Medicare Status Research Articles

Abstract 4133: Disparities in colon cancer survival according to payer status: Findings from national cancer data bank

Abstract BACKGROUND: The objective of the current study was to examine the impact of payer status on relative survival outcomes in colon cancer patients. METHODS: A population-based analysis of National Cancer Data Bank (NCDB) records for invasive colon cancer was done using data from patients diagnosed between 1998 and 2006 and followed up to 2011. The cohort consisted of colon cancer patients of analytic stage I to stage IV. Information regarding age, race, gender, stage of cancer at the time of diagnosis, year of diagnosis, insurance status, income, treatment received and diagnostic facility, and type of treating facility were included in this study. Age, sex, race, calendar year specific US life table between 1970 and 2007 were used to compute expected survival. Multivariate Poisson modeling was used to estimate relative survival for payer status adjusting for other factors. RESULTS: 436,235 colon cancer patients who met the inclusion criteria were included in the study. The mean age at diagnosis was 68.9 years. The stage distribution among the variables listed above is statistically significant. The 5-year cumulative relative survivals are 0.76, 0.84, 0.93, 1.74 and 1.10 for uninsured, Medicaid, private insurance, Medicare, and unknown payer status respectively. In multivariate analysis of relative survival, adjusting for other factors, the excess hazard ratios (EHR) were 1.74, 1.14, 0.89 and 1.29 for uninsured, Medicaid, Medicare, and unknown payer status versus private insurance respectively (P<0.05). The EHRs for blacks and other races versus whites were 1.07 and 1.53 respectively (p<0.05). The EHRs for follow-up year of 2, 3, 4, 5 versus year 1 were 1.17, 0.21, 0.18, and 0.54 respectively (P <0.05). Compared to academic/research program facility type, the EHRs for community cancer program, comprehensive community cancer program, and other specified types of cancer programs were 1.02,0.77 and 25.9 respectively (P <0.05). The relative survival rates for stage II, III, IV versus stage I were 0.95, 0.82, and 0.70 respectively (P<0.05). Diagnosis before or after 2002 and the type of treatment facility lead to a marginal difference in the relative survival. CONCLUSIONS: Our study shows the impact of payer status on the relative survival of patients with colon cancer and demonstrated increased mortality for uninsured patients in contrast to survival benefit for patients with Medicare and private insurance. Citation Format: Srinivas S. Devarakonda, Runhua Shi, Amarendra Neppalli, Glenn Mills. Disparities in colon cancer survival according to payer status: Findings from national cancer data bank. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 4133. doi:10.1158/1538-7445.AM2014-4133

Population-Based Study on the Effect of Socioeconomic Factors and Race on Management and Outcomes of 35,535 Inpatient Ectopic Pregnancies

Study ObjectiveTo evaluate whether socioeconomic variables influence the management and outcomes of ectopic pregnancies. DesignRetrospective cohort study (Canadian Task Force classification II-2). SettingHospitals in the United States participating in the Health Care Cost and Utilization Project. PatientsWomen (n = 35 535) with a primary discharge diagnosis of ectopic pregnancy. InterventionsEffect of socioeconomic factors and race/ethnicity on management and adverse outcomes of ectopic pregnancy. Measurements and Main ResultsDuring the 9-year study, 35 535 ectopic pregnancies were identified. The development of hemoperitoneum in 8706 patients (24.50%) was the most common complication. Asian race was the sociodemographic variable most predictive of hemoperitoneum (odds ratio [OR], 1.41; 95% confidence interval [CI], 1.24–1.61; p < .01) and transfusion (OR, 1.62; 95% CI, 1.39–1.89; p < .01), and Medicare status was most influential on prolonged hospitalization (OR, 1.83; 95% CI, 1.36–2.47; p < .01). Major complications were not affected by socioeconomic factors. Laparotomy in 25 075 patients (70.6%) was the most common treatment option. Patients of Asian or Pacific Islander descent were least likely to be treated non-surgically (OR, 0.62; 95% CI, 0.51–0.76; p < .01), whereas Medicare recipients were most likely to be treated non-surgically (OR, 1.70; 95% CI, 1.32–2.18; p < .01). All non-white groups were less likely to undergo a laparoscopic approach. ConclusionMajor complications from ectopic pregnancy are not influenced by socioeconomic variables; however, less serious complications and management approaches are persistently affected.

