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Journal articles on the topic 'Medicare disability'

Author: Grafiati

Published: 4 June 2021

Last updated: 6 February 2022

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1

Riley, Gerald F., James D. Lubitz, and Nancy Zhang. "Patterns of Health Care and Disability for Medicare Beneficiaries under 65." INQUIRY: The Journal of Health Care Organization, Provision, and Financing 40, no. 1 (February 2003): 71–83. http://dx.doi.org/10.5034/inquiryjrnl_40.1.71.

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Disabled people under age 65 are a vulnerable and growing segment of the Medicare population, yet Medicare reform has focused on the needs of the aged. This study linked the Medicare Current Beneficiary Survey to Social Security Administration records to analyze patterns of health care for disabled beneficiaries by reason for disability. We found substantial variation in average health care costs by type of service, including prescription drugs, and in sources of payment. Rates of institutionalization were high among some disability categories and there was heavy reliance on Medicaid and other public programs for payment. It is essential that the special needs of the disabled not be overlooked as policymakers consider fundamental modifications to Medicare and Medicaid.

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Benevides, Teal W., Henry J. Carretta, George Rust, and Lindsay Shea. "Racial and ethnic disparities in benefits eligibility and spending among adults on the autism spectrum: A cohort study using the Medicare Medicaid Linked Enrollees Analytic Data Source." PLOS ONE 16, no. 5 (May 25, 2021): e0251353. http://dx.doi.org/10.1371/journal.pone.0251353.

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Background Research on children and youth on the autism spectrum reveal racial and ethnic disparities in access to healthcare and utilization, but there is less research to understand how disparities persist as autistic adults age. We need to understand racial-ethnic inequities in obtaining eligibility for Medicare and/or Medicaid coverage, as well as inequities in spending for autistic enrollees under these public programs. Methods We conducted a cross-sectional cohort study of U.S. publicly-insured adults on the autism spectrum using 2012 Medicare-Medicaid Linked Enrollee Analytic Data Source (n = 172,071). We evaluated differences in race-ethnicity by eligibility (Medicare-only, Medicaid-only, Dual-Eligible) and spending. Findings The majority of white adults (49.87%) were full-dual eligible for both Medicare and Medicaid. In contrast, only 37.53% of Black, 34.65% Asian/Pacific Islander, and 35.94% of Hispanic beneficiaries were full-dual eligible for Medicare and Medicare, with most only eligible for state-funded Medicaid. Adjusted logistic models controlling for gender, intellectual disability status, costly chronic condition, rural status, county median income, and geographic region of residence revealed that Black beneficiaries were significantly less likely than white beneficiaries to be dual-eligible across all ages. Across these three beneficiary types, total spending exceeded $10 billion. Annual total expenditures median expenditures for full-dual and Medicaid-only eligible beneficiaries were higher among white beneficiaries as compared with Black beneficiaries. Conclusions Public health insurance in the U.S. including Medicare and Medicaid aim to reduce inequities in access to healthcare that might exist due to disability, income, or old age. In contrast to these ideals, our study reveals that racial-ethnic minority autistic adults who were eligible for public insurance across all U.S. states in 2012 experience disparities in eligibility for specific programs and spending. We call for further evaluation of system supports that promote clear pathways to disability and public health insurance among those with lifelong developmental disabilities.

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Dai, Mingliang, Pamela Roberto, Sarah Tom, Emma Gentry, and Bruce Stuart. "Quantifying the Cost of Disability Transitions in Medicare." Journal of Aging and Health 29, no. 5 (April 28, 2016): 788–804. http://dx.doi.org/10.1177/0898264316645547.

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Objective: To investigate the impact of disability transitions on annual Medicare Part A and B cost. Method: We analyzed 6,385 community-dwelling beneficiaries who were continuously enrolled in fee-for-service Medicare Part A and B from 2008 to 2009. We estimated adjusted effects of disability transitions on Medicare cost using a generalized linear model. Results: Transitions to more severe disability states were associated with significantly higher average annual Medicare cost ranging from US$2,639 to US$5,405. Lower spending levels were observed for beneficiaries with improvements in functioning. Beneficiaries who transitioned from severe to moderate activities of daily living (ADLs) disability cost significantly less (−US$6,045) than those who remained severely disabled. Discussion: Interventions aimed at preventing disability progression and efforts to restore functional capacity are promising strategies for containing costs and generating savings for Medicare. Future research is needed to assess the longer term impact of disability in association with the progression of chronic conditions.

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4

Cutler, David M. "Disability and the Future of Medicare." New England Journal of Medicine 349, no. 11 (September 11, 2003): 1084–85. http://dx.doi.org/10.1056/nejme038129.

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5

Rogers, Austin R., Sue-Min Lai, John Keighley, and Jessica Jungk. "The Incidence of Breast Cancer among Disabled Kansans with Medicare." Kansas Journal of Medicine 8, no. 3 (August 5, 2015): 93–100. http://dx.doi.org/10.17161/kjm.v8i3.11526.

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BACKGROUND: Breast cancer disparities by disability status are poorly understood. While previous studies have shown increased odds of late stage at diagnosis, it is unclear whether the incidence of breast cancer varies by disability status. METHODS: To assess cancer incidence and stage at diagnosis among disabled and nondisabled Medicare beneficiaries in Kansas, a retrospective cohort study was conducted using linked Medicare enrollment and Kansas Cancer Registry data from 2007 to 2009. Disability status was determined by the indicator for the original reason for Medicare eligibility. RESULTS: Among the 651,337 Medicare beneficiaries included in the cohort, there were 2,384 cases of breast cancer. The age-adjusted incidence was 313 per 100,000 among female beneficiaries with disabilities and 369 per 100,000 among nondisabled female beneficiaries. The adjusted incidence rate ratio was 0.93 (95% CI 0.73-1.18). When assessing stage at diagnosis, there was no difference in the odds of late stage at diagnosis by disability status (OR = 1.02; 95% CI 0.68-1.50). CONCLUSION: No significant difference in incidence or stage at diagnosis was identified among this cohort. The use of Medicare eligibility to define disability status presented a number of limitations. Future studies should seek alternate definitions of disability to assess disparities in breast cancer incidence, including definitions using Medicare claims data.

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6

Habermann, E. B., B. A. Virnig, P. M. McGovern, A. M. McBean, B. H. Alexander, and N. N. Baxter. "The effect of a cancer diagnosis on disability status." Journal of Clinical Oncology 27, no. 15_suppl (May 20, 2009): 6531. http://dx.doi.org/10.1200/jco.2009.27.15_suppl.6531.

