scholarly journals Could There Be a Role for Home Telemedicine in the U.S. Medicare Program?

10.5772/13535 ◽  
2011 ◽  
Author(s):  
Lorenzo Moreno ◽  
Arnold Chen ◽  
Rachel Shapiro ◽  
Stacy Dale
Keyword(s):  
Medicare Program ◽  
The U.S

scholarly journals 823. Characteristics, Comorbidities, and Medication Burden among People Living with HIV in the U.S. Medicare Program

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S504-S504
Author(s):  
Pengxiang Li ◽  
Vrushabh P Ladage ◽  
Jianbin Mao ◽  
Girish Prajapati ◽  
Dovie L Watson ◽  
...  
Keyword(s):  
Panel Member ◽  
Administrative Claims ◽  
People Living With Hiv ◽  
Medicare Beneficiaries ◽  
Research Support ◽  
Review Panel ◽  
Material Support ◽  
Medicare Program ◽  
Living With Hiv ◽  
The U.S

Abstract Background Among the 1.2 million people living with HIV (PLWH) in the U.S., many are covered by Medicare, a federally funded health insurance program for elderly (≥65 years) and disabled (< 65 years) individuals. Medicare has emerged as a major source of HIV care for PLWH. Given limited research in this population, a better understanding of patient characteristics, comorbidities, and comedication use among PLWH in the Medicare program is needed to help optimize clinical care. Methods A retrospective claims analysis of a national cross-sectional sample of fee-for-service (FFS) Medicare beneficiaries with continuous medical and prescription coverage in 2018 was conducted using 100% Medicare administrative claims. The PLWH group included individuals with ≥1 HIV diagnosis code in medical claims and ≥1 pharmacy claim for an anchor antiretroviral (ARV) drug (i.e., NNRTI, PI or InSTI) in 2018. The comparison group included a random sample of Medicare beneficiaries without HIV (PLWoH). Sociodemographic characteristics, comorbidities, and medication use were compared between PLWH and PLWoH. Results The study sample included 86,856 PLWH and 552,645 PLWoH. PLWH were more likely to be younger (mean age: 57.4 vs 71.1 years and < 65 years: 72% vs 18%), male (75% vs 42%), Black (42% vs 10%), eligible for Medicare due to disability (83% vs 27%) and receiving full low-income subsidies (77% vs 31%); all p< 0.001. Prevalence of >3 comorbidities was high in PLWH (70.2%) and only slightly lower than in PLWoH (71.7% p< 0.001). Prevalence of neuropsychiatric conditions, chronic kidney disease, liver disease, COPD, hepatitis B, and hepatitis C were higher in PLWH (Figure 1). The mean hierarchical condition categories risk score was higher in PLWH vs PLWoH (1.81 vs. 1.32; p< 0.001). On average, polypharmacy was higher among PLWH vs PLWoH (annual number of unique medications: 12.6 vs. 9.4 for all drugs and 10.3 vs. 9.4 for non-ARV drugs, both p< 0.001). Figure 1. Percentage of PLWH and PLWoH with multimorbidity and selected comorbid conditions. Abbreviations: COPD=chronic obstructive pulmonary disease; GI=gastrointestinal; PLWH=people living with HIV; PLWoH=people living without HIV All p-values <0.001 except GI Disorders (p=0.14). Conclusion In the Medicare FFS population, multimorbidity and polypharmacy were highly prevalent in PLWH despite their substantially younger age compared to PLWoH. Our findings highlight the need to consider comorbidities and comedications in HIV management including ARV regimens to minimize medication burden and drug interactions, which might improve clinical outcomes. Disclosures Pengxiang Li, PhD, Avalon Health Economics LLC (Consultant)COVIA Health Solutions (Consultant)Healthstatistics, LLC (Consultant) Jianbin Mao, PhD, Merck (Employee)Merck (Shareholder) Girish Prajapati, M.B.B.S., MPH , Merck & Co., Inc. (Employee, Shareholder) Robert Gross, MD, MSCE, Pfizer (Other Financial or Material Support, Serve on DSMB for drug unrelated to HIV) Jalpa A. Doshi, PhD, Acadia (Consultant, Advisor or Review Panel member)Allergan (Advisor or Review Panel member)Biogen (Grant/Research Support)Boehringer Ingelheim (Other Financial or Material Support, Scientific lecture)Catabasis (Consultant)Humana (Grant/Research Support)Janssen, Inc. (Consultant, Grant/Research Support)MeiraGTX (Consultant)Merck (Grant/Research Support, Advisor or Review Panel member)Novartis (Grant/Research Support)Otsuka (Advisor or Review Panel member)Regeneron (Grant/Research Support)SAGE Therapeutics (Consultant)Sanofi (Grant/Research Support)Shire (Advisor or Review Panel member)The Medicines Company (Advisor or Review Panel member)

scholarly journals PHP35 TELEMEDICINE IN THE U.S. MEDICARE PROGRAM: 2007 REIMBURSEMENT IMPLICATIONS

