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.

Overlap between Medicare's Voluntary Bundled Payment and Accountable Care Organization Programs

Aug. 21, 2019

Amol S. Navathe, Claire Dinh, Sarah E. Dykstra, Rachel M. Werner, Joshua M. Liao

Abstract [from journal]

Accountable care organizations (ACOs) and bundled payments represent prominent value-based payment models, but the magnitude of overlap between the two models has not yet been described. Using Medicare data, we defined overlap based on attribution to Medicare Shared Savings Program (MSSP) ACOs and hospitalization for Bundled Payments for Care Improvement (BPCI) episodes at BPCI participant hospitals. Between 2013 and 2016, overlap as a share of ACO patients increased from 2.7% to 10% across BPCI episodes, while overlap as a share of all bundled

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Characteristics of Physicians Participating in Medicare's Oncology Care Model Bundled Payment Program

Aug. 8, 2019

Ravi B. Parikh, Justin E. Bekelman, Qian Huang, Joseph R. Martinez, Ezekiel J. Emanuel, Amol S. Navathe

Abstract [from journal]

Purpose: The Oncology Care Model (OCM) is Medicare's first bundled payment program for patients with cancer. We examined baseline characteristics of OCM physician participants and markets with high OCM physician participation to inform generalizability and complement the ongoing practice-level evaluation of the OCM.

Methods: In this cross-sectional study, we identified characteristics of US medical oncologists practicing in 2016, using a national telephone-verified physician database. We linked these data with

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Cost of Dementia in Medicare Managed Care: a Systematic Literature Review

Aug. 1, 2019

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

Abstract [from journal]

Objectives: We conducted a systematic review of studies reporting the direct healthcare costs of treating older adults with diagnosed Alzheimer disease and related dementias (ADRD) within private Medicare managed care plans.

Study Design: A systematic review of all studies published in English reporting original empirical analyses of direct costs for older adults with ADRD in Medicare managed care.

Methods: All papers indexed in PubMed or Web of Science reporting ADRD costs within

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Meeting the Oral Health Needs of an Aging Population

May. 7, 2019

An important, yet often overlooked aspect of comprehensive health care for a “graying” U.S. population is dental health. In a new commentary, Tim Wang, Mark Wolff, and Neeraj Panchal bring attention to the oral health needs of a growing geriatric population in the U.S., and suggest practical ways to prepare providers to meet the challenge of treating this unique group.

Five-Year Cost of Dementia: Medicare

Research Brief
Apr. 29, 2019

[dropcap]A[/dropcap]bout 5.5 million older adults are living with dementia, a chronic, progressive disease characterized by severe cognitive decline. This number will likely grow significantly as the U.S. population ages, which has cost implications for the Medicare program. A full accounting of these additional expenses will help policymakers plan for them in their Medicare budgets. In this study, Norma Coe and colleagues examined survival and Medicare expenditures in older adults with and without dementia to estimate dementia’s incremental costs to Medicare in the five years after diagnosis.

Medicaid and Nursing Home Choice: Why Do Duals End Up in Low-Quality Facilities?

Apr. 17, 2019

Hari Sharma, Marcelo Coca Perraillon, Rachel M. Werner, David C. Grabowski, R. Tamara Konetzka

ABSTRACT [FROM JOURNAL]

We provide empirical evidence on the relative importance of specific observable factors that can explain why individuals enrolled in both Medicare and Medicaid (duals) are concentrated in lower quality nursing homes, relative to those not on Medicaid. Descriptive results show that duals are 9.7 percentage points more likely than nonduals to be admitted to a low-quality (1-2 stars) nursing home. Using the Blinder–Oaxaca decomposition approach in a multivariate framework, we find that 35.4% of the difference in admission to low-quality nursing homes can be...

Tracking a Trend: Nursing Home Specialists

Apr. 12, 2019

The world of health care is divided into many areas of specialization. At one point or another, we may have seen a podiatrist for a foot problem or a dermatologist for skin issues. Not all of us realize that – in addition to specializing in, say, the lungs – clinicians can devote their practice to providing general care to patients in a specific setting. For example, some physicians, called ‘hospitalists,’ see all or most of their patients in a hospital environment.

Assessing First Visits By Physicians To Medicare Patients Discharged To Skilled Nursing Facilities

Research Brief
Kira Rysinka, MD
Apr. 1, 2019

In this study of postacute care, more than 10% of Medicare skilled nursing facility (SNF) stays included no visit from
a physician or advanced practitioner. Of stays with visits, about half of initial assessments occurred within a day of
admission, and nearly 80% occurred within four days. Patients who did not receive a visit from a physician or advanced
practitioner were nearly twice as likely to be readmitted to a hospital (28%) or to die (14%) within 30 days of SNF
admission than patients who had an initial visit.

Patient Outcomes After Hospital Discharge to Home with Home Health Care vs to a Skilled Nursing Facility

Research Brief
Mar. 11, 2019

In this study of more than 17 million Medicare hospitalizations between 2010 and 2016, patients discharged to home
health care had a 5.6 percent higher 30-day readmission rate than similar patients discharged to a skilled nursing facility
(SNF). There was no difference in mortality or functional outcomes between the two groups, but home health care was
associated with an average savings of $4,514 in total Medicare payments in the 60 days after the first hospital admission.

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