Digital Commons Network^™

Was Covid-19 Associated With Worsening Inequities In Stroke Treatment And Outcomes?, Laurent G Glance, Curtis G Benesch, Karen E Joynt Maddox, Matthew T Bender, Jingjing Shang, Patricia W Stone, Stewart J Lustik, Jacob W Nadler, Christopher Galton, Andrew W Dick

2020-Current year OA Pubs

Background COVID-19 stressed hospitals and may have disproportionately affected the stroke outcomes and treatment of Black and Hispanic individuals. Methods and Results This retrospective study used 100% Medicare Provider Analysis and Review file data from between 2016 and 2020. We used interrupted time series analyses to examine whether the COVID-19 pandemic exacerbated disparities in stroke outcomes and reperfusion therapy. Among 1 142 560 hospitalizations for acute ischemic strokes, 90 912 (8.0%) were Hispanic individuals; 162 752 (14.2%) were non-Hispanic Black individuals; and 888 896 (77.8%) were non-Hispanic White individuals. The adjusted odds of mortality increased by 51% (adjusted odds ratio …

The Covid-19 Pandemic And Associated Inequities In Acute Myocardial Infarction Treatment And Outcomes, Laurent G Glance, Karen E Joynt Maddox, Jingjing Shang, Patricia W Stone, Stewart J Lustik, Peter W Knight, Andrew W Dick

2020-Current year OA Pubs

IMPORTANCE: The COVID-19 pandemic disrupted usual care for emergent conditions, such as acute myocardial infarction (AMI). Understanding whether Black and Hispanic individuals experiencing AMI had greater increases in poor outcomes compared with White individuals during the pandemic has important equity implications.

OBJECTIVE: To investigate whether the COVID-19 pandemic was associated with increased disparities in treatment and outcomes among Medicare patients hospitalized with AMI.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used Medicare data for patients hospitalized with AMI between January 2016 and November 2020. Patients were categorized as Hispanic, non-Hispanic Black, and non-Hispanic White. The association between race and ethnicity …

Real-World Safety Of Neurohormonal Antagonist Initiation Among Older Adults Following A Heart Failure Hospitalization, Parag Goyal, Andrew R Zullo, Barbara Gladders, Chukwuma Onyebeke, Min Ji Kwak, Larry A Allen, Emily B Levitan, Monika M Safford, Lauren Gilstrap

Faculty, Staff and Student Publications

AIMS: To optimize guideline-directed medical therapy for heart failure, patients may require the initiation of multiple neurohormonal antagonists (NHAs) during and following hospitalization. The safety of this approach for older adults is not well established.

METHODS AND RESULTS: We conducted an observational cohort study of 207 223 Medicare beneficiaries discharged home following a hospitalization for heart failure with reduced ejection fraction (HFrEF) (2008-2015). We performed Cox proportional hazards regression to examine the association between the count of NHAs initiated within 90 days of hospital discharge (as a time-varying exposure) and all-cause mortality, all-cause rehospitalization, and fall-related adverse events over the …

[Excerpt From] Hospice & Palliative Care Handbook: Quality, Compliance, And Reimbursement (4th Ed.), Tina M. Marrelli, Jennifer Kennedy

Sigma Publications: Book Excerpts

This item record pertains to an excerpt and additional resources from Hospice & Palliative Care Handbook: Quality, Compliance, and Reimbursement, Fourth Edition, which is provided free of charge by the publisher.

About this book: Hospice & Palliative Care Handbook, 4th Ed., offers updated coverage of all aspects of hospice and palliative care for the entire healthcare team who provide important care while meeting difficult multilevel regulations. This edition includes examples and strategies covering key topics related to standards, guidelines, goals, and effective care planning.

New to this edition are:

• Expanded pediatric and geriatric clinical care guidelines
• More robust …

Part 4: Death And Dying In Virginia, Dragas Center For Economic Analysis And Policy, Old Dominion University

State of the Commonwealth Reports

Death and taxes may be inevitable, but where we die is usually not a topic of public policy or discussion. Hospice care is the specialized treatment that provides support and comfort to patients who are terminally ill with a general life expectancy of six months or less. In this chapter, we take a close look at serious disease and hospice care in the United States and Virginia. We examine the demand for hospice care by Medicare beneficiaries as well as the changing nature of hospice care suppliers as now more than two-thirds of hospices nationwide operate as for-profit entities. We …

False Claims: The Coordinated Exploitation Of The United States Government By The Healthcare Industry, Grady Mcmichen

Journal of Law and Health

The False Claims Act (FCA) has a long-standing history of protecting the United States government from being defrauded by merchants and other parties submitting claims for repayment. Affording Americans who have enrolled in Medicaid and Medicare expansion plans the same protection afforded to the federal government will allow for action to be brought to prevent large hospital networks from engaging in price-fixing behaviors. Implementing this change will have the effect of reducing healthcare prices for all Americans.

