This study examines the impact of primary care provider payment policy on outpatient care, clinical events, and medical spending.
Study Overview
Problem: People who are eligible for both Medicare and Medicaid, referred to as “dually eligible beneficiaries,” are a medically vulnerable population with high medical care costs. Dually eligible beneficiaries also often have inadequate access to high quality care.
Main Objective: To identify the effects of the temporary Affordable Care Act increases in Medicaid payment rates for primary care providers in 2013 and 2014, which increased payment rates for dually eligible beneficiaries by up to 25%.
Approach: The research team is using Medicare claims data to compare primary care visit rates for beneficiaries who were eligible for increased primary care payments to a control group of Medicare beneficiaries with lower incomes in the same geographical area who were not eligible for increased payments. The team is also examining differences in the proportion of primary care providers’ Medicare patients who are dually eligible before and after the policy change in States with temporary or extended fee bumps (i.e., States that continued payment increases after 2014) versus minimal change in payments.
Results: To date, findings from this study show that relative rates of primary care visits for dually eligible beneficiaries did not increase overall during the years with a reimbursement increase compared with the control group, although there was wide variation across States. In addition, primary care providers’ caseloads of dually eligible beneficiaries declined between 2011 and 2017 and were not consistently associated with the payment change.1 These findings indicate that administrative and implementation barriers may have limited the effects of the reimbursement increase.2 Additional publications for this study are expected. Current and future publications can be found here.
Primary Care Relevance
Findings from this study can help policymakers consider how to best improve primary care access and utilization for Medicare beneficiaries with lower incomes.
AHRQ Primary Care Priority Area
Research to improve primary care, including regarding quality, access and affordability, the workforce, care delivery models, financing, digital healthcare, person-centeredness, and health equity.
Notes
1. Fung, V., McCarthy, S., Price, M., Hull, P., Lê Cook, B., Hsu, J., & Newhouse, J. P. (2021). Payment discrepancies and access to primary care physicians for dual-eligible Medicare-Medicaid beneficiaries. Medical Care 59(6), 487.
2. Fung, V., Price, M., Hull, P., Lê Cook, B., Hsu, J., & Newhouse, J. P. (2021). Assessment of the patient protection and affordable care act’s increase in fees for primary care and access to care for dual-eligible beneficiaries. JAMA Network Open 4(1), e2033424-e2033424.
