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. 1995 Dec;30(5):637–655.

Impact of Medicare payment reductions on access to surgical services.

J B Mitchell 1, J Cromwell 1
PMCID: PMC1070082  PMID: 8537224

Abstract

OBJECTIVE. This study evaluates the impact of surgical fee reductions under Medicare on the utilization of surgical services. DATA SOURCES. Medicare physician claims data were obtained from 11 states for a five-year time period (1985-1989). STUDY DESIGN. Under OBRA-87, Medicare reduced payments for 11 surgical procedures. A fixed effects regression method was used to determine the impact of these payment reductions on access to care for potentially vulnerable Medicare beneficiaries: joint Medicaid-eligibles, blacks, and the very old. DATA COLLECTION/EXTRACTION METHODS. Medicare claims and enrollment data were used to construct a cross-section time-series of population-based surgical rates from 1985 through 1989. PRINCIPAL FINDINGS. Reductions in surgical fees led to small but significant increases in use for three procedures, small decreases in use for two procedures, and no impact on the remaining six procedures. There was little evidence that access to surgery was impaired for potentially vulnerable enrollees; in fact, declining fees often led to greater rates of increases for some subgroups. CONCLUSIONS. Our results suggest that volume responses by surgeons to payment changes under the Medicare Fee Schedule may be smaller than HCFA's original estimates. Nevertheless, both access and quality of care should continue to be closely monitored.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Boutwell R. C., Mitchell J. B. Diffusion of new technologies in the treatment of the Medicare population. Implications for patient access and program expenditures. Int J Technol Assess Health Care. 1993 Winter;9(1):62–75. doi: 10.1017/s0266462300003032. [DOI] [PubMed] [Google Scholar]
  2. Christensen S. Volume responses to exogenous changes in Medicare's payment policies. Health Serv Res. 1992 Apr;27(1):65–79. [PMC free article] [PubMed] [Google Scholar]
  3. Escarce J. J. Effects of lower surgical fees on the use of physician services under Medicare. JAMA. 1993 May 19;269(19):2513–2518. [PubMed] [Google Scholar]
  4. Ford E., Cooper R., Castaner A., Simmons B., Mar M. Coronary arteriography and coronary bypass survey among whites and other racial groups relative to hospital-based incidence rates for coronary artery disease: findings from NHDS. Am J Public Health. 1989 Apr;79(4):437–440. doi: 10.2105/ajph.79.4.437. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Gabel J. R., Rice T. H. Reducing public expenditures for physician services: the price of paying less. J Health Polit Policy Law. 1985 Winter;9(4):595–609. doi: 10.1215/03616878-9-4-595. [DOI] [PubMed] [Google Scholar]
  6. Garfinkel S. A., Bonito A. J., McLeroy K. R. Socioeconomic factors and Medicare supplemental health insurance. Health Care Financ Rev. 1987 Fall;9(1):21–30. [PMC free article] [PubMed] [Google Scholar]
  7. Hsiao W. C., Braun P., Dunn D., Becker E. R., DeNicola M., Ketcham T. R. Results and policy implications of the resource-based relative-value study. N Engl J Med. 1988 Sep 29;319(13):881–888. doi: 10.1056/NEJM198809293191330. [DOI] [PubMed] [Google Scholar]
  8. Levy J. M., Borowitz M. J., Jencks S. F., Kay T. L., Williams D. K. Impact of the Medicare fee schedule on payments to physicians. JAMA. 1990 Aug 8;264(6):717–722. [PubMed] [Google Scholar]
  9. Long S. H., Settle R. F., Link C. R. Who bears the burden of Medicare cost sharings? Inquiry. 1982 Fall;19(3):222–234. [PubMed] [Google Scholar]
  10. McGuire T. G., Pauly M. V. Physician response to fee changes with multiple payers. J Health Econ. 1991;10(4):385–410. doi: 10.1016/0167-6296(91)90022-f. [DOI] [PubMed] [Google Scholar]
  11. Mitchell J. B., Cromwell J. Physician behavior under the Medicare assignment option. J Health Econ. 1982 Dec;1(3):245–264. doi: 10.1016/0167-6296(82)90003-0. [DOI] [PubMed] [Google Scholar]
  12. Mitchell J. B., Wedig G., Cromwell J. The Medicare physician fee freeze: what really happened? Health Aff (Millwood) 1989 Spring;8(1):21–33. doi: 10.1377/hlthaff.8.1.21. [DOI] [PubMed] [Google Scholar]
  13. Wenneker M. B., Epstein A. M. Racial inequalities in the use of procedures for patients with ischemic heart disease in Massachusetts. JAMA. 1989 Jan 13;261(2):253–257. [PubMed] [Google Scholar]
  14. Winslow C. M., Kosecoff J. B., Chassin M., Kanouse D. E., Brook R. H. The appropriateness of performing coronary artery bypass surgery. JAMA. 1988 Jul 22;260(4):505–509. [PubMed] [Google Scholar]

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