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6531 Background: Although cancer and cancer treatments may lead to an inability to work, working-age adults eligible for Medicare benefits on the basis of disability face a 29-month waiting period between initial application due to disability and enrollment in the program. In this study we evaluated patterns of Medicare enrollment for working-age adults with cancer and determined factors predicting enrollment. Methods: The Surveillance, Epidemiology, and End Results (SEER) and SEER-Medicare data were used for this retrospective cohort analysis. We included patients age 21 to 59 diagnosed with lung, prostate, colorectal, and breast cancer (female) cases from 1992 through 2002. Patients were followed until 2005 or death. We constructed line plots of time from cancer diagnosis to enrollment in Medicare due to disability, anticipating a spike in enrollment around 29 months post-diagnosis. We compared demographic and tumor characteristics in the disabled to the all similarly aged patients included in SEER. We used logistic regression to determine factors associated with enrollment in Medicare due to disability 29 to 35 months post-diagnosis including demographic characteristics, stage at diagnosis, and type of surgical treatment. Results: We identified 359,049 working-age adults who were diagnosed with prostate, lung, colorectal, or female breast cancer. Within 5 years of diagnosis, 4.4% had enrolled in Medicare due to disability, most between 29 and 31 months post-diagnosis (the earliest time period of eligibility on the basis of cancer diagnosis). Later stage at diagnosis, lack of surgical treatment, aggressive surgical treatment, unmarried marital status, Hispanic or African American race/ethnicity, older age, and male gender were associated with statistically significantly higher odds of enrollment in Medicare due to disability. Conclusions: A significant number of working-age cancer patients become eligible for enrollment in Medicare due to disability. Most become eligible between 29 and 31 months after diagnosis indicating that cancer and/or treatment had a substantial permanent impact on ability to work from the time of diagnosis. Federal policy offering Medicare benefits only 29 months after application should be reevaluated. No significant financial relationships to disclose.

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7

Reichard, Amanda, Elsa Haile, and Andrew Morris. "Characteristics of Medicare Beneficiaries With Intellectual or Developmental Disabilities." Intellectual and Developmental Disabilities 57, no. 5 (October 2019): 405–20. http://dx.doi.org/10.1352/1934-9556-57.5.405.

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Gaps in knowledge and systematic tracking of the prevalence of intellectual and developmental disabilities (IDD) and characteristics that may affect the health of this disability group limits our ability to address the health disparities they experience in comparison to people without disability. The purpose of this study is to begin to fill one relevant critical gap in knowledge: understanding the demographics and health outcomes of adults with IDD who receive services under Medicare Fee-for-Service (FFS), many of who are also eligible for Medicaid. Using 2016 Medicare administrative claims, we examined the prevalence and characteristics of five diagnosis groups of IDD, in those under 65 and those 65 and over, as well as their health outcomes. We found that the IDD Medicare FFS group had high prevalence rates for chronic physical and mental health conditions, overuse of emergency departments, and high rate of 30-day readmission. These findings highlight the need for evidence-based health care coordination, improved and increased public health interventions, and continued surveillance.

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8

Sheldon, James R., and John S. Trach. "Social Security Disability Insurance and Supplemental Security Income Work Incentives with Recommendations for Policy Change." Journal of Applied Rehabilitation Counseling 29, no. 4 (December 1, 1998): 8–17. http://dx.doi.org/10.1891/0047-2220.29.4.8.

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This paper summarizes current Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) rules governing how work affects benefits, and explains how work activity affects Medicare and Medicaid. Recommendations are provided for policy change in order for the SSDI and SSI rules to operate as true work incentives.

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9

Peters, Jillian L., Wesley M. Durand, Kristina A. Monteiro, Luba Dumenco, and Paul George. "Opioid Overdose Hospitalizations among Medicare-Disability Beneficiaries." Journal of the American Board of Family Medicine 31, no. 6 (November 2018): 881–96. http://dx.doi.org/10.3122/jabfm.2018.06.180152.

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10

Liu, Korbin, Susan Wall, and Douglas Wissoker. "Disability and Medicare Costs of Elderly Persons." Milbank Quarterly 75, no. 4 (December 1997): 461–93. http://dx.doi.org/10.1111/1468-0009.00066.

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11

Fortinsky, Richard H., Ramon I. Garcia, T. Joseph Sheehan, Elizabeth A. Madigan, and Susan Tullai-McGuinness. "Measuring Disability in Medicare Home Care Patients." Medical Care 41, no. 5 (May 2003): 601–15. http://dx.doi.org/10.1097/01.mlr.0000062553.63745.7a.

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12

Ciol, Marcia A., Anne Shumway-Cook, Jeanne M. Hoffman, Kathryn M. Yorkston, Brian J. Dudgeon, and Leighton Chan. "Minority Disparities in Disability Between Medicare Beneficiaries." Journal of the American Geriatrics Society 56, no. 3 (March 2008): 444–53. http://dx.doi.org/10.1111/j.1532-5415.2007.01570.x.

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13

Porell, Frank W., and Helen B. Miltiades. "Disability Outcomes of Older Medicare HMO Enrollees and Fee-for-Service Medicare Beneficiaries." Journal of the American Geriatrics Society 49, no. 5 (May 2001): 615–31. http://dx.doi.org/10.1046/j.1532-5415.2001.49123.x.

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14

Chernew, Michael E., Dana P. Goldman, Feng Pan, and Baoping Shang. "Disability And Health Care Spending Among Medicare Beneficiaries." Health Affairs 24, Suppl2 (January 2005): W5—R42—W5—R52. http://dx.doi.org/10.1377/hlthaff.w5.r42.

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15

Chirikos, Thomas N. "Medicare And The Social Security Disability Insurance Program." Health Affairs 14, no. 4 (January 1995): 244–52. http://dx.doi.org/10.1377/hlthaff.14.4.244.

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16

Leutz, Walter, Tim Ford, Moon Leung, Marlin Mueller, Lucy Nonnenkamp, and Robert Newcomer. "Medicare Managed Care and Frail Elders: Lessons From Social HMOs." Care Management Journals 4, no. 3 (September 2003): 161–69. http://dx.doi.org/10.1891/cmaj.4.3.161.57518.

