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9. The association between long-term care setting and potentially preventable hospitalizations among older dual eligibles

Author

Wysocki, Andrea, Kane, Robert L., Golberstein, Ezra, Dowd, Bryan, Lum, Terry, and Shippee, Tetyana

Subjects
Management, Analysis, Company business management, Medicaid -- Analysis, Nursing homes -- Analysis -- Management, Long term care -- Analysis, Long-term care of the sick -- Analysis
Abstract

Elderly long-term care (LTC) users in both nursing homes and home and community-based settings often have complex needs that require support for functional and cognitive limitations, as well as medical [...], Objective. To compare the probability of experiencing a potentially preventable hospitalization (PPH) between older dual eligible Medicaid home and community-based service (HCBS) users and nursing home residents. Data Sources. Three years of Medicaid and Medicare claims data (2003-2005) from seven states, linked to area characteristics from the Area Resource File. Study Design. A primary diagnosis of an ambulatory care sensitive condition on the inpatient hospital claim was used to identify PPHs. We used inverse probability of treatment weighting to mitigate the potential selection of HCBS versus nursing home use. Principal Findings. The most frequent conditions accounting for PPHs were the same among the HCBS users and nursing home residents and included congestive heart failure, pneumonia, chronic obstructive pulmonary disease, urinary tract infection, and dehydration. Compared to nursing home residents, elderly HCBS users had an increased probability of experiencing both a PPH and a non-PPH. Conclusions. HCBS users' increased probability for potentially and non-PPHs suggests a need for more proactive integration of medical and long-term care. Key Words. Long-term care, home care/nursing homes, acute inpatient care, Medicaid, Medicare

Published
2014
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16. Military Base Realignments and Closures: Impact of Terminating, Relocating, or Outsourcing the Services of the Armed Forces Institute of Pathology

Author

GOVERNMENT ACCOUNTABILITY OFFICE WASHINGTON DC, Williamson, Randall B., Avruch, Sheila, Griffin, Adrienne, Hamann, Cathy, Hoban, Nora, Modi, Jasleen, Morgan, Carolina, Wysocki, Andrea, GOVERNMENT ACCOUNTABILITY OFFICE WASHINGTON DC, Williamson, Randall B., Avruch, Sheila, Griffin, Adrienne, Hamann, Cathy, Hoban, Nora, Modi, Jasleen, Morgan, Carolina, and Wysocki, Andrea

Abstract

Armed Forces Institute of Pathology (AFIP) pathologists perform three key services -- diagnostic consultations, education, and research -- primarily for physicians from DoD, the Department of Veterans Affairs (VA), and civilian institutions. The 2005 Base Realignment and Closure (BRAC) provision required the Department of Defense (DoD) to close the AFIP). GAO was asked to address the status and potential impact of implementing this BRAC provision. This report discusses the following: (1) key services AFIP provides to the military and civilian communities; (2) DoD's plans to terminate, relocate, or outsource services currently provided by AFIP; and (3) the potential impacts of disestablishing AFIP on military and civilian communities. New legislation requires DoD to consider this GAO report as it develops its plan for the reorganization of AFIP. GAO reviewed DoD's plans, analysis, and other relevant information, and interviewed officials from the public and private sectors. GAO recommends DoD report to Congress on the following: (1) its strategies for organizing consultation services, (2) AFIP's tissue specimen repository's assets and their potential use, and (3) its strategies for using the repository. DoD generally concurred with GAO's findings and conclusions. GAO has modified its recommendations to reflect concerns DoD raised about additional steps it needs to take before it can report on its strategies for using the repository. The Department of Veterans Affairs (VA) stated that GAO's report was factually accurate, but believed that it did not sufficiently describe the impact of closing AFIP. GAO believes that this report provides a balanced assessment of AFIP's services and the impact of its closing., Report to the Committee on Health, Education, Labor, and Pensions, U.S. Senate.

Published
2007

19. Agents Overlook Gaps In E&O

Author

BLECHMAN, LINDA, WILD, CRAIG, and WYSOCKI, ANDREA

Subjects
Insurance industry -- Insurance, Business, Insurance
Abstract

LINDA BLECHMAN MAN IS A SENIOR UNDERWRITER, AND CRAIG WILD AND ANDREA WYSOCKI ARE UNDERWRITERS WITH EXECUTIVE RISK INC. IN SIMSBURY, CONN. Insurance agents and brokers work daily to provide [...]

Published
1998

20. Potentially preventable hospitalizations among elderly medicaid long-term care users

Author

Wysocki, Andrea Jeanne

Subjects
Hospitalizations, Long-term care, Medicaid, Older adults
Abstract

Over the last several decades, most states have increasingly shifted their Medicaid long-term care (LTC) expenditures away from primarily institutional services toward more home and community-based services (HCBS). Despite the increase in HCBS, the risk for potentially preventable hospitalizations among elderly Medicaid HCBS users is largely unknown. Given the health implications and the high cost of hospitalizations, it is important to better understand potentially preventable hospitalizations among these LTC users. This dissertation research empirically examined potentially preventable hospitalizations among elderly Medicaid LTC users in community and institutional settings. Specifically this research aimed to (1) identify the factors associated with potentially preventable hospitalizations among elderly Medicaid HCBS users, (2) compare the risk for a potentially preventable hospitalization between elderly Medicaid HCBS users and nursing home residents, and (3) compare the risk for a potentially preventable hospitalization between elderly Medicaid LTC users who transition from a nursing home to a home or community LTC setting and those who remain in a nursing home. Results from these analyses found that potentially preventable hospitalizations were frequent among elderly Medicaid HCBS recipients, and a few conditions accounted for the majority of these hospitalizations. Several characteristics were significantly associated with an increased risk for a potentially preventable hospitalization suggesting that there is variation in preventable hospitalizations among the elderly Medicaid HCBS population and improvements could be made in reducing this variation. After controlling for a number of characteristics and correcting for endogeneity, HCBS users had an increased risk for a preventable hospitalization compared to nursing home residents. More proactive medical care and policies focusing on reducing hospitalizations may be needed for the HCBS population, as well as better aligned incentives for providers to coordinate care. Elderly Medicaid LTC users who transitioned from a nursing home to using HCBS had an increased but non-significant risk for a preventable hospitalization compared with individuals who remained in the nursing home. The medical care and continuity of providers within the nursing home setting are likely important factors in keeping nursing home residents out of the hospital.

Published
2012

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