Association of Daily Copayments with Use of Hospital Care among Medicare Advantage Enrollees

Abstract Background While the traditional Medicare program imposes a deductible for hospital admissions, many Medicare Advantage plans have instituted per-diem copayments for hospital care. Little evidence exists about the effects of changes in cost-sharing for hospital care among the elderly. Changing inpatient benefits from a deductible to a per diem may benefit enrollees with shorter lengths of stay, but adversely affect the out-of-pocket burden for hospitalized enrollees with longer lengths of stay. Methods We used a quasi-experimental difference-in-differences study to compare longitudinal changes in proportion hospitalized, inpatient admissions and days per 100 enrollees, and hospital length of stay between enrollees in MA plans that changed inpatient benefit from deductible at admission to per diem, intervention plans, and enrollees in matched control plans – similar plans that maintained inpatient deductibles. The study population included 423,634 unique beneficiaries enrolled in 23 intervention plans and 36 matched control plans in the 2007–2010 period. Results The imposition of per-diem copayments were associated with adjusted declines of 1.3 admissions/100 enrollees (95% CI − 1.8 to − 0.9), 6.9 inpatient days/100 enrollees (95% CI − 10.1 to − 3.8) and 0.7 percentage points in the probability of hospital admission (95% CI − 1.0 to − 0.4), with no significant change in adjusted length of stay in intervention plans relative to control plans. For persons with 2 or more hospitalizations in the year prior to the cost-sharing change, adjusted declines were 3.5 admissions/100 (95% CI − 8.4 to 1.4), 31.1 days/100 (95% CI − 75.2 to 13.0) and 2.2 percentage points in the probability of hospitalization (95% CI − 3.8 to − 0.6) in intervention plans relative to control plans. Conclusions Instituting per-diem copayments was associated with reductions in number of admissions and hospital stays, but not length of stay once admitted. Effects of inpatient cost-sharing changes were magnified for persons with greater baseline use of hospital care.

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Association of Daily Copayments with Use of Hospital Care among Medicare Advantage Enrollees

10.21203/rs.2.13034/v1 ◽

2019 ◽

Author(s):

John McHugh ◽

Laura Keohane ◽

Regina Grebla ◽

Yoojin Lee ◽

Amal Trivedi

Keyword(s):

Length Of Stay ◽

Cost Sharing ◽

Hospital Care ◽

Hospital Admissions ◽

Matched Control ◽

Hospital Length Of Stay ◽

Inpatient Cost ◽

Medicare Advantage ◽

Lengths Of Stay ◽

Percentage Points

Abstract Background: While the traditional Medicare program imposes a deductible for hospital admissions, many Medicare Advantage plans have instituted per-diem copayments for hospital care. Little evidence exists about the effects of changes in cost-sharing for hospital care among the elderly. Changing inpatient benefits from a deductible to a per diem may benefit enrollees with shorter lengths of stay, but adversely affect the out-of-pocket burden for hospitalized enrollees with longer lengths of stay. Methods: We used a quasi-experimental difference-in-differences study to compare longitudinal changes in proportion hospitalized, inpatient admissions and days per 100 enrollees, and hospital length of stay between enrollees in MA plans that changed inpatient benefit from deductible at admission to per diem, intervention plans, and enrollees in matched control plans – similar plans that maintained inpatient deductibles. The study population included 423,634 unique beneficiaries enrolled in 23 intervention plans and 36 matched control plans in the 2007-2010 period. Results: The imposition of per-diem copayments were associated with adjusted declines of 1.3 admissions/100 enrollees (95% CI -1.8 to -0.9), 6.9 inpatient days/100 enrollees (95% CI -10.1 to -3.8) and 0.7 percentage points in the probability of hospital admission (95% CI -1.0 to -0.4), with no significant change in adjusted length of stay in intervention plans relative to control plans. For persons with 2 or more hospitalizations in the year prior to the cost-sharing change, adjusted declines were 3.5 admissions/100 (95% CI -8.4 to 1.4), 31.1 days/100 (95% CI -75.2 to 13.0) and 2.2 percentage points in the probability of hospitalization (95% CI -3.8 to -0.6) in intervention plans relative to control plans. Conclusions: Instituting per-diem copayments was associated with reductions in number of admissions and hospital stays, but not length of stay once admitted. Effects of inpatient cost-sharing changes were magnified for persons with greater baseline use of hospital care.