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After 20 years of operations, the Social HMO demonstration of integrated acute and long-term care is scheduled to end on December 31, 2004. While a new disability adjustment to the Medicare payment system promises to provide the financial underpinning for continuing to serve the 113,000 beneficiaries now enrolled at four sites, a broader regulatory structure as an alternative to current waivers is also needed. The regulations could also accommodate other frail elderly programs, which serve nursing home residents and beneficiaries of both Medicare and Medicaid. The relevance of Social HMOs—the largest and most broadly targeted of frail elderly programs—is reviewed herein, particularly regarding marketing, selectivity, reimbursement, and special frail elderly benefits and geriatric services.

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17

Omaira, M., M. Mozayen, R. Mushtaq, and K. Katato. "The impact of ethnicity and insurance status on stage of cancer at diagnosis and overall survival of breast cancer." Journal of Clinical Oncology 29, no. 27_suppl (September 20, 2011): 154. http://dx.doi.org/10.1200/jco.2011.29.27_suppl.154.

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154 Background: Major advances in early diagnosis and treatment of breast cancer (BC) have been achieved with significant declines in mortality. However, not all segments of the United States population have experienced equal benefits from this progress. Though ethnic disparities in BC outcome have been attributed to lack of adequate health insurance, the differences in outcome when insurance and socioeconomic status are similar still exist. We elected to examine the effect of insurance status at diagnosis, and whether race is an independent risk of poor outcome in a population from a community-based cancer database. Methods: A retrospective study on BC among patients aged 18 to 64 years were identified, between 1993 and 2005, using data from the Tumor Registry at Hurley Medical Center in Flint, Michigan. Patient’s characteristics included age, race, stage at diagnosis, and primary payer. Insurance status was classified as uninsured/Medicaid, private insurance, and Medicare disability (Medicare under age 65). The 5-year overall survival (OS) was calculated, in respect to patient ethnicity, and compared between the three insurance groups using Fisher’s exact test. Results: A total of 779 patients have been identified with diagnosis of BC. 147 patients were excluded due to incomplete data. 632 patients were analyzed. African Americans were 228 (36%), Caucasians 391 (62%), and other ethnicities 13 (2%). Mean age at diagnosis was (49.21) for African Americans versus (51.35) for Caucasians (p = 0.002). African Americans were more likely to present at advanced stage (III, IV) than Caucasians (17% versus 10%, p = 0.017). However, this difference was not statistically significant when adjusting for insurance status. Although both ethnicities had similar OS in respect of their insurance group, patients with Medicaid/uninsured had significantly lower OS compared to patients with Medicare disability (p = 0.006) and private insurance (p < 0.0001) respectively. Conclusions: Uninsured/Medicaid patients with breast cancer have worse outcome when compared to patients with Medicare or private insurance. Ethnicity is not an independent risk factor of advanced stage at diagnosis and poorer outcome.

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18

Degenholtz, Howard. "MANDATORY MEDICAID MANAGED LONG-TERM SERVICES AND SUPPORTS IN PENNSYLVANIA: EVALUATING POLICY CHANGE." Innovation in Aging 3, Supplement_1 (November 2019): S230. http://dx.doi.org/10.1093/geroni/igz038.849.

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Abstract The Commonwealth of Pennsylvania is implementing a mandatory Medicaid managed Long-Term Services and Supports (LTSS) program that covers people age 21 and older who are fully eligibly for both Medicare and Medicaid, living in a nursing facility paid for by Medicaid, or in an aged or physical disability home and community based services (HCBS) waiver. The overall program goals are to: Enhance Opportunities for Community Living; Improve Service Coordination; Enhance Quality and Accountability; Advance Program and Innovation; and Increase Efficiency. The program will be administered by 3 managed care organizations (MCOs) that are obligated to coordinate with Medicare Advantage and D-SNP plans. This major policy change affects the traditional roles and responsibilities of the aging network by shifting the locus of control to insurance companies. This presentation will describe the policy change, the implications for the aging network, and the multi-method evaluation designed to assess the implementation and outcomes.

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19

Martino, Steven, Megan Mathews, Cheryl Damberg, Judy Ng, Denis Agniel, Loida Tamayo, Shondelle Wilson-Frederick, and Marc N. Elliott. "RATES OF DISENROLLMENT FROM MEDICARE MANAGED CARE PLANS ARE HIGHER AMONG RACIAL, ETHNIC, AND LINGUISTIC MINORITIES." Innovation in Aging 3, Supplement_1 (November 2019): S429. http://dx.doi.org/10.1093/geroni/igz038.1604.

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Abstract Voluntary disenrollment from Medicare managed care (Medicare Advantage; MA) plans is related to beneficiaries’ negative experiences with their plan, disrupts continuity of care, and conflicts with goals to reduce Medicare costs. Information on associated factors may help illuminate the dynamics that drive decisions to disenroll. We used data from 17,517,852 beneficiaries enrolled in 736 MA plans in 2015 to investigate differences in rates of disenrollment by race, ethnicity, and preferred language. Disenrollment data came from Medicare’s enrollment system. Social Security Administration data on race and ethnicity were augmented with surname, address, and other Medicare administrative data to calculate probabilities of membership in seven race/ethnicity/language-preference groups: White, Black, English-preferring Hispanic, Spanish-preferring Hispanic, Asian or Pacific Islander (API), American Indian or Alaska Native, and multiracial. We summarized disparities across groups using regression models with and without plan intercepts, controlling for gender, disability, and Medicaid eligibility. Adjusted rates of disenrollment were significantly higher for Spanish-preferring Hispanics (19.1%), Blacks (10.2%), and APIs (9.4%) than for Whites (7.7%), and significantly lower for English-preferring Hispanics (7.4%, p’s<0.001). Within-plan disparities accounted for only a small fraction of overall disparities, indicating that Spanish-preferring Hispanics, Blacks, and APIs tended to be enrolled in plans with higher disenrollment than plans in which Whites were enrolled, whereas English-preferring Hispanics tended to be enrolled in plans with lower disenrollment. These between-plan differences may indicate that high-minority-enrollment plans less effectively inform beneficiaries about the cost and coverage of care or that racial/ethnic/linguistic minorities more often select plans that raise rates or restrict coverage.

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Choi, Namkee G., Diana M. DiNitto, and Bryan Y. Choi. "Unmet Healthcare Needs and Healthcare Access Gaps Among Uninsured U.S. Adults Aged 50–64." International Journal of Environmental Research and Public Health 17, no. 8 (April 15, 2020): 2711. http://dx.doi.org/10.3390/ijerph17082711.

