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This article provides an overview of the progress made in mental health policy to improve access and quality of services for older adults. It highlights the high prevalence of mental health conditions and substance use disorders among older adults, with only 40% receiving any services. The article discusses recent legislative successes, proposed administrative action, and legislation aimed at addressing barriers and ensuring accessibility and quality care for older adults. It also mentions the inclusion of licensed mental health counselors and licensed marriage and family therapists in Medicare coverage to increase workforce capacity. The article discusses changes to Medicare related to service delivery and payment, reauthorizations and funding increases for mental health and substance use disorder programs, and upcoming policy initiatives. The authors emphasize the importance of these changes and initiatives in improving access and quality of behavioral health services for older adults. [Extracted from the article]

Objective: To determine whether county‐level or patient‐level social risk factors are associated with patient‐reported outcomes after total knee replacement when added to the comprehensive joint replacement risk‐adjustment model. Data Sources and Study Setting: Patient and outcomes data from the Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement cohort were merged with the Social Vulnerability Index from the Centers for Disease Control and Prevention. Study Design: This prospective longitudinal cohort measured the change in patient‐reported pain and physical function from baseline to 12 months after surgery. The cohort included a nationally diverse sample of adult patients who received elective unilateral knee replacement between 2012 and 2015. Data Collection/Extraction Methods: Using a national network of over 230 surgeons in 28 states, the cohort study enrolled patients from diverse settings and collected one‐year outcomes after the surgery. Patients <65 years of age or who did not report outcomes were excluded. Principal Findings: After adjusting for clinical and demographic factors, we found patient‐reported race, education, and income were associated with patient‐reported pain or functional scores. Pain improvement was negatively associated with Black race (CI = −8.71, −3.02) and positively associated with higher annual incomes (≥$45,00) (CI = 0.07, 2.33). Functional improvement was also negatively associated with Black race (CI = −5.81, −0.35). Patients with higher educational attainment (CI = −2.35, −0.06) reported significantly less functional improvement while patients in households with three adults reported greater improvement (CI = 0.11, 4.57). We did not observe any associations between county‐level social vulnerability and change in pain or function. Conclusions: We found patient‐level social factors were associated with patient‐reported outcomes after total knee replacement, but county‐level social vulnerability was not. Our findings suggest patient‐level social factors warrant further investigation to promote health equity in patient‐reported outcomes after total knee replacement. [ABSTRACT FROM AUTHOR]

Since the implementation of Medicare's Hospital Readmissions Reduction Program (HRRP), safety-net hospitals have received a disproportionate share of financial penalties for excess readmissions, raising concerns about the fairness of the policy. In response, the HRRP now stratifies hospitals into five quintiles by low-income Medicare (dual Medicare-Medicaid eligible) stay proportion and compares readmission rates within quintiles. To better understand the potential effects of the revised policy, we used difference-in-differences models to compare changes in 30-day readmission, 30-day mortality, and 90th-day community-dwelling rates after discharge of fee-for-service Medicare beneficiaries hospitalized for acute myocardial infarction, heart failure and pneumonia during 2007-2014, for hospitals in the highest (N = 677) and lowest (N = 678) dual-proportion quintiles before and after the original HRRP implementation in fiscal year 2013. We find that high dual-proportion hospitals lowered readmissions for all three conditions, while their patients' health outcomes remained largely stable. We also find that for heart failure, high dual-proportion hospitals reduced readmissions more than low dual-proportion hospitals, albeit with a relative increase in mortality. Contrary to concerns about fairness, our findings imply that, under the original HRRP, high dual-proportion hospitals improved readmissions performance generally without adverse effects on patients' health. Whether these gains could be retained under the new policy should be closely monitored.

