Health Practitioner Bonuses and Their Impact on the Availability and Utilization of Primary Care Services. Appendix B: Additional Exhibits

12/22/2014

Exhibit B1: Distribution of Primary Care Providers with PCIP Eligible Specialty
by Age, Sex and Year

Sex

Age

2005

2006

2007

2008

2009

2010

2011

Male

<35

11.4%

10.4%

10.2%

9.8%

9.4%

8.8%

7.9%

Male

35-44

29.9%

29.5%

28.8%

28.2%

27.6%

27.1%

26.5%

Male

45-54

34.7%

33.8%

32.3%

31.1%

29.9%

28.7%

28.1%

Male

55-64

18.6%

20.4%

22.0%

23.5%

25.0%

26.3%

27.5%

Male

65+

5.3%

5.9%

6.6%

7.4%

8.2%

9.0%

10.0%

Male

Total

95,911

101,781

111,971

116,133

118,868

121,264

122,048

Female

<35

21.5%

20.5%

20.6%

20.4%

20.1%

19.7%

18.9%

Female

35-44

36.8%

36.7%

35.9%

35.3%

34.7%

34.2%

34.0%

Female

45-54

31.5%

31.2%

30.4%

29.8%

29.1%

28.4%

27.8%

Female

55-64

9.1%

10.4%

11.7%

12.8%

14.2%

15.5%

16.8%

Female

65+

1.0%

1.2%

1.4%

1.7%

1.9%

2.2%

2.4%

Female

Total

59,446

66,054

78,531

86,972

93,905

100,930

106,003

Missing Sex/Age

29,633

33,759

42,945

49,954

54,580

60,665

73,232

Total

184,990

201,594

233,447

253,059

267,353

282,859

301,283

Exhibit B2: Average Number of PCIP Eligible E&M Claims per PCP under Medicare
by Specialty, 2005-2011

Specialty

2005

2006

2007

2008

2009

2010

2011

Internal Medicine

869

823

759

746

712

697

653

Family Medicine

722

694

651

649

631

626

605

Pediatrics

51

50

42

39

41

40

36

Geriatrics

989

1,026

990

978

960

955

958

Clinical Nurse Specialist

86

85

77

87

97

107

118

Nurse Practitioner

258

257

230

219

219

228

228

Physician Assistant

125

128

120

121

124

134

140

Exhibit B3: Average Allowed Charges ($) for the PCIP Eligible E&M Claims per PCP under Medicare, 2005-2011

Specialty

2005

2006

2007

2008

2009

2010

2011

Physicians

 

 

 

 

 

 

 

Internal Medicine

$52,896

$51,477

$51,149

$51,737

$51,438

$55,188

$53,641

Family Medicine

$41,019

$40,557

$41,279

$42,369

$43,075

$46,833

$47,163

Pediatrics

$3,008

$3,028

$2,705

$2,533

$2,771

$3,055

$2,835

Geriatrics

$61,243

$70,593

$68,845

$73,829

$76,317

$82,230

$84,453

Non-Physicians

 

 

 

 

 

 

 

Clinical Nurse Specialist

$4,219

$4,446

$3,974

$4,883

$5,824

$6,841

$7,890

Nurse Practitioner

$12,139

$13,055

$11,929

$12,019

$12,600

$14,274

$14,752

Physician Assistant

$5,724

$6,122

$6,064

$6,333

$6,765

$8,133

$8,831

Exhibit B4: Proportion of PCIP Eligible E&M Claims per 2011 PCIP Recipients by Specialty, 2005-2011

Specialty

2005

2006

2007

2008

2009

2010

2011

Physicians

 

 

 

 

 

 

 

Internal Medicine

45%

45%

44%

44%

41%

42%

41%

Family Medicine

45%

45%

44%

44%

41%

42%

40%

Pediatrics

45%

47%

47%

47%

45%

41%

39%

Geriatrics

67%

72%

70%

68%

64%

62%

64%

Non-Physicians

 

 

 

 

 

 

 

Clinical Nurse Specialist

64%

66%

64%

60%

57%

57%

56%

Nurse Practitioner

66%

66%

69%

68%

65%

67%

68%

Physician Assistant

55%

56%

56%

55%

51%

52%

50%

Note: the proportions are calculated out of all Medicare claims (excluding hospital inpatient, ER, drug and lab)

Exhibit B5: Average Number of PCIP Eligible E&M Claims per 2011 PCIP Recipients under Medicare by Specialty, 2005-2011

Specialty

2005

2006

2007

2008

2009

2010

2011

Physicians

 

 

 

 

 

 

 

Internal Medicine

1,113

1,088

1,050

1,057

1,015

1,035

1,011

Family Medicine

808

785

752

756

729

752

743

Pediatrics

157

149

130

118

111

129

132

Geriatrics

1,168

1,237

1,191

1,187

1,145

1,181

1,193

Non-Physicians

 

 

 

 

 

 

 

