38 CFR 1.600 - Purpose.

Code of Federal Regulations, 2013 CFR

2013-07-01

... categories of data: (i) Beneficiary identification data such as name, social security number, sex, date of..., payment data, educational facility and program data (except chapter 32 benefits), and education program...) Inquiry), SINQ (Status Inquiry), MINQ (Master Record Inquiry), PINQ (Pending Issue Inquiry) and TINQ...

38 CFR 1.600 - Purpose.

Code of Federal Regulations, 2011 CFR

2011-07-01

... categories of data: (i) Beneficiary identification data such as name, social security number, sex, date of..., payment data, educational facility and program data (except chapter 32 benefits), and education program...) Inquiry), SINQ (Status Inquiry), MINQ (Master Record Inquiry), PINQ (Pending Issue Inquiry) and TINQ...

38 CFR 1.600 - Purpose.

Code of Federal Regulations, 2012 CFR

2012-07-01

... categories of data: (i) Beneficiary identification data such as name, social security number, sex, date of..., payment data, educational facility and program data (except chapter 32 benefits), and education program...) Inquiry), SINQ (Status Inquiry), MINQ (Master Record Inquiry), PINQ (Pending Issue Inquiry) and TINQ...

38 CFR 1.600 - Purpose.

Code of Federal Regulations, 2010 CFR

2010-07-01

... categories of data: (i) Beneficiary identification data such as name, social security number, sex, date of..., payment data, educational facility and program data (except chapter 32 benefits), and education program...) Inquiry), SINQ (Status Inquiry), MINQ (Master Record Inquiry), PINQ (Pending Issue Inquiry) and TINQ...

38 CFR 1.600 - Purpose.

Code of Federal Regulations, 2014 CFR

2014-07-01

... categories of data: (i) Beneficiary identification data such as name, social security number, sex, date of..., payment data, educational facility and program data (except chapter 32 benefits), and education program...) Inquiry), SINQ (Status Inquiry), MINQ (Master Record Inquiry), PINQ (Pending Issue Inquiry) and TINQ...

Klebsiella Species Infections in the Department of the Navy [DoN] and Department of Defense [DoD]: Annual Report 2014

DTIC Science & Technology

2016-03-14

microbiology data from MHS facilities were used to identify all Klebsiella spp. isolates. The isolates were matched to three databases: (1) HL7...Klebsiella species infections among DON and DOD beneficiaries. HL7 formatted microbiology data that originated from the Composite Health Care System...and inpatient isolates as determined by the Medical Expense and Performance Reporting System (MEPRS) codes in microbiology data. A MEPRS code

Geographic and Demographic Variation in Use of Ranibizumab Versus Bevacizumab for Neovascular Age-related Macular Degeneration in the United States.

PubMed

Gower, Emily W; Stein, Joshua D; Shekhawat, Nakul S; Mikkilineni, Shravani; Blachley, Taylor S; Pajewski, Nicholas M

2017-12-01

To examine demographic and geographic variation in the use of ranibizumab and bevacizumab for the treatment of neovascular age-related macular degeneration (AMD) among Medicare beneficiaries. Retrospective cohort study. Using a 100% sample of Medicare claims data, we evaluated Medicare beneficiaries (N = 195 812) with an index claim for neovascular AMD between July 1, 2006, and June 30, 2009, to determine whether beneficiaries first received ranibizumab or bevacizumab following initial diagnosis. The overall proportion of beneficiaries that first received ranibizumab for neovascular AMD was 35%, and varied significantly (0.9%-84.6%) across the 306 US hospital referral regions (median = 33%, interquartile range = 17%-49%). Based on hierarchical logistic regression models, the likelihood of receiving ranibizumab declined over time (adjusted odds ratio (aOR) comparing treatment in 2009 vs 2006 = 0.39, P < .001). After we controlled for year of treatment, black beneficiaries were 45% less likely to receive ranibizumab compared to non-blacks (P < .0001). Beneficiaries residing in urban areas (aOR vs isolated rural towns = 1.12, P < .001), in zip codes with higher median incomes, and in the New England and East South Central census regions (aOR vs Pacific census region = 5.57, P < .001; aOR = 3.58, P < .001, respectively) had increased odds of receiving ranibizumab. The odds of receiving bevacizumab vs ranibizumab as initial therapy for neovascular AMD among US Medicare beneficiaries varied substantially across geographic and demographic groups. Relatively fewer patients received ranibizumab for initial neovascular AMD treatment in 2009 vs 2006. Future research should study the drivers of variation in utilization of these interventions, the extent this variation indicates differential access to these agents, and whether treatment choice impacts patient outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

Trends in urodynamics in U.S. female medicare beneficiaries, 2000-2010.

PubMed

Reynolds, W Stuart; Ni, Shenghua; Kaufman, Melissa R; Penson, David F; Dmochowski, Roger R

2015-06-01

To document variations and temporal trends in the use of urodynamics (UDS) in female U.S. Medicare beneficiaries. Using a 5% sample of U.S. Medicare utilization records, we identified female beneficiaries who had undergone UDS studies between 2000 and 2010 by the presence of Common Procedural Terminology codes for cystometrogram in claims from the Carrier file. We abstracted data for each patient on age, race, residence, ICD9 diagnoses, dates of service, and provider specialty. We calculated rates per 100,000 beneficiaries with data available from the enrollment files (i.e., Denominator files) and reported the numbers and rates per 100,000 by year. During this period, 1.4 million female U.S. Medicare beneficiaries underwent UDS, of which 6% were videourodynamics. Seventy four percent of UDS were associated with a diagnosis of any urinary incontinence, with 50% specific for stress incontinence. The annual rates of UDS increased by 29%, from 422 in 2000 to 543 in 2010 per 100,000. Similar increases were seen across age groups, geographic regions and racial/ethnic groups. The rate of UDS performed by gynecologists increased by 144% over the study period, while that of urologists decreased by 3%. In 2010, gynecologists performed 35% and urologists 58% of all UDS. The use of UDS in the female Medicare program increased substantially between 2000 and 2010, with some variation across demographics and marked variation across provider specialty. © 2014 Wiley Periodicals, Inc.

Association Between Medicare Accountable Care Organization Implementation and Spending Among Clinically Vulnerable Beneficiaries

PubMed Central

Colla, Carrie H.; Lewis, Valerie A.; Kao, Lee-Sien; O’Malley, A. James; Chang, Chiang-Hua; Fisher, Elliott S.

2016-01-01

IMPORTANCE Accountable care contracts hold physician groups financially responsible for the quality and cost of health care delivered to patients. Focusing on clinically vulnerable patients, those with serious conditions who are responsible for the greatest proportion of spending, may result in the largest effects on both patient outcomes and financial rewards for participating physician groups. OBJECTIVE To estimate the effect of Medicare accountable care organization (ACO) contracts on spending and high-cost institutional use for all Medicare beneficiaries and for clinically vulnerable beneficiaries. DESIGN, SETTING, AND PARTICIPANTS For this cohort study, 2 study populations were defined: the overall Medicare population and the clinically vulnerable subgroup of Medicare beneficiaries. The overall Medicare population was based on a random 40% sample drawn from continuously enrolled fee-for-service beneficiaries with at least 1 evaluation and management visit in a calendar year. The clinically vulnerable study population included all Medicare beneficiaries 66 years or older who had at least 3 Hierarchical Condition Categories (HCCs). Beneficiaries entered the cohort during the quarter between January 2009 to December 2011 when they first had at least 3 HCCs and remained in the cohort until death. Cohort entry was restricted to the preperiod to account for potential changes in coding practices after ACO implementation. Difference-in-difference estimations were used to compare changes in health care outcomes for Medicare beneficiaries attributed to physicians in ACOs with those attributed to non-ACO physicians from January 2009 to December 2013. EXPOSURES Medicare ACOs beginning contracts in January 2012, April 2012, July 2012, and January 2013 through the Pioneer and Medicare Shared Savings Programs. MAIN OUTCOMES AND MEASURES Total spending per beneficiary-quarter, spending categories, use of hospitals and emergency departments, ambulatory care sensitive admissions, and 30-day readmissions. RESULTS Total spending decreased by $34 (95% CI, −$52 to −$15) per beneficiary-quarter after ACO contract implementation across the overall Medicare population (n = 15 592 600) and decreased $114 in clinically vulnerable patients (n = 8 673 823) (95% CI, −$178 to −$50). In the overall Medicare cohort, hospitalizations and emergency department visits decreased by 1.3 and 3.0 events per 1000 beneficiaries per quarter, respectively (95% CIs: −2.1 to −0.4 and −4.8 to −1.3), and hospitalizations and emergency department visits decreased in the clinically vulnerable cohort by 2.9 and 4.1 events per 1000 beneficiaries per quarter, respectively (95% CIs: −5.2 to −0.7 and −7.1 to −1.2). Changes in total spending associated with ACOs did not vary by clinical condition of beneficiaries. CONCLUSIONS AND RELEVANCE Medicare ACO programs are associated with modest reductions in spending and use of hospitals and emergency departments. Savings were realized through reductions in use of institutional settings in clinically vulnerable patients. PMID:27322485

78 FR 57807 - Aged Beneficiary Designation Forms

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-20

... received by the TSP record- keeper not more than one year after date of the participant's signature. DATES... after the date of the participant's signature on the form. Regulatory Flexibility Act I certify that... the participant's signature. * * * * * [FR Doc. 2013-22894 Filed 9-19-13; 8:45 am] BILLING CODE 6760...

7 CFR 226.19 - Outside-school-hours care center provisions.

Code of Federal Regulations, 2012 CFR

2012-01-01

...; Provided, however, That public and private nonprofit centers shall not be eligible to participate in the...-exempt status under the Internal Revenue Code of 1986. (3) Nonresidential public or private nonprofit... beneficiaries. (6) Each outside-school-hours care center must require key operational staff, as defined by the...

7 CFR 226.19 - Outside-school-hours care center provisions.

Code of Federal Regulations, 2014 CFR

2014-01-01

...; Provided, however, That public and private nonprofit centers shall not be eligible to participate in the...-exempt status under the Internal Revenue Code of 1986. (3) Nonresidential public or private nonprofit... beneficiaries. (6) Each outside-school-hours care center must require key operational staff, as defined by the...

Self-reported Function, Health Resource Use, and Total Health Care Costs Among Medicare Beneficiaries With Glaucoma.

PubMed

Prager, Alisa J; Liebmann, Jeffrey M; Cioffi, George A; Blumberg, Dana M

2016-04-01

The effect of glaucoma on nonglaucomatous medical conditions and resultant secondary health care costs is not well understood. To assess self-reported medical conditions, the use of medical services, and total health care costs among Medicare beneficiaries with glaucoma. Longitudinal observational study of 72,587 Medicare beneficiaries in the general community using the Medicare Current Beneficiary Survey (2004-2009). Coding to extract data started in January 2015, and analyses were performed between May and July 2015. Self-reported health, the use of health care services, adjusted mean annual total health care costs per person, and adjusted mean annual nonoutpatient costs per person. Participants were 72,587 Medicare beneficiaries 65 years or older with (n = 4441) and without (n = 68,146) a glaucoma diagnosis in the year before collection of survey data. Their mean age was 76.9 years, and 43.2% were male. Patients with glaucoma who responded to survey questions on visual disability were stratified into those with (n = 1748) and without (n = 2639) self-reported visual disability. Medicare beneficiaries with glaucoma had higher adjusted odds of inpatient hospitalizations (odds ratio [OR], 1.27; 95% CI, 1.17-1.39; P < .001) and home health aide visits (OR, 1.27; 95% CI, 1.13-1.43; P < .001) compared with Medicare beneficiaries without glaucoma. Furthermore, patients with glaucoma with self-reported visual disability were more likely to report depression (OR, 1.47; 95% CI, 1.26-1.71; P < .001), falls (OR, 1.34; 95% CI, 1.09-1.66; P = .006), and difficulty walking (OR, 1.22; 95% CI, 1.02-1.45; P = .03) compared with those without self-reported visual disability. In the risk-adjusted model, Medicare beneficiaries with glaucoma incurred an additional $2903 (95% CI, $2247-$3558; P < .001) annual total health care costs and $2599 (95% CI, $1985-$3212; P < .001) higher costs for nonoutpatient services compared with Medicare beneficiaries without glaucoma. Glaucoma is associated with greater use of inpatient and home health aide services and with higher annual total and nonoutpatient medical costs. Perception of vision loss among patients with glaucoma may be associated with depression, falls, and difficulty walking. Reducing the prevalence and severity of glaucoma may result in improvements in associated nonglaucomatous medical conditions and resultant reduction in health care costs.

Characteristics, determinants and perspectives of experienced medical humanitarians: a qualitative approach

PubMed Central

Asgary, Ramin; Lawrence, Katharine

2014-01-01

Objective To explore the characteristics, motivations, ideologies, experience and perspectives of experienced medical humanitarian workers. Design We applied a qualitative descriptive approach and conducted in-depth semistructured interviews, containing open-ended questions with directing probes, with 44 experienced international medical aid workers from a wide range of humanitarian organisations. Interviews were coded and analysed, and themes were developed. Setting International non-governmental organisations (INGOs) and United Nations (UN). Results 61% of participants were female; mean age was 41.8 years with an average of 11.8 years of humanitarian work experience with diverse major INGOs. Significant core themes included: population's rights to assistance, altruism and solidarity as motives; self-identification with the mission and directives of INGOs; shared personal and professional morals fostering collegiality; accountability towards beneficiaries in areas of programme planning and funding; burnout and emotional burdens; uncertainties in job safety and security; and uneasiness over changing humanitarian principles with increasing professionalisation of aid and shrinking humanitarian access. While dissatisfied with overall aid operations, participants were generally satisfied with their work and believed that they were well-received by, and had strong relationships with, intended beneficiaries. Conclusions Despite regular use of language and ideology of rights, solidarity and concepts of accountability, tension exists between the philosophy and practical incorporation of accountability into operations. To maintain a humanitarian corps and improve aid worker retention, strategies are needed regarding management of psychosocial stresses, proactively addressing militarisation and neo-humanitarianism, and nurturing individuals’ and organisations’ growth with emphasis on humanitarian principles and ethical practices, and a culture of internal debate, reflection and reform. PMID:25492274

Descriptive analysis of spinal neuroaxial injections, surgical interventions and physical therapy utilization for degenerative lumbar spondylolisthesis within Medicare beneficiaries from 2000–2011

PubMed Central

Sclafani, Joseph A.; Constantin, Alexandra; Ho, Pei-Shu; Akuthota, Venu; Chan, Leighton

2016-01-01

Study Design Retrospective, observational study. Objective To determine the utilization of various treatment modalities in the management of degenerative spondylolisthesis within Medicare beneficiaries. Summary of Background Data Degenerative lumbar spondylolisthesis is a condition often identified in symptomatic low back pain. A variety of treatment algorithms including physical therapy and interventional techniques can be used to manage clinically significant degenerative spondylolisthesis. Methods This study utilized the 5% national sample of Medicare carrier claims from 2000 through 2011. A cohort of beneficiaries with a new ICD-9 diagnosis code for degenerative lumbar spondylolisthesis was identified. Current procedural terminology codes were used to identify the number of procedures performed each year by specialty on this cohort. Results A total of 95,647 individuals were included in the analysis. Average age at the time of initial diagnosis was 72.8 ± 9.8 years. Within this study cohort, spondylolisthesis was more prevalent in females (69%) than males and in Caucasians (88%) compared to other racial demographics. Over 40% of beneficiaries underwent at least one injection, approximately one third (37%) participated in physical therapy, one in five (22%) underwent spinal surgery, and one third (36%) did not utilize any of these interventions. Greater than half of all procedures (124,280/216,088) occurred within 2 years of diagnosis. The ratio of focal interventions (transforaminal and facet interventions) to less selective (interlaminar) procedures was greater for the specialty of Physical Medicine and Rehabilitation compared to the specialties of Anesthesiology, Interventional Radiology, Neurosurgery, and Orthopedic Surgery. The majority of physical therapy was dedicated to passive treatment modalities and range of motion exercises rather than active strengthening modalities within this cohort. Conclusion Interventional techniques and physical therapy are frequently used treatment modalities for symptomatic degenerative spondylolisthesis. Understanding utilization of these techniques is important to determine relative clinical efficacies and to optimize future health care expenditures. PMID:28207664

76 FR 44945 - Agency Information Collection Activities: New Information Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-27

... an Internet-based tool that processes, displays, and retrieves biometric and biographic data from the Automated Biometric Identification System (IDENT) within the US- Visitor and Immigrant Status Indicator... process the required biometric and biographic data from an applicant, petitioner, sponsor, beneficiary, or...

Immediate effects of the initial FDA notification on the use of surgical mesh for pelvic organ prolapse surgery in medicare beneficiaries.

PubMed

Reynolds, W Stuart; Gold, Karen P; Ni, Shenghua; Kaufman, Melissa R; Dmochowski, Roger R; Penson, David F

2013-04-01

Prompted by increased reports of complications with the use of mesh for pelvic organ prolapse (POP) surgery, the FDA issued an initial public health notification (PHN) in 2008. We proposed to determine if the numbers of POP cases augmented with surgical mesh performed in U.S. Medicare beneficiaries changed relative to this PHN. Using administrative healthcare claims for beneficiaries enrolled in the U.S. Medicare program from 2008 to 2009, we identified women who underwent POP surgery with and without surgical mesh by procedural and diagnosis coding. In addition to comparing cases with and without mesh, we also calculated rates (number of cases per 100,000 female beneficiaries) and compared these relative to the timing of the PHN. We identified 104,185 POP procedures, of which 27,839 (26.7%) included mesh material and 76,346 (73.3%) did not. Between the last three quarters of 2008 and the first three of 2009, the rates of mesh cases increased (40.3-42.1, P < 0.001) and those without mesh decreased (115.5-111.4, P < 0.001). Inpatient procedures decreased and outpatient procedures increased for both those with and without mesh augmentation. For inpatient procedures, the relative use of biologic graft and synthetic mesh material did not vary over the study period. A substantial number of Medicare beneficiaries underwent mesh POP procedures in 2008-2009. However, despite the PHN cautioning about potential mesh complications, the numbers of mesh cases continued to rise in the immediate period after the PHN. Copyright © 2012 Wiley Periodicals, Inc.

[The right to medical rehabilitation according to the 2007 act to strengthen health insurance competition, GKV-WSG].

PubMed

Liebold, D

2008-02-01

Since April 1, 2007 medical rehabilitation is a standard insurance benefit of the statutory health insurance scheme (covered by the SGB V, book 5 of the German social code), with the right of the beneficiary to comply especially with the intentions, the principles and the preconditions of the benefits as stipulated in the SGB IX (book 9 of the German social code covering rehabilitation and participation of persons with disabilities). In claiming benefits the applicable rules primarily are those of the SGB IX, as long as the SGB V does not contain different rules. In light of the demands of the SGB IX, the prevailing case law of the Federal Social Court concerning technical aids and assistive devices cannot persist any longer. The so-called "basic-compensation" is contradictory to the specifications of the SGB IX. Medical rehabilitation does not only consist of complex benefits, but every single benefit pursuant to section sign 26 Abs. 2, Abs. 3 SGB IX is a medical rehabilitation benefit if its priority intention is to achieve the beneficiary's participation in society.

77 FR 47852 - Agency Information Collection Activities: Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-10

... Beneficiaries Receiving NaF-18 Positron Emission Tomography (PET) to Identify Bone Metastasis in Cancer; Use: In... NaF-18 PET scan to identify bone metastasis in cancer is reasonable and necessary only when the... strategy by the identification, location and quantification of bone [[Page 47853

75 FR 63484 - Agency Information Collection Activities: Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-15

... Bone Metastasis in Cancer; Use: In Decision Memorandum CAG-00065R, issued on February 26, 2010, the... that for Medicare beneficiaries receiving NaF-18 PET scan to identify bone metastasis in cancer is... or to guide subsequent treatment strategy by the identification, location and quantification of bone...

Self-report of diabetes and claims-based identification of diabetes among Medicare beneficiaries.

PubMed

Day, Hannah R; Parker, Jennifer D

2013-11-01

This report compares self-reported diabetes in the National Health Interview Survey (NHIS) with diabetes identified using the Medicare Chronic Condition (CC) Summary file. NHIS records have been linked with Medicare data from the Centers for Medicare & Medicaid Services. The CC Summary file, one of several linked files derived from Medicare claims data, contains indicators for chronic conditions based on an established algorithm. This analysis was limited to 2005 NHIS participants aged 65 and over whose records were linked to 2005 Medicare data. Linked NHIS participants had at least 1 month of fee-for-service Medicare coverage in 2005. Concordance between self-reported diabetes and the CC Summary indicator for diabetes is compared and described by demographics, socioeconomic status, health status indicators, and geographic characteristics. Of the Medicare beneficiaries in the 2005 NHIS, 20.0% self-reported diabetes and 27.8% had an indicator for diabetes in the CC Summary file. Of those who self-reported diabetes in NHIS, the percentage with a CC Summary indicator for diabetes was high (93.1%). Of those with a CC Summary indicator for diabetes, the percentage self-reporting diabetes was comparatively lower (67.0%). Statistically significant differences by subgroup existed in the percentage concordance between the two sources. Of those with self-reported diabetes, the percentage with a CC Summary indicator differed by sex and age. Of those with a CC Summary indicator for diabetes, the percentage with self-reported diabetes differed by age, self-rated health, number of self-reported conditions, and geographic location. Among Medicare beneficiaries who self-reported diabetes in NHIS, a high concordance was observed with identification of diabetes in the CC Summary file. However, among Medicare beneficiaries with an indicator for diabetes in the CC Summary file, concordance with self-reported diabetes in NHIS is comparatively lower. Differences exist by subgroup.

National study of utilization of male incontinence procedures.

PubMed

Chughtai, Bilal; Sedrakyan, Art; Isaacs, Abby J; Mao, Jialin; Lee, Richard; Te, Alexis; Kaplan, Steven

2016-01-01

We explored re-interventions and short and long term adverse events associated with procedures for male incontinence among Medicare beneficiaries. All inpatient and outpatient claims for a simple random sample of Medicare beneficiaries for 2000-2011 were queried to identify patients of interest. All male patients with an International Classification of Diseases, 9th Edition (ICD-9) diagnosis code for stress incontinence or mixed incontinence were included. Artificial urinary sphincter recipients, patients who underwent a sling operation and those receiving an injection of a bulking agent were identified with Current Procedure Terminology (CPT-4) and ICD-9 Procedure Codes. The entire cohort of 1,246 patients were operated on between 2001 and 2011. 34.9% of them received an artificial urinary sphincter (AUS), 28.7% with a bulking agent, and 36.4% with a sling. There were no statistically significant differences in demographics or comorbidities between the treatment groups, except that more sling patients were obese (P = 0.006) and fewer bulk patients had diabetes (P = 0.007). There are, however, significant changes in procedures selected over time (P < 0.001). In the first year and over the entire follow-up after surgery, patients treated with bulking agents had the most subsequent interventions (40.1% and 52.9%), followed by sling (10.4% and 15.5%), and AUS (2.3% and 20%) (P < 0.001). Post-operative and 90 day complications were low. All three treatments seem to be safe among Medicare beneficiaries with multiple comorbidities. The urological, infectious, and neurological complication occurrences were low. © 2014 Wiley Periodicals, Inc.

Regional Variations in Diagnostic Practices

PubMed Central

Song, Yunjie; Skinner, Jonathan; Bynum, Julie; Sutherland, Jason; Wennberg, John E.; Fisher, Elliott S.

2010-01-01

BACKGROUND Current methods of risk adjustment rely on diagnoses recorded in clinical and administrative records. Differences among providers in diagnostic practices could lead to bias. METHODS We used Medicare claims data from 1999 through 2006 to measure trends in diagnostic practices for Medicare beneficiaries. Regions were grouped into five quintiles according to the intensity of hospital and physician services that beneficiaries in the region received. We compared trends with respect to diagnoses, laboratory testing, imaging, and the assignment of Hierarchical Condition Categories (HCCs) among beneficiaries who moved to regions with a higher or lower intensity of practice. RESULTS Beneficiaries within each quintile who moved during the study period to regions with a higher or lower intensity of practice had similar numbers of diagnoses and similar HCC risk scores (as derived from HCC coding algorithms) before their move. The number of diagnoses and the HCC measures increased as the cohort aged, but they increased to a greater extent among beneficiaries who moved to regions with a higher intensity of practice than among those who moved to regions with the same or lower intensity of practice. For example, among beneficiaries who lived initially in regions in the lowest quintile, there was a greater increase in the average number of diagnoses among those who moved to regions in a higher quintile than among those who moved to regions within the lowest quintile (increase of 100.8%; 95% confidence interval [CI], 89.6 to 112.1; vs. increase of 61.7%; 95% CI, 55.8 to 67.4). Moving to each higher quintile of intensity was associated with an additional 5.9% increase (95% CI, 5.2 to 6.7) in HCC scores, and results were similar with respect to laboratory testing and imaging. CONCLUSIONS Substantial differences in diagnostic practices that are unlikely to be related to patient characteristics are observed across U.S. regions. The use of clinical or claims-based diagnoses in risk adjustment may introduce important biases in comparative-effectiveness studies, public reporting, and payment reforms. PMID:20463332

Characteristics, determinants and perspectives of experienced medical humanitarians: a qualitative approach.

PubMed

Asgary, Ramin; Lawrence, Katharine

2014-12-08

To explore the characteristics, motivations, ideologies, experience and perspectives of experienced medical humanitarian workers. We applied a qualitative descriptive approach and conducted in-depth semistructured interviews, containing open-ended questions with directing probes, with 44 experienced international medical aid workers from a wide range of humanitarian organisations. Interviews were coded and analysed, and themes were developed. International non-governmental organisations (INGOs) and United Nations (UN). 61% of participants were female; mean age was 41.8 years with an average of 11.8 years of humanitarian work experience with diverse major INGOs. Significant core themes included: population's rights to assistance, altruism and solidarity as motives; self-identification with the mission and directives of INGOs; shared personal and professional morals fostering collegiality; accountability towards beneficiaries in areas of programme planning and funding; burnout and emotional burdens; uncertainties in job safety and security; and uneasiness over changing humanitarian principles with increasing professionalisation of aid and shrinking humanitarian access. While dissatisfied with overall aid operations, participants were generally satisfied with their work and believed that they were well-received by, and had strong relationships with, intended beneficiaries. Despite regular use of language and ideology of rights, solidarity and concepts of accountability, tension exists between the philosophy and practical incorporation of accountability into operations. To maintain a humanitarian corps and improve aid worker retention, strategies are needed regarding management of psychosocial stresses, proactively addressing militarisation and neo-humanitarianism, and nurturing individuals' and organisations' growth with emphasis on humanitarian principles and ethical practices, and a culture of internal debate, reflection and reform. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Governing sexual behaviour through humanitarian codes of conduct.

PubMed

Matti, Stephanie

2015-10-01

Since 2001, there has been a growing consensus that sexual exploitation and abuse of intended beneficiaries by humanitarian workers is a real and widespread problem that requires governance. Codes of conduct have been promoted as a key mechanism for governing the sexual behaviour of humanitarian workers and, ultimately, preventing sexual exploitation and abuse (PSEA). This article presents a systematic study of PSEA codes of conduct adopted by humanitarian non-governmental organisations (NGOs) and how they govern the sexual behaviour of humanitarian workers. It draws on Foucault's analytics of governance and speech act theory to examine the findings of a survey of references to codes of conduct made on the websites of 100 humanitarian NGOs, and to analyse some features of the organisation-specific PSEA codes identified. © 2015 The Author(s). Disasters © Overseas Development Institute, 2015.

The economic consequences of irritable bowel syndrome: a US employer perspective.

PubMed

Leong, Stephanie A; Barghout, Victoria; Birnbaum, Howard G; Thibeault, Crystal E; Ben-Hamadi, Rym; Frech, Feride; Ofman, Joshua J

2003-04-28

The objective of this study was to measure the direct costs of treating irritable bowel syndrome (IBS) and the indirect costs in the workplace. This was accomplished through retrospective analysis of administrative claims data from a national Fortune 100 manufacturer, which includes all medical, pharmaceutical, and disability claims for the company's employees, spouses/dependents, and retirees. Patients with IBS were identified as individuals, aged 18 to 64 years, who received a primary code for IBS or a secondary code for IBS and a primary code for constipation or abdominal pain between January 1, 1996, and December 31, 1998. Of these patients with IBS, 93.7% were matched based on age, sex, employment status, and ZIP code to a control population of beneficiaries. Direct and indirect costs for patients with IBS were compared with those of matched controls. The average total cost (direct plus indirect) per patient with IBS was 4527 dollars in 1998 compared with 3276 dollars for a control beneficiary (P<.001). The average physician visit costs were 524 dollars and 345 dollars for patients with IBS and controls, respectively (P<.001). The average outpatient care costs to the employer were 1258 dollars and 742 dollars for patients with IBS and controls, respectively (P<.001). Medically related work absenteeism cost the employer 901 dollars on average per employee treated for IBS compared with 528 dollars on average per employee without IBS (P<.001). Irritable bowel syndrome is a significant financial burden on the employer that arises from an increase in direct and indirect costs compared with the control group.

Evaluation and Identification of Policy Issues in the Cuban Community.

ERIC Educational Resources Information Center

Diaz, Guarione M., Ed.

The research described in this report identifies the major health, education, and welfare-related needs of Cuban Americans as defined by directors of Cuban community service organizations and Cuban beneficiary populations in the selected urban areas of Miami/Dade County, Union City/West New York, New York City, Los Angeles, and Chicago. Data from…

Error-Detecting Identification Codes for Algebra Students.

ERIC Educational Resources Information Center

Sutherland, David C.

1990-01-01

Discusses common error-detecting identification codes using linear algebra terminology to provide an interesting application of algebra. Presents examples from the International Standard Book Number, the Universal Product Code, bank identification numbers, and the ZIP code bar code. (YP)

Trends in the surgical management of stress urinary incontinence among female Medicare beneficiaries, 2002-2007.

PubMed

Rogo-Gupta, Lisa; Litwin, Mark S; Saigal, Christopher S; Anger, Jennifer T

2013-07-01

To describe trends in the surgical management of female stress urinary incontinence (SUI) in the United States from 2002 to 2007. As part of the Urologic Diseases of America Project, we analyzed data from a 5% national random sample of female Medicare beneficiaries aged 65 and older. Data were obtained from the Centers for Medicare and Medicaid Services carrier and outpatient files from 2002 to 2007. Women who were diagnosed with urinary incontinence identified by the International Classification of Diseases, Ninth Edition (ICD-9) diagnosis codes and who underwent surgical management identified by Current Procedural Terminology, Fourth Edition (CPT-4) procedure codes were included in the analysis. Trends were analyzed over the 6-year period. Unweighted procedure counts were multiplied by 20 to estimate the rate among all female Medicare beneficiaries. The total number of surgical procedures remained stable during the study period, from 49,340 in 2002 to 49,900 in 2007. Slings were the most common procedure across all years, which increased from 25,840 procedures in 2002 to 33,880 procedures in 2007. Injectable bulking agents were the second most common procedure, which accounted for 14,100 procedures in 2002 but decreased to 11,320 in 2007. Procedures performed in ambulatory surgery centers and physician offices increased, although those performed in inpatient settings declined. Hospital outpatient procedures remained stable. The surgical management of women with SUI shifted toward a dominance of procedures performed in ambulatory surgery centers from 2002 to 2007, although the overall number of procedures remained stable. Slings remained the dominant surgical procedure, followed by injectable bulking agents, both of which are easily performed in outpatient settings. Copyright © 2013 Elsevier Inc. All rights reserved.

76 FR 69172 - Determination of Governmental Plan Status

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-08

...The Treasury Department and IRS anticipate issuing regulations under section 414(d) of the Internal Revenue Code (Code) to define the term ``governmental plan.'' This document describes the rules that the Treasury Department and IRS are considering proposing relating to the determination of whether a plan is a governmental plan within the meaning of section 414(d) and contains an appendix that includes a draft notice of proposed rulemaking on which the Treasury Department and IRS invite comments from the public. This document applies to sponsors of, and participants and beneficiaries in, employee benefit plans that are determined to be governmental plans.

A bill to amend title 38, United States Code, to provide for coverage under the beneficiary travel program of the Department of Veterans Affairs of certain disabled veterans for travel in connection with certain special disabilities rehabilitation, and for other purposes.

THOMAS, 113th Congress

Sen. Tester, Jon [D-MT

2013-03-21

Senate - 05/09/2013 Committee on Veterans' Affairs. Hearings held. Hearings printed: S.Hrg. 113-203. (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

A bill to amend title 38, United States Code, to provide for coverage under the beneficiary travel program of the Department of Veterans Affairs of certain disabled veterans for travel for certain special disabilities rehabilitation, and for other purposes.

THOMAS, 112th Congress

Sen. Tester, Jon [D-MT

2011-10-20

Senate - 06/27/2012 Committee on Veterans' Affairs. Hearings held. Hearings printed: S.Hrg. 112-668. (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

75 FR 30003 - Federal Advisory Committee; Meeting of the Uniform Formulary Beneficiary Advisory Panel

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-28

...: Notice of meeting. SUMMARY: Under the provisions of the Federal Advisory Committee Act of 1972 (title 5, United States Code (U.S.C.), Appendix, as amended) and the Government in the Sunshine Act of 1976 (5 U.S... Accessibility Pursuant to 5 U.S.C. 552b, as amended, and 41 CFR 102-3.140 through 102-3.165, and the...

Comparison of the costs of nonoperative care to minimally invasive surgery for sacroiliac joint disruption and degenerative sacroiliitis in a United States Medicare population: potential economic implications of a new minimally-invasive technology

PubMed Central

Ackerman, Stacey J; Polly, David W; Knight, Tyler; Schneider, Karen; Holt, Tim; Cummings, John

2013-01-01

Introduction The economic burden associated with the treatment of low back pain (LBP) in the United States is significant. LBP caused by sacroiliac (SI) joint disruption/degenerative sacroiliitis is most commonly treated with nonoperative care and/or open SI joint surgery. New and effective minimally invasive surgery (MIS) options may offer potential cost savings to Medicare. Methods An economic model was developed to compare the costs of MIS treatment to nonoperative care for the treatment of SI joint disruption in the hospital inpatient setting in the US Medicare population. Lifetime cost savings (2012 US dollars) were estimated from the published literature and claims data. Costs included treatment, follow-up, diagnostic testing, and retail pharmacy pain medication. Costs of SI joint disruption patients managed with nonoperative care were estimated from the 2005–2010 Medicare 5% Standard Analytic Files using primary International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes 720.2, 724.6, 739.4, 846.9, or 847.3. MIS fusion hospitalization cost was based on Diagnosis Related Group (DRG) payments of $46,700 (with major complications - DRG 459) and $27,800 (without major complications - DRG 460), weighted assuming 3.8% of patients have complications. MIS fusion professional fee was determined from the 2012 Medicare payment for Current Procedural Terminology code 27280, with an 82% fusion success rate and 1.8% revision rate. Outcomes were discounted by 3.0% per annum. Results The extrapolated lifetime cost of treating Medicare patients with MIS fusion was $48,185/patient compared to $51,543/patient for nonoperative care, resulting in a $660 million savings to Medicare (196,452 beneficiaries at $3,358 in savings/patient). Including those with ICD-9-CM code 721.3 (lumbosacral spondylosis) increased lifetime cost estimates (up to 478,764 beneficiaries at $8,692 in savings/patient). Conclusion Treating Medicare beneficiaries with MIS fusion in the hospital inpatient setting could save Medicare $660 million over patients’ lifetimes. PMID:24348055

Changing Utilization of Noninvasive Diagnostic Imaging Over 2 Decades: An Examination Family-Focused Analysis of Medicare Claims Using the Neiman Imaging Types of Service Categorization System.

PubMed

Rosman, David A; Duszak, Richard; Wang, Wenyi; Hughes, Danny R; Rosenkrantz, Andrew B

2018-02-01

The objective of our study was to use a new modality and body region categorization system to assess changing utilization of noninvasive diagnostic imaging in the Medicare fee-for-service population over a recent 20-year period (1994-2013). All Medicare Part B Physician Fee Schedule services billed between 1994 and 2013 were identified using Physician/Supplier Procedure Summary master files. Billed codes for diagnostic imaging were classified using the Neiman Imaging Types of Service (NITOS) coding system by both modality and body region. Utilization rates per 1000 beneficiaries were calculated for families of services. Among all diagnostic imaging modalities, growth was greatest for MRI (+312%) and CT (+151%) and was lower for ultrasound, nuclear medicine, and radiography and fluoroscopy (range, +1% to +31%). Among body regions, service growth was greatest for brain (+126%) and spine (+74%) imaging; showed milder growth (range, +18% to +67%) for imaging of the head and neck, breast, abdomen and pelvis, and extremity; and showed slight declines (range, -2% to -7%) for cardiac and chest imaging overall. The following specific imaging service families showed massive (> +100%) growth: cardiac CT, cardiac MRI, and breast MRI. NITOS categorization permits identification of temporal shifts in noninvasive diagnostic imaging by specific modality- and region-focused families, providing a granular understanding and reproducible analysis of global changes in imaging overall. Service family-level perspectives may help inform ongoing policy efforts to optimize imaging utilization and appropriateness.

Diagnosed prevalence and health care expenditures of mental health disorders among dual eligible older people.

PubMed

Lum, Terry Y; Parashuram, Shriram; Shippee, Tetyana P; Wysocki, Andrea; Shippee, Nathan D; Homyak, Patricia; Kane, Robert L; Williamson, John B

2013-04-01

Little is known about mental health disorders (MHDs) and their associated health care expenditures for the dual eligible elders across long-term care (LTC) settings. We estimated the 12-month diagnosed prevalence of MHDs among dual eligible older adults in LTC and non-LTC settings and calculated the average incremental effect of MHDs on medical care, LTC, and prescription drug expenditures across LTC settings. Participants were fee-for-service dual eligible elderly beneficiaries from 7 states. We obtained their 2005 Medicare and Medicaid claims data and LTC program participation data from federal and state governments. We grouped beneficiaries into non-LTC, community LTC, and institutional LTC groups and identified enrollees with any of 5 MHDs (anxiety, bipolar, major depression, mild depression, and schizophrenia) using the International Classification of Diseases Ninth Revision codes associated with Medicare and Medicaid claims. We obtained medical care, LTC, and prescription drug expenditures from related claims. Thirteen percent of all dual eligible elderly beneficiaries had at least 1 MHD diagnosis in 2005. Beneficiaries in non-LTC group had the lowest 12-month prevalence rates but highest percentage increase in health care expenditures associated with MHDs. Institutional LTC residents had the highest prevalence rates but lowest percentage increase in expenditures. LTC expenditures were less affected by MHDs than medical and prescription drug expenditures. MHDs are prevalent among dual eligible older persons and are costly to the health care system. Policy makers need to focus on better MHD diagnosis among community-living elders and better understanding in treatment of MHDs in LTC settings.

49 CFR 178.905 - Large Packaging identification codes.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 2 2010-10-01 2010-10-01 false Large Packaging identification codes. 178.905... FOR PACKAGINGS Large Packagings Standards § 178.905 Large Packaging identification codes. Large packaging code designations consist of: two numerals specified in paragraph (a) of this section; followed by...

Identifying the Transgender Population in the Medicare Program

PubMed Central

Proctor, Kimberly; Haffer, Samuel C.; Ewald, Erin; Hodge, Carla; James, Cara V.

2016-01-01

Abstract Purpose: To identify and describe the transgender population in the Medicare program using administrative data. Methods: Using a combination of International Classification of Diseases ninth edition (ICD-9) codes relating to transsexualism and gender identity disorder, we analyzed 100% of the 2013 Centers for Medicare & Medicaid Services (CMS) Medicare Fee-For-Service (FFS) “final action” claims from both institutional and noninstitutional providers (∼1 billion claims) to identify individuals who may be transgender Medicare beneficiaries. To confirm, we developed and applied a multistage validation process. Results: Four thousand ninety-eight transgender beneficiaries were identified, of which ∼90% had confirmatory diagnoses, billing codes, or evidence of a hormone prescription. In general, the racial, ethnic, and geographic distribution of the Medicare transgender population tends to reflect the broader Medicare population. However, age, original entitlement status, and disease burden of the transgender population appear substantially different. Conclusions: Using a variety of claims information, ranging from claims history to additional diagnoses, billing modifiers, and hormone prescriptions, we demonstrate that administrative data provide a valuable resource for identifying a lower bound of the Medicare transgender population. In addition, we provide a baseline description of the diversity and disease burden of the population and a framework for future research. PMID:28861539

Unique identification code for medical fundus images using blood vessel pattern for tele-ophthalmology applications.

PubMed

Singh, Anushikha; Dutta, Malay Kishore; Sharma, Dilip Kumar

2016-10-01

Identification of fundus images during transmission and storage in database for tele-ophthalmology applications is an important issue in modern era. The proposed work presents a novel accurate method for generation of unique identification code for identification of fundus images for tele-ophthalmology applications and storage in databases. Unlike existing methods of steganography and watermarking, this method does not tamper the medical image as nothing is embedded in this approach and there is no loss of medical information. Strategic combination of unique blood vessel pattern and patient ID is considered for generation of unique identification code for the digital fundus images. Segmented blood vessel pattern near the optic disc is strategically combined with patient ID for generation of a unique identification code for the image. The proposed method of medical image identification is tested on the publically available DRIVE and MESSIDOR database of fundus image and results are encouraging. Experimental results indicate the uniqueness of identification code and lossless recovery of patient identity from unique identification code for integrity verification of fundus images. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Implementing a hybrid approach to select patients for care management: variations across practices.

PubMed

Vogeli, Christine; Spirt, Jenna; Brand, Richard; Hsu, John; Mohta, Namita; Hong, Clemens; Weil, Eric; Ferris, Timothy G

2016-05-01

Appropriate selection of patients is key to the success of care management programs (CMPs). Hybrid patient selection approaches, in which large data assets are culled to develop a list of patients for more targeted clinical review, are increasingly common. We sought to describe the patient and practice characteristics associated with high-risk patient identification and selection for a CMP during clinical review, and to explore variation across primary care practices. Retrospective cohort study. Standardized estimates of Medicare beneficiaries identified as high risk for poor outcomes and high medical expense, and appropriate for a CMP within a large Pioneer Accountable Care Organization, were developed using mixed effects logistic models. Study subjects were 2685 Medicare beneficiaries aged over 18 (includes individuals eligible for Medicare due to a disability) aligned to 35 primary care practices in 2013. Independent predictors of patient identification as high risk include older age; higher risk score; recent increases in medical conditions; higher numbers of medical hospitalizations, skilled nursing facility days, and primary care physician visits; and shorter relationships with the primary care physician. Older age, and lower income, but no prior hospice use were independently associated with patient selection for a CMP among the subset of patients identified as being high risk. Adjusted predicted percents of high-risk patients varied significantly across practices overall and for 5 of the 6 patient characteristics that were independently associated with identification as high risk. Inconsistency in high-risk patient identification and selection for a CMP may reflect differences in practice resources, but also highlight the need for continual training and feedback in order to protect against unintentional biases.

Variation in geographic access to chemotherapy by definitions of providers and service locations: a population-based observational study.

PubMed

Schroeder, Mary C; Chapman, Cole G; Nattinger, Matthew C; Halfdanarson, Thorvardur R; Abu-Hejleh, Taher; Tien, Yu-Yu; Brooks, John M

2016-07-18

An aging population, with its associated rise in cancer incidence and strain on the oncology workforce, will continue to motivate patients, healthcare providers and policy makers to better understand the existing and growing challenges of access to chemotherapy. Administrative data, and SEER-Medicare data in particular, have been used to assess patterns of healthcare utilization because of its rich information regarding patients, their treatments, and their providers. To create measures of geographic access to chemotherapy, patients and oncologists must first be identified. Others have noted that identifying chemotherapy providers from Medicare claims is not always straightforward, as providers may report multiple or incorrect specialties and/or practice in multiple locations. Although previous studies have found that specialty codes alone fail to identify all oncologists, none have assessed whether various methods of identifying chemotherapy providers and their locations affect estimates of geographic access to care. SEER-Medicare data was used to identify patients, physicians, and chemotherapy use in this population-based observational study. We compared two measures of geographic access to chemotherapy, local area density and distance to nearest provider, across two definitions of chemotherapy provider (identified by specialty codes or billing codes) and two definitions of chemotherapy service location (where chemotherapy services were proven to be or possibly available) using descriptive statistics. Access measures were mapped for three representative registries. In our sample, 57.2 % of physicians who submitted chemotherapy claims reported a specialty of hematology/oncology or medical oncology. These physicians were associated with 91.0 % of the chemotherapy claims. When providers were identified through billing codes instead of specialty codes, an additional 50.0 % of beneficiaries (from 23.8 % to 35.7 %) resided in the same ZIP code as a chemotherapy provider. Beneficiaries were also 1.3 times closer to a provider, in terms of driving time. Our access measures did not differ significantly across definitions of service location. Measures of geographic access to care were sensitive to definitions of chemotherapy providers; far more providers were identified through billing codes than specialty codes. They were not sensitive to definitions of service locations, as providers, regardless of how they are identified, generally provided chemotherapy at each of their practice locations.

A Quantitative Analysis of the Relationship between Medicare Payment and Service Volume for Glaucoma Procedures from 2005 through 2009.

PubMed

Gong, Dan; Jun, Lin; Tsai, James C

2015-05-01

To calculate the association between Medicare payment and service volume for 6 commonly performed glaucoma procedures. Retrospective, longitudinal database study. A 100% dataset of all glaucoma procedures performed on Medicare Part B beneficiaries within the United States from 2005 to 2009. Fixed-effects regression model using Medicare Part B carrier data for all 50 states and the District of Columbia, controlling for time-invariant carrier-specific characteristics, national trends in glaucoma service volume, Medicare beneficiary population, number of ophthalmologists, and income per capita. Payment-volume elasticities, defined as the percent change in service volume per 1% change in Medicare payment, for laser trabeculoplasty (Current Procedural Terminology [CPT] code 65855), trabeculectomy without previous surgery (CPT code 66170), trabeculectomy with previous surgery (CPT code 66172), aqueous shunt to reservoir (CPT code 66180), laser iridotomy (CPT code 66761), and scleral reinforcement with graft (CPT code 67255). The payment-volume elasticity was nonsignificant for 4 of 6 procedures studied: laser trabeculoplasty (elasticity, -0.27; 95% confidence interval [CI], -1.31 to 0.77; P = 0.61), trabeculectomy without previous surgery (elasticity, -0.42; 95% CI, -0.85 to 0.01; P = 0.053), trabeculectomy with previous surgery (elasticity, -0.28; 95% CI, -0.83 to 0.28; P = 0.32), and aqueous shunt to reservoir (elasticity, -0.47; 95% CI, -3.32 to 2.37; P = 0.74). Two procedures yielded significant associations between Medicare payment and service volume. For laser iridotomy, the payment-volume elasticity was -1.06 (95% CI, -1.39 to -0.72; P < 0.001): for every 1% decrease in CPT code 66761 payment, laser iridotomy service volume increased by 1.06%. For scleral reinforcement with graft, the payment-volume elasticity was -2.92 (95% CI, -5.72 to -0.12; P = 0.041): for every 1% decrease in CPT code 67255 payment, scleral reinforcement with graft service volume increased by 2.92%. This study calculated the association between Medicare payment and service volume for 6 commonly performed glaucoma procedures and found varying magnitudes of payment-volume elasticities, suggesting that the volume response to changes in Medicare payments, if present, is not uniform across all Medicare procedures. Copyright © 2015 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Privacy Act of 1974; matching program--HCFA. Notice of a matching program--the Internal Revenue Service (IRS), the Social Security Administration (SSA), and HCFA--disclosure of IRS taxpayer identity and filing status information to be matched with SSA earned income information for Medicare beneficiaries and their spouses.

PubMed

1990-09-21

As required by Section 6202 of the Omnibus Budget Reconciliation Act of 1989 (OBRA 1989), Public Law 101-239, the Department of Health and Human Services is providing public notice that the IRS and the SSA will disclose certain information regarding the taxpayer identification and filing status and the earned income of Medicare beneficiaries and their spouses for HCFA's use in identifying Medicare secondary payer (MSP) situations. This will enable HCFA to seek recovery of identified mistaken payments that were the liability of another primary insurer or other type of payer. The matching report set forth below is in compliance with the Computer Matching and Privacy Protection Act of 1988 (Pub. L. No. 100-503).

The co-construction of medical humanitarianism: analysis of personal, organizationally condoned narratives from an agency website.

PubMed

Ager, Alastair; Iacovou, Melina

2014-11-01

Recent years have seen significant growth in both the size and profile of the humanitarian sector. However, little research has focused upon the constructions of humanitarian practice negotiated by agencies and their workers that serve to sustain engagement in the face personal challenges and critique of the humanitarian enterprise. This study used the public narrative of 129 website postings by humanitarian workers deployed with the health-focused international humanitarian organization Médecins Sans Frontières (MSF) to identify recurrent themes in personal, organizationally-condoned, public discourse regarding humanitarian practice. Data represented all eligible postings from a feature on the agency's UK website from May 2002 to April 2012. The text of postings was analysed with respect to emergent themes on an iterative basis. Comprehensive coding of material was achieved through a thematic structure that reflected the core domains of project details, the working environment, characteristics of beneficiaries and recurrent motivational sub-texts. Features of the co-construction of narratives include language serving to neutralize complex political contexts; the specification of barriers as substantive but surmountable; the dominance of the construct of national-international in understanding the operation of teams; intense personal identification with organization values; and the use of resilience as a framing of beneficiary adaptation and perseverance in conditions that--from an external perspective--warrant despair and withdrawal. Recurrent motivational sub-texts include 'making a difference' and contrasts with 'past professional constraints' and 'ordinary life back home.' The prominence of these sub-texts not only highlights key personal agendas but also suggests--notwithstanding policy initiatives regarding stronger contextual rooting and professionalism--continuing organizational emphasis on externality and volunteerism. Overall, postings illustrate a complex co-construction of medical humanitarianism that reflects a negotiated script of personal and organizational understandings adapted to evolving demands of humanitarian engagement. Copyright © 2014 Elsevier Ltd. All rights reserved.

Epidemiology and outcomes of community-acquired Clostridium difficile infections in Medicare beneficiaries.

PubMed

Collins, Courtney E; Ayturk, M Didem; Flahive, Julie M; Emhoff, Timothy A; Anderson, Frederick A; Santry, Heena P

2014-06-01

The incidence of community-acquired Clostridium difficile (CACD) is increasing in the United States. Many CACD infections occur in the elderly, who are predisposed to poor outcomes. We aimed to describe the epidemiology and outcomes of CACD in a nationally representative sample of Medicare beneficiaries. We queried a 5% random sample of Medicare beneficiaries (2009-2011 Part A inpatient and Part D prescription drug claims; n = 864,604) for any hospital admission with a primary ICD-9 diagnosis code for C difficile (008.45). We examined patient sociodemographic and clinical characteristics, preadmission exposure to oral antibiotics, earlier treatment with oral vancomycin or metronidazole, inpatient outcomes (eg, colectomy, ICU stay, length of stay, mortality), and subsequent admissions for C difficile. A total of 1,566 (0.18%) patients were admitted with CACD. Of these, 889 (56.8%) received oral antibiotics within 90 days of admission. Few were being treated with oral metronidazole (n = 123 [7.8%]) or vancomycin (n = 13 [0.8%]) at the time of admission. Although 223 (14%) patients required ICU admission, few (n = 15 [1%]) underwent colectomy. Hospital mortality was 9%. Median length of stay among survivors was 5 days (interquartile range 3 to 8 days). One fifth of survivors were readmitted with C difficile, with a median follow-up time of 393 days (interquartile range 129 to 769 days). Nearly half of the Medicare beneficiaries admitted with CACD have no recent antibiotic exposure. High mortality and readmission rates suggest that the burden of C difficile on patients and the health care system will increase as the US population ages. Additional efforts at primary prevention and eradication might be warranted. Copyright © 2014 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

78 FR 55103 - Notice of Proposed Exemption involving AT&T Inc. (Together With AT&T Inc.'s Affiliates, AT&T or...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-09

...This document contains a notice of pendency before the Department of Labor (the Department) of a proposed individual exemption from certain prohibited transaction restrictions of the Employee Retirement Income Security Act of 1974, as amended (ERISA or the Act), and the Internal Revenue Code of 1986, as amended (the Code). The proposed transactions involve AT&T, the AT&T Pension Benefit Plan (the Plan), and the SBC Master Pension Trust (the Trust). The proposed exemption, if granted, would affect the Plan and its participants and beneficiaries. Effective Date: If granted, this proposed exemption will be effective as of September 1, 2013.

Inpatient Utilization and Costs for Medicare Fee-for-Service Beneficiaries with Heart Failure.