Applying the False Claims Act at the price-fixing level will have the largest affect; however, it is still important to iron out procedures …

Patterns Of Health Care Use Among Rural-Urban Medicare Beneficiaries Age 85 And Older, 2010-2017, Yvonne Jonk Phd, Heidi O'Connor Ms, Amanda Burgess Mppm, Carly Milkowski Mph

Access / Insurance

The purpose of this study was to examine rural-urban differences in health care use among Medicare beneficiaries age 85+. Understanding these differences, and the socioeconomic characteristics that contribute to them, can have important implications for Medicare policies aimed at serving the age 85+ population. Using the Medicare Current Beneficiary Survey 2010-13 Cost and Use and 2015-17 Cost Supplement Files, we examined whether and how rural and urban Medicare beneficiaries age 85+ differ in terms of their:

1. socioeconomic and health characteristics that may inform health care use;
2. trends in health care use, including use of inpatient and emergency department (ED) care; …

A Comparison Of Us Medicare Expenditures For Hemodialysis And Peritoneal Dialysis, Jennifer M Kaplan, Jingbo Niu, Vivian Ho, Wolfgang C Winkelmayer, Kevin F Erickson

Center for Medical Ethics and Health Policy Staff Publications

Background: Observations that peritoneal dialysis (PD) may be an effective, lower-cost alternative to hemodialysis for the treatment of ESKD have led to policies encouraging PD and subsequent increases in its use in the United States.

Methods: In a retrospective cohort analysis of Medicare beneficiaries who started dialysis between 2008 and 2015, we ascertained average annual expenditures (for up to 3 years after initiation of dialysis) for patients ≥67 years receiving in-center hemodialysis or PD. We also determined whether differences in Medicare expenditures across dialysis modalities persisted as more patients were placed on PD. We used propensity scores to match 8305 …

“That’S What Hospice Is Supposed To Do”: How U.S. Hospice Care Staff Bridge Philosophy And Institutions, Morgan Alexa Leff

Senior Honors Papers / Undergraduate Theses

Hospice founder Cicely Saunders wrote that “the dignity and worth of each individual patient [are] central to Hospice philosophy—an idea closely tied to anthropological personhood (Saunders and Clark 2002). As dying in hospice becomes an increasing reality of life in the United States, we must grapple with how the ideals, costs, and challenges of hospice care play out in the healthcare system. The institutional structures meant to ensure a ‘good death’ (while protecting the interests of the state) can fracture care of the dying. As hospice staff work within and around these structures, they build meaning in care strategies that …

County Social Isolation And Opioid Use Disorder Among Older Adults: A Longitudinal Analysis Of Medicare Data, 2013–2018, Tse-Chuan Yang, Carla Shoff, Seulki Kim, Benjamin A. Shaw

Department of Sociology: Faculty Publications

This study aims to fill three knowledge gaps: (1) unclear role of ecological factors in shaping older adults’ risk of opioid use disorder (OUD), (2) a lack of longitudinal perspective in OUD research among older adults, and (3) underexplored racial/ethnic differences in the determinants of OUD in older populations. This study estimates the effects of county-level social isolation, concentrated disadvantage, and income inequality on older adults’ risk of OUD using longitudinal data analysis. We merged the 2013–2018 Medicare population (aged 65+) data to the American Community Survey 5-year county-level estimates to create a person-year dataset (N = 47,291,217 person-years) and …

Healthcare Utilization And Costs Among High-Need And Frail Mexican American Medicare Beneficiaries, Maricruz Rivera-Hernandez, Amit Kumar, Lin-Na Chou, Tamra Keeney, Nasim Ferdows, Amol Karmarkar, Kyriakos S. Markides, Kenneth Ottenbacher

Physical Medicine and Rehabilitation Publications

Objectives
To examine Medicare health care spending and health services utilization among high-need population segments in older Mexican Americans, and to examine the association of frailty on health care spending and utilization.

