American journal of public health, Vol. 78, No. 5. (May 1988), pp. 553-556.
We assessed impacts of the Medicare Prospective Payment System (PPS) during its first two years of operation (1984-85) on 467 hospitals using data from the Commission on Professional and Hospital Activities and from the American Hospital Association. Medicare discharges as a per cent of total discharges remained constant between 1983 and 1985, but the per cent of uninsured patients increased, especially at large public hospitals. The number of Medicare and total discharges per hospital declined. The number of complex diagnosis related groups (DRGs) increased, both for Medicare and non-Medicare. This trend began before the implementation of PPS and affected all types of hospitals. There was also an appreciable increase in case mix types of hospitals. There was also an appreciable increase in case mix severity within specific DRGs during 1980-85. The proportion of total patients received from or transferred to other hospitals rose after 1983, but these increases were very small. The per cent of Medicare patients admitted through the emergency room increased, especially after 1983. By contrast, the share of total non-Medicare admissions through the emergency room (ER) remained stable. Although the growth of the number of uninsured and Medicare patients admitted through the ER predate PPS, they may be influenced by it and warrant further monitoring.
FA Sloan, MA Morrisey, J Valvona
American journal of public health, Vol. 78, No. 5. (May 1988), pp. 553-556.Obama: McCain Wants to Cut Medicare
Medicare News, Video
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Oct 172008
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Barack Obama accused John McCain of wanting to cut $882 billion from Medicare on Friday, and claims that would mean seniors pay more for drugs, receive fewer services and get lower quality care. (Oct. 17) |
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Obama on McCain’s Plans to Cut Medicare
Medicare News, Video
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Oct 172008
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October 17, 2008, Roanoke, VA Obama: Senator McCain's been eager to share some details of his health care plan -- but not all of them. It's like those ads for prescription drugs, you know they start off everybody's running in the field and everybody's happy, then there's the little fine print that says, you know, 'side effects may include...' Now first of all, we found out that Senator McCain wants to pay for his plan by taxing your health care benefits for the first time in history, just like George Bush. That was bad enough. But the Wall Street Journal recently reported that it was actually worse than we thought. It turns out, Senator McCain would pay for part of his plan by making drastic cuts in Medicare -- $882 billion worth. $882 billion in Medicare cuts to pay for an ill-conceived, badly thought-through health care plan that won't provide more health care to people. Even though Medicare is already facing a looming shortfall. Now, this should come as no surprise, it's entirely consistent with Senator McCain's record during his 26 years in Congress where, time and again, he's opposed Medicare. In fact, Senator McCain has voted against protecting Medicare 40 times. 40 times, he's failed to stand up for Medicare. So what would Senator McCain's cuts mean for Medicare at a time when more and more Americans are relying on it? It would mean a cut of more than 20 percent in Medicare benefits next year. If you count on Medicare, it would mean fewer places to get care, and <b>...</b> |
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Geographic variations in the rates of elective total hip and knee arthroplasties among Medicare beneficiaries in the United States.
Medicare News, Syndicated
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Oct 172008
The Journal of bone and joint surgery. American volume, Vol. 74, No. 10. (December 1992), pp. 1530-1539.
We analyzed the variations in the rates of elective total hip and total knee arthroplasties for 1988 in the United States to determine whether the rates correlated with the numbers of surgeons. There were 56,204 total hip arthroplasties and 68,491 total knee arthroplasties, performed in the home states of the patients among all of the Medicare beneficiaries. Medicare beneficiaries include most people who are more than sixty-five years old in the United States and a small proportion of younger people who are eligible for Medicare for other reasons. Seventy-nine per cent of the patients who had had a total hip arthroplasty and 89 per cent of those who had had a total knee arthroplasty had been managed with the operation because of osteoarthrosis. Both operations were most common in the seventy to seventy-four-year age-group. We calculated the rate of operations per 100 beneficiaries for each state and age-adjusted the results. Across all of the states, bilateral procedures constituted 1.6 per cent of the total hip arthroplasties and 4.8 per cent of the total knee arthroplasties. The in-hospital rates of mortality were 0.72 per cent for total hip arthroplasties and 0.45 per cent for total knee arthroplasties. The destinations after discharge from the hospital were similar for the two groups of patients, with more than 65 per cent of the patients being discharged directly to their homes. There were no significant differences among states in terms of the length of stay in the hospital or reimbursement of the hospital.(ABSTRACT TRUNCATED AT 250 WORDS)
MG Peterson, JP Hollenberg, TP Szatrowski, NA Johanson, CA Mancuso, ME Charlson
We analyzed the variations in the rates of elective total hip and total knee arthroplasties for 1988 in the United States to determine whether the rates correlated with the numbers of surgeons. There were 56,204 total hip arthroplasties and 68,491 total knee arthroplasties, performed in the home states of the patients among all of the Medicare beneficiaries. Medicare beneficiaries include most people who are more than sixty-five years old in the United States and a small proportion of younger people who are eligible for Medicare for other reasons. Seventy-nine per cent of the patients who had had a total hip arthroplasty and 89 per cent of those who had had a total knee arthroplasty had been managed with the operation because of osteoarthrosis. Both operations were most common in the seventy to seventy-four-year age-group. We calculated the rate of operations per 100 beneficiaries for each state and age-adjusted the results. Across all of the states, bilateral procedures constituted 1.6 per cent of the total hip arthroplasties and 4.8 per cent of the total knee arthroplasties. The in-hospital rates of mortality were 0.72 per cent for total hip arthroplasties and 0.45 per cent for total knee arthroplasties. The destinations after discharge from the hospital were similar for the two groups of patients, with more than 65 per cent of the patients being discharged directly to their homes. There were no significant differences among states in terms of the length of stay in the hospital or reimbursement of the hospital.(ABSTRACT TRUNCATED AT 250 WORDS)
MG Peterson, JP Hollenberg, TP Szatrowski, NA Johanson, CA Mancuso, ME Charlson
Safety and Efficacy of Mechanical Embolectomy in Acute Ischemic Stroke: Results of the MERCI Trial
Stroke, Syndicated
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Oct 082008
Stroke, Vol. 36, No. 7. (1 July 2005), pp. 1432-1438.
