Medicare Advantage Associated With More Racial Disparity Than Traditional Medicare For Hospital Readmissions [Web First]
We compared racial disparities in thirty-day readmissions between traditional Medicare and Medicare Advantage beneficiaries who underwent one of six major surgeries in New York State in 2013. We found that Medicare Advantage was associated with greater racial disparity, compared to traditional Medicare. After controlling for patient, hospital, and geographic characteristics in a propensity score based approach, we found that in traditional Medicare, black patients were 33 percent more likely than white patients to be readmitted, whereas in Medicare Advantage, black patients were 64 percent more likely than white ...
Source: Health Affairs - July 5, 2017 Category: International Medicine & Public Health Authors: Li, Y., Cen, X., Cai, X., Thirukumaran, C. P., Zhou, J., Glance, L. G. Tags: Hospitals, Medicare, Minority Health Web First Source Type: research
Health Spending By State 1991-2014: Measuring Per Capita Spending By Payers And Programs [Web First]
This study examines per capita health spending by state of residence and per enrollee spending for the three largest payers (Medicare, Medicaid, and private health insurance) through 2014. Moreover, it discusses in detail the impacts of the Affordable Care Act implementation and the most recent economic recession and recovery on health spending at the state level. According to this analysis, these factors affected overall annual growth in state health spending and the payers and programs that paid for that care. They did not, however, substantially change state rankings based on per capita spending levels over the period. ...
Source: Health Affairs - July 5, 2017 Category: International Medicine & Public Health Authors: Lassman, D., Sisko, A. M., Catlin, A., Barron, M. C., Benson, J., Cuckler, G. A., Hartman, M., Martin, A. B., Whittle, L. Tags: Health Care Finance, Medicaid, Medicare, State/Local Issues, Health Spending Web First Source Type: research
High-Cost Dual Eligibles Service Use Demonstrates The Need For Supportive And Palliative Models Of Care [Dual Eligibles]
Health care spending is generally highest among people who need both complex medical care and long-term services and supports, such as adults dually eligible for Medicare and Medicaid. Understanding how different types of complex patients use services over time can inform policies that target this population. High combined Medicare and Medicaid spending are found in two distinct groups of high-cost dual eligibles: older beneficiaries who are nearing the end of life, and younger beneficiaries with sustained need for functional supports. However, both groups have high hospitalization costs. Among high-cost dual eligibles liv...
Source: Health Affairs - July 5, 2017 Category: International Medicine & Public Health Authors: Bynum, J. P. W., Austin, A., Carmichael, D., Meara, E. Tags: Medicaid, Medicare, Chronic Care, Health Spending Dual Eligibles Source Type: research
CMS Strategies To Reduce Antipsychotic Drug Use In Nursing Home Patients With Dementia Show Some Progress [Nursing Homes]
We examined 86,163 state recertification surveys conducted at 15,055 facilities in the period January 1, 2009–March 31, 2015. We found that these strategies were associated with increases in citations for only one of two targeted deficiencies (unnecessary drug use) and only after the third strategy (revisions to the federal guidelines for the citations) was implemented. Each strategy was associated with a modest but significant reduction in antipsychotic prevalence in the general nursing home population. Initial reductions were greater in the ten states with the highest prevalence of antipsychotic use in nu...
Source: Health Affairs - July 5, 2017 Category: International Medicine & Public Health Authors: Lucas, J. A., Bowblis, J. R. Tags: Mental Health/Substance Abuse, Pharmaceuticals, Elderly Nursing Homes Source Type: research
A Positive Association Between Hospice Profit Margin And The Rate At Which Patients Are Discharged Before Death [Hospice & Palliative Care]
Hospice care is designed to support patients and families through the final phase of illness and death. Yet for more than a decade, hospices have steadily increased the rate at which they discharge patients before death—a practice known as "live discharge." Although certain live discharges are consistent with high-quality care, regulators have expressed concern that some hospices’ desire to maximize profits drives them to inappropriately discharge patients. We used Medicare claims data for 2012–13 and cost reports for 2011–13 to explore relationships between hospice-level financial margins and live ...
