Medicare Population Research Articles

Comparing the Centers for Medicare and Medicaid Services (CMS) enrollment data death dates to the National Death Index (NDI).

In the United States, the National Death Index (NDI) is the most complete source of death information, while epidemiologic studies with mortality outcomes often rely on U.S. Medicare data for outcome ascertainment. The purpose of this study was to assess the agreement of death information between the Centers for Medicare & Medicaid Services (CMS) Medicare enrolment data and NDI. Using Medicare and NDI data from 1999 through 2016, we identified Medicare beneficiaries who were reported dead in the CMS Medicare enrolment database (EDB) and Common Medicare Environment (CME), linked these beneficiaries to the NDI using CMS Health Insurance Claim number, and compared death dates between the two data sources. To assess agreement between our data sources, we calculated kappa scores; where a kappa of 1 indicates perfect agreement and a kappa of 0 indicates agreement equivalent to chance. We also examined CMS to NDI linkage and death date matching for stability over time. Of the 36 785 640, Medicare beneficiaries reported dead in CMS enrollment data from 1999 to 2016, 97.5% were linked to the NDI. A kappa score of 0.98 showed a near perfect agreement between NDI and CMS reported deaths. The percentage of linked cases exactly matching on death dates increased from 94.8% in 1999 to 99.4% in 2016. Our findings suggest strong concordance between death dates as recorded by CMS enrollment data and the NDI in the entire Medicare population.

Disparity in treatment patterns among Medicare beneficiaries diagnosed with chronic lymphocytic leukemia: an analysis of patient and contextual factors

This study characterizes the patterns and timing of CLL treatment and, to our knowledge, is the first to identify social vulnerability factors associated with CLL treatment receipt in the Medicare population. A total of 3508 Medicare beneficiaries diagnosed with CLL from 2017 to 2019 were identified. We reported the proportion of individuals who received CLL treatment and the time until the first CLL treatment receipt after the first observed claim with a CLL diagnosis. Logistic regression and time-to-event models provided adjusted odds ratios and hazard ratios associated with baseline individual-level and county-level factors. Sixteen percent of individuals received CLL treatment, and the median follow-up time was 540 d. The median time to receipt of CLL treatment was 61 d. Older age and residence in a county ranked high in social vulnerability (as defined by minority status and language) were negatively associated with treatment receipt and time to treatment receipt.

Mode of Fixation and Survivorship in Primary Total Knee Arthroplasty in the American Joint Replacement Registry

BackgroundA recent rapid increase in cementless total knee arthroplasty (TKA) has been noted in the American Joint Replacement Registry (AJRR). The purpose of our study was to compare TKA survivorship based on the mode of fixation reported to the AJRR in the Medicare population. MethodsPrimary TKAs from Medicare patients submitted to AJRR from 2012 to 2022 were analyzed. The Medicare and AJRR databases were merged. Cox regression stratified by sex compared revision outcomes (all-cause, infection, mechanical loosening, and fracture) for cemented, cementless, and hybrid fixation, controlling for age and the Charlson comorbidity index (CCI). ResultsA total of 634,470 primary TKAs were analyzed. Cementless TKAs were younger (71.8 versus 73.1 years, P < .001) than cemented TKAs and more frequently utilized in men (8.2 versus 5.8% women, P < .001). Regional differences were noted, with cementless fixation more common in the Northeast (10.5%) and South (9.2%) compared to the West (4.4%) and Midwest (4.3%) (P < .001). No significant differences were identified in all-cause revision rates in men or women ≥ 65 for cemented, cementless, or hybrid TKA after adjusting for age and CCI. Significantly lower revision for fracture was identified for cemented compared to cementless and hybrid fixation in women ≥ 65 after adjusting for age and CCI (P = .0169). ConclusionsNo survivorship advantage for all-cause revision was noted based on the mode of fixation in men or women ≥ 65 after adjusting for age and CCI. A significantly lower revision rate for fractures was noted in women ≥ 65 utilizing cemented fixation. Cementless fixation in primary TKA should be used with caution in elderly women.

