scholarly journals Impacts of COVID-19 on the Utilization of the Medicare Hospice Benefit

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 63-63
Author(s):  
Michael Plotzke ◽  
Betty Fout ◽  
Thomas Christian
Keyword(s):  
Healthcare Services ◽  
Public Health Emergency ◽  
Fee For Service ◽  
Medicare Beneficiaries ◽  
Skilled Nursing ◽  
Substantial Impact ◽  
Profound Impact ◽  
Time Period ◽  
Medicare Patients ◽  
Utilization Of Healthcare

Abstract The Coronavirus Disease 2019 (COVID-19) Public Health Emergency (PHE) has had a substantial impact on the provision and utilization of healthcare services. Given the high mortality rate associated with COVID-19 amongst older adults, COVID-19 is likely to have a profound impact on all hospice users due to disruptions in providing services. Our work describes how Medicare beneficiaries have utilized the Medicare Hospice Benefit (MHB) during the PHE and how that compares to utilization of the MHB prior to the PHE. We conducted a retrospective analysis of 100% Part A and Part B Fee-for-Service (FFS) Medicare claims from January 1, 2019 – December 31, 2020. We identified approximately 42.3 million unique Medicare FFS beneficiaries from January 2019 through December 2020. Of these, 1.6 million (3.8%) had at least one hospice claim and 1.7 million (4.0%) had at least one Medicare Part A or Part B claim with a COVID-19 diagnosis during the same time period. The rate of COVID-19 amongst FFS Medicare patients who utilized hospice was 8.3%. Average per-beneficiary per-month hospice visits fell by 28.2% for aides and 15.4% for nurses from December 2019 (7.1 aide visits, 6.5 skilled nursing visits) through December 2020 (5.1 aide visits, 5.5 skilled nursing visits). CMS should continue to monitor the prevalence of COVID-19 amongst hospice users and measures of hospice utilization amongst all hospice users in order to better understand how the PHE impacts the provision of the MHB and ensure beneficiaries continue to have access to needed services.

Abstract 15: Trends in Performance and Outcomes of Carotid Endarterectomy Among Elderly Medicare Beneficiaries, 2003-2010

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Judith H Lichtman ◽  
Michael R Jones ◽  
Alice J Sheffet ◽  
George Howard ◽  
Yun Wang ◽  
...  
Keyword(s):  
Carotid Endarterectomy ◽  
Mixed Model ◽  
Patient Characteristics ◽  
Annual Number ◽  
Fee For Service ◽  
Medicare Beneficiaries ◽  
Hospital Level ◽  
Medicare Patients ◽  
Annual Reduction ◽  
Service Data

Background: Carotid endarterectomy (CEA) is the leading procedure for carotid stenosis, yet national data on trends in rates and outcomes are limited. We determined CEA rates among Medicare beneficiaries and evaluated mortality and readmission over 8 years. Methods: We used Medicare fee-for-service data to identify beneficiaries aged ≥65y who had their first CEA (ICD-9 38.12) from 2003-2010 and calculated annual rates per 100,000 person-years (PY). We fit mixed models to assess trends in patient-level outcomes, adjusting for demographics, comorbidities, and symptomatic status. We also evaluated hospital-level trends by calculating risk-standardized mortality (RSMR) and readmission (RSRR) rates. A spatial mixed model adjusted for age, sex, and race was fit to calculate county-specific risk-standardized CEA rates in 2003-2004. Results: There were 505,966 unique CEA hospitalizations. The annual number of CEA discharges decreased from 81,604 in 2003 to 47,597 in 2010 (42% decrease), though the patient characteristics remained largely similar. The national CEA rate was 283 per 100,000 PY in 2003, and there was considerable geographic variability (Figure A). This rate decreased each year to a low of 172 per 100,000 PY in 2010. The rate of stroke or death within 30 days decreased from 3.2 to 2.7%, with a significant adjusted annual reduction of 3% (Figure B). Annual reductions in other short- and long-term outcomes were similar, ranging from 2-3%. The median hospital-level 30-day RSMR decreased over time from 0.99 to 0.57%, while the variation between hospitals increased (interquartile range of 0.7-1.67 percentage points). The 30-day RSRR decreased from 11.0 to 10.1%, but there was more homogeneity across hospitals and years. Conclusions: CEA use among Medicare patients decreased dramatically from 2003-2010, while mortality and readmission outcomes improved. The relative importance of biological and sociological mechanisms for these trends merits further study.

