Trends In Medicare Fee-For-Service Spending Growth For Dual-Eligible Beneficiaries, 2007–15

Keohane, Laura M.; Stevenson, David G.; Freed, Salama; Thapa, Sunita; Stewart, Lucas; Buntin, Melinda Beeuwkes

doi:10.1377/hlthaff.2018.0143

Cited by 25 publications

(29 citation statements)

References 18 publications

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“…By 2012, the cumulative growth in actual spending dropped slightly below the CMS estimate, implying that the states began to subsidize the federal government in aggregate. This finding is consistent with Keohane et al (2018), who show that dual-eligible spending growth slowed dramatically around 2010 relative to the general Medicare population, and with Cutler et al (2019), who document that the growth of medical spending by the elderly declined during this period. 22 Extrapolating beyond 2012, the direction of the aggregate subsidy will depend on how the dual-eligibles utilize prescription drugs relative to the Medicare Part D population overall.…”

Section: Intergovernmental Subsidization Of Dual-eligible Prescription Drug Spendingsupporting

confidence: 88%

Do States Adjust Medicaid Enrollment in Response to Capitation Rates? Evidence from the Medicare Part D Clawback

Quinby

Wettstein

2019

SSRN Journal

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Section: Intergovernmental Subsidization Of Dual-eligible Prescription Drug Spendingsupporting

confidence: 88%

Do States Adjust Medicaid Enrollment in Response to Capitation Rates? Evidence from the Medicare Part D Clawback

Quinby

Wettstein

2019

SSRN Journal

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“…Dual-eligible beneficiaries meet a state’s income and disease cutoffs for Medicaid coverage and federal Medicare eligibility requirements. 38 We stratified all analysis by dual eligibility because dual-eligible participants are allowed to switch to TM at any time, have most of their cost sharing paid for by Medicaid, and may constitute a substantially different enrollee population. Data for identifying high-need status came from the Medicare Provider and Analysis Review file for hospitalizations, 14 the Minimum Data Set for nursing home stays, the Outcome and Assessment Information Set for home health, and the Inpatient Rehabilitation Facility-Patient Assessment Instrument for rehabilitation services.…”

Section: Methodsmentioning

confidence: 99%

Analysis of Drivers of Disenrollment and Plan Switching Among Medicare Advantage Beneficiaries

et al. 2019

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IMPORTANCE How often enrollees with complex care needs leave the Medicare Advantage (MA) program and what might drive their decisions remain unknown. OBJECTIVE To characterize trends in switching to and from MA among high-need beneficiaries and to evaluate the drivers of disenrollment decisions. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study of MA and traditional Medicare (TM) enrollees from January 1, 2014, through December 31, 2015, used a multinomial logit regression stratified by Medicare-Medicaid eligibility status. All 14 589 645 non-high-need MA enrollees and 1302 470 high-need enrollees in the United States who survived until the end of 2014 were eligible for the analysis. Data were analyzed from November 1, 2017, through August 1, 2018. EXPOSURES Enrollee dual eligibility and high-need status (based on complex chronic conditions, multiple morbidities, use of health care services, functional impairment, and frailty indicators), MA plan star rating, and cost sharing. MAIN OUTCOMES AND MEASURES The proportion of enrollees who disenrolled into TM, remained in the same MA plan, or who switched plans within the MA program. RESULTS A total of 13 901 816 enrollees were included in the analysis (56.2% women; mean [SD] age, 70.9 [9.9] years). Among the 1302 470 high-need enrollees, an adjusted 4.6% (95% CI, 4.5%-4.6%) of Medicare-only and 14.8% (95% CI, 14.5%-15.0%) of Medicare-Medicaid members switched from MA to TM compared with 3.3% (95% CI, 3.3%-3.3%) and 4.6% (95% CI, 4.5%-4.7%), respectively, among non-high-need enrollees. Among enrollees in low-quality plans, 23.0% (95% CI, 22.3%-23.9%) of Medicare and 42.8% (95% CI, 40.5%-45.1%) of dual-eligible high-need enrollees left MA. Even in high-quality plans, high-need members disenrolled at higher rates than non-high-need members (4.9% [95% CI, 4.6%-5.2%] vs 1.8% [95% CI, 1.8%-1.9%] for Medicare-only enrollees and 11.3% vs 2.4% dual eligible enrollees). Enrollment in a 5.0-star rated plan was associated with a 30.1-percentage point reduction (95% CI, −31.7 to −28.4 percentage points) in the probability of disenrollment among high-need individuals. A $100 increase in monthly premiums was associated with a 33.9–percentage point increase (95% CI, −34.9 to −33.0 percentage points) in the likelihood of switching plans, and a small reduction in the likelihood of disenrolling (−2.7 percentage points; 95% CI, −3.2 to −2.2 percentage points). Among Medicare-Medicaid eligible participants, 14.1% (95% CI, 14.0%-14.2%) of high-need and 16.7% (95% CI, 16.6%-16.7%) of non-high-need enrollees switched from TM to MA. CONCLUSIONS AND RELEVANCE Results of this study suggest that substantially higher disenrollment from MA plans occurs among high-need and Medicare-Medicaid eligible enrollees. This study’s findings suggest that star ratings have the strongest association with disenrollment trends, whereas increases in monthly premiums are associated with greater likelihood of switching plans.

