Public-use Files Research Articles

The effects of a universal income transfer on food insecurity within households

Abstract Using the public-use files of the Canadian Community Health Survey and a difference-in-differences methodology, we estimate the impact of a universal income transfer (the Universal Child Care Benefit) on food insecurity, separately for adults and children within households. The income transfer reduced the risk of overall food insecurity by 20% at the child level, and the effect was larger in households with lower education or income. The transfer also reduced the likelihood of moderate/severe food insecurity among adults in single-parent families, as well as adults and children in households with secondary education or less. These findings withstand several robustness checks.

Financial Performance of Accountable Care Organizations: A 5-Year National Empirical Analysis.

Of 513 accountable care organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP) in 2020, 67% generated a positive shared savings of approximately $2.3 billion. This research aimed to examine their financial performance trends and drivers over time. The unit of analysis was the ACO in each year of the study period from 2016 to 2020. The dependent variable was the ACOs' total shared savings earned annually per beneficiary. The independent variables included ACO age, risk model, clinician staffing type, and provider type (hybrid, hospital-led, or physician-led). Covariates were the average risk score among beneficiaries, payer type, and calendar year. The Centers for Medicare & Medicaid Services (CMS) public use files (PUFs) and a commercial healthcare data aggregator were the data sources. ACOs' earned shared savings grew annually by 35%, while the proportions of ACOs with positive shared savings grew by 21%. For 1-year increase in ACO age, an additional $0.57 of shared savings per beneficiary was observed. ACOs with two-sided risk contracting were associated with an average marginal increase of $109 in shared savings per beneficiary compared to ACOs with one-sided risk contracting. Primary care physicians were associated with the greatest increase in earned shared savings per beneficiary. In contrast, nurse practitioners/physician assistants/clinical nurse specialists were associated with a reduction in earned shared savings. Under a one-sided risk model, hospital-led ACOs were associated with $18 higher average shared savings earning per beneficiary compared to hybrid ACOs, while physician-led ACOs were associated with lower average saved shared earnings per beneficiary at -$2 compared to hybrid ACOs. Provider-type results were not statistically significant at the 5% nominal level. No statistically significant differences were observed between provider types under a two-sided risk model. For all ACO provider types, building broader primary care provider networks was correlated with positive financial results. Future research should examine whether ACOs are conducting specific preventive screenings for cancer or monitoring conditions such as diabetes, hypertension, heart disease, obesity, mental disorders, and joint disorders. Such studies may answer health policy and strategy questions about the effects of incentives for improved ACO performance in serving a healthier population.

Association between Priority Conditions and Access to Care, Treatment of an Ongoing Condition, and Ability to Obtain Prescription Medications among Medicare Beneficiaries during the COVID-19 Pandemic

Several comorbid conditions have been observed to be associated with an increased risk of poor outcomes following a diagnosis of COVID-19. The purpose of this investigation was to assess associations between Centers for Medicare and Medicaid Services (CMS) designated priority conditions and an inability to access care, treat ongoing conditions, and obtain prescription medications among Medicare beneficiaries in the United States during the COVID-19 pandemic. Nationally representative CMS Medicare Current Beneficiary Survey (MCBS) COVID-19 Supplement Public Use Files (PUF) were analyzed via bivariable, binomial generalized linear models across three time periods: (1) Summer 2020; (2) Fall 2020; and (3) Winter 2021. Across an estimated 55.3–57.4 million Medicare beneficiaries, approximately one-fifth reported an inability to access at least one type of care at the onset of the pandemic. Significantly worse odds of an ability to get care across various time periods was observed among several priority conditions including immune disorders, cancer, depression, osteoporosis, diabetes, arthritis, and numerous cardiovascular and pulmonary conditions. Among those reporting an inability to access care, approximately one-third involved treatment of an ongoing condition, and under one-tenth involved prescription medications. To identify modifiable risk factors and to develop active interventions, future work should continue to assess the complex associations between outcomes, access to care, comorbidities, evolving healthcare infrastructures, computerization, and various public health initiatives.