scholarly journals Economic Burden of Osteoporosis-Related Fractures in the US Medicare Population

2020 ◽  
pp. 106002802097051 ◽  
Author(s):  
Setareh A. Williams ◽  
Shanette G. Daigle ◽  
Richard Weiss ◽  
Yamei Wang ◽  
Tarun Arora ◽  
...  
Keyword(s):  
Economic Burden ◽  
Linear Models ◽  
Hospice Care ◽  
Skilled Nursing Facility ◽  
Fee For Service ◽  
Medicare Beneficiaries ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Public Health Burden ◽  
Osteoporosis Related Fracture

Background Osteoporosis-related fractures are an important public health burden. Objective To examine health care costs in Medicare patients with an osteoporosis-related fracture. Methods Medicare fee-for-service members with an osteoporosis-related fracture between January 1, 2010, to September 30, 2014 were included. A nonfracture comparator group was selected by propensity score matching. Generalized linear models using a gamma distribution were used to compare costs between fracture and nonfracture cohorts. Results A total of 885 676 Medicare beneficiaries had fracture(s) and met inclusion criteria. Average age was 80.5 (±8.4) years; 91% were White, and 94% female. Mean all-cause costs were greater in the fracture vs nonfracture cohort ($47 163.25 vs $16 034.61) overall and for men ($52 273.79 vs $17 352.68). The highest mean costs were for skilled nursing facility ($29 216), inpatient costs ($24 190.19), and hospice care ($20 996.83). The highest incremental costs versus the nonfracture cohort were for hip ($71 057.83 vs $16 807.74), spine ($37 543.87 vs $16 860.49), and radius/ulna ($24 505.27 vs $14 673.86). Total medical and pharmacy costs for patients who experienced a second fracture were higher compared with those who did not ($78 137.59 vs $44 467.47). Proportionally more patients in the fracture versus nonfracture cohort died (18% vs 9.3%), with higher death rates among men (20% vs 11%). Conclusion and Relevance The current findings suggest a significant economic burden associated with fractures. Early identification and treatment of patients at high risk for fractures is of paramount importance for secondary prevention and reduced mortality.

Hospitalization and hospital discharge destinations after chemotherapy: Using the Oncology Care Model (OCM) methodology in 2012–2015 Medicare data.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 113-113
Author(s):  
Yi Peng ◽  
Jiannong Liu ◽  
Leon Raskin ◽  
Michael Anthony Kelsh ◽  
Rebecca Zaha ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Financial Incentives ◽  
Quality Care ◽  
Skilled Nursing Facility ◽  
Cancer Type ◽  
Fee For Service ◽  
Medicare Beneficiaries ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Practice Performance

113 Background: The Medicare OCM gives financial incentives for efficient, high-quality care. Hospitalizations of cancer patients receiving chemotherapy substantially increases costs. We assessed reasons for hospitalization and hospitalization discharge destinations after chemotherapy in cancer patients. Methods: We applied OCM methodology in a Medicare fee-for-service 20% sample data to estimate 6-month patient episodes triggered by chemotherapy from 2012 to 2015. We summarized the most frequent reasons for hospitalization (using ICD-9-CM codes in the first 5 positions of hospital claims) and the discharge destinations among all episodes and by cancer type. Results: Of 485,186 6-month episodes in 255,229 patients, 121,886 (25%) episodes had ≥1 hospitalization. The most frequent reasons for hospitalization were infection (13%), anemia (7%), dehydration (5%), and congestive heart failure (CHF; 3%; Table). Most hospitalized patients were discharged to home (71%) or a skilled nursing facility (SNF; 13%); some died in the hospital (6%) or went to hospice (5%). Reasons for hospitalization and discharge destination varied by cancer type. Patients with lung cancer had the highest rates of infection and anemia and higher proportions of death and hospice discharge compared with other cancers. Conclusions: Among Medicare beneficiaries receiving chemotherapy, hospitalizations most often occurred as a result of infection or anemia. Patients were most often discharged to home or SNF. Variations across cancer types in the reasons for hospitalization, as well as discharge destinations, should be considered when evaluating OCM practice performance. [Table: see text]

scholarly journals Cost Analysis and Clinical Outcomes of Ambulatory Care Monitoring in Medicare Patients: Describing the Diagnostic Odyssey

