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Medicare modernization and diffusion of endoscopy in FFS medicare

OBJECTIVE: To examine how FFS Medicare utilization of endoscopy procedures for colorectal cancer (CRC) screening changed after implementation of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) in 2006, which provided subsidized drug coverage and expanded the geographic avail...

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Autores principales: Mobley, Lee R., Amaral, Pedro, Kuo, Tzy-Mey, Zhou, Mei, Bose, Srimoyee
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5344871/
https://www.ncbi.nlm.nih.gov/pubmed/28281245
http://dx.doi.org/10.1186/s13561-017-0147-5
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author Mobley, Lee R.
Amaral, Pedro
Kuo, Tzy-Mey
Zhou, Mei
Bose, Srimoyee
author_facet Mobley, Lee R.
Amaral, Pedro
Kuo, Tzy-Mey
Zhou, Mei
Bose, Srimoyee
author_sort Mobley, Lee R.
collection PubMed
description OBJECTIVE: To examine how FFS Medicare utilization of endoscopy procedures for colorectal cancer (CRC) screening changed after implementation of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) in 2006, which provided subsidized drug coverage and expanded the geographic availability of Medicare managed care plans across the US. Data Sources/Study Setting. Using secondary data from 100% FFS Medicare enrollees, we analyzed endoscopy utilization during two intervals, 2001-2005 and 2006-2009. STUDY DESIGN: We examined change in predictors of county-level endoscopy utilization rates based on a conceptual model of market supply and demand with spillovers from managed care practices. The equations for each period were estimated jointly in a spatial lag regression model that properly accounts for both place and time effects, allowing robust assessment of changes over time. DATA COLLECTION/EXTRACTION METHODS: All Medicare FFS enrollees with both Parts A and B coverage who were age 65+, remained alive and living in the same state over the interval were included in the analyses. The later interval used a new cohort defined the same as the earlier interval. 100% Medicare denominator files were also used, providing county of address to use for county-level aggregation. The outcome variable was defined as county-level proportion of enrollees who ever used endoscopy over the interval. PRINCIPAL FINDINGS: Endoscopy utilization by FFS Medicare increased, and became more accessible across the US. Medicare managed care plan spillovers onto FFS Medicare endoscopy utilization changed over time from a significant negative (restraining) effect in the early period to no significant effect by the later period. CONCLUSIONS: The MMA eased budget constraints for seniors, making endoscopic CRC screening more affordable. The MMA policies also strengthened managed care business prospects, and enrollments in Medicare managed care escalated. The change in managed care spillover effects reflects the gradual acceptance of endoscopic CRC screening procedures, as they emerged as the gold standard during the period.
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spelling pubmed-53448712017-03-21 Medicare modernization and diffusion of endoscopy in FFS medicare Mobley, Lee R. Amaral, Pedro Kuo, Tzy-Mey Zhou, Mei Bose, Srimoyee Health Econ Rev Research OBJECTIVE: To examine how FFS Medicare utilization of endoscopy procedures for colorectal cancer (CRC) screening changed after implementation of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) in 2006, which provided subsidized drug coverage and expanded the geographic availability of Medicare managed care plans across the US. Data Sources/Study Setting. Using secondary data from 100% FFS Medicare enrollees, we analyzed endoscopy utilization during two intervals, 2001-2005 and 2006-2009. STUDY DESIGN: We examined change in predictors of county-level endoscopy utilization rates based on a conceptual model of market supply and demand with spillovers from managed care practices. The equations for each period were estimated jointly in a spatial lag regression model that properly accounts for both place and time effects, allowing robust assessment of changes over time. DATA COLLECTION/EXTRACTION METHODS: All Medicare FFS enrollees with both Parts A and B coverage who were age 65+, remained alive and living in the same state over the interval were included in the analyses. The later interval used a new cohort defined the same as the earlier interval. 100% Medicare denominator files were also used, providing county of address to use for county-level aggregation. The outcome variable was defined as county-level proportion of enrollees who ever used endoscopy over the interval. PRINCIPAL FINDINGS: Endoscopy utilization by FFS Medicare increased, and became more accessible across the US. Medicare managed care plan spillovers onto FFS Medicare endoscopy utilization changed over time from a significant negative (restraining) effect in the early period to no significant effect by the later period. CONCLUSIONS: The MMA eased budget constraints for seniors, making endoscopic CRC screening more affordable. The MMA policies also strengthened managed care business prospects, and enrollments in Medicare managed care escalated. The change in managed care spillover effects reflects the gradual acceptance of endoscopic CRC screening procedures, as they emerged as the gold standard during the period. Springer Berlin Heidelberg 2017-03-09 /pmc/articles/PMC5344871/ /pubmed/28281245 http://dx.doi.org/10.1186/s13561-017-0147-5 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Research
Mobley, Lee R.
Amaral, Pedro
Kuo, Tzy-Mey
Zhou, Mei
Bose, Srimoyee
Medicare modernization and diffusion of endoscopy in FFS medicare
title Medicare modernization and diffusion of endoscopy in FFS medicare
title_full Medicare modernization and diffusion of endoscopy in FFS medicare
title_fullStr Medicare modernization and diffusion of endoscopy in FFS medicare
title_full_unstemmed Medicare modernization and diffusion of endoscopy in FFS medicare
title_short Medicare modernization and diffusion of endoscopy in FFS medicare
title_sort medicare modernization and diffusion of endoscopy in ffs medicare
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5344871/
https://www.ncbi.nlm.nih.gov/pubmed/28281245
http://dx.doi.org/10.1186/s13561-017-0147-5
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