Medicare & medicaid research review最新文献

{"title":"Impacts of generic competition and benefit management practices on spending for prescription drugs: evidence from Medicare's Part D benefit.","authors":"Steven Sheingold,&nbsp;Nguyen Xuan Nguyen","doi":"10.5600/mmrr.004.01.a01","DOIUrl":"https://doi.org/10.5600/mmrr.004.01.a01","url":null,"abstract":"<p><strong>Objective: </strong>This study estimates the effects of generic competition, increased cost-sharing, and benefit practices on utilization and spending for prescription drugs.</p><p><strong>Data and methods: </strong>We examined changes in Medicare price and utilization from 2007 to 2009 of all drugs in 28 therapeutic classes. The classes accounted for 80% of Medicare Part D spending in 2009 and included the 6 protected classes and 6 classes with practically no generic competition. All variables were constructed to measure each drug relative to its class at a specific plan sponsor.</p><p><strong>Results: </strong>We estimated that the shift toward generic utilization had cut in half the rate of increase in the price of a prescription during 2007-2009. Specifically, the results showed that (1) rapid generic penetration had significantly held down costs per prescription, (2) copayment and other benefit practices shifted utilization to generics and favored brands, and (3) price increases were generally greater in less competitive classes of drugs.</p><p><strong>Conclusion: </strong>In many ways, Part D was implemented at a fortuitous time; since 2006, there have been relatively few new blockbuster drugs introduced, and many existing high-volume drugs used by beneficiaries were in therapeutic classes with multiple brands and generic alternatives. Under these conditions, our paper showed that plan sponsors have been able to contain costs by encouraging use of generics or drugs offering greater value within therapeutic classes. It is less clear what will happen to future Part D costs if a number of new and effective drugs for beneficiaries enter the market with no real competitors.</p>","PeriodicalId":89601,"journal":{"name":"Medicare & medicaid research review","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2014-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4049516/pdf/mmrr2014-004-01-a01.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32413611","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":"Examination of the accuracy of coding hospital-acquired pressure ulcer stages.","authors":"Nicole M Coomer,&nbsp;Nancy T McCall","doi":"10.5600/mmrr.003.04.b03","DOIUrl":"https://doi.org/10.5600/mmrr.003.04.b03","url":null,"abstract":"<p><strong>Objective: </strong>Pressure ulcers (PU) are considered harmful conditions that are reasonably prevented if accepted standards of care are followed. They became subject to the payment adjustment for hospitalacquired conditions (HACs) beginning October 1, 2008. We examined several aspects of the accuracy of coding for pressure ulcers under the Medicare Hospital-Acquired Condition Present on Admission (HAC-POA) Program. We used the \"4010\" claim format as a basis of reference to show some of the issues of the old format, such as the underreporting of pressure ulcer stages on pressure ulcer claims and how the underreporting varied by hospital characteristics. We then used the rate of Stage III and IV pressure ulcer HACs reported in the Hospital Cost and Utilization Project State Inpatient Databases data to look at the sensitivity of PU HAC-POA coding to the number of diagnosis fields.</p><p><strong>Methods: </strong>We examined Medicare claims data for FYs 2009 and 2010 to examine the degree that the presence of stage codes were underreported on pressure ulcer claims. We selected all claims with a secondary diagnosis code of pressure ulcer site (ICD-9 diagnosis codes 707.00-707.09) that were not reported as POA (POA of \"N\" or \"U\"). We then created a binary indicator for the presence of any pressure ulcer stage diagnosis code. We examine the percentage of claims with a diagnosis of a pressure ulcer site code with no accompanying pressure ulcer stage code.</p><p><strong>Results: </strong>Our results point to underreporting of PU stages under the \"4010\" format and that the reporting of stage codes varied across hospital type and location. Further, our results indicate that under the \"5010\" format, a higher number of pressure ulcer HACs can be expected to be reported and we should expect to encounter a larger percentage of pressure ulcers incorrectly coded as POA under the new format.