10.36469/9897 ◽  
2015 ◽  
Vol 2 (2) ◽  
pp. 161-169 ◽  
Author(s):  
Renée JG Arnold ◽  
Andrew Layton
Keyword(s):  
Holter Monitoring ◽  
Fee For Service ◽  
Medicare Beneficiaries ◽  
Claims Analysis ◽  
Diagnostic Odyssey ◽  
Clinical Events ◽  
Ambulatory Ecg Monitoring ◽  
Number Of Patients ◽  
Medicare Patients ◽  
Additional Monitoring

Objectives: The diagnostic sequence and costs for arrhythmia detection utilizing Holter ambulatory ECG monitoring have not been well studied. The objective of the current study was to characterize the number of patients and associated costs incurred in the diagnosis, additional monitoring, clinical events and sequelae after an initial Holter monitor in Medicare patients with arrhythmia—the diagnostic odyssey. Methods: We performed a retrospective, longitudinal claims analysis using a 5% random sample of Medicare beneficiaries’ claims from the Fee-for-Service (FFS) Standard Analytic Files. The analysis was limited to patients with full benefits for 1 year prior and 2 years post the index 24- or 48-hour Holter event, no prior arrhythmia or Holter. Results: The group of greatest interest was the “No results” category, since these 1,976 patients (11.1% of the total 17,887 patients evaluated) reflected the failure of repeat Holter monitoring to either detect clinical events or diagnose disease. In spite of this failure, there was a total allowed charge of more than $45 million or slightly more than $23,000 per involved patient. When extrapolated over the entire Medicare FFS population, this category was estimated to cost more than $900 million over the 2-year study period. Conclusions: Additional diagnostic paradigms need to be explored to improve upon these patient and system outcomes, where repeat monitoring frequently did not yield a diagnosis and patients continued to experience clinical events.

Influence of shunt surgery on healthcare expenditures of elderly fee-for-service Medicare beneficiaries with hydrocephalus

2007 ◽  
Vol 107 (1) ◽  
pp. 21-28 ◽  
Author(s):  
Michael A. Williams ◽  
Phoebe Sharkey ◽  
Doris Van Doren ◽  
George Thomas ◽  
Daniele Rigamonti
Keyword(s):  
Skilled Nursing Facility ◽  
Health Care Expenditures ◽  
Hospital Inpatient ◽  
Fee For Service ◽  
Shunt Surgery ◽  
Medicare Beneficiaries ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Shunt Procedure ◽  
Medicare Program

Object The goal in this study was to determine the percentage of patients with hydrocephalus who were treated with shunt surgery and to assess Medicare expenditures for those with and without shunt surgery. Methods Retrospective cost analyses were performed using the Standard Analytic Files of paid claims for beneficiaries enrolled in both Parts A (Inpatient) and B (Outpatient) of the Medicare program for 1997 through 2001. The main outcome measures were 5-year total payments and 5-year payments for separate types of service; for example, acute hospital (inpatient and outpatient), skilled nursing facility, home health, and physician/supplier services. Results Of 1441 patients with hydrocephalus, 25.1% underwent shunt surgery during the study period. The effect of a shunt procedure on 5-year Medicare expenditures is a cost difference of $25,477 (p < 0.0001) less per patient, which is equal to a potential −$184.3 million difference in 5-year Medicare expenditures. The following three factors had a negative association with whether shunt surgery was performed: 1) age 80 to 84 years (odds ratio [OR] 0.619, confidence interval [CI] 0.390–0.984); 2) age 85 years or older (OR 0.201, CI 0.110–0.366); and 3) African-American race (OR 0.506, CI 0.295–0.869). The effect of age on the likelihood of shunt surgery persisted after adjusting for the propensity to die score. Conclusions Medicare expenditures for patients with hydrocephalus treated with shunt surgery are significantly lower than expenditures for untreated patients. Research to improve the diagnosis and treatment of hydrocephalus has the potential to improve outcomes and reduce health care expenditures further.

scholarly journals Medicare Reimbursement Reform for Provider Visits and Health Outcomes in Patients on Hemodialysis

2014 ◽  
Vol 17 (1) ◽  
pp. 53-77 ◽  
Author(s):  
Kevin F. Erickson ◽  
Wolfgang C. Winkelmayer ◽  
Glenn M. Chertow ◽  
Jay Bhattacharya
Keyword(s):  
Health Outcomes ◽  
Kidney Transplant ◽  
Service System ◽  
Healthcare Services ◽  
Economic Incentive ◽  
Fee For Service ◽  
Medicare Reimbursement ◽  
Medicare Beneficiaries ◽  
Medicare Costs ◽  
Incentive Payments

