Examining Measures of Income and Poverty in Medicare Administrative Data

Samson, Lok Wong; Finegold, Kenneth; Ahmed, Azeem; Jensen, Matthew; Filice, Clara E.; Joynt, Karen E.

doi:10.1097/mlr.0000000000000606

Cited by 28 publications

(36 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These differences were particularly pronounced for measures of health status (notably, self‐rated health, functional limitations, and hearing and vision impairments) and were sizeable for socioeconomic indicators (specifically, education and income) that are typically not observable to or used by policy makers for risk adjustment. Although policy makers and researchers routinely use dual enrollment to proxy for low SES and poor health in risk adjustment, our results show that this binary categorization belies substantial heterogeneity in what it means to have Medicaid in different states.…”

Section: Discussionmentioning

confidence: 80%

“…Ideally, risk adjustment would be based on the underlying social and clinical constructs for which dual enrollment is intended to proxy. Although administrative data sources provide a limited picture of these risk factors, research has demonstrated how claims can be used to measure constructs such as frailty, disability status, institutionalization, and via linked Census data, income, education, and social supports . Incorporating these measures of medical and social risk may help to account for some state‐level differences in the characteristics of dual enrollees in ways that current risk‐adjustment methods do not.…”

Section: Discussionmentioning

confidence: 99%

“…12,13 This heterogeneity complicates what it means to adjust for dual enrollment status, particularly if the health and socioeconomic characteristics of dual enrollees differ between providers, regions, or states for which an analyst wishes to compare risk-adjusted performance. 6,11 Two factors may contribute to differences in the characteristics of dual enrollees between states in particular. First, the composi- Medicaid.…”

Section: Roberts Et Almentioning

confidence: 99%

“…In 2019, CMS began to compare readmission rates and determine penalties in the Hospital Readmission Reduction Program based on each hospital's proportion of Medicare beneficiaries who were enrolled in Medicaid . These methods are intended to account for the higher average risk of dual enrollees, which are a reflection of the pathways to eligibility for both programs: Patients establish eligibility for Medicare if they are elderly or have a qualifying disability, and can receive Medicaid if they have low income and assets, or incur high medical expenses relative to income in states with Medically Needy programs …”

Section: Introductionmentioning

confidence: 99%

“…Although higher risk on average, dual enrollees are a heterogeneous group: 38 percent have limitations performing 3 or more activities of daily living, while a nearly equal proportion have none; 45 percent have less than a high school education, while approximately one‐quarter completed some college; and 51 percent originally qualified for Medicare because of a disability, while 47 percent qualified because of age . This heterogeneity complicates what it means to adjust for dual enrollment status, particularly if the health and socioeconomic characteristics of dual enrollees differ between providers, regions, or states for which an analyst wishes to compare risk‐adjusted performance …”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

State variation in the characteristics of Medicare‐Medicaid dual enrollees: Implications for risk adjustment

Roberts

Mellor

McInerney

et al. 2019

Health Services Research

View full text Add to dashboard Cite

Objective To examine between‐state differences in the socioeconomic and health characteristics of Medicare beneficiaries dually enrolled in Medicaid, focusing on characteristics not observable to or used by policy makers for risk adjustment. Data Source 2010‐2013 Medicare Current Beneficiary Survey. Study Design Retrospective analyses of survey‐reported health and socioeconomic status (SES) measures among low‐income Medicare beneficiaries and low‐income dual enrollees. We used hierarchical linear regression models with state random effects to estimate the between‐state variation in respondent characteristics and linear models to compare the characteristics of dual enrollees by state Medicaid policies. Principal Findings Between‐state differences in health and socioeconomic risk among low‐income Medicare beneficiaries, as measured by the coefficient of variation, ranged from 17.5 percent for an index of socioeconomic risk to 20.3 percent for an index of health risk. Between‐state differences were comparable among the subset of low‐income beneficiaries dually enrolled in Medicare and Medicaid. Dual enrollees with incomes below the Federal Poverty Level were in better health and had higher SES in states that offered Medicaid to individuals with relatively higher incomes. Duals' average incomes were higher in states with Medically Needy programs. Conclusions Characteristics of dual enrollees differ substantially across states, reflecting differences in states' low‐income Medicare populations and Medicaid policies. Risk‐adjustment methods using dual enrollment to proxy for poor health and low SES should account for this state‐level heterogeneity.

show abstract

Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Section: Roberts Et Almentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

State variation in the characteristics of Medicare‐Medicaid dual enrollees: Implications for risk adjustment