Trends in Opioid Misuse Among Individuals Aged 12 to 21 Years in the US

Although opioid misuse has been decreasing among US youths and adolescents in recent years, it is unclear what has contributed to this trend and how this trend differs by age group and sex over time. To identify trends in opioid misuse among youths and young adults across and between ages, birth cohorts, and sexes. Cross-sectional National Survey on Drug Use and Health (NSDUH) public-use files were used to produce nationally representative pseudocohorts. The survey population includes the civilian US population in the 50 states and Washington, DC. Individuals without a fixed address and institutionalized individuals were excluded. Respondents to the NSDUH are a population-based sample selected using a stratified cluster design. For the years (January 1, 2002, to December 31, 2019) and ages (12-21 years) analyzed, the sample sizes ranged from 1607 to 3239 respondents. Data were analyzed from January 1, 2022, to April 12, 2023, for the main outcome by age, sex, and pseudocohort. Respondents were asked whether they misused prescription opioids or used heroin in the past year. The analysis hypotheses were formulated and tested after data collection. In a total of 5 pseudocohorts, data from 114 412 respondents aged 12 to 21 years were analyzed; the unweighted distribution of male sex (complement was female) ranged from 47.7% to 52.6% (mean [SD], 50.6% [1.1%]). Response rates ranged from 45.8% to 71.3%. High school-aged youths and young adults had distinctly lower rates of opioid misuse in later pseudocohorts compared with earlier ones. Rates of misuse among individuals aged 16 years were 2.80% (95% CI, 1.06%-4.54%) higher in 2002 vs 2008; among those aged 18 years, rates were 4.36% (95% CI, 1.85%-6.87%) higher in 2002. Similarly, rates of misuse among individuals aged 16 years were 3.93% (95% CI, 2.15%-5.71%) higher in 2008 vs 2014; among those aged 17 years, rates were 3.41% (95% CI, 1.94%-4.88%) higher in 2008. Similar patterns were observed by sex. In earlier cohorts, younger female participants had higher rates of opioid misuse than their male counterparts and older male participants had higher rates than their female counterparts. Sex differences decreased in later cohorts. The findings of this cross-sectional study of US youths and young adults suggest that high school-aged individuals consistently misused fewer opioids in later pseudocohorts overall and by sex. Sex differences in opioid rates also diminished in later pseudocohorts. A decrease in drug availability and general exposure to the harms of opioid use could be contributing to these findings. Future planned research using this pseudocohort approach will examine polysubstance use and evaluate how substance use differs by other sociodemographic characteristics.

Outcomes of Robotic-Assisted Bariatric Surgery Compared to Standard Laparoscopic Approach Using a Standardized Definition: First Look at the 2020 Metabolic and Bariatric Surgery Accreditation Quality Improvement Project (MBSAQIP) Data.

The primary objective of this study is to evaluate the outcomes of robotic-assisted (RA-) approach compared to the standard laparoscopic (L-) approach usingthe 2020 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP)registry Public Use File (PUF). Our secondary objective is to establish standards for the reporting of outcomes using PUF. Using the PUF database (n = 168,568), patients were divided into sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), revisions, and conversions and then analyzed separately. We created balanced covariate through propensity score matching and inverse probability treatment weighting (IPTW). We also conducted multivariable relative risk regression to confirm our results. For RYGB, the incidence of "transfusion" was significantly lower in the RA-RYGB compared to the L-RYGB. There was no significant difference in the rate of Serious Event Occurrences (SEOs) or rate of intervention at 30days. For SG, there was a higher rate of "transfusion" in the RA group. Incidence ofSEOs was also significantly higher in the RA-group. There was no significant difference in SEOs for conversions; however, revisions had a trend toward a lower rate of SEOs favoring the robotic approach. Operative times were significantly higher for all RA-groups. RA- approach in metabolic and bariatric surgery (MBS) remains controversial because of differences in outcomes. The use of SEOs as reported by MBSAQIP in its semi-annual report can be used as a composite score to assess outcomes while using PUF. Further studies are needed to compare RA- to L- MBS.

