Brief Report: Physician Reimbursement and Retention in HIV Care: Racial Disparities in the US South. (1st January 2023)

• Record Type: Journal Article
• Authors: Pan, Zhongzhe; Dahman, Bassam; Bono, Rose S.; Sabik, Lindsay M.; Belgrave, Faye Z.; Yerkes, Lauren; Nixon, Daniel E.; Kimmel, April D.
• Is Part Of: Journal of acquired immune deficiency syndromes. Volume 92:Number 1(2023)
• Page Start: 1
• Page End: 5
• Publication Date: 2023-01-01
• Subjects: HIV -- physician reimbursement -- retention in care -- racial disparities -- US South; AIDS (Disease) -- Periodicals; Acquired Immunodeficiency Syndrome -- Periodicals; AIDS (Disease); Periodicals; 616.9792005
• DOI: 10.1097/QAI.0000000000003105
• Languages: English
• ISSNs: 1525-4135

Abstract

Abstract : Supplemental Digital Content is Available in the Text. Abstract : Background: Retention in HIV care remains a national challenge. Addressing structural barriers to care may improve retention. We examined the association between physician reimbursement and retention in HIV care, including racial differences. Methods: We integrated person-level administrative claims (Medicaid Analytic eXtract, 2008–2012), state Medicaid-to-Medicare physician fee ratios (Urban Institute, 2008, 2012), and county characteristics for 15 Southern states plus District of Columbia. The fee ratio is a standardized measure of physician reimbursement capturing Medicaid relative to Medicare physician reimbursement across states. Generalized estimating equations assessed the association between the fee ratio and retention (≥2 care markers ≥90 days apart in a calendar year). Stratified analyses assessed racial differences. We varied definitions of retention, subsamples, and definitions of the fee ratio, including the fee ratio at parity. Results: The sample included 55, 237 adult Medicaid enrollees with HIV (179, 002 enrollee years). Enrollees were retained in HIV care for 76.6% of their enrollment years, with retention lower among non-Hispanic Black (76.1%) versus non-Hispanic White enrollees (81.3%, P < 0.001). A 10-percentage point increase in physician reimbursement was associated with 4% increased odds of retention (adjusted odds ratio 1.04, 95% confidence interval: 1.01 to 1.07). In stratified analyses, the positive, significant association occurred among non-Hispanic Black (1.08, 1.05–1.12) but not non-Hispanic White enrollees (0.87, 0.74–1.02). Findings were robust across sensitivity analyses. When the fee ratio reached parity, predicted retention increased significantly overall and for non-Hispanic Black enrollees. Conclusion: Higher physician reimbursement may improve retention in HIV care, particularly among non-Hispanic Black individuals, and could be a mechanism to promote health equity.