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Lack of health insurance (HI) is a particular problem for near-older Americans aged 50–64 because they tend to have more chronic health conditions than younger age groups and are at increased risk of disability; however, little recent research has focused on HI coverage and healthcare access among this age group. Using the U.S. National Health Interview Survey data for the years 2013 to 2018, we compared HI coverage and healthcare access between the 50–64 and 65+ age groups. Using logistic regression analysis, we then examined the sociodemographic and health characteristics of past-year healthcare access of near-older Americans without HI to those with private HI or public HI (Medicare without Medicaid, Medicaid without Medicare, Medicare and Medicaid, and VA/military HI). We estimated the odds of healthcare access among those without HI compared to those with private or public HI. Near-older Americans without HI were at least seven times more likely to have postponed or foregone needed healthcare due to costs, and only 15% to 23% as likely to have had contact with any healthcare professional in the preceding 12 months. Expanding HI to near-older adults would increase healthcare access and likely result in reduced morbidity and mortality and higher quality of life for them.

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21

Kabiri, Mina, Alison Sexton Ward, Abhilasha Ramasamy, Rebecca Kee, Rahul Ganguly, Brian Gabriel Smolarz, Tracy Zvenyach, James R. Baumgardner, and Dana P. Goldman. "Simulating the Fiscal Impact of Anti-Obesity Medications as an Obesity Reduction Strategy." INQUIRY: The Journal of Health Care Organization, Provision, and Financing 58 (January 2021): 004695802199051. http://dx.doi.org/10.1177/0046958021990516.

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While substantial public health investment in anti-smoking initiatives has had demonstrated benefits on health and fiscal outcomes, similar investment in reducing obesity has not been undertaken, despite the substantial burden obesity places on society. Anti-obesity medications (AOMs) are poorly prescribed despite evidence that weight loss is not sustained using other strategies alone. We used a simulation model to estimate the potential impact of 100% uptake of AOMs on Medicare and Medicaid spending, disability payments, and taxes collected relative to status quo with negligible AOM use. Relative to status quo, AOM use simulation would result in Medicare and Medicaid savings of $231.5 billion and $188.8 billion respectively over 75 years. Government tax revenues would increase by $452.8 billion. Overall, the net benefit would be $746.6 billion. Anti-smoking efforts have had substantial benefits for society. A similar investment in obesity reduction, including broad use of AOMs, should be considered.

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22

Fabius, Chanee D., Portia Y. Cornell, and Kali S. Thomas. "MEDICAID FINANCING IN ASSISTED LIVING AND CHARACTERISTICS OF MEDICARE DUAL-ELIGIBLE RESIDENTS." Innovation in Aging 3, Supplement_1 (November 2019): S300. http://dx.doi.org/10.1093/geroni/igz038.1102.

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Abstract An increasing number of assisted living (AL) residents rely on Medicaid waivers or state plans to pay for personal care and other supportive services. States may finance services for duals residing in AL through Medicaid waivers and state plans, but the availability of coverage varies – some states offer little to no Medicaid coverage for services in AL, and others offer multiple pathways to receiving assistance. Little is known about duals in AL, including how many have access to AL and the quality of care they receive there. The present study compares the characteristics of Medicare beneficiaries residing in large AL settings, by dual-eligibility status, and investigates the variability in the share of duals in AL among states. We identified 586,397 Medicare beneficiaries residing in AL in 2014. Medicare claims were used to measure health characteristics and health care utilization. Duals represented 16% of AL residents in our cohort. Compared to non-duals, duals were more often older adults of color (24 vs 4%), and more likely to qualify for Medicare due to disability (46 vs 7%). Duals had higher rates of hospitalizations (24 vs 21%) and skilled nursing facility use while in AL (11 vs 10%), and more chronic conditions than non-duals. States varied in the share of AL residents who are duals, ranging from 6% in New Hampshire to 41% in New York. State policies that may contribute to variation in the prevalence of duals in AL and implications of these findings for policy-makers and residents will be discussed.

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23

Chan, Leighton, Shelli Beaver, Richard F. MacLehose, Amitabh Jha, Matthew Maciejewski, and Jason N. Doctor. "Disability and health care costs in the Medicare population." Archives of Physical Medicine and Rehabilitation 83, no. 9 (September 2002): 1196–201. http://dx.doi.org/10.1053/apmr.2002.34811.

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24

Jha, Amitabh, Leighton Chan, Jason Doctor, Richard MacLehose, and Donald Patrick. "DISABILITY AND DISSATISFACTION WITH CARE IN THE MEDICARE POPULATION." American Journal of Physical Medicine & Rehabilitation 79, no. 2 (March 2000): 211. http://dx.doi.org/10.1097/00002060-200003000-00069.

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25

Ankuda, Claire K., Katherine A. Ornstein, Kenneth E. Covinsky, Evan Bollens-Lund, Diane E. Meier, and Amy S. Kelley. "Switching Between Medicare Advantage And Traditional Medicare Before And After The Onset Of Functional Disability." Health Affairs 39, no. 5 (May 1, 2020): 809–18. http://dx.doi.org/10.1377/hlthaff.2019.01070.

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26

Choun, Soyoung, Lan Doan, Diana J. Govier, Karen Hooker, Carolyn Mendez-Luck, Shelbie Turner, and Veronica L. Irvin. "PREDICTORS OF MORTALITY RISK AMONG MEDICARE ADVANTAGE ENROLLEES." Innovation in Aging 3, Supplement_1 (November 2019): S724. http://dx.doi.org/10.1093/geroni/igz038.2654.

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Abstract Overall all-cause mortality rates have declined significantly in past decades among individuals aged 65 and above in every racial and ethnic group. We explored demographic, overall health, and disability development as predictors of mortality in Medicare beneficiaries enrolled in Medicare Advantage plans. We used data from the 2014-2018 Medicare Health Outcomes Survey, a nationally representative panel survey with a two-year follow-up, administered by the Centers for Medicare and Medicaid Services. Our sample consisted of 1,273,494 community-dwelling adults aged 65 and older (Mage = 74.5 years, age range: 65-109 years) enrolled in Medicare Advantage plans. Mortality was assessed over a 2-year follow-up period. We used Cox proportional hazards regression analysis to predict risk of all-cause mortality by demographics, self-rated health, chronic health conditions, smoking status, and activities of daily living (ADLs). Among all participants, the mortality rate was 7.0% (n = 88,058) at 2-year follow-up. Advanced age and being male were significantly associated with greater risk of mortality, while higher levels of education and income were inversely associated with mortality. Controlling for other factors, white adults had higher mortality risk than black or African American, Hispanic, and Asian older adults. Individuals who were unmarried, had lower self-rated health, had more chronic health conditions, smoked, and had more ADL limitations had higher mortality risk. Our findings suggest that sustained health and better functional capacity are important elements in decreasing the risk of mortality in older adults.

