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1.
Health Aff (Millwood) ; 43(3): 318-326, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38437601

RESUMO

Nursing home ownership has become increasingly complicated, partly because of the growth of facilities owned by institutional investors such as private equity (PE) firms and real estate investment trusts (REITs). Although the ownership transparency and accountability of nursing homes have historically been poor, the Biden administration's nursing home reform plans released in 2022 included a series of data releases on ownership. However, our evaluation of the newly released data identified several gaps: One-third of PE and fewer than one-fifth of REIT investments identified in the proprietary Irving Levin Associates and S&P Capital IQ investment data were present in Centers for Medicare and Medicaid Services (CMS) publicly available ownership data. Similarly, we obtained different results when searching for the ten top common owners of nursing homes using CMS data and facility survey reports of chain ownership. Finally, ownership percentages were missing in the CMS data for 82.40 percent of owners in the top ten chains and 55.21 percent of owners across all US facilities. Although the new data represent an important step forward, we highlight additional steps to ensure that the data are timely, accurate, and responsive. Transparent ownership data are fundamental to understanding the adequacy of public payments to provide patient care, enable policy makers to make timely decisions, and evaluate nursing home quality.


Assuntos
Medicare , Propriedade , Idoso , Estados Unidos , Humanos , Centers for Medicare and Medicaid Services, U.S. , Casas de Saúde , Instituições de Cuidados Especializados de Enfermagem
2.
Pharmacoepidemiol Drug Saf ; 33(3): e5772, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38449020

RESUMO

PURPOSE: In the United States, the National Death Index (NDI) is the most complete source of death information, while epidemiologic studies with mortality outcomes often rely on U.S. Medicare data for outcome ascertainment. The purpose of this study was to assess the agreement of death information between the Centers for Medicare & Medicaid Services (CMS) Medicare enrolment data and NDI. METHODS: Using Medicare and NDI data from 1999 through 2016, we identified Medicare beneficiaries who were reported dead in the CMS Medicare enrolment database (EDB) and Common Medicare Environment (CME), linked these beneficiaries to the NDI using CMS Health Insurance Claim number, and compared death dates between the two data sources. To assess agreement between our data sources, we calculated kappa scores; where a kappa of 1 indicates perfect agreement and a kappa of 0 indicates agreement equivalent to chance. We also examined CMS to NDI linkage and death date matching for stability over time. RESULTS: Of the 36 785 640, Medicare beneficiaries reported dead in CMS enrollment data from 1999 to 2016, 97.5% were linked to the NDI. A kappa score of 0.98 showed a near perfect agreement between NDI and CMS reported deaths. The percentage of linked cases exactly matching on death dates increased from 94.8% in 1999 to 99.4% in 2016. CONCLUSIONS: Our findings suggest strong concordance between death dates as recorded by CMS enrollment data and the NDI in the entire Medicare population.


Assuntos
Medicare , Idoso , Humanos , Estados Unidos/epidemiologia , Centers for Medicare and Medicaid Services, U.S. , Bases de Dados Factuais
4.
BMJ Open ; 14(2): e079351, 2024 02 05.
Artigo em Inglês | MEDLINE | ID: mdl-38316594

RESUMO

OBJECTIVES: In the USA and UK, pandemic-era outcome data have been excluded from hospital rankings and pay-for-performance programmes. We assessed the relationship between US hospitals' pre-pandemic Centers for Medicare and Medicaid Services (CMS) Overall Hospital Star ratings and early pandemic 30-day mortality among both patients with COVID and non-COVID to understand whether pre-existing structures, processes and outcomes related to quality enabled greater pandemic resiliency. DESIGN AND DATA SOURCE: A retrospective, claim-based data study using the 100% Inpatient Standard Analytic File and Medicare Beneficiary Summary File including all US Medicare Fee-for-Service inpatient encounters from 1 April 2020 to 30 November 2020 linked with the CMS Hospital Star Ratings using six-digit CMS provider IDs. OUTCOME MEASURE: The outcome was risk-adjusted 30-day mortality. We used multivariate logistic regression adjusting for age, sex, Elixhauser mortality index, US Census Region, month, hospital-specific January 2020 CMS Star rating (1-5 stars), COVID diagnosis (U07.1) and COVID diagnosis×CMS Star Rating interaction. RESULTS: We included 4 473 390 Medicare encounters from 2533 hospitals, with 92 896 (28.2%) mortalities among COVID-19 encounters and 387 029 (9.3%) mortalities among non-COVID encounters. There was significantly greater odds of mortality as CMS Star Ratings decreased, with 18% (95% CI 15% to 22%; p<0.0001), 33% (95% CI 30% to 37%; p<0.0001), 38% (95% CI 34% to 42%; p<0.0001) and 60% (95% CI 55% to 66%; p<0.0001), greater odds of COVID mortality comparing 4-star, 3-star, 2-star and 1-star hospitals (respectively) to 5-star hospitals. Among non-COVID encounters, there were 17% (95% CI 16% to 19%; p<0.0001), 24% (95% CI 23% to 26%; p<0.0001), 32% (95% CI 30% to 33%; p<0.0001) and 40% (95% CI 38% to 42%; p<0.0001) greater odds of mortality at 4-star, 3-star, 2-star and 1-star hospitals (respectively) as compared with 5-star hospitals. CONCLUSION: Our results support a need to further understand how quality outcomes were maintained during the pandemic. Valuable insights can be gained by including the reporting of risk-adjusted pandemic era hospital quality outcomes for high and low performing hospitals.


