Informal care provided in US nursing homes: Reduced from 2010 to 2021 and lower for Medicaid residents.

Background: Little is known about the trend of informal care (unpaid care provided by family or other caregivers) provided to nursing home residents before or during the COVID-19 pandemic. This study assessed this trend during 2010-2021, for all and Medicaid versus non-Medicaid residents.

Methods: Using data from the RAND Health and Retirement Study longitudinal file, our study sample included a total of 2025 resident-years (860 for Medicaid and 1165 for non-Medicaid residents).

Trend in Respite Use by Race Among Caregivers for People Living With Dementia.

Background: Respite care provides short-term relief for caregivers. Despite efforts to promote respite use among Black caregivers, little is known if disparities in respite use between Black and White dementia caregivers have decreased over time. We examined a trend nationally to see if more recent efforts may have helped reduce disparities in respite use.

Trends in forgone medical care and unmet needs among Medicare beneficiaries with a history of depression during the COVID-19 pandemic: a national, repeated cross-sectional study.

Objectives: To investigate trends in forgone medical care, basic needs disruption, financial and mental health disruption, engagement of preventive behaviours guidelines, and perceived severity of COVID-19 among community-living Medicare beneficiaries in the USA with and without a self-reported history of depression from Summer 2020 to Winter 2021.

Design/setting: A repeated cross-sectional study using a nationally representative sample of Medicare beneficiaries of three rounds of survey data from the Medicare Current Beneficiary Survey COVID-19 Supplement Public Use Files: Summer 2020, Fall 2020 and Winter 2021.

Participants: A total of 28 480 community-dwelling Medicare beneficiaries.

Association of Sources of COVID-19 Information with Vaccine Uptake, Preventive Behaviors, and Perceived Severity of COVID-19.

Objective: To investigate the association of using informal sources and reliance on multiple sources of information with actual COVID-19 vaccine uptake, the number of doses of vaccine received, COVID-19 testing, essential preventive measures, and perceived severity of COVID-19.

Design: Retrospective cross-sectional study.

Setting And Participants: Our study sample consisted of 9584 community-dwelling Medicare beneficiaries, representing a weighted 50,029,030 beneficiaries from the Winter 2021 Medicare Current Beneficiary Survey COVID-19 Supplement.

Did Massachusetts COVID-19 vaccine lottery increase vaccine uptake?

Objective: We evaluated whether the Massachusetts COVID-19 vaccine lottery increased vaccine uptake.

Methods: We analyzed data from the Centers for Disease Control and Prevention COVID-19 Vaccine Tracker to identify total number of adults aged 18 to 64 who received at least first dose of the COVID-19 vaccine or who were fully vaccinated in Massachusetts, Connecticut, Rhode Island, New Jersey, and Vermont during the study period of March 6 -July 31, 2021. Each of the five states contributed 148 days of a daily report on cumulative number of vaccinated people, comprising 740 state-days as the total sample size.

Post-Acute Care Use Associated with Medicare Shared Savings Program and Disparities.

Objectives: Medicare Shared Savings Program (MSSP) was implemented in 2012, but the impact of the MSSP on institutional post-acute care (PAC) use, and by race/ethnicity and payer status is less studied. We studied the impact of hospital participation in the MSSP on institutional PAC use and variations by race/ethnicity and payer status among 3 Medicare patient groups: ischemic stroke, hip fracture, and elective total joint arthroplasty (TJA).

Design: A retrospective analysis of 2010-2016 Medicare Provider Analysis and Review files.

The Impact of the COVID-19 Pandemic on Health Care Utilization Among Insured Individuals With Common Chronic Conditions.

Objective: The COVID pandemic has had a significant impact on the US health care system. Our primary objective was to understand the impact of the COVID pandemic on non-COVID-related health care utilization among insured individuals with chronic conditions. Our secondary objective was to examine the differential impact by individual characteristics.

Medicare Accountable Care Organizations: Post-acute Care Use and Post-surgical Outcomes in Urologic Cancer Surgery.

Objective: To evaluate association between Medicare accountable care organizations (ACOs) participation of hospitals on post-acute care (PAC) use and spending, and post-surgical outcomes in Medicare beneficiaries undergoing urologic cancer surgeries. Despite increasing prevalence of urologic cancer and surgical care contributing to a large proportion of total health care costs, and recent Medicare payment reforms such as accountable care organizations, the role of ACOs in urologic cancer care has been unexplored.

Methods: We conducted a longitudinal analysis of 2011-2017 Medicare claims data to compare post-surgical outcomes between Medicare ACO and non-ACO patients before and after implementation of Medicare shared savings program (MSSP).

Pain and the Alzheimer's Disease and Related Dementia Spectrum in Community-Dwelling Older Americans: A Nationally Representative Study.

Context: Pain is a significant concern among older adults with Alzheimer's disease and related dementias (ADRD).

Objectives: Examine the association between cognitive impairment across the ADRD spectrum and pain assessment and treatment in community-dwelling older Americans.