</p><p><strong>Conclusions: </strong>The combination of the capture of 25 diagnosis codes under the new \"5010\" format and the change from ICD-9 to ICD-10 will likely alleviate the observed underreporting of pressure ulcer HACs. However, as long as coding guidelines direct that Stage III and IV pressure ulcers be coded as POA, if a lower stage pressure ulcer was POA and progressed to a higher stage pressure ulcer during the admission, the acquisition of Stage III and IV pressure ulcers in the hospital will be underreported.</p>","PeriodicalId":89601,"journal":{"name":"Medicare & medicaid research review","volume":"3 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2013-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4011644/pdf/mmrr2013-003-04-b03.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32346361","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":"Migration patterns for Medicaid enrollees 2005-2007.","authors":"David K Baugh,&nbsp;Shinu Verghese","doi":"10.5600/mmrr.003.04.b02","DOIUrl":"https://doi.org/10.5600/mmrr.003.04.b02","url":null,"abstract":"<p><strong>Background: </strong>Although Medicaid is a federal program, it is administered primarily by the states. Enrollees move from state to state, but their migration patterns have remained largely unknown. There are concerns about the possibility of enrollment gaps, lack of health insurance coverage, breaks in continuity of care, unmet need, risks to health status, and increased system-wide costs due to uncompensated care and the use of higher cost emergency room services because of enrollment gaps. There is also concern about the extent to which people enrolled in more than one state are double counted.</p><p><strong>Objective: </strong>To examine the migration of Medicaid enrollees across states.</p><p><strong>Methods: </strong>We use 2005-2007 Medicaid enrollment records that were unduplicated and linked across states and over the study period. We report descriptive statistics on enrollee migration across states.</p><p><strong>Results: </strong>Among all enrollees, 3.7 percent moved to another state at least once and most moved only once. Overall, 72.2 percent of moves did not result in an enrollment gap, whereas 8.2 percent of moves resulted in gaps of fewer than three months, and 11.4 percent of moves resulted in gaps of more than six months.</p><p><strong>Conclusions: </strong>These initial findings provide a context for further examining the consequences of enrollee moves on their health and on program expenditures. The consequences of enrollment gaps will become increasingly important as the Medicaid population grows under the provisions of the Affordable Care Act.</p>","PeriodicalId":89601,"journal":{"name":"Medicare & medicaid research review","volume":"3 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2013-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4011649/pdf/mmrr2013-003-04-b02.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32347833","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":"Asthma medication ratio predicts emergency department visits and hospitalizations in children with asthma.","authors":"Annie Lintzenich Andrews,&nbsp;Annie N Simpson,&nbsp;William T Basco,&nbsp;Ronald J Teufel","doi":"10.5600/mmrr.003.04.a05","DOIUrl":"https://doi.org/10.5600/mmrr.003.04.a05","url":null,"abstract":"<p><strong>Objective: </strong>To determine if the asthma medication ratio predicts subsequent emergency department (ED) visits and hospital admissions in children.</p><p><strong>Design: </strong>Retrospective cohort with two year pairs.</p><p><strong>Setting/participants: </strong>2007-2009 South Carolina Medicaid recipients with persistent asthma age 2-18.</p><p><strong>Main exposure: </strong>Controller-to-total asthma medication ratios were calculated for each patient in 2007 and 2008. Ratios range from 0-1 (1 = ideal, 0 = no controller).</p><p><strong>Outcome measures: </strong>2008 and 2009 asthma related ED visits, hospitalizations, and a combined outcome of ED visit or hospitalization in the subsequent 3, 6, and 12 month time periods.</p><p><strong>Results: </strong>19,512 patients were included. Mean age 8.9 years, 58% male, and 55% black. The ratio significantly predicted ED visits and hospitalizations over subsequent 3, 6, and 12 month time periods. The cut-point that maximized the ability to predict visits ranged from 0.4-0.6. A cutpoint of 0.5 was used in the final models. After controlling for age, race, gender, and rurality, patients with a ratio <0.5 were significantly more likely to have a subsequent emergent healthcare visit (OR 1.5-2.0). The ratio retained its predictive ability in both year-pairs for all three outcome variables, in all three time periods, with the exception of the 2008 ratio not predicting 2009 3-month and 6-month hospitalizations.