Roberts

Mellor

McInerney

et al. 2019

Health Services Research

View full text Add to dashboard Cite

show abstract

Association of Medicare Advantage Star Ratings With Racial, Ethnic, and Socioeconomic Disparities in Quality of Care

et al. 2021

View full text Add to dashboard Cite

IMPORTANCE Medicare Advantage (MA) plans, which disproportionately enroll racial/ethnic minorities and persons with socioeconomic disadvantage, receive bonus payments on the basis of overall performance on a 5-star rating scale. The association between plans' overall quality and disparities in quality is not well understood. OBJECTIVE To examine the association between MA star ratings and disparities in care for racial/ ethnic minorities and enrollees with lower income and educational attainment. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included 1 578 564 MA enrollees from 454 contracts across the 2015 and 2016 calendar years. Data analyses were conducted between June 2019 and June 2020. EXPOSURES Self-reported race and ethnicity and low socioeconomic status (SES) (defined by low income or less than a high school education) vs high SES (neither low income nor low educational attainment). MAIN OUTCOMES AND MEASURES Performance on 22 measures of quality and satisfaction determined at the individual enrollee level, aggregated into simulated star ratings (scale, 2-5) stratified by SES and race/ethnicity. RESULTS A total of 1 578 564 enrollees were included in this analysis (55.8% female; mean [SD] age, 71.4 [11.3] years; 65.8% White; 12.3% Black; 14.6% Hispanic). Enrollees with low SES had simulatedstratified star ratings 0.5 stars lower (95% CI, 0.4-0.6 stars) than individuals with high SES in the same contract. Black and Hispanic enrollees had simulated star ratings that were 0.3 stars (95% CI, 0.2-0.4 stars) and 0.1 stars (95% CI, −0.04 to 0.2 stars) lower than White enrollees within the same contracts. Black enrollees had a 0.4-star lower rating (95% CI, 0.1-0.7 stars) in 4.5-to 5-star contracts and a no statistical difference in 2.0-to 2.5-star-rated contracts (difference, 0.3 stars; 95% CI, −0.02 to 0.7 stars). Hispanic enrollees had a 0.6-star lower simulated rating (95% CI, 0.2-1.0 stars) in 4.5to 5-star contracts and no statistical difference in 2-to 2.5-star contracts (difference, −0.01 stars; 95% CI, −0.5 to 0.4 stars). There was low correlation between simulated ratings for enrollees of low SES and high SES (difference, 0.2 stars; 95% CI, 0.03-0.4 stars) and between simulated ratings for White and Black enrollees (difference, 0.4 stars; 95% CI, 0.3-0.5 stars) and White and Hispanic enrollees (difference, 0.3 stars; 95% CI, 0.2-0.4 stars). As the proportion of Black and Hispanic enrollees increased in a contract, racial/ethnic disparities in ratings decreased. CONCLUSIONS AND RELEVANCEIn this cross-sectional study, simulated MA star ratings were only weakly correlated with those for enrollees of low SES in the same contract, and contracts with higher star ratings had larger disparities in quality. Measures of equity in MA plans' quality of care may be needed.

show abstract

Changes in Patient Experiences and Assessment of Gaming Among Large Clinician Practices in Precursors of the Merit-Based Incentive Payment System

et al. 2021

View full text Add to dashboard Cite

IMPORTANCE Medicare's Merit-Based Incentive Payment System (MIPS), a public reporting and pay-for-performance program, adjusts clinician payments based on publicly reported measures that are chosen primarily by clinicians or their practices. However, measure selection raises concerns that practices could earn bonuses or avoid penalties by selecting measures on which they already perform well, rather than by improving care-a form of gaming. This has prompted calls for mandatory reporting on a smaller set of measures including patient experiences. OBJECTIVE To examine (1) practices' selection of Consumer Assessment of Healthcare Providers and Systems (CAHPS) patient experience measures for quality scoring under the pay-forperformance program and (2) the association between mandated public reporting on CAHPS measures and performance on those measures within precursor programs of the MIPS. DESIGN, SETTING, AND PARTICIPANTSThis cross-sectional study included 2 analyses. The first analysis examined the association between the baseline CAHPS scores of large practices (Ն100 clinicians) and practices' selection of these measures for quality scoring under a pay-for-performance program up to 2 years later. The second analysis examined changes in patient experiences associated with a requirement that large practices publicly report CAHPS measures starting in 2014. A difference-in-differences analysis of 2012 to 2017 fee-for-service Medicare CAHPS data was conducted to compare changes in patient experiences between large practices (111-150 clinicians) that became subject to this reporting mandate and smaller unaffected practices (50-89 clinicians).

show abstract

Examining Measures of Income and Poverty in Medicare Administrative Data

Cited by 28 publications

References 25 publications

State variation in the characteristics of Medicare‐Medicaid dual enrollees: Implications for risk adjustment

State variation in the characteristics of Medicare‐Medicaid dual enrollees: Implications for risk adjustment

Association of Medicare Advantage Star Ratings With Racial, Ethnic, and Socioeconomic Disparities in Quality of Care

Changes in Patient Experiences and Assessment of Gaming Among Large Clinician Practices in Precursors of the Merit-Based Incentive Payment System

Contact Info

Product

Resources

About