AbstractThe relation between the quantity of many healthcare services delivered and health outcomes is uncertain. In January 2004, the Centers for Medicare and Medicaid Services introduced a tiered fee-for-service system for patients on hemodialysis, creating an incentive for providers to see patients more frequently. We analyzed the effect of this change on patient mortality, transplant wait-listing, and costs. While mortality rates for Medicare beneficiaries on hemodialysis declined after reimbursement reform, mortality declined more – or was no different – among patients whose providers were not affected by the economic incentive. Similarly, improved placement of patients on the kidney transplant waitlist was no different among patients whose providers were not affected by the economic incentive; payments for dialysis visits increased 13.7% in the year following reform. The payment system designed to increase provider visits to hemodialysis patients increased Medicare costs with no evidence of a benefit on survival or kidney transplant listing.

scholarly journals Analysis of vertebral augmentation practice patterns: a 2016 update

2016 ◽  
Vol 8 (12) ◽  
pp. 1299-1304 ◽  
Author(s):  
Joshua A Hirsch ◽  
Ronil V Chandra ◽  
Vidsysagar Pampati ◽  
John D Barr ◽  
Allan L Brook ◽  
...  
Keyword(s):  
Practice Patterns ◽  
Significant Decline ◽  
Vertebral Augmentation ◽  
Fee For Service ◽  
Medicare Beneficiaries ◽  
Medicare Population ◽  
Orthopedic Surgeons ◽  
Time Period ◽  
The Us ◽  
Utilization Patterns

ObjectiveTo evaluate procedure utilization patterns for vertebroplasty and kyphoplasty in the US Medicare population from 2004 to 2014.MethodsThe analysis was performed using the Centers for Medicare and Medicaid Services database of specialty utilization files for the fee for service (FFS) Medicare population.ResultsThe FFS Medicare population increased by 28% with an annual increase of 2.5% from 2004 to 2014. Utilization of vertebroplasty procedures decreased by 63% with an average annual decrease of 9.5% from 2004 to 2014 per 100 000 FFS Medicare beneficiaries. During the same time period, kyphoplasty procedures decreased by a total of 10%, with an average annual decrease of 1.3%. For augmentation generally (combined vertebroplasty/kyphoplasty data) there was thus an overall decrease in the rate per 100 000 Medicare population of 32% from 2004 to 2014, with an average annual decrease of 4.8%. The majority of vertebroplasty procedures were performed by radiologists whereas the majority of kyphoplasties were performed by orthopedic surgeons and neurosurgeons.ConclusionsThere has been a significant decline in vertebroplasty and kyphoplasty procedures in the FFS Medicare population between 2004 and 2014.

Abstract WP416: African Americans are Less Likely to be Adherent to Statins After Ischemic Stroke: an Analysis of Medicare Beneficiaries Following Hospital Discharge

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Karen C Albright ◽  
Justin Blackburn ◽  
Virginia Howard ◽  
T. Mark Beasley ◽  
Nita Limdi ◽  
...  
Keyword(s):  
Older Adults ◽  
African American ◽  
Ischemic Stroke ◽  
African Americans ◽  
Recurrent Stroke ◽  
Fee For Service ◽  
Medicare Beneficiaries ◽  
Stroke Event ◽  
Skilled Nursing ◽  
Index Stroke

Introduction: Statins have been shown to decrease cardiovascular disease morbidity and mortality. Although statins have proven efficacious in reducing the risk of recurrent stroke, little is known about adherence among older adults following ischemic stroke. Methods: We compiled a retrospective cohort of Caucasian and African-American Medicare beneficiaries in the 5% sample to estimate statin adherence among older adults initiating therapy following hospitalization for ischemic stroke in 2007 - 2011. To be included, beneficiaries were required to have 365 days of Medicare fee-for-service coverage with no claims for stroke-related events or statins prior to the index stroke event. The cohort was limited to beneficiaries with an initial Part D claim for a statin within 30 days plus at least 1 additional claim during follow-up. Adherence was determined by percent of days covered (PDC) for the 365 days following discharge home (time spent in rehabilitation or skilled nursing was excluded); non-adherence was defined as a PDC <80%. Relative risk of statin non-adherence was determined using modified Poisson regression. Results: Among 6,251 statin-naïve beneficiaries with stroke, 2,070 (33.1%) initiated statin therapy and were included in the analysis. Among them, 13.1% (n=271) were African American. African Americans were more likely than Caucasians to have a PDC <80%, 15.4% vs. 11.7%, respectively (crude RR 1.21, 95% CI 1.04-1.40). The racial disparity remained after adjusting for demographics, dual Medicare-Medicaid eligibility, and baseline comorbidities (adjusted RR 1.17, 95% CI 0.99-1.37). Conclusions: African Americans may not be obtaining the recurrent stroke prevention therapy provided by statins, possibly contributing to the higher rate of recurrent stroke in this population.