A sampling strategy for longitudinal and cross-sectional analyses using a large national claims database.

The United States (US) Medicare claims files are valuable sources of national healthcare utilization data with over 45 million beneficiaries each year. Due to their massive sizes and costs involved in obtaining the data, a method of randomly drawing a representative sample for retrospective cohort studies with multi-year follow-up is not well-documented. To present a method to construct longitudinal patient samples from Medicare claims files that are representative of Medicare populations each year. Retrospective cohort and cross-sectional designs. US Medicare beneficiaries with diabetes over a 10-year period. Medicare Master Beneficiary Summary Files were used to identify eligible patients for each year in over a 10-year period. We targeted a sample of ~900,000 patients per year. The first year's sample is stratified by county and race/ethnicity (white vs. minority), and targeted at least 250 patients in each stratum with the remaining sample allocated proportional to county population size with oversampling of minorities. Patients who were alive, did not move between counties, and stayed enrolled in Medicare fee-for-service (FFS) were retained in the sample for subsequent years. Non-retained patients (those who died or were dropped from Medicare) were replaced with a sample of patients in their first year of Medicare FFS eligibility or patients who moved into a sampled county during the previous year. The resulting sample contains an average of 899,266 ± 408 patients each year over the 10-year study period and closely matches population demographics and chronic conditions. For all years in the sample, the weighted average sample age and the population average age differ by <0.01 years; the proportion white is within 0.01%; and the proportion female is within 0.08%. Rates of 21 comorbidities estimated from the samples for all 10 years were within 0.12% of the population rates. Longitudinal cohorts based on samples also closely resembled the cohorts based on populations remaining after 5- and 10-year follow-up. This sampling strategy can be easily adapted to other projects that require random samples of Medicare beneficiaries or other national claims files for longitudinal follow-up with possible oversampling of sub-populations.

Clinical Risk and Outpatient Therapy Utilization for COVID-19 in the Medicare Population

Multiple therapies are available for outpatient treatment of COVID-19 that are highly effective at preventing hospitalization and mortality. Although racial and socioeconomic disparities in use of these therapies have been documented, limited evidence exists on what factors explain differences in use and the potential public health relevance of these differences. To assess COVID-19 outpatient treatment utilization in the Medicare population and simulate the potential outcome of allocating treatment according to patient risk for severe COVID-19. This cross-sectional study included patients enrolled in Medicare in 2022 across the US, identified with 100% Medicare fee-for-service claims. The primary outcome was any COVID-19 outpatient therapy utilization. Secondary outcomes included COVID-19 testing, ambulatory visits, and hospitalization. Differences in outcomes were estimated based on patient demographics, treatment contraindications, and a composite risk score for mortality after COVID-19 based on demographics and comorbidities. A simulation of reallocating COVID-19 treatment, particularly with nirmatrelvir, to those at high risk of severe disease was performed, and the potential COVID-19 hospitalizations and mortality outcomes were assessed. In 2022, 6.0% of 20 026 910 beneficiaries received outpatient COVID-19 treatment, 40.5% of which had no associated COVID-19 diagnosis within 10 days. Patients with higher risk for severe disease received less outpatient treatment, such as 6.4% of those aged 65 to 69 years compared with 4.9% of those 90 years and older (adjusted odds ratio [aOR], 0.64 [95% CI, 0.62-0.65]) and 6.4% of White patients compared with 3.0% of Black patients (aOR, 0.56 [95% CI, 0.54-0.58]). In the highest COVID-19 severity risk quintile, 2.6% were hospitalized for COVID-19 and 4.9% received outpatient treatment, compared with 0.2% and 7.5% in the lowest quintile. These patterns were similar among patients with a documented COVID-19 diagnosis, those with no claims for vaccination, and patients who are insured with Medicare Advantage. Differences were not explained by variable COVID-19 testing, ambulatory visits, or treatment contraindications. Reallocation of 2022 outpatient COVID-19 treatment, particularly with nirmatrelvir, based on risk for severe COVID-19 would have averted 16 503 COVID-19 deaths (16.3%) in the sample. In this cross-sectional study, outpatient COVID-19 treatment was disproportionately accessed by beneficiaries at lower risk for severe infection, undermining its potential public health benefit. Undertreatment was not driven by lack of clinical access or treatment contraindications.

