Trends in and Factors Contributing to the Slowdown in Medicare Spending Growth, 2007-2018.

Importance: After decades of rapid increase, Medicare per-beneficiary spending growth was historically low in the period leading up to the passage of the Affordable Care Act. In the years immediately following the legislation, Medicare expenditure growth slowed even further.

Objective: To evaluate factors contributing to the slowdown in Medicare per-beneficiary spending growth.

Medicare Two-Midnight Rule Accelerated Shift To Observation Stays.

During the past two decades several policies have attempted to replace inappropriate hospital inpatient stays with observation hospital stays, where patients receive hospital care but are classified as outpatients. The Two-Midnight rule, adopted in October 2013 by the Centers for Medicare and Medicaid Services, states that more highly reimbursed inpatient payment is appropriate if care is expected to last at least two midnights; otherwise, observation stays should be used. For hospitals, the administrative burden associated with making these status determinations is substantial.

Establishing Medicaid incentives for liberating nursing home patients from ventilators.

Background: Chronic ventilator use in Tennessee nursing homes surged following 2010 increases in respiratory care payment rates. Tennessee's Medicaid program implemented multiple policies between 2014 and 2017 to promote ventilator liberation in 11 nursing homes, including quality reporting, on-site monitoring, and pay-for-performance incentives.

Methods: Using repeated cross-sectional analysis of Medicare and Medicaid nursing home claims (2011-2017), hospital discharge records (2010-2017), and nursing home quality reports (2015-2017), we examined how service use changed as Tennessee implemented policies designed to promote ventilator liberation in nursing homes.

Disparities in receipt of medications for opioid use disorder among pregnant women.

: Medications for opioid use disorder (MOUD) improve outcomes for pregnant women and infants. Our primary aim was to examine disparities in maternal MOUD receipt by family sociodemographic characteristics. : This retrospective cohort study included mother-infant dyads with Medicaid-covered deliveries in Tennessee from 2009 to 2016.

Body mass index and all-cause readmissions following acute heart failure hospitalization.

Background/objectives: Obesity is associated with a lower mortality risk among patients with heart failure (HF). Whether this obesity paradox applies to all-cause hospitalizations is unknown. We aimed to investigate the association between body mass index (BMI) and 30-day all-cause readmissions following HF hospitalization.

Change in admission blood glucose from chronic glycemic status in acute heart failure hospitalization and 30-day outcomes: A retrospective analysis.

Background: Admission blood glucose (BG) has demonstrated contradictory association with 30-day mortality in acute heart failure (AHF) hospitalization. To explore these contradictory findings, we aimed to determine if admission BG reflects an acute change from chronic glucose control and investigate the association between the admission and chronic BG change (ΔBG) with 30-day mortality in AHF.

Methods: We analyzed patients (n = 1045) age ≥ 65 with Centers of Medicare Services benefits and known 30-day all-cause mortality hospitalized with AHF at an academic medical center from 2009 to 2016.

Customizing national models for a medical center's population to rapidly identify patients at high risk of 30-day all-cause hospital readmission following a heart failure hospitalization.

Background: Nationally-derived models predicting 30-day readmissions following heart failure (HF) hospitalizations yield insufficient discrimination for institutional use.

Objective: Develop a customized readmission risk model from Medicare-employed and institutionally-customized risk factors and compare the performance against national models in a medical center.

Methods: Medicare patients age ≥ 65 years hospitalized for HF (n = 1,454) were studied in a derivation cohort and in a separate validation cohort (n = 243).

Centers for Medicare and Medicaid Services' readmission reports inaccurately describe an institution's decompensated heart failure admissions.

Hospitals typically use Center for Medicare and Medicaid Services' (CMS) Hospital Readmission Reduction Program (HRRP) administrative reports as the standard of heart failure (HF) admission quantification. We aimed to evaluate the HF admission population identified by CMS HRRP definition of HF hospital admissions compared with a clinically based HF definition. We evaluated all hospital admissions at an academic medical center over 16 months in patients with Medicare fee-for service benefits and age ≥65 years.

Validation of an automated electronic algorithm and "dashboard" to identify and characterize decompensated heart failure admissions across a medical center.

Background: We aim to validate the diagnostic performance of the first fully automatic, electronic heart failure (HF) identification algorithm and evaluate the implementation of an HF Dashboard system with 2 components: real-time identification of decompensated HF admissions and accurate characterization of disease characteristics and medical therapy.

Methods: We constructed an HF identification algorithm requiring 3 of 4 identifiers: B-type natriuretic peptide >400 pg/mL; admitting HF diagnosis; history of HF International Classification of Disease, Ninth Revision, diagnosis codes; and intravenous diuretic administration. We validated the diagnostic accuracy of the components individually (n = 366) and combined in the HF algorithm (n = 150) compared with a blinded provider panel in 2 separate cohorts.