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Association of Daily Copayments with Use of Hospital Care among Medicare Advantage Enrollees

10.21203/rs.2.13034/v2 ◽

2019 ◽

Author(s):

John McHugh ◽

Laura Keohane ◽

Regina Grebla ◽

Yoojin Lee ◽

Amal Trivedi

Keyword(s):

Length Of Stay ◽

Cost Sharing ◽

Hospital Care ◽

Hospital Admissions ◽

Matched Control ◽

Hospital Length Of Stay ◽

Inpatient Cost ◽

Medicare Advantage ◽

Lengths Of Stay ◽

Percentage Points

Abstract Background: While the traditional Medicare program imposes a deductible for hospital admissions, many Medicare Advantage plans have instituted per-diem copayments for hospital care. Little evidence exists about the effects of changes in cost-sharing for hospital care among the elderly. Changing inpatient benefits from a deductible to a per diem may benefit enrollees with shorter lengths of stay, but adversely affect the out-of-pocket burden for hospitalized enrollees with longer lengths of stay. Methods: We used a quasi-experimental difference-in-differences study to compare longitudinal changes in proportion hospitalized, inpatient admissions and days per 100 enrollees, and hospital length of stay between enrollees in MA plans that changed inpatient benefit from deductible at admission to per diem, intervention plans, and enrollees in matched control plans – similar plans that maintained inpatient deductibles. The study population included 423,634 unique beneficiaries enrolled in 23 intervention plans and 36 matched control plans in the 2007-2010 period. Results: The imposition of per-diem copayments were associated with adjusted declines of 1.3 admissions/100 enrollees (95% CI -1.8 to -0.9), 6.9 inpatient days/100 enrollees (95% CI -10.1 to -3.8) and 0.7 percentage points in the probability of hospital admission (95% CI -1.0 to -0.4), with no significant change in adjusted length of stay in intervention plans relative to control plans. For persons with 2 or more hospitalizations in the year prior to the cost-sharing change, adjusted declines were 3.5 admissions/100 (95% CI -8.4 to 1.4), 31.1 days/100 (95% CI -75.2 to 13.0) and 2.2 percentage points in the probability of hospitalization (95% CI -3.8 to -0.6) in intervention plans relative to control plans. Conclusions: Instituting per-diem copayments was associated with reductions in number of admissions and hospital stays, but not length of stay once admitted. Effects of inpatient cost-sharing changes were magnified for persons with greater baseline use of hospital care.

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Association of Daily Copayments with Use of Hospital Care among Medicare Advantage Enrollees

10.21203/rs.2.13034/v4 ◽

2019 ◽

Author(s):

John McHugh ◽

Laura Keohane ◽

Regina Grebla ◽

Yoojin Lee ◽

Amal Trivedi

Keyword(s):

