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Initial Choice of Spinal Manipulative Therapy for Treatment of Chronic Low Back Pain Leads to Reduced Long-term Risk of Adverse Drug Events Among Older Medicare Beneficiaries.

Spine (Phila Pa 1976) 2021 Apr 19. Epub 2021 Apr 19.

Southern California University of Health Sciences, Whittier, CA Geisel School of Medicine at Dartmouth, Hanover, NH.

Study Design: Retrospective observational study.

Objective: Opioid Analgesic Therapy (OAT) and Spinal Manipulative Therapy (SMT) are evidence-based strategies for treatment of chronic low back pain (cLBP), but the long-term safety of these therapies is uncertain. The objective of this study was to compare OAT versus SMT with regard to risk of adverse drug events (ADEs) among older adults with cLBP. Read More

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Medicare beneficiary panel characteristics associated with high Part D biologic disease-modifying anti-rheumatic drug prescribing for older adults among rheumatologists.

Medicine (Baltimore) 2021 Apr;100(16):e25644

University of Michigan, Ann Arbor, MI.

Abstract: The aim of this study was to investigate beneficiary panel characteristics associated with rheumatologists' prescribing of biologic DMARDs (bDMARDs) for older adults.In this retrospective observational study, we used Medicare Public Use Files (PUFs) to identify rheumatologists who met criteria for high-prescribing, defined as bDMARD prescription constituting ≥20% of their DMARD claims for beneficiaries ≥65 years of age. We first used descriptive analysis then multivariable regression model to test the association of high prescribing of bDMARDs with rheumatologists' panel size and beneficiary characteristics. Read More

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The changing patterns of comorbidities associated with human immunodeficiency virus infection, a longitudinal retrospective cohort study of Medicare patients.

Medicine (Baltimore) 2021 Apr;100(16):e25428

The Lister Hill National Center for Biomedical Communications at the National Library of Medicine, National Institutes of Health in the United States, Bethesda, Maryland.

Abstract: The objective of this paper is to determine the temporal trend of the association of 66 comorbidities with human immunodeficiency virus (HIV) infection status among Medicare beneficiaries from 2000 through 2016.We harvested patient level encounter claims from a 17-year long 100% sample of Medicare records. We used the chronic conditions warehouse comorbidity flags to determine HIV infection status and presence of comorbidities. Read More

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Transitional care management visits to improve coordination of care.

Am J Manag Care 2021 Apr 1;27(4):e130-e134. Epub 2021 Apr 1.

Quality Insights, 557 Cranbury Rd #6, East Brunswick, NJ 08816. Email:

Objectives: This report aimed to determine whether transitional care management (TCM) services, provided by Inspira Care Connect, LLC (ICC), a Track 1 Medicare Shared Savings Program accountable care organization, were effective in reducing 30-day readmission rates, observation stay days, and emergency department visits, along with mortality rates, total costs, and frequency of primary care physician (PCP) visits among Medicare beneficiaries served by ICC.

Study Design: In accordance with TCM programming, ICC contacted the majority of patients telephonically within 48 business hours after discharge from an inpatient setting and scheduled a face-to-face visit with the patient's PCP within 1 to 14 days after discharge from an inpatient setting. The patients were provided with non-face-to-face services as needed throughout the 30-day period. Read More

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ASO Author Reflections: Impact of Residential Racial Integration on Postoperative Outcomes Among Medicare Beneficiaries Undergoing Resection for Cancer.

Ann Surg Oncol 2021 Apr 19. Epub 2021 Apr 19.

Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, USA.

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Herpes Zoster Vaccine Live and Risk of Stroke Among Medicare Beneficiaries: A Population-Based Cohort Study.

Stroke 2021 Apr 20:STROKEAHA120032788. Epub 2021 Apr 20.

Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA.

Background And Purpose: Herpes zoster (HZ) is associated with increased risk of stroke, and zoster vaccine live (ZVL, Zostavax) reduces the risk of HZ. No study has examined the association between ZVL (Zostavax) and risk of stroke. Present study examined association between receipt of ZVL (Zostavax) and risk of stroke among older US population. Read More

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Use of Peripheral μ-Opioid Receptor Antagonists for Treating Opioid-Induced Constipation among US Medicare Beneficiaries from 2014 to 2018.

J Palliat Med 2021 Apr 19. Epub 2021 Apr 19.

Medical Oncology, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA.

