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1.
MMWR Morb Mortal Wkly Rep ; 68(45): 1020-1023, 2019 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-31725705

RESUMO

Approximately 30 million persons in the United States have diabetes.* Persons with diabetes are at risk for vision loss from diabetic retinopathy and other eye diseases (1). Diabetic retinopathy, the most common diabetes-related eye disease, affects 29% of U.S. adults aged ≥40 years with diabetes (2) and is the leading cause of incident blindness among working-age adults (1). It is caused by chronically high blood glucose damaging blood vessels in the retina.† Annual dilated eye exams are recommended for persons with diabetes because early detection and timely treatment of diabetic eye diseases can prevent irreversible vision loss§,¶ (3,4). Studies have documented prevalence of annual eye exams among U.S. adults with diabetes (5,6); however, a lack of recent state-level data limits identification of geographic disparities in adherence to this recommendation. Medicare claims from the 50 states, the District of Columbia (DC), Puerto Rico, and U.S. Virgin Islands (USVI) were examined to assess the prevalence of eye exams in 2017 among beneficiaries with diabetes who were continuously enrolled in Part B fee-for-service insurance, which covers annual eye exams for beneficiaries with diabetes.** This report also examines disparities, by state and race/ethnicity, in receipt of eye exams. Nationally, 54.1% of beneficiaries with diabetes had an eye exam in 2017. Prevalence ranged from 43.9% in Puerto Rico to 64.8% in Rhode Island. Fewer than 50% of beneficiaries received an eye exam in seven states (Alabama, Alaska, Kentucky, Louisiana, Nevada, West Virginia, and Wyoming) and Puerto Rico. Non-Hispanic white (white) beneficiaries had a higher prevalence of receiving an eye exam (55.6%) than did non-Hispanic blacks (blacks) (48.9%) and Hispanics (48.2%). Barriers to receiving eye care (e.g., suboptimal clinical care coordination and referral, low health literacy, and lack of perceived need for care) might limit Medicare beneficiaries' ability to follow this preventive care recommendation. Understanding and addressing these barriers might prevent irreversible vision loss among persons with diabetes.


Assuntos
Diabetes Mellitus/epidemiologia , Planos de Pagamento por Serviço Prestado/estatística & dados numéricos , Disparidades em Assistência à Saúde , Medicare Part B/economia , Seleção Visual , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Disparidades em Assistência à Saúde/etnologia , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Adulto Jovem
3.
Am Surg ; 85(10): 1079-1082, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31657298

RESUMO

The objective of this study was to examine the association between surgeon characteristics, procedural volume, and short-term outcomes of hemodialysis vascular access. A retrospective cohort study was performed using Medicare Part A and B data from 2007 through 2014 merged with American Medical Association Physician Masterfile surgeon data. A total of 29,034 procedures met the inclusion criteria: 22,541 (78%) arteriovenous fistula (AVF) and 6,493 (22%) arteriovenous graft (AVG). Of these, 13,110 (45.2%) were performed by vascular surgeons, 9,398 (32.3%) by general surgeons, 2,313 (8%) by thoracic surgeons, 1,517 (5.2%) by other specialties, and 2,696 (9.3%) were unknown. Every 10-year increase in years in practice was associated with a 6.9 per cent decrease in the odds of creating AVF versus AVG (P = 0.02). Surgeon characteristics were not associated with the likelihood of vascular access failure. Every 10-procedure increase in cumulative procedure volume was associated with a 5 per cent decrease in the odds of vascular access failure (P = 0.007). There was no association of provider characteristics or procedure volume with survival free of repeat AVF/AVG or TC placement at 12 months. A significant portion of the variability in likelihood of creating AVF versus AVG is attributable to the provider-level variation. Increase in procedure volume is associated with decreased odds of vascular access failure.


