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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results1 to 21 of 21 Research Studies Displayed
Adler-Milstein J, Linden A, Bernstein S
Longitudinal participation in delivery and payment reform programs among US primary care organizations.
The purpose of this retrospective, observational study was to assess longitudinal primary care organization participation patterns in large-scale reform programs and to identify organizational characteristics associated with multiprogram participation. Medicare claims were used to identify organizations that delivered primary care services. Findings showed that no program achieved more than 50% participation; 36% of organizations did not participate in any program; 50% participated in one; 13% in two; and 1% in all three. Larger organizations, those with younger providers, those with more primary care providers, and those with larger Medicare patient panels were more likely to participate in more programs.
Citation: Adler-Milstein J, Linden A, Bernstein S . Longitudinal participation in delivery and payment reform programs among US primary care organizations. Health Serv Res 2022 Feb;57(1):47-55. doi: 10.1111/1475-6773.13646..
Keywords: Primary Care, Medicare, Healthcare Delivery
Markovitz AA, Ryan AM, Peterson TA
ACO awareness and perceptions among specialists versus primary care physicians: a survey of a large Medicare Shared Savings program.
This research letter describes a survey that was conducted to compare accountable care organization (ACO) awareness and perceptions among specialists versus primary care physicians (PCPs). The survey was administered in 2018 to clinicians in the Physician Organization of Michigan ACO, which was the largest Medicare Shared Savings Program (MSSP) in Michigan and among the ten largest nationally at the time. The analysis focused on 1022 non-pediatrician physician respondents practicing within 10 provider organizations. Physician respondents included PCPs (23%) and specialists (77%). The most common specialty was internal medicine (20%), followed by surgeons (14%). Specialists were less likely to be aware of ACO participation and incentives. They were also 25% less likely to know they were in an ACO compared to PCPs. In addition, specialists were 18% less likely to know their ACO was accountable for both spending and quality or that their ACO had lowered spending in the previous year. This difference in perception may help to explain ACOs’ modest impact on spending and quality.
Citation: Markovitz AA, Ryan AM, Peterson TA . ACO awareness and perceptions among specialists versus primary care physicians: a survey of a large Medicare Shared Savings program. J Gen Intern Med 2022 Feb;37(2):492-94. doi: 10.1007/s11606-020-06556-w..
Keywords: Primary Care, Healthcare Costs, Medicare, Provider: Physician
Neprash HT, Zink A, Sheridan B
The effect of Medicaid expansion on Medicaid participation, payer mix, and labor supply in primary care.
Citation: Neprash HT, Zink A, Sheridan B . The effect of Medicaid expansion on Medicaid participation, payer mix, and labor supply in primary care. J Health Econ 2021 Dec;80:102541. doi: 10.1016/j.jhealeco.2021.102541..
Keywords: Medicare, Healthcare Utilization, Primary Care, Workforce, Health Insurance
Luo Z, Gritz M, Connelly L
A survey of primary care practices on their use of the intensive behavioral therapy for obese Medicare patients.
The objective of this study was to fill the gap in knowledge on systematic differences between primary care practices (PCP) that do or do not provide intensive behavioral therapy (IBT) for obese Medicare patients. The investigators concluded that although the Centers for Medicare and Medicaid Services established payment codes for PCPs to deliver IBT for obesity in 2011, very few providers submitted fee-for-service claims for these services after almost 10 years.
Citation: Luo Z, Gritz M, Connelly L . A survey of primary care practices on their use of the intensive behavioral therapy for obese Medicare patients. J Gen Intern Med 2021 Sep;36(9):2700-08. doi: 10.1007/s11606-021-06596-w..
Keywords: Primary Care, Obesity, Behavioral Health, Medicare, Elderly
Nederveld A, Phimphasone-Brady P, Connelly L
The joys and challenges of delivering obesity care: a qualitative study of US primary care practices.
