Grantee Publication

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BACKGROUND: There is little national data on the characteristics of patients who receive high quality inpatient care defined as either the receipt of all applicable processes (all-or-none performance) or the proportion of applicable processes received during their hospitalization. OBJECTIVES: To assess the quality of care provided to patients hospitalized for acute myocardial infarction (AMI), heart failure or pneumonia, to describe variations in quality by patient and hospital characteristics, and the sensitivity of all-or-none performance to the number and type of processes.

Since enacting comprehensive health care reform in 2003, Maine’s Dirigo Health program has helped expand coverage for low- and moderate-income individuals. By September 2006, about 16,100 individuals were enrolled in two coverage initiatives: DirigoChoice, a subsidized insurance product, and a Medicaid eligibility expansion for low-income parents of dependent children.

BACKGROUND: Multiple measures of adherence have been reported in the research literature and it is difficult to determine which is best, as each is nuanced. Occurrences of medication switching and polypharmacy or therapeutic duplication can substantially complicate adherence calculations when adherence to a therapeutic class is sought. OBJECTIVE: To contrast the Proportion of Days Covered (PDC) adherence metric with 2 variants of the Medication Possession Ratio (MPR, truncated MPR).

Billing and insurance–related functions have been reported to consume 14 percent of medical group revenue, but little is known about the costs associated with performing specific activities. We conducted semistructured interviews, observed work flows, analyzed department budgets, and surveyed clinicians to evaluate these activities at a large multispecialty medical group. We identified 0.67 nonclinical full-time-equivalent (FTE) staff working on billing and insurance functions per FTE physician.

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This report is the second in a series that explores the cross-payer effects of providing Medicaid long-term supports and services on Medicare acute care resource use. Patterns of Medicaid eligibility, as well as resource use under both Medicare and Medicaid are examined primarily within the context of service use-based groups that might be used to set rates for Medicaid capitation payments for managed long-term care.

The Hilltop Institute prepared this resource guide intended for analysts who plan to integrate data on Medicare and Medicaid service use and costs. The Hilltop Crossover Framework is introduced in the guide as an orienting reference device for linked Medicare and Medicaid claims, and is based on a two-by-two format whereby data are arrayed by category of service—with specific reference to Medicaid crossover claims—in order to highlight the relationships between government programs and service use.

This paper estimates the relationship between Medicare fees and quantities provided by physicians for eight specific services. It uses data for 13,707 physicians who responded to surveys in 2000/2001 and/or 2004/2005 and were linked to all Medicare claims for their Medicare patients. Results show that Medicare fees are positively related to quantity provided for all eight services, and are significantly different from zero and elastic for five of them.