Length Of Stay ◽

Cost Sharing ◽

Hospital Care ◽

Hospital Admissions ◽

Matched Control ◽

Hospital Length Of Stay ◽

Inpatient Cost ◽

Medicare Advantage ◽

Lengths Of Stay ◽

Percentage Points

Abstract Background: While the traditional Medicare program imposes a deductible for hospital admissions, many Medicare Advantage plans have instituted per-diem copayments for hospital care. Little evidence exists about the effects of changes in cost-sharing for hospital care among the elderly. Changing inpatient benefits from a deductible to a per diem may benefit enrollees with shorter lengths of stay, but adversely affect the out-of-pocket burden for hospitalized enrollees with longer lengths of stay. Methods: We used a quasi-experimental difference-in-differences study to compare longitudinal changes in proportion hospitalized, inpatient admissions and days per 100 enrollees, and hospital length of stay between enrollees in MA plans that changed inpatient benefit from deductible at admission to per diem, intervention plans, and enrollees in matched control plans – similar plans that maintained inpatient deductibles. The study population included 423,634 unique beneficiaries enrolled in 23 intervention plans and 36 matched control plans in the 2007-2010 period. Results: The imposition of per-diem copayments were associated with adjusted declines of 1.3 admissions/100 enrollees (95% CI -1.8 to -0.9), 6.9 inpatient days/100 enrollees (95% CI -10.1 to -3.8) and 0.7 percentage points in the probability of hospital admission (95% CI -1.0 to -0.4), with no significant change in adjusted length of stay in intervention plans relative to control plans. For persons with 2 or more hospitalizations in the year prior to the cost-sharing change, adjusted declines were 3.5 admissions/100 (95% CI -8.4 to 1.4), 31.1 days/100 (95% CI -75.2 to 13.0) and 2.2 percentage points in the probability of hospitalization (95% CI -3.8 to -0.6) in intervention plans relative to control plans. Conclusions: Instituting per-diem copayments was associated with reductions in number of admissions and hospital stays, but not length of stay once admitted. Effects of inpatient cost-sharing changes were magnified for persons with greater baseline use of hospital care.

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Pharmacogenomic and drug interaction risk associations with hospital length of stay among Medicare Advantage members with COVID-19

10.1101/2021.05.06.21256769 ◽

2021 ◽

Author(s):

Kristine Ashcraft ◽

Chad Moretz ◽

Chantelle Schenning ◽

Susan Rojahn ◽

Kae Vines Tanudtanud ◽

...

Keyword(s):

Drug Interaction ◽

Length Of Stay ◽

Drug Interactions ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Administrative Database ◽

Insurance Company ◽

Medicare Advantage ◽

Lengths Of Stay ◽

Pharmacy Claims

Importance: COVID-19 has severely impacted older populations and strained healthcare resources, with many patients requiring long periods of hospitalization. Reducing the hospital length of stay (LOS) reduces patient and hospital burden. Given that adverse drug reactions are known to prolong LOS, unmanaged pharmacogenomic risk and drug interactions among COVID-19 patients may be a risk factor for longer hospital stays. Objective: The objective of this study was to determine if pharmacogenomic and drug interaction risks were associated with longer lengths of stay among high-risk patients hospitalized with COVID-19. Design: Retrospective cohort study of medical and pharmacy claims Setting: Administrative database from a large U.S. health insurance company Participants: Medicare Advantage members with a first COVID-19 hospitalization between January 2020 and June 2020, who did not die during the stay. Exposures: (1) Pharmacogenetic interaction probability (PIP) of ≤25% (low), 26%-50% (moderate), or >50% (high), which indicate the likelihood that one or more clinically actionable gene-drug or gene-drug-drug interactions would be identified with testing; (2) drug-drug interaction (DDI) severity of minimal, minor, moderate, major, or contraindicated, which indicate the severity of an interaction between two or more active medications. Main Outcomes and Measures: The primary outcome was hospital length of stay. Results were stratified by hierarchical condition categories (HCC) counts and chronic conditions. Results: A total of 6,025 patients hospitalized with COVID-19 were included in the study. Patients with moderate or high PIP were hospitalized for 9% (CI: 4%-15%; p < 0.001) and 16% longer (CI: 8%-24%; p < 0.001), respectively, compared to those with low PIP, whereas RAF score was not associated with LOS. High PIP was significantly associated with 12%-22% longer lengths of stay compared to low PIP in patients with hypertension, hyperlipidemia, diabetes, or COPD. Finally, among patients with 2 or 3 HCCs, a 10% longer length of stay was observed among patients with moderate or more severe DDI compared to minimal or minor DDI. Conclusions and Relevance: Proactively mitigating pharmacogenomic risk has the potential to reduce length of stay in patients hospitalized with COVID-19 especially those with COPD, diabetes, hyperlipidemia, and hypertension.

