Medicare & medicaid research review最新文献

{"title":"Indirect medical education and disproportionate share adjustments to Medicare inpatient payment rates.","authors":"Nguyen Xuan Nguyen,&nbsp;Steven H Sheingold","doi":"10.5600/mmrr.001.04.a01","DOIUrl":"https://doi.org/10.5600/mmrr.001.04.a01","url":null,"abstract":"<p><p>The indirect medical education (IME) and disproportionate share hospital (DSH) adjustments to Medicare's prospective payment rates for inpatient services are generally intended to compensate hospitals for patient care costs related to teaching activities and care of low income populations. These adjustments were originally established based on the statistical relationships between IME and DSH and hospital costs. Due to a variety of policy considerations, the legislated levels of these adjustments may have deviated over time from these \"empirically justified levels,\" or simply, \"empirical levels.\" In this paper, we estimate the empirical levels of IME and DSH using 2006 hospital data and 2009 Medicare final payment rules. Our analyses suggest that the empirical level for IME would be much smaller than under current law-about one-third to one-half. Our analyses also support the DSH adjustment prescribed by the Affordable Care Act of 2010 (ACA)--about one-quarter of the pre-ACA level. For IME, the estimates imply an increase in costs of 1.88% for each 10% increase in teaching intensity. For DSH, the estimates imply that costs would rise by 0.52% for each 10% increase in the low-income patient share for large urban hospitals.</p>","PeriodicalId":89601,"journal":{"name":"Medicare & medicaid research review","volume":"1 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2011-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4010444/pdf/mmrr2011-001-04-a01.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30464434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Market characteristics and awareness of managed care options among elderly beneficiaries enrolled in traditional Medicare.","authors":"Jessica N Mittler, Bruce E Landon, Alan M Zaslavsky, Paul D Cleary","doi":"10.5600/mmrr.001.03.a03","DOIUrl":"10.5600/mmrr.001.03.a03","url":null,"abstract":"<p><strong>Background: </strong>Medicare beneficiaries' awareness of Medicare managed care plans is critical for realizing the potential benefits of coverage choices.</p><p><strong>Objectives: </strong>To assess the relationships of the number of Medicare risk plans, managed care penetration, and stability of plans in an area with traditional Medicare beneficiaries' awareness of the program.</p><p><strong>Research design: </strong>Cross-sectional analysis of Medicare Current Beneficiary Survey data about beneficiaries' awareness and knowledge of Medicare managed care plan availability. Logistic regression models used to assess the relationships between awareness and market characteristics.</p><p><strong>Subjects: </strong>Traditional Medicare beneficiaries (n = 3,597) who had never been enrolled in Medicare managed care, but had at least one plan available in their area in 2002, and excluding beneficiaries under 65, receiving Medicaid, or with end stage renal disease.</p><p><strong>Measures: </strong>Traditional Medicare beneficiaries' knowledge of Medicare managed care plans in general and in their area.</p><p><strong>Results: </strong>Having more Medicare risk plans available was significantly associated with greater awareness, and having an intermediate number of plans (2-4) was significantly associated with more accurate knowledge of Medicare risk plan availability than was having fewer or more plans.</p><p><strong>Conclusions: </strong>Medicare may have more success engaging consumers in choice and capturing the benefits of plan competition by more actively selecting and managing the plan choice set.</p>","PeriodicalId":89601,"journal":{"name":"Medicare & medicaid research review","volume":"1 3","pages":"E1-19"},"PeriodicalIF":0.0,"publicationDate":"2011-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4010617/pdf/mmrr2011-001-03-a03.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30464433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of paradoxical comorbidities on risk-adjusted mortality of Medicare beneficiaries with cardiovascular disease.","authors":"Mary S Vaughan-Sarrazin,&nbsp;Xin Lu,&nbsp;Peter Cram","doi":"10.5600/mmrr.001.03.a02","DOIUrl":"https://doi.org/10.5600/mmrr.001.03.a02","url":null,"abstract":"<p><strong>Background: </strong>Persistent uncertainty remains regarding assessments of patient comorbidity based on administrative data for mortality risk adjustment. Some models include comorbid conditions that are associated with improved mortality while other models exclude these so-called paradoxical conditions. The impact of these conditions on patient risk assessments is unknown.</p><p><strong>Objective: </strong>To examine trends in the prevalence of conditions with a paradoxical (protective) relationship with mortality, and the impact of including these conditions on assessments of risk adjusted mortality.