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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 576 Research Studies DisplayedSimpson RL, Lee JA, Li Y
Medicare meets the cloud: the development of a secure platform for the storage and analysis of claims data.
This case report outlines the development and implementation of Amazon Web Services (AWS) at Emory University to securely store and analyze research data from the Centers for Medicare and Medicaid Services (CMS). Several interdisciplinary teams collaborated and ensured compliance with CMS policy. Results showed successful transition to a cloud-based environment with enhanced security measures and regular review processes. User training addressed cloud computing challenges. Lessons learned from challenges benefited CMS and interdisciplinary teams university-wide.
AHRQ-funded; HS026232.
Citation: Simpson RL, Lee JA, Li Y .
Medicare meets the cloud: the development of a secure platform for the storage and analysis of claims data.
JAMIA Open 2024 Apr; 7(1):ooae007. doi: 10.1093/jamiaopen/ooae007.
Keywords: Medicare, Health Information Technology (HIT)
Anderson KE, Wu RJ, Darden M
Medicare Advantage is associated with lower utilization of total joint arthroplasty.
To discover whether Medicare Advantage enrollees have a lower utilization of elective surgical procedures such as inpatient hip and knee total joint arthroplasty (TJA), which have usually been covered by traditional Medicare without restrictions, researchers conducted a cross-sectional study comparing traditional Medicare claims and Medicare Advantage encounter records for enrollees aged 65-85. Their results showed a lower incidence of TJA in Medicare Advantage enrollees. The interval from initial diagnosis to contact with an orthopedic surgeon and to the surgical procedure were shorter among traditional enrollees.
AHRQ-funded; HS000029.
Citation: Anderson KE, Wu RJ, Darden M .
Medicare Advantage is associated with lower utilization of total joint arthroplasty.
J Bone Joint Surg Am 2024 Feb 7; 106(3):198-205. doi: 10.2106/jbjs.23.00507..
Keywords: Medicare, Orthopedics, Surgery
Post B, Hollenbeck BK, Norton EC
Hospital-physician integration and clinical volume in traditional Medicare.
The purpose of this study was to test the effect of hospital-physician integration on primary care physicians' (PCP) clinical volume in traditional Medicare. The researchers identified 70,000 PCPs, some of whom remained non-integrated and some who became hospital-integrated during this study period. An event study design was utilized to identify the effect of integration on key measures of physicians' clinical volume, including the number of claims, work-relative value units (RVUs), professional revenue generated, number of patients treated, and facility fee revenue generated. The study found that per-physician clinical volume declined by statistically and economically significant margins. Relative to the comparison group who remained non-integrated, work RVUs fell by 7%; the number of patients treated fell by 4%; and claims volume among PCPs who became hospital-integrated fell by over 15%.
AHRQ-funded; HS027044; HS025707.
Citation: Post B, Hollenbeck BK, Norton EC .
Hospital-physician integration and clinical volume in traditional Medicare.
Health Serv Res 2024 Feb; 59(1):e14172. doi: 10.1111/1475-6773.14172..
Keywords: Medicare, Primary Care, Healthcare Delivery, Provider: Physician
Hoffman GJ, Alexander Nb, Ha J
Medicare's hospital readmission reduction program reduced fall-related health care use: an unexpected benefit?
This study’s objective was to assess whether the Medicare Hospital Readmissions Reduction Program (HRRP) was associated with a reduction in severe fall-related injuries (FRIs). The authors looked at secondary data from Medicare to assess changes in 30- and 90-day FRI readmissions before and after HRRP's announcement (April 2010) and implementation (October 2012) for conditions targeted by the HRRP (acute myocardial infarction [AMI], congestive heart failure [CHF], and pneumonia) versus "non-targeted" (gastrointestinal) conditions. They tested for modification by hospitals with "high-risk" before HRRP and accounted for potential upcoding. They also explored changes in 30-day FRI readmissions involving emergency department (ED) or outpatient care, care processes (length of stay, discharge destination, and primary care visit), and patient selection (age and comorbidities). They identified 1.5 million (522,596 pre-HRRP, 514,844 announcement, and 474,029 implementation period) index discharges. After its announcement, HRRP was associated with 12%-20% reductions in 30- and 90-day FRI readmissions for patients with CHF (-0.42 percentage points [ppt]) and AMI (-0.35). Two years after implementation, HRRP was associated with reductions in 90-day FRI readmission for AMI (-1.27 ppt) and CHF (-0.98 ppt) patients. After HRRP's announcement, decreases were observed in home health (AMI: -2.43 ppt; CHF: -8.83 ppt; pneumonia: -1.97 ppt) and skilled nursing facility referrals (AMI: -5.95 ppt; CHF: -3.19 ppt; pneumonia: -10.27 ppt).