Assuntos
COVID-19 , Humanos , Idoso , Estados Unidos/epidemiologia , COVID-19/epidemiologia , Pandemias , Medicare , Estudos Retrospectivos , Centers for Medicare and Medicaid Services, U.S. , Reembolso de Incentivo , Hospitais
6.
Pancreas ; 53(2): e176-e179, 2024 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-38194634

RESUMO

OBJECTIVE: Pancreata recovered for research are included as a success (or positive) in the Centers for Medicare and Medicaid Services' (CMS) donation and organ transplantation rate metrics for recertification of organ procurement organizations (OPOs). MATERIALS AND METHODS: Given these metrics directly incentivize recovery of pancreata for research, this study tracks trends in recovery of pancreata for research across the implementation of the CMS metrics. RESULTS: In the 26 months before the December 2, 2020, publication of the CMS metrics, research pancreata as a percent of organs transplanted, including research pancreata, was 1.7% nationally, including as much as 10.8% of organs transplanted within any OPO. In the 26 months after the CMS metrics were published, research pancreata increased to 5.1% of organs counted as transplants nationally, including as much as 20.3% within any OPO. If research pancreata were excluded from the CMS metrics, 6 OPOs would change their CMS evaluation status for recertification purposes: 2 would move up a tier and 4 would move down a tier. CONCLUSIONS: Procurement of research pancreata has increased since the publication of the CMS performance metrics, OPOs vary in their recovery of pancreata for research, and recovery of pancreata for research can affect recertification of OPOs.


Assuntos
Transplante de Órgãos , Obtenção de Tecidos e Órgãos , Idoso , Humanos , Estados Unidos , Centers for Medicare and Medicaid Services, U.S. , Medicare , Doadores de Tecidos
7.
Crit Care Med ; 52(3): 357-361, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38180116

RESUMO

Centers for Medicare and Medicaid Services imparts financial penalties for central line-associated bloodstream infections (CLABSIs) and other healthcare-acquired infections. Data for this purpose is obtained from the Centers for Disease Control and Prevention (CDC)'s National Health Safety Network. We present examples of misclassification of bloodstream infections into CLABSI by the CDC's definition and present the financial implications of such misclassification and potential long-term implications.


Assuntos
Bacteriemia , Infecções Relacionadas a Cateter , Cateterismo Venoso Central , Infecção Hospitalar , Sepse , Idoso , Humanos , Estados Unidos , Infecções Relacionadas a Cateter/diagnóstico , Infecções Relacionadas a Cateter/prevenção & controle , Medicare , Sepse/diagnóstico , Sepse/prevenção & controle , Centers for Medicare and Medicaid Services, U.S. , Infecção Hospitalar/prevenção & controle , Cateterismo Venoso Central/efeitos adversos , Bacteriemia/diagnóstico , Bacteriemia/prevenção & controle , Controle de Infecções
9.
Am J Hosp Palliat Care ; 41(3): 302-308, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-37194055

