106 results on '"Medicaid trends"'
Search Results
2. The Increasing Adoption of Out-of-Pocket Cost Caps: Benefits, Unintended Consequences, and Policy Opportunities.
- Author
-
Wharam JF and Rosenthal MB
- Subjects
- Medicaid economics, Medicaid trends, Policy, United States epidemiology, Health Expenditures trends, Medicare economics, Medicare trends, Health Policy economics, Health Policy trends, Cost Sharing economics, Cost Sharing trends
- Published
- 2023
- Full Text
- View/download PDF
3. Outpatient Dialysis for Acute Kidney Injury: Progress and Pitfalls.
- Author
-
Heung M
- Subjects
- Acute Kidney Injury economics, Acute Kidney Injury epidemiology, Ambulatory Care economics, Ambulatory Care legislation & jurisprudence, Health Policy economics, Health Policy legislation & jurisprudence, Humans, Medicaid economics, Medicaid legislation & jurisprudence, Medicare economics, Medicare legislation & jurisprudence, Renal Dialysis economics, United States epidemiology, Acute Kidney Injury therapy, Ambulatory Care trends, Health Policy trends, Medicaid trends, Medicare trends, Renal Dialysis trends
- Abstract
Dialysis-requiring acute kidney injury (AKI) has increased markedly in the United States. At the same time, mortality rates have recently improved. As such, increasing numbers of patients with AKI are surviving to hospital discharge, including up to 30% who will continue to require outpatient dialysis. In recent years, policy changes have significantly affected the care of this high-risk population. Beginning in 2017, new legislation reversed a previous Centers for Medicare & Medicaid Services policy that prohibited dialysis for AKI at end-stage renal disease (ESRD) facilities. This has improved dialysis options for patients, but the impact on patient outcomes remains uncertain. Unfortunately, there is currently a lack of evidence basis to guide management of this vulnerable patient population. Moving forward, additional data reporting and analyses will be required, analogous to how the US Renal Data System has helped inform ESRD care. As the dialysis setting for patients with AKI shifts to the ESRD setting, it is incumbent on the nephrology community to identify best practices to promote kidney recovery, recognizing that these practices will differ from standard ESRD protocols., (Copyright © 2019 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.)
- Published
- 2019
- Full Text
- View/download PDF
4. Evolving Trends in Insurance Coverage of Vascular Surgery Patients in Academic Practice.
- Author
-
Dua A, Rothenberg K, Srivastava G, Brown K, Lewis B, Rossi P, Seabrook G, Malinowski M, Wohlauer M, and Lee CJ
- Subjects
- Databases, Factual, Health Services Accessibility economics, Health Services Accessibility trends, Humans, Insurance Benefits economics, Insurance Coverage economics, Insurance, Health economics, Medicaid economics, Medicare economics, Partnership Practice economics, Patient Protection and Affordable Care Act economics, Patient Protection and Affordable Care Act trends, Retrospective Studies, Time Factors, United States, Vascular Surgical Procedures economics, Insurance Benefits trends, Insurance Coverage trends, Insurance, Health trends, Medicaid trends, Medically Uninsured, Medicare trends, Partnership Practice trends, Vascular Surgical Procedures trends
- Abstract
Background: Insurance coverage of vascular surgery patients may differ from patients with less chronic surgical pathologies. The goal of this study is to identify trends in insurance status of vascular surgery patients over the last 10 years at a busy academic center., Methods: All consecutive patient visits for a vascular procedure from 2006 to 2016 were retrospectively reviewed from a prospectively collected institutional database. Data points included insurance status, procedures performed, and date of admission. The insurance status was categorized as Medicare, Medicaid, and uninsured. Samples were divided between 2006-2009 and 2011-2016 for comparison. Unpaired t-test, chi-squared test, and regression analysis were used to determine significant trends over the study period., Results: From 2006 to 2016, 6,007 vascular surgery procedures were performed. Procedure volume increased significantly from 1,309 to 4,698 between the 2 timeframes (P < 0.05), whereas the percentage of Medicaid and Medicare patients trended upward but did not achieve significance. There was a significant decrease in the percentage of uninsured patients between the cohorts (5.65% vs. 2.96%, P < 0.05). In 2012, 10.14% of patients were uninsured compared with 2.56% in 2016 (P < 0.05)., Conclusions: Insurance status affects access to care and subsequent outcomes. In our busy academic center, insurance coverage for vascular surgery has significantly increased over the past decade. The number of Medicaid and Medicare patients has slowly increased, but a significant and continuing decline in uninsured patients was observed. Implementation of the Affordable Care Act during this time period may have played a role in providing coverage for patient needing vascular surgery., (Copyright © 2018. Published by Elsevier Inc.)
- Published
- 2019
- Full Text
- View/download PDF
5. Cost-effectiveness of financial incentives for improving diet and health through Medicare and Medicaid: A microsimulation study.
- Author
-
Lee Y, Mozaffarian D, Sy S, Huang Y, Liu J, Wilde PE, Abrahams-Gessel S, Jardim TSV, Gaziano TA, and Micha R
- Subjects
- Adult, Aged, Aged, 80 and over, Cost-Benefit Analysis trends, Diet, Healthy trends, Female, Humans, Male, Medicaid trends, Medicare trends, Middle Aged, Nutrition Surveys economics, Nutrition Surveys methods, Nutrition Surveys trends, Risk Reduction Behavior, United States epidemiology, Cost-Benefit Analysis methods, Diet, Healthy economics, Diet, Healthy methods, Medicaid economics, Medicare economics, Motivation
- Abstract
Background: Economic incentives through health insurance may promote healthier behaviors. Little is known about health and economic impacts of incentivizing diet, a leading risk factor for diabetes and cardiovascular disease (CVD), through Medicare and Medicaid., Methods and Findings: A validated microsimulation model (CVD-PREDICT) estimated CVD and diabetes cases prevented, quality-adjusted life years (QALYs), health-related costs (formal healthcare, informal healthcare, and lost-productivity costs), and incremental cost-effectiveness ratios (ICERs) of two policy scenarios for adults within Medicare and Medicaid, compared to a base case of no new intervention: (1) 30% subsidy on fruits and vegetables ("F&V incentive") and (2) 30% subsidy on broader healthful foods including F&V, whole grains, nuts/seeds, seafood, and plant oils ("healthy food incentive"). Inputs included national demographic and dietary data from the National Health and Nutrition Examination Survey (NHANES) 2009-2014, policy effects and diet-disease effects from meta-analyses, and policy and health-related costs from established sources. Overall, 82 million adults (35-80 years old) were on Medicare and/or Medicaid. The mean (SD) age was 68.1 (11.4) years, 56.2% were female, and 25.5% were non-whites. Health and cost impacts were simulated over the lifetime of current Medicare and Medicaid participants (average simulated years = 18.3 years). The F&V incentive was estimated to prevent 1.93 million CVD events, gain 4.64 million QALYs, and save $39.7 billion in formal healthcare costs. For the healthy food incentive, corresponding gains were 3.28 million CVD and 0.12 million diabetes cases prevented, 8.40 million QALYs gained, and $100.2 billion in formal healthcare costs saved, respectively. From a healthcare perspective, both scenarios were cost-effective at 5 years and beyond, with lifetime ICERs of $18,184/QALY (F&V incentive) and $13,194/QALY (healthy food incentive). From a societal perspective including informal healthcare costs and lost productivity, respective ICERs were $14,576/QALY and $9,497/QALY. Results were robust in probabilistic sensitivity analyses and a range of one-way sensitivity and subgroup analyses, including by different durations of the intervention (5, 10, and 20 years and lifetime), food subsidy levels (20%, 50%), insurance groups (Medicare, Medicaid, and dual-eligible), and beneficiary characteristics within each insurance group (age, race/ethnicity, education, income, and Supplemental Nutrition Assistant Program [SNAP] status). Simulation studies such as this one provide quantitative estimates of benefits and uncertainty but cannot directly prove health and economic impacts., Conclusions: Economic incentives for healthier foods through Medicare and Medicaid could generate substantial health gains and be highly cost-effective., Competing Interests: I have read the journal's policy and the authors of this manuscript have the following competing interests: RM reports research funding from NIH, Bill & Melinda Gates Foundation, and Unilever and personal fees from the World Bank and Bunge. DM reports research funding from the National Institutes of Health and the Gates Foundation; personal fees from GOED, Nutrition Impact, Pollock Communications, Bunge, Indigo Agriculture, Amarin, Acasti Pharma, Cleveland Clinic Foundation, America’s Test Kitchen, and Danone; scientific advisory board, Elysium Health (with stock options), Omada Health, and DayTwo; and chapter royalties from UpToDate, all outside the submitted work. TAG has also received research funds and/or consulting fees from Astra Zeneca, Novartis, United Health Group, Teva Pharmacueticals, and Takeda in the past five years, all of which were outside the submitted work.
