大象APP

U.S. flag

SHARE:

FacebookXEmail AHRQPrint

Search All Research Studies

 

大象APPResearch Studies Date

Topics

大象APPResearch Studies

Sign up:

Research Studies is a compilation of published research articles funded by 大象APPor authored by 大象APPresearchers.

Results

1 to 3 of 3 Research Studies Displayed
Mulcahy JF, Patel SY, Mehrotra A
Quantifying indirect billing within the Medicare physician fee schedule.
This cohort study鈥檚 goal was to quantify indirect billing within the Medicare physician fee schedule. Under certain circumstances advance practice clinicians (APCs) such as physician assistants and nurse practitioners can bill Medicare directly or indirectly. Indirect billing means the submitted claim states the care was provided by the physician, and the reimbursement is higher. The authors looked at Medicare fee-for-service and Medicare Advantage claims data to identify indirectly billed APC services. Office-based Medicare Part B claims were linked to Part D claims for prescription drug fills. The number of indirect billings for office encounters provided by an APC in 2022 was 38.9%. For all median physician visits in 2022, indirect billing on behalf of APCs represented 11.1% of all billed encounters. APC billing was most common among surgical specialists (29.7% of all encounters) and least common for primary care physicians (3.9%). The authors found that if all indirectly billed APC-provided care was billed directly by the APC, Medicare would have saved $270 million in 2022.
AHRQ-funded; HS028490.
Citation: Mulcahy JF, Patel SY, Mehrotra A . Quantifying indirect billing within the Medicare physician fee schedule. JAMA Health Forum 2025 Apr 4; 6(4):e250433. doi: 10.1001/jamahealthforum.2025.0433.
Keywords: Medicare, Payment
Ianni K, Chen A, Rodrigues D
Transporting difference-in-differences estimates to assess health equity impacts of payment and delivery models.
This simulation study鈥檚 objective was to transport the effects of the Comprehensive Primary Care Plus (CPC+) model to a target population of Black fee-for-service (FFS) Medicare beneficiaries living outside the original 18 CPC+ regions. Main outcome variable was total Medicare spending per beneficiary per year (pbpy). The authors simulated practice-level spending in 18 CPC+ regions and 32 non-CPC+ regions (1200 practices per region). They calibrated the parameters from the literature and then varied four key parameters to create 16 realistic simulation scenarios. Across the 16 simulation scenarios, transporting the treatment effect regions yielded median treatment effects that ranged from $15.5 pbpy smaller to $10 pbpy larger than in the sample. These differences turned out to be roughly the same magnitude as the estimated overall effect of $13 pbpy.
AHRQ-funded; HS028985.
Citation: Ianni K, Chen A, Rodrigues D . Transporting difference-in-differences estimates to assess health equity impacts of payment and delivery models. Health Serv Res 2025 Apr; 60(suppl 2):e14419. doi: 10.1111/1475-6773.14419.
Keywords: Primary Care, Payment, Medicare, Healthcare Costs, Simulation
Potluri VS, Reddy YNV, Tummalapalli SL
Early effects of the end-stage renal disease treatment choices model on kidney transplant waitlist additions.
This study examined the effect of End-Stage Renal Disease Treatment Choices (ETC) payment adjustments on U.S. kidney transplant waitlist additions. Researchers used data from the Organ Procurement and Transplantation Network registry to analyze waitlisting trends. The ETC Model was not found to be associated with significant changes in new waitlist additions.
AHRQ-funded; HS026372; HS028684.
Citation: Potluri VS, Reddy YNV, Tummalapalli SL . Early effects of the end-stage renal disease treatment choices model on kidney transplant waitlist additions. Clin J Am Soc Nephrol 2025 Jan; 20(1):124-35. doi: 10.2215/cjn.0000000000000571.
Keywords: Kidney Disease and Health, Transplantation, Payment

Related Content

Research Findings & Reports