</p><p><strong>Methods: </strong>Patients age 65 and older admitted for acute myocardial infarction (AMI) or coronary artery bypass graft (CABG) surgery during 1994 through 2005 were identified in Medicare Part A files. Comorbid conditions defined using a common algorithm were categorized as having a paradoxical or non-paradoxical relationship with 30-day mortality, based upon regression coefficients in multivariable logistic regression models.</p><p><strong>Results: </strong>For AMI, the proportion of patients with one or more paradoxical condition and one or more non-paradoxical condition increased by 24% and 3% respectively between 1994 and 2005. The odds of death for patients with one-or-more paradoxical comorbidities, relative to patients with no paradoxical comorbidity, declined from 0.69 to 0.54 over the study period. In contrast, the risk associated with having one or more non-paradoxical comorbidities increased from 2.66 to 4.62 for AMI. This pattern was even stronger for CABG. Risk adjustment models that included paradoxical comorbidities found larger improvements, in risk-adjusted mortality for AMI and CABG, over time than models that did not include paradoxical comorbidities.</p><p><strong>Conclusion: </strong>The relationship between individual comorbid conditions and mortality is changing over time, with potential impact on estimates of hospital performance and trends in mortality. Development of a standard approach for handling conditions with a paradoxical relationship to mortality is needed.</p>","PeriodicalId":89601,"journal":{"name":"Medicare & medicaid research review","volume":"1 3","pages":"E1-17"},"PeriodicalIF":0.0,"publicationDate":"2011-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4010616/pdf/mmrr2011-001-03-a02.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30464432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How does the volume of post-acute care respond to changes in the payment rate?","authors":"Chapin White,&nbsp;Nguyen Nguyen","doi":"10.5600/mmrr.001.03.a01","DOIUrl":"https://doi.org/10.5600/mmrr.001.03.a01","url":null,"abstract":"<p><strong>Objective: </strong>Measure the effect of changes from 1997 to 2001 in Medicare's payment rates for skilled nursing facilities (SNFs) on the volume of SNF services and services in other settings.</p><p><strong>Methods: </strong>This study uses as its source of variation in payment rates the substantial changes that occurred as a result of the Balanced Budget Act of 1997. SNF volume equals the number of Medicare-covered SNF days per fee-for-service beneficiary per year, measured at the level of the hospital service area.</p><p><strong>Results: </strong>The estimated elasticity of SNF volume with respect to SNF payment rates is 0.13, meaning that an increase in SNF payment rates is associated with an increase in SNF volume and a decrease in payment rates is associated with a decrease in volume-this implies that SNFs exhibit a normal supply curve, consistent with standard economic theory. In an extension of our main analysis, we find that volume changes appear to be driven largely by facility openings and closures. Among facilities that remained open throughout the study period, volume responses were influenced by changes in the number of admissions (rather than length of stay) and changes in payer mix (rather than changes in capacity). We also find that changes in SNF volume primarily reflect net changes in total days of Medicare-covered institutional care, rather than substitution of one setting for another.</p>","PeriodicalId":89601,"journal":{"name":"Medicare & medicaid research review","volume":"1 3","pages":"E1-22"},"PeriodicalIF":0.0,"publicationDate":"2011-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4010618/pdf/mmrr2011-001-03-a01.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30464431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of the transition to ICD-10 on Medicare inpatient hospital payments.","authors":"Ronald E Mills,&nbsp;Rhonda R Butler,&nbsp;Elizabeth C McCullough,&nbsp;Mona Z Bao,&nbsp;Richard F Averill","doi":"10.5600/mmrr.001.02.a02","DOIUrl":"https://doi.org/10.5600/mmrr.001.02.a02","url":null,"abstract":"<p><strong>Objective: </strong>On October 1, 2013, the reporting of diagnoses and procedures in the U.S. will transition from the clinical modification of the ninth revision of the International Classification of Diseases (ICD-9-CM) to the tenth revision (ICD-10). We estimate the impact of conversion to ICD-10 on Medicare MS-DRG payments to hospitals using 2009 Medicare data.</p><p><strong>Methods: </strong>Using the ICD-9-CM MS-DRG v27 (FY 2010), the converted ICD-10 MS-DRG v27, and the ICD-10 to ICD-9-CM Reimbursement Map for fiscal year 2010, we estimate the impact on aggregate payments to hospitals and the distribution of payments across hospitals.</p><p><strong>Results: </strong>Although the transition from the ICD-9-CM to the ICD-10 version of MS-DRGs resulted in 1.68 percent of the patients being assigned to a different MS-DRG, payment increases and decreases due to the changes in MS-DRG assignment essentially netted out, resulting in a minimal impact on aggregate payments to hospitals (+0.05 percent) and on the distribution of payments across hospital types (-0.01 to +0.18 percent). Mapping ICD-10 data back to ICD-9-CM, and using the ICD-9-CM MS-DRGs, resulted in 3.66 percent of patients being assigned to a different MS-DRG, a modest decrease in aggregate payments to hospitals (-0.34 percent), and modest changes in the distribution of payments across hospital types (-0.14 to -0.46 percent).