Number Of Medicare Beneficiaries Research Articles

Medicare Payment for Opioid Treatment Programs

Medicare began paying for medications for opioid use disorder (MOUD) at opioid treatment programs (OTPs) that dispense methadone and other MOUD in January 2020. There has been little research describing the response to this payment change and whether it resulted in more patients receiving MOUD or just a shift in who pays for this care. To describe how many and which Medicare beneficiaries receive care from OTPs and how this compares to those receiving MOUD in other settings. This cross-sectional study included all patients receiving MOUD care identified in 2019-2022 100% US Medicare Parts B and D claims. Patients receiving care in an OTP who were dually insured with Medicare and Medicaid in the 2019-2020 Transformed Medicaid Statistical Information System were also included. Receiving MOUD care in an OTP. Comparisons of 2022 beneficiaries treated in OTPs vs other non-OTP settings in 2022. The share of Medicare beneficiaries treated by OTPs rose steadily from 4 per 10 000 (14 160 beneficiaries) in January 2020 to 7 per 10 000 (25 596 beneficiaries) in August 2020, then plateaued through December 2022; of 38 870 patients (23% ≥66 years; 35% female) treated at an OTP in 2022, 96% received methadone. Patients in OTPs, compared to those receiving MOUD in other settings, were more likely be 65 years and younger (65% vs 62%; P < .001), less likely to be White (72% vs 82%; P < .001), and more likely to be an urban resident (86% vs 74%; P < .001). When Medicare OTP coverage began, there was no associated drop in the number of dually insured patients with Medicaid with an OTP claim. Of the 1854 OTPs, 1115 (60%) billed Medicare in 2022, with the share billing Medicare ranging from 13% to 100% across states. This study showed that since the initiation of Medicare OTP coverage in 2020, there has been a rapid increase in the number of Medicare beneficiaries with claims for OTP services for MOUD, and most OTPs have begun billing Medicare. Patients in OTPs were more likely to be urban residents and members of racial or ethnic minority groups than the patients receiving other forms of MOUD.

Regional variation from 2013 to 2021 in primary total shoulder arthroplasty utilization, reimbursement, and patient populations

BackgroundTotal shoulder arthroplasty (TSA), encompassing both anatomical and reverse total shoulder arthroplasty, has increased in popularity worldwide. The purpose of this study was to assess how TSA utilization, reimbursement, surgeon practices, and patient populations have evolved within the Medicare population from 2013 to 2021 at a national and regional level. MethodsThe Medicare Physician and Other Practitioners dataset was queried for all episodes of primary TSA (CPT-23472), both anatomic and reverse, between years 2013 and 2021. TSA utilization was assessed as volume per 10,000 Medicare beneficiaries. Average inflation-adjusted reimbursement, physician practice styles, and patient demographics of each TSA surgeon were extracted each year. Data was stratified geographically based on US census classifications and rural-urban commuting codes. Kruskal-Wallis and multivariate regressions were utilized to determine differences between regions. ResultsBetween 2013 and 2021, TSA utilization increased by 121.8% nationally. The increase was greatest in the Northeast (+147.2%) and least in the Midwest (+115.5%). Average TSA reimbursement declined by 8.8% nationally, with the least decline in the Northeast (6.4%) and the greatest decline in the Midwest (-11.9%). In 2021, the Midwest had the highest TSA utilization (18.1/10,000), while having the lowest average reimbursement ($1,108.59; p<0.001). The Northeast had the lowest utilization (11.5/10,000) and highest reimbursement ($1,223.44; p<0.001) in 2021. Nationally, the number of Medicare beneficiaries per surgeon performing shoulder arthroplasty declined by 5.9%, while the average number of TSAs per surgeon (+8.5%) and average number of billable services per beneficiary (+16.6%) both increased. Surgeons in the South performed the most services per beneficiary in 2021 (9.0; p<0.001). The average comorbidity burden of patients decreased by 4.8% between 2013 and 2021, with the West having the healthiest patients in 2021. Higher patient comorbidities were associated with lower physician reimbursement nationally (p<0.001). ConclusionThis study demonstrates that TSA utilization in the Medicare population has more than doubled between 2013 and 2021, while average inflation-adjusted reimbursement has declined by nearly 10%. The Midwest has the highest per-capita TSA utilization, while simultaneously having the lowest average reimbursement per TSA. Over time, TSA surgeons are seeing fewer and healthier beneficiaries but performing more services per beneficiary. Additionally, increased patient complexity may be associated with lower reimbursement. Together, these findings are concerning for long-term equitable access to care within shoulder surgery.

