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- Title
PQRS Participation, Inappropriate Utilization of Health Care Services, and Medicare Expenditures.
- Authors
Dowd, Bryan E.; Swenson, Tami; Parashuram, Shriram; Coulam, Robert; Kane, Robert
- Abstract
Medicare's Physician Quality Reporting System (PQRS) is the largest quality-reporting system in the U.S. health care system and a basis for the new value-based modifier system for physician payment. The PQRS allows health care providers to report measures of quality of care that include both the process of care and physiological outcomes. Using a multivariate difference-in-differences model, we examine the relationship of PQRS participation to three claims-computable measures of inappropriate utilization of health care services and risk-adjusted per capita Medicare expenditures. The data are a national random sample of PQRS-participating providers matched to nonparticipating providers by zip code and caseload. We found few significant relationships in the overall analysis. However, the magnitude and statistical significance of the desirable associations increased in subgroups of providers and beneficiaries more prone to overutilization (e.g., males, older beneficiaries, beneficiaries treated in larger medical practices or by nonphysicians, and practices in rural areas), and among beneficiaries with heart conditions, diabetes, and eye problems.
- Subjects
UNITED States; MEDICAL quality control; MEDICAL care costs; MEDICAL informatics; MEDICAL care use; INFORMATION prescriptions; MEDICAL practice; MEDICAL economics; ECONOMIC impact; PATIENT Protection &; Affordable Care Act -- Economic aspects; AGE distribution; COMPARATIVE studies; MATHEMATICAL models; RESEARCH methodology; MEDICAL care; MEDICAL cooperation; MEDICARE; PHYSICIANS; RESEARCH; SEX distribution; THEORY; EVALUATION research; PATIENT Protection &; Affordable Care Act; ECONOMICS
- Publication
Medical Care Research & Review, 2016, Vol 73, Issue 1, p106
- ISSN
1077-5587
- Publication type
journal article
- DOI
10.1177/1077558715597846