Trends of Surgery, Patient, and Surgeon Characteristics for Corneal Transplants in the Medicare Population From 2011 to 2020.

The aim of this study was to describe recent trends in corneal transplants and patient and surgeon characteristics for corneal transplants that occurred in the Medicare population. This was a retrospective, cross-sectional study using Current Procedural Terminology codes. We identified Medicare Fee-For-Service (FFS) claims for different types of corneal transplant procedures performed on Medicare beneficiaries aged 65 years or older from 2011 to 2020. Number and types of corneal transplants performed each year and patient and surgeon demographics and characteristics were analyzed. We analyzed 148,981 corneal transplants performed by 2972 surgeons within the study period. Most corneal transplants performed were endothelial keratoplasties (70.1%). Most patients were women (60.3%) and White (85.8%). 18.2% of patients lived in a rural area, whereas only 3.5% of transplants occurred in a rural area and 5% of surgeons practiced in a rural area. Male surgeons represented 77.8% of all surgeons and performed 84.9% of all corneal transplants in the study period. The proportion of corneal transplants performed by female surgeons gradually increased over time, from 12.1% in 2011 to 19.0% in 2020. The proportion of female surgeons also increased from 16.2% in 2011 to 23.8% in 2020. Most surgeons (67%) performed <6 corneal transplants per year. Although the number of female corneal transplant surgeons has increased over time, women remain underrepresented in the surgical workforce. Further investigation should be conducted to identify the underlying reason and address the identified disparities within the landscape of corneal transplantation.

Use of the 40-Gene Expression Profile (40-GEP) Test in Medicare-Eligible Patients Diagnosed with Cutaneous Squamous Cell Carcinoma (cSCC) to Guide Adjuvant Radiation Therapy (ART) Decisions Leads to a Significant Reduction in Healthcare Costs

Objective: Adjuvant radiation therapy (ART) is often recommended for high-risk cSCC patients but carries significant costs and risks. This study aims to determine if utilizing the 40-GEP test to guide ART can reduce healthcare costs in cSCC management. Methods: Medical claims data with new diagnoses of cSCC for the 12 months ending June 2022 in the Medicare (≥65 years) population (source: IQVIA claims database) were obtained and normalized to the general population for missingness. CPT codes associated with radiation therapy within one-year post diagnosis were used to establish adjuvant RT use (defined as ‘ART’). Average weighted direct costs for four major ART modalities were calculated from published studies and (IQVIA). Sensitivity analysis was used to assess the financial impact of ART treatment using varying distributions of 40-GEP Class results. Results: Normalized medical claims data identified 22,917 Medicare-eligible cSCC patients who received ART within the United States. The weighted average direct cost for ART, which includes the four most used CPT code-defined modalities (IGRT, IMRT, IMPT, and XRT), was $60,693 per patient, amounting to an annual projected ART cost of $1.4 billion. Using the distribution of 40-GEP results from published studies, utilization of a 40-GEP test result to avoid ART in these patients could save up to $972 million in Medicare-eligible population. Sensitivity analysis shows, depending upon the distribution of the 40-GEP results, that for every 10% of Class 2A test results omitting ART, an extra $38-66 million in annual savings is expected Limitations: Potential limitations include a need for more comprehensive patient information and the cost of ART-related complications. Conclusion: Utilizing the 40-GEP test results to guide ART decision-making would result in material savings to Medicare.

Valuing innovative endoscopic techniques: hemostatic powder for the treatment of GI tumor bleeding

Access to new endoscopic treatment modalities often depends on price. To resolve this gap and therefore help to ensure that care delivery can occur on a clinical basis, we aimed to establish the value to insurers of novel hemostatic powder to treat GI tumor bleeding. A decision-analytic model developed to assess the impact of endoscopic intervention on the risk of 30-day readmission for GI bleeding from an insurer perspective was adapted to assess GI tumor bleeding with hemostatic powder or standard endoscopic therapy. Costs were derived from Medicare populations. Outcomes were derived from a recent multicenter randomized clinical trial. Costs ranged from $651 to $1613 to treat upper GI tumor bleeding and from $531 to $1014 to treat lower GI tumor bleeding based on risk reduction in 30-day hospital readmission for recurrent bleeding. These valuations should represent medical device and incremental facility costs in addition to incremental physician and staff time. Coverage for novel endoscopic hemostatic powder therapy seems cost-saving to insurers.