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McClintock, Heather F., Jibby E. Kurichi, Pui L. Kwong, Dawei Xie, Joel E. Streim, Liliana E. Pezzin, Sean Hennessey, Ling Na, and Hillary R. Bogner. "Disability Stages and Trouble Getting Needed Health Care Among Medicare Beneficiaries." American Journal of Physical Medicine & Rehabilitation 96, no. 6 (June 2017): 408–16. http://dx.doi.org/10.1097/phm.0000000000000638.

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28

Manton, Kenneth G., Vicki L. Lamb, and XiLiang Gu. "Medicare Cost Effects of Recent U.S. Disability Trends in the Elderly." Journal of Aging and Health 19, no. 3 (June 2007): 359–81. http://dx.doi.org/10.1177/0898264307300186.

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Maciejewski, Matthew L., Sarah Birken, Mark Perkins, James F. Burgess, Nancy Sharp, and Chuan-Fen Liu. "Medicare Managed Care Enrollment by Disability-Eligible and Age-Eligible Veterans." Medical Care 47, no. 11 (November 2009): 1180–85. http://dx.doi.org/10.1097/mlr.0b013e3181b58e17.

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30

Ben-Shalom, Yonatan, and David C. Stapleton. "Predicting Disability among Community-Dwelling Medicare Beneficiaries Using Claims-Based Indicators." Health Services Research 51, no. 1 (May 25, 2015): 262–81. http://dx.doi.org/10.1111/1475-6773.12316.

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31

Na, Ling, Sean Hennessy, Hillary R. Bogner, Jibby E. Kurichi, Margaret Stineman, Joel E. Streim, Pui L. Kwong, Dawei Xie, and Liliana E. Pezzin. "Disability stage and receipt of recommended care among elderly medicare beneficiaries." Disability and Health Journal 10, no. 1 (January 2017): 48–57. http://dx.doi.org/10.1016/j.dhjo.2016.09.007.

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32

Zhang, Yuting, Seo Hyon Baik, Chung-Chou H. Chang, Cameron M. Kaplan, and Judith R. Lave. "Disability, race/ethnicity, and medication adherence among Medicare myocardial infarction survivors." American Heart Journal 164, no. 3 (September 2012): 425–33. http://dx.doi.org/10.1016/j.ahj.2012.05.021.

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33

Manchikanti, Laxmaiah. "Obamacare 2012: Prognosis Unclear for Interventional Pain Management." Pain Physician 5;15, no. 5;9 (September 14, 2012): E629—E640. http://dx.doi.org/10.36076/ppj.2012/15/e629.

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The Patient Protection and Affordable Care Act (ACA), informally referred to as ObamaCare, is a United States federal statute signed into law by President Barack Obama on March 23, 2010. ACA has substantially changed the landscape of medical practice in the United States and continues to influence all sectors, in particular evolving specialties such as interventional pain management. ObamaCare has been signed into law amidst major political fallouts, has sustained a Supreme Court challenge and emerged bruised, but still very much alive. While proponents argue that ObamaCare will provide insurance for almost everyone, with an improvement in the quality of and reduction in the cost of health care, opponents criticize it as being a massive bureaucracy laden with penalties and taxes, that will ultimately eliminate personal medicine and individual practices. Based on the 2 years since the passage of ACA in 2010, the prognosis for interventional pain management is unclear. The damage sustained to interventional pain management and the majority of medicine practices is irreparable. ObamaCare may provide insurance for all, but with cuts in Medicare to fund ObamaCare, a limited expansion of Medicaid, the inadequate funding of exchanges, declining employer health insurance coverage and skyrocketing disability claims, the coverage will be practically nonexistent. ObamaCare is composed of numerous organizations and bureaucracies charged with controlling the practice of medicine through the extension of regulations. Apart from cutting reimbursements and reducing access to interventional pain management, administration officials are determined to increase the role of midlevel practitioners and reduce the role of individual physicians by liberalizing the scope of practice regulations and introducing proposals to reduce medical education and training. Key words: Patient Protection and Affordable Care Act, ObamaCare, interventional pain management, Patient-Centered Outcomes Research Institute, Independent Payment Advisory Board, Centers for Medicare and Medicaid Services, Accountable Care Organizations, Medicare, Medicaid

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Reichard, Amanda, and Michael H. Fox. "Using population-based data to examine preventive services by disability type among dually eligible (Medicare/Medicaid) adults." Disability and Health Journal 6, no. 2 (April 2013): 75–86. http://dx.doi.org/10.1016/j.dhjo.2012.12.001.

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Brandfonbrener, Alice G. "“But I Didn’t Ask to Be a Lawyer”: Dealing with Questions of Disability." Medical Problems of Performing Artists 17, no. 2 (June 1, 2002): 57–58. http://dx.doi.org/10.21091/mppa.2002.2008.

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Everyone involved in the practice of medicine is acutely aware that the nature of their work has changed dramatically over the past one to two decades. For one thing, given the requisites of dealing with managed care, Medicare, Medicaid, HMOs, and PPOs, there is a new language to be learned. The new systems often demand spending paperwork time in excess of that allowed for clinical work, filling out a myriad of constantly changing forms, and doing battle, not with one’s medical peers but with unseen gatekeepers trained in business not in medicine, in defense of treatment plans. To add insult to injury, and perhaps even more in conflict with the practice of good medicine, are those cases involving (1) workman’s compensation (WC) and (2) personal injury (PI) litigation. Most physicians presumably elected medicine over other professions, including business or law, and thus have reason to resent the proportion of their time taken from what they do best, taking care of patients, by the many administrative and legal aspects of practicing medicine.

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Miles, Jennifer, Stephen Crystal, Peter Treitler, and Richard Hermida. "Medically Assisted Treatment of Opioid Use Disorder Among Elderly and Non-Elderly Medicare Beneficiaries." Innovation in Aging 4, Supplement_1 (December 1, 2020): 54. http://dx.doi.org/10.1093/geroni/igaa057.175.

