73,163 results match your criteria medicare


Survey of Hospital Chargemaster Transparency.

Appl Clin Inform 2021 Mar 5;12(2):391-398. Epub 2021 May 5.

Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, United States.

Background:  In January 2019, the Centers for Medicare & Medicaid Services (CMS) required hospitals to list their standard charges (chargemasters) publicly in an effort to increase price transparency in health care. Surveying hospital chargemasters may be informative to assess the implementation of this rule and its utility to consumers.

Objective:  We aimed to compare hospital chargemaster data within a local hospital market where patients would reasonably try to shop or compare services. Read More

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Predictors of Adherence to Anti-Impulse Therapy Among Patients Treated for Acute Type-B Aortic Dissections.

Ann Vasc Surg 2021 May 2. Epub 2021 May 2.

Division of Vascular Surgery.

Objectives: Medical management remains the mainstay of treatment for patients who present with acute Type-B aortic dissections (TBAD). However, it is unclear whether patients maintain adherence to their anti-impulse therapy medication regimen following hospital discharge. This study was designed to evaluate rates and predictors of medication adherence among insured patients treated for acute TBAD. Read More

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Association of Drug Rebates and Competition With Out-of-Pocket Coinsurance in Medicare Part D, 2014 to 2018.

JAMA Netw Open 2021 May 3;4(5):e219030. Epub 2021 May 3.

Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles.

Importance: Prior research has documented the increase in prescription drug rebates and the coincident increase in out-of-pocket burden for patients paying coinsurance tied to list prices.

Objective: To describe the out-of-pocket burden on patients with coinsurance and assess its association with pharmaceutical competition, which increases payers' leverage to seek higher rebates.

Design, Setting, And Participants: This retrospective cohort study used branded prescription drugs with US sales reported by publicly traded companies. Read More

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Factors Influencing Telehealth Implementation and Use in Frontier Critical Access Hospitals: Qualitative Study.

JMIR Form Res 2021 May 5;5(5):e24118. Epub 2021 May 5.

RTI International, Research Triangle Park, NC, United States.

Background: Telehealth has potential to help individuals in rural areas overcome geographical barriers and to improve access to care. The factors that influence the implementation and use of telehealth in critical access hospitals are in need of exploration.

Objective: The aim of this study is to understand the factors that influenced telehealth uptake and use in a set of frontier critical access hospitals in the United States. Read More

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Predictors of Success in the Bundled Payments for Care Improvement Program.

J Gen Intern Med 2021 May 4. Epub 2021 May 4.

Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.

Background: Hospitals participating in Medicare's Bundled Payments for Care Improvement (BPCI) program were incented to reduce Medicare payments for episodes of care.

Objective: To identify factors that influenced whether or not hospitals were able to save in the BPCI program, how the cost of different services changed to produce those savings, and if "savers" had lower or decreased quality of care.

Design: Retrospective cohort study. Read More

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Prevalence of Frailty and Associations with Oral Anticoagulant Prescribing in Atrial Fibrillation.

J Gen Intern Med 2021 May 4. Epub 2021 May 4.

Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA.

Background: Frailty is often cited as a factor influencing oral anticoagulation (OAC) prescription in patients with non-valvular atrial fibrillation (NVAF). We sought to determine the prevalence of frailty and its association with OAC prescription in older veterans with NVAF.

Methods: We used ICD-9 codes in Veterans Affairs (VA) records and Medicare claims data to identify patients with NVAF and CHADSVASC ≥2 receiving care between February 2010 and September 2015. Read More

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Annual wellness visits and care management before and after dialysis initiation.

BMC Nephrol 2021 May 5;22(1):164. Epub 2021 May 5.

Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA.

