Dataset Information

Effects of Caps on Cost Sharing for Skilled Nursing Facility Services in Medicare Advantage Plans.

ABSTRACT: OBJECTIVES:To evaluate a federal regulation effective in 2011 that limited how much that Medicare Advantage (MA) plans could charge for the first 20 days of care in a skilled nursing facility (SNF). DESIGN:Difference-in-differences retrospective analysis comparing SNF utilization trends from 2008-2012. SETTING:Select MA plans. PARTICIPANTS:Members of 27 plans with mandatory cost sharing reductions (n=132,000) and members of 21 plans without such reductions (n=138,846). MEASUREMENTS:Mean monthly number of SNF admissions and days per 1,000 members; annual proportion of MA enrollees exiting the plan. RESULTS:In plans with mandated cost sharing reductions, cost sharing for the first 20 days of SNF care decreased from an average of $2,039 in 2010 to $992 in 2011. In adjusted analyses, plans with mandated cost-sharing reductions averaged 158.1 SNF days (95% confidence interval (CI)=153.2-163.1 days) per 1,000 members per month before the cost sharing cap. This measure increased by 14.3 days (95% CI=3.8-24.8 days, p=0.009) in the 2 years after cap implementation. However, increases in SNF utilization did not significantly differ between plans with and without mandated cost-sharing reductions (adjusted between-group difference: 7.1 days per 1,000 members, 95% CI=-6.5-20.8, p=.30). Disenrollment patterns did not change after the cap took effect. CONCLUSIONS:When a federal regulation designed to protect MA members from high out-of-pocket costs for postacute care took effect, the use of SNF services did not change.

SUBMITTER: Keohane LM

PROVIDER: S-EPMC5992084 | biostudies-literature | 2018 May

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Effects of Caps on Cost Sharing for Skilled Nursing Facility Services in Medicare Advantage Plans.

Keohane Laura M LM Rahman Momotazur M Thomas Kali S KS Trivedi Amal N AN

Journal of the American Geriatrics Society 20180312 5

<h4>Objectives</h4>To evaluate a federal regulation effective in 2011 that limited how much that Medicare Advantage (MA) plans could charge for the first 20 days of care in a skilled nursing facility (SNF).<h4>Design</h4>Difference-in-differences retrospective analysis comparing SNF utilization trends from 2008-2012.<h4>Setting</h4>Select MA plans.<h4>Participants</h4>Members of 27 plans with mandatory cost sharing reductions (n=132,000) and members of 21 plans without such reductions (n=138,846 ...[more]

PMID: 29528484

Similar Datasets

Project description:ImportanceSeveral policy proposals advocate introducing copayments for home health care in the Medicare program. To our knowledge, no prior studies have assessed this cost-containment strategy.ObjectiveTo determine the association of home health copayments with use of home health services.Design, setting, and participantsA difference-in-differences case-control study of 18 Medicare Advantage (MA) plans that introduced copayments for home health care between 2007 and 2011 and 18 concurrent control MA plans. The study included 135 302 enrollees in plans that introduced copayment and 155 892 enrollees in matched control plans.ExposuresIntroduction of copayments for home health care between 2007 and 2011.Main outcomes and measuresProportion of enrollees receiving home health care, annual numbers of home health episodes, and days receiving home health care.ResultsCopayments for home health visits ranged from $5 to $20 per visit, which were estimated to be associated with $165 (interquartile range [IQR], $45-$180) to $660 (IQR, $180-$720) in out-of-pocket spending for the average user of home health care. The increased copayment for home health care was not associated with the proportion of enrollees receiving home health care (adjusted difference-in-differences, -0.15 percentage points; 95% CI, -0.38 to 0.09), the number of home health episodes per user (adjusted difference-in-differences, 0.01; 95% CI, -0.01 to 0.03), and home health days per user (adjusted difference-in-differences, -0.19; 95% CI, -3.02 to 2.64). In both intervention and control plans and across all levels of copayments, we observed higher disenrollment rates among enrollees with greater baseline use of home health care.Conclusions and relevanceWe found no evidence that imposing copayments reduced the use of home health services among older adults. More intensive use of home health services was associated with increased rates of disenrollment in MA plans. The findings raise questions about the potential effectiveness of this cost-containment strategy.

Project description:ObjectivesTo investigate the association of the utilization of Medicare-certified home health agency (CHHA) services with post-acute skilled nursing facility (SNF) discharge outcomes that included home time, rehospitalization, SNF readmission, and mortality.DesignRetrospective cohort study.SettingNew York State fee-for-service Medicare beneficiaries aged 65 years and older admitted to SNFs for post-acute care and discharged to the community in 2014.ParticipantsA total of 25,357 older adults.MeasurementsThe outcomes included days spent alive in the community ("home time"), rehospitalization, SNF readmission, and mortality within 30- and 90-day post-SNF discharge periods. The primary independent variables were SNF five-star overall quality rating and receipt of CHHA services within 7 days of SNF discharge. Zero-inflated negative binomial regression and logistic regression models characterized the association of CHHA linkage with home time and other outcomes, respectively.ResultsFollowing SNF discharge, 17,657 (69.6%) patients received CHHA services. In analyses that adjusted for patient-, market-, and other SNF-level factors, older adults discharged from higher quality SNFs were more likely to receive CHHA services. In analyses that adjusted for patient- and market-level factors, receipt of post-SNF CHHA services was associated with 2.03 and 4.17 (P < .001) more days in the community over 30- and 90-day periods. Receiving CHHA services was also associated with decreased odds for rehospitalization (odds ratio [OR] = .68; P < .001; OR = .91; P = .008), SNF readmission (OR = .36; P < .001; OR = .62; P < .001), and death (OR = .34; P < .001; OR = .63; P < .001) over 30- and 90-day periods, respectively.ConclusionAmong older adults discharged from a post-acute SNF stay, those who received CHHA services had better discharge outcomes. They were less likely to experience admissions to institutional care settings and had a lower mortality risk. Future efforts that examine how the type and intensity of CHHA services affect outcomes would build on this work. J Am Geriatr Soc 68:1573-1578, 2020.

Dataset Information

Effects of Caps on Cost Sharing for Skilled Nursing Facility Services in Medicare Advantage Plans.

Publications

Effects of Caps on Cost Sharing for Skilled Nursing Facility Services in Medicare Advantage Plans.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets