Association of Reference Payment for Colonoscopy With Consumer Choices, Insurer Spending, and Procedural Complications

JAMA Internal Medicine
James C RobinsonEmily Finlayson

Abstract

Regulatory limits on consumer cost sharing permit wide variation in the prices charged for screening and diagnostic tests such as colonoscopy. Employers are experimenting with reference payment initiatives that offer full insurance coverage at low-priced facilities but require substantial cost sharing if patients select high-priced alternatives. To ascertain the effect of reference payment on facility choice, insurer spending, consumer cost sharing, and procedural complications for colonoscopy. The California Public Employees' Retirement System (CalPERS) implemented reference payment in January 2012. We obtained data on 21 644 CalPERS enrollees who underwent colonoscopy in the 3 years prior to implementation and on 13 551 patients in the 2 years after implementation. Control group data were obtained on 258 616 Anthem Blue Cross enrollees who underwent colonoscopy and who were not subject to reference payment initiatives during this 5-year period. Consumer choice of facility, price paid per procedure, total insurer spending, consumer cost sharing, and procedural complications. Choices, prices, and complications were compared for CalPERS and Anthem patients before and after implementation of reference payments, using difference-i...Continue Reading

Citations

Mar 1, 2016·Gastroenterology·Douglas K Rex, John J Vargo
Jul 4, 2016·Gastrointestinal Endoscopy Clinics of North America·Douglas K Rex
Apr 5, 2018·The New England Journal of Medicine·Ateev MehrotraAnna D Sinaiko
Mar 8, 2017·Health Affairs·James C RobinsonChristopher Whaley
Jan 21, 2020·Annals of Internal Medicine·Ryan CrowleyUNKNOWN Health and Public Policy Committee of the American College of Physicians
Aug 17, 2017·The New England Journal of Medicine·James C RobinsonTimothy T Brown
Aug 14, 2019·Journal of Oncology Practice·Sheetal M KircherBlase N Polite
Jul 24, 2020·Health Services Research·Bryan E Dowd, Miriam J Laugesen

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