Epidemiologic Associations Between Inflammatory Bowel Disease and Hodgkin Lymphoma or Multiple Sclerosis

Background and AimsEpidemiologic evidence suggests that Hodgkin lymphoma (HL) and multiple sclerosis (MS) share a common set of risk factors with Crohn’s disease (CD) and ulcerative colitis (UC). It was hypothesized that such shared risk factors would lead to similar geographic distributions of these 4 diagnoses and to their concurrence in identical patients. MethodsAll subjects with HL, MS, CD, or UC were identified in the complete Inpatient Standard Analytic File of the Centers for Medicare and Medicaid Services (CMS) from 2018. In a cross-sectional study, we evaluated whether the frequencies of HL, MS, CD, and UC occurrence among different US states were statistically correlated with each other. In a case-control study, the observed concurrences of each 2 of 4 diagnoses were compared with their expected frequencies in the overall Medicare population by calculating odds ratios (OR) with their 95% confidence intervals (CI). ResultsThe total CMS population comprised 6,462,321 unique patients, of whom 8,027 presented with HL, 42,934 with MS, 40,623 with CD, and 32,521 with UC. Statistically significant positive correlations (r) with p<0.001 were found between HL and MS (r=0.50), HL and CD (0.46), HL and UC (0.68), MS and CD (0.66), MS and UC (0.72), CD and UC (0.68). Any inflammatory bowel disease (IBD) was significantly associated with a diagnosis of concurrent HL (OR: 1.22, 95%CI: 1.01-1.48) or MS (1.35, 1.25-1.46). ConclusionsThe epidemiologic associations of IBD with HL or MS may reflect on a common pathway in the etiology or pathogenesis of these diseases.

Impact of medication therapy management programs on potentially inappropriate medication use in older adults: A systematic review.

The use of potentially inappropriate medications (PIMs) is prevalent, costly, and harmful for older adults. These medications are to be avoided among older adults because they generally have (1) a high risk of adverse events in this population and/or (2) limited evidence of benefits in the presence of safer or more effective alternatives. Medication therapy management (MTM) programs can help address PIM use; however, there has not been a synthesis of studies examining the impact of MTM programs on PIM use. To review published literature evaluating the impact of MTM on PIM use in older adults. A systematic literature review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines using MEDLINE (PubMed) studies were included if they (1) had a Medicare population, (2) were based in the United States, (3) examined an MTM program (ie, used the term "medication therapy management"), (4) focused on the impact of MTM programs on PIM use as the primary outcome, (5) had a randomized controlled trial or an observational study design, and (6) were available in English. Of 221 articles identified, 31 full-text articles were assessed, and 7 met all inclusion and exclusion criteria. The studies took place in various settings, ranging from single-site tertiary medical centers to multisite outpatient clinics, community pharmacies, and nationwide telehealth MTM providers. Patient populations were majority female sex (ranging from 61% to 71%) and majority White (ranging from 81% to 94%), with a mean age of 73 to 78 years. In 5 of the 7 studies, MTM reduced the use of PIMs; however, 3 did not adjust for confounding or apply a comparator group. Measurement of MTM impacts on PIM use varied across studies. Patient-level and plan-level studies mostly assessed shorter-term PIM usage reduction (4 months or less), whereas studies performed at the provider and institutional level assessed PIM usage reduction trends across consecutive measurement years. Based on the current limited evidence, MTM programs in older adults appear to have a positive impact on reducing PIM use. However, evidence was limited by study design, the lack of consistency in outcome measures, and a short follow-up period. Future work should adjust for confounding, apply comparator groups, include longer-term outcomes, and develop a core set of measures that can be consistently applied across studies.

