Medicare & Medicaid Research Review

[This corrects the article DOI: 10.5600/mmrr.004.04.a02.].

BACKGROUND: Serious adverse events that occur in hospitals rank as a leading cause of preventable death in the United States. Many states operate reporting systems to monitor and publicly report serious adverse events, a subset that falls under Medicare's Hospital-Acquired Conditions (HACs). PURPOSES: Identify and describe state efforts, and the supporting role of federal initiatives, to track and report HACs and other serious adverse events. DATA SOURCES: Document review of state and federal reports, databases, and policies for HACs and other serious adverse events; conduct semi-structured telephone interviews with state health department officials and directors of patient safety organizations...

BACKGROUND: With the steady growth in Medicaid enrollment since the recent recession, concerns have been raised about care for newborns with complications. This paper uses all-payer administrative data from the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS), to examine trends from 2002 through 2009 in complicated newborn hospital stays, and explores the relationship between expected sources of payment and reasons for hospitalizations. METHODS: Trends in complicated newborn stays, expected sources of payment, costs, and length of stay were examined...

BACKGROUND: Erythropoiesis-stimulating agents (ESAs) are widely used to treat anemia associated with myelodysplastic syndromes (MDS) as an off-label indication. In early 2007, the U.S. Food and Drug Administration (FDA) released safety alerts and mandated label changes, and the Centers for Medicare & Medicaid Services (CMS) implemented a National Coverage Determination (NCD) in August 2007, dramatically restricting ESA coverage based on specific clinical parameters in non-MDS patients...

OBJECTIVE: Patient activation questions from a major national Medicare survey are used to highlight characteristics of Medicare beneficiaries with low activation. We demonstrate that Medicare Current Beneficiary Survey (MCBS) data is an untapped resource for further research on patient activation within Medicare beneficiaries and programs. DATA SOURCE: Data are from the 2012 MCBS Access to Care file and include 10,650 beneficiaries. METHODS: Patient Activation levels were derived by taking the weighted average responses to the Patient Activation Supplement...

RESEARCH OBJECTIVE: Hospital-acquired conditions, or HACs, often result in additional Medicare payments, generated during the initial hospitalization and in subsequent health care encounters. The purpose of this article is to estimate the incremental cost to Medicare, as measured by Medicare program payments, of six HACs. STUDY DESIGN: The researchers used a matched case-control design to determine the incremental increase in Medicare payments attributable to each HAC...

OBJECTIVE: Examine use of the Internet (eHealth) and mobile health (mHealth) technologies by privately insured, publicly insured (Medicare/Medicaid), or uninsured U.S. adults in 2012. DATA SOURCE: Pew Charitable Trust telephone interviews of a nationally representative, random sample of 3,014 adult U.S. residents, age 18+. METHODS: Estimate health information seeking behavior overall and by segment (i.e., insurance type), then, adjust estimates for individual traits, clinical need, and technology access using logistic regression...

Beginning in 2014, individuals and small businesses will be able to purchase private health insurance through competitive marketplaces. The Affordable Care Act (ACA) provides for a program of risk adjustment in the individual and small group markets in 2014 as Marketplaces are implemented and new market reforms take effect. The purpose of risk adjustment is to lessen or eliminate the influence of risk selection on the premiums that plans charge and the incentive for plans to avoid sicker enrollees. This article--the first of three in the Medicare & Medicaid Research Review--describes the key program goal and issues in the Department of Health and Human Services (HHS) developed risk adjustment methodology, and identifies key choices in how the methodology responds to these issues...

Beginning in 2014, individuals and small businesses are able to purchase private health insurance through competitive Marketplaces. The Affordable Care Act (ACA) provides for a program of risk adjustment in the individual and small group markets in 2014 as Marketplaces are implemented and new market reforms take effect. The purpose of risk adjustment is to lessen or eliminate the influence of risk selection on the premiums that plans charge. The risk adjustment methodology includes the risk adjustment model and the risk transfer formula...

The Affordable Care Act provides for a program of risk adjustment in the individual and small group health insurance markets in 2014 as Marketplaces are implemented and new market reforms take effect. The purpose of risk adjustment is to lessen or eliminate the influence of risk selection on the premiums that plans charge. The risk adjustment methodology includes the risk adjustment model and the risk transfer formula. This article is the third of three in this issue of the Medicare & Medicaid Research Review that describe the ACA risk adjustment methodology and focuses on the risk transfer formula...

