Mathematica Policy Research Washington

Mathematica Policy Research Washington

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Reschovsky J.D.,Mathematica Policy Research Washington | Saiontz-Martinez C.B.,Silver Spring Networks
Health Services Research | Year: 2017

Objective: To estimate the cost of defensive medicine among elderly Medicare patients. Data Sources: We use a 2008 national physician survey linked to respondents' elderly Medicare patients' claims data. Study Design: Using a sample of survey respondent/beneficiary dyads stratified by physician specialty, we estimated cross-sectional regressions of annual costs on patient covariates and a medical malpractice fear index formed from five validated physician survey questions. Defensive medicine costs were calculated as the difference between observed patient costs and those under hypothetical alternative levels of malpractice concern, and then aggregated to estimate average defensive medicine costs per beneficiary. Data Collection Methods: The physician survey was conducted by mail. Patient claims were linked to survey respondents and reweighted to approximate the elderly Medicare beneficiary population. Principal Findings: Higher levels of the malpractice fear index were associated with higher patient spending. Based on the measured associations, we estimated that defensive medicine accounted for 8 to 20 percent of total costs under alternative scenarios. The highest estimate is associated with a counterfactual of no malpractice concerns, which is unlikely to be socially optimal as some extrinsic incentives to avoid medical errors are desirable. Among specialty groups, primary care physicians contributed the most to defensive medicine spending. Higher costs resulted mostly from more hospital admissions and greater postacute care. Conclusions: Although results are based on measured associations between malpractice fears and spending, and may not reflect the true causal effects, they suggest defensive medicine likely contributes substantial additional costs to Medicare. © Health Research and Educational Trust.


Poznyak D.,Mathematica Policy Research Princeton | Peikes D.N.,Mathematica Policy Research Princeton | Wakar B.A.,Mathematica Policy Research Washington | Brown R.S.,Mathematica Policy Research Princeton | Reid R.J.,University of Toronto
Health Services Research | Year: 2017

Objective: To describe the modified Patient-Centered Medical Home Assessment (M-PCMH-A) survey module developed to track primary care practices' care delivery approaches over time, assess whether its underlying factor structure is reliable, and produce factor scores that provide a more reliable summary measure of the practice's care delivery than would a simple average of question responses. Data Sources/Study Setting: Survey data collected from diverse practices participating in the Comprehensive Primary Care (CPC) initiative in 2012 (n = 497) and 2014 (n = 493) and matched comparison practices in 2014 (n = 423). Study Design: Confirmatory factor analysis. Data Collection: Thirty-eight questions organized in six domains: Access and Continuity of Care, Planned Care for Chronic Conditions and Preventive Care, Risk-Stratified Care Management, Patient and Caregiver Engagement, Coordination of Care across the Medical Neighborhood, and Continuous Data-Driven Improvement. Principal Findings: Confirmatory factor analysis suggested using seven factors (splitting one domain into two), reassigning two questions to different domain factors, and removing one question, resulting in high reliability, construct validity, and stability in all but one factor. The seven factors together formed a single higher-order factor summary measure. Factor scores guard against potential biases from equal weighting. Conclusions: The M-PCMH-A can validly and reliably track primary care delivery across practices and over time using factors representing seven key components of care as well as an overall score. Researchers should calculate factor loadings for their specific data if possible, but average scores may be suitable if they cannot use factor analysis due to resource or sample constraints. © Health Research and Educational Trust.


Mitchell J.M.,Georgetown University | Reschovsky J.D.,Mathematica Policy Research Washington | Reicherter E.A.,University of Maryland Baltimore County
Health Services Research | Year: 2016

Objective: To examine whether the course of physical therapy treatments received by patients who undergo total knee replacement (TKR) surgery differs depending on whether the orthopedic surgeon has a financial stake in physical therapy services. Data: Sample of Medicare beneficiaries who underwent TKR surgery during the years 2007-2009. Study Design: We used regression analysis to evaluate the effect of physician self-referral on the following outcomes: (1) time from discharge to first physical therapy visit; (2) episode length; (3) number of physical therapy visits per episode; (4) number of physical therapy service units per episode; and (5) number of physical therapy services per episode expressed in relative value units. Principal Findings: TKR patients who underwent physical therapy treatment at a physician-owned clinic received on average twice as many physical therapy visits (8.3 more) than patients whose TKR surgery was performed by a orthopedic surgeon who did not self-refer physical therapy services (p < .001). Regression-adjusted results show that TKR patients treated at physician-owned clinics received almost nine fewer physical therapy service units during an episode compared with patients treated by nonself-referring providers (p < .001). In relative value units, this difference was 4 (p < .001). In contrast, episodes where the orthopedic surgeon owner does not profit from physical therapy services rendered to the patient look virtually identical to episodes where the TKR surgery was performed by a surgeon nonowner. Conclusions: Physical therapists not involved with physician-owned clinics saw patients for fewer visits, but the composition of physical therapy services rendered during each visit included more individualized therapeutic exercises. © Health Research and Educational Trust.

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