Inappropriate Utilization in Fee-for-Service Medicare and Medicare Advantage Plans

Details

• Personal Author:
  Dowd B ; Kim S ; Parashuram S
• Description:
  This study uses a national multi-payer claims database to test for differences in potentially inappropriate emergency department (ED) visits and ambulatory care sensitive (ACS) admissions in fee-for-service (FFS) Medicare and Medicare Advantage (MA) plans. Rates of ACS admissions for MA enrollees were approximately one third those of FFS beneficiaries, controlling for covariates, which included the beneficiary's health status as represented by their risk score. This study then compared FFS and MA beneficiaries when they moved from one type of health plan to another. Again, controlling for covariates, potentially inappropriate ED visits and ACS admissions remained at their low baseline values for FFS beneficiaries who switched from FFS Medicare to MA plans, but rose for MA enrollees switching to FFS Medicare. [Description provided by NIOSH]
• Subjects:
  Emergency Responders Occupational Health Safety
• Keywords:
  ACS Admissions Author Keywords: Medicare Cost Analyses Costs ED Visits Emergency Care Health Care Inappropriate Utilization Medicare Advantage Policy
• ISSN:
  1062-8606
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article
• Place as Subject:
  Maryland ; Minnesota ; OSHA Region 3 ; OSHA Region 5
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  58-64
• Volume:
  33
• Issue:
  1
• NIOSHTIC Number:
  nn:20064245
• Citation:
  Am J Med Qual 2018 Jan/Feb; 33(1):58-64
• Contact Point Address:
  Bryan Dowd, PhD, Division of Health Policy and Management, School of Public Health, University of Minnesota, Box 729 MMC, Minneapolis, MN 55455
• Email:
  dowdx001@umn.edu
• Federal Fiscal Year:
  2018
• Performing Organization:
  University of Minnesota Twin Cities
• Peer Reviewed:
  True
• Start Date:
  20050701
• Source Full Name:
  American Journal of Medical Quality
• End Date:
  20250630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:1c2b86a32d6265550840d68e86875afdd215189db173a56b3f79e72e34bdf6ac9c3509421404a804f2c122dbfbfe50d2023f9ebbdfb1a94bdcf84749fd4292e3
• Download URL:
  https://stacks.cdc.gov/view/cdc/222744/cdc_222744_DS1.pdf
• File Type:
  [PDF - 122.14 KB ]