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Medical Care Apr 2021Medicare home health providers are now required to deliver family caregiver training, but potential consequences for service intensity are unknown. (Observational Study)
Observational Study
BACKGROUND
Medicare home health providers are now required to deliver family caregiver training, but potential consequences for service intensity are unknown.
OBJECTIVE
The objective of this study was to assess how family caregiver training needs affect the number and type of home health visits received.
DESIGN
Observational study using linked National Health and Aging Trends Study (NHATS), Outcomes and Assessment Information Set (OASIS), and Medicare claims data. Propensity score adjusted, multivariable logistic, and negative binomial regressions model the relationship between caregivers' training needs and number/type of home health visits.
SUBJECTS
A total of 1217 (weighted n=5,870,905) National Health and Aging Trends Study participants receiving Medicare-funded home health between 2011 and 2016.
MEASURES
Number and type of home health visits, from Medicare claims. Family caregivers' training needs, from home health clinician reports.
RESULTS
Receipt of nursing visits was more likely when family caregivers had medication management [adjusted odds ratio (aOR): 3.03; 95% confidence interval (CI): 1.06, 8.68] or household chore training needs (aOR: 3.38; 95% CI: 1.33, 8.59). Receipt of therapy visits was more likely when caregivers had self-care training needs (aOR: 1.70; 95% CI: 1.01, 2.86). Receipt of aide visits was more likely when caregivers had household chore (aOR: 3.54; 95% CI: 1.82, 6.92) or self-care training needs (aOR: 2.12; 95% CI: 1.11, 4.05). Medication management training needs were associated with receiving an additional 1.06 (95% CI: 0.11, 2.01) nursing visits, and household chores training needs were associated with an additional 3.24 total (95% CI: 0.21, 6.28) and 1.32 aide visits (95% CI: 0.36, 2.27).
CONCLUSION
Family caregivers' activity-specific training needs may affect home health visit utilization.
Topics: Aged; Aged, 80 and over; Caregivers; Family; Female; Home Care Services; Humans; Male; Medicare; Medication Therapy Management; Patient Acceptance of Health Care; Severity of Illness Index; United States
PubMed: 33480658
DOI: 10.1097/MLR.0000000000001487 -
Home Healthcare Now 2020
Topics: Humans; Insurance Claim Reporting; Medicare; Quality Improvement; United States
PubMed: 32134812
DOI: 10.1097/NHH.0000000000000862 -
JAMA May 2022
Topics: Aged; Humans; Medicare; Patient Care Bundles; Reimbursement Mechanisms; United States
PubMed: 35452088
DOI: 10.1001/jama.2022.6402 -
Annual Review of Public Health Apr 2020Over the past decade, the Centers for Medicare and Medicaid Services (CMS) have led the nationwide shift toward value-based payment. A major strategy for achieving this... (Review)
Review
Over the past decade, the Centers for Medicare and Medicaid Services (CMS) have led the nationwide shift toward value-based payment. A major strategy for achieving this goal has been to implement alternative payment models (APMs) that encourage high-value care by holding providers financially accountable for both the quality and the costs of care. In particular, the CMS has implemented and scaled up two types of APMs: population-based models that emphasize accountability for overall quality and costs for defined patient populations, and episode-based payment models that emphasize accountability for quality and costs for discrete care. Both APM types have been associated with modest reductions in Medicare spending without apparent compromises in quality. However, concerns about the unintended consequences of these APMs remain, and more work is needed in several important areas. Nonetheless, both APM types represent steps to build on along the path toward a higher-value national health care system.
Topics: Aged; Aged, 80 and over; Delivery of Health Care; Female; Humans; Male; Medicare; Reimbursement Mechanisms; United States; Value-Based Health Insurance
PubMed: 32237986
DOI: 10.1146/annurev-publhealth-040119-094327 -
AJR. American Journal of Roentgenology Jan 2021Medicare permits radiologists to bill for trainee work but only in narrowly defined circumstances and with considerable consequences for noncompliance. The purpose of... (Review)
Review
Medicare permits radiologists to bill for trainee work but only in narrowly defined circumstances and with considerable consequences for noncompliance. The purpose of this article is to introduce relevant policy rationale and definitions, review payment requirements, outline documentation and operational considerations for diagnostic and interventional radiology services, and offer practical suggestions for academic radiologists striving to optimize regulatory compliance. As academic radiology departments advance their missions of service, teaching, and scholarship, most rely on residents and fellows to support expanding clinical demands. Given the risks of technical noncompliance, institutional commitment and ongoing education regarding teaching supervision compliance are warranted.