- Published
- 2019
- Full Text
- View/download PDF
6. Emerging Trends in Financing of Adult Heart Transplantation in the United States.
- Author
-
DeFilippis EM, Vaduganathan M, Machado S, Stehlik J, and Mehra MR
- Subjects
- Adolescent, Adult, Black or African American, Female, Humans, Insurance Coverage, Insurance, Health trends, Male, Middle Aged, Reimbursement Mechanisms, Sex Factors, United States, White People, Young Adult, Financing, Government trends, Heart Transplantation economics, Medicaid trends, Medicare trends
- Abstract
Objectives: This study examined longitudinal trends in types of payers for adult heart transplantations in the United States., Background: In the last decade, volume of heart transplantations in the United States has substantially increased, a trend that has coincided with Medicaid expansion and greater insurance coverage in the general U.S., Population: Limited data are available characterizing the changes in payer mix supporting these recent increases in heart transplantation activity., Methods: De-identified data were obtained from the Organ Procurement and Transplantation Network for heart transplantation recipients 18 to 64 years of age in the United States between 1997 and 2017. Primary sources of insurance payment were determined at the time of transplantation in aggregate and stratified by sex and race. Changes in volume and payer mix of patients added to the candidate waitlist between 1997 and 2017 were also examined., Results: A total of 36,340 adults from 18 to 64 years of age underwent heart transplantations between 1997 and 2017. Support by public payer insurance increased from 28.2% (in 1997) to a peak of 48.8% (in 2016). Medicaid coverage increased from 9.4% in 1997 to 15.5% in 2007 and remained stable to 2017 (14.7%; β-coefficient: +0.23% [0.04]; p < 0.001 for trend). Medicare beneficiaries accounted for 18.2% of recipients in 1997, 22% in 2007, and 30.3% in 2016 (β-coefficient: +0.60% [0.06]; p < 0.001 for trend). The proportion of transplantation candidates receiving Medicare coverage increased over time across all races and both sexes. Similar aggregate patterns were observed in waitlist trends for adult heart transplantation candidates., Conclusions: Public payer insurance has emerged as an increasingly dominant source of funding for adult heart transplantations in the United States, supporting nearly half of all transplants in 2017., (Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2019
- Full Text
- View/download PDF
7. Disparity in Medicaid physician payments for vascular surgery.
- Author
-
Perri JL, Powell RJ, Goodney PP, Mabry CD, Gurien LA, Smith S, and Zwolak R
- Subjects
- Health Services Accessibility economics, Healthcare Disparities economics, Humans, Medicaid trends, Medicare trends, Reimbursement Mechanisms trends, Retrospective Studies, United States, Vascular Surgical Procedures trends, Health Care Costs trends, Health Expenditures trends, Medicaid economics, Medicare economics, Reimbursement Mechanisms economics, Vascular Surgical Procedures economics
- Abstract
Objective: Medicare reimbursements are standardized nationwide on the basis of resource-dependent inputs of physicians' time, intensity, practice costs, and malpractice costs, whereas Medicaid payments vary and are determined by individual states. Our objectives were to determine Medicaid reimbursement to physicians for common vascular procedures for the seven states in the Northeast that compose the New England Society for Vascular Surgery and to compare Medicaid payments with Medicare., Methods: Using publicly available data, we obtained Medicaid physician payments in Connecticut, Massachusetts, Maine, New Hampshire, New York, Rhode Island, and Vermont for 10 commonly performed vascular surgery procedures. For comparison, Medicare physician payments for these procedures were adjusted for regional differences using Medicare geographic payment cost indices. Descriptive statistics were calculated by state; Wilcoxon signed rank test was used to compare fees, and one-way analysis of variance was used to compare variance., Results: Medicaid payments varied widely by state. Within individual states (except Vermont), there was no relationship between Medicaid and Medicare payments. Medicaid reimbursement for common vascular procedures ranged from 25% to 91% of Medicare rates and had up to a threefold variation in payment among states for a single procedure. The mean Medicaid payment was 60% of Medicare payment. The greatest state-to-state variance in payment was for open abdominal aortic repair (standard deviation, $227.31); the least was for femoral artery exposure (standard deviation, $31.86). For a Medicaid-based, frequency-weighted analysis of services, New Hampshire exhibited the lowest payments (43% Medicare) and Vermont the highest (80% Medicare)., Conclusions: Among the seven Northeast states considered, with the exception of Vermont, there is no logical relationship between Medicaid and Medicare payments. Because Medicare payments are determined by the Centers for Medicare and Medicaid Services with consideration of resource-based inputs, we conclude that in six of the seven states, Medicaid payments bear no relationship to resource utilization. With Medicaid expansion, access to vascular procedures may be limited by payments insufficient to meet resource needs., (Copyright © 2018. Published by Elsevier Inc.)
- Published
- 2018
- Full Text
- View/download PDF
8. Factors of U.S. Hospitals Associated with Improved Profit Margins: An Observational Study.
- Author
-
Ly DP and Cutler DM
- Subjects
- Diagnosis-Related Groups economics, Diagnosis-Related Groups trends, Humans, Medicaid economics, Medicare economics, Retrospective Studies, United States epidemiology, Costs and Cost Analysis trends, Hospital Costs trends, Medicaid trends, Medicare trends
- Abstract
Background: Hospitals face financial pressure from decreased margins from Medicare and Medicaid and lower reimbursement from consolidating insurers., Objectives: The objectives of this study are to determine whether hospitals that became more profitable increased revenues or decreased costs more and to examine characteristics associated with improved financial performance over time., Design: The design of this study is retrospective analyses of U.S. non-federal acute care hospitals between 2003 and 2013., Subjects: There are 2824 hospitals as subjects of this study., Main Measures: The main measures of this study are the change in clinical operating margin, change in revenues per bed, and change in expenses per bed between 2003 and 2013., Key Results: Hospitals that became more profitable had a larger magnitude of increases in revenue per bed (about $113,000 per year [95% confidence interval: $93,132 to $133,401]) than of decreases in costs per bed (about - $10,000 per year [95% confidence interval: - $28,956 to $9617]), largely driven by higher non-Medicare reimbursement. Hospitals that improved their margins were larger or joined a hospital system. Not-for-profit status was associated with increases in operating margin, while rural status and having a larger share of Medicare patients were associated with decreases in operating margin. There was no association between improved hospital profitability and changes in diagnosis related group weight, in number of profitable services, or in payer mix. Hospitals that became more profitable were more likely to increase their admissions per bed per year., Conclusions: Differential price increases have led to improved margins for some hospitals over time. Where significant price increases are not possible, hospitals will have to become more efficient to maintain profitability.
- Published
- 2018
- Full Text
- View/download PDF
9. Designing a Medicare Help at Home Benefit: Lessons from Maryland’s Community First Choice Program.
- Author
-
Davis K, Willink A, Stockwell I, Whiton K, Burgdorf J, and Woodcock C
- Subjects
- Adult, Aged, Community Health Services trends, Forecasting, Government Programs, Home Care Services trends, Home Nursing trends, Humans, Insurance Benefits trends, Maryland, Medicaid trends, Medicare trends, Middle Aged, State Government, United States, Community Health Services economics, Dual MEDICAID MEDICARE Eligibility, Home Care Services economics, Home Nursing economics, Insurance Benefits economics, Medicaid economics, Medicare economics
- Published
- 2018
10. Change in Health Insurance Coverage After Liver Transplantation Can Be Associated with Worse Outcomes.
- Author
-
Akateh C, Tumin D, Beal EW, Mumtaz K, Tobias JD, Hayes D Jr, and Black SM
- Subjects
- Adolescent, Adult, Databases, Factual, Female, Graft Survival, Humans, Kaplan-Meier Estimate, Liver Transplantation mortality, Liver Transplantation trends, Male, Middle Aged, Multivariate Analysis, Proportional Hazards Models, Risk Factors, Time Factors, Treatment Outcome, United States, Young Adult, Insurance Coverage, Insurance, Health trends, Liver Transplantation adverse effects, Medicaid trends, Medicare trends, Private Sector trends, Public Sector trends, Tissue and Organ Procurement
- Abstract
Background: Health insurance coverage changes for many patients after liver transplantation, but the implications of this change on long-term outcomes are unclear., Aims: To assess post-transplant patient and graft survival according to change in insurance coverage within 1 year of transplantation., Methods: We queried the United Network for Organ Sharing for patients between ages 18-64 years undergoing liver transplantation in 2002-2016. Patients surviving > 1 year were categorized by insurance coverage at transplantation and the 1-year transplant anniversary. Multivariable Cox regression characterized the association between coverage pattern and long-term patient or graft survival., Results: Among 34,487 patients in the analysis, insurance coverage patterns included continuous private coverage (58%), continuous public coverage (29%), private to public transition (8%) and public to private transition (4%). In multivariable analysis of patient survival, continuous public insurance (HR 1.29, CI 1.22, 1.37, p < 0.001), private to public transition (HR 1.17, CI 1.07, 1.28, p < 0.001), and public to private transition (HR 1.14, CI 1.00, 1.29, p = 0.044), were associated with greater mortality hazard, compared to continuous private coverage. After disaggregating public coverage by source, mortality hazard was highest for patients transitioning from private insurance to Medicaid (HR vs. continuous private coverage = 1.32; 95% CI 1.14, 1.52; p < 0.001). Similar differences by insurance category were found for death-censored graft failure., Conclusion: Post-transplant transition to public insurance coverage is associated with higher risk of adverse outcomes when compared to retaining private coverage.
