Medicare SNF Payment Policy: What a Difference a Day Makes
It is hardly surprising that there’s a spike in the number of Medicare patients discharged from postacute care in a skilled nursing facility (SNF) the day before their copayment jumps from $0 to more than $150. However, the question remains whether this payment policy – which completely covers the first 20 days of a SNF stay – affects patient outcomes in any way.
Sepsis Survivors Transitioned to Home Health Care: Characteristics and Early Readmission Risk Factors
Kathryn Bowles,Christopher Murtaugh, Lizeyka Jordan, Yolanda Barrón, Mark Mikkelsen, Christina Whitehouse, Jo-Ana D.Chase, Miriam Ryvicker, Penny Hollander Feldman
Abstract [from journal]
Objective: To profile the characteristics of growing numbers of sepsis survivors receiving home healthcare (HHC) by type of sepsis before, during, and after a sepsis hospitalization and identify characteristics significantly associated with 7-day readmission.
Design: Cross-sectional descriptive study. Data sources included the Outcome and Assessment Information Set (OASIS) and Medicare administrative and claims data.
...
Could a Public Health Insurance Option Lead to More Competitive Markets?
Calls for the establishment of a “public option,” which emerged during the debate on the Affordable Care Act, have reemerged in this election season. Some proposals base the public option on Medicare, while others on Medicaid. In this article, Wharton professor and LDI Senior Fellow Mark Pauly discusses the likely effects of a public option on private markets, using experience in Medicare Advantage as a guide. Will the public option become the preferred one, sweeping away the private market? Or can the public and private options peacefully coexist?
Association Between HIV Infection and Outcomes of Care Among Medicare Enrollees with Breast Cancer
Sumedha Chhatre, Marilyn Schapira, David S. Metzger, Ravishankar Jayadevappa
Abstract [from journal]
Background: To assess the interaction of breast cancer, HIV infection, Medicare disability status, cancer stage and its implications for outcomes, after accounting for competing risks among female, fee-for-service Medicare enrollees.
Methods: We used data from Surveillance, Epidemiology and End Results (SEER) -Medicare (2000-2013). From primary female breast cancer cases diagnosed between 2001 and 2011, we identified those with HIV infection. We used Generalized Linear Model for phase-specific incremental cost
...Your Health Insurance is Making You Ignore Your Doctor
[cross posted from the Health Cents blog on philly.com]
Disease-Specific Plan Switching Between Traditional Medicare and Medicare Advantage
Sungchul Park, Paul Fishman, Lindsay White, Eric B Larson, Norma B Coe
Abstract [from journal]
Introduction: Previous research has reported switching from traditional Medicare (TM) to Medicare Advantage (MA) plans increased from 2006 to 2011 at the aggregate level, and switching from MA plans to TM also increased. However, little is known about switching behavior among individuals with specific chronic diseases.
Objective: To examine disease-specific switching patterns between TM and MA to understand the impact on MA
Critics Say ‘Junk Plans’ Are Being Pushed on ACA Exchanges
Physician Consolidation and the Spread of Accountable Care Organizations
Accountable Care Organizations (ACOs) are groups of physicians and hospitals that jointly contract to care for a patient population. ACO contracts incentivize coordination of care across providers. This can lead to greater consolidation of physician practices, which can in turn generate higher costs and lower quality. Given this, the study asks, as ACOs enter health care markets, do physician practices grow larger?
Medicare for All Could Bring Higher Wages, But Not for Everyone
[cross posted from the Health Cents blog on philly.com]
New "Tradeoffs" Podcast Show Launches
Social and Health-Related Factors Associated with Enrollment in Medicare Advantage Plans in Older Adults
Amit Kumar, Maricruz Rivera‐Hernandez, Amol M. Karmarkar, Lin‐Na Chou, Yong‐Fang Kuo, Julie A. Baldwin, Orestis A. Panagiotou, Robert E. Burke, Kenneth J. Ottenbacher
Abstract [from journal]
Objectives: We assessed the characteristics of older Mexican American enrollees in traditional fee-for-service (FFS) and Medicare Advantage (MA) plans and the factors associated with disenrollment from FFS and enrollment in MA plans.
Design: Longitudinal study linked with Medicare claims data.
Setting: The Hispanic Established Populations for the Epidemiologic Study of the Elderly.
Participants: Community-dwelling Mexican American older adults (N = 1455).
...Article by Hoffman Details the Failures of Market-Based Health Care Policies
[cross-posted with the University of Pennsylvania Law School]
Association of Bundled Payments for Joint Replacement Surgery and Patient Outcomes With Simultaneous Hospital Participation in Accountable Care Organizations
Joshua M. Liao, Ezekiel J. Emanuel, Atheendar S. Venkataramani, Qian Huang, Claire T. Dinh, Eric Z. Shan, Erkuan Wang, Jingsan Zhu, Deborah S. Cousins, Amol S. Navathe
Abstract [from journal]
Importance: An increasing number of hospitals have participated in Medicare’s bundled payment and accountable care organization (ACO) programs. Although participation in bundled payments has been associated with savings for lower-extremity joint replacement (LEJR) surgery, simultaneous participation in ACOs may be associated with different outcomes given the prevalence of LEJR among patients receiving care at ACO participant organizations and potential overlap in care redesign strategies adopted under the 2 payment models.
...Health Care Safety-Net Programs After The Affordable Care Act
Prior to the Affordable Care Act (ACA), health care safety-net programs were the primary source of care for over 44 million uninsured people. While the ACA cut the number of uninsured substantially, about 30 million people remain uninsured, and many millions more are vulnerable to out-of-pocket costs beyond their resources. The need for the safety net remains, even as the distribution and types of need have shifted. This brief reviews the effects of the ACA on the funding and operation of safety-net institutions. It highlights the challenges and opportunities that health care reform presents to safety-net programs, and how they have adapted and evolved to continue to serve our most vulnerable residents.
Health Care Safety-Net Programs Continue to Serve Most Vulnerable
[cross-posted from the United States of Care blog]