AHRQ-funded; HS025838.
Citation: Hoffman GJ, Alexander Nb, Ha J .
Medicare's hospital readmission reduction program reduced fall-related health care use: an unexpected benefit?
Health Serv Res 2024 Feb; 59(1):e14246. doi: 10.1111/1475-6773.14246..
Keywords: Hospital Readmissions, Medicare, Falls
Kalata S, Schaefer SL, Nuliyahu U
Low-volume elective surgery and outcomes in Medicare beneficiaries treated at hospital networks.
This cross-sectional study’s objective was to quantify low-volume surgery and associated outcomes within hospital networks. This study used Medicare Provider Analysis and Review data to examine fee-for-service beneficiaries aged 66 to 99 years who underwent 1 of 10 elective surgical procedures (abdominal aortic aneurysm repair, carotid endarterectomy, mitral valve repair, hip or knee replacement, bariatric surgery, or resection for lung, esophageal, pancreatic, or rectal cancers) in a network hospital from 2016 to 2018. Hospital volume for each procedure (calculated with the use of National Inpatient Sample data) was compared with yearly hospital volume standards for that procedure recommended by The Leapfrog Group. The authors analyzed primary outcomes which were postoperative complications, 30-day readmission, and 30-day mortality, stratified by the volume status of the hospital and network type. Secondary outcome was the availability of a different high-volume hospital within the same network or outside the network and its proximity to the patient (based on hospital referral region and zip code). In all, data were analyzed for 950,079 Medicare fee-for-service beneficiaries (average age 74.4 years; 621,138 females and 427,931 males) who underwent 1,049,069 procedures at 2469 hospitals within 382 networks. Of these networks, almost 100% [380 (99.5%)] had at least 1 low-volume hospital performing the elective procedure of interest. In 79.8% of procedures that were performed at low-volume hospitals, there was a hospital that met volume standards within the same network and hospital referral region located a median (IQR) distance of 29 (12-60) miles from the patient's home. In adjusted analyses, postoperative outcomes were inferior at low-volume hospitals compared with hospitals meeting volume standards, with a 30-day mortality of 8.1% at low-volume hospitals vs 5.5% at hospitals that met volume standards.
AHRQ-funded; HS028606.
Citation: Kalata S, Schaefer SL, Nuliyahu U .
Low-volume elective surgery and outcomes in Medicare beneficiaries treated at hospital networks.
JAMA Surg 2024 Feb; 159(2):203-10. doi: 10.1001/jamasurg.2023.6542.
Keywords: Surgery, Medicare, Hospitals, Outcomes
Danielson EC, Li W, Suleiman L
Social risk and patient-reported outcomes after total knee replacement: implications for Medicare policy.
The objective of this study was to determine if county- or patient-level social risk factors are associated with patient-reported outcomes after total knee replacement when added to the comprehensive joint replacement risk-adjustment model. Patient and outcomes data from the Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement cohort were merged with the CDC Social Vulnerability Index. The findings indicated that patient-reported race, education, and income were associated with patient-reported pain or functional scores; pain improvement was negatively associated with Black race and positively associated with higher annual incomes. The authors concluded that these findings suggested that patient-level social factors warrant further investigation to promote health equity in patient-reported outcomes after total knee replacement.
Citation: Danielson EC, Li W, Suleiman L .
Social risk and patient-reported outcomes after total knee replacement: implications for Medicare policy.
Health Serv Res 2024 Feb; 59(1):e14215. doi: 10.1111/1475-6773.14215.