Trends in the Characteristics and Outcomes of Older Medicare Patients With Traumatic Brain Injury Treated in Inpatient Rehabilitation Facilities: 2013 to 2018

ObjectiveTo describe the characteristics and outcomes of older (65+) Medicare beneficiaries with traumatic brain injury (TBI) treated in inpatient rehabilitation facilities between 2013 and 2018. DesignDescriptive study using IRF Patient Assessment Instrument (IRF-PAI) data reporting trends of the sociodemographic and clinical characteristics and outcomes of inpatient rehabilitation facilities Medicare patients with TBI. SettingInpatient rehabilitation facilities in the United States. Participants99,804 older Medicare fee-for-service and Medicare Advantage patients with TBI (N=99,804). InterventionsNot applicable. Main Outcome MeasuresLength of stay, self-care, and mobility functional outcomes, discharge destination. ResultsThe number of older Medicare beneficiaries with TBI treated in inpatient rehabilitation facilities increased from 14,657 in 2013 to 18,791 in 2018, an increase of 28.2%. In addition to this overall increase in patients, we also found the percentage of men increased slightly (52.9% to 54.8%), there was a higher percentage of patients with tier 3 comorbidities, there was a decrease in the variability of length of stay, there was slightly more self-care and mobility improvement and a slightly higher percentage of patients discharged to the community (67.8% in 2013 and 71.6% in 2018). Newer standardized data showed that prior to the injury, more than one-third used a walker and more than three-quarters had a history of recent falls. ConclusionsBetween 2013 and 2018, the number of Medicare beneficiaries with TBI treated in IRFs increased by approximately 28%. The characteristics of IRF older patients with TBI changed between 2013 and 2018 toward a slightly higher proportion of men, more comorbidities, and a higher percentage being discharged home after inpatient rehabilitation.

EPID-30. DYSPHAGIA-RELATED HEALTHCARE UTILIZATION AMONG OLDER PATIENTS WITH PRIMARY AND METASTATIC BRAIN TUMORS: A NATIONAL STUDY OF MEDICARE BENEFICIARIES

Abstract BACKGROUND Swallowing dysfunction is common among older adults and the presence of a malignant brain tumor (primary or metastatic) may compound the existing burden of dysphagia in this population. We aimed to characterize the dysphagia-specific healthcare utilization among Medicare beneficiaries with malignant brain tumors. METHODS Using a Medicare 5% limited dataset (2013-2018) and ICD-9/10 codes, we identified beneficiaries (≥ 65 years) with primary malignant brain tumors (PMBTs) as well as the five most common solid tumors metastasizing to the brain (lung, breast, melanoma, renal, and colorectal). Those with disorders predisposing to dysphagia were excluded. Healthcare utilization was quantified using CPT codes for hospitalizations, gastroenterology services (endoscopy [EGD]), nutrition consultation, speech language management, radiographic testing, and enteral feeding access, occurring after cancer diagnosis. Comparisons of utilization by dysphagia status were made using chi-square and Wilcoxon rank-sum tests. RESULTS Among 79,926 beneficiaries, we identified 3,184 (4.0%) with malignant PBTs and 1,033 (1.3%) with brain metastases. Of the total cohort, 4.7% (n=3,777) experienced dysphagia. Whereas, 11.0% (n=349) of those with PMBTs and 7.9% (n=82) with brain metastases experienced dysphagia. Those with PMBTs were diagnosed with dysphagia significantly earlier in their disease course compared to other groups (median 20 vs. 36 vs. 58 days for PMBTs, brain metastases, and no brain metastases, respectively; p&amp;lt; 0.01). Speech pathology services use was highest among PMBT patients compared other groups (36.1%; n=126; p&amp;lt; 0.001). Gastroenterology services utilization overall was high among all groups and enteral feeding tube placement was significantly higher among PMBTs (p&amp;lt; 0.001). CONCLUSIONS Dysphagia increases with age and older patients with brain malignancies are at particularly high risk. Those with PMBTs experience dysphagia earlier in their disease course and dysphagia-related healthcare utilization is higher when compared to other cancers. Our findings have important implications as the number of Medicare beneficiaries is expected to increase.

Impact of Fellowship Training on Practice Patterns of Glaucoma Surgeons Treating Medicare fee-for-service Beneficiaries

