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3.
Ann Intern Med ; 174(8): 1101-1109, 2021 08.
Article in English | MEDLINE | ID: covidwho-1368019

ABSTRACT

BACKGROUND: New cases of COVID-19 continue to occur daily in the United States, and the need for medical treatments continues to grow. Knowledge of the direct medical costs of COVID-19 treatments is limited. OBJECTIVE: To examine the characteristics of older adults with COVID-19 and their costs for COVID-19-related medical care. DESIGN: Retrospective observational study. SETTING: Medical claims for Medicare fee-for-service (FFS) beneficiaries. PATIENTS: Medicare FFS beneficiaries aged 65 years or older who had a COVID-19-related medical encounter during April through December 2020. MEASUREMENTS: Patient characteristics and direct medical costs of COVID-19-related hospitalizations and outpatient visits. RESULTS: Among 28.1 million Medicare FFS beneficiaries, 1 181 127 (4.2%) sought COVID-19-related medical care. Among these patients, 23.0% had an inpatient stay and 4.2% died during hospitalization. The majority of the patients were female (57.0%), non-Hispanic White (79.6%), and residents of an urban county (77.2%). Medicare FFS costs for COVID-19-related medical care were $6.3 billion; 92.6% of costs were for hospitalizations. The mean hospitalization cost was $21 752, and the mean length of stay was 9.2 days; hospitalization cost and length of stay were higher if the patient needed a ventilator ($49 441 and 17.1 days) or died ($32 015 and 11.3 days). The mean cost per outpatient visit was $164. Patients aged 75 years or older were more likely to be hospitalized, but their hospitalizations were associated with lower costs than for younger patients. Male sex and non-White race/ethnicity were associated with higher probability of being hospitalized and higher medical costs. LIMITATION: Results are based on Medicare FFS patients. CONCLUSION: The COVID-19 pandemic has resulted in substantial disease and economic burden among older Americans, particularly those of non-White race/ethnicity. PRIMARY FUNDING SOURCE: None.


Subject(s)
Ambulatory Care/economics , COVID-19/economics , Direct Service Costs , Hospital Costs , Hospitalization/economics , Medicare/economics , Aged , Aged, 80 and over , Direct Service Costs/trends , Fee-for-Service Plans , Female , Hospital Costs/trends , Humans , Male , Pandemics , Retrospective Studies , SARS-CoV-2 , United States
6.
J Health Polit Policy Law ; 46(4): 627-639, 2021 08 01.
Article in English | MEDLINE | ID: covidwho-1045578

ABSTRACT

Medicare initiatives have been instrumental in improving care delivery and payment as exemplified by its role in broadly expanding the use of telehealth during the COVID-19 pandemic. Medicare innovations have been adopted or adapted in Medicaid and by private payers, while Medicare Advantage plans successfully compete with traditional Medicare only because their payment rates are tied by regulation to those in the traditional Medicare program. However, Medicare has not succeeded in implementing new, value-based payment approaches that also would serve as models for other payers, nor has Medicare succeeded in improving quality by relying on public reporting of measured performance. It is increasingly clear that burdensome attention to measurement and reporting distracts from what could be successful efforts to actually improve care through quality improvement programs, with Medicare leading in partnership with providers, other payers, and patients. Although Congress is unlikely to adopt President Biden's proposals to decrease the eligibility age for Medicare or to adopt a public option based on Medicare prices and payment methods in the marketplaces, the Biden administration has an opportunity to provide overdue, strategic direction to the pursuit of value-based payments and to replace failed pay-for-performance with provider-managed projects to improve quality and reduce health disparities.


Subject(s)
Delivery of Health Care/economics , Health Policy , Medicare/economics , Quality Improvement , Reimbursement Mechanisms , Humans , Telemedicine/economics , United States
7.
Int J Radiat Oncol Biol Phys ; 109(1): 41-43, 2021 01 01.
Article in English | MEDLINE | ID: covidwho-1023596
8.
Health Aff (Millwood) ; 40(1): 146-155, 2021 01.
Article in English | MEDLINE | ID: covidwho-1007110

ABSTRACT

Medicare's Skilled Nursing Facility Value-Based Purchasing Program, which awards value-based incentive payments based on hospital readmissions, distributed its first two rounds of incentives during fiscal years 2019 and 2020. Incentive payments were based on achievement or improvement scores-whichever was better. Incentive payments were as low as -2.0 percent in both program years and as high as +1.6 percent in FY 2019 and +3.1 percent in FY 2020. In FY 2019, 26 percent of facilities earned positive incentives and 72 percent earned negative incentives, compared with 19 percent positive and 65 percent negative incentives in FY 2020. Larger, rural, and not-for-profit facilities were more likely to earn positive incentives, as were those with the highest registered nurse staffing levels. Although these findings indicate the potential to reward high-quality care at skilled nursing facilities, intended and unintended outcomes of this new value-based purchasing program should be monitored closely for possible program refinements, particularly in light of the disproportionate impacts of coronavirus disease 2019 (COVID-19) on nursing facilities.