</p><p><strong>Discussion: </strong>As demonstrated by MS-DRGs, a direct conversion of an application to ICD-10 can produce consistent results with the ICD-9-CM version of the application. However, the use of mappings between ICD-10 and ICD-9-CM will produce less consistent results, especially if the mapping is not tailored to the specific application.</p>","PeriodicalId":89601,"journal":{"name":"Medicare & medicaid research review","volume":"1 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2011-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4010447/pdf/mmrr2011-001-02-a02.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30464430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physician willingness and resources to serve more Medicaid patients: perspectives from primary care physicians.","authors":"Anna S Sommers,&nbsp;Julia Paradise,&nbsp;Carolyn Miller","doi":"10.5600/mmrr.001.02.a01","DOIUrl":"https://doi.org/10.5600/mmrr.001.02.a01","url":null,"abstract":"<p><strong>Objective: </strong>Sixteen million people will gain Medicaid under health reform. This study compares primary care physicians (PCPs) on reported acceptance of new Medicaid patients and practice characteristics.</p><p><strong>Data and methods: </strong>Sample of 1,460 PCPs in outpatient settings was drawn from a 2008 nationally representative survey of physicians. PCPs were classified into four categories based on distribution of practice revenue from Medicaid and Medicare and acceptance of new Medicaid patients. Fifteen in-depth telephone interviews supplemented analysis.</p><p><strong>Findings: </strong>Most high- and moderate-share Medicaid PCPs report accepting \"all\" or \"most\" new Medicaid patients. High-share Medicaid PCPs were more likely than others to work in hospital-based practices (20%) and health centers (18%). About 30% of high- and moderate-share Medicaid PCPs worked in practices with a hospital ownership interest. Health IT use was similar between these two groups and high-share Medicare PCPs, but more high- and moderate-share Medicaid PCPs provided interpreters and non-physician staff for patient education. Over 40% of high- and moderate-share Medicaid PCPs reported inadequate patient time as a major problem. Low- and no-share Medicaid PCPs practiced in higher-income areas than high-share Medicaid PCPs. In interviews, difficulty arranging specialist care, reimbursement, and administrative hassles emerged as reasons for limiting Medicaid patients.</p><p><strong>Policy implications: </strong>PCPs already serving Medicaid are positioned to expand capacity but also face constraints. Targeted efforts to increase their capacity could help. Acceptance of new Medicaid patients under health reform will hinge on multiple factors, not payment alone. Trends toward hospital ownership could increase practices' capacity and willingness to serve Medicaid.</p>","PeriodicalId":89601,"journal":{"name":"Medicare & medicaid research review","volume":"1 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2011-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4010445/pdf/mmrr2011-001-02-a01.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30464429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Public-private substitution among Medicaid adults: evidence from Ohio.","authors":"Eric E Seiber,&nbsp;Timothy R Sahr","doi":"10.5600/mmrr.001.01.a01","DOIUrl":"https://doi.org/10.5600/mmrr.001.01.a01","url":null,"abstract":"<p><strong>Unlabelled: </strong>OBJECTIVE To estimate substitution from private insurance to public coverage among adult Medicaid enrollees.</p><p><strong>Data sources: </strong>2004 and 2008 Ohio Family Health Surveys (OFHS) STUDY DESIGN: Substitution is estimated from respondents' self-reported current insurance coverage and coverage prior to Medicaid enrollment. A linear probability model estimates the association between prior private coverage and respondent characteristics.</p><p><strong>Data collection/extraction methods: </strong>Random digit dialing telephone survey of 50,944 Ohio residents in 2008-2009 and 39,953 in 2003-2004.</p><p><strong>Principal findings: </strong>Few adult Medicaid enrollees in Ohio voluntarily replace their private coverage with Medicaid. In 2008, only 2.9% of new Medicaid adults voluntarily substituted public for private coverage (4.6% in 2004). Of these 2.9% who voluntarily substituted from private to public coverage, 38% reported that they could not afford their employer sponsored plan. The multivariate results for all private to Medicaid transitions find few significant differences, other than income, in the probability of transition.</p><p><strong>Conclusions: </strong>Few transitions from private coverage to Medicaid are voluntary, and substitution is a minor issue among current Ohio Medicaid adults.</p>","PeriodicalId":89601,"journal":{"name":"Medicare & medicaid research review","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2011-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4010449/pdf/mmrr2011-001-01-a01.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30465084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}