Geospatial Evaluation of Disparities in Access to Cervical Spine Fusion in Metropolitan Areas Across the United States.

Retrospective study with epidemiologic analysis of public Medicare data. The purpose of this study is to use geospatial analysis to identify disparities in access to cervical spine fusions in metropolitan Medicare populations. Cervical spine fusion is among the most common elective procedures performed by spine surgeons and is the most common surgical intervention for degenerative cervical spine disease. Although some studies have examined demographic and socioeconomic trends in cervical spine fusion, few have attempted to identify where disparities exist and quantify them at a community level. Center for Medicare and Medicaid Services physician billing and Medicare demographic data sets from 2013 to 2020 were filtered to contain only cervical spine fusion procedures and then combined with US Census socioeconomic data. The Moran Index geospatial clustering algorithm was used to identify statistically significant hotspot and coldspots of cervical spine fusions per 100,000 Medicare members at a county level. Univariate and multivariate analysis was subsequently conducted to identify demographic and socioeconomic factors that are associated with access to care. A total of 285,405 cervical spine fusions were analyzed. Hotspots of cervical spine fusion were located in the South, while coldspots were throughout the Northern Midwest, the Northeast, South Florida, and West Coast. The percent of Medicare patients that were Black was the largest negative predictor of cervical spine fusions per 100,000 Medicare members ( β =-0.13, 95% CI: -0.16, -0.10). Barriers to access can have significant impacts on health outcomes, and these impacts can be disproportionately felt by marginalized groups. Accounting for socioeconomic disadvantage and geography, this analysis found the Black race to be a significant negative predictor of access to cervical spine fusions. Future studies are needed to further explore potential socioeconomic barriers that exist in access to specialized surgical care. Level III-retrospective.

Distribution of various demographic groups within the Medicare population at different Mohs medical practice settings

Distribution of various demographic groups within the Medicare population at different Mohs medical practice settings

DEFYING THE ODDS: EXCEPTIONAL HOME HEALTH AGENCIES SERVING HIGH PROPORTIONS OF BLACK PATIENTS

Abstract Healthcare providers with the highest proportions of Black patients are typically assumed to be lower quality, whether they be hospitals, nursing homes, or primary care physicians. However, little research examines the providers that “defy these odds” and rise to the top of the quality ratings. Each year, Medicare home health provides skilled nursing and therapy services to over 3 million homebound older adults with physical and cognitive impairments, and compared to the general Medicare population, Medicare home health patients are more likely to identify as Black. This mixed-methods (QUANT--&amp;gt;QUAL) project uses an assets-based approach as well as the tenets of the Public Health Critical Race Praxis to understand home health providers that are generally assumed to be low-quality providers – that is those who have the highest proportions of Black patients – but instead are high quality providers. This study uses star ratings and the Post-Acute Care Public Use File for home health agencies to characterize and identify agencies with high quality care and a high proportion of Black patients. Publicly available data allows us to characterize the structures and outcomes of these unique home health agencies; while primary data collection (via case studies of exceptional agencies) will allow us to report on their unique processes of care. Data collection and analyses are currently underway and will be completed by May 2023. In 2019, 28% of home health agencies were identified as having high-quality with a high proportion of Black patients, we have selected three agencies for case studies.

Association Between States' Certificate of Need Laws and Home Health Care Access in the US.

Home health care has a significant role in the care of Medicare beneficiaries. Certificate of Need (CON) laws for home health agencies limit their number in affected states. This study's objective was to evaluate the association of CON laws with the availability and service utilization of urban and rural home health agencies in CON states and non-CON states using the generalized estimating equations (GEE) method. The results from this study indicated that CON states have fewer home health agencies for their Medicare population than non-CON states, regardless of urbanicity or rurality. Home health agencies in CON states also have less service utilization in terms of care episodes and visits per patient. This study provides an understanding of the effects of CON laws on Medicare beneficiaries' home health access and experiences.