- Published
- 2018
- Full Text
- View/download PDF
11. Drivers of Medicare Reimbursement for Thoracolumbar Fusion: An Analysis of Data From The Centers For Medicare and Medicaid Services.
- Author
-
Khanna K, Padegimas EM, Zmistowski B, Howley M, and Verma K
- Subjects
- Aged, Centers for Medicare and Medicaid Services, U.S. economics, Centers for Medicare and Medicaid Services, U.S. trends, Data Analysis, Diagnosis-Related Groups economics, Diagnosis-Related Groups trends, Health Expenditures trends, Humans, Insurance, Health, Reimbursement trends, Medicaid trends, Medicare trends, Retrospective Studies, Spinal Diseases economics, Spinal Diseases epidemiology, Spinal Diseases surgery, Spinal Fusion trends, United States epidemiology, Young Adult, Insurance, Health, Reimbursement economics, Lumbar Vertebrae surgery, Medicaid economics, Medicare economics, Spinal Fusion economics, Thoracic Vertebrae surgery
- Abstract
Study Design: A retrospective observational study., Objective: The purpose of this study is to examine the variation in thoracolumbar fusion (TLF) payment and determine the drivers of this variation., Summary of Background Data: As health care spending continues to increase, variation in surgical procedures reimbursements has come under more scrutiny. TLF is an example of a high-cost, proven-benefit procedure that is often the focus of Centers for Medicare and Medicaid Services (CMS) administrators. There is a wide variation in TLF charges, but the drivers for this variation are not clear., Methods: Claims for TLF were identified in the CMS data by analyzing Diagnosis Related Group (DRG) number 460 ("Spinal Fusion Except Cervical without Major Complications or Comorbidities"). Data on factors that may impact cost of care were collected from four sources: the United States Census Bureau, CMS, the Dartmouth Atlas, and WWAMI Rural Health Research Center. These were then grouped into seven categories: quality, supply, demand, substitute treatment availability, patient characteristics, competitive factors, and provider characteristics. Predictive reimbursement models were created from the data using multivariate linear regression to understand the factors that influence TLF reimbursement., Results: There was significant geographic variability in reimbursement. The largest contribution to reimbursement variation came from variables in the demand (ΔR = 13.4%, P < 0.001), supply (ΔR = 9.2%, P < 0.001), and competitive factor domains (ΔR = 9.1%, P < 0.001). The top three drivers that increased reimbursement were provider charges (β = 0.37, P < 0.001), total Medicare reimbursement in the region (β = 0.19, P < 0.001), and the number of spinal surgeries per 1000 patients in that region (β = 0.06, P = 0.02). Institutional volume, a surrogate for quality was negatively associated with TLF reimbursement., Conclusion: There was wide variation in reimbursement for TLF across the U.S. The variables that drive TLF reimbursement variation include supply, demand, and competition. Interestingly, quality of care was not associated with increased TLF reimbursement., Level of Evidence: N/A.
- Published
- 2017
- Full Text
- View/download PDF
12. Prescribing Oxygen for Cluster Headache: A Guide for the Provider.
- Author
-
Tepper SJ, Duplin J, Nye B, and Tepper DE
- Subjects
- Cluster Headache epidemiology, Humans, Medicaid trends, Medicare trends, Oxygen administration & dosage, Oxygen economics, Oxygen Inhalation Therapy standards, Oxygen Inhalation Therapy trends, United States epidemiology, Cluster Headache economics, Cluster Headache therapy, Medicaid economics, Medicare economics, Oxygen Inhalation Therapy economics, Prescriptions economics
- Abstract
Background: Oxygen is the standard of care for acute treatment of cluster headache. CMS, the US Centers for Medicaid and Medicare Services, has made the indefensible decision to not cover oxygen for cluster headache for patients with Medicaid and Medicare insurance, despite the evidence and professional guidelines. Commercial insurance generally covers oxygen for cluster headache., Objective: This is a "how-to" guide for successfully prescribing oxygen in the US., Summary: Prescription information is provided that can be incorporated as dot phrases, smart sets, or other standard templates for prescribing oxygen for cluster patients. In many states, oxygen is affordable and can be prescribed for Medicaid and Medicare patients who wish to pay cash. Welding or nonmedical grade industrial oxygen is almost the same cost as medical oxygen. However, it is less pure, lacks the same inspection of tanks, and is delivered without regulators to provide appropriate flow rates. Patients who pay cash should be strongly encouraged to buy medical oxygen., (© 2017 American Headache Society.)
- Published
- 2017
- Full Text
- View/download PDF
13. Health Services Utilization Among Fee-for-Service Medicare and Medicaid Patients Under Age 65 with Behavioral Health Illness at an Urban Safety Net Hospital.
- Author
-
Cancino RS, Jack BW, Jarvis J, Cummings AK, Cooper E, Cremieux PY, and Burgess JF Jr
- Subjects
- Adult, Cross-Sectional Studies, Fee-for-Service Plans economics, Female, Hospitals, Urban economics, Hospitals, Urban trends, Humans, Male, Medicaid economics, Medicare economics, Middle Aged, Retrospective Studies, Safety-net Providers economics, United States epidemiology, Fee-for-Service Plans trends, Medicaid trends, Medicare trends, Patient Acceptance of Health Care, Problem Behavior, Safety-net Providers trends
- Abstract
Background: In 2011, fee-for-service patients with both Medicare and Medicaid (dual eligible) sustained $319.5 billion in health care costs., Objective: To describe the emergency department (ED) use and hospital admissions of adult dual eligible patients aged under 65 years who used an urban safety net hospital., Methods: This was a retrospective database analysis of patients aged between 18 and 65 years with Medicare and Medicaid, who used an urban safety net academic health center between January 1, 2011, and December 31, 2011. We compared patients with and without behavioral health illness. The main outcome measures were hospital admission and ED use. Chi-square and Wilcoxon rank-sum tests were used for descriptive statistics on categorical and continuous variables, respectively. Greedy propensity score matching was used to control for confounding factors. Rate ratios (RR) and 95% confidence intervals (CI) were determined after matching and after adjusting for those variables that remained significantly different after matching., Results: In 2011, 10% of all fee-for-service dual eligible patients aged less than 65 years in Massachusetts were seen at Boston Medical Center. Data before propensity score matching showed significant differences in age, sex, race/ethnicity, marital status, education, employment, physical comorbidities, and Charlson Comorbidity Index score between patients with and without behavioral health illness. Analysis after propensity score matching found significant differences in sex, Hispanic race, and other education and employment status. Compared with patients without behavioral health illness, patients with behavioral health illness had a higher RR for hospital admissions (RR = 2.07; 95% CI = 1.81-2.38; P < 0.001) and ED use (RR = 1.61; 95% CI = 1.46-1.77; P < 0.001). Results were robust after adjusting for characteristics that remained statistically significantly different after propensity score matching., Conclusions: Adult dual eligible patients aged less than 65 years with behavioral health illness in the Medicaid fee-for-service plan had significantly higher rates of hospital admission and ED use compared with dual eligible patients without behavioral health illness at the largest urban safety net medical center in New England. Safety net hospitals care for a large proportion of dual eligible patients with behavioral health illness. Further research is needed to elucidate the systems-related and patient-centered factors contributing to the utilization behaviors of this patient population., Disclosures: This research was funded in part by a National Research Service Award (T3HP10028-14-01). The authors have no conflicts of interests to disclose. Cancino had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design were contributed by Cancino, Jack, and Burgess, with assistance from Cremieux. Cancino and Cremieux took the lead in data collection, along with Jack and Burgess, and data interpretation was performed by Jarvis, Cummings, and Cooper, along with the other authors. The manuscript was written primarily by Cancino, along with Jack and Burgess, and revised primarily by Cancino, along with the other authors.
- Published
- 2017
- Full Text
- View/download PDF
14. Use of Federally Qualified Health Centers and Potentially Preventable Hospital Utilization Among Older Medicare-Medicaid Enrollees.