The authors sought to explore the experience of providing obesity management among primary care clinicians and their team members involved with weight loss in primary care practices. They identified three primary themes: (1) clinicians and staff involved in obesity management in primary care believe that addressing obesity is an essential part of primary care services, (2) because providing obesity care can be challenging, many practices opt out of treatment, and (3) despite the challenges, many clinicians and others find treating obesity feasible, satisfying, and worthwhile. The authors concluded that, in order to improve the ability of clinicians and practice members to treat obesity, important changes in payment, education, and work processes are necessary.
Citation: Nederveld A, Phimphasone-Brady P, Connelly L . The joys and challenges of delivering obesity care: a qualitative study of US primary care practices. J Gen Intern Med 2021 Sep;36(9):2709-16. doi: 10.1007/s11606-020-06548-w..
Keywords: Obesity, Obesity: Weight Management, Primary Care, Medicare
Fung V, McCarthy S, Price M
Payment discrepancies and access to primary care physicians for dual-eligible Medicare-Medicaid beneficiaries.
This study examined whether the Affordable Care Act (ACA) primary care fee bump for dual-eligible Medicare-Medicaid beneficiaries impacted primary care physicians (PCP) acceptance of duals. The authors 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. The proportion of PCPs with dual caseloads of ≥10% or 20% decreased significantly between 2012 and 2017. The fee bump was not consistently associated with increases in dual caseloads.
Citation: Fung V, McCarthy S, Price M . Payment discrepancies and access to primary care physicians for dual-eligible Medicare-Medicaid beneficiaries. Med Care 2021 Jun;59(6):487-94. doi: 10.1097/mlr.0000000000001525..
Keywords: Primary Care, Medicaid, Medicare, Health Insurance, Payment, Access to Care
Whaley CM, Zhao X, Richards M
Higher Medicare spending on imaging and lab services after primary care physician group vertical integration.
This study looked at the impact of direct ownership of physician practices by hospitals and health systems (vertical integration) on Medicare spending for imaging and lab services. A 100% sample of 2013-16 Medicare fee-for-service claims data was examined to determine if vertical integration was associated with changes in site of care and Medicare reimbursement rates for ten common diagnostic imaging and laboratory services. After vertical integration, the monthly number of diagnostic imaging tests per 1,000 attributed beneficiaries increased in a hospital setting by 26.3 per 1000, and the number performed in a nonhospital setting decreased by 24.8 per 1,000. Hospital-based laboratory tests increased by 44.5 per 1,000 and non-hospital-based laboratory tests decreased by 36.0 per 1,000. Average Medicare reimbursement rose by $6.38 for imaging tests and $0.57 for laboratory tests. This translates to $40.2 million increase for imaging and $32.9 million increase for laboratory tests in Medicare spending for the study period.
Citation: Whaley CM, Zhao X, Richards M . Higher Medicare spending on imaging and lab services after primary care physician group vertical integration. Health Aff 2021 May;40(5):702-09. doi: 10.1377/hlthaff.2020.01006..
Keywords: Medicare, Healthcare Costs, Imaging, Primary Care
Kuo YF, Lin YL, D Jupiter, et al.
How to identify team-based primary care in the United States using Medicare data.
The authors assessed whether analyses using different sets of Medicare data can produce results similar to those from analyses using 100% data from an entire state in identifying primary care teams through social network analysis. They found that, depending on specific study purposes, researchers could use either 100% data from Medicare beneficiaries in randomly selected primary care services areas or data from a 20% national sample of Medicare beneficiaries to study team-based primary care in the United States.
Citation: Kuo YF, Lin YL, D Jupiter, et al.. How to identify team-based primary care in the United States using Medicare data. Med Care 2021 Feb;59(2):118-22. doi: 10.1097/mlr.0000000000001478.
Keywords: Teams, Primary Care: Models of Care, Primary Care, Medicare, Health Services Research (HSR), Healthcare Delivery
Soylu TG, Goldberg DG, Cuellar AE
Medicare access and CHIP reauthorization act in small to medium-sized primary care practices.