Using a newly validated algorithm to estimate prevalence and incidence of Alzheimer’s Disease and related dementias in Medicare claims

AbstractBackgroundFew published studies have estimated the prevalence and incidence of Alzheimer’s disease (AD) and AD related dementias (ADRD) in the US Medicare population using fit‐for‐purpose claims algorithms. This study utilized a newly validated administrative claims algorithm for identifying ADRD, the “1‐year Bynum‐Standard ADRD algorithm”, adjusted for positive predictive value (PPV) and sensitivity, to estimate the 2019 annual prevalence and annual incidence of ADRD in US Medicare patients 65+ years of age.MethodsThis study utilized Medicare Part A and B claims (Fee‐For‐Service and Medicare Advantage) limited to patients with at least one 2019 medical encounter. The study’s source population was limited to those 65+ years of age with Medicare Part D coverage and 1‐year pre‐encounter continuous enrollment. Utilizing the 1‐year Bynum‐Standard ADRD claims algorithm, patients with ADRD were compiled. As the Brynum‐Standard algorithm includes AD as well as related dementias, a second AD cohort was built adapting the algorithm’s code list to include only specific AD diagnoses. Prevalence was calculated as a percent of the source population after adjustment for PPV and sensitivity of the algorithm. Incidence calculations required a 1‐year pre‐diagnosis exclusion period.ResultsFrom 53.9 million Medicare patients with at least one 2019 medical encounter, 33.3 million patients qualified for the source population. Of these patients, 2.7 million (8.0%) qualified as having ADRD using the 1‐year Bynum‐Standard algorithm and 0.86 million of these patients (32.2%) were newly diagnosed (incident). After adjusting for 31.3% sensitivity and 70.3% PPV of the algorithm the estimated 2019 annual prevalence and incidence of ADRD in the Medicare population aged 65 or older was 18% and 5.8% respectively. When limited to patients with specific AD diagnoses only, 1.0 million prevalent and 0.37 million incident patients were identified resulting in an annual adjusted prevalence and incidence of 6.9% and 2.5% respectively. Prevalence and incidence calculations including adjustments are provided in figure 1.ConclusionUsing a fit‐for‐purpose validated algorithm, the 2019 annual prevalence and incidence of ADRD in the Medicare population aged 65+ with Part D enrollment was estimated to be 18% and 5.8% respectively.

Incidence of Alzheimer’s disease (AD) dementia and mild cognitive impairment (MCI) in the United States Medicare population

AbstractBackgroundAlzheimer’s disease (AD) is a chronic, neurodegenerative condition. Mild cognitive impairment (MCI) is characterized by cognitive decline, without dementia. We aimed to estimate the incidence of AD and MCI among Medicare beneficiaries.MethodPatients were identified from the US Center for Medicare and Medicaid Services (CMS) database using International Classification of Diseases (ICD) codes for AD (331.0, G30.9, G30.8, or G30.1,) and MCI (331.83 or G31.84). Both AD and MCI were identified using the search rule of 2 ICD codes ≥30 days apart ≤365 days from both Medicare fee‐for‐service (FFS: 2008‐2018) and Medicare Advantage (MA: 2015‐2018). US regions were derived using zip codes and categorized by National Center for Chronic Disease Prevention/Health Promotion regions. Yearly incidence was defined as the number of new cases of AD or MCI in each year divided by the population at risk in the year. Confidence intervals were not reported due to small intervals.ResultThe incidence of AD and MCI per 10,000 person‐years was 82.9 and 4.9, 80.3 and 7.4, 74.5 and 9.3, 69.8 and 10.9, 65.3 and 13.4, 62.8 and 15.8, 60.7 and 17.4, 65.5 and 20.7, 61.4 and 22.4, 56.0 and 22.9, and 52.2 and 23.2 spanning from 2008 through 2018, respectively. In 2018, the incidence of AD and MCI per 10,000 person‐years by demographic subgroups was: 43 and 21 for men and 59 and 25 for women; 16 and 10 among those aged 65‐69 years, 30 and 18 for ages 70‐74 years, 58 and 30 for ages 75‐79, 102 and 44 for ages 80‐84, 176 and 57 for age ≥85 years old; 56 and 26 for Whites, 38 and 13 for Blacks, and 43 and 15 for Asians. The incidence of AD and MCI per 10,000 person‐years in 2018 was highest in the US Northeast, especially in New Hampshire (77 and 39), Vermont (74 and 47), and New Jersey (73 and 33).ConclusionAmong Medicare beneficiaries from 2008 to 2018, AD incidence generally decreased while MCI increased. Women, older age, White race, and Northeast region were associated with higher incidence of AD and MCI in 2018.