BACKGROUND: Biosimilars, highly similar versions of biologic agents, can offer patients equivalent efficacy at reduced costs, which could help expand medication access to more patients. Market uptake and adoption of biosimilars in the United States have been relatively slow, however. This summary aims to explore the challenges and opportunities in healthcare systemwide adoption of biosimilars based on a roundtable discussion including multistakeholder healthcare providers. OBJECTIVES: To identify barriers that contribute to slow market uptake and adoption of biosimilars in the United States and suggest strategies to mitigate such barriers. DISCUSSION: The article systematically examines factors affecting biosimilar adoption and offers insights into potential solutions and system-based strategies to facilitate the adoption and implementation of biosimilar agents in healthcare systems. Misinformation and knowledge gaps among providers and patients continue to hinder the adoption of biosimilars. External barriers related to payers' incentives, patent litigation, and Medicare policy were also identified as obstacles to the adoption of biosimilars. Strategies can be designed and implemented to overcome many of these barriers and realize the economic and societal benefits of biosimilar drugs. CONCLUSION: Overcoming key barriers to biosimilar adoption may be possible by implementing actionable system-level strategies that enable the dissemination of accurate and timely information to key stakeholders and improve organizational readiness for institutions considering biosimilar implementation. The resulting benefits would help to achieve the goals of reducing cost and thereby improving patient access while simultaneously reducing the historical barriers to broad biosimilar adoption. [ABSTRACT FROM AUTHOR]

The current policy environment for rehabilitation in skilled nursing facilities (SNFs) is complex and dynamic, and SNFs are facing the dual challenges of recent Medicare payment policy change that disproportionately impacts rehabilitation for older adults and the COVID‐19 pandemic. This article introduces an adapted framework based on Donabedian's model for evaluating quality of care and applies it to decades of Medicare payment policy to provide a historical view of how payment policy changes have impacted rehabilitation processes and patient outcomes for Medicare beneficiaries in SNFs. This review demonstrates how SNF responses to Medicare payment policy have historically varied based on organizational factors, highlighting the importance of considering such organizational factors in monitoring policy response and patient outcomes. This historical perspective underscores the mixed success of previous Medicare policies impacting rehabilitation and patient outcomes for older adults receiving care in SNFs and can help in predicting SNF industry response to current and future Medicare policy changes. [ABSTRACT FROM AUTHOR]

Previous work found a substantial growth in therapy staffing among nursing home providers following the introduction of Medicare's Prospective Payment System (PPS). Since the PPS, however, several new Medicare policies have been implemented that may impact the provision of rehabilitative care in nursing homes. In view of the rising focus on patient outcomes and provider performance, it is worthwhile to explore more recent therapy staffing patterns following the introduction of these Medicare programs. While our results show stable staffing levels through prior policy changes, upcoming Medicare payment changes will likely have a stronger impact that may result in reduced therapy staffing. In addition, given that our findings show that staffing patterns vary across provider type, we may see greater variation as a result of the upcoming changes. Thus, therapy staffing should continue to be monitored and deeper explorations into the impact of staffing changes on patient outcomes should be undertaken. [ABSTRACT FROM AUTHOR]

Background and Purpose: Inefficient imaging practices merit renewed attention in preparation for full implementation of the Appropriate Use Criteria Program. This study's purpose is to quantify changes in outpatient brain CT imaging efficiency from 2013 to 2018, including changes in relative efficiency by hospital category.Materials and Methods: Imaging efficiency data were obtained from the Medicare Hospital Compare website. Summary statistics were calculated for rates of unnecessarily combined brain and sinus CT scans from 2013 to 2018. Relative performance was compared by hospital Medicare payment structure, type of ownership, and affiliation with a radiology residency program. The predictive value of these hospital characteristics on brain CT efficiency was determined using linear regression analysis.Results: From 2013 to 2018, the mean frequency of unnecessarily combined brain and sinus CT scans decreased by 1.82% (95% confidence interval, 1.74%-1.90%). Proprietary and physician-owned hospitals exhibited a higher mean frequency of combined scans than other hospitals in 2013 (P < .001), and government-owned hospitals exhibited a lower mean frequency of combined scans than other hospitals in 2018 (P < .001). Radiology residency-affiliated hospitals exhibited no significant difference in 2013 but exhibited a higher mean frequency in 2018 (difference: 0.45%; 95% confidence interval, 0.29%-0.61%). Critical access hospital status and nonaffiliation with a radiology residency program were the strongest predictors of brain CT efficiency in the regression model.Conclusion: Recent changes in hospitals' relative brain CT efficiency suggest category-specific differences in responsiveness to quality improvement efforts and may foreshadow similar trends under forthcoming initiatives. [ABSTRACT FROM AUTHOR]

