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BMC Health Services Research Feb 2018To estimate changes in the cost and utilization of Medicare among beneficiaries over age 65 who have been impacted by a natural disaster, we merged publically available...
BACKGROUND
To estimate changes in the cost and utilization of Medicare among beneficiaries over age 65 who have been impacted by a natural disaster, we merged publically available county-level Medicare claims for the years 2008-2012 with Federal Emergency Management Agency (FEMA) data related to disasters in each U.S. County from 2007 to 2012.
METHODS
Fixed-effects generalized linear models were used to calculate change in per capita costs standardized by region and utilization per 1000 beneficiaries at the county level. Aggregate county demographic characteristics of Medicare participants were included as predictors of change in county-level utilization and cost. FEMA data was used to determine counties that experienced no, some, high, and extreme hazard exposure. FEMA data was merged with claims data to create a balanced panel dataset from 2008 to 2012.
RESULTS
In general, both cost and utilization of Medicare services were higher in counties with more hazard exposure. However, utilization of home health services was lower in counties with more hazard exposure.
CONCLUSIONS
Additional research using individual-level data is needed to address limitations and determine the impacts of the substitution of services (e.g., inpatient rehabilitation for home health) that may be occurring in disaster affected areas during the post-disaster period.
Topics: Aged; Disasters; Eligibility Determination; Female; Frail Elderly; Health Services Research; Health Services for the Aged; Humans; Insurance Claim Review; Male; Medicare; United States
PubMed: 29415716
DOI: 10.1186/s12913-018-2900-9 -
Inquiry : a Journal of Medical Care... 2019High Medicaid nursing homes (85% and higher of Medicaid residents) operate in resource-constrained environments. High Medicaid nursing homes (on average) have lower...
High Medicaid nursing homes (85% and higher of Medicaid residents) operate in resource-constrained environments. High Medicaid nursing homes (on average) have lower quality and poorer financial performance. However, there is significant variation in performance among high Medicaid nursing homes. The purpose of this study is to examine the organizational and market factors that may be associated with better financial performance among high Medicaid nursing homes. Data sources included Long-Term Care Focus (LTCFocus), Centers for Medicare and Medicaid Services' (CMS) Medicare Cost Reports, CMS Nursing Home Compare, and the Area Health Resource File (AHRF) for 2009-2015. There were approximately 1108 facilities with high Medicaid per year. The dependent variables are nursing homes operating and total margin. The independent variables included size, chain affiliation, occupancy rate, percent Medicare, market competition, and county socioeconomic status. Control variables included staffing variables, resident quality, for-profit status, acuity index, percent minorities in the facility, percent Medicaid residents, metropolitan area, and Medicare Advantage penetration. Data were analyzed using generalized estimating equations with state and year fixed effects. Results suggest that organizational and market slack resources are associated with performance differentials among high Medicaid nursing homes. Higher financial performing facilities are characterized as having nurse practitioners/physician assistants, more beds, higher occupancy rate, higher Medicare and Medicaid census, and being for-profit and located in less competitive markets. Higher levels of Registered Nurse (RN) skill mix result in lower financial performance in high Medicaid nursing homes. Policy and managerial implications of the study are discussed.
Topics: Aged; Economic Competition; Financial Management; Humans; Medicaid; Medicare; Nursing Homes; Quality of Health Care; United States
PubMed: 30739512
DOI: 10.1177/0046958018825061 -
The Milbank Quarterly Jun 2019
Topics: Climate Change; Global Health; Medicare; Reproductive Rights; United States; Universal Health Insurance
PubMed: 31172598
DOI: 10.1111/1468-0009.12392 -
Health Services Research Aug 2018To evaluate whether greater experience and success with performance incentives among physician practices are related to increased participation in Medicare's voluntary...
OBJECTIVES
To evaluate whether greater experience and success with performance incentives among physician practices are related to increased participation in Medicare's voluntary value-based payment reforms.
DATA SOURCES/STUDY SETTING
Publicly available data from Medicare's Physician Compare (n = 1,278; January 2012 to November 2013) and nationally representative physician practice data from the National Survey of Physician Organizations 3 (NSPO3; n = 907,538; 2013).
STUDY DESIGN
We used regression analysis to examine practice-level relationships between prior exposure to performance incentives and participation in key Medicare value-based payment reforms: accountable care organization (ACO) programs, the Physician Quality Reporting System ("Physician Compare"), and the Meaningful Use of Health Information Technology program ("Meaningful Use"). Prior experience and success with financial incentives were measured as (1) the percentage of practices' revenue from financial incentives for quality or efficiency; and (2) practices' exposure to public reporting of quality measures.
DATA COLLECTION/EXTRACTION METHODS
We linked physician participation data from Medicare's Physician Compare to the NSPO3 survey.