Avoidance of Complications in Older Patients and Medicare Recipients Undergoing Gastric Bypass

Perioperative morbidity and mortality do not increase in carefully evaluated and managed Medicare and elderly patients undergoing gastric bypass. Retrospective review of a prospectively maintained bariatric database. Academic tertiary care medical center. We reviewed our database of 928 consecutive patients who underwent gastric bypass from March 24, 1998, through May 31, 2006. Of these patients, 36 underwent revision surgery and were excluded. The remaining 892 patients were separated into 4 groups by age and Medicare status. Group 1 consisted of 46 patients 60 years or older at the time of gastric bypass (range, 60-66 years). Group 2 consisted of 846 patients 59 years or younger at the time of gastric bypass (range, 18-59 years). Group 3 consisted of 31 Medicare recipients (age range, 31-66 years). Group 4 consisted of 861 non-Medicare recipients (age range, 18-64 years). Groups were compared in terms of demographics, morbidity, and mortality. No differences were found in outcomes between older vs younger and Medicare vs non-Medicare patients for any postoperative complication or mortality. Bariatric surgery can be performed in carefully selected Medicare recipients and patients 60 years or older with acceptable morbidity and mortality. No difference was found in the occurrence of complications in Medicare patients, patients younger than 60 years, or patients 60 years and older. We believe that these results reflect careful patient selection, intensive preoperative education, and expert operative and perioperative management. Our results indicate that bariatric surgery should not be denied solely based on age or Medicare status.

Managing Medicare's HIV caseload in the era of suppressive therapy.

The 1996 introduction of antiretroviral medications changed Medicare's role in providing HIV care. We analyzed Medicare's patient database in an effort to document the new HIV therapies' effects on expenditures and outcomes. We examined the medical billing records of a 5% national Medicare sample from 1997 through 2003. The cohort was stratified by year and categorized by age, race/ethnicity, gender, and Medicare status. Population summaries were categorized according to presence of major chronic diseases and HIV-related conditions. The number of Medicare beneficiaries with HIV increased from 42520 in 1997 to 76500 in 2003, whereas mortality among this group fell by 35%. HIV-associated infections declined by as much as 43% (mycoses). Heart and liver disease and diabetes increased by more than 50%. Adjusted annual per person Medicare expenditures fell 28%; expenditures were 49% higher for Blacks than for Whites. Improved HIV medical management has led to fewer deaths and has shifted treatment toward chronic care. However, successful management is complicated by conditions that have not been historically linked to HIV and whose effects vary according to race/ethnicity.

Influence of economic and demographic factors on quality of life in renal transplant recipients

The purpose of this study was to determine the influence of annual income, Medicare status, and demographic variables on the health-related quality of life (HQoL) of renal transplant recipients. A cross-sectional survey was mailed to 146 Georgia renal transplant recipients who had functional grafts. Data were collected using the SF-12 Health Survey (version 2), a demographics survey, and 2003 tax documents. One-way ANOVAs and Pearson's R correlations were used to examine relationships between annual income, Medicare status, demographic variables and SF-12 scores. Significant variables were included in stepwise multiple regression analyses. Data from 130 participants (89% response rate) were collected. Recipients with no Medicare coverage had significantly higher scores on the Physical Functioning and Role Physical SF-12 scales (p = 0.005) compared to recipients with Medicare. Annual income was positively correlated with General Health (p < 0.05). Age and race were significant predictors of Vitality (p = 0.004) and Physical Component Summary (p < 0.001) scores. Age, race, and Medicare status were significant predictors of Physical Functioning and Role Physical scores (p < 0.001). Age, annual income, race, and years post-transplant were significant predictors of General Health score (p < 0.001). Age was the sole predictor of Bodily Pain score (p = 0.002), and marital status was the sole predictor of Social Functioning score (p = 0.005). Interventions designed to offset financial barriers may be needed to bolster renal transplant recipients' HQoL.

