Medicare

28 Jul

Posted at 17:26h in Medicare

Turning 65 brings a lot of changes, and figuring out your health coverage shouldn't add to the stress. Medicare can feel confusing at first, especially with all the different parts, deadlines, and enrollment windows. But once you understand the basics, the process becomes much easier to manage.

This guide breaks down everything you need to know about getting started with Medicare. We'll cover the different parts of the program, how to enroll, and what happens if you miss a deadline. Whether you're approaching 65 or helping a parent navigate this process, you'll find clear, practical answers here. For a deeper look at how Medicare Advantage plans work in practice — including how to match a plan to your specific healthcare needs — see this guide to navigating Medicare Advantage plan selection.

medicare_enrollment_made_simple

19 May

Posted at 19:17h in Medicare
[caption id="attachment_73847" align="aligncenter" width="500"]Houston Methodist Medicare Advantage Plan Photo by SHVETS production[/caption] If you live around Houston and you are getting close to 65, or you already have your red, white, and blue Medicare card in your wallet, you are probably asking one simple question: will my Medicare Advantage plan let me walk into a Houston Methodist building and use my benefits without a problem? The short answer is usually yes, but you have to pick the right carrier. The longer answer is what this post is for. Let's go through it together, slow and clear, with none of the insurance jargon that makes your eyes glaze over.

About Houston Methodist

Houston Methodist runs a big footprint in the city. They have a main campus inside the Texas Medical Center, and they keep community hospitals out in places like The Woodlands, Sugar Land, Willowbrook, Clear Lake, Baytown, and West Houston. They also have a Continuing Care unit, plus a long list of smaller clinics and physician offices around town. The reason people care so much about which Medicare plan works there is simple — the system has a strong name, and many seniors want their cardiologist, surgeon, or cancer doctor to sit somewhere inside that group.

12 May

Posted at 15:23h in Medicare, Radiology
[caption id="attachment_73691" align="aligncenter" width="500"]does-medicare-pay-for-echocardiogram.jpg Photo by Los Muertos Crew[/caption] If your doctor just ordered an echocardiogram and you are on Medicare, your first question is probably simple: will Medicare pay for this? The short answer is yes, but with conditions. Let us walk through exactly how it works so you are not caught off guard at billing time. Medicare Part B covers echocardiograms when they are deemed medically necessary — a phrase that carries real weight. There needs to be a documented clinical reason, and both the ordering physician and the performing facility must be properly enrolled and credentialed with Medicare before any claim will be reimbursed.

04 Mar

Posted at 11:01h in Medical Insurance, Medicare
[caption id="attachment_72690" align="aligncenter" width="500"]Medicare Eligibility Influences Preventive Care Freepix[/caption] Preventive care plays a central role in maintaining long-term health, particularly among older adults and individuals with disabilities. Services such as annual wellness visits, cancer screenings, cardiovascular assessments, and vaccinations are designed to detect conditions early or prevent them altogether. Yet access to these services often depends on insurance coverage. In the United States, Medicare eligibility marks a significant turning point in how individuals engage with preventive care. Understanding when and how a person becomes eligible for Medicare can shape healthcare decisions, provider relationships, and overall utilization of preventive services.

14 Oct

Posted at 18:24h in Insurance, Medicare
[caption id="attachment_70986" align="aligncenter" width="500"]medical-insurance-cigna Photo by Pixabay[/caption] Navigating Medicare can feel like wandering through a maze, even for the most diligent seniors. Between dozens of plan options, coverage details, and deadlines, it’s easy to feel overwhelmed. That’s where can Cigna Medicare Advantage plans stand out. Beyond standard medical coverage, they offer hidden perks that make your healthcare simpler, more rewarding, and surprisingly affordable. Let’s explore the lesser-known benefits that can help you make the most of your plan.

Complete Preventive Care beyond the Fundamentals

Cigna aims to emphasize preventative treatment. This covers immunizations, regular checkups, and wellness visits. Many of these services are free or almost so. What sets these plans apart is the expanded preventive care. They include vision and hearing assessments. Certain programs even cover expenses for corrective aids. These small actions help ward off more significant medical problems later. Members of Cigna could also have access to individualized health evaluations. These tests help older people find the right wellness programs. They help identify potential health issues before they become major. Better health outcomes and fewer long-term expenses follow from this.

