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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 14 of 14 Research Studies DisplayedLikosky DS, Yang G, Zhang M
Interhospital variability in health care-associated infections and payments after durable ventricular assist device implant among Medicare beneficiaries.
The purpose of this study was to examine differences in durable ventricular assist device implantation infection rates and associated costs across hospitals. The researchers utilized clinical data for 8,688 patients who received primary durable ventricular assist devices from the Society of Thoracic Surgeons Interagency Registry for Mechanically Assisted Circulatory Support (Intermacs) hospitals (n = 120) and merged that data with post-implantation 90-day Medicare claims. The primary outcome included infections within 90 days of implantation and Medicare payments. The study found that 27.8% of patients developed 3982 identified infections. The median adjusted incidence of infections (per 100 patient-months) across hospitals was 14.3 and differed according to hospital. Total Medicare payments from implantation to 90 days were 9.0% more in high versus low infection tercile hospitals. The researchers concluded that health-care-associated infection rates post durable ventricular assist device implantation varied according to hospital and were associated with increased 90-day Medicare expenditures.
AHRQ-funded; HS026003.
Citation: Likosky DS, Yang G, Zhang M .
Interhospital variability in health care-associated infections and payments after durable ventricular assist device implant among Medicare beneficiaries.
J Thorac Cardiovasc Surg 2022 Nov;164(5):1561-68. doi: 10.1016/j.jtcvs.2021.04.074..
Keywords: Healthcare-Associated Infections (HAIs), Medical Devices, Medicare, Heart Disease and Health, Cardiovascular Conditions, Hospitals, Payment, Healthcare Costs
Glynn A, Hernandez I, Roberts ET
Consequences of forgoing prescription drug subsidies among low-income Medicare beneficiaries with diabetes.
This study’s objective was to estimate the take-up of the Medicare Part D Low-Income Subsidy (LIS) among Medicare beneficiaries with diabetes and examine differences in out-of-pocket costs and prescription drug use between LIS enrollees and LIS-eligible non-enrollees. Data from the Health and Retirement Study linked to Medicare administrative data from 2008 to 2016 was used. The authors first estimated LIS take-up stratified by income (≤100% of the Federal Poverty Level [FPL] and >100% to ≤150% of FPL). Second, to assess the consequences of forgoing the LIS among near-poor beneficiaries (incomes >100% to ≤150% of FPL), they conducted propensity score-weighted regression analyses to compare out-of-pocket costs, prescription drug use, and cost-related medication non-adherence among LIS enrollees and LIS-eligible non-enrollees. Among Medicare beneficiaries with diabetes, 68.1% of those considered near-poor (incomes >100% to ≤150% of FPL) received the LIS, compared to 90.3% of those with incomes ≤100% of FPL. Among near-poor beneficiaries, LIS-eligible non-enrollees incurred higher annual out-of-pocket drug spending ($518], filled 7.3 fewer prescriptions for diabetes, hypertension, and hyperlipidemia drugs, and were 8.9 percentage points more likely to report skipping drugs due to cost. all compared to LIS enrollees.
AHRQ-funded; HS026727.
Citation: Glynn A, Hernandez I, Roberts ET .
Consequences of forgoing prescription drug subsidies among low-income Medicare beneficiaries with diabetes.
Health Serv Res 2022 Oct;57(5):1136-44. doi: 10.1111/1475-6773.13990..
Keywords: Medication, Diabetes, Chronic Conditions, Low-Income, Medicare, Healthcare Costs
Kim KD, Funk RJ, Hou H
Association between care fragmentation and total spending after durable left ventricular device implant: a mediation analysis of health care-associated infections within a national Medicare-Society of Thoracic Surgeons INTERMACS linked dataset.
The purpose of this study was to examine the relationship between care fragmentation and total spending for durable left ventricular assisted device (LVAD) implant, and whether this relationship is mediated by infections. The researchers developed a measure of care fragmentation based on the number of shared medical professionals providing care to 4,987 Medicare beneficiaries undergoing LVAD implantation. The study found that the indirect effect of care fragmentation, through infections, was positive and statistically significant. The researchers concluded that higher care fragmentation associated with durable LVAD implantation is related with a greater incidence of infections and higher Medicare beneficiary payments.
AHRQ-funded; HS026003.