Synthetic Individual Income Tax Data: Promises and Challenges

Tax data are invaluable for research, but privacy concerns severely limit access. Although the US Internal Revenue Service produces a public-use file (PUF), improved technology and the proliferation of individual data have made it increasingly difficult to protect. Synthetic data are an alternative that reproduce the statistical properties of administrative data without revealing individual taxpayer information. This paper evaluates the quality and safety of the first fully synthetic PUF and demonstrates its performance in tax model microsimulations. The synthetic PUF could also be used to develop and debug statistical programs that could then be safely run on confidential data via a validation server.

MP56-14 UTILIZING THE MODIFIED FRAILTY INDEX TO PREDICT OUTCOMES AFTER RADICAL CYSTECTOMY

You have accessJournal of UrologyCME1 May 2022MP56-14 UTILIZING THE MODIFIED FRAILTY INDEX TO PREDICT OUTCOMES AFTER RADICAL CYSTECTOMY Hannah Jarvis, and Andrew Harris Hannah JarvisHannah Jarvis More articles by this author , and Andrew HarrisAndrew Harris More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002639.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: For patients with muscle invasive bladder cancer radical cystectomy remains the gold standard. There is significant risk associated with this procedure and we aim to evaluate patient characteristics that may predict outcomes following surgery. The modified frailty index (MFI) is used as a tool for predicting morbidity. METHODS: Data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) public use files (PUF) between 2012 and 2018 were reviewed for cases of radical cystectomy, with 10,338 total observations. Morbidity was defined by the following 30-day complications: mortality, superficial incisional surgical site infection (SSI), deep incisional SSI, organ/space SSI, wound dehiscence, pneumonia, bleeding requiring transfusion, urinary tract infection (UTI), unplanned intubation, ventilator for more than 48 hours, sepsis, acute renal failure, progressive renal insufficiency, pulmonary embolism, deep vein thrombosis (DVT) or thrombophlebitis, cardiac arrest requiring CPR, myocardial infarction, and stroke with neurological deficit or cerebrovascular accident (CVA). The modified frailty index score is defined on a scale of 1 to 5, with each patient receiving one point per each of their existing comorbidities: congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), diabetes mellitus, hypertension that requires medication, or a functional status that was not dependent. RESULTS: Variables found to have significant differences when compared to MFI scores include patient age, gender, race, BMI, ASA class, and smoking history. Post-operative variables with statistical significance in relation to MFI scores include LOS, surgical site infection, sepsis, pneumonia, unplanned intubations, need for transfusion, readmission, and returns to the operating room. Under multivariate analysis of morbidity by frailty score, adjusting for all significant patient characteristics and operation duration, significance was found for MFI >2, age >80, male sex, minority race, smoking history, disseminated cancer, and operation duration greater than 320 minutes. CONCLUSIONS: We believe mFI score is an effective pre-operative tool for evaluating potential morbidity in patients with MIBC who are under consideration for radical cystectomy. Source of Funding: N/A © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e978 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hannah Jarvis More articles by this author Andrew Harris More articles by this author Expand All Advertisement PDF DownloadLoading ...

A Cross-Sectional Analysis of the National Survey on Drug Use and Health Data: Mental Health Determinants of Major Depression and Suicidal Ideation in Older Adults

ABSTRACT This study examined the mental health determinants of race, sex, education, poverty, and overall health and whether they are significant predictors of major depressive episodes (MDE) and suicidal ideation (SI) among older adults while adjusting for marital status. Data were obtained from the National Survey on Drug Use and Health public-use file. Weighted MLR analyses of the five predictors were used to predict MDE and SI risk among older adults. Study results confirmed that the five mental health determinants significantly predicted MDE and SI among older adults with adjustment for marital status (p < .05). The findings highlight the role that mental health determinants play in predicting MDE and SI among older adults and important confounders that can impact the examination of their risk for MDE and SI. Clinicians and gerontologists need to develop tailored interventions that meet the needs of older adults.

Geographic Variation in Otolaryngologist Intranasal Steroid Prescribing Patterns Among Medicare Beneficiaries.