BACKGROUND: Prior to the implementation of the Hospital-Acquired Condition-Present on Admission (HAC-POA) payment policy, concerns regarding its potential impact were raised by a number of organizations and individuals. The purpose of this study was to explore direct and indirect effects of the HAC-POA payment policy on hospitals, patients, and other payers during the policy's first 3 years of implementation. METHODS: The study included semi-structured telephone interviews with representatives of national organizations, hospitals, patient advocacy organizations, and other payers...

INTRODUCTION: As states make home- and community-based services (HCBS) more accessible, researchers have become more interested in understanding service use and spending. Because state Medicaid programs differ in the types of services they offer and in how they report these services, analyzing HCBS at the national level is challenging. OBJECTIVE: Describe the HCBS taxonomy and present findings on HCBS waiver expenditures and users. DATA: This brief analyzed fee-for-service claims from 28 approved states in 2010 Medicaid Analytic eXtract (MAX) files...

OBJECTIVES: Medicaid pays for about half the births in the United States, at very high cost. Compared to usual obstetrical care, care by midwives at a birth center could reduce costs to the Medicaid program. This study draws on information from a previous study of the outcomes of birth center care to determine whether such care reduces Medicaid costs for low income women. METHODS: The study uses results from a study of maternal and infant outcomes at the Family Health and Birth Center in Washington, D...

OBJECTIVE: Determine the association between access to primary care by the underserved and Medicare spending and clinical quality across hospital referral regions (HRRs). DATA SOURCES: Data on elderly fee-for-service beneficiaries across 306 HRRs came from CMS' Geographic Variation in Medicare Spending and Utilization database (2010). We merged data on number of health center patients (HRSA's Uniform Data System) and number of low-income residents (American Community Survey)...

OBJECTIVE: To examine the impact of the Medicare Physician Group Practice (PGP) demonstration on expenditure, utilization, and quality outcomes. DATA SOURCE: Secondary data analysis of 2001-2010 Medicare claims for 1,776,387 person years assigned to the ten participating provider organizations and 1,579,080 person years in the corresponding local comparison groups. STUDY DESIGN: We used a pre-post comparison group observational design consisting of four pre-demonstration years (1/01-12/04) and five demonstration years (4/05-3/10)...

OBJECTIVE: This work provides descriptive statistics on hospice users. It also explores the magnitude of relative resource use during hospice episodes and whether such patterns vary by episode length for patients who only use routine home care as compared to those who use multiple levels of hospice care. Examining resource use for hospice users who require different hospice levels of care within an episode versus solely routine home care provides insight to the varied resource use associated with the different patient populations (i...

BACKGROUND: In 2004, Medicare implemented a system of paying Medicare Advantage (MA) plans that gave them greater incentive than fee-for-service (FFS) providers to report diagnoses. DATA: Risk scores for all Medicare beneficiaries 2004-2013 and Medicare Current Beneficiary Survey (MCBS) data, 2006-2011. MEASURES: Change in average risk score for all enrollees and for stayers (beneficiaries who were in either FFS or MA for two consecutive years)...

OBJECTIVE: Descriptive analysis comparing changes in hospital inpatient readmissions to emergency department visits and observation stays that occurred within 30 days of an inpatient stay. POPULATION: Medicare fee-for-service (FFS) beneficiaries that had at least one acute hospital inpatient stay. DATA SOURCE: Using 100 percent of claims in the Chronic Condition Data Warehouse, we compare growth in annual readmission stays to post-hospitalization emergency department visits and observation stays that were not accompanied by an inpatient stay...

OBJECTIVE: The Medicare Current Beneficiary Survey's (MCBS) Access to Care (ATC) file is designed to provide timely access to information on the Medicare population, yet because of the survey's complex sampling design and expedited processing it is difficult to use the file to make both "always-enrolled" and "ever-enrolled" estimates on the Medicare population. In this study, we describe the ATC file and sample design, and we evaluate and review various alternatives for producing "ever-enrolled" estimates...

PURPOSE: To explore two issues that are relevant to inclusion of PQRS reporting in a value-based payment system: (1) what are the characteristics of PQRS reports and the providers who file them; and (2) could PQRS provide active attribution information to supplement existing attribution algorithms? DESIGN AND METHODS: Using data from five states for the years 2008 (the first full year of the program) and 2009, we examined the number and type of providers who reported PQRS measures and the types of measures that were reported...