Clinical Nurse Specialist

375

384

361

346

335

382

389

Nurse Practitioner

384

403

369

392

405

457

492

Physician Assistant

251

266

260

268

266

301

301

Exhibit B6: Average Allowed Charges for the PCIP Eligible E&M Claims per 2011 PCIP Recipients under Medicare, 2005-2011

Specialty

2005

2006

2007

2008

2009

2010

2011

Physicians

 

 

 

 

 

 

 

Internal Medicine

$67,863

$68,281

$70,869

$73,505

$73,494

$81,629

$82,500

Family Medicine

$45,958

$45,878

$47,781

$49,440

$49,827

$56,350

$58,004

Pediatrics

$9,336

$9,051

$8,460

$7,864

$7,631

$9,836

$10,450

Geriatrics

$72,412

$85,046

$82,732

$89,548

$90,821

$101,283

$104,284

Non-Physicians

 

 

 

 

 

 

 

Clinical Nurse Specialist

$17,795

$19,741

$18,922

$19,279

$19,557

$24,141

$25,405

Nurse Practitioner

$19,633

$21,605

$19,496

$22,516

$24,830

$29,740

$32,837

Physician Assistant

$11,628

$12,949

$13,457

$14,496

$15,128

$18,717

$19,363

Exhibit B7: Proportion of Allowed Charges for PCIP Eligible E&M Claims per 2011 PCIP Recipients, 2005-2011

Specialty

2005

2006

2007

2008

2009

2010

2011

Physicians

 

 

 

 

 

 

 

Internal Medicine

71%

72%

74%

76%

77%

79%

76%

Family Medicine

73%

75%

77%

77%

78%

80%

77%

Pediatrics

70%

73%

75%

75%

77%

77%

76%

Geriatrics

77%

87%

88%

89%

89%

90%

89%

Non-Physicians

 

 

 

 

 

 

 

Clinical Nurse Specialist

76%

80%

81%

83%

85%

86%

85%

Nurse Practitioner

68%

71%

75%

79%

82%

87%

87%

Physician Assistant

72%

74%

76%

78%

81%

83%

82%

Note: the proportions are of allowed charges for all Medicare claims (excluding hospital inpatient, ER, drug and lab)

Exhibit B8: Distribution of the Number of NPs and PAs across HPSA and PSA regions

Profession Type

2005

2006

2007

2008

2009

2010

2011

Nurse Practitioners

 

 

 

 

 

 

 

Total Providers

23,610

27,450

35,286

42,144

46,973

52,472

59,505

in HPSA*

x

X

14,171

16,978

18,858

20,929

23,045

in PSA**

2,946

3,331

4,139

4,694

N/A

N/A

N/A

in HPSA & PSA

x

X

1,638

1,855

N/A

N/A

N/A

PCIP 2011 Recipients

12,267

14,146

18,008

23,070

27,698

25,369

23,707

in HPSA*

x

X

7,335

9,344

11,148

10,178

9,312

in PSA**

1,558

1,754

2,168

2,571

N/A

N/A

N/A

 in PSA & HPSA

x

X

861

1,027

N/A

N/A

N/A

Physician Assistants

 

 

 

 

 

 

 

Total Providers

21,240

24,439

30,823

35,593

39,226

42,871

47,340

in HPSA*

x

X

13,246

15,236

16,889

18,489

19,828

in PSA**

2,166

2,436

3,098

3,467

N/A

N/A

N/A

in HPSA & PSA

x

X

1,230

1,363

N/A

N/A

N/A

PCIP 2011 Recipients

6,168

7,033

8,852

10,898

13,038

11,961

11,288

in HPSA*

x

X

3,830

4,732

5,760

5,226

4,755

in PSA**

760

839

1,034

1,217

N/A

N/A

N/A

 in PSA & HPSA

x

X

408

494

N/A

N/A

N/A

Note: *HPSA includes only full HPSA areas (data from Area Resource File and HPSA status data are not available prior to 2007). **PSA status after 2008 is not applicable as 2008 was the final year of the PSA bonus.

Exhibit B9.a: Distribution of Male Primary Care Physicians with PCIP Eligible Specialty by Age and Year

Note: Primary care physicians include following specialties: internal medicine, family practice, pediatrics, geriatrics.

Exhibit B9.b: Distribution of Female Primary Care Physicians with PCIP Eligible Specialty by Age and Year

Distribution of Female Primary Care Physicians with PCIP Eligible Specialty by Age and Year

Note: Primary care physicians include following specialties: internal medicine, family practice, pediatrics, geriatrics.

Exhibit B10: Distribution of Male Primary Care Non-Physicians with PCIP Eligible Specialty by Age and Year

Distribution of Male Primary Care Non-Physicians with PCIP Eligible Specialty by Age and Year

Note: Primary care non-physicians include following specialties: PA, NP and CNS.

Exhibit B11: Distribution of Female Primary Care Non-Physicians with PCIP Eligible Specialty by Age and Year

Distribution of Female Primary Care Non-Physicians with PCIP Eligible Specialty by Age and Year

Note: Primary care non-physicians include following specialties: PA, NP and CNS.