Assuntos
Derivação Arteriovenosa Cirúrgica/estatística & dados numéricos , Diálise Renal/estatística & dados numéricos , Especialidades Cirúrgicas/estatística & dados numéricos , Cirurgiões/estatística & dados numéricos , Idoso , Feminino , Cirurgia Geral/estatística & dados numéricos , Humanos , Masculino , Medicare Part A/estatística & dados numéricos , Medicare Part B/estatística & dados numéricos , Razão de Chances , Sistema de Registros , Estudos Retrospectivos , Cirurgiões/classificação , Cirurgia Torácica/estatística & dados numéricos , Fatores de Tempo , Resultado do Tratamento , Estados Unidos
4.
AJR Am J Roentgenol ; 213(5): 992-997, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31509444

RESUMO

OBJECTIVE. Nonphysician providers (NPPs) increasingly perform imaging-guided procedures, but their roles interpreting imaging have received little attention. We characterize diagnostic imaging services rendered by NPPs (i.e., nurse practitioners and physician assistants) in the Medicare population. MATERIALS AND METHODS. Using 1994-2015 Medicare Physician/Supplier Procedure Summary Master Files, we identified all diagnostic imaging services, including those billed by NPPs, and categorized these by modality and body region. Using 2004-2015 Medicare Part B 5% Research Identifiable File Carrier Files, we separately assessed state-level variation in imaging services rendered by NPPs. Total and relative utilization rates were calculated annually. RESULTS. Between 1994 and 2015 nationally, diagnostic imaging services increased from 339,168 to 420,172 per 100,000 Medicare beneficiaries (an increase of 24%). During this same period, diagnostic imaging services rendered by NPPs increased 14,711% (from 36 to 5332 per 100,000 beneficiaries) but still represented only 0.01% and 1.27% of all imaging in 1994 and 2015, respectively. Across all years, radiography and fluoroscopy constituted most of the NPP-billed imaging services and remained constant over time (e.g., 94% of all services billed in 1994 and 2015), representing only 0.01% and 2.1% of all Medicare radiography and fluoroscopy services. However, absolute annual service counts for NPP-billed radiography and fluoroscopy services increased from 10,899 to 1,665,929 services between 1994 and 2015. NPP-billed imaging was most common in South Dakota (7987 services per 100,000 beneficiaries) and Alaska (6842 services per 100,000 beneficiaries) and was least common in Hawaii (231 services per 100,000 beneficiaries) and Pennsylvania (478 services per 100,000 beneficiaries). CONCLUSION. Despite increasing roles of NPPs in health care across the United States, NPPs still rarely interpret diagnostic imaging studies. When they do, it is overwhelmingly radiography and fluoroscopy. Considerable state-to-state variation exists and may relate to local care patterns and scope-of-practice laws.


Assuntos
Diagnóstico por Imagem/economia , Revisão da Utilização de Seguros , Medicare Part B/economia , Profissionais de Enfermagem/economia , Assistentes Médicos/economia , Papel Profissional , Idoso , Diagnóstico por Imagem/estatística & dados numéricos , Feminino , Humanos , Masculino , Profissionais de Enfermagem/estatística & dados numéricos , Assistentes Médicos/estatística & dados numéricos , Estados Unidos
6.
AJR Am J Roentgenol ; 213(5): 998-1002, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31180736