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Abstract Although medication for addiction treatment (MAT) is known to be the most effective treatment for opioid use disorder (OUD), these medications are widely underutilized, especially among older adults and racial/ethnic minorities. Of the three main MAT modalities, Medicare covered buprenorphine and naltrexone in 2017; methadone was not covered until 2020. We examined MAT prescribing among elderly compared with non-elderly Medicare beneficiaries. Our sample was drawn from a ~40% random sample of 2017 Medicare beneficiaries with Part D coverage and was comprised of elderly beneficiaries (age 65+) with OUD (N=112,314) or who experienced opioid poisoning (N=9,657), and non-elderly Medicare beneficiaries (the Medicare disability population, age 0-64) with OUD (N=161,423) or opioid poisoning (N=13,591). MAT was underutilized in both Medicare populations, but especially in the elderly population. Of elderly beneficiaries with OUD, 5.1% and 0.8% were prescribed buprenorphine and naltrexone, respectively, compared to 15.5% and 2.3% among non-elderly. Among elderly beneficiaries with opioid poisoning, 3.1% and 0.8% were prescribed buprenorphine and naltrexone, respectively, compared to 10.1% and 3.2% in the non-elderly population. Sharp racial/ethnic disparities were identified within each age group. These findings highlight the need to expand access to MAT for Medicare beneficiaries, particularly older adults among whom underutilization is pronounced. Several recent Medicare policy changes have sought to address this issue, but continuing efforts and close monitoring are warranted in an effort to dramatically increase rates of treatment for elderly with opioid use disorder.

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Ottenbacher, Kenneth. "Rehabilitation of Aging Persons: The Past, The Present & The Promise." Innovation in Aging 4, Supplement_1 (December 1, 2020): 867. http://dx.doi.org/10.1093/geroni/igaa057.3208.

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Abstract The 2020 Excellence in Rehabilitation of Aging Persons Award presentation will address my efforts over the past 35 years related to research methods, functional status, mobility, and self-care. Studies conducted in the past 25 years on disability and recovery in older adults with an emphasis on minority health will be presented. Research examining rehabilitation outcomes related to health care reform including the Improving Medicare Post-Acute Care Transformation (IMPACT) Act, and using Medicare files, will be described. The role of Data Science and Discovery, as defined by the NIH and related to rehabilitation in older adults, will also be presented.

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Kuo, Yong-Fang, Mukaila A. Raji, and James S. Goodwin. "Association of Disability With Mortality From Opioid Overdose Among US Medicare Adults." JAMA Network Open 2, no. 11 (November 15, 2019): e1915638. http://dx.doi.org/10.1001/jamanetworkopen.2019.15638.

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Zhang, Yuting, and Seo Hyon Baik. "Race/Ethnicity, Disability, and Medication Adherence Among Medicare Beneficiaries with Heart Failure." Journal of General Internal Medicine 29, no. 4 (December 24, 2013): 602–7. http://dx.doi.org/10.1007/s11606-013-2692-x.

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Manchikanti, Laxmaiah. "An Updated Assessment of Utilization of Interventional Pain Management Techniques in the Medicare Population: 2000 – 2013." Pain Physician 2;18, no. 2;3 (March 14, 2015): E115—E127. http://dx.doi.org/10.36076/ppj/2015.18.e115.

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Background: The rapid increase in the prevalence of chronic pain and disability, and the explosion of interventional pain management associated health care costs are a major concern for our community. Further, the increasing utilization of numerous modalities of treatments in managing chronic pain, continue to escalate at a pace which may not be sustainable. There are multiple regulations in place to control the growth of health care expenditures which seem to have been largely ineffective. Among the various modalities utilized in managing chronic pain, interventional techniques have shown a significant increase in their utilization in the face of continued debate with respect to the accuracy of diagnostic interventions and the efficacy of therapeutic interventions. Objective: To update and assess the utilization of interventional techniques in chronic pain management in fee-for-service Medicare population. Study Design: An updated analysis of the growth of interventional techniques in managing chronic pain in fee-for-service Medicare beneficiaries from 2000 through 2013. Methods: The data were derived and analyzed utilizing the Centers for Medicare and Medicaid Services (CMS) Physician Supplier Procedure Summary Master Data from 2000 through 2013. Results: From 2000 through 2013, in fee-for-service Medicare beneficiaries, the overall utilization of interventional techniques services increased 236% at an annual average growth of 9.8%, whereas the per 100,000 Medicare population utilization increased 156% with an annual average growth of 7.5%. During this period, the US population increased 12% with an annual average increase of 0.9%, whereas those above 65 years of age increased 27% with an annual average increase of 1.9%. Total Medicare beneficiaries increased 31% with an annual average increase of 2.1%, with an overall increase of 64% for those above 65 years of age, an increase of 26%, constituting 17% of the US population in 2013. The overall increases in epidural and adhesiolysis procedures were 165% compared to 102% per 100,000 fee-for-service population with annual average increases of 7.8% and 5.6%. Facet joint and sacroiliac joint injections increased 417% for services with an annual average increase of 13.5%, whereas the rate per 100,000 fee-for-service Medicare beneficiaries increased 295% with an annual average increase of 11.1%. Limitations: Limitations of this assessment include the lack of inclusion of participants from Medicare Advantage plans, lack of appropriate available data for state-wide utilization, and potential errors in documentation, coding, and billing. Conclusion: This update once again shows a significant increase in interventional techniques in feefor-service Medicare beneficiaries from 2000 through 2013 with an increase of 156% per 100,000 Medicare population with an annual average increase of 7.5%. During this period the Medicare population increased 31% with an annual average increase of 2.1%. Key words: Chronic pain, chronic spinal pain, interventional pain management, interventional techniques, epidural injections, facet joint interventions, sacroiliac joint injections

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Raji, Mukaila A., Matthew Lowery, Yu-Li Lin, Yong-Fang Kuo, Jacques Baillargeon, and James S. Goodwin. "National Utilization Patterns of Warfarin Use in Older Patients with Atrial Fibrillation: A Population-Based Study of Medicare Part D Beneficiaries." Annals of Pharmacotherapy 47, no. 1 (January 2013): 35–42. http://dx.doi.org/10.1345/aph.1r515.