Opioid-induced constipation (OIC) remains the most common adverse event associated with opioid use. Treatment with more novel and costly agents (such as peripheral μ-opioid receptor antagonists [PAMORAs]) may be indicated in patients with laxative-refractory OIC. Three PAMORAs are U. Read More

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Five-year impact of Medicare Part D coverage gap reform on drug expenditures and utilization.

Health Serv Res 2021 Apr 18. Epub 2021 Apr 18.

Social and Administrative Sciences Division, University of Wisconsin-Madison School of Pharmacy, Madison, Wisconsin, USA.

Objective: To estimate the impact of the Medicare Part D coverage gap reform under the Affordable Care Act (ACA) on the utilization of and expenditures for prescription drugs within the first five years of the policy's implementation.

Data Sources: 2008-2015 Medicare Current Beneficiary Survey (MCBS).

Study Design: We used a difference-in-differences approach to estimate the year-by-year changes in prescription drug use and expenditures before (2006-2010) and after (2011-2015) the ACA's Part D coverage gap reform between Part D beneficiaries not receiving the Low-Income Subsidy (LIS) and those receiving the LIS. Read More

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Collecting Objective Measures of Visual and Auditory Function in a National in-Home Survey of Older Adults.

J Surv Stat Methodol 2021 Apr 14;9(2):309-334. Epub 2021 Feb 14.

Professor with the Johns Hopkins University Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.

Maintenance of visual and auditory function is important for preventing the onset of activity limitations and preserving quality of life in later life. To date, national panel studies focused on health and aging have mostly collected subjective (self-reported) measures of visual and auditory function. The National Health and Aging Trends Study (NHATS), a study of Medicare beneficiaries ages sixty-five and older, recently developed a protocol for measuring objective visual and auditory function for its annual, in-home data collection conducted by trained interviewers. Read More

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Bipartite Causal Inference with Interference.

Stat Sci 2021 Feb 21;36(1):109-123. Epub 2020 Dec 21.

Department of Statistical Science, Duke University, 206 Old Chem Bldg, Durham, NC 27708.

Statistical methods to evaluate the effectiveness of interventions are increasingly challenged by the inherent interconnectedness of units. Specifically, a recent flurry of methods research has addressed the problem of between observations, which arises when one observational unit's outcome depends not only on its treatment but also the treatment assigned to other units. We introduce the setting of which arises when 1) treatments are defined on observational units that are distinct from those at which outcomes are measured and 2) there is between units in the sense that outcomes for some units depend on the treatments assigned to many other units. Read More

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February 2021

Comparative effectiveness of biologics and targeted therapies for psoriatic arthritis.

RMD Open 2021 Apr;7(1)

Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA

Objective: To quantify comparative effectiveness of interleukin (IL)-12/23 antagonist (ustekinumab), IL-17A antagonists (secukinumab and ixekizumab), PDE4 inhibitor (apremilast) and tumour necrosis factor-alpha (TNF-α) inhibitors (infliximab, etanercept, adalimumab, certolizumab pegol and golimumab) for psoriatic arthritis (PsA).

Methods: We adapted a deidentified claims-based algorithm validated for inflammatory arthritis treatments to compare treatments among a retrospective cohort of commercially insured and Medicare Advantage beneficiaries with PsA from October 2013 to April 2019 in the OptumLabs Data Warehouse. Main outcomes include (1) treatment effectiveness, based on: adherence, adding or switching biologic or PDE4, addition of new non-biologic disease-modifying antirheumatic drug, increase in biologic or PDE4 dose or frequency and glucocorticoid use and (2) percentage of each group fulfilling the effectiveness algorithm. Read More

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Sensory Impairment and the Odds of Adverse Consequences of Unmet Needs for Care Among Older Adults.

J Gerontol B Psychol Sci Soc Sci 2021 Apr 16. Epub 2021 Apr 16.

Cochlear Center for Hearing & Public Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.

Introduction: Vision and hearing impairments are highly prevalent conditions among older adults, and well-established links exist between sensory impairment and household, mobility, and self-care activity limitations. However, studies examining the impact of unmet long-term services and supports (LTSS) needs have not considered the role of vision and hearing impairment on the risk of experiencing adverse consequences, including wetting or soiling oneself.

Methods: Using Rounds 1 and 5 of the National Health and Aging Trends Study, a nationally-representative survey of Medicare beneficiaries aged 65 and older, we examine the association of vision and hearing impairment on the odds of experiencing an adverse consequence while accounting for other socio-demographic and health status factors. Read More

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Provision of Collaborative Care Model and General Behavioral Health Integration Services in Medicare.

Psychiatr Serv 2021 Apr 15:appips202000265. Epub 2021 Apr 15.

