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Psychiatric codes and billing patterns under Medicare, 1987–1990

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Mar 032012

Administration and Policy in Mental Health, Vol. 24, No. 3. (1997), pp. 243-249, doi:10.1007/BF02042477

Presents findings from a study examining data for trends in both utilization and cost of psychiatric services provided to Medicare beneficiaries for calendar years 1987–89, and for the last 6 mo of 1990. Measures of utilization and cost include allowed services, allowed charges, and average allowed charge per beneficiary. National-level data reflecting volume and charges for services by type and place of service, as well as provider specialty (psychiatrist, clinical psychologist, non-clinical psychologist, and psychiatric social worker) were used in the analyses. Results show that regulations from the Omnibus Budget Reconciliation Acts of 1987 and 1989 allowed for expanded coverage of psychiatric therapeutic services, thereby increasing access to mental health care for Medicare recipients. Implications for type of services offered, the response of physician providers to removal of some government restrictions, and possible treatment outcomes are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Jean Turner, Michael McCue

Relevance of race and ethnicity for self-reported functional limitation

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Mar 032012

Journal of the American Geriatrics Society, Vol. 56, No. 3. (2008), pp. 553-557, doi:10.1111/j.1532-5415.2007.01595.x

It is unclear whether older adults of different race or ethnicity vary in the ways they perceive functional limitations. Variation in such self-reports may be relevant clinically, because many diagnoses (and subsequent care) depend on self-reported disability. To examine this question, self-reported hand function was compared with performance-based assessment of strength (hand dynamometer) and dexterity (Moberg Pick-Up Test) in white (n = 102), African-American (n = 67), and Hispanic (n = 196) elderly people. Participants were Medicare beneficiaries from northern Manhattan, New York City, aged 70 and older. In adjusted analyses, self-reported hand function was associated with weaker grip strength in African-American and Hispanic participants but not in white participants. Self-reported difficulty with hand function was associated with poorer dexterity in all three groups. Similar results were observed in the subsample of participants with arthritis. These results suggest that culture or socio-environmental differences associated with culture may influence reports of functional limitation. (PsycINFO Database Record (c) 2010 APA, all rights reserved) (journal abstract)
SM Spencer, Steven Albert, Jane Bear-Lehman, Ann Burkhardt

Guest editorial: Part A Medicare coverage for the cognitively impaired resident

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Mar 032012

American Journal of Alzheimer's Disease and Other Dementias, Vol. 19, No. 3. (2004), pp. 149-152, doi:10.1177/153331750401900308

In skilled nursing facilities (SNFs), therapy is initiated on most new admissions to achieve the highest practicable level as mandated by the federal Omnibus Budget Reconciliation Act of 1987 (OBRA). But, the questions, why initiate therapy on a medically unstable resident? By initiating therapy on admission, the SNF loses the opportunity to capture the "look-back" elements of the Minimum Data Set (MDS). The Prospective Payment System (PPS) regulation also allows for deemed coverage for an automatic five days after admission, as long as the Resource Utilization Group (RUG) score is in the top 26 categories. Therapists sometimes balk at the suggestion that they refrain from starting treatment directly upon admission. However, they usually agree that medical stabilization is imperative prior to therapy to ensure success. The prudent case manager might cover the resident under Part A for a minimum of five days, and up to 30 days for assessing Global Deterioration Scale (GDS) score and stabilizing the treatment regimen. In some cases, depending on the assessment reference date of the MDS, extensive services, the highest paying nursing RUG category, is the one that emerges during this time. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Ellen Meyers

Medicare Hospice Referral Criteria for Patients with Amyotrophic Lateral Sclerosis: A Need for Improvement

Medicare News, Syndicated Comments Off

Mar 032012

Journal of palliative medicine, Vol. 7, No. 1. (2004), pp. 47-53

We conducted a retrospective review of 97 consecutive patients with amyotrophic lateral sclerosis (ALS) who were accepted into hospice care from a tertiary ALS center. Five patients met Medicare criteria at time of hospice enrollment. The mean number of hospice days was 85 (range, 1-534). All but 2 patients met hospice criteria proposed by the Columbia University ALS group. The present Medicare hospice criteria should be changed to reflect the reality of patients dying of ALS. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (from the journal abstract)
Leo McCluskey, Gail Houseman

Would the elderly be better off if they were given more placebos?