Abstract PR010: Cutaneous melanoma treatment outcomes in Texas: A study of the Texas Cancer Registry/Medicare linked database and an analysis of disparities

Abstract Background: Given that Hispanics make up a large portion of the United States, further research has been necessary to analyze the effects of treatment methods on all-cause and skin cancer mortality in Hispanic populations. While Caucasians have the highest incidence of melanoma, Hispanics make up the second most common group in the United States and in Texas. Incidence of melanoma is increasing, including in the Hispanic population. Importantly, mortality from melanoma is higher in the Hispanic than in the Caucasian population. Methods: We conducted an analysis of patients with cutaneous melanoma in the Texas Cancer Registry Medicare database to assess treatment modalities used and outcomes among demographic groups from 2007 to 2018. A bivariate analysis using Chi-square, Fisher’s exact test, and Student’s T-Test was done to compare patient, clinical, cancer and treatment characteristics between Hispanic and Non-Hispanic White (NHW). A Cox Proportional Hazard regression analysis was performed to assess treatment effect on outcome, with race-ethnicity as an effector modifier. Models were adjusted for patient age, sex, cancer stage, primary care provider, and comorbidity. Results: A higher percentage of Hispanic patients (7.6%) presented with a metastatic tumor stage diagnosis and cancer-related mortality (22.11%) compared to NHW patients (p &amp;lt;0 .0001). In both the Hispanic and NHW cohorts, post-diagnosis radiation (Hispanic 95% CI 0.984 – 2.634, NHW 95% CI 2.082-2.648) and post-diagnosis chemotherapy (Hispanic 95% CI 1.085-3.321, NHW 95% CI 1.664-2.489) are each associated with an increased risk in cancer-related mortality. Similar results are seen with post-diagnosis radiation (Hispanic 95% CI 1.121-2.40, NHW 95% CI 1.644-1.971) and chemotherapy (Hispanic 95% CI 0.900-2.368, NHW 95% CI 1.356-1.869) when considering all-cause mortality in both populations. However, post-diagnosis surgery (95% CI 0.571-0.678) and post-diagnosis immunotherapy (95% CI 0.032-1.565) had the opposite effect in cancer-related mortality for NHW. Cancer-related mortality for post-diagnosis surgery in the Hispanic cohort had a similar trend (95% CI 0.395-0.856), yet the effect of post-diagnosis immunotherapy was dismissed due to small sample size. Conclusion: Our results propose differences in all-cause and cancer-only related mortality with separate treatment modalities, particularly with chemotherapy and radiation therapy; this retrospective cohort study validated that health disparities exist in the Hispanic Medicare population of Texas with cutaneous melanoma. Citation Format: Hannah R. Riva, Fabiola Ramirez, Lorena Fernandez, Yae Kye, David Lopez, Biai Digbeu, Jessica Chacon. Cutaneous melanoma treatment outcomes in Texas: A study of the Texas Cancer Registry/Medicare linked database and an analysis of disparities [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr PR010.