</p><p><strong>Conclusions: </strong>The asthma medication ratio is a significant predictor of ED visits and hospitalizations in children. Using a cutoff of <0.5 to signal at-risk patients may be an effective way for populations who would benefit from increased use of controller medications to reduce future emergent asthma visits. CPT only copyright XXXX-2012 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. Applicable FARS/DFARS Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. See attached CMS CPT 2013 end user license.</p>","PeriodicalId":89601,"journal":{"name":"Medicare & medicaid research review","volume":"3 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2013-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4011648/pdf/mmrr2013-003-04-a05.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32347832","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":"Telehealth and Medicare: payment policy, current use, and prospects for growth.","authors":"Matlin Gilman, Jeff Stensland","doi":"10.5600/mmrr.003.04.a04","DOIUrl":"10.5600/mmrr.003.04.a04","url":null,"abstract":"<p><strong>Objective: </strong>Evaluate the growth in various types of Medicare-paid telehealth services.</p><p><strong>Background: </strong>There has been a long-standing hope that telehealth could be used to reduce rural patients' travel times to specialty physicians. Medicare covers telehealth services provided through live, interactive videoconferencing between a beneficiary located at a certified rural site and a distant practitioner.</p><p><strong>Methods: </strong>We analyzed 100% of telehealth Medicare claims for 2009 matched to individual patient ZIP codes and individual provider characteristics.</p><p><strong>Results: </strong>Despite increases in Medicare payment rates for telehealth services, expansions of covered services, reductions in provider requirements, and provisions of federal grants to encourage telehealth, growth in adoption of telehealth among providers has been modest. Medicare claims indicate that only 369 providers had 10 or more Medicare telehealth consultations in 2009. Roughly half of the 369 were mental health professionals, and about one-in-five of the 369 were non-physician professionals (e.g., physician assistants and nurse practitioners). On balance, the strong areas of telehealth are mental health and, surprisingly, nonphysician professionals. The comparative advantage of mental health could be the verbal (rather than physical contact) nature of mental health care, and the comparative advantage of non-physician professionals could be their lower labor costs.</p>","PeriodicalId":89601,"journal":{"name":"Medicare & medicaid research review","volume":"3 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2013-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4011650/pdf/mmrr2013-003-04-a04.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32347834","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":"Modeling per capita state health expenditure variation: state-level characteristics matter.","authors":"Gigi Cuckler,&nbsp;Andrea Sisko","doi":"10.5600/mmrr.003.04.a03","DOIUrl":"https://doi.org/10.5600/mmrr.003.04.a03","url":null,"abstract":"<p><strong>Objective: </strong>In this paper, we describe the methods underlying the econometric model developed by the Office of the Actuary in the Centers for Medicare & Medicaid Services, to explain differences in per capita total personal health care spending by state, as described in Cuckler, et al. (2011). Additionally, we discuss many alternative model specifications to provide additional insights for valid interpretation of the model.</p><p><strong>Data source: </strong>We study per capita personal health care spending as measured by the State Health Expenditures, by State of Residence for 1991-2009, produced by the Centers for Medicare & Medicaid Services' Office of the Actuary. State-level demographic, health status, economic, and health economy characteristics were gathered from a variety of U.S. government sources, such as the Census Bureau, Bureau of Economic Analysis, the Centers for Disease Control, the American Hospital Association, and HealthLeaders-InterStudy.</p><p><strong>Principal findings: </strong>State-specific factors, such as income, health care capacity, and the share of elderly residents, are important factors in explaining the level of per capita personal health care spending variation among states over time. However, the slow-moving nature of health spending per capita and close relationships among state-level factors create inefficiencies in modeling this variation, likely resulting in incorrectly estimated standard errors. In addition, we find that both pooled and fixed effects models primarily capture cross-sectional variation rather than period-specific variation.</p>","PeriodicalId":89601,"journal":{"name":"Medicare & medicaid research review","volume":"3 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2013-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4011645/pdf/mmrr2013-003-04-a03.