Dataset Information

Medicare Utilization and Spending Among Nurses Compared with the General United States Population.

ABSTRACT: Background: To better understand health habits in older nurses versus the general population, we sought to determine whether the demographics, health care utilization, and Medicare spending by the Nurses' Health Study (NHS) participants enrolled in Medicare and a matched sample of Medicare beneficiaries meaningfully differed. Materials and Methods: Analytic cohorts included a random 20% sample of Medicare beneficiaries continuously enrolled in fee for service (FFS) Medicare that were propensity matched to the NHS participants continuously enrolled in FFS Medicare in a single year (2012). Matching was based upon preselected demographic factors and health status, using a nearest-neighbor matching algorithm to obtain a 1:1 match without replacement. Healthcare utilization and spending were compared between the two groups; we also stratified findings by number of chronic comorbidities. Results: Similar rates of utilization of primary care and most outpatient services. However, NHS participants had slightly higher rates of cancer screening, specialist care, and inpatient surgery were observed. When stratified by comorbidity status, the largest differences in utilization and spending were found in women with no comorbidity. Conclusions: The modest differences in observed healthcare utilization and spending suggest that older healthcare professionals may access care in fairly similar ways to the general population, and that health status may be a more important determinant of utilization and spending than health profession in older age groups.

SUBMITTER: Kapadia NS

PROVIDER: S-EPMC6306677 | biostudies-literature | 2018 Dec

REPOSITORIES: biostudies-literature

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Medicare Utilization and Spending Among Nurses Compared with the General United States Population.

Kapadia Nirav S NS Austin Andrea M AM Carmichael Donald Q DQ Wang Qianfei Q Erekson Elisabeth D ED Feskanich Diane D Grodstein Francine F Tosteson Anna N A ANA Bynum Julie P W JPW

Journal of women's health (2002) 20180817 12

Background: To better understand health habits in older nurses versus the general population, we sought to determine whether the demographics, health care utilization, and Medicare spending by the Nurses' Health Study (NHS) participants enrolled in Medicare and a matched sample of Medicare beneficiaries meaningfully differed. Materials and Methods: Analytic cohorts included a random 20% sample of Medicare beneficiaries continuously enrolled in fee for service (FFS) Me ...[more]

PMID: 30118370

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Project description:In 2006, the Centers for Medicare & Medicaid Services, which administers the Medicare program in the United States, launched the Chronic Condition Data Warehouse (CCW). The CCW contains all Medicare fee-for-service (FFS) institutional and non-institutional claims, nursing home and home health assessment data, and enrollment/eligibility information from January 1, 1999 forward for a random 5% sample of Medicare beneficiaries (and 100% of the Medicare population from 2000 forward). Twenty-one predefined chronic condition indicator variables are coded within the CCW, to facilitate research on chronic conditions. The current article describes this new data source, and the authors demonstrate the utility of the CCW in describing the extent of chronic disease among Medicare beneficiaries. Medicare claims were analyzed to determine the prevalence, utilization, and Medicare program costs for some common and high cost chronic conditions in the Medicare FFS population in 2005. Chronic conditions explored include diabetes, chronic obstructive pulmonary disease (COPD), heart failure, cancer, chronic kidney disease (CKD), and depression. Fifty percent of Medicare FFS beneficiaries were receiving care for one or more of these chronic conditions. The highest prevalence is observed for diabetes, with nearly one-fourth of the Medicare FFS study cohort receiving treatment for this condition (24.3 percent). The annual number of inpatient days during 2005 is highest for CKD (9.51 days) and COPD (8.18 days). As the number of chronic conditions increases, the average per beneficiary Medicare payment amount increases dramatically. The annual Medicare payment amounts for a beneficiary with only one of the chronic conditions is $7,172. For those with two conditions, payment jumps to $14,931, and for those with three or more conditions, the annual Medicare payments per beneficiary is $32,498. The CCW data files have tremendous value for health services research. The longitudinal data and beneficiary linkage within the CCW are features of this data source which make it ideal for further studies regarding disease prevalence and progression over time. As additional years of administrative data are accumulated in the CCW, the expanded history of beneficiary services increases the value of this already rich data source.

Project description:ObjectivesAs key team members caring for people with advanced illness, nurses teach patients and families about managing their illnesses and help them to understand their options. Our objective was to determine if nurses' personal healthcare experience with serious illness and end-of-life (EOL) care differs from the general population as was shown for physicians.DesignObservational propensity-matched cohort study.SettingFee-for-service Medicare.ParticipantsNurses' Health Study (NHS) and a random 20% national sample of Medicare beneficiaries aged 66 years or older with Alzheimer's disease and related dementias (ADRD) or congestive heart failure (CHF) diagnosed in the hospital.MeasurementsCharacteristics of care during the first year after diagnosis and the last 6 months of life (EOL).ResultsAmong 57 660 NHS participants, 7380 had ADRD and 5375 had CHF; 3227 ADRD patients and 2899 CHF patients subsequently died. Care patterns in the first year were similar for NHS participants and the matched national sample: hospitalization rates, emergency visits, and preventable hospitalizations were no different in either disease. Ambulatory visits were slightly higher for NHS participants than the national sample with ADRD (13.1 vs 12.5 visits; P < .01) and with CHF (13.7 vs 12.5; P < .001). Decedents in the NHS and national sample had similar acute care use (hospitalization and emergency visits) in both diseases, but those with ADRD were less likely to use life-prolonging treatments such as mechanical ventilation (10.9% vs 13.5%; P = .001), less likely to die in a hospital with a stay in the intensive care unit (10.4% vs 12.1%; P = .03), and more likely to use hospice (58.9% vs 54.8%; P < .001). CHF at the EOL results were similar.ConclusionsNurses with newly identified serious illness experience similar care as the general Medicare population. However, at EOL, nurses are more likely to choose less aggressive treatments than the patients for whom they care. J Am Geriatr Soc 67:1582-1589, 2019.

Dataset Information

Medicare Utilization and Spending Among Nurses Compared with the General United States Population.

Publications

Medicare Utilization and Spending Among Nurses Compared with the General United States Population.

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