This study describes demographic characteristics and hospital bed capacities of the 5 New York City boroughs, and evaluates whether differences in testing for coronavirus disease 2019 (COVID-19), ...hospitalizations, and deaths have emerged as a signal of racial, ethnic, and financial disparities.
Some policymakers have pushed for the HRRP to be expanded to cover all conditions treated in inpatient settings. Others, including many clinicians and researchers, have expressed skepticism regarding ...the program’s effects and concerns about unintended consequences.
People living in rural areas have worse health outcomes than their urban counterparts do. Understanding what factors account for this could inform policy interventions for reducing rural-urban ...disparities in health. We examined a nationally representative survey of Medicare beneficiaries with one or more complex chronic conditions, which represented 61 percent of rural and 57 percent of urban Medicare beneficiaries. We found that rural residence was associated with a 40 percent higher preventable hospitalization rate and a 23 percent higher mortality rate, compared to urban residence. Having one or more specialist visits during the previous year was associated with a 15.9 percent lower preventable hospitalization rate and a 16.6 percent lower mortality rate for people with chronic conditions, after we controlled for having one or more primary care provider visits. Access to specialists accounted for 55 percent and 40 percent of the rural-urban difference in preventable hospitalizations and mortality, respectively. Medicare should consider interventions for rural beneficiaries who lack access to specialist care to reduce rural-urban disparities in health outcomes.
Guidelines on how the medical community and policy makers should prepare for the second surge of COVID-19 patients on postacute care facilities are suggested. In such a scenario, adequate ...infrastructure, staff training and protective equipment must be ensured for postacute care facilities.
Understanding and addressing the unique health needs of people residing in rural America is critical to the American Heart Association’s pursuit of a world with longer, healthier lives. Improving the ...health of rural populations is consistent with the American Heart Association’s commitment to health equity and its focus on social determinants of health to reduce and ideally to eliminate health disparities. This presidential advisory serves as a call to action for the American Heart Association and other stakeholders to make rural populations a priority in programming, research, and policy. This advisory first summarizes existing data on rural populations, communities, and health outcomes; explores 3 major groups of factors underlying urban-rural disparities in health outcomes, including individual factors, social determinants of health, and health delivery system factors; and then proposes a set of solutions spanning health system innovation, policy, and research aimed at improving rural health.
IMPORTANCE: Declines in cardiovascular mortality have stagnated in the US over the past decade, in part related to worsening risk factor control in older adults. Little is known about how the ...prevalence, treatment, and control of cardiovascular risk factors have changed among young adults aged 20 to 44 years. OBJECTIVE: To determine if the prevalence of cardiovascular risk factors (hypertension, diabetes, hyperlipidemia, obesity, and tobacco use), treatment rates, and control changed among adults aged 20 to 44 years from 2009 through March 2020, overall and by sex and race and ethnicity. DESIGN, SETTING, AND PARTICIPANTS: Serial cross-sectional analysis of adults aged 20 to 44 years in the US participating in the National Health and Nutrition Examination Survey (2009-2010 to 2017–March 2020). MAIN OUTCOMES AND MEASURES: National trends in the prevalence of hypertension, diabetes, hyperlipidemia, obesity, and smoking history; treatment rates for hypertension and diabetes; and blood pressure and glycemic control in those receiving treatment. RESULTS: Among 12 924 US adults aged 20 to 44 years (mean age, 31.8 years; 50.6% women), the prevalence of hypertension was 9.3% (95% CI, 8.1%-10.5%) in 2009-2010 and 11.5% (95% CI, 9.6%-13.4%) in 2017-2020. The prevalence of diabetes (from 3.0% 95% CI, 2.2%-3.7% to 4.1% 95% CI, 3.5%-4.7%) and obesity (from 32.7% 95% CI, 30.1%-35.3% to 40.9% 95% CI, 37.5%-44.3%) increased from 2009-2010 to 2017-2020, while the prevalence of hyperlipidemia decreased (from 40.5% 95% CI, 38.6%-42.3% to 36.1% 95% CI, 33.5%-38.7%). Black adults had high rates of hypertension across the study period (2009-2010: 16.2% 95% CI, 14.0%-18.4%; 2017-2020: 20.1% 95% CI, 16.8%-23.3%), and significant increases in hypertension were observed among Mexican American adults (from 6.5% 95% CI, 5.0%-8.0% to 9.5% 95% CI, 7.3%-11.7%) and other Hispanic adults (from 4.4% 95% CI, 2.1%-6.8% to 10.5% 95% CI, 6.8%-14.3%), while Mexican American adults had a significant rise in diabetes (from 4.3% 95% CI, 2.3%-6.2% to 7.5% 95% CI, 5.4%-9.6%). The percentage of young adults treated for hypertension who achieved blood pressure control did not significantly change (from 65.0% 95% CI, 55.8%-74.2% in 2009-2010 to 74.8% 95% CI, 67.5%-82.1% in 2017-2020, while glycemic control among young adults receiving treatment for diabetes remained suboptimal throughout the study period (2009-2010: 45.5% 95% CI, 27.7%-63.3%) to 2017-2020: 56.6% 95% CI, 39.2%-73.9%). CONCLUSIONS AND RELEVANCE: In the US, diabetes and obesity increased among young adults from 2009 to March 2020, while hypertension did not change and hyperlipidemia declined. There was variation in trends by race and ethnicity.