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BACKGROUND Although warfarin therapy reduces stroke incidence in patients with atrial fibrillation (AF), the rate of warfarin use in this population remains low. In 2008, the Medicare Part D program was expanded to pay for medications for Medicare enrollees. OBJECTIVE To examine rates and predictors of warfarin use in Medicare Part D beneficiaries with AF. METHODS This population-based retrospective cohort study used claims data from 41,447 Medicare beneficiaries aged 66 and older with at least 2 AF diagnoses in 2007 and at least 1 diagnosis in 2008. All subjects had continuous Medicare Part D prescription coverage in 2008. Statistical analysis using χ2 was used to examine differences in warfarin use by patient characteristics (age, ethnicity, sex, Medicaid eligibility, comorbidities, contraindications to warfarin, and whether they visited a cardiologist or a primary care physician [PCP]), CHADS2 score (congestive heart failure, hypertension, age, diabetes, and stroke or transient ischemic attack; higher scores indicate higher risks of stroke), and geographic regions. Using hierarchical generalized linear models restricted to subjects without warfarin contraindications (n = 34,947), we examined the effect of patient characteristics and geographic regions on warfarin use. RESULTS The overall warfarin use rate was 66.8%. The warfarin use rates varied between hospital referral regions, with highest rates in the Midwestern states and lowest rates in the South. The regional variation persisted even after adjustment for patient characteristics. Multivariable analysis showed that the odds of being on warfarin decreased significantly with age and increasing comorbidity, in blacks, and among those with low income. Seeing a cardiologist (OR 1.10; 95% CI 1.05–1.16), having a PCP (OR 1.23; 95% CI 1.17–1.29), and CHADS2 score of 2 or greater (OR 1.09; 95% CI 1.01–1.17) were associated with increased odds of warfarin use. CONCLUSIONS Warfarin use rates vary by patient characteristics and region, with higher rates among residents of the Midwest and among patients seen by cardiologists and PCPs. Preventing stroke-related disability in AF requires implementation of evidence-based initiatives to increase warfarin use.

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Khavjou, Olga A., Wayne L. Anderson, Amanda A. Honeycutt, Laurel G. Bates, NaTasha D. Hollis, Scott D. Grosse, and Hilda Razzaghi. "State-Level Health Care Expenditures Associated With Disability." Public Health Reports 136, no. 4 (March 5, 2021): 441–50. http://dx.doi.org/10.1177/0033354920979807.

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Objective Given the growth in national disability-associated health care expenditures (DAHE) and the changes in health insurance–specific DAHE distribution, updated estimates of state-level DAHE are needed. The objective of this study was to update state-level estimates of DAHE. Methods We combined data from the 2013-2015 Medical Expenditure Panel Survey, 2013-2015 Behavioral Risk Factor Surveillance System, and 2014 National Health Expenditure Accounts to calculate state-level DAHE for US adults in total, per adult, and per (adult) person with disability (PWD). We adjusted expenditures to 2017 prices and assessed changes in DAHE from 2003 to 2015. Results In 2015, DAHE were $868 billion nationally (range, $1.4 billion in Wyoming to $102.8 billion in California) accounting for 36% of total health care expenditures (range, 29%-41%). From 2003 to 2015, total DAHE increased by 65% (range, 35%-125%). In 2015, DAHE per PWD were highest in the District of Columbia ($27 839) and lowest in Alabama ($12 603). From 2003 to 2015, per-PWD DAHE increased by 13% (range, −20% to 61%) and per-capita DAHE increased by 28% (range, 7%-84%). In 2015, Medicare DAHE per PWD ranged from $10 067 in Alaska to $18 768 in New Jersey. Medicaid DAHE per PWD ranged from $9825 in Nevada to $43 365 in the District of Columbia. Nonpublic–health insurer per-PWD DAHE ranged from $7641 in Arkansas to $18 796 in Alaska. Conclusion DAHE are substantial and vary by state. The public sector largely supports the health care costs of people with disabilities. State policy makers and other stakeholders can use these results to inform the development of public health programs that support and provide ongoing health care to people with disabilities.

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Michaels, Alex D., J. Hunter Mehaffey, Robert B. Hawkins, Max O. Meneveau, Bruce D. Schirmer, and Peter T. Hallowell. "Ten-year outcomes of Roux-en-Y gastric bypass are equivalent in patients with Medicare disability and non-Medicare patients." Surgery 164, no. 4 (October 2018): 905–8. http://dx.doi.org/10.1016/j.surg.2018.05.041.

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Xue, Qian-Li, Kristine Ensrud, and Shari Lin. "Leveraging Existing Data from CMS-Linked Cohort Studies for the Advancement and Translation of Frailty Research." Innovation in Aging 4, Supplement_1 (December 1, 2020): 777. http://dx.doi.org/10.1093/geroni/igaa057.2810.

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Abstract As population aging is accelerating rapidly, there is growing concern on how to best provide patient-centered care for the most vulnerable. Establishing a predictable and affordable cost structure for healthcare services is key to improving quality, accessibility, and affordability. One such effort is the “frailty” adjustment model implemented by the Centers for Medicare & Medicaid Services (CMS) that adjusts payments to a Medicare managed care organization based on functional impairment of its beneficiaries. Earlier studies demonstrated added value of this frailty adjuster for prediction of Medicare expenditures independent of the diagnosis-based risk adjustment. However, we hypothesize that further improvement is possible by implementing more rigorous frailty assessment rather than relying on self-report of ADL difficulties as used for the frailty adjuster. This is supported by the consensus and clinical observations that neither multimorbidity nor disability alone is sufficient for frailty identification. This symposium consists of four talks that leverage data from three CMS-linked cohort studies to investigate the utility of assessment of the frailty phenotype for predicting healthcare utilization and costs. Talk 1 and 2 use data from the NHATS cohort to assess healthcare utilization by frailty status in the general population and the homebound subset. Talk 3 and 4 use data from the MrOS study and the SOF study to investigate the impact of frailty phenotype on healthcare costs. Taken together, their findings highlight the potential of incorporating phenotypic frailty assessment into CMS risk adjustment to improve the planning and management of care for frail older adults.

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Stearns, Sally C., Edward C. Norton, and Zhou Yang. "How Age and Disability Affect Long-Term Care Expenditures in the United States." Social Policy and Society 6, no. 3 (June 7, 2007): 367–78. http://dx.doi.org/10.1017/s1474746407003697.