Intranasal corticosteroids (INCS) are a commonly prescribed medication to treat various rhinological conditions. However, no prior studies have looked at factors and patterns that influence the rates of INCS prescriptions among Medicare beneficiaries in the United States. This study aims to describe the patterns of INCS prescriptions by otolaryngologists for Medicare beneficiaries in the United States between 2013 and 2017. Data on the most common INCS prescriptions by otolaryngologists for Medicare beneficiaries were obtained from the 2013 to 2017 Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File (PUF) and the Part D Public Use Files from the Centers for Medicare and Medicaid Services (CMS). INCS prescriptions were analyzed by cost, state, provider, and regional temperature. State temperature data was collected through the National Centers for Environmental Information. From 2013 to 2017, the total claims per beneficiary for fluticasone, mometasone, and triamcinolone combined increased from 2.31 to 2.39. Combined cost/beneficiary was similar for mometasone and triamcinolone at 102.47 and 103.60 respectively, while it was much lower for fluticasone at 39.12. There was a strong correlation between otolaryngology providers per beneficiary in each state and total claims per state with a correlation coefficient of .79. Additionally, comparing the average state temperature to the claims/beneficiary yielded a moderately strong correlation coefficient of .44, suggesting that temperature was a possible factor for INCS prescription patterns. INCS prescriptions by otolaryngologists and the number of INCS beneficiaries have increased between 2013 and 2017. Over the same time period, the costs of fluticasone and triamcinolone have decreased while the cost of mometasone increased. Total providers by state correlated with claims per state. Additionally, average annual temperature was positively correlated with INCS claims per beneficiary in each state.

Individual Characteristics and Demographics Associated with Mask Wearing During the COVID-19 Pandemic in the United States

Introduction: Many scientific studies provide evidence of mask wearing as an effective strategy to reduce the spread of the COVID-19 virus. However, US citizens do not adhere to this prevention practice universally. Although past studies have shown disparities in mask wearing by age, gender, ethnicity, and location, the literature lacks a work that uses large-scale national survey data to understand the mask-wearing resistors' characteristics and demographics. This study's purpose is to fill this gap. Methods: We obtained this study's data from the COVID-19 Impact Survey, a nationally representative survey conducted by NORC at the University of Chicago. This survey aims at generating national and regional statistics by surveying representative regional and national samples in three time periods: April 20–26, 2020, May 4–10, 2020, and June 1–8, 2020. Data for our analysis are from the public-use files of these three waves. We performed logistic regressions to estimate the adjusted risk ratio (ARR) of not wearing masks for several personal characteristics and demographics. Results: Our results suggest that younger (average ARR = 1.66) and lower-income (average ARR = 1.51) adults are more likely not to wear a face mask to prevent the coronavirus spread. On the other hand, unhealthy (average ARR = 0.81), female (average ARR = 0.68), and minority (average ARR = 0.65) adults are less likely not to wear a mask. Furthermore, residents in the Northeast region (average ARR = 0.34) and urban residents (average ARR = 0.54) are less likely not to wear a face mask. Conclusion: Mask-wearing behavior differs by age, income, health status, gender, race, region, and geographical residence in the US.

The Medicare Current Beneficiary Survey (MCBS): Providing Unique Access to Data on the Medicare Population

The Medicare Current Beneficiary Survey (MCBS) is a continuous, multipurpose survey of a nationally representative sample of the Medicare population, conducted by the Centers for Medicare & Medicaid Services (CMS). It collects data on demographics, health insurance, health status, health care expenditures, satisfaction with care, and access to care for Medicare beneficiaries. The MCBS provides a unique source of information regarding beneficiaries aged 65 and over and beneficiaries aged 64 and below with disabilities residing in the United States that cannot be obtained solely through CMS administrative sources. For researchers interested in issues of health care utilization and cost, CMS releases two Limited Data Set (LDS) files for each data year and a Public Use File (PUF) freely available for download and use. Also, special topic based PUFs have been released on the impact of COVID-19 on Medicare beneficiaries. This presentation will demonstrate the importance of the MCBS for research on the Medicare population, discuss how researchers can access the data, where researchers can find published MCBS estimates, what content areas have recently been added, such as food insecurity, limited English proficiency, and COVID-19 vaccination uptake and what new content is on the horizon. The presentation will also discuss the operational challenges posed by the COVID-19 pandemic, and the content enhancement opportunities created by the public health emergency. It will conclude with a review of the suite of materials and documentation available for data users to enhance their research and utilize more timely data.

