Nav: Home

Research suggests strategy for more equitable Medicare reimbursement

April 29, 2019

Those who were enrolled in both Medicare and Medicaid were sicker, had more cognitive impairments and difficulty functioning, and needed more social support than those who were not enrolled in both government programs, Saint Louis University research found. These patients also had significantly higher healthcare costs.

Kenton Johnston, Ph.D., assistant professor of health management and policy at Saint Louis University, is the lead author of the paper, which was published in the April 2019 issue of Health Affairs.

The findings have implications for improving outcomes and reducing disparities in that they target a more vulnerable patient population that faces higher medical expenses.

"For example, home-based primary care has shown significant promise for reducing costs and adverse health events in frail elders. Such programs might also benefit dual enrollees with poor functional status, many of whom may also be at risk for frailty," Johnston wrote.

The findings also suggest that adjusting for the risk factors seen in patients who receive both Medicare and Medicaid could be a more equitable way of reimbursing for health care.

"This suggests that such adjustment would not only reduce potentially inappropriate penalties among providers that disproportionately care for vulnerable populations but would also reduce inappropriate bonuses for providers that care for less complex populations," Johnston wrote.

"Medicare could consider using such adjustment to improve accuracy and fairness in value-based payment programs in the future."
-end-
Karen Joynt Maddox, M.D., assistant professor of medicine at Washington University, is co-author of the paper. Her work is supported by the National Heart, Lung and Blood Institute (grant number K23-HL109177-03). She also does work under contract with the Office of the Assistant Secretary for Planning and Evaluation in the Department of Health and Human Services.

Johnston received support from Saint Louis University, which purchased and provided access to data from the Medicare Current Beneficiary Survey and respondents' fee-for-service Medicare claims and administrative data used in this study.

The Saint Louis University College for Public Health and Social Justice is the only academic unit of its kind, studying social, environmental and physical influences that together determine the health and well-being of people and communities. It also is the only accredited school or college of public health among nearly 250 Catholic institutions of higher education in the United States.

Guided by a mission of social justice and focus on finding innovative and collaborative solutions for complex health problems, the College offers nationally recognized programs in public health, social work, health administration, applied behavior analysis, and criminology and criminal justice.

Saint Louis University

Related Health Care Articles:

Large federal program aimed at providing better health care underfunds primary care
Despite a mandate to help patients make better-informed health care decisions, a ten-year research program established under the Affordable Care Act has funded a relatively small number of studies that examine primary care, the setting where the majority of patients in the US receive treatment.
International medical graduates care for Medicare patients with greater health care needs
A study by a Massachusetts General Hospital research team indicates that internal medicine physicians who are graduates of medical schools outside the US care for Medicare patients with more complex medical needs than those cared for by graduates of American medical schools.
The Lancet Global Health: Improved access to care not sufficient to improve health, as epidemic of poor quality care revealed
Of the 8.6 million deaths from conditions treatable by health care, poor-quality care is responsible for an estimated 5 million deaths per year -- more than deaths due to insufficient access to care (3.6 million) .
Under Affordable Care Act, Americans have had more preventive care for heart health
By reducing out-of-pocket costs for preventive treatment, the Affordable Care Act appears to have encouraged more people to have health screenings related to their cardiovascular health.
High-deductible health care plans curb both cost and usage, including preventive care
A team of researchers based at IUPUI has conducted the first systematic review of studies examining the relationship between high-deductible health care plans and the use of health care services.
More Health Care News and Health Care Current Events

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Erasing The Stigma
Many of us either cope with mental illness or know someone who does. But we still have a hard time talking about it. This hour, TED speakers explore ways to push past — and even erase — the stigma. Guests include musician and comedian Jordan Raskopoulos, neuroscientist and psychiatrist Thomas Insel, psychiatrist Dixon Chibanda, anxiety and depression researcher Olivia Remes, and entrepreneur Sangu Delle.
Now Playing: Science for the People

#537 Science Journalism, Hold the Hype
Everyone's seen a piece of science getting over-exaggerated in the media. Most people would be quick to blame journalists and big media for getting in wrong. In many cases, you'd be right. But there's other sources of hype in science journalism. and one of them can be found in the humble, and little-known press release. We're talking with Chris Chambers about doing science about science journalism, and where the hype creeps in. Related links: The association between exaggeration in health related science news and academic press releases: retrospective observational study Claims of causality in health news: a randomised trial This...