PubMed

Fitch, Kathryn; Pelizzari, Pamela M; Pyenson, Bruce

2016-04-01

Although the medical and economic burden of heart failure in the United States is already substantial, it will likely grow as the population ages and life expectancy increases. Not surprisingly, most of the heart failure burden is borne by individuals aged ≥65 years, many of whom are in the Medicare population. The population-based utilization and costs of inpatient care for Medicare beneficiaries with heart failure are not well understood by payers and providers. To create a real-world view of utilization and costs associated with inpatient admissions, readmissions, and admissions to skilled nursing facilities among Medicare fee-for-service (FFS) beneficiaries with heart failure. The study used the 2011 and 2012 Medicare 5% sample limited data set to perform a retrospective analysis of claims data. The look-back year that was used to identify certain patient characteristics was 2011, and 2012 was the analysis period for the study. Beneficiaries with heart failure were defined as those who had ≥1 acute inpatient, emergency department, nonacute inpatient, or outpatient claims in 2012 containing an International Classification of Diseases, Ninth Revision code for heart failure. To be included in the study, beneficiaries with heart failure had to have eligibility for ≥1 months in 2012 and in all 2011 months, with Part A and Part B eligibility in all the study months, and no enrollment in an HMO (Medicare Advantage plan). Utilization of inpatient admissions, inpatient readmissions, and skilled nursing facility admissions in 2012 were reported for Medicare FFS beneficiaries with heart failure and for all Medicare FFS beneficiaries. The costs for key metrics included all allowed Medicare payments in 2012 US dollars. The 2012 Medicare FFS population for this study consisted of 1,461,935 patients (1,301,545 without heart failure; 160,390 with heart failure); the heart failure prevalence was 11%. The Medicare-allowed cost per member per month (PMPM) was $3395 for a patient with heart failure, whereas the allowed cost for the total Medicare population was $1045 PMPM. The Medicare-allowed amounts for the population with heart failure accounted for 34% of the total annual Medicare FFS population-allowed amounts. The heart failure population constituted 41.5%, 55.3%, and 49.5% of total Medicare FFS inpatient admissions, readmissions, and admissions to skilled nursing facilities, respectively. The costs of inpatient admissions, readmissions, and admissions to skilled nursing facilities among the heart failure population contributed $182 PMPM (17.5%), $58 PMPM (5.6%), and $46 PMPM (4.4%), respectively, to the total Medicare FFS population-allowed cost of $1045 PMPM. Medicare FFS beneficiaries with heart failure have high inpatient admission and readmission rates and generate substantial costs. Because a substantial portion of all inpatient admissions are for Medicare beneficiaries with heart failure, it is reasonable for hospitals in Medicare accountable care organizations to focus on more aggressive post-acute care management, including a focus on reducing readmissions for the population with heart failure. Our study findings highlight areas of high service utilization and cost for Medicare patients with heart failure that can be of value to Medicare, Medicare Advantage plans, and providers.

48 CFR 304.7001 - Numbering acquisitions.

Code of Federal Regulations, 2014 CFR

2014-10-01

... numeric identification code assigned by ASFR/OGAPA/DA to the contracting office within the servicing... following: (1) The three-digit identification code (HHS) of the Department. (2) A one-digit numeric...: P SAMHSA: S (3) The three-digit numeric identification code assigned by ASFR/OGAPA/DA to the...

48 CFR 304.7001 - Numbering acquisitions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... numeric identification code assigned by ASFR/OGAPA/DA to the contracting office within the servicing... following: (1) The three-digit identification code (HHS) of the Department. (2) A one-digit numeric...: P SAMHSA: S (3) The three-digit numeric identification code assigned by ASFR/OGAPA/DA to the...

48 CFR 304.7001 - Numbering acquisitions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... numeric identification code assigned by ASFR/OGAPA/DA to the contracting office within the servicing... following: (1) The three-digit identification code (HHS) of the Department. (2) A one-digit numeric...: P SAMHSA: S (3) The three-digit numeric identification code assigned by ASFR/OGAPA/DA to the...

Concentration of Potentially Preventable Spending Among High-Cost Medicare Subpopulations: An Observational Study.

PubMed

Figueroa, Jose F; Joynt Maddox, Karen E; Beaulieu, Nancy; Wild, Robert C; Jha, Ashish K

2017-11-21

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.

Analysis of Hospital Readmission Patterns in Medicare Fee-for-Service and Medicare Advantage Beneficiaries.

PubMed

Oh, Joobong June Park

The study was conducted to examine the hospital readmission patterns of two groups of Medicare beneficiaries-those covered by traditional Medicare (Medicare fee-for-service [FFS]) and those enrolled in a Medicare risk plan (Medicare Advantage [MA])-and to determine the characteristics that significantly increase the likelihood of multiple hospital readmissions. The study setting is the Hospital of the University of Pennsylvania (HUP) located in Philadelphia, PA. A retrospective descriptive study design was used to analyze the electronic data from the HUP information technology system for Medicare beneficiaries, 65 years and older, who had an index hospital admission at the HUP during 2012 (January 1, 2012, through December 31, 2012), and were subsequently readmitted one or more times to the HUP during the observation period. FFS and MA beneficiaries were hospitalized an average of 1.5 (±1.0) times; 69% were rehospitalized once and 30% were rehospitalized two or more times. Characteristics that increased the likelihood of multiple hospital readmissions included being discharged on a weekend, admitted through the emergency department with a diagnosis of injury and poisoning, being diagnosed with a new problem of the circulatory system, having an exacerbation of a circulatory system illness, and having an infection related to a previous admission. Characteristics that decreased the likelihood of multiple hospital readmissions included being discharged to a skilled nursing facility and being discharged home with home health services. Identification of the risk factors and characteristics that increase the likelihood of multiple hospital readmissions will permit early interventions in discharge planning, as evidenced by decreasing the rate of hospital readmissions and the length of hospital stays, increasing in time to hospital readmission, and preventing the first readmission and a subsequent return to the hospital.

We Are Not Numbers: The Use of Identification Codes in Online Learning

ERIC Educational Resources Information Center

Francis-Poscente, Krista; Moisey, Susan Darlene

2012-01-01

This paper discusses students' experiences with the use of identification codes in a graduate course delivered asynchronously via the Internet. While teaching an introductory masters level graduate course in distance learning, the authors discovered that the learning management system, Moodle, was programmed to display identification codes rather…

The effect of access restrictions on the vintage of drugs used by Medicaid enrollees.

PubMed

Lichtenberg, Frank R

2005-01-01

To examine the extent to which recent Medicaid drug access restrictions, such as preferred drug lists (PDLs), may affect the vintage (or time since Food and Drug Administration approval) of 6 types of drugs used by Medicaid beneficiaries. Retrospective claims database analysis using National Drug Code pharmacy claims data. A regression model was developed to analyze the effect that Medicaid access restrictions had on the vintage of medications prescribed in 6 different therapeutic categories. A "difference in differences" approach was used to compare the change in vintage of medications prescribed in Medicaid versus non-Medicaid patients between the January-June 2001 and July-December 2003 study periods. The results of the regression model showed that PDLs increased the age of Medicaid prescriptions by less than 1 year for drugs in 5 of the 6 therapeutic classes analyzed. In the case of pain management medications, the increase was more than 1.2 years. The results of the regression model suggest that Medicaid drug access restriction programs (e.g., PDLs) have resulted in an increase in the age of drugs prescribed for Medicaid beneficiaries versus non-Medicaid patients. Since previous research has suggested a clinical and economic advantage to utilizing newer versus older drugs, further research should be conducted to explore how these medication restriction policies may unduly affect Medicaid beneficiaries compared with privately insured patients.

Inflammatory bowel disease and risk of Parkinson's disease in Medicare beneficiaries.

PubMed

Camacho-Soto, Alejandra; Gross, Anat; Searles Nielsen, Susan; Dey, Neelendu; Racette, Brad A

2018-05-01

Gastrointestinal (GI) dysfunction precedes the motor symptoms of Parkinson's disease (PD) by several years. PD patients have abnormal aggregation of intestinal α-synuclein, the accumulation of which may be promoted by inflammation. The relationship between intestinal α-synuclein aggregates and central nervous system neuropathology is unknown. Recently, we observed a possible inverse association between inflammatory bowel disease (IBD) and PD as part of a predictive model of PD. Therefore, the objective of this study was to examine the relationship between PD risk and IBD and IBD-associated conditions and treatment. Using a case-control design, we identified 89,790 newly diagnosed PD cases and 118,095 population-based controls >65 years of age using comprehensive Medicare data from 2004-2009 including detailed claims data. We classified IBD using International Classification of Diseases version 9 (ICD-9) diagnosis codes. We used logistic regression to calculate odds ratios (ORs) and 95% confidence intervals (CIs) to evaluate the association between PD and IBD. Covariates included age, sex, race/ethnicity, smoking, Elixhauser comorbidities, and health care use. PD was inversely associated with IBD overall (OR = 0.85, 95% CI 0.80-0.91) and with both Crohn's disease (OR = 0.83, 95% CI 0.74-0.93) and ulcerative colitis (OR = 0.88, 95% CI 0.82-0.96). Among beneficiaries with ≥2 ICD-9 codes for IBD, there was an inverse dose-response association between number of IBD ICD-9 codes, as a potential proxy for IBD severity, and PD (p-for-trend = 0.006). IBD is associated with a lower risk of developing PD. Copyright © 2018 Elsevier Ltd. All rights reserved.

Explaining the increased health care expenditures associated with gastroesophageal reflux disease among elderly Medicare beneficiaries with chronic obstructive pulmonary disease: a cost-decomposition analysis.

PubMed

Ajmera, Mayank; Raval, Amit D; Shen, Chan; Sambamoorthi, Usha

2014-01-01

To estimate excess health care expenditures associated with gastroesophageal reflux disease (GERD) among elderly individuals with chronic obstructive pulmonary disease (COPD) and examine the contribution of predisposing characteristics, enabling resources, need variables, personal health care practices, and external environment factors to the excess expenditures, using the Blinder-Oaxaca linear decomposition technique. This study utilized a cross-sectional, retrospective study design, using data from multiple years (2006-2009) of the Medicare Current Beneficiary Survey linked with fee-for-service Medicare claims. Presence of COPD and GERD was identified using diagnoses codes. Health care expenditures consisted of inpatient, outpatient, prescription drugs, dental, medical provider, and other services. For the analysis, t-tests were used to examine unadjusted subgroup differences in average health care expenditures by the presence of GERD. Ordinary least squares regressions on log-transformed health care expenditures were conducted to estimate the excess health care expenditures associated with GERD. The Blinder-Oaxaca linear decomposition technique was used to determine the contribution of predisposing characteristics, enabling resources, need variables, personal health care practices, and external environment factors, to excess health care expenditures associated with GERD. Among elderly Medicare beneficiaries with COPD, 29.3% had co-occurring GERD. Elderly Medicare beneficiaries with COPD/GERD had 1.5 times higher ($36,793 vs $24,722 [P<0.001]) expenditures than did those with COPD/no GERD. Ordinary least squares regression revealed that individuals with COPD/GERD had 36.3% (P<0.001) higher expenditures than did those with COPD/no GERD. Overall, 30.9% to 43.6% of the differences in average health care expenditures were explained by differences in predisposing characteristics, enabling resources, need variables, personal health care practices, and external environment factors between the two groups. Need factors explained up to 41% of the differences in average health care expenditures between the two groups. Among elderly Medicare beneficiaries with COPD, the presence of GERD was associated with higher expenditures. Need factors primarily contributed to the differences in average health care expenditures, suggesting that the comanagement of chronic conditions may reduce excess health care expenditures associated with GERD.

Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); TRICARE uniform health maintenance organization (HMO) benefit--Prime enrollment fee exemption for survivors of active duty deceased sponsors and medically retired uniformed services members and their dependents. Final rule.

PubMed

2014-09-30

This final rule creates an exception to the usual rule that TRICARE Prime enrollment fees are uniform for all retirees and their dependents and responds to public comments received to the proposed rule published in the Federal Register on June 7, 2013. Survivors of Active Duty Deceased Sponsors and Medically Retired Uniformed Services Members and their Dependents are part of the retiree group under TRICARE rules. In acknowledgment and appreciation of the sacrifices of these two beneficiary categories, the Secretary of Defense has elected to exercise his authority under the United States Code to exempt Active Duty Deceased Sponsors and Medically Retired Uniformed Services Members and their Dependents enrolled in TRICARE Prime from paying future increases to the TRICARE Prime annual enrollment fees. The Prime beneficiaries in these categories have made significant sacrifices for our country and are entitled to special recognition and benefits for their sacrifices. Therefore, the beneficiaries in these two TRICARE beneficiary categories who enrolled in TRICARE Prime prior to 10/1/2013, and those since that date, will have their annual enrollment fee frozen at the appropriate fiscal year rate: FY2011 rate $230 per single or $460 per family, FY2012 rate $260 or $520, FY2013 rate $269.38 or $538.56, or the FY2014 rate $273.84 or $547.68. The future beneficiaries added to these categories will have their fee frozen at the rate in effect at the time they are classified in either category and enroll in TRICARE Prime or, if not enrolling, at the rate in effect at the time of enrollment. The fee remains frozen as long as at least one family member remains enrolled in TRICARE Prime and there is not a break in enrollment. The fee charged for the dependent(s) of a Medically Retired Uniformed Services Member would not change if the dependent(s) was later re-classified a Survivor.

Influenza vaccination coverage estimates in the fee-for service Medicare beneficiary population 2006 - 2016: Using population-based administrative data to support a geographic based near real-time tool.

PubMed

Shen, Angela K; Warnock, Rob; Brereton, Stephaeno; McKean, Stephen; Wernecke, Michael; Chu, Steve; Kelman, Jeffrey A

2018-04-11

Older adults are at great risk of developing serious complications from seasonal influenza. We explore vaccination coverage estimates in the Medicare population through the use of administrative claims data and describe a tool designed to help shape outreach efforts and inform strategies to help raise influenza vaccination rates. This interactive mapping tool uses claims data to compare vaccination levels between geographic (i.e., state, county, zip code) and demographic (i.e., race, age) groups at different points in a season. Trends can also be compared across seasons. Utilization of this tool can assist key actors interested in prevention - medical groups, health plans, hospitals, and state and local public health authorities - in supporting strategies for reaching pools of unvaccinated beneficiaries where general national population estimates of coverage are less informative. Implementing evidence-based tools can be used to address persistent racial and ethnic disparities and prevent a substantial number of influenza cases and hospitalizations.

26 CFR 1.652(c)-2 - Death of individual beneficiaries.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 26 Internal Revenue 8 2014-04-01 2014-04-01 false Death of individual beneficiaries. 1.652(c)-2... Death of individual beneficiaries. If income is required to be distributed currently to a beneficiary... beneficiary (because of the beneficiary's death), the extent to which the income is included in the gross...

26 CFR 1.652(c)-2 - Death of individual beneficiaries.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 26 Internal Revenue 8 2012-04-01 2012-04-01 false Death of individual beneficiaries. 1.652(c)-2... Death of individual beneficiaries. If income is required to be distributed currently to a beneficiary... beneficiary (because of the beneficiary's death), the extent to which the income is included in the gross...

26 CFR 1.652(c)-2 - Death of individual beneficiaries.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 26 Internal Revenue 8 2013-04-01 2013-04-01 false Death of individual beneficiaries. 1.652(c)-2... Death of individual beneficiaries. If income is required to be distributed currently to a beneficiary... beneficiary (because of the beneficiary's death), the extent to which the income is included in the gross...

26 CFR 1.652(c)-2 - Death of individual beneficiaries.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 26 Internal Revenue 8 2011-04-01 2011-04-01 false Death of individual beneficiaries. 1.652(c)-2... Death of individual beneficiaries. If income is required to be distributed currently to a beneficiary... beneficiary (because of the beneficiary's death), the extent to which the income is included in the gross...

27 CFR 73.12 - What security controls must I use for identification codes and passwords?

Code of Federal Regulations, 2010 CFR

2010-04-01

... 27 Alcohol, Tobacco Products and Firearms 2 2010-04-01 2010-04-01 false What security controls... controls must I use for identification codes and passwords? If you use electronic signatures based upon use of identification codes in combination with passwords, you must employ controls to ensure their...

77 FR 2797 - Notice of Proposed Exemption; BlackRock, Inc. and Its Investment Advisory, Investment Management...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-19

...This document contains a notice of pendency before the Department of Labor (the Department) of a proposed individual exemption from certain prohibited transaction restrictions of the Employee Retirement Income Security Act of 1974, as amended (ERISA), the Federal Employees' Retirement System Act of 1986, as amended (FERSA), and the Internal Revenue Code of 1986, as amended (the Code). The proposed transactions involve BlackRock, Inc. and its investment advisory, investment management and broker-dealer affiliates and their successors. The proposed exemption, if granted, would affect plans for which BlackRock, Inc. and its investment advisory, investment management and broker-dealer affiliates and their successors serve as fiduciaries, and the participants and beneficiaries of such plans.

Inpatient Utilization and Costs for Medicare Fee-for-Service Beneficiaries with Heart Failure

PubMed Central

Fitch, Kathryn; Pelizzari, Pamela M.; Pyenson, Bruce

2016-01-01

Background Although the medical and economic burden of heart failure in the United States is already substantial, it will likely grow as the population ages and life expectancy increases. Not surprisingly, most of the heart failure burden is borne by individuals aged ≥65 years, many of whom are in the Medicare population. The population-based utilization and costs of inpatient care for Medicare beneficiaries with heart failure are not well understood by payers and providers. Objective To create a real-world view of utilization and costs associated with inpatient admissions, readmissions, and admissions to skilled nursing facilities among Medicare fee-for-service (FFS) beneficiaries with heart failure. Methods The study used the 2011 and 2012 Medicare 5% sample limited data set to perform a retrospective analysis of claims data. The look-back year that was used to identify certain patient characteristics was 2011, and 2012 was the analysis period for the study. Beneficiaries with heart failure were defined as those who had ≥1 acute inpatient, emergency department, nonacute inpatient, or outpatient claims in 2012 containing an International Classification of Diseases, Ninth Revision code for heart failure. To be included in the study, beneficiaries with heart failure had to have eligibility for ≥1 months in 2012 and in all 2011 months, with Part A and Part B eligibility in all the study months, and no enrollment in an HMO (Medicare Advantage plan). Utilization of inpatient admissions, inpatient readmissions, and skilled nursing facility admissions in 2012 were reported for Medicare FFS beneficiaries with heart failure and for all Medicare FFS beneficiaries. The costs for key metrics included all allowed Medicare payments in 2012 US dollars. Results The 2012 Medicare FFS population for this study consisted of 1,461,935 patients (1,301,545 without heart failure; 160,390 with heart failure); the heart failure prevalence was 11%. The Medicare-allowed cost per member per month (PMPM) was $3395 for a patient with heart failure, whereas the allowed cost for the total Medicare population was $1045 PMPM. The Medicare–allowed amounts for the population with heart failure accounted for 34% of the total annual Medicare FFS population–allowed amounts. The heart failure population constituted 41.5%, 55.3%, and 49.5% of total Medicare FFS inpatient admissions, readmissions, and admissions to skilled nursing facilities, respectively. The costs of inpatient admissions, readmissions, and admissions to skilled nursing facilities among the heart failure population contributed $182 PMPM (17.5%), $58 PMPM (5.6%), and $46 PMPM (4.4%), respectively, to the total Medicare FFS population–allowed cost of $1045 PMPM. Conclusions Medicare FFS beneficiaries with heart failure have high inpatient admission and readmission rates and generate substantial costs. Because a substantial portion of all inpatient admissions are for Medicare beneficiaries with heart failure, it is reasonable for hospitals in Medicare accountable care organizations to focus on more aggressive post–acute care management, including a focus on reducing readmissions for the population with heart failure. Our study findings highlight areas of high service utilization and cost for Medicare patients with heart failure that can be of value to Medicare, Medicare Advantage plans, and providers. PMID:27182428

36 CFR 1237.24 - What are special considerations for storage and maintenance of aerial photographic records?

Code of Federal Regulations, 2014 CFR

2014-07-01

... maintenance of aerial photographic records? (a) Mark each aerial film container with a unique identification code to facilitate identification and filing. (b) Mark aerial film indexes with the unique aerial film identification codes or container codes for the aerial film that they index. Also, file and mark the aerial...

36 CFR § 1237.24 - What are special considerations for storage and maintenance of aerial photographic records?

Code of Federal Regulations, 2013 CFR

2013-07-01

... maintenance of aerial photographic records? (a) Mark each aerial film container with a unique identification code to facilitate identification and filing. (b) Mark aerial film indexes with the unique aerial film identification codes or container codes for the aerial film that they index. Also, file and mark the aerial...

36 CFR 1237.24 - What are special considerations for storage and maintenance of aerial photographic records?

Code of Federal Regulations, 2012 CFR

2012-07-01

... maintenance of aerial photographic records? (a) Mark each aerial film container with a unique identification code to facilitate identification and filing. (b) Mark aerial film indexes with the unique aerial film identification codes or container codes for the aerial film that they index. Also, file and mark the aerial...

36 CFR 1237.24 - What are special considerations for storage and maintenance of aerial photographic records?

Code of Federal Regulations, 2011 CFR

2011-07-01

... maintenance of aerial photographic records? (a) Mark each aerial film container with a unique identification code to facilitate identification and filing. (b) Mark aerial film indexes with the unique aerial film identification codes or container codes for the aerial film that they index. Also, file and mark the aerial...

36 CFR 1237.24 - What are special considerations for storage and maintenance of aerial photographic records?

Code of Federal Regulations, 2010 CFR

2010-07-01

... maintenance of aerial photographic records? (a) Mark each aerial film container with a unique identification code to facilitate identification and filing. (b) Mark aerial film indexes with the unique aerial film identification codes or container codes for the aerial film that they index. Also, file and mark the aerial...

[QR-Code based patient tracking: a cost-effective option to improve patient safety].

PubMed

Fischer, M; Rybitskiy, D; Strauß, G; Dietz, A; Dressler, C R

2013-03-01

Hospitals are implementing a risk management system to avoid patient or surgery mix-ups. The trend is to use preoperative checklists. This work deals specifically with a type of patient identification, which is realized by storing patient data on a patient-fixed medium. In 127 ENT surgeries data relevant for patient identification were encrypted in a 2D-QR-Code. The code, as a separate document coming with the patient chart or as a patient wristband, has been decrypted in the OR and the patient data were presented visible for all persons. The decoding time, the compliance of the patient data, as well as the duration of the patient identification was compared with the traditional patient identification by inspection of the patient chart. A total of 125 QR codes were read. The time for the decrypting of QR-Code was 5.6 s, the time for the screen view for patient identification was 7.9 s, and for a comparison group of 75 operations traditional patient identification was 27.3 s. Overall, there were 6 relevant information errors in the two parts of the experiment. This represents a ratio of 0.6% for 8 relevant classes per each encrypted QR code. This work allows a cost effective way to technically support patient identification based on electronic patient data. It was shown that the use in the clinical routine is possible. The disadvantage is a potential misinformation from incorrect or missing information in the HIS, or due to changes of the data after the code was created. The QR-code-based patient tracking is seen as a useful complement to the already widely used identification wristband. © Georg Thieme Verlag KG Stuttgart · New York.

Incidence and Risk Factors for Volar Wrist Ganglia in the U.S. Military and Civilian Populations.

PubMed

Balazs, George C; Dworak, Theodora C; Tropf, Jordan; Nanos, George P; Tintle, Scott M

2016-11-01

To identify the incidence and demographic factors associated with volar wrist ganglia in both military and civilian beneficiary populations. The U.S. Department of Defense Management Analysis and Reporting Tool (M2) accesses a comprehensive database of all health care visits by military personnel and their dependents. Because there is no specific code for ganglions of the wrist, the database was searched for all military personnel and civilian beneficiaries with an International Classification of Diseases, 9th Revision, diagnosis of 727.41 (ganglion of a joint) or 727.43 (ganglion, unspecified location) between 2009 and 2014. Two random samples of 1000 patients were selected from both the military and the civilian beneficiary cohorts, and their electronic medical records were examined to identify those with volar wrist ganglia. The proportion of volar wrist ganglia was then applied to the overall population data to estimate the total incidence with a 95% confidence interval and 5% margin of error. Unadjusted incidence rates and adjusted incidence rate ratios were determined using Poisson regression, controlling for age, sex, branch of military service, and military seniority. The unadjusted incidence of volar wrist ganglia is 3.72 per 10,000 person-years (0.04%/y) in female civilian beneficiaries, 1.04 per 10,000 person-years (0.01%/y) in male civilian beneficiaries, 7.98 per 10,000 person-years (0.08%/y) in female military personnel, and 3.73 per 10,000 person-years (0.04%/y) in male military personnel. When controlled for age, military personnel have a 2.5-times increased rate of volar wrist ganglia, and women have a 2.3-times increased rate. In the military cohort, female sex, branch of service, and seniority were significantly associated with the diagnosis of a volar wrist ganglion when controlled for age. In the civilian beneficiary cohort, only female sex was significant. Military service members have higher rates of volar wrist ganglia diagnoses than their age- and sex-matched civilian counterparts. Women are significantly more likely to be diagnosed with a volar wrist ganglion, regardless of age or military status. The epidemiology of volar wrist ganglia is poorly defined, and few studies have firmly defined demographic factors associated with the diagnosis. We provide the overall incidence rate of the diagnosis and report a significant association with female sex even when controlled for age. Copyright © 2016 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Out of Pocket Expenditure for Hospitalization among Below Poverty Line Households in District Solan, Himachal Pradesh, India, 2013.

PubMed

Gupt, Anadi; Kaur, Prabhdeep; Kamraj, P; Murthy, B N

2016-01-01

Health insurance schemes, like Rashtriya Swasthya Bima Yojana (RSBY), should provide financial protection against catastrophic health costs by reducing out of pocket expenditure (OOPE) for hospitalizations. We estimated and compared the proportion and extent of OOPE among below poverty line (BPL) families beneficiaries and not beneficiaries by RSBY during hospitalizations in district Solan, H.P., India, 2013. We conducted a cross sectional survey among hospitalized BPL families in the beneficiaries and non-beneficiaries groups. We compared proportion incurring OOPE and its extent during hospitalization, pre/post-hospitalization periods in different domains. Overall, proportion of non-beneficiaries who incurred OOPE was higher than the beneficiaries but it was not statistically significant (87.2% vs. 80.9%). The median overall OOPE was $39 (Rs 2567) in the non-beneficiaries group as compared to $11 (Rs 713) in the beneficiaries group (p<0.01). Median expenditure on in house and out house drugs and consumables was $23 (Rs 1500) in the non beneficiaries group as compared to nil in the beneficiaries group (p<0.01). Non-beneficiary status was significantly associated [OR: 2.4 (1.3-4.3)] with OOPE above median independently and also after adjusting for various covariates. RSBY has decreased the extent of OOPE among the beneficiaries; however OOPE was incurred mainly due to purchase of drugs from outside the health facility. The treatment seeking behaviour in beneficiaries group has improved among comparatively older group with chronic conditions. RSBY has enabled beneficiaries to get more facilities such as drugs, consumables and diagnostics from the health facility.

19 CFR 10.177 - Cost or value of materials produced in the beneficiary developing country.

Code of Federal Regulations, 2011 CFR

2011-04-01

...) Wholly the growth, product, or manufacture of the beneficiary developing country; or (2) Substantially... beneficiary developing country. 10.177 Section 10.177 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION... produced in the beneficiary developing country. (a) “Produced in the beneficiary developing country...

19 CFR 10.177 - Cost or value of materials produced in the beneficiary developing country.

Code of Federal Regulations, 2010 CFR

2010-04-01

...) Wholly the growth, product, or manufacture of the beneficiary developing country; or (2) Substantially... beneficiary developing country. 10.177 Section 10.177 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION... produced in the beneficiary developing country. (a) “Produced in the beneficiary developing country...

5 CFR 1651.16 - Missing and unknown beneficiaries.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 5 Administrative Personnel 3 2012-01-01 2012-01-01 false Missing and unknown beneficiaries. 1651... § 1651.16 Missing and unknown beneficiaries. (a) Locate and identify beneficiaries. (1) The TSP record... one or more beneficiaries (and not all) appear to be missing, payment of part of the participant's...

5 CFR 1651.16 - Missing and unknown beneficiaries.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 5 Administrative Personnel 3 2013-01-01 2013-01-01 false Missing and unknown beneficiaries. 1651... § 1651.16 Missing and unknown beneficiaries. (a) Locate and identify beneficiaries. (1) The TSP record... one or more beneficiaries (and not all) appear to be missing, payment of part of the participant's...

5 CFR 1651.16 - Missing and unknown beneficiaries.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Missing and unknown beneficiaries. 1651... § 1651.16 Missing and unknown beneficiaries. (a) Locate and identify beneficiaries. (1) The TSP record... one or more beneficiaries (and not all) appear to be missing, payment of part of the participant's...

5 CFR 1651.16 - Missing and unknown beneficiaries.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 5 Administrative Personnel 3 2011-01-01 2011-01-01 false Missing and unknown beneficiaries. 1651... § 1651.16 Missing and unknown beneficiaries. (a) Locate and identify beneficiaries. (1) The TSP record... one or more beneficiaries (and not all) appear to be missing, payment of part of the participant's...

5 CFR 1651.16 - Missing and unknown beneficiaries.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 5 Administrative Personnel 3 2014-01-01 2014-01-01 false Missing and unknown beneficiaries. 1651... § 1651.16 Missing and unknown beneficiaries. (a) Locate and identify beneficiaries. (1) The TSP record... one or more beneficiaries (and not all) appear to be missing, payment of part of the participant's...

Characteristics and healthcare utilisation patterns of high-cost beneficiaries in the Netherlands: a cross-sectional claims database study

PubMed Central

Wammes, Joost Johan Godert; Tanke, Marit; Jonkers, Wilma; Westert, Gert P; Van der Wees, Philip; Jeurissen, Patrick PT

2017-01-01

Objective To determine medical needs, demographic characteristics and healthcare utilisation patterns of the top 1% and top 2%–5% high-cost beneficiaries in the Netherlands. Design Cross-sectional study using 1 year claims data. We broke down high-cost beneficiaries by demographics, the most cost-incurring condition per beneficiary and expensive treatment use. Setting Dutch curative health system, a health system with universal coverage. Participants 4.5 million beneficiaries of one health insurer. Measures Annual total costs through hospital, intensive care unit use, expensive drugs, other pharmaceuticals, mental care and others; demographics; most cost-incurring and secondary conditions; inpatient stay; number of morbidities; costs per ICD10-chapter (International Statistical Classification of Diseases, 10th revision); and expensive treatment use (including dialysis, transplant surgery, expensive drugs, intensive care unit and diagnosis-related groups >€30 000). Results The top 1% and top 2%–5% beneficiaries accounted for 23% and 26% of total expenditures, respectively. Among top 1% beneficiaries, hospital care represented 76% of spending, of which, respectively, 9.0% and 9.1% were spent on expensive drugs and ICU care. We found that 54% of top 1% beneficiaries were aged 65 years or younger and that average costs sharply decreased with higher age within the top 1% group. Expensive treatments contributed to high costs in one-third of top 1% beneficiaries and in less than 10% of top 2%–5% beneficiaries. The average number of conditions was 5.5 and 4.0 for top 1% and top 2%–5% beneficiaries, respectively. 53% of top 1% beneficiaries were treated for circulatory disorders but for only 22% of top 1% beneficiaries this was their most cost-incurring condition. Conclusions Expensive treatments, most cost-incurring condition and age proved to be informative variables for studying this heterogeneous population. Expensive treatments play a substantial role in high-costs beneficiaries. Interventions need to be aimed at beneficiaries of all ages; a sole focus on the elderly would leave many high-cost beneficiaries unaddressed. Tailored interventions are needed to meet the needs of high-cost beneficiaries and to avoid waste of scarce resources. PMID:29133323

ACA-mandated elimination of cost sharing for preventive screening has had limited early impact.

PubMed

Mehta, Shivan J; Polsky, Daniel; Zhu, Jingsan; Lewis, James D; Kolstad, Jonathan T; Loewenstein, George; Volpp, Kevin G

2015-07-01

The Affordable Care Act eliminated patient cost sharing for evidence-based preventive care, yet the impact of this policy on colonoscopy and mammography rates is unclear. We examined the elimination of cost sharing among small business beneficiaries of Humana, a large national insurer. This was a retrospective interrupted time series analysis of whether the change in cost-sharing policy was associated with a change in screening utilization, using grandfathered plans as a comparison group. We compared beneficiaries in small business nongrandfathered plans that were required to eliminate cost sharing (intervention) with those in grandfathered plans that did not have to change cost sharing (control). There were 63,246 men and women aged 50 to 64 years eligible for colorectal cancer screening, and 30,802 women aged 50 to 64 years eligible for breast cancer screening. The primary outcome variables were rates of colonoscopy and mammography per person-month, with secondary analysis of colonoscopy rates coded as preventive only. There was no significant change in the level or slope of colonoscopy and mammography utilization for intervention plans relative to the control plans. There was also no significant relevant change among those colonoscopies coded as preventive. The results suggest that the implementation of the policy is not having its intended effects, as cost sharing rates for colonoscopy and mammography did not change substantially, and utilization of colonoscopy and mammography changed little, following this new policy approach.

Medicare costs and surgeon supply in hospital service areas.

PubMed

Ricketts, Thomas C; Belsky, Daniel W

2012-03-01

To quantify the correlates of variations of Medicare per beneficiary costs at the hospital service area level and determine whether physician supply and the specialty of physicians has a significant relationship with cost variation. The American Medical Association Masterfile data on physician and surgeon location, characteristics and specialty; Census derived sociodemographic data from 2006 ZIP code level Claritas PopFacts database; and Medicare per beneficiary costs from the Dartmouth Atlas of Health Care project. A correlational analysis using bivariate plots and fixed effects linear regression models controlling for hospital service area sociodemographics and the number and characteristics of the physician supply. Data were aggregated to the Dartmouth hospital service area level from ZIP code level files. We found that costs are strongly related to the sociodemographic character of the hospital service areas and the overall supply of physicians but a mixed correlation to the specialist supply depending on the interaction of the proportion of the physician supply who are international medical graduates. The ratio of general surgeons and surgical subspecialists to population are associated with lower costs in the models, again with difference depending on the influence of international medical graduates. There is a strong association between higher costs and the local proportion of physician supply made up of graduates of non-US or Canadian medical schools and female graduates. These results suggest that strategies to reduce overall costs by changing physician supply must consider more than just overall numbers.

Out of Pocket Expenditure for Hospitalization among Below Poverty Line Households in District Solan, Himachal Pradesh, India, 2013

PubMed Central

Gupt, Anadi; Kaur, Prabhdeep; Kamraj, P.; Murthy, B. N.

2016-01-01

Introduction Health insurance schemes, like Rashtriya Swasthya Bima Yojana (RSBY), should provide financial protection against catastrophic health costs by reducing out of pocket expenditure (OOPE) for hospitalizations. We estimated and compared the proportion and extent of OOPE among below poverty line (BPL) families beneficiaries and not beneficiaries by RSBY during hospitalizations in district Solan, H.P., India, 2013. Methods We conducted a cross sectional survey among hospitalized BPL families in the beneficiaries and non-beneficiaries groups. We compared proportion incurring OOPE and its extent during hospitalization, pre/post-hospitalization periods in different domains. Results Overall, proportion of non-beneficiaries who incurred OOPE was higher than the beneficiaries but it was not statistically significant (87.2% vs. 80.9%). The median overall OOPE was $39 (Rs 2567) in the non-beneficiaries group as compared to $ 11 (Rs 713) in the beneficiaries group (p<0.01). Median expenditure on in house and out house drugs and consumables was $ 23 (Rs 1500) in the non beneficiaries group as compared to nil in the beneficiaries group (p<0.01). Non-beneficiary status was significantly associated [OR: 2.4 (1.3–4.3)] with OOPE above median independently and also after adjusting for various covariates. Conclusion RSBY has decreased the extent of OOPE among the beneficiaries; however OOPE was incurred mainly due to purchase of drugs from outside the health facility. The treatment seeking behaviour in beneficiaries group has improved among comparatively older group with chronic conditions. RSBY has enabled beneficiaries to get more facilities such as drugs, consumables and diagnostics from the health facility. PMID:26895419

Transgender Medicare Beneficiaries and Chronic Conditions: Exploring Fee-for-Service Claims Data.

PubMed

Dragon, Christina N; Guerino, Paul; Ewald, Erin; Laffan, Alison M

2017-12-01

Data on the health and well-being of the transgender population are limited. However, using claims data we can identify transgender Medicare beneficiaries (TMBs) with high confidence. We seek to describe the TMB population and provide comparisons of chronic disease burden between TMBs and cisgender Medicare beneficiaries (CMBs), thus laying a foundation for national level TMB health disparity research. Using a previously validated claims algorithm based on ICD-9-CM codes relating to transsexualism and gender identity disorder, we identified a cohort of TMBs using Medicare Fee-for-Service (FFS) claims data. We then describe the demographic characteristics and chronic disease burden of TMBs (N = 7454) and CMBs (N = 39,136,229). Compared to CMBs, a greater observed proportion of TMBs are young (under age 65) and Black, although these differences vary by entitlement. Regardless of entitlement, TMBs have more chronic conditions than CMBs, and more TMBs have been diagnosed with asthma, autism spectrum disorder, chronic obstructive pulmonary disease, depression, hepatitis, HIV, schizophrenia, and substance use disorders. TMBs also have higher observed rates of potentially disabling mental health and neurological/chronic pain conditions, as well as obesity and other liver conditions (nonhepatitis), compared to CMBs. This is the first systematic look at chronic disease burden in the transgender population using Medicare FFS claims data. We found that TMBs experience multiple chronic conditions at higher rates than CMBs, regardless of Medicare entitlement. TMBs under age 65 show an already heavy chronic disease burden which will only be exacerbated with age.

26 CFR 1.662(c)-2 - Death of individual beneficiary.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 26 Internal Revenue 8 2010-04-01 2010-04-01 false Death of individual beneficiary. 1.662(c)-2... Corpus § 1.662(c)-2 Death of individual beneficiary. If an amount specified in section 662(a) (1) or (2... not end with or within the last taxable year of a beneficiary (because of the beneficiary's death...

19 CFR 10.196 - Cost or value of materials produced in a beneficiary country or countries.

Code of Federal Regulations, 2013 CFR

2013-04-01

... raw, perishable skin of an animal grown in one beneficiary country is sent to another beneficiary..., perishable skin of an animal grown in a non-beneficiary country is sent to a beneficiary country where it is tanned to create nonperishable “crust leather”. The tanned skin is then imported directly into the U.S...

19 CFR 10.196 - Cost or value of materials produced in a beneficiary country or countries.

Code of Federal Regulations, 2012 CFR

2012-04-01

... raw, perishable skin of an animal grown in one beneficiary country is sent to another beneficiary..., perishable skin of an animal grown in a non-beneficiary country is sent to a beneficiary country where it is tanned to create nonperishable “crust leather”. The tanned skin is then imported directly into the U.S...

19 CFR 10.196 - Cost or value of materials produced in a beneficiary country or countries.

Code of Federal Regulations, 2014 CFR

2014-04-01

... raw, perishable skin of an animal grown in one beneficiary country is sent to another beneficiary..., perishable skin of an animal grown in a non-beneficiary country is sent to a beneficiary country where it is tanned to create nonperishable “crust leather”. The tanned skin is then imported directly into the U.S...

19 CFR 10.196 - Cost or value of materials produced in a beneficiary country or countries.

Code of Federal Regulations, 2011 CFR

2011-04-01

... raw, perishable skin of an animal grown in one beneficiary country is sent to another beneficiary..., perishable skin of an animal grown in a non-beneficiary country is sent to a beneficiary country where it is tanned to create nonperishable “crust leather”. The tanned skin is then imported directly into the U.S...

Health Insurance Knowledge Among Medicare Beneficiaries

PubMed Central

McCormack, Lauren A; Garfinkel, Steven A; Hibbard, Judith H; Keller, Susan D; Kilpatrick, Kerry E; Kosiak, Beth

2002-01-01

Objective To assess the effect of new consumer information materials about the Medicare program on beneficiary knowledge of their health care coverage under the Medicare system. Data Source A telephone survey of 2,107 Medicare beneficiaries in the 10-county Kansas City metropolitan statistical area. Study Design Beneficiaries were randomly assigned to a control group and three treatment groups each receiving a different set of Medicare informational materials. The “handbook-only” group received the Health Care Financing Administration's new Medicare & You 1999 handbook. The “bulletin” group received an abbreviated version of the handbook, and the “handbook + CAHPS” group received the Medicare & You handbook plus the Consumer Assessment of Health Plans (CAHPS)® survey report comparing the quality of health care provided by Medicare HMOs. Beneficiaries interested in receiving information were oversampled. Data Collection Methods Data were collected during two separate telephone surveys of Medicare beneficiaries: one survey of new beneficiaries and another survey of experienced beneficiaries. The intervention materials were mailed to sample members in advance of the interviews. Knowledge for the treatment groups was measured shortly after beneficiaries received the intervention materials. Principal Findings Respondents' knowledge was measured using a psychometrically valid and reliable 15-item measure. Beneficiaries who received the intervention materials answered significantly more questions correctly than control group members. The effect on beneficiary knowledge of providing the information was modest for all intervention groups but varied for experienced beneficiaries only, depending on the intervention they received. Conclusions The findings suggest that all of the new materials had a positive effect on beneficiary knowledge about Medicare and the Medicare + Choice program. While the absolute gain in knowledge was modest, it was greater than increases in knowledge associated with traditional Medicare information sources.

Are there differences in the Medicare experiences of beneficiaries in Puerto Rico compared with those in the U.S. mainland?

PubMed

Elliott, Marc N; Haviland, Amelia M; Dembosky, Jacob W; Hambarsoomian, Katrin; Weech-Maldonado, Robert

2012-03-01

Little is known about the healthcare experiences of Medicare beneficiaries in Puerto Rico. We compare the experiences of elderly Medicare beneficiaries in Puerto Rico with their English-preferring and Spanish-preferring Medicare counterparts in the U.S. mainland. Linear regression models compared mean Consumer Assessment of Healthcare Providers and Systems scores for these groups, using cross-sectional data from the 2008 Medicare Consumer Assessment of Healthcare Providers and Systems survey. Medicare beneficiaries aged 65 years and older (6733 in Puerto Rico, 282,654 in the U.S. mainland) who completed the 2008 Medicare Consumer Assessment of Healthcare Providers and Systems survey. Six composite measures of beneficiary reports and two measures of beneficiary-reported immunization. Beneficiaries in Puerto Rico reported less positive experiences than both English-preferring and Spanish-preferring U.S. mainland beneficiaries for getting needed care, getting care quickly, and immunization (P<0.05 in all cases). Beneficiaries in Puerto Rico reported better customer service than Spanish-preferring U.S. mainland beneficiaries and better doctor communication experiences than English-preferring U.S. mainland beneficiaries. Additional analyses find little variation in care experiences within Puerto Rico by region, plan type, or specific plan. Medicare beneficiaries in Puerto Rico report generally worse healthcare experiences than beneficiaries in the U.S. mainland for several Consumer Assessment of Healthcare Providers and Systems outcomes and lower immunization rates. Lower funding of healthcare services in Puerto Rico relative to the U.S. mainland may affect healthcare. Strategies such as patient and provider education, provider financial incentives, and increased use of information technologies may improve adherence to the recommended preventive care practices.

Responses to Medicare Drug Costs among Near-Poor versus Subsidized Beneficiaries

PubMed Central

Fung, Vicki; Reed, Mary; Price, Mary; Brand, Richard; Dow, William H; Newhouse, Joseph P; Hsu, John

2013-01-01

Objective There is limited information on the protective value of Medicare Part D low-income subsidies (LIS). We compared responses to drug costs for LIS recipients with near-poor (≤200 percent of the Federal Poverty Level) and higher income beneficiaries without the LIS. Data Sources/Study Setting Medicare Advantage beneficiaries in 2008. Study Design We examined three drug cost responses using multivariate logistic regression: cost-reducing behaviors (e.g., switching to generics), nonadherence (e.g., not refilling prescriptions), and financial stress (e.g., going without necessities). Data Collection Telephone interviews in a stratified random sample (N = 1,201, 70 percent response rate). Principal Findings After adjustment, a comparable percentage of unsubsidized near-poor (26 percent) and higher income beneficiaries reported cost-reducing behaviors (23 percent, p = .63); fewer LIS beneficiaries reported cost-reducing behaviors (15 percent, p = .019 vs near-poor). Unsubsidized near-poor beneficiaries were more likely to reduce adherence (8.2 percent) than higher income (3.5 percent, p = .049) and LIS beneficiaries (3.1 percent, p = .027). Near-poor beneficiaries also more frequently experienced financial stress due to drug costs (20 percent) than higher income beneficiaries (11 percent, p = .050) and LIS beneficiaries (11 percent, p = .015). Conclusions Low-income subsidies provide protection from drug cost-related nonadherence and financial stress. Beneficiaries just above the LIS income threshold are most at risk for these potentially adverse behaviors. PMID:23663197

Natural language processing of clinical notes for identification of critical limb ischemia.

PubMed

Afzal, Naveed; Mallipeddi, Vishnu Priya; Sohn, Sunghwan; Liu, Hongfang; Chaudhry, Rajeev; Scott, Christopher G; Kullo, Iftikhar J; Arruda-Olson, Adelaide M

2018-03-01

Critical limb ischemia (CLI) is a complication of advanced peripheral artery disease (PAD) with diagnosis based on the presence of clinical signs and symptoms. However, automated identification of cases from electronic health records (EHRs) is challenging due to absence of a single definitive International Classification of Diseases (ICD-9 or ICD-10) code for CLI. In this study, we extend a previously validated natural language processing (NLP) algorithm for PAD identification to develop and validate a subphenotyping NLP algorithm (CLI-NLP) for identification of CLI cases from clinical notes. We compared performance of the CLI-NLP algorithm with CLI-related ICD-9 billing codes. The gold standard for validation was human abstraction of clinical notes from EHRs. Compared to billing codes the CLI-NLP algorithm had higher positive predictive value (PPV) (CLI-NLP 96%, billing codes 67%, p < 0.001), specificity (CLI-NLP 98%, billing codes 74%, p < 0.001) and F1-score (CLI-NLP 90%, billing codes 76%, p < 0.001). The sensitivity of these two methods was similar (CLI-NLP 84%; billing codes 88%; p < 0.12). The CLI-NLP algorithm for identification of CLI from narrative clinical notes in an EHR had excellent PPV and has potential for translation to patient care as it will enable automated identification of CLI cases for quality projects, clinical decision support tools and support a learning healthcare system. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

Design Challenges of an Episode-Based Payment Model in Oncology: The Centers for Medicare & Medicaid Services Oncology Care Model.

PubMed

Kline, Ronald M; Muldoon, L Daniel; Schumacher, Heidi K; Strawbridge, Larisa M; York, Andrew W; Mortimer, Laura K; Falb, Alison F; Cox, Katherine J; Bazell, Carol; Lukens, Ellen W; Kapp, Mary C; Rajkumar, Rahul; Bassano, Amy; Conway, Patrick H

2017-07-01

The Centers for Medicare & Medicaid Services developed the Oncology Care Model as an episode-based payment model to encourage participating practitioners to provide higher-quality, better-coordinated care at a lower cost to the nearly three-quarter million fee-for-service Medicare beneficiaries with cancer who receive chemotherapy each year. Episode payment models can be complex. They combine into a single benchmark price all payments for services during an episode of illness, many of which may be delivered at different times by different providers in different locations. Policy and technical decisions include the definition of the episode, including its initiation, duration, and included services; the identification of beneficiaries included in the model; and beneficiary attribution to practitioners with overall responsibility for managing their care. In addition, the calculation and risk adjustment of benchmark episode prices for the bundle of services must reflect geographic cost variations and diverse patient populations, including varying disease subtypes, medical comorbidities, changes in standards of care over time, the adoption of expensive new drugs (especially in oncology), as well as diverse practice patterns. Other steps include timely monitoring and intervention as needed to avoid shifting the attribution of beneficiaries on the basis of their expected episode expenditures as well as to ensure the provision of necessary medical services and the development of a meaningful link to quality measurement and improvement through the episode-based payment methodology. The complex and diverse nature of oncology business relationships and the specific rules and requirements of Medicare payment systems for different types of providers intensify these issues. The Centers for Medicare & Medicaid Services believes that by sharing its approach to addressing these decisions and challenges, it may facilitate greater understanding of the model within the oncology community and provide insight to others considering the development of episode-based payment models in the commercial or government sectors.

A review of automatic patient identification options for public health care centers with restricted budgets.

PubMed

García-Betances, Rebeca I; Huerta, Mónica K

2012-01-01

A comparative review is presented of available technologies suitable for automatic reading of patient identification bracelet tags. Existing technologies' backgrounds, characteristics, advantages and disadvantages, are described in relation to their possible use by public health care centers with budgetary limitations. A comparative assessment is presented of suitable automatic identification systems based on graphic codes, both one- (1D) and two-dimensional (2D), printed on labels, as well as those based on radio frequency identification (RFID) tags. The analysis looks at the tradeoffs of these technologies to provide guidance to hospital administrator looking to deploy patient identification technology. The results suggest that affordable automatic patient identification systems can be easily and inexpensively implemented using 2D code printed on low cost bracelet labels, which can then be read and automatically decoded by ordinary mobile smart phones. Because of mobile smart phones' present versatility and ubiquity, the implantation and operation of 2D code, and especially Quick Response® (QR) Code, technology emerges as a very attractive alternative to automate the patients' identification processes in low-budget situations.

A Review of Automatic Patient Identification Options for Public Health Care Centers with Restricted Budgets

PubMed Central

García-Betances, Rebeca I.; Huerta, Mónica K.

2012-01-01

A comparative review is presented of available technologies suitable for automatic reading of patient identification bracelet tags. Existing technologies’ backgrounds, characteristics, advantages and disadvantages, are described in relation to their possible use by public health care centers with budgetary limitations. A comparative assessment is presented of suitable automatic identification systems based on graphic codes, both one- (1D) and two-dimensional (2D), printed on labels, as well as those based on radio frequency identification (RFID) tags. The analysis looks at the tradeoffs of these technologies to provide guidance to hospital administrator looking to deploy patient identification technology. The results suggest that affordable automatic patient identification systems can be easily and inexpensively implemented using 2D code printed on low cost bracelet labels, which can then be read and automatically decoded by ordinary mobile smart phones. Because of mobile smart phones’ present versatility and ubiquity, the implantation and operation of 2D code, and especially Quick Response® (QR) Code, technology emerges as a very attractive alternative to automate the patients’ identification processes in low-budget situations. PMID:23569629

20 CFR 411.400 - Can an EN to which a beneficiary's ticket is assigned refer the beneficiary to a State VR agency...

Code of Federal Regulations, 2011 CFR

2011-04-01

... assigned refer the beneficiary to a State VR agency for services? 411.400 Section 411.400 Employees... Rehabilitation Agencies' Participation Referrals by Employment Networks to State Vr Agencies § 411.400 Can an EN to which a beneficiary's ticket is assigned refer the beneficiary to a State VR agency for services...

20 CFR 411.400 - Can an EN to which a beneficiary's ticket is assigned refer the beneficiary to a State VR agency...

Code of Federal Regulations, 2010 CFR

2010-04-01

... assigned refer the beneficiary to a State VR agency for services? 411.400 Section 411.400 Employees... Rehabilitation Agencies' Participation Referrals by Employment Networks to State Vr Agencies § 411.400 Can an EN to which a beneficiary's ticket is assigned refer the beneficiary to a State VR agency for services...

The effect of a redundant color code on an overlearned identification task

NASA Technical Reports Server (NTRS)

Obrien, Kevin

1992-01-01

The possibility of finding redundancy gains with overlearned tasks was examined using a paradigm varying familiarity with the stimulus set. Redundant coding in a multidimensional stimulus was demonstrated to result in increased identification accuracy and decreased latency of identification when compared to stimuli varying on only one dimension. The advantages attributable to redundant coding are referred to as redundancy gain and were found for a variety of stimulus dimension combinations, including the use of hue or color as one of the dimensions. Factors that have affected redundancy gain include the discriminability of the levels of one stimulus dimension and the level of stimulus-to-response association. The results demonstrated that response time is in part a function of familiarity, but no effect of redundant color coding was demonstrated. Implications of research on coding in identification tasks for display design are discussed.

Income and assets of Social Security beneficiaries by type of benefit.

PubMed

Grad, S

1989-01-01

The SIPP data have provided a first look at the relative economic status of various types of Social Security beneficiaries. They have shown that the different types of Social Security beneficiaries face very different economic circumstances. Retired workers and wife beneficiaries have the highest family incomes adjusted for family size. Aged widows and minor children have the lowest family incomes, with high proportions of poor or near poor. And disabled workers are in between, but also have high proportions of poor or near poor. Retired-worker and wife beneficiary households also have considerably more asset holdings than disabled-worker or widow beneficiary households. Beneficiaries with high family incomes are very likely to live with relatives and to rely heavily on the relatives' income. The high-income families tend to have non-means-tested sources of family income other than Social Security amounting to substantial proportions of their total income and to have high asset holdings. Conversely, beneficiaries with low family incomes are very likely to live alone or with nonrelatives, to rely heavily on Social Security and means-tested benefits, and to have low asset holdings. A majority of ever-poor beneficiaries (with the exception of widow beneficiaries) are poor in only some months of a year. This situation is not consistent with the stereotype of beneficiaries living on fixed incomes. But the change in poverty status is often due to a change in the income of other family members rather than of the beneficiary. And in some cases, a change in poverty status occurs with little or no change in income as the cost of living rises.

The economic well-being of Social Security beneficiaries, with an emphasis on divorced beneficiaries.