The impact of age and medicare status on bariatric surgical outcomes

The impact of age and medicare status on bariatric surgical outcomes

The Impact of Age and Medicare Status on Bariatric Surgical Outcomes

Medicare status and increasing age are associated with poor outcomes from bariatric surgical procedures. Survey. National sample of hospitalized patients in the United States. Adult patients undergoing bariatric surgery in 2001 and 2002. Mortality and adverse events. We assessed 25 428 bariatric procedures with logistic regression, finding that age (odds ratio, 1.04; 95% confidence interval, 1.02-1.07), male sex (odds ratio, 2.45; 95% confidence interval, 1.48-4.03), electrolyte disorders (odds ratio, 13.91; 95% confidence interval, 8.29-23.33), and congestive heart failure (odds ratio, 4.96; 95% confidence interval, 2.52-9.77) were independent risk factors for bariatric surgery mortality. Adverse outcomes increased as a function of age in a nearly linear fashion, with a steep increase after the age of 65 years. Most Medicare patients undergoing these operations were younger than 65 years and had a much greater disease burden than non-Medicare patients. Age, male sex, electrolyte disorders, and congestive heart failure were independent risk factors for bariatric surgical mortality. Limiting bariatric surgical procedures to those younger than 65 years is warranted because of the high morbidity and mortality associated with these operations in older patients.

The Impact of Age and Medicare Status on Bariatric Surgical Outcomes—Invited Critique

The Impact of Age and Medicare Status on Bariatric Surgical Outcomes—Invited Critique

Cost-Effectiveness of Extending Medicare Coverage of Immunosuppressive Medications to the Life of a Kidney Transplant

Unless they maintain Medicare status through disability or age, kidney transplant recipients lose their Medicare coverage of immunosuppression 3 years after transplantation. A significant transplant survival advantage has previously been demonstrated by the extension of Medicare immunosuppressive medication coverage from 1 year to 3 years, which occurred between 1993 and 1995.The United States Renal Data System (USRDS) was analyzed for recipients of kidney transplants from 1995 to 1999. Using a Markov model, we estimated survival and costs of the current system of 3-year coverage compared with lifetime immunosuppression coverage. Results were calculated from the perspectives of society and Medicare.Extension of immunosuppression coverage produced an expected improvement from 38.6% to 47.6% in graft survival and from 55.4% to 61.8% in patient survival.The annualized expected savings to society from lifetime coverage was $136 million assuming current rates of transplantation. Medicare would break-even compared with current coverage if the fraction of patients using extended coverage was <32%. The extension would be cost-effective to Medicare if this fraction was <91%.Extended Medicare immunosuppression coverage to the life of a kidney transplant should result in better transplant and economic outcomes, and should be considered by policy makers.

Community Health Assessment Program (CHAP) Update: Millennium Edition—Home Health Standards

During 2002, the CHAP went under several leadership changes. The board of the organization continued to rise to the challenges it faced and appointed an interim chief executive officer, Theresa S. Ayer, MS, RN, CNAA, to lead the organization while it undertook a national search for a new chief executive officer. It was during this time of interim leadership that the new Millennium CHAP Home Health and Hospice Standards received approval from the Centers for Medicare and Medicaid Status for continuation of the organization’s deemed status for its accreditation process. In November 2002, the board’s search for a chief executive officer came to fruition with the appointment of an individual with 25 years of experience in acute and community-based health care management, Terry A. Duncombe, RN, MSHA.