Trends In Medicaid Physician Fees, 2003–2008

Zuckerman, Stephen; Williams, Aimee F.; Stockley, Karen

doi:10.1377/hlthaff.28.3.w510

Cited by 126 publications

(93 citation statements)

References 8 publications

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“…Compounding this problem is the fact that Medicaid offers lower reimbursement rates than other payers, which contributes to Medicaid enrollees' poorer access to primary care in general. 28 When primary care providers deliver more accessible care after hours and avoid potentially unnecessary emergency department visits, decreasing overall costs to the system, the current fee-for-service system does not reward them. It is hoped that future payment reform under patient-centered medical homes and bundled payments may begin to address these issues.…”

Section: Discussionmentioning

confidence: 99%

After-Hours Access To Primary Care Practices Linked With Lower Emergency Department Use And Less Unmet Medical Need

2013

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Section: Discussionmentioning

confidence: 99%

After-Hours Access To Primary Care Practices Linked With Lower Emergency Department Use And Less Unmet Medical Need

2013

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“…A. Norton, 1995;Zuckerman, McFeeters, Cunningham, & Nichols, 2004;Zuckerman, Williams, & Stockley, 2009). Those Medicaid fee indices are only available for selected years (1993, 1998, 2003, and 2008).…”

Section: Fixed Effects Estimatesmentioning

confidence: 99%

The Effect of the Children’s Health Insurance Program on Pediatricians’ Work Hours

White

2013

MMRR

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Objective: Our study examines changes in physicians' work hours in response to a coverage expansion. Methods: We use as a natural experiment the Children's Health Insurance Program (CHIP), which was established in 1997 and significantly expanded children's eligibility for public health insurance coverage. The magnitude of the CHIP expansion varied across states and over time, allowing its effects to be identified using a state-year fixed effects model. We focus on pediatricians, and we measure their selfreported work hours using multiple waves (pre-and post-CHIP) of the physician survey component of the Community Tracking Study. To address endogeneity concerns, we instrument for CHIP enrollment using key program features (income eligibility cutoffs and waiting times). Results:We find a large negative relationship between the magnitude of a state's CHIP expansion and trends in pediatricians' work hours. This relationship could be due to key supply-side features of CHIP, including relatively low provider reimbursements and heavy use of managed care tools. He, F., White, C. Keywords: E2 IntroductionThe Congressional Budget Office (CBO) has estimated that providing insurance coverage for all of those who are currently uninsured would increase the demand for health care services by 2 to 5 percent (Congressional Budget Office, 2008). But, for the quantity of services to actually increase, providers have to supply the additional care, and it is not clear whether, or how, they will do so. Based on a purely demand-driven model of physician labor supply, the CBO and other researchers have hypothesized that a large coverage expansion could lead, in the short run, to physicians working longer hours to accommodate such an influx of patient demand. On the other hand, a supply-driven model hypothesizes that physicians could choose to work fewer hours with a large coverage expansion, due to constraints on the supply side. To test between the two hypotheses, we analyze the impact of the Children's Health Insurance Program (CHIP), a public health insurance program for children in low-and middle-income families.Established in 1997, CHIP has several features that make it well suited to our purposes. First, the CHIP expansion was large, resulting in almost one in five children becoming newly eligible for public coverage-that expansion in eligibility is roughly similar in magnitude to the expansion for adults that will occur under the Affordable Care Act (ACA). Second, states play a central role in designing and financing their CHIP programs, and have some latitude to determine eligibility criteria. As a result, eligibility criteria and other key program features vary widely from state to state, which we exploit in our analysis. Third, CHIP was established relatively recently. This allows access to fairly rich and recent data sources, and also makes it more plausible that any findings would be relevant to upcoming reforms.We use a state-year level panel data analysis, with observations spanning the period before and after the establi...

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“…It is possible that family practices in rural settings may have relatively more financial resources compared with rural pediatric practices because of higher reimbursement through Medicare for adult patients compared with Medicaid for pediatric patients. 18 Concerns have been raised that practices that serve low-income populations may be at a disadvantage for medical home certification, although the only study specifically examining this issue found that safety-net practices may be at a relative advantage. 31 In our results, it was encouraging to find that a higher proportion of practice visits covered by Medicaid/SCHIP was not associated with lower medical home infrastructure scores and was actually associated with higher infrastructure scores for pediatric practices with moderate levels of Medicaid/SCHIP visits.…”

Section: Discussionmentioning

confidence: 99%

“…[12][13][14][15][16] Primary care practices that serve children may be at an added disadvantage for medical home certification because of the high proportion of children enrolled in Medicaid, 17 which pays significantly less than other insurers, potentially limiting practices' resources to implement the services and infrastructure needed for medical home certification. 18 Little is known about the readiness for medical home certification in primary care practices serving children, however.…”

mentioning

confidence: 99%

Readiness of Primary Care Practices for Medical Home Certification

2013

PEDIATRICS

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WHAT'S KNOWN ON THIS SUBJECT: Practice characteristics, such as practice size, have been associated with the readiness of adult primary care practices for medical home certification. Little is known about how ready primary care practices for children are for medical home certification.WHAT THIS STUDY ADDS: Primary care practices for children attained only 38% of the infrastructure required for medical home certification. Smaller practice size was significantly associated with lower infrastructure scores. Medical home programs need effective approaches to support practices with limited resources. abstract OBJECTIVES: To assess the prevalence of medical home infrastructure among primary care practices for children and identify practice characteristics associated with medical home infrastructure. METHODS:Cross-sectional analysis of restricted data files from 2007 and 2008 of the National Ambulatory Medical Care Survey. We mapped survey items to the 2011 National Committee on Quality Assurance' s Patient-Centered Medical home standards. Points were awarded for each "passed" element based on National Committee for Quality Assurance scoring, and we then calculated the percentage of the total possible points met for each practice. We used multivariate linear regression to assess associations between practice characteristics and the percentage of medical home infrastructure points attained. RESULTS:On average, pediatric practices attained 38% (95% confidence interval 34%-41%) of medical home infrastructure points, and family/general practices attained 36% (95% confidence interval 33%-38%). Practices scored higher on medical home elements related to direct patient care (eg, providing comprehensive health assessments) and lower in areas highly dependent on health information technology (eg, computerized prescriptions, test ordering, laboratory result viewing, or quality of care measurement and reporting). In multivariate analyses, smaller practice size was significantly associated with lower infrastructure scores. Practice ownership, urban versus rural location, and proportion of visits covered by public insurers were not consistently associated with a practice' s infrastructure score.CONCLUSIONS: Medical home programs need effective approaches to support practice transformation in the small practices that provide the vast majority of the primary care for children in the United States.

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Trends In Medicaid Physician Fees, 2003–2008

Cited by 126 publications

References 8 publications

After-Hours Access To Primary Care Practices Linked With Lower Emergency Department Use And Less Unmet Medical Need

After-Hours Access To Primary Care Practices Linked With Lower Emergency Department Use And Less Unmet Medical Need

The Effect of the Children’s Health Insurance Program on Pediatricians’ Work Hours

Readiness of Primary Care Practices for Medical Home Certification

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