PubMed

Weaver, D A

1997-01-01

There are numerous types of benefits paid under the Social Security programs of the United States, with each type of benefit having its own set of eligibility rules and benefit formula. It is likely that there is an association between the type of benefit a person receives and the economic circumstances of the beneficiary. This article explores that association using records from the Current Population Survey exactly matched to administrative records from the Social Security Administration. Divorced beneficiaries are a particular focus of this article. Type of benefit is found to be a strong predictor of economic well-being. Two large groups of beneficiaries, retired-worker and aged married spouse beneficiaries, are fairly well-off. Other types of beneficiaries tend to resemble the overall U.S. population or are decidedly worse off. Divorced spouse beneficiaries have an unusually high incidence of poverty and an unusually high incidence of serious health problems. A proposal to increase benefits for these beneficiaries is evaluated. Results of the analyses indicate that much of the additional Government expenditures would be received by those with low income.

42 CFR 414.1235 - Cost measures.

Code of Federal Regulations, 2014 CFR

2014-10-01

...) Total per capita costs for all attributed beneficiaries with coronary artery disease. (4) Total per capita costs for all attributed beneficiaries with chronic obstructive pulmonary disease. (5) Total per capita costs for all attributed beneficiaries with heart failure. (6) Medicare Spending per Beneficiary...

20 CFR 416.621 - What is our order of preference in selecting a representative payee for you?

Code of Federal Regulations, 2011 CFR

2011-04-01

... beneficiary or who demonstrates strong concern for the personal welfare of the beneficiary; (2) A friend who... friend who does not have custody of the beneficiary but is demonstrating concern for the beneficiary's...

20 CFR 416.621 - What is our order of preference in selecting a representative payee for you?

Code of Federal Regulations, 2010 CFR

2010-04-01

... beneficiary or who demonstrates strong concern for the personal welfare of the beneficiary; (2) A friend who... friend who does not have custody of the beneficiary but is demonstrating concern for the beneficiary's...

Delays in Emergency Care and Mortality during Major U.S. Marathons

PubMed Central

Jena, Anupam B.; Mann, N. Clay; Wedlund, Leia N.; Olenski, Andrew

2017-01-01

BACKGROUND Large marathons frequently involve widespread road closures and infrastructure disruptions, which may create delays in emergency care for nonparticipants with acute medical conditions who live in proximity to marathon routes. METHODS We analyzed Medicare data on hospitalizations for acute myocardial infarction or cardiac arrest among Medicare beneficiaries (≥65 years of age) in 11 U.S. cities that were hosting major marathons during the period from 2002 through 2012 and compared 30-day mortality among the beneficiaries who were hospitalized on the date of a marathon, those who were hospitalized on the same day of the week as the day of the marathon in the 5 weeks before or the 5 weeks after the marathon, and those who were hospitalized on the same day as the marathon but in surrounding ZIP Code areas unaffected by the marathon. We also analyzed data from a national registry of ambulance transports and investigated whether ambulance transports occurring before noon in marathon-affected areas (when road closures are likely) had longer scene-to-hospital transport times than on nonmarathon dates. We also compared transport times on marathon dates with those on nonmarathon dates in these same areas during evenings (when roads were reopened) and in areas unaffected by the marathon. RESULTS The daily frequency of hospitalizations was similar on marathon and nonmarathon dates (mean number of hospitalizations per city, 10.6 and 10.5, respectively; P=0.71); the characteristics of the beneficiaries hospitalized on marathon and nonmarathon dates were also similar. Unadjusted 30-day mortality in marathon-affected areas on marathon dates was 28.2% (323 deaths in 1145 hospitalizations) as compared with 24.9% (2757 deaths in 11,074 hospitalizations) on nonmarathon dates (absolute risk difference, 3.3 percentage points; 95% confidence interval, 0.7 to 6.0; P=0.01; relative risk difference, 13.3%). This pattern persisted after adjustment for covariates and in an analysis that included beneficiaries who had five or more chronic medical conditions (a group that is unlikely to be hospitalized because of marathon participation). No significant differences were found with respect to where patients were hospitalized or the treatments they received in the hospital. Ambulance scene-to-hospital transport times for pickups before noon were 4.4 minutes longer on marathon dates than on nonmarathon dates (relative difference, 32.1%; P=0.005). No delays were found in evenings or in marathon-unaffected areas. CONCLUSIONS Medicare beneficiaries who were admitted to marathon-affected hospitals with acute myocardial infarction or cardiac arrest on marathon dates had longer ambulance transport times before noon (4.4 minutes longer) and higher 30-day mortality than beneficiaries who were hospitalized on nonmarathon dates. PMID:28402772

Relative importance of attributes of drug benefit plans: Thai civil servants' perspective.

PubMed

Ngorsuraches, Surachat; Wanishayakorn, Tanatape; Tanvejsilp, Pimwara; Udomaksorn, Siripa

2013-01-01

The drug benefit plan of Thailand's Civil Servant Medical Benefit Scheme (CSMBS) must be amended to control increasing costs; to that end, it is important to gather the views of beneficiaries before making changes to the benefit plan. To examine the relative importance of attributes of drug benefit plans from the perspective of CSMBS beneficiaries. Attributes and levels adopted from focus group discussions and a preliminary survey were used to develop a questionnaire concerning hypothetical drug benefit plans. A convenience sample of 650 CSMBS beneficiaries in Songkhla province was asked to rate the drug benefit plans. To determine the beneficiaries' decision models, judgment analysis was used. Policy-capturing analysis was used to examine the beneficiaries' preferences, and cluster analysis was conducted to explore the variability among judgment plans. Judgment policy insight was also examined. The results of the study showed that the beneficiaries weighed on cost-sharing as their most important attribute. The results remained unchanged, although only data from the beneficiaries who used the compensatory model were analyzed. The results of the cluster analysis showed that the largest cluster of beneficiaries weighed mostly on the cost-sharing attribute. The judgment policy insight results not only supported the finding that most beneficiaries focused on the cost-sharing attribute but also revealed that they might have the least understanding of how the formulary attribute affected beneficiaries' decision making. Cost-sharing was the most important attribute for the CSMBS beneficiaries. This study indicated that a possible preferred drug benefit plan should have no cost-sharing, permit access only to drugs listed in a closed formulary, allow beneficiaries to obtain 3 months of drugs, and allow them to obtain drugs from either a community pharmacy or a government hospital. Copyright © 2013 Elsevier Inc. All rights reserved.

Disenrollment from Medicare HMOs.

PubMed

Call, K T; Dowd, B E; Feldman, R; Lurie, N; McBean, M A; Maciejewski, M

2001-01-01

Since the program's inception, there has been great interest in determining whether beneficiaries who enter and subsequently leave Medicare health maintenance organizations (HMOs) are more or less costly than those remaining in fee-for-service (FFS) Medicare. To examine whether relatively high-cost beneficiaries disenroll from Medicare HMOs (disenrollment bias) and whether disenrollment bias varies by Medicare HMO market characteristics. In addition, we compare rates of surgical procedures and hospitalizations for ambulatory care-sensitive conditions for disenrollees and continuing FFS beneficiaries. Cross-sectional analysis of 1994 Medicare data. Medicare beneficiaries were first sampled from the 124 counties with at least 1000 Medicare HMO enrollees. From this pool, HMO disenrollees and a sample of continuing FFS beneficiaries were drawn. The FFS beneficiaries were assigned dates of "pseudodisenrollment." Expenditures and inpatient service use were compared for 6 months after disenrollment or pseudodisenrollment. The HMO disenrollees were no more likely than the continuing FFS beneficiaries to have positive total expenditures (Part A plus Part B) or Part B expenditures in the first 6 months after disenrollment. However, disenrollees were more likely to have Part A expenditures. Among beneficiaries with spending, disenrollees had higher total and Part B expenditures than continuing FFS beneficiaries. Moreover, the disparity in total and Part B spending between disenrollees and continuing FFS beneficiaries increased with HMO market penetration. Although Part A spending was higher for disenrollees with spending, it was not sensitive to changes in market share. The HMO disenrollees received more surgical procedures and were hospitalized for more of the ambulatory care-sensitive conditions than the FFS beneficiaries. On several measures, Medicare HMOs experienced favorable disenrollment relative to continuing FFS beneficiaries as recently as 1994, which increased as HMO market share increased.

78 FR 53507 - Agency Information Collection (Beneficiary Travel Mileage Reimbursement Application Form...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-29

... (Beneficiary Travel Mileage Reimbursement Application Form) Activity Under OMB Review AGENCY: Veterans Health... Control No. 2900- NEW (Beneficiary Travel Mileage Reimbursement Application Form)'' in any correspondence....gov . Please refer to ``OMB Control No. 2900-NEW (Beneficiary Travel Mileage Reimbursement Application...

Do Medicare Beneficiaries Living With HIV/AIDS Choose Prescription Drug Plans That Minimize Their Total Spending?

PubMed

Desmond, Katherine A; Rice, Thomas H; Leibowitz, Arleen A

2017-01-01

This article examines whether California Medicare beneficiaries with HIV/AIDS choose Part D prescription drug plans that minimize their expenses. Among beneficiaries without low-income supplementation, we estimate the excess cost, and the insurance policy and beneficiary characteristics responsible, when the lowest cost plan is not chosen. We use a cost calculator developed for this study, and 2010 drug use data on 1453 California Medicare beneficiaries with HIV who were taking antiretroviral medications. Excess spending is defined as the difference between projected total spending (premium and cost sharing) for the beneficiary's current drug regimen in own plan vs spending for the lowest cost alternative plan. Regression analyses related this excess spending to individual and plan characteristics. We find that beneficiaries pay more for Medicare Part D plans with gap coverage and no deductible. Higher premiums for more extensive coverage exceeded savings in deductible and copayment/coinsurance costs. We conclude that many beneficiaries pay for plan features whose costs exceed their benefits.

Understanding Trends in Medicare Spending, 2007-2014.

PubMed

Keohane, Laura M; Gambrel, Robert J; Freed, Salama S; Stevenson, David; Buntin, Melinda B

2018-03-06

To analyze the sources of per-beneficiary Medicare spending growth between 2007 and 2014, including the role of demographic characteristics, attributes of Medicare coverage, and chronic conditions. Individual-level Medicare spending and enrollment data. Using an Oaxaca-Blinder decomposition model, we analyzed whether changes in price-standardized, per-beneficiary Medicare Part A and B spending reflected changes in the composition of the Medicare population or changes in relative spending levels per person. We identified a 5 percent sample of fee-for-service Medicare beneficiaries age 65 and above from years 2007 to 2014. Mean payment-adjusted Medicare per-beneficiary spending decreased by $180 between the 2007-2010 and 2011-2014 time periods. This decline was almost entirely attributable to lower spending levels for beneficiaries. Notably, declines in marginal spending levels for beneficiaries with chronic conditions were associated with a $175 reduction in per-beneficiary spending. The decline was partially offset by the increasing prevalence of certain chronic diseases. Still, we are unable to attribute a large share of the decline in spending levels to observable beneficiary characteristics or chronic conditions. Declines in spending levels for Medicare beneficiaries with chronic conditions suggest that changing patterns of care use may be moderating spending growth. © Health Research and Educational Trust.

[Health care use by free complementary health insurance coverage beneficiaries in France in 2012].

PubMed

Tuppin, P; Samson, S; Colinot, N; Gastaldi-Menager, C; Fagot-Campagna, A; Gissot, C

2016-04-01

The objective was to investigate healthcare use among people covered by one of the two complementary healthcare insurance schemes available for people with low annual income: CMUC (universal complementary healthcare insurance) and, for people whose income exceeds the CMUC ceiling, ACS (aid for complementary healthcare insurance). Comparisons were made between CMUC and ACS beneficiaries versus CMUC and ACS non-beneficiaries and between CMUC beneficiaries and ACS beneficiaries. Using the national health insurance information system (SNIIRAM), people less than 60 years old covered by the general national health insurance (86% of the 66 million inhabitants) and with ACS or CMUC coverage in 2012 were selected. Diseases were identified using hospital diagnosis, drugs refunds and long-term chronic disease status. Hospital related diagnoses were categorized in major hospital activity groups. Sex- and age-standardized relative risk (RR) were calculated. There were 4.4 million (9.6%) CMUC beneficiaries and 732,000 (1.6%) ACS beneficiaries (56% and 54% women; mean age: 24 years and 29 years respectively versus 52% and 30 years for CMUC or ACS non-beneficiaries). CMUC or ACS beneficiaries had more often cardiovascular diseases (RR=1.4;2.1) and diabetes (RR=2.2;2.4). Their sex- and age-standardized hospitalisation rates for all diagnosis were higher (18%; 17%, RR=1.3;1.4) than CMUC or ACS non-beneficiaries (13%). This was especially the case for the following major groups: toxicology, intoxications, alcohol major group (RR=3.8;4.0); psychiatry (RR=2.8;4.1); respiratory disease (RR=1.9;2.3); infectious disease (RR=1.9;2.7). Compared with CMUC beneficiaries, ACS beneficiaries had more often cancer (RR=1.5), cardiovascular disease (RR=1.5), neurological disease (RR=2.7), psychiatric illness (RR=2.6), end-stage renal disease (RR=2.8), hemophilia (RR=1.4) or cystic fibrosis (RR=1.6) and they received also more often disability allowance (20%, 4%). The disease and hospitalisation rates of ACS beneficiaries are similar or higher than those of CMUC beneficiaries, especially for disabling diseases. Both CMUC and ACS beneficiaries received healthcare for chronic diseases that can be targeted by prevention and screening programs for more optimal healthcare. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Transgender Medicare Beneficiaries and Chronic Conditions: Exploring Fee-for-Service Claims Data

PubMed Central

Guerino, Paul; Ewald, Erin; Laffan, Alison M.

2017-01-01

Abstract Purpose: Data on the health and well-being of the transgender population are limited. However, using claims data we can identify transgender Medicare beneficiaries (TMBs) with high confidence. We seek to describe the TMB population and provide comparisons of chronic disease burden between TMBs and cisgender Medicare beneficiaries (CMBs), thus laying a foundation for national level TMB health disparity research. Methods: Using a previously validated claims algorithm based on ICD-9-CM codes relating to transsexualism and gender identity disorder, we identified a cohort of TMBs using Medicare Fee-for-Service (FFS) claims data. We then describe the demographic characteristics and chronic disease burden of TMBs (N = 7454) and CMBs (N = 39,136,229). Results: Compared to CMBs, a greater observed proportion of TMBs are young (under age 65) and Black, although these differences vary by entitlement. Regardless of entitlement, TMBs have more chronic conditions than CMBs, and more TMBs have been diagnosed with asthma, autism spectrum disorder, chronic obstructive pulmonary disease, depression, hepatitis, HIV, schizophrenia, and substance use disorders. TMBs also have higher observed rates of potentially disabling mental health and neurological/chronic pain conditions, as well as obesity and other liver conditions (nonhepatitis), compared to CMBs. Conclusion: This is the first systematic look at chronic disease burden in the transgender population using Medicare FFS claims data. We found that TMBs experience multiple chronic conditions at higher rates than CMBs, regardless of Medicare entitlement. TMBs under age 65 show an already heavy chronic disease burden which will only be exacerbated with age. PMID:29125908

32 CFR 728.58 - Federal Aviation Agency (FAA) beneficiaries.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 32 National Defense 5 2011-07-01 2011-07-01 false Federal Aviation Agency (FAA) beneficiaries. 728.58 Section 728.58 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL... Federal Agencies § 728.58 Federal Aviation Agency (FAA) beneficiaries. (a) Beneficiaries. Air Traffic...

32 CFR 728.58 - Federal Aviation Agency (FAA) beneficiaries.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 32 National Defense 5 2013-07-01 2013-07-01 false Federal Aviation Agency (FAA) beneficiaries. 728.58 Section 728.58 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL... Federal Agencies § 728.58 Federal Aviation Agency (FAA) beneficiaries. (a) Beneficiaries. Air Traffic...

32 CFR 728.58 - Federal Aviation Agency (FAA) beneficiaries.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 5 2010-07-01 2010-07-01 false Federal Aviation Agency (FAA) beneficiaries. 728.58 Section 728.58 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL... Federal Agencies § 728.58 Federal Aviation Agency (FAA) beneficiaries. (a) Beneficiaries. Air Traffic...

32 CFR 728.58 - Federal Aviation Agency (FAA) beneficiaries.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 32 National Defense 5 2014-07-01 2014-07-01 false Federal Aviation Agency (FAA) beneficiaries. 728.58 Section 728.58 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL... Federal Agencies § 728.58 Federal Aviation Agency (FAA) beneficiaries. (a) Beneficiaries. Air Traffic...

32 CFR 728.58 - Federal Aviation Agency (FAA) beneficiaries.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 32 National Defense 5 2012-07-01 2012-07-01 false Federal Aviation Agency (FAA) beneficiaries. 728.58 Section 728.58 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL... Federal Agencies § 728.58 Federal Aviation Agency (FAA) beneficiaries. (a) Beneficiaries. Air Traffic...

42 CFR 411.23 - Beneficiary's cooperation.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Beneficiary's cooperation. 411.23 Section 411.23... Medicare Payment: General Provisions § 411.23 Beneficiary's cooperation. (a) If CMS takes action to recover conditional payments, the beneficiary must cooperate in the action. (b) If CMS's recovery action is...

42 CFR § 512.450 - Beneficiary choice and beneficiary notification.

Code of Federal Regulations, 2010 CFR

2017-10-01

... HEALTH AND HUMAN SERVICES (CONTINUED) HEALTH CARE INFRASTRUCTURE AND MODEL PROGRAMS EPISODE PAYMENT MODEL... providers or suppliers, nor may the EPM participant accept such payments. (b) Required beneficiary... beneficiary will be responsible for payment for the services furnished by the SNF during that stay, except...

Determinants of Medicare plan choices: are beneficiaries more influenced by premiums or benefits?

PubMed

Jacobs, Paul D; Buntin, Melinda B

2015-07-01

To evaluate the sensitivity of Medicare beneficiaries to premiums and benefits when selecting healthcare plans after the introduction of Part D. We matched respondents in the 2008 Medicare Current Beneficiary Survey to the Medicare Advantage (MA) plans available to them using the Bid Pricing Tool and previously unavailable data on beneficiaries' plan choices. We estimated a 2-stage nested logit model of Medicare plan choice decision making, including the decision to choose traditional fee-for-service (FFS) Medicare or an MA plan, and for those choosing MA, which specific plan they chose. Beneficiaries living in areas with higher average monthly rebates available from MA plans were more likely to choose MA rather than FFS. When choosing MA plans, beneficiaries are roughly 2 to 3 times more responsive to dollars spent to reduce cost sharing than reductions in their premium. We calculated an elasticity of plan choice with respect to the monthly MA premium of -0.20. Beneficiaries with lower incomes are more sensitive to plan premiums and cost sharing than higher-income beneficiaries. MA plans appear to have a limited incentive to aggressively price their products, and seem to compete primarily over reduced beneficiary cost sharing. Given the limitations of the current plan choice environment, policies designed to encourage the selection of lower-cost plans may require increasing premium differences between plans and providing the tools to enable beneficiaries to easily assess those differences.

Inferior Vena Cava Filter Placement and Retrieval Rates among Radiologists and Nonradiologists.

PubMed

Guez, David; Hansberry, David R; Eschelman, David J; Gonsalves, Carin F; Parker, Laurence; Rao, Vijay M; Levin, David C

2018-04-01

To evaluate inferior vena cava (IVC) filter placement and retrieval rates among radiologists, vascular surgeons, cardiologists, other surgeons, and all other health care providers for Medicare fee-for-service beneficiaries in the years 2012-2015. The nationwide Medicare Physician/Supplier Procedure Summary Master Files were used to determine the volume and utilization rate of IVC filter placement, IVC filter repositioning, and IVC filter retrieval, which correspond to procedure codes 37191, 37192, and 37193, respectively. Procedural code 37193 was not available before 2012, so data were reviewed for the years 2012-2015. The total volume of Medicare IVC filter placement decreased from 57,785 in 2012 to 44,378 in 2015, with radiologists responsible for 60% of all filter placements. Volume of IVC filter placement declined across all specialties, including radiologists, who placed 33,744 in 2012 and 27,957 in 2015. In contrast, total retrieval of IVC filters increased from 4,060 removals in 2012 to 6,166 in 2015. Retrieval rate per 100,000 Medicare beneficiaries increased from 11 in 2012 to 16 in 2015. Radiologists removed the bulk of the filters: 64% in both 2012 and 2015. Vascular surgeons, cardiologists, and other surgeons retrieved, respectively, 20%, 10%, and 5% of all IVC filters in 2012 and 22%, 9%, and 5% in 2015. From 2012 to 2015, IVC filter placement steadily decreased across all specialties. Retrieval rate of IVC filters continued to rise over the same period. Radiologists were responsible for the majority of IVC filter placements and retrievals. Copyright © 2017 SIR. Published by Elsevier Inc. All rights reserved.

Trends in surgical management and pre-operative urodynamics in female medicare beneficiaries with mixed incontinence.

PubMed

Chughtai, Bilal; Hauser, Nicholas; Anger, Jennifer; Asfaw, Tirsit; Laor, Leanna; Mao, Jialin; Lee, Richard; Te, Alexis; Kaplan, Steven; Sedrakyan, Art

2017-02-01

We sought to examine the surgical trends and utilization of treatment for mixed urinary incontinence among female Medicare beneficiaries. Data was obtained from a 5% national random sample of outpatient and carrier claims from 2000 to 2011. Included were female patients 65 and older, diagnosed with mixed urinary incontinence, who underwent surgical treatment identified by Current Procedural Terminology, Fourth Edition (CPT-4) codes. Urodynamics (UDS) before initial and secondary procedure were also identified using CPT-4 codes. Procedural trends and utilization of UDS were analyzed. Utilization of UDS increased during the study period, from 38.4% to 74.0% prior to initial surgical intervention, and from 28.6% to 62.5% preceding re-intervention. Sling surgery (63.0%) and injectable bulking agents (28.0%) were the most common surgical treatments adopted, followed by sacral nerve stimulation (SNS) (4.8%) and Burch (4.0%) procedures. Re-intervention was performed in 4.0% of patients initially treated with sling procedures and 21.3% of patients treated with bulking agents, the majority of whom (51.7% and 76.3%, respectively) underwent injection of a bulking agent. Risk of re-intervention was not different among those who did or did not receive urodynamic tests prior to the initial procedure (8.5% vs. 9.3%) CONCLUSIONS: Sling and bulk agents are the most common treatment for MUI. Preoperative urodynamic testing was not related to risk of re-intervention following surgery for mixed urinary incontinence in this cohort. Neurourol. Urodynam. 36:422-425, 2017. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

Medicare Cancer Screening in the Context of Clinical Guidelines: 2000 to 2012.

PubMed

Maroongroge, Sean; Yu, James B

2018-04-01

Cancer screening is a ubiquitous and controversial public health issue, particularly in the elderly population. Despite extensive evidence-based guidelines for screening, it is unclear how cancer screening has changed in the Medicare population over time. We characterize trends in cancer screening for the most common cancer types in the Medicare fee-for-service (FFS) program in the context of conflicting guidelines from 2000 to 2012. We performed a descriptive analysis of retrospective claims data from the Medicare FFS program based on billing codes. Our data include all claims for Medicare part B beneficiaries who received breast, colorectal (CRC), or prostate cancer screening from 2000 to 2012 based on billing codes. We utilize a Monte Carlo permutation method to detect changes in screening trends. In total, 231,416,732 screening tests were analyzed from 2000 to 2012, representing an average of 436.8 tests per 1000 beneficiaries per year. Mammography rates declined 7.4%, with digital mammography extensively replacing film. CRC cancer screening rates declined overall. As a percentage of all CRC screening tests, colonoscopy grew from 32% to 71%. Prostate screening rates increased 16% from 2000 to 2007, and then declined to 7% less than its 2000 rate by 2012. Both the aggressiveness of screening guidelines and screening rates for the Medicare FFS population peaked and then declined from 2000 to 2012. However, guideline publications did not consistently precede utilization trend shifts. Technology adoption, practical and financial concerns, and patient preferences may have also contributed to the observed trends. Further research should be performed on the impact of multiple, conflicting guidelines in cancer screening.

Patient financial responsibility for observation care.

PubMed

Kangovi, Shreya; Cafardi, Susannah G; Smith, Robyn A; Kulkarni, Raina; Grande, David

2015-11-01

As observation care grows, Medicare beneficiaries are increasingly likely to revisit observation care instead of being readmitted. This trend has potential financial implications for Medicare beneficiaries because observation care-although typically hospital based-is classified as an outpatient service. Beneficiaries who are readmitted pay the inpatient deductible only once per benefit period. In contrast, beneficiaries who have multiple care episodes under observations status are subject to coinsurance at every stay and could accrue higher cumulative costs. We were interested in answering the question: Do Medicare beneficiaries who revisit observation care pay more than they would have had they been readmitted? We used a 20% sample of the Medicare Outpatient Standard Analytic File (2010-2012) to determine the total cumulative financial liability for Medicare beneficiaries who revisit observation care multiple times within a 60-day period. Participants were fee-for-service Medicare beneficiaries who had Part A and Part B coverage for a full calendar year (or until death) during the study period. Our primary measure was beneficiary financial responsibility for facilities fees. On average, beneficiaries with multiple observation stays in a 60-day period had a cumulative financial liability of $947.40 (803.62), which is significantly lower than the $1100 inpatient deductible (P < 0.01). However, 26.6% of these beneficiaries had a cumulative financial liability that exceeded the inpatient deductible. More than a quarter of Medicare beneficiaries with multiple observation stays in a 60-day time period have a higher financial liability than they would have had under Part A benefits. © 2015 Society of Hospital Medicine.

38 CFR 9.4 - Beneficiaries and options.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Beneficiaries and options... SERVICEMEMBERS' GROUP LIFE INSURANCE AND VETERANS' GROUP LIFE INSURANCE § 9.4 Beneficiaries and options. Any designation of beneficiary or election of settlement options is subject to the provisions of 38 U.S.C. 1970...

42 CFR 425.708 - Beneficiaries may decline data sharing.

Code of Federal Regulations, 2012 CFR

2012-10-01

... beneficiary for purposes of its care coordination and quality improvement work, and give the beneficiary... to decline data sharing as part of their first primary care service visit with an ACO participant... beneficiaries that have a primary care service office visit with an ACO participant who provides primary care...

42 CFR 425.708 - Beneficiaries may decline data sharing.

Code of Federal Regulations, 2014 CFR

2014-10-01

... beneficiary for purposes of its care coordination and quality improvement work, and give the beneficiary... to decline data sharing as part of their first primary care service visit with an ACO participant... beneficiaries that have a primary care service office visit with an ACO participant who provides primary care...

42 CFR 425.708 - Beneficiaries may decline data sharing.

Code of Federal Regulations, 2013 CFR

2013-10-01

... beneficiary for purposes of its care coordination and quality improvement work, and give the beneficiary... to decline data sharing as part of their first primary care service visit with an ACO participant... beneficiaries that have a primary care service office visit with an ACO participant who provides primary care...

38 CFR 6.6 - Change of beneficiary.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Change of beneficiary. 6.6 Section 6.6 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS UNITED STATES GOVERNMENT LIFE INSURANCE Beneficiary of United States Government Life Insurance § 6.6 Change of beneficiary...

42 CFR 422.262 - Beneficiary premiums.

Code of Federal Regulations, 2011 CFR

2011-10-01

... and Plan Approval § 422.262 Beneficiary premiums. (a) Determination of MA monthly basic beneficiary premium. (1) For an MA plan with an unadjusted statutory non-drug bid amount that is less than the relevant unadjusted non-drug benchmark amount, the basic beneficiary premium is zero. (2) For an MA plan...

42 CFR 422.262 - Beneficiary premiums.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Information and Plan Approval § 422.262 Beneficiary premiums. (a) Determination of MA monthly basic beneficiary premium. (1) For an MA plan with an unadjusted statutory non-drug bid amount that is less than the relevant unadjusted non-drug benchmark amount, the basic beneficiary premium is zero. (2) For an MA plan...

42 CFR 422.262 - Beneficiary premiums.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Information and Plan Approval § 422.262 Beneficiary premiums. (a) Determination of MA monthly basic beneficiary premium. (1) For an MA plan with an unadjusted statutory non-drug bid amount that is less than the relevant unadjusted non-drug benchmark amount, the basic beneficiary premium is zero. (2) For an MA plan...

42 CFR 422.262 - Beneficiary premiums.

Code of Federal Regulations, 2010 CFR

2010-10-01

... and Plan Approval § 422.262 Beneficiary premiums. (a) Determination of MA monthly basic beneficiary premium. (1) For an MA plan with an unadjusted statutory non-drug bid amount that is less than the relevant unadjusted non-drug benchmark amount, the basic beneficiary premium is zero. (2) For an MA plan...

42 CFR 422.262 - Beneficiary premiums.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Information and Plan Approval § 422.262 Beneficiary premiums. (a) Determination of MA monthly basic beneficiary premium. (1) For an MA plan with an unadjusted statutory non-drug bid amount that is less than the relevant unadjusted non-drug benchmark amount, the basic beneficiary premium is zero. (2) For an MA plan...

25 CFR 17.13 - Government employees as beneficiaries.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 25 Indians 1 2011-04-01 2011-04-01 false Government employees as beneficiaries. 17.13 Section 17... INDIANS § 17.13 Government employees as beneficiaries. In considering the will of a deceased Osage Indian the superintendent may disapprove any will which names as a beneficiary thereunder a government...

25 CFR 17.13 - Government employees as beneficiaries.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 25 Indians 1 2010-04-01 2010-04-01 false Government employees as beneficiaries. 17.13 Section 17... INDIANS § 17.13 Government employees as beneficiaries. In considering the will of a deceased Osage Indian the superintendent may disapprove any will which names as a beneficiary thereunder a government...

25 CFR 17.13 - Government employees as beneficiaries.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 25 Indians 1 2013-04-01 2013-04-01 false Government employees as beneficiaries. 17.13 Section 17... INDIANS § 17.13 Government employees as beneficiaries. In considering the will of a deceased Osage Indian the superintendent may disapprove any will which names as a beneficiary thereunder a government...

25 CFR 17.13 - Government employees as beneficiaries.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 25 Indians 1 2012-04-01 2011-04-01 true Government employees as beneficiaries. 17.13 Section 17.13....13 Government employees as beneficiaries. In considering the will of a deceased Osage Indian the superintendent may disapprove any will which names as a beneficiary thereunder a government employee who is not...

25 CFR 17.13 - Government employees as beneficiaries.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 25 Indians 1 2014-04-01 2014-04-01 false Government employees as beneficiaries. 17.13 Section 17... INDIANS § 17.13 Government employees as beneficiaries. In considering the will of a deceased Osage Indian the superintendent may disapprove any will which names as a beneficiary thereunder a government...

Evaluation and implementation of QR Code Identity Tag system for Healthcare in Turkey.

PubMed

Uzun, Vassilya; Bilgin, Sami

2016-01-01

For this study, we designed a QR Code Identity Tag system to integrate into the Turkish healthcare system. This system provides QR code-based medical identification alerts and an in-hospital patient identification system. Every member of the medical system is assigned a unique QR Code Tag; to facilitate medical identification alerts, the QR Code Identity Tag can be worn as a bracelet or necklace or carried as an ID card. Patients must always possess the QR Code Identity bracelets within hospital grounds. These QR code bracelets link to the QR Code Identity website, where detailed information is stored; a smartphone or standalone QR code scanner can be used to scan the code. The design of this system allows authorized personnel (e.g., paramedics, firefighters, or police) to access more detailed patient information than the average smartphone user: emergency service professionals are authorized to access patient medical histories to improve the accuracy of medical treatment. In Istanbul, we tested the self-designed system with 174 participants. To analyze the QR Code Identity Tag system's usability, the participants completed the System Usability Scale questionnaire after using the system.

78 FR 59917 - Limitations of Duty- and Quota-Free Imports of Apparel Articles Assembled in Beneficiary Sub...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-30

... of Apparel Articles Assembled in Beneficiary Sub-Saharan African Countries From Regional and Third... quota-free treatment for certain textile and apparel articles imported from designated beneficiary sub... apparel articles wholly assembled in one or more beneficiary sub-Saharan African countries from fabric...

42 CFR 422.314 - Special rules for beneficiaries enrolled in MA MSA plans.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 3 2011-10-01 2011-10-01 false Special rules for beneficiaries enrolled in MA MSA... Advantage Organizations § 422.314 Special rules for beneficiaries enrolled in MA MSA plans. (a) Establishment and designation of medical savings account (MSA). A beneficiary who elects coverage under an MA...

42 CFR 422.314 - Special rules for beneficiaries enrolled in MA MSA plans.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Special rules for beneficiaries enrolled in MA MSA... Advantage Organizations § 422.314 Special rules for beneficiaries enrolled in MA MSA plans. (a) Establishment and designation of medical savings account (MSA). A beneficiary who elects coverage under an MA...

42 CFR 425.110 - Number of ACO professionals and beneficiaries.

Code of Federal Regulations, 2014 CFR

2014-10-01

... number of assigned beneficiaries. (2) If the ACO's assigned population is not returned to at least 5,000... 42 Public Health 3 2014-10-01 2014-10-01 false Number of ACO professionals and beneficiaries. 425... Program Eligibility Requirements § 425.110 Number of ACO professionals and beneficiaries. (a)(1) The ACO...

42 CFR 425.110 - Number of ACO professionals and beneficiaries.

Code of Federal Regulations, 2012 CFR

2012-10-01

... number of assigned beneficiaries. (2) If the ACO's assigned population is not returned to at least 5,000... 42 Public Health 3 2012-10-01 2012-10-01 false Number of ACO professionals and beneficiaries. 425... Program Eligibility Requirements § 425.110 Number of ACO professionals and beneficiaries. (a)(1) The ACO...

42 CFR 425.110 - Number of ACO professionals and beneficiaries.

Code of Federal Regulations, 2013 CFR

2013-10-01

... number of assigned beneficiaries. (2) If the ACO's assigned population is not returned to at least 5,000... 42 Public Health 3 2013-10-01 2013-10-01 false Number of ACO professionals and beneficiaries. 425... Program Eligibility Requirements § 425.110 Number of ACO professionals and beneficiaries. (a)(1) The ACO...

20 CFR 411.610 - When should a beneficiary receive information on the procedures for resolving disputes?

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false When should a beneficiary receive information on the procedures for resolving disputes? 411.610 Section 411.610 Employees' Benefits SOCIAL SECURITY... Between Beneficiaries and Employment Networks § 411.610 When should a beneficiary receive information on...

20 CFR 411.610 - When should a beneficiary receive information on the procedures for resolving disputes?

Code of Federal Regulations, 2014 CFR

2014-04-01

... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false When should a beneficiary receive information on the procedures for resolving disputes? 411.610 Section 411.610 Employees' Benefits SOCIAL SECURITY... Between Beneficiaries and Employment Networks § 411.610 When should a beneficiary receive information on...

20 CFR 411.610 - When should a beneficiary receive information on the procedures for resolving disputes?

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false When should a beneficiary receive information on the procedures for resolving disputes? 411.610 Section 411.610 Employees' Benefits SOCIAL SECURITY... Between Beneficiaries and Employment Networks § 411.610 When should a beneficiary receive information on...

20 CFR 411.610 - When should a beneficiary receive information on the procedures for resolving disputes?

Code of Federal Regulations, 2013 CFR

2013-04-01

... 20 Employees' Benefits 2 2013-04-01 2013-04-01 false When should a beneficiary receive information on the procedures for resolving disputes? 411.610 Section 411.610 Employees' Benefits SOCIAL SECURITY... Between Beneficiaries and Employment Networks § 411.610 When should a beneficiary receive information on...

20 CFR 411.610 - When should a beneficiary receive information on the procedures for resolving disputes?

Code of Federal Regulations, 2012 CFR

2012-04-01

... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false When should a beneficiary receive information on the procedures for resolving disputes? 411.610 Section 411.610 Employees' Benefits SOCIAL SECURITY... Between Beneficiaries and Employment Networks § 411.610 When should a beneficiary receive information on...

How does beneficiary knowledge of the Medicare program vary by type of insurance?

PubMed

McCormack, Lauren A; Uhrig, Jennifer D

2003-08-01

Prior research found that Medicare beneficiaries' knowledge of the Medicare program varied by the type of supplemental insurance they had. However, none of these studies used both multivariate methods and nationally representative data to examine the issue. OBJECTIVES To measure beneficiary knowledge of the Medicare program and to evaluate how knowledge varies by type of supplemental insurance. A mail survey with telephone follow-up to a nationally representative random sample of Medicare beneficiaries, which had a 76% response rate. The purpose of the study was to evaluate the effects of providing the Medicare & You handbook on beneficiary knowledge, information needs, and health plan decision making. A total of 3738 Medicare beneficiaries who completed the survey. A psychometrically validated 22-item index that reflects Medicare-related knowledge in seven different content areas. RESULTS Overall, beneficiaries with a Medicare HMO or non-employer-sponsored supplemental insurance were more knowledgeable about Medicare than those who had Medicare only. In general, beneficiaries tended to be more knowledgeable about issues related to the type of insurance they had (fee-for-service or managed care) than other types of insurance. Higher levels of knowledge about one's own type of insurance may suggest that beneficiaries learn by experience or they learn more about that type of insurance before enrollment. Further research is needed to better understand how and when beneficiaries learn about insurance and what educational strategies are more effective at increasing knowledge.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

Standardization of grant and contract awardee names has been an area of concern since the development of the Department`s Procurement and Assistance Data System (PADS). A joint effort was begun in 1983 by the Office of Scientific and Technical Information (OSTI) and the Office of Procurement and Assistance Management/Information Systems and Analysis Division to develop a means for providing uniformity of awardee names. As a result of this effort, a method of assigning vendor identification codes to each unique awardee name, division, city, and state combination was developed and is maintained by OSTI. Changes to vendor identification codes or awardeemore » names contained in PADS can be made only by OSTI. Awardee names in the Directory indicate that the awardee has had a prime contract (excluding purchase orders of $10,000 or less) with, or a financial assistance award from, the Department. Award status--active, inactive, or retired--is not shown. The Directory is in alphabetic sequence based on awardee name and reflects the OSTI-assigned vendor identification code to the right of the name. A vendor identification code is assigned to each unique awardee name, division, city, and state (for place of performance). The same vendor identification code is used for awards throughout the Department.« less

Use and Spending for Biologic Disease-Modifying Antirheumatic Drugs for Rheumatoid Arthritis Among US Medicare Beneficiaries.

PubMed

Yazdany, Jinoos; Tonner, Chris; Schmajuk, Gabriela

2015-09-01

Biologic therapies have assumed an important role in treating rheumatoid arthritis (RA). We sought to investigate use, spending, and patient cost-sharing for Medicare beneficiaries using biologic drugs for RA, comparing patients exposed to minimal cost-sharing because of a Part D low-income subsidy (LIS) to those facing substantial out-of-pocket costs (OOP). We performed a retrospective, nationwide study using 2009 Medicare claims for a 5% random sample of beneficiaries with RA who had at least 1 RA drug dispensed. We analyzed biologic drug utilization and costs across the Part B (medical benefit) and Part D (pharmacy benefit) programs by LIS status using multinomial regression. We also projected OOP costs as the Affordable Care Act (ACA) mandates closure of the Part D coverage gap by 2020. Among 6,932 beneficiaries, 1,812 (26.1%) received a biologic drug. LIS beneficiaries were significantly more likely to obtain Part D home-administered biologics (relative risk ratio [RRR] 2.98, 95% confidence interval [95% CI] 2.50-3.56), while non-LIS beneficiaries were less likely to receive Part D biologic agents (RRR 0.58, 95% CI 0.48-0.69). OOP costs in Part D were lower, as expected, for LIS beneficiaries ($72 versus $3,751 per year for non-LIS). Non-LIS beneficiaries had lower costs for Part B facility-administered biologic agents (range $0-$2,584) than for Part D home-administered biologic agents. ACA reforms will narrow OOP differences between Part D and B for non-LIS beneficiaries. In contrast to LIS beneficiaries who receive mostly Part D home-administered biologic DMARDs, nonsubsidized beneficiaries have significant cost-based incentives to obtain facility-administered biologic DMARDs through Part B. The ACA will result in only slightly lower costs for Part D biologic drugs for these beneficiaries. © 2015, American College of Rheumatology.

Influence of sustained deworming pressure on the anthelmintic resistance status in strongyles of sheep under field conditions.

PubMed

Vijayasarathi, M K; Sreekumar, C; Venkataramanan, R; Raman, M

2016-10-01

Anthelmintic resistance (AR) status in Madras Red sheep from selected field flocks of a government funded scheme, covered by regular, sustained anthelmintic treatment for more than 10 years was determined. Parameters such as fecal egg count reduction test (FECRT), larval paralysis assay (LPA), and allele-specific-PCR (AS-PCR) were used to test the efficacy of fenbendazole, tetramisole, and ivermectin at recommended doses, in two seasons. Sheep belonging to non-beneficiary farmers were used as controls. Mean FECRT values of beneficiary group during winter and summer seasons were 77.77 and 76.04, 93.65 and 92.12, and 95.37 and 98.06 %, respectively, for fenbendazole, tetramisole, and ivermectin. In the non-beneficiary groups, the corresponding values were 74.82 and 81.09 %, 96.05 and 97.40 %, and 97.26 and 98.23 %, respectively. The results revealed resistance to fenbendazole, suspect resistance to tetramisole and susceptibility to ivermectin in beneficiary flock. In non-beneficiary flock, while resistance was noticed against fenbendazole, both tetramisole and ivermectin were effective. FECR values were found to be significantly different between beneficiary and non-beneficiary groups against tetramisole. The results of LPA confirmed this finding, as 50 % of the Haemonchus contortus larvae were paralyzed at the concentration of 0.0156 μg/ml in the beneficiary group, while those of non-beneficiary groups required lower concentrations of 0.0078 μg/ml. AS-PCR revealed the predominance of heterozygous susceptible population of H. contortus in the beneficiary group. In this study, resistance to fenbendazole was confirmed in both the beneficiary and non-beneficiary groups and this could be attributed to frequent use of benzimidazoles as seen from the deworming records. Emergence of tetramisole resistance was detected in the beneficiary group, where the drug was used continuously for 4 years. Ivermectin was found to be effective in all the flocks. It is recommended that the practice of routine deworming of three to four times a year should be avoided, as it can lead to emergence of anthelmintic resistance.

Multimorbidity: constellations of conditions across subgroups of midlife and older individuals, and related Medicare expenditures.

PubMed

Koroukian, Siran M; Schiltz, Nicholas K; Warner, David F; Sun, Jiayang; Stange, Kurt C; Given, Charles W; Dor, Avi

2017-01-01

The Department of Health and Human Services' 2010 Strategic Framework on Multiple Chronic Conditions called for the identification of common constellations of conditions in older adults. To analyze patterns of conditions constituting multimorbidity (CCMM) and expenditures in a US representative sample of midlife and older adults (50-64 and ≥65 years of age, respectively). A cross-sectional study of the 2010 Health and Retirement Study (HRS; n =17,912). The following measures were used: (1) count and combinations of CCMM, including (i) chronic conditions (hypertension, arthritis, heart disease, lung disease, stroke, diabetes, cancer, and psychiatric conditions), (ii) functional limitations (upper body limitations, lower body limitations, strength limitations, limitations in activities of daily living, and limitations in instrumental activities of daily living), and (iii) geriatric syndromes (cognitive impairment, depressive symptoms, incontinence, visual impairment, hearing impairment, severe pain, and dizziness); and (2) annualized 2011 Medicare expenditures for HRS participants who were Medicare fee-for-service beneficiaries ( n =5,677). Medicaid beneficiaries were also identified based on their self-reported insurance status. No large representations of participants within specific CCMM categories were observed; however, functional limitations and geriatric syndromes were prominently present with higher CCMM counts. Among fee-for-service Medicare beneficiaries aged 50-64 years, 26.7% of the participants presented with ≥10 CCMM, but incurred 48% of the expenditure. In those aged ≥65 years, these percentages were 16.9% and 34.4%, respectively. Functional limitations and geriatric syndromes considerably add to the MM burden in midlife and older adults. This burden is much higher than previously reported.

Assessment of tissue allograft safety monitoring with administrative healthcare databases: a pilot project using Medicare data.

PubMed

Dhakal, Sanjaya; Burwen, Dale R; Polakowski, Laura L; Zinderman, Craig E; Wise, Robert P

2014-03-01

Assess whether Medicare data are useful for monitoring tissue allograft safety and utilization. We used health care claims (billing) data from 2007 for 35 million fee-for-service Medicare beneficiaries, a predominantly elderly population. Using search terms for transplant-related procedures, we generated lists of ICD-9-CM and CPT(®) codes and assessed the frequency of selected allograft procedures. Step 1 used inpatient data and ICD-9-CM procedure codes. Step 2 added non-institutional provider (e.g., physician) claims, outpatient institutional claims, and CPT codes. We assembled preliminary lists of diagnosis codes for infections after selected allograft procedures. Many ICD-9-CM codes were ambiguous as to whether the procedure involved an allograft. Among 1.3 million persons with a procedure ascertained using the list of ICD-9-CM codes, only 1,886 claims clearly involved an allograft. CPT codes enabled better ascertainment of some allograft procedures (over 17,000 persons had corneal transplants and over 2,700 had allograft skin transplants). For spinal fusion procedures, CPT codes improved specificity for allografts; of nearly 100,000 patients with ICD-9-CM codes for spinal fusions, more than 34,000 had CPT codes indicating allograft use. Monitoring infrequent events (infections) after infrequent exposures (tissue allografts) requires large study populations. A strength of the large Medicare databases is the substantial number of certain allograft procedures. Limitations include lack of clinical detail and donor information. Medicare data can potentially augment passive reporting systems and may be useful for monitoring tissue allograft safety and utilization where codes clearly identify allograft use and coding algorithms can effectively screen for infections.

42 CFR 422.314 - Special rules for beneficiaries enrolled in MA MSA plans.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 3 2012-10-01 2012-10-01 false Special rules for beneficiaries enrolled in MA MSA... Medicare Advantage Organizations § 422.314 Special rules for beneficiaries enrolled in MA MSA plans. (a) Establishment and designation of medical savings account (MSA). A beneficiary who elects coverage under an MA...

42 CFR 422.314 - Special rules for beneficiaries enrolled in MA MSA plans.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 3 2013-10-01 2013-10-01 false Special rules for beneficiaries enrolled in MA MSA... Medicare Advantage Organizations § 422.314 Special rules for beneficiaries enrolled in MA MSA plans. (a) Establishment and designation of medical savings account (MSA). A beneficiary who elects coverage under an MA...

42 CFR 422.314 - Special rules for beneficiaries enrolled in MA MSA plans.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 3 2014-10-01 2014-10-01 false Special rules for beneficiaries enrolled in MA MSA... Medicare Advantage Organizations § 422.314 Special rules for beneficiaries enrolled in MA MSA plans. (a) Establishment and designation of medical savings account (MSA). A beneficiary who elects coverage under an MA...

20 CFR 404.2040 - Use of benefit payments.

Code of Federal Regulations, 2010 CFR

2010-04-01

..., if a beneficiary is a member of an Aid to Families With Dependent Children (AFDC) assistance unit, we... beneficiary's brother, who is the payee, learns the beneficiary needs new shoes and does not have any funds to... a pair of shoes for $29. He also takes the beneficiary to see a movie which costs $3. When they...

26 CFR 1.501(c)(8)-1 - Fraternal beneficiary societies.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 26 Internal Revenue 7 2011-04-01 2009-04-01 true Fraternal beneficiary societies. 1.501(c)(8)-1... beneficiary societies. (a) A fraternal beneficiary society is exempt from tax only if operated under the lodge... exempt it is also necessary that the society have an established system for the payment to its members or...

26 CFR 1.501(c)(8)-1 - Fraternal beneficiary societies.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 26 Internal Revenue 7 2010-04-01 2010-04-01 true Fraternal beneficiary societies. 1.501(c)(8)-1... beneficiary societies. (a) A fraternal beneficiary society is exempt from tax only if operated under the lodge... exempt it is also necessary that the society have an established system for the payment to its members or...

5 CFR 1651.4 - How to change or cancel a designation of beneficiary.

Code of Federal Regulations, 2010 CFR

2010-01-01

... of beneficiary, the participant must submit to the TSP record keeper a new TSP designation of beneficiary form meeting the requirements of § 1651.3 to the TSP record keeper. If the TSP receives more than... the participant. A participant may change a TSP beneficiary at any time, without the knowledge or...

[Conflicts between nursing ethics and health care legislation in Spain].

PubMed

Gea-Sánchez, Montserrat; Terés-Vidal, Lourdes; Briones-Vozmediano, Erica; Molina, Fidel; Gastaldo, Denise; Otero-García, Laura

2016-01-01

To identify the ethical conflicts that may arise between the nursing codes of ethics and the Royal Decree-law 16/2012 modifying Spanish health regulations. We conducted a review and critical analysis of the discourse of five nursing codes of ethics from Barcelona, Catalonia, Spain, Europe and International, and of the discourse of the Spanish legislation in force in 2013. Language structures referring to five different concepts of the theoretical framework of care were identified in the texts: equity, human rights, right to healthcare, access to care, and continuity of care. Codes of ethics define the function of nursing according to equity, acknowledgement of human rights, right to healthcare, access to care and continuity of care, while legal discourse hinges on the concept of beneficiary or being insured. The divergence between the code of ethics and the legal discourse may produce ethical conflicts that negatively affect nursing practice. The application of RDL 16/2012 promotes a framework of action that prevents nursing professionals from providing care to uninsured collectives, which violates human rights and the principles of care ethics. Copyright © 2016 SESPAS. Published by Elsevier Espana. All rights reserved.

Identification codes for organizations listed in computerized data systems of the U.S. Geological Survey

USGS Publications Warehouse

Blackwell, C.D.

1988-01-01

Codes for the unique identification of public and private organizations listed in computerized data systems are presented. These codes are used by the U.S. Geological Survey 's National Water Data Exchange (NAWDEX), National Water Data Storage and Retrieval System (WATSTORE), National Cartographic Information Center (NCIC), and Office of Water Data Coordination (OWDC). The format structure of the codes is discussed and instructions are given for requesting new books. (Author 's abstract)

Medicare Part D Roulette: Potential Implications of Random Assignment and Plan Restrictions

PubMed Central

Patel, Rajul A.; Walberg, Mark P.; Woelfel, Joseph A.; Amaral, Michelle M.; Varu, Paresh

2013-01-01

Background Dual-eligible (Medicare/Medicaid) beneficiaries are randomly assigned to a benchmark plan, which provides prescription drug coverage under the Part D benefit without consideration of their prescription drug profile. To date, the potential for beneficiary assignment to a plan with poor formulary coverage has been minimally studied and the resultant financial impact to beneficiaries unknown. Objective We sought to determine cost variability and drug use restrictions under each available 2010 California benchmark plan. Methods Dual-eligible beneficiaries were provided Part D plan assistance during the 2010 annual election period. The Medicare Web site was used to determine benchmark plan costs and prescription utilization restrictions for each of the six California benchmark plans available for random assignment in 2010. A standardized survey was used to record all de-identified beneficiary demographic and plan specific data. For each low-income subsidy-recipient (n = 113), cost, rank, number of non-formulary medications, and prescription utilization restrictions were recorded for each available 2010 California benchmark plan. Formulary matching rates (percent of beneficiary's medications on plan formulary) were calculated for each benchmark plan. Results Auto-assigned beneficiaries had only a 34% chance of being assigned to the lowest cost plan; the remainder faced potentially significant avoidable out-of-pocket costs. Wide variations between benchmark plans were observed for plan cost, formulary coverage, formulary matching rates, and prescription utilization restrictions. Conclusions Beneficiaries had a 66% chance of being assigned to a sub-optimal plan; thereby, they faced significant avoidable out-of-pocket costs. Alternative methods of beneficiary assignment could decrease beneficiary and Medicare costs while also reducing medication non-compliance. PMID:24753963

Assessing Medicare beneficiaries' willingness-to-pay for medication therapy management services.

PubMed

Woelfel, Joseph A; Carr-Lopez, Sian M; Delos Santos, Melanie; Bui, Ann; Patel, Rajul A; Walberg, Mark P; Galal, Suzanne M

2014-02-01

To assess Medicare beneficiaries' willingness-to-pay (WTP) for medication therapy management (MTM) services and determine sociodemographic and clinical characteristics influencing this payment amount. A cross-sectional, descriptive study design was adopted to elicit Medicare beneficiaries' WTP for MTM. Nine outreach events in cities across Central/Northern California during Medicare's 2011 open-enrollment period. A total of 277 Medicare beneficiaries participated in the study. Comprehensive MTM was offered to each beneficiary. Pharmacy students conducted the MTM session under the supervision of licensed pharmacists. At the end of each MTM session, beneficiaries were asked to indicate their WTP for the service. Medication, self-reported chronic conditions, and beneficiary demographic data were collected and recorded via a survey during the session. The mean WTP for MTM was $33.15 for the 277 beneficiaries receiving the service and answering the WTP question. WTP by low-income subsidy recipients (mean ± standard deviation; $12.80 ± $24.10) was significantly lower than for nonsubsidy recipients ($41.13 ± $88.79). WTP was significantly (positively) correlated with number of medications regularly taken and annual out-of-pocket drug costs. The mean WTP for MTM was $33.15. WTP for MTM significantly varied by race, subsidy status, and number of prescription medications taken. WTP was significantly higher for nonsubsidy recipients than subsidy recipients, and significantly positively correlated with the number of medications regularly taken and the beneficiary rating of the delivered services.

19 CFR 10.198b - Products of Puerto Rico processed in a beneficiary country.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 19 Customs Duties 1 2014-04-01 2014-04-01 false Products of Puerto Rico processed in a beneficiary... Basin Initiative § 10.198b Products of Puerto Rico processed in a beneficiary country. Except in the... of Puerto Rico and that is by any means advanced in value or improved in condition in a beneficiary...