Despite major efforts to transition to a new physician payment system under the Medicare Access and CHIP Reauthorization Act (MACRA), little is known about how well practices are prepared. This study aimed to understand how small and medium-sized primary care practices in the Heart of Virginia Healthcare (https://www.vahealthinnovation.org/hvh/) perceived their quality incentives under MACRA.
Citation: Soylu TG, Goldberg DG, Cuellar AE . Medicare access and CHIP reauthorization act in small to medium-sized primary care practices. J Am Board Fam Med 2020 Nov-Dec;33(6):942-52. doi: 10.3122/jabfm.2020.06.200142..
Keywords: Children's Health Insurance Program (CHIP), Medicare, Primary Care, Health Insurance
Fraze TK, Briggs ADM, Whitcomb EK
Role of nurse practitioners in caring for patients with complex health needs.
The objective of this study was to estimate trends in the percentage of Medicare beneficiaries cared for by nurse practitioners from 2012 to 2017, to characterize beneficiaries cared for by nurse practitioners in 2017, and to examine how the percentage of beneficiaries cared for by nurse practitioners varies by practice characteristics. Findings showed that nurse practitioners are caring for Medicare beneficiaries with complex needs at rates that match or exceed their physician colleagues. The growing role of nurse practitioners, especially in health care systems, warrants attention as organizations embark on payment and delivery reform.
Citation: Fraze TK, Briggs ADM, Whitcomb EK . Role of nurse practitioners in caring for patients with complex health needs. Med Care 2020 Oct;58(10):853-60. doi: 10.1097/mlr.0000000000001364..
Keywords: Provider: Clinician, Provider: Nurse, Provider, Chronic Conditions, Primary Care, Medicare
Lin SC, Yan PL, Moloci NM
Out-of-network primary care is associated with higher per beneficiary spending in Medicare ACOs.
Despite expectations that Medicare accountable care organizations (ACOs) would curb health care spending, their effect has been modest. One possible explanation is that ACOs' inability to prohibit out-of-network care limits their control over spending. To examine this possibility, the investigators evaluated the association between out-of-network care and per beneficiary spending using national Medicare data for 2012-15.
AHRQ-funded; HS024728; HS024525; HS025165; HS025875.
Citation: Lin SC, Yan PL, Moloci NM . Out-of-network primary care is associated with higher per beneficiary spending in Medicare ACOs. Health Aff 2020 Feb;39(2):310-18. doi: 10.1377/hlthaff.2019.00181..
Keywords: Healthcare Costs, Primary Care, Medicare, Health Insurance
Kuo YF, Raji MA, Lin YL
Use of Medicare data to identify team-based primary care: is it possible?
This study’s goal was to determine if Medicare data can be used to identify type and degree of collaboration between primary care providers (PCPs), nurse practitioners, and physician assistants in a team care model. Researchers surveyed 63 primary care practices in Texas and linked the survey results to 2015 100% Medicare data. They measured sensitivity, specificity and positive predictive value (PPV) of dyad teams in Medicare data. They found a higher PPV between MD-nurse practitioner/physician assistant pairs than for MD-MD pairs. There was low sensitivity over all (27.8%), but specificity was 91.7% and PPV 72.2%.
Citation: Kuo YF, Raji MA, Lin YL . Use of Medicare data to identify team-based primary care: is it possible? Med Care 2019 Nov;57(11):905-12. doi: 10.1097/mlr.0000000000001201..
Keywords: Medicare, Primary Care, Teams, Primary Care: Models of Care, Healthcare Delivery
Abara NO, Huang N, Raji MA
Effect of retail clinic use on continuity of care among Medicare beneficiaries.
Researchers examined the relationship between retail clinic use and primary care physician (PCP) continuity among Medicare enrollees in the Houston metropolitan area. They found that retail clinic use was lower in the elderly population, compared with the previously published rate in the younger populations. The lower rate of continuity of care observed among retail clinic users was an issue of concern, especially for those with chronic medical conditions.