Methods
Retrospective cohort study of the innovative linkage of Medicare data with the Hispanic Established Populations for the Epidemiologic Study of the Elderly (H-EPESE) were used. There were 863 participants, which contributed 1,629 person years of information. Frailty, cognition, and social risk factors were identified from the H-EPESE, and chronic conditions were identified from the Medicare file. The Cost and Use file was used to calculate four categories …

Social Isolation, Residential Stability, And Opioid Use Disorder Among Older Medicare Beneficiaries: Metropolitan And Non-Metropolitan County Comparison, Tse-Chuan Yang, Carla Shoff, Seulki Kim

Department of Sociology: Faculty Publications

Research has shown that the prevalence of opioid use disorder (OUD) may rise substantially as society ages, but this issue receives the least attention in the literature. To address this gap, this study utilizes county-level data from multiple data sources (1) to investigate whether social isolation is associated with OUD prevalence among older Medicare beneficiaries, (2) to examine whether and how residential stability moderates the association between social isolation and OUD prevalence in US counties, and (3) to determine if there are any differences in these associations between metropolitan and nonmetropolitan counties. The results show that social isolation is a …

Association Of Body Mass Index In Midlife With Morbidity Burden In Older Adulthood And Longevity, Sadiya S. Khan, Amy E. Krefman, Lihui Zhao, Lei Liu, Anna Chorniy, Martha L. Daviglus, Cuiping Schiman, Kiang Liu, Tina Shih, Daniel Garside, Thanh-Huyen T. Vu, Donald M. Lloyd-Jones, Norrina B. Allen

Open Access Publications

Importance: Abundant evidence links obesity with adverse health consequences. However, controversies persist regarding whether overweight status compared with normal body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) is associated with longer survival and whether this occurs at the expense of greater long-term morbidity and health care expenditures.

Objective: To examine the association of BMI in midlife with morbidity burden, longevity, and health care expenditures in adults 65 years and older.

Design, Setting, and Participants: Prospective cohort study at the Chicago Heart Association Detection Project in Industry, with baseline in-person examination between November 1967 …

Medicare "Bankruptcy", Matthew B. Lawrence

Faculty Articles

Medicare, the social insurance program for the elderly and disabled, is once again facing insolvency. Spending from the program’s hospital insurance trust fund is predicted to exceed the accumulated payroll taxes and other revenues that support the fund within the next five years, leaving Medicare unable to honor some of its obligations. Yet, what happens if and when Medicare becomes insolvent has not previously been explored in legal scholarship and is not addressed in statute or regulation. This Article confronts for the first time the major legal questions that Medicare insolvency would present. It explains what policymakers could do to …

Medicare Reimagined: Past, Present And Future Envisioned For Aging In Place, Nancy Patterson

DSW Capstone Projects

The older population is persons aged 65 and older. Many older adults live healthy and active lives while others have one or more illnesses or comorbidities that make it difficult for them to live alone. Older adults aged sixty-five and older who have one or more comorbidities often require assistance to remain in their homes for as long as possible. Older adults who do not have this needed assistance often have frequent falls, make frequent trips to the emergency room, have frequent hospital admissions, or end up in a nursing home.

Product one of the Capstone Presentation is the systematic …

The First 20 Months Of The Covid-19 Pandemic: Mortality, Intubation And Icu Rates Among 104,590 Patients Hospitalized At 21 United States Health Systems, Michael C. Fiore, Li-Shiun Chen, Et Al.

2020-Current year OA Pubs

MAIN OBJECTIVE: There is limited information on how patient outcomes have changed during the COVID-19 pandemic. This study characterizes changes in mortality, intubation, and ICU admission rates during the first 20 months of the pandemic.

STUDY DESIGN AND METHODS: University of Wisconsin researchers collected and harmonized electronic health record data from 1.1 million COVID-19 patients across 21 United States health systems from February 2020 through September 2021. The analysis comprised data from 104,590 adult hospitalized COVID-19 patients. Inclusion criteria for the analysis were: (1) age 18 years or older; (2) COVID-19 ICD-10 diagnosis during hospitalization and/or a positive COVID-19 PCR …

Upcoding Medicare: Is Healthcare Fraud And Abuse Increasing?, Alberto Coustasse, Whitney Layton, Laikyn Nelson, Victoria Walker

Management Faculty Research

Medicare fraud has been the cause of up to $60 billion in overpaid claims in 2015 alone. Upcoding occurs when a healthcare provider has submitted codes for more severe conditions than diagnosed for the patient to receive higher reimbursement. The purpose of this study was to assess the impact of Medicare and Medicaid fraud to determine the magnitude of upcoding inpatient and outpatient claims throughout reimbursements.