RESUMO

OBJECTIVE. The purpose of this study was to assess the percentage and characteristics of radiologists who meet criteria for facility-based measurement in the Merit-Based Incentive Payment System (MIPS). MATERIALS AND METHODS. The Provider Utilization and Payment Data: Physician and Other Supplier Public Use File was used to identify radiologists who bill 75% or more of their Medicare Part B claims in the facility setting. RESULTS. Among 31,217 included radiologists nationwide, 71.0% met the eligibility criteria for facility-based measurement as individuals in MIPS. The percentage of predicted eligibility was slightly higher for male than female radiologists (72.9% vs 64.5%). The percentage decreased slightly with increasing years in practice (from 78.8% for radiologists with < 10 years in practice to 67.3% for radiologists with ≥ 25 years in practice). The eligibility percentage was also higher for radiologists in rural as opposed to urban practices (81.6% vs 71.3%) and in academic as opposed to nonacademic practices (77.2% vs 70.3%). However, the percentages were similar across practices of varying sizes. There was also a greater degree of heterogeneity by state, ranging from 50.9% in Minnesota to 94.0% in West Virginia. By overall geographic region, the percentage of predicted eligibility was lowest in the Northeast (64.7%) and highest in the Midwest (78.3%). A higher percentage of generalists met the 75% facility-based threshold than did subspecialists (77.3% vs 65.4%). When stratified by subspecialty, however, facility-based eligibility was lowest for musculoskeletal radiologists (38.1%) and breast imagers (45.1%) and highest for cardiothoracic radiologists (85.1%). For other subspecialties, predicted eligibility ranged from 66.0% to 77.8%. CONCLUSION. Most radiologists will be eligible for facility-based reporting for MIPS in 2019, with some variation by demographic and specialty characteristics. The facility-based option provides a safety net for radiologists who face challenges accessing hospital data for reporting quality measures. In general, radiologists should not alter their current MIPS strategy but should instead consider facility-based measurement as a contingency plan that could result in a higher final score.


Assuntos
Medicare Part B/economia , Planos de Incentivos Médicos/economia , Radiologistas/economia , Idoso , Centers for Medicare and Medicaid Services, U.S. , Avaliação de Desempenho Profissional , Feminino , Humanos , Masculino , Estados Unidos
7.
Orbit ; 38(6): 453-460, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30712428

RESUMO

Purpose: Endoscopic surgeries, such as dacryocystorhinostomy (DCR), are increasingly performed for orbital and lacrimal conditions. This study describes and compares recent trends in endoscopic DCR with open, or external, DCR in the United States (US). Methods: Medicare-Part-B National Summary data files were analyzed from 2000 to 2015 for temporal and geographic trends in endoscopic and external DCR. Medicare Physician and Other Supplier public use files detailing provider information were collected and analyzed from 2012 to 2015. Results: Between 2000 and 2015, the number of external DCRs remained relatively unchanged (8008 to 7086, -0.7% average annual growth), while the number of endoscopic DCRs steadily increased (881 to 1674, 4.6% average annual growth). The greatest number of endoscopic DCRs were performed in the South Atlantic region, whereas the Mountain region had the greatest number per capita. From 2000 to 2015, the average payment per procedure for external DCR was $526.63, compared with $512.45 for endoscopic DCR. Of endoscopic DCRs performed from 2012 to 2015, 831 (79%) were performed by Ophthalmology, 184 (18%) were performed by Otolaryngology, and the remainder by other subspecialties. Conclusions: The number of endoscopic DCR surgeries increased over the last 15 years while the number of external DCR surgeries remained stable and continued to surpass endoscopic procedures. While ophthalmologists perform the overwhelming majority of endoscopic DCR, otolaryngologists are performing a growing number.


Assuntos
Dacriocistorinostomia/tendências , Endoscopia/tendências , Medicare Part B/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Dacriocistorinostomia/economia , Endoscopia/economia , Feminino , Humanos , Doenças do Aparelho Lacrimal/cirurgia , Masculino , Oftalmologia/estatística & dados numéricos , Doenças Orbitárias/cirurgia , Estados Unidos
8.
Am J Manag Care ; 25(2): 78-83, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30763038