15 Oct

Posted at 10:55h in Alzheimer's - Dementia, Author Interviews, Cost of Health Care, Medicare, UCLA
MedicalResearch.com Interview with: [caption id="attachment_64014" align="alignleft" width="150"]Frank F. Zhou  |  he/himMD Candidate, Class of 2025 David Geffen School of Medicine at UCLA Frank F Zhou[/caption] Frank F. Zhou  |  he/him MD Candidate, Class of 2025 David Geffen School of Medicine at UCLA MedicalResearch.com: What is the background for this study? What is Lecanemab used for?  How is it given to patients? Response: Lecanemab is a new infusion therapy for Alzheimer's disease. Its dosing is based on each patient's body weight (10 mg/kg every two weeks), but the drug is only available in 500 mg and 200 mg single-use vials, meaning that any leftover drug in vials must be thrown away. Given that lecanemab is expected to cost Medicare billions of dollars each year, we hypothesized that discarded drug could result in significant wasteful spending.

26 Sep

Posted at 12:20h in Geriatrics, Medicare
senior-health-plan.jpg

Source

As healthcare continues to evolve, more attention is being given to senior health, and wellness programs are increasingly becoming a cornerstone of comprehensive senior care. Wellness programs focus on improving quality of life and managing chronic conditions through proactive measures such as exercise, nutrition, mental health support, and preventive care. For seniors, these programs are especially valuable because they address the unique challenges that come with aging. As part of senior health plans, wellness programs are not only a way to treat existing issues but also a way to prevent future problems by promoting healthy lifestyles. These programs offer a broad range of benefits, from improved physical health to enhanced mental well-being. Seniors enrolled in wellness initiatives often experience better control of conditions such as diabetes, heart disease, and arthritis. In addition, wellness programs can help reduce hospital visits, lower healthcare costs, and increase overall longevity by encouraging proactive health management. Seniors who engage in regular fitness activities, for instance, are less likely to experience falls, fractures, and other mobility-related issues, which are common concerns in older age.

20 Sep

Posted at 13:05h in Medicare
  [caption id="attachment_63416" align="aligncenter" width="500"]medicare-insurance-agent.png Source[/caption] Using Medicare can be quite challenging for those without experience dealing with this system and its numerous programs, plans, and services. Hiring a Medicare insurance agent is one of the best ways to guarantee that you get the right Medicare plan suitable for your needs. However, the problem of choosing the right agent might be even more daunting than the task of comprehending the insurance plans. This guide is designed to help you select the best Medicare insurance agent and make the right decision.

20 Aug

Posted at 11:27h in Medicare
[caption id="attachment_62903" align="alignleft" width="200"]retirement-medicare_pexels-cottonbro-6158648 Source[/caption] Medicare can often seem like a maze of deadlines and enrollments, especially for retirees. Missing critical Medicare enrollment periods can lead to fines and gaps in coverage. Understanding why these specific time frames exist can save a lot of hassle and ensure continuous healthcare access. The Initial Enrollment Period (IEP) is a seven-month window that allows retirees to enroll in Medicare. Specifically, it starts three months before the month you turn 65, includes your birth month, and ends three months after. Missing this period usually results in penalties that could affect your healthcare costs for the rest of your life. Understanding this window is crucial because it shapes the foundation of your healthcare plan. To make the most of your IEP, it's advisable to start planning as soon as you approach 65. Setting reminders and being proactive can help you take full advantage of this period, avoid future complications, and ensure you receive medical coverage without interruptions or financial strains. 

23 Jul

Posted at 20:02h in Medicare, Primary Care
Navigating the complexities of Medicare can be challenging, especially when it comes to finding and choosing the right primary care doctor. This guide will help you understand the different parts of Medicare, how it covers primary care services, and provide actionable steps to find and evaluate primary care doctors that accept Medicare.

