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Comparing the Cost of Caring for Medicare Beneficiaries in Federally Funded Health Centers to Other Care Settings
Author(s) -
Mukamel Dana B.,
White Laura M.,
Nocon Robert S.,
Huang Elbert S.,
Sharma Ravi,
Shi Leiyu,
NgoMetzger Quyen
Publication year - 2016
Publication title -
health services research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.706
H-Index - 121
eISSN - 1475-6773
pISSN - 0017-9124
DOI - 10.1111/1475-6773.12339
Subject(s) - medicaid , medicine , specialty , family medicine , medicare part b , health care , primary care , total cost , outpatient visits , medline , emergency medicine , business , payment , finance , accounting , economics , economic growth , political science , law
Objective To compare total annual costs for Medicare beneficiaries receiving primary care in federally funded health centers ( HC s) to Medicare beneficiaries in physician offices and outpatient clinics. Data Sources/Study Settings Part A and B fee‐for‐service Medicare claims from 14 geographically diverse states. The sample was restricted to beneficiaries residing within primary care service areas ( PCSA s) with at least one HC . Study Design We modeled separately total annual costs, annual primary care costs, and annual nonprimary care costs as a function of patient characteristics and PCSA fixed effects. Data Collection Data were obtained from the Centers for Medicare & Medicaid Services. Principal Findings Total median annual costs (at $2,370) for HC Medicare patients were lower by 10 percent compared to patients in physician offices ($2,667) and by 30 percent compared to patients in outpatient clinics ($3,580). This was due to lower nonprimary care costs in HC s, despite higher primary care costs. Conclusions HC s may offer lower total cost practice style to the Centers for Medicare & Medicaid Services, which administers Medicare. Future research should examine whether these lower costs reflect better management by HC practitioners or more limited access to specialty care by HC patients.