Introduction: Demands of dialysis regimens may pose challenges for primary care provider (PCP) engagement and timely preventive care. This is especially the case for patients initiating dialysis adjusting to new logistical challenges and management of symptoms and existing comorbid conditions. Since 2011, Medicare has provided coverage for annual wellness visits (AWV), which are primarily conducted by PCPs and may be useful for older adults undergoing dialysis. Read More

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Digital Pathology Initiatives and Experience of a Large Academic Institution During the Coronavirus Disease 2019 (COVID-19) Pandemic.

Arch Pathol Lab Med 2021 May 4. Epub 2021 May 4.

All authors are in the Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH.

Context.: Pathology practices have begun integrating digital pathology tools into their routine workflow. During 2020 the coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), emerged as a pandemic causing a global health crisis that significantly affected the world population in several areas, including medical practice, and pathology was no exception. Read More

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Emergency Department Utilization and Readmissions Following Major Surgery, A Retrospective Study of Medicare Data.

J Surg Res 2021 May 1;265:187-194. Epub 2021 May 1.

Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan.

Background: Reliable strategies for reducing postoperative readmissions remain elusive. As the emergency department (ED) is a frequent source of post-operative admissions, we investigated whether hospitals with high readmission rates also have high rates of post-discharge ED visits and high rates of readmission once an ED visit occurs.

Methods: We conducted a retrospective analysis of 1,947,621 Medicare beneficiaries undergoing 1 of 5 common procedures in 2,894 hospitals between 2008 and 2011. Read More

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Is There An Association Between Bundled Payments and "Cherry Picking" and "Lemon Dropping" in Orthopaedic Surgery? A Systematic Review.

Clin Orthop Relat Res 2021 04 30. Epub 2021 Apr 30.

D. N. Bernstein, R. W. Poolman, Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, the Netherlands.

Background: The goal of bundled payments-lump monetary sums designed to cover the full set of services needed to provide care for a condition or medical event-is to provide a reimbursement structure that incentivizes improved value for patients. There is concern that such a payment mechanism may lead to patient screening and denying or providing orthopaedic care to patients based on the number and severity of comorbid conditions present associated with complications after surgery. Currently, however, there is no clear consensus about whether such an association exists. Read More

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Health care access and utilization among adult cancer survivors: Results from the National Institutes of Health "All of Us" Research Program.

Cancer Med 2021 May 3. Epub 2021 May 3.

Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA.

Background: Many cancer survivors face financial difficulties that prevent them from receiving appropriate health care. Racial/ethnic disparities in receipt of health care have been reported among cancer survivors, but recent data for important racial/ethnic subgroups of the US population are lacking.

Methods: To learn more about barriers to healthcare access faced by cancer survivors, we analyzed data from the NIH "All of Us" Research Program. Read More

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Outcomes of Medicare Patients Admitted for Less Than 24 Hours: an Observational Study.

J Gen Intern Med 2021 May 3. Epub 2021 May 3.

National Clinician Scholars Program, Yale University School of Medicine, New Haven, CT, USA.

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Race and prostate specific antigen surveillance testing and monitoring 5-years after definitive therapy for localized prostate cancer.

Prostate Cancer Prostatic Dis 2021 May 3. Epub 2021 May 3.

University of Georgia, College of Pharmacy, Department of Clinical and Administrative Pharmacy, Division of Pharmaceutical Health Services, Outcomes, and Policy, Athens, Georgia.

Background: Prostate-specific antigen (PSA) surveillance testing is a cornerstone of prostate cancer survivorship because patients with biochemical recurrence often have no symptoms. However, the investigation of guideline-concordant PSA surveillance across racial groups is limited. We examined racial differences in PSA surveillance testing 5-years post-definitive treatment for localized prostate cancer. Read More

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Hospital Admissions from the Emergency Department and Subsequent Critical Care Interventions for Influenza during Pregnancy.

Am J Perinatol 2021 May 3. Epub 2021 May 3.

Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York.

Objective:  The objectives of this study were to determine (1) whether obstetrical patients were more likely to be admitted from the emergency department (ED) for influenza compared with nonpregnant women, and (2) require critical care interventions once admitted.