- Author
-
Wright B, Potter AJ, and Trivedi AN
- Subjects
- Aged, Community Health Centers economics, Community Health Centers statistics & numerical data, Emergency Service, Hospital economics, Emergency Service, Hospital statistics & numerical data, Female, Hospitalization economics, Humans, Insurance Claim Review statistics & numerical data, Male, Medicaid economics, Medicaid statistics & numerical data, Medicare economics, Medicare statistics & numerical data, Retrospective Studies, Sex Distribution, United States, Community Health Centers trends, Emergency Service, Hospital trends, Hospitalization trends, Medicaid trends, Medicare trends
- Abstract
Using Medicare claims data from 2007 to 2010, we sought to determine whether dual eligibles 65 years and older who utilize federally qualified health centers (FQHCs) have lower rates of ambulatory care-sensitive hospitalizations and emergency department visits compared with nonusers. We found that FQHC use is associated with increased ambulatory care-sensitive hospitalization rates for whites and other races, but a decrease among blacks. Depending on race, FQHC use is associated with an increase of 24 to 43 ambulatory care-sensitive emergency department visits per thousand persons annually. More research is needed to understand why FQHC use is associated with these outcomes among dual eligibles.
- Published
- 2017
- Full Text
- View/download PDF
15. The Past, Present, and Future of the Centers for Medicare and Medicaid Services Quality Measure SEP-1: The Early Management Bundle for Severe Sepsis/Septic Shock.
- Author
-
Faust JS and Weingart SD
- Subjects
- Early Medical Intervention standards, Emergency Service, Hospital trends, Forecasting, Humans, Medicaid trends, Medicare trends, Patient Care Bundles trends, Quality Indicators, Health Care trends, United States, Emergency Service, Hospital standards, Medicaid standards, Medicare standards, Patient Care Bundles standards, Quality Indicators, Health Care standards, Sepsis therapy, Shock, Septic therapy
- Abstract
SEP-1, the new national quality measure on sepsis, resulted from an undertaking to standardize care for severe sepsis and septic shock regardless of the size of the emergency department where the patient is being treated. SEP-1 does not necessarily follow the best current evidence available. Nevertheless, a thorough understanding of SEP-1 is crucial because all hospitals and emergency providers will be accountable for meeting the requirements of this measure. SEP-1 is the first national quality measure on early management of sepsis care. This article provides a review of SEP-1 and all its potential implications on sepsis care in the United States., (Copyright © 2016 Elsevier Inc. All rights reserved.)
- Published
- 2017
- Full Text
- View/download PDF
16. Estimating National Trends in Inpatient Antibiotic Use Among US Hospitals From 2006 to 2012.
- Author
-
Baggs J, Fridkin SK, Pollack LA, Srinivasan A, and Jernigan JA
- Subjects
- Adult, Child, Drug Prescriptions statistics & numerical data, Drug Resistance, Microbial, Hospitals, Pediatric trends, Hospitals, Public trends, Humans, Length of Stay statistics & numerical data, Patient Discharge statistics & numerical data, Prescription Drug Misuse statistics & numerical data, Retrospective Studies, United States, Anti-Bacterial Agents therapeutic use, Inpatients statistics & numerical data, Length of Stay trends, Medicaid trends, Medicare trends, Patient Discharge trends, Prescription Drug Misuse trends
- Abstract
Importance: The rising threat of antibiotic resistance and other adverse consequences resulting from the misuse of antibiotics requires a better understanding of antibiotic use in hospitals in the United States., Objective: To use proprietary administrative data to estimate patterns of US inpatient antibiotic use in recent years., Design, Setting, and Participants: For this retrospective analysis, adult and pediatric in-patient antibiotic use data was obtained from the Truven Health MarketScan Hospital Drug Database (HDD) from January 1, 2006, to December 31, 2012. Data from adult and pediatric patients admitted to 1 of approximately 300 participating acute care hospitals provided antibiotic use data for over 34 million discharges representing 166 million patient-days., Main Outcomes and Measures: We retrospectively estimated the days of therapy (DOT) per 1000 patient-days and the proportion of hospital discharges in which a patient received at least 1 dose of an antibiotic during the hospital stay. We calculated measures of antibiotic usage stratified by antibiotic class, year, and other patient and facility characteristics. We used data submitted to the Centers for Medicare and Medicaid Services Healthcare Cost Report Information System to generate estimated weights to apply to the HDD data to create national estimates of antibiotic usage. A multivariate general estimating equation model to account for interhospital covariance was used to assess potential trends in antibiotic DOT over time., Results: During the years 2006 to 2012, 300 to 383 hospitals per year contributed antibiotic data to the HDD. Across all years, 55.1% of patients received at least 1 dose of antibiotics during their hospital visit. The overall national DOT was 755 per 1000 patient-days. Overall antibiotic use did not change significantly over time. The multivariable trend analysis of data from participating hospitals did not show a statistically significant change in overall use (total DOT increase, 5.6; 95% CI, -18.9 to 30.1; P = .65). However, the mean change (95% CI) for the following antibiotic classes increased significantly: third- and fourth-generation cephalosporins, 10.3 (3.1-17.5); macrolides, 4.8 (2.0-7.6); glycopeptides, 22.4 (17.5-27.3); β-lactam/β-lactamase inhibitor combinations, 18.0 (13.3-22.6); carbapenems, 7.4 (4.6-10.2); and tetracyclines, 3.3 (2.0-4.7)., Conclusions and Relevance: Overall DOT of all antibiotics among hospitalized patients in US hospitals has not changed significantly in recent years. Use of some antibiotics, especially broad spectrum agents, however, has increased significantly. This trend is worrisome in light of the rising challenge of antibiotic resistance. Our findings can help inform national efforts to improve antibiotic use by suggesting key targets for improvement interventions.
- Published
- 2016
- Full Text
- View/download PDF
17. Patterns of Adherence to Oral Atypical Antipsychotics Among Patients Diagnosed with Schizophrenia.
- Author
-
MacEwan JP, Forma FM, Shafrin J, Hatch A, Lakdawalla DN, and Lindenmayer JP
- Subjects
- Adolescent, Adult, Aged, Antipsychotic Agents economics, Female, Humans, Insurance Claim Review economics, Insurance Claim Review trends, Longitudinal Studies, Male, Medicaid economics, Medicare economics, Middle Aged, Schizophrenia economics, United States, Young Adult, Antipsychotic Agents administration & dosage, Medicaid trends, Medicare trends, Medication Adherence, Schizophrenia diagnosis, Schizophrenia drug therapy
- Abstract
Background: Poor medication adherence contributes to negative treatment response, symptom relapse, and hospitalizations in schizophrenia. Many health plans use claims-based measures like medication possession ratios or proportion of days covered (PDC) to measure patient adherence to antipsychotics. Classifying patients solely on the basis of a single average PDC measure, however, may mask clinically meaningful variations over time in how patients arrive at an average PDC level., Objective: To model patterns of medication adherence evolving over time for patients with schizophrenia who initiated treatment with an oral atypical antipsychotic and, based on these patterns, to identify groups of patients with different adherence behaviors., Methods: We analyzed health insurance claims for patients aged ≥ 18 years with schizophrenia and newly prescribed oral atypical antipsychotics in 2007-2013 from 3 U.S. insurance claims databases: Truven MarketScan (Medicaid and commercial) and Humana (Medicare). Group-based trajectory modeling (GBTM) was used to stratify patients into groups with distinct trends in adherence and to estimate trends for each group. The response variable was the probability of adherence (defined as PDC ≥ 80%) in each 30-day period after the patient initiated antipsychotic therapy. GBTM proceeds from the premise that there are multiple distinct adherence groups. Patient demographics, health status characteristics, and health care resource use metrics were used to identify differences in patient populations across adherence trajectory groups., Results: Among the 29,607 patients who met the inclusion criteria, 6 distinct adherence trajectory groups emerged from the data: adherent (33%); gradual discontinuation after 3 months (15%), 6 months (7%), and 9 months (5%); stop-start after 6 months (15%); and immediate discontinuation (25%). Compared to patients 18-24 years of age in the adherent group, patients displaying a stop-start pattern after 6 months had greater odds of having a history of drug abuse (OR = 1.46; 95% CI = 1.26-1.66; P < 0.001), alcohol abuse (OR = 1.34; 95% CI = 1.14-1.53; P< 0.001), and a codiagnosis of major depressive disorder (OR = 1.24; 95% CI = 1.05-1.44; P < 0.001) and were less likely to be aged 35-54 years (OR = 0.66; 95% CI = 0.46-0.85; P < 0.001)., Conclusions: Longitudinal medication adherence patterns can be expressed as distinct trajectories associated with specific patient characteristics and health care utilization patterns. We found 6 distinct patterns of adherence to antipsychotics over 12 months. Patients in different groups may warrant different types of clinical interventions to prevent hospitalizations, longer hospital stays, and increased clinical complexity. For example, clinicians may consider regular home visits, assertive community treatment, and other related interventions for patients at high risk of immediate discontinuation. Health plans should consider supplementing claims-based adherence measures with new technologies that are able to track patient adherence patterns over time., Disclosures: Otsuka Pharmaceutical Development & Commercialization provided support for this research. MacEwan and Shafrin are employees of Precision Health Economics, which was contracted by Otsuka Pharmaceutical Development & Commercialization to conduct this study. Lakdawalla is the Chief Scientific Officer and a founding partner of Precision Health Economics. Forma is an employee of Otsuka Pharmaceutical Development & Commercialization. Hatch is a former employee of Otsuka Pharmaceutical Development & Commercialization and is a current employee of ODH, Inc. Lindenmayer has received grant/research support from Janssen, Lilly, AstraZeneca, Johnson & Johnson, Pfizer, BMS, Otsuka, Dainippon, and Roche and is a consultant for Janssen, Lilly, Merck, Shire, and Lundbeck. Portions of this study were presented as a poster at the American Society of Clinical Psychopharmacology Annual Meeting in Miami Beach, Florida; June 23, 2015; and at the 28th Annual U.S. Psychiatric and Mental Health Congress; San Diego, California; September 12, 2015. Study concept and design were contributed by Forma, Ladkawalla, MacEwan, and Shafrin, along with Hatch and Lindenmayer. MacEwan, Shafrin, Forma, and Lakdawalla collected the data, along with Hatch and Lindenmayer. Data interpretation was performed by Hatch, Lindenmayer, MacEwan, and Shafrin, assisted by Forma and Lakdawalla. The manuscript was written and revised by MacEwan, Forma, and Shafrin, along with Hatch Lakdawalla, and Lindenmayer.