ABSTRACT Purpose Analyze practice patterns of glaucoma surgeons with and without fellowship training. Materials and Methods Physician-specific 2017 Medicare data were obtained from the Centers for Medicare & Medicaid Services website. Current Procedural Terminology codes identified procedures including iStent, tube shunts, trabeculectomy, complicated trabeculectomy, endoscopic cyclophotocoagulation, internal Xen Implant, external Xen or Express shunt, Gonioscopy-Assisted Transluminal Trabeculotomy, and Kahook Dual Blade Goniotomy. Physicians with fellowship training were identified via the American Glaucoma Society website. Results A total of 1547 glaucoma surgeons were identified, of which 319 had completed fellowship training. Overall, fellowship-trained glaucoma surgeons performed more services (50.4 ± 47.0 vs 40.5 ± 35.3, P < .001) with a larger variety of procedures (1.8 ± 1.0 vs 1.3 ± 0.6, P < .001) than those without fellowship training. Surgeons without fellowship training were more likely to perform iStent and endoscopic cyclophotocoagulation and less likely to perform the remaining procedures than their fellowship-trained counterparts. Medicare payments did not differ between groups and the number of Medicare beneficiaries only differed for internal Xen implant (P = .03). Patient comorbidity burden was similar between groups with about one-third of patients being diagnosed with ischemic heart disease. Conclusions Surgeons without fellowship training can treat a similar volume of glaucoma patients as those with fellowship training. However, based on surgical procedures employed, their practices are skewed towards mild and moderate glaucoma and they are more limited in their breadth of procedures. In addition, ischemic heart disease was prevalent in the glaucoma patient population.

Difference in rural and urban Medicare prescription pattern for Parkinson’s disease in Hawai‘i

BackgroundMedical management of Parkinson’s Disease (PD) is becoming complex. Increasing evidence suggests that patients have better outcomes when they are managed by neurologists. However, access to neurologists can be limited in rural areas. Analysis of prescription pattern can provide insight into access gap rural patients face. MethodsThis retrospective observational study used National Medicare Provider Utilization and Payment Data: Part D Prescriber Public Use Files from 2013 to 2018. Query was made for levodopa, dopamine agonists and other antiparkinsonian medications. The data elements obtained included drug name, number of prescribers, prescriber specialty, number of claims, number of standardized 30-day Part D prescriptions, and number of Medicare beneficiaries in the state of Hawai‘i. Individual prescribing providers were categorized as urban or rural based on their cities of practice. Prescription patterns of urban and rural providers in Hawai‘i as well as difference in provider specialty were compared, using standardized 30-day prescriptions as the primary measure of utilization. ResultsPractice patterns differed between rural and urban areas. In rural Hawai‘i, Rytary, Rotigoitne and selegiline were rarely prescribed. Levodopa percentage was higher in urban Hawai‘i. In urban Hawai‘i, 74.4% of the prescriptions were provided by movement disorders and general neurologists. In rural Hawai'i, 25.1% of the prescriptions were written by neurologists and 74.9% by general practitioners. ConclusionsIn the state of Hawai‘i, there is an urban–rural access gap to neurologists as evidenced by Medicare prescription pattern. Further study is needed to understand the reasons for rural–urban differences in prescription patterns and their impact on outcomes.

Do Practice Characteristics Influence Online Ratings of Oral and Maxillofacial Surgeons?

Do Practice Characteristics Influence Online Ratings of Oral and Maxillofacial Surgeons?

MP23-15 EXPLORING PRACTICE PATTERNS AND REGIONAL PARTICIPATION OF UROLOGISTS IN ONCOLOGY CARE MODEL

You have accessJournal of UrologyHealth Services Research: Practice Patterns, Quality of Life and Shared Decision Making III (MP23)1 Sep 2021MP23-15 EXPLORING PRACTICE PATTERNS AND REGIONAL PARTICIPATION OF UROLOGISTS IN ONCOLOGY CARE MODEL Zafardjan Dalimov, Umar Iqbal, Zhe Jing, Ahmed S. Elsayed, Khurshid A. Guru, and Ahmed A. Hussein Zafardjan DalimovZafardjan Dalimov More articles by this author , Umar IqbalUmar Iqbal More articles by this author , Zhe JingZhe Jing More articles by this author , Ahmed S. ElsayedAhmed S. Elsayed More articles by this author , Khurshid A. GuruKhurshid A. Guru More articles by this author , and Ahmed A. HusseinAhmed A. Hussein More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002014.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Oncology Care Model (OCM) is an episode-based payment model for chemotherapy-related care. It provides traditional fee-for-service, monthly payments for oncology services, and performance-based payments on eligible episodes linked to quality performance and benchmarked costs. This study aims to evaluate OCM participation by urologists and identify variation in practice patterns and utilization among OCM and non-OCM urologists. METHODS: We used Centers for Medicare and Medicaid Services Quality Payment Program Participation Eligibility tool to classify urologists based on their participation in OCM. Provider level utilization data were extracted from Medicare Provider Utilization and Payment Data for the 2017 OCM participation year. We used Chi-square and Mann-Whitney tests for to compare categorical and continuous variables, respectively. RESULTS: Among 9055 urologists who received Medicare payments in 2017, 359 (4.0%) participated in OCM. There was a significant difference in distribution of OCM participating urologists across all American Urological Association sections (p <0.01), with higher than US average (4%) participation within New York (11.2%) and North Central (7.0%) sections. OCM urologists compared to non-OCM urologists provided care to patients with cancer diagnosis more frequently (23% vs 22%, p <0.01) and dealt with more complex patients evidenced by higher Hierarchical Condition Category (HCC) risk adjustment scores (1.50 vs 1.40, p <0.01). Number of Medicare beneficiaries did not significantly differ between OCM and non-OCM urologists (504 vs 518, p=0.50). However, OCM urologists received higher median Medicare payments per beneficiary ($314vs $281, p <0.01) and per service ($60 vs $50, p <0.01). OCM urologists provided fewer services than non-OCM urologists (2534 vs 3101, p=0.06) (Table 1). CONCLUSIONS: Only small number of urologists are participating in the OCM. New York had above average participation of urologists in OCM. OCM urologists were more likely to provide care to patients with the diagnosis of cancer and higher HCC scores. They received higher payment per services provided and beneficiaries seen. Source of Funding: Roswell Park Alliance Foundation © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e407-e408 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Zafardjan Dalimov More articles by this author Umar Iqbal More articles by this author Zhe Jing More articles by this author Ahmed S. Elsayed More articles by this author Khurshid A. Guru More articles by this author Ahmed A. Hussein More articles by this author Expand All Advertisement Loading ...