RESUMO

Hospice care facilities are required to provide prescription drugs related to a hospice patient's terminal illness. From October 2010 to present, the Center for Medicare and Medicaid Services (CMS) has issued a series of communications regarding Medicare paying for hospice patients' prescription drugs under Part D that should be covered under the hospice Medicare Part A benefit. On April 4, 2011, CMS issued specific policy guidance to providers aimed at preventing inappropriate billing. While CMS has documented Part D prescription decreases in hospice patients, no research exists that connects these decreases and the policy guidance. This study aims to evaluate the effect of the April 4, 2011, policy guidance on hospice patients' Part D prescriptions. This study employed generalized estimating equations to assess (1) total monthly average prescriptions of all medications and (2) four categories of commonly prescribed hospice medications in pre-and-post policy guidance. This research used the Medicare claims of 113,260 Part D-enrolled Medicare male patients aged 66 and older between April 2009 and March 2013, including 110,547 non-hospice patients and 2713 hospice patients. Hospice patients' monthly average total Part D prescriptions decreased from 7.3 pre-policy guidance to 6.5 medications following the issuing of the guidance, while the four categories of hospice-specific medications decreased from .57 to .49. The findings of this study show that CMS's guidance issued to providers to prevent the inappropriate billing of hospice patients' prescriptions to the Part D benefit may lead to Part D prescription decreases as observed in this sample.


Assuntos
Hospitais para Doentes Terminais , Medicare Part D , Medicamentos sob Prescrição , Humanos , Masculino , Idoso , Estados Unidos , Feminino , Medicaid , Centers for Medicare and Medicaid Services, U.S. , Prescrições de Medicamentos , Políticas
10.
J Manag Care Spec Pharm ; 30(3): 218-225, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38088899

RESUMO

Under the 2022 Inflation Reduction Act, the Centers for Medicare and Medicaid Services (CMS) are able to negotiate prices for topselling drugs in the Medicare Part B and D programs. In determining initial price offers, CMS will compare the prices and clinical benefits of the drugs subject to negotiation to the prices and clinical benefits of therapeutic alternatives. Despite the central role that the selection of therapeutic alternatives will play in the price negotiations, the available guidance published by CMS provides few details about how the organization will undertake this process, which will be particularly complex for drugs approved for more than one indication. To better inform the selection process, we identified all US Food and Drug Administration-approved indications for the first 10 drugs subject to negotiation. Using 2020-2021 Medicare claims data, we identified Medicare Part D beneficiaries using each of the 10 drugs. We extracted medical claims with diagnosis codes for each of the approved indications to report the relative treated prevalence of use by indication for each drug. We reviewed published clinical guidelines to identify relevant therapeutic alternatives for each of the indications. We integrated the evidence on the relative treated prevalence of indications and clinical guidelines to propose therapeutic alternatives for each of the 10 drugs. We describe challenges that CMS may face in selecting therapeutic alternatives.


Assuntos
Medicare Part B , Medicare Part D , Idoso , Estados Unidos , Humanos , Negociação , Centers for Medicare and Medicaid Services, U.S. , United States Food and Drug Administration
11.
AMA J Ethics ; 25(12): E901-908, 2023 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-38085993

RESUMO

When physicians admit patients to a hospital, their decisions about where-and to whose professional stewardship and services-those patients belong are influenced by federal policies, of which many clinicians are not aware. The distinction between observation and admission has clinical and ethical implications for patients and practices. The evolution of "observation status" from a clinical tool to a catchall of vague and imprecise meaning has been driven by changes to physician payment and compensation structures, particularly Current Procedural Terminology codes and Centers for Medicare and Medicaid Services regulations, and its current value to clinicians and patients is questionable. This article contextualizes clinicians' admission and observation practices and considers how metrics influence patient costs and how clinicians and organizations are compensated.


Assuntos
Hospitalização , Medicare , Idoso , Humanos , Estados Unidos , Hospitais , Centers for Medicare and Medicaid Services, U.S. , Custos e Análise de Custo
12.
Dermatol Surg ; 49(12): 1170-1173, 2023 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-37910514

RESUMO

BACKGROUND: There are limited data on female Mohs surgeon industry relationships. OBJECTIVE: To evaluate industry payment activity between female and male Mohs surgeons. MATERIALS AND METHODS: A retrospective review of the U.S. Centers for Medicare and Medicaid Services open payments data was performed between 2015 and 2021 for Mohs surgeons in the United States. Gender, academic affiliation, practice region, annual total payment, cumulative payment, and industry payment type was collected. RESULTS: Male Mohs surgeons received higher mean total payments than female Mohs surgeons ( p = .04), which persisted when data were stratified based on industry payment type and practice region. Both genders had similar median total payments ( p = .4). Females in academic practice received higher mean total payments than those in private practice. Females experienced a significant lower mean total payment compared with males in the South ( p = .03). CONCLUSION: High total payments received by male Mohs surgeons skewed the data, which is supported by a significant mean total payment difference despite a similar median total payment distribution. Female Mohs surgeons receiving the top payments may address this mean payment difference. Females seem to have higher payments if they practice in the Northeast and are in academics. Further studies are needed to evaluate this payment gap.