The article reports on the increase in the number of Medicare beneficiaries who utilized the telehealth service during the first 12 months of the coronavirus disease 2019 (COVID-19) pandemic.

Site-neutral payment is a policy created by federal rule making and implemented by the Centers for Medicare and Medicaid Services (CMS) that aims to reduce healthcare costs by aligning payment rates for certain services provided in multiple care settings. Site-neutral payments are intended to eliminate the incentive for providers to acquire facilities, such as physician offices or ambulatory surgical centers (ASCs), that Medicare reimburses at the lower non-facility rate and convert those settings into hospital outpatient departments (HOPDs), where Medicare reimburses at the higher facility rate. Although initiated by Congress to address payment disparities in Medicare, similar payment discrepancies can be seen in the commercial market where individual and employer-sponsored health plans often pay more for certain outpatient services depending on their location. This analysis presents a simulation of the impact of applying site-neutral payments to the commercial market with respect to overall potential savings for consumers, health plans and the federal government. To conduct the analysis, we use an all-payer claims data base generalizable to the United States. The analysis focused on a select group of outpatient services identified by the Medicare Payment Advisory Commission (MedPAC). We mapped the MedPAC identified 68 Ambulatory Payment Classifications (APCs), the codes Medicare uses to reimburse facilities for outpatient services, to the relevant CPT4/HCPCS codes, which the commercial market uses for billing. The potential cost savings of applying the site-neutral payment policy to the commercial insurance market to be $58 billion for year 2022. We estimate the 10-year total (2024-2033) employer market premium reduction ranges from 5.35% to 5.0% and found that those premium reductions would result in employer-sponsored insurance (ESI) tax subsidy savings of $140 billion to the federal government over a 10-year period (2024-2033)., Competing Interests: Declaration of Conflicting InterestsThe author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The author received no financial support for this research from The Alliance to Fight for Health Care.

Background: Physicians spend significant time outside of regular office visits caring for complex patients, and this work is often uncompensated. In 2015, the Centers for Medicare & Medicaid Services (CMS) introduced a billing code for care coordination between office visits for beneficiaries with multiple chronic conditions.Objective: Characterize use of the Chronic Care Management (CCM) code in New England in 2015.Design: Retrospective observational analysis.Participants: All Medicare fee-for-service beneficiaries in New England continuously enrolled in Parts A and B in 2015.Intervention: None.Main Measures: The primary outcome was the number of beneficiaries with a CCM claim per 1000 eligible beneficiaries. Secondary outcomes included the total number of CCM claims, total reimbursement, mean number of claims per beneficiary, and beneficiary characteristics independently associated with receiving CCM services.Key Results: Of the more than two million Medicare fee-for-service beneficiaries in New England, almost 1.7 million were potentially eligible for CCM services. Among eligible beneficiaries, 10,951 (0.65%) had a CCM claim in 2015. Massachusetts had the highest penetration of CCM use (9.40 claims per 1000 eligible beneficiaries); Vermont had the lowest (0.54 claims per 1000 eligible beneficiaries). Mean reimbursement per physician was $1745.98. Age, race/ethnicity, dual-eligible status, income, number of chronic conditions, and state of residence were associated with receiving CCM services in an adjusted model.Conclusions: The CCM code is likely underutilized in New England; the program may therefore not be achieving its intended goal of encouraging consistent, team-based chronic care management for Medicare's most complex beneficiaries. Or practices may be foregoing reimbursement for care coordination that they are already providing. Recently implemented revisions may improve uptake of CCM services; it will be important to compare our results with future utilization. [ABSTRACT FROM AUTHOR]

The authors explore the implications of the recent success of the Graduate Nurse Education (GNE) Demonstration for Medicare policy. They describe the effectiveness of a new model of organizing and paying for graduate nurse education that involves consortia of hospitals, health systems, community partners, and university nursing schools. They also present a graph that shows Medicare payments for hospitals for nursing and allied health training from 1991 to 2015.