PRINCIPAL FINDINGS
There was wide variation in practices' exposure to performance incentives, with 64 percent exposed to financial incentives, 45 percent exposed to public reporting, and 2.2 percent of practice revenue coming from financial incentives. For each percentage-point increase in financial incentives, there was a 0.9 percentage-point increase in the probability of participating in ACOs (standard error [SE], 0.1, p < .001) and a 0.8 percentage-point increase in the probability of participating in Meaningful Use (SE, 0.1, p < .001), controlling for practice characteristics. Financial incentives were not associated with participation in Physician Compare. Among ACO participants, a 1 percentage-point increase in incentives was associated with a 0.7 percentage-point increase in the probability of being "very well" prepared to utilize cost and quality data (SE, 0.1, p < .001).
CONCLUSIONS
Physicians organizations' prior experience and success with performance incentives were related to participation in Medicare ACO arrangements and participation in the meaningful use criteria but not to participation in Physician Compare. We conclude that Medicare must complement financial incentives with additional efforts to address the needs of practices with less experience with such incentives to promote value-based payment on a broader scale.
Topics: Accountable Care Organizations; Benchmarking; Efficiency, Organizational; Humans; Meaningful Use; Medicare; Motivation; Organizational Culture; Patient Safety; Physicians; Quality of Health Care; Regression Analysis; Reimbursement, Incentive; United States
PubMed: 28748535
DOI: 10.1111/1475-6773.12743 -
The American Journal of Managed Care Apr 2021Proponents of a single-payer or public option health care system often cite the lower administrative expenses in public Medicare compared with those in private Medicare,...
OBJECTIVES
Proponents of a single-payer or public option health care system often cite the lower administrative expenses in public Medicare compared with those in private Medicare, claiming that this difference represents efficiency. We check the validity of this comparison in terms of accuracy and definitions and suggest expanding its scope to include expanded financial data of the 2 Medicare systems.
STUDY DESIGN
Using annual Medicare Boards of Trustees and National Health Expenditure Accounts data from CMS and health insurers' financial statement data, we compare the level and percentage of the administrative expenses of the Medicare systems and show incompatible and not reconcilable definitions of administrative expenses. We expand our analysis to income, benefits, gains and losses, and loss ratios of the programs.
METHODS
Our methodology is a careful comparison of categories of expenses between public and private insurers using official data sources. The comparison is both qualitative and quantitative.
RESULTS
We validate the low administrative expenses of Medicare parts A, B, and D (1.35% of benefits in 2018) compared with Medicare Part C (10.86% of benefits without loss adjustment expenses [LAE] and 14.84% with LAE for 2018). Expanding the focus, the income and benefits per beneficiary grew faster and larger in Medicare parts A, B, and D than in Medicare Part C-a reversal of earlier trends. The public Medicare program suffered losses in 11 years during 2002-2018, whereas private insurers' Medicare remained solvent with about an 85% loss ratio.
CONCLUSIONS
Comparisons of the systems in the United States would benefit from expanding the focus beyond incomparable administrative expenses. For the current period of coronavirus disease 2019, if the trends continue, public Medicare may suffer greater deficits relative to the private Medicare Part C.
Topics: Costs and Cost Analysis; Humans; Medicare Part A; Medicare Part B; Medicare Part C; Medicare Part D; Private Sector; Public Sector; United States
PubMed: 33877779
DOI: 10.37765/ajmc.2021.88621 -
Health Services Research Dec 2017To compare performance between Medicare Advantage (MA) and Fee-for-Service (FFS) Medicare during a time of policy changes affecting both programs.
OBJECTIVE
To compare performance between Medicare Advantage (MA) and Fee-for-Service (FFS) Medicare during a time of policy changes affecting both programs.
DATA SOURCES/STUDY SETTING
Performance data for 16 clinical quality measures and 6 patient experience measures for 9.9 million beneficiaries living in California, New York, and Florida.
STUDY DESIGN
We compared MA and FFS performance overall, by plan type, and within service areas associated with contracts between CMS and MA organizations. Case mix-adjusted analyses (for measures not typically adjusted) were used to explore the effect of case mix on MA/FFS differences.
DATA COLLECTION/EXTRACTION METHODS
Performance measures were submitted by MA organizations, obtained from the nationwide fielding of the Medicare Consumer Assessment of Healthcare Providers and Systems (MCAHPS) Survey, or derived from claims.
PRINCIPAL FINDINGS
Overall, MA outperformed FFS on all 16 clinical quality measures. Differences were large for HEDIS measures and small for Part D measures and remained after case mix adjustment. MA enrollees reported better experiences overall, but FFS beneficiaries reported better access to care. Relative to FFS, performance gaps were much wider for HMOs than PPOs. Excluding HEDIS measures, MA/FFS differences were much smaller in contract-level comparisons.