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The ageing of the population and increasing longevity result in predictions of sizeable increases in long-term care expenditures. Other analyses have shown significant decreases in disability prevalence among older people in the US. This study provides an empirical quantification of the net result of these two forces (increased expenditures due to ageing versus potential expenditure reductions due to reduced disability) using the Medicare Current Beneficiary Survey. The analyses show that the implications of ageing and increasing longevity for long-term care expenditures are modest relative to the effects of future increases or decreases in functional abilities of older people.

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Bailey, Michelle Stegman, and Robert R. Weathers. "The Accelerated Benefits Demonstration: Impacts on the Employment of Disability Insurance Beneficiaries." American Economic Review 104, no. 5 (May 1, 2014): 336–41. http://dx.doi.org/10.1257/aer.104.5.336.

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We use data from the Accelerated Benefits demonstration to estimate the impacts of providing newly entitled disability insurance (DI) beneficiaries with health insurance and additional services during the DI program's 24-month Medicare waiting period. While health insurance alone did not increase employment, the additional employment services appeared to have positive short-term impacts on labor market activity. We find a statistically significant increase in employment and earnings in the second calendar year after random assignment; although these findings disappear in the third calendar year. Our results may have implications for disability reform proposals and provisions within the Affordable Care Act.

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Snih, Soham Al, Lin-Na Chou, Brian Downer, Mukaila Raji, Yong-fang Kuo, Kyriakos Markides, and Kenneth Ottenbacher. "ALZHEIMER’S DISEASE AND RELATED DEMENTIAS IN MEXICAN AMERICAN MEDICARE BENEFICIARIES." Innovation in Aging 3, Supplement_1 (November 2019): S118. http://dx.doi.org/10.1093/geroni/igz038.435.

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Abstract Objective: To determine the prevalence and incidence of Alzheimer’s Disease and Related Dementias (ADRD), and to identify the socio-demographic and health characteristics of Mexican-American older adults with ADRD. Methods: Data are from wave 5 (2004/05) of the Hispanic Established Population for the Epidemiological Study of the Elderly linked with Centers for Medicare and Medicaid Services files. We studied 1166 participants of which 927 did not have an ADRD diagnosis before wave 5 interview and followed until 2016. Measures included socio-demographics, medical conditions, depression, physical function, Mini-Mental-State- Examination (MMSE), body mass index (BMI), disability, and ICD-9-CM codes for ADRD. Results: A total of 424 participants had an index diagnosis of ADRD during 11-years. The total prevalence rate ranged from 31.6% in 2006 to 72.8% in 2016, and the total incidence rate ranged from 9.3% in 2006 to 15.8% in 2016. The prevalence rate ranged from 30.3% to 69.7% in men and 32.5% to 74.1% in women. The incidence rate ranged from 8.5% to 12.9% in men and 9.8% to 12.9% in women. Those with ADRD were significantly more likely to be older (82.1 versus 81.6 years; p-value=0.024) and to have a lower score in the MMSE (21.1 versus 21.7; p-value=0.013) compared with whole sample (N=927). Non-significant differences were observed by sex, education, medical conditions, BMI, depression, physical function or disability compared with whole sample. Conclusions: The prevalence and incidence rates of ADRD in Mexican-American Beneficiaries is high. These findings underscore the need for clinical services and caregiving resources in this population.

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Akushevich, I., J. Kravchenko, S. Ukraintseva, K. Arbeev, and A. Yashin. "Population-Based Analysis of Incidence Rates of Cancer and Noncancer Chronic Diseases in the US Elderly Using NLTCS/Medicare-Linked Database." ISRN Geriatrics 2013 (March 20, 2013): 1–15. http://dx.doi.org/10.1155/2013/943418.

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The age, disability, and comorbidity patterns of incidence rates of cancer and chronic noncancer diseases such as heart failure, diabetes mellitus, asthma, Parkinson's disease, Alzheimer's disease, skin melanoma, and cancers of breast, prostate, lung, and colon were studied for the US elderly population (aged 65+) using the National Long-Term Care Survey (NLTCS) data linked to Medicare records for 1991–2005. Opposite to breast cancer and asthma, incidence rates of heart failure and Alzheimer's diseases were increasing with age. Higher incidence rates of heart failure, diabetes, asthma, and Parkinson's and Alzheimer's diseases were observed among individuals with severe disabilities or/and comorbidities, while rates of breast and prostate cancers were higher among those with minor disabilities or fewer comorbidities. Our results were in agreement with those obtained from other epidemiological datasets, thus suggesting that Medicare administrative records can provide nationally representative incidence rates. Detailed sensitivity analysis that focused on the effects of alternative onset definitions, latent censoring, study design, and other procedural uncertainties showed the stability of reconstructed incidence rates. This Medicare-linked dataset can be used for studying highly debated effects of new medical technologies on aging-related diseases burden and future Medicare costs.

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Kumar, Amit, Maricruz Rivera-Hernandez, Lin-Na Chou, Amol Karmarkar, Yong-Fang Kuo, and Kenneth J. Ottenbacher. "ROLE OF SOCIAL DETERMINANTS IN ENROLLMENT AND DISENROLLMENT IN MEDICARE INSURANCE PLANS IN OLDER MEXICAN AMERICANS." Innovation in Aging 3, Supplement_1 (November 2019): S563. http://dx.doi.org/10.1093/geroni/igz038.2081.

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Abstract Objective: The objective of this study is to examine the association between social-medical risk factor with disenrollment from Medicare Fee-for-Service (FFS) and enrollment in a Medicare Advantage (MA) plan in Older Mexican Americans. Methods: The sample included older adults participating in the Hispanic Established Populations for the Epidemiologic Study of the Elderly linked with Medicare data. We used logistic regression to estimate odds ratios (OR) for the association of each sociodemographic and clinical factor with insurance plan switching. Results: FFS enrollees were more likely to speak Spanish, less educated, lower income, disability, and be dual eligible compared to MA enrollees. At 2-year follow up, older adults with social support had higher odds of switching from FFS to MA after controlling for all covariates (OR; 1.73, 95% CI: 1.11-2.69). Conclusion: Having social support from family and the community was strongly associated with disenrollment from FFS and transition to an MA plan.

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Foote, Sandra M., and Christopher Hogan. "Disability Profile And Health Care Costs Of Medicare Beneficiaries Under Age Sixty-Five." Health Affairs 20, no. 6 (November 2001): 242–53. http://dx.doi.org/10.1377/hlthaff.20.6.242.

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