Importance The Centers for Medicare & Medicaid Services’ mandatory End-Stage Renal Disease Treatment Choices (ETC) model, launched on January 1, 2021, randomly assigned approximately 30% of US dialysis facilities and managing clinicians to financial incentives increase the use home kidney transplant. Objective To assess ETC’s association with transplant during model’s first 2 years examine changes in these outcomes by race, ethnicity, socioeconomic status. Design, Setting,...

The End-Stage Renal Disease Treatment Choices (ETC) model randomly selected 30% of US dialysis facilities to receive financial incentives based on their use home dialysis, kidney transplant waitlisting, or receipt. Facilities that disproportionately serve populations with high social risk have a lower and raising concerns these sites may fare poorly in the payment model. To examine first-year ETC performance scores penalties across facilities, stratified by incident patients' risk. A...

With Medicare Advantage (MA) enrollment surpassing 50 percent of beneficiaries, accurate risk-adjusted plan payment rates are essential. However, artificially exaggerated coding intensity, where plans seek to enhance measured health risk through the addition or inflation diagnoses, may threaten rate integrity. One factor that play a role in escalating intensity is assessments (HRAs)—typically in-home reviews enrollees' status—that enable capture information about their enrollees. In this...

Post-acute care users in Medicare Advantage (MA) plans may seek coverage changes if facing issues with plan benefits. In 2019, the Centers for and Medicaid Services extended deadline to disenroll from an MA February 14 March 31 and, first time, permitted beneficiaries switch a different instead of traditional Medicare. Using 2016–2019 administrative data, we implemented difference-in-differences approach evaluate impact this policy on disenrollment within 1 month initiating skilled nursing...

Studies of excess deaths during the coronavirus disease 2019 (COVID-19) pandemic suggest a 19%-21% increase in mortality US population from March to July 2020.1Woolf S.H. Chapman D.A. Sabo R.T. Weinberger D.M. Hill L. Excess COVID-19 and other causes, March-April 2020.JAMA. 2020; 324: 510-513Crossref PubMed Scopus (273) Google Scholar, 2Weinberger Chen J. Cohen T. et al.Estimation associated with United States, May 2020.JAMA Intern Med. 180: 1336-1344Crossref (304) 3Woolf Taylor D.D.H....

Persons with kidney failure require treatment (ie, dialysis or transplantation) for survival. The burden of the COVID-19 pandemic and pandemic-related disruptions in care have disproportionately affected racial ethnic minority socially disadvantaged populations, raising importance understanding disparities initiation during pandemic. To examine changes number demographic characteristics patients initiating incident following by race ethnicity, county-level mortality rate, neighborhood-level...

Abstract Background The Medicare Advantage (MA) program is rapidly growing. Limited evidence exists about the care experiences of MA beneficiaries with Alzheimer's Disease and Related Dementia (ADRD). Our objective was to compare for without ADRD. Methods We examined who completed Consumer Assessment Healthcare Providers Systems (CAHPS) used inpatient, nursing home, or home health services in past 3 years. classified ADRD using presence diagnosis codes hospitals, homes, records. key measures...

Abstract Enrollment in Medicare Advantage (MA) has been rapidly growing. We examined whether MA enrollment affects the outcomes of post-acute nursing home care among patients with Alzheimer's disease and related dementias (ADRD). exploited year-to-year changes penetration rates within counties from 2012 through 2019. After adjusting for patient-level characteristics county fixed effects, we found that was not associated days spent at home, days, likelihood becoming a long-stay resident,...

Importance In January 2021, under the 21st Century Cures Act, Medicare beneficiaries with end-stage renal disease (ESRD) were permitted to enroll in private Advantage (MA) plans for first time. year of there was a 51% increase MA enrollment among ESRD. Objective To examine changes ESRD 2 years Act and, newly enrolled assess proportion who switched contracts and how characteristics changed. Design, Setting, Participants This cross-sectional, population-based time-trend study conducted from...

