G2TT
来源类型Research Reports
规范类型报告
DOIhttps://doi.org/10.7249/RR1802
来源IDRR-1802-ASPEC
Examining the Implementation of the Medicaid Primary Care Payment Increase
Justin W. Timbie; Christine Buttorff; Virginia Kotzias; Spencer R. Case; Ammarah Mahmud
发表日期2017
出版年2017
页码72
语种英语
结论

High Provider Participation Rates in Medicaid Pre-Implementation

  • For most states, primary care provider participation was generally viewed as high preceding the policy.
  • Providers who decline to participate in the Medicaid program tend to do so because of low reimbursement rates, administrative difficulties, and challenges associated with caring for Medicaid patients.

Implementation Complicated by Limited Time Line

  • States did not receive final guidance until two months before the policy was supposed to begin and additional clarification was required subsequently. This delayed states' ability to provide attestation guidance to providers, which, in turn, delayed states' and MCOs' efforts to configure claims-processing systems and initiate payments.

Implementation Challenges Posed by Provider Eligibility Criteria and Attestation Processes

  • A large number of physicians who met the eligibility criteria viewed themselves as specialists rather than primary care physicians.
  • Several respondents suggested that the eligibility criteria failed to reflect the way primary care was delivered in many states — particularly by excluding advanced practice nurses.

No Formal Evaluations Conducted by State-Level Stakeholders; Perception of Limited Impact

  • Most respondents indicated that the policy had, at best, a modest impact on incentivizing higher rates of provider participation.
  • Respondents in most states noted that increased payments over a span of only two years did not provide a potent incentive for physicians to make investments needed to expand their participation in Medicaid.

Patients and Providers Realized Benefits

  • Most respondents suggested that the program was beneficial and helped keep Medicaid providers "afloat" for the duration of the policy.
摘要
  • Additional lead time would help states to ensure that policies and procedures critical to program function are in place before launch and reduce the need to retool or revise midstream.
  • Clearer eligibility requirements could ensure a rapid start to the program.
  • Given the complexities of the policymaking and implementation environment, clear, bidirectional communication with key stakeholders is important to ensure a smooth implementation process.
  • By performing targeted outreach to stakeholders who fall outside of existing communication channels or stakeholder groups (e.g., primary care providers not currently enrolled in Medicaid), states may be able to expand program participation.
  • Web-based attestation forms that are securely and centrally collected could reduce administrative burdens on providers.
  • The need to make payments retroactively or to recoup monies that were improperly disbursed and the protracted period over which providers were able to attest, places a large burden on the state, MCOs, and providers. Properly sequencing eligibility determinations and the initiation of enhanced payments and ensuring that they align with a policy's start date would substantially lower the burden on all stakeholders.
  • Many respondents urged CMS to allow for more flexibility in implementing similar payment policies that better reflect the primary care delivery system in the state and that are complementary with other ongoing payment and delivery reforms.
  • Respondents reported that health care providers would have been more inclined to make investments to expand their participation in Medicaid had the federal government provided full funding for a period longer than two years.
主题Affordable Care Act ; Health Care Access ; Health Care Costs ; Health Care Program Evaluation ; Medicaid ; Primary Care
URLhttps://www.rand.org/pubs/research_reports/RR1802.html
来源智库RAND Corporation (United States)
引用统计
资源类型智库出版物
条目标识符http://119.78.100.153/handle/2XGU8XDN/108481
推荐引用方式
GB/T 7714
Justin W. Timbie,Christine Buttorff,Virginia Kotzias,et al. Examining the Implementation of the Medicaid Primary Care Payment Increase. 2017.
条目包含的文件
文件名称/大小 资源类型 版本类型 开放类型 使用许可
x1495316258322.jpg(3KB)智库出版物 限制开放CC BY-NC-SA浏览
RAND_RR1802.pdf(1040KB)智库出版物 限制开放CC BY-NC-SA浏览
个性服务
推荐该条目
保存到收藏夹
导出为Endnote文件
谷歌学术
谷歌学术中相似的文章
[Justin W. Timbie]的文章
[Christine Buttorff]的文章
[Virginia Kotzias]的文章
百度学术
百度学术中相似的文章
[Justin W. Timbie]的文章
[Christine Buttorff]的文章
[Virginia Kotzias]的文章
必应学术
必应学术中相似的文章
[Justin W. Timbie]的文章
[Christine Buttorff]的文章
[Virginia Kotzias]的文章
相关权益政策
暂无数据
收藏/分享
文件名: x1495316258322.jpg
格式: JPEG
文件名: RAND_RR1802.pdf
格式: Adobe PDF

除非特别说明,本系统中所有内容都受版权保护,并保留所有权利。