Exhibit 1.
Association between Annual Wellness Visit exposure and screening, referrals, utilization, and spending in difference-in-differences analyses, 2008–10 versus 2015
SOURCE Authors’ beneficiary-level analysis of 20 percent Medicare claims data
| Outcome category |
Outcome | Yearly rate among beneficiaries in pre-AWV period, 2008–10 |
Difference-in-difference estimates, 2008–10 vs. 2015b |
|||
|---|---|---|---|---|---|---|
| Non- adopter prac- tices |
Adopter prac- tices |
Adjusted difference between adopter and non-adopter practices |
Not adjusted for pre- intervention trend, 95% CI |
Adjusted for pre- intervention trend, 95% CI |
||
| Appropriate screening | Mammography, % | 46.3 | 53.7 | 2.3 | 0.82c (0.37, 1.27) | 0.41 (−0.96, 1.79) |
| CRC screening, % | 12.9 | 14.3 | 1.4 | 0.14 (−0.23, 0.51) | 0.18 (−0.66, 1.01) | |
| Low-value screening | Pap smears, % | 9.8 | 11.0 | 0.61 | −0.61c (−0.80, 0.43) | −0.46 (−1.02, 0.11) |
| PSA testing, % | 46.8 | 46.9 | 2.5 | −1.41c (−2.00, 0.82) | 0.47 (−1.29, 2.24) | |
| CRC screening, % | 8.1 | 8.2 | 0.61 | −0.16 (−0.47, 0.16) | 0.54 (−0.57, 1.66) | |
| Neuropsychiatric and functional care | Specialist referral, % | 3.5 | 3.7 | 0.21 | 0.03 (−0.06, 0.11) | −0.03 (−0.31, 0.26) |
| PT/OT visits, rate per 100 beneficiary -years | 19.2 | 21.4 | 0.77 | 0.86c (0.51, 1.21) | 0.17 (−0.81, 1.15) | |
| Emergency Department visitsa | All, rate per 100 beneficiary-years | 77.7 | 70.1 | −1.3 | −2.07c (−2.92, −1.22) | 0.00 (−2.68, 2.68) |
| Ambulatory sensitive condition, rate per 100 beneficiary -years | 46.4 | 42.6 | −0.18 | −1.57c (−2.22, −0.92) | −0.38 (−2.12, 1.36) | |
| Hospitalizationsa | All, rate per 100 beneficiary-years | 41.7 | 37.7 | −1.07 | −0.30 (−0.74, 0.14) | 0.89 (−0.51, 2.28) |
| Ambulatory sensitive condition, rate per 100 beneficiary -years | 36.7 | 33.0 | −1.0 | 0.0 (−0.38, 0.39) | 1.07 (−0.26, 2.40) | |
| Spending | Total, per beneficiary, $ | 10,262.0 | 9,140.6 | −192.9 | −58.14 (−159.00, 42.72) | 290.84 (19.80, 561.88) |
NOTES CRC is colorectal cancer; Pap is Papanicolaou. PSA is prostate specific antigen. Specialist refers to physicians with specialty in neurology or psychiatry. PT is physical therapy. OT is occupational therapy.
Emergency Department visits and hospitalizations were examined from January 1-September 30 of each year to allow consistent use of ICD-9 codes for these measures (transition to ICD-10 coding October 1, 2015).
Both models controlled for beneficiary characteristics (age, sex, race, dual enrollment in Medicaid, Hierarchical Condition Category score), practice characteristics (geographic setting, hospital-based vs independent site, specialty mix, size, number of attributed Medicare beneficiaries), geography at the level of hospital referral region (HRR), and the interaction between beneficiary characteristics and year and between HRR and year. The model adjusted for pre-intervention trend also included a term for AWV adoption interacted with a continuous year variable.