PQRS Participation, Inappropriate Utilization of Health Care Services, and Medicare Expenditures

Medicare’s Physician Quality Reporting System (PQRS) is the largest quality-reporting system in the U.S. health care system and a basis for the new value-based modifier system for physician payment. The PQRS allows health care providers to report measures of quality of care that include both the pro...

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Bibliographic Details
Published in:Medical care research and review 2016-02, Vol.73 (1), p.106-123
Main Authors: Dowd, Bryan E., Swenson, Tami, Parashuram, Shriram, Coulam, Robert, Kane, Robert
Format: Article
Language:English
Subjects:
Age Factors
Aged
Aged, 80 and over
Beneficiaries
Caseloads
Clinical outcomes
Diabetes
Diabetes mellitus
Expenditures
Female
Government programs
Health care
Health care expenditures
Health risks
Health services
Health Services - economics
Health Services - statistics & numerical data
Health Services - utilization
Heart
Help seeking behavior
Humans
Inappropriateness
Male
Males
Medical personnel
Medicare
Medicare - economics
Medicare - utilization
Men
Models, Theoretical
Patient Protection and Affordable Care Act - economics
Patient Protection and Affordable Care Act - standards
Per capita
Physicians - economics
Physicians - standards
Prone
Quality of care
Quality of Health Care - economics
Quality of Health Care - standards
Risk adjustment
Rural areas
Rural communities
Sex Factors
Subgroups
United States
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Summary:Medicare’s Physician Quality Reporting System (PQRS) is the largest quality-reporting system in the U.S. health care system and a basis for the new value-based modifier system for physician payment. The PQRS allows health care providers to report measures of quality of care that include both the process of care and physiological outcomes. Using a multivariate difference-in-differences model, we examine the relationship of PQRS participation to three claims-computable measures of inappropriate utilization of health care services and risk-adjusted per capita Medicare expenditures. The data are a national random sample of PQRS-participating providers matched to nonparticipating providers by zip code and caseload. We found few significant relationships in the overall analysis. However, the magnitude and statistical significance of the desirable associations increased in subgroups of providers and beneficiaries more prone to overutilization (e.g., males, older beneficiaries, beneficiaries treated in larger medical practices or by nonphysicians, and practices in rural areas), and among beneficiaries with heart conditions, diabetes, and eye problems.
ISSN:1077-5587
1552-6801
DOI:10.1177/1077558715597846