Trends in Anti-VEGF Injection Medicare Part B Claims among Male and Female Ophthalmologists from 2012-2016

ABSTRACT Background: Compared to male ophthalmologists, female ophthalmologists have significantly reduced salaries, fewer faculty roles and authored publications, garnered less federal research funding, and achieved less editorial advancement. We aimed to use the most recently available Centers for Medicare and Medicaid Services data to characterize trends and differences in anti-VEGF reimbursements coded for by male and female ophthalmologists. Methods: We used Medicare Fee-For Service Provider Utilization and Payment Data: Part B Provider public use files for 2012–2016 to quantify service and reimbursement patterns for anti-VEGF injections between male and female ophthalmologists. Five outcome variables were studied: number of providers, average Medicare payment amount, total payment, number of services, and number of Medicare beneficiaries. Results: Number of services performed per female provider was 71.2% that of a male ophthalmologist in 2012, and this percentage did not change from 2012 to 2016 (95%CI [0.63, 0.804], [0.984, 1.04], respectively). Female providers had 76.1% of beneficiaries as males in 2012, and this percentage stayed constant throughout the years (95%CI [0.69, 0.84] and [0.99, 1.03], respectively). The total payment difference between female and males was $102,175 per provider in 2012, and this gap widened by $18,292 yearly (95% CI [−162599.17, −41760.47], [−33060.35, −3524.38], respectively). Conclusion: While male and female providers saw considerable increases in aflibercept services and payments in the 5-year period, the gap between male and female reimbursements widened significantly. Moving forward, analysis of large-scale Medicare datasets provides a tangible report card on how effective our attitudes and policies are in cultivating equal opportunity.

Demographic Variations in Patient Populations and Regional Distributions Between Male and Female Ophthalmologists in the United States: Cross-Sectional Analysis

ABSTRACT Purpose: To determine if patient demographics differ by ophthalmologist gender. Methods: Demographic data on U.S. ophthalmologists were collected from the 2017 Medicare Physician and Other Supplier National Provider Identifier Aggregate Report. Results: Of the 17,230 ophthalmologists included, female ophthalmologists (23.7%) provided care for a smaller proportion of White patients (77.4% ± 24.9% female, 81.0% ± 22.1% male; p < .001), had younger beneficiaries (73.8 ± 3.2 years old females, 74.8 ± 2.9 years old males; p < .001) and had a higher proportion of female beneficiaries per provider (61.1% ± 4.6% females, 59.6% ± 4.0% males; p < .001). Average age of beneficiaries and number of beneficiaries were correlated with years since medical school (rho = 0.283, rho = 0.148; both p < .001). The number of Medicare beneficiaries, proportion of female beneficiaries, years since medical school and group practice size were independently associated with physician gender (p < .001). Conclusion: Female ophthalmologists saw a larger proportion of ethnically diverse, younger, female patients.

Surgeon Gender and Post-Operative In-Hospital Mortality

Background: Prior studies report improved mortality rates for patients of female internists, few studies have evaluated the effect of surgeon gender on post-operative mortality. Methods: A retrospective analysis using the Agency for Health Care Administration Florida database from 2010-2015 examined patients undergoing one of 25 selected surgical procedures. Surgeon gender (self-reported), number of Medicare beneficiaries and years of experience were imported from CMS Physician Compare/Provider Utilization &amp; Payment Data set using NPI. 25 procedures of varying complexity from all subspecialties were selected. For each procedure, inverse probability of treatment weighting (IPTW) was used to match cases performed by male vs female surgeons to achieve maximum balance between the groups. Results: There were 73,994 admissions for patients undergoing surgical procedures performed by 2,828 surgeons(361 females, 2467 males). Fewer patients who had emergent procedures performed by female surgeons died in the hospital(291/13957,2.08% vs 348/14017,2.48% p=0.026). Those who underwent the following procedures had significantly lower rates of in-hospital mortality if the surgeon was female: CABG(2/387,0.52% vs 8/387,2.07%), mastectomy(2/4797,0.04% vs 10/4797,0.21%), open cholecystectomy(7/955,0.73% vs 17/955, 1.78%) all p≤0.05. Conclusion: Patients who underwent CABG, mastectomy and open cholecystectomy had lower rates of in-hospital mortality if the surgeon was female while male surgeons did not have a significant mortality advantage for any procedure. Further studies examining national data may provide additional insight regarding the effect of surgeon gender on patient outcomes.