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Introduction of the Abbreviated Westmead Post-Traumatic Amnesia Scale and Impact on Length of Stay

Scandinavian Journal of Surgery ◽

10.1177/1457496917698642 ◽

2017 ◽

Vol 106 (4) ◽

pp. 356-360 ◽

Cited By ~ 1

Author(s):

C. E. Watson ◽

E. A. Clous ◽

M. Jaeger ◽

S. K. D’Amours

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Length Of Stay ◽

Mild Traumatic Brain Injury ◽

Brain Injuries ◽

Hospital Admissions ◽

Assessment Tool ◽

Hospital Length Of Stay ◽

Traumatic Amnesia ◽

Post Traumatic

Background and Aims: Mild traumatic brain injury is a common presentation to Emergency Departments. Early identification of patients with cognitive deficits and provision of discharge advice are important. The Abbreviated Westmead Post-traumatic Amnesia Scale provides an early and efficient assessment of post-traumatic amnesia for patients with mild traumatic brain injuries, compared with the previously used assessment, the Modified Oxford Post-traumatic Scale. Material and Methods: This retrospective cohort study reviewed 270 patients with mild traumatic brain injury assessed for post-traumatic amnesia over a 2-year period between February 2011 and February 2013. It identified those assessed with Abbreviated Westmead Post-traumatic Amnesia Scale versus Modified Oxford Post-traumatic Scale, the outcomes of these post-traumatic amnesia assessments, the hospital length of stay for patients, and their readmission rates. Results: The Abbreviated Westmead Post-traumatic Amnesia Scale was used in 91% of patient cases (and the Modified Oxford Post-traumatic Scale in 7%), and of those assessed with the Abbreviated Westmead Post-traumatic Amnesia Scale, 94% cleared post-traumatic amnesia testing within 4 h. Of those assessed with the Abbreviated Westmead Post-traumatic Amnesia Scale, 56% had a shorter length of stay than had they been assessed with the Modified Oxford Post-traumatic Scale, resulting in 295 bed-days saved. Verbal and written discharge advice was provided to those assessed for post-traumatic amnesia to assist their recovery. In all, 1% of patients were readmitted for monitoring of mild post-concussion symptoms. Conclusion: The Abbreviated Westmead Post-traumatic Amnesia Scale provides an effective and timely assessment of post-traumatic amnesia for patients presenting to the Emergency Department with mild traumatic brain injury compared with the previously used assessment tool. It helps identify patients with cognitive impairment and the need for admission and further investigation, resulting in appropriate access to care. It also results in a decreased length of stay and decreased hospital admissions, with subsequent cost savings to the hospital.

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Survival trends in palliative care patients with cancer: A Mayo Clinic 5-year review

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.9592 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. 9592-9592

Author(s):

A. H. Kamal ◽

K. M. Swetz ◽

H. Liu ◽

S. R. Ruegg ◽

E. C. Carey ◽

...

Keyword(s):

Palliative Care ◽

Length Of Stay ◽

Median Time ◽

Mayo Clinic ◽

Hospital Admissions ◽

Cox Model ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Care Plan ◽

Palliative Care Consultation

9592 Background: Palliative care (PC) is an essential part of the continuum of care for cancer (CA) patients (pts). Little is known about the aggregate characteristics and survival of pts receiving inpatient palliative care consultation (PCC). Methods: We reviewed data prospectively collected on patients seen by the Palliative Care Inpatient Consult Service at Mayo Clinic - Rochester from 2003–2008. Demographics, consult characteristics, and survival were analyzed. Kaplan-Meier survival curves and a Cox model of survival were produced. Results: 1794 total patients were seen over the five year period. Cancer is the most common primary diagnosis (47%). Growth in annual PCC has risen dramatically (113 in 2003 vs. 414 in 2007) despite stable total hospital admissions. Patient are predominantly men (52% vs. 48%, p=0.02); median age is 76. General medicine, medical cardiology, and medical intensive care unit services refer most often. Most frequent issues addressed are goals of care, dismissal planning, and pain control (29%, 19%, 17%). PCC in actively dying pts have increased with 27% of all non-operating room, non-trauma in-hospital deaths being seen. Although CA pts have the highest median survival after PCC vs. other diagnoses (17 days, p = 0.018), we observed a five-year trend of decreasing survival from admission to death and PCC to death. Median time from admission to death in CA pts is 36 days in 2003 and 19 days in 2008 (p<0.01). Median time from PCC to death is 33 versus 11.5 days (p<0.01). Despite this, median hospital length of stay and time from PCC to discharge have remained fixed at 8 and 2.5 days, respectively. A Cox model of survival to discharge and <6 months survival (hospice eligibility) shows hospital length of stay, time from consult to discharge, and dismissal location from hospital are all prognostic factors. Conclusions: Survival window for PC intervention for CA pts is lessening. With the trend of shorter survival after PCC, PC professionals have little over two days to implement a comprehensive, ongoing care plan. This highlights the importance of earlier outpatient palliative care involvement with advanced cancer patients and families. No significant financial relationships to disclose.