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Mar 032012

Geriatrics & Gerontology International, Vol. 10, No. 2. (2010), pp. 131-137

Placebos are useful in the medical care of the elderly, although the exact definition of a "placebo" or "placebo effect" is difficult to define precisely. They have an important role as control treatments in research trials, but a non-specific “placebo effect” may also be beneficial part of many physician–patient interactions. Physicians also give them deliberately according to several studies worldwide to satisfy patient demands or because they believe in a “placebo effect” among other reasons. A significant placebo effect has been observed among older patients in clinical trials of antidepressants (12–15%), and in treatments of Parkinson’s disease (16%). Placebos activate serotonergic pathways in the brain used by antidepressants. In Parkinson’s disease, the administration of a placebo stimulates dopamine release in the dorsal (resulting in motor effects) and ventral striatum (which influences expectation of reward). Much of our understanding of the placebo effect comes from studies of placebo analgesia which is influenced by conditioning, expectation, meaning and context of the treatment for the patient, and patient–physician interaction. It is anatomically medicated by brain opioid pathways. Response to “sham” acupuncture in osteoarthritis may be an example of its use in the elderly. Placebos have often been considered a deception and thus unethical. On the other hand, some physicians and ethicists have suggested conditions for appropriate uses for placebos. A placebo might offer the theoretical advantage of an inexpensive treatment that would not cause adverse drug reactions or interactions with other medications, potentially avoiding complications of polypharmacy. (PsycINFO Database Record (c) 2010 APA, all rights reserved) (journal abstract)
EP Cherniack

Depression and cost-related medication nonadherence in Medicare beneficiaries

Medicare News, Syndicated Comments Off

Mar 032012

Archives of General Psychiatry, Vol. 64, No. 5. (2007), pp. 602-608

Context: Treatment for depression can be expensive and depression can affect the use of other medical services, yet there is little information on how depression affects the prevalence of cost-related medication nonadherence (CRN) in elderly patients and patients with disabilities. Objective: To quantify the presence of CRN in depressed and nondepressed elderly Medicare beneficiaries and nonelderly Medicare beneficiaries with disabilities prior to the implementation of the Medicare Drug Benefit. Design and Setting: 2004 Medicare Current Beneficiary Survey. Participants: Depressed and nondepressed elderly Medicare beneficiaries and beneficiaries with disabilities. Main Outcome Measures: Cost-related medication nonadherence included taking smaller doses or skipping doses of a prescription to make it last longer, or failing to fill a prescription because of cost, controlling for health insurance status, comorbid conditions, age, race, sex, and functional status. Results: In a nationally representative sample of 13 835 noninstitutionalized elderly Medicare enrollees and Medicare enrollees with disabilities, 44% of beneficiaries with disabilities and 13% of elderly beneficiaries reported being depressed during the previous year. Among enrollees with disabilities reporting depressive symptoms, 38% experienced CRN compared with 22% of enrollees with disabilities who did not report depressive symptoms. Among elderly enrollees who reported depressive symptoms, 19% experienced CRN, compared with 12% of elderly enrollees who did not report such symptoms. In adjusted analyses, depressive symptoms remained a significant predictor of CRN in both groups (persons with disabilities: odds ratio, 1.7; 95% confidence interval, 1.3-2.3; elderly persons: odds ratio, 1.4; 95% confidence interval, 1.1-1.7). Conclusions: Depressive symptoms were associated with CRN in elderly Medicare enrollees and Medicare enrollees with disabilities. Providers should elicit information on economic barriers that might interfere with treatment of Medicare beneficiaries with depression. (PsycINFO Database Record (c) 2009 APA, all rights reserved) (from the journal abstract)
Kara Bambauer, Dana Safran, Dennis Ross-Degnan, Fang Zhang, Alyce Adams, Jerry Gurwitz, Marsha Pierre-Jacques, Stephen Soumerai

Rep. Kevin Brady questioning HHS Sec. Sebelius on Medicare Cuts 2-28-12

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Feb 282012

	Rep. Kevin Brady questioning HHS Sec. Sebelius on Medicare Cuts 2-28-12 At today's House Ways and Means Committee hearing, Congressman Kevin Brady questioned HHS Secretary Sebelius about how ObamaCare will affect Medicare.	From: KBrady8 Views: 299 0 ratings
	Time: 05:10	More in News & Politics

Discussing the Congressional Conference Agreement Preventing Medicare Physician Pay Cuts

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Feb 232012

	Discussing the Congressional Conference Agreement Preventing Medicare Physician Pay Cuts Medicare Rights Center President, Joe Baker, discusses the congressional conference agreement preventing Medicare physician pay cuts. For more information, please see our press release here: www.medicarerights.org If you would like to receive weekly Policy updates in your e-mail please sign up for our newsletter, Medicare Watch, here: www.medicarerights.org	From: MedicareRightsCenter Views: 1234 5 ratings
	Time: 04:41	More in Nonprofits & Activism

Trends in healthcare utilization among older Americans with colorectal cancer: a retrospective database analysis.