19 CFR 10.198b - Products of Puerto Rico processed in a beneficiary country.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 19 Customs Duties 1 2012-04-01 2012-04-01 false Products of Puerto Rico processed in a beneficiary... Basin Initiative § 10.198b Products of Puerto Rico processed in a beneficiary country. Except in the... of Puerto Rico and that is by any means advanced in value or improved in condition in a beneficiary...

19 CFR 10.198b - Products of Puerto Rico processed in a beneficiary country.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 19 Customs Duties 1 2013-04-01 2013-04-01 false Products of Puerto Rico processed in a beneficiary... Basin Initiative § 10.198b Products of Puerto Rico processed in a beneficiary country. Except in the... of Puerto Rico and that is by any means advanced in value or improved in condition in a beneficiary...

19 CFR 10.198b - Products of Puerto Rico processed in a beneficiary country.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 19 Customs Duties 1 2010-04-01 2010-04-01 false Products of Puerto Rico processed in a beneficiary... Basin Initiative § 10.198b Products of Puerto Rico processed in a beneficiary country. Except in the... of Puerto Rico and that is by any means advanced in value or improved in condition in a beneficiary...

19 CFR 10.198b - Products of Puerto Rico processed in a beneficiary country.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 19 Customs Duties 1 2011-04-01 2011-04-01 false Products of Puerto Rico processed in a beneficiary... Basin Initiative § 10.198b Products of Puerto Rico processed in a beneficiary country. Except in the... of Puerto Rico and that is by any means advanced in value or improved in condition in a beneficiary...

26 CFR 1.662(c)-2 - Death of individual beneficiary.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 26 Internal Revenue 8 2011-04-01 2011-04-01 false Death of individual beneficiary. 1.662(c)-2... Distribute Corpus § 1.662(c)-2 Death of individual beneficiary. If an amount specified in section 662(a) (1... death), the extent to which the amount is included in the gross income of the beneficiary for his last...

26 CFR 1.662(c)-2 - Death of individual beneficiary.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 26 Internal Revenue 8 2014-04-01 2014-04-01 false Death of individual beneficiary. 1.662(c)-2... Distribute Corpus § 1.662(c)-2 Death of individual beneficiary. If an amount specified in section 662(a) (1... death), the extent to which the amount is included in the gross income of the beneficiary for his last...

26 CFR 1.662(c)-2 - Death of individual beneficiary.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 26 Internal Revenue 8 2013-04-01 2013-04-01 false Death of individual beneficiary. 1.662(c)-2... Distribute Corpus § 1.662(c)-2 Death of individual beneficiary. If an amount specified in section 662(a) (1... death), the extent to which the amount is included in the gross income of the beneficiary for his last...

26 CFR 1.662(c)-2 - Death of individual beneficiary.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 26 Internal Revenue 8 2012-04-01 2012-04-01 false Death of individual beneficiary. 1.662(c)-2... Distribute Corpus § 1.662(c)-2 Death of individual beneficiary. If an amount specified in section 662(a) (1... death), the extent to which the amount is included in the gross income of the beneficiary for his last...

Market variations in intensity of Medicare service use and beneficiary experiences with care.

PubMed

Mittler, Jessica N; Landon, Bruce E; Fisher, Elliot S; Cleary, Paul D; Zaslavsky, Alan M

2010-06-01

Examine associations between patient experiences with care and service use across markets. Medicare fee-for-service (FFS) and managed care (Medicare Advantage [MA]) beneficiaries in 306 markets from the 2003 Consumer Assessments of Healthcare Providers and Systems (CAHPS) surveys. Resource use intensity is measured by the 2003 end-of-life expenditure index. We estimated correlations and linear regressions of eight measures of case-mix-adjusted beneficiary experiences with intensity of service use across markets. We merged CAHPS data with service use data, excluding beneficiaries under 65 years of age or receiving Medicaid. Overall, higher intensity use was associated (p<.05) with worse (seven measures) or no better care experiences (two measures). In higher-intensity markets, Medicare FFS and MA beneficiaries reported more problems getting care quickly and less helpful office staff. However, Medicare FFS beneficiaries in higher-intensity markets reported higher overall ratings of their personal physician and main specialist. Medicare MA beneficiaries in higher-intensity markets also reported worse quality of communication with physicians, ability to get needed care, and overall ratings of care. Medicare beneficiaries in markets characterized by high service use did not report better experiences with care. This trend was strongest for those in managed care.

Do Medicare Beneficiaries Living With HIV/AIDS Choose Prescription Drug Plans That Minimize Their Total Spending?

PubMed Central

Desmond, Katherine A.; Rice, Thomas H.; Leibowitz, Arleen A.

2017-01-01

This article examines whether California Medicare beneficiaries with HIV/AIDS choose Part D prescription drug plans that minimize their expenses. Among beneficiaries without low-income supplementation, we estimate the excess cost, and the insurance policy and beneficiary characteristics responsible, when the lowest cost plan is not chosen. We use a cost calculator developed for this study, and 2010 drug use data on 1453 California Medicare beneficiaries with HIV who were taking antiretroviral medications. Excess spending is defined as the difference between projected total spending (premium and cost sharing) for the beneficiary’s current drug regimen in own plan vs spending for the lowest cost alternative plan. Regression analyses related this excess spending to individual and plan characteristics. We find that beneficiaries pay more for Medicare Part D plans with gap coverage and no deductible. Higher premiums for more extensive coverage exceeded savings in deductible and copayment/coinsurance costs. We conclude that many beneficiaries pay for plan features whose costs exceed their benefits. PMID:28990452

Cost-Related Medication Nonadherence and Cost-Saving Behaviors Among Patients With Glaucoma Before and After the Implementation of Medicare Part D.

PubMed

Blumberg, Dana M; Prager, Alisa J; Liebmann, Jeffrey M; Cioffi, George A; De Moraes, C Gustavo

2015-09-01

Understanding factors that lead to nonadherence to glaucoma treatment is important to diminish glaucoma-related disability. To determine whether the implementation of the Medicare Part D prescription drug benefit affected rates of cost-related nonadherence and cost-reduction strategies in Medicare beneficiaries with and without glaucoma and to evaluate associated risk factors for such nonadherence. Serial cross-sectional study using 2004 to 2009 Medicare Current Beneficiary Survey data linked with Medicare claims. Coding to extract data started in January 2014 and analyses were performed between September and November of 2014. Participants were all Medicare beneficiaries, including those with a glaucoma-related diagnosis in the year prior to the collection of the survey data, those with a nonglaucomatous ophthalmic diagnosis in the year prior to the collection of the survey data, and those without a recent eye care professional claim. Effect of the implementation of the Medicare Part D drug benefit. The change in cost-related nonadherence and the change in cost-reduction strategies. Between 2004 and 2009, the number of Medicare beneficiaries with glaucoma who reported taking smaller doses and skipping doses owing to cost dropped from 9.4% and 8.2% to 2.7% (P < .001) and 2.8%, respectively (P = .001). However, reports of failure to obtain prescriptions owing to cost did not improve in the same period (3.4% in 2004 and 2.1% in 2009; P = .12). After Part D, patients with glaucoma had a decrease in several cost-reduction strategies, namely price shopping (26.2%-15.2%; P < .001), purchasing outside the United States (6.9%-1.3%; P < .001), and spending less money to save for medications (8.0% to 3.5%; P < .001). Using a multivariate analysis, the main independent risk factors common to all cost-related nonadherence measures were female sex, younger age, lower income (<$30 000), self-reported visual disability, and a smaller Lawton index. After the implementation of Part D, there was a decrease in the rate that beneficiaries with glaucoma reported engaging in cost-saving measures. Although there was a decline in the rate of several cost-related nonadherence behaviors, patients reporting failure to fill prescriptions owing to cost remained stable. This suggests that efforts to improve cost-related nonadherence should focus both on financial hardship and medical therapy prioritization, particularly in certain high-risk sociodemographic groups.

Four year-olds use norm-based coding for face identity.

PubMed

Jeffery, Linda; Read, Ainsley; Rhodes, Gillian

2013-05-01

Norm-based coding, in which faces are coded as deviations from an average face, is an efficient way of coding visual patterns that share a common structure and must be distinguished by subtle variations that define individuals. Adults and school-aged children use norm-based coding for face identity but it is not yet known if pre-school aged children also use norm-based coding. We reasoned that the transition to school could be critical in developing a norm-based system because school places new demands on children's face identification skills and substantially increases experience with faces. Consistent with this view, face identification performance improves steeply between ages 4 and 7. We used face identity aftereffects to test whether norm-based coding emerges between these ages. We found that 4 year-old children, like adults, showed larger face identity aftereffects for adaptors far from the average than for adaptors closer to the average, consistent with use of norm-based coding. We conclude that experience prior to age 4 is sufficient to develop a norm-based face-space and that failure to use norm-based coding cannot explain 4 year-old children's poor face identification skills. Copyright © 2013 Elsevier B.V. All rights reserved.

Development of a Medicare Beneficiary Comprehension Test: Assessing Medicare Part D Beneficiaries' Comprehension of Their Benefits

PubMed Central

Aruru, Meghana V.; Salmon, J. Warren

2013-01-01

Background Medicare Part D, the senior prescription drug benefit plan, was introduced through the Medicare Modernization Act of 2003. Medicare beneficiaries receive information about plan options through multiple sources, and it is often assumed by consumer health plans and healthcare providers that beneficiaries can understand and compare plan information. Medicare beneficiaries are older, may have cognitive problems, and may not have a true understanding of managed care. They are more likely than younger persons to have inadequate health literacy, thereby demonstrating significant gaps in knowledge and information about healthcare. Objective To develop a Medicare Beneficiary Comprehension Test (MBCT) to evaluate Medicare beneficiaries' understanding of Part D plan concepts, as presented in the 2008 Medicare & You handbook. Methods A 10-question MBCT was developed using a case-vignette approach that required beneficiaries to read portions of the Medicare & You handbook and answer Part D–related questions associated with healthcare decision-making. The test was divided into 2 sections: (I) insurance concepts and (II) utilization management/appeals and grievances to cover standard terminology, as well as newer utilization management and appeals and grievances procedures that are unique to Part D. The test was administered to 100 beneficiaries at 2 sites—a university geriatrics clinic and a private retirement facility. Beneficiaries were tested for cognition and health literacy before being administered the test. Results The mean score on the MBCT was 3.5 of a maximum of 5, with no statistical difference found between both sites. Ten faculty members and 4 graduate students assessed the content validity of the instrument using a 4-point Likert rating rubric. The construct validity of the instrument was assessed using a principal components analysis with varimax rotation. The principal components analysis yielded 4 factors that were labeled as “Plan D concepts,” “managed care/utilization management,” “cost-sharing,” and “plan comparisons.” The factor analysis indicated that the test is multidimensional and did measure the construct. Conclusions Medicare beneficiaries' understanding of Part D may play a key role in the management of their drug use and health and the associated outcomes. The MBCT and its pending revisions can be administered to beneficiaries with differing health outcomes. Medicare beneficiaries are often faced with several pieces of information involving a complex array of choices amidst bewildering plan options. It is crucial that beneficiaries and/or their family members involved in the decision-making process understand the plan benefits to truly make an informed decision. As the number of Medicare beneficiaries increases over the coming years with the baby boomers, it becomes even more imperative that the elderly have improved access to treatments that can achieve desirable outcomes. Measuring comprehension by Medicare beneficiaries may be an initial step toward understanding more complex issues, such as treatment adherence, decision-making, and, ultimately, trends in healthcare utilization and outcomes. PMID:24991375

Medicare Beneficiary Satisfaction with Durable Medical Equipment Suppliers

PubMed Central

Hoerger, Thomas J.; Finkelstein, Eric A.; Bernard, Shulamit L.

2001-01-01

CMS has recently launched a series of initiatives to control Medicare spending on durable medical equipment (DME) and prosthetics, orthotics, and supplies (DMEPOS). An important question is how these initiatives will affect beneficiary satisfaction. Using survey data, we analyze Medicare beneficiary satisfaction with DMEPOS suppliers in two Florida counties. Our results show that beneficiaries are currently highly satisfied with their DMEPOS suppliers. Beneficiary satisfaction is positively related to rapid delivery, training, dependability, and frequency of service. Results of our analysis can be used as baseline estimates in evaluating CMS initiatives to reduce Medicare payments for DMEPOS. PMID:12500367

48 CFR 853.215-70 - VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA.

Code of Federal Regulations, 2011 CFR

2011-10-01

..., Application for Furnishing Nursing Home Care to Beneficiaries of VA. 853.215-70 Section 853.215-70 Federal... 853.215-70 VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA. VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA, will be used for...

48 CFR 853.215-70 - VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA.

Code of Federal Regulations, 2012 CFR

2012-10-01

..., Application for Furnishing Nursing Home Care to Beneficiaries of VA. 853.215-70 Section 853.215-70 Federal... 853.215-70 VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA. VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA, will be used for...

48 CFR 853.215-70 - VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA.

Code of Federal Regulations, 2013 CFR

2013-10-01

..., Application for Furnishing Nursing Home Care to Beneficiaries of VA. 853.215-70 Section 853.215-70 Federal... 853.215-70 VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA. VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA, will be used for...

48 CFR 853.215-70 - VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., Application for Furnishing Nursing Home Care to Beneficiaries of VA. 853.215-70 Section 853.215-70 Federal... 853.215-70 VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA. VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA, will be used for...

48 CFR 853.215-70 - VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA.

Code of Federal Regulations, 2014 CFR

2014-10-01

..., Application for Furnishing Nursing Home Care to Beneficiaries of VA. 853.215-70 Section 853.215-70 Federal... 853.215-70 VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA. VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA, will be used for...

Proposing national identification number on dental prostheses as universal personal identification code - A revolution in forensic odontology

PubMed Central

Baad, Rajendra K.; Belgaumi, Uzma; Vibhute, Nupura; Kadashetti, Vidya; Chandrappa, Pramod Redder; Gugwad, Sushma

2015-01-01

The proper identification of a decedent is not only important for humanitarian and emotional reasons, but also for legal and administrative purposes. During the reconstructive identification process, all necessary information is gathered from the unknown body of the victim and hence that an objective reconstructed profile can be established. Denture marking systems are being used in various situations, and a number of direct and indirect methods are reported. We propose that national identification numbers be incorporated in all removable and fixed prostheses, so as to adopt a single and definitive universal personal identification code with the aim of achieving a uniform, standardized, easy, and fast identification method worldwide for forensic identification. PMID:26005294

A close examination of healthcare expenditures related to fractures.

PubMed

Kilgore, Meredith L; Curtis, Jeffrey R; Delzell, Elizabeth; Becker, David J; Arora, Tarun; Saag, Kenneth G; Morrisey, Michael A

2013-04-01

This study evaluated reasons for healthcare expenditures both before and after the occurrence of fractures among Medicare beneficiaries. In a previous study we examined healthcare expenditures in the 6 months before and after fractures. The difference-"incremental" expenditures-provides one estimate of the potentially avoidable costs associated with fractures. We constructed a second estimate of the cost burden-"attributable" expenditures-using only those costs recorded in claims with fracture diagnosis codes. Attributable expenditures accounted for only 24% to 60% of incremental expenditures, depending on the fracture site. We examined health care expenditures between 1999 and 2005 among Medicare beneficiaries who experienced fractures (cases) and among beneficiaries who did not experience fractures (controls), matched to cases on age, race, and sex. We also examined healthcare expenditures for cases and controls for 24 months prior to the fracture index date. When expenditures associated with diagnoses for aftercare, joint pain, and osteoporosis, other musculoskeletal diagnoses, pneumonia, and pressure ulcers were included, the proportion of incremental costs directly attributable to fracture care rose to 72% to 88%. Expenditures prior to fracture were higher for cases than controls, and the rate of increase accelerated over the 12 months prior to the hip fracture. Our findings confirm that the original incremental cost analysis constituted a satisfactory method for estimating avoidable costs associated with fractures. We also conclude that those with fractures had much higher and growing healthcare expenditures in the 12 months prior to the event, compared with age-, race-, and sex-matched controls. This suggests that patterns of healthcare services utilization may provide a means to improve fracture prediction rules. Copyright © 2013 American Society for Bone and Mineral Research.

Long term safety of sacral nerve modulation in medicare beneficiaries.

PubMed

Chughtai, Bilal; Sedrakyan, Art; Isaacs, Abby; Lee, Richard; Te, Alexis; Kaplan, Steven

2015-09-01

Sacral nerve stimulation (SNS) is FDA approved as second-line therapy for both urinary and bowel control. However, there is limited evidence regarding long term safety. We determined adverse events associated with SNS among Medicare beneficiaries. We used the 5% national random sample of Medicare claims for 2001-2011 to identify patients. Patients who underwent SNS implantation were identified with Current Procedure Terminology (CPT-4) codes. We determined safety of SNS using analysis of complication occurrences on day of surgery and during 5 years following initial procedure. SAS v9.3 statistical package was used. One thousand four hundred seventy-four patients underwent treatment with SNS in the 5% national sample of Medicare patients within the time period. Representative of real-world patients undergoing SNS surgery, comorbidities included hypertension (69.3%), diabetes (29.4%), chronic pulmonary disease (25.5%), hypothyroidism (25.2%), and depression (22.7%). Few complications occurred on day of surgery. At 90 days, 3.2% of patients had bowel complications, 2.0% urological, 9.4% infectious, and 1.5% stroke. Overall, bowel, neurological health event occurrences were consistent with prior year rates, while infectious events decreased. Of 206 patients who were followed for at least 5 years, 17.3% had devices removed and 11.3% replaced, with 26.1% having at least one of those, leaving 73.9% with original devices. Urological, infectious, and bowel complication occurrences were low after SNS among Medicare beneficiaries with multiple comorbidities. There were infrequent serious complications like hemorrhage and stroke postoperatively. Although SNS appears safe in this high-risk population, a comprehensive registry will ensure continuous safety. © 2014 Wiley Periodicals, Inc.

The quality of Medicaid and Medicare data obtained from CMS and its contractors: implications for pharmacoepidemiology.

PubMed

Leonard, Charles E; Brensinger, Colleen M; Nam, Young Hee; Bilker, Warren B; Barosso, Geralyn M; Mangaali, Margaret J; Hennessy, Sean

2017-04-26

Administrative claims of United States Centers for Medicare and Medicaid Services (CMS) beneficiaries have long been used in non-experimental research. While CMS performs in-house checks of these claims, little is known of their quality for conducting pharmacoepidemiologic research. We performed exploratory analyses of the quality of Medicaid and Medicare data obtained from CMS and its contractors. Our study population consisted of Medicaid beneficiaries (with and without dual coverage by Medicare) from California, Florida, New York, Ohio, and Pennsylvania. We obtained and compiled 1999-2011 data from these state Medicaid programs (constituting about 38% of nationwide Medicaid enrollment), together with corresponding national Medicare data for dually-enrolled beneficiaries. This descriptive study examined longitudinal patterns in: dispensed prescriptions by state, by quarter; and inpatient hospitalizations by federal benefit, state, and age group. We further examined discrepancies between demographic characteristics and disease states, in particular frequencies of pregnancy complications among men and women beyond childbearing age, and prostate cancers among women. Dispensed prescriptions generally increased steadily and consistently over time, suggesting that these claims may be complete. A commercially-available National Drug Code lookup database was able to identify the dispensed drug for 95.2-99.4% of these claims. Because of co-coverage by Medicare, Medicaid data appeared to miss a substantial number of hospitalizations among beneficiaries ≥ 45 years of age. Pregnancy complication diagnoses were rare in males and in females ≥ 60 years of age, and prostate cancer diagnoses were rare in females. CMS claims from five large states obtained directly from CMS and its contractors appeared to be of high quality. Researchers using Medicaid data to study hospital outcomes should obtain supplemental Medicare data on dual enrollees, even for non-elders. Not applicable.

Risk of seizures and status epilepticus in older patients with liver disease.

PubMed

Alkhachroum, Ayham M; Rubinos, Clio; Kummer, Benjamin R; Parikh, Neal S; Chen, Monica; Chatterjee, Abhinaba; Reynolds, Alexandra; Merkler, Alexander E; Claassen, Jan; Kamel, Hooman

2018-06-06

Seizures can be provoked by systemic diseases associated with metabolic derangements, but the association between liver disease and seizures remains unclear. We performed a retrospective cohort study using inpatient and outpatient claims between 2008 and 2015 from a nationally representative 5% sample of Medicare beneficiaries. The primary exposure variable was cirrhosis, and the secondary exposure was mild, noncirrhotic liver disease. The primary outcome was seizure, and the secondary outcome was status epilepticus. Diagnoses were ascertained using validated International Classification of Diseases, Ninth Edition, Clinical Modification codes. Survival statistics were used to calculate incidence rates, and Cox proportional hazards models were used to examine the association between exposures and outcomes while adjusting for seizure risk factors. Among 1 782 402 beneficiaries, we identified 10 393 (0.6%) beneficiaries with cirrhosis and 19 557 (1.1%) with mild, noncirrhotic liver disease. Individuals with liver disease were older and had more seizure risk factors than those without liver disease. Over 4.6 ± 2.2 years of follow-up, 49 843 (2.8%) individuals were diagnosed with seizures and 25 patients (0.001%) were diagnosed with status epilepticus. Cirrhosis was not associated with seizures (hazard ratio [HR] = 1.1, 95% confidence interval [CI] = 1.0-1.3), but there was an association with status epilepticus (HR = 1.9, 95% CI = 1.3-2.8). Mild liver disease was not associated with a higher risk of seizures (HR = 0.8, 95% CI = 0.6-0.9) or status epilepticus (HR = 1.1, 95% CI = 0.7-1.5). In a large, population-based cohort, we found an association between cirrhosis and status epilepticus, but no overall association between liver disease and seizures. Wiley Periodicals, Inc. © 2018 International League Against Epilepsy.

The role of cerebrovascular disease and the association between diabetes mellitus and dementia among aged medicare beneficiaries.

PubMed

Lu, Z Kevin; Li, Minghui; Yuan, Jing; Wu, Jun

2016-01-01

The aim of this study is to assess whether diabetes mellitus is associated with overall dementia and its subtypes (Alzheimer's disease and vascular dementia) among the elderly and to identify the role of cerebrovascular disease in the association between diabetes and dementia. In a retrospective cross-sectional study, 5160 community-dwelling and institutionalized Medicare beneficiaries aged 65 years or over without health maintenance organization enrollment from the Medicare Current Beneficiary Survey in 2010 were included. The International Classification of Diseases-9 codes were used to identify the outcome and independent variables from the Medicare claims. The key predictor was diabetes mellitus and the outcomes were overall dementia and its subtypes. Logistic regression was employed to assess the association between dementia and diabetes after adjusting for age, gender, race, education, income, smoking status, and Charlson Comorbidity Index. After adjusting for potential confounders, diabetes mellitus was significantly associated with overall dementia (odds ratio [OR] = 1.42; 95% confidence interval [CI], 1.14-1.77), vascular dementia (OR = 1.29; 95% CI, 1.02-1.64), and Alzheimer's disease (OR = 1.51, 95% CI, 1.10-2.09). The OR decreased to 1.26 (95% CI, 1.01-1.58) for overall dementia, controlling for cerebrovascular disease. The associations between diabetes mellitus and vascular dementia (OR = 1.13, 95% CI, 0.89-1.44) and Alzheimer's disease (OR = 1.39, 95% CI, 1.00-1.92) were no longer statistically significant once cerebrovascular disease was controlled. The association between diabetes mellitus and dementia is only partially mediated through cerebrovascular disease, suggesting that diabetes mellitus is associated independently with overall dementia among the elderly, but not with vascular dementia and Alzheimer's disease. Copyright © 2015 John Wiley & Sons, Ltd.

Access to Oral Osteoporosis Drugs among Female Medicare Part D Beneficiaries

PubMed Central

Lin, Chia-Wei; Karaca-Mandic, Pinar; McCullough, Jeffrey S.; Weaver, Lesley

2014-01-01

Background For women living with osteoporosis, high out-of-pocket drug costs may prevent drug therapy initiation. We investigate the association between oral osteoporosis out-of-pocket medication costs and female Medicare beneficiaries’ initiation of osteoporosis drug therapy. Methods We used 2007 and 2008 administrative claims and enrollment data for a 5% random sample of Medicare beneficiaries. Our study sample included age-qualified, female beneficiaries who had no prior history of osteoporosis but were diagnosed with osteoporosis in 2007 or 2008. Additionally, we only included beneficiaries continuously enrolled in standalone prescription drug plans. We excluded beneficiaries who had a chronic condition that was contraindicated with osteoporosis drug utilization. Our final sample included 25,069 beneficiaries. Logistic regression analysis was used to examine the association between the out-of-pocket costs and initiation of oral osteoporosis drug therapy during the year of diagnosis. Findings Twenty-six percent of female Medicare beneficiaries newly diagnosed with osteoporosis initiated oral osteoporosis drug therapy. Beneficiaries’ out-of-pocket costs were not associated with the initiation of drug therapy for osteoporosis. However, there were statistically significant racial disparities in beneficiaries’ initiation of drug therapy. African Americans were 3 percentage points less likely to initiate drug therapy than whites. In contrast, Asian/Pacific Islander and Hispanic beneficiaries were 8 and 18 percentage points respectively more likely to initiate drug therapy than whites. Additionally, institutionalized beneficiaries were 11 percentage points less likely to initiate drug therapy than other beneficiaries. Conclusions Access barriers for drug therapy initiation may be driven by factors other than patients’ out-of-pocket costs. These results suggest that improved osteoporosis treatment requires a more comprehensive approach that goes beyond payment policies. PMID:24837398

Medicare Advantage: options for standardizing benefits and information to improve consumer choice.

PubMed

O'Brien, Ellen; Hoadley, Jack

2008-04-01

The Medicare Advantage (MA) program offers beneficiaries a choice of private health plans as alternatives to the traditional fee-for-service Medicare program. MA plans potentially provide additional value, but as plan choices have proliferated, consumers contemplating their options have had difficulty understanding how they differ. Through "standardization" more consistent types of information and a limited number of dimensions along which plans vary--MA plans could reduce complexity and improve beneficiaries' ability to make informed choices. Such standardization steps would offer more meaningful variation in the health coverage options available to beneficiaries, Medicare officials and their community partners would find it far easier to educate beneficiaries about their health plan choices, and beneficiaries would better understand what they were buying. Standardization might also strengthen the ability of the market-based Medicare Advantage program to incorporate beneficiary preferences.

Recent Health Care Use and Medicaid Entry of Medicare Beneficiaries.

PubMed

Keohane, Laura M; Trivedi, Amal N; Mor, Vincent

2017-10-01

To examine the relationship between Medicaid entry and recent health care use among Medicare beneficiaries. We identified Medicare beneficiaries without full Medicaid or use of hospital or nursing home services in 2008 (N = 2,163,387). A discrete survival analysis estimated beneficiaries' monthly likelihood of entry into the full Medicaid program between January 2009 and June 2010. During the 18-month study period, Medicaid entry occurred for 1.1% and 3.7% of beneficiaries who aged into Medicare or originally qualified for Medicare due to disability, respectively. Among beneficiaries who aged into Medicare, 49% of new Medicaid participants had no use of inpatient, skilled nursing facility, or nursing home services during the study period. Individuals who recently used inpatient, skilled nursing facility or nursing home services had monthly rates of 1.9, 14.0, and 38.1 new Medicaid participants per 1,000 beneficiaries, respectively, compared with 0.4 new Medicaid participants per 1,000 beneficiaries with no recent use of these services. Although recent health care use predicted greater likelihood of Medicaid entry, half of new Medicaid participants used no hospital or nursing home care during the study period. These patterns should be considered when designing and evaluating interventions to reform health care delivery for dual-eligible beneficiaries. © The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Secure ADS-B authentication system and method

NASA Technical Reports Server (NTRS)

Viggiano, Marc J (Inventor); Valovage, Edward M (Inventor); Samuelson, Kenneth B (Inventor); Hall, Dana L (Inventor)

2010-01-01

A secure system for authenticating the identity of ADS-B systems, including: an authenticator, including a unique id generator and a transmitter transmitting the unique id to one or more ADS-B transmitters; one or more ADS-B transmitters, including a receiver receiving the unique id, one or more secure processing stages merging the unique id with the ADS-B transmitter's identification, data and secret key and generating a secure code identification and a transmitter transmitting a response containing the secure code and ADSB transmitter's data to the authenticator; the authenticator including means for independently determining each ADS-B transmitter's secret key, a receiver receiving each ADS-B transmitter's response, one or more secure processing stages merging the unique id, ADS-B transmitter's identification and data and generating a secure code, and comparison processing comparing the authenticator-generated secure code and the ADS-B transmitter-generated secure code and providing an authentication signal based on the comparison result.

Market characteristics and awareness of managed care options among elderly beneficiaries enrolled in traditional Medicare.

PubMed

Mittler, Jessica N; Landon, Bruce E; Zaslavsky, Alan M; Cleary, Paul D

2011-10-14

Medicare beneficiaries' awareness of Medicare managed care plans is critical for realizing the potential benefits of coverage choices. To assess the relationships of the number of Medicare risk plans, managed care penetration, and stability of plans in an area with traditional Medicare beneficiaries' awareness of the program. Cross-sectional analysis of Medicare Current Beneficiary Survey data about beneficiaries' awareness and knowledge of Medicare managed care plan availability. Logistic regression models used to assess the relationships between awareness and market characteristics. Traditional Medicare beneficiaries (n = 3,597) who had never been enrolled in Medicare managed care, but had at least one plan available in their area in 2002, and excluding beneficiaries under 65, receiving Medicaid, or with end stage renal disease. Traditional Medicare beneficiaries' knowledge of Medicare managed care plans in general and in their area. Having more Medicare risk plans available was significantly associated with greater awareness, and having an intermediate number of plans (2-4) was significantly associated with more accurate knowledge of Medicare risk plan availability than was having fewer or more plans. Medicare may have more success engaging consumers in choice and capturing the benefits of plan competition by more actively selecting and managing the plan choice set. Public Domain.

Disability Stages and Trouble Getting Needed Health Care Among Medicare Beneficiaries.

PubMed

McClintock, Heather F; Kurichi, Jibby E; Kwong, Pui L; Xie, Dawei; Streim, Joel E; Pezzin, Liliana E; Hennessey, Sean; Na, Ling; Bogner, Hillary R

2017-06-01

The aim of this study was to examine whether activity limitation stages were associated with patient-reported trouble getting needed health care among Medicare beneficiaries. This was a population-based study (n = 35,912) of Medicare beneficiaries who participated in the Medicare Current Beneficiary Survey for years 2001-2010. Beneficiaries were classified into an activity limitation stage from 0 (no limitation) to IV (complete) derived from self-reported or proxy-reported difficulty performing activities of daily living and instrumental activities of daily living. Beneficiaries reported whether they had trouble getting health care in the subsequent year. A multivariable logistic regression model examined the association between activity limitation stages and trouble getting needed care. Compared with beneficiaries with no limitations (activities of daily living stage 0), the adjusted odds ratios (ORs) (95% confidence intervals [CIs]) for stage I (mild) to stage IV (complete) for trouble getting needed health care ranged from OR = 1.53 (95% CI, 1.32-1.76) to OR = 2.86 (95% CI, 1.97-4.14). High costs (31.7%), not having enough money (31.2%), and supplies/services not covered (24.2%) were the most common reasons for reporting trouble getting needed health care. Medicare beneficiaries at higher stages of activity limitations reported trouble getting needed health care, which was commonly attributed to financial barriers.

Market Characteristics and Awareness of Managed Care Options Among Elderly Beneficiaries Enrolled in Traditional Medicare

PubMed Central

Mittler, Jessica N.; Landon, Bruce E.; Zaslavsky, Alan M.; Cleary, Paul D.

2011-01-01

Background Medicare beneficiaries' awareness of Medicare managed care plans is critical for realizing the potential benefits of coverage choices. Objectives To assess the relationships of the number of Medicare risk plans, managed care penetration, and stability of plans in an area with traditional Medicare beneficiaries' awareness of the program. Research Design Cross-sectional analysis of Medicare Current Beneficiary Survey data about beneficiaries' awareness and knowledge of Medicare managed care plan availability. Logistic regression models used to assess the relationships between awareness and market characteristics. Subjects Traditional Medicare beneficiaries (n = 3,597) who had never been enrolled in Medicare managed care, but had at least one plan available in their area in 2002, and excluding beneficiaries under 65, receiving Medicaid, or with end stage renal disease. Measures Traditional Medicare beneficiaries' knowledge of Medicare managed care plans in general and in their area. Results Having more Medicare risk plans available was significantly associated with greater awareness, and having an intermediate number of plans (2-4) was significantly associated with more accurate knowledge of Medicare risk plan availability than was having fewer or more plans. Conclusions Medicare may have more success engaging consumers in choice and capturing the benefits of plan competition by more actively selecting and managing the plan choice set. PMID:22340776

Comparing the Health Care Experiences of Medicare Beneficiaries with and without Depressive Symptoms in Medicare Managed Care versus Fee-for-Service.

PubMed

Martino, Steven C; Elliott, Marc N; Haviland, Amelia M; Saliba, Debra; Burkhart, Q; Kanouse, David E

2016-06-01

To compare patient experiences and disparities for older adults with depressive symptoms in managed care (Medicare Advantage [MA]) versus Medicare Fee-for-Service (FFS). Data came from the 2010 Medicare CAHPS survey, to which 220,040 MA and 135,874 FFS enrollees aged 65 and older responded. Multivariate linear regression was used to test whether case-mix-adjusted associations between depressive symptoms and patient experience differed for beneficiaries in MA versus FFS. Dependent measures included four measures of beneficiaries' experiences with doctors (e.g., reports of doctor communication) and seven measures of beneficiaries' experiences with plans (e.g., customer service). Beneficiaries with depressive symptoms reported worse experiences than those without depressive symptoms regardless of coverage type. For measures assessing interactions with the plan (but not for measures assessing interactions with doctors), the disadvantage for beneficiaries with versus without depressive symptoms was larger in MA than in FFS. Disparities in care experienced by older Medicare beneficiaries with depressive symptoms tend to be more negative in managed care than in FFS. Efforts are needed to identify and address the barriers these beneficiaries encounter to help them better traverse the managed care environment. © Health Research and Educational Trust.

Optimized scalar promotion with load and splat SIMD instructions

DOEpatents

Eichenberger, Alexander E; Gschwind, Michael K; Gunnels, John A

2013-10-29

Mechanisms for optimizing scalar code executed on a single instruction multiple data (SIMD) engine are provided. Placement of vector operation-splat operations may be determined based on an identification of scalar and SIMD operations in an original code representation. The original code representation may be modified to insert the vector operation-splat operations based on the determined placement of vector operation-splat operations to generate a first modified code representation. Placement of separate splat operations may be determined based on identification of scalar and SIMD operations in the first modified code representation. The first modified code representation may be modified to insert or delete separate splat operations based on the determined placement of the separate splat operations to generate a second modified code representation. SIMD code may be output based on the second modified code representation for execution by the SIMD engine.

Optimized scalar promotion with load and splat SIMD instructions

DOEpatents

Eichenberger, Alexandre E [Chappaqua, NY; Gschwind, Michael K [Chappaqua, NY; Gunnels, John A [Yorktown Heights, NY

2012-08-28

Mechanisms for optimizing scalar code executed on a single instruction multiple data (SIMD) engine are provided. Placement of vector operation-splat operations may be determined based on an identification of scalar and SIMD operations in an original code representation. The original code representation may be modified to insert the vector operation-splat operations based on the determined placement of vector operation-splat operations to generate a first modified code representation. Placement of separate splat operations may be determined based on identification of scalar and SIMD operations in the first modified code representation. The first modified code representation may be modified to insert or delete separate splat operations based on the determined placement of the separate splat operations to generate a second modified code representation. SIMD code may be output based on the second modified code representation for execution by the SIMD engine.

Disparities in home health service providers among Medicare beneficiaries with stroke.

PubMed

Iyer, Medha; Bhavsar, Grishma P; Bennett, Kevin J; Probst, Janice C

2016-01-01

This study examined the intensity of home health services, as defined by the number of visits and service delivery by rehabilitation specialists, among Medicare beneficiaries with stroke. A cross-sectional secondary data analysis was conducted using 2009 home health claims data obtained from the Centers for Medicare and Medicaid Services' Research Data Assistance Center. There were no significant rural-urban differences in the number of home health visits. Rural beneficiaries were significantly less likely than urban beneficiaries to receive services from rehabilitation specialists. Current home health payment reform recommendations may have unintended consequences for rural home health beneficiaries who need therapy services.

Competitive code-based fast palmprint identification using a set of cover trees

NASA Astrophysics Data System (ADS)

Yue, Feng; Zuo, Wangmeng; Zhang, David; Wang, Kuanquan

2009-06-01

A palmprint identification system recognizes a query palmprint image by searching for its nearest neighbor from among all the templates in a database. When applied on a large-scale identification system, it is often necessary to speed up the nearest-neighbor searching process. We use competitive code, which has very fast feature extraction and matching speed, for palmprint identification. To speed up the identification process, we extend the cover tree method and propose to use a set of cover trees to facilitate the fast and accurate nearest-neighbor searching. We can use the cover tree method because, as we show, the angular distance used in competitive code can be decomposed into a set of metrics. Using the Hong Kong PolyU palmprint database (version 2) and a large-scale palmprint database, our experimental results show that the proposed method searches for nearest neighbors faster than brute force searching.

Purchased Behavioral Health Care Received by Military Health System Beneficiaries in Civilian Medical Facilities, 2000-2014.

PubMed

Wooten, Nikki R; Brittingham, Jordan A; Pitner, Ronald O; Tavakoli, Abbas S; Jeffery, Diana D; Haddock, K Sue

2018-02-06

Behavioral health conditions are a significant concern for the U.S. military and the Military Health System (MHS) because of decreased military readiness and increased health care utilization. Although MHS beneficiaries receive direct care in military treatment facilities, a disproportionate majority of behavioral health treatment is purchased care received in civilian facilities. Yet, limited evidence exists about purchased behavioral health care received by MHS beneficiaries. This longitudinal study (1) estimated the prevalence of purchased behavioral health care and (2) identified patient and visit characteristics predicting receipt of purchased behavioral health care in acute care facilities from 2000 to 2014. Medical claims with Major Diagnostic Code 19 (mental disorders/diseases) or 20 (alcohol/drug disorders) as primary diagnoses and TRICARE as the primary/secondary payer were analyzed for MHS beneficiaries (n = 17,943) receiving behavioral health care in civilian acute care facilities from January 1, 2000, to December 31, 2014. The primary dependent variable, receipt of purchased behavioral health care, was modeled for select mental health and substance use disorders from 2000 to 2014 using generalized estimating equations. Patient characteristics included time, age, sex, and race/ethnicity. Visit types included inpatient hospitalization and emergency department (ED). Time was measured in days and visits were assumed to be correlated over time. Behavioral health care was described by both frequency of patients and visit type. The University of South Carolina Institutional Review Board approved this study. From 2000 to 2014, purchased care visits increased significantly for post-traumatic stress disorder, adjustment, anxiety, mood, bipolar, tobacco use, opioid/combination opioid dependence, nondependent cocaine abuse, psychosocial problems, and suicidal ideation among MHS beneficiaries. The majority of care was received for mental health disorders (78.8%) and care was most often received in EDs (56%). Most commonly treated diagnoses included mood, tobacco use, and alcohol use disorders. ED visits were associated with being treated for anxiety (excluding post-traumatic stress disorder; Adjusted odds ratio [AOR]: 9.14 [95% confidence interval (CI): 8.26, 10.12]), alcohol use disorders (AOR = 1.67 [95% CI: 1.53, 1.83]), tobacco use (AOR = 1.16 [95% CI: 1.06, 1.26]), nondependent cocaine abuse (AOR = 5.47 [95% CI: 3.28, 9.12]), nondependent mixed/unspecified drug abuse (AOR = 7.30 [95% CI: 5.11, 10.44]), and psychosis (AOR = 1.38 [95% CI: 1.20, 1.58]). Compared with adults age 60 yr and older, adolescents (ages 12-17 yr), and adults under age 60 yr were more likely to be treated for suicidal ideation, adjustment, mood, bipolar, post-traumatic stress disorder, nondependent cocaine, and mixed/unspecified drug abuse. Adults under age 60 yr also had increased odds of being treated for tobacco use disorders, alcohol use disorders, and opioid/combination opioid dependence compared with adults age 60 yr and older. Over the past 15 yr, purchased behavioral health care received by MHS beneficiaries in acute care facilities increased significantly. MHS beneficiaries received the majority of purchased behavioral health care for mental health disorders and were treated most often in the ED. Receiving behavioral health care in civilian EDs raises questions about access to outpatient behavioral health care and patient-centered care coordination between civilian and military facilities. Given the influx of new Veterans Health Administration users from the MHS, findings have implications for military, veteran, and civilian facilities providing behavioral health care to military and veteran populations. © Association of Military Surgeons of the United States 2018. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

38 CFR 17.106 - VA collection rules; third-party payers.

Code of Federal Regulations, 2014 CFR

2014-07-01

... beneficiary were to incur the costs on the beneficiary's own behalf. (2) Definitions. For the purposes of this... beneficiary for healthcare services or products. (H) A third-party administrator. (b) Calculating reasonable...

Codestream-Based Identification of JPEG 2000 Images with Different Coding Parameters

NASA Astrophysics Data System (ADS)

Watanabe, Osamu; Fukuhara, Takahiro; Kiya, Hitoshi

A method of identifying JPEG 2000 images with different coding parameters, such as code-block sizes, quantization-step sizes, and resolution levels, is presented. It does not produce false-negative matches regardless of different coding parameters (compression rate, code-block size, and discrete wavelet transform (DWT) resolutions levels) or quantization step sizes. This feature is not provided by conventional methods. Moreover, the proposed approach is fast because it uses the number of zero-bit-planes that can be extracted from the JPEG 2000 codestream by only parsing the header information without embedded block coding with optimized truncation (EBCOT) decoding. The experimental results revealed the effectiveness of image identification based on the new method.

MEDICARE CURRENT BENEFICIARY SURVEY (MCBS) DATA

EPA Science Inventory

The Medicare Current Beneficiary Survey (MCBS) is a continuous, multipurpose survey of a nationally representative sample of aged, disabled, and institutionalized Medicare beneficiaries. MCBS, which is sponsored by the Centers for Medicare & Medicaid Services (CMS), is a comprehe...

7 CFR 1710.104 - Service to non-RE Act beneficiaries.

Code of Federal Regulations, 2010 CFR

2010-01-01

... GUARANTEES Loan Purposes and Basic Policies § 1710.104 Service to non-RE Act beneficiaries. (a) To the... made to finance electric facilities to serve consumers that are not RE Act beneficiaries. (b) Loan...

Employment among Social Security disability program beneficiaries, 1996-2007.

PubMed

Mamun, Arif; O'Leary, Paul; Wittenburg, David C; Gregory, Jesse

2011-01-01

We use linked administrative data from program and earnings records to summarize the 2007 employment rates of Social Security disability program beneficiaries at the national and state levels, as well as changes in employment since 1996. The findings provide new information on the employment activities of beneficiaries that should be useful in assessing current agency policies and providing benchmarks for ongoing demonstration projects and future return-to-work initiatives. The overall employment rate--which we define as annual earnings over $1,000--was 12 percent in 2007. Substantial variation exists within the population. Disability Insurance beneficiaries and those younger than age 40 were much more likely to work relative to other Social Security beneficiaries. Additionally, substantial regional variation exists across states; employment rates ranged from 7 percent (West Virginia) to 23 percent (North Dakota). Moreover, we find that the employment rates among beneficiaries were sensitive to the business cycle and persistent over time.

Discontinuity of Medicaid Coverage: Impact on Cost and Utilization Among Adult Medicaid Beneficiaries With Major Depression.

PubMed

Ji, Xu; Wilk, Adam S; Druss, Benjamin G; Lally, Cathy; Cummings, Janet R

2017-08-01

Gaps in Medicaid coverage may disrupt access to and continuity of care. This can be detrimental for beneficiaries with chronic conditions, such as major depression, for whom disruptions in access to outpatient care may lead to increased use of acute care. However, little is known about how Medicaid coverage discontinuities impact acute care utilization among adults with depression. Examine the relationship between Medicaid discontinuities and service utilization among adults with major depression. A total of 139,164 adults (18-64) with major depression was identified using the 2003-2004 Medicaid Analytic eXtract Files. We used generalized linear and two-part models to examine the effect of Medicaid discontinuity on service utilization. To establish causality in this relationship, we used instrumental variables analysis, relying on exogenous variation in a state-level policy for identification. Emergency department (ED) visits, inpatient episodes, inpatient days, and Medicaid-reimbursed costs. Approximately 29.4% of beneficiaries experienced coverage disruptions. In instrumental variables models, those with coverage disruptions incurred an increase of $650 in acute care costs per-person per Medicaid-covered month compared with those with continuous coverage, evidenced by an increase in ED use (0.1 more ED visits per-person-month) and inpatient days (0.6 more days per-person-month). The increase in acute costs contributed to an overall increase in all-cause costs by $310 per-person-month (all P-values<0.001). Among depressed adults, those experiencing coverage disruptions have, on average, significantly greater use of costly ED/inpatient services than those with continuous coverage. Maintenance of continuous Medicaid coverage may help prevent acute episodes requiring high-cost interventions.

Multimorbidity: constellations of conditions across subgroups of midlife and older individuals, and related Medicare expenditures

PubMed Central

Schiltz, Nicholas K.; Warner, David F.; Sun, Jiayang; Stange, Kurt C.; Given, Charles W.; Dor, Avi

2017-01-01

Introduction: The Department of Health and Human Services’ 2010 Strategic Framework on Multiple Chronic Conditions called for the identification of common constellations of conditions in older adults. Objectives: To analyze patterns of conditions constituting multimorbidity (CCMM) and expenditures in a US representative sample of midlife and older adults (50–64 and ≥65 years of age, respectively). Design: A cross-sectional study of the 2010 Health and Retirement Study (HRS; n=17,912). The following measures were used: (1) count and combinations of CCMM, including (i) chronic conditions (hypertension, arthritis, heart disease, lung disease, stroke, diabetes, cancer, and psychiatric conditions), (ii) functional limitations (upper body limitations, lower body limitations, strength limitations, limitations in activities of daily living, and limitations in instrumental activities of daily living), and (iii) geriatric syndromes (cognitive impairment, depressive symptoms, incontinence, visual impairment, hearing impairment, severe pain, and dizziness); and (2) annualized 2011 Medicare expenditures for HRS participants who were Medicare fee-for-service beneficiaries (n=5,677). Medicaid beneficiaries were also identified based on their self-reported insurance status. Results: No large representations of participants within specific CCMM categories were observed; however, functional limitations and geriatric syndromes were prominently present with higher CCMM counts. Among fee-for-service Medicare beneficiaries aged 50–64 years, 26.7% of the participants presented with ≥10 CCMM, but incurred 48% of the expenditure. In those aged ≥65 years, these percentages were 16.9% and 34.4%, respectively. Conclusion: Functional limitations and geriatric syndromes considerably add to the MM burden in midlife and older adults. This burden is much higher than previously reported. PMID:29090187

32 CFR 220.14 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-07-01

... COLLECTION FROM THIRD PARTY PAYERS OF REASONABLE CHARGES FOR HEALTHCARE SERVICES § 220.14 Definitions....2). Covered beneficiaries. Covered beneficiaries are all healthcare beneficiaries under chapter 55...-99 (often referred to as “Uniformed Services Treatment Facilities” or “USTFs”). Healthcare services...

32 CFR 220.14 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-07-01

... COLLECTION FROM THIRD PARTY PAYERS OF REASONABLE CHARGES FOR HEALTHCARE SERVICES § 220.14 Definitions....2). Covered beneficiaries. Covered beneficiaries are all healthcare beneficiaries under chapter 55...-99 (often referred to as “Uniformed Services Treatment Facilities” or “USTFs”). Healthcare services...

32 CFR 220.14 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... COLLECTION FROM THIRD PARTY PAYERS OF REASONABLE CHARGES FOR HEALTHCARE SERVICES § 220.14 Definitions....2). Covered beneficiaries. Covered beneficiaries are all healthcare beneficiaries under chapter 55...-99 (often referred to as “Uniformed Services Treatment Facilities” or “USTFs”). Healthcare services...

32 CFR 220.14 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-07-01

... COLLECTION FROM THIRD PARTY PAYERS OF REASONABLE CHARGES FOR HEALTHCARE SERVICES § 220.14 Definitions....2). Covered beneficiaries. Covered beneficiaries are all healthcare beneficiaries under chapter 55...-99 (often referred to as “Uniformed Services Treatment Facilities” or “USTFs”). Healthcare services...

32 CFR 220.14 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-07-01

... COLLECTION FROM THIRD PARTY PAYERS OF REASONABLE CHARGES FOR HEALTHCARE SERVICES § 220.14 Definitions....2). Covered beneficiaries. Covered beneficiaries are all healthcare beneficiaries under chapter 55...-99 (often referred to as “Uniformed Services Treatment Facilities” or “USTFs”). Healthcare services...

26 CFR 509.121 - Beneficiaries of an estate or trust.

Code of Federal Regulations, 2010 CFR

2010-04-01

...) REGULATIONS UNDER TAX CONVENTIONS SWITZERLAND General Income Tax § 509.121 Beneficiaries of an estate or trust... concerned, a nonresident alien who is a resident of Switzerland and who is a beneficiary of an estate or...

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rasouli, C.; Abbasi Davani, F., E-mail: fabbasidavani@gmail.com

A series of experiments and numerical calculations have been done on the Damavand tokamak for accurate determination of equilibrium parameters, such as the plasma boundary position and shape. For this work, the pickup coils of the Damavand tokamak were recalibrated and after that a plasma boundary shape identification code was developed for analyzing the experimental data, such as magnetic probes and coils currents data. The plasma boundary position, shape and other parameters are determined by the plasma shape identification code. A free-boundary equilibrium code was also generated for comparison with the plasma boundary shape identification results and determination of requiredmore » fields to obtain elongated plasma in the Damavand tokamak.« less

21 CFR 1271.290 - Tracking.

Code of Federal Regulations, 2010 CFR

2010-04-01

... TISSUE-BASED PRODUCTS Current Good Tissue Practice § 1271.290 Tracking. (a) General. If you perform any... designed to facilitate effective tracking, using the distinct identification code, from the donor to the... for recording the distinct identification code and type of each HCT/P distributed to a consignee to...

Medicare Part D: successes and continuing challenges. Impact of Medicare Part D on Massachusetts health programs and beneficiaries.

PubMed

Thomas, Cindy Parks; Sussman, Jeffrey

2007-05-30

On January 1, 2006, the Centers for Medicare and Medicaid Services (CMS) implemented the Medicare Drug Benefit, or "Medicare Part D." The program offers prescription drug coverage for the one million Medicare beneficiaries in Massachusetts. Part D affects Massachusetts state health programs and beneficiaries in a number of ways. The program: (1) provides prescription drug insurance, including catastrophic coverage, through a choice of private prescription drug plans (PDPs) or integrated Medicare Advantage (MA-PD) health plans; (2) shifts prescription drug coverage for dual-eligible Medicare / Medicaid beneficiaries from Medicaid to Medicare Part D drug plans; (3) requires a maintenance-of-effort, or "clawback" payments from states to CMS designed to capture a portion of states' Medicaid savings to help finance the benefit; (4) offers additional help for premiums and cost sharing to low income beneficiaries through the Low Income Subsidy (LIS); and (5) provides a subsidy to employer groups that maintain their own prescription drug coverage for retired beneficiaries. This paper summarizes the activities involved in implementing Medicare Part D, the impact it has had on Massachusetts health programs, and the experiences of beneficiaries and others conducting outreach and enrollment. The data are drawn from interviews with officials and documents provided by state health programs, CMS and the Social Security Administration, and representatives of provider and advocacy groups involved in the enrollment and ongoing support of Medicare beneficiaries.

Effects of various electrode configurations on music perception, intonation and speaker gender identification.

PubMed

Landwehr, Markus; Fürstenberg, Dirk; Walger, Martin; von Wedel, Hasso; Meister, Hartmut

2014-01-01

Advances in speech coding strategies and electrode array designs for cochlear implants (CIs) predominantly aim at improving speech perception. Current efforts are also directed at transmitting appropriate cues of the fundamental frequency (F0) to the auditory nerve with respect to speech quality, prosody, and music perception. The aim of this study was to examine the effects of various electrode configurations and coding strategies on speech intonation identification, speaker gender identification, and music quality rating. In six MED-EL CI users electrodes were selectively deactivated in order to simulate different insertion depths and inter-electrode distances when using the high definition continuous interleaved sampling (HDCIS) and fine structure processing (FSP) speech coding strategies. Identification of intonation and speaker gender was determined and music quality rating was assessed. For intonation identification HDCIS was robust against the different electrode configurations, whereas fine structure processing showed significantly worse results when a short electrode depth was simulated. In contrast, speaker gender recognition was not affected by electrode configuration or speech coding strategy. Music quality rating was sensitive to electrode configuration. In conclusion, the three experiments revealed different outcomes, even though they all addressed the reception of F0 cues. Rapid changes in F0, as seen with intonation, were the most sensitive to electrode configurations and coding strategies. In contrast, electrode configurations and coding strategies did not show large effects when F0 information was available over a longer time period, as seen with speaker gender. Music quality relies on additional spectral cues other than F0, and was poorest when a shallow insertion was simulated.

