Repeat Testing Among Medicare Beneficiaries

Welch, H. Gilbert; Hayes, Kevin J.; Frost, C.J.

doi:10.1001/2013.jamainternmed.727

Cited by 43 publications

(34 citation statements)

References 9 publications

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“…We used routine eye examinations as a nonequivalent outcome; prior researchers have used eye examinations as an outcome anticipated to repeat on a regular basis in the Medicare population (Welch, Hayes, & Frost, 2012). An eye examination is a preventive service (recommended by the American Optometric Association to be repeated every 12 months for adults age 61 and older) but should not be affected by the 2009 USPSTF mammography guideline (American Optometric Association, 2014).…”

Section: Outcome and Measuresmentioning

confidence: 99%

Screening Mammography Rates in the Medicare Population before and after the 2009 U.S. Preventive Services Task Force Guideline Change: An Interrupted Time Series Analysis

Jiang

Hughes

Duszak

2015

Women's Health Issues

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Section: Outcome and Measuresmentioning

confidence: 99%

Screening Mammography Rates in the Medicare Population before and after the 2009 U.S. Preventive Services Task Force Guideline Change: An Interrupted Time Series Analysis

Jiang

Hughes

Duszak

2015

Women's Health Issues

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“…The relationship between EUM and the incidence of downstream cardiac imaging has not been evaluated in commercially insured patient cohorts. In light of the continued growth of echocardiography testing (Chen et al 2011) and reported increase in downstream testing following echocardiography (Welch, Hayes, and Frost 2012), this study contributes to our understanding of the emerging practice of EUM programs. This is one of the first studies to our knowledge to quantify the relationship between an EUM program and a lower rate of downstream imaging in commercially insured patients.…”

Section: Discussionmentioning

confidence: 89%

“…This is one of the first studies to our knowledge to quantify the relationship between an EUM program and a lower rate of downstream imaging in commercially insured patients. Unlike prior studies (Welch, Hayes, and Frost 2012), we accounted for censoring and variable follow-up time in addition to the common practice of adjusting for covariates. The results of this retrospective analysis demonstrated that downstream cardiac imaging occurs frequently within the commercially insured population.…”

Section: Discussionmentioning

confidence: 99%

Examining the Association between Utilization Management and Downstream Cardiovascular Imaging

Agiro

Sylwestrzak

Shah

et al. 2014

Health Services Research

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Objectives. To examine the association of echocardiography utilization management (EUM) program with downstream cardiac imaging utilization. Data Sources/Study Setting. Administrative claims data from commercial health plans in Indiana, Ohio, Kentucky, Wisconsin, and Georgia. Study Design. Patients undergoing index cardiovascular imaging with no imaging in the preceding year were identified (N = 112,308). Claims-derived cardiac risk scores were used for one-to-one propensity score matching of patients subject to EUM to patients without EUM (n = 96,906). Downstream cardiac imaging utilization for 12-24 months postindex imaging was analyzed using generalized linear models and Cox proportional hazards model. Principal Findings. Downstream cardiac imaging tests were performed for 10,630 (21.9 percent) and 12,012 (24.8 percent) patients in the EUM and non-EUM groups, respectively. At 12-month follow-up, adjusted utilization was 15.2 (95 percent CI, 7.6-22.5) tests per 1,000 initially tested patients lower in the EUM group (p < .001). The likelihood of obtaining downstream cardiac imaging in the EUM group was 7.0 percent lower than the non-EUM group (hazard ratio: 0.930; 95 percent CI, 0.897-0.964, p < .001). Conclusions. Downstream cardiac imaging is relatively common among commercially insured patients. Every 10 initial diagnostic tests yielded two downstream imaging tests in first 24 months. EUM program was associated with lower volumes of downstream imaging.

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“…Another possible explanation is the high degree of fragmentation of care in Medicare, leading to frequent duplication of testing. 25 However, the difference in use could also be due to underuse of testing at the VA because some features of the VA system such as constrained budgets and restrictions on expansion may disincentivize use of health care resources and lead to delays in scheduling of testing. In addition, patients in the VA cohort had a higher rate of hospitalization for HF, which could indicate that more frequent testing might be associated with less need for acute care.…”

Section: Discussionmentioning

confidence: 99%

Variation in use of echocardiography among veterans who use the Veterans Health Administration vs Medicare

Kini

McCarthy

Rajaei

et al. 2015

American Heart Journal

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Background Rapid growth in the provision of cardiac imaging tests has led to concerns about overuse. Little is known about the degree to which health care delivery system characteristics influence use and variation in echocardiography. Methods We analyzed administrative claims of veterans with heart failure older than 65 years from 2007 to 2010 across 34 metropolitan service areas (MSAs). We compared overall rates and geographic variation in use of transthoracic echocardiography (TTE) between veterans who used the Veterans Health Administration (VA) and propensity-matched veterans who used Medicare. “Dual users” were excluded. Results There were no significant differences in clinical characteristics or mortality between the propensity-matched cohorts (overall n = 30,404 veterans, mean age 76 years, mortality rate 52%). The Medicare cohort had a significantly higher overall rate of TTE use compared with the VA cohort (1.25 vs 0.38 TTEs per person-year, incidence rate ratio 2.89 [95% CI 2.80-3.00], both P< .001), but a similar coefficient of variation across MSAs (0.36 [95% CI 0.27-045] vs 0.48 [95% CI 0.37-0.59]). There was a moderate to strong correlation in variation at the MSA level between cohorts (Spearman r = 0.58, P < .001). Conclusion Overall rates of TTE use were significantly higher in a Medicare cohort compared with a propensity score-matched VA cohort of veterans with heart failure living in urban areas, with similar relative degrees of geographic variation and moderate to strong regional correlation. Rates of TTE use may be strongly influenced by health care system characteristics, but local practice styles influence echocardiography rates irrespective of health system.

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Repeat Testing Among Medicare Beneficiaries

Cited by 43 publications

References 9 publications

Screening Mammography Rates in the Medicare Population before and after the 2009 U.S. Preventive Services Task Force Guideline Change: An Interrupted Time Series Analysis

Screening Mammography Rates in the Medicare Population before and after the 2009 U.S. Preventive Services Task Force Guideline Change: An Interrupted Time Series Analysis

Examining the Association between Utilization Management and Downstream Cardiovascular Imaging

Variation in use of echocardiography among veterans who use the Veterans Health Administration vs Medicare

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