Department of Medicine (Marcotte, Reddy, Zhou, Liao) and Department of Psychiatry and Behavioral Science (Razliff, Unützer, Chang), School of Medicine, University of Washington, Seattle; Value and Systems Science Lab, Seattle (Marcotte, Reddy, Zhou, Liao).

Objective: The authors sought to describe the early use of collaborative care model (CoCM) and general behavioral health integration (BHI) billing codes among clinicians.

Methods: Counts and payments were calculated for accepted and denied claims for CoCM and general BHI services delivered to Medicare beneficiaries nationwide in 2017-2018. Payment and utilization data were stratified by clinical specialty and site of service. Read More

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The Utilization and Costs of Grade D USPSTF Services in Medicare, 2007-2016.

J Gen Intern Med 2021 Apr 14. Epub 2021 Apr 14.

Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.

Background: Low-value care, or patient care that offers no net benefit in specific clinical scenarios, is costly and often associated with patient harm. The US Preventive Services Task Force (USPSTF) Grade D recommendations represent one of the most scientifically sound and frequently delivered groups of low-value services, but a more contemporary measurement of the utilization and spending for Grade D services beyond the small number of previously studied measures is needed.

Objective: To estimate utilization and costs of seven USPSTF Grade D services among US Medicare beneficiaries. Read More

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Glucose-Lowering Medication Use in CKD: Analysis of US Medicare Beneficiaries Between 2007 and 2016.

Kidney Med 2021 Mar-Apr;3(2):173-182.e1. Epub 2020 Dec 30.

Department of Pharmaceutical Care & Health Systems, University of Minnesota, College of Pharmacy, Minneapolis, MN.

Background: Information regarding the use of glucose-lowering medications in patients with chronic kidney disease (CKD) is limited.

Study Design: Retrospective cohort study.

Setting & Participants: Medicare 5% random sample of patients with CKD with type 2 diabetes, 2007 to 2016. Read More

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December 2020

Temporal Trends and Geographic Variations in the Supply of Clinicians Who Provide Spinal Manipulation to Medicare Beneficiaries: A Serial Cross-Sectional Study.

J Manipulative Physiol Ther 2021 Apr 10. Epub 2021 Apr 10.

The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, New Hampshire.

Objective: Spinal manipulation (SM) is recommended for first-line treatment of patients with low back pain. Inadequate access to SM may result in inequitable spine care for older US adults, but the supply of clinicians who provide SM under Medicare is uncertain. The purpose of this study was to measure temporal trends and geographic variations in the supply of clinicians who provide SM to Medicare beneficiaries. Read More

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The Relationship Between Medicare Advantage Star Ratings and Enrollee Experience.

J Gen Intern Med 2021 Apr 12. Epub 2021 Apr 12.

Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA.

Background: Medicare Advantage plans, private managed care plans that enrolled 34% of Medicare beneficiaries in 2019, received $6 billion in annual bonus payments on the basis of their performance on a 5-star rating system. Little is known, however, as to the extent these ratings adequately capture enrollee experience.

Objectives: To measure the effect of exposure to higher rated Medicare Advantage contracts on enrollee experience. Read More

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Joint Latent Class Analysis of Oral Anticoagulation Use and Risk of Stroke or Systemic Thromboembolism in Patients with Atrial Fibrillation.

Am J Cardiovasc Drugs 2021 Apr 12. Epub 2021 Apr 12.

Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, 3609 Forbes Avenue, Room 103, Pittsburgh, PA, 15261, USA.

Background: Oral anticoagulation (OAC) is recommended to reduce the risk of stroke or systemic thromboembolism (TE) in atrial fibrillation (AF). In this study, we applied novel joint latent class mixed models to identify heterogeneous patterns of trajectories of OAC use and determined how these trajectories are associated with risks of thromboembolic outcomes.

Methods And Results: We used 2013-2016 claims data from a 5% random sample of Medicare beneficiaries, obtained from the Centers for Medicare and Medicaid Services. Read More

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Impact of Race/Ethnicity and County-Level Vulnerability on Receipt of Surgery Among Older Medicare Beneficiaries With the Diagnosis of Early Pancreatic Cancer.

Ann Surg Oncol 2021 Apr 12. Epub 2021 Apr 12.

Department of Surgery, Division of Surgical Oncology, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University, Wexner Medical Center, Columbus, OH, USA.

Background: Patients can experience barriers and disparities to access high-quality cancer care. This study sought to characterize receipt of surgery and chemotherapy among Medicare beneficiaries with a diagnosis of early-stage pancreatic adenocarcinoma cancer (PDAC) relative to race/ethnicity and social vulnerability.