Understanding Medicare and Its Different Parts

Medicare is a federal health insurance program primarily for individuals aged 65 and older, though it also covers certain younger people with disabilities. Medicare consists of four parts:
  1. Medicare Part A: Covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
  2. Medicare Part B: Covers certain doctors' services, outpatient care, medical supplies, and preventive services.
  3. Medicare Part C (Medicare Advantage): An alternative to Original Medicare that offers all Part A and Part B services through private insurance companies. These plans often include additional benefits like vision, dental, and prescription drug coverage.
  4. Medicare Part D: Covers prescription drugs.

11 Jan

Posted at 19:00h in Author Interviews, Cost of Health Care, JAMA, Kidney Disease, Medicare
MedicalResearch.com Interview with: [caption id="attachment_61226" align="alignleft" width="134"]Kalli Koukounas, MPHPh.D. Student, Health Services Research Brown University School of Public Health Providence, RI Kalli Koukounas[/caption] Kalli Koukounas, MPH Ph.D. Student, Health Services Research Brown University School of Public Health Providence, RI MedicalResearch.com: What is the background for this study? Response:  On Jan. 1st, 2021, the Centers for Medicare and Medicaid Services (CMS) implemented the End-Stage Renal Disease Treatment Choices (ETC) Model, one of the largest randomized tests of pay-for-performance incentives ever conducted in the US. The goal of the model was to enhance the use of home dialysis and kidney transplant or waitlisting among kidney failure patients in traditional Medicare. The model randomly assigned approximately 30% of US dialysis facilities and nephrologists to receive financial incentives, ranging from bonuses of 4% to penalties of 5%, based on their patients’ use of home dialysis and kidney transplant/waitlisiting. The payment adjustments apply to all Medicare-based reimbursement for dialysis services. Prior research has demonstrated that dialysis facilities that disproportionately serve populations with high social risk have lower use of home dialysis and kidney transplant, raising concerns that these sites may fare poorly in the payment model. Using data released by CMS, we examined the first year of ETC model performance and financial penalties across dialysis facilities, stratified by the measured social risk of the facilities’ incident patients.

12 Dec

Posted at 13:19h in Author Interviews, Cost of Health Care, JAMA, Medicare
MedicalResearch.com Interview with: [caption id="attachment_58508" align="alignleft" width="150"]Jeanne Madden, PhD Associate Professor Department of Pharmacy and Health Systems Sciences School of Pharmacy and Pharmaceutical Sciences Bouvé College of Health Science Northeastern University   Dr. Madden[/caption] Jeanne Madden, PhD Associate Professor Department of Pharmacy and Health Systems Sciences School of Pharmacy and Pharmaceutical Sciences Bouvé College of Health Science Northeastern University MedicalResearch.com: What is the background for this study? Response: Medicare is the US public insurance program mainly serving people 65 years and older, but also some younger adults who have long-term disabling conditions. As such, on average, the Medicare population bears a heavy burden of illness and has high health care needs, compared to the general US population. The under-65 group for the most part has quite low incomes, while the older group represents a wide spectrum, from poor to well-off. Medicare beneficiaries also differ a great deal in terms of whether they have access to supplemental insurance that can help with patient cost-sharing requirements. I’m referring to Medicaid assistance, or a self-purchased Medigap plan, or retiree health benefits, etc. The cost-sharing requirements in traditional Medicare are substantial — e.g., 20% for doctor visits — and there is no annual cap on patient out-of-pocket spending. That’s in contrast to commercial insurance and Medicare Advantage managed care plans — all of those have an annual cap on patient out-of-pocket costs. There’s a good amount of existing research on whether people in Medicare can afford their drugs, and on the affordability of medical care among younger groups such as working-aged uninsured people and those in ACA exchange plans. But there hasn’t been much research into medical care affordability among older Americans.

