Are Fewer Diagnoses Better? Assessing A Proposal To Improve The Medicare Advantage Payment System.

Medicare Advantage (MA) plans report diagnoses more completely than they are reported in traditional Medicare. As a result, payment to MA plans is greater than it would be if coding patterns were identical in the two sectors. The Medicare Payment Advisory Commission estimates that the overpayment to MA attributable to differential coding was $50 billion in 2024.

Contributions of neurologists to diagnostic timelines of ALS and thinkALS as an early referral instrument for clinicians.

To evaluate neurologists and other clinicians' contributions to U.S. ALS diagnostic timelines.

National Health Accounts: A Framework For Understanding Health Care Financing.

Over the course of the past century, the challenges facing the United States in its consumption of health care goods and services have not changed very much. What is being consumed, who is paying for it, and how much is affordable are questions that arise in every cycle of the debate-if they ever go dormant. National Health Accounts are one tool to use in the search for answers to these questions and to the challenges behind the questions.

Oregon nurse staffing law: is it working?

In 2001, Oregon enacted a law mandating the creation of hospital nurse staffing committees to oversee staffing in acute care hospitals. The study design is a descriptive case study (qualitative method) using semistructured interviews and focus groups to assess the law requiring hospital nurse staffing committees to monitor nurse staffing in Oregon. One significant theme of the study was the wide variation among facilities in the way the staffing legislation is viewed, interpreted, understood, appreciated, and implemented.

Prescription medication cost-related non-adherence among Medicare CAHPS respondents: disparity by Hispanic ethnicity.

Purpose: We examined whether there was disparity in prescription medication cost-related non-adherence (CRN) by Hispanic ethnicity among Medicare enrollees.

Methods: Multivariate logistic regression, adjusting for race, other socio-demographic variables, health status, health care utilization, and patient rating of their personal physician, was used to examine association of Hispanic ethnicity with CRN using cross-sectional data from Medicare's Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey (data collected in Spring 2007).

Results: Hispanic respondents constituted 6.

National study of medications associated with injury in elderly Medicare/Medicaid dual enrollees during 2003.

Objectives: To address the association between inappropriate prescribing for the elderly and adverse outcomes and to identify the magnitude of the cost of medication-associated injury in this population.

Design: Cross sectional.

Setting: United States, 2003.

Accuracy and Bias of Race/Ethnicity Codes in the Medicare Enrollment Database.

Medicare administrative data are fairly accurate in identifying people who affiliate with White or Black racial groups; but less so for other race groups or for Hispanic/Latino origin. Some differences were found between people who were identified as members of these other race groups and those who were missed by the administrative data. Although Medicare administrative files are a useful source of data for analysis of disparities in health care, researchers should be careful to use alternate data sources to test for potential differences between identified and unidentified members of racial and ethnic groups in the attributes being studied.

Milk production of Holstein heifers fed either alfalfa or corn silage diets at two rates of daily gain.

Seventy-five prepubertal heifers were fed diets based on either alfalfa silage or corn silage plus soybean meal for daily gains of either 725 or 950 g/d in a 2 x 2 factorial. Heifers were fed from 175 to 325 kg of body weight (BW). The alfalfa diet contained more digestible protein and less digestible energy than did the diet containing corn silage plus soybean meal.

Components of growth in Holstein heifers fed either alfalfa or corn silage diets to produce two daily gains.

Growth components were compared in an experiment with a 2 x 2 factorial design. Eight replicates of Holstein heifers were fed diets based on either alfalfa or corn silage for daily gain of either 725 or 950 g from 181 to 334 kg of body weight (BW). Mean daily gains from corn diets were greater than gains from alfalfa diets for BW, udder, empty body, fat, fat-free matter, protein, H2O, C, and energy but were less than gains from alfalfa for gut contents and ash.

Glucose and norepinephrine challenges during abomasal infusion of cis or trans octadecenoates in Holstein cows.

This experiment determined the effects of infusion of mixtures of fat containing predominantly cis-C18:1 or trans-C18:1 fatty acids into the abomasum on responses of cows to glucose and norepinephrine challenges administered i.v. Six lactating Holstein cows, each with a rumen cannula, were arranged in two Latin squares with 21-d periods.

National health expenditure projections, 1994-2005.

Using 1993 as a baseline and assuming that current laws and practices continue, the authors project U.S. health expenditures through the year 2005.

Influence of prepubertal dietary regimen on mammary growth of Holstein heifers.