Study Design:  Using data from the 2006 to 2011 Nationwide Emergency Department Sample, ED encounters for influenza for women aged 15 to 54 years without underlying chronic medical conditions were identified. Women were categorized as pregnant or nonpregnant using billing codes. Read More

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Financial Toxicity in Patients with Brain and Spine Metastases.

World Neurosurg 2021 Apr 30. Epub 2021 Apr 30.

Department of Radiation Oncology, Stanford Cancer Institute, Stanford, CA, USA. Electronic address:

Objective: Financial toxicity associated with cancer treatment has a deleterious impact on patient outcomes but has not been well-characterized among patients with metastatic cancers. We characterize the extent of financial toxicity among this population and identify factors associated with financial toxicity.

Methods: We prospectively surveyed adult patients with brain and spine metastases who received radiosurgery at a large academic medical center between January 2018 and December 2019. Read More

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Higher Medicare Spending On Imaging And Lab Services After Primary Care Physician Group Vertical Integration.

Health Aff (Millwood) 2021 May;40(5):702-709

Cheryl L. Damberg is the RAND Distinguished Chair in Health Care Payment Policy and a principal senior researcher at the RAND Corporation in Santa Monica.

In recent years direct ownership of physician practices by hospitals and health systems (that is, vertical integration) has become a prominent feature of the US health care system. One unexplored impact of vertical integration is the impact on referral patterns for common diagnostic tests and procedures and the associated spending. Using a 100 percent sample of 2013-16 Medicare fee-for-service claims data, we examined whether hospital and health system ownership of physician practices was associated with changes in site of care and Medicare reimbursement rates for ten common diagnostic imaging and laboratory services. Read More

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Nursing Home Staffing Levels Did Not Change Significantly During COVID-19.

Health Aff (Millwood) 2021 05;40(5):795-801

Norma B. Coe is an associate professor in the Department of Medical Ethics and Health Policy, Perelman School of Medicine, and senior fellow at the Leonard Davis Institute of Health Economics, both at the University of Pennsylvania.

Prior research and the popular press have anecdotally reported inadequate nursing home staffing levels during the COVID-19 pandemic. Maintaining adequate staffing levels is critical to ensuring high-quality nursing home care and an effective response to the pandemic. We therefore sought to examine nursing home staffing levels during the first nine months of 2020 (compared with the same period in 2019), using auditable daily payroll-based staffing data from the Centers for Medicare and Medicaid Services. Read More

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Medicare Beneficiaries With Self-Reported Functional Hearing Difficulty Have Unmet Health Care Needs.

Health Aff (Millwood) 2021 May;40(5):786-794

Amber Willink is an associate professor at the Menzies Centre for Health Policy and Economics, University of Sydney, in New South Wales, Australia.

Hearing loss is associated with higher health care spending and use, but little is known about the unmet health care needs of people with hearing loss or difficulty. Analysis of 2016 Medicare Current Beneficiary Survey data for beneficiaries ages sixty-five and older reveals that those who reported a lot of trouble hearing in the past year were 49 percent more likely than those who reported no trouble hearing to indicate not having a usual source of care. Compared with those who reported no trouble hearing, those who reported some trouble hearing were more likely to indicate not having obtained medical care in the past year when they thought it was needed, as well as not filling a prescription, with the risk for both behaviors being greater among those reporting a lot of trouble hearing versus a little. Read More

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Fewer Pharmacies In Black And Hispanic/Latino Neighborhoods Compared With White Or Diverse Neighborhoods, 2007-15.

Health Aff (Millwood) 2021 05;40(5):802-811

Dima Mazen Qato is an associate professor at the University of Southern California School of Pharmacy, senior fellow at the Leonard D. Schaeffer Center for Health Policy and Economics, and director of the school's Program on Medicines and Public Health.

The accessibility of pharmacies may be an overlooked contributor to persistent racial and ethnic disparities in the use of prescription medications and essential health care services within urban areas in the US. We examined the availability and geographic accessibility of pharmacies across neighborhoods based on their racial/ethnic composition in the thirty most populous US cities. In all cities examined, we found persistently fewer pharmacies located in Black and Hispanic/Latino neighborhoods than White or diverse neighborhoods throughout 2007-15. Read More

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Spending On Targeted Therapies Reduced Mortality In Patients With Advanced-Stage Breast Cancer.

Health Aff (Millwood) 2021 May;40(5):763-771

Alice J. Chen is an associate professor in the Sol Price School of Public Policy and senior fellow at the Leonard D. Schaeffer Center for Health Policy and Economics, USC.

Costly targeted therapies are playing an increasingly important role in treating cancer. To characterize trends in spending on targeted therapies for breast cancer and to estimate the association of these therapies with cancer mortality, we analyzed cancer diagnoses in the Surveillance, Epidemiology, and End Results Program-Medicare linked database. We categorized total cancer spending into spending on targeted therapies, spending on nontargeted therapies, and spending on other cancer care. Read More

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Outcomes After Shortened Skilled Nursing Facility Stays Suggest Potential For Improving Postacute Care Efficiency.

Health Aff (Millwood) 2021 May;40(5):745-753

J. Michael McWilliams is the Warren Alpert Foundation Professor of Health Care Policy in the Department of Health Care Policy at Harvard Medical School and a professor of medicine and general internist at Brigham and Women's Hospital, in Boston, Massachusetts.

Reducing postacute care in skilled nursing facilities (SNFs) in favor of home-based care is a leading cost-saving strategy in new payment models. Yet the extent to which SNF stays can be safely shortened remains unclear. We leveraged the exposure of fee-for-service Medicare beneficiaries without supplemental coverage to cost sharing after SNF benefit day 20 as a cause of shortened stays. Read More

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Cancer Outcomes Among Medicare Beneficiaries And Their Younger Uninsured Counterparts.

Health Aff (Millwood) 2021 May;40(5):754-762

Helmneh Sineshaw is principal scientist, Epidemiology-Oncology Core, at Merck Research Laboratories, in West Point, Pennsylvania. He was a senior scientist in the Surveillance and Health Services Research Department, American Cancer Society, when this work was conducted.

Proposals for expanding Medicare insurance coverage to uninsured Americans approaching the Medicare eligibility age of sixty-five has been the subject of intense debate. We undertook this study to assess cancer survival differences between uninsured patients younger than age sixty-five and older Medicare beneficiaries by using data from the National Cancer Database from the period 2004-16. The main outcomes were survival at one, two, and five years for sixteen cancer types in 1,206,821 patients. Read More

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Social support reduces the risk of unintended pregnancy in a low-income population.

Public Health Nurs 2021 May 3. Epub 2021 May 3.

College of Nursing, University of Kentucky, Lexington, KY, USA.

Almost half of all pregnancies (45%) in the United States (US) are unintended, with the highest concentration in women with low incomes. Targeted research is warranted to identify risk and protective factors that influence pregnancy intention to improve maternal/child health.

Purpose: To identify individual and interpersonal level associations to pregnancy intention to use as leverage points to build resilience. Read More

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Outcomes following port-a-catheter placement in the Medicare population.

Surg Open Sci 2021 Jan 11;3:39-43. Epub 2020 Nov 11.

Department of Surgery, Rush University Medical Center, Chicago, IL.

Background: We aimed to evaluate the long-term complication profile associated with port-a-catheter placement.

Methods: Patients undergoing port-a-catheter placement from 2007 to 2012 with 5-year follow up were identified. Descriptive statistics, tests, and multivariate regression models were analyzed. Read More

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January 2021

Outcomes following percutaneous endoscopic gastrostomy versus fluoroscopic procedures in the Medicare population.

Surg Open Sci 2021 Jan 17;3:2-7. Epub 2020 Jul 17.

Rush Cook County Center for Outcomes Research and Department of Surgery, Rush University Medical Center, Chicago, IL.