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Unmanaged Pharmacogenomic and Drug Interaction Risk Associations with Hospital Length of Stay among Medicare Advantage Members with COVID-19: A Retrospective Cohort Study

Journal of Personalized Medicine ◽

10.3390/jpm11111192 ◽

2021 ◽

Vol 11 (11) ◽

pp. 1192

Author(s):

Kristine Ashcraft ◽

Chad Moretz ◽

Chantelle Schenning ◽

Susan Rojahn ◽

Kae Vines Tanudtanud ◽

...

Keyword(s):

Drug Interaction ◽

Chronic Conditions ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Chronic Obstructive ◽

Medicare Advantage ◽

Obstructive Pulmonary Disease ◽

Lengths Of Stay ◽

Pharmacy Claims ◽

Or Gene

Unmanaged pharmacogenomic and drug interaction risk can lengthen hospitalization and may have influenced the severe health outcomes seen in some COVID-19 patients. To determine if unmanaged pharmacogenomic and drug interaction risks were associated with longer lengths of stay (LOS) among patients hospitalized with COVID-19, we retrospectively reviewed medical and pharmacy claims from 6025 Medicare Advantage members hospitalized with COVID-19. Patients with a moderate or high pharmacogenetic interaction probability (PIP), which indicates the likelihood that testing would identify one or more clinically actionable gene–drug or gene–drug–drug interactions, were hospitalized for 9% (CI: 4–15%; p < 0.001) and 16% longer (CI: 8–24%; p < 0.001), respectively, compared to those with low PIP. Risk adjustment factor (RAF) score, a commonly used measure of disease burden, was not associated with LOS. High PIP was significantly associated with 12–22% longer LOS compared to low PIP in patients with hypertension, hyperlipidemia, diabetes, or chronic obstructive pulmonary disease (COPD). A greater drug–drug interaction risk was associated with 10% longer LOS among patients with two or three chronic conditions. Thus, unmanaged pharmacogenomic risk was associated with longer LOS in these patients and managing this risk has the potential to reduce LOS in severely ill patients, especially those with chronic conditions.

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Post-vaccination COVID-19: A case-control study and genomic analysis of 119 breakthrough infections in partially vaccinated individuals

Clinical Infectious Diseases ◽

10.1093/cid/ciab714 ◽

2021 ◽

Author(s):

Ioannis Baltas ◽

Florencia A T Boshier ◽

Charlotte A Williams ◽

Nadua Bayzid ◽

Marius Cotic ◽

...

Keyword(s):

Length Of Stay ◽

Hospital Admissions ◽

Genomic Analysis ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Escape Mutation ◽