Exhibit B12: Average Number of PCIP Eligible E&M Claims Submitted by 2011 PCIP Recipients, 2005 – 2011

Average Number of PCIP Eligible E&M Claims Submitted by 2011 PCIP Recipients, 2005 – 2011

Exhibit B13: Allowed Charges for PCIP Eligible E&M Claims per 2011 PCIP Recipients,
2005-2011

Allowed Charges for PCIP Eligible E&M Claims per 2011 PCIP Recipients,2005-2011

Exhibit B14: Total Number of PCIP Eligible E&M Claims submitted by All Providers in the Control Group, 2005-2011

Specialty

2005

2006

2007

2008

2009

2010

2011

OB/GYN

2,597,637 2,612,513 2,728,810 2,813,472 2,893,204 3,047,849 3,040,383

Ophthalmology

5,615,010 5,648,040 6,070,483 5,976,720 5,832,440 6,361,330 6,164,821

Pathology

46,894 51,364 54,748 57,005 57,147 64,078 63,652

Urology

6,964,185 7,202,012 7,571,544 7,775,857 7,777,728 8,616,096 8,641,898

Optometry

2,464,734 2,550,764 2,758,214 2,891,543 2,969,244 3,048,668 3,088,461

Podiatry

7,788,889 8,195,973 8,957,163 9,739,404 10,012,630 10,645,394 10,890,676

Psychology

42 11 27 64 1,552 2,440 2,097

Neurophysiology

12,609 13,838 13,858 15,451 18,142 17,962 17,714

Additional Regression Results

Exhibit B15: Impact of Medicare PCIP Policy on the Number of Primary Care Providers Who Have submitted any Medicare Claims (not necessarily under PCIP Eligible Services),
(2005-2011)

Dependent Variable: Number of Providers per county All Providers (1) Physicians Only (2) Non-Physicians Only (3)
PCIP Elig. Specialty Indicator 65.50* 40.54* 48.59*
(3.929) (4.449) (2.759)
Elig. Specialty Ind x Post 2009 4.408* 3.255* 5.710*
(0.503) (0.758) (0.482)
Post 2009

4.588*

3.314*

4.187*

(0.505)

(0.593)

(0.350)

Median Income ($10k)

2.306*

2.728*

1.643*

(0.424)

(0.513)

(0.241)

Percent in poverty

0.466*

0.541*

0.360*

(0.0535)

(0.0653)

(0.0332)

Population (10k)

0.727*

0.771*

0.487*

(0.0298)

(0.0359)

(0.0144)

Percent Population over 65

-0.406*

-0.262*

-0.337*

(0.0407)

(0.0502)

(0.0280)

Unemployment Rate

-0.660*

-0.652*

-0.493*

(0.0522)

(0.0621)

(0.0392)

Intercept

-72.42*

-79.09*

-49.0*

(4.371)

(4.812)

(3.069)

Specialty Fixed Effects

Yes

Yes

Yes

Year Fixed Effects

Yes

Yes

Yes

State Fixed Effects

Yes

Yes

Yes

N

140,192

107,526

95,647

Adj. R-sq.

0.391

0.396

0.480

Note: Robust standard errors are in parentheses; + significance at 10%; * significance at 5%. The number of observation is based on the number of counties, the number of years, and the number of provider specialties in each model (i.e., physicians include 4 primary care specialties and non-physicians include 3 sub- specialties).

Exhibit B16: Impact of Medicare PCIP Policy on the Number of Primary Care Providers Who Met 60% PCIP Eligibility Threshold Each Year, (2005-2011)

Dependent Variable: Number of Providers per county All Providers

 

(1)

Physicians Only (2) Non-Physicians Only (3)
PCIP Elig. Specialty Indicator 20.62* 21.94* 6.540*
(1.769) (2.050) (0.642)
Elig. Specialty Ind x Post 2009 2.322* 1.841* 2.776*
(0.341) (0.543) (0.243)
Post 2009 1.252* 0.750+ 0.994*
(0.348) (0.427) (0.143)
Median Income ($10k) 0.549+ 0.847* 0.0118
(0.305) (0.380) (0.0942)
Percent in poverty 0.0663+ 0.0965* 0.0165
(0.0379) (0.0473) (0.0137)
Population (10k) 0.264* 0.298* 0.0610*
(0.0229) (0.0284) (0.00579)
Percent Population over 65 -0.155* -0.105* -0.127*
(0.0277) (0.0355) (0.0111)
Unemployment Rate -0.252* -0.259* -0.0864*
(0.0357) (0.0444) (0.0166)
Intercept -22.81* -27.17* -3.777*
(2.029) (2.419) (0.775)

Specialty Fixed Effects

Yes

Yes

Yes

Year Fixed Effects

Yes

Yes

Yes

State Fixed Effects

Yes

Yes

Yes

N

140,192

107,526

95,647

Adj. R-sq.

0.174

0.184

0.119

Note: Robust standard errors are in parentheses; + significance at 10%; * significance at 5%. The number of observation is based on the number of counties, the number of years, and the number of provider specialties in each model (i.e., physicians include 4 primary care specialties and non-physicians include 3 sub- specialties).

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