Keywords: Surgery, Orthopedics, Medicare, Outcomes, Patient-Centered Outcomes Research, Social Determinants of Health
Roberts ET, Xue L, Lovelace J
Changes in care associated with integrating Medicare and Medicaid for dual-eligible individuals.
This study’s objective was to evaluate changes in care associated with integrating Medicare and Medicaid coverage in a fully integrated dual-eligible special needs plan (FIDE-SNP) in Pennsylvania. This cohort study used a difference-in-differences analysis compared changes in care between 2 cohorts of dual-eligible individuals: (1) an integration cohort composed of Medicare Dual Eligible Special Needs Plan enrollees who joined a companion Medicaid plan following a 2018 state reform mandating Medicaid managed care (leading to integration), and (2) a comparison cohort with nonintegrated coverage before and after the start of Medicaid managed care. Analyses were conducted of outcomes in 4 domains: use of home- and community-based services (HCBS), care management and coordination, hospital stays and postacute care, and long-term nursing home stays. The study included 7967 individuals in the integration cohort and 3832 individuals in the comparison cohort. HCBS use increased differentially in the integration vs comparison cohorts by 0.61 days/person-month. However, integration was not associated with changes in care management and coordination, including medication use for chronic conditions (-0.02 fills/person-month) or follow-up outpatient care after a hospital stay (-0.01 visits/hospital stay). There was no significant difference in hospital stays between the cohorts.
AHRQ-funded; HS026727.
Citation: Roberts ET, Xue L, Lovelace J .
Changes in care associated with integrating Medicare and Medicaid for dual-eligible individuals.
JAMA Health Forum 2023 Dec; 4(12):e234583. doi: 10.1001/jamahealthforum.2023.4583..
Keywords: Medicare, Medicaid, Health Insurance, Surgery, Outcomes
Xu JF, Anderson KE, Liu A
Role of patient sorting in avoidable hospital stays in Medicare Advantage vs traditional Medicare.
The purpose of this cross-sectional study was to explore whether differences in avoidable hospital stays between Medicare Advantage (MA) patients and traditional Medicare (TM) patients can be explained by the primary care clinicians who treat MA and TM beneficiaries. The study’s main outcome and measures included whether a beneficiary had avoidable hospital stays in 2019 due to any of the 5 chronic ambulatory care-sensitive conditions (ACSCs). Avoidable hospital stays included both hospitalizations and observation stays. The study found that when controlling for the primary care clinician, the relative risk (RR) of avoidable hospital stays in MA vs TM changed by 2.6 percentage points, indicating that when compared with TM beneficiaries, MA beneficiaries saw clinicians with lower rates of avoidable hospital stays.
AHRQ-funded; HS000029.
Citation: Xu JF, Anderson KE, Liu A .
Role of patient sorting in avoidable hospital stays in Medicare Advantage vs traditional Medicare.
JAMA Health Forum 2023 Nov 3; 4(11):e233931. doi: 10.1001/jamahealthforum.2023.3931..
Keywords: Medicare, Hospitalization
Henke RM, Fingar KR, Liang L
AHRQ Author: Liang L, Jiang HJ
Medicare Advantage in rural areas: implications for hospital sustainability.
This study examined the association between Medicare Advantage penetration levels in rural areas and hospital financial distress and closure. This retrospective study followed rural general acute hospitals open from 2008-2019 or until closure using HCUP State Inpatient Databases for 14 states. Medicare Advantage penetration at rural hospitals grew from 6.5% in 2008 to 20.6% in 2019. A 1-percentage point increase in hospital penetration was associated with an increase in financial stability of 0.04 units on the Altman Z score and a 4% reduction in risk of closure (HR, 0.96).
AHRQ-authored; AHRQ-funded; 290201800005C.
Citation: Henke RM, Fingar KR, Liang L .
Medicare Advantage in rural areas: implications for hospital sustainability.
Am J Manag Care 2023 Nov; 29(11):594-600. doi: 10.37765/ajmc.2023.89455..
Keywords: Medicare, Rural Health, Rural/Inner-City Residents, Hospitals
Ganguli I, Mackwood MB, Yang CW
Racial differences in low value care among older adult Medicare patients in US health systems: retrospective cohort study.