Utilization Of Healthcare Services To General Patient At Inpatient Unit of Anutapura General Hospital, Palu City

2020 ◽  
Vol 10 (1) ◽  
pp. 35-44
Author(s):  
Fausiah Fausiah
Keyword(s):  
Health Services ◽  
General Hospital ◽  
Health Beliefs ◽  
Secondary Data ◽  
Healthcare Services ◽  
Primary Data ◽  
Utilization Of Health Services ◽  
The People ◽  
Quantitative Descriptive ◽  
Utilization Of Healthcare

The number of inpatient visits in RSU Anutapura Palu, where in 2015 inpatient visits of 5,640, then in 2016 patient visits decreased to 5,451, in 2017 also decreased to 3,999 and in 2018 also decreased Drastic to 1,146 patient visits. This research aims to determine the utilization of health services in patients in general hospitalization in RSU Anutapura Palu. This type of research is quantitative descriptive. Research was conducted from May-June 2019. The population in the study is a visitor (number of hospitalizations) at the General Hospital (RSU) Anutapura Palu. In this case the people who use health services in the General Hospital (RSU) Anutapura Palu recorded as many as 1,146 visitors (patients) in the year 2018. Primary data collection is through questionnaires and secondary data through the study of patient record documents and other supporting documents. The utilization of health services in patients in general hospitalization in RSU Anutapura Palu is well from the aspects of health beliefs, abilities and needs. RSU Anutapura Palu is expected to be able to improve the promotion of health services so that people use the health services provided.  

scholarly journals Socioeconomic determinants of unmet need for outpatient healthcare services in Iran: a national cross-sectional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sajad Vahedi ◽  
Amin Torabipour ◽  
Amirhossein Takian ◽  
Saeed Mohammadpur ◽  
Alireza Olyaeemanesh ◽  
...  
Keyword(s):  
Health System ◽  
Age Groups ◽  
Unmet Need ◽  
Healthcare Services ◽  
Cross Sectional Study ◽  
Outpatient Services ◽  
Self Medication ◽  
Cross Sectional ◽  
Organizational Policies ◽  
Utilization Of Healthcare

Abstract Background Unmet need is a critical indicator of access to healthcare services. Despite concrete evidence about unmet need in Iran’s health system, no recent evidence of this negative outcome is available. This study aimed to measure the subjective unmet need (SUN), the factors associated with it and various reasons behind it in Iran. Methods We used the data of 13,005 respondents over the age of 15 from the Iranian Utilization of Healthcare Services Survey in 2016. SUN was defined as citizens whose needs were not sought through formal healthcare services, while they did not show a history of self-medication. The reasons for SUN were categorized into availability, accessibility, responsibility and acceptability of the health system. The multivariable logistic regression was used to determine significant predictors of SUN and associated major reasons. Results About 17% of the respondents (N = 2217) had unmet need for outpatient services. Nearly 40% of the respondents chose only accessibility, 4% selected only availability, 78% chose only responsibility, and 13% selected only acceptability as the main reasons for their unmet need. Higher outpatient needs was the only factor that significantly increased SUN, responsibility-related SUN and acceptability-related SUN. Low education was associated with higher SUN and responsibility-related SUN, while it could also reduce acceptability-related SUN. While SUN and responsibility-related SUN were prevalent among lower economic quintiles, having a complementary insurance was associated with decreased SUN and responsibility-related SUN. The people with basic insurance had lower chances to face with responsibility-related SUN, while employed individuals were at risk to experience SUN. Although the middle-aged group had higher odds to experience SUN, the responsibility-related SUN were prevalent among elderly, while higher age groups had significant chance to be exposed to acceptability-related SUN. Conclusion It seems that Iran is still suffering from unmet need for outpatient services, most of which emerges from its health system performance. The majority of the unmet health needs could be addressed through improving financial as well as organizational policies. Special attention is needed to address the unmet need among individuals with poor health status.

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