Objectives: Whole genome sequencing (WGS) is an emerging tool in clinical diagnostics. However, little has been said about its procedure costs, owing to a dearth of related cost studies. This study helps fill this research gap by analyzing the execution costs of WGS within the setting of German clinical practice.Methodology: First, to estimate costs, a sequencing process related to clinical practice was undertaken. Once relevant resources were identified, a quantification and monetary evaluation was conducted using data and information from expert interviews with clinical geneticists, and personnel at private enterprises and hospitals. This study focuses on identifying the costs associated with the standard sequencing process, and the procedure costs for a single WGS were analyzed on the basis of two sequencing platforms-namely, HiSeq 2500 and HiSeq Xten, both by Illumina, Inc. In addition, sensitivity analyses were performed to assess the influence of various uses of sequencing platforms and various coverage values on a fixed-cost degression.Results: In the base case scenario-which features 80 % utilization and 30-times coverage-the cost of a single WGS analysis with the HiSeq 2500 was estimated at €3858.06. The cost of sequencing materials was estimated at €2848.08; related personnel costs of €396.94 and acquisition/maintenance costs (€607.39) were also found. In comparison, the cost of sequencing that uses the latest technology (i.e., HiSeq Xten) was approximately 63 % cheaper, at €1411.20.Conclusions: The estimated costs of WGS currently exceed the prediction of a 'US$1000 per genome', by more than a factor of 3.8. In particular, the material costs in themselves exceed this predicted cost. [ABSTRACT FROM AUTHOR]

The course of history is changed by the major figures. Even though the reformists and revolutionists are not always appreciated while they are alive, the pacemakers, whose value is appreciated after many years, carve out a niche in history and are recognized by the society. The physicians, surgeons, and politicians influence the society deeply in the historical process. Dr. Behcet Uz, born in 1893, has been greatly admired for his medical skills, his personality promoting common action with the community when he was a mayor, and his revolutionary health care plans executed when he was the Minister of Health. Dr. Uz has been a recognized and an appreciated statesman by many. In this study, Dr. Behcet Uz, who served as the Minister of Health for two terms between 1946 and 1948; and 1954 and 1955, and his efforts in establishing the first and second National Health Care Plans and the Health Bank, which were planned to be executed both in his ministerial terms, were analyzed. Data from the Republic Archives of the Republic of Turkey Prime Ministry, Archives of the Turkish Grand National Assembly, Official Gazettes and private newspapers of the period and face to face interviews performed with the relatives of Dr. Behcet Uz were taken into account. [ABSTRACT FROM AUTHOR]

The article offers insight to the establishment of Medicare programs in the U.S. Topics discussed include history of the Medicare program focusing on public health; enactment of Medicare Secondary Payer Act of 1980 and Medicare Prescription Drug, Improvement, and Modernization Act of 2003 for the same; and role of attorneys in becoming aware of Medicare Secondary Payer (MSP) laws for providing ethical and competent representation of Medicare beneficiaries.

In this article, the author discusses effect of U.S. President Donald Trump administration such as reshaping of domestic policies and role in international affairs on the economy. Topics discussed include entering a kleptocracy with goals such as public sector draining and privatizing, billionaires becoming supermanagers providing a very specific kind of governance needed for specific regimes and republicans relishing chance of altering policies such as Medicare and social security.