Lower Wages of Nurses in Long-Term Care: Does Racial and Ethnic Diversity Explain the Difference?

Registered nurses (RNs) are a key component of the long-term care (LTC) workforce and prior research demonstrates their importance to ensuring patient safety in LTC settings. RNs who work in LTC settings earn less than those who work in hospitals and also are more likely to be from racial and ethnic minority groups. This study seeks to measure wage differences between Registered Nurses (RNs) working in LTC and other settings (e.g., hospitals) and whether differences are associated with the characteristics of the RN workforce between and within settings. We used the 2018 National Sample Survey of Registered Nurses (NSSRN) public-use file to examine RN employment and earnings. Our study population included a sample of 15,373 employed RNs who provided patient care. Characteristics such as race/ethnicity, type of RN degree completed, census region, and union status were included in bivariate analyses and multiple regression analyses to examine the effect of these characteristics on wages. Logistic regression was used to predict RN employment in LTC settings. We found that RNs in LTC experienced lower wages compared to those in non-LTC settings, yet this difference was not associated with racial/ethnic or international educational differences. LTC nurses were also significantly less likely to be represented by a labor union, and there was not a statistically significant wage difference for LTC RNs who were unionized. Because RNs in LTC earn lower wages than RNs in other settings, policies to minimize pay inequities are needed to support the RN workforce caring for frail older adults.

Re-examining Adult Education and Training Participation by Education, Literacy, Gender, and Race/Ethnicity in the U.S.

This study examined the associations between adult education and training (AET) participation, educational attainment, literacy skills, gender, and race/ethnicity among the U.S. adult population aged 25 to 65 years old (n = 5,450). Given the socioeconomic advancements of women and racial/ethnic minorities in the last few decades, including higher educational attainment, increased labor force participation, and greater income, and as new data becomes available, it is important to re-examine AET participation by gender and race/ethnicity in the U.S while controlling for educational attainment and literacy skills. This study employed the 2012/2014 Program for International Assessment of Adult Competencies (PIAAC) public-use file (PUF). Binary logistic regression was used to examine (1) any AET, (2) formal AET, and (3) non-formal AET across all variables of interest. Indeed, educational attainment and literacy skills are associated with greater AET participation. Further analyses showed that more women than men participated in all forms of AET, and there were some variations in AET participation by racial/ethnic minorities. More Black, Hispanic, and other racial/ethnic minority adults participated in formal AET, and more Black adults participated in all forms of AET, compared to their White counterparts. This study also provides within-race/ethnicity group variations.

The Association of Race, Ethnicity, and Wages Among Registered Nurses in Long-term Care.

Objective:This study seeks to measure wage differences between registered nurses (RNs) working in long-term care (LTC) (eg, nursing homes, home health) and non-LTC settings (eg, hospitals, ambulatory care) and whether differences are associated with the characteristics of the RN workforce between and within settings.Study Design:This was a cross-sectional design. This study used the 2018 National Sample Survey of Registered Nurses (NSSRN) public-use file to examine RN employment and earnings.Methods:Our study population included a sample of 15,373 RNs who were employed at least 1000 hours in nursing in the past year and active in patient care. Characteristics such as race/ethnicity, type of RN degree completed, census region, and union status were included. Multiple regression analyses examined the effect of these characteristics on wages. Logistic regression was used to predict RN employment in LTC settings.Results:RNs in LTC experienced lower wages compared with those in non-LTC settings, yet this difference was not associated with racial/ethnic or international educational differences. Among RNs working in LTC, lower wages were associated with part-time work, less experience, lack of union representation, and regional wage differences.Conclusion:Because RNs in LTC earn lower wages than RNs in other settings, policies to minimize pay inequities are needed to support the RN workforce caring for frail older adults.

