ACA Fee Increase Effect on Primary Care Access for Dual-Eligible Beneficiaries

In an effort to accommodate potential increases in demand for care under the Affordable Care Act (ACA), a fee bump was implemented in 2013 and 2014, increasing Medicaid payments to Medicare levels for certain services for primary care practitioners (PCP). Researchers sought to better understand the effect the fee bump had on dual-eligible patients and their access to primary care.

The JAMA Network Open study of 3,052,044 Medicare beneficiaries used a difference-in-difference design and examined Medicare claims data from 2012 to 2016 to compare visit rates for both full-subsidy dual-eligible Medicare and Medicaid beneficiaries with nondual-eligible Medicare beneficiaries with low income whose fees did not change.

According to the results, “primary care visit rates for dual-eligible Medicare and Medicaid beneficiaries did not increase during years of the fee bump compared with Medicare beneficiaries with low income whose fees did not change.”

The researchers note that decreases in relative visit rates with PCPs were partially offset by increases in visits with nurse practitioners and physician assistants.

Dual-eligible often have high levels of clinical need and spending but little data exists on the implication of payment policy on access to care. Additionally, this is a patient population often hit by policy changes.

“Although the policy increased fees for PCPs treating dual-eligible patients by up to 25% in many states, we did not find temporary or sustained increases in primary care visits for dualeligible beneficiaries living in states with fee increases vs comparable non–dual-eligible beneficiaries, on average,” concluded the researchers. 

“This result is consistent with other studies that have examined the impact of the fee bump on changes in practitioners’ Medicaid participation for Medicaid-only enrollees.” —Edan Stanley