Medicare Consumer Assessment Of Healthcare Providers And Systems Research Articles

Associations of multimorbidity and patient-reported experiences of care with conservative management among elderly patients with localized prostate cancer.

BackgroundMany elderly localized prostate cancer patients could benefit from conservative management (CM). This retrospective cohort study examined the associations of patient‐reported access to care and multimorbidity on CM use patterns among Medicare Fee‐for‐Service (FFS) beneficiaries with localized prostate cancer.MethodsWe used linked Surveillance, Epidemiology, and End Results cancer Registry, Medicare Claims, and the Medicare Consumer Assessment of Healthcare Providers and Systems (MCAHPS) survey files. We identified FFS Medicare Beneficiaries (age ≥ 66; continuous enrollment in Parts A & B) with incident localized prostate cancer from 2003 to 2013 and a completed MCAHPS survey measuring patient‐reported experiences of care within 24 months after diagnosis (n = 496). We used multivariable models to examine MCAHPS measures (getting needed care, timeliness of care, and doctor communication) and multimorbidity on CM use.ResultsLocalized prostate cancer patients with multimorbidity were less likely to use CM (adjusted odds ratio (AOR)=0.42 (0.27‐ 0.66), P < .001); those with higher scores on timeliness of care (AOR = 1.21 (1.09, 1.35), P < .001), higher education attainment (3.21 = AOR (1.50,6.89), P = .003), and impaired mental health status (4.32 = AOR (1.86, 10.1) P < .001) were more likely to use CM.Conclusion(s)Patient‐reported experience with timely care was significantly and positively associated with CM use. Multimorbidity was significantly and inversely associated with CM use. Addressing specific modifiable barriers to timely care along the cancer continuum for elderly localized prostate cancer patients with limited life expectancy could reduce the adverse effects of overtreatment on health outcomes and costs.

Abstract B010: Association of cancer survivors' sociodemographic characteristics with survivorship care patterns

Abstract Cancer survivors may have unique medical care needs due to chronic/late-occurring effects of cancer or cancer treatment. “Shared care,” which involves delivery of components of survivorship care by both oncologists and primary care providers (PCPs), may lead to increased coordination of care and may better address survivors' needs. However, little is known regarding potential disparities in receipt of shared care among cancer survivors. We examined associations between cancer survivors' sociodemographic characteristics and their receipt of shared care. SEER-CAHPS data, linking NCI's Surveillance, Epidemiology, and End Results (SEER) registry data, Medicare claims, and Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey responses, were used. Individuals age &amp;gt;65 years at diagnosis in 2000-2011 SEER-CAHPS with breast, cervical, colorectal, lung, renal, or prostate cancers or hematologic malignancies who responded to a Medicare CAHPS survey &amp;gt;18 months after diagnosis were included. Individuals were classified in four mutually exclusive survivorship care patterns: Shared Care, Oncologist-led, PCP-led, or Other survivorship care, based on the proportions of their oncologist, PCP, and other physician encounters in Medicare claims data. Differences in survivorship care pattern by sex, age, education, race/ethnicity, and dual Medicare-Medicaid status were examined. Among the 10,132 survivors included in the study, 15.1%, 10.0%, 32.7%, and 42.2% received Shared Care, Oncologist-led, PCP-led, and Other care patterns, respectively. Compared with survivors in Shared Care, significantly greater proportions of those in the PCP-led pattern were over age 85 (24% PCP-led vs. 16% Shared Care), female (55% PCP-led vs. 44% Shared Care), and had high school or less educational attainment (52% PCP-led vs. 46% Shared Care). A significantly smaller proportion of survivors in the Oncologist-led pattern were older than age 85 (12% Oncologist-led vs. 16% Shared Care). Significantly more of those in the Other survivorship care pattern compared with Shared Care were older than age 85 (21% Other vs. 16% Shared Care) and non-Hispanic White (87% Other vs. 81% Shared Care), and fewer survivors in the Other care pattern had high school or less educational attainment (42% Other vs. 46% Shared Care). Overall, we found few significant and consistent associations between sociodemographic characteristics and receipt of Shared Care among cancer survivors in the SEER-CAHPS data set. However, these characteristics may influence type of survivorship care pattern received. Further research is needed to examine the role of patient characteristics in receiving different survivorship care patterns. Citation Format: Michael T. Halpern, Julia Cohen, Lisa M. Lines, Michelle A. Mollica, Erin E. Kent. Association of cancer survivors' sociodemographic characteristics with survivorship care patterns [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B010.

