increases, incentives, and delivery system changes can lead to increases in preventive care use among children in Medicaid and CHIP, but reported preventive care receipt still falls short of recommended levels.

show abstract

“…Attention should be paid to physician reimbursement as a predictor of the quality of care that children and adolescents receive. 4 By including the precepts of primary care in the delivery of services, managed care can be instrumental in increasing access to a full range of health care services and clinicians within a medical home. It is imperative that managed care plans fully support the intent and desired outcomes of a medical home.…”

Section: Introductionmentioning

confidence: 99%

Guiding Principles for Managed Care Arrangements for the Health Care of Newborns, Infants, Children, Adolescents, and Young Adults

2006

Pediatrics

View full text Add to dashboard Cite

By including the precepts of primary care and the medical home in the delivery of services, managed care can be instrumental in increasing access to a full range of health care services and clinicians. If not designed and administered carefully, managed care plans result in underutilization of appropriate services and reduced quality of care. Therefore, the American Academy of Pediatrics urges the use of the key principles outlined in this statement in designing and implementing managed care for newborns, infants, children, adolescents, and young adults. This policy statement replaces the 2000 policy statement "Guiding Principles for Managed Care Arrangements for the Health Care of Infants, Children, Adolescents, and Young Adults." INTRODUCTIONFaced with persistent growth in health care costs, employers, state Medicaid programs, the State Children's Health Insurance Program, and other purchasers of care continue to study and often reconfigure managed care plans to find the most efficient strategies that provide access to quality health care while controlling costs. As the delivery and financing of health care services continue to face profound challenges, diligent and focused efforts are needed to ensure that managed care plans serve the varied health care needs of neonates, infants, children, adolescents, and young adults (hereinafter referred to as children) and their families.The effect of managed care on children's access to services and actual health outcomes remains poorly defined. Some studies suggest no statistically significant differences in self-reported outcomes for children enrolled in managed care plans versus traditional health plans. 1 The effectiveness of managed care in linking more low-income children to a medical home is uncertain. Medicaid program shifts from fee-for-service to managed care plans have had little consistent effect on the pattern of children's health care use and satisfaction with care received. 2 The American Academy of Pediatrics (AAP) urges the use of the principles outlined in this statement in designing and implementing managed care for children. Managed care plans typically use certain cost and utilization management features. (A glossary of managed care terms is available in the AAP publication A Pediatrician's Guide to Managed Care. 3 ) It is important to monitor the effects of cost-containment measures on the quality and outcome of medical services for children. The finanwww.pediatrics.org/cgi

show abstract

Physician Reimbursement Levels and Adherence to American Academy of Pediatrics Well-Visit and Immunization Recommendations

Cited by 64 publications

References 15 publications

Adolescent Immunizations and Other Clinical Preventive Services: A Needle and a Hook?

Adolescent Immunizations and Other Clinical Preventive Services: A Needle and a Hook?

The Effects of Medicaid and CHIP Policy Changes on Receipt of Preventive Care among Children

Guiding Principles for Managed Care Arrangements for the Health Care of Newborns, Infants, Children, Adolescents, and Young Adults

Contact Info

Product

Resources

About