Financial Incentives and Variations in the Care of Medicare Beneficiaries

Summary

Principal Investigator: BRUCE E contact LANDON
Abstract: DESCRIPTION (provided by applicant): The care of 40 million Medicare beneficiaries may be changed significantly in upcoming years as a result of the Medicare Modernization Act of 2003 (MMA). As Medicare moves to improve both the efficiency and quality of care physicians provide to Medicare beneficiaries in the fee-for-service (FFS) program, modifying financial incentives aimed at physicians will be one of Medicare's most important policy levers. Until recently, Medicare's tool bag for manipulating financial incentives was limited. The Centers for Medicare and Medicaid Services (CMS) is now exploring additional financial incentives to encourage more cost effective and higher quality care. In order to guide the development of these policies, it is critical to have a more general understanding of the components of a physician's practice pattern that are most influenced by Financial incentives. With regard to financial incentives, there is a growing knowledge base about how practices of physicians have changed over the past two decades (e.g., more large group practices) and how different types of financial arrangements are structured between physician groups and insurers or health plans. Much less, however, is known about the ways individuals are compensated or the effect of these alternative arrangements on cost or quality. Without this basic knowledge to use as a building block, experiments with individual financial incentives might have unintended consequences. The results from this study will inform the policy debates that occur for traditional fee-for-service Medicare beneficiaries, particularly with regards to the implementation of pay for performance and other similar programs that rely on incentives. The proposed study seeks to take advantage of the largest and most timely national survey of physicians, the Community Tracking Study physician survey. The study will build upon new data that are being collected from ~7,000 direct patient care physicians for the fourth round of the survey. These data will then be linked with data from the Centers for Medicaid and Medicare Services on the care delivered to Medicare beneficiaries being cared for by these physicians over a three year period to create an unparalleled data set for addressing several issues related to payment and cost/quality for Medicare beneficiaries. The overall goal of this research is to assess empirically the impact of physician financial incentives on the costs/efficiency and quality of care for Medicare patients treated between 2004 and 2006. Because patients will be clustered within physicians and physicians clustered within markets, we will use hierarchical analytic methods.
Funding Period: ----------------2007 - ---------------2011-
more information: NIH RePORT

Top Publications

  1. pmc Supplemental coverage associated with more rapid spending growth for Medicare beneficiaries
    Ezra Golberstein
    Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
    Health Aff (Millwood) 32:873-81. 2013
  2. ncbi Geographic variation in fee-for-service medicare beneficiaries' medical costs is largely explained by disease burden
    James D Reschovsky
    1Center for Studying Health System Change, Washington, DC, USA
    Med Care Res Rev 70:542-63. 2013
  3. pmc Geographic variations in the cost of treating condition-specific episodes of care among Medicare patients
    James D Reschovsky
    Center for Studying Health System Change, Washington, DC
    Health Serv Res 49:32-51. 2014
  4. pmc Rapidity and modality of imaging for acute low back pain in elderly patients
    Hoangmai H Pham
    Center for Studying Health System Change, 600 Maryland Ave SW, Ste 550, Washington, DC 20024, USA
    Arch Intern Med 169:972-81. 2009
  5. pmc Following the money: factors associated with the cost of treating high-cost Medicare beneficiaries
    James D Reschovsky
    Center for Studying Health System Change, 600 Maryland Avenue SW, Washington, DC 20024, USA
    Health Serv Res 46:997-1021. 2011
  6. pmc The relationship between physician compensation strategies and the intensity of care delivered to Medicare beneficiaries
    Bruce E Landon
    Department of Health Care Policy, Harvard Medical School and the Division of General Medicine, 180 Longwood Avenue, Boston, MA 02115, USA
    Health Serv Res 46:1863-82. 2011

Scientific Experts

  • BRUCE E contact LANDON
  • Hoangmai H Pham
  • James D Reschovsky
  • Jack Hadley
  • Ezra Golberstein
  • A James O'Malley
  • Kayo Walsh
  • Michael E Chernew
  • Patrick S Romano
  • Yulei He
  • Ellyn R Boukus
  • Cynthia B Saiontz-Martinez

Detail Information

Publications7

  1. pmc Supplemental coverage associated with more rapid spending growth for Medicare beneficiaries
    Ezra Golberstein
    Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
    Health Aff (Millwood) 32:873-81. 2013
    ..Our results are consistent with the belief that current trends away from generous employer-sponsored supplemental coverage and efforts to restrict the generosity of supplemental coverage may slow spending growth...
  2. ncbi Geographic variation in fee-for-service medicare beneficiaries' medical costs is largely explained by disease burden
    James D Reschovsky
    1Center for Studying Health System Change, Washington, DC, USA
    Med Care Res Rev 70:542-63. 2013
    ..Diagnosis-based approaches are more appropriate when current rather than prior year diagnoses are used. Population health likely explains more than 75% to 85% of cost variations across fixed sets of areas...
  3. pmc Geographic variations in the cost of treating condition-specific episodes of care among Medicare patients
    James D Reschovsky
    Center for Studying Health System Change, Washington, DC
    Health Serv Res 49:32-51. 2014
    ....
  4. pmc Rapidity and modality of imaging for acute low back pain in elderly patients
    Hoangmai H Pham
    Center for Studying Health System Change, 600 Maryland Ave SW, Ste 550, Washington, DC 20024, USA
    Arch Intern Med 169:972-81. 2009
    ..Most quality metrics focus on underuse of services, leaving unclear what factors are associated with potential overuse...
  5. pmc Following the money: factors associated with the cost of treating high-cost Medicare beneficiaries
    James D Reschovsky
    Center for Studying Health System Change, 600 Maryland Avenue SW, Washington, DC 20024, USA
    Health Serv Res 46:997-1021. 2011
    ..To identify factors associated with the cost of treating high-cost Medicare beneficiaries...
  6. pmc The relationship between physician compensation strategies and the intensity of care delivered to Medicare beneficiaries
    Bruce E Landon
    Department of Health Care Policy, Harvard Medical School and the Division of General Medicine, 180 Longwood Avenue, Boston, MA 02115, USA
    Health Serv Res 46:1863-82. 2011
    ..To examine the relationship between primary care physicians' (PCPs) payment arrangements and the total costs and intensity of care for specific episodes of care for Medicare beneficiaries...