The objective of this retrospective cohort study was to characterize racial differences in receipt of low-value care among older Medicare beneficiaries overall and within U.S. health systems. Medicare fee-for-service administrative data was used for Black and White Medicare patients who were at least 65 as of 2016. Findings showed that, of the 40 low value services examined, Black patients had a higher adjusted receipt of 9 services and lower receipt of 20 services than White patients. Differences were generally small and largely due to differential care within health systems, but the authors concluded that their findings suggested potential factors that researchers, policymakers, and health system leaders might investigate to improve health care quality and equity.
AHRQ-funded; HS024930.
Citation: Ganguli I, Mackwood MB, Yang CW .
Racial differences in low value care among older adult Medicare patients in US health systems: retrospective cohort study.
BMJ 2023 Oct 25; 383:e074908. doi: 10.1136/bmj-2023-074908..
Keywords: Elderly, Racial and Ethnic Minorities, Medicare, Health Systems
Mullens CL, Lussiez A, Scott JW
Association of health professional shortage area hospital designation with surgical outcomes and expenditures among Medicare beneficiaries.
This study’s objective was to compare surgical outcomes and expenditures at hospitals located in Health Professional Shortage Areas to nonshortage area designated hospitals among Medicare beneficiaries. This cross-sectional retrospective study used data from 842,787 Medicare beneficiary patient admissions to hospitals with and without Health Professional Shortage Area designations for common operations including appendectomy, cholecystectomy, colectomy, and hernia repair from 2014 to 2018. Primary outcomes measures were 30-day mortality, hospital readmissions, and 30-day surgical episode payments. Patients (mean age=75.6 years, males=44.4%) undergoing common surgical procedures in shortage area hospitals were less likely to be White (84.6% vs 88.4%) and less likely to have≥2 Elixhauser comorbidities (75.5% vs 78.2%). Patients undergoing surgery at Health Professional Shortage Area hospitals had lower risk-adjusted rates of 30-day mortality (6.05% vs 6.69%) and readmission (14.99% vs 15.74%). Medicare expenditures at Health Professional Shortage Area hospitals were also lower than nonshortage designated hospitals ($28,517 vs $29,685).
AHRQ-funded; HS028606; HS028672.
Citation: Mullens CL, Lussiez A, Scott JW .
Association of health professional shortage area hospital designation with surgical outcomes and expenditures among Medicare beneficiaries.
Ann Surg 2023 Oct 1; 278(4):e733-e39. doi: 10.1097/sla.0000000000005762..
Keywords: Hospitals, Surgery, Medicare, Healthcare Costs, Workforce, Outcomes
Thompson MP, Stewart JW, Hou H
Determinants and outcomes associated with skilled nursing facility use after coronary artery bypass grafting: a statewide experience.
The purpose of this study was to assess determinants and outcomes related with Skilled nursing facility (SNF) use after isolated coronary artery bypass grafting. The study sample included 8,614 patients, with an average age of 73.3 years. A skilled nursing facility (SNF) was used by 22.3% of patients within 90 days of discharge and ranged from 3.2% to 58.3% across the 33 hospitals. Patients utilizing SNFs had a greater likelihood of being female, older, non-White, with greater comorbidities, worse cardiovascular function, a perioperative morbidity, and longer hospital lengths of stay. Outcomes were significantly worse for users of SNFs, including higher rates of 90-day readmissions and ED visits and lower use of home health and rehabilitation services. Compared with non-SNF users, users of SNFs had a greater risk-adjusted hazard of mortality and had 2.7-percentage point greater 5-year mortality rate in a propensity-matched cohort of patients.
AHRQ-funded; HS027830.
Citation: Thompson MP, Stewart JW, Hou H .
Determinants and outcomes associated with skilled nursing facility use after coronary artery bypass grafting: a statewide experience.
Circ Cardiovasc Qual Outcomes 2023 Oct; 16(10):e009639. doi: 10.1161/circoutcomes.122.009639..
Keywords: Elderly, Nursing Homes, Heart Disease and Health, Cardiovascular Conditions, Medicare, Surgery
Graves JA, Lee D, Leszinsky L
Physician patient sharing relationships within insurance plan networks.