Quality of care for cancer survivors: Does a model of shared care affect experience of care?

213 Background: Cancer survivors may have unique medical care needs due to chronic/late-occurring effects of cancer or cancer treatment. “Shared care,” survivorship care delivered by both oncologists and primary care providers (PCPs), may better address these needs. Little is known about outcomes for survivors receiving shared care vs. oncologist-led or PCP-led patterns of care. We compared patient reported experiences of care for survivors receiving oncologist-led, PCP-led, shared care, or other patterns of care. Methods: Analyses of SEER-CAHPS, a data resource linking NCI's Surveillance, Epidemiology, and End Results (SEER) registry data, Medicare claims, and Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey responses. Individuals age ≥ 65 in SEER-CAHPS diagnosed 2000-2011 with breast, cervical, colorectal, lung, renal, or prostate cancer or hematologic malignancies who completed a Medicare CAHPS survey ≥ 18 months after diagnosis and were continuously enrolled in Medicare A &amp; B ≥ 6 months before and 6 months after survey completion were included. CAHPS included ratings of Overall Care, Personal Doctor, Specialist Physician, Health Plan, and composite scores for Doctor Communication, Care Coordination, Getting Needed Care, Getting Care Quickly, and Getting Needed Drugs. Survivorship care patterns were identified using proportions of oncologist, PCP, and other physician encounters. Multivariable regressions examined associations between survivorship care patterns and CAHPS outcomes. Results: Among 10,132 survivors, 15% received Shared Care; 10% Oncologist-led; 33% PCP-led; and 42% Other. Compared with Shared Care, we found no significant differences in survivors' experience of care except for Getting Needed Drugs (lower for PCP-led and Other). Sensitivity analyses using different pattern of care definitions showed no associations between survivorship model and experience of care. Conclusions: Survivors’ experiences of care were similar for those in Shared Care vs. Oncologist-led, PCP-led, and Other patterns of care. Within the study’s limitations, these results do not indicate enhanced patient reported medical care experiences for survivors receiving shared care.

Differences in Hospitalizations Between Fee-for-Service and Medicare Advantage Beneficiaries.

Previous studies found lower hospitalization rates for enrollees in Medicare Advantage (MA) plans than for beneficiaries with fee-for-service (FFS) coverage. MA enrollment is increasing, especially for those newly eligible for Medicare, but little is known about how service use in FFS or MA differs for new beneficiaries. To compare differences in rates of hospitalization between MA and FFS. A retrospective study of hospitalization among FFS and MA respondents to the Medicare Consumer Assessment of Healthcare Providers and Systems (MCAHPS) survey. Differences in hospitalization rates were assessed using multivariable logistic regression models that controlled for patient sociodemographic and health characteristics. Models included an interaction between age and coverage type to determine whether patterns of care were distinct for enrollees recently eligible for Medicare. In total, 259,335 respondents to the 2013 MCAHPS survey. In total, 14% of FFS and 12% of MA enrollees had ≥1 hospitalization in the 6 months before survey administration. Models adjusted for enrollee demographics found that MA enrollees had 0.81 the odds of being hospitalized relative to those with FFS coverage (95% confidence interval, 0.78-0.84). Differences between groups were substantially reduced and no longer statistically significant when they were fully adjusted (adjusted odds ratio 1.01, 95% confidence interval, 0.97-1.08). Models with interactions indicated no significant age differences in the MA/FFS hospitalization gap. Differences in hospital admissions between those with MA and FFS coverage appear to be primarily related to differences in health status.

Geographic context of black-white disparities in Medicare CAHPS patient experience measures.