- Published
- 2016
- Full Text
- View/download PDF
18. Health Insurance Trajectories and Long-Term Survival After Heart Transplantation.
- Author
-
Tumin D, Foraker RE, Smith S, Tobias JD, and Hayes D Jr
- Subjects
- Adolescent, Adult, Female, Healthcare Disparities economics, Humans, Insurance Coverage economics, Insurance, Health economics, Kaplan-Meier Estimate, Long-Term Care economics, Male, Medicaid economics, Medicare economics, Middle Aged, Private Sector economics, Proportional Hazards Models, Registries, Risk Factors, Time Factors, Tissue and Organ Procurement, Treatment Outcome, United States, Young Adult, Healthcare Disparities trends, Heart Transplantation adverse effects, Heart Transplantation mortality, Insurance Coverage trends, Insurance, Health trends, Long-Term Care trends, Medicaid trends, Medicare trends, Private Sector trends, Survivors
- Abstract
Background: Health insurance status at heart transplantation influences recipient survival, but implications of change in insurance for long-term outcomes are unclear., Methods and Results: Adults aged 18 to 64 receiving first-time orthotopic heart transplants between July 2006 and December 2013 were identified in the United Network for Organ Sharing registry. Patients surviving >1 year were categorized according to trajectory of insurance status (private compared with public) at wait listing, transplantation, and 1-year follow-up. The most common insurance trajectories were continuous private coverage (44%), continuous public coverage (27%), and transition from private to public coverage (11%). Among patients who survived to 1 year (n=9088), continuous public insurance (hazard ratio =1.36; 95% confidence interval 1.19, 1.56; P<0.001) and transition from private to public insurance (hazard ratio =1.25; 95% confidence interval 1.04, 1.50; P=0.017) were associated with increased mortality hazard relative to continuous private insurance. Supplementary analyses of 11 247 patients included all durations of post-transplant survival and examined post-transplant private-to-public and public-to-private transitions as time-varying covariates. In these analyses, transition from private to public insurance was associated with increased mortality hazard (hazard ratio =1.25; 95% confidence interval 1.07, 1.47; P=0.005), whereas transition from public to private insurance was associated with lower mortality hazard (hazard ratio =0.78; 95% confidence interval 0.62, 0.97; P=0.024)., Conclusions: Transition from private to public insurance after heart transplantation is associated with worse long-term outcomes, compounding disparities in post-transplant survival attributed to insurance status at transplantation. By contrast, post-transplant gain of private insurance among patients receiving publicly funded heart transplants was associated with improved outcomes., (© 2016 American Heart Association, Inc.)
- Published
- 2016
- Full Text
- View/download PDF
19. Defining the Disconnects in the Medical Profession.
- Author
-
Jacobs HE
- Subjects
- Cost Allocation economics, Delivery of Health Care trends, Economic Competition economics, Government Agencies, Health Information Exchange economics, Humans, Leadership, Medicaid trends, Medicare trends, Patient Care trends, Patient Protection and Affordable Care Act trends, Telemedicine economics, United States, Delivery of Health Care economics, Medicaid economics, Medicare economics, Patient Care economics, Patient Protection and Affordable Care Act economics, Physician's Role psychology, Politics
- Published
- 2016
20. More state expansion fights ... managed-care regulation ... fate of dual-eligible demonstrations.
- Author
-
Dickson V
- Subjects
- Health Care Costs, Humans, Insurance Coverage trends, Managed Care Programs economics, Managed Care Programs trends, Medicaid economics, Medicaid trends, Medicare economics, Medicare trends, Patient Protection and Affordable Care Act, Prepaid Health Plans economics, Prepaid Health Plans trends, United States, Eligibility Determination, Insurance Coverage economics, Managed Care Programs legislation & jurisprudence, Medicaid legislation & jurisprudence, Medicare legislation & jurisprudence, Prepaid Health Plans legislation & jurisprudence
- Published
- 2016
21. Identifying a sample of HIV-positive beneficiaries from Medicaid claims data and estimating their treatment costs.
- Author
-
Leibowitz AA and Desmond K
- Subjects
- California, Data Interpretation, Statistical, Female, HIV Seropositivity therapy, Humans, Insurance Claim Review statistics & numerical data, Insurance Coverage trends, Male, Medicaid legislation & jurisprudence, Medicaid trends, Medicare legislation & jurisprudence, Medicare trends, United States, HIV Seropositivity economics, Health Care Costs, Insurance Coverage standards, Medicaid economics, Medicare economics, Patient Protection and Affordable Care Act
- Abstract
Objectives: We sought to identify people living with HIV/AIDS from Medicare and Medicaid claims data to estimate Medicaid costs for treating HIV/AIDS in California. We also examined how alternate methods of identifying the relevant sample affect estimates of per capita costs., Methods: We analyzed data on Californians enrolled in Medicaid with an HIV/AIDS diagnosis reported in 2007 Medicare or Medicaid claims data. We compared alternative selection criteria by examining use of antiretroviral drugs, HIV-specific monitoring tests, and medical costs. We compared the final sample and average costs with other estimates of the size of California's HIV/AIDS population covered by Medicaid in 2007 and their average treatment costs., Results: Eighty-seven percent (18,290) of potentially identifiable HIV-positive individuals satisfied at least 1 confirmation criterion. Nearly 80% of confirmed observations had claims for HIV-specific tests, compared with only 3% of excluded cases. Female Medicaid recipients were particularly likely to be miscoded as having HIV. Medicaid treatment spending for Californians with HIV averaged $33,720 in 2007., Conclusions: The proposed algorithm displays good internal and external validity. Accurately identifying HIV cases in claims data is important to avoid drawing biased conclusions and is necessary in setting appropriate HIV managed-care capitation rates.
- Published
- 2015
- Full Text
- View/download PDF
22. Payment generosity and physician acceptance of Medicare and Medicaid patients.
- Author
-
Brunt CS and Jensen GA
- Subjects
- Attitude of Health Personnel, Computer Simulation, Fee Schedules economics, Fee Schedules trends, Health Services Accessibility legislation & jurisprudence, Health Services Accessibility trends, Humans, Medicaid legislation & jurisprudence, Medicaid trends, Medicare legislation & jurisprudence, Medicare trends, Models, Econometric, Physicians, Primary Care legislation & jurisprudence, Regression Analysis, Reimbursement Mechanisms economics, Reimbursement Mechanisms trends, United States, Fee Schedules legislation & jurisprudence, Health Services Accessibility economics, Medicaid economics, Medicare economics, Patient Protection and Affordable Care Act economics, Physicians, Primary Care economics, Reimbursement Mechanisms legislation & jurisprudence
- Abstract
Using 2008 physician survey data, we estimate the relationship between the generosity of fees paid to primary care physicians under Medicaid and Medicare and his/her willingness to accept new patients covered by Medicaid, Medicare, or both programs (i.e., dually enrolled patients). Findings reveal physicians are highly responsive to fee generosity under both programs. Also, their willingness to accept patients under either program is affected by the generosity of fees under the other program, i.e., there are significant spillover effects between Medicare and Medicare fee generosity. We also simulate how physicians in 2008 would have likely responded to Medicaid and Medicare payment reforms similar to those embodied in the 2010 Affordable Care Act, had they been permanently in place in 2008. Our findings suggest that "Medicaid Parity" for primary care physicians would have likely dramatically improved physician willingness to accept new Medicaid patients while only slightly reducing their willingness to accept new Medicare patients. Also, many more primary care physicians would have been willing to treat dually enrolled patients.