Topics: Humans; Insurance, Health, Reimbursement; Internship and Residency; Medicare; Radiology; United States
PubMed: 33211571
DOI: 10.2214/AJR.20.22887 -
JAMA Jun 2023
Topics: Insurance Benefits; Insurance Coverage; Medicare Part D; United States; Medicare
PubMed: 37140895
DOI: 10.1001/jama.2023.6371 -
JAMA Health Forum Dec 2022
Topics: United States; Medicare Part C
PubMed: 36580327
DOI: 10.1001/jamahealthforum.2022.4896 -
Journal of the American Geriatrics... Dec 2021Model 3 of Medicare's Bundled Payments for Care Improvement (BPCI) was a voluntary alternative payment model that held participating skilled nursing facilities (SNFs)...
BACKGROUND
Model 3 of Medicare's Bundled Payments for Care Improvement (BPCI) was a voluntary alternative payment model that held participating skilled nursing facilities (SNFs) accountable for 90-day costs of care. Its overall impact on Medicare spending and clinical outcomes is unknown.
METHODS
Retrospective cohort study using Medicare claims from 2012 to 2017. We used an interrupted time-series design to compare participating vs matched control SNFs on total 90-day Medicare payments and payment components (initial SNF stay, readmissions, and outpatient/clinician), case mix (volume, proportion Medicaid, proportion black, number of comorbidities), and clinical outcomes (90-day readmission, mortality and healthy days at home, and length of initial SNF stay), overall and among key subgroups with frailty or dementia, for 47 of the 48 conditions in the program (excluding major lower extremity joint replacement).
RESULTS
Our sample included 1001 participating and 3873 matched control SNFs. At baseline, total Medicare institutional payments were increasing at BPCI SNFs at a rate of $121 per episode per quarter; during the intervention period, payments decreased at a rate of -$398/episode/quarter. Among controls, payments were stable in the baseline period (+$17/episode/quarter) but decreased at -$424/episode/quarter during the intervention period, yielding a nonsignificant difference in slope changes of -$79/episode/quarter (95% confidence interval [CI] -$188, $31, p = 0.16). However, among patients with frailty, spending declined by $620/episode/quarter in the BPCI group, compared with $330/episode/quarter in the non-BPCI group, for a difference in slope changes of -$289 (95% CI -$482, -$96, p = 0.003). There were no differences in the change in slopes in case selection or clinical outcomes overall or in any clinical subgroup.
CONCLUSIONS
SNF participation in BPCI was associated with no overall differential change in total Medicare payments per episode, case selection, or clinical outcomes. Exploratory analyses revealed a decrease in Medicare payments in patients with frailty that may warrant further study.
Topics: Aged; Aged, 80 and over; Case-Control Studies; Diagnosis-Related Groups; Episode of Care; Female; Health Expenditures; Humans; Interrupted Time Series Analysis; Male; Medicare; Outcome Assessment, Health Care; Patient Care Bundles; Reimbursement Mechanisms; Retrospective Studies; Skilled Nursing Facilities; United States
PubMed: 34379323
DOI: 10.1111/jgs.17409 -
JAMA Network Open Aug 2023Reducing Medicare expenditures is a key objective of Medicare's transition to value-based reimbursement models. Improving access to primary care is an important way to...
IMPORTANCE
Reducing Medicare expenditures is a key objective of Medicare's transition to value-based reimbursement models. Improving access to primary care is an important way to reduce expenditures, yet less is known about how visits should be organized to maximize savings.
OBJECTIVE
To examine the association between Medicare savings and primary care visit patterns.
