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Vol. 3, No. 3, 2013

Medicare Non-Payment of Hospital-Acquired Infections: Infection Rates Three Years Post Implementation

This study reports lower rates of hospital-acquired vascular catheter-associated infections, by up to 43%, in Florida after the Medicare non-payment policy went into effect, even after accounting for a range of patient characteristics. Similar declines were not found in catheter-associated urinary tract infections, but these results are still encouraging.

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Utilization of Dental Services Among Medicaid-Enrolled Children

Authors analyzed dental service use among Medicaid-enrolled children in nine states, and found that higher age, shorter length of enrollment, and disability were associated with lower use of preventive and treatment services. This data may be useful to states in support of outreach to increase dental service use and improve the oral health of children and adolescents.

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Episode-Based Payment:Evaluating the Impact on Chronic Conditions

A recent study examined two currently available episode classification methods for patients with diabetes and ischemic heart disease. Each method identified different people as having each chronic disease and different amounts of disease-related services. The authors examine how different levels of severity led to those differences and how each classification method handled multiple chronic conditions. Episode-based payments should not be used as a payment method for treating chronic diseases until these issues are better understood.

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Standardizing Medicare Payment Information to Support Examining Geographic Variation in Costs

Researchers show that without standard Medicare payment data, we may misidentify some geographic areas with high or low medical resource use, because of area- and policy-based payment differences. They describe the method for standardizing payments adopted by CMS and show the differences in actual versus standard payments by geographic region. Their study confirms earlier findings that some geographic variation in medical resource use cannot be unexplained by Medicare payment differences.

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Effect of Long-term Care Use on Medicare and Medicaid Expenditures for Dual Eligible and Non-dual Eligible Elderly Beneficiaries

Beneficiaries enrolled in both Medicare and Medicaid (commonly termed “duals”) are known for high service use compared to those eligible for only one of these programs (“non-duals”). Researchers separated duals into subgroups to understand better their higher use of services. A larger chronic disease burden explains the use of Medicare services, but does not account for higher service use in Medicaid. Long-Term Care use is connected with higher medical expenses in duals compared to non-duals; medical care use is greater among those receiving long-term care in the community than those in nursing homes. Policy planners and managed care program administrators, including Accountable Care Organizations, should consider the role of nursing homes in lowering medical costs for this vulnerable population.

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