- Published
- 2014
- Full Text
- View/download PDF
23. Health insurance coverage for persons in HIV care, 2006-2012.
- Author
-
Yehia BR, Fleishman JA, Agwu AL, Metlay JP, Berry SA, and Gebo KA
- Subjects
- Adolescent, Adult, Aged, Ethnicity, Female, HIV Infections epidemiology, Humans, Insurance, Health economics, Insurance, Health trends, Logistic Models, Male, Medicaid economics, Medicaid trends, Medicare economics, Middle Aged, United States epidemiology, Young Adult, HIV Infections economics, Insurance, Health statistics & numerical data, Medicaid statistics & numerical data, Medically Uninsured statistics & numerical data, Medicare statistics & numerical data
- Abstract
We examined trends in health insurance coverage among 36,999 HIV-infected adults in care at 11 US HIV clinics between 2006 and 2012. Aggregate health insurance coverage was stable during this time. The proportions of patient-years with private, Medicaid, Medicare, and no insurance during this period were 15.9%, 35.7%, 20.1%, and 28.4%, respectively. Medicaid coverage was more prevalent among women than men, blacks, and Hispanics than whites, and individuals with injection drug use risk compared with other transmission risk factors. Hispanics and younger age groups were more likely to be uninsured than other racial/ethnic and older age groups, respectively.
- Published
- 2014
- Full Text
- View/download PDF
24. Building on success with new fields to conquer.
- Author
-
Iglehart JK
- Subjects
- Cost Control trends, Forecasting, Humans, Patient Protection and Affordable Care Act trends, United States, Health Care Reform economics, Health Care Reform trends, Health Policy economics, Health Policy trends, Medicaid economics, Medicaid trends, Medicare economics, Medicare trends, Patient Protection and Affordable Care Act economics
- Published
- 2014
- Full Text
- View/download PDF
25. The US healthcare workforce and the labor market effect on healthcare spending and health outcomes.
- Author
-
Pellegrini LC, Rodriguez-Monguio R, and Qian J
- Subjects
- Adolescent, Adult, Cause of Death trends, Economic Recession, Female, Health Expenditures trends, Health Workforce trends, Humans, Male, Medicaid trends, Medicare trends, Middle Aged, Outcome Assessment, Health Care economics, Outcome Assessment, Health Care statistics & numerical data, Regression Analysis, Risk Factors, Unemployment trends, United States, Young Adult, Health Expenditures statistics & numerical data, Health Status Disparities, Health Workforce economics, Medicaid economics, Medicare economics
- Abstract
The healthcare sector was one of the few sectors of the US economy that created new positions in spite of the recent economic downturn. Economic contractions are associated with worsening morbidity and mortality, declining private health insurance coverage, and budgetary pressure on public health programs. This study examines the causes of healthcare employment growth and workforce composition in the US and evaluates the labor market's impact on healthcare spending and health outcomes. Data are collected for 50 states and the District of Columbia from 1999-2009. Labor market and healthcare workforce data are obtained from the Bureau of Labor Statistics. Mortality and health status data are collected from the Centers for Disease Control and Prevention's Vital Statistics program and Behavioral Risk Factor Surveillance System. Healthcare spending data are derived from the Centers for Medicare and Medicaid Services. Dynamic panel data regression models, with instrumental variables, are used to examine the effect of the labor market on healthcare spending, morbidity, and mortality. Regression analysis is also performed to model the effects of healthcare spending on the healthcare workforce composition. All statistical tests are based on a two-sided [Formula: see text] significance of [Formula: see text] .05. Analyses are performed with STATA and SAS. The labor force participation rate shows a more robust effect on healthcare spending, morbidity, and mortality than the unemployment rate. Study results also show that declining labor force participation negatively impacts overall health status ([Formula: see text] .01), and mortality for males ([Formula: see text] .05) and females ([Formula: see text] .001), aged 16-64. Further, the Medicaid and Medicare spending share increases as labor force participation declines ([Formula: see text] .001); whereas, the private healthcare spending share decreases ([Formula: see text] .001). Public and private healthcare spending also has a differing effect on healthcare occupational employment per 100,000 people. Private healthcare spending positively impacts primary care physician employment ([Formula: see text] .001); whereas, Medicare spending drives up employment of physician assistants, registered nurses, and personal care attendants ([Formula: see text] .001). Medicaid and Medicare spending has a negative effect on surgeon employment ([Formula: see text] .05); the effect of private healthcare spending is positive but not statistically significant. Labor force participation, as opposed to unemployment, is a better proxy for measuring the effect of the economic environment on healthcare spending and health outcomes. Further, during economic contractions, Medicaid and Medicare's share of overall healthcare spending increases with meaningful effects on the configuration of state healthcare workforces and subsequently, provision of care for populations at-risk for worsening morbidity and mortality.
- Published
- 2014
- Full Text
- View/download PDF
26. States delay CMS dual eligible demonstration projects.
- Author
-
Schrag WF
- Subjects
- Case Management trends, Humans, Managed Care Programs trends, Medicaid trends, Medicare trends, Nephrology economics, Time Factors, United States, Case Management economics, Health Policy trends, Managed Care Programs economics, Medicaid economics, Medicare economics
- Published
- 2013
27. Effect of race and ethnicity on outcomes with drug-eluting and bare metal stents: results in 423 965 patients in the linked National Cardiovascular Data Registry and centers for Medicare & Medicaid services payer databases.
- Author
-
Kumar RS, Douglas PS, Peterson ED, Anstrom KJ, Dai D, Brennan JM, Hui PY, Booth ME, Messenger JC, and Shaw RE
- Subjects
- Aged, Aged, 80 and over, Cardiovascular Diseases diagnosis, Cohort Studies, Databases, Factual trends, Drug-Eluting Stents adverse effects, Drug-Eluting Stents trends, Ethnicity ethnology, Female, Follow-Up Studies, Humans, Longitudinal Studies, Male, Registries, Stents adverse effects, Treatment Outcome, United States ethnology, Cardiovascular Diseases ethnology, Cardiovascular Diseases therapy, Medicaid trends, Medicare trends, Racial Groups ethnology, Stents trends
- Abstract
Background: Black, Hispanic, and Asian patients have been underrepresented in percutaneous coronary intervention clinical trials; therefore, there are limited data available on outcomes for these race/ethnicity groups., Methods and Results: We examined outcomes in 423 965 patients in the National Cardiovascular Data Registry CathPCI Registry database linked to Medicare claims for follow-up. Within each race/ethnicity group, we examined trends in drug-eluting stent (DES) use, 30-month outcomes, and relative outcomes of DES versus bare metal stents. Overall, 390 351 white, 20 191 black, 9342 Hispanic, and 4171 Asian patients > 65 years of age underwent stent implantation from 2004 through 2008 at 940 National Cardiovascular Data Registry participating sites. Trends in adoption of DES were similar across all groups. Relative to whites, black and Hispanic patients undergoing percutaneous coronary intervention had higher long-term risks of death and myocardial infarction (blacks: hazard ratio, 1.28; 95% confidence interval, 1.24-1.32; Hispanics: hazard ratio, 1.15; 95% confidence interval, 1.10-1.21). Long-term outcomes were similar in Asians and whites (hazard ratio, 0.99; 95% confidence interval, 0.92-1.08). Use of DES was associated with better 30-month survival and lower myocardial infarction rates compared with the use of bare metal stents among all race/ethnicity groups except Hispanics, who had similar outcomes with DES or bare metal stents., Conclusions: Black and Hispanic patients undergoing percutaneous coronary intervention had worse long-term outcomes relative to white and Asian patients. Compared with bare metal stent use, DES use was generally associated with superior long-term outcomes in all racial and ethnic groups, although these differences were not statistically significant in Hispanic patients.