The methodology for this study utilized a literature review. The literature review analyzed physician upcoding throughout present on admission infections, diagnostic related group upcoding, emergency department, and clinic upcoding. It was found that upcoding …

Kamila Clustering For A Mixed-Type Data Analysis Of Illinois Medicare Data, Heather Elizabeth Baldacci

Undergraduate Honors Thesis Collection

The Centers for Medicare and Medicare Services (CMS) releases annual reports regarding the Market Saturation and Utilization of nationwide Medicare coverage. CMS data provide an opportunity for an in-depth analysis of Medicare usage patterns within the United States that may provide insight into socioeconomic conditions in certain regions. To discover any potential patterns, the KAMILA (KAy-means for MIxed LArge data sets) clustering algorithm has been utilized within the most recent CMS dataset from 2018. Due to the large size of the original data set, the focus of this research has been limited to Illinois Medicare data, grouped by the 102 …

Using Machine Learning To Predict Super-Utilizers Of Healthcare Services, Kevin Paul Buchan Jr.

Legacy Theses & Dissertations (2009 - 2024)

In this dissertation, I aim to forecast high utilizers of emergency care and inpatient Medicare services (i.e., healthcare visits). Through a literature review, I demonstrate that accurate and reliable prediction of these future high utilizers will not only reduce healthcare costs but will also improve the overall quality of healthcare for patients. By identifying this population at risk before manifestation, I propose that there is still time to reverse undesirable healthcare trajectories (i.e., individuals whose clinical risk increases an excessive healthcare and treatment burden) through timely attention and proper care coordination. My dissertation culminates in the delivery of state-of-the-art predictive …

Health Care Civil Rights Under Medicare For All, Valarie K. Blake

Law Faculty Scholarship

The passage of Medicare for All would go a long way toward curing the inequality that plagues our health care system along racial, sex, age, health status, disability, and socioeconomic lines. Yet, while laudably creating a universal right to access to health care, Medicare for All may inadvertently dampen civil rights protections that are necessary to ensure equality in health care delivery, an outcome its creators and supporters surely would not intend.

Federal money is typically requisite for civil rights enforcement. Title VI, Title IX, and the Age Discrimination Act of 1975 all apply to recipients of federal financial assistance. …

Cost Burden Of Post-Transplant Lymphoproliferative Disease Following Kidney Transplants In Medicare-Eligible Patients By Survival Status, Allyson Hart, Yoon Son Ahn, Crystal Watson, Melissa Skeans, Arie Barlev, Bryn Thompson, Vikas R Dharnidharka

Open Access Publications

AIMS AND OBJECTIVES: Patients diagnosed with post-transplant lymphoproliferative disease (PTLD) experience high mortality within the first 2 years of diagnosis; however, few data exist on the economic burden of PTLD in these patients. We determined the healthcare resource utilization (HRU) and cost burden of post-kidney transplant PTLD and evaluated how these differ by survival status.

MATERIALS AND METHODS: Utilizing data from the United States Renal Data System and the Scientific Registry of Transplant Recipients, we identified 83,818 Medicare-covered kidney transplant recipients between 2007 and 2016, of which 347 had at least one Medicare claim during the first year after diagnosis …

"Will The Real Mens Rea Please Stand Up: Assessing The Fifth Circuit's Kickback Jurisprudence After United States V. Nora, John J. Locurto

Faculty Articles

When an appellate court goes out of its way to note, not once but twice, that a defendant convicted of fraud and conspiracy was just twenty-two years old and had only a high school degree when he joined a criminal venture, it is probably a safe bet that a reversal is coming. That is exactly what happened in United States v. Nora. The United States Court of Appeals for the Fifth Circuit overturned young Jonathon Nora's conviction for his part in a multi-million-dollar scheme to defraud Medicare. The case is, sadly enough, nondescript as health care frauds go, except for …

Primary Care Physicians’ Attitudes, Beliefs, And Actions Toward Geriatric Treatment, Andrea Renee Holzner

Walden Dissertations and Doctoral Studies

AbstractIn the United States, an estimated 49.2 million older adults seek specialized geriatric medical treatment from a primary care physician (PCP). Due to a nationwide geriatrician deficit resulting from significant aging population growth, PCPs now manage specialized geriatric issues, such as Alzheimer’s disease, cognitive assessments, and physiological impairments, such as Parkinson’s, due to non-normative aging. Although PCPs may take geriatric courses, geriatric specialization is beyond a normative primary care medical practice. The purpose of this generic qualitative study was to explore primary care physician attitudes, beliefs, and actions, toward geriatrics and to expand the understanding of primary care physicians’ geriatric …

Factors Affecting Care Quality In South Dakota Nursing Homes, Brice Cowman, Debra S. Norris

Aesculapius Journal (Health Sciences & Medicine)