21 CFR 11.300 - Controls for identification codes/passwords.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 1 2011-04-01 2011-04-01 false Controls for identification codes/passwords. 11.300 Section 11.300 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... attempts at their unauthorized use to the system security unit, and, as appropriate, to organizational...

21 CFR 11.300 - Controls for identification codes/passwords.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 1 2010-04-01 2010-04-01 false Controls for identification codes/passwords. 11.300 Section 11.300 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... attempts at their unauthorized use to the system security unit, and, as appropriate, to organizational...

22 CFR 228.03 - Identification of principal geographic code numbers.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Identification of principal geographic code numbers. 228.03 Section 228.03 Foreign Relations AGENCY FOR INTERNATIONAL DEVELOPMENT RULES ON SOURCE, ORIGIN AND NATIONALITY FOR COMMODITIES AND SERVICES FINANCED BY USAID Definitions and Scope of This Part...

21 CFR 11.300 - Controls for identification codes/passwords.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 1 2012-04-01 2012-04-01 false Controls for identification codes/passwords. 11.300 Section 11.300 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ELECTRONIC RECORDS; ELECTRONIC SIGNATURES Electronic Signatures § 11.300 Controls for...

47 CFR 3.22 - Number of accounting authority identification codes per applicant.

Code of Federal Regulations, 2010 CFR

2010-10-01

... AUTHORIZATION AND ADMINISTRATION OF ACCOUNTING AUTHORITIES IN MARITIME AND MARITIME MOBILE-SATELLITE RADIO SERVICES Application Procedures § 3.22 Number of accounting authority identification codes per applicant... assign U.S. AAICs for entities settling accounts of U.S. licensed vessels in the maritime mobile and...

20 CFR 404.2021 - What is our order of preference in selecting a representative payee for you?

Code of Federal Regulations, 2010 CFR

2010-04-01

... or who demonstrates strong concern for the personal welfare of the beneficiary; (2) A friend who has... friend who does not have custody of the beneficiary but is demonstrating concern for the beneficiary's...

20 CFR 404.2021 - What is our order of preference in selecting a representative payee for you?

Code of Federal Regulations, 2011 CFR

2011-04-01

... or who demonstrates strong concern for the personal welfare of the beneficiary; (2) A friend who has... friend who does not have custody of the beneficiary but is demonstrating concern for the beneficiary's...

20 CFR 411.635 - Can a beneficiary be represented in the dispute resolution process under the Ticket to Work program?

Code of Federal Regulations, 2012 CFR

2012-04-01

... SOCIAL SECURITY ADMINISTRATION THE TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM Ticket to Work Program Dispute Resolution Disputes Between Beneficiaries and Employment Networks § 411.635 Can a beneficiary be...

20 CFR 411.635 - Can a beneficiary be represented in the dispute resolution process under the Ticket to Work program?

Code of Federal Regulations, 2011 CFR

2011-04-01

... SOCIAL SECURITY ADMINISTRATION THE TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM Ticket to Work Program Dispute Resolution Disputes Between Beneficiaries and Employment Networks § 411.635 Can a beneficiary be...

20 CFR 411.635 - Can a beneficiary be represented in the dispute resolution process under the Ticket to Work program?

Code of Federal Regulations, 2014 CFR

2014-04-01

... SOCIAL SECURITY ADMINISTRATION THE TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM Ticket to Work Program Dispute Resolution Disputes Between Beneficiaries and Employment Networks § 411.635 Can a beneficiary be...

20 CFR 411.635 - Can a beneficiary be represented in the dispute resolution process under the Ticket to Work program?

Code of Federal Regulations, 2010 CFR

2010-04-01

... SOCIAL SECURITY ADMINISTRATION THE TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM Ticket to Work Program Dispute Resolution Disputes Between Beneficiaries and Employment Networks § 411.635 Can a beneficiary be...

20 CFR 411.635 - Can a beneficiary be represented in the dispute resolution process under the Ticket to Work program?

Code of Federal Regulations, 2013 CFR

2013-04-01

... SOCIAL SECURITY ADMINISTRATION THE TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM Ticket to Work Program Dispute Resolution Disputes Between Beneficiaries and Employment Networks § 411.635 Can a beneficiary be...

Beneficiaries' perceptions of new Medicare health plan choice print materials.

PubMed

Harris-Kojetin, L D; McCormack, L A; Jaël, E M; Lissy, K S

2001-01-01

This article presents findings from a study involving seven focus groups with aged and disabled Medicare beneficiaries in the Kansas City area regarding their impressions of a pilot version of the Medicare & You 1999 handbook and the Medicare Consumer Assessment of Health Plans Study (CAHPS) survey report. Beneficiaries generally had positive reactions to both booklets and viewed the handbook as an important reference tool. Based on the findings, we present policy recommendations for the development and dissemination of Medicare health plan information to beneficiaries.

A multisite randomized controlled trial on time to self-support among sickness absence beneficiaries. The Danish national return-to-work programme.

PubMed

Nielsen, Maj Britt D; Vinsløv Hansen, Jørgen; Aust, Birgit; Tverborgvik, Torill; Thomsen, Birthe L; Bue Bjorner, Jakob; Steen Mortensen, Ole; Rugulies, Reiner; Winzor, Glen; Ørbæk, Palle; Helverskov, Trine; Kristensen, Nicolai; Melchior Poulsen, Otto

2015-02-01

In 2010, the Danish Government launched the Danish national return-to-work (RTW) programme to reduce sickness absence and promote labour market attainment. Multidisciplinary teams delivered the RTW programme, which comprised a coordinated, tailored and multidisciplinary effort (CTM) for sickness absence beneficiaries at high risk for exclusion from the labour market. The aim of this article was to evaluate the effectiveness of the RTW programme on self-support. Beneficiaries from three municipalities (denoted M1, M2 and M3) participated in a randomized controlled trial. We randomly assigned beneficiaries to CTM (M1: n = 598; M2: n = 459; M3: n = 331) or to ordinary sickness absence management (OSM) (M1: n = 393; M2: n = 324; M3: n = 95). We used the Cox proportional hazards model to estimate hazard ratios (HR) comparing rates of becoming self-supporting between beneficiaries receiving CTM and OSM. In M2, beneficiaries from employment receiving CTM became self-supporting faster compared with beneficiaries receiving OSM (HR = 1.32, 95% CI: 1.08-1.61). In M3, beneficiaries receiving CTM became self-supporting slower than beneficiaries receiving OSM (HR = 0.72, 95% CI: 0.54-0.95). In M1, we found no difference between the two groups (HR = 0.99, 95% CI: 0.84-1.17). The effect of the CTM programme on return to self-support differed substantially across the three participating municipalities. Thus, generalizing the study results to other Danish municipalities is not warranted. ISRCTN43004323. © The Author 2014. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Potential savings associated with drug substitution in Medicare Part D: the Translating Research into Action for Diabetes (TRIAD) study.

PubMed

Duru, O Kenrik; Ettner, Susan L; Turk, Norman; Mangione, Carol M; Brown, Arleen F; Fu, Jeffery; Simien, Leslie; Tseng, Chien-Wen

2014-01-01

Drug substitution is a promising approach to reducing medication costs. To calculate the potential savings in a Medicare Part D plan from generic or therapeutic substitution for commonly prescribed drugs. Cross-sectional, simulation analysis. Low-income subsidy (LIS) beneficiaries (n = 145,056) and non low-income subsidy (non-LIS) beneficiaries (n = 1,040,030) enrolled in a large, national Part D health insurer in 2007 and eligible for a possible substitution. Using administrative data from 2007, we identified claims filled for brand-name drugs for which a direct generic substitute was available. We also identified the 50 highest cost drugs separately for LIS and non-LIS beneficiaries, and reached consensus on which drugs had possible therapeutic substitutes (27 for LIS, 30 for non-LIS). For each possible substitution, we used average daily costs of the original and substitute drugs to calculate the potential out-of-pocket savings, health plan savings, and when applicable, savings for the government/LIS subsidy. Overall, 39 % of LIS beneficiaries and 51 % of non-LIS beneficiaries were eligible for a generic and/or therapeutic substitution. Generic substitutions resulted in an average annual savings of $160 in the case of LIS beneficiaries and $127 in the case of non-LIS beneficiaries. Therapeutic substitutions resulted in an average annual savings of $452 in the case of LIS beneficiaries and $389 in the case of non-LIS beneficiaries. Our findings indicate that drug substitution, particularly therapeutic substitution, could result in significant cost savings. There is a need for additional studies evaluating the acceptability of therapeutic substitution interventions within Medicare Part D.

Impact of the 2013 National Rollout of CMS Competitive Bidding Program: The Disruption Continues.

PubMed

Puckrein, Gary A; Hirsch, Irl B; Parkin, Christopher G; Taylor, Bruce T; Xu, Liou; Marrero, David G

2018-05-01

Use of glucose monitoring is essential to the safety of individuals with insulin-treated diabetes. In 2011, the Centers for Medicare & Medicaid Services (CMS) implemented the Medicare Competitive Bidding Program (CBP) in nine test markets. This resulted in a substantial disruption of beneficiary access to self-monitoring of blood glucose (SMBG) supplies and significant increases in the percentage of beneficiaries with either reduced or no acquisition of supplies. These reductions were significantly associated with increased mortality, hospitalizations, and costs. The CBP was implemented nationally in July 2013. We evaluated the impact of this rollout to determine if the adverse outcomes seen in 2011 persisted. This longitudinal study followed 529,627 insulin-treated beneficiaries from 2009 through 2013 to assess changes in beneficiary acquisition of testing supplies in the initial nine test markets (TEST, n = 43,939) and beneficiaries not affected by the 2011 rollout (NONTEST, n = 485,688). All Medicare beneficiary records for analysis were obtained from CMS. The percentages of beneficiaries with partial/no SMBG acquisition were significantly higher in both the TEST (37.4%) and NONTEST (37.6%) groups after the first 6 months of the national CBP rollout, showing increases of 48.1% and 60.0%, respectively (both P < 0.0001). The percentage of beneficiaries with no record for SMBG acquisition increased from 54.1% in January 2013 to 62.5% by December 2013. Disruption of beneficiary access to their prescribed SMBG supplies has persisted and worsened. Diabetes testing supplies should be excluded from the CBP until transparent, science-based methodologies for safety monitoring are adopted and implemented. © 2017 by the American Diabetes Association.

Observation Status, Poverty, and High Financial Liability Among Medicare Beneficiaries.

PubMed

Goldstein, Jennifer N; Zhang, Zugui; Schwartz, J Sanford; Hicks, LeRoi S

2018-01-01

Medicare beneficiaries hospitalized under observation status are subject to cost-sharing with no spending limit under Medicare Part B. Because low-income status is associated with increased hospital use, there is concern that such beneficiaries may be at increased risk for high use and out-of-pocket costs related to observation care. Our objective was to determine whether low-income Medicare beneficiaries are at risk for high use and high financial liability for observation care compared with higher-income beneficiaries. We performed a retrospective, observational analysis of Medicare Part B claims and US Census Bureau data from 2013. Medicare beneficiaries with Part A and B coverage for the full calendar year, with 1 or more observation stay(s), were included in the study. Beneficiaries were divided into quartiles representing poverty level. The associations between poverty quartile and high use of observation care and between poverty quartile and high financial liability for observation care were evaluated. After multivariate adjustment, the risk of high use was higher for beneficiaries in the poor (Quartile 3) and poorest (Quartile 4) quartiles compared with those in the wealthiest quartile (Quartile 1) (adjusted odds ratio [AOR], 1.21; 95% confidence interval [CI], 1.13-1.31; AOR, 1.24; 95% CI, 1.16-1.33). The risk of high financial liability was higher in every poverty quartile compared with the wealthiest and peaked in Quartile 3, which represented the poor but not the poorest beneficiaries (AOR, 1.17; 95% CI, 1.10-1.24). Poverty predicts high use of observation care. The poor or near poor may be at highest risk for high liability. Copyright © 2018 Elsevier Inc. All rights reserved.

78 FR 36035 - Proposed Information Collection Activity: [Beneficiary Travel Mileage Reimbursement Application...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-14

... Activity: [Beneficiary Travel Mileage Reimbursement Application Form]; Comment Request AGENCY: Veterans... qualified Veterans or other claimants who incur expense in traveling to healthcare. DATES: Written comments...: [email protected] . Please refer to ``OMB Control No. 2900--NEW (Beneficiary Travel Mileage...

19 CFR 10.173 - Evidence of country of origin.

Code of Federal Regulations, 2010 CFR

2010-04-01

... entry—(1) Merchandise not wholly the growth, product, or manufacture of a beneficiary developing country... growth, product, or manufacture of a single beneficiary developing country, the exporter of the... treatment. (2) Merchandise wholly the growth, product, or manufacture of a beneficiary developing country...

19 CFR 10.173 - Evidence of country of origin.

Code of Federal Regulations, 2011 CFR

2011-04-01

... entry—(1) Merchandise not wholly the growth, product, or manufacture of a beneficiary developing country... growth, product, or manufacture of a single beneficiary developing country, the exporter of the... treatment. (2) Merchandise wholly the growth, product, or manufacture of a beneficiary developing country...

20 CFR 10.718 - Are payments to a beneficiary as a result of an insurance policy which the beneficiary has...

Code of Federal Regulations, 2010 CFR

2010-04-01

... OWCP or SOL? 10.718 Section 10.718 Employees' Benefits OFFICE OF WORKERS' COMPENSATION PROGRAMS... reported to OWCP or SOL? Since payments received by a FECA beneficiary pursuant to an insurance policy...

20 CFR 411.625 - Can the beneficiary or the EN that is not a State VR agency request a review of the PM's...

Code of Federal Regulations, 2014 CFR

2014-04-01

... SOCIAL SECURITY ADMINISTRATION THE TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM Ticket to Work Program Dispute Resolution Disputes Between Beneficiaries and Employment Networks § 411.625 Can the beneficiary or...

20 CFR 411.625 - Can the beneficiary or the EN that is not a State VR agency request a review of the PM's...

Code of Federal Regulations, 2012 CFR

2012-04-01

... SOCIAL SECURITY ADMINISTRATION THE TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM Ticket to Work Program Dispute Resolution Disputes Between Beneficiaries and Employment Networks § 411.625 Can the beneficiary or...

20 CFR 411.625 - Can the beneficiary or the EN that is not a State VR agency request a review of the PM's...

Code of Federal Regulations, 2013 CFR

2013-04-01

... SOCIAL SECURITY ADMINISTRATION THE TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM Ticket to Work Program Dispute Resolution Disputes Between Beneficiaries and Employment Networks § 411.625 Can the beneficiary or...

Cost-sharing, physician utilization, and adverse selection among Medicare beneficiaries with chronic health conditions.

PubMed

Hoffman, Geoffrey

2015-02-01

Pooled data from the 2007, 2009, and 2011/2012 California Health Interview Surveys were used to compare the number of self-reported annual physician visits among 36,808 Medicare beneficiaries ≥65 in insurance groups with differential cost-sharing. Adjusted for adverse selection and a set of health covariates, Medicare fee-for-service (FFS) only beneficiaries had similar physician utilization compared with HMO enrollees but fewer visits compared with those with supplemental (1.04, p = .001) and Medicaid (1.55, p = .003) coverage. FFS only beneficiaries in very good or excellent health had fewer visits compared with those of similar health status with supplemental (1.30, p = .001) or Medicaid coverage (2.15, p = .002). For subpopulations with several chronic conditions, FFS only beneficiaries also had fewer visits compared with beneficiaries with supplemental or Medicaid coverage. Observed differences in utilization may reflect efficient and necessary physician utilization among those with chronic health needs. © The Author(s) 2014.

Additional reductions in Medicare spending growth will likely require shifting costs to beneficiaries.

PubMed

Chernew, Michael E

2013-05-01

Policy makers have considerable interest in reducing Medicare spending growth. Clarity in the debate on reducing Medicare spending growth requires recognition of three important distinctions: the difference between public and total spending on health, the difference between the level of health spending and rate of health spending growth, and the difference between growth per beneficiary and growth in the number of beneficiaries in Medicare. The primary policy issue facing the US health care system is the rate of spending growth in public programs, and solving that problem will probably require reforms to the entire health care sector. The Affordable Care Act created a projected trajectory for Medicare spending per beneficiary that is lower than historical growth rates. Although opportunities for one-time savings exist, any long-term savings from Medicare, beyond those already forecast, will probably require a shift in spending from taxpayers to beneficiaries via higher beneficiary premium contributions (overall or via means testing), changes in eligibility, or greater cost sharing at the point of service.

Shifting to Medicaid-Managed Long-Term Care: Are Vulnerable Florida Beneficiaries Properly Informed?

PubMed

Peterson, Lindsay J; Hyer, Kathryn

2016-10-01

To examine and assess the adequacy of informational material provided to Florida long-term care beneficiaries being required to choose a managed care provider as part of a statewide, mandatory shift to Medicaid-managed long-term care (MMLTC). Informational materials provided by the state of Florida to 90,000 Medicaid long-term care beneficiaries via print mailings and a state website were examined using established content, usability, and readability criteria. Overall, the presentation minimized cognitive complexity, but the information was lacking in critical areas, such as providing clear explanations of the change taking place and the significance of beneficiaries' choices, and enabling beneficiaries to assess their own needs and preferences. A key feature of managed care is the users' choice of plans, but amid a significant policy shift toward MMLTC in Florida, vulnerable beneficiaries may not be receiving the information necessary to make choices that best meet their needs. Our analysis offers lessons to other states shifting to MMLTC. © The Author(s) 2015.

Social Security disability beneficiaries with work-related goals and expectations.

PubMed

Livermore, Gina A

2011-01-01

This study examines working-age Social Security Disability Insurance and Supplemental Security Income beneficiaries who report having work goals or expectations, referring to these individuals as "work-oriented." The study uses data from the 2004 National Beneficiary Survey matched to administrative data spanning 2004-2007 to identify work-oriented beneficiaries and to analyze their sociodemographic, health, and employment characteristics, as well as their earnings-related benefit suspensions and terminations. Relative to other disability beneficiaries, the 40 percent classified as work-oriented were younger and more educated, had been on the disability rolls a shorter time, had lower income from public assistance, and were healthier. Just over half had recently engaged in work or in work preparation activities at interview, about half had earnings at some point during 2004-2007, and 10 percent left the disability rolls because of earnings for at least 1 month during that period. The findings show that a large share of beneficiaries have work goals, most are attempting to work, and many experience some success.

Reforming Access: Trends in Medicaid Enrollment for New Medicare Beneficiaries, 2008-2011.

PubMed

Keohane, Laura M; Rahman, Momotazur; Mor, Vincent

2016-04-01

To evaluate whether aligning the Part D low-income subsidy and Medicaid program enrollment pathways in 2010 increased Medicaid participation among new Medicare beneficiaries. Medicare enrollment records for years 2007-2011. We used a multinomial logistic model with state fixed effects to examine the annual change in limited and full Medicaid enrollment among new Medicare beneficiaries for 2 years before and after the reforms (2008-2011). We identified new Medicare beneficiaries in the years 2008-2011 and their participation in Medicaid based on Medicare enrollment records. The percentage of beneficiaries enrolling in limited Medicaid at the start of Medicare coverage increased in 2010 by 0.3 percentage points for individuals aging into Medicare and by 1.3 percentage points for those qualifying due to disability (p < .001). There was no significant difference in the size of enrollment increases between states with and without concurrent limited Medicaid eligibility expansions. Our findings suggest that streamlining financial assistance programs may improve Medicare beneficiaries' access to benefits. © Health Research and Educational Trust.

Market and beneficiary characteristics associated with enrollment in Medicare managed care plans and fee-for-service.

PubMed

Shimada, Stephanie L; Zaslavsky, Alan M; Zaborski, Lawrence B; O'Malley, A James; Heller, Amy; Cleary, Paul D

2009-05-01

Risk selection in the Medicare managed care program ("Medicare Advantage") is an important policy concern. Past research has shown that Medicare managed care plans tend to attract healthier beneficiaries and that market characteristics such as managed care penetration may also affect risk selection. To assess whether patient enrollment in Medicare managed care (MMC) or traditional fee-for-service (FFS) Medicare is related to beneficiary and market characteristics and provide a baseline for understanding how changes in Medicare policy affect MMC enrollment over time. Data sources were the 2004 Medicare MMC and FFS CAHPS surveys, the Social Security Administration's Master Beneficiary Record, MMC Market Penetration Files, and 2000 Census data. We estimated logistic regression models to assess what beneficiary characteristics predict enrollment in MMC and the moderating effects of market characteristics. Enrollees in MMC plans tend to have better health than those in FFS. This effect is weaker in areas with more competition. Latinos and beneficiaries with less education and lower income, as indicated by earnings history or local-area median income, are more likely to enroll in MMC. Enrollment in MMC is related to beneficiary characteristics, including health status and socioeconomic status, and is modified by MMC presence in the local market. Because vulnerable subgroups are more likely to enroll in MMC plans, the Centers for Medicare & Medicaid Services should monitor how changes to Medicare Advantage policies and payment methods may affect beneficiaries in those groups.

32 CFR 728.59 - Peace Corps beneficiaries.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 5 2010-07-01 2010-07-01 false Peace Corps beneficiaries. 728.59 Section 728.59 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL MEDICAL AND DENTAL CARE FOR ELIGIBLE PERSONS AT NAVY MEDICAL DEPARTMENT FACILITIES Beneficiaries of Other Federal Agencies...

32 CFR 728.55 - Department of Justice beneficiaries.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 32 National Defense 5 2014-07-01 2014-07-01 false Department of Justice beneficiaries. 728.55 Section 728.55 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL MEDICAL AND DENTAL CARE FOR ELIGIBLE PERSONS AT NAVY MEDICAL DEPARTMENT FACILITIES Beneficiaries of Other...

32 CFR 728.55 - Department of Justice beneficiaries.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 32 National Defense 5 2012-07-01 2012-07-01 false Department of Justice beneficiaries. 728.55 Section 728.55 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL MEDICAL AND DENTAL CARE FOR ELIGIBLE PERSONS AT NAVY MEDICAL DEPARTMENT FACILITIES Beneficiaries of Other...

32 CFR 728.52 - Veterans Administration beneficiaries (VAB).

Code of Federal Regulations, 2012 CFR

2012-07-01

... 32 National Defense 5 2012-07-01 2012-07-01 false Veterans Administration beneficiaries (VAB). 728.52 Section 728.52 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL MEDICAL AND DENTAL CARE FOR ELIGIBLE PERSONS AT NAVY MEDICAL DEPARTMENT FACILITIES Beneficiaries of Other...

32 CFR 728.59 - Peace Corps beneficiaries.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 32 National Defense 5 2011-07-01 2011-07-01 false Peace Corps beneficiaries. 728.59 Section 728.59 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL MEDICAL AND DENTAL CARE FOR ELIGIBLE PERSONS AT NAVY MEDICAL DEPARTMENT FACILITIES Beneficiaries of Other Federal Agencies...

32 CFR 728.52 - Veterans Administration beneficiaries (VAB).

Code of Federal Regulations, 2011 CFR

2011-07-01

... 32 National Defense 5 2011-07-01 2011-07-01 false Veterans Administration beneficiaries (VAB). 728.52 Section 728.52 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL MEDICAL AND DENTAL CARE FOR ELIGIBLE PERSONS AT NAVY MEDICAL DEPARTMENT FACILITIES Beneficiaries of Other...

32 CFR 728.52 - Veterans Administration beneficiaries (VAB).

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 5 2010-07-01 2010-07-01 false Veterans Administration beneficiaries (VAB). 728.52 Section 728.52 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL MEDICAL AND DENTAL CARE FOR ELIGIBLE PERSONS AT NAVY MEDICAL DEPARTMENT FACILITIES Beneficiaries of Other...

32 CFR 728.59 - Peace Corps beneficiaries.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 32 National Defense 5 2013-07-01 2013-07-01 false Peace Corps beneficiaries. 728.59 Section 728.59 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL MEDICAL AND DENTAL CARE FOR ELIGIBLE PERSONS AT NAVY MEDICAL DEPARTMENT FACILITIES Beneficiaries of Other Federal Agencies...

32 CFR 728.55 - Department of Justice beneficiaries.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 32 National Defense 5 2013-07-01 2013-07-01 false Department of Justice beneficiaries. 728.55 Section 728.55 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL MEDICAL AND DENTAL CARE FOR ELIGIBLE PERSONS AT NAVY MEDICAL DEPARTMENT FACILITIES Beneficiaries of Other...

32 CFR 728.55 - Department of Justice beneficiaries.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 5 2010-07-01 2010-07-01 false Department of Justice beneficiaries. 728.55 Section 728.55 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL MEDICAL AND DENTAL CARE FOR ELIGIBLE PERSONS AT NAVY MEDICAL DEPARTMENT FACILITIES Beneficiaries of Other...

32 CFR 728.55 - Department of Justice beneficiaries.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 32 National Defense 5 2011-07-01 2011-07-01 false Department of Justice beneficiaries. 728.55 Section 728.55 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL MEDICAL AND DENTAL CARE FOR ELIGIBLE PERSONS AT NAVY MEDICAL DEPARTMENT FACILITIES Beneficiaries of Other...

32 CFR 728.59 - Peace Corps beneficiaries.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 32 National Defense 5 2012-07-01 2012-07-01 false Peace Corps beneficiaries. 728.59 Section 728.59 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL MEDICAL AND DENTAL CARE FOR ELIGIBLE PERSONS AT NAVY MEDICAL DEPARTMENT FACILITIES Beneficiaries of Other Federal Agencies...

20 CFR 410.585 - Conservation and investment of payments.

Code of Federal Regulations, 2010 CFR

2010-04-01

....585 Section 410.585 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL COAL MINE HEALTH AND... beneficiary) (Social Security No.), a minor, for whom (Name of payee) is representative payee for black lung... adult beneficiary should be registered as follows: , (Name of beneficiary) (Social Security No.), for...

32 CFR 728.59 - Peace Corps beneficiaries.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 32 National Defense 5 2014-07-01 2014-07-01 false Peace Corps beneficiaries. 728.59 Section 728.59 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL MEDICAL AND DENTAL CARE FOR ELIGIBLE PERSONS AT NAVY MEDICAL DEPARTMENT FACILITIES Beneficiaries of Other Federal Agencies...

75 FR 32480 - Funding Opportunity: Affordable Care Act Medicare Beneficiary Outreach and Assistance Program...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-08

... Care Act Medicare Beneficiary Outreach and Assistance Program Funding for Title VI Native American Programs Purpose of Notice: Availability of funding opportunity announcement. Funding Opportunity Title/Program Name: Affordable Care Act Medicare Beneficiary Outreach and Assistance Program Funding for Title...

32 CFR 728.56 - Treasury Department beneficiaries.

Code of Federal Regulations, 2010 CFR

2010-07-01

... AND DENTAL CARE FOR ELIGIBLE PERSONS AT NAVY MEDICAL DEPARTMENT FACILITIES Beneficiaries of Other... may be beneficiaries of the Treasury Department and may be rendered care as set forth below. (1.... Customs Service. (5) Prisoners (detainees) of the U.S. Customs Service. (b) Care authorized. (1) Secret...

Environmental durability diagnostic for printed identification codes of polymer insulation for distribution pipelines

NASA Astrophysics Data System (ADS)

Zhuravleva, G. N.; Nagornova, I. V.; Kondratov, A. P.; Bablyuk, E. B.; Varepo, L. G.

2017-08-01

A research and modelling of weatherability and environmental durability of multilayer polymer insulation of both cable and pipelines with printed barcodes or color identification information were performed. It was proved that interlayer printing of identification codes in distribution pipelines insulation coatings provides high marking stability to light and atmospheric condensation. This allows to carry out their distant damage control. However, microbiological fouling of upper polymer layer hampers the distant damage pipelines identification. The color difference values and density changes of PE and PVC printed insolation due to weather and biological factors were defined.

Utilization and growth patterns of sacroiliac joint injections from 2000 to 2011 in the medicare population.

PubMed

Manchikanti, Laxmaiah; Hansen, Hans; Pampati, Vidyasagar; Falco, Frank J E

2013-01-01

  The high prevalence of persistent low back pain and growing number of diagnostic and therapeutic modalities employed to manage chronic low back pain and the subsequent impact on society and the economy continue to hold sway over health care policy. Among the multiple causes responsible for chronic low back pain, the contributions of the sacroiliac joint have been a subject of debate albeit a paucity of research. At present, there are no definitive conservative, interventional or surgical management options for managing sacroiliac joint pain. It has been shown that the increases were highest for facet joint interventions and sacroiliac joint blocks with an increase of 310% per 100,000 Medicare beneficiaries from 2000 to 2011. There has not been a systematic assessment of the utilization and growth patterns of sacroiliac joint injections. Analysis of the growth patterns of sacroiliac joint injections in Medicare beneficiaries from 2000 to 2011. To evaluate the utilization and growth patterns of sacroiliac joint injections. This assessment was performed utilizing Centers for Medicare and Medicaid Services (CMS) Physician/Supplier Procedure Summary (PSPS) Master data from 2000 to 2011. The findings of this assessment in Medicare beneficiaries from 2000 to 2011 showed a 331% increase per 100,000 Medicare beneficiaries with an annual increase of 14.2%, compared to an increase in the Medicare population of 23% or annual increase of 1.9%. The number of procedures increased from 49,554 in 2000 to 252,654 in 2011, or a rate of 125 to 539 per 100,000 Medicare beneficiaries. Among the various specialists performing sacroiliac joint injections, physicians specializing in physical medicine and rehabilitation have shown the most increase, followed by neurology with 1,568% and 698%, even though many physicians from both specialties have been enrolling in interventional pain management and pain management. Even though the numbers were small for nonphysician providers including certified registered nurse anesthetists, nurse practitioners, and physician assistants, these numbers increased substantially at a rate of 4,526% per 100,000 Medicare beneficiaries with 21 procedures performed in 2000 increasing to 4,953 procedures in 2011. The, majority of sacroiliac joint injections were performed in an office setting. The utilization of sacroiliac joint injections by state from 2008 to 2010 showed increases of more than 20% in New Hampshire, Alabama, Minnesota, Vermont, Oregon, Utah, Massachusetts, Kansas, and Maine. Similarly, some states showed significant decreases of 20% or more, including Oklahoma, Louisiana, Maryland, Arkansas, New York, and Hawaii. Overall, there was a 1% increase per 100,000 Medicare population from 2008 to 2010. However, 2011 showed significant increases from 2010. The limitations of this study included a lack of inclusion of Medicare participants in Medicare Advantage plans, the availability of an identifiable code for only sacroiliac joint injections, and the possibility that state claims data may include claims from other states. . This study illustrates the explosive growth of sacroiliac joint injections even more than facet joint interventions. Furthermore, certain groups of providers showed substantial increases. Overall, increases from 2008 to 2010 were nominal with 1%, but some states showed over 20% increases whereas some others showed over 20% decreases.

26 CFR 1.401-2 - Impossibility of diversion under the trust instrument.

Code of Federal Regulations, 2010 CFR

2010-04-01

... thereafter before the satisfaction of all liabilities to employees or their beneficiaries covered by the... not solely designed for the proper satisfaction of all liabilities to employees or their beneficiaries... phrase “prior to the satisfaction of all liabilities with respect to employees and their beneficiaries...

26 CFR 1.501(c)(9)-4 - Voluntary employees' beneficiary associations; inurement.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 26 Internal Revenue 7 2010-04-01 2010-04-01 true Voluntary employees' beneficiary associations... Voluntary employees' beneficiary associations; inurement. (a) General rule. No part of the net earnings of an employees' association may inure to the benefit of any private shareholder or individual other...

42 CFR 482.92 - Condition of participation: Organ recovery and receipt.

Code of Federal Regulations, 2014 CFR

2014-10-01

... donor-beneficiary blood type and other vital data for the deceased organ recovery, organ receipt, and... donor's blood type and other vital data are compatible with transplantation of the intended beneficiary... donor's blood type and other vital data are compatible with transplantation of the intended beneficiary...

26 CFR 20.2206-1 - Liability of life insurance beneficiaries.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 26 Internal Revenue 14 2010-04-01 2010-04-01 false Liability of life insurance beneficiaries. 20.2206-1 Section 20.2206-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY... § 20.2206-1 Liability of life insurance beneficiaries. With respect to the right of the district...

26 CFR 20.2206-1 - Liability of life insurance beneficiaries.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 26 Internal Revenue 14 2011-04-01 2010-04-01 true Liability of life insurance beneficiaries. 20.2206-1 Section 20.2206-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY... § 20.2206-1 Liability of life insurance beneficiaries. With respect to the right of the district...

75 FR 60066 - Limitations of Duty- and Quota-Free Imports of Apparel Articles Assembled in Beneficiary ATPDEA...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-29

... of Apparel Articles Assembled in Beneficiary ATPDEA Countries From Regional Country Fabric AGENCY... (ATPA) to provide for duty and quota-free treatment for certain textile and apparel articles imported... articles assembled in ATPDEA beneficiary countries from regional fabric and components. More specifically...

42 CFR 435.1007 - Categorically needy, medically needy, and qualified Medicare beneficiaries.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Categorically needy, medically needy, and qualified Medicare beneficiaries. 435.1007 Section 435.1007 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... Limitations on Ffp § 435.1007 Categorically needy, medically needy, and qualified Medicare beneficiaries. (a...

20 CFR 10.712 - What amounts are included in the gross recovery?

Code of Federal Regulations, 2010 CFR

2010-04-01

... contested verdict attributable to each of several plaintiffs, OWCP or SOL will accept that division. (b) In..., OWCP or SOL will determine the appropriate amount of the FECA beneficiary's gross recovery and advise the beneficiary of its determination. FECA beneficiaries may accept OWCP's or SOL's determination or...

26 CFR 20.2206-1 - Liability of life insurance beneficiaries.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 26 Internal Revenue 14 2014-04-01 2013-04-01 true Liability of life insurance beneficiaries. 20.2206-1 Section 20.2206-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY... § 20.2206-1 Liability of life insurance beneficiaries. With respect to the right of the district...

26 CFR 20.2206-1 - Liability of life insurance beneficiaries.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 26 Internal Revenue 14 2013-04-01 2013-04-01 false Liability of life insurance beneficiaries. 20.2206-1 Section 20.2206-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY... § 20.2206-1 Liability of life insurance beneficiaries. With respect to the right of the district...

26 CFR 20.2206-1 - Liability of life insurance beneficiaries.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 26 Internal Revenue 14 2012-04-01 2012-04-01 false Liability of life insurance beneficiaries. 20.2206-1 Section 20.2206-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY... § 20.2206-1 Liability of life insurance beneficiaries. With respect to the right of the district...

26 CFR 1.501(c)(10)-1 - Certain fraternal beneficiary societies.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 26 Internal Revenue 7 2011-04-01 2009-04-01 true Certain fraternal beneficiary societies. 1.501(c... fraternal beneficiary societies. (a) For taxable years beginning after December 31, 1969, an organization... society order, or association, described in section 501(c)(8) and the regulations thereunder except that...

26 CFR 1.501(c)(10)-1 - Certain fraternal beneficiary societies.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 26 Internal Revenue 7 2010-04-01 2010-04-01 true Certain fraternal beneficiary societies. 1.501(c... fraternal beneficiary societies. (a) For taxable years beginning after December 31, 1969, an organization... society order, or association, described in section 501(c)(8) and the regulations thereunder except that...

42 CFR 415.120 - Conditions for payment: Radiology services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Conditions for payment: Radiology services. 415.120... Services to Beneficiaries in Providers § 415.120 Conditions for payment: Radiology services. (a) Services to beneficiaries. The carrier pays for radiology services furnished by a physician to a beneficiary...

Beneficiary price sensitivity in the Medicare prescription drug plan market.

PubMed

Frakt, Austin B; Pizer, Steven D

2010-01-01

The Medicare stand-alone prescription drug plan (PDP) came into existence in 2006 as part of the Medicare prescription drug benefit. It is the most popular plan type among Medicare drug plans and large numbers of plans are available to all beneficiaries. In this article we present the first analysis of beneficiary price sensitivity in the PDP market. Our estimate of elasticity of enrollment with respect to premium, -1.45, is larger in magnitude than has been found in the Medicare HMO market. This high degree of beneficiary price sensitivity for PDPs is consistent with relatively low product differentiation, low fixed costs of entry in the PDP market, and the fact that, in contrast to changing HMOs, beneficiaries can select a PDP without disrupting doctor-patient relationships.

Patient Population Loss At A Large Pioneer Accountable Care Organization And Implications For Refining The Program.

PubMed

Hsu, John; Price, Mary; Spirt, Jenna; Vogeli, Christine; Brand, Richard; Chernew, Michael E; Chaguturu, Sreekanth K; Mohta, Namita; Weil, Eric; Ferris, Timothy

2016-03-01

There is an ongoing move toward payment models that hold providers increasingly accountable for the care of their patients. The success of these new models depends in part on the stability of patient populations. We investigated the amount of population turnover in a large Medicare Pioneer accountable care organization (ACO) in the period 2012-14. We found that substantial numbers of beneficiaries became part of or left the ACO population during that period. For example, nearly one-third of beneficiaries who entered in 2012 left before 2014. Some of this turnover reflected that of ACO physicians-that is, beneficiaries whose physicians left the ACO were more likely to leave than those whose physicians remained. Some of the turnover also reflected changes in care delivery. For example, beneficiaries who were active in a care management program were less likely to leave the ACO than similar beneficiaries who had not yet started such a program. We recommend policy changes to increase the stability of ACO beneficiary populations, such as permitting lower cost sharing for care received within an ACO and requiring all beneficiaries to identify their primary care physician before being linked to an ACO. Project HOPE—The People-to-People Health Foundation, Inc.

Access to Care for Medicare-Medicaid Dually Eligible Beneficiaries: The Role of State Medicaid Payment Policies.

PubMed

Zheng, Nan Tracy; Haber, Susan; Hoover, Sonja; Feng, Zhanlian

2017-12-01

Medicaid programs are not required to pay the full Medicare coinsurance and deductibles for Medicare-Medicaid dually eligible beneficiaries. We examined the association between the percentage of Medicare cost sharing paid by Medicaid and the likelihood that a dually eligible beneficiary used evaluation and management (E&M) services and safety net provider services. Medicare and Medicaid Analytic eXtract enrollment and claims data for 2009. Multivariate analyses used fee-for-service dually eligible and Medicare-only beneficiaries in 20 states. A comparison group of Medicare-only beneficiaries controlled for state factors that might influence utilization. Paying 100 percent of the Medicare cost sharing compared to 20 percent increased the likelihood (relative to Medicare-only) that a dually eligible beneficiary had any E&M visit by 6.4 percent. This difference in the percentage of cost sharing paid decreased the likelihood of using safety net providers, by 37.7 percent for federally qualified health centers and rural health centers, and by 19.8 percent for hospital outpatient departments. Reimbursing the full Medicare cost-sharing amount would improve access for dually eligible beneficiaries, although the magnitude of the effect will vary by state and type of service. © Health Research and Educational Trust.

Following the Money: Factors Associated with the Cost of Treating High-Cost Medicare Beneficiaries

PubMed Central

Reschovsky, James D; Hadley, Jack; Saiontz-Martinez, Cynthia B; Boukus, Ellyn R

2011-01-01

Objective To identify factors associated with the cost of treating high-cost Medicare beneficiaries. Data Sources A national sample of 1.6 million elderly, Medicare beneficiaries linked to 2004–2005 Community Tracking Study Physician Survey respondents and local market data from secondary sources. Study Design Using 12 months of claims data from 2005 to 2006, the sample was divided into predicted high-cost (top quartile) and lower cost beneficiaries using a risk-adjustment model. For each group, total annual standardized costs of care were regressed on beneficiary, usual source of care physician, practice, and market characteristics. Principal Findings Among high-cost beneficiaries, health was the predominant predictor of costs, with most physician and practice and many market factors (including provider supply) insignificant or weakly related to cost. Beneficiaries whose usual physician was a medical specialist or reported inadequate office visit time, medical specialist supply, provider for-profit status, care fragmentation, and Medicare fees were associated with higher costs. Conclusions Health reform policies currently envisioned to improve care and lower costs may have small effects on high-cost patients who consume most resources. Instead, developing interventions tailored to improve care and lowering cost for specific types of complex and costly patients may hold greater potential for “bending the cost curve.” PMID:21306368

Medicaid beneficiaries in california reported less positive experiences when assigned to a managed care plan.

PubMed

McDonnell, Diana D; Graham, Carrie L

2015-03-01

In 2011 California began transitioning approximately 340,000 seniors and people with disabilities from Medicaid fee-for-service (FFS) to Medicaid managed care plans. When beneficiaries did not actively choose a managed care plan, the state assigned them to one using an algorithm based on their previous FFS primary and specialty care use. When no clear link could be established, beneficiaries were assigned by default to a managed care plan based on weighted randomization. In this article we report the results of a telephone survey of 1,521 seniors and people with disabilities enrolled in Medi-Cal (California Medicaid) and who were recently transitioned to a managed care plan. We found that 48 percent chose their own plan, 11 percent were assigned to a plan by algorithm, and 41 percent were assigned to a plan by default. People in the latter two categories reported being similarly less positive about their experiences compared to beneficiaries who actively chose a plan. Many states in addition to California are implementing mandatory transitions of Medicaid-only beneficiaries to managed care plans. Our results highlight the importance of encouraging beneficiaries to actively choose their health plan; when beneficiaries do not choose, states should employ robust intelligent assignment algorithms. Project HOPE—The People-to-People Health Foundation, Inc.

Primary care physician workforce and Medicare beneficiaries' health outcomes.

PubMed

Chang, Chiang-Hua; Stukel, Therese A; Flood, Ann Barry; Goodman, David C

2011-05-25

Despite a widespread interest in increasing the numbers of primary care physicians to improve care and to moderate costs, the relationship of the primary care physician workforce to patient-level outcomes remains poorly understood. To measure the association between the adult primary care physician workforce and individual patient outcomes. A cross-sectional analysis of the outcomes of a 2007 20% sample of fee-for-service Medicare beneficiaries aged 65 years or older (N = 5,132,936), which used 2 measures of adult primary care physicians (general internists and family physicians) across Primary Care Service Areas (N = 6542): (1) American Medical Association (AMA) Masterfile nonfederal, office-based physicians per total population and (2) office-based primary care clinical full-time equivalents (FTEs) per Medicare beneficiary derived from Medicare claims. Annual individual-level outcomes (mortality, ambulatory care sensitive condition [ACSC] hospitalizations, and Medicare program spending), adjusted for individual patient characteristics and geographic area variables. Marked variation was observed in the primary care physician workforce across areas, but low correlation was observed between the 2 primary care workforce measures (Spearman r = 0.056; P < .001). Compared with areas with the lowest quintile of primary care physician measure using AMA Masterfile counts, beneficiaries in the highest quintile had fewer ACSC hospitalizations (74.90 vs 79.61 per 1000 beneficiaries; relative rate [RR], 0.94; 95% confidence interval [CI], 0.93-0.95), lower mortality (5.38 vs 5.47 per 100 beneficiaries; RR, 0.98; 95% CI, 0.97-0.997), and no significant difference in total Medicare spending ($8722 vs $8765 per beneficiary; RR, 1.00; 95% CI, 0.99-1.00). Beneficiaries residing in areas with the highest quintile of primary care clinician FTEs compared with those in the lowest quintile had lower mortality (5.19 vs 5.49 per 100 beneficiaries; RR, 0.95; 95% CI, 0.93-0.96), fewer ACSC hospitalizations (72.53 vs 79.48 per 1000 beneficiaries; RR, 0.91; 95% CI, 0.90-0.92), and higher overall Medicare spending ($8857 vs $8769 per beneficiary; RR, 1.01; 95% CI, 1.004-1.02). A higher level of primary care physician workforce, particularly with an FTE measure that may more accurately reflect ambulatory primary care, was generally associated with favorable patient outcomes.

High-temperature superconductivity for avionic electronic warfare and radar systems

NASA Astrophysics Data System (ADS)

Ryan, Paul A.

1994-01-01

The electronic warfare (EW) and radar communities expect to be major beneficiaries of the performance advantages high-temperature superconductivity (HTS) has to offer over conventional technology. Near term upgrades to system hardware can be envisioned using extremely small, high Q, microwave filters and resonators; compact, wideband, low loss, microwave delay and transmission lines; as well as, wideband, low loss, monolithic microwave integrated circuit phase shifters. The most dramatic impact will be in the far term, using HTS to develop new, real time threat identification and response strategy receiver/processing systems designed to utilize the unique high frequency properties of microwave and ultimately digital HTS.

Value of a national administrative database to guide public decisions: From the système national d'information interrégimes de l'Assurance Maladie (SNIIRAM) to the système national des données de santé (SNDS) in France.

PubMed

Tuppin, P; Rudant, J; Constantinou, P; Gastaldi-Ménager, C; Rachas, A; de Roquefeuil, L; Maura, G; Caillol, H; Tajahmady, A; Coste, J; Gissot, C; Weill, A; Fagot-Campagna, A

2017-10-01

In 1999, French legislators asked health insurance funds to develop a système national d'information interrégimes de l'Assurance Maladie (SNIIRAM) [national health insurance information system] in order to more precisely determine and evaluate health care utilization and health care expenditure of beneficiaries. These data, based on almost 66 million inhabitants in 2015, have already been the subject of numerous international publications on various topics: prevalence and incidence of diseases, patient care pathways, health status and health care utilization of specific populations, real-life use of drugs, assessment of adverse effects of drugs or other health care procedures, monitoring of national health insurance expenditure, etc. SNIIRAM comprises individual information on the sociodemographic and medical characteristics of beneficiaries and all hospital care and office medicine reimbursements, coded according to various systems. Access to data is controlled by permissions dependent on the type of data requested or used, their temporality and the researcher's status. In general, data can be analyzed by accredited agencies over a period covering the last three years plus the current year, and specific requests can be submitted to extract data over longer periods. A 1/97th random sample of SNIIRAM, the échantillon généraliste des bénéficiaires (EGB), representative of the national population of health insurance beneficiaries, was composed in 2005 to allow 20-year follow-up with facilitated access for medical research. The EGB is an open cohort, which includes new beneficiaries and newborn infants. SNIIRAM has continued to grow and extend to become, in 2016, the cornerstone of the future système national des données de santé (SNDS) [national health data system], which will gradually integrate new information (causes of death, social and medical data and complementary health insurance). In parallel, the modalities of data access and protection systems have also evolved. This article describes the SNIIRAM data warehouse and its transformation into SNDS, the data collected, the tools developed in order to facilitate data analysis, the limitations encountered, and changing access permissions. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Impact of cost sharing on prescription drugs used by Medicare beneficiaries.

PubMed

Goedken, Amber M; Urmie, Julie M; Farris, Karen B; Doucette, William R

2010-06-01

Incentive-based prescription drug cost sharing can encourage seniors to use generic medications. Little information exists about prescription drug cost sharing and generic use in employer-sponsored plans after the implementation of Medicare Part D. To compare prescription drug cost sharing across prescription insurance type for Medicare beneficiaries after Medicare Part D, to assess the impact of that cost sharing on the number of medications used, and to examine how generic utilization rates differ before and after Medicare Part D and across the type of insurance. This longitudinal study of Medicare beneficiaries aged 65 years and older used Web-based surveys administered in 2005 and 2007 by Harris Interactive((R)) to collect information on prescription drug coverage and medication use. Co-payment plans were categorized as low, medium, or high co-payment plans. Multiple regression was used to assess the impact of co-payment rank on the number of prescription drugs. t-Tests and analysis of variance were used to compare generic use over time and between coverage types. One thousand two hundred twenty and 1024 respondents completed the baseline and follow-up surveys, respectively. Among 3-tier co-payment plans, brand drug co-payments were higher for Part D plans ($26 for preferred brand and $55 for nonpreferred brand) than employer-based plans ($20 for preferred brand and $39 for nonpreferred brand). Co-payment was not a significant predictor for the number of prescription drugs. Generic use was lowest among beneficiaries in employer plans both before and after Part D. In 2007, generic use among beneficiaries with Part D was not significantly different from the generic use for beneficiaries with no drug coverage. Medicare beneficiaries in Part D had higher cost sharing amounts than those with employer coverage, but higher cost sharing was not significantly linked to lower prescription use. Generic use for Part D beneficiaries was higher than that for beneficiaries with employer coverage but the same as that for beneficiaries without drug coverage. Copyright 2010 Elsevier Inc. All rights reserved.

Comparison of Long-term Care in Nursing Homes Versus Home Health: Costs and Outcomes in Alabama.

PubMed

Blackburn, Justin; Locher, Julie L; Kilgore, Meredith L

2016-04-01

To compare acute care outcomes and costs among nursing home residents with community-dwelling home health recipients. A matched retrospective cohort study of Alabamians aged more than or equal to 65 years admitted to a nursing home or home health between March 31, 2007 and December 31, 2008 (N = 1,291 pairs). Medicare claims were compared up to one year after admission into either setting. Death, emergency department and inpatient visits, inpatient length of stay, and acute care costs were compared using t tests. Medicaid long-term care costs were compared for a subset of matched beneficiaries. After one year, 77.7% of home health beneficiaries were alive compared with 76.2% of nursing home beneficiaries (p < .001). Home health beneficiaries averaged 0.2 hospital visits and 0.1 emergency department visits more than nursing home beneficiaries, differences that were statistically significant. Overall acute care costs were not statistically different; home health beneficiaries' costs averaged $31,423, nursing home beneficiaries' $32,239 (p = .5032). Among 426 dual-eligible pairs, Medicaid long-term care costs averaged $4,582 greater for nursing home residents (p < .001). Using data from Medicare claims, beneficiaries with similar functional status, medical diagnosis history, and demographics had similar acute care costs regardless of whether they were admitted to a nursing home or home health care. Additional research controlling for exogenous factors relating to long-term care decisions is needed. © The Author 2014. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Comprehensive Medication Reviews in Long-term Care Facilities: History of Process Implementation and 2015 Results.

PubMed

O'Shea, Terrence E; Zarowitz, Barbara J; Erwin, W Gary

2017-01-01

Since 2013, Part D sponsors have been required to offer comprehensive medication reviews (CMRs) to all beneficiaries enrolled in their medication therapy management (MTM) programs at least annually, including those in long-term care (LTC) settings. Since that time, MTM providers have found that accessing and completing CMRs with beneficiaries is frequently prohibitively complex, since the process often requires a live, face-to-face interactive interview where the beneficiary resides. However, with the migration of the CMR completion rate from a star ratings display measure to an active measure, coupled with the new CMR completion rate cutpoints for 2016, accessing this population for CMR completion has heightened importance. Our proprietary consultant pharmacist (CP) software was programmed in 2012 to produce a cover letter, medication action plan, and personal medication list per CMS standardized format specifications. Using this system, CPs were trained to perform and document CMRs and the interactive interviews. MTM-eligible Part D beneficiaries, identified by several contracted clients as residing in LTC serviced by Omnicare, were provided CMRs and summaries written in CMS standardized format by CPs. Residents with cognitive impairment were identified using 3 data elements in the Minimum Data Set (MDS). In 2015, 7,935 MTM-eligible beneficiaries were identified as receiving medications from an Omnicare pharmacy. After excluding those who were disenrolled by their prescription drug plans, discharged from the LTC facility, or resided in a LTC facility no longer serviced by Omnicare, 5,593 residents were available for CMR completion. Of these, only 3% refused the CMR offer, and 5,392 CMRs (96%) were completed successfully. Thirty-nine percent of residents had cognitive impairment per MDS assessments; in those instances, CMRs were conducted with someone other than the beneficiary. Based on the CMRs and interactive interviews, 7,527 drug therapy problem recommendations were made to prescribers, about 50% of which resulted in an alteration in therapy, including reductions in polypharmacy and high-risk medications. The CMR process and written summary in CMS standardized format works effectively for residents in LTC when performed by CPs in the facility, as evidenced by high completion rates and drug therapy problem identification/resolution. Part D plans should further consider using CPs to conduct CMRs in LTC settings. No outside funding supported this research. All authors are employees of Omnicare, a CVS Health Company, and are stockholders of CVS Health. O'Shea and Zarowitz have received research funding (unrelated to the submitted work) from Acadia, AstraZeneca, and Sunovion. The abstract for this article was presented as a research poster at the Academy of Managed Care and Specialty Pharmacy 2016 Annual Meeting; April 21, 2016; San Francisco, California. Study concept and design were contributed by O'Shea and Zarowitz, along with Erwin. O'Shea collected the data, and data interpretation was performed primarily by O'Shea, along with Zarowitz and Erwin. The manuscript was written by O'Shea, along with Zarowitz, and revised primarily by Zarowitz, along with O'Shea and Erwin.

Trends in management of pelvic organ prolapse among female Medicare beneficiaries.

