2026/03/01 by Eric Christensen, Eric W. Christensen, Alexandra R. Drake +5
Economics, Econometrics and Finance · Health Professions · #Geriatric Care and Nursing Homes #Healthcare Policy and Management #Primary Care and Health Outcomes
paper · doi:10.1177/00469580261473400
crossref issued 2026/03/01 · crossref published 2026/03/01 · crossref published-print 2026/03/01 · openalex publication_date 2026/03/01 · crossref published-online 2026/07/25 · crossref created 2026/07/25 · openalex created_date 2026/07/26 · crossref deposited 2026/07/28 · crossref indexed 2026/07/28 · openalex updated_date 2026/07/29
CMS has maintained budget neutrality in the Medicare Physician Fee Schedule through decreases in the conversion factor, but reduced reimbursement may have secondary access-to-care consequences for Medicare beneficiaries. Hence, this study examined the association between inflation-adjusted conversion factor declines and changes in care utilization for various socioeconomically defined subgroups of Medicare beneficiaries. Using all claims from a nationally representative 5% sample of Medicare fee-for-service beneficiaries, we determined by year (2005-2023) whether beneficiaries used care. Care utilization was compared between subgroups: metropolitan versus small/rural communities, high-income versus low-income communities, and least-deprived versus most-deprived (Area Deprivation Index [ADI]) communities. Care-utilization rates were normalized to account for within and between year differences in subgroup characteristics using multivariable logistic regression. Care-utilization gaps were computed as the difference in normalized utilization values between subgroups. The temporal association between gap size and the inflation-adjusted conversion factor was assessed with linear regression. There were 32,764,305 beneficiary years (4,662,729 unique beneficiaries) that met the selection criteria. Over the 2005-2023 period, the care-utilization gaps for any physician care increased 1.76, 5.89, and 3.82 percentage points for the urbanicity, community-income, and ADI gaps, respectively. Gap growth was significantly associated with the inflation-adjusted conversion factor, which decreased 48.3% between 2005 and 2025. This inflation-adjusted conversion factor decrease was associated with care-utilization gap increases of 2.46 (urbanicity), 7.00 (community-income), and 5.31 (ADI) percentage points across all physicians. Percentage-point gap increases varied by specialty and were largest for family practice physicians: 21.31 (urbanicity), 14.02 (community-income), and 19.55 (ADI) percentage points. Hence, decreased reimbursement resulting from the Medicare budget neutrality mandate may exacerbate disparities in access to care for traditionally underserved Americans.