Methods: This cross-sectional, population-based study included 16,836 community-dwelling participants ≥ 50 years in the 2018 Health and Retirement Study.

Association of the Comprehensive Care for Joint Replacement Model With Disparities in the Use of Total Hip and Total Knee Replacement.

Importance: The Comprehensive Care for Joint Replacement (CJR) model is Medicare's mandatory bundled payment reform to improve quality and spending for beneficiaries who need total hip replacement (THR) or total knee replacement (TKR), yet it does not account for sociodemographic risk factors such as race/ethnicity and income. Results of this study could be the basis for a Medicare payment reform that addresses inequities in joint replacement care.

Objective: To examine the association of the CJR model with racial/ethnic and socioeconomic disparities in the use of elective THR and TKR among older Medicare beneficiaries after accounting for the population of patients who were at risk or eligible for these surgical procedures.

Institutional Postacute Care Use May Help Reduce Readmissions for Ischemic Stroke Patients.

Objectives: Readmissions for Medicare patients initially admitted for stroke are common and costly. Rehabilitation in an institutional postacute care (PAC) setting is an evidence-based component of recovery for stroke. Under current Medicare payment reforms, care coordination across hospitals and PAC providers is key to improving quality and efficiency of care.

The Effect of Medicare Shared Savings Program on Readmissions and Variations by Race/Ethnicity and Payer Status (December 9, 2020).

Objective: Accountable care organizations in the Medicare Shared Savings Program (MSSP) in the United States attempt to reduce cost and improve quality for their patients by improving care coordination across care settings. We examined the impact of hospital participation in the MSSP on 30-day readmissions for several groups of Medicare inpatients, and by race/ethnicity and payer status.

Main Data Source: A 2010-2016 Medicare Provider Analysis and Review files.

Geographic Variation and Disparities in Total Joint Replacement Use for Medicare Beneficiaries: 2009 to 2017.

Background: Little is known about how the geographic variation and disparities in use of elective primary total hip and knee replacements for Medicare beneficiaries have evolved in recent years. The study objectives are to determine these variations and disparities, whether Black Medicare beneficiaries have continued to undergo fewer total hip replacements and total knee replacements across regions, and whether disparities affected all Black beneficiaries or mainly affected socioeconomically disadvantaged Black beneficiaries.

Methods: We used 2009 to 2017 Medicare enrollment and claims data to examine Hospital Referral Region (HRR)-level variation and disparities by race (non-Hispanic White and Black) and socioeconomic status (Medicare-only and dual eligibility for both Medicare and Medicaid).

Medicare Shared Savings Program and readmission rate among patients with ischemic stroke.

Objective: Hospitals participating in the Medicare Shared Savings Program (MSSP) share with the Centers for Medicare and Medicaid Services (CMS) the savings generated by reduced cost of care. Our aim was to determine whether MSSP is associated with changes in readmissions and mortality for Medicare patients hospitalized with ischemic stroke, and whether MSSP has a different impact on safety net hospitals (SNHs) compared to non-SNHs.

Methods: This study was based on the CMS Hospital Compare data for risk-standardized 30-day readmission and mortality rates for Medicare patients hospitalized with ischemic strokes between 2010 and 2017.

Trends in Postacute Care Use and Outcomes After Hip and Knee Replacements in Dual-Eligible Medicare and Medicaid Beneficiaries, 2013-2016.

Importance: Several Medicare alternative payment models were implemented in recent years, but their implications for socioeconomic gaps in postacute care (PAC) are unknown.

Objectives: To determine the longitudinal trends in PAC use and outcomes after hip and knee replacements and in gaps among 3 groups: Medicare-only patients, dual-eligible patients with full Medicaid benefits, and dual-eligible patients with partial Medicaid benefits.

Design, Setting, And Participants: A cohort study was conducted of PAC use and outcomes among Medicare fee-for-service patients undergoing hip or knee replacement surgery from January 1, 2013, to December 31, 2016, in approximately 3000 hospitals, using Medicare claims, assessment, hospital, and skilled nursing facility (SNF) files.

Penalties and Rewards for Safety Net vs Non-Safety Net Hospitals in the First 2 Years of the Comprehensive Care for Joint Replacement Model.

This study compared monetary penalties and rewards among safety net vs non–safety net hospitals under Medicare’s Comprehensive Care for Joint Replacement (CJR) model, a bundled payment plan for hip and knee replacements intended to incentivize health care quality and savings, in 2016 and 2017.

Greater Reductions in Readmission Rates Achieved by Urban Hospitals Participating in the Medicare Shared Savings Program.

Background: Accountable Care Organizations in the Medicare Shared Savings Program (MSSP) have financial incentives to reduce the cost and improve the quality of care delivered to Medicare beneficiaries that they serve. However, previous research about the impact of the MSSP on readmissions is limited and mixed.

Objective: To examine the association between hospital participation in the MSSP during the 2012-2013 period and reductions in 30-day risk-standardized readmission rates for Medicare patients initially admitted for acute myocardial infarction, heart failure (HF), pneumonia, or any cause.