On September 20, 2017, one of the most destructive hurricanes in US history made landfall Puerto Rico. Anecdotal reports suggest that many persons with kidney failure left Rico after Hurricane Maria; however, empirical estimates migration and health outcomes for this population are scarce. To assess changes mortality among patients need dialysis treatment Maria. This cross-sectional study used an interrupted time-series design 6-month rates 11 652 who received hemodialysis or peritoneal care...

Using a unique longitudinal dataset, we exploit within-patient variations in the timing of activation and subsequent use patient portal. Active portal is motived by significant uptick office visits phone encounters. This followed drop back to pre-portal use, as substitutes for increase telephone Portal reduces encounters 14-percent 19-percent per year, respectively, over three year period. Total cost savings are estimated be $89.73 period, net operating expenses patients doctors opportunity...

Low-income individuals without health insurance have limited access to care. Medicaid expansions may reduce kidney failure incidence by improving chronic disease Using a difference-in-differences analysis, we examined the association between expansion status under Affordable Care Act (ACA) and rate among all nonelderly adults, aged 19-64 years, in United States, from 2012 through 2018. We compared changes states that implemented with concurrent nonexpansion during pre-expansion, early...

This article examines the effect of Affordable Care Act (ACA) dependent coverage mandate on health insurance and labor supply. The author applies three research designs—difference-in-differences, regression discontinuity, kink designs—and conducts extensive robustness checks falsification tests, along with a formal test for location discontinuity kink. finds no discernible evidence supply impact ACA during first years after its implementation (2011–2013), despite substantial eligible young...

The Hospital Readmissions Reduction Program publicly reports and financially penalizes hospitals according to 30-day risk-standardized readmission rates (RSRRs) exclusively among traditional Medicare (TM) beneficiaries but not persons with Advantage (MA) coverage. Exclusively reporting for the TM population may accurately reflect hospitals' older adults. To examine how inclusion of MA patients in performance is associated measures eligibility financial penalties. This a retrospective cohort...

National estimates suggest that kidney failure incidence is declining in the US. However, whether this trend evident areas with socioeconomic disadvantage unknown. We examined trends by county-level poverty between 2000 and 2017 divided study period into 1 (2000–05), 2 (2006–11), 3 (2012–17). The magnitude of disparity high- low-poverty counties increased from 42.8 more incident cases per million high-poverty to 100.1 3. Despite a national decline, counties, disparities widened 2017....

This paper examines how health insurance affects labor supply by exploiting a quasi-experimental change in provision under the Affordable Care Act (ACA) early Medicaid expansion Connecticut implemented 2010. Applying an instrumental variables approach to difference-in-differences-in-differences strategy, I find remarkable impacts of ACA Connecticut. show evidence that Connecticut's increased coverage for low-income childless adults 5.9 percentage points, and as result reduced employment rate...

Lifestyle modifications are associated with better outcomes for patients diabetes. Patients' awareness of having diabetes may promote lifestyle changes, but there is limited evidence to support this assertion. This study examined whether a report physician-diagnosed dietary changes and efforts lose weight. Cross-sectional comparison individuals without or prediabetes diagnosis, matched on glycosylated hemoglobin (HbA1c) level, socio-demographic characteristics, health status using...

This cross-sectional study evaluates the agreement between readmission rates reported by Medicare Advantage contracts and calculated from their encounter data in Healthcare Effectiveness Data Information Set (HEDIS).

To compare the use of top-ranked cancer hospitals for complex surgery between Medicare Advantage (MA) and traditional fee-for-service (FFS) enrollees. Cross-sectional analysis claims enrollment data. The study used Provider Analysis Review files to differences in (lobectomy, esophagectomy, gastrectomy, colectomy, Whipple procedure [pancreaticoduodenectomy]) MA FFS enrollees 65 years older who underwent 2015 2017. After adjusting demographic characteristics county fixed effects, were less...

This paper examines how the value of health insurance affects labor supply, exploiting a quasi-experimental change in provision - i.e., Affordable Care Act (ACA) dependent coverage mandate implemented 2010. Using difference-in-differences, regression discontinuity, and kink designs, I find no evidence market impact ACA despite its substantial on for young adults. also show that "aging-out-at-26" condition eligibility leads to low valuation turn supply