To examine trends in the utilization and cost of eye care in the Medicare population. Methods: Data were obtained from fee-for-service physician claims (Part B) from a 5% sample of Medicare beneficiaries 65 years and older. Use of eye care services and procedures, frequency of ocular diagnoses, and allowed charges were compared for each year from 1991 through 1998. Results: The proportion of beneficiaries receiving eye care increased from 41.4% to 48.1% during the 8-year period. Part B charges attributable to eye care decreased from 12.5% to 10.4%, with annual inflation-adjusted charges per beneficiary decreasing from $235 to $176 (1998 dollars). The proportion of beneficiaries with cataract related claims increased from 23.4% to 27.3%, accounting for approximately 60% of eye care charges each year; beneficiaries with retinal disease claims increased from 7.8% to 11.4%, capturing 15.4% of eye care charges in 1998, up from 10.7% in 1991; and beneficiaries with glaucoma claims increased from 6.8% to 9.5%, accounting for nearly 10% of eye care charges each year. Conclusions: The proportion of the Medicare population receiving eye care increased between 1991 and 1998. Nevertheless, eye care costs did not increase, primarily because of constraints in charges associated with the management of cataract.

Insured enrollees with MS are two to three times more expensive than average insured enrollees. If the premiums that employers or governments pay health insurers and the capitation amounts that insurers pay health care providers do not account for these higher costs, a disincentive is created for the enrollment and care of persons with MS.

Despite having similar Medicare health insurance coverage, elderly utilization and IHD mortality rates differ markedly not only between whites and minorities, but within minority groups themselves. A large, nationally representative survey of physicians and patients is needed to distinguish between systemwide "failures to refer" and patient "aversions to surgery" as explanations for lower black rates of surgical interventions.

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Research Objective Identifying characteristics of beneficiaries, primary care physicians, and primary care practice sites that predict highly fragmented ambulatory care (that is, care spread across multiple providers without a dominant provider) is essential to develop effective interventions targeted at reducing fragmentation. High care fragmentation is associated with unnecessary procedures and testing, increased emergency department visits and hospitalizations, and increased medical costs. Study Design This study was conducted in the context of the Comprehensive Primary Care Plus Model (CPC+), a large primary care redesign initiative. We used Medicare claims data from January through December 2018 on Medicare fee‐for‐service (FFS) beneficiaries attributed to primary care practice sites participating in CPC+ and to comparison practices that were similar at baseline. We used hierarchical linear models to predict the likelihood of a beneficiary receiving highly fragmented care, defined as having a fragmentation score (measured by the reversed Bice‐Boxerman Index) ≥ 0.85. We used an extensive set of explanatory variables at each level (74 total variables) and group‐level random intercepts to understand how characteristics at each level help explain variation in fragmentation. We estimated separate models for the two CPC+ transformation/payment tracks. Population Studied 3,541,136 Medicare FFS beneficiaries attributed to 26,344 primary care physicians in 9300 primary care practice sites. Principal Findings The three sets of explanatory variables (beneficiary, physician, and practice site) together only explained about 5 percent of the variation in the likelihood of high care fragmentation. Unobserved differences between primary care physicians and between primary care practice sites together accounted for only 4 percent of the variation. Instead, more than 91 percent of the variation in fragmentation consisted of unobserved residual variance. We identified several characteristics of beneficiaries (age, reason for original Medicare entitlement, and dual status), physicians (gender and measures of comprehensiveness of care), and practice sites (size, being part of a system/hospital, and census region) that had small associations with high fragmentation. Findings were similar by track. Conclusions Although we identified a number of characteristics that predict high care fragmentation, most of the variation in fragmentation was not explained by observed beneficiary, primary care physician, or primary care practice characteristics. This suggests other providers and beneficiaries' preferences may be important factors. Implications for Policy or Practice Our findings show that primary care physician and practice site characteristics explain only a small share of variation in care fragmentation. Behaviors of other health care providers not captured by regional controls, as well as unmeasured patient preferences, are likely to be important predictors of high care fragmentation. One implication of these findings is that inte...