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Uptake of the centers for medicare and medicaid obesity benefit: 2012-2013.

ABSTRACT: To assess the use of the Medicare Obesity Benefit (MOB) by a licensed physician or associate provider in an outpatient setting in older adults.A serial cross-sectional analysis of fee-for-service Medicare claims (2012 and 2013) was used to assess the use of the MOB. Number and proportion of Medicare beneficiaries over age 65 using the benefit were assessed. Correlation between state-obesity rates and MOB uptake was determined based on state-specific obesity prevalence data from the Behavioral Risk Factor Surveillance System. Results There were 27,338 (0.10%) Medicare beneficiaries over age 65 in 2012 using the MOB and slightly more in 2013 (n?=?46,821 [0.17%]). Mean age of MOB users in both years was 73 years, and 62% were females. Use declined with older age and was highest in the Northeast and lowest in the Midwest. High state obesity prevalence was not correlated with higher uptake of the MOB. Estimated proportion of persons with obesity using the MOB was 0.35% and 0.60% in successive years. A mean of 1.99 and 2.16 claims/MOB user was observed.While the rate of MOB use increased in the second full year of its implementation, few were availing themselves of this benefit.

SUBMITTER: Batsis JA

PROVIDER: S-EPMC5003721 | biostudies-literature | 2016 Sep

REPOSITORIES: biostudies-literature

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Uptake of the centers for medicare and medicaid obesity benefit: 2012-2013.

Batsis John A JA Bynum Julie P W JP

Obesity (Silver Spring, Md.) 20160728 9

<h4>Objective</h4>To assess the use of the Medicare Obesity Benefit (MOB) by a licensed physician or associate provider in an outpatient setting in older adults.<h4>Methods</h4>A serial cross-sectional analysis of fee-for-service Medicare claims (2012 and 2013) was used to assess the use of the MOB. Number and proportion of Medicare beneficiaries over age 65 using the benefit were assessed. Correlation between state-obesity rates and MOB uptake was determined based on state-specific obesity prev ...[more]

PMID: 27465909

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Project description:STUDY OBJECTIVES:Centers for Medicare and Medicaid Services (CMS) reimbursement for positive airway pressure (PAP) devices for obstructive sleep apnea treatment is dependent on patients meeting adherence expectations within the first 3 months on therapy. Adherence is defined as usage of the device for at least 4 hours per night on 70% of nights during a consecutive 30-day period. We hypothesize that the adherence pattern may be established beyond this initial period, which may limit the opportunity to treat many patients. METHODS:Treatment and adherence data from PAP devices were monitored via wireless modems for 42 consecutive PAP-naïve military veterans who completed 1 year of nightly monitoring. Their baseline characteristics were as follows: age (mean ± standard deviation) 58.5 ± 12.5 years; body mass index 33.7 ± 5.7 kg/m2; diagnostic apnea-hypopnea index (pretreatment) 28.1 ± 18.5 events/h; apnea-hypopnea index on PAP: 4.3 ± 3.3 events/h. We examined daily, monthly, quarterly, semiannual, and annual reports, and the best 30-day adherence report for each quarter. RESULTS:In the first 3 months, 19 of 42 participants were adherent by CMS criteria, and 23 of 42 participants were not. Of the 19 adherent participants, 13 remained adherent and 6 became nonadherent or stopped PAP treatment for the remainder of the year. In the 23 initially nonadherent participants, 16 stopped PAP treatment, and 7 participants (30.4%) became adherent (using CMS criteria) during the rest of the year. Thus, PAP adherence during the first 3 months was predictive for the rest of the year in only 68.4%. PAP nonadherence during the first 3 months was predictive for further nonadherence in only 69.6% of the cases. Overall, this led to a 65% sensitivity and 72% specificity of using adherence at 3 months in predicting adherence at 1 year. CONCLUSIONS:CMS adherence criteria affecting PAP coverage are restrictive and can result in the withholding of therapy in many patients who otherwise might become adherent. CLINICAL TRIAL REGISTRATION:Registry: ClinicalTrials.gov, Title: Remote Monitoring in Obstructive Sleep Apnea, Identifier: NCT01678560, URL: https:// clinicaltrials.gov/ct2/show/NCT01678560.

