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Medical Care ◽  
2022 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
William B. Weeks ◽  
Stacey Y. Cao ◽  
Jeremy Smith ◽  
Huabo Wang ◽  
James N. Weinstein

2022 ◽  
Vol 28 (1) ◽  
pp. 39-47
Author(s):  
Jeromie Ballreich ◽  
Ijeamaka Ezebilo ◽  
Banda Abdallah Khalifa ◽  
Joshua Choe ◽  
Gerard Anderson

Author(s):  
Francine Grodstein ◽  
Chiang-Hua Chang ◽  
Ana W Capuano ◽  
Melinda C Power ◽  
David X Marquez ◽  
...  

Abstract BACKGROUND Medicare fee-for-service (FFS) claims data are increasingly leveraged for dementia research. Few studies address the validity of recent claims data to identify dementia, or carefully evaluate characteristics of those assigned the wrong diagnosis in claims. METHODS We used claims data from 2014-2018, linked to participants administered rigorous, annual dementia evaluations in five cohorts at the Rush Alzheimer’s Disease Center. We compared prevalent dementia diagnosed through the 2016 cohort evaluation versus claims identification of dementia, applying the Bynum-standard algorithm. RESULTS Of 1,054 participants with Medicare Parts A and B FFS in a 3-year window surrounding their 2016 index date, 136 had prevalent dementia diagnosed during cohort evaluations; the claims algorithm yielded 217. Sensitivity of claims diagnosis was 79%, specificity 88%, positive predictive value 50%, negative predictive value 97%, and overall accuracy 87%. White participants were disproportionately represented among detected dementia cases (true-positive) versus cases missed (false-negative) by claims (90% versus 75%, respectively, p=0.04). Dementia appeared more severe in detected than missed cases in claims (mean MMSE=15.4 versus 22.0, respectively, p<0.001; 28% with no limitations in activities of daily living versus 45%, p=0.046). By contrast, those with “over-diagnosis” of dementia in claims (false-positive) had several worse health indicators than true negatives (eg, self-reported memory concerns=51% versus 29%, respectively, p<0.001; mild cognitive impairment in cohort evaluation=72% versus 44%, p<0.001; mean comorbidities=7 versus 4, p<0.001). CONCLUSIONS Recent Medicare claims perform reasonably well in identifying dementia; however, there are consistent differences in cases of dementia identified through claims than in rigorous cohort evaluations.


Author(s):  
Kael Wherry ◽  
Cyrus Zhu ◽  
Robert A Vigersky

Abstract Context Health inequity is often associated with race-ethnicity. Objective To determine the prevalence of insulin pump therapy and continuous glucose monitoring (CGM) among Medicare beneficiaries with Type 1 diabetes (T1D) by race-ethnicity, and to compare diabetes-related technology users to non-users. Design The prevalence of technology use (pump, CGM) was determined by race-ethnicity for enrollees in coverage years (CY) 2017-2019 in the Medicare fee-for-service database. Using CY2019 data, technology users were compared to non-users by race-ethnicity, sex, average age, Medicare eligibility criteria, and visit to an endocrinologist. Setting Community Patients or Other Participants Beneficiaries with T1D and at least one inpatient or two outpatient claims in a CY Intervention(s) Pump or CGM therapy, visit to an endocrinologist Main Outcome Measure(s) Diabetes-related technology use by race-ethnicity groups Results Between 2017 and 2019 CGM and insulin pump use increased among all groups. Prevalence of insulin pump use was <5% for Black and Other beneficiaries yet increased from 14% to 18% among White beneficiaries. In CY2019 57% of White patients used a pump compared to 33.1% of Black and 30.3% of Other patients (P<0.001). Black patients were more likely than White patients to be eligible due to disability/end-stage renal disease or to be Medicare/Medicaid eligible (both P<0.001), whether using technology or not. Significant race-ethnicity differences (P<0.001) existed between technology users and non-users for all evaluated factors except visiting an endocrinologist. Conclusions Significant race-ethnicity associated differences existed in T1D management. The gap in diabetic technology adoption between Black and White beneficiaries grew between 2017 and 2019.


Author(s):  
Yiting Wang ◽  
Wenhui Hou ◽  
Xiaokang Wang ◽  
Hongyu Zhang ◽  
Jianqiang Wang

It is a consensus that Fee-for-Service (FFS) is a traditional medical insurance payment scheme with significant disadvantages, namely the waste of health care resources. However, the majority of the prior works that draw such conclusions from the perspective of social welfare while analyzing the impacts of FFS on operation outcomes of hospitals still lack attention from the existing literature, considering the fact that the majority of public hospitals are self-founding. Under this motivation, we collected operation data of 301 public hospitals with different grades (grade II and III) in central China. Here, we present a novel statistical evaluation framework on the impact of FFS on hospital operation outcomes from four dimensions (financial income, efficiency, medical service capacity, and sustainability) using fixed-effects multivariate regression. With verification by the robustness test, our results indicate that: (i) The classification of the hospital (COH) significantly affected the impacts of FFS on hospitals’ operations. (ii) For grade III hospitals, FFS leads to higher financial income, medical service capacity (MSC) and longer length-of-stay (LOS). (iii) However, as for grade II hospitals, hospitals with FFS adoptions achieve lower financial income, lower MSC and shorter LOS, which violates the common sense from previous works. (iv) FFS has a significant negative impact on public hospital’s sustainable development; however, there is lack of evidence showing that sustainability would be affected by the interaction effects between FFS and COH. We believe these new findings from the perspective of hospital operation provide insights and could serve as a reference for the healthcare payment hierarchical reform by COH in low and middle-income countries (LMICs), which are going through the primary stage of the healthcare reform.


2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 165-166
Author(s):  
Megan Mullins ◽  
Jasdeep Kler ◽  
Marissa Eastman ◽  
Mohammed Kabeto ◽  
Lauren Wallner ◽  
...  

Abstract Exploring the relationship between cognition and cancer is increasingly important as the number of older adults in the US grows. The Health and Retirement Study (HRS) has longitudinal data on cognitive status and self-reported cancer diagnoses, but these self-reports have not been validated. Using HRS linked to Medicare Fee for Service (FFS) claims (1998-2016), we evaluated the validity of self-reported cancer diagnoses (excluding non-melanoma skin) against Medicare claims by respondent cognitive status. We included 8,280 Medicare-eligible HRS participants aged ≥67 with at least 90% FFS coverage. Cognitive status was ascertained from the HRS interview following the date of cancer diagnosis (or reference claim date) using the Langa-Weir method and was classified as normal, cognitive impairment no dementia (CIND), or dementia. We calculated the sensitivity, specificity, and Cohen's kappa for first incident malignant cancer diagnosis by cognitive status group. The majority (76.4%) of participants scored as cognitively normal, 9.6% had CIND, 14.0% had dementia and, overall, 1,478 had an incident cancer diagnosis. Among participants with normal cognition, sensitivity of self-reported cancer diagnosis was 70.2% and specificity was 99.8% (kappa=0.79). Among participants with CIND, sensitivity was 56.7% and specificity was 99.8% (kappa=0.66). Among participants with dementia, sensitivity was 53.0% and specificity was 99.6% (kappa=0.64). Results indicate poor validity of self-reported cancer diagnoses for older adults with CIND or dementia. These findings suggest researchers interested in cancer and cognition should use the HRS-Medicare linkage to ascertain cancer diagnosis from claims, and they highlight the importance of cognitive status in research among older adults.


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