18 Feb

Posted at 20:45h in Author Interviews, Cost of Health Care, Dermatology, Gender Differences, JAMA, Medicare, Race/Ethnic Diversity
MedicalResearch.com Interview with: [caption id="attachment_56715" align="alignleft" width="107"]Lauren A. V. Orenstein, MD | She/her/hers  Assistant Professor of Dermatology Dr. Orenstein[/caption] Lauren A. V. Orenstein, MD | She/her/hers Assistant Professor of Dermatology [caption id="attachment_56716" align="alignleft" width="100"]Robert A. Swerlick, MD Professor and Alicia Leizman Stonecipher Chair of Dermatology Emory University School of Medicine Dr. Swerlick[/caption] Robert A. Swerlick, MD Professor and Alicia Leizman Stonecipher Chair of Dermatology Emory University School of Medicine Atlanta, GA 30322 MedicalResearch.com: What is the background for this study? Response: Financial incentives have the potential to drive provider behavior, even unintentionally. The aim of this study was to evaluate differences in clinic “productivity” measures that occur in outpatient dermatology encounters. Specifically, we used data from 2016-2020 at one academic dermatology practice to evaluate differences in work relative value units (wRVUs, a measure of clinical productivity) and financial reimbursement by patient race, sex, and age. 66,463 encounters were included in this study, among which 70.1% of encounters were for white patients, 59.6% were for females, and the mean age was 55.9 years old.

10 Apr

Posted at 18:31h in Author Interviews, JAMA, Kidney Disease, Medicare
MedicalResearch.com Interview with: Lead and Senior coauthors contributing to this interview: [caption id="attachment_53849" align="alignleft" width="105"] Abby Hoffman[/caption] Abby Hoffman, BA is a Pre-Doctoral Fellow in Population Health Sciences at Duke University and a PhD Candidate in Health Policy and Management University of North Carolina at Chapel Hill. [caption id="attachment_53850" align="alignleft" width="117"]Virginia Wang, PhD, MSPH is an Associate Professor in the Department of Population Health Sciences, Associate Director of the Center for Health Innovation and Outcomes Research, and Core Faculty at the Margolis Center for Health Policy at Duke University and Investigator at Durham VA HSR&D Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT). Dr. Virginia Wang[/caption] Virginia Wang, PhD, MSPH is an Associate Professor in the Department of Population Health Sciences, Associate Director of the Center for Health Innovation and Outcomes Research, and Core Faculty in the Margolis Center for Health Policy at Duke University and Investigator at the Durham VA HSR&D Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT).   MedicalResearch.com: What is the background for this study? Response: It is well established that healthcare providers are sensitive to changes in price, though their behavioral response varies. Dialysis facilities are particularly responsive to changes in Medicare reimbursement. Many dialysis patients are eligible for Medicare regardless of age, but dialysis facilities generally receive significantly higher reimbursement from private insurers than from Medicare. In 2011, Medicare implemented a new prospective bundled payment for dialysis that was expected to decrease Medicare payment and reduce overall revenues flowing into facilities. Then the Affordable Care Act (ACA) rules against refusing to insure patients for preexisting conditions and the 2014 ACA Marketplace provided an additional avenue for patients to purchase private insurance. As a result of these policies, dialysis facilities had a strong motivation and opportunity to increase the share of patients with private insurance coverage. We were interested in understanding whether dialysis facilities were shifting their payer mix away from Medicare, possibly in response to these policy changes. 

12 Mar

Posted at 16:00h in Author Interviews, Beth Israel Deaconess, Brigham & Women's - Harvard, Cost of Health Care, Geriatrics, JAMA, Medicare
MedicalResearch.com Interview with: [caption id="attachment_53434" align="alignleft" width="160"]Rishi K. Wadhera, MD Harvard Medical Faculty Physicians Cardiovasular Diseases Beth Israel Deaconess Medical Center Dr. Wadhera[/caption] Rishi K. Wadhera, MD Harvard Medical Faculty Physicians Cardiovasular Diseases Beth Israel Deaconess Medical Center  MedicalResearch.com: What is the background for this study? Response: In the U.S., income inequality has steadily increased over the last several decades. Given widening inequities, there has been significant concern about the health outcomes of older Americans who experience poverty, particularly because prior studies have shown a strong link between socioeconomic status and health. In this study, we evaluated how health outcomes for low-income older adults who are dually enrolled in both Medicare and Medicaid have changed since the early 2000’s, and whether disparities have narrowed or widened over time compared with more affluent older adults who are solely enrolled in Medicare (non-dually enrolled).

