Primary care physicians' participation in the Medicare shared savings program and preventive services delivery: Evidence from the first 7 years

Huang Huang, Xi Zhu, George L Wehby, Huang Huang, Xi Zhu, George L Wehby

Abstract

Objective: To evaluate whether primary care physicians' participation in the Medicare Shared Savings Program (MSSP) is associated with changes in their preventive services delivery.

Data sources: Medicare Provider Utilization and Payment Physician and Other Supplier Public Use File and MSSP Accountable Care Organizations (ACO) Provider-Level Research Identifiable File from 2012 to 2018.

Study design: The design was a two-way fixed effects model estimating within-provider changes in preventive services delivery over time controlling for provider time-invariant characteristics, national time trends, and characteristics of served patients. The following preventive services were evaluated: influenza vaccination, pneumococcal vaccination, clinical depression screening, colorectal cancer screening, breast cancer screening, Body Mass Index (BMI) screening and follow-up, tobacco use assessment, and annual wellness visits. Both the likelihood of providing services and the volume of services delivered were evaluated.

Data collection/extraction methods: Secondary data linked at the provider level.

Principal findings: MSSP participation was associated with an increase in the likelihood of providing influenza vaccination (0.7 percentage-points), pneumococcal vaccination (2.0 percentage-points), clinical depression screening (2.1 percentage-points), tobacco use assessment (0.3 percentage-points), and annual wellness visits (4.1 percentage-points). A similar increase was found for the volume of services delivered per 100 patients for several preventive services: influenza vaccination (0.18), pneumococcal vaccination (0.56), clinical depression screening (0.46), and annual wellness visits (1.52). MSSP participation was associated with a decrease in the likelihood (-0.4 percentage-points) and the volume of colorectal cancer screening (-0.03).

Conclusions: Primary care physicians' participation in MSSP was associated with an increase in the likelihood and the volume of several preventive services.

Keywords: Medicare; Medicare shared savings program; accountable care organizations; health care delivery; preventive care.

Conflict of interest statement

The authors declare no conflict of interest.

© 2022 Health Research and Educational Trust.

Figures

FIGURE 1
FIGURE 1
PCP MSSP participation rate. MSSP, Medicare shared savings program; PCP, primary care physician
FIGURE 2
FIGURE 2
Regression estimates of the association of MSSP participation with likelihood of preventive services delivery by duration of MSSP participation. The independent variable and x‐axis are based on the number of years PCPs have participated in the MSSP. All models included year and provider fixed effects and controlled for patient average age, race/ethnicity and gender compositions, and a state‐level indicator of Medicaid expansion. Standard errors are clustered at the provider level. BMI, body mass index; MSSP, Medicare shared savings program; PCP, primary care physician
FIGURE 3
FIGURE 3
Regression estimates of the association of MSSP participation with volume of preventive services delivery by duration of MSSP participation. The independent variable and x‐axis are based on the number of years PCPs have participated in the MSSP. All models included year and provider fixed effects and controlled for patient average age, race/ethnicity and gender compositions, and a state‐level indicator of Medicaid expansion. Standard errors are clustered at the provider level. BMI, body mass index; MSSP, Medicare shared savings program; PCP, primary care physician

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Source: PubMed

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