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Medicare fees and physicians’ medicare service volume: Beneficiaries treated and services per beneficiary

  • Jack Hadley
  • James D. Reschovsky
Article

Abstract

Using merged physician survey and Medicare claims data, this study analyzes how fee levels, market factors, and financial incentives affect physicians’ fee-for-service Medicare service volume. We find that Medicare fees are positively related to both the number of beneficiaries treated (η = 0.12 to 0.61) and service intensity (η = 1.04–1.71). Physicians with apparent incentives to induce demand appear to manipulate the mix of services provided in order to increase the effective Medicare fee. Finally, several market factors appear to influence the quantity of Medicare services physicians provide. Results highlight limitations of the present system for compensating physicians in Medicare’s fee-for-service program.

Keywords

Supply response Service intensity Market factors Demand inducement 

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References

  1. Bound, J., D. Jaeger, and R. Baker. (1995). “Problems with Instrumental Variables Estimation When the Correlation between the Instruments and the Endogenous Explanatory Variable Is Weak.” Journal of the American Statistical Association 90(430), 443–450.CrossRefGoogle Scholar
  2. Center for Studying Health System Change. (2003). “Community Tracking Study 2000–2001. Physician Survey Summary File: User’s Guide and Codebook.” Technical Publication No. 51. Washington DC: Center for Studying Health System Change.Google Scholar
  3. Centers for Medicare and Medicaid Services. (2001). “Claims and Utilization Data,” available online at http://www.cms.hhs.gov/data/durg/clmutil.pdf, accessed May 26.
  4. Christensen, S. (1992). “Volume Responses to Exogenous Changes in Medicare’s Payment Policies.” Health Services Research 27(1), 65–79.Google Scholar
  5. Escarce, J. (1993a). “Medicare Patients’ Use of Overpriced Procedures before and after the Omnibus Reconciliation Act of 1987.” American Journal of Public Health 83(3), 349–355.CrossRefGoogle Scholar
  6. Escarce, J. (1993b). “Effects of the Relative Fee Structure on the Use of Surgical Operations.” Health Services Research 28(4), 479–502.Google Scholar
  7. Fisher, E., D. Wennberg, T. Stukel, et al. (2003). “The Implications of Regional Variations in Medicare Spending. Part 1: The Content, Quality, and Accessibility of Care.” Annals of Internal Medicine 138(4), 273–287.Google Scholar
  8. Foote, S. B., R. Halpern, and D. Wholey. (2005). “Variation in Medicare’s Local Coverage Policies: Content Analysis of Local Medical Review Policies. ” American Journal of Managed Care 11(3), 181–187.Google Scholar
  9. GAO (Government Accountability Office). (2005). “Medicare Fee Schedule: Geographic Adjustment Indices Are Valid in Design, but Data and Methods Need Refinement.” Washington DC, Report No. GAO-05-119, March.Google Scholar
  10. Hackbarth, G. (2004). “Payment for Physicians’ Services in the Medicare Program. ” Testimony to the Subcommittee on Health, Committee on Energy and Commerce, U. S. House of Representatives. May 5.Google Scholar
  11. Hadley, J., J. Mandelblatt, J. Mitchell, J. Weeks, E. Guadagnoli, and Y. Hwang. (2003). “Medicare Breast Surgery Fees and Treatment Received by Older Women with Localized Breast Cancer.” Health Services Research 38(2), 553–574.CrossRefGoogle Scholar
  12. Hadley, J., J. Mitchell, and J. Mandelblatt. (2001). “Medicare Fees and Small Area Variations in Breast Conserving Surgery among Elderly Women.” Medical Care Research and Review 58(3), 334–360.Google Scholar
  13. HCFA (Health Care Financing Administration) Office of the Actuary. (1998). “Physician Volume and Intensity Response.” August 13. http://www.cms.hhs.gov/statistics/actuary/physicianresponse/.
  14. Holahan, J, and S. Zuckerman. (1993). “The Future of Medicare Volume Performance Standards.” Inquiry 30(4), 235–248.Google Scholar
  15. Hsiao, W., P. Braun, D. Dunn, and E. Becker. (1988). “Resource-Based Relative Values: An Overview.” Journal of the American Medical Association 260(16), 2347–2353.CrossRefGoogle Scholar