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Feb 192012

BMC Health Serv Res, Vol. 9 (2009), 227

BACKGROUND: Analyses of utilization trends (cost drivers) allow us to understand changes in colorectal cancer (CRC) costs over time, better predict future costs, identify changes in the use of specific types of care (eg, hospice), and provide inputs for cost-effectiveness models. This retrospective cohort study evaluated healthcare resource use among US Medicare beneficiaries diagnosed with CRC between 1992 and 2002. METHODS: Cohorts included patients aged 66+ newly diagnosed with adenocarcinoma of the colon (n = 52,371) or rectum (n = 18,619) between 1992 and 2002 and matched patients from the general Medicare population, followed until death or December 31, 2005. Demographic and clinical characteristics were evaluated by cancer subsite. Resource use, including the percentage that used each type of resource, number of hospitalizations, and number of hospital and skilled nursing facility days, was evaluated by stage and subsite. The number of office, outpatient, and inpatient visits per person-year was calculated for each cohort, and was described by year of service, subsite, and treatment phase. Hospice use rates in the last year of life were calculated by year of service, stage, and subsite for CRC patients who died of CRC. RESULTS: CRC patients (mean age: 77.3 years; 44.9% male) used more resources than controls in every category (P < .001), with the largest differences seen in hospital days and home health use. Most resource use (except hospice) remained relatively steady over time. The initial phase was the most resource intense in terms of office and outpatient visits. Hospice use among patients who died of CRC increased from 20.0% in 1992 to 70.5% in 2004, and age-related differences appear to have evened out in later years. CONCLUSION: Use of hospice care among CRC decedents increased substantially over the study period, while other resource use remained generally steady. Our findings may be useful for understanding CRC cost drivers, tracking trends, and forecasting resource needs for CRC patients in the future.
K Lang, LM Lines, DW Lee, JR Korn, CC Earle, J Menzin

Racial and ethnic differences in end-of-life care in fee-for-service Medicare beneficiaries with advanced cancer.

Medicare News, Syndicated Comments Off

Feb 192012

J Am Geriatr Soc, Vol. 57, No. 1. (January 2009), pp. 153-8

OBJECTIVES: To examine racial and ethnic variation in use of hospice and high-intensity care in patients with terminal illness. DESIGN: Retrospective, secondary data analysis. SETTING: Surveillance, Epidemiology, and End Results-Medicare Database from 1992 to 1999 with follow-up data until December 31, 2001. PARTICIPANTS: Forty thousand nine hundred sixty non-Hispanic white, non-Hispanic black, Asian, and Hispanic fee-for-service Medicare beneficiaries aged 65 and older with advanced-stage lung, colorectal, breast, and prostate cancer. MEASURMENTS: Hospice use and indicators of high-intensity care at the end of life. RESULTS: Whereas 42.0% of elderly white patients with advanced cancer enrolled in hospice, enrollment was lower for black (36.9%), Asian (32.2%), and Hispanic (37.7%) patients. Differences between white and Hispanic patients disappeared after adjustment for clinical and sociodemographic factors. Higher proportions of black and Asian patients than of white patients were hospitalized two or more times (11.7%, 15.0%, 13.7%, respectively), spent more than 14 days hospitalized (11.4%, 17.4%, 15.6%, respectively), and were admitted to the intensive care unit (ICU) (12.0%, 17.0%, 16.2%, respectively) in the last month of life and died in the hospital (26.5%, 31.3%, 33.7%, respectively). Unadjusted differences in receipt of high-intensity care according to race or ethnicity remained after adjustment. CONCLUSION: Black and Asian patients with advanced cancer were more likely than whites to be hospitalized frequently and for prolonged periods, be admitted to the ICU, die in the hospital, and be enrolled in hospice at lower rates. Further research is needed to examine the degree to which patient preferences or other factors explain these differences.
AK Smith, CC Earle, EP McCarthy

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