Medicaid Payment Policy and Access to Care for Dual Eligible Beneficiaries

双重合格受益人的医疗补助付款政策和获得护理的机会

• 批准号: 9768326
• 负责人: Vicki Fung
• 金额: $ 35.55万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-01 至 2021-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9768326
• 关键词: Medicaid; Payment; Policy; Access; Care

ABSTRACT This project will assess the impact of primary care provider (PCP) payment policy on outpatient care, clinical events, and medical spending. This project focuses on dual-eligible Medicare-Medicaid beneficiaries, as they are among the most costly and clinically vulnerable individuals in both programs and have historically had suboptimal access to care. We will assess the effects of temporary increases in Medicaid payment rates for PCPs in 2013 and 2014 that were mandated by the Affordable Care Act (ACA); this policy increased PCP payments for dual-eligible beneficiaries by up to 25 percent. The intent of the policy was to improve access to primary care for low-income populations, especially given large expected increases in the number of individuals covered by private insurance and Medicaid coverage due to the ACA. While one study found increased PCP appointment availability associated with the higher payments, there is little evidence on the effects of the policy on actual utilization, clinical outcomes, or total spending. Despite the limited evidence, most states returned to pre-2013 Medicaid payment rates in 2015, while 16 states continued the payment increase. We will examine the association between PCP payment changes and three types of outcomes: 1) outpatient care, including PCP visits and sentinel quality measures; 2) clinical events, including emergency department visits, preventable hospitalizations, and mortality; and 3) total and component medical spending. Our primary analyses will use Medicare claims data for low-income beneficiaries (N=1.48 million in 2011) from 2011-2017 linked with supplemental data on providers and individual- and area-level characteristics. We will use a quasi-experimental difference-in-difference design with fixed effects (within-person) estimation approaches to compare (1) dual-eligibles with incomes ≤100% of the federal poverty level (FPL) for whom PCP payments increased (policy intervention group) with (2) a concurrent control group of low-income (101-135% FPL) non-dual Medicare beneficiaries without payment changes who live in the same geographic areas. We will examine variation in outcomes for beneficiaries living in states that did and did not expand Medicaid, and did and did not continue the payment increase after 2014. We will also conduct supplemental analyses using the Massachusetts All-Payer Claims Database to examine outcomes for all Medicaid enrollees in the state (with and without Medicare). In short, we will use the natural experiment created by the ACA and comprehensive datasets to provide timely information on the impact of increasing provider payments for low- income patients, with a focus on vulnerable dual-eligibles. Information on the potential effects of this policy is urgently needed as the federal government and states are continuing to make ongoing decisions regarding provider payment policy.

摘要 本项目将评估初级保健提供者（PCP）支付政策对门诊护理、临床 事件和医疗支出。该项目的重点是双重资格的医疗保险-医疗补助受益人，因为他们 在这两个项目中，他们都是最昂贵和临床上最脆弱的人， 获得护理的机会欠佳。我们将评估医疗补助支付率临时增加的影响， 2013年和2014年，《平价医疗法案》（ACA）授权的PCP;该政策增加了PCP 双重资格受益人的付款高达25%。该政策的目的是改善获得 为低收入人口提供初级保健，特别是考虑到预计低收入人口的数量将大幅增加， 由于ACA，私人保险和医疗补助覆盖的个人。一项研究发现， 增加PCP预约可用性与更高的付款，几乎没有证据表明， 政策对实际使用、临床结果或总支出的影响。尽管证据有限， 大多数州在2015年恢复到2013年前的医疗补助支付率，而16个州继续支付 增加我们将研究PCP支付变化与三种结果之间的关联：1） 门诊治疗，包括PCP访视和哨点质量措施; 2）临床事件，包括急诊 部门访问，可预防的住院，和死亡率;和3）总的和组成部分的医疗支出。 我们的主要分析将使用低收入受益人的医疗保险索赔数据（2011年N= 148万）， 2011-2017年与供应商以及个人和地区一级特征的补充数据相关联。我们将 使用具有固定效应（人内）估计的准实验差异中差异设计 比较（1）双重资格且收入≤联邦贫困线（FPL）100%的PCP的方法 支付增加（政策干预组）与（2）同时控制组的低收入（101-135%） FPL）非双重医疗保险受益人没有支付变化谁住在同一地理区域。我们 将研究居住在扩大和没有扩大医疗补助的州的受益人的结果变化， 2014年后确实也没有继续增加付款。我们还将使用 马萨诸塞州所有支付者索赔数据库，以检查该州所有医疗补助登记者的结果 (with没有医疗）。简而言之，我们将使用ACA创建的自然实验， 全面的数据集，以提供及时的信息，说明增加供应商支付低， 收入的病人，重点是脆弱的双杀。关于这项政策的潜在影响的信息是 迫切需要的联邦政府和各州继续作出持续的决定， 供应商付款政策。