The purpose of this cross-sectional study was to assess patient relationships shared between primary care physicians (PCPs), cardiologists, and oncologists, and the level at which those relationships were indicated within insurance networks. The study found that on average, networks captured 64.6% of PCP-cardiology shared patient ties, and 61.8% of PCP-oncologist ties. Fewer than 50% of in-network ties were among physicians with a mutual organizational affiliation. After adjusting for the breadth of the network, the researchers found no evidence of differences in the shared patient percentage across insurance market segments or different types of networks. One exception was among national networks compared to local and regional networks, where national plans indicated fewer shared patient ties, especially in the narrowest networks.
AHRQ-funded; HS025976.
Citation: Graves JA, Lee D, Leszinsky L .
Physician patient sharing relationships within insurance plan networks.
Health Serv Res 2023 Oct;58(5):1056-65. doi: 10.1111/1475-6773.14138..
Keywords: Health Insurance, Provider: Physician, Medicare
Rubio K, Fraze TK, Bibi S
Racial-ethnic composition of primary care practices and Comprehensive Primary Care Plus initiative participation.
The purpose of this study was to explore whether primary care practices serving high rates of Black or Latino Medicare fee-for-service (FFS) beneficiaries were less likely to participate in CPC+ in 2021 compared to practices serving lower rates of these same populations. 11,718 primary care practices and 7,264,812 attributed Medicare FFS beneficiaries across 18 eligible regions participated in the study. The study found that 26.9% of the eligible practices were CPC+ participants. In statistically adjusted analyses, primary care practices with high shares of Black and Latino beneficiaries had a lower likelihood of participating in CPC+ compared to practices with lower shares of these beneficiary groups. Participation disparities for practices with relatively high shares of Black beneficiaries partially explained state differences in CPC+ participation rates but did not explain participation disparities for practices with relatively high shares of Latino beneficiaries.
AHRQ-funded; HS024075.
Citation: Rubio K, Fraze TK, Bibi S .
Racial-ethnic composition of primary care practices and Comprehensive Primary Care Plus initiative participation.
J Gen Intern Med 2023 Oct; 38(13):2945-52. Epub ahead of print. doi: 10.1007/s11606-023-08160-0..
Keywords: Racial and Ethnic Minorities, Primary Care, Medicare
Mellor JM, McInerney M, Garrow RC
The impact of Medicaid expansion on spending and utilization by older low-income Medicare beneficiaries.
This study examined indirect spillover effects of Affordable Care Act (ACA) Medicaid expansions to working-age adults on health care coverage, spending, and utilization by older low-income Medicare beneficiaries. The authors used data from the 2010-2018 Health and Retirement Study survey linked to annual Medicare beneficiary summary files. They estimated individual-level difference-in-differences models of total spending for inpatient, institutional outpatient, physician/professional provider services; inpatient stays, outpatient visits, physician visits; and Medicaid and Part A and B Medicare coverage. They also compared changes in outcomes before and after Medicaid expansion in expansion versus nonexpansion states. The sample included low-income respondents aged 69 and older with linked Medicare data, enrolled in full-year traditional Medicare, and living in the community. ACA Medicaid expansion was associated with a 9.8 percentage point increase in Medicaid coverage, a 4.4 percentage point increase in having any institutional outpatient spending, and a positive but statistically insignificant 2.4 percentage point change in Part B enrollment.
AHRQ-funded; HS025422.
Citation: Mellor JM, McInerney M, Garrow RC .
The impact of Medicaid expansion on spending and utilization by older low-income Medicare beneficiaries.
Health Serv Res 2023 Oct; 58(5):1024-34. doi: 10.1111/1475-6773.14155..
Keywords: Medicaid, Medicare, Low-Income, Healthcare Utilization, Healthcare Costs, Health Insurance
Mullens CL, Lussiez A, Scott JW
High-risk surgery among Medicare beneficiaries living in health professional shortage areas.