254 Comparing 2017 Medicare Reimbursement of Emergency Physicians by Sex

Little is known about variation in services provided to Medicare beneficiaries by male and female emergency physicians. The aim of this study is to compare sex differences in the number of Medicare patients seen, the medical complexity of those patients, the number of services provided per beneficiary, and amount earned per patient encounter. Data used in the study were obtained from the Medicare Physician and Other Supplier National Provider Identifier (NPI) Aggregate Report 2017 from the Centers for Medicare and Medicaid Services Web site. This online interactive dataset provides information regarding the services and procedures provided to Medicare Part B beneficiaries based on claims data organized by NPI and service code. Claims data submitted by emergency physicians in 2017 were analyzed; providers who did not have sufficient data regarding sex, credentialing, or complete claims data were excluded. Out of 1,088,687 listed health care providers on the dataset, 43,792 were listed as emergency physicians. Of these, 2,031 physicians were excluded because they were not located in the United States or failed to indicate relevant information such as credentialing, sex, number of Medicare beneficiaries, number of services, total Medicare payment amount, and average HCC Risk score of beneficiaries. A final total of 41,761 emergency physicians were included in the study. Of these, 11,537 (27.63%) were women and 30,224 (72.37%) were men. Overall, female physicians saw a number of 358 patients per billing cycle compared to a number of 439 patients seen by men. In addition, female physicians performed fewer services per Medicare beneficiary than their male counterparts (1.54 services vs. 1.72 services). Together, these differences resulted in women billing Medicare significantly less per billing cycle compared to men: $48,708 vs $59,897. Notably, Medicare beneficiaries treated by female physicians had a slightly higher hierarchical condition category (HCC) score than beneficiaries treated by male physicians (2.15 vs 2.10). Female physicians were also noted to earn slightly more than males per service provided ($83.59 vs $79.15).Tabled 1Emergency Physician SexNumber of Medicare BeneficiariesNumber of Services/MedicareBeneficiaryTotal Medicare Payment Amount/ServiceTotal Medicare Payment AmountAverage HCC Risk Score of BeneficiariesFemale3581.54S83.59S48,708.412.15Male4391.72S79.15S59,897.142.10 Open table in a new tab Based on the data presented, in 2017, female emergency physicians treated fewer Medicare patients, performed fewer services per beneficiary, and received less reimbursement from Medicare than their male counterparts. Female physicians also saw slightly higher complexity patients, as measured by the HCC score, and earned a slightly larger amount per service provided. These difference may be related to patient sex differences in patient selection or practice location, as both of these could contribute to the billing differences seen in our data but cannot be analyzed with the database used here. Future studies are needed to confirm whether these trends have been consistent over time and to determine what factors are contributing to these sex discrepancies.

WITHDRAWN: Battle of the sexes: The effect of surgeon gender on postoperative in-hospital mortality

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Resource Utilization and Outcomes of Medicare Recipients With Chronic Hepatitis B in the United States.

To assess the outcomes and resource utilization of chronic hepatitis B (CH-B) among Medicare beneficiaries. CH-B is highly prevalent among immigrants from endemic areas. Although incidence of CH-B is stable in the United States, CH-B patients have become Medicare eligible. We used the inpatient and outpatient Medicare database (2005 to 2014). Adult patients with CH-B diagnosis were included. One-year mortality and resource utilization were assessed. Independent associations with resource utilization and mortality were determined using multivariate analysis. Study cohort included 18,603 Medicare recipients with CH-B. Between 2005 and 2014, number of Medicare beneficiaries with CH-B increased by 4.4% annually. The proportion of beneficiaries with CH-B who were whites decreased while those who were Asians increased (P<0.05). Furthermore, 7.4% of CH-B Medicare cohort experienced decompensated cirrhosis, 2.9% hepatocellular carcinoma (HCC) and 11.9% 1-year mortality. Although the number of inpatients with CH-B remained stable, the number of outpatient encounters increased. Annual total inpatient charges increased from $66,610 to $94,221 while these charges for outpatient increased from $9257 to $47,863. In multivariate analysis, age [odds ratio (OR), 1.05; 95% confidence interval (CI), 1.04-1.05], male gender [OR, 1.24 (95% CI, 1.12-1.38)], decompensated cirrhosis [OR, 3.02 (95% CI, 2.63-3.48)], HCC [OR, 2.64 (95% CI, 2.10-3.32)], and higher Charlson comorbidity index [OR, 1.24 (95% CI, 1.21-1.27)] were independently associated with increased 1-year mortality. HCC and higher Charlson comorbidity index were also associated with higher inpatient and outpatient charges, and inpatient length of stay (all P<0.001). CH-B infection has been rising in Medicare population and is responsible for significant mortality and resource utilization.