RESUMO

OBJECTIVES: To assess the extent to which medication adherence in congestive heart failure (CHF) and diabetes may serve as a measure of physician-level quality. STUDY DESIGN: A retrospective analysis of Medicare data from 2007 to 2009, including parts A (inpatient), B (outpatient), and D (pharmacy). METHODS: For each disease, we assessed the correlation between medication adherence and health outcomes at the physician level. We controlled for selection bias by first regressing patient-level outcomes on a set of covariates including comorbid conditions, demographic attributes, and physician fixed effects. We then classified physicians into 3 levels of average patient medication adherence-low, medium, and high-and compared health outcomes across these groups. RESULTS: There is a clear relationship between average medication adherence and patient health outcomes as measured at the physician level. Within the diabetes sample, among physicians with high average adherence and controlling for patient characteristics, 26.3 per 1000 patients had uncontrolled diabetes compared with 45.9 per 1000 patients among physicians with low average adherence. Within the CHF sample, also controlling for patient characteristics, the average rate of CHF emergency care usage among patients seen by physicians with low average adherence was 16.3% compared with 13.5% for doctors with high average adherence. CONCLUSIONS: This study's results establish a physician-level correlation between improved medication adherence and improved health outcomes in the Medicare population. Our findings suggest that medication adherence could be a useful measure of physician quality, at least for chronic conditions for which prescription medications are an important component of treatment.


Assuntos
Adesão à Medicação , Médicos/normas , Indicadores de Qualidade em Assistência à Saúde , Idoso , Feminino , Humanos , Masculino , Medicare Part A/estatística & dados numéricos , Medicare Part B/estatística & dados numéricos , Medicare Part D/estatística & dados numéricos , Adesão à Medicação/estatística & dados numéricos , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Qualidade da Assistência à Saúde/normas , Qualidade da Assistência à Saúde/estatística & dados numéricos , Estudos Retrospectivos , Resultado do Tratamento , Estados Unidos
9.
J Am Coll Radiol ; 16(5): 674-682, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30611682

RESUMO

PURPOSE: The aim of this study was to assess national and state-specific changes in emergency department (ED) chest imaging utilization from 1994 to 2015. METHODS: Using aggregate 100% Medicare Physician/Supplier Procedure Summary Master Files for 1994 to 2015, the annual frequency of chest imaging in Medicare Part B beneficiaries in the ED setting was identified, and utilization was normalized to annual Medicare enrollment as well as annual ED visits. Using individual Medicare beneficiary 5% research-identifiable files, similar determinations were performed for each state. RESULTS: Between 1994 and 2015, per 1,000 beneficiaries, ED utilization of chest radiography and CT increased by 173% (compound annual growth rate [CAGR] 4.9%) and 5,941.8% (CAGR 21.6%). Per 1,000 ED visits, utilization increased by 81% (CAGR 2.9%) and 3,915.4% (CAGR 19.2%), respectively. Across states, utilization was highly variable, with 2015 radiography utilization per 1,000 ED visits ranging from 82 (Wyoming) to 731 (Hawaii) and CT utilization ranging from 18 (Wyoming) to 76 (Hawaii). Between 2004 and 2015, most states demonstrated increases in the utilization of both radiography (maximal increase of CAGR 11.0% in Vermont) and CT (maximal increase of CAGR 21.0% in Maine). Nonetheless, utilization of radiography declined in four states and utilization of CT in a single state. CONCLUSIONS: Over the past two decades, ED utilization of chest imaging has increased. This was related not only to an increasing frequency of ED visits but also to increasing utilization per ED visit. Across states, utilization is highly variable, but with radiography and CT both increasing, the use of CT seems additive to, rather than replacing, radiography.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Radiografia Torácica/estatística & dados numéricos , Revisão da Utilização de Recursos de Saúde , Humanos , Medicare Part B , Estados Unidos
11.
JAMA Intern Med ; 179(3): 374-380, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30640379