This study’s objective was to compare high-risk surgical outcomes at hospitals located in Health Professional Shortage Areas to nonshortage area designated hospitals among Medicare beneficiaries. The authors performed a retrospective review of Medicare beneficiaries living in health professional shortage areas and nonshortage areas who underwent abdominal aortic aneurysm repair, coronary artery bypass graft, esophagectomy, liver resection, pancreatectomy, or rectal resection between 2014 and 2018. They compared rates of postoperative complications and 30-day mortality between the patient cohorts. They used beneficiary and hospital ZIP codes to quantify travel time to obtain care. Compared with patients living in nonshortage areas, patients living in health professional shortage areas traveled longer (median 60.0 vs 28.0 minutes). There were no differences in risk-adjusted rates of complications (28.5% vs 28.6%) and small differences in rates of 30-day mortality (4.2% vs 4.4%) between beneficiaries living in shortage areas versus those not in shortage areas, respectively.
AHRQ-funded; HS028606; HS028672; HS027788.
Citation: Mullens CL, Lussiez A, Scott JW .
High-risk surgery among Medicare beneficiaries living in health professional shortage areas.
J Rural Health 2023 Sep; 39(4):824-32. doi: 10.1111/jrh.12748..
Keywords: Surgery, Hospitals, Workforce, Medicare, Outcomes
McGarry BE, Mao Y, Nelson D
Hospital proximity and emergency department use among assisted living residents.
The purpose of this retrospective cohort study was to explore the association between the distance of assisted living (AL) communities to the nearest hospital and AL residents' rates of emergency department (ED) utilization. The researchers hypothesized that when access to an ED is a shorter distance, AL-to-ED transfers are more common, especially for non-emergency conditions. The study found that among 540,944 resident-years from 16,514 AL communities, the median distance to the closest hospital was 2.5 miles. After statistical adjustment, a doubling of distance to the closest hospital was related with 43.5 fewer ED treat-and-release visits per 1000 resident years and no significant difference in the rate of ED visits resulting in an inpatient admission. Among ED treat-and-release visits, a doubling of distance was related with a 3.0% decrease in visits classified as nonemergent, and a 1.6% decrease in visits classified as emergent, not primary care treatable.
AHRQ-funded; HS026893.
Citation: McGarry BE, Mao Y, Nelson D .
Hospital proximity and emergency department use among assisted living residents.
J Am Med Dir Assoc 2023 Sep; 24(9):1349-55.e.5. doi: 10.1016/j.jamda.2023.05.002..
Keywords: Emergency Department, Elderly, Long-Term Care, Medicare, Hospitals
Anderson KE, DiStefano MJ, Liu A
Incorporating added therapeutic benefit and domestic reference pricing into Medicare payment for expensive part B drugs.
The objective of this retrospective analysis was to identify expensive Part B drugs and to consider the evidence for each drug's added benefit in order to model a reimbursement policy for Medicare that integrates added benefit assessment and domestic reference pricing. Data were taken from a nationally representative sample of traditional Medicare Part B claims. The analysis showed that more than one-third of the expensive Part B drugs prescribed in 2019 offered low added benefit. The authors concluded that reference pricing based on added benefit assessment could be used to address the launch prices for expensive Part B drugs with low added benefit.
AHRQ-funded; HS000029.
Citation: Anderson KE, DiStefano MJ, Liu A .
Incorporating added therapeutic benefit and domestic reference pricing into Medicare payment for expensive part B drugs.
Value Health 2023 Sep; 26(9):1381-88. doi: 10.1016/j.jval.2023.05.018..
Keywords: Medicare, Payment, Medication, Healthcare Costs
Landon BE, Lam MB, Landrum MB
Opportunities for savings in risk arrangements for oncologic care.
High spending for cancer care is a target for savings as the United States hastens adoption of alternative payment through global payment models such as Accountable Care Organizations (ACOs) or Medicare Advantage (MA). The purpose of this study was to quantify the level at which Accountable Care Organizations ACOs and other risk-bearing organizations operating in a specific geographic area could realize savings by directing patients to efficient medical oncology practices. The incident cohort included 1,309,825 patients Options for directing differed across markets; the top quartile market had 10 or more oncology practices, but the bottom quartile had 3 or fewer oncology practices. Total spending (including Medicare Part D) in the incident cohort increased from a mean of $57,314 in 2009 to 2010 to $66,028 in 2016 to 2017. Within markets, total spending for practices in the highest spending quartile was 19% greater than in the lowest quartile. Hospital spending was the single largest component of spending in both time periods followed by Part B (infused) chemotherapy. Correlations in practice-level spending between the first-year (2009) and second-year (2010) spending were high.