Citation: Abara NO, Huang N, Raji MA . Effect of retail clinic use on continuity of care among Medicare beneficiaries. J Am Board Fam Med 2019 Jul-Aug;32(4):531-38. doi: 10.3122/jabfm.2019.04.180349..
Keywords: Medicare, Transitions of Care, Ambulatory Care and Surgery, Primary Care
Reid R, Damberg C, Friedberg MW
Primary care spending in the fee-for-service Medicare population.
This research letter examine primary care spending in the fee-for-service Medicare population the US for 2015. Data was analyzed for all Medicare beneficiaries 65 years or older with 12 months of Part A and B fee-for-service medical coverage and Part D prescription cover. They used narrow and broad definitions of primary care practitioners (PCPs) and primary care services. The narrow definition only included physicians, while the broader definition included care by nurse practitioners, physician assistants, geriatric medicine and gynecology. Both definitions did not include care in hospitals. Primary care spending was analyzed for over 16 million beneficiaries, and spending represented 2.12% of total medical and prescription spending for the narrow definitions and 4.88% for the broad definitions. Spending was lower among older beneficiaries, black or North American Native, dually eligible for Medicare and Medicaid, and those with chronic conditions. Spending also varied state to state ranging from 1.59% in North Dakota to 4.74% in Iowa.
Citation: Reid R, Damberg C, Friedberg MW . Primary care spending in the fee-for-service Medicare population. JAMA Intern Med 2019 Jul;179(7):977-80. doi: 10.1001/jamainternmed.2018.8747..
Keywords: Elderly, Medicare, Primary Care, Healthcare Costs
da Graca B, Ogola GO, Fullerton C
Offsetting patient-centered medical homes investment costs through per-member-per-month or Medicare merit-based incentive payment system incentive payments.
The purpose of this study was to examine potential offsets through commercial payer per-member-per-month (PMPM) payments and the Medicare Merit-based Incentive Payment System (MIPS). The researchers found that with PMPM, breaking even required that 2.4% to 6.4% of commercially insured patients per physician to be covered; with MIPS incentive payments, they would exceed PCMH costs by 2022.
Citation: da Graca B, Ogola GO, Fullerton C . Offsetting patient-centered medical homes investment costs through per-member-per-month or Medicare merit-based incentive payment system incentive payments. J Ambul Care Manage 2018 Apr/Jun;41(2):105-13. doi: 10.1097/jac.0000000000000224..
Keywords: Healthcare Costs, Medicare, Patient-Centered Healthcare, Payment, Primary Care
Xue Y, Goodwin JS, Adhikari D
Trends in primary care provision to Medicare beneficiaries by physicians, nurse practitioners, or physician assistants: 2008-2014.
This study documented the temporal trends in alternative primary care models in which physicians, nurse practitioners (NPs), or physician assistants (PAs) engaged in care provision to the elderly, and examined the role of these models in serving elders with multiple chronic conditions. It found a decrease in the physician model and an increase in the shared care model and NP/PA model from 2008 to 2014.
AHRQ-funded; HS020642; HS022134.
Citation: Xue Y, Goodwin JS, Adhikari D . Trends in primary care provision to Medicare beneficiaries by physicians, nurse practitioners, or physician assistants: 2008-2014. J Prim Care Community Health 2017 Oct;8(4):256-63. doi: 10.1177/2150131917736634.
Keywords: Chronic Conditions, Elderly, Healthcare Delivery, Primary Care, Medicare
Loresto FL, Jr., Jupiter D, Kuo YF
Examining differences in characteristics between patients receiving primary care from nurse practitioners or physicians using Medicare Current Beneficiary Survey data and Medicare claims data.
There is a perception that nurse practitioners (NPs), as compared with primary care medical doctors (PCMDs), tend to provide care to healthier patients. In this study, patients utilizing NP-only or PCMD-only models for primary care were characterized and compared in terms of functional, cognitive, and psychological factors. The results were contrary to the initial perception. In terms of health status, NP-only patients were similar to PCMD-only patients.