  16. Kuhn, H. (2005). “Letter to Glenn Hackbarth, Chair, Medicare Payment Advisory Commission.” Center for Medicare Management, Centers for Medicare and Medicaid Services, Dept. of Health and Human Services, March 31.Google Scholar
  17. McGuire, T. and M. Pauly. (1991). “Physician Response to Fee Changes with Multiple Payers.” Journal of Health Economics 10, 385–410.CrossRefGoogle Scholar
  18. MedPAC (Medicare Payment Advisory Commission). (2005a). “Physician Services.” Chapter 2B in Report to the Congress. March.Google Scholar
  19. MedPAC (Medicare Payment Advisory Commission). (2005b). “Physician Services.” Chapter 9 in Report to the Congress: Issues in a Modernized Medicare Program. June.Google Scholar
  20. MedPAC. (2004). “Purchasing Strategies.” Chapter 4 in Report to the Congress: New Approaches in Medicare. June.Google Scholar
  21. MedPAC. (2003a). “Growth and Variation in Use of Physician Services.” Chapter 4 in Report to the Congress: Variation and Innovation in Medicare. June.Google Scholar
  22. MedPAC. (2003b). “Geographic Practice Cost Indexes.” www.medpac.gov/publications/other_reports/Aug03_GPCI_2pgrKH.pdf.
  23. MedPAC (Medicare Payment Advisory Commission). (2001). Report to the Congress. March.Google Scholar
  24. Mitchell, J. and J. Cromwell. (1995). “Impact of Medicare Payment Reductions on Access to Surgical Services.” Health Services Research 30(5), 637–655.Google Scholar
  25. Mitchell, J., J. Hadley, and D. Gaskin. (2002). “Spillover Effects of Medicare Fee Reductions: Evidence from Ophthalmology.” International Journal of Health Care Finance and Economics 2(3), 171–188.CrossRefGoogle Scholar
  26. Mitchell, J., J. Hadley, and D. Gaskin. (2000). “Physicians’ Responses to Medicare Fee Schedule Reductions.” Medical Care 38(10), 1029–1039.CrossRefGoogle Scholar
  27. Mitchell J., J. Hadley, D. Sulmasy, and G. Bloche. (2000). “Measuring the Effects of Managed Care on Physicians’ Perceptions of Their Financial Incentives.” Inquiry 37, 134–45.Google Scholar
  28. Nguyen, N. and F. Derrick. (1997). “Physician Behavioral Response to a Medicare Price Reduction.” Health Services Research 32(3), 283–298.Google Scholar
  29. Reschovsky, J., J. Hadley and B. Landon. (2004). “The Effects of Compensation Methods and Practice Structure on Physicians’ Perceived Incentives to Reduce or Increase Services to Patients.” Unpublished manuscript, Washington DC: Center for Studying Health System Change.Google Scholar
  30. Rice, T. (1983). “The Impact of Changing Medicare Reimbursement Rates on Physician-Induced Demand.” Medical Care 21(8), 803–815.Google Scholar
  31. Rice, T. and N. McCall. (1982). “Changes in Medicare Reimbursement in Colorado: Impact on Physicians’ Economic Behavior.” Health Care Financing Review 3(4), 67–86.Google Scholar
  32. Staiger, D. and J. Stock. (1997). “Instrumental Variables Regression with Weak Instruments.” Econometica 65(3), 557–586.Google Scholar
  33. Super, N. (2003). “The Geography of Medicare: Explaining Differences in Payments and Costs.” National Health Policy Forum Issue Brief No. 792. July 3.Google Scholar
  34. Wennberg, J., E. Fisher, and J. Skinner. (2003). “Geography and the Debate over Medicare Reform.” Health Affairs Web Exclusive. May 29. (http://www.healthaffairs.org/WebExclusives/Wennberg_Web_Excl_021302.htm).
  35. Yip, W. (1998). “Physician Response to Medicare Fee Reductions: Changes in the Volume of coronary Artery Bypass Graft (CABG) Surgeries in the Medicare and Private Sectors.” Journal of Health Economics 17(6), 675–699.CrossRefGoogle Scholar
  36. Zuckerman, S., J. McFeeters, P. Cunningham, and L. Nichols. (2004). “Changes in Medicaid Physician Fees, 1998–2003.” Health Affairs Web Exclusive: W4-374-384. June 23.Google Scholar
  37. Zuckerman, S., S. Norton, and D. Virilli. (1998). “Price Controls and Medicare Spending: Assessing the Volume Offset Assumption.” Medical Care Research and Review 55(4), 457–478.Google Scholar

Copyright information

© Springer Science + Business Media, LLC 2006

Authors and Affiliations

  1. 1.The Urban Institute, and Senior FellowCenter for Studying Health System ChangeWashington DC
  2. 2.Center for Studying Health System ChangeWashington DC

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