Objectives: Medicare does not usually include a dental benefit. Adults who are unaware of this fact risk unanticipated expenses after retirement. This report will explore the sociodemographic and oral health literacy determinants of this knowledge.Methods: Data came from the Multi-Site Oral Health Literacy Research Study, a survey of patients presenting to two university dental clinics. Sociodemographic descriptors included age, sex, race/ethnicity, education level, and dental insurance status. Oral health literacy was measured by the Rapid Estimate of Adult Literacy in Medicine and Dentistry (REALM-D).Results: Only 34 percent of respondents knew the correct answer to the Medicare question. Knowledge was significantly associated with age, race/ethnicity, education level (bivariate only), and REALM-D score.Conclusions: Policymakers and those assisting in Medicare enrollment should ensure information regarding dental coverage is communicated in ways that individuals of varying literacy, language, and culture understand what is necessary to make appropriate decisions. [ABSTRACT FROM AUTHOR]

The article discusses the changes in the U. S. socioeconomic policy including tax rates, Social Security Disability Insurance, and the medicare act.

The article focuses on the Medicare payment reform in the U.S., which puts emphasis on the quantity of imaging services. Topics discussed include the effort for the efficiency of Medicare, the implementation of Medicare Access and CHIP Reauthorization Act, the quality measures clinicians can choose for report, and the imbalance of Medicare funding.

The article highlights a report on the study of effects of the Affordable Care Act (ACA) on Women's Health. Topics discussed include method of the study to compare changes for health insurance coverage and health care affordability, by family income; results indicating greater decrease in uninsured status in the lowest income group compared to the highest income group; and discussion on challenges women facing on affording insurance and medical care after the ACA.

An impending policy change in Medicare will provide reimbursement for the end-of-life conversation. The rise in numbers of older adults who face serious illness coupled with advances in healthcare technology are increasing the need for providers to address end of life issues in the acute care setting. Doctoral-level nurse practitioners who specialize in acute care of older adults are poised to be leaders and facilitators of this conversation in a particularly challenging context–the intensive care unit. The focus of this article is the new end-of-life policy in relation to the particular contributions that adult gerontology acute care nurse practitioners offer in the acute care setting. [ABSTRACT FROM AUTHOR]

Background: Change is difficult for health care organizations where adoption of new practices is notoriously slow. Inertial behavior may reflect organizations' rational, strategic nonresponse to its environment or latent, institutionalizing preservation of dominant organizational routines and norms. Such strategic and selective influences of organizational inertia have different implications on the efficacy of policy to induce intended change. Purpose: The aim of this study was to examine whether strategic and selective factors were associated with the provision of peritoneal dialysis (PD) services in outpatient dialysis facilities in the United States between 1995 and 2003. Approach: We conducted a longitudinal retrospective study of all outpatient end-stage renal disease dialysis facilities, using 1995-2003 administrative data from the U.S. Renal Data System. Findings: Less than half of U.S. dialysis facilities offered PD, and this pattern was stable despite substantial growth of dialysis facilities entering the market. We found little support for strategic influences and some evidence that selective factors were predictive of dialysis facilities' PD provision. Practice Implications: Although the design of many policy and health care reform efforts widely accepts the strategic perspective of altering incentives and the environment to induce change, the presence of selective inertial influences raises concerns about the efficacy of policy intervention in the face of institutionalized organizational behavior that may be less amenable to policy intervention. Incentives recently introduced by Medicare to increase facility provision of PD may be less effective than might be expected. [ABSTRACT FROM AUTHOR]

Federal government spending through the Medicare program represents a large source of physician payments. Detailed payment and claims data has historically not been available; however, the Centers for Medicare and Medicaid Services recently released physician level billing data for calendar year 2012. These data allow assessment of the overall volume of Medicare physician spending in Mississippi and analysis of how spending varies by location, procedure and specialty. Overall Medicare spending for physician fees in Mississippi exceeded $723 million. [ABSTRACT FROM AUTHOR]

The article discusses the ruling of the U.S. Supreme Court in the case NFIB v. Sebelius in which court upheld the Congress's power for enactment of the Patient Protection and Affordable Care Act (ACA) and that all the Americans should be insured. It argues that constraints on legislative authority related to fundamental economic rights and federalism operate in relationship with each other. It also adds the Lochner-era of the Supreme Court.

