Percentage Of Medicare Beneficiaries Research Articles

Examining the Relationship Between Hospice Agency Characteristics and Complaint Deficiencies

Promising technologies, which are simple, portable, quick, non-invasive, and inexpensive, may open new horizons on fall risk assessments and provide important information for older adults. We used a mixed-methods approach to examine the feasibility and acceptability of technology-based fall risk assessments, including the BTrackS Balance System, Bioelectrical Impedance Analysis, and activity monitoring devices among older adults. Data were collected via a Qualtrics survey and interviews. The acceptability was measured by the Senior Technology Acceptance (STA) and semi-structured interviews with 15 participants. The STA consists of four domains with 14 items, and the semi-structured interview includes three main questions related to experiences about balance performance tests, body composition, and activity monitoring. One hundred twenty-four community-dwelling older adults completed the online survey, and 15 older adults participated in the interviews. The majority of participants were female, and 72% had no history of falls. Race and ethnicity were 17% Hispanic, 7% African Americans, and 3% Asian Americans. About 7% had COVID-19 positive, 31% reported fear of COVID, and 14.5% were afraid of losing their life to COVID. The word-of-mouth strategy and key person approach were used and had an incredible impact on the recruitment process. None of the participants had ever had their fall risk and fear of falling assessed before agreeing to participate in this study. The technology-based fall risk assessments were feasible and acceptable. About 78% of participants liked the idea of using technology to assess falls risk, and 79% agreed that using technology would enhance their effectiveness in daily activities.

Opioid Prescribing Among Adults With Disabilities in the United States After the 2014 Federal Hydrocodone Rescheduling Regulation.

Deaths from prescription opioid overdoses have reached an epidemic level in the United States, particularly among persons with disabilities. The 2014 federal rescheduling regulation is associated with reduced opioid prescribing in the general US population; however, to date, no data have been published on this regulation's effect on persons with disabilities. We examined whether the 2014 hydrocodone rescheduling change was associated with reduced opioid prescribing among adult Medicare beneficiaries with disabilities. We identified 680 876 Medicare beneficiaries with disabilities aged 21-64 in 2013 and 657 687 in 2015 from a 20% national sample. We examined changes in the monthly opioid-prescribing rates from January 1, 2013, through December 31, 2015. We also compared opioid-prescribing rates in 2013 with rates in 2015. In 2014, the percentage of Medicare beneficiaries with disabilities who received hydrocodone prescriptions decreased by 0.154% per month (95% confidence interval [CI], -0.186 to -0.121, P < .001). The percentage of Medicare beneficiaries with disabilities who received hydrocodone prescriptions decreased from 32.2% in 2013 to 27.7% in 2015, whereas rates of any opioid prescribing, prolonged prescribing (≥90-day supply), and high-dose prescribing (≥100 morphine milligram equivalents per day for >30 days) decreased only modestly, from 50.2% to 49.0%, from 27.4% to 26.5%, and from 7.5% to 7.0%, respectively. The 2014 federal rescheduling of hydrocodone was associated with only minor changes in overall and potentially high-risk opioid-prescribing rates. Neither state variation in long-term prescribing nor beneficiary characteristics explained the changes in persistently high opioid-prescribing rates among adults with disabilities after the 2014 regulation. Future studies should examine patient and provider characteristics underlying the persistent high-risk prescribing patterns in this population.

PC-FACS

PC-FACS

Abstract 188: Hospital and Regional Variation in Use of High-intensity Statins Following Myocardial Infarction Among Medicare Beneficiaries