Citation: Kim KD, Funk RJ, Hou H .
Association between care fragmentation and total spending after durable left ventricular device implant: a mediation analysis of health care-associated infections within a national Medicare-Society of Thoracic Surgeons INTERMACS linked dataset.
Circ Cardiovasc Qual Outcomes 2022 Sep;15(9):e008592. doi: 10.1161/circoutcomes.121.008592..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Healthcare Costs, Healthcare-Associated Infections (HAIs), Medicare, Medical Devices, Healthcare Delivery
Oronce CIA, Arbanas JC, Leng M
Estimated wasteful spending on aducanumab dispensing in the U.S. Medicare population: a cross-sectional analysis.
The purpose of this study was to quantify the amount of aducanumab that is discarded because of vial dose size and calculate the potential Medicare savings that could be created by changing the vial size and drug weight to make dispensing more efficient and reduce the amount of discarded drug. The researchers calculated estimates for the monthly amount of discarded drug for each study participant, and then annualized the estimates. Costs were calculated using the 300 mg vial price, which is the larger of the two vial sizes currently available, and calculations were then made for simulated vials in three combinations (100 and 170 mg; 170 and 250mg; and 80mg, 170, and 300 mg.) Costs for each combination were then calculated. The study found that assuming a 10% drug uptake, the equivalent of between 132,398 and 694,258 vials of aducanumab would be discarded costing Medicare between $115.4 million and $604.9
million each year. If the 300 mg/3.0 ml vial was reduced to 100 mg/1.0 ml, Medicare savings would range between $70.9 and $369.0 million per year. The researchers concluded that reducing aducanumab vial size could decrease wasteful spending from discarded vials by over 60%.
million each year. If the 300 mg/3.0 ml vial was reduced to 100 mg/1.0 ml, Medicare savings would range between $70.9 and $369.0 million per year. The researchers concluded that reducing aducanumab vial size could decrease wasteful spending from discarded vials by over 60%.
AHRQ-funded; HS026498.
Citation: Oronce CIA, Arbanas JC, Leng M .
Estimated wasteful spending on aducanumab dispensing in the U.S. Medicare population: a cross-sectional analysis.
J Am Geriatr Soc 2022 Sep;70(9):2714-18. doi: 10.1111/jgs.17891..
Keywords: Medicare, Healthcare Costs, Medication
Anderson KE, Polsky D, Dy S
Prescribing of low- versus high-cost Part B drugs in Medicare Advantage and traditional Medicare.
The purpose of this study was to compare Medicare Advantage (MA) coverage with traditional Medicare (TM) coverage as it relates to whether MA is associated with greater efficiency of prescribing Part B drugs. The authors sampled 20% of all 2016 outpatient and carrier TM claims and MA encounter records and Master Beneficiary Summary File data and analyzed whether MA enrollees more often received the low-cost Part B drug compared to TM enrollees. Four clinical scenarios were evaluated where multiple, similarly effective drugs exist: (1) anti-VEGF agents to treat macular degeneration, (2) bone resorption inhibitors for osteoporosis, (3) bone resorption inhibitors for malignant neoplasms, and (4) intravenous iron for iron deficiency anemia. The researchers estimated spending differences if TM prescribing aligned with MA prescribing and evaluated whether differences between MA and TM prescribing patterns were due to differences in the hospitals and provider practices who treat MA and TM enrollees or differences in how those hospitals and provider practices engage with their MA vs TM patients. The researchers found that more MA enrollees received the low-cost drug vs. TM enrollees in all 4 clinical scenarios, and that if TM prescribing matched that of ME prescribing, there would be a spending savings of 6% to 20% for each of the 4 scenarios. The study concluded that in 4 clinical scenarios in which similarly or equally effective treatment options exist, MA enrollees were more likely than TM enrollees to receive low-cost Part B drugs.
AHRQ-funded; HS000029.
Citation: Anderson KE, Polsky D, Dy S .
Prescribing of low- versus high-cost Part B drugs in Medicare Advantage and traditional Medicare.
Health Serv Res 2022 Jun;57(3):537-47. doi: 10.1111/1475-6773.13912..
Keywords: Medication, Medicare, Healthcare Costs
DeKeyser GJ, Martin BI, Ko H
Increased complications and cost associated with hip arthroplasty for femoral neck fracture: evaluation of 576,119 Medicare patients treated with hip arthroplasty.
The authors compared perioperative complications and costs of total hip arthroplasty (THA) for treatment of osteoarthritis (OA) to hemiarthroplasty (HA) and THA for treatment of femoral neck fractures (FNFs). Data from CMS were used to identify all patients 65 or older undergoing primary hip arthroplasty. The results showed that CMS hip arthroplasty patients with an FNF had significantly higher rates of mortality, thromboembolic events, readmission, and greater direct cost. The authors concluded that reimbursement models for arthroplasty should account for different perioperative complication and resource utilization for FNF patients.
AHRQ-funded; HS024714.
Citation: DeKeyser GJ, Martin BI, Ko H .
Increased complications and cost associated with hip arthroplasty for femoral neck fracture: evaluation of 576,119 Medicare patients treated with hip arthroplasty.
J Arthroplasty 2022 Apr; 37(4):742-47.e2. doi: 10.1016/j.arth.2021.12.027..
Keywords: Orthopedics, Surgery, Healthcare Costs, Medicare
Presskreischer R, Steinglass JE, Anderson KE
Eating disorders in the U.S. Medicare population.
This cross-sectional study explored the prevalence, sociodemographic and clinical characteristics, and health care spending for Medicare enrollees with eating disorders. A representative 20% sample of 2016 Medicare inpatient, outpatient, carrier, and home health fee-for-service claims and Medicare Advantage encounter records was used. The sample included almost 12 million Medicare enrollees of whom 0.15% had an eating disorder diagnosis. A greater proportion of individuals diagnosed with an eating disorder diagnosis were female, under age 65, and dually eligible for Medicaid due to disability or low-income qualification than those without a diagnosis. Individuals with eating disorders had higher rates of comorbid conditions, with the greatest differences in cardiac arrythmias, arthritis, and thyroid conditions. Spending was $29,456 for enrollees with eating disorders compared to $7,418 without.
AHRQ-funded; HS000029.
Citation: Presskreischer R, Steinglass JE, Anderson KE .
Eating disorders in the U.S. Medicare population.
Int J Eat Disord 2022 Mar;55(3):362-71. doi: 10.1002/eat.23676..
Keywords: Behavioral Health, Medicare, Healthcare Costs
Rodriguez HP, Ciemins EL, Rubio K
Physician practices with robust capabilities spend less on Medicare beneficiaries than more limited practices.
Researchers used data from the 2017 National Survey of Healthcare Organizations and Systems to examine the association of practice-level capabilities with process measures of quality, utilization, and spending. They found that quality and utilization did not differ by practice-level capabilities. Physician practice locations with robust capabilities spent less on Medicare fee-for-service beneficiaries but delivered quality of care comparable to the quality delivered in locations with low or mixed capabilities.
AHRQ-funded; HS024075.
Citation: Rodriguez HP, Ciemins EL, Rubio K .
Physician practices with robust capabilities spend less on Medicare beneficiaries than more limited practices.
Health Aff 2022 Mar;41(3):414-23. doi: 10.1377/hlthaff.2021.00302..
Keywords: Healthcare Costs, Medicare, Provider: Physician
Markovitz AA, Ryan AM, Peterson TA
ACO awareness and perceptions among specialists versus primary care physicians: a survey of a large Medicare Shared Savings program.
This research letter describes a survey that was conducted to compare accountable care organization (ACO) awareness and perceptions among specialists versus primary care physicians (PCPs). The survey was administered in 2018 to clinicians in the Physician Organization of Michigan ACO, which was the largest Medicare Shared Savings Program (MSSP) in Michigan and among the ten largest nationally at the time. The analysis focused on 1022 non-pediatrician physician respondents practicing within 10 provider organizations. Physician respondents included PCPs (23%) and specialists (77%). The most common specialty was internal medicine (20%), followed by surgeons (14%). Specialists were less likely to be aware of ACO participation and incentives. They were also 25% less likely to know they were in an ACO compared to PCPs. In addition, specialists were 18% less likely to know their ACO was accountable for both spending and quality or that their ACO had lowered spending in the previous year. This difference in perception may help to explain ACOs’ modest impact on spending and quality.
AHRQ-funded; HS025615.
Citation: Markovitz AA, Ryan AM, Peterson TA .