The article presents a reprint of the article "Rationing by Another Name" by Scott W. Atlas, which was published in an issue of the journal "Forbes." It discusses the failure of the actions by the U.S. government to reduce medicare cost. It informs about the establishment of Independent Payment Advisory Board (IPAB) by Affordable Care Act (ACA) of 2010. It further reflects on the reality behind IPAB, which is an unusual shift of power from Americans to a centralized authority.

In this article, the author discusses the significance of Medicare reform in 2011 for U.S. which is undergoing a fiscal crisis. The author, relating the oldest baby boomers who retire and drive up demand for Medicare spending, says that the program should provide incentives to patients or providers to make cost-effective decisions. He adds that Medicare must be put on a budget to ensure its fiscal stability. The author also mentions the accountable care organizations (ACOs).

ABSTRACT: Objectives: Pharmacotherapeutic treatments for drug addiction offer new options, but only if they are affordable for patients. The objective of this study is to assess the current availability and cost of five common antiaddiction medications in the largest federal medication insurance program in the US, Medicare Part D. Methods: In early 2010, we collected coverage and cost data from 41 Medicare Part D prescription drug plans (PDPs) and 45 Medicare Advantage Plans (MAPs) in Washington State. Results: The great majority of Medicare plans (82–100%) covered common pharmacotherapeutic treatments for drug addiction. These Medicare plans typically placed patent protected medications on their highest formulary tiers, leading to relatively high patient co-payments during the initial Part D coverage period. For example, median monthly co-payments for buprenorphine (Suboxone®) were about $46 for PDPs, and about $56 for MAPs. Conclusion: While Medicare prescription plans usually cover pharmacotherapeutic treatments for drug addiction, high co-payments can limit access. For example, beneficiaries without supplemental coverage who use Vivitrol® would exceed their initial coverage cap in 7–8 months, reaching the “doughnut hole” in their Part D coverage and becoming responsible for the full cost of the medication (over $900 per month). The 2010 Patient Protection and Affordable Care Act will gradually eliminate this coverage gap, and loss of patent protection for other antiaddiction medications (Suboxone® and Campral®) should also drive down patient costs, improving access and compliance. [Copyright &y& Elsevier]

The authors discuss aspects of the nomination of orthopedic surgeon and Representative Tom Price of Georgia as health and human services (HHS) secretary by 2016 U.S. President-elect Donald Trump. Topics include Price's less concern for the sick, poor, and public health, willingness to convert Medicare to a premium-support system, and plan to withdraw the Affordable Care Act's (ACA) federal consumer-protection regulations.

The study investigates the effect of excluding the U.S. Medicare payment for eight hospital-acquired conditions (HACs) on hospital payments in Victoria, Australia. It mentions that the U.S. Centers for Medicare, and Medicaid Services (CMS) have implemented a non-payment for eight specific hospital-acquired conditions (HACs) policy in 2008. It covers all acute inpatient admissions to Victorian public and private hospitals from 1 July 2007 to 30 June 2008. It concludes that nonpayment for HACs policy would have little direct financial impact in Australia.