RESUMO

Importance: The US Department of Health and Human Services (HHS) has proposed to reform drug pricing in Medicare Part B, which primarily covers physician-administered drugs and biologic agents. One HHS proposal would shift coverage of certain drugs from Medicare Part B to Part D, which is administered by private prescription drug plans. Objective: To estimate the association of changes of a shift in Medicare Part B to Part D with total drug spending and patient cost-sharing. Design, Setting, and Participants: Retrospective drug cohort study of the 75 brand-name drugs associated with the highest Part B expenditures among fee-for-service Medicare beneficiaries in 2016. Main Outcomes and Measures: Estimated total Medicare spending in Part B and Part D; annual out-of-pocket costs in Part B and under the standard 2018 Part D benefit; and proportion of drugs in Part D's protected drug classes (immunosuppressants for prophylaxis of organ transplant rejection, antidepressants, antipsychotics, anticonvulsants, antiretrovirals, and antineoplastics). Results: At 2018 prices, total Medicare Part B spending for the 75 brand-name drugs with the highest Part B expenditures was estimated to be $21.6 billion annually. Under the proposed policy, total Part D drug spending for these drugs was estimated to range between $17.6 billion and $20.1 billion after rebates, corresponding to a 6.9% to 18.3% decrease in drug spending in Part D compared with Part B. Of the 75 drugs studied, 33 (44.0%) drugs, accounting for $9.5 billion (43.9%) in Part B spending, were in protected Part D classes where plans must cover essentially all drugs. For 67 drugs with available information, the prices for 65 (97.0%) were a median of 45.8% to 59.7% lower in comparator high-income countries than Part B drug prices. Median patient cost-sharing in Part B for all 75 brand-name drugs was $4683 (interquartile range [IQR], $1069-$9282) per year. Shifting Part B drugs to the 2018 standard Part D benefit was projected to decrease out-of-pocket costs by a median of $860 (IQR, -$3884 to $496) among Medicare beneficiaries without Medicaid or Part B supplemental insurance (Medigap). For beneficiaries who would qualify for the low-income subsidy program in Part D, cost-sharing would be lower in Part D than in Part B for all drugs. For beneficiaries with Medigap insurance, estimated Part D out-of-pocket costs exceeded average Medigap premium costs by a median of $1460 for those with Part D coverage and by a median of $1952 for those without Part D coverage. Conclusions and Relevance: Although the HHS proposal to shift certain drugs from Medicare Part B to Part D may reduce total drug spending, it may increase out-of-pocket costs for some Medicare beneficiaries, including those with Medicare supplement insurance. The Department of Health and Human Services should ensure that the proposed reforms benefit both patients and payers.


Assuntos
Custo Compartilhado de Seguro , Medicare Part B/economia , Medicare Part D/economia , Medicamentos sob Prescrição/economia , Idoso , Feminino , Humanos , Masculino , Estudos Retrospectivos , Estados Unidos
13.
Arch Phys Med Rehabil ; 100(1): 78-85, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30179590

RESUMO

OBJECTIVE: To determine if there was a change in the number of outpatient physical therapy (PT) and occupational therapy (OT) visits for Medicare beneficiaries, and in the number of beneficiaries receiving extended courses of >12 therapy visits, after the Jimmo vs Sebelius settlement. DESIGN: Cross-sectional analysis of the Medical Expenditure Panel Survey (MEPS) comparing calendar years 2011-2012 to 2014-2015. SETTING: Community in-home survey. PARTICIPANTS: Medicare Part-B recipients who received outpatient PT/OT (N=1183, median age 70.8) during pre-Jimmo settlement (2011-2012) and post-Jimmo settlement (2014-2015) time periods. INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: Number of therapy visits/patient/year and number of subjects who received >12 therapy visits/year estimated by linear and logistic regressions controlling for potential confounders (age, body mass index [BMI], and geographic region). RESULTS: The unadjusted median number of therapy visits/year increased from 7 to 8 after the settlement. Linear regression estimated a 1.02 increase in the number of therapy visits after the settlement (95% confidence interval [CI] 0.23, 1.80; P=.01). The odds of having >12 therapy visits/year increased (odds ratio=1.41; 95% CI 1.02,1.96; P=.04). We observed a significant interaction between race and the effect of the settlement on the odds of having >12 therapy visits (OR 3.64; 95% CI 1.58, 8.39). Non-Hispanic white subjects saw an increase in utilization while a combined group of black, Hispanic and Asian subjects' utilization declined. CONCLUSION: Utilization of outpatient PT/OT changed after the 2013 Jimmo settlement. Further research is needed to determine the effect on patient outcomes and cost.