PubMed

Khan, Aqsa A; Eilber, Karyn S; Clemens, J Quentin; Wu, Ning; Pashos, Chris L; Anger, Jennifer T

2015-04-01

In the last decade, many new surgical treatments have been developed to achieve less-invasive approaches to prolapse management. However, limited data exist on how the patterns of care for women with pelvic organ prolapse (POP) may have changed over the last decade, and whether mesh implantation techniques have influenced the type of specific compartment repair performed. We used a national data set to analyze the temporal trends in patterns of care for women with POP. Data were obtained from Public Use Files from the Centers for Medicare and Medicaid Services for a 5% random sample of national beneficiaries with an International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis of POP from 1999 through 2009. Current Procedural Terminology, 4th Edition and International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes were used to evaluate nonsurgical and surgical management trends for this cohort. Types of surgery were categorized by prolapse compartment and combinations of repairs. After 2005, when applicable codes became available, mesh or graft repairs were also analyzed. Over the study time period, the number of women with a diagnosis of POP in any 1 year in our 5% sample of Medicare beneficiaries remained relatively stable (range, 21,245-23,268 per year). Rates of pessary insertion were also consistent at 11-13% over the study period. Of the women with a prolapse diagnosis, 14-15% underwent surgical repair, and there was little change over time in surgical management patterns based on compartment. Most commonly, multiple compartments were repaired simultaneously. There was a rapid increase in mesh use such that in 2009, 41% of all women who underwent surgery (5.8% of the total cohort) had mesh or graft inserted in their repair. Hysterectomy rates for prolapse decreased over time. Rates of vault suspension at the time of hysterectomy for prolapse were low; however, they showed a relative increase over time (22% in 1999 to 26% in 2009). Patterns and rates of prolapse repairs remained relatively unchanged from 1999 through 2009, with an exception of a rapid rise in mesh use. These data suggest that the majority of mesh techniques were used for augmentation purposes only, but did not result in an increase in apical repairs performed in the United States. There remains a disappointingly low rate of vault suspension repairs concomitantly at time of hysterectomy for POP. Copyright © 2015. Published by Elsevier Inc.

Trends in management of pelvic organ prolapse among female Medicare beneficiaries

PubMed Central

Khan, Aqsa A.; Eilber, Karyn S.; Clemens, J. Quentin; Wu, Ning; Pashos, Chris L.; Anger, Jennifer T.

2016-01-01

OBJECTIVE In the last decade, many new surgical treatments have been developed to achieve less-invasive approaches to prolapse management. However, limited data exist on how the patterns of care for women with pelvic organ prolapse (POP) may have changed over the last decade, and whether mesh implantation techniques have influenced the type of specific compartment repair performed. We used a national data set to analyze the temporal trends in patterns of care for women with POP. STUDY DESIGN Data were obtained from Public Use Files from the Centers for Medicare and Medicaid Services for a 5% random sample of national beneficiaries with an International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis of POP from 1999 through 2009. Current Procedural Terminology, 4th Edition and International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes were used to evaluate nonsurgical and surgical management trends for this cohort. Types of surgery were categorized by prolapse compartment and combinations of repairs. After 2005, when applicable codes became available, mesh or graft repairs were also analyzed. RESULTS Over the study time period, the number of women with a diagnosis of POP in any 1 year in our 5% sample of Medicare beneficiaries remained relatively stable (range, 21,245–23,268 per year). Rates of pessary insertion were also consistent at 11–13% over the study period. Of the women with a prolapse diagnosis, 14–15% underwent surgical repair, and there was little change over time in surgical management patterns based on compartment. Most commonly, multiple compartments were repaired simultaneously. There was a rapid increase in mesh use such that in 2009, 41% of all women who underwent surgery (5.8% of the total cohort) had mesh or graft inserted in their repair. Hysterectomy rates for prolapse decreased over time. Rates of vault suspension at the time of hysterectomy for prolapse were low; however, they showed a relative increase over time (22% in 1999 to 26% in 2009). CONCLUSION Patterns and rates of prolapse repairs remained relatively unchanged from 1999 through 2009, with an exception of a rapid rise in mesh use. These data suggest that the majority of mesh techniques were used for augmentation purposes only, but did not result in an increase in apical repairs performed in the United States. There remains a disappointingly low rate of vault suspension repairs concomitantly at time of hysterectomy for POP. PMID:25446663

78 FR 22593 - Generalized System of Preferences (GSP): Initiation of a Review of the Union of Burma and the Lao...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-16

...) as beneficiary developing countries under the GSP program, and, if designated, whether either country...-preference-gsp/gsp-program-inf . Burma was previously designated a beneficiary developing country under GSP...-developed country beneficiary developing country for purposes of the GSP program. Submissions should not...

26 CFR 54.4980B-3 - Qualified beneficiaries.

Code of Federal Regulations, 2012 CFR

2012-04-01

... qualified beneficiary is— (i) Any individual who, on the day before a qualifying event, is covered under a... qualifying event that is the bankruptcy of the employer, a covered employee who had retired on or before the... bankruptcy qualifying event, the spouse, surviving spouse, or dependent child is a beneficiary under the plan...

26 CFR 54.4980B-3 - Qualified beneficiaries.

Code of Federal Regulations, 2013 CFR

2013-04-01

... qualified beneficiary is— (i) Any individual who, on the day before a qualifying event, is covered under a... qualifying event that is the bankruptcy of the employer, a covered employee who had retired on or before the... bankruptcy qualifying event, the spouse, surviving spouse, or dependent child is a beneficiary under the plan...

5 CFR 870.802 - Designation of beneficiary.

Code of Federal Regulations, 2010 CFR

2010-01-01

... the specified period, insurance benefits will be paid as if the beneficiary had died before the..., benefits will be paid according to the order of precedence shown in § 870.801(a). (3) If a court order... before the death of the insured, the insured individual can designate a beneficiary. Benefits will be...

77 FR 1862 - Mailing of Tickets Under the Ticket to Work Program

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-12

... Tickets Under the Ticket to Work Program AGENCY: Social Security Administration. ACTION: Interim final... Ticket to Work (Ticket) to disabled beneficiaries for participation in the Ticket to Work program (Ticket... beneficiaries who are most likely to return to work. We will send a Ticket to any eligible disabled beneficiary...

42 CFR 423.6 - Cost-sharing in beneficiary education and enrollment-related costs.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Cost-sharing in beneficiary education and enrollment-related costs. 423.6 Section 423.6 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... BENEFIT General Provisions § 423.6 Cost-sharing in beneficiary education and enrollment-related costs. The...

78 FR 21002 - Andean Trade Preference Act (ATPA), as Amended: Request for Public Comments Regarding Beneficiary...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-08

... countries. The original ATPA allowed Bolivia, Ecuador, Colombia, and Peru to be considered as beneficiary... November 25, 2008, the President determined that Bolivia no longer satisfied the eligibility criteria related to counternarcotics and suspended Bolivia's status as a beneficiary country for purposes of the...

5 CFR 831.2005 - Designation of beneficiary for lump-sum payment.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 5 Administrative Personnel 2 2013-01-01 2013-01-01 false Designation of beneficiary for lump-sum payment. 831.2005 Section 831.2005 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED.... (e) A change of beneficiary may be made at any time and without the knowledge or consent of the...

5 CFR 831.2005 - Designation of beneficiary for lump-sum payment.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 5 Administrative Personnel 2 2011-01-01 2011-01-01 false Designation of beneficiary for lump-sum payment. 831.2005 Section 831.2005 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED.... (e) A change of beneficiary may be made at any time and without the knowledge or consent of the...

5 CFR 831.2005 - Designation of beneficiary for lump-sum payment.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 5 Administrative Personnel 2 2012-01-01 2012-01-01 false Designation of beneficiary for lump-sum payment. 831.2005 Section 831.2005 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED.... (e) A change of beneficiary may be made at any time and without the knowledge or consent of the...

5 CFR 831.2005 - Designation of beneficiary for lump-sum payment.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 5 Administrative Personnel 2 2014-01-01 2014-01-01 false Designation of beneficiary for lump-sum payment. 831.2005 Section 831.2005 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED.... (e) A change of beneficiary may be made at any time and without the knowledge or consent of the...

42 CFR 405.2401 - Scope and definitions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... units of packed red blood cells furnished to a beneficiary during any calendar year. (See §§ 410.160 and... means that portion of the clinic's charge for covered services for which the beneficiary is liable in... beneficiary is entitled to have payment made on his or her behalf under this subpart. Deductible means: (1...

42 CFR 405.2401 - Scope and definitions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... units of packed red blood cells furnished to a beneficiary during any calendar year. (See §§ 410.160 and... means that portion of the clinic's charge for covered services for which the beneficiary is liable in... beneficiary is entitled to have payment made on his or her behalf under this subpart. Deductible means: (1...

42 CFR 405.2401 - Scope and definitions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... units of packed red blood cells furnished to a beneficiary during any calendar year. (See §§ 410.160 and... means that portion of the clinic's charge for covered services for which the beneficiary is liable in... beneficiary is entitled to have payment made on his or her behalf under this subpart. Deductible means: (1...

77 FR 23265 - Agency Information Collection Activities: Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-18

... utilization of Medicare services by American Indian and Alaska Native (AI/AN) beneficiaries, to identify and... evaluated previously by any agency or individual, so data on the extent of transportation barriers for rural AI/AN beneficiaries to Medicare services by AI/AN Medicare beneficiaries are not available except...

20 CFR 416.615 - Information considered in determining whether to make representative payment.

Code of Federal Regulations, 2010 CFR

2010-04-01

... management of benefit payments. For example, a statement by a physician or other medical professional based upon his or her recent examination of the beneficiary and his or her knowledge of the beneficiary's... other medical professional as to whether the beneficiary is able to manage or direct the management of...

5 CFR 831.2005 - Designation of beneficiary for lump-sum payment.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Designation of beneficiary for lump-sum payment. 831.2005 Section 831.2005 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED.... (e) A change of beneficiary may be made at any time and without the knowledge or consent of the...

20 CFR 416.601 - Introduction.

Code of Federal Regulations, 2012 CFR

2012-04-01

... representative payee if we have determined that the beneficiary is not able to manage or direct the management of... payment. (1) Our policy is that every beneficiary has the right to manage his or her own benefits. However... beneficiary and a question arises concerning his or her ability to manage or direct the management of benefit...

20 CFR 416.601 - Introduction.

Code of Federal Regulations, 2014 CFR

2014-04-01

... representative payee if we have determined that the beneficiary is not able to manage or direct the management of... payment. (1) Our policy is that every beneficiary has the right to manage his or her own benefits. However... beneficiary and a question arises concerning his or her ability to manage or direct the management of benefit...

20 CFR 410.584 - Use of benefits for current maintenance.

Code of Federal Regulations, 2011 CFR

2011-04-01

... SAFETY ACT OF 1969, TITLE IV-BLACK LUNG BENEFITS (1969- ) Payment of Benefits § 410.584 Use of benefits... for the beneficiary's current maintenance. Where a beneficiary is receiving care in an institution... individuals it provides with care and services like those it provides the beneficiary and charges made for...

20 CFR 410.584 - Use of benefits for current maintenance.

Code of Federal Regulations, 2010 CFR

2010-04-01

... SAFETY ACT OF 1969, TITLE IV-BLACK LUNG BENEFITS (1969- ) Payment of Benefits § 410.584 Use of benefits... for the beneficiary's current maintenance. Where a beneficiary is receiving care in an institution... individuals it provides with care and services like those it provides the beneficiary and charges made for...

Self-Reported Cancer Screening among Elderly Medicare Beneficiaries: A Rural-Urban Comparison

ERIC Educational Resources Information Center

Fan, Lin; Mohile, Supriya; Zhang, Ning; Fiscella, Kevin; Noyes, Katia

2012-01-01

Purpose: We examined the rural-urban disparity of screening for breast cancer and colorectal cancer (CRC) among the elder Medicare beneficiaries and assessed rurality's independent impact on receipt of screening. Methods: Using 2005 Medicare Current Beneficiary Survey, we applied weighted logistic regression to estimate the overall rural-urban…

Are Consumer-Directed Home Care Beneficiaries Satisfied? Evidence from Washington State

ERIC Educational Resources Information Center

Wiener, Joshua M.; Anderson, Wayne L.; Khatutsky, Galina

2007-01-01

Purpose: This study analyzed the effect of consumer-directed versus agency-directed home care on satisfaction with paid personal assistance services among Medicaid beneficiaries in Washington State. Design and Methods: The study analyzed a survey of 513 Medicaid beneficiaries receiving home- and community-based services. As part of a larger study,…

42 CFR 456.604 - Physician team member inspecting care of beneficiaries.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 4 2014-10-01 2014-10-01 false Physician team member inspecting care of... in Intermediate Care Facilities and Institutions for Mental Diseases § 456.604 Physician team member inspecting care of beneficiaries. No physician member of a team may inspect the care of a beneficiary for...

42 CFR 456.604 - Physician team member inspecting care of beneficiaries.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 4 2013-10-01 2013-10-01 false Physician team member inspecting care of... in Intermediate Care Facilities and Institutions for Mental Diseases § 456.604 Physician team member inspecting care of beneficiaries. No physician member of a team may inspect the care of a beneficiary for...

42 CFR 456.604 - Physician team member inspecting care of beneficiaries.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 4 2012-10-01 2012-10-01 false Physician team member inspecting care of... in Intermediate Care Facilities and Institutions for Mental Diseases § 456.604 Physician team member inspecting care of beneficiaries. No physician member of a team may inspect the care of a beneficiary for...

26 CFR 1.673(c)-1 - Reversionary interest after income beneficiary's death.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 26 Internal Revenue 8 2011-04-01 2011-04-01 false Reversionary interest after income beneficiary's death. 1.673(c)-1 Section 1.673(c)-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE... Substantial Owners § 1.673(c)-1 Reversionary interest after income beneficiary's death. The subject matter of...

26 CFR 1.673(c)-1 - Reversionary interest after income beneficiary's death.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 26 Internal Revenue 8 2014-04-01 2014-04-01 false Reversionary interest after income beneficiary's death. 1.673(c)-1 Section 1.673(c)-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE... Substantial Owners § 1.673(c)-1 Reversionary interest after income beneficiary's death. The subject matter of...

26 CFR 1.673(c)-1 - Reversionary interest after income beneficiary's death.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 26 Internal Revenue 8 2012-04-01 2012-04-01 false Reversionary interest after income beneficiary's death. 1.673(c)-1 Section 1.673(c)-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE... Substantial Owners § 1.673(c)-1 Reversionary interest after income beneficiary's death. The subject matter of...

5 CFR 843.205 - Designation of beneficiary-form and execution.

Code of Federal Regulations, 2010 CFR

2010-01-01

... execution. 843.205 Section 843.205 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL... One-time Payments § 843.205 Designation of beneficiary—form and execution. (a) A designation of..., corporation, or legal entity may be named as beneficiary. (e) A change of beneficiary may be made at any time...

32 CFR 728.60 - Job Corps and Volunteers in Service to America (VISTA) beneficiaries.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 32 National Defense 5 2013-07-01 2013-07-01 false Job Corps and Volunteers in Service to America (VISTA) beneficiaries. 728.60 Section 728.60 National Defense Department of Defense (Continued... FACILITIES Beneficiaries of Other Federal Agencies § 728.60 Job Corps and Volunteers in Service to America...

32 CFR 728.60 - Job Corps and Volunteers in Service to America (VISTA) beneficiaries.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 32 National Defense 5 2011-07-01 2011-07-01 false Job Corps and Volunteers in Service to America (VISTA) beneficiaries. 728.60 Section 728.60 National Defense Department of Defense (Continued... FACILITIES Beneficiaries of Other Federal Agencies § 728.60 Job Corps and Volunteers in Service to America...

32 CFR 728.60 - Job Corps and Volunteers in Service to America (VISTA) beneficiaries.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 32 National Defense 5 2012-07-01 2012-07-01 false Job Corps and Volunteers in Service to America (VISTA) beneficiaries. 728.60 Section 728.60 National Defense Department of Defense (Continued... FACILITIES Beneficiaries of Other Federal Agencies § 728.60 Job Corps and Volunteers in Service to America...

32 CFR 728.60 - Job Corps and Volunteers in Service to America (VISTA) beneficiaries.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 32 National Defense 5 2014-07-01 2014-07-01 false Job Corps and Volunteers in Service to America (VISTA) beneficiaries. 728.60 Section 728.60 National Defense Department of Defense (Continued... FACILITIES Beneficiaries of Other Federal Agencies § 728.60 Job Corps and Volunteers in Service to America...

38 CFR 3.217 - Submission of statements or information affecting entitlement to benefits.

Code of Federal Regulations, 2010 CFR

2010-07-01

... the identity of the provider as either the beneficiary or his or her fiduciary by obtaining specific information about the beneficiary that can be verified from the beneficiary's VA records, such as Social... statement provided, the date such information or statement was provided, the identity of the provider, the...

76 FR 36173 - U.S. Registration of Aircraft in the Name of Owner Trustees for Non-U.S. Citizen Beneficiary

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-21

... DEPARTMENT OF TRANSPORTATION Federal Aviation Administration U.S. Registration of Aircraft in the Name of Owner Trustees for Non-U.S. Citizen Beneficiary AGENCY: Federal Aviation Administration, (FAA..., Oklahoma, concerning aircraft registration by owner trustees for non- U.S. citizen beneficiaries...

Weighted SAW reflector gratings for orthogonal frequency coded SAW tags and sensors

NASA Technical Reports Server (NTRS)

Puccio, Derek (Inventor); Malocha, Donald (Inventor)

2011-01-01

Weighted surface acoustic wave reflector gratings for coding identification tags and sensors to enable unique sensor operation and identification for a multi-sensor environment. In an embodiment, the weighted reflectors are variable while in another embodiment the reflector gratings are apodized. The weighting technique allows the designer to decrease reflectively and allows for more chips to be implemented in a device and, consequently, more coding diversity. As a result, more tags and sensors can be implemented using a given bandwidth when compared with uniform reflectors. Use of weighted reflector gratings with OFC makes various phase shifting schemes possible, such as in-phase and quadrature implementations of coded waveforms resulting in reduced device size and increased coding.

Priming processes in the Simon task: more evidence from the lexical decision task for a third route in the Simon effect.

PubMed

Metzker, Manja; Dreisbach, Gesine

2011-06-01

Recently, it was proposed that the Simon effect would result not only from two interfering processes, as classical dual-route models assume, but from three processes. It was argued that priming from the spatial code to the nonspatial code might facilitate the identification of the nonspatial stimulus feature in congruent Simon trials. In the present study, the authors provide evidence that the identification of the nonspatial information can be facilitated by the activation of an associated spatial code. In three experiments, participants first associated centrally presented animal and fruit pictures with spatial responses. Subsequently, participants decided whether laterally presented letter strings were words (animal, fruit, or other words) or nonwords; stimulus position could be congruent or incongruent to the associated spatial code. As hypothesized, animal and fruit words were identified faster at congruent than at incongruent stimulus positions from the association phase. The authors conclude that the activation of the spatial code spreads to the nonspatial code, resulting in facilitated stimulus identification in congruent trials. These results speak to the assumption of a third process involved in the Simon task.

Obtaining advance beneficiary notices for Medicare physician providers.

PubMed

Carter, Darren

2003-01-01

Medicare has established medical necessity rules that define the medical conditions that make beneficiaries eligible for particular services. These rules are codified in local medical review policies (LMRPs) that are established by Medicare claims payment contractors. If a beneficiary's provider does not inform the patient that a service may not be covered, the provider cannot subsequently bill the beneficiary for the service if it is denied. This article discusses the application of these policies. It illustrates the circumstances in which advance beneficiary notices (ABN) are required to ensure that patients have been notified that services rendered will not be covered by Medicare and will become their financial responsibility. The author also presents special applications of the ABN regulations as they apply to the EMTALA rules, anti-kickback, and other statutes. Samples of the official ABN forms are illustrated.

Cognition and take-up of subsidized drug benefits by Medicare beneficiaries.

PubMed

Kuye, Ifedayo O; Frank, Richard G; McWilliams, J Michael

2013-06-24

Take-up of the Medicare Part D low-income subsidy (LIS) by eligible beneficiaries has been low despite the attractive drug coverage it offers at no cost to beneficiaries and outreach efforts by the Social Security Administration. To examine the role of beneficiaries' cognitive abilities in explaining this puzzle. Analysis of survey data from the nationally representative Health and Retirement Study. Elderly Medicare beneficiaries who were likely eligible for the LIS, excluding Medicaid and Supplemental Security Income recipients who automatically receive the subsidy without applying. Using survey assessments of overall cognition and numeracy from 2006 to 2010, we examined how cognitive abilities were associated with self-reported Part D enrollment, awareness of the LIS, and application for the LIS. We also compared out-of-pocket drug spending and premium costs between LIS-eligible beneficiaries who did and did not report receipt of the LIS. Analyses were adjusted for sociodemographic characteristics, household income and assets, health status, and presence of chronic conditions. Compared with LIS-eligible beneficiaries in the top quartile of overall cognition, those in the bottom quartile were significantly less likely to report Part D enrollment (adjusted rate, 63.5% vs 52.0%; P = .002), LIS awareness (58.3% vs 33.3%; P = .001), and LIS application (25.5% vs 12.7%; P < .001). Lower numeracy was also associated with lower rates of Part D enrollment (P = .03) and LIS application (P = .002). Reported receipt of the LIS was associated with significantly lower annual out-of-pocket drug spending (adjusted mean difference, -$256; P = .02) and premium costs (-$273; P = .02). Among Medicare beneficiaries likely eligible for the Part D LIS, poorer cognition and numeracy were associated with lower reported take-up. Current educational and outreach efforts encouraging LIS applications may not be sufficient for beneficiaries with limited abilities to process and respond to information. Additional policies may be needed to extend the financial protection conferred by the LIS to all eligible seniors.

Home Health Agency Characteristics and Quality Outcomes for Medicare Beneficiaries With Rehabilitation-Sensitive Conditions.

PubMed

Mroz, Tracy M; Meadow, Ann; Colantuoni, Elizabeth; Leff, Bruce; Wolff, Jennifer L

2018-06-01

To examine associations between organizational characteristics of home health agencies (eg, profit status, rehabilitation therapy staffing model, size, and rurality) and quality outcomes in Medicare beneficiaries with rehabilitation-sensitive conditions, conditions for which occupational, physical, and/or speech therapy have the potential to improve functioning, prevent or slow substantial decline in functioning, or increase ability to remain at home safely. Retrospective analysis. Home health agencies. Fee-for-service beneficiaries (N=1,006,562) admitted to 9250 Medicare-certified home health agencies in 2009. Not applicable. Institutional admission during home health care, community discharge, and institutional admission within 30 days of discharge. Nonprofit (vs for-profit) home health agencies were more likely to discharge beneficiaries to the community (odds ratio [OR], 1.23; 95% confidence interval [CI], 1.13-1.33) and less likely to have beneficiaries incur institutional admissions within 30 days of discharge (OR, .93; 95% CI, .88-.97). Agencies in rural (vs urban) counties were less likely to discharge patients to the community (OR, .83; 95% CI, .77-.90) and more likely to have beneficiaries incur institutional admissions during home health (OR, 1.24; 95% CI, 1.18-1.30) and within 30 days of discharge (OR, 1.15; 95% CI, 1.10-1.22). Agencies with contract (vs in-house) therapy staff were less likely to discharge beneficiaries to the community (OR, .79, 95% CI, .70-.91) and more likely to have beneficiaries incur institutional admissions during home health (OR, 1.09; 95% CI, 1.03-1.15) and within 30 days of discharge (OR, 1.17; 95% CI, 1.07-1.28). As payers continue to test and implement reimbursement mechanisms that seek to reward value over volume of services, greater attention should be paid to organizational factors that facilitate better coordinated, higher quality home health care for beneficiaries who may benefit from rehabilitation. Copyright © 2017 American Congress of Rehabilitation Medicine. All rights reserved.

The Differences in Health Care Utilization between Medical Aid and Health Insurance: A Longitudinal Study Using Propensity Score Matching

PubMed Central

Kim, Jae-Hyun; Lee, Kwang-Soo; Yoo, Ki-Bong; Park, Eun-Cheol

2015-01-01

Study Objectives Health care utilization has progressively increased, especially among Medical Aid beneficiaries in South Korea. The Medical Aid classifies beneficiaries into two categories, type 1 and 2, on the basis of being incapable (those under 18 or over 65 years of age, or disabled) or capable of working, respectively. Medical Aid has a high possibility for health care utilization due to high coverage level. In South Korea, the national health insurance (NHI) achieved very short time to establish coverage for the entire Korean population. However there there remaine a number of problems to be solved. Therefore, the objective of this study was to investigate the differences in health care utilization between Medical Aid beneficiaries and Health Insurance beneficiaries. Methods & Design Data were collected from the Korean Welfare Panel Study from 2008 to 2012 using propensity score matching. Of the 2,316 research subjects, 579 had Medical Aid and 1,737 had health insurance. We also analyzed three dependent variables: days spent in the hospital, number of outpatient visits, and hospitalizations per year. Analysis of variance and longitudinal data analysis were used. Results The number of outpatient visits was 1.431 times higher (p<0.0001) in Medical Aid beneficiaries, the number of hospitalizations per year was 1.604 times higher (p<0.0001) in Medical Aid beneficiaries, and the number of days spent in the hospital per year was 1.282 times higher (p<0.268) for Medical Aid beneficiaries than in individuals with Health Insurance. Medical Aid patients had a 0.874 times lower frequency of having an unmet needs due to economic barrier (95% confidence interval: 0.662-1.156). Conclusions Health insurance coverage has an impact on health care utilization. More health care utilization among Medical Aid beneficiaries appears to have a high possibility of a moral hazard risk under the Health Insurance program. Therefore, the moral hazard for Medical Aid beneficiaries should be avoided. PMID:25816234

Significance of Infectious Agents in Colorectal Cancer Development

PubMed Central

Antonic, Vlado; Stojadinovic, Alexander; Kester, Kent E.; Weina, Peter J; Brücher, Björn LDM; Protic, Mladjan; Avital, Itzhak; Izadjoo, Mina

2013-01-01

Colorectal cancer (CRC) is a major burden to healthcare systems worldwide accounting for approximately one million of new cancer cases worldwide. Even though, CRC mortality has decreased over the last 20 years, it remains the third most common cause of cancer-related mortality, accounting for approximately 600,000 deaths in 2008 worldwide. A multitude of risk factors have been linked to CRC, including hereditary factors, environmental factors and inflammatory syndromes affecting the gastrointestinal tract. Recently, various pathogens were added to the growing list of risk factors for a number of common epithelial cancers, but despite the multitude of correlative studies, only suggestions remain about the possible relationship between selected viruses and bacteria of interest and the CRC risk. United States military service members are exposed to various risk factors impacting the incidence of cancer development. These exposures are often different from that of many sectors of the civilian population. Thereby, cancer risk identification, screening and early detection are imperative for both the military health care beneficiaries and the population as a whole. In this review, we will focus on several pathogens and their potential roles in development of CRC, highlighting the clinical trials evaluating this correlation and provide our personal opinion about the importance of risk reduction, health promotion and disease prevention for military health care beneficiaries. PMID:23459622

Incentive-Based Conservation Programs in Developing Countries: A Review of Some Key Issues and Suggestions for Improvements

NASA Astrophysics Data System (ADS)

Spiteri, Arian; Nepalz, Sanjay K.

2006-01-01

Biodiversity conservation in developing countries has been a challenge because of the combination of rising human populations, rapid technological advances, severe social hardships, and extreme poverty. To address the social, economic, and ecological limitations of people-free parks and reserves, incentives have been incorporated into conservation programs in the hopes of making conservation meaningful to local people. However, such incentive-based programs have been implemented with little consideration for their ability to fulfill promises of greater protection of biodiversity. Evaluations of incentive-based conservation programs indicate that the approach continually falls short of the rhetoric. This article provides an overview of the problems associated with incentive-based conservation approaches in developing countries. It argues that existing incentive-based programs (IBPs) have yet to realize that benefits vary greatly at different “community” scales and that a holistic conceptualization of a community is essential to incorporate the complexities of a heterogeneous community when designing and implementing the IBPs. The spatial complexities involved in correctly identifying the beneficiaries in a community and the short-term focus of IBPs are two major challenges for sustaining conservation efforts. The article suggests improvements in three key areas: accurate identification of “target” beneficiaries, greater inclusion of marginal communities, and efforts to enhance community aptitudes.

Identification and Classification of Orthogonal Frequency Division Multiple Access (OFDMA) Signals Used in Next Generation Wireless Systems

DTIC Science & Technology

2012-03-01

advanced antenna systems AMC adaptive modulation and coding AWGN additive white Gaussian noise BPSK binary phase shift keying BS base station BTC ...QAM-16, and QAM-64, and coding types include convolutional coding (CC), convolutional turbo coding (CTC), block turbo coding ( BTC ), zero-terminating

Resource utilization and costs of age-related macular degeneration.

PubMed

Halpern, Michael T; Schmier, Jordana K; Covert, David; Venkataraman, Krithika

2006-01-01

Data were analyzed from the 1999-2001 Medicare Beneficiary Encrypted Files for patients with age-related macular degeneration (AMD), an ophthalmic condition characterized by central vision loss. Classifying AMD subtype by International Classification of Diseases, Ninth Revision, Clinical Modifications (ICD-9-CM) (Centers for Disease Control and Prevention, 2003) code, resource utilization rates increased with disease progression. Individuals with more severe disease (wet only or wet and dry AMD) had greater costs than did those with less severe disease (drusen only or dry only). Costs among patients with wet disease increased yearly at rates exceeding inflation, possibly due in part to increased rates of treatment with photodynamic therapy among these individuals and the aging of the population.

20 CFR 410.586 - Use of benefits for beneficiary in institution.

Code of Federal Regulations, 2011 CFR

2011-04-01

... HEALTH AND SAFETY ACT OF 1969, TITLE IV-BLACK LUNG BENEFITS (1969- ) Payment of Benefits § 410.586 Use of... certified on behalf of the beneficiary shall give highest priority to expenditure of the payments for the... § 410.584) in providing care and maintenance. It is considered in the best interest of the beneficiary...

20 CFR 410.586 - Use of benefits for beneficiary in institution.

Code of Federal Regulations, 2010 CFR

2010-04-01

... HEALTH AND SAFETY ACT OF 1969, TITLE IV-BLACK LUNG BENEFITS (1969- ) Payment of Benefits § 410.586 Use of... certified on behalf of the beneficiary shall give highest priority to expenditure of the payments for the... § 410.584) in providing care and maintenance. It is considered in the best interest of the beneficiary...

38 CFR 10.15 - Designation of more than one beneficiary under an adjusted service certificate.

Code of Federal Regulations, 2014 CFR

2014-07-01

... World War Adjusted Compensation Act may name more than one beneficiary to receive the proceeds of his... 38 Pensions, Bonuses, and Veterans' Relief 1 2014-07-01 2014-07-01 false Designation of more than one beneficiary under an adjusted service certificate. 10.15 Section 10.15 Pensions, Bonuses, and...

38 CFR 10.15 - Designation of more than one beneficiary under an adjusted service certificate.

Code of Federal Regulations, 2013 CFR

2013-07-01

... World War Adjusted Compensation Act may name more than one beneficiary to receive the proceeds of his... 38 Pensions, Bonuses, and Veterans' Relief 1 2013-07-01 2013-07-01 false Designation of more than one beneficiary under an adjusted service certificate. 10.15 Section 10.15 Pensions, Bonuses, and...

38 CFR 10.15 - Designation of more than one beneficiary under an adjusted service certificate.

Code of Federal Regulations, 2010 CFR

2010-07-01

... World War Adjusted Compensation Act may name more than one beneficiary to receive the proceeds of his... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Designation of more than one beneficiary under an adjusted service certificate. 10.15 Section 10.15 Pensions, Bonuses, and...

38 CFR 10.15 - Designation of more than one beneficiary under an adjusted service certificate.

Code of Federal Regulations, 2012 CFR

2012-07-01

... World War Adjusted Compensation Act may name more than one beneficiary to receive the proceeds of his... 38 Pensions, Bonuses, and Veterans' Relief 1 2012-07-01 2012-07-01 false Designation of more than one beneficiary under an adjusted service certificate. 10.15 Section 10.15 Pensions, Bonuses, and...

38 CFR 10.15 - Designation of more than one beneficiary under an adjusted service certificate.

Code of Federal Regulations, 2011 CFR

2011-07-01

... World War Adjusted Compensation Act may name more than one beneficiary to receive the proceeds of his... 38 Pensions, Bonuses, and Veterans' Relief 1 2011-07-01 2011-07-01 false Designation of more than one beneficiary under an adjusted service certificate. 10.15 Section 10.15 Pensions, Bonuses, and...

26 CFR 1.652(c)-2 - Death of individual beneficiaries.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 26 Internal Revenue 8 2010-04-01 2010-04-01 false Death of individual beneficiaries. 1.652(c)-2...) INCOME TAX (CONTINUED) INCOME TAXES Trusts Which Distribute Current Income Only § 1.652(c)-2 Death of... the beneficiary's death), the extent to which the income is included in the gross income of the...

12 CFR 745.4 - Revocable trust accounts.

Code of Federal Regulations, 2011 CFR

2011-01-01

...-death account naming the same niece and a friend as beneficiaries. The maximum coverage available to the... beneficiaries in the revocable trust accounts—his niece and cousin in the first, and the same niece and a friend... names two friends, “B” and “C” as beneficiaries. At the same NCUA-insured credit union, A establishes a...

3 CFR 8467 - Proclamation 8467 of December 23, 2009. To Modify Duty-Free Treatment Under the Generalized...

Code of Federal Regulations, 2010 CFR

2010-01-01

... determined that Cape Verde should be removed from the list of least-developed beneficiary countries. 7. In... reflect in the HTS the termination of the designation of Cape Verde as a least-developed beneficiary... Verde” from the list of least-developed beneficiary developing countries, effective with respect to...

Choice of Personal Assistance Services Providers by Medicare Beneficiaries Using a Consumer-Directed Benefit: Rural-Urban Differences

ERIC Educational Resources Information Center

Meng, Hongdao; Friedman, Bruce; Wamsley, Brenda R.; Van Nostrand, Joan F.; Eggert, Gerald M.

2010-01-01

Purpose: To examine the impact of an experimental consumer-choice voucher benefit on the selection of independent and agency personal assistance services (PAS) providers among rural and urban Medicare beneficiaries with disabilities. Methods: The Medicare Primary and Consumer-Directed Care Demonstration enrolled 1,605 Medicare beneficiaries in 19…

Identifying Homelessness among Veterans Using VA Administrative Data: Opportunities to Expand Detection Criteria.

PubMed

Peterson, Rachel; Gundlapalli, Adi V; Metraux, Stephen; Carter, Marjorie E; Palmer, Miland; Redd, Andrew; Samore, Matthew H; Fargo, Jamison D

2015-01-01

Researchers at the U.S. Department of Veterans Affairs (VA) have used administrative criteria to identify homelessness among U.S. Veterans. Our objective was to explore the use of these codes in VA health care facilities. We examined VA health records (2002-2012) of Veterans recently separated from the military and identified as homeless using VA conventional identification criteria (ICD-9-CM code V60.0, VA specific codes for homeless services), plus closely allied V60 codes indicating housing instability. Logistic regression analyses examined differences between Veterans who received these codes. Health care services and co-morbidities were analyzed in the 90 days post-identification of homelessness. VA conventional criteria identified 21,021 homeless Veterans from Operations Enduring Freedom, Iraqi Freedom, and New Dawn (rate 2.5%). Adding allied V60 codes increased that to 31,260 (rate 3.3%). While certain demographic differences were noted, Veterans identified as homeless using conventional or allied codes were similar with regards to utilization of homeless, mental health, and substance abuse services, as well as co-morbidities. Differences were noted in the pattern of usage of homelessness-related diagnostic codes in VA facilities nation-wide. Creating an official VA case definition for homelessness, which would include additional ICD-9-CM and other administrative codes for VA homeless services, would likely allow improved identification of homeless and at-risk Veterans. This also presents an opportunity for encouraging uniformity in applying these codes in VA facilities nationwide as well as in other large health care organizations.

Identifying Homelessness among Veterans Using VA Administrative Data: Opportunities to Expand Detection Criteria

PubMed Central

Peterson, Rachel; Gundlapalli, Adi V.; Metraux, Stephen; Carter, Marjorie E.; Palmer, Miland; Redd, Andrew; Samore, Matthew H.; Fargo, Jamison D.

2015-01-01

Researchers at the U.S. Department of Veterans Affairs (VA) have used administrative criteria to identify homelessness among U.S. Veterans. Our objective was to explore the use of these codes in VA health care facilities. We examined VA health records (2002-2012) of Veterans recently separated from the military and identified as homeless using VA conventional identification criteria (ICD-9-CM code V60.0, VA specific codes for homeless services), plus closely allied V60 codes indicating housing instability. Logistic regression analyses examined differences between Veterans who received these codes. Health care services and co-morbidities were analyzed in the 90 days post-identification of homelessness. VA conventional criteria identified 21,021 homeless Veterans from Operations Enduring Freedom, Iraqi Freedom, and New Dawn (rate 2.5%). Adding allied V60 codes increased that to 31,260 (rate 3.3%). While certain demographic differences were noted, Veterans identified as homeless using conventional or allied codes were similar with regards to utilization of homeless, mental health, and substance abuse services, as well as co-morbidities. Differences were noted in the pattern of usage of homelessness-related diagnostic codes in VA facilities nation-wide. Creating an official VA case definition for homelessness, which would include additional ICD-9-CM and other administrative codes for VA homeless services, would likely allow improved identification of homeless and at-risk Veterans. This also presents an opportunity for encouraging uniformity in applying these codes in VA facilities nationwide as well as in other large health care organizations. PMID:26172386

Potential adult Medicaid beneficiaries under the Patient Protection and Affordable Care Act compared with current adult Medicaid beneficiaries.

PubMed

Chang, Tammy; Davis, Matthew

2013-01-01

Under health care reform, states will have the opportunity to expand Medicaid to millions of uninsured US adults. Information regarding this population is vital to physicians as they prepare for more patients with coverage. Our objective was to describe demographic and health characteristics of potentially eligible Medicaid beneficiaries. We performed a cross-sectional study using data from the National Health and Nutrition Examination Survey (2007-2010) to identify and compare adult US citizens potentially eligible for Medicaid under provisions of the Patient Protection and Affordable Care Act (ACA) with current adult Medicaid beneficiaries. We compared demographic characteristics (age, sex, race/ethnicity, education) and health measures (self-reported health status; measured body mass index, hemoglobin A1c level, systolic and diastolic blood pressure, depression screen [9-item Patient Health Questionnaire], tobacco smoking, and alcohol use). Analyses were based on an estimated 13.8 million current adult non-elderly Medicaid beneficiaries and 13.6 million nonelderly adults potentially eligible for Medicaid. Potentially eligible individuals are expected to be more likely male (49.2% potentially eligible vs 33.3% current beneficiaries; P <.001), to be more likely white and less likely black (58.8% white, 20.0% black vs 49.9% white, 25.2% black; P = .02), and to be statistically indistinguishable in terms of educational attainment. Overall, potentially eligible adults are expected to have better health status (34.8% "excellent" or "very good," 40.4% "good") than current beneficiaries (33.5% "excellent" or "very good," 31.6% "good"; P <.001). The proportions obese (34.5% vs 42.9%; P = .008) and with depression (15.5% vs 22.3%; P = .003) among potentially eligible individuals are significantly lower than those for current beneficiaries, while there are no significant differences in the expected prevalence of diabetes or hypertension. Current tobacco smoking (49.2% vs 38.0%; P = .002), and moderate and heavier alcohol use (21.6% vs 16.0% and 16.5% vs 9.8%; P <.001, respectively) are more common among the potentially eligible population than among current beneficiaries. Under the ACA, physicians can anticipate a potentially eligible Medicaid population with equal if not better current health status and lower prevalence of obesity and depression than current Medicaid beneficiaries. Federal Medicaid expenditures for newly covered beneficiaries therefore may not be as high as anticipated in the short term. Given the higher prevalence of tobacco smoking and alcohol use, however, broad enrollment and engagement of this potentially eligible population is needed to address their higher prevalence of modifiable risk factors for future chronic disease.

Are Press Depictions of Affordable Care Act Beneficiaries Favorable to Policy Durability?

PubMed

Chattopadhyay, Jacqueline

2015-01-01

If successfully implemented and enduring, the Affordable Care Act (ACA) stands to expand health insurance access in absolute terms, reduce inter-group disparities in that access, and reduce exposure to the financial vulnerabilities illness entails. Its durability--meaning both avoidance of outright retrenchment and fidelity to its policy aims--is thus of scholarly interest. Past literature suggests that social constructions of a policy's beneficiaries may impact durability. This paper first describes media portrayals of ACA beneficiaries with an eye toward answering three descriptive questions: (1) Do portrayals depict beneficiaries as economically heterogeneous? (2) Do portrayals focus attention on groups that have acquired new political relevance due to the ACA, such as young adults? (3) What themes that have served as messages about beneficiary "deservingness" in past social policy are most frequent in ACA beneficiary portrayals? The paper then assesses how the portrayal patterns that these questions uncover may work both for and against the ACA's durability, finding reasons for confidence as well as caution. Using manual and automated methods, this paper analyzes newspaper text from August 2013 through January 2014 to trace portrayals of two ACA "target populations" before and during the new law's first open-enrollment period: those newly eligible for Medicaid, and those eligible for subsidies to assist in the purchase of private health insurance under the ACA. This paper also studies newspaper text portrayals of two groups informally crafted by the ACA in this timeframe: those gaining health insurance and those losing it. The text data uncover the following answers to the three descriptive questions for the timeframe studied: (1) Portrayals may underplay beneficiaries' economic heterogeneity. (2) Portrayals pay little attention to young adults. (3) Portrayals emphasize themes of workforce participation, economic self-sufficiency, and insider status. Health status, age, gender, and race/ethnicity appear to receive little attention. Existing literature suggests that these portrayal patterns may both support and limit ACA durability. In favor of durability is that ACA beneficiaries are depicted in terms that have been associated with deservingness in past American social policy--particularly being cast as workers and insiders. Yet, the results also give three reasons for caution. First, ACA insurance-losers are also portrayed as deserving. Second, it is unclear how the portrayal patterns found may impact the durability of the ACA's efforts to cut insurance disparities by age, health status, and especially race/ethnicity. Third, portrayals' strong casting of beneficiaries as workers, and limited attention to beneficiaries' economic heterogeneity and to young adults, may do little to help cultivate beneficiary political engagement around the ACA.

Five-way smoking status classification using text hot-spot identification and error-correcting output codes.

PubMed

Cohen, Aaron M

2008-01-01

We participated in the i2b2 smoking status classification challenge task. The purpose of this task was to evaluate the ability of systems to automatically identify patient smoking status from discharge summaries. Our submission included several techniques that we compared and studied, including hot-spot identification, zero-vector filtering, inverse class frequency weighting, error-correcting output codes, and post-processing rules. We evaluated our approaches using the same methods as the i2b2 task organizers, using micro- and macro-averaged F1 as the primary performance metric. Our best performing system achieved a micro-F1 of 0.9000 on the test collection, equivalent to the best performing system submitted to the i2b2 challenge. Hot-spot identification, zero-vector filtering, classifier weighting, and error correcting output coding contributed additively to increased performance, with hot-spot identification having by far the largest positive effect. High performance on automatic identification of patient smoking status from discharge summaries is achievable with the efficient and straightforward machine learning techniques studied here.

48 CFR 252.211-7006 - Passive Radio Frequency Identification.

Code of Federal Regulations, 2013 CFR

2013-10-01

... radio frequency identification (RFID) or item unique identification (IUID) information, order... CodeTM (EPC®) means an identification scheme for universally identifying physical objects via RFID tags... passive RFID technology. Exterior container means a MIL-STD-129 defined container, bundle, or assembly...

48 CFR 252.211-7006 - Passive Radio Frequency Identification.

Code of Federal Regulations, 2012 CFR

2012-10-01

... radio frequency identification (RFID) or item unique identification (IUID) information, order... CodeTM (EPC®) means an identification scheme for universally identifying physical objects via RFID tags... passive RFID technology. Exterior container means a MIL-STD-129 defined container, bundle, or assembly...

48 CFR 252.211-7006 - Passive Radio Frequency Identification.

Code of Federal Regulations, 2014 CFR

2014-10-01

... radio frequency identification (RFID) or item unique identification (IUID) information, order... CodeTM (EPC®) means an identification scheme for universally identifying physical objects via RFID tags... passive RFID technology. Exterior container means a MIL-STD-129 defined container, bundle, or assembly...

The Impact of Medicare Part D on the Proportion of Out-of-Pocket Prescription Drug Costs Among Older Adults With Diabetes.

PubMed

Choi, Yoon Jeong; Jia, Haomiao; Gross, Tal; Weinger, Katie; Stone, Patricia W; Smaldone, Arlene M

2017-04-01

The purpose of this study was to evaluate the impact of Medicare Part D on reducing the financial burden of prescription drugs in older adults with diabetes. Using Medical Expenditure Panel Survey data (2000-2011), interrupted time series and difference-in-difference analyses were used to examine out-of-pocket costs for prescription drugs in 4,664 Medicare beneficiaries (≥65 years of age) compared with 2,938 younger, non-Medicare adults (50-60 years) with diabetes and to estimate the causal effects of Medicare Part D. Part D enrollment of Medicare beneficiaries with diabetes gradually increased from 45.7% (2006) to 52.4% (2011). Compared with years 2000-2005, out-of-pocket pharmacy costs decreased by 13.5% (SE 2.1) for all Medicare beneficiaries with diabetes following Part D implementation; on average, Part D beneficiaries had 5.3% (0.8) lower costs compared with those without Part D. Compared with a younger group with diabetes, out-of-pocket pharmacy costs decreased by 19.4% (1.7) for Medicare beneficiaries after Part D. Part D beneficiaries with diabetes who experienced the coverage gap decreased from 60.1% (2006) to 40.9% (2011) over this period. These findings demonstrate that although Medicare Part D has been effective in reducing the out-of-pocket cost burden of prescription drugs, approximately two out of five Part D beneficiaries with diabetes experienced the coverage gap in 2011. Future research is needed to examine the impact of Affordable Care Act provisions to close the coverage gap on the cost burden of prescription drugs for Medicare beneficiaries with diabetes. © 2017 by the American Diabetes Association.

Patient-Centered Medical Home Features and Health Care Expenditures of Medicare Beneficiaries with Chronic Disease Dyads.

PubMed

Philpot, Lindsey M; Stockbridge, Erica L; Padrón, Norma A; Pagán, José A

2016-06-01

Three out of 4 Medicare beneficiaries have multiple chronic conditions, and managing the care of this growing population can be complex and costly because of care coordination challenges. This study assesses how different elements of the patient-centered medical home (PCMH) model may impact the health care expenditures of Medicare beneficiaries with the most prevalent chronic disease dyads (ie, co-occurring high cholesterol and high blood pressure, high cholesterol and heart disease, high cholesterol and diabetes, high cholesterol and arthritis, heart disease and high blood pressure). Data from the 2007-2011 Medical Expenditure Panel Survey suggest that increased access to PCMH features may differentially impact the distribution of health care expenditures across health care service categories depending on the combination of chronic conditions experienced by each beneficiary. For example, having no difficulty contacting a provider after regular hours was associated with significantly lower outpatient expenditures for beneficiaries with high cholesterol and diabetes (n = 635; P = 0.038), but it was associated with significantly higher inpatient expenditures for beneficiaries with high blood pressure and high cholesterol (n = 1599; P = 0.015), and no significant differences in expenditures in any category for beneficiaries with high blood pressure and heart disease (n = 1018; P > 0.05 for all categories). However, average total health care expenditures are largely unaffected by implementing the PCMH features considered. Understanding how the needs of Medicare beneficiaries with multiple chronic conditions can be met through the adoption of the PCMH model is important not only to be able to provide high-quality care but also to control costs. (Population Health Management 2016;19:206-211).

Richer but fatter: the unintended consequences of microcredit financing on household health and expenditure in Jamaica.

PubMed

Gordon-Strachan, Georgiana; Cunningham-Myrie, Colette; Fox, Kristin; Kirton, Claremont; Fraser, Raphael; McLeod, Georgia; Forrester, Terrence

2015-01-01

To determine whether there was a difference in wealth and cardiovascular disease (CVD) risk between microcredit loan beneficiaries and community-matched non-beneficiaries (controls). Seven hundred and twenty-six households of microcredit loan beneficiaries were matched with 726 controls by age, sex and community. A standardised interviewer administered questionnaire was used to collect data on health and household expenditure. Weights, heights, waist circumference and blood pressure measurements were taken for an adult and one child (6-16 years) from each household. Amongst adults, there was no difference in the prevalence of pre-hypertension and hypertension. More male (68.1% vs. 47.8%) and female beneficiaries (84.5% vs. 77.9%) were overweight/obese. More male (17.2% vs. 7.1%; P < 0.05) and female beneficiaries (68.5% vs. 63.3%; P < 0.05) exhibited substantially increased risk for CVD. Children of beneficiaries displayed higher mean BMI-for-age z-scores than their control peers: males 0.56 [95% CI 0.40-0.72] vs. 0.18 [95% CI 0.02-0.35] (P < 0.001) and females 0.66 [95% CI 0.52-0.80] vs. 0.42 [95% CI 0.29-0.56] (P < 0.001). Based on BMI-for-age z-scores, children of beneficiaries had greater odds of being overweight/obese (OR = 1.46; 95% CI 1.18-1.82) Beneficiaries were economically better off; their mean total annual expenditure and house ownership were significantly higher than controls (P < 0.001). Microcredit financing is positively associated with wealth acquisition but worsened cardiovascular risk status. © 2014 John Wiley & Sons Ltd.

Trends in Aortic Valve Replacement Procedures Between 2009 and 2015: Has Transcatheter Aortic Valve Replacement Made a Difference?

PubMed

Culler, Steven D; Cohen, David J; Brown, Phillip P; Kugelmass, Aaron D; Reynolds, Matthew R; Ambrose, Karen; Schlosser, Michael L; Simon, April W; Katz, Marc R

2018-04-01

This study reports trends in volume and adverse events associated with isolated aortic valve procedures performed in Medicare beneficiaries between 2009 and 2015. This retrospective study used the annual fiscal year Medicare Provider Analysis and Review file to identify all Medicare beneficiaries undergoing an isolated aortic valve procedure. Outcome measures included three mortality rates and nine in-hospital adverse events. The final study population consisted of 233,660 hospitalizations. During the study period, Medicare beneficiaries undergoing an aortic valve procedure increased from 22,076 to 49,362, for an average annual growth rate of 14.45%. Transcatheter aortic valve replacement (TAVR) procedures per 100,000 Medicare beneficiaries grew from 10.7 in 2012 to 41.1 in 2015. Overall, in-hospital mortality rates, cumulative 30-day mortality rates, and 90-day postdischarge mortality rates declined annually during the study period. However, the 90-day mortality rate for TAVR was nearly double the rate for the tissue surgical aortic valve replacement group. Nearly 68% of Medicare beneficiaries experienced at least one in-hospital adverse event during their index hospitalization. Medicare beneficiaries undergoing TAVR had the lowest observed adverse events rates among the aortic valve procedures in 2015. The total number of Medicare beneficiaries undergoing isolated aortic valve procedures increased from 47.5 to 88.9 per 100,000 Medicare beneficiaries during the study period. Aortic valve procedures increased significantly during this study period primarily due to the increase in TAVR, with clinical outcomes improving as well. Although long-term outcomes of TAVR are still under investigation, these results are promising. Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Underutilization of high-intensity statin therapy after hospitalization for coronary heart disease.

PubMed

Rosenson, Robert S; Kent, Shia T; Brown, Todd M; Farkouh, Michael E; Levitan, Emily B; Yun, Huifeng; Sharma, Pradeep; Safford, Monika M; Kilgore, Meredith; Muntner, Paul; Bittner, Vera

2015-01-27

National guidelines recommend use of high-intensity statins after hospitalization for coronary heart disease (CHD) events. This study sought to estimate the proportion of Medicare beneficiaries filling prescriptions for high-intensity statins after hospital discharge for a CHD event and to analyze whether statin intensity before hospitalization is associated with statin intensity after discharge. We conducted a retrospective cohort study using a 5% random sample of Medicare beneficiaries between 65 and 74 years old. Beneficiaries were included in the analysis if they filled a statin prescription after a CHD event (myocardial infarction or coronary revascularization) in 2007, 2008, or 2009. High-intensity statins included atorvastatin 40 to 80 mg, rosuvastatin 20 to 40 mg, and simvastatin 80 mg. Among 8,762 Medicare beneficiaries filling a statin prescription after a CHD event, 27% of first post-discharge fills were for a high-intensity statin. The percent filling a high-intensity statin post-discharge was 23.1%, 9.4%, and 80.7%, for beneficiaries not taking statins pre-hospitalization, taking low/moderate-intensity statins, and taking high-intensity statins before their CHD event, respectively. Compared with beneficiaries not on statin therapy pre-hospitalization, multivariable adjusted risk ratios for filling a high-intensity statin were 4.01 (3.58-4.49) and 0.45 (0.40-0.52) for participants taking high-intensity and low/moderate-intensity statins before their CHD event, respectively. Only 11.5% of beneficiaries whose first post-discharge statin fill was for a low/moderate-intensity statin filled a high-intensity statin within 365 days of discharge. The majority of Medicare beneficiaries do not fill high-intensity statins after hospitalization for CHD. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

On fuzzy semantic similarity measure for DNA coding.

PubMed

Ahmad, Muneer; Jung, Low Tang; Bhuiyan, Md Al-Amin

2016-02-01

A coding measure scheme numerically translates the DNA sequence to a time domain signal for protein coding regions identification. A number of coding measure schemes based on numerology, geometry, fixed mapping, statistical characteristics and chemical attributes of nucleotides have been proposed in recent decades. Such coding measure schemes lack the biologically meaningful aspects of nucleotide data and hence do not significantly discriminate coding regions from non-coding regions. This paper presents a novel fuzzy semantic similarity measure (FSSM) coding scheme centering on FSSM codons׳ clustering and genetic code context of nucleotides. Certain natural characteristics of nucleotides i.e. appearance as a unique combination of triplets, preserving special structure and occurrence, and ability to own and share density distributions in codons have been exploited in FSSM. The nucleotides׳ fuzzy behaviors, semantic similarities and defuzzification based on the center of gravity of nucleotides revealed a strong correlation between nucleotides in codons. The proposed FSSM coding scheme attains a significant enhancement in coding regions identification i.e. 36-133% as compared to other existing coding measure schemes tested over more than 250 benchmarked and randomly taken DNA datasets of different organisms. Copyright © 2015 Elsevier Ltd. All rights reserved.

