title: Costs and clinical quality among Medicare beneficiaries: associations with health center penetration of low-income residents.
abstract: OBJECTIVE
  Determine the association between access to primary care by the underserved and Medicare spending and clinical quality across hospital referral regions (HRRs).
  
  
  METHODS
  Data on elderly fee-for-service beneficiaries across 306 HRRs came from CMS' Geographic Variation in Medicare Spending and Utilization database (2010). We merged data on number of health center patients (HRSA's Uniform Data System) and number of low-income residents (American Community Survey).
  
  
  METHODS
  We estimated access to primary care in each HRR by "health center penetration" (health center patients as a proportion of low-income residents). We calculated total Medicare spending (adjusted for population size, local input prices, and health risk). We assessed clinical quality by preventable hospital admissions, hospital readmissions, and emergency department visits. We sorted HRRs by health center penetration rate and compared spending and quality measures between the high- and low-penetration deciles. We also employed linear regressions to estimate spending and quality measures as a function of health center penetration.
  
  
  RESULTS
  The high-penetration decile had 9.7% lower Medicare spending ($926 per capita, p=0.01) than the low-penetration decile, and no different clinical quality outcomes.
  
  
  CONCLUSIONS
  Compared with elderly fee-for-service beneficiaries residing in areas with low-penetration of health center patients among low-income residents, those residing in high-penetration areas may accrue Medicare cost savings. Limited evidence suggests that these savings do not compromise clinical quality.
authors.affiliation: Health Resources and Services Administration-Bureau of Primary Health Care.
authors.forename: Ravi
authors.initials: R
authors.lastname: Sharma
authors.affiliation: Health Resources and Services Administration-Office of Planning, Analysis and Evaluation.
authors.forename: Lydie A
authors.initials: LA
authors.lastname: Lebrun-Harris
authors.affiliation: Agency for Healthcare Research and Quality-Center for Primary Care, Prevention, and Clinical Partnerships.
authors.forename: Quyen
authors.initials: Q
authors.lastname: Ngo-Metzger
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003151:Community Health Centers / Q000191:economics* / Q000706:statistics & numerical data; D017046:Cost Savings / Q000191:economics / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D018588:Fee-for-Service Plans / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D006278:Medicare / Q000191:economics* / Q000706:statistics & numerical data; D011203:Poverty / Q000191:economics* / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000191:economics* / Q000706:statistics & numerical data; D014481:United States
keywords: Health centers; Medicare; clinical quality; costs; safety-net