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“…Although this analy-sis does not capture spending for outpatient services that are not linked to an inpatient admission, prior work demonstrates that annual growth in total Medicare spending per beneficiary (episode related or not) has recently declined for the inpatient sector but increased for outpatient and physician sectors. 30 By offering other outpatient services, hospitals may be able to recoup some declining inpatient revenues. However, outpatient services are reimbursed at a lower rate than inpatient services, suggesting these trends may create financial pressure for hospitals.…”

Section: Discussionmentioning

confidence: 99%

“…Some services, such as elective surgeries, have probably shifted from an inpatient to an outpatient setting, which would be consistent with our finding that there are larger relative declines in planned hospitalizations. Although this analysis does not capture spending for outpatient services that are not linked to an inpatient admission, prior work demonstrates that annual growth in total Medicare spending per beneficiary (episode‐related or not) has recently declined for the inpatient sector but increased for outpatient and physician sectors 30 . By offering other outpatient services, hospitals may be able to recoup some declining inpatient revenues.…”

Section: Discussionmentioning

confidence: 99%

Traditional Medicare Spending on Inpatient Episodes as Hospitalizations Decline

Keohane

Kripalani

Buntin

2021

Journal of Hospital Medicine

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OBJECTIVE: To describe Medicare inpatient episode spending trends between 2009 and 2017 as inpatient use declined among traditional Medicare beneficiaries. METHODS: Inpatient episodes included claims for all traditional Medicare inpatient, outpatient, and Part D services provided during the 30 days prehospitalization, the inpatient stay, and the 90 subsequent days. We describe the mean number of episodes per 1000 beneficiaries, mean episode-related spending per beneficiary, and mean spending per episode for all beneficiaries and for specific populations and types of episodes. Spending measures are reported with and without adjustment for payment rate increases over the study period. RESULTS: The number of inpatient-initiated episodes per 1000 beneficiaries declined by 18.2% between 2009 and 2017 from 326 to 267. After adjusting for payment rate increases, Medicare spending per beneficiary on episode-related care declined by 8.9%, although spending per episode increased by 11.4% over this period. Between 2009 and 2017, all subgroups defined by age, sex, race, or Medicaid status experienced declines in inpatient use accompanied by decreased overall episode-related spending per beneficiary and increased spending per episode. Larger declines in the number of episodes per 1000 beneficiaries were seen among episodes that began with a planned admission (28.8%) or involved no use of post–acute care services (23.9%). When comparing admissions according to medical diagnosis, the largest decline occurred for episodes initiated by a hospitalization for a cardiac or circulatory condition (31.8%). CONCLUSION: Medicare inpatient episodes per beneficiary decreased, but spending decreases due to declining volume were offset by increased spending per episode.

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Trends In Medicare Fee-For-Service Spending Growth For Dual-Eligible Beneficiaries, 2007–15

Cited by 25 publications

References 18 publications

Do States Adjust Medicaid Enrollment in Response to Capitation Rates? Evidence from the Medicare Part D Clawback

Do States Adjust Medicaid Enrollment in Response to Capitation Rates? Evidence from the Medicare Part D Clawback

Analysis of Drivers of Disenrollment and Plan Switching Among Medicare Advantage Beneficiaries

Traditional Medicare Spending on Inpatient Episodes as Hospitalizations Decline

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