24 Feb

Posted at 15:06h in Author Interviews, Health Care Systems, Heart Disease, JAMA, Medicare
MedicalResearch.com Interview with: [caption id="attachment_53210" align="alignleft" width="160"]Rishi K. Wadhera, MD Beth Israel Deaconess Medical Center Harvard Medical Faculty Physicians Dr. Wadhera[/caption] Rishi K. Wadhera, MD Beth Israel Deaconess Medical Center Harvard Medical Faculty Physicians MedicalResearch.com: What is the background for this study? Response: In recent years, the Centers for Medicare and Medicaid Services has implemented nationally mandated value-based programs to incentivize hospitals to deliver higher quality care. The Hospital Readmissions Reduction Program (HRRP), for example, has financially penalized hospitals over $2.5 billion to date for high 30-day readmission rates. In addition, the Value-Based Purchasing Program (VBP) rewards or penalizes hospitals based on their performance on multiple domains of care.  Both programs have focused on cardiovascular care. The evidence to date, however, suggests that these programs have not improved health outcomes, and there is growing concern that they may disproportionately penalize hospitals that care for sick and poor patients, rather than for poor quality care.

06 Sep

Posted at 13:49h in Author Interviews, Cost of Health Care, JAMA, Medicare
MedicalResearch.com Interview with: [caption id="attachment_51121" align="alignleft" width="99"]Md Momotazur Rahman PhD Associate Professor of Health Services, Policy and Practice Dr. Rahman[/caption] Md Momotazur Rahman PhD Associate Professor of Health Services, Policy and Practice [caption id="attachment_51158" align="alignleft" width="125"] Margot Schwartz[/caption] Margot Schwartz MPH Doctoral program Brown University MedicalResearch.com: What is the background for this study? Response: Although one third of Medicare beneficiaries are currently enrolled in Medicare Advantage (MA), it is difficult to assess the quality of healthcare providers that serve MA beneficiaries, or to compare them to providers that serve Traditional Medicare (TM) beneficiaries. While Medicare Advantage plans are required to cover the same minimum healthcare services as TM, MA beneficiaries receive care from their plan’s network of preferred providers, while TM beneficiaries may select any Medicare-certified provider. The objective of this study is to compare the quality of Home health Agencies (HHAs) that serve Medicare Advantage and TM beneficiaries. Approximately 3.5 million Medicare beneficiaries receive home health care annually.  

28 Aug

Posted at 19:21h in Author Interviews, Brigham & Women's - Harvard, JAMA, Medicare
MedicalResearch.com Interview with: [caption id="attachment_51047" align="alignleft" width="128"]Jose F. Figueroa, MD, MPH Instructor , Harvard Medical School, Department of Medicine Brigham and Women’s Hospital Dr. Figueroa[/caption] Jose F. Figueroa, MD, MPH Instructor , Harvard Medical School, Department of Medicine Brigham and Women’s Hospital  MedicalResearch.com: What is the background for this study? Response: Hospitalizations related to ambulatory-care sensitive conditions are widely considered a key measure of access to high-quality ambulatory care. It is included as a quality measure in many national value-based care programs. To date, we do not really know whether rates of these avoidable hospitalizations are meaningfully improving for Medicare beneficiaries over time.

14 Aug

Posted at 15:12h in Author Interviews, Cost of Health Care, Medicare
MedicalResearch.com Interview with: ABT-AssociatesMatthew Trombley, Ph.D. Associate/Scientist Abt Associates  MedicalResearch.com: What is the background for this study?   Response: CMS developed the Accountable Care Organization (ACO) Investment Model (AIM) as part of the Medicare Shared Savings Program (MSSP) to encourage the growth of ACOs in rural and underserved areas.  The goal of our study was to see if AIM ACOs could successfully decrease Medicare spending in these areas.

