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The American Journal of Medicine Feb 2018
Topics: Humans; Medicare; United States; Value-Based Health Insurance
PubMed: 29079401
DOI: 10.1016/j.amjmed.2017.10.015 -
The New England Journal of Medicine Oct 2022
Topics: Aged; Humans; Antibodies, Monoclonal, Humanized; Contracts; Insurance Coverage; Medicare; United States
PubMed: 36301560
DOI: 10.1056/NEJMp2210198 -
JAMA Jan 2019
Topics: Clinical Coding; Delivery of Health Care, Integrated; Fee-for-Service Plans; Humans; Medicare; Reimbursement Mechanisms; United States
PubMed: 30543367
DOI: 10.1001/jama.2018.19315 -
Yale Journal of Health Policy, Law, and... 2007
Review
Topics: Aged; Biomedical Technology; Clinical Trials as Topic; Health Policy; Humans; Medicare; United States
PubMed: 17824405
DOI: No ID Found -
The New England Journal of Medicine Nov 2018
Topics: Health Expenditures; Medicare; United States
PubMed: 30380389
DOI: 10.1056/NEJMc1811049 -
Health Affairs (Project Hope) Jun 2015
Topics: Humans; Insurance Coverage; Medicare; United States
PubMed: 26056215
DOI: 10.1377/hlthaff.2015.0446 -
Annals of Internal Medicine Oct 2015
Topics: Humans; Long-Term Care; Medicare; Primary Health Care; Reimbursement Mechanisms
PubMed: 26390053
DOI: 10.7326/M15-1992 -
BMC Health Services Research Jul 2022Three major hospital pay for performance (P4P) programs were introduced by the Affordable Care Act and intended to improve the quality, safety and efficiency of care...
BACKGROUND
Three major hospital pay for performance (P4P) programs were introduced by the Affordable Care Act and intended to improve the quality, safety and efficiency of care provided to Medicare beneficiaries. The financial risk to hospitals associated with Medicare's P4P programs is substantial. Evidence on the positive impact of these programs, however, has been mixed, and no study has assessed their combined impact. In this study, we examined the combined impact of Medicare's P4P programs on clinical areas and populations targeted by the programs, as well as those outside their focus.
METHODS
We used 2007-2016 Healthcare Cost and Utilization Project State Inpatient Databases for 14 states to identify hospital-level inpatient quality indicators (IQIs) and patient safety indicators (PSIs), by quarter and payer (Medicare vs. non-Medicare). IQIs and PSIs are standardized, evidence-based measures that can be used to track hospital quality of care and patient safety over time using hospital administrative data. The study period of 2007-2016 was selected to capture multiple years before and after introduction of program metrics. Interrupted time series was used to analyze the impact of the P4P programs on study outcomes targeted and not targeted by the programs. In sensitivity analyses, we examined the impact of these programs on care for non-Medicare patients.
RESULTS
Medicare P4P programs were not associated with consistent improvements in targeted or non-targeted quality and safety measures. Moreover, mortality rates across targeted and untargeted conditions were generally getting worse after the introduction of Medicare's P4P programs. Trends in PSIs were extremely mixed, with five outcomes trending in an expected (improving) direction, five trending in an unexpected (deteriorating) direction, and three with insignificant changes over time. Sensitivity analyses did not substantially alter these results.
CONCLUSIONS
Consistent with previous studies for individual programs, we detect minimal, if any, effect of Medicare's hospital P4P programs on quality and safety. Given the growing evidence of limited impact, the administrative cost of monitoring and enforcing penalties, and potential increase in mortality, CMS should consider redesigning their P4P programs before continuing to expand them.
Topics: Hospitals; Humans; Inpatients; Medicare; Patient Protection and Affordable Care Act; Quality of Health Care; Reimbursement, Incentive; United States
PubMed: 35902910
DOI: 10.1186/s12913-022-08348-w -
Lancet (London, England) Apr 1998
Topics: Eligibility Determination; Humans; Medicare; United States
PubMed: 9660569
DOI: No ID Found -
Health Services Research Apr 2018To isolate the effect of greater inpatient cost-sharing on Medicaid entry among Medicare beneficiaries.
OBJECTIVE
To isolate the effect of greater inpatient cost-sharing on Medicaid entry among Medicare beneficiaries.
DATA SOURCES
Medicare administrative data (years 2007-2010) were linked to nursing home assessments and area-level socioeconomic indicators.
STUDY DESIGN
Medicare beneficiaries who are readmitted to a hospital must pay an additional deductible ($1,100 in 2010) if their readmission occurs more than 59 days following discharge. In a regression discontinuity analysis, we take advantage of this Medicare benefit feature to test whether beneficiaries with greater cost-sharing have higher rates of Medicaid enrollment.
DATA EXTRACTION METHODS
We identified 221,248 Medicare beneficiaries with an initial hospital stay and a readmission 53-59 days later (no deductible) or 60-66 days later (charged a deductible).
PRINCIPAL FINDINGS
Among beneficiaries in low-socioeconomic areas with two hospitalizations, those readmitted 60-66 days after discharge were 21 percent more likely to join Medicaid compared with those readmitted 53-59 days following their initial hospitalization (absolute difference in adjusted risk of Medicaid entry: 3.7 percent vs. 3.1 percent, p = .01).
CONCLUSIONS
Increasing Medicare cost-sharing requirements may promote Medicaid enrollment among low-income beneficiaries. Potential savings from an increased cost-sharing in the Medicare program may be offset by increased Medicaid participation.
Topics: Aged; Aged, 80 and over; Cost Sharing; Female; Financing, Personal; Humans; Male; Medicaid; Medicare; Medicare Part A; Patient Readmission; Regression Analysis; Residence Characteristics; Socioeconomic Factors; United States
PubMed: 28295261
DOI: 10.1111/1475-6773.12682