Theses and Dissertations at Montana State University (MSU)
Permanent URI for this collectionhttps://scholarworks.montana.edu/handle/1/733
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Item Does direct primary care affect medicare opt-out rates? Evidence from state business of insurance legislation(Montana State University - Bozeman, College of Agriculture, 2022) Vogel, Trevor Jacob; Chairperson, Graduate Committee: Mariana CarreraPast economic research has examined factors influencing the degree to which physicians accept assignment from Medicare and allow new Medicare patients into their practice. There is no known examination of physicians' decision to opt out of Medicare completely. I study this decision in the context of Direct Primary Care, a growing alternative to fee-for-service healthcare delivery in the United States that has been enabled by state-level policy shielding DPC practitioners from insurance regulations. Using the publicly available National Provider Identifier Registry and Opt- Out Affidavit datasets in a difference-in-difference framework, I study the effect of said policy on the propensity of physicians to opt out of Medicare. In my main analysis, I estimate that treatment increases the likelihood of family physicians opting out by 38 - 46% of the panel's baseline opt-out rate, but find no consistent effect on internal medicine providers. This relationship is valuable for policymakers and healthcare providers to keep in mind in evaluating DPC and possible Medicare reform.Item Developing a nurse-led Medicare annual wellness visit program for the outpatient setting(Montana State University - Bozeman, College of Nursing, 2021) Wahrer, Sarah Rahal; Chairperson, Graduate Committee: Angela JukkalaChronic disease causes preventable deaths each year. The financial cost of preventable diseases continues to grow. Many evidenced-based screenings and recommendations provide ways to stop or decrease the effects of chronic diseases. The number of preventive care screenings individuals received increases when a wellness visit is provided. Yet, less than a quarter of eligible Medicare beneficiaries receive their free annual wellness visit. Low participation rates in the annual wellness visit leads to missed preventive services, increased chronic disease, and increased cost. Medical providers continue to have mixed opinions regarding the importance of the visit, leading to decreased buy-in and patient education about the visit. A nurse-led annual wellness visit program, created in an outpatient primary care setting, aims to increase awareness about the visit and increase the number of patients receiving preventive care. A multi-professional committee formed to implement and continue the program. One registered nurse was trained and piloted the program by seeing patients one day per week for their annual wellness visit and recruiting patients for the visit on another half-day. The number of people receiving the annual wellness visit will be tracked to analyze the impact of nurses recruiting and conducting the visit at an outpatient clinic. Previous programs have shown an increase in participation in the annual wellness visit and an increase in preventive services being performed.