Cost containment for dual-eligible beneficiaries (those enrolled in Medicare and Medicaid) is a key policy goal, but few studies have examined spending trends for this population. We contrasted growth in Medicare fee-for-service per beneficiary spending for those with and without Medicaid in the period 2007-15. Relative to Medicare-only enrollees, dual-eligible beneficiaries consistently had higher overall Medicare spending levels; however, they experienced steeper declines in spending growth over the study period. These trends varied across populations of interest. For instance, dual-eligible beneficiaries ages sixty-five and older went from having annual spending growth rates that were 1.8 percentage points higher than Medicare-only beneficiaries in 2008 to rates that were 1.1 percentage points lower in 2015. Across population groups, long-term users of nursing home care had some of the highest spending growth rates, averaging 1.7-4.1 percent annually depending on age group and Medicaid participation. These findings have implications for value-based payment and other Medicare policies aimed at controlling spending for dual-eligible beneficiaries.

Background Alternative Payment Models (APMs) piloted by the Centers for Medicare and Medicaid Services (CMS) such as ACO Realizing Equity, Access and Community Health (REACH) seek to improve care and quality of life among seriously ill populations (SIP). Days at Home (DAH) was proposed for use in this model to evaluate organizational performance. It is important to assess the utility and feasibility of person‐centered outcomes measures, such as DAH, as CMS seeks to advance care models for seriously ill beneficiaries. We leverage existing Accountable Care Organization (ACO) contracts to evaluate the feasibility of ACO‐level DAH measure and examine characteristics associated with ACOs with more DAH. Methods We calculated DAH for Medicare fee‐for‐service beneficiaries aged 68 and over who were retrospectively attributed to a Medicare ACO between 2014 and 2018 and met the seriously ill criteria. We then aggregated to the ACO level DAH for each ACO's seriously ill beneficiaries and risk‐adjusted this aggregated measure. Finally, we evaluated associations between risk‐adjusted DAH per person‐year and ACO, beneficiary, and market characteristics. Results ACOs' seriously ill beneficiaries spent an average of 349.3 risk‐adjusted DAH per person‐year. Risk‐adjusted ACO variation, defined as the interquartile range, was 4.21 days (IQR = 347.32–351.53). Beneficiaries of ACOs are composed of a less racially diverse beneficiary cohort, opting for two‐sided risk models, and operating in markets with fewer hospital and Skilled Nursing Facility beds had more DAH. Conclusions Substantial variation across ACOs in the DAH measure for seriously ill beneficiaries suggests the measure can differentiate between high and low performing provider groups. Key to the success of the metric is accurate risk adjustment to ensure providers have adequate resources to care for seriously ill beneficiaries. Organizational factors, such as the ACO size and level of risk, are strongly associated with more days at home.

Changes taking place in both Qi Gong Masters and their patients during Qi Gong treatment were evaluated using the Bi-Digital O-Ring Test. During the Qi Gong state, on the Qi-Gong Master's body, as well as the body of the patient being treated, acupuncture points CV5 (Shi Men) and CV6 (Qi Hai)-- located below the umbilicus-- show changes from +4 in the pre-Qi Gong state to between -3 and -4 during the Qi Gong state. Before and after the Qi Gong, there is a normal +4 response to the Bi-Digital O-Ring Test at these acupuncture points. Similar changes were also observed on acupuncture points CV17 (Shan Zhong), CV 22 (Tian Tu), Yin Tang (at an area just between the eyebrows: the pituitary gland representation area, colloquially known as the "third eye") and GV20(Bai Hui), the entire pericardium meridian & triple burner meridian, their acupuncture points, the adrenal glands, testes, ovaries and perineum, as well as along the entire spinal vertebrae, particularly on and above the 12th thoracic vertebra, medulla oblongata, pons, and the intestinal representation areas of the brain located just above and behind the upper ear. Using these findings as criteria for evaluating the effectiveness of reaching the Qi Gong state, we were able to reproduce during the experimental trials similar changes in ourselves and the patient being treated with therapeutic effects comparable to those of the Qi Gong Master. Beneficial effects of external Qi Gong treatment given by a Qi Gong practitioner 1 to 3 times for 10-20 seconds each (although most Qi Gong masters take 3-20 minutes per treatment) often resulted in improvement of circulation and lowering of high blood pressure, as well as relaxation of spastic muscles, relief of pain, and enhanced general well-being, all of which resemble acupuncture effects. In order to reproduce the same procedure with others, we selected 4 children ranging between 8 and 11 years of age who had no knowledge of Qi Gong or Oriental medicine. One of these four children, the 8 year old, was able to consistently reach the same Qi Gong state after less than a half day and another child, 11, after less than 2 days. Within a week, the other two were sometimes able to reproduce the Qi Gong state but not always. Using the Qi Gong state thus obtained, it was found that this type of Qi Gong energy is directed to specific directions from the hand and can even penetrate wooden or metal doors.(ABSTRACT TRUNCATED AT 400 WORDS)

Declines in spending levels for Medicare beneficiaries with chronic conditions suggest that changing patterns of care use may be moderating spending growth.