The Relationship Between Governing Board Composition and Medicare Shared Savings Program Accountable Care Organizations Outcomes: an Observational Study.

Early studies of Medicare Shared Savings Program (MSSP) accountable care organizations (ACOs) suggested that physician leadership was an important driver of ACO success, but it is unknown whether the demographic and professional composition of current MSSP ACO governing boards is associated with ACOs' publicly reported outcomes. To investigate whether governing boards with higher physician participation and greater female involvement have better outcomes. Cross-sectional observational study. All 2017 MSSP ACOs identified by the Center for Medicare and Medicaid Services ACO Public Use Files (PUF). We collected governing board composition from ACO websites in 2019. Outcome metrics included risk-standardized readmission and unplanned admissions rates. We used descriptive statistics and linear regression models to examine the association between board composition and outcomes. Of the 339 ACOs that still existed in 2019 and had available data, 77% had physician-majority boards and 11.5% had no women on their boards. Eighty-nine percent reported a Medicare beneficiary on their board, of which about one-third had a woman representative. The average number of members on MSSP ACO boards was 12, with a mean of 67% physicians and 24% women. Board composition varied minimally by ACO characteristics, such as geographic region, number of beneficiaries, or type of participants. Higher levels of physician participation in ACO governing boards were associated with lower all-cause unplanned admission rates for patients with heart failure (p = - 0.26, p < 0.001) and for patients with multiple chronic conditions (p = - 0.28, p = 0.001). The number of women on the board was not associated with any outcome differences. MSSP ACO governing boards were predominately male and physician-led. Physician involvement may be important for achieving quality goals, while lack of female involvement showcases an opportunity to diversify boards.

Geographic access to brachytherapy services in the United States

PURPOSEDisparities in geographic access to medical care exist in nearly all fields of medicine including radiation oncology. We aim to update knowledge of the geographic distribution of radiation oncologists in the United States. METHODS AND MATERIALSWe used the Physician and Other Supplier Public Use File (PUF) from the Centers for Medicare & Medicaid Services (CMS) as well as the International Atomic Energy Agency (IAEA) Directory of Radiotherapy Centers (DIRAC) database to identify practices that either coded for or are marked as having access to brachytherapy services. Geographic analysis was performed on several levels including United States (US) Census region, Dartmouth Atlas Healthcare Referral Region, and the county level. RESULTSWe identified 327 providers that billed for a brachytherapy code during the calendar year 2018 and 564 facilities providing brachytherapy. Within the 306 HRRs in the US, 149 have access to brachytherapy. This represents 247.5 million people based on 2018 estimates of population from the US Census Bureau. This implies that 76.7% of people within the US live in an HRR with access to brachytherapy, and, conversely, that 75.3 million people (23.3%) do not. Numerically, counties in metropolitan areas were more likely to have access to brachytherapy than those outside of a metropolitan area. CONCLUSIONSGeographic disparities exist in access to brachytherapy; metropolitan counties are more likely to have access than non-metropolitan counties. We support continued development of databases of brachytherapy providers and programs that may support travel and lodging costs to minimize these disparities.

Black Girls in Mathematics: (Re)envisioning an Inclusive Parent Involvement Measure

Building upon research utilizing Martin’s Mathematical Socialization and Identity Framework, we examine factors related to community and family involvement to advance the current discourse that informs policies. Data from the High School Longitudinal Study (HSLS:09) public-use file provided a sample of 1,029 Black girls for our analyses. We developed a theoretically-sound inclusive measure, as defined by Black girls, titled the Community and Family Involvement Predictive Scale for Mathematics Outcomes utilizing Nonlinear Principal Components Analysis with a Categorical Principal Components Analysis program. Results are an intersectional measure that considers family, peers, and teachers. Implications for policy include a need for federal, state, and district policymakers to consider a wider variety of contexts, specifically for Black girls, in which community and family partnerships are empowered and prioritized in policies focused on parental involvement.