One hundred-sixteen Holstein heifers (mean BW, 175 kg) were randomly assigned to diets of alfalfa silage or corn silage and were fed to gain approximately 725 or 950 g/d in order to study the influence of prepubertal diet and rate of gain on mammary growth and milk production. Blood was collected before puberty for hormone determination, and 8 heifers per group were killed at puberty for evaluation of tissue variables. Serum growth hormone was reduced, and IGF-I was increased, in the group of heifers reared at a high rate of gain on the corn silage diet.

Milk fat depression, the glucogenic theory, and trans-C18:1 fatty acids.

Metabolic and endocrinological characteristics were compared for cows that differed in the extent of milk fat depression. Forty-one multiparous Holstein cows were fed control (40% concentrate and 60% forage) and high concentrate (80% concentrate and 20% forage) diets in a doubale-reversal design. Cows showing one or more percentage units of depression in milk fat were arbitrarily classified as responders (n = 26); those remaining were classified as nonresponders (n = 15).

Effects of prepubertal growth rate and diet on lipid metabolism in lactating Holstein cows.

The objectives were to determine the effects of rate of BW gain and type of silage fed before puberty on the partitioning of excess dietary energy between synthesis of milk and BW gain in second or third lactation. Accordingly, 41 Holstein heifers weighing 175 kg were fed diets containing either alfalfa silage or corn silage to gain either 725 or 950 g/d until BW was 325 kg and two estrous cycles were observed. Puberty occurred near 281 kg of BW.

Prediction of body composition of dairy cows at three physiological stages from deuterium oxide and urea dilution.

To develop equations for predicting body composition, mature Holstein cows (n = 21) were slaughtered at three physiological stages (-7, 63, and 269 d postpartum) after consecutive intravenous dosing with urea and D2O. Blood was sampled at 0 and 12 min after dosing with urea for determination of urea space and from 0 to 72 h after dosing with D2O. Empty body water and total body water were estimated by dilution kinetics for D2O using two- and one-compartment models, respectively.

Estimating the cost of a Medicare outpatient prescription drug benefit.

People enrolled in Medicare account for more than one-third of all outpatient prescription drug expenditures in the United States. That being the case, a proposed prescription drug benefit under the Medicare program would insure a substantial part of the market and would create the largest expansion of the program in the past 20 years. This article explains how the cost of a drug benefit was estimated as part of the Clinton Administration's health reform initiative.

An efficient delivery of historical information for the Mendelian Inheritance in Man database.

The ability to manage information with regard to changes in a database is critical for quality control. This information can also provide audit trails about the time of the change and the person who made the change. In addition, historical information can provide the proper context in which to interpret the relationships between the current and past data.

Direct analysis of body composition of dairy cows at three physiological stages.

Holstein cows were killed at three physiological stages, prepartum (-7 d, n = 10), early lactation (63 d, n = 7), and late lactation (269 d, n = 8), for determination of chemical composition and prediction of energy changes during lactation. Cows were weighed, slaughtered, and separated into five or six fractions, including carcass, gastrointestinal tract, mammary gland, uterus, and fetus (if present); the remainder was noncarcass. Live BW and weight of all empty body components except fat were unaffected by physiological stage.

Health insurance and the elderly: data from MCBS (Medicare Current Beneficiary Survey).

This article shows the supplemental insurance distribution and Medicare spending per capita by insurance status for elderly persons in 1991. The data are from the Medicare Current Beneficiary Survey (MCBS) and Medicare bill records. Persons with Medicare only are a fairly small share of the elderly (11.

Milk fat yield and composition during abomasal infusion of cis or trans octadecenoates in Holstein cows.

The role of trans-C18:1 fatty acids in milk fat depression was examined. Six rumen-cannulated Holstein cows were assigned to two Latin squares with 21-d periods. The common basal diet contained 40% forage and 60% concentrate.

Why more cost-sharing won't slow Medicare spending.

In considering ways to slow the growth in Medicare expenditures, policymakers have concluded that increasing point-of-service cost-sharing for patients will reduce demand for health services. Under the current system, Medicare beneficiaries faced with increased cost-sharing can reduce their demand for services or purchase additional private insurance. New data from the 1991 Medicare Current Beneficiary Survey show that high-income persons protect themselves from out-of-pocket costs by purchasing private supplemental insurance.

National health expenditures projections through 2030.

If current laws and practices continue, health expenditures in the United States will reach $1.7 trillion by the year 2000, an amount equal to 18.1 percent of the Nation's gross domestic product (GDP).