%0 Journal Article %J Health Services Research %D 2019 %T Medicare expenditures attributable to dementia. %A Lindsay L Waite %A Fishman, Paul %A Basu, Anirban %A Paul K Crane %A Eric B Larson %A Norma B Coe %K Cognition & Reasoning %K Dementia %K Medicare linkage %K Medicare/Medicaid/Health Insurance %X

OBJECTIVE: To estimate dementia's incremental cost to the traditional Medicare program.

DATA SOURCES: Health and Retirement Study (HRS) survey-linked Medicare part A and B claims from 1991 to 2012.

STUDY DESIGN: We compared Medicare expenditures for 60 months following a claims-based dementia diagnosis to those for a randomly selected, matched comparison group.

DATA COLLECTION/EXTRACTION METHODS: We used a cost estimator that accounts for differential survival between individuals with and without dementia and decomposes incremental costs into survival and cost intensity components.

PRINCIPAL FINDINGS: Dementia's five-year incremental cost to the traditional Medicare program is approximately $15 700 per patient, nearly half of which is incurred in the first year after diagnosis. Shorter survival with dementia mitigates the incremental cost by about $2650. Increased costs for individuals with dementia were driven by more intensive use of Medicare part A covered services. The incremental cost of dementia was about $7850 higher for females than for males because of sex-specific differential mortality associated with dementia.

CONCLUSIONS: Dementia's cost to the traditional Medicare program is significant. Interventions that target early identification of dementia and preventable inpatient and post-acute care services could produce substantial savings.

%B Health Services Research %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/30868557?dopt=Abstract %R 10.1111/1475-6773.13134 %0 Journal Article %J Medical Care %D 2018 %T Changes in Case-Mix and Health Outcomes of Medicare Fee-for-Service Beneficiaries and Managed Care Enrollees During the Years 1992-2011. %A Siran M Koroukian %A Basu, Jayasree %A Nicholas K Schiltz %A Navale, Suparna %A Paul M Bakaki %A David F Warner %A Avi Dor %A Charles W Given %A Kurt C Stange %K Medicare linkage %K Medicare/Medicaid/Health Insurance %K Mortality %X

BACKGROUND: Recent studies suggest that managed care enrollees (MCEs) and fee-for-service beneficiaries (FFSBs) have become similar in case-mix over time; but comparisons of health outcomes have yielded mixed results.

OBJECTIVE: To examine changes in differentials between MCEs and FFSBs both in case-mix and health outcomes over time.

DESIGN: Temporal study of the linked Health and Retirement Study (HRS) and Medicare data, comparing case-mix and health outcomes between MCEs and FFSBs across 3 time periods: 1992-1998, 1999-2004, and 2005-2011. We used multivariable analysis, stratified by, and pooled across the study periods. The unit of analysis was the person-wave (n=167,204).

SUBJECTS: HRS participants who were also enrolled in Medicare.

MEASURES: Outcome measures included self-reported fair/poor health, 2-year self-rated worse health, and 2-year mortality. Our main covariate was a composite measure of multimorbidity (MM), MM0-MM3, defined as the co-occurrence of chronic conditions, functional limitations, and/or geriatric syndromes.

RESULTS: The case-mix differential between MCEs and FFSBs persisted over time. Results from multivariable models on the pooled data and incorporating interaction terms between managed care status and study period indicated that MCEs and FFSBs were as likely to die within 2 years from the HRS interview (P=0.073). This likelihood remained unchanged across the study periods. However, MCEs were more likely than FFSBs to report fair/poor health in the third study period (change in probability for the interaction term: 0.024, P=0.008), but less likely to rate their health worse in the last 2 years, albeit at borderline significance (change in probability: -0.021, P=0.059).

CONCLUSIONS: Despite the persistence of selection bias, the differential in self-reported fair/poor status between MCEs and FFSBs seems to be closing over time.

