The national ambulatory medical care survey (NAMCS) at fifty: Past and future.

Introduction: NAMCS, sponsored by the Centers for Disease Control and Prevention, is an annual nationally representative sample survey of visits to non-federal office-based physicians, excluding anesthesiologists, radiologists, and pathologists. NAMCS has collected physician-reported ambulatory care encounter-specific content over five decades. We assessed trends in the use of the data by the health services research community, response rates, and questionnaire changes.

Changes in coverage among non-elderly adults with chronic diseases following Affordable Care Act implementation.

Importance: Changes in insurance coverage after the Affordable Care Act (ACA) among non-elderly adults with self-reported chronic conditions across income categories have not been described.

Objective: To examine changes in insurance coverage after the ACA among non-elderly adults with chronic conditions across income categories, by geographic region.

Design: We compared self-reported access to health insurance pre-ACA (2010-2013) and post-ACA (2014-2017) for individuals 18-64 years of age with ≥ 2 chronic conditions, including hypertension, heart disease/stroke, emphysema, diabetes, asthma, cancer, and arthritis, across regions using a logistic regression approach, adjusted for covariates.

Geographic variations in specialty distribution and specialty-related mortality.

Using data from the Centers for Disease Control and Centers for Medicare and Medicaid Services, we analyzed the relationship between specialty physician location and specialty-specific mortality rates for diagnoses where access to specialty expertise could plausibly reduce death rates. After adjustment for demographic and health indicators, counties with the highest quartile specialty physician density had lower mortality rates compared to counties with the lowest quartile. The observed association in endocrinology, infectious disease, and neurology was 10.

Differences in the Complexity of Office Visits by Physician Specialty: NAMCS 2013-2016.

Background: Specialty-to-specialty variation in use of outpatient evaluation and management service codes could lead to important differences in reimbursement among specialties.

Objective: To compare the complexity of visits to physicians whose incomes are largely dependent on evaluation and management services to the complexity of visits to physicians whose incomes are largely dependent on procedures.

Design, Setting, And Participants: We analyzed 53,670 established patient outpatient visits reported by physicians in the National Ambulatory Medical Care Survey (NAMCS) from 2013 to 2016.

The undervaluation of evaluation and management professional services: the lasting impact of current procedural terminology code deficiencies on physician payment.

The Resource-Based Relative Value Scale (RBRVS) is fundamentally undermined by the following foundational errors: (1) The full range of office-based evaluation and management (E/M) activities are not captured by the Current Procedural Terminology (CPT) code choices, (2) it places relatively high values on procedural services, (3) there is no measure of intensity for complex outpatient E/M care, and (4) its maintenance and update have been delegated to select professional societies. Limitations imposed on the development of the RBRVS dating back to the early 1980s have not been corrected. The repertoire of codes for physician office-based E/M work must be expanded to create a new topology of choices with new outpatient code families with discrete service code levels, such as comprehensive outpatient consultation care, comprehensive outpatient primary care, and limited outpatient consultation care.

Patient Protection and Affordable Care Act: promise and peril for primary care.

The Patient Protection and Affordable Care Act (PPACA) of 2010 brings both promise and peril for primary care. This Act has the potential to reestablish primary care as the foundation of U.S.