- Published
- 2013
- Full Text
- View/download PDF
28. Medical home pivotal to addressing healthcare reform, workforce issues. Interview by Lois A. Bowers.
- Author
-
Derksen DK
- Subjects
- Health Insurance Exchanges economics, Health Insurance Exchanges legislation & jurisprudence, Health Insurance Exchanges trends, Health Plan Implementation, Health Workforce trends, Humans, Insurance Coverage economics, Insurance Coverage legislation & jurisprudence, Insurance Coverage trends, Medicaid economics, Medicaid trends, Medically Uninsured legislation & jurisprudence, Medically Uninsured statistics & numerical data, Medicare economics, Medicare trends, Needs Assessment, New Mexico, Patient Protection and Affordable Care Act economics, Patient Protection and Affordable Care Act standards, Patient-Centered Care economics, Patient-Centered Care trends, United States, Health Workforce standards, Medicaid legislation & jurisprudence, Medicare legislation & jurisprudence, Patient-Centered Care legislation & jurisprudence
- Published
- 2013
29. See what OIG has planned for SNFs in 2013.
- Author
-
Zemel E
- Subjects
- Antipsychotic Agents administration & dosage, Antipsychotic Agents standards, Drug Utilization Review, Financial Audit, Health Plan Implementation methods, Health Plan Implementation standards, Humans, Insurance Claim Review, Medicaid economics, Medicaid trends, Medicare economics, Medicare trends, Quality Assurance, Health Care economics, Quality Assurance, Health Care methods, Skilled Nursing Facilities economics, Skilled Nursing Facilities trends, United States, United States Dept. of Health and Human Services economics, United States Dept. of Health and Human Services standards, United States Dept. of Health and Human Services trends, Medicaid standards, Medicare standards, Quality Assurance, Health Care standards, Skilled Nursing Facilities standards
- Published
- 2012
30. Medicare and Medicaid spending trends and the deficit debate.
- Author
-
Holahan J and McMorrow S
- Subjects
- Cost Savings, Humans, Medicaid trends, Medicare trends, State Health Plans, United States, Health Expenditures trends, Medicaid economics, Medicare economics
- Published
- 2012
- Full Text
- View/download PDF
31. The Ryan plan redux.
- Author
-
Gorin SH
- Subjects
- Cost Sharing economics, Cost Sharing legislation & jurisprudence, Cost Sharing trends, Financing, Government economics, Financing, Government legislation & jurisprudence, Financing, Government trends, Health Expenditures legislation & jurisprudence, Health Expenditures trends, Humans, Medicaid economics, Medicaid trends, Medicare economics, Medicare trends, Patient Protection and Affordable Care Act economics, Politics, Social Security economics, Social Security trends, United States, Medicaid legislation & jurisprudence, Medicare legislation & jurisprudence, Patient Protection and Affordable Care Act legislation & jurisprudence, Social Security legislation & jurisprudence
- Published
- 2012
- Full Text
- View/download PDF
32. CROWNWeb: the potential and the problems.
- Author
-
Rottura S
- Subjects
- Humans, Pilot Projects, United States, Medicaid trends, Medical Records Systems, Computerized organization & administration, Medical Records Systems, Computerized trends, Medicare trends, Nephrology organization & administration
- Published
- 2012
33. Gray economic outlook. Medicare, Medicaid may double? Provider cuts likely.
- Author
-
Zigmond J
- Subjects
- Budgets, Financing, Government, Humans, Medicaid trends, Medicare trends, Politics, United States, Medicaid economics, Medicare economics, Patient Protection and Affordable Care Act economics, Population Dynamics
- Published
- 2012
34. Price increases ease: Medicare curbs slow some growth; Medicaid ticks up.
- Author
-
Evans M
- Subjects
- Humans, Medicaid trends, Medicare trends, Reimbursement Mechanisms trends, United States, Hospital Charges trends, Medicaid economics, Medicare economics, Reimbursement Mechanisms economics
- Published
- 2012
35. CBO projects rise in spending. Cuts, changes needed to prevent 'substantial harm'.
- Author
-
Daly R and Zigmond J
- Subjects
- Financing, Government, Humans, Life Expectancy trends, Medicaid trends, Medicare trends, Politics, Population Dynamics, Taxes economics, United States, Health Expenditures trends, Medicaid economics, Medicare economics, Patient Protection and Affordable Care Act economics
- Published
- 2012
36. Medicaid RACs--whole new ballgame.
- Subjects
- Financial Audit, Financial Management, Hospital standards, Financial Management, Hospital trends, Humans, Inpatients, Medicaid standards, Medicaid trends, Medicare standards, Medicare trends, Outpatient Clinics, Hospital economics, Outpatient Clinics, Hospital standards, Outpatient Clinics, Hospital trends, United States, Financial Management, Hospital economics, Medicaid economics, Medicare economics
- Published
- 2011
37. Transfusions increase with nationally driven reimbursement changes of erythropoiesis stimulating agents for chemotherapy-induced anemia.
- Author
-
Yu JM, Shord SS, and Cuellar S
- Subjects
- Aged, Anemia economics, Anemia epidemiology, Antineoplastic Agents adverse effects, Antineoplastic Agents economics, Blood Transfusion economics, Female, Hematinics economics, Humans, Insurance Coverage economics, Insurance Coverage trends, Male, Medicaid economics, Medicare economics, Middle Aged, Reimbursement Mechanisms economics, Retrospective Studies, United States epidemiology, Anemia chemically induced, Blood Transfusion trends, Hematinics therapeutic use, Medicaid trends, Medicare trends, Reimbursement Mechanisms trends
- Abstract
Background: The Centers for Medicare and Medicaid Services (CMS) issued a national coverage determination (NCD) in July 2007, which imposed restrictions on the reimbursement of ESAs for Medicare and Medicaid beneficiaries. Since a majority of our patients are Medicare or Medicaid beneficiaries, we changed our clinical practice regarding the use of erythropoiesis stimulating agents (ESAs) to coincide with the NCD's reimbursement restriction., Objective: To evaluate the number of transfusions in patients diagnosed with chemotherapy-induced anemia (CIA) receiving ESAs before and after the clinical practice was changed at the University of Illinois Medical Center (UIMC)., Methods: The medical records of all adult patients diagnosed with a nonmyeloid malignancy and CIA who received an ESA between July 2006 and June 2008 at the UIMC were evaluated. The patients were divided into two groups: patients in receipt of ESAs BEFORE (group 1) and AFTER (group 2). The number of transfusions, the response rates to chemotherapy and ESAs therapy, and overall survival were compared., Results: Medical records for 110 patients were reviewed. More transfusions were given to patients AFTER we implemented the change in clinical practice (BEFORE 18 transfusions vs. AFTER 52 transfusions, p = 0.004). More patients responded to ESA therapy AFTER we implemented the change (67% vs. 83%, p = NS). The treatment response to chemotherapy and overall survival were similar between the two groups., Conclusion: The primary goal of reducing the number of transfusions in patients with CIA by administering ESAs cannot be met when clinical practice coincides with the NCD.
- Published
- 2011
- Full Text
- View/download PDF
38. Dual eligibles pose funding challenge.
- Author
-
Wagner L
- Subjects
- Cost Savings methods, Eligibility Determination, Humans, Long-Term Care organization & administration, Long-Term Care trends, Managed Care Programs organization & administration, Managed Care Programs trends, Medicaid organization & administration, Medicaid trends, Medicare organization & administration, Medicare trends, Patient-Centered Care organization & administration, Patient-Centered Care trends, United States, Long-Term Care economics, Managed Care Programs economics, Medicaid economics, Medicare economics, Patient-Centered Care economics
- Published
- 2011
39. Six strategies for boosting outcomes as Medicare/Medicaid pay tightens.
- Author
-
Peters J and David Y
- Subjects
- Appointments and Schedules, Cost Control methods, Diagnosis-Related Groups economics, Diagnosis-Related Groups standards, Diagnosis-Related Groups trends, Efficiency, Organizational economics, Humans, Medicaid standards, Medicaid trends, Medicare standards, Medicare trends, Operating Rooms economics, Operating Rooms organization & administration, Patient Protection and Affordable Care Act, Politics, Reimbursement, Incentive standards, Reimbursement, Incentive trends, United States, Financial Management, Hospital methods, Medicaid economics, Medicare economics, Reimbursement, Incentive economics
- Published
- 2011
40. Looking at reactions to the ACO rules.
- Author
-
Keating T
- Subjects
- Attitude of Health Personnel, Cost Savings, Humans, United States, Medicaid economics, Medicaid legislation & jurisprudence, Medicaid trends, Medicare economics, Medicare legislation & jurisprudence, Medicare trends, Patient Protection and Affordable Care Act economics, Patient Protection and Affordable Care Act legislation & jurisprudence, Quality of Health Care economics
- Published
- 2011
41. Medicare and medicaid in long-term care.
- Author
-
Ng T, Harrington C, and Kitchener M
- Subjects
- Adolescent, Adult, Aged, Delivery of Health Care economics, Health Expenditures trends, Health Services Needs and Demand, Home Care Services legislation & jurisprudence, Hospice Care, Humans, Insurance Coverage legislation & jurisprudence, Personal Health Services, State Health Plans, United States, Community Health Services economics, Community Health Services supply & distribution, Delivery of Health Care methods, Financing, Government methods, Health Expenditures statistics & numerical data, Long-Term Care economics, Long-Term Care statistics & numerical data, Long-Term Care trends, Medicaid economics, Medicaid trends, Medicare economics, Medicare trends, Program Evaluation
- Abstract
Medicare and Medicaid, two publicly funded health programs, both cover populations in need of long-term care, but they are poorly coordinated. Gaps often exist in some services while there is overlap in others. This can lead to inefficient delivery of services and confusion among program recipients and providers alike. Spending on postacute services in Medicare and long-term care services in Medicaid has grown more rapidly than enrollment in either program since 1999. Although growing numbers of people receive home and community-based services paid for by the two programs, there are wide variations across states and among target groups. The system of long-term care is in need of structural reform.
