Milken Institute School of Public Health Poster Presentations (Marvin Center & Video)
Poster Number
92
Document Type
Poster
Status
Graduate Student - Doctoral
Abstract Category
Health Policy and Management
Keywords
Medicare, workforce, physicians, nurses
Publication Date
Spring 2018
Abstract
Objective: Over the past decade, U.S. medical school enrollment has increased nearly 30 percent, and the growth in mid-level new graduates was even faster. Many of these new graduates are currently serving the large and growing Medicare population. Yet, little evidence so far has documented the workforce that are serving Medicare population. In the anticipation of physician supply shortages, it is important to understand who are taking care of Medicare population recently, and whether there are changes in the overall capacity and patient risk profiles of Medicare providers.
Methods: Data were from 2012-2015 Medicare Physician and Other Supplier Aggregate Tables at the Centers for Medicare & Medicaid Services website, which contain information on utilization, payment, and procedures provided to more than 10 Medicare Part B beneficiaries by U.S. physicians and nurses. We identified primary care physicians (i.e., family practice, internal medicine, general practitioners, and geriatric medicine), specialists, and mid-level providers (e.g., nurse practitioners, physician assistants, etc.) based on self-reported provider type in the data. We conducted trend analysis to examine the changes in the proportion of physicians and mid-level providers over time, and also compared utilization, payment amount, and patient risk profiles of physicians and nurses between 2012 and 2015, respectively.
Findings: Over the study period, the number of providers with more than 10 Medicare patients increased from 709,982 in 2012 to 782,836 in 2015. The proportion of both primary care physicians and specialists declined consistently, while in contrast, the proportion of mid-level providers increased correspondingly, from 20% in 2012 to 24% in 2015. Compared to 2012, Physicians in 2015 served fewer Medicare patients, but provided more services to beneficiaries, and had no changes in payment received than in 2015. In contrast, mid-level providers served more patients, provided more services per patient, and received higher payments in 2015 than in 2012. Both physicians and mid-level providers served more patients diagnosed with depression, asthma, chronic kidney disease, and stroke in 2015 than in 2012.
Conclusion: Medicare provider composition has been changing in recent years, where mid-level providers are playing an increasing role in serving Medicare beneficiaries. State legislatures and policymakers may consider expanding scope-of-practice for mid-level providers and also weigh the importance of innovating new payment policy to better reimburse mid-level providers. Future research is needed to compare the capacity of new and existing providers and the relationship between year of practicing and capacity building to serve more Medicare patients.
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Open Access
1
The Changing Composition and Capacity of Medicare Providers, 2012-2015
Objective: Over the past decade, U.S. medical school enrollment has increased nearly 30 percent, and the growth in mid-level new graduates was even faster. Many of these new graduates are currently serving the large and growing Medicare population. Yet, little evidence so far has documented the workforce that are serving Medicare population. In the anticipation of physician supply shortages, it is important to understand who are taking care of Medicare population recently, and whether there are changes in the overall capacity and patient risk profiles of Medicare providers.
Methods: Data were from 2012-2015 Medicare Physician and Other Supplier Aggregate Tables at the Centers for Medicare & Medicaid Services website, which contain information on utilization, payment, and procedures provided to more than 10 Medicare Part B beneficiaries by U.S. physicians and nurses. We identified primary care physicians (i.e., family practice, internal medicine, general practitioners, and geriatric medicine), specialists, and mid-level providers (e.g., nurse practitioners, physician assistants, etc.) based on self-reported provider type in the data. We conducted trend analysis to examine the changes in the proportion of physicians and mid-level providers over time, and also compared utilization, payment amount, and patient risk profiles of physicians and nurses between 2012 and 2015, respectively.
Findings: Over the study period, the number of providers with more than 10 Medicare patients increased from 709,982 in 2012 to 782,836 in 2015. The proportion of both primary care physicians and specialists declined consistently, while in contrast, the proportion of mid-level providers increased correspondingly, from 20% in 2012 to 24% in 2015. Compared to 2012, Physicians in 2015 served fewer Medicare patients, but provided more services to beneficiaries, and had no changes in payment received than in 2015. In contrast, mid-level providers served more patients, provided more services per patient, and received higher payments in 2015 than in 2012. Both physicians and mid-level providers served more patients diagnosed with depression, asthma, chronic kidney disease, and stroke in 2015 than in 2012.
Conclusion: Medicare provider composition has been changing in recent years, where mid-level providers are playing an increasing role in serving Medicare beneficiaries. State legislatures and policymakers may consider expanding scope-of-practice for mid-level providers and also weigh the importance of innovating new payment policy to better reimburse mid-level providers. Future research is needed to compare the capacity of new and existing providers and the relationship between year of practicing and capacity building to serve more Medicare patients.
Comments
Presented at GW Annual Research Days 2018.