Estimates of diagnosed dementia prevalence and incidence among diverse beneficiaries in Traditional Medicare and Medicare Advantage

AbstractBackgroundApproximately half of Medicare beneficiaries are enrolled in Medicare Advantage (MA) ‐ a private plan alternative to Traditional Medicare (TM). Yet little is known about diagnosed dementia rates among Medicare Advantage enrollees, limiting population estimates.Methods100% claims of Medicare beneficiaries using Encounter data for MA and claims for TM were used to quantify diagnosed dementia prevalence and incidence rates in MA, compare rates to TM, and provide estimates for the entire Medicare population and for different racial/ethnic populations.ResultDementia incidence and prevalence among MA beneficiaries was 2.54% (95%CI 2.53‐2.55) and 7.04% (95%CI 7.03‐7.06). Comparison to TM adjusted for sociodemographic and health differences among beneficiaries in MA and TM; the prevalence of diagnosed dementia among beneficiaries in MA was lower (7.1%; 95%CI 7.12‐7.13) than in TM (8.7%; 95%CI 8.71‐8.72). Diagnosed dementia incidence rate was also lower in MA (2.50%; 95%CI 2.50‐2.50) compared to TM (2.99%; 95%CI 2.99‐2.99). There were lower rates in MA compared to TM for men and women and White, Black, Hispanic, Asian, American Indian/Alaska Native persons. Diagnosed dementia prevalence and incidence for the entire Medicare population was 7.9% (95%CI: 7.91‐7.93) and 2.8% (95%CI: 2.77‐2.78).ConclusionLower diagnosed dementia rates in MA compared to TM may exacerbate racial/ethnic disparities in diagnosed dementia. Rates tracked over time will provide understanding of impact on dementia diagnosis of 2020 MA risk adjustment for dementia.

The impact of dentition status and barriers to dental care services on perceived oral health of medicare beneficiaries.

To examine the association among barriers to dental care services, dentition groups, and self-reported oral health status for Medicare beneficiaries. We used data from the 2017 to 2018 National Health and Nutrition Examination Survey (NHANES), which included participants aged ≥65 years who were enrolled in Medicare and had completed the oral health exam. We created a dentition group variable using the detailed dental examination data to account for the presence of natural, replaced, removable, or missing teeth. Through bivariate and logistic analyses, we explored the relationship between barriers to receiving dental care services, dentition groups, and reported oral and general health statuses, along with other control variables. For the total Medicare population as well as in the four subgroup analyses, we showed that those with barriers to dental care services were more likely to report fair or poor oral health status. Those who were edentulous, had complete dentures, or had less than a full mouth of teeth had greater barriers and worse oral and general health than did those with all-natural teeth. Among those who reported fair or poor general health, those with less than a full mouth of teeth showed similar levels of barriers to dental care services and worse perceived oral health than did those without any teeth. Helping the 65 years and older population retain their teeth in good condition will improve their overall health. Investment in oral hygiene and health for the current and future Medicare populations could improve their overall health.

Concurrent Hospice and Dialysis Care: Considerations for Implementation.

Hospice positively impacts care at the end of life for patients and their families. However, compared to the general Medicare population, patients on dialysis are half as likely to receive hospice. Concurrent hospice and dialysis care offers an opportunity to improve care for people living with end-stage kidney disease (ESKD). We sought to (1) develop a conceptual model of the Program and (2) identify key components, resources, and considerations for further implementation. We conducted a template analysis of qualitative interviews and convened a community advisory panel (CAP) to get feedback on current concurrent care design and considerations for dissemination and implementation. Thirty-nine patients with late-stage chronic kidney disease (CKD), family caregivers, bereaved family caregivers, hospice clinicians, nephrology clinicians, administrators, and policy experts participated in interviews. A purposive subset of 19 interviewees composed the CAP. Qualitative feedback on concurrent care design refinements, implementation, and resources. Participants identified four themes that define an effective model of concurrent hospice and dialysis: it requires (1) timely goals-of-care conversations and (2) an interdisciplinary approach; (3) clear guidelines ensure smooth transitions for patients and families; and (4) hospice payment policy must support concurrent care. CAP participants provided feedback on the phases of an effective model of concurrent hospice and dialysis, and resources, including written and interactive educational materials, communication tools, workflow processes, and order sets. We developed a conceptual model for concurrent hospice and dialysis care and a corresponding resource list. In addition to policy changes, clinical implementation and educational resources can facilitate scalable and equitable dissemination of concurrent care. Concurrent hospice and dialysis care must be systematically evaluated via a hybrid implementation-effectiveness trial that includes the resources outlined herein, based on our conceptual model of concurrent care delivery.