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JAMA Nov 2023
Topics: Aged; Humans; Fees, Medical; Medicare; Physicians; United States
PubMed: 37988093
DOI: 10.1001/jama.2023.18969 -
JAMA Nov 2023
Topics: Aged; Humans; Fee Schedules; Medicare; Medicare Part B; Physicians; Relative Value Scales; United States
PubMed: 37988089
DOI: 10.1001/jama.2023.18975 -
JAMA Nov 2023
Topics: Aged; Humans; Fee Schedules; Medicare; Medicare Part B; Physicians; Relative Value Scales; United States
PubMed: 37988095
DOI: 10.1001/jama.2023.18963 -
JAMA Nov 2023
Topics: Aged; Humans; Medicare; United States; Fees, Medical; Physicians
PubMed: 37988094
DOI: 10.1001/jama.2023.18966 -
The American Journal of Geriatric... Jun 2024
Topics: Humans; United States; Medicare Part C; Health Expenditures; Medicare; Mental Disorders; Aged; Financial Stress
PubMed: 38350832
DOI: 10.1016/j.jagp.2024.01.227 -
Journal of the American Board of Family... Jan 2024The Medicare Advantage Program, home to nearly half of the eligible Medicare population, has recently come under increased scrutiny. The Government Accountability Office...
The Medicare Advantage Program, home to nearly half of the eligible Medicare population, has recently come under increased scrutiny. The Government Accountability Office called on the Centers for Medicare & Medicaid Services to monitor "disenrollment of MA beneficiaries in the last year of life, validate MA-provided encounter data, and strengthen audits used to identify and recover improper payments to MA plans." The House Subcommittee on Oversight and Investigations of the Committee on Energy & Commerce, dedicated a hearing to "Protecting America's Seniors: Oversight of Private Sector Medicare Advantage Plans." In addition, a recently conducted audit of the Office of the Inspector General of the Department of Health and Human Services raised concerns over "denials of prior authorization requests" and "beneficiary access to medically necessary care." In this article we consider the backdrop for the growing scrutiny of the MA program and the implications thereof to its future trajectory.
Topics: Aged; Humans; United States; Medicare Part C
PubMed: 37857442
DOI: 10.3122/jabfm.2023.230111R1 -
The Journal of Rural Health : Official... Sep 2023The Medicare Rural Hospital Flexibility (Flex) Program and the Critical Access Hospital (CAH) provider type are now 25 years old. Since the inception of the program, the... (Review)
Review
PURPOSE
The Medicare Rural Hospital Flexibility (Flex) Program and the Critical Access Hospital (CAH) provider type are now 25 years old. Since the inception of the program, the needs of CAHs have evolved greatly. This article describes the history of the limited-service hospital model that led to the creation of CAHs, the evolution and impact of the Flex Program on CAHs, and the trends likely to impact CAHs and rural healthcare in the future. It concludes with recommendations to address these future needs.
METHODS
This review of the 25-year history of the Flex Program and CAHs is based on a detailed analysis of the literature on the limited-service hospital model and CAHs, the evaluation reports of the Flex Tracking and Flex Monitoring Teams, and the author's 25-year history with the program.
FINDINGS
The Flex Program has made important contributions to the viability of rural hospitals through the conversion of 1,360 CAHs. The program has encouraged attention on CAH quality of care and the role of CAHs in addressing the population health needs of their communities. It has further encouraged the development of a robust rural health policy and advocacy infrastructure that has heightened attention on the needs of rural providers and communities.
CONCLUSIONS
The needs of CAHs and rural delivery systems have evolved greatly since the implementation of the Flex Program. The 25th anniversary of the program is an ideal time to re-evaluate and update the program to support CAHs in adapting to the fast-changing healthcare environment.
Topics: Aged; Humans; United States; Adult; Health Services Accessibility; Hospitals, Rural; Medicare
PubMed: 36922153
DOI: 10.1111/jrh.12754 -
BMC Health Services Research Sep 2023The post-acute patient standardized functional items (Section GG) include non-response options such as refuse, not attempt and not applicable. We examined non-response...
BACKGROUND
The post-acute patient standardized functional items (Section GG) include non-response options such as refuse, not attempt and not applicable. We examined non-response patterns and compared four methods to address non-response functional data in Section GG at nation-wide inpatient rehabilitation facilities (IRF).
METHODS
We characterized non-response patterns using 100% Medicare 2018 data. We applied four methods to generate imputed values for each non-response functional item of each patient: Monte Carlo Markov Chains multiple imputations (MCMC), Fully Conditional Specification multiple imputations (FCS), Pattern-mixture model (PMM) multiple imputations and the Centers for Medicare and Medicaid Services (CMS) approach. We compared changes of Spearman correlations and weighted kappa between Section GG and the site-specific functional items across impairments before and after applying four methods.
RESULTS
One hundred fifty-nine thousand six hundred ninety-one Medicare fee-for-services beneficiaries admitted to IRFs with stroke, brain dysfunction, neurologic condition, orthopedic disorders, and debility. At discharge, 3.9% (self-care) and 61.6% (mobility) of IRF patients had at least one non-response answer in Section GG. Patients tended to have non-response data due to refused at discharge than at admission. Patients with non-response data tended to have worse function, especially in mobility; also improved less functionally compared to patients without non-response data. Overall, patients coded as 'refused' were more functionally independent in self-care and patients coded as 'not applicable' were more functionally independent in transfer and mobility, compared to other non-response answers. Four methods showed similar changes in correlations and agreements between Section GG and the site-specific functional items, but variations exist across impairments between multiple imputations and the CMS approach.
CONCLUSIONS
The different reasons for non-response answers are correlated with varied functional status. The high proportion of patients with non-response data for mobility items raised a concern of biased IRF quality reporting. Our findings have potential implications for improving patient care, outcomes, quality reporting, and payment across post-acute settings.
Topics: United States; Humans; Aged; Medicare; Centers for Medicare and Medicaid Services, U.S.; Hospitalization; Markov Chains; Musculoskeletal Diseases
PubMed: 37674152
DOI: 10.1186/s12913-023-09982-8 -
Journal of the American Board of Family... 2024This issue highlights climate change, its effects on patients, and actions clinicians can take to make a difference for their patients and communities. The issue also...
This issue highlights climate change, its effects on patients, and actions clinicians can take to make a difference for their patients and communities. The issue also includes several reports on current trends in family physician practice patterns and the influence of practice structure. Four articles focus on controlled or illicit substances. Noteworthy among them is the description of an innovative yet simple device that allows patients to safely discard unused opioids. Other research covers adverse childhood experiences (ACEs), smoking cessation programs, and the impact of Medicare reimbursement rates on influenza vaccination.
Topics: Aged; Humans; United States; Climate Change; Family Practice; Medicare; Analgesics, Opioid
PubMed: 38467431
DOI: 10.3122/jabfm.2023.230448R0 -
JAMA Health Forum Aug 2023
Topics: Aged; United States; Humans; Hospices; Medicare
PubMed: 37651120
DOI: 10.1001/jamahealthforum.2023.3532