Mongan Institute, Massachusetts General Hospital.
Department of Medicine, Harvard Medical School, Boston, MA.
Med Care. 2021 Jun 1;59(6):487-494. doi: 10.1097/MLR.0000000000001525.
Physicians often receive lower payments for dual-eligible Medicare-Medicaid beneficiaries versus nondual Medicare beneficiaries because of state reimbursement caps. The Affordable Care Act (ACA) primary care fee bump temporarily eliminated this differential in 2013-2014.
To examine how dual payment policy impacts primary care physicians' (PCP) acceptance of duals.
We assessed differences in the likelihood that PCPs had dual caseloads of ≥10% or 20% in states with lower versus full dual reimbursement using linear probability models adjusted for physician and area-level traits. Using a triple-difference approach, we examined changes in dual caseloads for PCPs versus a control group of specialists in states with fee bumps versus no change during years postbump versus prebump.
PCPs and specialists (cardiologists, orthopedic surgeons, general surgeons) that billed fee-for-service Medicare.
State dual payment policies and physicians' dual caseloads as a percentage of their Medicare patients.
In 2012, 81% of PCPs had dual caseloads of ≥10% and this was less likely among PCPs in states with lower versus full dual reimbursement (eg, difference=-4.52 percentage points; 95% confidence interval, -6.80 to -2.25). The proportion of PCPs with dual caseloads of ≥10% or 20% decreased significantly between 2012 and 2017 and the fee bump was not consistently associated with increases in dual caseloads.
Pre-ACA, PCPs' participation in the dual program appeared to be lower in states with lower reimbursement for duals. Despite the ACA fee bump, dual caseloads declined over time, raising concerns of worsening access to care.
由于州级报销上限，对于同时享受联邦医疗保险和医疗补助的双重医保受益人，医生的报酬往往低于非双重医保受益人。平价医疗法案（ACA）在 2013-2014 年期间暂时通过提高初级保健费用来消除这种差异。
研究双重支付政策如何影响初级保健医生（PCP）对双重医保受益人的接受程度。
我们使用线性概率模型，根据医生和地区特征调整了模型，评估了在低额度和全额双重报销的州，PCP 的双重病例比例≥10%或≥20%的可能性差异。使用三重差分法，我们比较了在有费用增长和无变化的州，PCP 与专家的双重病例比例在增长期（postbump）和增长前（prebump）的变化。
按服务收费的 Medicare 计费的 PCP 和专家（心脏病专家、矫形外科医生、普通外科医生）。
州级双重支付政策和 PCP 作为其 Medicare 患者的双重病例比例。
2012 年，81%的 PCP 有≥10%的双重病例比例，在低额度和全额双重报销的州，这一比例较低（例如，差异=-4.52 个百分点；95%置信区间，-6.80 至-2.25）。2012 年至 2017 年间，有≥10%或≥20%双重病例比例的 PCP 比例显著下降，而费用增长并不始终与双重病例比例的增加相关。
在平价医疗法案实施之前，在双重医保报销额度较低的州，PCP 参与双重医保计划的比例似乎较低。尽管平价医疗法案提高了费用，但双重病例比例随着时间的推移而下降，这令人担忧医疗服务的可及性会恶化。