2006 ◽  
Vol 9 (6) ◽  
pp. A218
Author(s):  
CA Pierce ◽  
JJ Baker ◽  
C McClard
Keyword(s):  
Medicare Program ◽  
The U.S

scholarly journals The Effects of Medicare on Health Care Utilization and Outcomes

2002 ◽  
Vol 5 (1) ◽  
Author(s):  
Frank R. Lichtenberg
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Death Rate ◽  
Morbidity And Mortality ◽  
Fiscal Year ◽  
Care Utilization ◽  
Hospital Services ◽  
Physician Visits ◽  
Medicare Program ◽  
The U.S

Medicare, which provides health insurance to Americans over the age of 65 and to Americans living with disabilities, is one of the government’s largest social programs. It accounts for 12 percent of federal on- and off-budget outlays, and in fiscal year 1999,$212 billion in Medicare benefits were paid. The largest shares of spending are for inpatient hospital services (48 percent) and physician services (27 percent). In thirty years, the number of Americans covered by Medicare will nearly double to 77 million, or 22 percent of the U.S. population.Perhaps the most important question we can ask about the Medicare program is, What impact does it have on the health of the U.S. population? One feature of the Medicare program can be exploited to shed light on its impacts: its age specificity. Most people become eligible for Medicare suddenly, the day they turn 65. Consequently, the age profiles of health services utilization and health outcomes (morbidity and mortality) can provide revealing evidence about Medicare’s impacts.My objective is to obtain precise estimates of medical utilization and outcomes, by single year of age, for ages close to age 65. The most precise estimates can be obtained by using information obtained from medical providers (hospitals and doctors) pooled over several years.Utilization of ambulatory care and, to a much smaller extent, inpatient care increases suddenly and significantly at age 65, presumably due to Medicare eligibility. The evidence points to a structural change in the frequency of physician visits precisely at age 65. Attainment of age 65 marks not only an upward shift but also the beginning of a rapid upward trend (up until age 75) of about 2.8 percent per year in annual visits per capita. The number of physician visits in which at least one drug is prescribed also jumps up at age 65. Reaching age 65 has a strong positive impact on the consumption of hospital services, but most of this impact appears to be the result of postponement of hospitalization in the prior two years.We also examine whether this increase in utilization leads to an improvement in outcomes--a reduction in morbidity and mortality--relative to what one would expect given the trends in outcomes prior to age 65. The estimates are consistent with the hypothesis that the Medicare-induced increase in health care utilization leads to a reduction in days spent in bed of about 13 percent and to slower growth in the probability of death after age 65. Physician visits are estimated to have a negative effect on the male death rate, conditional on age and the death rate in the previous year. The short-run elasticity of the death rate with respect to the number of physician visits is -.095, and the long-run elasticity is -.497: a permanent or sustained 10 percent increase in the number of visits ultimately leads to a 5 percent reduction in the death rate.Data on age-specific death probabilities every 10 years since 1900, i.e., before as well as after Medicare was enacted, provide an alternative way to test for the effect of Medicare on longevity. They also provide strong support for the hypothesis that Medicare increased the survival rate of the elderly by about 13 percent.

Historical Introduction

1977 ◽  
Vol 35 ◽  
pp. 2-5
Author(s):  
R. D. Heidenreich
Keyword(s):  
Electron Emission ◽  
Secondary Electron ◽  
Secondary Electron Emission ◽  
50Th Anniversary ◽  
Secondary Emission ◽  
Wave Nature ◽  
Nobel Prize In Physics ◽  
Primary Electrons ◽  
The U.S ◽  
Mutual Agreement

This program has been organized by the EMSA to commensurate the 50th anniversary of the experimental verification of the wave nature of the electron. Davisson and Germer in the U.S. and Thomson and Reid in Britian accomplished this at about the same time. Their findings were published in Nature in 1927 by mutual agreement since their independent efforts had led to the same conclusion at about the same time. In 1937 Davisson and Thomson shared the Nobel Prize in physics for demonstrating the wave nature of the electron deduced in 1924 by Louis de Broglie.The Davisson experiments (1921-1927) were concerned with the angular distribution of secondary electron emission from nickel surfaces produced by 150 volt primary electrons. The motivation was the effect of secondary emission on the characteristics of vacuum tubes but significant deviations from the results expected for a corpuscular electron led to a diffraction interpretation suggested by Elasser in 1925.