Assuntos
Medicare , Cirurgiões , Idoso , Humanos , Masculino , Feminino , Estados Unidos , Bases de Dados Factuais , Estudos Retrospectivos , Centers for Medicare and Medicaid Services, U.S.
13.
Pain Physician ; 26(7): 503-525, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-37976475

RESUMO

Evaluation of new and established patients is an integral part of interventional pain management. Over the last 3 decades, there has been significant confusion over the proper documentation for evaluation and management (E/M) services in general and for interventional pain management in particular. Interventional pain physicians have learned how to evaluate patients presenting with pain on the basis of their specialty training. Although modern training programs are introducing residents and fellows to the intricacies of E/M services and federal regulations, this has not always been the case. Multiple textbooks about pain management, physiatry, and neurology, and numerous journal articles have described the evaluation of pain patients, but they have not been specific to chronic pain patients and may not meet the regulatory perspective.A multitude of these issues led to the development of guidelines in 1995 and 1997, which were highly complicated and difficult to follow. These also led to significant criticism from clinicians. Consequently, further guidance was developed to be effective January 2021.The crucial concept in the present system of coding for E/M services is medical decision making, which includes 3 elements since 2021: 1.The number and complexity of problems addressed. 2. Amount or complexity of data to be reviewed and analyzed. 3. Risk of complications and/or morbidity or mortality of patient management. In order to select a level of E/M service, 2 of the 3 elements of medical decision making (MDM) must be met or exceeded. This is in contrast to prior guidelines wherein for new patients, all 3 elements with history, physical examination and MDM , and for established patients have been met. For ease of appreciation, an algorithmic approach created by the American Medical Association (AMA), and Centers for Medicare and Medicaid Services (CMS) approved a new MDM table outlining all of the appropriate criteria.This review systematically describes the changes and provides an algorithmic approach for application in interventional pain management practices.


Assuntos
Dor Crônica , Manejo da Dor , Idoso , Humanos , Estados Unidos , Medicare , Dor Crônica/diagnóstico , Dor Crônica/terapia , Documentação , Centers for Medicare and Medicaid Services, U.S.
14.
Surg Obes Relat Dis ; 19(12): 1331-1338, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37891102

RESUMO

This position statement is issued by the American Society for Metabolic and Bariatric. Surgery in response to inquiries made to the Society by patients, physicians, Society members, hospitals, health insurance payors, the media, and others regarding the access and outcomes of metabolic and bariatric surgery for beneficiaries of Centers for Medicare and Medicaid Services. This position statement is based on current clinical knowledge, expert opinion, and published peer-reviewed scientific evidence available at this time. The statement is not intended to be and should not be construed as stating or establishing a local, regional, or national standard of care. This statement will be revised in the future as additional evidence becomes available.


Assuntos
Cirurgia Bariátrica , Medicare , Idoso , Humanos , Estados Unidos , Centers for Medicare and Medicaid Services, U.S.
15.
JAMA Health Forum ; 4(10): e233557, 2023 Oct 06.
Artigo em Inglês | MEDLINE | ID: mdl-37862031

RESUMO

This Viewpoint discusses the CMS approach to incentivize excellent care for underserved populations.


Assuntos
Centers for Medicare and Medicaid Services, U.S. , Equidade em Saúde , Estados Unidos
16.
J Comp Eff Res ; 12(11): e230125, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-37815792

