PACE and the Medicare+Choice Risk-Adjusted Payment Model

2001 ◽  
Vol 38 (1) ◽  
pp. 60-72 ◽  
Author(s):  
Helena Temkin-Greener ◽  
Mark R. Meiners ◽  
Leonard Gruenberg
Keyword(s):  
Risk Adjustment ◽  
The Elderly ◽  
Medicare Beneficiaries ◽  
Balanced Budget Act ◽  
Functional Impairments ◽  
Payment Model ◽  
Care For The Elderly ◽  
Diagnostic Cost ◽  
Balanced Budget ◽  
The Impact

This paper investigates the impact of the Medicare principal inpatient diagnostic cost group (PIP-DCG) payment model on the Program of All-Inclusive Care for the Elderly (PACE). Currently, more than 6,000 Medicare beneficiaries who are nursing home certifiable receive care from PACE, a program poised for expansion under the Balanced Budget Act of 1997. Overall, our analysis suggests that the application of the PIP-DCG model to the PACE program would reduce Medicare payments to PACE, on average, by 38%. The PIP-DCG payment model bases its risk adjustment on inpatient diagnoses and does not capture adequately the risk of caring for a population with functional impairments.

The effect of brain vitalization activity on dementia incidence in elderly at Budi Luhur Nursing Home of Yogyakarta, Kasongan, Bantul

2020 ◽  
Vol 1 (3) ◽  
pp. 43-50
Author(s):  
Firstyono Miftahul Aziz ◽  
Suratini Suratini
Keyword(s):  
Nursing Home ◽  
The Elderly ◽  
Control Group ◽  
P Value ◽  
Sampling System ◽  
Randomized Sampling ◽  
Care For The Elderly ◽  
Dementia Incidence ◽  
The Family ◽  
The Impact

For some people, dementia is considered as a disease that is common in elderly, regardless the impact of dementia. Taking care for the elderly with dementia brings stress for the family. It can cause and increase the family burden. Brain vitalization gymnastics is one of the methods to improve memory. The study aims to investigate the effect of brain vitalization activity on dementia incidence in elderly at Budi Luhur Nursing Home of Yogyakarta. The study used Quasi Experimental with Pretest-Posttest control group and randomized sampling system. The samples were taken randomly as many as 26 respondents and were divided into two groups namely 13 respondents of experimental group and 13 respondents of control group. The statistical test used Wilcoxon Match Pairs Test. The result showed that Wilcoxon Match pairs test obtained p value 0,003, which is smaller than 0,005. There is an effect of brain vitalization activity on dementia incidence in elderly at Budi Luhur Nursing Home of Yogyakarta

Communication challenges with the elderly

2017 ◽  
Author(s):  
Ronald D. Adelman ◽  
Michele G. Greene ◽  
Milagros D. Silva
Keyword(s):  
Health Professionals ◽  
Terminal Illness ◽  
The Elderly ◽  
Psychosocial Needs ◽  
Care For The Elderly ◽  
Great Heterogeneity ◽  
Negative Perceptions ◽  
Communication Challenges ◽  
Utilization Of Healthcare ◽  
The Impact

The significant growth in the elderly population brings with it increased utilization of healthcare resources. Effective geriatric medical care requires effective communication and consideration of the challenges to communication in all stages of the continuum through health and disease. Given the often-negative perceptions of the elderly and the great heterogeneity of this population, it is imperative that health professionals assess each older patient as an individual. The impact of a cancer diagnosis and treatment, as well as a terminal illness, has a powerful effect on the lives of older people. Health professionals who care for the elderly with sensitivity to their personhood, their medical status, and psychosocial needs will have a profound influence on the quality of older patients’ lives.

scholarly journals CMS Payments Necessary to Support HMO Participation in Medicare Managed Care