Background: American College of Cardiology/American Heart Association guidelines published in 2013 recommend high-intensity statins (atorvastatin 40 or 80 mg or rosuvastatin 20 or 40 mg) for most adults ≤75 years of age with atherosclerotic cardiovascular disease (ASCVD). For adults &gt;75 years of age with ASCVD, the guidelines recommend continuation of tolerated statins or initiation of moderate intensity statins for most patients. Objective: To examine whether guideline concordant use of high-intensity statins following myocardial infarction (MI) among Medicare beneficiaries differed by hospital size, medical school affiliation, and region of the US in 2014 (after publication of the guidelines). Methods: We identified 28,086 Medicare beneficiaries with fee-for-service and pharmacy coverage who filled a statin within 30 days following hospital discharge for MI in 2014. The analyses were restricted to 731 hospitals with at least 20 beneficiaries discharged for MI in 2014. Hospital size and medical school affiliation were determined from the American Hospital Association survey. In subgroups ≤75 and &gt;75 years of age, we calculated the proportion of beneficiaries whose first statin fill after MI was a high-intensity statin by hospital, hospital size, medical school affiliation, and region. Results: Among statin users ≤75 years of age, 10,696 (55%) beneficiaries filled a prescription for a high-intensity statin following MI. The percentage filling high-intensity statins range from 0-100% (25 th percentile 39%, 75 th percentile 69%) across hospitals. High-intensity statin use was more common following hospitalization at larger hospitals, hospitals with medical school affiliations, and those in New England ( Figure ). A lower percentage of Medicare beneficiaries &gt;75 years of age filled high-intensity statins (n = 8,441, 44%), but patterns were similar across hospital characteristics and region. Conclusions: Similar patterns of high-intensity statin use were present among individuals ≤75 years of age, in whom high-intensity statin use is guideline concordant, and individuals &gt;75 years of age, in whom high-intensity statin use is not necessarily guideline concordant, suggesting that variation in high-intensity statin prescriptions may not be directly related to close adherence to guidelines.

The Prevalence and Regional Variation of Major Depressive Disorder Among Patients With Peripheral Arterial Disease in the Medicare Population

Current evidence suggests an association between coronary artery disease and major depressive disorder (MDD). Data to support a similar association between peripheral arterial disease (PAD) and MDD are more limited. This study examines the prevalence and regional variation of both PAD and MDD in a large contemporary patient sample. All Medicare claims, part A and B, from January 2009 until December 2011 were queried using diagnosis codes specific for a previously validated clinical algorithm for PAD and major depression. Codes for PAD included those specific to cerebrovascular disease, abdominal aortic aneurysm, and peripheral vascular disease. Peripheral arterial disease prevalence, major depression prevalence, and coprevalence rates were determined, respectively. Regional variation of both conditions was determined using zip code data to identify potential endemic areas of disease intensity for both diagnoses. Over the study interval, the percentage of Medicare beneficiaries with a diagnosis of PAD remained relatively constant (3.0%-3.7%, n = 0.85-1.06 million in part A and 17.4%-17.5%, n = 4.82-4.93 million in part B), and MDD showed a similar trend (1.6%-2.7%, n = 0.46-0.79 million in part A and 6.1%-6.7%, n = 1.69-1.90 million in part B). The observed rate of MDD in those with an established diagnosis of PAD was 5-fold higher than those without PAD in part A claims (1.8-fold in part B claims). Moreover, there was a significant linear geographic correlation among patients with PAD and MDD (r = .54, P ≤ .01). This study documents a correlation between PAD and MDD and may, therefore, identify an at-risk population susceptible to inferior clinical outcomes. Significant regional variation exists in the prevalence of PAD and MDD, though there appear to be specific endemic regions notable for both disorders. Accordingly, health-care resource allocation toward endemic regions may help improve population health among this at-risk cohort.

LONG-TERM STATIN USE FOLLOWING RE-INITIATION AMONG MEDICARE BENEFICIARIES WITH CORONARY HEART DISEASE

The benefits of statin use after a myocardial infarction (MI) hospitalization accrue over time. Discontinuing statins in the year following initiation is common. We determined the percentage of Medicare beneficiaries who re-initiate statins and had high statin persistence following re-initiation.