Roles of community helpers in using the Medicare Part D benefit

PubMed Central

Hensley, Melissa A.

2013-01-01

Objectives To examine the experiences of low-income Part D beneficiaries with mental illness and their use of community helpers to access prescription medicines. Methods Individual semi-structured interviews were conducted with 26 Medicare beneficiaries with mental illness in community settings. The transcripts were analyzed for content related to community help-seeking and attitudes toward family and professional helpers. Results Medicare Part D beneficiaries with mental illness used the assistance of community helpers extensively. Pharmacists, nurses, community mental health case managers, and family members assisted beneficiaries with understanding their benefit plans and interpreting paperwork from plans and government agencies. Community helpers also assisted with tasks related to medication adherence. Mental health consumers appreciated the help that they received from family members and professionals. Conclusion This group of Medicare beneficiaries would have experienced difficulty in using their benefits and obtaining their medication without considerable help from professionals and family members in the community. PMID:21317520

FASB Statement No. 136 clarifies transfers of assets.

PubMed

Luecke, R W; Meeting, D T

2000-03-01

FASB Statement of Financial Accounting Standards No. 136, Transfers of Assets to a Not-for-Profit Organization or Charitable Trust That Raises or Holds Contributions for Others, provides guidance and establishes accounting standards for the transfer of assets from donors to not-for-profit organizations that may then transfer those same assets to a beneficiary organization. Recipient organizations that accept financial assets from a donor and agree to use those assets on behalf of a specified unaffiliated beneficiary or transfer those assets, the return on investment of those assets, or both to that beneficiary must recognize the assets received from the donor and recognize the assets' fair value as a liability to the beneficiary. The statement describes circumstances in which a transfer of assets to a recipient organization is accounted for as an asset and corresponding liability of the recipient organization, and as an asset and donation revenue by the beneficiary organization because the transfer is irrevocable.

Medicare Part D Beneficiaries' Plan Switching Decisions and Information Processing.

PubMed

Han, Jayoung; Urmie, Julie

2017-03-01

Medicare Part D beneficiaries tend not to switch plans despite the government's efforts to engage beneficiaries in the plan switching process. Understanding current and alternative plan features is a necessary step to make informed plan switching decisions. This study explored beneficiaries' plan switching using a mixed-methods approach, with a focus on the concept of information processing. We found large variation in beneficiary comprehension of plan information among both switchers and nonswitchers. Knowledge about alternative plans was especially poor, with only about half of switchers and 2 in 10 nonswitchers being well informed about plans other than their current plan. We also found that helpers had a prominent role in plan decision making-nearly twice as many switchers as nonswitchers worked with helpers for their plan selection. Our study suggests that easier access to helpers as well as helpers' extensive involvement in the decision-making process promote informed plan switching decisions.

Computer-assisted bar-coding system significantly reduces clinical laboratory specimen identification errors in a pediatric oncology hospital.

PubMed

Hayden, Randall T; Patterson, Donna J; Jay, Dennis W; Cross, Carl; Dotson, Pamela; Possel, Robert E; Srivastava, Deo Kumar; Mirro, Joseph; Shenep, Jerry L

2008-02-01

To assess the ability of a bar code-based electronic positive patient and specimen identification (EPPID) system to reduce identification errors in a pediatric hospital's clinical laboratory. An EPPID system was implemented at a pediatric oncology hospital to reduce errors in patient and laboratory specimen identification. The EPPID system included bar-code identifiers and handheld personal digital assistants supporting real-time order verification. System efficacy was measured in 3 consecutive 12-month time frames, corresponding to periods before, during, and immediately after full EPPID implementation. A significant reduction in the median percentage of mislabeled specimens was observed in the 3-year study period. A decline from 0.03% to 0.005% (P < .001) was observed in the 12 months after full system implementation. On the basis of the pre-intervention detected error rate, it was estimated that EPPID prevented at least 62 mislabeling events during its first year of operation. EPPID decreased the rate of misidentification of clinical laboratory samples. The diminution of errors observed in this study provides support for the development of national guidelines for the use of bar coding for laboratory specimens, paralleling recent recommendations for medication administration.

Physician Reimbursement in Medicare Advantage Compared With Traditional Medicare and Commercial Health Insurance.

PubMed

Trish, Erin; Ginsburg, Paul; Gascue, Laura; Joyce, Geoffrey

2017-09-01

Nearly one-third of Medicare beneficiaries are enrolled in a Medicare Advantage (MA) plan, yet little is known about the prices that MA plans pay for physician services. Medicare Advantage insurers typically also sell commercial plans, and the extent to which MA physician reimbursement reflects traditional Medicare (TM) rates vs negotiated commercial prices is unclear. To compare prices paid for physician and other health care services in MA, traditional Medicare, and commercial plans. Retrospective analysis of claims data evaluating MA prices paid to physicians and for laboratory services and durable medical equipment between 2007 and 2012 in 348 US core-based statistical areas. The study population included all MA and commercial enrollees with a large national health insurer operating in both markets, as well as a 20% sample of TM beneficiaries. Enrollment in an MA plan. Mean reimbursement paid to physicians, laboratories, and durable medical equipment suppliers for MA and commercial enrollees relative to TM rates for 11 Healthcare Common Procedure Coding Systems (HCPCS) codes spanning 7 sites of care. The sample consisted of 144 million claims. Physician reimbursement in MA was more strongly tied to TM rates than commercial prices, although MA plans tended to pay physicians less than TM. For a mid-level office visit with an established patient (Current Procedural Terminology [CPT] code 99213), the mean MA price was 96.9% (95% CI, 96.7%-97.2%) of TM. Across the common physician services we evaluated, mean MA reimbursement ranged from 91.3% of TM for cataract removal in an ambulatory surgery center (CPT 66984; 95% CI, 90.7%-91.9%) to 102.3% of TM for complex evaluation and management of a patient in the emergency department (CPT 99285; 95% CI, 102.1%-102.6%). However, for laboratory services and durable medical equipment, where commercial prices are lower than TM rates, MA plans take advantage of these lower commercial prices, ranging from 67.4% for a walker (HCPCS code E0143; 95% CI, 66.3%-68.5%) to 75.8% for a complete blood cell count (CPT 85025; 95% CI, 75.0%-76.6%). Traditional Medicare's administratively set rates act as a strong anchor for physician reimbursement in the MA market, although MA plans succeed in negotiating lower prices for other health care services for which TM overpays. Reforms that transition the Medicare program toward some premium support models could substantially affect how physicians and other clinicians are paid.

Variation in Postsepsis Readmission Patterns: A Cohort Study of Veterans Affairs Beneficiaries.

PubMed

Prescott, Hallie C

2017-02-01

Rehospitalization is common after sepsis, but little is known about the variation in readmission patterns across patient groups and care locations. To examine the variation in postsepsis readmission rates and diagnoses by patient age, nursing facility use, admission year, and hospital among U.S. Veterans Affairs (VA) beneficiaries. Observational cohort study of VA beneficiaries who survived a sepsis hospitalization (2009-2011) at 114 VA hospitals, stratified by age (<65 vs. ≥65 yr), nursing home usage (none, chronic, or acute), year of admission (2009, 2010, 2011), and hospital. In the primary analysis, sepsis hospitalizations were identified using a previously validated method. Sensitivity analyses were performed using alternative definitions with explicit International Classification of Diseases, Ninth Revision, Clinical Modification, codes for sepsis, and separately for severe sepsis and septic shock. The primary outcomes were rate of 90-day all-cause hospital readmission after sepsis hospitalization and proportion of readmissions resulting from specific diagnoses, including the proportion of "potentially preventable" readmissions. Readmission diagnoses were similar from 2009 to 2011, with little variation in readmission rates across hospitals. The top six readmission diagnoses (heart failure, pneumonia, sepsis, urinary tract infection, acute renal failure, and chronic obstructive pulmonary disease) accounted for 30% of all readmissions. Although about one in five readmissions had a principal diagnosis for infection, 58% of all readmissions received early systemic antibiotics. Infection accounted for a greater proportion of readmissions among patients discharged to nursing facilities compared with patients discharged to home (25.0-27.1% vs. 16.8%) and among older vs. younger patients (22.2% vs. 15.8%). Potentially preventable readmissions accounted for a quarter of readmissions overall and were more common among older patients and patients discharged to nursing facilities. Hospital readmission rates after sepsis were similar by site and admission year. Heart failure, pneumonia, sepsis, and urinary tract infection were common readmission diagnoses across all patient groups. Readmission for infection and potentially preventable diagnoses were more common in older patients and patients discharged to nursing facilities.

Falling Down on the Job: Evaluation and Treatment of Fall Risk Among Older Adults With Upper Extremity Fragility Fractures.

PubMed

McDonough, Christine M; Colla, Carrie H; Carmichael, Donald; Tosteson, Anna N A; Tosteson, Tor D; Bell, John-Erik; Cantu, Robert V; Lurie, Jonathan D; Bynum, Julie P W

2017-03-01

Clinical practice guidelines recommend fall risk assessment and intervention for older adults who sustain a fall-related injury to prevent future injury and mobility decline. The aim of this study was to describe how often Medicare beneficiaries with upper extremity fracture receive evaluation and treatment for fall risk. Observational cohort. Participants were fee-for-service beneficiaries age 66 to 99 treated as outpatients for proximal humerus or distal radius/ulna ("wrist") fragility fractures. -Participants were studied using Carrier and Outpatient Hospital files. The proportion of patients evaluated or treated for fall risk up to 6 months after proximal humerus or wrist fracture from 2007-2009 was examined based on evaluation, treatment, and diagnosis codes. Time to evaluation and number of treatment sessions were calculated. Logistic regression was used to analyze patient characteristics that predicted receiving evaluation or treatment. Narrow (gait training) and broad (gait training or therapeutic exercise) definitions of service were used. There were 309,947 beneficiaries who sustained proximal humerus (32%) or wrist fracture (68%); 10.7% received evaluation or treatment for fall risk or gait issues (humerus: 14.2%; wrist: 9.0%). Using the broader definition, the percentage increased to 18.5% (humerus: 23.4%; wrist: 16.3%). Factors associated with higher likelihood of services after fracture were: evaluation or treatment for falls or gait prior to fracture, more comorbidities, prior nursing home stay, older age, humerus fracture (vs wrist), female sex, and white race. Claims analysis may underestimate physician and physical therapist fall assessments, but it is not likely to qualitatively change the results. A small proportion of older adults with upper extremity fracture received fall risk assessment and treatment. Providers and health systems must advance efforts to provide timely evidence-based management of fall risk in this population. © 2017 American Physical Therapy Association

Falling Down on the Job: Evaluation and Treatment of Fall Risk Among Older Adults With Upper Extremity Fragility Fractures

PubMed Central

Colla, Carrie H.; Carmichael, Donald; Tosteson, Anna N. A.; Tosteson, Tor D.; Bell, John-Erik; Cantu, Robert V.; Lurie, Jonathan D.; Bynum, Julie P. W.

2017-01-01

Abstract Background: Clinical practice guidelines recommend fall risk assessment and intervention for older adults who sustain a fall-related injury to prevent future injury and mobility decline. Objective: The aim of this study was to describe how often Medicare beneficiaries with upper extremity fracture receive evaluation and treatment for fall risk. Design: Observational cohort. Methods: Participants were fee-for-service beneficiaries age 66 to 99 treated as outpatients for proximal humerus or distal radius/ulna (“wrist”) fragility fractures. -Participants were studied using Carrier and Outpatient Hospital files. The proportion of patients evaluated or treated for fall risk up to 6 months after proximal humerus or wrist fracture from 2007–2009 was examined based on evaluation, treatment, and diagnosis codes. Time to evaluation and number of treatment sessions were calculated. Logistic regression was used to analyze patient characteristics that predicted receiving evaluation or treatment. Narrow (gait training) and broad (gait training or therapeutic exercise) definitions of service were used. Results: There were 309,947 beneficiaries who sustained proximal humerus (32%) or wrist fracture (68%); 10.7% received evaluation or treatment for fall risk or gait issues (humerus: 14.2%; wrist: 9.0%). Using the broader definition, the percentage increased to 18.5% (humerus: 23.4%; wrist: 16.3%). Factors associated with higher likelihood of services after fracture were: evaluation or treatment for falls or gait prior to fracture, more comorbidities, prior nursing home stay, older age, humerus fracture (vs wrist), female sex, and white race. Limitations: Claims analysis may underestimate physician and physical therapist fall assessments, but it is not likely to qualitatively change the results. Conclusions: A small proportion of older adults with upper extremity fracture received fall risk assessment and treatment. Providers and health systems must advance efforts to provide timely evidence-based management of fall risk in this population. PMID:28340130

75 FR 10414 - Researcher Identification Card

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-08

... capturing administrative information on the characteristics of our users. Other forms of identification are... use bar-codes on researcher identification cards in the Washington, DC, area. The plastic cards we... plastic researcher identification cards as part of their security systems, we issue a plastic card to...

26 CFR 1.652(a)-1 - Simple trusts; inclusion of amounts in income of beneficiaries.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 26 Internal Revenue 8 2012-04-01 2012-04-01 false Simple trusts; inclusion of amounts in income of beneficiaries. 1.652(a)-1 Section 1.652(a)-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE... Only § 1.652(a)-1 Simple trusts; inclusion of amounts in income of beneficiaries. Subject to the rules...

26 CFR 1.652(a)-1 - Simple trusts; inclusion of amounts in income of beneficiaries.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 26 Internal Revenue 8 2014-04-01 2014-04-01 false Simple trusts; inclusion of amounts in income of beneficiaries. 1.652(a)-1 Section 1.652(a)-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE... Only § 1.652(a)-1 Simple trusts; inclusion of amounts in income of beneficiaries. Subject to the rules...

26 CFR 1.652(a)-1 - Simple trusts; inclusion of amounts in income of beneficiaries.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 26 Internal Revenue 8 2013-04-01 2013-04-01 false Simple trusts; inclusion of amounts in income of beneficiaries. 1.652(a)-1 Section 1.652(a)-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE... Only § 1.652(a)-1 Simple trusts; inclusion of amounts in income of beneficiaries. Subject to the rules...

26 CFR 54.4980B-9 - Business reorganizations and employer withdrawals from multiemployer plans.

Code of Federal Regulations, 2012 CFR

2012-04-01

... employees) because they are M&A qualified beneficiaries with respect to the sale of C. Example 4. (i... available to these two M&A qualified beneficiaries. In addition, the one employee P does not hire as well as... available to these M&A qualified beneficiaries. Example 6. (i) Selling Group S provides group health plan...

26 CFR 54.4980B-9 - Business reorganizations and employer withdrawals from multiemployer plans.

Code of Federal Regulations, 2013 CFR

2013-04-01

... employees) because they are M&A qualified beneficiaries with respect to the sale of C. Example 4. (i... available to these two M&A qualified beneficiaries. In addition, the one employee P does not hire as well as... available to these M&A qualified beneficiaries. Example 6. (i) Selling Group S provides group health plan...

26 CFR 54.4980B-9 - Business reorganizations and employer withdrawals from multiemployer plans.

Code of Federal Regulations, 2014 CFR

2014-04-01

... employees) because they are M&A qualified beneficiaries with respect to the sale of C. Example 4. (i... available to these two M&A qualified beneficiaries. In addition, the one employee P does not hire as well as... available to these M&A qualified beneficiaries. Example 6. (i) Selling Group S provides group health plan...

26 CFR 54.4980B-9 - Business reorganizations and employer withdrawals from multiemployer plans.

Code of Federal Regulations, 2011 CFR

2011-04-01

... employees) because they are M&A qualified beneficiaries with respect to the sale of C. Example 4. (i... available to these two M&A qualified beneficiaries. In addition, the one employee P does not hire as well as... available to these M&A qualified beneficiaries. Example 6. (i) Selling Group S provides group health plan...

20 CFR 10.706 - How will a beneficiary know if OWCP or SOL has determined that action against a third party is...

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false How will a beneficiary know if OWCP or SOL... Third Party Liability § 10.706 How will a beneficiary know if OWCP or SOL has determined that action... is transferred to SOL, a second notification may be issued. ...

The State of Diabetes Care Provided to Medicare Beneficiaries Living in Rural America

ERIC Educational Resources Information Center

Weingarten, Joseph P.; Brittman, Susan; Hu, Wenrong; Przybyszewski, Chris; Hammond, Judith M.; FitzGerald, Dawn

2006-01-01

Context: Diabetes poses a growing health burden in the United States, but much of the research to date has been at the state and local level. Purpose: To present a national profile of diabetes care provided to Medicare beneficiaries living in urban, semirural, and rural communities. Methods: Medicare beneficiaries with diabetes aged 18-75 were…

26 CFR 1.652(a)-1 - Simple trusts; inclusion of amounts in income of beneficiaries.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 26 Internal Revenue 8 2011-04-01 2011-04-01 false Simple trusts; inclusion of amounts in income of beneficiaries. 1.652(a)-1 Section 1.652(a)-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE... Only § 1.652(a)-1 Simple trusts; inclusion of amounts in income of beneficiaries. Subject to the rules...

20 CFR 411.400 - Can an EN to which a beneficiary's ticket is assigned refer the beneficiary to a State VR agency...

Code of Federal Regulations, 2012 CFR

2012-04-01

...' Benefits SOCIAL SECURITY ADMINISTRATION THE TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM State Vocational Rehabilitation Agencies' Participation Referrals by Employment Networks to State Vr Agencies § 411.400 Can an EN... beneficiary to the State VR agency for services. Agreements Between Employment Networks and State VR Agencies ...

20 CFR 411.400 - Can an EN to which a beneficiary's ticket is assigned refer the beneficiary to a State VR agency...

Code of Federal Regulations, 2014 CFR

2014-04-01

...' Benefits SOCIAL SECURITY ADMINISTRATION THE TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM State Vocational Rehabilitation Agencies' Participation Referrals by Employment Networks to State Vr Agencies § 411.400 Can an EN... beneficiary to the State VR agency for services. Agreements Between Employment Networks and State VR Agencies ...

20 CFR 411.400 - Can an EN to which a beneficiary's ticket is assigned refer the beneficiary to a State VR agency...

Code of Federal Regulations, 2013 CFR

2013-04-01

...' Benefits SOCIAL SECURITY ADMINISTRATION THE TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM State Vocational Rehabilitation Agencies' Participation Referrals by Employment Networks to State Vr Agencies § 411.400 Can an EN... beneficiary to the State VR agency for services. Agreements Between Employment Networks and State VR Agencies ...

26 CFR 1.167(h)-1 - Life tenants and beneficiaries of trusts and estates.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 26 Internal Revenue 2 2010-04-01 2010-04-01 false Life tenants and beneficiaries of trusts and estates. 1.167(h)-1 Section 1.167(h)-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE... and Corporations § 1.167(h)-1 Life tenants and beneficiaries of trusts and estates. (a) Life tenants...

76 FR 59663 - Limitations of Duty- and Quota-Free Imports of Apparel Articles Assembled in Beneficiary Sub...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-27

... of Apparel Articles Assembled in Beneficiary Sub-Saharan African Countries From Regional and Third... Acceleration Act of 2004, Pub. L. 108-274; Division D, Title VI, section 6002 of the Tax Relief and Health Care... beneficiary sub-Saharan African countries. Section 112(b)(3) of TDA 2000 provides duty- and quota-free...

The Impact of Changing Financial Work Incentives on the Earnings of Social Security Disability Insurance (SSDI) Beneficiaries

ERIC Educational Resources Information Center

Weathers, Robert R., II; Hemmeter, Jeffrey

2011-01-01

SSDI beneficiaries lose their entire cash benefit if they perform work that is substantial gainful activity (SGA) after using Social Security work incentive programs. The complete loss of benefits might be a work disincentive for beneficiaries. We report results from a pilot project that replaces the complete loss of benefits with a gradual…

Obesity utilization and health-related quality of life in Medicare enrollees.

PubMed

Malinoff, Rochelle L; Elliott, Marc N; Giordano, Laura A; Grace, Susan C; Burroughs, James N

2013-01-01

The obese, with disproportionate chronic disease incidence, consume a large share of health care resources and drive up per capita Medicare spending. This study examined the prevalence of obesity and its association with health status, health-related quality of life (HRQOL), function, and outpatient utilization among Medicare Advantage seniors. Results indicate that obese beneficiaries, much more than overweight beneficiaries, have poorer health, functions, and HRQOL than normal weight beneficiaries and have substantially higher outpatient utilization. While weight loss is beneficial to both the overweight and obese, the markedly worse health status and high utilization of obese beneficiaries may merit particular attention.

The effect of consumer incentives on Medicaid beneficiaries' compliance with well-child visit guidelines.

PubMed

Nyman, John A; Abraham, Jean M; Riley, William

2013-01-01

The Affordable Care Act of 2010 recommends that consumer incentives be employed to increase the use of preventive care by Medicaid beneficiaries, but few evaluative studies exist. This study evaluates a Target gift card incentive employed by a Minnesota health plan serving Medicaid beneficiaries over the period 2002-2003. Lacking a contemporaneous control group, the proximity between the child's residence and the nearest Target store was used as the intervention variable. Using alternative specifications for the intervention variable, results of the difference-in-differences equations suggest that the incentive program significantly increased the likelihood that a Medicaid beneficiary would have a well-child visit.

Out-of-pocket health spending by poor and near-poor elderly Medicare beneficiaries.

PubMed

Gross, D J; Alecxih, L; Gibson, M J; Corea, J; Caplan, C; Brangan, N

1999-04-01

To estimate out-of-pocket health care spending by lower-income Medicare beneficiaries, and to examine spending variations between those who receive Medicaid assistance and those who do not receive such aid. DATA SOURCES AND COLLECTION: 1993 Medicare Current Beneficiary Survey (MCBS) Cost and Use files, supplemented with data from the Bureau of the Census (Current Population Survey); the Congressional Budget Office; the Health Care Financing Administration, Office of the Actuary (National Health Accounts); and the Social Security Administration. We analyzed out-of-pocket spending through a Medicare Benefits Simulation model, which projects out-of-pocket health care spending from the 1993 MCBS to 1997. Out-of-pocket health care spending is defined to include Medicare deductibles and coinsurance; premiums for private insurance, Medicare Part B, and Medicare HMOs; payments for non-covered goods and services; and balance billing by physicians. It excludes the costs of home care and nursing facility services, as well as indirect tax payments toward health care financing. Almost 60 percent of beneficiaries with incomes below the poverty level did not receive Medicaid assistance in 1997. We estimate that these beneficiaries spent, on average, about half their income out-of-pocket for health care, whether they were enrolled in a Medicare HMO or in the traditional fee-for-service program. The 75 percent of beneficiaries with incomes between 100 and 125 percent of the poverty level who were not enrolled in Medicaid spent an estimated 30 percent of their income out-of-pocket on health care if they were in the traditional program and about 23 percent of their income if they were enrolled in a Medicare HMO. Average out-of-pocket spending among fee-for-service beneficiaries varied depending on whether beneficiaries had Medigap policies, employer-provided supplemental insurance, or no supplemental coverage. Those without supplemental coverage spent more on health care goods and services, but spent less than the other groups on prescription drugs and dental care-services not covered by Medicare. While Medicaid provides substantial protection for some lower-income Medicare beneficiaries, out-of-pocket health care spending continues to be a substantial burden for most of this population. Medicare reform discussions that focus on shifting more costs to beneficiaries should take into account the dramatic costs of health care already faced by this vulnerable population.

Codes for the identification of aquifer names and geologic units in the United States and the Caribbean outlying areas

USGS Publications Warehouse

,

1988-01-01

This standard provides codes to be used for the identification of aquifer names and geologic units in the United States, the Caribbean and other outlying areas. Outlying areas include Puerto Rico, the Virgin Islands, American Samoa, the Midway Islands, Trust Territories of the Pacific Islands, and miscellaneous Pacific Islands. Each code identifies an aquifer or rock-stratigraphic unit and its age designation. The codes provide a standardized base for use by organizations in the storage, retrieval, and exchange of ground-water data; the indexing and inventory of ground-water data and information; the cataloging of ground-water data acquisition activities; and a variety of other applications.

Codes for the identification of aquifer names and geologic units in the United States and the Caribbean outlying areas

USGS Publications Warehouse

,

1985-01-01

This standard provides codes to be used for the identification of aquifer names and geologic units in the United States, the Caribbean and other outlying areas. Outlying areas include Puerto Rico, the Virgin Islands, American Samoa, the Midway Islands, Trust Territories of the Pacific Islands, and miscellaneous Pacific Islands. Each code identifies an aquifer or rock-stratigraphic unit and its age designation. The codes provide a standardized base for use by organizations in the storage, retrieval, and exchange of ground-water data; the indexing and inventory of ground-water data and information; the cataloging of ground-water data acquisition activities; and a variety of other applications.

Effective Identification of Similar Patients Through Sequential Matching over ICD Code Embedding.

PubMed

Nguyen, Dang; Luo, Wei; Venkatesh, Svetha; Phung, Dinh

2018-04-11

Evidence-based medicine often involves the identification of patients with similar conditions, which are often captured in ICD (International Classification of Diseases (World Health Organization 2013)) code sequences. With no satisfying prior solutions for matching ICD-10 code sequences, this paper presents a method which effectively captures the clinical similarity among routine patients who have multiple comorbidities and complex care needs. Our method leverages the recent progress in representation learning of individual ICD-10 codes, and it explicitly uses the sequential order of codes for matching. Empirical evaluation on a state-wide cancer data collection shows that our proposed method achieves significantly higher matching performance compared with state-of-the-art methods ignoring the sequential order. Our method better identifies similar patients in a number of clinical outcomes including readmission and mortality outlook. Although this paper focuses on ICD-10 diagnosis code sequences, our method can be adapted to work with other codified sequence data.

48 CFR 304.7001 - Numbering acquisitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... contracting office identification codes currently in use is contained in the DCIS Users' Manual, available at... than one code may apply in a specific situation, or for additional codes, refer to the DCIS Users' Manual or consult with the cognizant DCIS coordinator/focal point for guidance on which code governs...

Do Experiences with Medicare Managed Care Vary According to the Proportion of Same-Race/Ethnicity/Language Individuals Enrolled in One's Contract?

PubMed Central

Price, Rebecca Anhang; Haviland, Amelia M; Hambarsoomian, Katrin; Dembosky, Jacob W; Gaillot, Sarah; Weech-Maldonado, Robert; Williams, Malcolm V; Elliott, Marc N

2015-01-01

Objective To examine whether care experiences and immunization for racial/ethnic/language minority Medicare beneficiaries vary with the proportion of same-group beneficiaries in Medicare Advantage (MA) contracts. Data Sources/Study Setting Exactly 492,495 Medicare beneficiaries responding to the 2008–2009 MA Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey. Data Collection/Extraction Methods Mixed-effect regression models predicted eight CAHPS patient experience measures from self-reported race/ethnicity/language preference at individual and contract levels, beneficiary-level case-mix adjustors, along with contract and geographic random effects. Principal Findings As a contract's proportion of a given minority group increased, overall and non-Hispanic, white patient experiences were poorer on average; for the minority group in question, however, high-minority plans may score as well as low-minority plans. Spanish-preferring Hispanic beneficiaries also experience smaller disparities relative to non-Hispanic whites in plans with higher Spanish-preferring proportions. Conclusions The tendency for high-minority contracts to provide less positive patient experiences for others in the contract, but similar or even more positive patient experiences for concentrated minority group beneficiaries, may reflect cultural competency, particularly language services, that partially or fully counterbalance the poorer overall quality of these contracts. For some beneficiaries, experiences may be just as positive in some high-minority plans with low overall scores as in plans with higher overall scores. PMID:25752334

How Medicare Could Provide Dental, Vision, and Hearing Care for Beneficiaries.

PubMed

Willink, Amber; Shoen, Cathy; Davis, Karen

2018-01-01

The Medicare program specifically excludes coverage of dental, vision, and hearing services. As a result, many beneficiaries do not receive necessary care. Those that do are subject to high out-of-pocket costs. Examine gaps in access to dental, vision, and hearing services for Medicare beneficiaries and design a voluntary dental, vision, and hearing benefit plan with cost estimates. Uses the Medicare Current Beneficiary Survey, Cost and Use File, 2012, with population and costs projected to 2016 values. Among Medicare beneficiaries, 75 percent of people who needed a hearing aid did not have one; 70 percent of people who had trouble eating because of their teeth did not go to the dentist in the past year; and 43 percent of people who had trouble seeing did not have an eye exam in the past year. Lack of access was particularly acute for poor beneficiaries. Because few people have supplemental insurance covering these additional services, among people who received care, three-fourths of their costs of dental and hearing services and 60 percent of their costs of vision services were paid out of pocket. We propose a basic benefit package for dental, vision, and hearing services offered as a premium-financed voluntary insurance option under Medicare. Assuming the benefit package could be offered for $25 per month, we estimate the total coverage costs would be $1.924 billion per year, paid for by premiums. Subsidies to reach low-income beneficiaries would follow the same design as the Part D subsidy.

Method and apparatus for data decoding and processing

DOEpatents

Hunter, Timothy M.; Levy, Arthur J.

1992-01-01

A system and technique is disclosed for automatically controlling the decoding and digitizaiton of an analog tape. The system includes the use of a tape data format which includes a plurality of digital codes recorded on the analog tape in a predetermined proximity to a period of recorded analog data. The codes associated with each period of analog data include digital identification codes prior to the analog data, a start of data code coincident with the analog data recording, and an end of data code subsequent to the associated period of recorded analog data. The formatted tape is decoded in a processing and digitization system which includes an analog tape player coupled to a digitizer to transmit analog information from the recorded tape over at least one channel to the digitizer. At the same time, the tape player is coupled to a decoder and interface system which detects and decodes the digital codes on the tape corresponding to each period of recorded analog data and controls tape movement and digitizer initiation in response to preprogramed modes. A host computer is also coupled to the decoder and interface system and the digitizer and programmed to initiate specific modes of data decoding through the decoder and interface system including the automatic compilation and storage of digital identification information and digitized data for the period of recorded analog data corresponding to the digital identification data, compilation and storage of selected digitized data representing periods of recorded analog data, and compilation of digital identification information related to each of the periods of recorded analog data.

Trends in surgical treatment of Chiari malformation Type I in the United States.

PubMed

Wilkinson, D Andrew; Johnson, Kyle; Garton, Hugh J L; Muraszko, Karin M; Maher, Cormac O

2017-02-01

OBJECTIVE The goal of this analysis was to define temporal and geographic trends in the surgical treatment of Chiari malformation Type I (CM-I) in a large, privately insured health care network. METHODS The authors examined de-identified insurance claims data from a large, privately insured health care network of over 58 million beneficiaries throughout the United States for the period between 2001 and 2014 for all patients undergoing surgical treatment of CM-I. Using a combination of International Classification of Diseases (ICD) diagnosis codes and Current Procedural Terminology (CPT) codes, the authors identified CM-I and associated diagnoses and procedures over a 14-year period, highlighting temporal and geographic trends in the performance of CM-I decompression (CMD) surgery as well as commonly associated procedures. RESULTS There were 2434 surgical procedures performed for CMD among the beneficiaries during the 14-year interval; 34% were performed in patients younger than 20 years of age. The rate of CMD increased 51% from the first half to the second half of the study period among younger patients (p < 0.001) and increased 28% among adult patients between 20 and 65 years of age (p < 0.001). A large sex difference was noted among adult patients; 78% of adult patients undergoing CMD were female compared with only 53% of the children. Pediatric patients undergoing CMD were more likely to be white with a higher household net worth. Regional variability was identified among rates of CMD as well. The average annual rate of surgery ranged from 0.8 surgeries per 100,000 insured person-years in the Pacific census division to 2.0 surgeries per 100,000 insured person-years in the East South Central census division. CONCLUSIONS Analysis of a large nationwide health care network showed recently increasing rates of CMD in children and adults over the past 14 years.

Provably secure identity-based identification and signature schemes from code assumptions

PubMed Central

Zhao, Yiming

2017-01-01

Code-based cryptography is one of few alternatives supposed to be secure in a post-quantum world. Meanwhile, identity-based identification and signature (IBI/IBS) schemes are two of the most fundamental cryptographic primitives, so several code-based IBI/IBS schemes have been proposed. However, with increasingly profound researches on coding theory, the security reduction and efficiency of such schemes have been invalidated and challenged. In this paper, we construct provably secure IBI/IBS schemes from code assumptions against impersonation under active and concurrent attacks through a provably secure code-based signature technique proposed by Preetha, Vasant and Rangan (PVR signature), and a security enhancement Or-proof technique. We also present the parallel-PVR technique to decrease parameter values while maintaining the standard security level. Compared to other code-based IBI/IBS schemes, our schemes achieve not only preferable public parameter size, private key size, communication cost and signature length due to better parameter choices, but also provably secure. PMID:28809940

Provably secure identity-based identification and signature schemes from code assumptions.

PubMed

Song, Bo; Zhao, Yiming

2017-01-01

Code-based cryptography is one of few alternatives supposed to be secure in a post-quantum world. Meanwhile, identity-based identification and signature (IBI/IBS) schemes are two of the most fundamental cryptographic primitives, so several code-based IBI/IBS schemes have been proposed. However, with increasingly profound researches on coding theory, the security reduction and efficiency of such schemes have been invalidated and challenged. In this paper, we construct provably secure IBI/IBS schemes from code assumptions against impersonation under active and concurrent attacks through a provably secure code-based signature technique proposed by Preetha, Vasant and Rangan (PVR signature), and a security enhancement Or-proof technique. We also present the parallel-PVR technique to decrease parameter values while maintaining the standard security level. Compared to other code-based IBI/IBS schemes, our schemes achieve not only preferable public parameter size, private key size, communication cost and signature length due to better parameter choices, but also provably secure.

Refining the accuracy of validated target identification through coding variant fine-mapping in type 2 diabetes.

PubMed

Mahajan, Anubha; Wessel, Jennifer; Willems, Sara M; Zhao, Wei; Robertson, Neil R; Chu, Audrey Y; Gan, Wei; Kitajima, Hidetoshi; Taliun, Daniel; Rayner, N William; Guo, Xiuqing; Lu, Yingchang; Li, Man; Jensen, Richard A; Hu, Yao; Huo, Shaofeng; Lohman, Kurt K; Zhang, Weihua; Cook, James P; Prins, Bram Peter; Flannick, Jason; Grarup, Niels; Trubetskoy, Vassily Vladimirovich; Kravic, Jasmina; Kim, Young Jin; Rybin, Denis V; Yaghootkar, Hanieh; Müller-Nurasyid, Martina; Meidtner, Karina; Li-Gao, Ruifang; Varga, Tibor V; Marten, Jonathan; Li, Jin; Smith, Albert Vernon; An, Ping; Ligthart, Symen; Gustafsson, Stefan; Malerba, Giovanni; Demirkan, Ayse; Tajes, Juan Fernandez; Steinthorsdottir, Valgerdur; Wuttke, Matthias; Lecoeur, Cécile; Preuss, Michael; Bielak, Lawrence F; Graff, Marielisa; Highland, Heather M; Justice, Anne E; Liu, Dajiang J; Marouli, Eirini; Peloso, Gina Marie; Warren, Helen R; Afaq, Saima; Afzal, Shoaib; Ahlqvist, Emma; Almgren, Peter; Amin, Najaf; Bang, Lia B; Bertoni, Alain G; Bombieri, Cristina; Bork-Jensen, Jette; Brandslund, Ivan; Brody, Jennifer A; Burtt, Noël P; Canouil, Mickaël; Chen, Yii-Der Ida; Cho, Yoon Shin; Christensen, Cramer; Eastwood, Sophie V; Eckardt, Kai-Uwe; Fischer, Krista; Gambaro, Giovanni; Giedraitis, Vilmantas; Grove, Megan L; de Haan, Hugoline G; Hackinger, Sophie; Hai, Yang; Han, Sohee; Tybjærg-Hansen, Anne; Hivert, Marie-France; Isomaa, Bo; Jäger, Susanne; Jørgensen, Marit E; Jørgensen, Torben; Käräjämäki, Annemari; Kim, Bong-Jo; Kim, Sung Soo; Koistinen, Heikki A; Kovacs, Peter; Kriebel, Jennifer; Kronenberg, Florian; Läll, Kristi; Lange, Leslie A; Lee, Jung-Jin; Lehne, Benjamin; Li, Huaixing; Lin, Keng-Hung; Linneberg, Allan; Liu, Ching-Ti; Liu, Jun; Loh, Marie; Mägi, Reedik; Mamakou, Vasiliki; McKean-Cowdin, Roberta; Nadkarni, Girish; Neville, Matt; Nielsen, Sune F; Ntalla, Ioanna; Peyser, Patricia A; Rathmann, Wolfgang; Rice, Kenneth; Rich, Stephen S; Rode, Line; Rolandsson, Olov; Schönherr, Sebastian; Selvin, Elizabeth; Small, Kerrin S; Stančáková, Alena; Surendran, Praveen; Taylor, Kent D; Teslovich, Tanya M; Thorand, Barbara; Thorleifsson, Gudmar; Tin, Adrienne; Tönjes, Anke; Varbo, Anette; Witte, Daniel R; Wood, Andrew R; Yajnik, Pranav; Yao, Jie; Yengo, Loïc; Young, Robin; Amouyel, Philippe; Boeing, Heiner; Boerwinkle, Eric; Bottinger, Erwin P; Chowdhury, Rajiv; Collins, Francis S; Dedoussis, George; Dehghan, Abbas; Deloukas, Panos; Ferrario, Marco M; Ferrières, Jean; Florez, Jose C; Frossard, Philippe; Gudnason, Vilmundur; Harris, Tamara B; Heckbert, Susan R; Howson, Joanna M M; Ingelsson, Martin; Kathiresan, Sekar; Kee, Frank; Kuusisto, Johanna; Langenberg, Claudia; Launer, Lenore J; Lindgren, Cecilia M; Männistö, Satu; Meitinger, Thomas; Melander, Olle; Mohlke, Karen L; Moitry, Marie; Morris, Andrew D; Murray, Alison D; de Mutsert, Renée; Orho-Melander, Marju; Owen, Katharine R; Perola, Markus; Peters, Annette; Province, Michael A; Rasheed, Asif; Ridker, Paul M; Rivadineira, Fernando; Rosendaal, Frits R; Rosengren, Anders H; Salomaa, Veikko; Sheu, Wayne H-H; Sladek, Rob; Smith, Blair H; Strauch, Konstantin; Uitterlinden, André G; Varma, Rohit; Willer, Cristen J; Blüher, Matthias; Butterworth, Adam S; Chambers, John Campbell; Chasman, Daniel I; Danesh, John; van Duijn, Cornelia; Dupuis, Josée; Franco, Oscar H; Franks, Paul W; Froguel, Philippe; Grallert, Harald; Groop, Leif; Han, Bok-Ghee; Hansen, Torben; Hattersley, Andrew T; Hayward, Caroline; Ingelsson, Erik; Kardia, Sharon L R; Karpe, Fredrik; Kooner, Jaspal Singh; Köttgen, Anna; Kuulasmaa, Kari; Laakso, Markku; Lin, Xu; Lind, Lars; Liu, Yongmei; Loos, Ruth J F; Marchini, Jonathan; Metspalu, Andres; Mook-Kanamori, Dennis; Nordestgaard, Børge G; Palmer, Colin N A; Pankow, James S; Pedersen, Oluf; Psaty, Bruce M; Rauramaa, Rainer; Sattar, Naveed; Schulze, Matthias B; Soranzo, Nicole; Spector, Timothy D; Stefansson, Kari; Stumvoll, Michael; Thorsteinsdottir, Unnur; Tuomi, Tiinamaija; Tuomilehto, Jaakko; Wareham, Nicholas J; Wilson, James G; Zeggini, Eleftheria; Scott, Robert A; Barroso, Inês; Frayling, Timothy M; Goodarzi, Mark O; Meigs, James B; Boehnke, Michael; Saleheen, Danish; Morris, Andrew P; Rotter, Jerome I; McCarthy, Mark I

2018-04-01

We aggregated coding variant data for 81,412 type 2 diabetes cases and 370,832 controls of diverse ancestry, identifying 40 coding variant association signals (P < 2.2 × 10 -7 ); of these, 16 map outside known risk-associated loci. We make two important observations. First, only five of these signals are driven by low-frequency variants: even for these, effect sizes are modest (odds ratio ≤1.29). Second, when we used large-scale genome-wide association data to fine-map the associated variants in their regional context, accounting for the global enrichment of complex trait associations in coding sequence, compelling evidence for coding variant causality was obtained for only 16 signals. At 13 others, the associated coding variants clearly represent 'false leads' with potential to generate erroneous mechanistic inference. Coding variant associations offer a direct route to biological insight for complex diseases and identification of validated therapeutic targets; however, appropriate mechanistic inference requires careful specification of their causal contribution to disease predisposition.

Computerized Dental Comparison: A Critical Review of Dental Coding and Ranking Algorithms Used in Victim Identification.

PubMed

Adams, Bradley J; Aschheim, Kenneth W

2016-01-01

Comparison of antemortem and postmortem dental records is a leading method of victim identification, especially for incidents involving a large number of decedents. This process may be expedited with computer software that provides a ranked list of best possible matches. This study provides a comparison of the most commonly used conventional coding and sorting algorithms used in the United States (WinID3) with a simplified coding format that utilizes an optimized sorting algorithm. The simplified system consists of seven basic codes and utilizes an optimized algorithm based largely on the percentage of matches. To perform this research, a large reference database of approximately 50,000 antemortem and postmortem records was created. For most disaster scenarios, the proposed simplified codes, paired with the optimized algorithm, performed better than WinID3 which uses more complex codes. The detailed coding system does show better performance with extremely large numbers of records and/or significant body fragmentation. © 2015 American Academy of Forensic Sciences.

Plant identification credibility in ethnobotany: a closer look at Polish ethnographic studies

PubMed Central

2010-01-01

Background This paper is an attempt to estimate the percentage of erroneously identified taxa in ethnographic studies concerning the use of plants and to propose a code for recording credibility of identification in historical ethnobotany publications. Methods A sample of Polish-language ethnobotanical literature (45 published sources from 1874-2005) and four collections of voucher specimens (from 1894-1975) were analyzed. Errors were detected in the publications by comparing the data with existing knowledge on the distribution of plant names and species ranges. The voucher specimens were re-examined. A one-letter code was invented for quick identification of the credibility of data published in lists of species compiled from historical or ethnographic sources, according to the source of identification: voucher specimen, Latin binominal, botanical expert, obvious widespread name, folk name, mode of use, range, physical description or photograph. To test the use of the code an up-to-date list of wild food plants used in Poland was made. Results A significant difference between the ratio of mistakes in the voucher specimen collections and the ratio of detectable mistakes in the studies without herbarium documentation was found. At least 2.3% of taxa in the publications were identified erroneously (mean rate was 6.2% per publication), and in half of these mistakes even the genus was not correct. As many as 10.0% of voucher specimens (on average 9.2% per collection) were originally erroneously identified, but three quarters of the identification mistakes remained within-genus. The species of the genera Thymus, Rumex and Rubus were most often confused within the genus. Not all of the invented credibility codes were used in the list of wild food plants, but they may be useful for other researchers. The most often used codes were the ones signifying identification by: voucher specimen, botanical expert and by a common name used throughout the country. Conclusions The results of this study support the rigorous use of voucher specimens in ethnobotany, although they also reveal a relatively high percentage of misidentified taxa in the specimens studied. The invented credibility coding system may become a useful tool for communication between historical ethnobotanists, particularly in creating larger databases. PMID:21167056

20 CFR 411.600 - Is there a process for resolving disputes between beneficiaries and ENs that are not State VR...

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Is there a process for resolving disputes between beneficiaries and ENs that are not State VR agencies? 411.600 Section 411.600 Employees' Benefits... resolving disputes between beneficiaries and ENs that are not State VR agencies? Yes. After an IWP is signed...

20 CFR 411.600 - Is there a process for resolving disputes between beneficiaries and ENs that are not State VR...

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false Is there a process for resolving disputes between beneficiaries and ENs that are not State VR agencies? 411.600 Section 411.600 Employees' Benefits... resolving disputes between beneficiaries and ENs that are not State VR agencies? Yes. After an IWP is signed...

19 CFR 10.26 - Articles assembled or processed in a beneficiary country in whole of U.S. components or...

Code of Federal Regulations, 2010 CFR

2010-04-01

... textile components cut to shape in the United States. 10.26 Section 10.26 Customs Duties U.S. CUSTOMS AND... ingredients; articles assembled in a beneficiary country from textile components cut to shape in the United... assembled in a beneficiary country in whole of textile components cut to shape (but not to length, width, or...

26 CFR 1.652(a)-1 - Simple trusts; inclusion of amounts in income of beneficiaries.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 26 Internal Revenue 8 2010-04-01 2010-04-01 false Simple trusts; inclusion of amounts in income of beneficiaries. 1.652(a)-1 Section 1.652(a)-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE....652(a)-1 Simple trusts; inclusion of amounts in income of beneficiaries. Subject to the rules in §§ 1...

The Roles of Cost and Quality Information in Medicare Advantage Plan Enrollment Decisions: an Observational Study.

PubMed

Reid, Rachel O; Deb, Partha; Howell, Benjamin L; Conway, Patrick H; Shrank, William H

2016-02-01

To facilitate informed decision-making in the Medicare Advantage marketplace, the Centers for Medicare & Medicaid Services publishes plan information on the Medicare Plan Finder website, including costs, benefits, and star ratings reflecting quality. Little is known about how beneficiaries weigh costs versus quality in enrollment decisions. We aimed to assess associations between publicly reported Medicare Advantage plan attributes (i.e., costs, quality, and benefits) and brand market share and beneficiaries' enrollment decisions. We performed a nationwide, beneficiary-level cross-sectional analysis of 847,069 beneficiaries enrolling in Medicare Advantage for the first time in 2011. Matching beneficiaries with their plan choice sets, we used conditional logistic regression to estimate associations between plan attributes and enrollment to assess the proportion of enrollment variation explained by plan attributes and willingness to pay for quality. Relative to the total variation explained by the model, the variation in plan choice explained by premiums (25.7 %) and out-of-pocket costs (11.6 %) together explained nearly three times as much as quality ratings (13.6 %), but brand market share explained the most variation (35.3 %). Further, while beneficiaries were willing to pay more in total annual combined premiums and out-of-pocket costs for higher-rated plans (from $4,154.93 for 2.5-star plans to $5,698.66 for 5-star plans), increases in willingness to pay diminished at higher ratings, from $549.27 (95 %CI: $541.10, $557.44) for a rating increase from 2.5 to 3 stars to $68.22 (95 %CI: $61.44, $75.01) for an increase from 4.5 to 5 stars. Willingness to pay varied among subgroups: beneficiaries aged 64-65 years were more willing to pay for higher-rated plans, while black and rural beneficiaries were less willing to pay for higher-rated plans. While beneficiaries prefer higher-quality and lower-cost Medicare Advantage plans, marginal utility for quality diminishes at higher star ratings, and their decisions are strongly associated with plans' brand market share.

Reduction in specimen labeling errors after implementation of a positive patient identification system in phlebotomy.

PubMed

Morrison, Aileen P; Tanasijevic, Milenko J; Goonan, Ellen M; Lobo, Margaret M; Bates, Michael M; Lipsitz, Stuart R; Bates, David W; Melanson, Stacy E F

2010-06-01

Ensuring accurate patient identification is central to preventing medical errors, but it can be challenging. We implemented a bar code-based positive patient identification system for use in inpatient phlebotomy. A before-after design was used to evaluate the impact of the identification system on the frequency of mislabeled and unlabeled samples reported in our laboratory. Labeling errors fell from 5.45 in 10,000 before implementation to 3.2 in 10,000 afterward (P = .0013). An estimated 108 mislabeling events were prevented by the identification system in 1 year. Furthermore, a workflow step requiring manual preprinting of labels, which was accompanied by potential labeling errors in about one quarter of blood "draws," was removed as a result of the new system. After implementation, a higher percentage of patients reported having their wristband checked before phlebotomy. Bar code technology significantly reduced the rate of specimen identification errors.

A new method for species identification via protein-coding and non-coding DNA barcodes by combining machine learning with bioinformatic methods.

PubMed

Zhang, Ai-bing; Feng, Jie; Ward, Robert D; Wan, Ping; Gao, Qiang; Wu, Jun; Zhao, Wei-zhong

2012-01-01

Species identification via DNA barcodes is contributing greatly to current bioinventory efforts. The initial, and widely accepted, proposal was to use the protein-coding cytochrome c oxidase subunit I (COI) region as the standard barcode for animals, but recently non-coding internal transcribed spacer (ITS) genes have been proposed as candidate barcodes for both animals and plants. However, achieving a robust alignment for non-coding regions can be problematic. Here we propose two new methods (DV-RBF and FJ-RBF) to address this issue for species assignment by both coding and non-coding sequences that take advantage of the power of machine learning and bioinformatics. We demonstrate the value of the new methods with four empirical datasets, two representing typical protein-coding COI barcode datasets (neotropical bats and marine fish) and two representing non-coding ITS barcodes (rust fungi and brown algae). Using two random sub-sampling approaches, we demonstrate that the new methods significantly outperformed existing Neighbor-joining (NJ) and Maximum likelihood (ML) methods for both coding and non-coding barcodes when there was complete species coverage in the reference dataset. The new methods also out-performed NJ and ML methods for non-coding sequences in circumstances of potentially incomplete species coverage, although then the NJ and ML methods performed slightly better than the new methods for protein-coding barcodes. A 100% success rate of species identification was achieved with the two new methods for 4,122 bat queries and 5,134 fish queries using COI barcodes, with 95% confidence intervals (CI) of 99.75-100%. The new methods also obtained a 96.29% success rate (95%CI: 91.62-98.40%) for 484 rust fungi queries and a 98.50% success rate (95%CI: 96.60-99.37%) for 1094 brown algae queries, both using ITS barcodes.

Potential Adult Medicaid Beneficiaries Under the Patient Protection and Affordable Care Act Compared With Current Adult Medicaid Beneficiaries

PubMed Central

Chang, Tammy; Davis, Matthew

2013-01-01

PURPOSE Under health care reform, states will have the opportunity to expand Medicaid to millions of uninsured US adults. Information regarding this population is vital to physicians as they prepare for more patients with coverage. Our objective was to describe demographic and health characteristics of potentially eligible Medicaid beneficiaries. METHODS We performed a cross-sectional study using data from the National Health and Nutrition Examination Survey (2007–2010) to identify and compare adult US citizens potentially eligible for Medicaid under provisions of the Patient Protection and Affordable Care Act (ACA) with current adult Medicaid beneficiaries. We compared demographic characteristics (age, sex, race/ethnicity, education) and health measures (self-reported health status; measured body mass index, hemoglobin A1c level, systolic and diastolic blood pressure, depression screen [9-item Patient Health Questionnaire], tobacco smoking, and alcohol use). RESULTS Analyses were based on an estimated 13.8 million current adult non-elderly Medicaid beneficiaries and 13.6 million nonelderly adults potentially eligible for Medicaid. Potentially eligible individuals are expected to be more likely male (49.2% potentially eligible vs 33.3% current beneficiaries; P <.001), to be more likely white and less likely black (58.8% white, 20.0% black vs 49.9% white, 25.2% black; P = .02), and to be statistically indistinguishable in terms of educational attainment. Overall, potentially eligible adults are expected to have better health status (34.8% “excellent” or “very good,” 40.4% “good”) than current beneficiaries (33.5% “excellent” or “very good,” 31.6% “good”; P <.001). The proportions obese (34.5% vs 42.9%; P = .008) and with depression (15.5% vs 22.3%; P = .003) among potentially eligible individuals are significantly lower than those for current beneficiaries, while there are no significant differences in the expected prevalence of diabetes or hypertension. Current tobacco smoking (49.2% vs 38.0%; P = .002), and moderate and heavier alcohol use (21.6% vs 16.0% and 16.5% vs 9.8%; P <.001, respectively) are more common among the potentially eligible population than among current beneficiaries. CONCLUSIONS Under the ACA, physicians can anticipate a potentially eligible Medicaid population with equal if not better current health status and lower prevalence of obesity and depression than current Medicaid beneficiaries. Federal Medicaid expenditures for newly covered beneficiaries therefore may not be as high as anticipated in the short term. Given the higher prevalence of tobacco smoking and alcohol use, however, broad enrollment and engagement of this potentially eligible population is needed to address their higher prevalence of modifiable risk factors for future chronic disease. PMID:24019271

26 CFR 31.6011(b)-1 - Employers' identification numbers.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 26 Internal Revenue 15 2013-04-01 2013-04-01 false Employers' identification numbers. 31.6011(b)-1... Subtitle F, Internal Revenue Code of 1954) § 31.6011(b)-1 Employers' identification numbers. (a... Insurance Contributions Act, but who prior to such day neither has been assigned an identification number...