2002 ◽  
Vol 5 (1) ◽  
Author(s):  
John Cawley ◽  
Michael Chernew ◽  
Catherine McLaughlin
Keyword(s):  
Managed Care ◽  
Cost Effective ◽  
Health Maintenance Organizations ◽  
Medicare Beneficiaries ◽  
Balanced Budget Act ◽  
Health Maintenance ◽  
Relative Disadvantage ◽  
Balanced Budget ◽  
Normative Statement ◽  
Capitation Payments

In recent years, many health maintenance organizations (HMOs)have exited the market for Medicare managed care; since 1998, the number of participating plans has fallen from 346 to 174. As a result of this reduced participation by HMOs, hundreds of thousands of Medicare beneficiaries have been involuntarily disenrolled from the program at the end of each year from 1998 to 2001.This paper estimates the Centers for Medicare and Medicaid Services (CMS) capitation payments that are necessary to support the participation of various numbers of HMOs in Medicare managed care per county market. This paper does not make a normative statement about how many HMOs should be supported in this program; rather, it makes a positive statement about the levels of payment necessary to support various numbers of HMOs.The identification strategy is to observe how the number of participating HMOs varies over counties and time in response to CMS payment, while controlling for estimated costs. This paper studies the period 1993-2001 and focuses in particular on the variation in payment, independent of costs, that occurred as a result of the Balanced Budget Act of 1997, which dramatically changed the way that HMOs are paid in this program. In light of the fact that it may not be cost-effective for CMS to support HMO participation in relatively rural or unpopulated counties, the sample used in this paper is limited to the 60 percent of U.S. counties with the largest populations of Medicare beneficiaries.The ordered probit results presented in this paper indicate that, to support one Medicare HMO in 2001 in half of the counties in the sample, CMS would have to pay $682.08 per average enrollee per month in the marginal county. To support one Medicare HMO in 2001 in every county in the sample, CMS would need to pay $1,008.25 per enrollee per month in the maximum-payment county. For comparison, the maximum monthly payment paid by CMS to any county in 2001 was $833.55.This paper finds that 79.3 percent of counties in the sample received a CMS payment in 2001 that was less than what was necessary to support a single HMO in Medicare managed care. Compared to those counties that received a payment exceeding the estimated threshold for HMO participation, these counties are, on average, more rural and less populated, with citizens who are less wealthy and less educated. The relative disadvantage of rural and unpopulated counties persists three years after the Balanced Budget Act of 1997, designed in part to eliminate such disparities, took effect.

scholarly journals Policy Forum: Quebec's Debt—Taming the Beast

2019 ◽  
Vol 67 (4) ◽  
pp. 1039-1050
Author(s):  
Luc Godbout
Keyword(s):  
Great Recession ◽  
Credit Rating ◽  
Balanced Budget Act ◽  
The Great Recession ◽  
Fiscal Balance ◽  
Balanced Budget ◽  
Canadian Provinces ◽  
The Government ◽  
The Impact ◽  
Policy Forum

The burden of Quebec's debt has changed significantly since 1960. While the province incurred very little debt in the years before the Quiet Revolution, its borrowing increased steadily from 1961 until the mid-1990s. By the time the trend was reversed, the Quebec government had recorded a deficit for 40 consecutive years. Having achieved one of the heaviest debt burdens, measured as a share of gross domestic product, among the Canadian provinces, and having seen two rapid downgrades of its credit rating by Moody's in the mid-1990s, fearing a further downgrade the Quebec government took steps to clean up its public finances. After outlining the evolution of Quebec's debt since the early 1960s, this article briefly describes two statutes enacted by the government to provide greater transparency with respect to the province's finances, enabling better management of its budget and debt. These statutes are the Balanced Budget Act, passed in 1996, and the Act To Reduce the Debt and Establish the Generations Fund, passed in 2006. The article discusses the impact of the Great Recession on the province's budgetary balance and indebtedness, and shows how Quebec's financial situation has changed in terms of its fiscal balance, debt, debt interest, and credit rating. It is now possible to affirm that the two statutes adopted by the government have clearly helped to improve Quebec's fiscal position.

scholarly journals Politicians’ priorities and the determinants of priorities in the Swedish social services