08 Aug

Posted at 20:48h in Author Interviews, Cost of Health Care, Medicare, UCLA
MedicalResearch.com Interview with: [caption id="attachment_50628" align="alignleft" width="154"]Auyon Siddiq PhD Assistant Professor/INFORMS Member Decisions, Operations & Technology Management  UCLA Anderson School of Management Dr. Siddiq[/caption] Auyon Siddiq PhD Assistant Professor/INFORMS Member Decisions, Operations & Technology Management UCLA Anderson School of Management MedicalResearch.com: What is the background for this study? What are the main findings? Response: The Medicare Shared Savings Program (MSSP) was created under the Patient Protection and Affordable Care Act to control escalating Medicare spending by incentivizing providers to deliver healthcare more efficiently. Medicare providers that enroll in the MSSP earn bonus payments for reducing spending to below a risk-adjusted financial benchmark that depends on the provider's historical spending. To generate savings, a provider must invest to improve efficiency, which is a cost that is absorbed entirely by the provider under the current contract. This has proven to be challenging for the MSSP, with a majority of participating providers unable to generate savings due to the associated costs. This study presents a predictive analytics approach to redesigning the MSSP contract, with the goal of better aligning incentives and improving financial outcomes from the MSSP. We build our model from data containing the financial performance of providers enrolled in the MSSP, which together accounted for 7 million beneficiaries and over $70 billion in Medicare spending.

07 Mar

Posted at 14:45h in Author Interviews, Cost of Health Care, Kidney Disease, Medicare, Transplantation
MedicalResearch.com Interview with: [caption id="attachment_47825" align="alignleft" width="100"]Allyson Hart MD MSDepartment of Medicine, Hennepin Healthcare,University of MinnesotaMinneapolis, Minnesota Dr. Hart[/caption] Allyson Hart MD MS Department of Medicine, Hennepin Healthcare, University of Minnesota Minneapolis, Minnesota MedicalResearch.com: What is the background for this study? What are the main findings? Response: Kidney transplantation confers profound survival, quality of life, and cost benefits over dialysis for the treatment of end-stage kidney disease. Kidney transplant recipients under 65 years of age qualify for Medicare coverage following transplantation, but coverage ends after three years for patients who are not disabled. We studied 78,861 Medicare-covered kidney transplant recipients under the age of 65, and found that failure of the transplanted kidney was 990 percent to 1630 percent higher for recipients who lost Medicare coverage before this three-year time point compared with recipients who lost Medicare on time. Those who lost coverage after 3 years had a lesser, but still very marked, increased risk of kidney failure. Recipients who lost coverage before or after the three-year time point also filled immunosuppressive medications at a significantly lower rate than those who lost coverage on time.

21 Sep

Posted at 15:09h in Author Interviews, Cancer Research, Cost of Health Care, Dermatology, Emory, JAMA, Medicare
MedicalResearch.com Interview with: “Actinic Keratosis” by Ed Uthman is licensed under CC BY 2.0Howa Yeung, MD Assistant Professor of Dermatology Emory University School of Medicine Atlanta, GA 30322  MedicalResearch.com: What is the background for this study? Would you briefly explain what is meant by actinic keratoses? Response: Actinic keratoses are common precancerous skin lesions caused by sun exposure. Because actinic keratoses may develop into skin cancers such as squamous cell carcinoma and basal cell carcinoma, they are often treated by various destructive methods. We used Medicare Part B billing claims to estimate the number and cost of treated actinic keratoses from 2007 to 2015. MedicalResearch.com: What are the main findings?  Response: While the number of Medicare Part B beneficiaries increased only moderately, the number of actinic keratoses treated by destruction rose from 29.7 million in 2007 to 35.6 million in 2015. Medicare paid an average annual amount of $413.1 million for actinic keratosis destruction from 2007 to 2015. Independently billing non-physician clinicians, including advanced practice registered nurses and physician assistants, are treating an increasing proportion of actinic keratosis, peaking at 13.5% in 2015. MedicalResearch.com: What should readers take away from your report? Response: Readers should understand that the burden of actinic keratosis treatment is increasing in the Medicare population. There is also an increasing proportion of actinic keratoses being treated by advanced practice registered nurses and physician assistants. 

