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Medicare Payments and ACOs for Dementia Patients Across Race and Social Vulnerability.
Am J Geriatr Psychiatry
December 2024
The Hospital And Public health interdisciPlinarY research (HAPPY) Lab (JC, SJ, MQW), School of Public Health, University of Maryland, College Park, MD; Department of Behavioral and Community Health, School of Public Health (MQW), University of Maryland, College Park, MD.
Objectives: This study investigated variations in Medicare payments for Alzheimer's disease and related dementia (ADRD) by race, ethnicity, and neighborhood social vulnerability, together with cost variations by beneficiaries' enrollment in Accountable Care Organizations (ACOs).
Methods: We used merged datasets of longitudinal Medicare Beneficiary Summary File (2016-2020), the Social Vulnerability Index (SVI), and the Medicare Shared Savings Program (MSSP) ACO to measure beneficiary-level ACO enrollment at the diagnosis year of ADRD. We analyzed Medicare payments for patients newly diagnosed with ADRD for the year preceding the diagnosis and for the subsequent 3 years.
Identifying Medicare beneficiaries with dementia.
J Am Geriatr Soc
August 2021
Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Background/objectives: No data exist regarding the validity of International Classification of Disease (ICD)-10 dementia diagnoses against a clinician-adjudicated reference standard within Medicare claims data. We examined the accuracy of claims-based diagnoses with respect to expert clinician adjudication using a novel database with individual-level linkages between electronic health record (EHR) and claims.
Design: In this retrospective observational study, two neurologists and two psychiatrists performed a standardized review of patients' medical records from January 2016 to December 2018 and adjudicated dementia status.
Hospital at Home services: An inventory of fee-for-service payments to inform Medicare reimbursement.
J Am Geriatr Soc
July 2021
Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Background: Hospital at Home (HaH) is a growing model of care with proven patient benefits. However, for the types of services required to provide an episode of HaH, full Medicare reimbursement is traditionally paid only if care is provided in inpatient facilities.
Design: This project identifies HaH services that could be reimbursable under Medicare to inform episodic care within fee-for-service (FFS) Medicare.
Background: Health insurance design can influence the extent to which clinical care is well-coordinated. Through alternative payment models, Medicare Advantage (MA) and Accountable Care Organizations (ACOs) have the potential to improve integration relative to traditional fee-for-service (FFS) Medicare.
Objective: To characterize patient experiences of integrated care within Medicare and identify whether MA or ACO beneficiaries perceive greater integration than FFS beneficiaries.
Aggressive Care near the End of Life for Cancer Patients in Medicare Accountable Care Organizations.
J Am Geriatr Soc
May 2019
The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts.
Objectives: To compare aggressiveness of end-of-life (EoL) care for older cancer patients attributed to Medicare Shared Savings Programs with that for similar fee for service (FFS) beneficiaries not in an accountable care organization (ACO) and examine whether observed differences in EoL care utilization vary across markets that differ in ACO penetration.
Design: Cross-sectional observational study comparing ACO-attributed beneficiaries with propensity score-matched beneficiaries not attributed to an ACO.
Setting: A total of 21 hospital referral regions (HRRs) in the United States.
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