The Medicaid Fee Bump: Increased Reimbursements to Primary Care Providers and Health Care Utilization Among Dual-Eligibles with Chronic Conditions

Project summary

The project team explored how the Medicaid primary care fee bump affected the health and costs for beneficiaries with chronic conditions who were covered by both Medicare and Medicaid. The team evaluated whether higher reimbursements to providers for primary care services led to better care and lower overall health care costs for this patient population.

Research Question(s)

  • Did the Medicaid primary care fee bump decrease ambulatory care sensitive admissions to hospitals and/or emergency department (ED) visits for dual-eligibles with chronic conditions?
  • Did the Medicaid primary care fee bump decrease the likelihood of readmission for hospitalized dual-eligibles with chronic conditions?
  • Did higher reimbursements to primary care providers resulting from the Medicaid fee bump decrease overall health care costs for dual-eligibles with chronic conditions?

Actionability

  • Inform policy-making decisions concerning Medicare reimbursement rates to primary care providers with evidence about whether higher reimbursements rates improve healthcare and lower costs for dual-eligibles compared to the broader Medicare population.

Outcomes

Health: Ambulatory care sensitive conditions (ACSC)-related hospitalizations, ACSC-related emergency department visits, and readmissions within 30 days.

Other: Total annual health care costs.

Methodology

This is a natural experiment created by the implementation of the Medicaid fee bump. A difference in differences (DD) approach will be used for estimation. The DD estimate is the adjusted difference in the outcome for dual-eligibles with chronic conditions before and after the Medicare fee bump minus the adjusted difference in the outcome for non-dually-eligible beneficiaries with chronic conditions before and after the fee bump. 


A stethoscope, money, and a calculator
Grantee and Partner organizations

Weill Cornell Medical College, Department of Healthcare Policy & Research

Grant status
Completed
Principal investigators
Hye-Young Jung, PhD
Mark Aaron Unruh, PhD
Start date
Award amount
$279,750
Duration
18 months

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