22 Aug

Posted at 16:22h in Author Interviews, Cost of Health Care, JAMA, Medicare, NYU/NYMC, Prostate Cancer
MedicalResearch.com Interview with: [caption id="attachment_44063" align="alignleft" width="200"]Danil V. Makarov, MD, MHS Department of Urology and Department of Population Health New York University Langone School of Medicine VA New York Harbor Healthcare System, Robert F. Wagner Graduate School of Public Service Cancer Institute, New York University School of Medicine, New York Dr. Makarov[/caption] Danil V. Makarov, MD, MHS Department of Urology and Department of Population Health New York University Langone School of Medicine VA New York Harbor Healthcare System, Robert F. Wagner Graduate School of Public Service Cancer Institute, New York University School of Medicine, New York MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Reducing prostate cancer staging imaging for men with low-risk disease is an important national priority to improve widespread guideline-concordant practice, as determined by the National Comprehensive Cancer Network guidelines. It appears that prostate cancer imaging rates vary by several factors, including health care setting. Within Veterans Health Administration (VHA), physicians receive no financial incentive to provide more services. Outside VHA, the fee-for-service model used in Medicare may encourage provision of more healthcare services due to direct physician reimbursement. In our study, we compared these health systems by investigating the association between prostate cancer imaging rates and a VA vs fee-for-service health care setting. We used novel methods to directly compare Veterans, Medicare Recipients, and Veterans that chose to receive care from both the VA at private facilities using Medicare insurance through the Choice Act with regard to rates of guideline-discordant imaging for prostate cancer. We found that Medicare beneficiaries were significantly more likely to receive guideline-discordant prostate cancer imaging than men treated only in VA. Moreover, we found that men with low-risk prostate cancer patients in the VA-only group had the lowest likelihood of guideline-discordant imaging, those in the VA and Medicare group had the next highest likelihood of guideline-discordant imaging (in the middle), and those in the Medicare-only group had the highest likelihood of guideline-discordant imaging. 

20 Aug

Posted at 00:38h in Author Interviews, Medicare, Race/Ethnic Diversity
MedicalResearch.com Interview with: [caption id="attachment_43985" align="alignleft" width="133"]Kim Lind, PhD, MPH Research Fellow Centre for Health Systems and Safety Research Australian Institute of Health Innovation Macquarie University, NSW  Dr. Lind[/caption] Kim Lind, PhD, MPH Research Fellow Centre for Health Systems and Safety Research Australian Institute of Health Innovation Macquarie University, NSW MedicalResearch.com: What is the background for this study? What are the main findings? Response: The Medicare Annual Wellness Visit (AWV) is a preventive care visit that was introduced in 2011 as part of the Patient Protection and Affordable Care Act. Prior to this, the only preventive care exam covered by Medicare was the Welcome to Medicare Visit, which is only available for people in their first year of Medicare enrolment. The AWV is available each year to beneficiaries without co-payment to people who are past their first year of Medicare enrolment. The AWV focuses on prevention and early detection of disease. Racial disparities in healthcare utilization and health outcomes have been well documented in the US. Prior expansions of Medicare coverage have had varied effects on reducing disparities. For example, in 2001 Medicare began to cover colorectal cancer screening which reduced racial disparities for some minority groups with respect to screening rates and improved early detection. Expanding coverage of preventive care for people on Medicare may help reduce disparities in health outcomes, but we first needed to know if people were using the Medicare Annual Wellness Visit. Our goal was to assess AWV utilization rates and determine if utilization differed by race or ethnicity. We analyzed a nationally representative database of Medicare beneficiaries (the Medicare Current Beneficiary Survey) that included self-reported race, ethnicity, income and education, linked to Medicare claims. We found that Medicare Annual Wellness Visit use was low but increased from 2011 to 2013. We also found that people on Medicare who self-identified as belonging to a racial or ethnic minority group had lower AWV utilization rates than non-Hispanic white people. People with lower income or education, and people living in rural areas had lower Medicare Annual Wellness Visit utilization. 

01 Aug

Posted at 11:43h in Author Interviews, Cost of Health Care, JAMA, Medicare, UCSF
MedicalResearch.com Interview with: [caption id="attachment_43578" align="alignleft" width="150"]Andrew B. Bindman, MD Professor of Medicine PRL- Institute for Health Policy Studies University of California San Francisco Dr. Bindman[/caption] Andrew B. Bindman, MD Professor of Medicine PRL- Institute for Health Policy Studies University of California San Francisco MedicalResearch.com: What is the background for this study?   Response: The purpose of this study was to evaluate the use and impact of a payment code for transitional care management services which was implemented by Medicare in. The transition of patients from hospitals or skilled nursing facilities back to the community often involves a change in a patient’s health care provider and introduces risks in communication which can contribute to lapses in health care quality and safety. Transitional care management services include contacting the patient within 2 business days after discharge and seeing the patient in the office within 7-14 days. Medicare implemented payment for transitional care management services with the hope that this would increase the delivery of these services believing that they could reduce readmissions, reduce costs and improve health outcomes.