Methods: The Surveillance, Epidemiology, and End Results (SEER)-Medicare database was used to identify patients with a diagnosis of early-stage (stage 1 or 2) PDAC between 2004 and 2016. Read More

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Bariatric surgery outcomes in Medicare beneficiaries.

Obes Sci Pract 2021 Apr 22;7(2):176-191. Epub 2020 Dec 22.

Department of Surgery University of Minnesota Minneapolis Minnesota USA.

Background: The Medicare population is increasing while the prevalence of obesity remains high. Bariatric surgery is the most efficacious treatment of obesity and its comorbidities. The objective of this investigation was to assess trends in utilization, readmission, mortality, and cost of bariatric surgery in the Medicare population. Read More

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Trends of Medicare Reimbursement Rates for Common Plastic Surgery Procedures.

Plast Reconstr Surg 2021 Apr 7. Epub 2021 Apr 7.

From the Division of Plastic and Reconstructive Surgery, Rush University Medical Center; the Department of Plastic Surgery, University of Texas Southwestern Medical Center; the Department of Mechanical and Industrial Engineering, University of Illinois at Chicago; the Royal Liverpool University Hospital; the School of Dentistry, National and Kapodistrian University of Athens; and the Center for Gender Confirmation Surgery, Weiss Memorial Hospital.

Background: Knowledge of Medicare reimbursement is essential for plastic surgeons providing care to Medicare beneficiaries. The authors sought to evaluate changes in Medicare reimbursement for common plastic surgery procedures from 2010 to 2020.

Methods: The authors assessed the Physician Fee Schedule of the Centers for Medicare and Medicaid Services website. Read More

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Transcatheter Versus Surgical Aortic Valve Replacement in Patients With Rheumatic Aortic Stenosis.

J Am Coll Cardiol 2021 Apr;77(14):1703-1713

Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA; Comprehensive Access and Delivery Research and Evaluation Center (CADRE), VA Medical Center, Iowa City, Iowa, USA.

Background: Patients with rheumatic aortic stenosis (AS) were excluded from transcatheter aortic valve replacement (TAVR) trials.

Objectives: The authors sought to examine outcomes with TAVR versus surgical aortic valve replacement (SAVR) in patients with rheumatic AS, and versus TAVR in nonrheumatic AS.

Methods: The authors identified Medicare beneficiaries who underwent TAVR or SAVR from October 2015 to December 2017, and then identified patients with rheumatic AS using prior validated International Classification of Diseases, Version 10 codes. Read More

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Conversations about wellness: A qualitative analysis of patient narratives post annual wellness visit.

Geriatr Nurs 2021 Apr 5;42(3):681-686. Epub 2021 Apr 5.

Purdue University Department of Public Health, 812 W. State Street, West Lafayette, IN 47907, United States.

Support for successful aging in place requires an understanding of the factors that impede or support health promotion behaviors. Nurse-led monthly follow-up calls between annual wellness visits (AWV) offer the opportunity to both provide support and collect data which can inform development of effective health promotion strategies. The aim of this research was to provide ongoing support for health promotion efforts and explore factors playing a role in meeting AWV recommendations. Read More

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Lower socioeconomic factors are associated with higher mortality in patients with septic shock.

Heart Lung 2021 Apr 5;50(4):477-480. Epub 2021 Apr 5.

Department of Pharmacy, Loyola University Medical Center USA; Department of Emergency Medicine, Loyola University Medical Center USA.

Background: Previous studies have explored the relationship between socioeconomic status and sepsis outcomes OBJECTIVES: The purpose of this investigation is to determine if race, ethnicity, economic stability, neighborhood environment, and access to health care are predictive of mortality in patients with septic shock.

Methods: Retrospective study of septic shock patients admitted to two medical centers.

Results: Caucasian patients had higher proportion of outpatient physician visits in the year prior to admission and were less likely to be Medicare or Medicaid beneficiaries. Read More

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Caring for Older Adults with Self-Reported Vision Impairment: Findings from the National Study of Caregiving.

Am J Ophthalmol 2021 Apr 5. Epub 2021 Apr 5.

