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Geographic Adjustment in Medicare Payment Phase II: Implications for Access, Quality, and Efficiency (2012) / Chapter Skim
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Appendix B: Methods for the Analysis of Associations of Quality Measures with Payments in Chapter 3
Pages 175-182

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From page 175...
... The sample of 275,000 noninstitutionalized beneficiaries with at least 6 months of continuous enrollment in traditional Medicare was stratified by state. Sampled beneficiaries were sent a prenotice letter followed by a mail survey, and initial nonrespondents were followed up with a replacement survey and up to 20 telephone contact attempts, with a final response rate of 58 percent.
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From page 176...
... The GAF drives geographical variation in total payments to practices for a given service mix, while the work GPCI is the component of the GAF specifically addressing the cost of physician labor; thus the two measures encompass the role of physicians both as operators of businesses and as workers. In most models including GAF or GPCI, the current CMS value for 2010 (excluding frontier floors)
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From page 177...
... HPSA coefficients without payment factor controls are compared to those with either GAF or GPCI controls in Table B-3, which shows the standard deviation of coefficients (representing adjusted differences)
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From page 178...
... The right-hand columns quantify the variation among RUCC categories, without regard to order, by the standard deviation of the 10 RUCC coefficients. The magnitude of variation increases for the majority of measures when the GAF or GPCI variable is added to the model.
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From page 179...
... Easy specialist appointment 0.22 ­1.37 ­0.07 ­0.30 0.1097 Rating of care overall 0.00 1.39 ­2.15* 1.91 0.6379 Rating of doctor 0.32 1.25 ­1.10 2.58 0.5376 Doctor communication 0.78 0.44 1.03 3.02 0.3147 Get needed care ­1.07 1.04 ­1.00 1.08 0.0004 Influenza immunization 0.15 ­2.51*
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From page 180...
... 1.86 ­2.64 6.63+ 0.0042+ Get needed care 3.24+ 0.98 2.03 1.55 0.73 2.79+ 1.29 ­2.13 ­0.67 0.1577 Influenza immunization ­0.30 0.62 0.40 ­2.05 ­1.11 ­3.36# ­2.61* ­5.19+ ­1.54 0.0006# Pneumovax immunization 2.08 2.24*
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From page 181...
... (& GAF) Have personal doctor ­0.352 ­0.383 ­0.338 1.581 1.885 1.638 Timely routine care 0.089 0.068 0.097 1.181 1.318 1.252 Timely care in illness ­0.034 ­0.036 ­0.035 1.972 1.970 1.977 Wait <15 minutes ­0.254 ­0.298 ­0.211 1.608 1.659 1.525 Easy specialist appointment ­0.184 ­0.232 ­0.180 1.600 1.960 1.685 Rating of care overall 0.110 0.080 0.112 2.251 2.202 2.225 Rating of doctor 0.205 0.157 0.205 1.224 1.342 1.228 Doctor communication 0.236 0.232 0.238 2.488 2.470 2.464 Get needed care ­0.365 ­0.409 ­0.352 1.610 1.864 1.648 Influenza immunization ­0.269 ­0.305 ­0.246 1.845 2.198 2.019 Pneumovax immunization ­0.473 ­0.543 ­0.448 1.940 2.611 2.196 Breast cancer screening ­0.126 ­0.134 ­0.118 1.150 1.192 1.161 Cholesterol screening (cardiac)
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From page 182...
... ­19.70 20.53 Timely routine care 13.76 8.32 ­12.16 19.47 Timely care in illness ­6.05 ­6.87 24.99 36.93 Wait <15 minutes ­0.16 0.70 ­8.45 ­21.49 Easy specialist appointment 6.23 2.21 23.81 56.14 Rating of care overall ­4.00 ­0.15 17.50 7.25 Rating of doctor ­8.48 ­16.02 16.20 40.62 Doctor communication ­15.25 ­10.67 29.52 15.33 Get needed care 9.40 18.96 6.98 ­1.46 Influenza immunization 20.31# 5.77 ­63.76+ ­23.80 Pneumovax immunization 18.76* 7.86 ­60.82+ ­31.52 Breast cancer screening 12.34 5.62 ­20.19 4.80 Cholesterol screening (cardiac)
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Key Terms

  • geographic adjustment
  • cancer screening
  • breast cancer
  • practice cost
  • cost index

  • adjustment factor
  • category coefficients
  • continuum code
  • geographic practice
  • timely routine

  • personal doctor
  • routine care
  • specialist appointment
  • easy specialist
  • professional shortage

  • health professional
  • current cms
  • controlled measure
  • medicaid services
  • entries summarize

  • proposed iom
  • mail survey
  • response rate
  • initial nonrespondents
  • public reporting

  • gpci slope
  • medicare physician
  • models including
  • sampled beneficiaries
  • gaf specifically


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