Digital Commons Network^™

The Utilization Of Models Of Care Transition To Reduce Medicare Beneficiaries’ Hospital Readmission Rates In Kentucky: A Case Study, Audra Putt

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Problem: Unsuccessful care transitions for Medicare beneficiaries have resulted in high health expenditures and a diminished quality of care as the 30-day hospital readmission rate has increased. This has prompted the Centers for Medicare and Medicaid Services to require hospitals with high readmission rates to pay penalties. As a result, the Community-based Care Transitions Program was established under Section 3026 of the Affordable Care Act to provide health organizations funding to utilize models of care transition to improve the care transition process. The purpose of this capstone project was to identify whether two community-based organization programs, the Kentucky Appalachian Transition …

Spending Medicare’S Dollars Wisely: Taking Aim At Hospitals’ Cultures Of Overtreatment, Jessica Mantel

University of Michigan Journal of Law Reform

With Medicare’s rising costs threatening the country’s fiscal health, policymakers have focused their attention on a primary cause of Medicare’s high price tag—the overtreatment of patients. Guided by professional norms that demand they do “everything possible” for their patients, physicians frequently order additional diagnostic tests, perform more procedures, utilize costly technologies, and provide more inpatient care. Much of this care, however, does not improve Medicare patients’ health, but only increases Medicare spending. Reducing the overtreatment of patients requires aligning physicians’ interests with the government’s goal of spending Medicare’s dollars wisely. Toward that end, recent Medicare payment reforms establish a range …

Can't Settle, Can't Sue: How Congress Stole Tort Remedies From Medicare Beneficiaries, Rick Swedloff

Akron Law Review

In this article, I show that, as amended, the MSP will likely have unforeseen consequences to the tort system. I start by reviewing the history of Medicare and the forces that led Congress to enact and amend the MSP. With illustration from the classic economic model of litigation, I then show that, not surprisingly, the MSP – as written – makes it more difficult for Medicare beneficiaries to bring and settle individual tort claims. What may be less obvious is that this amendment may have a profound impact in the area of mass tort litigation. If individual parties to a …

Diagnosed With Time Is Money: Arbitrary Medicare Provisions Differentiating Observation Services From Inpatient Admissions Violate Beneficiaries’ Due Process Rights, Stephanie Masaba

William & Mary Bill of Rights Journal

No abstract provided.

Posterior Versus Anterior Circulation Strokes: Comparison Of Treatment Costs, And Outcomes For Medicare Patients, Brian Matthew Lengers

MUSC Theses and Dissertations

This study used a 5% sample of Medicare billing records from 2012 to identify cost differences between posterior circulation (PCS) and anterior circulation strokes (ACS). We examined ICD-9 codes related to these stroke types at hospital admission, records for six months post stroke, or until death, and identified mean payment and charges by type of care received. The Charlson Comorbidity Score was used to control for the effects of comorbid conditions on cost, survival, and the use of tPA during the Index admission. We identified 105 PCS and a comparison group of 5230 subjects with ACS and compared mean Medicare …

Denying Death, Teneille R. Brown

Utah Law Faculty Scholarship

Terminal cancer patients are being kept in the dark about the purpose of their care. Several studies show that these patients undergo expensive and painful interventions because they are holding out hope for a cure, even when their physicians know that a cure is very unlikely. The current Medicare reimbursement system encourages this false hope by incentivizing physicians to medicate and operate on patients, rather than to talk about whether or why to do these things. Our culture also encourages this false hope by treating cancer as a war that must be won. As a result, patients are admitted to …

Modeling Solutions For Prevention Of Medicare Insolvency For The Baby Boomer Generation (Born 1946 - 1964), Gregory Thomas Scott

Health Services Research Dissertations

Medicare, a United States social insurance program operated by the United States federal government, began operating in a deficit in the year 2010. More funding was expended than revenue received for medical care, creating significant shortfalls for the Medicare Trust Fund. This study examined possible initiatives to describe Medicare funding related to issues as financial shortfalls utilizing mathematical modeling and simulation. The Park Conceptual Model is a framework created to identify internal and external changes that influence bankruptcies related to municipalities, and this Model served as the theoretical basis for this study.

The following study addressed insolvency as negative cash …

Geographic Variation Of Health Care Spending On Heart Failure In Metropolitan Areas, Kevin Mcmillan

Department of Geography: Dissertations, Theses, and Student Research

The costs of healthcare have long been a concern in the United States. It is well known that these costs vary geographically, but attempts to explain this variation have been met with limited and varied success. This is partly attributable to the fact that data available have restricted analyses to assessing the issue to using Medicare cost per beneficiary. In June, 2013, the Center for Medicare and Medicaid Services (CMS) released new Medicare data that detailed the charges and payments made to hospitals throughout the United States in 2011. In this thesis, this new dataset was used to examine costs …