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32346363","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":"Lessons from early Medicaid expansions under health reform: interviews with Medicaid officials.","authors":"Benjamin D Sommers, Emily Arntson, Genevieve M Kenney, Arnold M Epstein","doi":"10.5600/mmrr.003.04.a02","DOIUrl":"10.5600/mmrr.003.04.a02","url":null,"abstract":"<p><strong>Background: </strong>The Affordable Care Act (ACA) dramatically expands Medicaid in 2014 in participating states. Meanwhile, six states have already expanded Medicaid since 2010 to some or all of the low-income adults targeted under health reform. We undertook an in-depth exploration of these six \"early-expander\" states-California, Connecticut, the District of Columbia, Minnesota, New Jersey, and Washington-through interviews with high-ranking Medicaid officials.</p><p><strong>Methods: </strong>We conducted semi-structured interviews with 11 high-ranking Medicaid officials in six states and analyzed the interviews using qualitative methods. Interviews explored enrollment outreach, stakeholder involvement, impact on beneficiaries, utilization and costs, implementation challenges, and potential lessons for 2014. Two investigators independently analyzed interview transcripts and iteratively refined the codebook until reaching consensus.</p><p><strong>Results: </strong>We identified several themes. First, these expansions built upon pre-existing state-funded insurance programs for the poor. Second, predictions about costs and enrollment were challenging, indicating the uncertainty in projections for 2014. Other themes included greater than anticipated need for behavioral health services in the expansion population, administrative challenges of expansions, and persistent barriers to enrollment and access after expanding eligibility-though officials overall felt the expansions increased access for beneficiaries. Finally, political context-support or opposition from stakeholders and voters-plays a critical role in shaping the success of Medicaid expansions.</p><p><strong>Conclusions: </strong>Early Medicaid expansions under the ACA offer important lessons to federal and state policymakers as the 2014 expansions approach. While the context of each state's expansion is unique, key shared experiences were significant implementation challenges and opportunities for expanding access to needed services.</p>","PeriodicalId":89601,"journal":{"name":"Medicare & medicaid research review","volume":"3 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2013-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4015416/pdf/mmrr2013-003-04-a02.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32347835","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":"Accounting for unobservable exposure time bias when using Medicare prescription drug data.","authors":"Elizabeth A Cook,&nbsp;Kathleen M Schneider,&nbsp;Elizabeth Chrischilles,&nbsp;John M Brooks","doi":"10.5600/mmrr.003.04.a01","DOIUrl":"https://doi.org/10.5600/mmrr.003.04.a01","url":null,"abstract":"<p><strong>Objective: </strong>To describe the prevalence and correlates of unobservable medication exposure time, and to recommend approaches for minimizing bias, in studies using Medicare Part D data..</p><p><strong>Sample: </strong>179,065 Medicare patients hospitalized for an AMI in 2007 or 2008.</p><p><strong>Methods: </strong>We compared two methods for creating medication exposure observation periods using acute care discharge vs. post-acute care discharge dates. We examined options for increasing cohort sizes by requiring different thresholds for observable days, or by using as a covariate, in the observation period. We calculated the extent and health status correlates of unobserved Medicare Part D exposure time and examined its association with receipt of beta-blockers.</p><p><strong>Results: </strong>39% of patients had unobservable time during the 30 day exposure assessment period following acute care; they were significantly older, had more comorbidity and longer acute care stays, had worse 1-year survival, and were significantly less likely to be classified as beta-blocker users. Using the alternative exposure assessment window, only 29% of the sample had unobservable time, and differences between groups were less pronounced. Significant gains in sample size can be obtained by restricting or controlling for the number of observable days required in the exposure assessment period.