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Vol. 4, No. 2, 2014

Medicare’s Hospice Benefit: Analysis of Utilization and Resource Use

A study of  Medicare hospice episodes indicate service use is more intensive during initial days of the episode and last few days prior to death. The results provide useful information for potential discussions on hospice payment reform.

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Measuring Coding Intensity in the Medicare Advantage Program

Each year since 2004, the average Medicare Advantage (MA) risk score increased faster than the average fee-for-service (FFS) score, reflecting changes in diagnostic coding instead of real increases in the morbidity of MA enrollees, as survey-based data shows no trend in MA risk scores relative to FFS scores.

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Ever Enrolled Medicare Population Estimates from the MCBS Access to Care Files

Study determines feasibility of creating “ever enrolled” weight adjustments to the Medicare Beneficiary Survey Access to Care (ATC) files and suggests a reasonable alternative to traditional ATC survey weights.

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Medicare’s Physician Quality Reporting System (PQRS): Quality Measurement and Beneficiary Attribution

This study examined the characteristics of Medicare’s Physician Quality Reporting System  reports and the providers who file them, and compared assignment of beneficiaries to providers using PQRS reports versus primary care visit counts. As PQRS participation grows, improvements to attribution and information about the quality of health care services for beneficiaries in traditional Medicare may grow, too.

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Availability and Usability of Behavioral Health Organization Encounter Data in MAX 2009

Authors assessed the availability, completeness, and quality of Behavioral Health Organization encounter data in MAX 2009, finding inpatient (IP) data from four states usable for research and complete encounter data in the other (OT) file for only two states. Findings suggest that only limited encounter data are available and usable for behavioral health plans in MAX 2009.

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W. Pete Welch, Sally C. Stearns, Alison E. Cuellar, and Andrew B. Bindman
Bisakha Sen, Justin Blackburn, Michael Morrisey, David Becker, Meredith Kilgore, Cathy Caldwell, Nir Menachemi
Jon Christianson, Daniel Maeng, Jean Abraham, Dennis P. Scanlon, Jeffrey Alexander, Jessica Mittler, and Michael Finch
Derek DeLia, Jian Tong, Dorothy Gaboda, and Lawrence P. Casalino