Citation: Loresto FL, Jr., Jupiter D, Kuo YF . Examining differences in characteristics between patients receiving primary care from nurse practitioners or physicians using Medicare Current Beneficiary Survey data and Medicare claims data. J Am Assoc Nurse Pract 2017 Jun;29(6):340-47. doi: 10.1002/2327-6924.12465.
Keywords: Provider: Health Personnel, Medicare, Primary Care, Workforce
Raji MY, Chen NW, Raji M
Factors associated with seeking physician care by Medicare beneficiaries who receive all their primary care from nurse practitioners.
The authors sought to examine rate and correlates of switching from exclusive nurse practitioner (NP) primary care to receiving some or all primary care from physicians. The study group consisted of Medicare beneficiaries with diabetes, congrestive heart failure, or chronic obstructive pulmonary disease. The researchers found that about half of Medicare patients under exclusive NP primary care switched to physicians for some or all primary care over a 3-year period.
AHRQ-funded; HS022134; HS020642.
Citation: Raji MY, Chen NW, Raji M . Factors associated with seeking physician care by Medicare beneficiaries who receive all their primary care from nurse practitioners. J Prim Care Community Health 2016 Oct;7(4):249-57. doi: 10.1177/2150131916659674.
Keywords: Elderly, Medicare, Primary Care, Practice Patterns
Mukamel DB, White LM, Nocon RS
AHRQ Author: Ngo-Metzger Q
Comparing the cost of caring for Medicare beneficiaries in federally funded health centers to other care settings.
The purpose of this study was to compare total annual costs for Medicare beneficiaries receiving primary care in federally funded health centers (HCs) to Medicare beneficiaries in physician offices and outpatient clinics. It found that total median annual costs (at $2,370) for HC Medicare patients were lower by 10 percent compared to patients in physician offices ($2,667) and by 30 percent compared to patients in outpatient clinics ($3,580).
Citation: Mukamel DB, White LM, Nocon RS . Comparing the cost of caring for Medicare beneficiaries in federally funded health centers to other care settings. Health Serv Res 2016 Apr;51(2):625-44. doi: 10.1111/1475-6773.12339..
Keywords: Medicare, Primary Care, Safety Net, Healthcare Costs
Zanwar P, Lin YL, Kuo YF
Downstream tests, treatments, and annual direct payments in older men cared for by primary care providers with high or low prostate-specific antigen screening rates using 100 percent Texas U.S. Medicare public insurance claims data: a retrospective cohort
The investigators assessed the tests, treatments, and payments for prostate cancer care in men aged 75 or older who have primary care physicians (PCPs) with high or low prostate specific antigen (PSA) testing rates. They found that older men seeing PCPs with high rates of PSA testing undergo more testing and treatments for prostate cancer, with higher Medicare insurance payments.
Citation: Zanwar P, Lin YL, Kuo YF . Downstream tests, treatments, and annual direct payments in older men cared for by primary care providers with high or low prostate-specific antigen screening rates using 100 percent Texas U.S. Medicare public insurance claims data: a retrospective cohort BMC Health Serv Res 2016 Jan 15;16:17. doi: 10.1186/s12913-016-1265-1.
Keywords: Elderly, Medicare, Primary Care, Cancer: Prostate Cancer, Screening
Pfoh E, Mojtabai R, Bailey J
Impact of Medicare annual wellness visits on uptake of depression screening.
This study assessed whether patients with an initial annual wellness visit (AWV) were more likely to be screened for depression than those with a primary care visit. Fifteen percent of patients with non-AWVs and 10 percent of patients with AWVs received depression screening. After accounting for clustering, there was no statistically significant difference in depression screening by visit type.
Citation: Pfoh E, Mojtabai R, Bailey J . Impact of Medicare annual wellness visits on uptake of depression screening. Psychiatr Serv 2015 Nov;66(11):1207-12. doi: 10.1176/appi.ps.201400524.
Keywords: Depression, Screening, Medicare, Elderly, Primary Care