Citation: Landon BE, Lam MB, Landrum MB .
Opportunities for savings in risk arrangements for oncologic care.
JAMA Health Forum 2023 Sep; 4(9):e233124. doi: 10.1001/jamahealthforum.2023.3124..
Keywords: Cancer, Medicare, Healthcare Costs, Payment
Mullens CL, Scott JW, Mead M
Surgical procedures at critical access hospitals within hospital networks.
Critical access hospitals provide vital care to more than 80 million Americans. These facilities, often rural, are located greater than 35 miles away from another hospital and are required to maintain patient transfer agreements with other facilities capable of providing higher levels of care. The purpose of this cross-sectional retrospective study was to assess surgical outcomes and expenditures at critical access hospitals that do participate in a hospital network compared with those who do not participate in a hospital network among Medicare beneficiaries. From 2014 to 2018 the researchers compared 16,128 Medicare beneficiary admissions for appendectomy, cholecystectomy, colectomy, or hernia repair at critical access hospitals. The study found that Medicare beneficiaries who received care at critical access hospitals in a hospital network were more likely to carry 2 or more Elixhauser comorbidities. Rates of 30-day mortality and readmission rates were higher at critical access hospitals in a hospital network. Finally, total payments per episode were discovered to be $960 greater per patient at critical access hospitals that were in a hospital network ($23,878) when compared with critical access hospitals that were not in a hospital network ($22,918).
AHRQ-funded; HS028606; HS028672; HS027788.
Citation: Mullens CL, Scott JW, Mead M .
Surgical procedures at critical access hospitals within hospital networks.
Ann Surg 2023 Sep 1; 278(3):e496-e502. doi: 10.1097/sla.0000000000005772..
Keywords: Surgery, Hospitals, Medicare
Tummalapalli SL, Struthers SA, White D
Optimal care for kidney health: development of a Merit-based Incentive Payment System (MIPS) value pathway.
This article detailed the iterative consensus-building process used by the American Society of Nephrology Quality Committee to develop the Optimal Care for Kidney Health Merit-based Incentive Payment System (MIPS) Value Pathway (MVP). The Optimal Care for Kidney Health MVP, published in the 2023 Medicare Physician Fee Schedule Final Rule, included measures related to angiotensin-converting enzyme inhibitor and angiotensin receptor blocker use, hypertension control, readmissions, acute kidney injury requiring dialysis, and advance care planning. The MVP nephrology’s goal was to streamline measure selection in MIPS and served as a case study of collaborative policymaking between one professional organization and national regulatory agencies.
AHRQ-funded; HS028684.
Citation: Tummalapalli SL, Struthers SA, White D .
Optimal care for kidney health: development of a Merit-based Incentive Payment System (MIPS) value pathway.
J Am Soc Nephrol 2023 Aug; 34(8):1315-28. doi: 10.1681/asn.0000000000000163..
Keywords: Kidney Disease and Health, Payment, Healthcare Costs, Medicare
Slade EP, Wu RJ, Meiselbach MK
Psychiatrist and nonpsychiatrist physician network breadth in dual eligible special needs plans.
This study’s purpose was to compare the breadths of psychiatrist and nonpsychiatrist provider networks in Dual Eligible Special Needs Plans (D-SNPs) and other Medicare and Medicaid Advantage (MA) plans. D-SNP is a type of Medicare Advantage (MA) plan for individuals who have both Medicare and Medicaid coverage. The authors examined MA plan provider network data that was merged with plan service areas and a nationwide provider database to form a data set with 843 observations on networks subclassified by state and network type (D-SNP or other MA) covering 42 U.S. states and Washington, D.C. Mean psychiatrist network breadth was 0.319 in D-SNPs and 0.299 in other MA plans. Nonpsychiatrist network breadth was 0.346 in D-SNPs and 0.358 in other MA plans. Psychiatrist networks were narrower than nonpsychiatrist networks (0.303 vs. 0.355), but mean psychiatrist network breadth did not differ between D-SNPs and other MA plans. In regression analyses, the psychiatrist-nonpsychiatrist breadth difference was smaller in D-SNPs (-0.031) than in other MA plans (-0.060).