Abstract 177: The Burden of Sternal Wound Infections Following Coronary Artery Bypass Graft Surgery in Medicare Patients

Objectives: Since 2008, the Centers for Medicare and Medicaid Services (CMS) have not reimbursed costs associated with sternal wound infections (SWI) that follow coronary artery bypass graft surgery (CABG). Beginning FY 2015, the Hospital-Acquired Condition (HAC) Reduction Program, mandated by the Affordable Care Act, requires the CMS to reduce hospital payments by 1 percent for hospitals that rank among the lowest-performing 25 percent with regard to HACs. SWI resulting from CABG was added to the program in FY 2016. The cost of treating SWIs is thus absorbed by the hospital, making optimized SWI prophylaxis an important part of hospital care. Here the burden of SWI following CABG in the Medicare population is calculated and the impact of improved prophylaxis quantified. Methods: Literature review identified publications presenting the incidence of surgical site infections (including superficial and deep SWIs), the time required to treat SWIs, and the costs of providing post CABG care. Key parameters to estimate the burden of SWIs were: CABG procedures per year, SWI rate, ratio of superficial to deep SWIs, length of stay, hospital time to treat SWIs, and the cost per day of intensive care unit (ICU) and general ward. A previously presented Markov model was adapted to estimate the yearly burden of SWIs after CABG procedures, with costs in 2016 USD. As antibiotic prophylaxis is essentially ubiquitous for patients undergoing CABG, data on other methods of reducing the SWI were considered. Single-patient-use electrocardiogram cable and lead (ECG) systems have recently been shown to significantly reduce the incidence of surgical site infection after CABG. The risk reduction at 30-days post CABG was 18.8% over reusable ECG. Results: The number of Medicare beneficiaries totals approximately 55.3 million people, with an annual rate of CABG of circa 178 procedures per 100,000 beneficiaries. Isolated CABG procedures under Medicare thus total 98,434. The SWI rate was reported to be between 1 and 4%, with deep SWI representing up to 40.75% of SWI cases. Using an SWI rate of 2.5% at 30 days, 20% of which are DSWI, indicated the burden of SWIs was $88.5 million. This included an additional 4,443 ICU and 21,443 general ward days, as well as over 1,000 readmissions. At the higher end of estimates, SWI could be costing providers $115.0 million. Assuming a 18.8% reduction in the SWI rate at 30 days, providers could save $12.6 million going up to $26.8 million ($271 per procedure) at the higher end of estimates. At a $6 incremental cost, single-patient-use ECG could represent a 45-fold return on investment. Conclusions: Superficial and deep SWIs after CABG procedures in the Medicare population come at considerable cost to providers. Preventing SWI has advantages for both patients and providers.

Health Care Reimbursement and Service Utilization Among Medicare Beneficiaries with Multiple Myeloma Receiving Autologous Hematopoietic Cell Transplantation in Inpatient and Outpatient Settings