Background and Purpose-- The only Food and Drug Administration (FDA)-approved treatment for acute ischemic stroke is tissue plasminogen activator (tPA) given intravenously within 3 hours of symptom onset. An alternative strategy for opening intracranial vessels during stroke is mechanical embolectomy, especially for patients ineligible for intravenous tPA. Methods-- We investigated the safety and efficacy of a novel embolectomy device (Merci Retriever) to open occluded intracranial large vessels within 8 hours of the onset of stroke symptoms in a prospective, nonrandomized, multicenter trial. All patients were ineligible for intravenous tPA. Primary outcomes were recanalization and safety, and secondary outcomes were neurological outcome at 90 days in recanalized versus nonrecanalized patients. Results-- Recanalization was achieved in 46% (69/151) of patients on intention to treat analysis, and in 48% (68/141) of patients in whom the device was deployed. This rate is significantly higher than that expected using an historical control of 18% (P<0.0001). Clinically significant procedural complications occurred in 10 of 141 (7.1%) patients. Symptomatic intracranial hemorrhages was observed in 11 of 141 (7.8%) patients. Good neurological outcomes (modified Rankin score [≤]2) were more frequent at 90 days in patients with successful recanalization compared with patients with unsuccessful recanalization (46% versus 10%; relative risk [RR], 4.4; 95% CI, 2.1 to 9.3; P<0.0001), and mortality was less (32% versus 54%; RR, 0.59; 95% CI, 0.39 to 0.89; P=0.01). Conclusions-- A novel endovascular embolectomy device can significantly restore vascular patency during acute ischemic stroke within 8 hours of stroke symptom onset and provides an alternative intervention for patients who are otherwise ineligible for thrombolytics. 10.1161/01.STR.0000171066.25248.1d
Wade Smith, Gene Sung, Sidney Starkman, Jeffrey Saver, Chelsea Kidwell, Gobin, Helmi Lutsep, Gary Nesbit, Thomas Grobelny, Marilyn Rymer, Isaac Silverman, Randall Higashida, Ronald Budzik, Michael Marks, For
Background and Purpose-- The only Food and Drug Administration (FDA)-approved treatment for acute ischemic stroke is tissue plasminogen activator (tPA) given intravenously within 3 hours of symptom onset. An alternative strategy for opening intracranial vessels during stroke is mechanical embolectomy, especially for patients ineligible for intravenous tPA. Methods-- We investigated the safety and efficacy of a novel embolectomy device (Merci Retriever) to open occluded intracranial large vessels within 8 hours of the onset of stroke symptoms in a prospective, nonrandomized, multicenter trial. All patients were ineligible for intravenous tPA. Primary outcomes were recanalization and safety, and secondary outcomes were neurological outcome at 90 days in recanalized versus nonrecanalized patients. Results-- Recanalization was achieved in 46% (69/151) of patients on intention to treat analysis, and in 48% (68/141) of patients in whom the device was deployed. This rate is significantly higher than that expected using an historical control of 18% (P<0.0001). Clinically significant procedural complications occurred in 10 of 141 (7.1%) patients. Symptomatic intracranial hemorrhages was observed in 11 of 141 (7.8%) patients. Good neurological outcomes (modified Rankin score [≤]2) were more frequent at 90 days in patients with successful recanalization compared with patients with unsuccessful recanalization (46% versus 10%; relative risk [RR], 4.4; 95% CI, 2.1 to 9.3; P<0.0001), and mortality was less (32% versus 54%; RR, 0.59; 95% CI, 0.39 to 0.89; P=0.01). Conclusions-- A novel endovascular embolectomy device can significantly restore vascular patency during acute ischemic stroke within 8 hours of stroke symptom onset and provides an alternative intervention for patients who are otherwise ineligible for thrombolytics. 10.1161/01.STR.0000171066.25248.1d
Wade Smith, Gene Sung, Sidney Starkman, Jeffrey Saver, Chelsea Kidwell, Gobin, Helmi Lutsep, Gary Nesbit, Thomas Grobelny, Marilyn Rymer, Isaac Silverman, Randall Higashida, Ronald Budzik, Michael Marks, For
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