# Higher Reimbursements for Primary Care Services and the Quality of Care for Dually-Eligible Nursing Home Residents with Alzheimer's Disease and Related Dementias.

> **NIH NIH R01** · WEILL MEDICAL COLL OF CORNELL UNIV · 2021 · $37,856

## Abstract

PROJECT SUMMARY/ABSTRACT
There are 5.5 million people in the US with Alzheimer’s disease or related dementias (ADRD). Annual health
care expenditures for this population are $259 billion with the majority of these costs attributed to ADRD patients
receiving long-term care in nursing homes (NHs). Due to the cognitive decline and the behavioral and psychiatric
symptoms experienced by ADRD patients, there are few substitutes for long-term care provided by NHs. Nearly
two-thirds of NH residents have some degree of ADRD, over 60% of whom are dually-eligible. NH residents with
ADRD have high rates of hospitalization (45.8%/year) and emergency department visits (55.3%/year). Up to
80% of these events are associated with ambulatory care sensitive conditions, which are potentially preventable
with appropriate primary care in the NH. However, earlier research has indicated that dual-eligibles receive
primary care of lower quality than other beneficiaries. Once a patient becomes a long-stay NH resident, the NH
physician becomes his/her primary care provider. As the primary care provider, the NH physician is expected to
deal with problems as the patient’s dementia progresses, to refer appropriately, to coordinate with other
providers, to initiate and follow up on treatment issues, and to work with family members overseeing the patient’s
care. The Medicaid Primary Care Fee Bump provides a natural experiment to examine the impact of higher
physician reimbursement on the quality of care for dually-eligible NH residents with ADRD. Over a two-year
period (2013-2014), the initiative required states’ Medicaid programs to reimburse providers the same rates as
Medicare for primary care services for all Medicaid patients. For dual-eligibles, the fee bump required Medicaid
programs to reimburse providers the full 20% Medicare coinsurance for primary care services, which included
evaluation and management services provided in NHs. Prior to the fee bump and following its expiration, states
covered 0 to 20 percentage points of Medicare Part B coinsurance. Using a national sample of all dually-eligible
NH residents with ADRD over an eight-year period (2011-2018), this project will take advantage of the natural
experiment created by the Medicaid Primary Care Fee Bump to identify the impact of higher reimbursement for
primary care services on the quality and cost of care for these beneficiaries. This will be done using two sources
of variation: (1) the timing of both the implementation and termination of the fee bump and (2) variation in the
states reimbursing physicians the full 20% Medicare coinsurance for dual-eligibles before and after the fee bump.
The quasi-experimental nature of the research design will allow estimation strongly indicative of causation and
our national sample of all dually-eligible long-stay NH residents with ADRD will help ensure that the results are
generalizable. The project will provide highly valuable evidence indicating whether increased reimbur...

## Key facts

- **NIH application ID:** 10160733
- **Project number:** 5R01AG063935-02
- **Recipient organization:** WEILL MEDICAL COLL OF CORNELL UNIV
- **Principal Investigator:** Mark Aaron Unruh
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $37,856
- **Award type:** 5
- **Project period:** 2020-05-15 → 2023-02-28

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10160733

## Citation

> US National Institutes of Health, RePORTER application 10160733, Higher Reimbursements for Primary Care Services and the Quality of Care for Dually-Eligible Nursing Home Residents with Alzheimer's Disease and Related Dementias. (5R01AG063935-02). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10160733. Licensed CC0.

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