142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

304202
Comparing total Medicare costs for patients receiving primary care in Federally Funded Health Centers, physician offices and outpatient clinics

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Wednesday, November 19, 2014 : 8:30 AM - 8:45 AM

Dana B. Mukamel, PhD , Department of Medicine, Health Policy Research Institute, University of California, Irvine, Irvine, CA
Laura M. White, MS , Health Policy Research Institute, University of California, Irvine, Irvine, CA
Robert Nocon, MHS , Biological Sciences Division, Medicine, General Internal Medicine, University of Chicago, Chicago, IL
Elbert S. Huang, MD , Biological Sciences Division, Medicine, General Internal Medicine, University of Chicago, Chicago, IL
Ravi Sharma, PhD , Department of Health and Human Services, Bureau of Primary Health Care, Health Resources and Services Administration, Rockville, MD
Leiyu Shi, DrPH, MBA, MPA , School of Public Health, Johns Hopkins University, Baltimore, MD
Quyen Ngo-Metzger, MD, MPH , Department of Health and Human Services, Agency for Healthcare Research and Quality, Rockville, MD
We compared total (primary and non-primary) annual costs of care for Medicare beneficiaries receiving primary care in Federally-Funded Health-Centers (HCs) to those receiving care in physician offices and outpatient clinics.  We modeled separately total annual costs, annual primary care costs, and annual non-primary care costs as a function of patient characteristics (such as age, gender, race, Medicare eligibility, severity) and Primary Care Service Area (PCSA) fixed effects.  Inference was based on robust standard errors, and sensitivity analyses were conducted. Non-primary care costs included inpatient, emergency room, and specialty outpatient care costs.  Models were stratified by age (over and under 65). The sample included Part A and B claims for over 4 million Fee-For-Service Medicare beneficiaries from 14 states in 2009.  Costs increased with duration of insurance coverage, age, female gender, and illness severity, and differed by race. HC beneficiaries had total annual costs ($2370 for the median patient) that were 10% lower than those of physician office beneficiaries ($2,667), and 30 percent lower than those of outpatient clinic beneficiaries ($3,580).  This was due to lower non-primary care costs in HCs. Annual primary care costs were higher among beneficiaries receiving care in HCs compared to those seen in physician offices by 19 percent, and lower compared to those seen in outpatient clinics, by 23-25 percent. HCs might, therefore, offer a lower total cost alternative to CMS.  However, before policies encouraging beneficiaries to seek care in HCs are adopted, studies comparing the quality of care HCs provide should also be performed.

Learning Areas:

Biostatistics, economics
Provision of health care to the public
Public health or related public policy

Learning Objectives:
Describe the differences in Medicare costs between patients seen in federally funded health centers, physician offices and outpatient clinics. Discuss the policy implications for the Medicare program.

Keyword(s): Medicare, Policy/Policy Development

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: n/a

Qualified on the content I am responsible for because: I am a researcher in this topic area with over 20 years’ experience.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 5025.0: Medicare and Medicaid Policy