Strategies For Health Care Cost Containment (1980s-Present), Rick Mayes

Political Science Faculty Publications

The U.S. health care system during the past three decades has been over two interrelated questions: first, who will control the manner in which medical care is paid for, and, second, how much will it cost? Many health care experts believe that Medicare's efforts at cost control, primarily in the form of the program's seminal transition to and continual modification of prospective payment of health care providers, has both triggered and repeatedly intensified the economic restructuring of the U.S. health care system. Medicare is an almost $600 billion public health insurance program for individuals sixty-five years of age and older; …

Health Service Use And Expenditure Patterns Of Dual Eligibles In Michigan, Cristian Meghea, William Corser, Qi Zhu

Michigan Journal of Public Health

Objective: The objective is to provide a statewide population-based comparison of Michigan beneficiaries dually eligible for Medicare and Medicaid (duals) to Medicare-only beneficiaries, including the public health expenditures by service type, and to focus on the LTC service use patterns of elderly duals receiving care in various settings. Data Sources: Data sources were linked 2005 and 2006 individual Medicaid and Medicare claims from all Michigan duals. Methods: CMS provided Medicare claims and beneficiary data. Michigan Department of Community Health provided Medicaid claims data. Design: We compared characteristics and health expenditures across various categories of beneficiaries and LTC care settings. Principal …

Government Provided Health Insurance, Kristina Lambert, Ryan O’Connor

Academic Symposium of Undergraduate Scholarship

No abstract provided.

Disparity Implications Of The Medicare Medication Therapy Management Eligibility Criteria: A Literature Review, Kiraat D. Munshi, Ya-Chen Tina Shih, Lawrence M. Brown, Samuel Dagogo-Jack, Jim Y. Wan, Junling Wang

Pharmacy Faculty Articles and Research

The emphasis on eliminating racial and ethnic disparities in healthcare has received national attention, with various policy initiatives addressing this problem and proposing solutions. However, in the current economic era requiring tight monetary constraints, emphasis is increasingly being placed on economic efficiency, which often conflicts with the equality doctrine upon which many policies have been framed. The authors’ review aims to highlight the disparity implications of one such policy provision – the predominantly utilization-based eligibility criteria for medication therapy management services under Medicare Part D – by identifying studies that have documented racial and ethnic disparities in health status and …

Bedside Bureaucrats: Why Medicare Reform Hasn't Worked, Nicholas Bagley

Articles

Notwithstanding its obvious importance, Medicare is almost invisible in the legal literature. Part of the reason is that administrative law scholars typically train their attention on the sources of external control over agencies’ exercise of the vast discretion that Congress so often delegates to them. Medicare’s administrators, however, wield considerably less policy discretion than the agencies that feature prominently in the legal commentary. Traditional administrative law thus yields slim insight into Medicare’s operation. But questions about external control do not—or at least they should not—exhaust the field. An old and often disregarded tradition in administrative law focuses not on external …

Protecting The Disabled Individual Through The Use Of A Medicare Set-Aside Trust, Susan G. Haines, John J. Campbell

Marquette Elder's Advisor

In America, plaintiffs in tort settlements receive more benefits, including Medicare benefits, than plaintiffs in worker's compensation cases. A properly established Medicare set-aside trust can guarantee that a disabled worker's Medicare benefits will be available after a worker's compensation settlement. This article discusses the theory behind a Medicare set-aside trust and tips for properly using it.

Paying For Terminal Illness

Marquette Elder's Advisor

The need for public assistance for terminal care has moved death itself from a private family matter to the public professional sphere. Congress intended Medicare hospice coverage to be comprehensive, but its eligibility rules and per diem limits deprive some patients of needed care. This article examines these limits and the alternative models for care of the dying.

An Introduction To Medicare, Cheryldiane Feuerman, Edward Dale

Marquette Elder's Advisor

This column details the nuts and bolds of Medicare, noting that it Medicare is not always as familiar as it should be to beneficiaries, their advisors, or their doctors. This column presents an overview of Medicare's eligibility requirements, coverage, and appeals process.

Finding Internet Sites On Elder Issues: Health And Human Services, Robin C. Schard

Marquette Elder's Advisor

Have you ever heard the term information over load? Do you feel it every time you try to find an exact piece of information on the Internet? Here's the place to start.

Medicare Handbook, Jane M.R. Mulcahy

Marquette Elder's Advisor

No abstract provided.

Introduction To Medicare For People With Multiple Sclerosis, Judith Stein

Marquette Elder's Advisor

Stein explains what criteria are necessary for Medicare parts A, B, C, and D coverage, and why eligible recipients with Multiple Sclerosis are often erroneously denied coverage. Recent changes in applicable Medicare regulations are explored, as are some of the differences between Medicare and Medicaid. Various ways attorneys can help their clients through the application maze are discussed.

Medicare Advantage Private Fee-For-Service Plans: What Privatization Means For Today's Beneficiaries, Melissa M. Ostrowski

Marquette Elder's Advisor

Originally solely a government-administered program, Medicare is now offering options involving private insurers. Private fee-for-service plans may offer additional benefits and lower out-of-pocket costs. These plans are expected to have lower administrative costs, but currently require a government subsidy. Advantages and disadvantages of such plans are discussed, and examples showing detailed cost comparisons of two plans, SmartValue Classic and Humana Gold Choice, are given.