AHRQ-funded; HS000029.
Citation: Slade EP, Wu RJ, Meiselbach MK .
Psychiatrist and nonpsychiatrist physician network breadth in dual eligible special needs plans.
Psychiatr Serv 2023 Aug; 74(8):816-22. doi: 10.1176/appi.ps.20220239..
Keywords: Behavioral Health, Medicare, Provider: Physician
Sharma H, Xu L
Use of intergovernmental transfers-based Medicaid supplemental payments to boost nursing home finances: evidence from Indiana nursing homes.
The objective of this study was to estimate the effect of participation in the intergovernmental transfers-based Medicaid supplemental payment program on nursing home revenue and expenditures. Data was taken from all Medicare and Medicaid-certified nursing homes in Indiana from 2009-17. The findings indicated that nursing homes owned or operated by nonstate governmental organizations received a fraction of the total supplemental payments on average, but the authors observed increased payments in later years. Participating nursing homes did not increase clinical expenses. The authors concluded that these findings raised questions regarding the transparency of financing arrangements between nonstate governmental organizations and nursing homes and the need to link supplemental payments to clinical expenses.
AHRQ-funded; HS027235.
Citation: Sharma H, Xu L .
Use of intergovernmental transfers-based Medicaid supplemental payments to boost nursing home finances: evidence from Indiana nursing homes.
Med Care 2023 Aug; 61(8):546-53. doi: 10.1097/mlr.0000000000001875..
Keywords: Nursing Homes, Medicare, Medicaid, Healthcare Costs
Ganguli I, Crawford ML, Usadi B
Who's accountable? Low-value care received by Medicare beneficiaries outside of their attributed health systems.
This study examined where and from whom Medicare beneficiaries aged 65 and older received forty low-value services during 2017-18 and identified factors associated with out-of-system receipt. The authors used national Medicare data for fee-for-service beneficiaries aged sixty-five and older and attributed to 595 US health systems for 2017 and 2018. Almost half (43%) of low-value services received by attributed beneficiaries originated from out-of-system clinicians: 38 percent from specialists, 4 percent from primary care physicians, and 1 percent from advanced practice clinicians. Recipients of low-value care were more likely to obtain care out of system if age 75 or older, male, non-Hispanic white, rural dwelling, more medically complex, or experiencing lower continuity of care. Out-of-system receipt was not associated with recipients' health systems' accountable care organization status.
AHRQ-funded; HS024075.
Citation: Ganguli I, Crawford ML, Usadi B .
Who's accountable? Low-value care received by Medicare beneficiaries outside of their attributed health systems.
Health Aff 2023 Aug; 42(8):1128-39. doi: 10.1377/hlthaff.2022.01319..
Keywords: Medicare, Healthcare Costs
Di M, Keeney T, Belanger E
Functional status and therapy for older adults with diffuse large B-cell lymphoma in nursing homes: a population-based study.
The purpose of this study was to describe the prevalence of functional and cognitive impairments, and relationships between impairments and treatment in older patients with diffuse large B cell lymphoma (DLBCL) receiving nursing home (NH) care. The study found that of the eligible 649 NH patients 45% received chemoimmunotherapy; among the recipients, 47% received multi-agent, anthracycline-containing regimens. Those patients in a NH were less likely to receive chemoimmunotherapy, had higher 30-day mortality, and poorer OS compared with community-dwelling patients. NH patients with severe functional (61%) or any cognitive impairment (48%) were less likely to receive chemoimmunotherapy.
AHRQ-funded; HS000011.
Citation: Di M, Keeney T, Belanger E .
Functional status and therapy for older adults with diffuse large B-cell lymphoma in nursing homes: a population-based study.
J Am Geriatr Soc 2023 Jul; 71(7):2239-49. doi: 10.1111/jgs.18302..
Keywords: Elderly, Nursing Homes, Medicare, Cancer, Treatments