Source: Health Affairs - July 5, 2017 Category: International Medicine & Public Health Authors: Dolin, R., Holmes, G. M., Stearns, S. C., Kirk, D. A., Hanson, L. C., Taylor, D. H., Silberman, P. Tags: Health Care Finance, Medicare, Quality Of Care, Elderly Hospice & amp; Palliative Care Source Type: research
Black And Hispanic Patients Receive Hospice Care Similar To That Of White Patients When In The Same Hospices [Hospice & Palliative Care]
Little is known about racial and ethnic variation in the quality of hospice care. We used data on 292,516 respondents for 2015–16 from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey to assess how the patient and family experience of hospice care differed among black, Hispanic, and white patients. We found that, on average, black and Hispanic patients received care from poorer quality hospices. Within a given hospice, we found that friends and relatives who served as caregivers of black and Hispanic patients reported significantly better hospice care experiences than their peers ser...
Source: Health Affairs - July 5, 2017 Category: International Medicine & Public Health Authors: Price, R. A., Parast, L., Haas, A., Teno, J. M., Elliott, M. N. Tags: Access To Care, Minority Health Hospice & amp; Palliative Care Source Type: research
Increasing Veterans Hospice Use: The Veterans Health Administrations Focus On Improving End-Of-Life Care [Hospice & Palliative Care]
In 2009 the Department of Veterans Affairs (VA) began a major, four-year investment in improving the quality of end-of-life care. The Comprehensive End of Life Care Initiative increased the numbers of VA medical center inpatient hospice units and palliative care staff members as well as the amount of palliative care training, quality monitoring, and community outreach. We divided male veterans ages sixty-six and older into categories based on their use of the VA and Medicare and examined whether the increases in their rates of hospice use in the last year of life differed from the concurrent increase among similar nonveter...
Source: Health Affairs - July 5, 2017 Category: International Medicine & Public Health Authors: Miller, S. C., Intrator, O., Scott, W., Shreve, S. T., Phibbs, C. S., Kinosian, B., Allman, R. M., Edes, T. E. Tags: Quality Of Care, Elderly Hospice & amp; Palliative Care Source Type: research
A National Strategy For Palliative Care [Hospice & Palliative Care]
In 2014 the World Health Organization called for palliative care to be integrated as an essential element of the health care continuum. Yet in 2017 US palliative care services are found largely in hospitals, and hospice care, which is delivered primarily in the home, is limited to people who are dying soon. The majority of Americans with a serious illness are not dying; are living at home, in assisted living facilities, or in nursing homes; and have limited access to palliative care. Most health care providers lack knowledge about and skills in pain and symptom management, communication, and care coordination, and both the...
Source: Health Affairs - July 5, 2017 Category: International Medicine & Public Health Authors: Meier, D. E., Back, A. L., Berman, A., Block, S. D., Corrigan, J. M., Morrison, R. S. Tags: Home Care Hospice & amp; Palliative Care Source Type: research
A Systematic Intervention To Improve Serious Illness Communication In Primary Care [Respecting Patients' Preferences]
Improving communication about goals and values for patients with advancing serious illness nearing the end of life is a key opportunity to improve the value of care. The Serious Illness Care Program, implemented at primary care clinics affiliated with Brigham and Women’s Hospital in Boston, Massachusetts, is a multicomponent intervention designed to support best practices in communication by clinicians to increase conversations with patients with serious illness about their goals and values. We conducted a study of the program in fourteen primary care clinics participating in a high-risk care management program based...
Source: Health Affairs - July 5, 2017 Category: International Medicine & Public Health Authors: Lakin, J. R., Koritsanszky, L. A., Cunningham, R., Maloney, F. L., Neal, B. J., Paladino, J., Palmor, M. C., Vogeli, C., Ferris, T. G., Block, S. D., Gawande, A. A., Bernacki, R. E. Tags: Quality Of Care Respecting Patients ' Preferences Source Type: research
Challenges In Understanding And Respecting Patients Preferences [Respecting Patients' Preferences]
The Institute of Medicine’s report on Dying in America called for honoring treatment preferences near the end of life for seriously ill patients. To achieve this objective, the report recommended that patients, their family members, other loved ones, and providers engage in shared decision making about current and future treatment decisions (that is, advance care planning). Yet decision science research suggests that preferences are objectively difficult to specify for complex contingencies and subjectively difficult to specify for unfamiliar choices. Because advance care planning involves both difficulties—the...