Assuntos
Medicare Part B/estatística & dados numéricos , Terapia Ocupacional/estatística & dados numéricos , Pacientes Ambulatoriais/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Modalidades de Fisioterapia/estatística & dados numéricos , Afro-Americanos/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Grupos de Populações Continentais/estatística & dados numéricos , Estudos Transversais , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Modelos Lineares , Masculino , Razão de Chances , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Estudos Retrospectivos , Estados Unidos
14.
Am Heart J ; 207: 19-26, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30404047

RESUMO

BACKGROUND: A key quality metric for Accountable Care Organizations (ACOs) is the rate of hospitalization among patients with heart failure (HF). Among this patient population, non-HF-related hospitalizations account for a substantial proportion of admissions. Understanding the types of admissions and the distribution of admission types across ACOs of varying performance may provide important insights for lowering admission rates. METHODS: We examined admission diagnoses among 220 Medicare Shared Savings Program ACOs in 2013. ACOs were stratified into quartiles by their performance on a measure of unplanned risk-standardized acute admission rates (RSAARs) among patients with HF. Using a previously validated algorithm, we categorized admissions by principal discharge diagnosis into: HF, cardiovascular/non-HF, and noncardiovascular. We compared the mean admission rates by admission type as well as the proportion of admission types across RSAAR quartiles (Q1-Q4). RESULTS: Among 220 ACOs caring for 227,356 patients with HF, the median (IQR) RSAARs per 100 person-years ranged from 64.5 (61.7-67.7) in Q1 (best performers) to 94.0 (90.1-99.9) in Q4 (worst performers). The mean admission rates by admission types for ACOs in Q1 compared with Q4 were as follows: HF admissions: 9.8 (2.2) vs 14.6 (2.8) per 100 person years (P < .0001); cardiovascular/non-HF admissions: 11.1 (1.6) vs 15.9 (2.6) per 100 person-years (P < .0001); and noncardiovascular admissions: 42.7 (5.4) vs 69.6 (11.3) per 100 person-years (P < .0001). The proportion of admission due to HF, cardiovascular/non-HF, and noncardiovascular conditions was 15.4%, 17.5%, and 67.1% in Q1 compared with 14.6%, 15.9%, and 69.4% in Q4 (P < .007). CONCLUSIONS: Although ACOs with the best performance on a measure of all-cause admission rates among people with HF tended to have fewer admissions for HF, cardiovascular/non-HF, and noncardiovascular conditions compared with ACOs with the worst performance (highest admission rates), the largest difference in admission rates were for noncardiovascular admission types. Across all ACOs, two-thirds of admissions of patients with HF were for noncardiovascular causes. These findings suggest that comprehensive approaches are needed to reduce the diverse admission types for which HF patients are at risk.


Assuntos
Organizações de Assistência Responsáveis/estatística & dados numéricos , Insuficiência Cardíaca/epidemiologia , Admissão do Paciente/estatística & dados numéricos , Organizações de Assistência Responsáveis/classificação , Organizações de Assistência Responsáveis/normas , Idoso , Algoritmos , Análise de Variância , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Comorbidade , Feminino , Insuficiência Cardíaca/diagnóstico , Hospitalização/estatística & dados numéricos , Humanos , Classificação Internacional de Doenças , Masculino , Medicare Part A/estatística & dados numéricos , Medicare Part B/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Assistência Centrada no Paciente/normas , Assistência Centrada no Paciente/estatística & dados numéricos , Distribuição por Sexo , Fatores de Tempo , Estados Unidos
15.
Popul Health Manag ; 22(2): 162-168, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-29957155