Subject(s)
Medicare , Motivation , Patient Readmission/statistics & numerical data , Skilled Nursing Facilities/statistics & numerical data , Value-Based Purchasing/statistics & numerical data , COVID-19 , Humans , Medicare/economics , Medicare/statistics & numerical data , Quality of Health Care/standards , Skilled Nursing Facilities/economics , United States
9.
Health Aff (Millwood) ; 40(1): 105-112, 2021 01.
Article in English | MEDLINE | ID: covidwho-1007103

ABSTRACT

The return of a Democratic administration to the White House, coupled with coronavirus disease 2019 (COVID-19) pandemic-induced contractions of job-based insurance, may reignite debate over public coverage expansion and its costs. Decades of research demonstrate that uninsured people and people with copays and deductibles use less care than people with first-dollar coverage. Hence, most economic analyses of Medicare for All proposals and other coverage expansions project increased utilization and associated costs. We review the utilization surges that such analyses have predicted and contrast them with the more modest utilization increments observed after past coverage expansions in the US and other affluent nations. The discrepancy between predicted and observed utilization changes suggests that analysts underestimate the role of supply-side constraints-for example, the finite number of physicians and hospital beds. Our review of the utilization effects of past coverage expansions suggests that a first-dollar universal coverage expansion would increase ambulatory visits by 7-10 percent and hospital use by 0-3 percent. Modest administrative savings could offset the costs of such increases.


Subject(s)
Ambulatory Care/statistics & numerical data , Costs and Cost Analysis/economics , Insurance Coverage/economics , Patient Acceptance of Health Care/statistics & numerical data , Universal Health Care , COVID-19 , Humans , Medicaid/economics , Medically Uninsured , Medicare/economics , Patient Protection and Affordable Care Act/economics , United States
16.
Int J Health Serv ; 50(4): 408-414, 2020 10.
Article in English | MEDLINE | ID: covidwho-628695

ABSTRACT

Four decades of neoliberal health policies have left the United States with a health care system that prioritizes the profits of large corporate actors, denies needed care to tens of millions, is extraordinarily fragmented and inefficient, and was ill prepared to address the COVID-19 pandemic. The payment system has long rewarded hospitals for providing elective surgical procedures to well-insured patients while penalizing those providing the most essential and urgent services, causing hospital revenues to plummet as elective procedures were cancelled during the pandemic. Before the recession caused by the pandemic, tens of millions of Americans were unable to afford care, compromising their physical and financial health; deep-pocketed corporate interests were increasingly dominating the hospital industry and taking over physicians' practices; and insurers' profits hit record levels. Meanwhile, yawning class-based and racial inequities in care and health outcomes remain and have even widened. Recent data highlight the failure of policy strategies based on market models and the need to shift to a nonprofit social insurance model.


Subject(s)
Coronavirus Infections/epidemiology , Delivery of Health Care/organization & administration , Pneumonia, Viral/epidemiology , Betacoronavirus , COVID-19 , Costs and Cost Analysis , Delivery of Health Care/economics , Health Services Accessibility/organization & administration , Health Status Disparities , Humans , Insurance Coverage/economics , Insurance Coverage/statistics & numerical data , Insurance, Health/economics , Insurance, Health/statistics & numerical data , Medicare/economics , Pandemics , Politics , SARS-CoV-2 , Socioeconomic Factors , United States/epidemiology
19.
J Aging Soc Policy ; 32(4-5): 350-357, 2020.
Article in English | MEDLINE | ID: covidwho-343189

ABSTRACT

The economic threat posed by responses to COVID 19 endangers financing for long-term care across the states that is already inadequate and inequitable. Increasing the federal share of Medicaid spending as unemployment rises would mitigate fiscal pressure on states and preserve public services. But unlike the demand for Medicaid's health care protections, which rises when economic activity declines, the demand for long-term care protections will grow even in a healthy economy as the population ages. Enhanced federal support is urgent not only to cope with the virus today but also to meet the long-term care needs of the nation's aging population in the years to come. Long-term care financing policy should be modified to either adjust federal matching funds by the age of each state's population, or fully federalize the funding of LTC expenses of Medicaid beneficiaries who are also eligible for Medicare.


Subject(s)
Coronavirus Infections/epidemiology , Federal Government , Long-Term Care/economics , Medicaid/economics , Medicare/economics , Pneumonia, Viral/epidemiology , Aging , Betacoronavirus , COVID-19 , Health Expenditures , Humans , Pandemics , SARS-CoV-2 , United States/epidemiology
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