ACO awareness and perceptions among specialists versus primary care physicians: a survey of a large Medicare Shared Savings program.
J Gen Intern Med 2022 Feb;37(2):492-94. doi: 10.1007/s11606-020-06556-w..
Keywords: Primary Care, Healthcare Costs, Medicare, Provider: Physician
Trish E, Joyce G, Goldman DP
Specialty drug spending trends among Medicare and Medicare Advantage enrollees, 2007-11.
The authors analyzed trends in specialty drug spending among Medicare beneficiaries ages sixty-five and older using 2007-11 pharmacy claims data. They found that annual specialty drug spending per beneficiary who used specialty drugs increased considerably during the study period, but specialty drugs accounted for less than ten percent of total drug spending per beneficiary. Additionally, in 2011, cost-sharing reductions under the Affordable Care Act significantly reduced specialty drug users' out-of-pocket burden, which decreased 26 percent from 2010.
AHRQ-funded; HS000046.
Citation: Trish E, Joyce G, Goldman DP .
Specialty drug spending trends among Medicare and Medicare Advantage enrollees, 2007-11.
Health Aff 2014 Nov;33(11):2018-24. doi: 10.1377/hlthaff.2014.0538.
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Keywords: Healthcare Costs, Health Insurance, Medicare, Medication
Schwartz AL, Landon BE, Elshaug AG
Measuring low-value care in Medicare.
To study health care overuse, this study developed claims-based measures of low-value services ranging from low-value cancer screening and preoperative testing to low-value surgical procedures. Services detected by a limited number of measures of low-value care constituted modest proportions of overall spending, but affected substantial proportions of Medicare beneficiaries and may reflect overuse.
AHRQ-funded; HS00055
Citation: Schwartz AL, Landon BE, Elshaug AG .
Measuring low-value care in Medicare.
JAMA Intern Med. 2014 Jul;174(7):1067-76. doi: 10.1001/jamainternmed.2014.1541..
Keywords: Medicare, Healthcare Costs
Zhang Y, Zhou C, Baik SH
A simple change to the Medicare Part D low-income subsidy program could save $5 billion.
The authors used an intelligent reassignment algorithm and 2008-09 Medicare Part D drug use and spending data to match enrollees to available Part D plans according to their medication needs. They found that such a reassignment approach, compared to the current approach, could have saved the federal government over $5 billion in 2009.
AHRQ-funded; HS018657.
Citation: Zhang Y, Zhou C, Baik SH .
A simple change to the Medicare Part D low-income subsidy program could save $5 billion.
Health Aff 2014 Jun;33(6):940-5. doi: 10.1377/hlthaff.2013.1083.
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Keywords: Healthcare Costs, Low-Income, Medicare, Medication
McGarry BE, Strawderman RL, Li Y
Lower Hispanic participation in Medicare Part D may reflect program barriers.
This study found that Hispanics were 35 percent less likely than non-Hispanic whites to have Medicare Part D coverage. This difference may be driven by ethnic disparities among those eligible for the low-income Part D subsidy but not automatically enrolled in it.
AHRQ-funded; HS00044
Citation: McGarry BE, Strawderman RL, Li Y .
Lower Hispanic participation in Medicare Part D may reflect program barriers.
Health Aff. 2014 May;33(5):856-62. doi: 10.1377/hlthaff.2013.0671..
Keywords: Medicare, Disparities, Racial and Ethnic Minorities, Low-Income, Healthcare Costs
Huckfeldt PJ, Sood N, Escarce JJ
Effects of Medicare payment reform: evidence from the home health interim and prospective payment systems.
The researchers contrasted the effects of two Medicare payment reforms for home health agencies: the interim payment system (IPS) and the prospective payment system (PPS). The 1997 IPS reform lowered payments for both fee-for-service and episode-based care, as predicted by their conceptual model. The PPS in 2000 raised average but lowered marginal payment.
AHRQ-funded; HS018541
Citation: Huckfeldt PJ, Sood N, Escarce JJ .
Effects of Medicare payment reform: evidence from the home health interim and prospective payment systems.
J Health Econ. 2014 Mar;34:1-18. doi: 10.1016/j.jhealeco.2013.11.005..
Keywords: Medicare, Healthcare Costs, Home Healthcare