Impact of Payment Methods on Service Delivery at Community Health Centers

支付方式对社区卫生服务中心服务提供的影响

• 批准号: 10665313
• 负责人: AVI DOR
• 金额: $ 5万
• 依托单位: GEORGE WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-03-01 至 2025-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10665313
• 关键词: Impact; Payment; Methods; Service; Delivery

Abstract Community health centers (CHCs) are important safety-net providers that provide comprehensive preventive and primary care to vulnerable populations in the United States, including Medicaid beneficiaries and the uninsured. CHCs are also notable for providing the spectrum of primary care services, i.e., medical, mental, and basic dental care within a single medical home. Our overall objective is to explore the impact of changes in Medicaid reimbursement rate structures on utilization and costs of providing these co-located services in CHCs, and on their financial position in general. To achieve this goal, we will first estimate regressions on pooled all-state data for 2011, 2014, and 2018, the years for all states reported rate setting information to the National Association of Community Health Centers (NAHCH), combined with the federal Uniform Data System (UDS), which encompasses all individual CHCs. Similarly, we will analyze a balanced panel for the subset of 21 states reporting rate-setting in the full longitudinal sample, years 2011-2019, yielding 3,868 center-year observations. In particular, we will evaluate effects of opting for the federal based PPS rates versus state variations known as APMs, and the effects of imposing a single bundled payment rate per visit, i.e., the “all- inclusive” rate, versus the bundled rates by services category (primary, mental, and dental care), known as the service-specific rates. Given that in both the PPS or APM regimes, states may opt for either the inclusive rate or service-specific methodologies, we will explore the interactions of these pairings of payment policies. We will then examine the policy effects in a pooling of all years, and test for validity of a balanced or unbalanced longitudinal design. In the panel data analysis, we will employ a fixed effect model, with CHC and year fixed effects that leverages variations of state policies between states and over time within states. Corresponding to Aim 1, for visits, we will explore volume in each service category separately, as well as the distribution (share) of services. Corresponding to Aims 2-3, we will explore unit-costs and financial margins respectively. We note that while the effects of Medicaid ACA expansions in the overlapping period are well documented in the earlier literature (generally increasing both volume and costs), remarkably little is known about the effects of variations in actual Medicaid payment methodologies for CHCs for these outcomes. Our study aims to fill this gap in both the health services research literature and policy literature. With that, we will use a novel study design to control the effects of the ACA Medicaid expansions to capture the separate effects of Medicaid payment approaches.

抽象的 社区卫生中心（CHC）是重要的安全网提供者，可提供全面的预防性 以及在美国的弱势群体的初级保健，包括医疗补助受益人和 没有保险。 CHC也值得注意的是提供多种初级保健服务，即医学，精神， 和一个医疗家中的基本牙科护理。我们的总体目标是探索变化的影响 医疗补助报销率结构有关利用率和成本提供这些共同确定服务的成本 CHC，总体上是其财务状况。为了实现这一目标，我们将首先估算回归 汇总了2011年，2014年和2018年的全州数据，所有州的年份报告了将信息设置为 全国社区卫生中心协会（NAHCH），结合了联邦统一数据系统 （UDS），其中包含所有单个CHC。同样，我们将分析平衡面板的子集 21个州在整个纵向样本（2011-2019年）中的报告率设定，产生了3,868个中心年度 观察。特别是，我们将评估选择基于联邦PPS率与州的效果 称为APM的变体，以及每次访问施加单一捆绑付款率的影响，即“ 包括“税率”，与服务类别（主要，精神和牙科护理）的捆绑费率相比，称为 特定于服务的费率。鉴于在PPS或APM制度中，各州都可以选择包含率 或特定于服务的方法，我们将探讨这些付款策略配对的交互。我们将 然后检查全年汇总的政策效果，并测试平衡或不平衡的有效性 纵向设计。在面板数据分析中，我们将使用CHC和固定年份采用固定效应模型 利用州与各州内随着时间的时间之间的国家政策变化的影响。对应于 AIM 1，对于访问，我们将分别探索每个服务类别中的数量，以及分布（共享） 服务。与目标2-3相对应，我们将分别探索单位成本和财务利润率。我们注意 尽管在重叠期间的医疗补助ACA扩展的影响已得到充分记录 文献（通常增加卷和成本），对变化的影响知之甚少 在这些结果的CHC的实际医疗补助付款方式中。我们的研究旨在填补这两个差距 卫生服务研究文献和政策文献。这样，我们将使用一种新颖的研究设计来 控制ACA医疗补助扩展的影响以捕获医疗补助支付的单独影响 方法。