Medicare

The federal program that covers medical care for people age 65 or older, younger people with disabilities, and people with End-Stage Renal Disease. Medicare covers about 13% of the US population and makes up a fifth of national health expenditures.

Understanding Racial and Ethnic Disparities in Autism-Related Service Use Among Medicaid-Enrolled Children

Nov. 21, 2020

Lucy A. Bilaver, Sarah A. Sobotka, David S. Mandell

Abstract [from journal]

Racial and ethnic disparities in the use of nine common autism-related services among Medicaid-enrolled children with autism spectrum disorder (ASD) were examined, distinguishing between school and other community-based outpatient settings. Using 2012 Medicaid Analytic Extract data, we identified 117,848 continuously enrolled children with ASD. Several racial and ethnic disparities were found, varying by geography. Black, Asian, and Native American/Pacific Islanders received fewer outpatient services compared with white children, but

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Costs and Outcomes for Patients with Dementia in Medicare Advantage Plans

Nov. 12, 2020

How do patients with Alzheimer's disease and related dementias (ADRD) fare in capitated Medicare Advantage (MA) managed care plans, compared to their peers in traditional Medicare (TM)? This question is increasingly important, as nearly one-third of beneficiaries now choose MA, and the human and financial cost of living with ADRD is substantial.

Identifying Cohabiting Couples In Administrative Data: Evidence From Medicare Address Data

Nov. 12, 2020

Sasmira Matta, Joanne W. Hsu, Theodore J. Iwashyna, Micah Y. Baum, Kenneth M. Langa & Lauren Hersch Nicholas 

Abstract [from journal]

Objectives: Assess whether frequently‐used claims‐based end‐of‐life (EOL) measures are associated with higher ratings of care quality.

Design: Retrospective cohort study.

Setting/Pariticpants: Deceased fee‐for‐service Medicare beneficiaries with cancer who underwent chemotherapy during July 2016 to January 2017 and died within 12 

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Identifying Cohabiting Couples In Administrative Data: Evidence From Medicare Address Data

Nov. 12, 2020

Sasmira Matta, Joanne W. Hsu, Theodore J. Iwashyna, Micah Y. Baum, Kenneth M. Langa & Lauren Hersch Nicholas

Abstract [from journal]

Marital status is recognized as an important social determinant of health, income, and social support, but is rarely available in administrative data. We assessed the feasibility of using exact address data and zip code history to identify cohabiting couples using the 2018 Medicare Vital Status file and ZIP codes in the 2011–2014 Master Beneficiary Summary Files. Medicare beneficiaries meeting our algorithm displayed characteristics consistent with assortative mating and resembled known married couples in the Health and Retirement Study linked to Medicare...

CMS’ Inpatient Psychiatric Facility Quality Reporting Program

Nov. 9, 2020

Patients in inpatient psychiatric care are especially vulnerable to physical and psychological harm, but they have largely been excluded from efforts to monitor, understand, and improve quality of care. In 2012, the Centers for Medicare and Medicaid Services (CMS) implemented the Inpatient Psychiatric Facility Quality Reporting (IPFQR) Program to ease inpatient psychiatry into the norms and scrutiny that general hospital care has received for a long time.

Using Medicare Claims In Identifying Alzheimer's Disease And Related Dementias

Oct. 8, 2020

Siddharth JainPaul R. Rosenbaum, Joseph G. Reiter, Geoffrey Hoffman, Dylan S. Small, Jinkyung Ha, Alexander S. Hill, David A. Wolk, Timothy GaultonMark D. Neuman, Roderic G. Eckenhoff, Lee A....

Abstract [form journal]

Introduction: This study develops a measure of Alzheimer's disease and related dementias (ADRD) using Medicare claims.

Methods: Validation resembles the approach of the American Psychological Association, including (1) content validity, (2) construct validity, and (3) predictive validity.

Results: We found that four items-a Medicare claim recording ADRD 1 year ago, 2 years ago, 3 years ago, and a total stay of 6 months in a nursing home-exhibit a pattern of association

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Differences In Health Care Utilization, Process Of Diabetes Care, Care Satisfaction, And Health Status In Patients With Diabetes In Medicare Advantage Versus Traditional Medicare

Norma Coe, PhD
Sep. 10, 2020

Sungchul Park, Eric B. Larson, Paul Fishman, Lindsay White, Norma B. Coe

Abstract [from journal]

Objective: The objective of this study was to determine differences in health care utilization, process of diabetes care, care satisfaction, and health status for Medicare Advantage (MA) and traditional Medicare (TM) beneficiaries with and without diabetes.

Methods: Using the 2010-2016 Medicare Current Beneficiary Survey, we identified MA and TM beneficiaries with and without diabetes. To address the endogenous plan choice between MA and TM, we used an instrumental variable approach. Using

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Health Care Costs Of Alzheimer's And Related Dementias Within A Medicare Managed Care Provider

Norma Coe, PhD, PARC Co-Director
Sep. 1, 2020

Paul A. Fishman, Lindsay White, Bailey Ingraham, Sungchul Park, Eric B. Larson, Paul Crane, Norma B. Coe 

Abstract [from journal]

Background: Although one third of Medicare beneficiaries are enrolled in Medicare Advantage (MA) plans, there is limited information about the cost of treating Alzheimer disease and related dementias (ADRD) in these settings.

Objective: The objective of this study was to estimate direct health care costs attributable to ADRD among older adults within a large MA plan.

Research design: A retrospective cohort design was used to estimate direct total, outpatient, inpatient

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The Beneficial Effects Of Medicare Advantage Special Needs Plans For Patients With End-Stage Renal Disease

Amole Navathe19-head
Sep. 1, 2020

Brian W. Powers, Jiali Yan, Jingsan Zhu, Kristin A. Linn, Sachin H. Jain, Jennifer Kowalski, Amol S. Navathe

Abstract [from journal]

Patients with end-stage renal disease (ESRD) are a vulnerable population with high rates of morbidity, mortality, and acute care use. Medicare Advantage Special Needs Plans (SNPs) are an alternative financing and delivery model designed to improve care and reduce costs for patients with ESRD, but little is known about their impact. We used detailed clinical, demographic, and claims data to identify fee-for-service Medicare beneficiaries who switched to ESRD SNPs offered by a single health plan (SNP enrollees) and similar

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Association Of Medicare Advantage Penetration With Per Capita Spending, Emergency Department Visits, And Readmission Rates Among Fee-for-Service Medicare Beneficiaries With High Comorbidity Burden

Norma Coe, PhD
Aug. 26, 2020

Sungchul Park, Brent A. Langellier, Robert E. Burke, Jose F. Figueroa, Norma B. Coe

Abstract [from journal]

Rapid growth of Medicare Advantage (MA) plans has the potential to change clinical practice for both MA and fee-for-service (FFS) beneficiaries, particularly for high-need, high-cost beneficiaries with multiple chronic conditions or a costly single condition. We assessed whether MA growth from 2010 to 2017 spilled over to county-level per capita spending, emergency department visits, and readmission rates among FFS beneficiaries, and how much this varied by the comorbidity burden of the beneficiary. We also examined whether the

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