Medicare and mental health coverage: An analysis of how current Medicare policy encumbers the Medicare-insured

Fullen, Matthew C.; Jordan, Justin; Sharma, Jyotsana; Wiley, Jonathan D.; Lawson, Gerard

doi:10.1080/2326716x.2019.1677531

Cited by 2 publications

(2 citation statements)

References 18 publications

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“…Medicare provides health care coverage for over 60 million Americans, 52 million of whom are 65 years of age and older, with the number of Medicare beneficiaries predicted to reach 80 million by 2030. 1 Rising health care spending, combined with an increasingly aging population, has led to concerns about fiscal sustainability and has made Medicare a target of reform. 2 In April 2014, following an executive order to increase transparency regarding the allocation of federal funds to Medicare through an open data policy, the Centers for Medicare & Medicaid Services (CMS) released detailed billing information for over 880,000 health care professionals who provided for Medicare beneficiaries in 2012, including nearly 10 million records representing more than $77 billion in payments.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Comprehensive analysis of trends in Medicare utilization and reimbursement in Physical Medicine & Rehabilitation: 2012 to 2017

Han

Carayannopoulos

2021

PM&R

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Introduction There is an absence of literature describing Medicare utilization by physiatrists, despite their key role in treating Medicare enrollees with qualifying disabilities and common neuromusculoskeletal conditions. Objective To analyze Medicare data regarding physiatrists and their beneficiaries, services, and reimbursement, as well as trends in utilization and geographic distribution. Design and Setting Retrospective analysis of publicly available Centers for Medicare & Medicaid Services data for Medicare beneficiaries receiving physiatric services from 2012 to 2017. Main Outcome Measures After adjustment for inflation, variables assessed for changes over time included provider and beneficiary demographics, total Medicare reimbursement, and the number of services provided, subsequently separated by drug and medical service metrics. Lorenz curves and Gini coefficients were computed to study reimbursement inequality. Choropleth maps were generated to assess geographic differences in physician density and reimbursement, both by state and ZIP code. Results The number of physiatrists utilizing Medicare increased from 7230 to 7895 from 2012 to 2017, whereas the average number of unique beneficiaries per clinician remained constant (307 vs. 310; p = .51). The beneficiaries' mean hierarchical conditions category (HCC) health risk score, normalized to 1.0 for the average beneficiary, increased significantly from 2012 to 2017 (1.72 vs. 1.80; p < .01). The mean Medicare reimbursement per physiatrist decreased significantly from 2012 to 2017 ($131,960 vs. $117,623; p < .001), whereas the mean number of services remained constant (3243 vs. 3077; p = .132). Botulinum toxin and baclofen injections were the two most reimbursed drug‐related services. Gini coefficients ranged from 0.52 to 0.53 for 2012 to 2017, suggesting moderate reimbursement inequality, with the 75th percentile receiving on average two times the median. Both physician density and top earners were concentrated in urban and metropolitan areas. Conclusions Despite rising health care costs and the increasing medical complexity of physiatrists' beneficiaries, Medicare payments have decreased over time. These trends are relevant to both providers and policymakers, particularly in light of unequal geographic distribution of physiatrists across the country.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comprehensive analysis of trends in Medicare utilization and reimbursement in Physical Medicine & Rehabilitation: 2012 to 2017

Han

Carayannopoulos

2021

PM&R

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“Heartbreaking” Referrals, Professional “Disgrace”: The Impact of Medicare Ineligibility on the Counseling Profession

et al. 2020

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To better understand the impact of the Medicare mental health coverage gap, the authors analyzed survey data provided by 1,859 members of the American Counseling Association using a conventional qualitative content analysis. One overarching theme, direct impact of Medicare policy on the counseling profession, is presented, along with 3 thematic categories: emotional impact on providers, economic toll on providers, and negative influence on profession's credibility. Implications for the counseling profession are discussed.

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Medicare and mental health coverage: An analysis of how current Medicare policy encumbers the Medicare-insured

Cited by 2 publications

References 18 publications

Comprehensive analysis of trends in Medicare utilization and reimbursement in Physical Medicine & Rehabilitation: 2012 to 2017

Comprehensive analysis of trends in Medicare utilization and reimbursement in Physical Medicine & Rehabilitation: 2012 to 2017

“Heartbreaking” Referrals, Professional “Disgrace”: The Impact of Medicare Ineligibility on the Counseling Profession

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