A study led by 3rd year health services research & policy doctoral student Linda Chyr and co-authors Chanee Fabius, and Emmanuel Drabo in the Gerontologist finds older adults in worse health, with less social support, and more limited economic resources are at heightened risk for transitioning from the community to residential care facilities or nursing homes, while those who were Black or Hispanic were more likely to remain living in the community. Read More.
A study by Jeromie Ballreich, Ijeamaka Ezebilo, and Joshua Sharfstein in JAMA Pediatrics explores potential solutions to the challenge of the high cost of genetic therapies and other specialty drugs for diseases of childhood. Findings suggest a pooled subscription model negotiated across therapies and Medicaid programs may allow manufacturers to focus on the cooperation necessary for the administration of these complex therapies and help achieve the shared public and private goal of assuring access to care.
Hearing loss affects an estimated two thirds of Americans aged 70 years and older, but Medicare currently excludes hearing aids and related services from coverage and many state Medicaid programs do not yet provide coverage of hearing aids for adults. A JAMA Otolaryngology - Head & Neck Surgery viewpoint by Amber Willink, Mary Ann Hernando and Sarah Steege discusses why hearing aids and related services should be covered for all Medicaid enrollees when medically necessary, regardless of age....Read More
We explore whether nonprofit hospitals report similar amounts of charity care to the Internal Revenue Service (IRS) and Centers for Medicare & Medicaid Services (CMS). We use nonprofit hospitals’ financial reports to the IRS and the CMS Medicare costs report for 2011 and 2012. In 2012, hospitals reported spending 7.6% more in charity care to the IRS than to CMS: 2.54% of revenues ($5.74 million per hospital) to the IRS versus 2.36% ($5.16 million) to CMS. While the averages are close, there are wide discrepancies for individual hospitals. For example, despite efforts for standardization, 80% of hospitals reported charity care to the CMS that was 40% greater in absolute value than what they reported to the IRS, and only 10% of hospitals reported charity care to CMS that was within 20% of what they reported to the IRS. Our findings suggest that individual hospitals routinely report different amounts of charity care to the IRS and CMS, yet we find relatively few hospital or market characteristics that may explain these differences....Read More
Concentration of Physician Services Across Insurers and Effects on Quality: Early Evidence From Medicare Advantage.
The percentage of Medicare enrollees covered by private insurers through Medicare Advantage (MA) has grown from 17% in 2000 to 33% in 2017. Over this period, research has shown that MA plans tend to provide lower-cost care compared with traditional Medicare (TM), due to both lower utilization and lower prices....Read More
Financial Eligibility Criteria and Medication Coverage for Independent Charity Patient Assistance Programs.
Independent charity patient assistance programs have grown rapidly since the enactment of the Medicare Modernization Act of 2003, which became effective in 2006. Between 2007 and 2016, the total amount of patient assistance granted by the 5 largest independent charities increased by 588%. Independent charity patient assistance programs must observe legal constraints on their program design and distribution of funds, and remain independent regardless of the source of their revenue....Read More
In collaboration with the West Health Institute and The John A. Hartford Foundation, [the authors] developed the National Home-Based Primary Care and Palliative Care Registry. While the QCDR delivered on its promise in terms of improved reporting and benchmarking, the development process was not without difficulty....Read More
Favorable Formulary Placement of Branded Drugs in Medicare Prescription Drug Plans When Generics Are Available
In the Medicare Part D program, the potential of generic drugs to achieve savings is underused. One reason is that prescription drug plans earn some of their profits through rebates and other price concessions paid by pharmaceutical manufacturers (Medicare calls this direct and indirect remuneration).1 Although the goal of prescription drug plans is to provide cost-effective drug management, the Medicare program has raised concerns that the remuneration structure creates an incentive for plans to prefer higher-priced drugs instead of less expensive alternatives, because manufacturers of higher-priced drugs may offer greater price concessions.1 ...Read More
Many older Americans in the Medicare program are at risk of incurring substantial costs from long-term services and supports (LTSS). An issue brief by Amber Willink, Karen Davis, John Mulcahy, Jennifer Wolff, and Judith Kasper using data from the National Health and Aging Trends Study (NHATS) analyzed medical and LTSS spending among older Medicare beneficiaries and the ways those costs are met. Findings suggest beneficiaries with high LTSS needs have higher Medicare and out-of-pocket spending, more medically-related credit card debt, and report trouble paying for food, rent, utilities, medical care, and prescription drugs....Read More
Study by Amber Willink, Nicholas S. Reed, and Frank R. Lin examines barriers faced by older Medicare beneficiaries when seeking optimal hearing care services. Results show that cost may constrain access to services. ...Read More