Navigating New Waters: How Did MACRA 2015 Transform Practices Among Medicare Part B Physicians?
研究评估2015年MACRA法案对Medicare B部分医生账单行为的影响，发现参与医生通过服务更多受益人而非提高人均支出来增加总收费和支付，提示效率提升但护理强度变化有限。
OBJECTIVES: To assess whether physicians participating in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) exhibit different billing behaviors and practice patterns compared to non-participating physicians after MACRA implementation. STUDY SETTING AND DESIGN: A quasi-experimental staggered difference-in-difference design was used to compare pre-and post-MACRA changes among participants and non-participants from 2013 to 2021. Primary outcomes included annual submitted charges, annual Medicare payments, and charge-to-payment ratios. Secondary outcomes were average charges and payments per beneficiary, total services, and the number of beneficiaries served. DATA SOURCES AND ANALYTIC SAMPLE: The study analyzed secondary data from Centers for Medicare & Medicaid Services (CMS) Medicare Fee-For-Service Provider Utilization and Payment Data (2013-2021), providing outcome measures and control variables; Quality Payment Program (QPP) Experience Reports (2017-2021), the National Plan and Provider Enumeration System, and Medicare Geographic Variation Public Use File. The analytic sample included 4,924,118 physician-year observations (749,129 unique physicians), with 50.2% participating in MACRA. PRINCIPAL FINDINGS: MACRA participation was associated with significant annual increases of $36,677 (95% CI: 28,918, 44,436) in total submitted charges and $9164 (95% CI: 7288, 11,041) in total Medicare payments compared to non-participation. However, these increases appeared primarily driven by a substantial increase in the total number of Medicare beneficiaries served per physician (29.77 beneficiaries; 95% CI: 20.75, 32.79) rather than by increases in spending per beneficiary, which were modest (average payment increase per beneficiary of $2.10; 95% CI: 0.22, 3.97). The charge-to-payment ratio decreased by 0.04 percentage points (95% CI: -0.08, -0.00) among MACRA participants, suggesting potential improvements in billing efficiency. CONCLUSIONS: MACRA participation is associated with increased billing and payment among Medicare Part B physicians, primarily driven by physicians treating a greater number of Medicare beneficiaries. However, modest changes in per-beneficiary spending suggest limited changes in care intensity. Further research is needed to explore factors influencing patient volumes and payer mix under MACRA.