</p><p><strong>Conclusions: </strong>Unobservable exposure time is common among Medicare Part D beneficiaries, and they are often in worse health. To retain patients with unobservable exposure time, we recommend stratifying patients on receipt of post-acute facility-based care, calculating and using observable days as a covariate and, when appropriate, using the discharge date from contiguous post-acute facility care for beginning the exposure assessment period.</p>","PeriodicalId":89601,"journal":{"name":"Medicare & medicaid research review","volume":"3 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2013-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4011646/pdf/mmrr2013-003-04-a01.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32346364","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":"Readiness for meaningful use of health information technology and patient centered medical home recognition survey results.","authors":"Peter Shin,&nbsp;Jessica Sharac","doi":"10.5600/mmrr.003.04.b01","DOIUrl":"https://doi.org/10.5600/mmrr.003.04.b01","url":null,"abstract":"<p><strong>Objective: </strong>Determine the factors that impact HIT use and MU readiness for community health centers (CHCs).</p><p><strong>Background: </strong>The HITECH Act allocates funds to Medicaid and Medicare providers to encourage the adoption of electronic health records (EHR), in an effort to improve health care quality and patient outcomes, and to reduce health care costs.</p><p><strong>Methods: </strong>We surveyed CHCs on their Readiness for Meaningful Use (MU) of Health Information Technology (HIT) and Patient Centered Medical Home (PCMH) Recognition, then we combined responses with 2009 Uniform Data System data to determine which factors impact use of HIT and MU readiness.</p><p><strong>Results: </strong>Nearly 70% of CHCs had full or partial EHR adoption at the time of survey. Results are presented for centers with EHR adoption, by the length of time that their EHR systems have been in operation.</p>","PeriodicalId":89601,"journal":{"name":"Medicare & medicaid research review","volume":"3 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2013-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4011647/pdf/mmrr2013-003-04-b01.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32347831","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":"Medicare non-payment of hospital-acquired infections: infection rates three years post implementation.","authors":"Samuel K Peasah, Niccie L McKay, Jeffrey S Harman, Mona Al-Amin, Robert L Cook","doi":"10.5600/mmrr.003.03.a08","DOIUrl":"10.5600/mmrr.003.03.a08","url":null,"abstract":"<p><strong>Background: </strong>Medicare ceased payment for some hospital-acquired infections beginning October 1, 2008, following provisions in the Medicare Modernization Act of 2003 and the Deficit Reduction Act of 2005.</p><p><strong>Objective: </strong>We examined the association of this policy with declines in rates of vascular catheter-associated infections (VCAI) and catheter-associated urinary tract infection (CAUTI).</p><p><strong>Data: </strong>Discharge data from the Florida Agency for Healthcare Administration from 2007 to 2011.</p><p><strong>Study design: </strong>We compared rates of hospital-acquired vascular catheter-associated infections (HA-VCAI) and catheter-associated urinary tract infections (HA-CAUTI) before and after implementation of the new policy (January 2007 to September 2008 vs. October 2008 to September 2011). This pre-post, retrospective, interrupted time series study was further analyzed with a generalized hierarchical logistic regression, by estimating the probability of a patient acquiring these infections in the hospital, post-policy compared to pre-policy.</p><p><strong>Principal findings: </strong>Pre-policy, 0.12% of admitted patients were diagnosed with CAUTI; of these, 32% were HA-CAUTI. Similarly, 0.24% of admissions were diagnosed as VCAI; of these, 60% were HA-VCAI. Post-policy, 0.16% of admissions were CAUTIs; of these, 31% were HA-CAUTI. Similarly, 0.3% of admissions were VCAIs and, of these, 45% were HA-VCAI. There was a statistically significant decrease in HA-VCAIs (OR: 0.571 (p < 0.0001)) post-policy, but the reduction in HA-CAUTI (OR: 0.968 (p < 0.4484)) was not statistically significant.</p><p><strong>Conclusions: </strong>The results suggest Medicare non payment policy is associated with both a decline in the rate of hospital-acquired VCAI (HA-VCAI) per quarter, and the probability of acquiring HA-VCAI post- policy. The strength of the association could be overestimated, because of concurrent ongoing infection control interventions.</p>","PeriodicalId":89601,"journal":{"name":"Medicare & medicaid research review","volume":"3 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2013-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3983733/pdf/mmrr2013-003-03-a08.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32279960","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}