Background: In the United States, few high-quality manuscripts have directly compared the complication profiles of percutaneous endoscopic versus fluoroscopic gastrostomy. Thus, it is our goal to compare these 2 common procedures to better understand their efficacy and complication profiles.

Materials And Methods: A retrospective analysis of patient records from Medicare parts A/B from 2007 to 2012 was used to identify percutaneous fluoroscopic gastrostomy and percutaneous endoscopic gastrostomy procedures. Read More

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January 2021

A Novel Machine Learning Predictive Tool Assessing Outpatient or Inpatient Designation for Medicare Patients Undergoing Total Hip Arthroplasty.

Arthroplast Today 2021 Apr 13;8:194-199. Epub 2021 Apr 13.

New York University Langone Orthopaedic Hospital, New York, NY.

Background: The Centers for Medicare and Medicaid Services removed total hip arthroplasty (THA) from the inpatient-only list. This has created significant confusion regarding which patients qualify for an inpatient designation. The purpose of this study is to develop and validate a novel predictive tool for preoperatively objectively determining "outpatient" vs "inpatient" status for THA in the Medicare population. Read More

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A Descriptive Study of HIV Patients Highly Adherent to Antiretroviral.

AMIA Annu Symp Proc 2020 25;2020:1295-1304. Epub 2021 Jan 25.

The Lister Hill National Center for Biomedical Communications, National Library of Medicine, NIH, Bethesda, MD.

HIV medication adherence is a topic of major public health concern in the United States. Adherent patients may be less likely to experience treatment failure, AIDS presentations and extreme medical costs. We evaluate a cohort of highly adherent Medicare beneficiaries to establish if the out of pocket costs of HIV medications are an inherent barrier to adherence. Read More

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January 2021

Development and Alpha Testing of Specifications for a Prolonged Opioid Prescribing Electronic Clinical Quality Measure (eCQM).

AMIA Annu Symp Proc 2020 25;2020:1022-1030. Epub 2021 Jan 25.

Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA.

Brigham and Women's Hospital (BWH) has received funding from the Centers for Medicare and Medicaid Services (CMS) to design and implement an electronic clinical quality measure (eCQM) assessing the rate of prolonged opioid prescribing practices following Total Hip Arthroplasty (THA) and Total Knee Arthroplasty (TKA). Utilizing an existing guideline, 'prolonged prescribing' has been defined as opioid prescriptions that exceed 42 days (6 weeks) following surgery. This measure was tested on 12,803 Partners' Healthcare (PHS) patients. Read More

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January 2021

Evaluation of the Reliability of Medicare Spending Per Beneficiary for Post-Acute Care.

Med Care 2021 May 3. Epub 2021 May 3.

Urban Institute, Health Policy Center Medicare Payment Advisory Commission Urban Institute, Statistical Methods Group, Washington, DC.

Background: A measure of episode spending, such as Medicare Spending Per Beneficiary (MSPB) is increasingly used to evaluate provider performance. Yet if the measure is unreliable, as is often true for low-volume providers, it cannot distinguish "good" from "poor" performance.

Objective: The objective of this study was to evaluate the reliability of a uniformly calculated MSPB measure for post-acute care (PAC) and the tradeoffs involved in setting a minimum case count threshold. Read More

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The Serious Illness Population: Ascertainment via Electronic Health Record or Claims Data.

J Pain Symptom Manage 2021 Apr 29. Epub 2021 Apr 29.

Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA. Electronic address:

Context: Palliative care can improve the lives of people with serious illness, yet clear operational definitions of this population do not exist. Prior efforts to identify this population have not focused on Medicare Advantage (MA) and commercial healthplan enrollees.

Objectives: We aimed to operationalize our conceptual definition of serious illness to identify those with serious medical conditions (SMC) among commercial insurance and MA enrollees, and to compare the populations identified through electronic health record (EHR) or claims data sources. Read More

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