- Published
- 2010
- Full Text
- View/download PDF
42. God forbid...
- Author
-
King K
- Subjects
- Humans, Medicaid economics, Medicaid legislation & jurisprudence, Medicare legislation & jurisprudence, Oklahoma, Societies, Medical legislation & jurisprudence, United States, Health Care Reform standards, Health Care Reform trends, Medicaid trends, Medicare trends, Societies, Medical trends
- Published
- 2009
43. Medicare Advantage Special Needs Plans for dual eligibles: a primer.
- Author
-
Milligan CJ Jr and Woodcock CH
- Subjects
- Chronic Disease, Disabled Persons, Eligibility Determination, Federal Government, Forecasting, Health Services Needs and Demand, Humans, Insurance Benefits, Medicaid statistics & numerical data, Medicaid trends, United States, Medicare statistics & numerical data, Medicare trends
- Abstract
The Special Needs Plan (SNP), a new type of Medicare Advantage plan created by the Medicare Modernization Act of 2003 (MMA), targets one of three special-needs populations--including beneficiaries who qualify both for Medicare and Medicaid benefits ("dual eligibles"), the focus of this issue brief. It identifies the key issues that underlie one of the MMA's central goals for dual eligible SNPs--"the potential to offer the full array of Medicare and Medicaid benefits, and supplemental benefits, through a single plan"--and it outlines their progress thus far. The brief observes that true coordination between SNPs and Medicaid programs, despite some state and federal initiatives, has largely failed to occur, and it discusses some of the reasons why. Consequently, the brief offers recommendations for improving dual-eligible SNPs' prospects and extending their lives (legal authorization for SNPs is scheduled to expire at year-end 2008).
- Published
- 2008
44. Hospice effect on government expenditures among nursing home residents.
- Author
-
Gozalo PL, Miller SC, Intrator O, Barber JP, and Mor V
- Subjects
- Age Factors, Aged, Aged, 80 and over, Catchment Area, Health, Cost Savings statistics & numerical data, Episode of Care, Female, Florida, Geriatric Assessment, Health Expenditures trends, Humans, Male, Medicaid trends, Medicare trends, Retrospective Studies, Time Factors, United States, Health Expenditures statistics & numerical data, Hospice Care economics, Hospice Care statistics & numerical data, Medicaid statistics & numerical data, Medicare statistics & numerical data, Nursing Homes economics, Nursing Homes statistics & numerical data
- Abstract
Objective: To examine the effect of the Medicare hospice benefit on Medicare and Medicaid expenditures by dual-eligible Medicare-Medicaid nursing home (NH) residents., Data Sources/study Setting: Secondary data for NH residents for 1998-1999., Study Design: Retrospective cohort study of NH residents in the state of Florida who died between July and December 1999 (N=5,774). Medicare claims identified hospice enrollment, and Medicare and Medicaid claims identified expenditures by categories of care. Nursing home resident assessments were used to control for case-mix differences. Geocoding of nursing homes, hospice providers and hospitals was used to identify and characterize local health care markets., Data Collection/extraction Methods: A file was constructed linking Medicare and Medicaid claims to Minimum Data Set assessments of NH residents, and NH provider (Online Survey and Certification Automated Record) and hospice provider files., Principal Findings: Hospice enrollment results in substantial savings in government expenditures (22 percent) among all short-stay (< or =90 days) dying NH residents. For long-stay (>90 days) dying NH residents, hospice provides some savings (8 percent) among cancer residents while it is cost-neutral among dementia residents and adds some cost (10 percent) for residents with a diagnosis other than cancer or dementia. There is evidence of selection bias, particularly among residents with cancer (19 percent savings unadjusted versus 8 percent adjusted). Among short-stay NH residents, hospice greatly reduces Medicare expenditures but increases Medicaid expenditures., Conclusions: Hospice enrollment results in lower combined Medicare/Medicaid expenditures in the last month of life, particularly among short-stay NH residents. This effect, however, varies by diagnosis and NH length of stay. In addition, for short-stay NH residents, current payment policy creates a Medicare incentive and Medicaid disincentive for promoting residents' referral to hospice.
- Published
- 2008
- Full Text
- View/download PDF
45. By the numbers. Medicare/Medicaid.
- Subjects
- Actuarial Analysis, Forecasting, Health Care Surveys, Health Services classification, Health Services economics, Humans, Medicaid trends, Medicare trends, United States, Medicaid statistics & numerical data, Medicare statistics & numerical data
- Published
- 2007
46. The challenge of rising health care costs--a view from the Congressional Budget Office.
- Author
-
Orszag PR and Ellis P
- Subjects
- Diffusion of Innovation, Fee-for-Service Plans economics, Forecasting, Government Agencies, Health Care Reform economics, Humans, Managed Care Programs economics, Managed Care Programs trends, Medicaid economics, Medicare economics, United States, Health Care Costs trends, Health Promotion economics, Medicaid trends, Medicare trends
- Published
- 2007
- Full Text
- View/download PDF
47. Budget crisis, entitlement crisis, health care financing problem--which is it?
- Author
-
Aaron HJ
- Subjects
- Forecasting, Humans, Insurance, Health trends, Medicaid trends, Medicare trends, Private Sector economics, Public Sector economics, Social Welfare legislation & jurisprudence, United States, Budgets, Insurance, Health economics, Medicaid economics, Medicare economics, Social Welfare economics
- Abstract
Many budget analysts allege that growing expenditures on entitlements will necessitate a reexamination of all public spending and taxes. In fact, anticipated budget problems are fully explained by projected growth of Medicare and Medicaid. But the same forces driving public-sector health care spending are also driving private spending. Sensible reforms of publicly financed health care require a systemwide approach. Apart from health care, currently legislated federal revenues suffice to cover all currently projected spending, including all Social Security and other entitlements. The United States confronts a public and private health care spending problem, not an entitlement crisis.
- Published
- 2007
- Full Text
- View/download PDF
48. The commercial health insurance industry in an era of eroding employer coverage.
- Author
-
Robinson JC
- Subjects
- Adolescent, Adult, Aged, Female, Health Benefit Plans, Employee trends, Humans, Male, Managed Care Programs, Medicaid trends, Medical Savings Accounts, Medicare trends, Middle Aged, Privatization trends, Health Care Sector trends, Insurance Carriers trends, Insurance, Health trends, Medicaid organization & administration, Medicare organization & administration
- Abstract
This paper analyzes the commercial health insurance industry in an era of weakening employer commitment to providing coverage and strengthening interest by public programs to offer coverage through private plans. It documents the willingness of the industry to accept erosion of employment-based enrollment rather than to sacrifice earnings, the movement of Medicaid beneficiaries into managed care, and the distribution of market shares in the employment-based, Medicaid, and Medicare markets. The profitability of the commercial health insurance industry, exceptionally strong over the past five years, will henceforth be linked to the budgetary cycles and political fluctuations of state and federal governments.
- Published
- 2006
- Full Text
- View/download PDF
49. Mixed signals. The CMS' 10-year spending projections inspire both hope and skepticism, and leave plenty of room for lobbyists.
- Author
-
DoBias M
- Subjects
- Actuarial Analysis, Forecasting, Lobbying, Medicaid economics, Medicare economics, United States, Centers for Medicare and Medicaid Services, U.S. economics, Health Expenditures trends, Medicaid trends, Medicare trends
- Abstract
The eye of the beholder matters just as much when assessing healthcare spending projections as when judging beauty. Last week, there was something for whatever your taste might be when the CMS released its 10-year healthcare spending projections and an estimated dollar 4 trillion price tag. "I think there are ways of taking out cost without compromising care," says Herbert Pardes of New York-Presbyterian.
- Published
- 2006
50. Conditions for coverage fail to relieve administrative burden.
- Author
-
Wish D
- Subjects
- Health Care Costs trends, Humans, Kidney Failure, Chronic therapy, Medicaid legislation & jurisprudence, Medicaid trends, Medicare legislation & jurisprudence, Medicare trends, United States, Kidney Failure, Chronic economics, Medicaid economics, Medicare economics, Renal Dialysis economics
- Published
- 2005
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.