RESUMO

The US health care system faces rising costs related to population aging, among other factors. One aspect of the high costs related to aging is Medicare outpatient therapy expenditures, which in 2010 totaled $5.642B for ∼4.7 million beneficiaries. Given the magnitude of these costs and the need to maximize value, this study developed and tested a predictive model of outpatient therapy costs. Retrospective analysis was performed on electronic medical record data from October 31, 2014-September 30, 2016 for 15,468 Medicare cases treated by physical therapists associated with a large, national rehabilitation provider. The analysis was a multiple linear regression of cost per case by 27 predictor variables: age group, sex, recent hospitalization, community vs. facility residence, the 10 states served, time from admission to initial evaluation, initial functional limitation reporting level, functional limitation reporting category, and 9 chronic conditions. The model was designed to be predictive and includes only variables available at the start of a case. The model was statistically significant (P < .0001) but explained only 7.4% of the variance in cost. Of the predictor variables, 16 had statistically significant effects. Those most highly predictive included state in which service was provided (8 of the 16 effects), and 3 variables indicating physical functioning at initial evaluation (initial functional limitation category and level, and residence in community vs. facility). There is need for more research focusing on the effects of specific types of treatment, and also for a more proactive model for outpatient therapy reimbursement that emphasizes prevention as well as treatment.


Assuntos
Assistência Ambulatorial , Serviços de Assistência Domiciliar , Medicare Part B , Modalidades de Fisioterapia , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial/economia , Assistência Ambulatorial/métodos , Assistência Ambulatorial/estatística & dados numéricos , Feminino , Serviços de Assistência Domiciliar/economia , Serviços de Assistência Domiciliar/estatística & dados numéricos , Humanos , Masculino , Medicare Part B/economia , Medicare Part B/estatística & dados numéricos , Pessoa de Meia-Idade , Modalidades de Fisioterapia/economia , Modalidades de Fisioterapia/estatística & dados numéricos , Estudos Retrospectivos , Estados Unidos/epidemiologia
16.
J Am Coll Radiol ; 16(2): 147-155, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30158087

RESUMO

PURPOSE: To assess recent trends in utilization of coronary CT angiography (CCTA), based upon place of service and provider specialty. MATERIALS AND METHODS: The nationwide Medicare Part B master files for 2006 through 2016 were the data source. Current Procedural Terminology, version 4 codes for CCTA were selected. The files provided procedure volume for each code. Utilization rates per 100,000 Medicare fee-for-service enrollees were then calculated. Medicare's place-of-service codes were used to identify CCTAs performed in private offices, hospital outpatient departments (HOPDs), emergency departments (EDs), and inpatient settings. Physician specialty codes were used to identify CCTAs interpreted by radiologists, cardiologists, and all other physicians as a group. Medicare practice share was defined as the percent of total Medicare utilization that was billed by each specialty. RESULTS: The total utilization rate of CCTA in the Medicare population rose sharply from 2006 to 2007, peaking at 210.3 per 100,000 enrollees in 2007. Radiologists' CCTA practice share in 2007 was 32%, compared with 60% for cardiologists. The overall utilization rate then declined to a nadir of 107.1 per 100,000 enrollees in 2013, but subsequently increased to 131.0 by 2016. By that year, radiologists' share of CCTA practice had risen to 58%, compared with 38% for cardiologists. HOPD utilization increased sharply since 2010, primarily among radiologists. In EDs and inpatient settings, greater utilization has also occurred recently, primarily among radiologists. By contrast, private office utilization has dropped sharply since 2007. CONCLUSION: After years of declining utilization, the utilization rate of CCTA is now increasing, predominantly among radiologists.