2012 ◽  
Vol 3 ◽  
Author(s):  
Marie Wörlén
Keyword(s):  
Social Work ◽  
Social Services ◽  
The Elderly ◽  
The Political ◽  
Political Affiliation ◽  
Regression Analyses ◽  
Clear Cut ◽  
Care For The Elderly ◽  
The Impact ◽  
Determining Factor

The setting of priorities is an integrated part of social-work politics in Sweden as well as internationally. This article explores Swedish social services and how politicians on the political boards wish to make priorities and what these priorities involve. The use of regression analyses also reveals which circumstances are of importance for allocative precedence and the impact different distributive principles have. It is hard to detect clear-cut patterns of circumstances that guide the judgements in any one direction. The results show that political affiliation overall is not a determining factor for attitudes towards how priorities are made. Another result is a manifest area bias, suggesting that respondents tend to see to the interests of their own professional domain, a result most visible among the politicians involved with Care for the Elderly and Disabled (CED). Yet, with regard to allocative principles, political colour seems to matter. Conservative politicians, as expected, agree with the principles of economy and of capacity to benefit, while the socialist block, less expectedly, seems to embrace the principle of deservingness.

Adult child migration and elderly parental health in rural China

2016 ◽  
Vol 8 (4) ◽  
pp. 677-697 ◽  
Author(s):  
Fang Chang ◽  
Yaojiang Shi ◽  
Hongmei Yi ◽  
Natalie Johnson
Keyword(s):  
Adult Children ◽  
Positive Impact ◽  
Rural China ◽  
Adult Child ◽  
The Elderly ◽  
Content Type ◽  
Elderly Parents ◽  
Care For The Elderly ◽  
Child Migration ◽  
The Impact

Purpose The purpose of this paper is to evaluate the effect of adult children migration on the health status of elderly parents. Increased labor migration in developing countries that lack adequate social security systems and institutionalized care for the elderly is a phenomenon that is important to understand. When their adult children go away to work, it is not clear what effect there will be on “left-behind” elderly parents. Design/methodology/approach This study employs nearly nationally representative data from five provinces, 25 counties, 101 villages and 2,000 households, collected from two waves of data in 2007 and 2011. This sample comprises a subset of households which include both elderly individuals (above 60 years old) and their grown (working-aged) children in order to estimate the impact of adult child migration on the health of elderly parents in rural China. Findings This study finds that adult child migration has a significant positive impact on the health of elderly family members. Practical implications These findings are consistent with the explanation that migration raises family resources, which in turn may contribute to better health outcomes for elderly household members. Originality/value This is the first paper to attempt to identify the relationship between household migration and the health of elderly parents within the Chinese context.

Impact of the Physical Environment of Residential Health, Care, and Support Facilities (RHCSF) on Staff and Residents

2016 ◽  
Vol 48 (10) ◽  
pp. 1203-1241 ◽  
Author(s):  
Anjali Joseph ◽  
Young-Seon Choi ◽  
Xiaobo Quan
Keyword(s):  
Health Care ◽  
Physical Environment ◽  
The Elderly ◽  
Organizational Outcomes ◽  
Future Research ◽  
Care For The Elderly ◽  
Care And Support ◽  
Outdoor Environments ◽  
Centered Care ◽  
The Impact

The physical environment of residential health, care, and support facilities (RHCSF) is a critical component in providing supportive and resident-centered care for the elderly. Although past reviews of the literature have focused on specific settings for the elderly or specific residential populations of the elderly, a systematic literature review that covers the range of settings and populations has been lacking. This article provides an overview and synthesis of the most recent empirical evidence addressing the impact of the physical environment on residents and staff of RHCSFs. The review also identifies gaps where future research is needed. This review found 66 studies examining the relationship between the built environment and outcomes in three broad domains of resident quality of life, resident safety, and staff and organizational outcomes. The studies address a range of topics including the impact on elderly residents of the facility scale and size, outdoor environments, and environmental quality.

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