ObjectiveTo examine whether black‐white patient experience disparities vary by geography and within‐county contextual factors.Data Sources321 300 Medicare beneficiaries responding to the 2015‐2016 Medicare Consumer Assessment of Health care Providers and Systems (MCAHPS) Surveys; 2010 Census data for several within‐county contextual factors.Study DesignMixed‐effects regression models predicted three MCAHPS patient experience measures for black and white beneficiaries from geographic random effects, contextual fixed effects, and beneficiary‐level case‐mix adjustors.Principal FindingsBlack‐white disparities in patient experiences were smaller in counties with higher average patient experiences. Black‐white disparities in patient experiences were not associated with county‐level poverty or racial segregation. However, county racial segregation and some measures of poverty were significantly associated with all beneficiaries’ level of health care access. Getting Needed Care scores were higher with greater racial segregation, while Getting Care Quickly scores were lower with higher poverty and racial segregation.ConclusionsEfforts to reduce black‐white disparities in patient experiences should focus on areas with low average patient experiences. Attempts to reduce disparities in timely access to health care should target primarily black, low‐income, and racially and economically segregated areas. Positive associations of racial segregation with accessing needed care were unexpected.

Medicare Advantage and Fee-for-Service Performance on Clinical Quality and Patient Experience Measures: Comparisons from Three Large States.

To compare performance between Medicare Advantage (MA) and Fee-for-Service (FFS) Medicare during a time of policy changes affecting both programs. Performance data for 16 clinical quality measures and 6 patient experience measures for 9.9million beneficiaries living in California, New York, and Florida. We compared MA and FFS performance overall, by plan type, and within service areas associated with contracts between CMS and MA organizations. Case mix-adjusted analyses (for measures not typically adjusted) were used to explore the effect of case mix on MA/FFS differences. Performance measures were submitted by MA organizations, obtained from the nationwide fielding of the Medicare Consumer Assessment of Healthcare Providers and Systems (MCAHPS) Survey, or derived from claims. Overall, MA outperformed FFS on all 16 clinical quality measures. Differences were large for HEDIS measures and small for Part D measures and remained after case mix adjustment. MA enrollees reported better experiences overall, but FFS beneficiaries reported better access to care. Relative to FFS, performance gaps were much wider for HMOs than PPOs. Excluding HEDIS measures, MA/FFS differences were much smaller in contract-level comparisons. Medicare Advantage/Fee-for-Service differences are often large but vary in important ways across types of measures and contracts.

Measuring cancer care experiences: Introducing SEER-CAHPS.

6595 Background: Care experience ratings are recognized as measures of healthcare quality. Here we introduce a new, public data resource, SEER-CAHPS, which links cancer registry data from the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) program with Medicare claims and the Medicare Consumer Assessment of Healthcare Providers and Systems (MCAHPS) survey. Methods: The SEER-CAHPS resource includes cancer registry data from 1973-2011 (diagnosis, incidence, mortality, and sociodemographic data), Medicare CAHPS survey data from 1998-2013 (sociodemographic, health status, and care experience ratings), and Medicare fee-for-service (FFS) claims data from 2002-2013. The survey includes global ratings of overall care, personal doctor, specialist, health plan, and prescription drug plans, and composite ratings of doctor communication, care coordination, getting needed care, and getting care quickly. Data also contain survey weights to account for the Medicare CAHPS sampling design. Cross-sectional and longitudinal analyses are possible. Results: Currently, SEER-CAHPS includes 205,339 individuals with a history of cancer documented in SEER (FFS: 26,802 with a survey before cancer diagnosis, and 55,231 with a survey after cancer diagnosis; Medicare Advantage [MA]: 57,227 with a survey before cancer diagnosis and 71,436 with a survey after cancer diagnosis). The data resource also includes 724,965 MCAHPS respondents without cancer in SEER regions (FFS: 282,592; MA: 447,358). The data provide insights on topics including experiences of cancer patients in their last year of life; experiences of cancer survivors; and the associations of guideline-concordant follow-up care with patient experiences among cancer survivors. We will demonstrate project sample-size estimation and present instructions for submitting data access applications. Conclusions: SEER-CAHPS, a new, publicly available resource, provides population-based, cancer-specific data on patient experiences, health outcomes and healthcare utilization.

Measuring experiences of patients with cancer with care: The SEER-CAHPS linked data resource.