Be a ‘star’: Get older patients off high-risk meds

Be a ‘star’: Get older patients off high-risk meds

Medicare Part D is Associated With Reducing the Financial Burden of Health Care Services in Medicare Beneficiaries With Diagnosed Diabetes

Medicare Part D, implemented in 2006, provided coverage for prescription drugs to all Medicare beneficiaries. To examine the effect of Part D on the financial burden of persons with diagnosed diabetes. We conducted an interrupted time-series analysis using data from the 1996 to 2008 Medical Expenditure Panel Survey (11,178 persons with diabetes who were covered by Medicare, and 8953 persons aged 45-64 y with diabetes who were not eligible for Medicare coverage). We then compared changes in 4 outcomes: (1) annual individual out-of-pocket expenditure (OOPE) for prescription drugs; (2) annual individual total OOPE for all health care services; (3) annual total family OOPE for all health care services; and (4) percentage of persons with high family financial burden (OOPE ≥10% of income). For Medicare beneficiaries with diabetes, Part D was associated with a 28% ($530) decrease in individual annual OOPE for prescription drugs, a 23% ($560) reduction in individual OOPE for all health care, a 23% ($863) reduction in family OOPE for all health care, and a 24% reduction in the percentage of families with high financial burden in 2006. There were similar reductions in 2007 and 2008. By 2008, the percentage of Medicare beneficiaries with diabetes living in high financial burden families was 37% lower than it would have been had Part D not been in place. Introduction of Part D coverage was associated with a substantial reduction in the financial burden of Medicare beneficiaries with diabetes and their families.

Did the 1997 Balanced Budget Act Reduce Use of Physical and Occupational Therapy Services?

Latham NK, Jette AM, Ngo LH, Soukup J, Iezzoni LI. Did the 1997 Balanced Budget Act reduce use of physical and occupational therapy services? Objective To investigate whether use of physical therapy (PT) and occupational therapy (OT) services decreased after the passage of the 1997 Balanced Budget Act (BBA). Design Data from the nationally representative Medicare Current Beneficiary Survey (MCBS) were merged with Medicare claims data. We conducted cross-sectional analyses of data from 1995 (n=7978), 1999 (n=7863), and 2001 (n=7973). All analyses used MCBS sampling weights to provide estimates that can be generalized to the Medicare population with 5 common conditions. Settings Skilled nursing facilities (SNFs), home health agencies, inpatient rehabilitation facilities (IRFs), and outpatient rehabilitation settings. Participants Medicare beneficiaries who participated in the MCBS survey in each of the study years and had 1 or more of the following conditions: acute stroke, acute myocardial infarction, chronic obstructive pulmonary disease, arthritis or degenerative joint disease, or mobility problems. Interventions Not applicable. Main Outcome Measures Percentage of persons meeting our inclusion criteria who received PT or OT in each setting, and total units of PT and OT received in each setting. Results Multivariable logistic regression revealed no statistically significant differences in the proportion of people who met our inclusion criteria who used PT or OT from home health agencies across the 3 time points. For SNFs, an increase in the odds of receiving PT was statistically significant from 1995 to 1999 (odds ratio [OR]=1.42; 95% confidence interval [CI], 1.19−1.69) and 1995 to 2001 (OR=1.69; 95% CI, 1.39−2.05). For IRF and outpatient settings, a significant increase was observed between 1995 and 2001 (OR=1.71, OR=1.27, respectively). For OT, a statistically significant increase was observed for IRF and outpatient rehabilitation settings from 1995 to 2001. For SNF, the increase was statistically significant from 1995 to 1999 and 1995 to 2001. Mean total PT and OT units received also increased across all settings from 1995 to 2001 except for IRFs. Conclusions Despite BBA mandates restricting postacute care expenditures, this nationally representative study showed no decreases in the percentage of Medicare beneficiaries with 5 common diagnoses receiving PT and/or OT across all settings and no decreases in units of PT and/or OT services received between 1995 and 2001 except for those in IRFs. This study suggests that the delivery of PT and OT services did not decline among persons with conditions for which rehabilitation services are often clinically indicated.