Research has shown that current healthcare infrastructure is unsuited to fulfill the needs of the quickly growing population of retired Americans, a large portion of whom will require some form of long term service or support. With this in mind, the purpose of this study is to determine how certain factors such as; the incidence of use of various classes of drugs, staffing measures and education of staff, local population, and facility size relate to the overall quality of care in South Dakota nursing homes. Population data was collected from the 2010 U.S. Census and specific nursing home data was …

How Government Created And Shaped The U.S. Nursing Home Industry, Leslie King

Sociology: Faculty Publications

Beginning in the 1960s, U.S. government policy largely created, and subsequently facilitated the corporatization of, a powerful, multi-billion dollar nursing home industry. Using data from trade publications, government agency reports, Congressional hearings, newspaper reports and existing scholarly research, I chart the relationship between the state and the U.S. nursing home industry over four time periods to reveal how, at different moments, government policy contributed to first the creation, then the corporatization and consolidation of the industry. I argue that the trajectory of Medicare and Medicaid policy is not wholly neoliberal but neither should it be considered progressive.

Effect Of The Expanded Prospective Payment System On Dialysis Initiation, The Usage Of Erythropoiesis-Stimulating Agents, And Medicare Expenditures, Lu Zhang

Dissertations and Theses (Open Access)

In January 2011, the U.S. Centers for Medicare & Medicaid Services (CMS) implemented the expanded prospective payment system (PPS) for financing the management of end-stage renal disease (ESRD). Expanded PPS may not only change healthcare providers’ decisions about patient care by removing the financial incentives associated with the previous composite rate payment methodology, but also change the Medicare expenditures associated with various treatment patterns by using a constant base rate for all dialysis modalities. This study aimed to examine the effect of the expanded PPS on providers’ decisions on timing of dialysis initiation and ESA utilizations in ESRD patients as …

"Heartbreaking" Referrals, Professional "Disgrace": The Impact Of Medicare Ineligibility On The Counseling Profession, Matther C. Fullen, Jonathan D. Wiley, Justin Jordan, Jyotsana Sharma, Gerard Lawson

Adultspan Journal

No abstract provided.

Treatment With Protease Inhibitor And Development Of Diabetes Among Medicare Beneficiaries With Human Immune Virus/Acquired Immune Deficiency Syndrome (Hiv/Aids), Eric Ejike Chinaeke

Theses and Dissertations

Background: The possibility of an association between the use of protease inhibitors (PI) by HIV/AIDS patients and the occurrence of T2DM mellitus (T2DM) is largely debated. Medicare recipients are disproportionally affected by T2DM. Unfortunately, evidence is unavailable from that particular segment of the population. Clinical management of HIV/AIDS is progressively expanding to include chronic/metabolic complications, which may pose a significant economic burden to both the patients and the Medicare system, which are disproportionally impacted. Objectives: The aims of this project were to (1) examine the association between the use of PIs and the odds of developing T2DM among Medicare beneficiaries …

Disease-Modifying Therapy Adherence And Associated Factors In A National Sample Of Medicare Patients With Multiple Sclerosis, Pengxiang Li, Vrushabh P Ladage, Joseph Berger, Salim Chahin, Mehul Jhaveri, Caroline Geremakis, Jalpa A Doshi

Open Access Publications

OBJECTIVES: Disease-modifying therapies (DMTs) reduce relapse rates and disability progression for relapsing multiple sclerosis (MS). Although 25% to 30% of all US patients with MS are Medicare beneficiaries, limited information exists on this population. This is the first study using national Medicare data to (1) describe characteristics of patients with MS using DMTs, (2) estimate adherence to DMTs over a 1-year and 3-year follow-up, and (3) examine factors associated with DMT adherence.

METHODS: This retrospective claims analysis used 2011-2014 100% Medicare files. Monthly adherence to MS DMTs was defined as the proportion of days covered ≥0.80 with any DMT in …

A Real-World Analysis Of Patient Characteristics And Predictors Of Hospitalization Among Us Medicare Beneficiaries With Respiratory Syncytial Virus Infection, Veronique Wyffels, Furaha Kariburyo, Sandra Gavart, Roman Fleischhackl, Huseyin Yuce

Publications and Research

Introduction: Little has been published on respiratory syncytial virus (RSV) among Medicare patients at high risk (HR) of RSV complications due to age or comorbidity. Methods: Adult patients (at least 18 years of age) with at least 1 diagnostic code for RSV were identified using the 5% US Medicare database from 2011 through 2015. Patients were required to have continuous health plan enrollment for 180 days pre- and 180 days post-RSV diagnosis (baseline and follow-up periods, respectively). HR was defined as diagnosis of chronic lung disease, congestive heart failure, or weakened immune system for 180 days during the base-line period. …