Background: New policies regulating physician/pharmaceutical company relationships propose to eliminate access to free prescription drug samples. Little is known about the prevalence of patient activity in requesting or receiving free prescription drug samples, or the characteristics of patients who access drug samples.Objective: To determine the prevalence of free sample access and to examine demographic, clinical, and insurance characteristics of Medicare beneficiaries who access free samples.Design: Cross-sectional study.Participants: A national sample of 13,847 Medicare beneficiaries participating in the fall 2004 Medicare Current Beneficiary Survey.Measurements and Main Results: Prevalence of free prescription drug sample access (self-reported request for or receipt of free drug samples) and the demographic, clinical, and insurance characteristics of Medicare beneficiaries who accessed drug samples. Overall, 48.3% (95% confidence of interval [CI]: 46.6%, 49.9%) of Medicare beneficiaries reported accessing free drug samples. Access was higher among beneficiaries reporting cost-related medication nonadherence compared to those without (77.7% (95% CI: 74.5%, 80.6%) vs 43.0% (95% CI: 41.4%, 44.7%)). Multivariable analysis revealed cost-related medication nonadherence (CRN) to have the strongest relationship with accessing drug samples (adjusted odds ratio [AOR] 4.43 [95% CI: 3.64, 5.39]). Compared to beneficiaries with generous drug benefits from Medicaid, beneficiaries who lacked prescription drug benefits were more likely to access drug samples (AOR 2.42 [95% CI: 2.06, 2.85]). Beneficiaries with drug coverage from employer-sponsored plans or partial coverage (Medicare HMO, self-purchased Medicare supplement, or state-sponsored low-income plans) were also more likely to access drug samples (AOR 2.02, 1.74, respectively). Having 2-3 or > or = 4 comorbidities (vs 0-1 comorbidities) also increased the likelihood of accessing drug samples (AOR 1.60 (95% CI: 1.44, 1.79) and 2.00 (95% CI: 1.74, 2.29).Conclusions: Accessing free prescription drug samples is prevalent among many categories of beneficiaries, especially among individuals with cost-related medication nonadherence and poor health status. Policies restricting or prohibiting drug sample distribution may adversely impact access to medications among patients in high-risk groups. [ABSTRACT FROM AUTHOR]

Congress has required CMS to expand the Medicare outpatient prospective payment system (PPS) for dialysis services to include as many drugs and diagnostic procedures provided to end stage renal disease (ESRD) patients as possible. One important implementation question is whether dialysis facility case mix should be reflected in payment. We use fiscal year (FY) 2000 cost report and patient billing and clinical data to determine the relationship between costs and case mix, as represented by several patient demographic, diagnostic, and clinical characteristics. Results indicate considerable variability in costs and case mix across facilities and a significant and substantial relationship between case mix and facility cost, suggesting case mix payment adjustment may be important. [ABSTRACT FROM AUTHOR]

Objective: To assess Medicare beneficiaries' willingness to cost share in order to minimize disruptions in coverage from HMO plan withdrawals.Design: Cross-sectional survey of Medicare beneficiaries from February 1999 to March 1999.Setting: Ten U.S. counties with the highest HMO plan withdrawal rates.Patients/participants: Seven hundred one Medicare beneficiaries for response rate of 69%.Measurements and Main Results: Percentage of respondents willing to accept more out-of-pocket costs in order to continue their Medicare HMO coverage. Most respondents (67%) were willing to pay more out-of-pocket costs so that their HMO could have continued Medicare coverage. Those who were white (P =.03), had higher incomes (P =.01), and returned to traditional fee-for-service Medicare (P =.004) were more likely than other respondents to accept increased patient cost sharing. Most beneficiaries preferred Medicare policies requiring HMOs to sign longer-term Health Care Financing Administration (HCFA) contracts (72%) and to offer coverage to beneficiaries regardless of where they lived in a given state (87%). However, respondents' preferences for such policy options were not associated with the amount of cost sharing that respondents were willing to accept.Conclusions: Most Medicare beneficiaries are willing to accept increased patient cost sharing in order to reduce disruptions in their HMO coverage. Policies intended to reduce HMO plan withdrawals, such as requiring health plans to sign longer-term HCFA contracts, are supported by many Medicare beneficiaries, but these policy preferences were not related to willingness to cost share. In light of an apparent willingness to pay more out-of-pocket medical costs, Medicare beneficiaries in general may accept increased cost sharing in order to retain their HMO coverage. [ABSTRACT FROM AUTHOR]

Analyzes four failed efforts by the Health Care Financing Administration to implement pilot competitive pricing demonstrations for Medicare. Three key reasons behind the strong opposition to these failed demonstrations; Need for policymakers to apply reforms fairly and equitably across the health care system.