Evolving Radiologist Participation in Medicare Shared Savings Program Accountable Care Organizations.

The aim of this study was to temporally characterize radiologist participation in Medicare Shared Savings Program (MSSP) accountable care organizations (ACOs). Using CMS Physician and Other Supplier Public Use Files, ACO provider-level Research Identifiable Files, and Shared Savings Program ACO Public-Use Files for 2013 through 2018, characteristics of radiologist ACO participation were assessed over time. Between 2013 and 2018, the percentage of Medicare-participating radiologists affiliated with MSSP ACOs increased from 10.4% to 34.9%. During that time, the share of large ACOs (>20,000 beneficiaries) with participating radiologists averaged 87.0%, and the shares of medium ACOs (10,000-20,000) and small ACOs (<10,000) with participating radiologists rose from 62.5% to 66.0% and from 26.3% to 51.6%, respectively. The number of physicians in MSSP ACOs with radiologists was substantially larger than those without radiologists (mean range across years, 573-945 versus 107-179). Primary care physicians constituted a larger percentage of the physician population for ACOs without radiologists (average across years, 66.3% versus 38.5%), and ACOs with radiologists had a higher rate of specialist representation (56.0% versus 33.7%). Beneficiary age, race, and sex demographics were similar among radiologist-participating versus nonparticipating ACOs. In recent years, radiologist participation in MSSP ACOs has increased substantially. ACOs with radiologist participation are large and more diverse in their physician specialty composition. Nonparticipating radiologists should prepare accordingly.

Medicare beneficiary panel characteristics associated with high Part D biologic disease-modifying anti-rheumatic drug prescribing for older adults among rheumatologists.

The aim of this study was to investigate beneficiary panel characteristics associated with rheumatologists’ prescribing of biologic DMARDs (bDMARDs) for older adults.In this retrospective observational study, we used Medicare Public Use Files (PUFs) to identify rheumatologists who met criteria for high-prescribing, defined as bDMARD prescription constituting ≥20% of their DMARD claims for beneficiaries ≥65 years of age. We first used descriptive analysis then multivariable regression model to test the association of high prescribing of bDMARDs with rheumatologists’ panel size and beneficiary characteristics. In particular, we quantified the proportion of panel beneficiaries ≥75 years of age to assess how caring for an older panel correlate with prescribing of bDMARDs.We identified 3197 unique rheumatologists, of whom 405 (13%) met criteria for high prescribing of bDMARDs for Medicare beneficiaries ≥65 years of age. The high-prescribers provided care to 12% of study older adults, and yet accounted for 21% of bDMARD prescriptions for them. High prescribing of bDMARDs was associated with smaller panel size, and their beneficiaries were more likely to be non-black, ≥75 years of age, non-dual eligible, have diagnosis of CHF, however, less likely to have CKD.Rheumatologists differ in their prescribing of bDMARDs for older adults, and those caring for more beneficiaries ≥75 years of age are more likely to be high-prescribers. Older adults are more prone to the side-effects of bDMARDs and further investigation is warranted to understand drivers of differential prescribing behaviors to optimize use of these high-risk and high-cost medications.

Impact of state scope-of-practice laws on nurse practitioner-provided home visits

Millions of older Americans receive nurse practitioner (NP)-provided home based primary care (HBPC). Little is known about how state scope-of- practice (SOP) laws may impact use of NP-home visits. Using 2017 Centers for Medicare and Medicaid Services Provider Utilization and Payment Data Public Use File (PUF), we examined the impact of state SOP laws on the use of NP-home visits. The PUF file was merged with the 2017 American Community Survey to assess area-level median income. Over 4.4 million home visits were provided to 1.6 million Medicare beneficiaries. NPs represented the largest share of providers (47.5%). In states with restricted SOP laws, compared to NPs, physicians and physician assistants had higher odds of providing HBPC. In states with reduced SOP laws, compared to NPs, physicians and PAs had decreased odds of providing HBPC. Our study provides evidence that SOP restrictions are associated with decreased utilization of NP-provided HBPC.