Introduction: Inpatient services are the leading drivers of cost for autologous hematopoietic cell transplantation (HCT), and the number of Medicare beneficiaries who receive autologous HCT is increasing. Using a merged dataset of Center for International Blood and Marrow Transplant Research (CIBMTR) transplant and outcomes data and Centers for Medicare and Medicaid Services (CMS) Medicare administrative claims data, we examined reimbursement and service utilization among Medicare beneficiaries with multiple myeloma (MM) who received IP and OP autologous HCT.Methods: This was a multicenter retrospective cohort study. A total of 11,358 HCT recipients from 2010-2012 were identified in the CMS Medicare database; 9,055 (80%) were linked with CIBMTR data. Selection criteria included first HCT for MM, diagnosis-to-HCT time between 0 and 18 months, and continuous enrollment for 30 days prior to index and 100 days post-HCT or until death. For IP-HCT, the index period for reimbursement and service utilization was day of admission for HCT through discharge date. For OP-HCT, the index period was day -2 through HCT date to capture the conditioning regimen. Total IP and OP service days from 30 days prior to index and 100 days post-HCT, and subsequent admissions post the HCT index period were calculated. Total reimbursement consisted of all payments made to providers (Medicare payments for Part A & B services, secondary payer, and patient responsibility of deductibles, coinsurance, and copayments), which was adjusted by a weighted generalized linear model (GLM). Patient responsibility was assessed separately and adjusted by the same GLM. Kaplan-Meier method was used for overall survival (OS) analysis; potential factors associated with OS were adjusted by Cox regression modeling.Results: The final cohort comprised 1,640 patients; 1,445 (88%) received IP-HCT (126 centers) and 195 (12%) OP-HCT (24 centers). Patient characteristics, functional status, disease status, and HCT year were similar between groups except a higher percentage of IP-HCT recipients were 70 years and older (IP-HCT: 31%, OP-HCT: 19%; P=0.0003), and a lower percentage of IP-HCT recipients received full dose melphalan 200 mg/m2 (IP-HCT: 68%, OP-HCT: 90%; P=0.0036). There was a significant difference between the cohorts in the utilization of IP services (IP-HCT group: median 19 days, OP-HCT group: 4 days; P < 0.0001) and OP services (IP-HCT group: median 16 days, OP-HCT group: 33 days; P < 0.0001) at day 100. Adjusted total mean reimbursement for the IP-HCT group ($83,380 [95% CI: $78,958-$88,051]) was higher than the OP-HCT group ($55,721 [95% CI: $38,595-$80,446]) (P= 0.0301) (Figure). Factors associated with total reimbursement in the GLM were transplant setting, age, sex, comorbidity index, diagnosis-to-HCT time, and melphalan dose. Adjusted total patient responsibility for the IP-HCT group was $4,567 (95% CI: $4,210- $4,955) and $7,372 ($4,218- $12,884) (P=0.0902) for the OP-HCT group. Within 100 days post-HCT, 107/195 (55%) OP-HCT recipients had at least one subsequent admission, compared to 348/1,445 (24%) IP-HCT recipients (P < 0.0001). OS at 100 days was high for both HCT settings and adjusted OS was not significantly different by transplant setting (IP-HCT 98% [95% CI: 97%-99%]; OP-HCT 99% [95% CI: 98%-100%; P=0.1903)Conclusions: Reimbursement and service utilization varied by HCT setting for Medicare beneficiaries with MM. Total reimbursement for 100 days post-HCT was $27,659 higher for IP-HCT than OP-HCT, after adjusting for patient and HCT-related characteristics. After the HCT index period, approximately 1 in 4 IP-HCT recipients required re-hospitalization within 100 days, whereas 1 in 2 OP-HCT recipients required subsequent hospitalization. Many factors influence the decision between IP or OP autologous HCT, including: center experience, severity of disease, patient co-morbidities, access to caregivers, proximity of lodging, cost to the patient, and reimbursement for services to the hospital system. The CIBMTR-CMS merged database is a new resource to support ongoing efforts to inform transplant centers and healthcare systems about provision of care options in the Medicare population. DisclosuresGanguly:Janssen: Consultancy; Amgen: Consultancy; Seattle Genetics: Speakers Bureau; Daiichi Sankyo: Research Funding.

Medicare in Oral and Maxillofacial Surgery Part 2: Academic Surgeons and Cancer Surgeons Are Reimbursed Less

The purpose was to evaluate predictors of reimbursement of oral and maxillofacial surgery services in the Medicare population. This was a cross-sectional study of Medicare Physician and Other Supplier Aggregate Data from 2015. Clinicians were included if they were confirmed to be oral and maxillofacial surgeons (OMSs) by National Provider Identifier data.The primary outcome variable of this study was the proportion reimbursed (actual payment amount divided by charge amount). Predictor variables included type of practice (private vs academic), scope (cancer vs non-cancer), number of Medicare beneficiaries seen, number of unique Current Procedural Terminology (CPT) codes billed, and total amount charged.Descriptive statistics and regression analyses were calculated, with P<.05 considered significant. The initial search revealed 952 providers categorized as performing maxillofacial surgery, with 894 confirmed to be OMSs (144 academic and 750 private practice). Of 894 OMSs, 39 were cancer surgeons and 855 were non-cancer surgeons. Academic OMSs saw more complex patients than OMSs in private practice (P<.0001). Academic surgeons (n=144) charged an average of $116,876.92 to Medicare, with a mean payment amount of $22,219.62. Private practice surgeons (n=750) submitted an average charge of $27,812.56, with average reimbursement of $9,472.76. Multiple linear regression showed that academia, cancer surgeons, number of unique CPT codes, higher Hierarchal Condition Category scores, and total submitted charge amount were negative predictors of the proportion of reimbursement. Roughly 10% of OMSs participate in and bill for Medicare. Factors associated with a lower reimbursement proportion include being in academia, treating head and neck cancer, billing more unique CPT codes, seeing sicker patients, and having larger total submitted charges. As third-party private insurers often follow fee schedules and rates set by the Centers for Medicare & Medicaid Services, this observed effect also should be evaluated in claims data of other insurers.

