Medicare Costs by Disability and Community-Dwelling Status

Understanding population-level Medicare expenditure patterns for older adults with functional disability is critical to focus supports to reduce costly and potentially burdensome health care use. We used the National Health and Aging Trends Study (NHATS) to assess quarterly Medicare expenditures over the 12 months following NHATS interview. We examine Medicare expenditure patterns for older adults in nursing homes (N=386), in the community and without disability (N=20,103), with disability and dementia (N=2,008), and with disability but not dementia (N=2,945). One-year mortality ranged from 2.0% for those without disability in the community to 25.9% for those residing in nursing homes. Among those surviving 1 year, Medicare expenditures the first quarter after NHATS survey ranged from $1,794 (95% CI $1,690-$1,898) for those with no disability to $5,177 (95% CI $4,535-$5,818) for those with disability and dementia. We assess trends over the following two years, and find that trajectories vary by clinical grouping.

A Time Series Analysis of Trends in Medicare Utilization and Reimbursement for Cancer Immunotherapy Drugs: 2012-2017

The adoption of immunotherapy has dramatically transformed the landscape of oncology, and improved the prognosis of patients diagnosed with metastatic malignancies. Fee-for-service (FFS) Medicare is the largest payer in the U.S, and pays for physician-administered oncolytics through its medical Part B benefit. However, to the best of our knowledge, trends in Medicare utilization and expenditures for cancer immunotherapy have yet to be described. The aim of this study was to describe trends in Medicare immunotherapy reimbursement. We utilized the public Drugs@FDA database to identify all immunotherapy drugs that were approved by the FDA for solid and hematological cancers in adults as of December 31, 2017. The Medicare Physician Supplier and Other Provider Public Use File (POSPUF) provides reimbursement and utilization data on all services and procedures provided to Medicare fee-for-service beneficiaries. Using the Medicare POSPUF, we aggregated the volume of services, average Medicare reimbursement, and the number of distinct patients receiving each immunotherapy drug from January 2012 to December 2017. The number of Medicare reimbursed cancer immunotherapy drugs increased from 3 in 2012 to 12 in 2017. Over this time period, the number of patients receiving immunotherapy administrations increased 88% from 59,506 to 111,577. Similarly, the number of drug administrations increased by 2,412% from 2,338,691 to 58,752,804. From 2012 to 2017, total Medicare expenditure on cancer immunotherapy drugs increased 154% from $771,434,031 to $1,962,279,164. Medicare expenditure on cancer immunotherapy drugs accounted for 26% of the increase in total Medicare Part B drug expenditures over this time period.