Assuntos
Angiografia por Tomografia Computadorizada/estatística & dados numéricos , Angiografia Coronária/estatística & dados numéricos , Medicare Part B , Padrões de Prática Médica/estatística & dados numéricos , Revisão da Utilização de Recursos de Saúde , Current Procedural Terminology , Planos de Pagamento por Serviço Prestado , Humanos , Estados Unidos
18.
Fed Regist ; 83(216): 55626-32, 2018 Nov 07.
Artigo em Inglês | MEDLINE | ID: mdl-30456937

RESUMO

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) changed the modified adjusted gross income (MAGI) ranges associated with Medicare Part B and Medicare prescription drug coverage premiums for years beginning in 2018. The Bipartisan Budget Act of 2018 (BBA 2018) revised the MAGI ranges again for years beginning with 2019. We consider a beneficiary's MAGI and tax filing status to determine: The percentage of the unsubsidized Medicare Part B premium that the beneficiary must pay; and the percentage of the cost of basic Medicare prescription drug coverage the beneficiary must pay. This final rule makes our regulations consistent with the MAGI ranges specified by MACRA and BBA 2018.


Assuntos
Renda , Seguro de Serviços Farmacêuticos/economia , Medicare Part B/economia , Humanos , Seguro de Serviços Farmacêuticos/legislação & jurisprudência , Medicare Part B/legislação & jurisprudência , Estados Unidos
19.
Consult Pharm ; 33(11): 611-618, 2018 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-30458904

RESUMO

Chronic care management (CCM) aims to improve health outcomes by enhancing care coordination for patients with multiple chronic conditions. However, few incentives have been provided in recent years for health care professionals to engage in models that improve care coordination. These potential models could help avoid poor health outcomes that lead to hospitalizations and rehospitalizations. Fortunately, in January 2015, under Medicare's physician fee schedule, Medicare began paying separately for CCM services. Qualified health care providers are reimbursed for these coordination of care services. Though pharmacists cannot bill Medicare for these services, they are in a prime position to deliver CCM services and be paid by forming contractual and collaborative partnerships with qualified providers. CCM bridges the gap between fee-for-service and value-based payment models by focusing on care coordination among health care providers.


Assuntos
Doença Crônica/terapia , Conduta do Tratamento Medicamentoso/tendências , Farmacêuticos , Idoso , Idoso de 80 Anos ou mais , Humanos , Medicare Part B , Farmácias , Resultado do Tratamento , Estados Unidos
20.
Issue Brief (Commonw Fund) ; 2018: 1-14, 2018 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-30358960

RESUMO

Issue: Out-of-pocket expenses are capped for enrollees in Medicare Advantage (MA) plans but not for beneficiaries in traditional Medicare, which also requires a high deductible for hospital care. The need for supplemental Medigap coverage adds to traditional Medicare's complexity and administrative costs. Shortfalls in financial protection also make it difficult to offer traditional Medicare as a choice for people under age 65, as some have proposed. Goals: Describe alternative benefit designs that would limit out-of-pocket costs for traditional Medicare's core services, assess their cost, and illustrate financing mechanisms. Methods: Analysis of a $3,500 ceiling on annual out-of-pocket expenses for Parts A and B benefits and options for replacing Part A hospital cost-sharing with a $350 or $100 copayment per admission. Key Findings: Estimates of the costs of the reforms are $36­$44 per beneficiary per month, assuming no behavioral or supplemental coverage changes. This could be financed by a $9­$11 increase in premiums combined with a 0.3-to-0.4-percentage-point increase in the Medicare payroll tax (split between employer and employees). Medicaid costs would decrease, while employers, retirees, and Medigap enrollees would see reduced premiums. Conclusion: The reforms would improve affordability and put traditional Medicare on a more equal footing with MA plans. They would also make it easier to open traditional Medicare to people under age 65.


Assuntos
Financiamento Pessoal , Benefícios do Seguro/economia , Medicare/economia , Custo Compartilhado de Seguro/economia , Humanos , Medicare Part B/economia , Medicare Part C/economia , Estados Unidos
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