Cost-Related Medication Nonadherence and Cost-Saving Behaviors Among Patients With Glaucoma Before and After the Implementation of Medicare Part D.

Understanding factors that lead to nonadherence to glaucoma treatment is important to diminish glaucoma-related disability. To determine whether the implementation of the Medicare Part D prescription drug benefit affected rates of cost-related nonadherence and cost-reduction strategies in Medicare beneficiaries with and without glaucoma and to evaluate associated risk factors for such nonadherence. Serial cross-sectional study using 2004 to 2009 Medicare Current Beneficiary Survey data linked with Medicare claims. Coding to extract data started in January 2014 and analyses were performed between September and November of 2014. Participants were all Medicare beneficiaries, including those with a glaucoma-related diagnosis in the year prior to the collection of the survey data, those with a nonglaucomatous ophthalmic diagnosis in the year prior to the collection of the survey data, and those without a recent eye care professional claim. Effect of the implementation of the Medicare Part D drug benefit. The change in cost-related nonadherence and the change in cost-reduction strategies. Between 2004 and 2009, the number of Medicare beneficiaries with glaucoma who reported taking smaller doses and skipping doses owing to cost dropped from 9.4% and 8.2% to 2.7% (P < .001) and 2.8%, respectively (P = .001). However, reports of failure to obtain prescriptions owing to cost did not improve in the same period (3.4% in 2004 and 2.1% in 2009; P = .12). After Part D, patients with glaucoma had a decrease in several cost-reduction strategies, namely price shopping (26.2%-15.2%; P < .001), purchasing outside the United States (6.9%-1.3%; P < .001), and spending less money to save for medications (8.0% to 3.5%; P < .001). Using a multivariate analysis, the main independent risk factors common to all cost-related nonadherence measures were female sex, younger age, lower income (<$30 000), self-reported visual disability, and a smaller Lawton index. After the implementation of Part D, there was a decrease in the rate that beneficiaries with glaucoma reported engaging in cost-saving measures. Although there was a decline in the rate of several cost-related nonadherence behaviors, patients reporting failure to fill prescriptions owing to cost remained stable. This suggests that efforts to improve cost-related nonadherence should focus both on financial hardship and medical therapy prioritization, particularly in certain high-risk sociodemographic groups.

MedPAC Probes High Mental Care Costs

Joyce Frieden is a senior editor with Elsevier Global Medical News. WASHINGTON — The Medicare Payment Advisory Commission is asking why fewer Medicare beneficiaries with mental illnesses are being treated as inpatients in psychiatric facilities but at higher costs. Dana Kelley, a staff member of the MedPAC, noted at a recent commission meeting that the number of Medicare beneficiaries who were treated for mental illness decreased from 483,000 in 2004—when the new inpatient prospective payment system was implemented—to 455,000 in 2007, a drop of 5.7%. But despite the drops Medicare inpatient mental health spending increased during the same time period, from $3.5 billion to $3.8 billion. As for the conditions prompting treatment, 73% of cases involved psychosis. Degenerative nervous system disorders, including dementia, came in a distant second, at 8%. The other most common diagnoses were organic disturbances and mental retardation (6%), depressive neurosis (4%), alcohol/drug use without rehabilitation (3%), and alcohol/drug use with comorbid conditions (2%). Said Ms. Kelley, “The commission has recommended that [the Centers for Medicare & Medicaid Services] establish a medical home pilot program for beneficiaries with chronic conditions, including chronic mental illness, to assess whether beneficiaries with medical homes receive higher quality, more coordinated care, without incurring higher health care spending.”

Employment and Insurance Status in Hodgkin Lymphoma Survivors

Materials/Methods: The study facilities include a small semi-urban, an inner-city, an urban, a rural, and a control hospital located in a semi-urban area. Using the UPMC EPIC billing system, new patients diagnosed with cancer who had consultations (CPT-4 codes: 99201-5, 99241-5, 99251-5) during 2003-2007 were identified. Results: The overall proportion of newly diagnosed cancer patients who had consultations and were insured by Medicare HMOs increased from 20.9% in 2003 to 26.5% in 2007. The estimated monthly cost of a qualifying clinical trial for a patient was $112.80 for trial #05-025, $326.60 for trial #03-091, $2,152.20 for trial #06-112, and $3082.8 for trial #05-044. In 2007, 103 subjects were screened for clinical trials in the UPMC cancer centers and opted out of enrolling on a Medicare qualifying clinical trial due to increased financial burden. Conclusions: Since the passing of the Medicare Modernization Act and the establishment of Medicare Advantage in 2003, the number of Medicare beneficiaries enrolled in managed care has increased. Our results are consistent with the national trend that there is an increasing number of aging cancer patients enrolled in Medicare HMOs. Our findings suggest that Medicare HMO reimbursement policy hinders cancer clinical trial participation in the ROCOG facilities.