CONCLUSIONS
Medicare Advantage/Fee-for-Service differences are often large but vary in important ways across types of measures and contracts.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Humans; Medicare; Medicare Part C; Medicare Part D; Middle Aged; Patient Satisfaction; Quality Indicators, Health Care; Risk Adjustment; United States; Young Adult
PubMed: 29130269
DOI: 10.1111/1475-6773.12787 -
The American Journal of Managed Care Sep 2019To explore whether the Affordable Care Act (ACA)'s Medicare Advantage (MA) payment cuts were associated with changes in enrollees' access to and affordability of... (Comparative Study)
Comparative Study
OBJECTIVES
To explore whether the Affordable Care Act (ACA)'s Medicare Advantage (MA) payment cuts were associated with changes in enrollees' access to and affordability of healthcare relative to traditional Medicare (TM).
STUDY DESIGN
Descriptive analyses of changes in access and affordability in MA relative to TM between 2009 and 2017 and between 2011 and 2017.
METHODS
Respondents who reported Medicare coverage on the National Health Interview Survey were divided into MA and TM enrollees. Using multivariate regression to adjust for demographic, economic, and health status changes over time, we compared changes in healthcare access and affordability for the 2 groups between 2009 and 2017, as the ACA payment cuts were implemented. For some measures, the analysis covers 2011 to 2017.
RESULTS
Between 2009 and 2017, MA respondents did not report statistically significant changes in healthcare access or affordability after adjusting for demographic, socioeconomic, and health status changes in the MA population. There were no statistically significant differences between changes in access and affordability for beneficiaries in MA relative to those in TM over this period.
CONCLUSIONS
Although MA payment cuts were expected to reduce the attractiveness of the MA program to both plans and enrollees, the program's enrollment grew steadily from 2009 to 2017. Over this period, plans reduced their costs for providing Part A and Part B benefits to their enrollees, thereby preserving room for rebates. Our findings show that plans made such cost reductions without significantly affecting enrollees' access to or affordability of care compared with TM beneficiaries.
Topics: Aged; Aged, 80 and over; Costs and Cost Analysis; Female; Forecasting; Health Services Accessibility; Humans; Male; Medicare; Medicare Part C; Patient Protection and Affordable Care Act; United States
PubMed: 31518097
DOI: No ID Found -
Health Services Research Feb 2023To construct a new measure of end-of-life (EoL) spending-the elevated EoL spending-and examine its associations with measures of quality of care and patient and...
OBJECTIVE
To construct a new measure of end-of-life (EoL) spending-the elevated EoL spending-and examine its associations with measures of quality of care and patient and physician preferences in comparison with the commonly used total Medicare EoL spending measures.
DATA SOURCES AND STUDY SETTING
Medicare claims data for a 20% random sample of Medicare fee-for-service (FFS) patients, from the health care quality data for 2015-2016, from the Hospital Compare and the Medicare Geographic Variation public use file, and survey data about patient and physician preferences.
STUDY DESIGN
We constructed the elevated EoL spending measure as the differential monthly spending between decedents and survivors with the same one-year mortality risk, where the risk was predicted using machine learning models. We then examined the associations of the hospital referral region (HRR)-level elevated EoL spending with various health care quality measures and with the survey-elicited patient and provider preferences. We also examined analogous associations for monthly total EoL spending on decedents.
DATA EXTRACTION METHODS
Medicare FFS patients who were continuously enrolled in Medicare Parts A & B in 2015 and were alive as of January 1, 2016.
PRINCIPAL FINDINGS
We found a large variation in the elevated EoL spending across HRRs in the United States. There was no evidence of an association between HRR-level elevated EoL spending and established health care quality measures, including those specific to EoL care, whereas total EoL spending was positively associated with certain quality of care measures. We also found no evidence that elevated EoL spending was associated with patient preferences for EoL care. However, elevated EoL spending was positively and significantly associated with physician preferences for treatment intensity.
CONCLUSIONS
Our findings suggested that elevated EoL spending captures different resource use from conventional measures of EoL spending and may be more valuable in identifying potentially wasteful spending.
Topics: Aged; Humans; United States; Medicare; Health Expenditures; Terminal Care; Medicare Part A; Death
PubMed: 36303444
DOI: 10.1111/1475-6773.14093 -
JAMA Health Forum Oct 2021
Topics: Delivery of Health Care; Health Facilities; Medicare; United States
PubMed: 36218896
DOI: 10.1001/jamahealthforum.2021.3017 -
Missouri Medicine 2015
Topics: Accountable Care Organizations; Health Expenditures; Humans; Medicare; Medicare Part C; Medicare Part D; Physician's Role; Physician-Patient Relations; Quality of Health Care; United States
PubMed: 26455051
DOI: No ID Found