238 Background: Care experience ratings are recognized as measures of quality. We introduce a new resource, SEER-CAHPS, linking cancer registry data from the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) program with Medicare claims and the Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. Methods: The SEER-CAHPS data resource includes registry data from 1973-2011 (diagnosis, incidence, mortality, and sociodemographic data), Medicare CAHPS survey data from 1998-2013 (sociodemographic, health status, and care experience ratings), and Medicare fee-for-service (FFS) claims data from 2002-2013. SEER-CAHPS includes global ratings of overall care, personal doctor, specialist, health plan, and prescription drug plan and composite ratings of doctor communication, care coordination, getting needed care, and getting care quickly. The data also contain optional survey weights to account for the Medicare CAHPS sampling design. Results: Currently, SEER-CAHPS includes 205,339 individuals with a history of cancer documented in SEER (FFS: 26,802 with a survey before cancer diagnosis, and 55,231 with a survey after cancer diagnosis; Medicare Advantage [MA]: 57,227 with a survey before cancer diagnosis and 71,436 with a survey after cancer diagnosis). The database also includes 724,965 MCAHPS respondents without cancer in SEER regions (FFS: 282,592; MA: 447,358). The data provide insights on topics including experiences of cancer patients in their last year of life; experiences of cancer survivors; experiences of dually eligible (Medicare-Medicaid) cancer patients; and the associations of guideline-concordant follow-up care with patient experiences among people with colorectal cancer. We will demonstrate project sample-size estimation and present instructions for submitting data access applications. Conclusions: SEER-CAHPS provides population-based, cancer-specific data on patient experiences and associations with both health outcomes and healthcare utilization.

Advice to Quit Smoking and Ratings of Health Care among Medicare Beneficiaries Aged 65.

To examine the relationship between physician advice to quit smoking and patient care experiences. The 2012 Medicare Consumer Assessment of Healthcare Providers and Systems (MCAHPS) surveys. Fixed-effects linear regression models were used to analyze cross-sectional survey data, which included a nationally representative sample of 26,432 smokers aged 65+. Eleven of 12 patient experience measures were significantly more positive among smokers who were always advised to quit smoking than those advised to quit less frequently. There was an attenuated but still significant and positive association of advice to quit smoking with both physician rating and physician communication, after controlling for other measures of care experiences. Physician-provided cessation advice was associated with more positive patient assessments of their physicians.

Living Alone and Patient Care Experiences: The Role of Gender in a National Sample of Medicare Beneficiaries.

Seniors who live alone are a large, growing population with poorer health outcomes. We examine the little-studied health care experiences and immunizations of older adults who live alone. We use regression-based case-mix adjustment to compare immunizations and health care experiences of 325,649 adults aged 65 and older who lived alone to those who did not, overall and by gender and health status, using nationally representative data from the Medicare Consumer Assessment of Healthcare Providers and Systems (MCAHPS) surveys. Outcomes were five global care ratings (health plan, drug plan, doctor, specialists, all care), six composite care measures (getting needed care, getting care quickly, doctor communication, customer service, getting needed drugs, getting information from drug plan), and two immunization measures (influenza, pneumonia). About 30.3% of respondents lived alone. Women, older beneficiaries, and low income (Medicaid eligible) beneficiaries reported living alone at substantially higher rates than their counterparts. Care experiences for 8 of the 13 measures were significantly worse for those who lived alone than for others. The association differed significantly in magnitude by gender for 10 measures, with larger average differences for men. The largest disadvantages for those living alone were for immunization measures (eg, influenza -6 percentage points, for men living alone vs other men). The disadvantages of living alone were not consistently greater for those in worse health. Living alone is associated with worse care experiences and immunization, especially for men. Health plans should target quality improvement and outreach efforts to beneficiaries who live alone, especially men.

Does the Racial/Ethnic Composition of Medicare Advantage Plans Reflect Their Areas of Operation?

To assess the extent to which the racial/ethnic composition of Medicare Advantage (MA) plans reflects the composition of their areas of operation, given the potential incentives created by the Centers for Medicare & Medicaid Services' Quality Bonus Payments for such plans to avoid enrolling racial/ethnic minority beneficiaries. 2009 Medicare Consumer Assessment of Healthcare Providers and Systems (MCAHPS) survey and administrative data from the Medicare Enrollment Database. We defined each plan's area of operation as all counties in which it had MA enrollees, and we created a matrix of race/ethnicity by plan by county of residence to assess the racial/ethnic distribution of each plan's enrollees in comparison with the racial/ethnic composition of MA beneficiaries in its operational area. There is little evidence that health plans are selectively underenrolling blacks, Latinos, or Asians to a substantial degree. A small but potentially important subset of plans disproportionately serves minority beneficiaries. These findings provide a baseline profile that will enable crucial ongoing monitoring to assess how the implementation of Quality Bonus Payments may affect MA plan coverage of minority populations.