Variations in Surface Textures of Quartz Sand using Electron Microscopy

1970 ◽  
Vol 28 ◽  
pp. 494-495
Author(s):  
Eugene J. Amaral
Keyword(s):  
Electron Microscopy ◽  
Glass Industry ◽  
Glass Slide ◽  
Distilled Water ◽  
Early Paleozoic ◽  
Secondary Effects ◽  
Surface Textures ◽  
High Silica ◽  
Sand Deposit ◽  
The U.S

Examination of sand grain surfaces from early Paleozoic sandstones by electron microscopy reveals a variety of secondary effects caused by rock-forming processes after final deposition of the sand. Detailed studies were conducted on both coarse (≥0.71mm) and fine (=0.25mm) fractions of St. Peter Sandstone, a widespread sand deposit underlying much of the U.S. Central Interior and used in the glass industry because of its remarkably high silica purity.The very friable sandstone was disaggregated and sieved to obtain the two size fractions, and then cleaned by boiling in HCl to remove any iron impurities and rinsed in distilled water. The sand grains were then partially embedded by sprinkling them onto a glass slide coated with a thin tacky layer of latex. Direct platinum shadowed carbon replicas were made of the exposed sand grain surfaces, and were separated by dissolution of the silica in HF acid.

The Effects of Estradiol on Chronically Damaged Human Fallopian Tubes: A SEM Study

1985 ◽  
Vol 43 ◽  
pp. 648-649
Author(s):  
A. Toledo ◽  
G. Stoelk ◽  
M. Yussman ◽  
R.P. Apkarian
Keyword(s):  
Menstrual Cycle ◽  
Epithelial Cell ◽  
Secretory Cell ◽  
Estrogen Therapy ◽  
Fallopian Tubes ◽  
Cell Surfaces ◽  
Proliferative Phase ◽  
Cyclic Patterns ◽  
Sem Study ◽  
The U.S

Today it is estimated that one of every three women in the U.S. will have problems achieving pregnancy. 20-30% of these women will have some form of oviductal problems as the etiology of their infertility. Chronically damaged oviducts present problems with loss of both ciliary and microvillar epithelial cell surfaces. Estradiol is known to influence cyclic patterns in secretory cell microvilli and tubal ciliogenesis, The purpose of this study was to assess whether estrogen therapy could stimulate ciliogenesis in chronically damaged human fallopian tubes.Tissues from large hydrosalpinges were obtained from six women undergoing tuboplastic repair while in the early proliferative phase of fheir menstrual cycle. In each case the damaged tissue was rinsed in heparinized Ringers-lactate and quartered.

Antitrust: U.S. Supreme Court Affirms FTC Jurisdiction but Vacates Scope of Analysis on CDA Policy

1999 ◽  
Vol 27 (2) ◽  
pp. 197-198
Author(s):  
Joseph R. Zakhary
Keyword(s):  
Public Relations ◽  
Supreme Court ◽  
Federal Trade Commission ◽  
Ninth Circuit ◽  
Court Of Appeals ◽  
For Profit ◽  
Rule Of Reason ◽  
Antitrust Analysis ◽  
Business Financing ◽  
The U.S

In California Dental Association v. FTC, 119 S. Ct. 1604 (1999), the U.S. Supreme Court reviewed a decision by the U.S. Court of Appeals for the Ninth Circuit that a nonprofit affiliation of dentists violated section 5 of the Federal Trade Commission Act (FTCA), 15 U.S.C.A. § 45 (1998), which prohibits unfair competition. The Court examined two issues: (1) the Federal Trade Commission's (FTC) jurisdiction over the California Dental Association (CDA); and (2) the proper scope of antitrust analysis. The Court unanimously held that CDA was subject to FTC's jurisdiction, but split 5-4 in its finding that the district court's use of abbreviated rule-of-reason analysis was inappropriate.CDA is a voluntary, nonprofit association of local dental societies. It boasts approximately 19,000 members, who constitute roughly threequarters of the dentists practicing in California. Although a nonprofit, CDA includes for-profit subsidiaries that financially benefit CDA members. CDA gives its members access to insurance and business financing, and lobbies and litigates on their behalf. Members also benefit from CDA marketing and public relations campaigns.

Life Beyond 1MeV

1980 ◽  
Vol 38 ◽  
pp. 30-33
Author(s):  
K.H. Westmacott
Keyword(s):  
Electron Microscopy ◽  
Past Experience ◽  
The Other ◽  
Good Case ◽  
Other Hand ◽  
The U.S

Life beyond 1MeV – like life after 40 – is not too different unless one takes advantage of past experience and is receptive to new opportunities. At first glance, the returns on performing electron microscopy at voltages greater than 1MeV diminish rather rapidly as the curves which describe the well-known advantages of HVEM often tend towards saturation. However, in a country with a significant HVEM capability, a good case can be made for investing in instruments with a range of maximum accelerating voltages. In this regard, the 1.5MeV KRATOS HVEM being installed in Berkeley will complement the other 650KeV, 1MeV, and 1.2MeV instruments currently operating in the U.S. One other consideration suggests that 1.5MeV is an optimum voltage machine – Its additional advantages may be purchased for not much more than a 1MeV instrument. On the other hand, the 3MeV HVEM's which seem to be operated at 2MeV maximum, are much more expensive.

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