Johns Hopkins Wilmer Eye Institute, Baltimore, MD, USA; The Johns Hopkins Disability Health Research Center, Johns Hopkins University, Baltimore, MD, USA; Johns Hopkins University Center on Aging and Health, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Electronic address:

Purpose: To examine caregiving relationships for older adults with vision impairment (VI) DESIGN: Cross-sectional study with a nationally representative sample METHODS: Setting: The National Health and Aging Trends Study linked to the National Study of Caregiving, Year 2011 STUDY POPULATION: 1,776 family/unpaid caregivers to community-dwelling Medicare beneficiaries age ≥65 years Main Outcome Measure(s): In the preceding month, the number of: (1) hours of care provided, (2) valued activities affected by caregiving, and (3) odds of experiencing substantial emotional, (4) financial, and (5) physical difficulty related to providing care EXPOSURE: VI defined as report of blindness or difficulty with distance or near vision RESULTS: Among 1,776 caregivers, 428 spent an average of 111 (SE=9.1) hours per month assisting older adults with VI, while 1,348 spent an average of 72 (SE=3.3) hours assisting older adults without VI. Read More

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Association of Dual Eligibility for Medicare and Medicaid With Heart Failure Quality and Outcomes Among Get With The Guidelines-Heart Failure Hospitals.

JAMA Cardiol 2021 Apr 7. Epub 2021 Apr 7.

Division of Cardiology, David Geffen School of Medicine, University of California, Los Angeles.

Importance: The Centers for Medicare & Medicaid Services uses a new peer group-based payment system to compare hospital performance as part of its Hospital Readmissions Reduction Program, which classifies hospitals into quintiles based on their share of dual-eligible beneficiaries for Medicare and Medicaid. However, little is known about the association of a hospital's share of dual-eligible beneficiaries with the quality of care and outcomes for patients with heart failure (HF).

Objective: To evaluate the association between a hospital's proportion of patients with dual eligibility for Medicare and Medicaid and HF quality of care and outcomes. Read More

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Impact of state scope-of-practice laws on nurse practitioner-provided home visits.

Geriatr Nurs 2021 Apr 3;42(3):674-680. Epub 2021 Apr 3.

Department of Community Health and Social Medicine, CUNY School of Medicine, Townsend Harris Hall, Suite 313, 160 Covent Avenue, NY 10031, United States. Electronic address:

Millions of older Americans receive nurse practitioner (NP)-provided home based primary care (HBPC). Little is known about how state scope-of- practice (SOP) laws may impact use of NP-home visits. Using 2017 Centers for Medicare and Medicaid Services Provider Utilization and Payment Data Public Use File (PUF), we examined the impact of state SOP laws on the use of NP-home visits. Read More

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Trends in Discharge Disposition Following Hepatectomy for Hepatocellular Carcinoma Among Medicare Beneficiaries.

J Gastrointest Surg 2021 Apr 5. Epub 2021 Apr 5.

Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, 395 W. 12th Ave., Suite, Columbus, OH, 670, USA.

Background: Post-acute care (PAC) services can include home healthcare, long-term care hospitals, and skilled nursing facilities. We sought to define factors associated with PAC discharge disposition among Medicare beneficiaries who underwent hepatectomy for hepatocellular carcinoma (HCC).

Methods: Data for Medicare beneficiaries with a diagnosis of HCC and who underwent a hepatectomy between 2004 and 2015 were retrieved from the SEER-Medicare database. Read More

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Medicaid Coverage 'Cliff' Increases Expenses And Decreases Care For Near-Poor Medicare Beneficiaries.

Health Aff (Millwood) 2021 Apr;40(4):552-561

Lindsay M. Sabik is an associate professor in the Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health.

Cost sharing in traditional Medicare can consume a substantial portion of the income of beneficiaries who do not have supplemental insurance from Medicaid, an employer, or a Medigap plan. Near-poor Medicare beneficiaries (with incomes more than 100 percent but less than 200 percent of the federal poverty level) are ineligible for Medicaid but frequently lack alternative supplemental coverage, resulting in a supplemental coverage "cliff" of 25.8 percentage points just above the eligibility threshold for Medicaid (100 percent of poverty). Read More

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Advance Care Planning For Medicare Beneficiaries Increased Substantially, But Prevalence Remained Low.

Health Aff (Millwood) 2021 Apr;40(4):613-621

Susan Enguidanos is an associate professor at the Leonard Davis School of Gerontology, University of Southern California.

In 2016 fee-for-service Medicare began reimbursing physicians for advance care planning conversations with enrollees during outpatient visits and waived the copayment for advance care planning when it was part of the Medicare annual wellness visit. Advance care planning is intended to help providers treat patients in ways consistent with their wishes and may also reduce unnecessary health care use and spending. Examining fee-for-service Medicare claims, we found a substantial increase in outpatient advance care planning claims between 2016 and 2019, although prevalence remained below 7. Read More

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