IMPORTANCE: The Hospital Readmissions Reduction Program (HRRP) has been associated with a reduction in readmission rates for heart failure (HF), acute myocardial infarction (AMI), and pneumonia. It ...is unclear whether the HRRP has been associated with change in patient mortality. OBJECTIVE: To determine whether the HRRP was associated with a change in patient mortality. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of hospitalizations for HF, AMI, and pneumonia among Medicare fee-for-service beneficiaries aged at least 65 years across 4 periods from April 1, 2005, to March 31, 2015. Period 1 and period 2 occurred before the HRRP to establish baseline trends (April 2005-September 2007 and October 2007-March 2010). Period 3 and period 4 were after HRRP announcement (April 2010 to September 2012) and HRRP implementation (October 2012 to March 2015). EXPOSURES: Announcement and implementation of the HRRP. MAIN OUTCOMES AND MEASURES: Inverse probability–weighted mortality within 30 days of discharge following hospitalization for HF, AMI, and pneumonia, and stratified by whether there was an associated readmission. An additional end point was mortality within 45 days of initial hospital admission for target conditions. RESULTS: The study cohort included 8.3 million hospitalizations for HF, AMI, and pneumonia, among which 7.9 million (mean age, 79.6 8.7 years; 53.4% women) were alive at discharge. There were 3.2 million hospitalizations for HF, 1.8 million for AMI, and 3.0 million for pneumonia. There were 270 517 deaths within 30 days of discharge for HF, 128 088 for AMI, and 246 154 for pneumonia. Among patients with HF, 30-day postdischarge mortality increased before the announcement of the HRRP (0.27% increase from period 1 to period 2). Compared with this baseline trend, HRRP announcement (0.49% increase from period 2 to period 3; difference in change, 0.22%, P = .01) and implementation (0.52% increase from period 3 to period 4; difference in change, 0.25%, P = .001) were significantly associated with an increase in postdischarge mortality. Among patients with AMI, HRRP announcement was associated with a decline in postdischarge mortality (0.18% pre-HRRP increase vs 0.08% post-HRRP announcement decrease; difference in change, −0.26%; P = .01) and did not significantly change after HRRP implementation. Among patients with pneumonia, postdischarge mortality was stable before HRRP (0.04% increase from period 1 to period 2), but significantly increased after HRRP announcement (0.26% post-HRRP announcement increase; difference in change, 0.22%, P = .01) and implementation (0.44% post-HPPR implementation increase; difference in change, 0.40%, P < .001). The overall increase in mortality among patients with HF and pneumonia was mainly related to outcomes among patients who were not readmitted but died within 30 days of discharge. For all 3 conditions, HRRP implementation was not significantly associated with an increase in mortality within 45 days of admission, relative to pre-HRRP trends. CONCLUSIONS AND RELEVANCE: Among Medicare beneficiaries, the HRRP was significantly associated with an increase in 30-day postdischarge mortality after hospitalization for HF and pneumonia, but not for AMI. Given the study design and the lack of significant association of the HRRP with mortality within 45 days of admission, further research is needed to understand whether the increase in 30-day postdischarge mortality is a result of the policy.
In 2016, Medicare started mandatory bundled payment for joint-replacement surgery in randomly selected areas. Hospitals receive bonuses or pay penalties based on spending through 90 days after ...discharge. In the first 2 years, there was a slight reduction in spending.
Little is known about whether potentially preventable spending is concentrated among a subset of high-cost Medicare beneficiaries.
To determine the proportion of total spending that is potentially ...preventable across distinct subpopulations of high-cost Medicare beneficiaries.
Beneficiaries in the highest 10% of total standardized individual spending were defined as "high-cost" patients, using a 20% sample of Medicare fee-for-service claims from 2012. The following 6 subpopulations were defined using a claims-based algorithm: nonelderly disabled, frail elderly, major complex chronic, minor complex chronic, simple chronic, and relatively healthy. Potentially preventable spending was calculated by summing costs for avoidable emergency department visits using the Billings algorithm plus inpatient and associated 30-day postacute costs for ambulatory care-sensitive conditions (ACSCs). The amount and proportion of potentially preventable spending were then compared across the high-cost subpopulations and by individual ACSCs.
Medicare.
6 112 450 Medicare beneficiaries.
Proportion of spending deemed potentially preventable.
In 2012, 4.8% of Medicare spending was potentially preventable, of which 73.8% was incurred by high-cost patients. Despite making up only 4% of the Medicare population, high-cost frail elderly persons accounted for 43.9% of total potentially preventable spending ($6593 per person). High-cost nonelderly disabled persons accounted for 14.8% of potentially preventable spending ($3421 per person) and the major complex chronic group for 11.2% ($3327 per person). Frail elderly persons accounted for most spending related to admissions for urinary tract infections, dehydration, heart failure, and bacterial pneumonia.
Potential misclassification in the identification of preventable spending and lack of detailed clinical data in administrative claims.
Potentially preventable spending varied across Medicare subpopulations, with the majority concentrated among frail elderly persons.
The Commonwealth Fund.
A study is presented which evaluates whether US hospitals with mostly Black patients are more likely than other hospitals to have penalties associated with Centers for Medicare & Medicaid Services ...(CMS) value-based payment programs. Over the last decade, the Centers for Medicare & Medicaid Services (CMS) has implemented national value-based payment programs that aim to incentivize hospitals to deliver higher quality of care. Black adults face systemic barriers in health care access and often receive care at a limited set of underresourced hospitals. Although recent changes have been made to some value-based programs to reduce the burden of penalties on safety-net hospitals that serve low-income patients, whether these initiatives disparately affect hospitals that care for a high proportion of Black patients remains unclear.
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