DESIGN, SETTING, AND PARTICIPANTS
This retrospective cohort study used data from a 5% sample of traditional Medicare claims from 2016 to 2019. Participants had at least 3 primary care visits with at least 180 days between the first and the last visit, were not enrolled in Medicare Advantage, did not have end-stage kidney disease, and were not institutionalized. Data were analyzed from June 2022 to April 2023.
EXPOSURES
Primary care visit patterns: visit frequency, regularity, continuity of care.
MAIN OUTCOMES AND MEASURES
Savings in Medicare expenditures; risk-adjusted Medicare expenditures, number of emergency department (ED) visits, and hospitalizations.
RESULTS
Among 504 471 beneficiaries (298 422 [59.16%] women; mean [SD] age, 74.26 [10.41] years), temporally regular visits with higher continuity were associated with the highest savings. For these patients, the savings increased with increasing visit frequencies, with peak savings observed at higher visit frequencies as clinical complexity increased. As regularity and continuity decreased, the association between savings and visit frequencies progressively inverted. The group with a regular and highly continuous pattern was associated with greater savings (175.87%; 95% CI, 167.40% to 184.33%; P < .001), lower risk-adjusted expenditures (-16.61%; 95% CI, -16.73% to -16.48%; P < .001), fewer risk-adjusted ED visits (-40.49%; 95% CI, -40.55% to -40.43%; P < .001), and fewer risk-adjusted hospitalizations (-53.32%; 95% CI, -53.49% to -53.14%; P < .001) compared with the irregular noncontinuous group.
CONCLUSIONS AND RELEVANCE
In this cohort study, savings in Medicare expenditures and improvements in acute care utilization were associated with visit frequency, regularity, and continuity in primary care in an interrelated fashion such that optimization of primary care visit patterns along each axis were associated with the largest improvement in outcomes. Demonstrating the magnitude and interdependence of these associations is useful for health care professionals and policymakers as Medicare continues its transition to value-based reimbursement models.
Topics: United States; Humans; Aged; Female; Male; Medicare; Cohort Studies; Retrospective Studies; Continuity of Patient Care; Critical Care
PubMed: 37603335
DOI: 10.1001/jamanetworkopen.2023.29991 -
The American Journal of Managed Care May 2024Most Medicare beneficiaries obtain supplemental insurance or enroll in Medicare Advantage (MA) to protect against potentially high cost sharing in traditional Medicare...
OBJECTIVES
Most Medicare beneficiaries obtain supplemental insurance or enroll in Medicare Advantage (MA) to protect against potentially high cost sharing in traditional Medicare (TM). We examined changes in Medicare supplemental insurance coverage in the context of MA growth.
STUDY DESIGN
Repeated cross-sectional analysis of the Medicare Current Beneficiary Survey from 2005 to 2019.
METHODS
We determined whether Medicare beneficiaries 65 years and older were enrolled in MA (without Medicaid), TM without supplemental coverage, TM with employer-sponsored supplemental coverage, TM with Medigap, or Medicaid (in TM or MA).
RESULTS
From 2005 to 2019, beneficiaries with TM and supplemental insurance provided by their former (or current) employer declined by approximately half (31.8% to 15.5%) while the share in MA (without Medicaid) more than doubled (13.4% to 35.1%). The decline in supplemental employer-sponsored insurance use was greater for White and for higher-income beneficiaries. Over the same period, beneficiaries in TM without supplemental coverage declined by more than a quarter (13.9% to 10.1%). This decline was largest for Black, Hispanic, and lower-income beneficiaries.
CONCLUSIONS
The rapid rise in MA enrollment from 2005 to 2019 was accompanied by substantial changes in supplemental insurance with TM. Our results emphasize the interconnectedness of different insurance choices made by Medicare beneficiaries.
Topics: Humans; United States; Medicare Part C; Aged; Cross-Sectional Studies; Male; Female; Medicare; Insurance Coverage; Aged, 80 and over; Cost Sharing; Insurance, Medigap
PubMed: 38748929
DOI: 10.37765/ajmc.2024.89539