Number Needed To Treat ◽

Sequencing Analysis ◽

Full Genome Sequencing ◽

Post Vaccination

Abstract Background Post-vaccination infections challenge the control of the COVID-19 pandemic. Methods We matched 119 cases of post-vaccination SARS-CoV-2 infection with BNT162b2 mRNA, or ChAdOx1 nCOV-19, to 476 unvaccinated patients with COVID-19 (Sept 2020-March 2021), according to age and sex. Differences in 60-day all-cause mortality, hospital admission, and hospital length of stay were evaluated. Phylogenetic, single nucleotide polymorphism (SNP) and minority variant allele (MVA) full genome sequencing analysis was performed. Results 116/119 cases developed COVID-19 post first vaccination dose (median 14 days, IQR 9 – 24 days). Overall, 13/119 (10∙9%) cases and 158/476 (33∙2%) controls died (p<0.001), corresponding to 4∙5 number needed to treat (NNT). Multivariably, vaccination was associated with 69∙3% (95%CI 45∙8 – 82∙6) relative risk (RR) reduction in mortality. Similar results were seen in subgroup analysis for patients with infection onset ≥14 days after first vaccination (RR reduction 65∙1%, 95%CI 27∙2 – 83∙2, NNT 4∙5), and across vaccine subgroups (BNT162b2: RR reduction 66%, 95%CI 34∙9 – 82∙2, NNT 4∙7, ChAdOx1: RR reduction 78∙4%, 95%CI 30∙4 – 93∙3, NNT 4∙1). Hospital admissions (OR 0∙80, 95%CI 0∙51 – 1∙28), and length of stay (-1∙89 days, 95%CI -4∙57 – 0∙78) were lower for cases, while Ct values were higher (30∙8 versus 28∙8, p = 0.053). B.1.1.7 was the predominant lineage in cases (100/108, 92.6%) and controls (341/446, 76.5%). Genomic analysis identified one post-vaccination case harboring the E484K vaccine escape mutation (B.1.525 lineage). Conclusions Previous vaccination reduces mortality when B.1.1.7 is the predominant lineage. No significant lineage-specific genomic changes during phylogenetic, SNP and MVA analysis were detected.

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MP44: TEC4Home heart failure: using home telemonitoring to decrease ED readmissions and clinical flow

CJEM ◽

10.1017/cem.2018.198 ◽

2018 ◽

Vol 20 (S1) ◽

pp. S56-S57

Author(s):

H. Novak Lauscher ◽

K. Ho ◽

J. L. Cordeiro ◽

A. Bhullar ◽

R. Abu Laban ◽

...

Keyword(s):

Heart Failure ◽

Length Of Stay ◽

Hospital Admissions ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Total Hospital ◽

Home Telemonitoring ◽

Patient Health ◽

Ed Visits ◽

Improve Patient

Introduction: Patients with Heart failure (HF) experience frequent decompensation necessitating multiple emergency department (ED) visits and hospitalizations. If patients are able to receive timely interventions and optimize self-management, recurrent ED visits may be reduced. In this feasibility study, we piloted the application of home telemonitoring to support the discharge of HF patients from hospital to home. We hypothesized that TEC4Home would decrease ED revisits and hospital admissions and improve patient health outcomes. Methods: Upon discharge from the ED or hospital, patients with HF received a blood pressure cuff, weight scale, pulse oximeter, and a touchscreen tablet. Participants submitted measurements and answered questions on the tablet about their HF symptoms daily for 60 days. Data were reviewed by a monitoring nurse. From November 2016 to July 2017, 69 participants were recruited from Vancouver General Hospital (VGH), St. Pauls Hospital (SPH) and Kelowna General Hospital (KGH). Participants completed pre-surveys at enrollement and post-surveys 30 days after monitoring finished. Administrative data related to ED visits and hospital admissions were reviewed. Interviews were conducted with the monitoring nurses to assess the impact of monitoring on patient health outcomes. Results: A preliminary analysis was conducted on a subsample of participants (n=22) enrolled across all 3 sites by March 31, 2017. At VGH and SPH (n=14), 25% fewer patients required an ED visit in the post-survey reporting compared to pre-survey. During the monitoring period, the monitoring nurse observed seven likely avoided ED admissions due to early intervention. In total, admissions were reduced by 20% and total hospital length of stay reduced by 69%. At KGH (n=8), 43% fewer patients required an ED visit in the post-survey reporting compared to the pre-survey. Hospital admissions were reduced by 20% and total hospital length of stay reduced by 50%. Overall, TEC4Home participants from all sites showed a significant improvement in health-related quality of life and in self-care behaviour pre- to 90 days post-monitoring. A full analysis of the 69 patients will be complete in February 2018. Conclusion: Preliminary findings indicate that home telemonitoring for HF patients can decrease ED revisits and improve patient experience. The length of stay data may also suggest the potential for early discharge of ED patients with home telemonitoring to avoid or reduce hospitalization. A stepped-wedge randomized controlled trial of TEC4Home in 22 BC communities will be conducted in 2018 to generate evidence and scale up the service in urban, regional and rural communities. This work is submitted on behalf of the TEC4Home Healthcare Innovation Community.

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