Project description:Importance:The Centers for Medicare & Medicaid Services (CMS) Five-Star measure for nursing homes is designed with input from expert panels about the importance of multiple quality indicators. Consumers may assign different values to these indicators, creating different 5-star ratings. Objective:To compare nursing homes' rankings based on the CMS Five-Star measure with rankings based on consumers' judgment about the importance of the same quality indicators. Design, Setting, and Participants:In this quality improvement study, CMS Five-Star data were linked with a measure calculated from CMS quality indicators and consumer values obtained from a national survey. Data covered the last quarter of 2016 and the first three quarters of 2017. The study included 10?676 nursing homes, comprising 69.8% of those with reported Five-Star measures. The national survey included adults, either nursing home residents or their family members who reported being familiar with the quality of care their relative received. Data analysis was performed from January 2019 to February 2020. Main Outcomes and Measures:The contingent valuation method was administered via the survey to obtain consumers' relative values of the quality indicators, and statistical analyses were used to create the contingent valuation measure. Agreement in nursing home rankings was assessed using the Five-Star measure, which is based on weights developed by expert panels, compared with rankings based on the contingent valuation measure. Results:Among 10?676 study nursing homes with a mean (SD) of 119.4 (59.4) beds, 7845 (73.5%) were for profit, 6424 (61.8%) were part of a chain, and 8009 (75.0%) were urban. The 4310 survey respondents (mean [SD] age, 39.9 [15.6] years; 1143 [26.5%] men; 3448 [80%] white) included mostly family members (3879 participants [90.0%]). The Pearson correlation coefficient (0.65) and weighted ? statistics (0.48) indicated only moderate agreement between ranking of nursing homes' performance by the 2 measures and disagreement on ranking for approximately one-half of the nursing homes. Conclusions and Relevance:Current nursing home report cards might not reflect consumers' values and the relative importance consumers place on each of the quality indicators that compose the overall Five-Star measure. Quality report cards might be more relevant to consumers by augmenting the Five-Star measure with a measure reflecting consumers' preferences. It is unknown whether these conclusions are generalizable to other report cards, such as Hospital and Home Health Compare, without conducting similar studies for these report cards.

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Project description:ImportanceIn 2016, the Centers for Medicare & Medicaid Services (CMS) launched its first mandatory bundled payment program, the Comprehensive Care for Joint Replacement (CJR) model, by randomizing metropolitan statistical areas (MSAs) into the payment model.ObjectiveTo evaluate changes in key economic and clinical outcomes associated with the CJR model.Design, setting, and participantsA retrospective, national, population-based analysis of Medicare fee-for-service beneficiaries undergoing lower extremity joint replacement was conducted using 100% Medicare Part A data and 5% Medicare Part B data. Within an intention-to-treat framework, a difference-in-differences approach was used to compare Medicare spending, quality of care, volume of episodes, and patient selection in episodes of lower extremity joint replacements in the first 2 years of the program between propensity score-matched CJR and non-CJR hospitals (episodes initiated from April 1, 2016, through December 31, 2017, with the latter completed by March 31, 2018). Lower extremity joint replacement episodes in MSAs randomly assigned to the CJR model were compared with those in MSAs not assigned to the CJR model.ExposuresRandom assignment of MSAs into the CJR model within prespecified strata.Main outcomes and measuresSpending and its components, quality of care, volume of episodes, and patient characteristics were the main outcomes.ResultsAfter propensity score matching, there were 157 828 primary lower extremity joint replacement cases across 684 hospitals in the CJR (treatment) group (101 641 [64.4%] women; mean [SD] age, 72.8 [8.9] years) and 180 594 cases across 726 hospitals in the non-CJR (control) group (115 580 women [64.0%] women; mean [SD] age, 72.6 [8.8] years). The CJR was associated with a decrease of $582 per episode in Medicare Part A spending, a 2.5% savings on claims (95% CI, -$873 to -$290; P < .001) driven by a 5.5% decline in 90-day postacute care spending, concentrated in skilled nursing facilities (-4.5% change from baseline; 95% CI, -$460 to -$26; P = .03) and inpatient rehabilitation facilities (-22.9% change from baseline; 95% CI,-$497 to -$176; P < .001). Estimated savings on claims, while consistent with changes in practice patterns, may not have exceeded the reconciliation payments to hospitals reported by CMS to date. No significant changes in hospital length of stay, readmissions, complications, 30- or 90-day mortality, volume of episodes, or patient characteristics relative to control were found.Conclusions and relevanceThe CJR was associated with reduced Medicare Part A spending on claims over 2 years, largely through lower postacute spending. Mandatory bundled payments may serve as a useful model for policy efforts to change clinicians' and facilities' behavior without harming quality.

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Uptake of the centers for medicare and medicaid obesity benefit: 2012-2013.

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Uptake of the centers for medicare and medicaid obesity benefit: 2012-2013.

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