RESUMO

Aim: To evaluate the availability of published comparative real-world evidence (RWE) studies in Medicare patients for the ten drugs set to undergo Centers for Medicare and Medicaid Services (CMS) price negotiations in 2026. Materials & methods: A scoping review was completed in MEDLINE/PubMed to evaluate the availability of comparative RWE investigations conducted among Medicare-eligible patient populations in the US for the following drugs: apixaban, rivaroxaban, sitagliptin, ibrutinib, empagliflozin, etanercept, dapagliflozin, sacubitril/valsartan, ustekinumab and insulin aspart. Results: Of the 170 real-world comparative studies identified, 55 (32.4%) used Medicare real-world data (RWD) while 34 (20.0%) used commercial claims data in conjunction with either Medicare Advantage or Medicare Supplementary databases. The number of studies varied considerably by drug with apixaban and rivaroxaban studies accounting for the majority (i.e., 67.1%) of comparative RWE studies. Approximately a third or less of the comparative RWE studies were conducted in CMS RWD per drug. Conclusion: Our results demonstrate there is a considerable amount of comparative RWE for apixaban, rivaroxaban, and etanercept but limited comparative RWE for the other drugs set to undergo CMS price negotiations in 2026; additionally, our findings set up a number of next steps (e.g., risk of bias assessments) for further exploration of the available evidence base. Overall, CMS and manufacturers should consider proactively generating high-quality comparative RWE studies in the Medicare population to ensure that future price negotiations are based on robust evidence.


Assuntos
Medicare , Rivaroxabana , Idoso , Humanos , Estados Unidos , Rivaroxabana/efeitos adversos , Negociação , Centers for Medicare and Medicaid Services, U.S. , Etanercepte
17.
Health Aff (Millwood) ; 42(9): 1298-1303, 2023 09.
Artigo em Inglês | MEDLINE | ID: mdl-37669494

RESUMO

Of people appointed to the Department of Health and Human Services between 2004 and 2020, 15 percent had been employed in private industry immediately before their appointment. At the end of their tenure, 32 percent exited to industry. The greatest net exits to industry were from the Centers for Disease Control and Prevention and the Centers for Medicare and Medicaid Services.


Assuntos
Instalações de Saúde , Medicare , Idoso , Estados Unidos , Humanos , Centers for Disease Control and Prevention, U.S. , Centers for Medicare and Medicaid Services, U.S.
19.
JAMA Netw Open ; 6(9): e2332395, 2023 09 05.
Artigo em Inglês | MEDLINE | ID: mdl-37672275

RESUMO

This cohort study examines changes in research pancreas procurement from deceased donors before and after the Centers for Medicare & Medicaid Services (CMS) updated its Final Rule in November 2020.


Assuntos
Pâncreas , Obtenção de Tecidos e Órgãos , Humanos , Centers for Medicare and Medicaid Services, U.S. , Estados Unidos , Obtenção de Tecidos e Órgãos/legislação & jurisprudência
20.
BMC Health Serv Res ; 23(1): 955, 2023 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-37674152

RESUMO

BACKGROUND: The post-acute patient standardized functional items (Section GG) include non-response options such as refuse, not attempt and not applicable. We examined non-response patterns and compared four methods to address non-response functional data in Section GG at nation-wide inpatient rehabilitation facilities (IRF). METHODS: We characterized non-response patterns using 100% Medicare 2018 data. We applied four methods to generate imputed values for each non-response functional item of each patient: Monte Carlo Markov Chains multiple imputations (MCMC), Fully Conditional Specification multiple imputations (FCS), Pattern-mixture model (PMM) multiple imputations and the Centers for Medicare and Medicaid Services (CMS) approach. We compared changes of Spearman correlations and weighted kappa between Section GG and the site-specific functional items across impairments before and after applying four methods. RESULTS: One hundred fifty-nine thousand six hundred ninety-one Medicare fee-for-services beneficiaries admitted to IRFs with stroke, brain dysfunction, neurologic condition, orthopedic disorders, and debility. At discharge, 3.9% (self-care) and 61.6% (mobility) of IRF patients had at least one non-response answer in Section GG. Patients tended to have non-response data due to refused at discharge than at admission. Patients with non-response data tended to have worse function, especially in mobility; also improved less functionally compared to patients without non-response data. Overall, patients coded as 'refused' were more functionally independent in self-care and patients coded as 'not applicable' were more functionally independent in transfer and mobility, compared to other non-response answers. Four methods showed similar changes in correlations and agreements between Section GG and the site-specific functional items, but variations exist across impairments between multiple imputations and the CMS approach. CONCLUSIONS: The different reasons for non-response answers are correlated with varied functional status. The high proportion of patients with non-response data for mobility items raised a concern of biased IRF quality reporting. Our findings have potential implications for improving patient care, outcomes, quality reporting, and payment across post-acute settings.


Assuntos
Medicare , Doenças Musculoesqueléticas , Estados Unidos , Humanos , Idoso , Centers for Medicare and Medicaid Services, U.S. , Hospitalização , Cadeias de Markov
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