06 Jul

Posted at 13:18h in Author Interviews, Cost of Health Care, End of Life Care, Medicare, Science
MedicalResearch.com Interview with: [caption id="attachment_42957" align="alignleft" width="200"]Amy Finkelstein PhD John & Jennie S. MacDonald Professor of Economics MIT Department of Economics National Bureau of Economic Research Cambridge MA 02139  Dr. Finkelstein[/caption] Amy Finkelstein PhD John & Jennie S. MacDonald Professor of Economics MIT Department of Economics National Bureau of Economic Research Cambridge MA 02139  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Although only 5% of Medicare beneficiaries die in a given year, they account for almost 25% of Medciare spending. This fact about high end of life spending has been constantly used to refer to inefficiency of the US healthcare system. A natural observation is that the fact is retrospective, and it motivated us to explore a prospective analog, which would take as an input the probability of someone dying in a given year rather than her realized outcome. We therefore used machine learning techniques to predict death, and somewhat to our surprise we found that at least using standardized and detailed claims-level data, predicting death is difficult, and there are only a tiny fraction of Medicare beneficiaries for whom we can predict death (within a year) with near certainty. Those who end up dying are obviously sicker, and our study finds that up to half of the higher spending on those who die could be attributed to the fact that those who die are sicker and sick individuals are associated with higher spending.  

02 Jul

Posted at 12:56h in Author Interviews, Cost of Health Care, Hospital Acquired, Medicare
MedicalResearch.com Interview with: [caption id="attachment_42878" align="alignleft" width="200"]Michael S. Calderwood, MD, MPH, FIDSA Regional Hospital Epidemiologist Assistant Professor of Medicine Infectious Disease & International Health Dr. Calderwood[/caption] Michael S. Calderwood, MD, MPH, FIDSA Regional Hospital Epidemiologist Assistant Professor of Medicine Infectious Disease & International Health MedicalResearch.com: What is the background for this study?   Response: Prior work by Lee et al. (N Engl J Med 2012;367:1428–1437) found that the 2008 CMS Hospital-Acquired Conditions (HAC) policy did not impact already declining national rates of central line-associated bloodstream infections (CLABSIs) or catheter-associated urinary tract infections (CAUTIs). We studied why this policy did not have its intended impact by looking at coding practices and the impact of the policy on the diagnosis-related group (DRG) assignment for Medicare hospitalizations. The DRG assignment determines reimbursement for inpatient hospitalizations.

12 Jun

Posted at 20:44h in Author Interviews, Cost of Health Care, Medicare, Orthopedics
MedicalResearch.com Interview with: [caption id="attachment_42352" align="alignleft" width="200"]Amol Navathe, MD, PhD Assistant Professor, Health Policy and Medicine Perelman School of Medicine University of Pennsylvania Dr. Navathe[/caption] Amol Navathe, MD, PhD Assistant Professor, Health Policy and Medicine Perelman School of Medicine University of Pennsylvania MedicalResearch.com: What is the background for this study? Response: Bundled payment is a key Medicare Alternative Payment Model (APM) developed by the Centers for Medicare and Medicaid Services (CMS) to increase health care value by holding health care organizations accountable for spending across an episode of care. The model provides financial incentives to maintain quality and contain spending below a predefined benchmark. In 2013, CMS launched the Bundled Payments for Care Improvement (BPCI) initiative to expand bundled payment nationwide. BPCI’s bundled payment design formed the basis for CMS’s Comprehensive Care for Joint Replacement (CJR) Model beginning in 2016. While the programs are similar in design, BPCI is voluntary while CJR is mandatory for hospitals in selected markets. Moreover, CJR is narrower in scope, focusing only on lower extremity joint replacement (LEJR) and limiting participation to hospitals.