%B Medical Care %V 56 %P 39-46 %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/29176368?dopt=Abstract %R 10.1097/MLR.0000000000000847 %0 Journal Article %J Medical Care Research & Review %D 2018 %T Do Medicare Advantage Rebates Reduce Enrollees' Out-of-Pocket Spending? %A Lauren Hersch Nicholas %A Wu, Shannon %K Medicare linkage %K Medicare/Medicaid/Health Insurance %X The majority of Medicare Advantage (MA) plans receive payments that exceed their costs of providing basic Medicare benefits. There is controversy about whether these payments are passed on to the enrollees as supplemental benefits or are retained by plans. We used survey data on MA beneficiaries' actual out-of-pocket (OOP) spending linked to MA payment information to test whether higher plan payments and rebates lowered enrollee OOP spending. We used instrumental variables regression models to address concerns that plan payments and rebates may reflect anticipation of enrollees with particular health-spending profiles. We found that beneficiaries recovered only $0.65 of every $1.00 in payments exceeding fee-for-service spending through lower OOP spending but more than fully recovered the value of the rebates supporting supplemental benefits. %B Medical Care Research & Review %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/30382801?dopt=Abstract %R 10.1177/1077558718807847 %0 Journal Article %J Research on Aging %D 2018 %T Estimating the Prevalence of Serious Mental Illness and Dementia Diagnoses Among Medicare Beneficiaries in the Health and Retirement Study %A Maria T. Brown %A Douglas A. Wolf %K Cognitive Ability %K Dementia %K Depressive symptoms %K Medicare linkage %K Mental Health %X Methods: This study utilizes HRS-linked Medicare claims data sets and inverse probability weighting to estimate overall and age-specific cumulative prevalence rates of dementia and serious mental illnesses among 18,740 Medicare beneficiaries. Two-way tabulations determine conditional probabilities of dementia diagnoses among beneficiaries diagnosed with specific mental illnesses, and binary logistic regressions determine conditional probabilities of dementia diagnoses among beneficiaries diagnosed with specific mental illnesses, controlling for covariates. Results: Weighted prevalence estimates for dementia, schizophrenia (SZP), bipolar disorder (BPD), and major depressive disorder (MDD) are similar to previous studies. Odds of dementia diagnosis are significantly greater for beneficiaries diagnosed with SZP, BPD, or MDD. Conclusions: Co-occurring mental disabilities require further investigation, as in the near future increasing numbers of mentally ill older adults will need appropriate and affordable community-based services and supports. %B Research on Aging %V 40 %P 668-686 %G eng %U http://journals.sagepub.com/doi/10.1177/0164027517728554 %N 7 %! Res Aging %R 10.1177/0164027517728554 %0 Journal Article %J Inquiry %D 2017 %T Medicare Expenditures Associated With Hospital and Emergency Department Use Among Beneficiaries With Dementia. %A Daras, Laura Coots %A Feng, Zhanlian %A Joshua M Wiener %A Kaganova, Yevgeniya %K Dementia %K Emergency services %K Medicare linkage %K Older Adults %X Understanding expenditure patterns for hospital and emergency department (ED) use among individuals with dementia is crucial to controlling Medicare spending. We analyzed Health and Retirement Study data and Medicare claims, stratified by beneficiaries' residence and proximity to death, to estimate Medicare expenditures for all-cause and potentially avoidable hospitalizations and ED visits. Analysis was limited to the Medicare fee-for-service population age 65 and older. Compared with people without dementia, community residents with dementia had higher average expenditures for hospital and ED services; nursing home residents with dementia had lower average expenditures for all-cause hospitalizations. Decedents with dementia had lower expenditures than those without dementia in the last year of life. Medicare expenditures for individuals with and without dementia vary by residential setting and proximity to death. Results highlight the importance of addressing the needs specific to the population with dementia. There are many initiatives to reduce hospital admissions, but few focus on people with dementia. %B Inquiry %V 54 %P 46958017696757 %8 2017 Jan %G eng %R 10.1177/0046958017696757 %0 Journal Article %J Medical Care %D 2014 %T The Concordance of Survey Reports and Medicare Claims in a Nationally Representative Longitudinal Cohort of Older Adults %A Frederic D Wolinsky %A Michael P Jones %A Fred A Ullrich %A Yiyue Lou %A George L Wehby %K Medicare linkage %K Medicare/Medicaid/Health Insurance %K Meta-analyses %K Survey Methodology %X Background: Concordance between survey reports and claims data is not well established. We compared them for disease histories, preventative, and other health services use in a large, nationally representative sample of older Medicare beneficiaries with special attention given to evaluating age, aging, memory, and respondent status effects. Methods: Baseline (1993) and biennial follow-up data (through 2010) from the Survey on Assets and Health Dynamics among the Oldest-Old were linked to Medicare claims from 1991 to 2010, for 4910 participants yielding 19,556 person-periods. Concordance was measured by simple, weighted, and prevalence and bias-adjusted κ, and Lin’s concordance statistics. Generalized estimating equation negative binomial models were used to predict the summary counts of concordant reports, survey underreports, and survey overreports. Results: Concordance was highly variable overall, unacceptably low for arthritis and physician visits, and less than substantial for angina, heart disease, hypertension, and outpatient surgery. Generalized estimating equation negative binomial models revealed reductions in reporting accuracy (more underreporting and overreporting) associated with both age (interindividual) and aging (intraindividual) effects, countervailing memory effects on concordance due to less underreporting but more overreporting, and countervailing proxy-respondent effects on concordance due to less underreporting but more overreporting. Conclusions: Further research should explore whether these findings are time or cohort bound, address the potential heterogeneity of the proxy-respondent effects based on the reason for and relationship of the proxy to the target person, and evaluate the effects of a broader spectrum of performance-based cognitive abilities. In the interim, the significant predictors identified here should be included in future studies. %B Medical Care %V 52 %P 462-468 %G eng %U http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00005650-201405000-00014 %N 5 %! Medical Care %R 10.1097/MLR.0000000000000120