What's So Special About Medicare Advantage Special Needs Plans? Assessing Medicare Special Needs Plans For "Dual Eligibles", Alissa Halperin, Patricia Nemore, Vicki Gottlich

Marquette Elder's Advisor

In 2003 Medicare Part C became Medicare Advantage, which included provisions for Special Needs Plans (SNP's), which have significant implications for dual eligibles, persons eligible for both Medicare and Medicaid. The authors explore why SNP's are needed, their advantages to beneficiaries if properly set up, why many plans do not meet beneficiaries' needs as well as they might, and draw conclusions for improvement.

Hospital System Readmissions: A Care Cycle Approach, Cody Mullen

The Journal of Purdue Undergraduate Research

Hospital readmission rates can be used as an indicator of the quality of health care services and can highlight high-priority research areas to ensure better health. A readmission is defined as when a patient is discharged from an acute care hospital and is admitted back to an acute care hospital in a set amount of days, with 30 days being the current national standard. On average, 19.6% of Medicare patients are readmitted to the hospital within 30 days of discharge and 56.1% within a year (Jencks, Williams, & Coleman, 2009). The hypothesis of this study was that the discharge location, …

Achieving Recovery For Patients In Hospital Rehabilitation Units Through Education, Sylvia Zendejas

Capstone Projects and Master's Theses

Millions of people are admitted to hospitals every day with the hope of alleviating, if not eliminating, their health conditions. Rehabilitation units within hospitals also admit patients every day for various medical conditions that result in decreased functioning. Unfortunately, many patients are not leaving hospital rooms healthier nor are they leaving with the confidence that they can follow through with their treatment instructions. Most importantly, patients lack health literacy skills that can help them navigate the healthcare system and understand their care, causing a limited recovery. As an intern at the Sam Karas Acute Rehabilitation Unit (ARU), I developed an …

Bending The Health Cost Curve: The Promise And Peril Of The Independent Payment Advisory Board, Ann Marie Marciarille

Faculty Works

Underlying today's and the future's health care reform debate is a consensus that America's health care financing system is in a slow-moving but deep crisis: care appears substandard in comparison with other advanced industrial countries, and relative costs are exploding beyond all reasonable measures. The Obama Administrations' Patient Protection and Affordable Care Act (ACA) attempts to grapple with both of these problems. One of the ACA's key instrumentalities is the Independent Payment Advisory Board - the IPAB, designed to discover and authorize ways to reduce the rate of growth of Medicare and other categories of health spending. The IPAB is …

A New State Plan Option To Integrate Care And Financing For Persons Dually Eligible For Medicare And Medicaid, Jane H. Thorpe, Katherine J. Hayes

Health Policy and Management Faculty Publications

As health care costs continue to escalate, Congress, the U.S. Department of Health and Human Services (HHS), the Centers for Medicare & Medicaid Services (CMS), state Medicaid agencies, researchers, and policymakers are focusing on identifying new approaches to care delivery and reimbursement for individuals who are dually eligible for both Medicare and Medicaid. Although relatively few in number (9 million), dual eligible beneficiaries are more likely than others to experience poor health, including multiple chronic conditions, functional and cognitive impairments, and a need for continuous care. Sixty-six percent of dual eligibles have three or more chronic conditions; sixty-one percent are …

Statistical Analysis And Data Mining Of Medicare Patients With Diabetes., Xiao Wang

Electronic Theses and Dissertations

The purpose of this dissertation is to find ways to decrease Medicare costs and to study health outcomes of diabetes patients as well as to investigate the influence of Medicare, part D since its introduction in 2006 using the CMS CCW (Chronic Condition Data Warehouse) Data and the MEPS (Medical Expenditure Panel Survey) data. In this dissertation, we introduce pattern recognition analysis into the study of medical characteristics and demographic characteristics of the inpatients who have a higher readmission risk. We also broaden the cost-effectiveness analysis by including medical resources usage when investigating the effects of Medicare, part D. In …

Happy 65th Birthday: What Now?, Peter J. Strauss

Articles & Chapters

No abstract provided.

Challenging Supremacy: Virginia's Response To The Patient Protection And Affordable Care Act, Matthew R. Farley

University of Richmond Law Review

No abstract provided.

Fool Me Once, Shame On Me; Fool Me Again And You’Re Gonna Pay For It: An Analysis Of Medicare’S New Reporting Requirements For Primary Payers And The Stiff Penalties Associated With Noncompliance, Monica A. Stahly

Law Student Publications

This article discusses the new requirements and the issues that currently face insurers, claimants, and attorneys in cases involving Medicare-eligible beneficiaries.

Fool Me Once, Shame On Me; Fool Me Again And You're Gonna Pay For It: An Analysis Of Medicare's New Reporting Requirements For Primary Payers And The Stiff Penalties Associated With Noncompliance, Brent M. Timberlake, Monica A. Stahly

University of Richmond Law Review

This article discusses the new requirements and the issues that currently face insurers, claimants, and attorneys in cases involving Medicare-eligible beneficiaries.