The projected growth, and widespread variation, in the cost of joint replacement surgeries prompted Medicare to introduce a bundled payment plan for these procedures. In a new JAMA Viewpoint, Said Ibrahim, a LDI Senior Fellow and Co-Director of the VA’s Center for Health Equity Research and Promotion, and co-authors Hyunjee Kim and K.
In Health Affairs, Jalpa Doshi and colleagues, including Pengxiang Lee, Andrea Troxel and Kevin Volpp, evaluate whether renewing all medications at the same time from the same pharmacy improves adherence to medication regimens. Synchronizing medication refills is an increasingly popular strategy, but there has been little research regarding its effectiveness. The authors looked at a pilot refill synchronization program implemented by Humana, a large national insurer, and analyzed patients’ adherence before and after participation in the program, compared to a control group. The...
How should social risk factors enter into Medicare’s value-based payments to hospitals? The answer goes beyond an arcane discussion of payment policy; it has a direct impact on hospital bottom lines and the quality of care provided to underserved communities. A new report from the National Academies of Sciences, Engineering, and Medicine—the third in a series of five—lays out criteria and methods to account for social risk factors in Medicare payment.
Impact of Medicare Advantage Prescription Drug Plan Star Ratings on Enrollment Before and After Implementation of Quality-Related Bonus Payments in 2012
In PLOS ONE, LDI Senior Fellows Pengxiang Li and Jalpa Doshi examine the impact of the Medicare Advantage Presciption Drug Plan star ratings before and after 2012, when they became tied to bonus payments. Does an increase in a plan’s star rating have a direct impact on concurrent year plan enrollment? What’s the indirect impact (via bonus payments) of star ratings on subsequent year plan enrollment?
Overbilling for physician services under Medicare Part B has long been a concern, as some estimates show that fraudulent “upcoding” or “overcharging” might have cost the program tens of billions of dollars per year. Existing methods to detect the prevalence and financial cost of overbilling have various limitations, so the authors developed a novel approach: create estimates of actual hours worked as implied by the medical service codes that providers submit to Medicare. In an NBER Working Paper, LDI Senior Fellow Hanming Fang and co-author Qing Gong examine whether this method can generate a quicker and more robust estimation of overbilling across medical specialties and geographic areas.
Some hospital leaders have complained that quality metrics like hospital readmissions unfairly penalize provider organizations for serving vulnerable, high-risk populations. Should Medicare readmission penalties be adjusted for patients’ socioeconomic risk factors?
High Cost Sharing and Specialty Drug Initiation Under Medicare Part D: A Case Study in Patients With Newly Diagnosed Chronic Myeloid Leukemia
Does high cost sharing in Medicare Part D drug plans affect whether and how quickly patients initiate a recommended and life-extending drug treatment? In American Journal of Managed Care, LDI Senior Fellows Jalpa Doshi, Pengxiang Li and colleagues assess whether Medicare patients newly diagnosed with chronic myeloid leukemia (CML) and subject to significant coinsurance, take longer to initiate tyrosine kinase inhibitors (TKI) treatment than low-income (subsidized) Medicare patients subject to a nominal copayment.
Biologic therapy adherence, discontinuation, switching, and restarting among patients with psoriasis in the US Medicare population
In the Journal of the American Academy of Dermatology, Jalpa Doshi and colleagues, including Penxiang Li and Preethi Rao, investigate real-world utilization patterns of biologic therapy in Medicare beneficiaries with psoriasis. Studies indicate low adherence to biologics among patients with psoriasis, yet little is known about the adherence level in the Medicare population. Using data from the Medicare Chronic Condition Data Warehouse Part A, B, and D files with 12-month follow-up after index prescription, Doshi and colleagues conducted a retrospective claims analysis on 2707...
Nurse staffing and the work environment linked to readmissions among older adults following elective total hip and knee replacement
In the International Journal for Quality in Health Care, Karen Lasater and Matthew McHugh examine the effect of nurse staffing and the work environment on 10- and 30-day unplanned readmissions for Medicare patients following elective total hip and knee replacement. The authors conducted a cross-sectional secondary data analysis using patient administrative data, nurse survey data, and hospital organizational data from acute care hospitals in California, Florida, New Jersey and Pennsylvania. Nurse survey responses were aggregated to construct hospital measures of nurse staffing and...
[cross-posted from the Health Cents blog on Philly.com]
Psoriasis in the US Medicare Population: Prevalence, Treatment, and Factors Associated with Biologic Use
In the Journal of Investigative Dermatology, Junko Takeshita and colleagues, including Preethi Rao and Jalpa Doshi, look at factors associated with the use of biologics and other treatments for psoriasis. They analyzed claims from a nationally representative sample of Medicare beneficiaries with Part D drug coverage. The researchers find that Medicare Part D beneficiaries without a low-income subsidy (LIS) had 70% lower odds of having received biologics than those with LIS. Similarly, the odds of having received biologics were 69% lower among black patients compared with white...