Source: Health Affairs - July 5, 2017 Category: International Medicine & Public Health Authors: Barnato, A. E. Tags: Ethical Issues Respecting Patients ' Preferences Source Type: research
Approximately One In Three US Adults Completes Any Type Of Advance Directive For End-Of-Life Care [Respecting Patients' Preferences]
Efforts to promote the completion of advance directives implicitly assume that completion rates of these documents, which help ensure care consistent with people’s preferences in the event of incapacity, are undesirably low. However, data regarding completion of advance directives in the United States are inconsistent and of variable quality. We systematically reviewed studies published in the period 2011–16 to determine the proportion of US adults with a completed living will, health care power of attorney, or both. Among the 795,909 people in the 150 studies we analyzed, 36.7 percent had completed an adv...
Source: Health Affairs - July 5, 2017 Category: International Medicine & Public Health Authors: Yadav, K. N., Gabler, N. B., Cooney, E., Kent, S., Kim, J., Herbst, N., Mante, A., Halpern, S. D., Courtright, K. R. Tags: Consumer Issues Respecting Patients ' Preferences Source Type: research
Applying Quality Indicators For Administrative Databases To Evaluate End-Of-Life Care For Cancer Patients In Belgium [Quality Of Care]
End-of-life cancer care has been criticized as frequently inappropriate and aggressive. Providing appropriate care to people with cancer is a public health priority. Quality indicators are considered a valid way to evaluate the appropriateness of end-of-life cancer care within a health care system. We conducted a population-level retrospective observational study of all cancer decedents in Belgium in 2012 to assess end-of-life care and risk factors for exposure to care. We linked eight full-population databases on health care use, cancer diagnoses, and demographic and socioeconomic variables. We used analysis of variance t...
Source: Health Affairs - July 5, 2017 Category: International Medicine & Public Health Authors: De Schreye, R., Smets, T., Annemans, L., Deliens, L., Gielen, B., De Gendt, C., Cohen, J. Tags: Access To Care, International Issues, Public Health, Chronic Care Quality Of Care Source Type: research
Challenges Of Measuring Quality Of Community-Based Programs For Seriously Ill Individuals And Their Families [Quality Of Care]
For many individuals and their families, acknowledging and confronting a serious illness such as cancer or advanced heart failure is a sentinel life event. From a health policy perspective, many individuals confronting such illnesses are high-need, high-cost patients who are increasingly cared for by community-based programs that may have competing goals: improving quality and reducing costs. Providing care to high-need, high-cost patients tests a health care system’s ability to coordinate care and adapt to highly variable disease trajectories that could result in improved health for some, sudden and unexpected death...
Source: Health Affairs - July 5, 2017 Category: International Medicine & Public Health Authors: Teno, J. M., Price, R. A., Makaroun, L. K. Tags: Quality Of Care Source Type: research
Disparities In Cancer Care And Costs At The End Of Life: Evidence From Englands National Health Service [International Experience]
This study examines disparities in end-of-life treatment costs for cancer patients in England. Analyzing data on over 250,000 colorectal, breast, prostate, and lung cancer patients from multiple national databases, we found evidence illustrating that disparities are driven largely by the greater use of emergency inpatient care among patients of lower socioeconomic status. Even within a system with free health care, differences in the use of care create disparities in cancer costs. While further studies of these barriers is required, our research suggests that disparities may be reduced through better management of needs th...
Source: Health Affairs - July 5, 2017 Category: International Medicine & Public Health Authors: Walsh, B., Laudicella, M. Tags: International Issues, Health Spending, Variations International Experience Source Type: research
End-Of-Life Medical Spending In Last Twelve Months Of Life Is Lower Than Previously Reported [International Experience]
Although end-of-life medical spending is often viewed as a major component of aggregate medical expenditure, accurate measures of this type of medical spending are scarce. We used detailed health care data for the period 2009–11 from Denmark, England, France, Germany, Japan, the Netherlands, Taiwan, the United States, and the Canadian province of Quebec to measure the composition and magnitude of medical spending in the three years before death. In all nine countries, medical spending at the end of life was high relative to spending at other ages. Spending during the last twelve months of life made up a modest share ...
Source: Health Affairs - July 5, 2017 Category: International Medicine & Public Health Authors: French, E. B., McCauley, J., Aragon, M., Bakx, P., Chalkley, M., Chen, S. H., Christensen, B. J., Chuang, H., Cote-Sergent, A., De Nardi, M., Fan, E., Echevin, D., Geoffard, P.-Y., Gastaldi-Menager, C., Gortz, M., Ibuka, Y., Jones, J. B., Kallestrup-Lamb, Tags: Health Care Finance, International Issues, Health Spending International Experience Source Type: research