26 CFR 31.6011(b)-1 - Employers' identification numbers.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 26 Internal Revenue 15 2014-04-01 2014-04-01 false Employers' identification numbers. 31.6011(b)-1... Subtitle F, Internal Revenue Code of 1954) § 31.6011(b)-1 Employers' identification numbers. (a... Insurance Contributions Act, but who prior to such day neither has been assigned an identification number...

Do adjusted clinical groups eliminate incentives for HMOs to avoid substance abusers? Evidence from the Maryland Medicaid HealthChoice program.

PubMed

Ettner, Susan L; Johnson, Steven

2003-01-01

The adequacy of risk adjustment to eliminate incentives for managed care organizations (MCOs) to avoid enrolling costly patients had been questioned. This study explored systematic differences in expenditures between beneficiaries with and without substance disorders assigned to the same capitation rate group under the Maryland Medicaid HealthChoice program. The investigators used fiscal year (FY) 1995 to 1997 Medicaid data to assign beneficiaries to rate cells based on FY 1995 diagnoses and compared the distribution of expenditures for beneficiaries with and without substance disorders, defined using FY 1997 and FY 1995 diagnoses. Results showed that differences in FY 1997 expenditures between beneficiaries with and without FY 1995 substance disorders were negligible. However, MCOs could expect greater average losses and lower average profits on beneficiaries with FY 1997 substance disorders. Thus, the adjusted clinical groups methodology used to adjust capitation payments in the HealthChoice program attenuated, but did not eliminate, financial incentives for MCOs to avoid substance abusers.

Effect of Long-term Care Use on Medicare and Medicaid Expenditures for Dual Eligible and Non-dual Eligible Elderly Beneficiaries

PubMed Central

Kane, Robert L; Wysocki, Andrea; Parashuram, Shriram; Shippee, Tetyana; Lum, Terry

2013-01-01

Background: Dual eligible Medicare and Medicaid beneficiaries consume disproportionate shares of both programs. Objectives: To compare Medicare and Medicaid expenditures of elderly dual eligible beneficiaries with non-dual eligible beneficiaries based on their long-term care (LTC) use. Research Design: Secondary analysis of linked MAX and Medicare data in seven states. Subjects: Dual eligible adults (65+) receiving LTC in institutions, in the community, or not at all; and Medicare non-dual eligibles. Measures: Medicaid acute medical and LTC expenditures per beneficiary year, Medicare expenditures. Results: Among dual eligibles and non-dual eligibles, the average number of diseases and case mix scores are higher for LTC users. Adjusting for case mix virtually eliminates the difference for medical costs, but not for LTC expenditures. Adjusting for LTC status reduces the difference in LTC costs, but increases the difference in medical costs. Conclusions: Efforts to control costs for dual eligibles should target those in LTC while better coordinating medical and LTC expenditures. PMID:24753971

Medicare Prescription Drug Plan Enrollees Report Less Positive Experiences Than Their Medicare Advantage Counterparts.

PubMed

Elliott, Marc N; Landon, Bruce E; Zaslavsky, Alan M; Edwards, Carol; Orr, Nathan; Beckett, Megan K; Mallett, Joshua; Cleary, Paul D

2016-03-01

Since 2006, Medicare beneficiaries have been able to obtain prescription drug coverage through standalone prescription drug plans or their Medicare Advantage (MA) health plan, options exercised in 2015 by 72 percent of beneficiaries. Using data from community-dwelling Medicare beneficiaries older than age sixty-four in 700 plans surveyed from 2007 to 2014, we compared beneficiaries' assessments of Medicare prescription drug coverage when provided by standalone plans or integrated into an MA plan. Beneficiaries in standalone plans consistently reported less positive experiences with prescription drug plans (ease of getting medications, getting coverage information, and getting cost information) than their MA counterparts. Because MA plans are responsible for overall health care costs, they might have more integrated systems and greater incentives than standalone prescription drug plans to provide enrollees medications and information effectively, including, since 2010, quality bonus payments to these MA plans under provisions of the Affordable Care Act. Project HOPE—The People-to-People Health Foundation, Inc.

20 CFR 411.390 - What does a State VR agency do if a beneficiary to whom it is already providing services has a...

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false What does a State VR agency do if a... VR agency do if a beneficiary to whom it is already providing services has a ticket that is available for assignment? If a beneficiary who is receiving services from the State VR agency under an existing...

20 CFR 411.390 - What does a State VR agency do if a beneficiary to whom it is already providing services has a...

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false What does a State VR agency do if a... VR agency do if a beneficiary to whom it is already providing services has a ticket that is available for assignment? If a beneficiary who is receiving services from the State VR agency under an existing...

20 CFR 411.390 - What does a State VR agency do if a beneficiary to whom it is already providing services has a...

Code of Federal Regulations, 2013 CFR

2013-04-01

... 20 Employees' Benefits 2 2013-04-01 2013-04-01 false What does a State VR agency do if a... VR agency do if a beneficiary to whom it is already providing services has a ticket that is available for assignment? If a beneficiary who is receiving services from the State VR agency under an existing...

20 CFR 411.390 - What does a State VR agency do if a beneficiary to whom it is already providing services has a...

Code of Federal Regulations, 2014 CFR

2014-04-01

... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false What does a State VR agency do if a... VR agency do if a beneficiary to whom it is already providing services has a ticket that is available for assignment? If a beneficiary who is receiving services from the State VR agency under an existing...

20 CFR 411.390 - What does a State VR agency do if a beneficiary to whom it is already providing services has a...

Code of Federal Regulations, 2012 CFR

2012-04-01

... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false What does a State VR agency do if a... VR agency do if a beneficiary to whom it is already providing services has a ticket that is available for assignment? If a beneficiary who is receiving services from the State VR agency under an existing...

The Role of Medicare's Inpatient Cost-Sharing in Medicaid Entry.

PubMed

Keohane, Laura M; Trivedi, Amal N; Mor, Vincent

2018-04-01

To isolate the effect of greater inpatient cost-sharing on Medicaid entry among Medicare beneficiaries. Medicare administrative data (years 2007-2010) were linked to nursing home assessments and area-level socioeconomic indicators. Medicare beneficiaries who are readmitted to a hospital must pay an additional deductible ($1,100 in 2010) if their readmission occurs more than 59 days following discharge. In a regression discontinuity analysis, we take advantage of this Medicare benefit feature to test whether beneficiaries with greater cost-sharing have higher rates of Medicaid enrollment. We identified 221,248 Medicare beneficiaries with an initial hospital stay and a readmission 53-59 days later (no deductible) or 60-66 days later (charged a deductible). Among beneficiaries in low-socioeconomic areas with two hospitalizations, those readmitted 60-66 days after discharge were 21 percent more likely to join Medicaid compared with those readmitted 53-59 days following their initial hospitalization (absolute difference in adjusted risk of Medicaid entry: 3.7 percent vs. 3.1 percent, p = .01). Increasing Medicare cost-sharing requirements may promote Medicaid enrollment among low-income beneficiaries. Potential savings from an increased cost-sharing in the Medicare program may be offset by increased Medicaid participation. © Health Research and Educational Trust.

Equity in the financing of social security for health in Chile.

PubMed

Bitran, R; Mu?oz, J; Aguad, P; Navarrete, M; Ubilla, G

2000-01-01

Real public health spending has more than doubled since 1990, raising concerns about the targeting of public subsidies. This study examined the degree of equity in the financing of FONASA, the public insurer, which in 1995 covered 8.6 million beneficiaries, or 62% of the country's population. Study results, covering calendar year 1995, indicated that (1) government health subsidies were well-targeted, with about 90% reaching the indigent and 8% going to other, low-income beneficiaries; (2) only 2.5% of government subsidies leaked to higher-income, non-beneficiaries of FONASA (people covered by private insurers known as ISAPRES, otherwise covered, or without any coverage); (3) overall, FONASA's contributing beneficiaries (i.e. the indigent aside) self-financed their health benefits, although higher-income beneficiaries were providing significant cross-subsidies to low-income ones, making the internal financing of FONASA somewhat progressive; (4) the indigent received the highest amount of annual net benefits per capita, followed by low-income beneficiaries; and (5) the evasion of FONASA's payroll tax was pervasive, although public providers delivered care on an equal basis irrespective of the patients' contributions to FONASA. FONASA's finances would improve significantly if affiliation to health social security by both dependent and independent workers was made compulsory.

The Effects of Health Coverage Schemes on Length of Stay and Preventable Hospitalization in Seoul

PubMed Central

Kim, Jungah; Shon, Changwoo

2018-01-01

The Medical Aid program is government’s medical benefit program to secure the minimum livelihood and medical services for low-income Korean households. In Seoul, the number of Medical Aid beneficiaries has grown, driving an increases in the length of stay (LOS) and healthcare cost. Until now, studies have focused on quantity indicators, such as LOS, but only a few studies have been conducted on the service quality. We investigated both LOS and the preventable hospitalization (PH) rate as proxy indicators for the quantity and quality of services provided to Medical Aid beneficiaries in Seoul. To understand the program’s impact, we extracted appropriate data of Medical Aid beneficiaries and data of the lower 20% of National Health Insurance (NHI) enrollees, performed Propensity Score Matching (PSM), and controlled the variables related to disease severity. The differences between Medical Aid beneficiaries and NHI enrollees were estimated using multilevel analysis. The LOS of Medical Aid beneficiaries was longer, and the preventable hospitalization (PH) rate was higher than that of NHI enrollees. It implies that these beneficiaries did not receive timely and adequate healthcare services, despite their high rate of service utilization. Thus, indicators such as patient’s visits and screening related to PHs should be included in management policies to improve primary care. PMID:29673147

Rapid Growth In Mental Health Telemedicine Use Among Rural Medicare Beneficiaries, Wide Variation Across States.

PubMed

Mehrotra, Ateev; Huskamp, Haiden A; Souza, Jeffrey; Uscher-Pines, Lori; Rose, Sherri; Landon, Bruce E; Jena, Anupam B; Busch, Alisa B

2017-05-01

Congress and many state legislatures are considering expanding access to telemedicine. To inform this debate, we analyzed Medicare fee-for-service claims for the period 2004-14 to understand trends in and recent use of telemedicine for mental health care, also known as telemental health. The study population consisted of rural beneficiaries with a diagnosis of any mental illness or serious mental illness. The number of telemental health visits grew on average 45.1 percent annually, and by 2014 there were 5.3 and 11.8 telemental health visits per 100 rural beneficiaries with any mental illness or serious mental illness, respectively. There was notable variation across states: In 2014 nine had more than twenty-five visits per 100 beneficiaries with serious mental illness, while four states and the District of Columbia had none. Compared to other beneficiaries with mental illness, beneficiaries who received a telemental health visit were more likely to be younger than sixty-five, be eligible for Medicare because of disability, and live in a relatively poor community. States with a telemedicine parity law and a pro-telemental health regulatory environment had significantly higher rates of telemental health use than those that did not. Project HOPE—The People-to-People Health Foundation, Inc.

Endovascular repair vs open surgical repair of abdominal aortic aneurysms: comparative utilization trends from 2001 to 2006.

PubMed

Levin, David C; Rao, Vijay M; Parker, Laurence; Frangos, Andrea J; Sunshine, Jonathan H

2009-07-01

Within the past few years, endovascular aneurysm repair (EVAR) has come into use for the treatment of abdominal aortic aneurysms (AAAs). In many cases, EVAR has the potential to replace traditional open surgical repair (OSR), which is more invasive, risky, and expensive. The aim of this study was to determine to what extent EVAR is replacing OSR, whether the frequency of treatment is increasing with the advent of the less invasive approach, and which specialties are performing the procedures. The Medicare Part B data sets for 2001 through 2006 were studied. Procedure volume and utilization rates per 100,000 Medicare beneficiaries were determined for the 7 Current Procedural Terminology, fourth edition, procedure codes that describe EVAR and the 4 codes that describe OSR for AAA. Medicare's physician specialty codes were used to ascertain the specialties of the physician providers. A total of 31,965 OSRs for AAA were performed in Medicare beneficiaries in 2001, dropping to 15,665 by 2006 (-51%). In contrast, EVAR was carried out in 11,028 instances in 2001, increasing to 28,937 by 2006 (+162%). The utilization rate per 100,000 for OSR dropped from 90 to 42 (a rate decrease of 48) during the study period, while the rate for EVAR increased from 31 to 77 (a rate increase of 46). The combined utilization rate per 100,000 of the two types of interventions for AAA (EVAR and OSR) decreased from 121 in 2001 to 119 in 2006. In performing EVAR, procedure volume and market share in 2006 by specialty were 1) 22,003 procedures by surgeons, a 76% share; 2) 3,287 procedures by radiologists, an 11% share; 3) 1,915 procedures by cardiologists, a 7% share; and 4) 1,732 procedures by all other physicians, a 6% share. Treatment for AAA seems to be an example of the responsible use of new technology by physicians. The newer, less invasive, and less risky procedure (EVAR) is replacing the older and more invasive procedure (OSR) to a considerable degree. However, the overall combined utilization rate of both types of AAA treatment has remained stable in the Medicare population. There is thus no evidence to suggest that the introduction of the newer approach has led to the overtreatment of patients. Although radiologists do have a role in EVAR, surgeons strongly predominate.

Effects of state-level medicaid policies and patient characteristics on time to breast cancer surgery among medicaid beneficiaries.

PubMed

Halpern, Michael T; Schrag, Deborah

2016-08-01

Medicaid beneficiaries with cancer are less likely to receive timely and high-quality care. This study examined whether differences in state-level Medicaid policies affect delays in time to surgery (TTS) among women diagnosed with breast cancer. Using 2006-2008 Medicaid data, we identified women aged 18-64 enrolled in Medicaid diagnosed with breast cancer. Analyses examined associations of state-specific Medicaid surgery reimbursements, Medicaid eligibility recertification period (annually vs. shorter) and required patient copayment on time from breast cancer diagnosis to receipt of breast surgery. Patients receiving neoadjuvant therapy were excluded. Separate multivariable regression analyses controlling for patient demographic characteristics and clustering by state were performed for breast conserving surgery (BCS), inpatient mastectomy, and outpatient mastectomy. The study included 7542 Medicaid beneficiaries with breast cancer: 3272 received BCS, 2156 outpatient mastectomy, and 2115 inpatient mastectomy. Higher Medicaid reimbursements for BCS were associated with decreased time from diagnosis to surgery. A 12-month (vs. <12 month) Medicaid eligibility recertification period was associated with decreased TTS for BCS and outpatient mastectomy. Black Medicaid beneficiaries (compared with non-Hispanic White beneficiaries) were more likely to experience delays for all three types of surgery, while Hispanic beneficiaries were more likely to experience delays only for outpatient mastectomy. State-level Medicaid policies and patient characteristics can affect receipt of timely surgery among Medicaid beneficiaries with breast cancer. As delays in surgery can increase morbidity and mortality, changes to state Medicaid policies and health system programs are needed to improve access to care for this vulnerable population.

How well does a single question about health predict the financial health of Medicare managed care plans?

PubMed

Bierman, A S; Bubolz, T A; Fisher, E S; Wasson, J H

1999-01-01

Responses to simple questions that predict subsequent health care utilization are of interest to both capitated health plans and the payer. To determine how responses to a single question about general health status predict subsequent health care expenditures. Participants in the 1992 Medicare Current Beneficiary Survey were asked the following question: "In general, compared to other people your age, would you say your health is: excellent, very good, good, fair or poor?" To obtain each participant's total Medicare expenditures and number of hospitalizations in the ensuing year, we linked the responses to this question with data from the 1993 Medicare Continuous History Survey. Nationally representative sample of 8775 noninstitutionalized Medicare beneficiaries 65 years of age and older. Annual age- and sex-adjusted Medicare expenditures and hospitalization rates. Eighteen percent of the beneficiaries rated their health as excellent, 56% rated it as very good or good, 17% rated it as fair, and 7% rated it as poor. Medicare expenditures had a marked inverse relation to self-assessed health ratings. In the year after assessment, age- and sex-adjusted annual expenditures varied fivefold, from $8743 for beneficiaries rating their health as poor to $1656 for beneficiaries rating their health as excellent. Hospitalization rates followed the same pattern: Respondents who rated their health as poor had 675 hospitalizations per 1000 beneficiaries per year compared with 136 per 1000 for those rating their health as excellent. The response to a single question about general health status strongly predicts subsequent health care utilization. Self-reports of fair or poor health identify a group of high-risk patients who may benefit from targeted interventions. Because the current Medicare capitation formula does not account for health status, health plans can maximize profits by disproportionately enrolling beneficiaries who judge their health to be good. However, they are at a competitive disadvantage if they enroll beneficiaries who view themselves as sick.

Opioid prescribing by multiple providers in Medicare: retrospective observational study of insurance claims

PubMed Central

Goldman, Dana; Weaver, Lesley; Karaca-Mandic, Pinar

2014-01-01

Objectives To estimate the frequency and characteristics of opioid prescribing by multiple providers in Medicare and the association with hospital admissions related to opioid use. Design Retrospective cohort study. Setting Database of prescription drugs and medical claims in 20% random sample of Medicare beneficiaries in 2010. Participants 1 808 355 Medicare beneficiaries who filled at least one prescription for an opioid from a pharmacy in 2010. Main outcome measures Proportion of beneficiaries who filled opioid prescriptions from multiple providers; proportion of these prescriptions that were concurrently supplied; adjusted rates of hospital admissions related to opioid use associated with multiple provider prescribing. Results Among 1 208 100 beneficiaries with an opioid prescription, 418 530 (34.6%) filled prescriptions from two providers, 171 420 (14.2%) from three providers, and 143 344 (11.9%) from four or more providers. Among beneficiaries with four or more opioid providers, 110 671 (77.2%) received concurrent opioid prescriptions from multiple providers, and the dominant provider prescribed less than half of the mean total prescriptions per beneficiary (7.9/15.2 prescriptions). Multiple provider prescribing was highest among beneficiaries who were also prescribed stimulants, non-narcotic analgesics, and central nervous system, neuromuscular, and antineoplastic drugs. Hospital admissions related to opioid use increased with multiple provider prescribing: the annual unadjusted rate of admission was 1.63% (95% confidence interval 1.58 to 1.67%) for beneficiaries with one provider, 2.08% (2.03% to 2.14%) for two providers, 2.87% (2.77% to 2.97%) for three providers, and 4.83% (4.70% to 4.96%) for four or more providers. Results were similar after covariate adjustment. Conclusions Concurrent opioid prescribing by multiple providers is common in Medicare patients and is associated with higher rates of hospital admission related to opioid use. PMID:24553363

Health plan decision making with new medicare information materials.

PubMed Central

McCormack, L A; Garfinkel, S A; Hibbard, J H; Norton, E C; Bayen, U J

2001-01-01

OBJECTIVE: To examine the effect of providing new Medicare information materials on consumers' attitudes and behavior about health plan choice. DATA SOURCE: New and experienced Medicare beneficiaries who resided in the Kansas City metropolitan statistical area during winter 1998-99 were surveyed. More than 2,000 computer-assisted telephone interviews were completed across the two beneficiary populations with a mean response rate of 60 percent. STUDY DESIGN: Medicare beneficiaries were randomly assigned to a control group or one of three treatment groups that received varying amounts and types of new Medicare information materials. One treatment group received the Health Care Financing Administrations's pilot Medicare & You 1999 handbook, a second group received the same version of the handbook and a Medicare version of the Consumer Assessment of Health Plans (CAHPS) report, and a third treatment group received the Medicare & You bulletin, an abbreviated version of the handbook. PRINCIPAL FINDINGS: Results of the study suggest that the federal government's new consumer information materials are having some influence on Medicare beneficiaries' attitudes and behaviors about health plan decision making. Experienced beneficiary treatment group members were significantly more confident with their current health plan choice than control group members, but new beneficiaries were significantly less likely to use the new materials to choose or change health plans than control group members. In general the effects on confidence and health plan switching did not vary across the different treatment materials. CONCLUSIONS: The 1999 version of the Medicare & You materials contained a message that it is not necessary to change health plans. This message appears to have decreased the likelihood of using the new materials to choose or change plans, whereas other materials to which beneficiaries are exposed may encourage plan switching. Because providing more information to beneficiaries did not result in commensurate increases in confidence levels or rate of health plan switching, factors other than the amount of information, such as how the information is presented, may be more critical than volume. PMID:11482588

Mind the Gap: Why Closing the Doughnut Hole Is Insufficient for Increasing Medicare Beneficiary Access to Oral Chemotherapy.

PubMed

Dusetzina, Stacie B; Keating, Nancy L

2016-02-01

Orally administered anticancer medications are among the fastest growing components of cancer care. These medications are expensive, and cost-sharing requirements for patients can be a barrier to their use. For Medicare beneficiaries, the Affordable Care Act will close the Part D coverage gap (doughnut hole), which will reduce cost sharing from 100% in 2010 to 25% in 2020 for drug spending above $2,960 until the beneficiary reaches $4,700 in out-of-pocket spending. How much these changes will reduce out-of-pocket costs is unclear. We used the Medicare July 2014 Prescription Drug Plan Formulary, Pharmacy Network, and Pricing Information Files from the Centers for Medicare & Medicaid Services for 1,114 stand-alone and 2,230 Medicare Advantage prescription drug formularies, which represent all formularies in 2014. We identified orally administered anticancer medications and summarized drug costs, cost-sharing designs used by available plans, and the estimated out-of-pocket costs for beneficiaries without low-income subsidies who take a single drug before and after the doughnut hole closes. Little variation existed in formulary design across plans and products. The average price per month for included products was $10,060 (range, $5,123 to $16,093). In 2010, median beneficiary annual out-of-pocket costs for a typical treatment duration ranged from $6,456 (interquartile range, $6,433 to $6,482) for dabrafenib to $12,160 (interquartile range, $12,102 to $12,262) for sunitinib. With the assumption that prices remain stable, after the doughnut hole closes, beneficiaries will spend approximately $2,550 less. Out-of-pocket costs for Medicare beneficiaries taking orally administered anticancer medications are high and will remain so after the doughnut hole closes. Efforts are needed to improve affordability of high-cost cancer drugs for beneficiaries who need them. © 2015 by American Society of Clinical Oncology.

Health plan decision making with new medicare information materials.

PubMed

McCormack, L A; Garfinkel, S A; Hibbard, J H; Norton, E C; Bayen, U J

2001-07-01

To examine the effect of providing new Medicare information materials on consumers' attitudes and behavior about health plan choice. New and experienced Medicare beneficiaries who resided in the Kansas City metropolitan statistical area during winter 1998-99 were surveyed. More than 2,000 computer-assisted telephone interviews were completed across the two beneficiary populations with a mean response rate of 60 percent. Medicare beneficiaries were randomly assigned to a control group or one of three treatment groups that received varying amounts and types of new Medicare information materials. One treatment group received the Health Care Financing Administrations's pilot Medicare & You 1999 handbook, a second group received the same version of the handbook and a Medicare version of the Consumer Assessment of Health Plans (CAHPS) report, and a third treatment group received the Medicare & You bulletin, an abbreviated version of the handbook. Results of the study suggest that the federal government's new consumer information materials are having some influence on Medicare beneficiaries' attitudes and behaviors about health plan decision making. Experienced beneficiary treatment group members were significantly more confident with their current health plan choice than control group members, but new beneficiaries were significantly less likely to use the new materials to choose or change health plans than control group members. In general the effects on confidence and health plan switching did not vary across the different treatment materials. The 1999 version of the Medicare & You materials contained a message that it is not necessary to change health plans. This message appears to have decreased the likelihood of using the new materials to choose or change plans, whereas other materials to which beneficiaries are exposed may encourage plan switching. Because providing more information to beneficiaries did not result in commensurate increases in confidence levels or rate of health plan switching, factors other than the amount of information, such as how the information is presented, may be more critical than volume.

IRIG Serial Time Code Formats

DTIC Science & Technology

2016-08-01

codes contain control functions (CFs) that are reserved for encoding various controls, identification, and other special- purpose functions. Time...set of CF bits for the encoding of various control, identification, and other special- purpose functions. The control bits may be programmed in any... recycles yearly. • There are 18 CFs occur between position identifiers P6 and P8. Any CF bit or combination of bits can be programmed to read a

Flu shots and the characteristics of unvaccinated elderly Medicare beneficiaries.

PubMed

Lochner, Kimberly A; Wynne, Marc

2011-12-21

Data from the Medicare Current Beneficiary Survey, 2009. • Overall, 73% of Medicare beneficiaries aged 65 years and older reported receiving a flu shot for the 2008 flu season, but vaccination rates varied by socio-demographic characteristics. Flu vaccination was lowest for beneficiaries aged 65-74 years old, who were non-Hispanic Blacks and Hispanics, were not married, had less than a high school education, or who were eligible for Medicaid (i.e., dual eligibles). • Healthcare utilization and personal health behavior were also related to vaccination rates, with current smokers and those with no hospitalizations or physician visits being less likely to be vaccinated. • Among those beneficiaries who reported receiving a flu shot, 59% received it in a physician's office or clinic, with the next most common setting being in the community (21%); e.g., grocery store, shopping mall, library, or church. • Among those beneficiaries who did not receive a flu shot, the most common reasons were beliefs that the shot could cause side effects or disease (20%), that they didn't think the shot could prevent the flu (17%), or that the shot wasn't needed (16%). Less than 1% reported that they didn't get the flu shot because of cost. Elderly persons (aged 65 years and older) are at increased risk of complications from influenza, with the majority of influenza-related hospitalizations and deaths occurring among the elderly (Fiore et al., 2010). Most physicians recommend their elderly patients get a flu shot each year, and many hospitals inquire about elderly patient's immunization status upon admission, providing a vaccination if requested. The importance of getting a flu shot is underscored by the Department of Health and Human Services' Healthy People initiative, which has set a vaccination goal of 90% for the Nation's elderly by the year 2020 (Department of Health and Human Services [DHHS], 2011). Although all costs related to flu shots are covered by Medicare, requiring no co-pay on the part of the beneficiary (Centers for Medicare and Medicaid Services, 2011), for the 2008 flu season, only 73% of non-institutionalized Medicare beneficiaries, aged 65 years and older, reported receiving one. This report presents the most recent data on flu vaccination rates among non-institutionalized elderly Medicare beneficiaries and their association with socio-demographic and personal health characteristics. The report also describes the places beneficiaries received their flu shot and, for those not getting vaccinated, the reasons reported for not doing so. Public Domain.

Resource Utilization and Costs of Age-Related Macular Degeneration

PubMed Central

Halpern, Michael T.; Schmier, Jordana K.; Covert, David; Venkataraman, Krithika

2006-01-01

Data were analyzed from the 1999-2001 Medicare Beneficiary Encrypted Files for patients with age-related macular degeneration (AMD), an ophthalmic condition characterized by central vision loss. Classifying AMD subtype by International Classification of Diseases, Ninth Revision, Clinical Modifications (ICD-9-CM) (Centers for Disease Control and Prevention, 2003) code, resource utilization rates increased with disease progression. Individuals with more severe disease (wet only or wet and dry AMD) had greater costs than did those with less severe disease (drusen only or dry only). Costs among patients with wet disease increased yearly at rates exceeding inflation, possibly due in part to increased rates of treatment with photodynamic therapy among these individuals and the aging of the population. PMID:17290647

21 CFR 801.57 - Discontinuation of legacy FDA identification numbers assigned to devices.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Discontinuation of legacy FDA identification... Device Identification § 801.57 Discontinuation of legacy FDA identification numbers assigned to devices... been assigned an FDA labeler code to facilitate use of NHRIC or NDC numbers may continue to use that...

20 CFR 411.385 - What does a State VR agency do if a beneficiary who is eligible for VR services has a ticket that...

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false What does a State VR agency do if a beneficiary who is eligible for VR services has a ticket that is available for assignment or reassignment? 411... a State VR agency do if a beneficiary who is eligible for VR services has a ticket that is available...

20 CFR 411.385 - What does a State VR agency do if a beneficiary who is eligible for VR services has a ticket that...

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false What does a State VR agency do if a beneficiary who is eligible for VR services has a ticket that is available for assignment or reassignment? 411... a State VR agency do if a beneficiary who is eligible for VR services has a ticket that is available...

Laboratory Characterization of Noroviruses Identified in Specimens from Military Health System Beneficiaries During an Outbreak in Germany, 2016-2017

DTIC Science & Technology

2017-07-01

Specimens from Military Health System Beneficiaries During an Outbreak in Germany, 2016–2017 Nellie D. Darling, MS; Daniela E. Poss, MPH; Krista M...outbreak.7 This study characterizes norovi- rus isolates from Military Health System (MHS) beneficiaries which corresponded temporally and geographically...identified using the Armed Forces Health Longitudinal Technology Appli- cation (AHLTA). Of all samples received by LRMC during this surveillance period

20 CFR 411.385 - What does a State VR agency do if a beneficiary who is eligible for VR services has a ticket that...

Code of Federal Regulations, 2014 CFR

2014-04-01

... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false What does a State VR agency do if a beneficiary who is eligible for VR services has a ticket that is available for assignment or reassignment? 411... a State VR agency do if a beneficiary who is eligible for VR services has a ticket that is available...

20 CFR 411.385 - What does a State VR agency do if a beneficiary who is eligible for VR services has a ticket that...

Code of Federal Regulations, 2013 CFR

2013-04-01

... 20 Employees' Benefits 2 2013-04-01 2013-04-01 false What does a State VR agency do if a beneficiary who is eligible for VR services has a ticket that is available for assignment or reassignment? 411... a State VR agency do if a beneficiary who is eligible for VR services has a ticket that is available...

20 CFR 411.385 - What does a State VR agency do if a beneficiary who is eligible for VR services has a ticket that...

Code of Federal Regulations, 2012 CFR

2012-04-01

... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false What does a State VR agency do if a beneficiary who is eligible for VR services has a ticket that is available for assignment or reassignment? 411... a State VR agency do if a beneficiary who is eligible for VR services has a ticket that is available...

Federal Health Care Center: VA and DOD Need to Develop Better Information to Monitor Operations and Improve Efficiency

DTIC Science & Technology

2017-01-01

delivery of health care that would be more accessible and less expensive than operating two federal medical centers serving VA and DOD beneficiaries in...departments—including DOD’s operational readiness mission—by integrating services previously provided by the former North Chicago VA Medical Center...1VA beneficiaries include veterans of military service and certain dependents and survivors. DOD beneficiaries include active duty

A profile of social security child beneficiaries and their families: sociodemographic and economic characteristics.

PubMed

Tamborini, Christopher R; Cupito, Emily; Shoffner, Dave

2011-01-01

Using a rich dataset that links the Census Bureau's Survey of Income and Program Participation calendar-year 2004 file with Social Security benefit records, this article provides a portrait of the sociodemographic and economic characteristics of Social Security child beneficiaries. We find that the incidence ofbenefit receipt in the child population differs substantially across individual and family-level characteristics. Average benefit amounts also vary across subgroups and benefit types. The findings provide a better understanding of the importance of Social Security to families with beneficiary children. Social Security is a major source of family income for many child beneficiaries, particularly among those with low income or family heads with lower education and labor earnings.

Pacific Northwest ecoclass codes for seral and potential natural communities.

Treesearch

Frederick C. Hall

1998-01-01

Lists codes for identification of potential natural communities (plant association, habitat types), their seral status, and vegetation structure in and around the Pacific Northwest. Codes are a six-digit alphanumeric system using the first letter of tree species, life-form, seral status, and structure so that most codes can be directly interpreted. Seven appendices...

Competitive region orientation code for palmprint verification and identification

NASA Astrophysics Data System (ADS)

Tang, Wenliang

2015-11-01

Orientation features of the palmprint have been widely investigated in coding-based palmprint-recognition methods. Conventional orientation-based coding methods usually used discrete filters to extract the orientation feature of palmprint. However, in real operations, the orientations of the filter usually are not consistent with the lines of the palmprint. We thus propose a competitive region orientation-based coding method. Furthermore, an effective weighted balance scheme is proposed to improve the accuracy of the extracted region orientation. Compared with conventional methods, the region orientation of the palmprint extracted using the proposed method can precisely and robustly describe the orientation feature of the palmprint. Extensive experiments on the baseline PolyU and multispectral palmprint databases are performed and the results show that the proposed method achieves a promising performance in comparison to conventional state-of-the-art orientation-based coding methods in both palmprint verification and identification.

38 CFR 70.31 - Deductibles.

Code of Federal Regulations, 2010 CFR

2010-07-01

... found at http://www.va.gov/healtheligibility/Library/pubs/BeneficiaryTravel/BeneficiaryTravel.pdf or by....gov/healtheligibility/Library/pubs/VAIncomeThresholds/VAIncomeThresholds.pdf); or (3) Has...

Phonological Coding Abilities: Identification of Impairments Related to Phonologically Based Reading Problems.

ERIC Educational Resources Information Center

Swank, Linda K.

1994-01-01

Relationships between phonological coding abilities and reading outcomes have implications for differential diagnosis of language-based reading problems. The theoretical construct of specific phonological coding ability is explained, including phonological encoding, phonological awareness and metaphonology, lexical access, working memory, and…

Signal Prediction With Input Identification

NASA Technical Reports Server (NTRS)

Juang, Jer-Nan; Chen, Ya-Chin

1999-01-01

A novel coding technique is presented for signal prediction with applications including speech coding, system identification, and estimation of input excitation. The approach is based on the blind equalization method for speech signal processing in conjunction with the geometric subspace projection theory to formulate the basic prediction equation. The speech-coding problem is often divided into two parts, a linear prediction model and excitation input. The parameter coefficients of the linear predictor and the input excitation are solved simultaneously and recursively by a conventional recursive least-squares algorithm. The excitation input is computed by coding all possible outcomes into a binary codebook. The coefficients of the linear predictor and excitation, and the index of the codebook can then be used to represent the signal. In addition, a variable-frame concept is proposed to block the same excitation signal in sequence in order to reduce the storage size and increase the transmission rate. The results of this work can be easily extended to the problem of disturbance identification. The basic principles are outlined in this report and differences from other existing methods are discussed. Simulations are included to demonstrate the proposed method.

Inequity in ecosystem service delivery: Socioeconomic gaps in the public-private conservation network

USGS Publications Warehouse

Villamagna, Amy M.; Mogollón, Beatriz; Angermeier, Paul L.

2017-01-01

Conservation areas, both public and private, are critical tools to protect biodiversity and deliver important ecosystem services (ES) to society. Although societal benefits from such ES are increasingly used to promote public support of conservation, the number of beneficiaries, their identity, and the magnitude of benefits are largely unknown for the vast majority of conservation areas in the United States public-private conservation network. The location of conservation areas in relation to people strongly influences the direction and magnitude of ES flows as well as the identity of beneficiaries. We analyzed benefit zones, the areas to which selected ES could be conveyed to beneficiaries, to assess who benefits from a typical conservation network. Better knowledge of ES flows and beneficiaries will help land conservationists make a stronger case for the broad collateral benefits of conservation and help to address issues of social-environmental justice. To evaluate who benefits the most from the current public-private conservation network, we delineated the benefit zones for local ES (within 16 km) that are conveyed along hydrological paths from public (federal and state) and private (easements) conservation lands in the states of North Carolina and Virginia, USA. We also discuss the challenges and demonstrate an approach for delineating nonhydrological benefits that are passively conveyed to beneficiaries. We mapped and compared the geographic distribution of benefit zones within and among conservation area types. We further compared beneficiary demographics across benefit zones of the conservation area types and found that hydrological benefit zones of federal protected areas encompass disproportionately fewer minority beneficiaries compared to statewide demographic patterns. In contrast, benefit zones of state protected areas and private easements encompassed a much greater proportion of minority beneficiaries (~22–25%). Benefit zones associated with private conservation lands included beneficiaries of significantly greater household income than benefit zones of other types of conservation areas. Our analysis of ES flows revealed significant socioeconomic gaps in how the current public-private conservation network benefits the public. These gaps warrant consideration in regional conservation plans and suggest that private conservation initiatives may be best suited for responding to the equity challenge. Enhancing the ecosystem benefits and the equity of benefit delivery from private conservation networks could build public and political support for long-term conservation strategies and ultimately enhance conservation efficacy.

Impact of the Bolsa Família program on food availability of low-income Brazilian families: a quasi experimental study.

PubMed

Martins, Ana Paula Bortoletto; Monteiro, Carlos Augusto

2016-08-19

The Bolsa Família Program was created in Brazil in 2003, by the joint of different social programs aimed at poor or very poor families with focus on income transfer to promote immediate poverty relief, conditionalities and complementary programs. Given the contributions of conditional cash transfer programs to poverty alleviation and their potential effects on nutrition and health, the objective of this study was to assess the impact of the Bolsa Família Program on food purchases of low-income households in Brazil. Representative data from the Household Budget Survey conducted in 2008-2009 were studied, with probabilistic sample of 55,970 households. 11,282 households were eligible for this study and 48.5 % were beneficiaries of the BFP. Food availability indicators were compared among paired blocks of households (n = 100), beneficiaries or non-beneficiaries of the Bolsa Família Program, with monthly per capita income up to R$ 210.00. Blocks of households were created based on the propensity score of each household to have beneficiaries and were homogeneous regarding potential confounding variables. The food availability indicators were weekly per capita expenditure and daily energy consumption, both calculated considering all food items and four food groups based on the extent and purpose of the industrial food processing. The comparisons between the beneficiaries and non-beneficiaries blocks of households were conducted through paired 't' tests. Compared to non-beneficiaries, the beneficiaries households had 6 % higher food expenditure (p = 0.015) and 9.4 % higher total energy availability (p = 0.010). It was found a 7.3 % higher expenditure on in natura or minimally processed foods and 10.4 % higher expenditure on culinary ingredients among the Bolsa Família Program families. No statistically significant differences were found regarding the expenditure and the availability of processed and ultra-processed food and drink products. In the in natura or minimally processed foods group, the expenditure and the availability of meat, tubers and vegetables were higher among the Bolsa Família Program beneficiaries. The Bolsa Família Program impact on food availability among low-income families was higher food expenditure, higher availability of fresh foods and culinary ingredients, including those foods that increase diet's quality and diversity.

Perceptions of Usefulness: Using the Holland Code Theory, Multiple Intelligences Theory, and Role Model Identification to Determine a Career Niche in the Fashion Industry for First-Quarter Fashion Students

ERIC Educational Resources Information Center

Green, Crystal D.

2010-01-01

This action research study investigated the perceptions that student participants had on the development of a career exploration model and a career exploration project. The Holland code theory was the primary assessment used for this research study, in addition to the Multiple Intelligences theory and the identification of a role model for the…

An implementation framework for the feedback of individual research results and incidental findings in research.

PubMed

Thorogood, Adrian; Joly, Yann; Knoppers, Bartha Maria; Nilsson, Tommy; Metrakos, Peter; Lazaris, Anthoula; Salman, Ayat

2014-12-23

This article outlines procedures for the feedback of individual research data to participants. This feedback framework was developed in the context of a personalized medicine research project in Canada. Researchers in this domain have an ethical obligation to return individual research results and/or material incidental findings that are clinically significant, valid and actionable to participants. Communication of individual research data must proceed in an ethical and efficient manner. Feedback involves three procedural steps: assessing the health relevance of a finding, re-identifying the affected participant, and communicating the finding. Re-identification requires researchers to break the code in place to protect participant identities. Coding systems replace personal identifiers with a numerical code. Double coding systems provide added privacy protection by separating research data from personal identifying data with a third "linkage" database. A trusted and independent intermediary, the "keyholder", controls access to this linkage database. Procedural guidelines for the return of individual research results and incidental findings are lacking. This article outlines a procedural framework for the three steps of feedback: assessment, re-identification, and communication. This framework clarifies the roles of the researcher, Research Ethics Board, and keyholder in the process. The framework also addresses challenges posed by coding systems. Breaking the code involves privacy risks and should only be carried out in clearly defined circumstances. Where a double coding system is used, the keyholder plays an important role in balancing the benefits of individual feedback with the privacy risks of re-identification. Feedback policies should explicitly outline procedures for the assessment of findings, and the re-identification and contact of participants. The responsibilities of researchers, the Research Ethics Board, and the keyholder must be clearly defined. We provide general guidelines for keyholders involved in feedback. We also recommend that Research Ethics Boards should not be directly involved in the assessment of individual findings. Hospitals should instead establish formal, interdisciplinary clinical advisory committees to help researchers determine whether or not an uncertain finding should be returned.

Health care use and costs for participants in a diabetes disease management program, United States, 2007-2008.

PubMed

Dall, Timothy M; Roary, Mary; Yang, Wenya; Zhang, Shiping; Chen, Yaozhu J; Arday, David R; Gantt, Cynthia J; Zhang, Yiduo

2011-05-01

The Disease Management Association of America identifies diabetes as one of the chronic conditions with the greatest potential for management. TRICARE Management Activity, which administers health care benefits for US military service personnel, retirees, and their dependents, created a disease management program for beneficiaries with diabetes. The objective of this study was to determine whether participation intensity and prior indication of uncontrolled diabetes were associated with health care use and costs for participants enrolled in TRICARE's diabetes management program. This ongoing, opt-out study used a quasi-experimental approach to assess program impact for beneficiaries (n = 37,370) aged 18 to 64 living in the United States. Inclusion criteria were any diabetes-related emergency department visits or hospitalizations, more than 10 diabetes-related ambulatory visits, or more than twenty 30-day prescriptions for diabetes drugs in the previous year. Beginning in June 2007, all participants received educational mailings. Participants who agreed to receive a baseline telephone assessment and telephone counseling once per month in addition to educational mailings were considered active, and those who did not complete at least the baseline telephone assessment were considered passive. We categorized the diabetes status of each participant as "uncontrolled" or "controlled" on the basis of medical claims containing diagnosis codes for uncontrolled diabetes in the year preceding program eligibility. We compared observed outcomes to outcomes predicted in the absence of diabetes management. Prediction equations were based on regression analysis of medical claims for a historical control group (n = 23,818) that in October 2004 met the eligibility criteria for TRICARE's program implemented June 2007. We conducted regression analysis comparing historical control group patient outcomes after October 2004 with these baseline characteristics. Per-person total annual medical savings for program participants, calculated as the difference between observed and predicted outcomes, averaged $783. Active participants had larger reductions in inpatient days and emergency department visits, larger increases in ambulatory visits, and larger increases in receiving retinal examinations, hemoglobin A1c tests, and urine microalbumin tests compared with passive participants. Participants with prior indication of uncontrolled diabetes had higher per-person total annual medical savings, larger reduction in inpatient days, and larger increases in ambulatory visits than did participants with controlled diabetes. Greater intensity of participation in TRICARE's diabetes management program was associated with lower medical costs and improved receipt of recommended testing. That patients who were categorized as having uncontrolled diabetes realized greater program benefits suggests diabetes management programs should consider indication of uncontrolled diabetes in their program candidate identification criteria.

Identification of Emergency Department Visits in Medicare Administrative Claims: Approaches and Implications.

PubMed

Venkatesh, Arjun K; Mei, Hao; Kocher, Keith E; Granovsky, Michael; Obermeyer, Ziad; Spatz, Erica S; Rothenberg, Craig; Krumholz, Harlan M; Lin, Zhenqui

2017-04-01

Administrative claims data sets are often used for emergency care research and policy investigations of healthcare resource utilization, acute care practices, and evaluation of quality improvement interventions. Despite the high profile of emergency department (ED) visits in analyses using administrative claims, little work has evaluated the degree to which existing definitions based on claims data accurately captures conventionally defined hospital-based ED services. We sought to construct an operational definition for ED visitation using a comprehensive Medicare data set and to compare this definition to existing operational definitions used by researchers and policymakers. We examined four operational definitions of an ED visit commonly used by researchers and policymakers using a 20% sample of the 2012 Medicare Chronic Condition Warehouse (CCW) data set. The CCW data set included all Part A (hospital) and Part B (hospital outpatient, physician) claims for a nationally representative sample of continuously enrolled Medicare fee-for-services beneficiaries. Three definitions were based on published research or existing quality metrics including: 1) provider claims-based definition, 2) facility claims-based definition, and 3) CMS Research Data Assistance Center (ResDAC) definition. In addition, we developed a fourth operational definition (Yale definition) that sought to incorporate additional coding rules for identifying ED visits. We report levels of agreement and disagreement among the four definitions. Of 10,717,786 beneficiaries included in the sample data set, 22% had evidence of ED use during the study year under any of the ED visit definitions. The definition using provider claims identified a total of 4,199,148 ED visits, the facility definition 4,795,057 visits, the ResDAC definition 5,278,980 ED visits, and the Yale definition 5,192,235 ED visits. The Yale definition identified a statistically different (p < 0.05) collection of ED visits than all other definitions including 17% more ED visits than the provider definition and 2% fewer visits than the ResDAC definition. Differences in ED visitation counts between each definition occurred for several reasons including the inclusion of critical care or observation services in the ED, discrepancies between facility and provider billing regulations, and operational decisions of each definition. Current operational definitions of ED visitation using administrative claims produce different estimates of ED visitation based on the underlying assumptions applied to billing data and data set availability. Future analyses using administrative claims data should seek to validate specific definitions and inform the development of a consistent, consensus ED visitation definitions to standardize research reporting and the interpretation of policy interventions. © 2016 by the Society for Academic Emergency Medicine.

Identification of Emergency Department Visits in Medicare Administrative Claims: Approaches and Implications

PubMed Central

Venkatesh, Arjun K.; Mei, Hao; Kocher, Keith E.; Granovsky, Michael; Obermeyer, Ziad; Spatz, Erica S.; Rothenberg, Craig; Krumholz, Harlan M.; Lin, Zhenqui

2018-01-01

Objectives Administrative claims data sets are often used for emergency care research and policy investigations of healthcare resource utilization, acute care practices, and evaluation of quality improvement interventions. Despite the high profile of emergency department (ED) visits in analyses using administrative claims, little work has evaluated the degree to which existing definitions based on claims data accurately captures conventionally defined hospital-based ED services. We sought to construct an operational definition for ED visitation using a comprehensive Medicare data set and to compare this definition to existing operational definitions used by researchers and policymakers. Methods We examined four operational definitions of an ED visit commonly used by researchers and policymakers using a 20% sample of the 2012 Medicare Chronic Condition Warehouse (CCW) data set. The CCW data set included all Part A (hospital) and Part B (hospital outpatient, physician) claims for a nationally representative sample of continuously enrolled Medicare fee-for-services beneficiaries. Three definitions were based on published research or existing quality metrics including: 1) provider claims–based definition, 2) facility claims–based definition, and 3) CMS Research Data Assistance Center (ResDAC) definition. In addition, we developed a fourth operational definition (Yale definition) that sought to incorporate additional coding rules for identifying ED visits. We report levels of agreement and disagreement among the four definitions. Results Of 10,717,786 beneficiaries included in the sample data set, 22% had evidence of ED use during the study year under any of the ED visit definitions. The definition using provider claims identified a total of 4,199,148 ED visits, the facility definition 4,795,057 visits, the ResDAC definition 5,278,980 ED visits, and the Yale definition 5,192,235 ED visits. The Yale definition identified a statistically different (p < 0.05) collection of ED visits than all other definitions including 17% more ED visits than the provider definition and 2% fewer visits than the ResDAC definition. Differences in ED visitation counts between each definition occurred for several reasons including the inclusion of critical care or observation services in the ED, discrepancies between facility and provider billing regulations, and operational decisions of each definition. Conclusion Current operational definitions of ED visitation using administrative claims produce different estimates of ED visitation based on the underlying assumptions applied to billing data and data set availability. Future analyses using administrative claims data should seek to validate specific definitions and inform the development of a consistent, consensus ED visitation definitions to standardize research reporting and the interpretation of policy interventions. PMID:27864915

Racial disparities across provider specialties in opioid prescriptions dispensed to Medicaid beneficiaries with chronic non-cancer pain

PubMed Central

Ringwalt, Chris; Roberts, Andrew W.; Gugelmann, Hallam; Skinner, Asheley Cockrell

2016-01-01

Objective Chronic pain affects both psychological and physical functioning, and is responsible for more than $60 billion in lost productivity annually in the United States. Although previous studies have demonstrated racial disparities in opioid treatment, there is little evidence regarding disparities in treatment of chronic non-cancer pain (CNCP) and the role of physician specialty. Design A retrospective cohort study. Setting We analyzed North Carolina Medicaid claims data, from July 1, 2009 to May 31, 2010, to examine disparities by different provider specialties in beneficiaries dispensed prescriptions for opioids. Subjects The population included White and Black North Carolina Medicaid beneficiaries with CNCP (n=75,458). Methods We used bivariate statistics and logistic regression analysis to examine race-based discrepancies in opioid prescribing by physician specialty. Results Compared to White beneficiaries with CNCP (n=49,197), Black beneficiaries (n=26,261) were less likely [OR 0.91 (CI: 0.88–0.94)] to fill an opioid prescription. Our hypothesis was partially supported: we found that race-based differences in beneficiaries dispensed opioid prescriptions were more prominent in certain specialties. In particular, these differences were most salient among patients of specialists in obstetrics and gynecology [OR 0.78 (CI: 0.67–0.89)] and internal medicine [OR 0.86 (CI: 0.79–0.92)], as well as general practitioners/family medicine physicians [OR 0.91 (CI: 0.85–0.97)]. Conclusions Our findings suggest that, in our study population, Black beneficiaries with CNCP are less likely than Whites to fill prescriptions for opioid analgesics as a function of their provider’s specialty. Although race-based differences in patients filling opioid prescriptions have been noted in previous studies, this is the first study that clearly demonstrates these disparities by provider specialty. PMID:25287703

Impact of United States Preventive Services Task Force Recommendations on Utilization of Prostate-specific Antigen Screening in Medicare Beneficiaries.

PubMed

Khairnar, Rahul; Mishra, Mark V; Onukwugha, Eberechukwu

2018-02-16

Previous studies assessing the impact of United States Preventive Services Task Force (USPSTF) recommendations on utilization of prostate-specific antigen (PSA) screening have not investigated longer-term impacts of 2008 recommendations nor have they investigated the impact of 2012 recommendations in the Medicare population. This study aimed to evaluate change in utilization of PSA screening, post-2008 and 2012 USPSTF recommendations, and assessed trends and determinants of receipt of PSA screening in the Medicare population. This retrospective study of male Medicare beneficiaries utilized Medicare Current Beneficiary Survey data and linked administrative claims from 2006 to 2013. Beneficiaries aged ≥65 years, with continuous enrollment in parts A and B for each year they were surveyed were included in the study. Beneficiaries with self-reported/claims-based diagnosis of prostate cancer were excluded. The primary outcome was receipt of PSA screening. Other measures included age groups (65 to 74 and ≥75), time periods (pre-2008/post-2008 and 2012 recommendations), and sociodemographic variables. The study cohort consisted of 11,028 beneficiaries, who were predominantly white (87.56%), married (69.25%), and unemployed (84.4%); 52.21% beneficiaries were aged ≥75. Declining utilization trends for PSA screening were observed in men aged ≥75 after 2008 recommendations and in both age groups after 2012 recommendations. The odds of receiving PSA screening declined by 17% in men aged ≥75 after 2008 recommendations and by 29% in men aged ≥65 after 2012 recommendations. The 2008 and 2012 USPSTF recommendations against PSA screening were associated with declines in utilization of PSA screening during the study period. USPSTF recommendations play a significant role in affecting utilization patterns of health services.

Bar code-based pre-transfusion check in pre-operative autologous blood donation.

PubMed

Ohsaka, Akimichi; Furuta, Yoshiaki; Ohsawa, Toshiya; Kobayashi, Mitsue; Abe, Katsumi; Inada, Eiichi

2010-10-01

The objective of this study was to demonstrate the feasibility of a bar code-based identification system for the pre-transfusion check at the bedside in the setting of pre-operative autologous blood donation (PABD). Between July 2003 and December 2008 we determined the compliance rate and causes of failure of electronic bedside checking for PABD transfusion. A total of 5627 (9% of all transfusions) PABD units were administered without a single mistransfusion. The overall rate of compliance with electronic checking was 99%. The bar code-based identification system was applicable to the pre-transfusion check for PABD transfusion. Copyright © 2010 Elsevier Ltd. All rights reserved.

CSTminer: a web tool for the identification of coding and noncoding conserved sequence tags through cross-species genome comparison

PubMed Central

Castrignanò, Tiziana; Canali, Alessandro; Grillo, Giorgio; Liuni, Sabino; Mignone, Flavio; Pesole, Graziano

2004-01-01

The identification and characterization of genome tracts that are highly conserved across species during evolution may contribute significantly to the functional annotation of whole-genome sequences. Indeed, such sequences are likely to correspond to known or unknown coding exons or regulatory motifs. Here, we present a web server implementing a previously developed algorithm that, by comparing user-submitted genome sequences, is able to identify statistically significant conserved blocks and assess their coding or noncoding nature through the measure of a coding potential score. The web tool, available at http://www.caspur.it/CSTminer/, is dynamically interconnected with the Ensembl genome resources and produces a graphical output showing a map of detected conserved sequences and annotated gene features. PMID:15215464

Hospital Choice of Rural Medicare Beneficiaries: Patient, Hospital Attributes, and the Patient–Physician Relationship

PubMed Central

Tai, Wan-Tzu Connie; Porell, Frank W; Adams, E Kathleen

2004-01-01

Objective To examine how patient and hospital attributes and the patient–physician relationship influence hospital choice of rural Medicare beneficiaries. Data Sources Medicare Current Beneficiary Survey (MCBS), Health Care Financing Administration (HCFA) Provider of Services (POS) file, American Hospital Association (AHA) Annual Survey, and Medicare Hospital Service Area (HSA) files for 1994 and 1995. Study Design The study sample consisted of 1,702 hospitalizations of rural Medicare beneficiaries. McFadden's conditional logit model was used to analyze hospital choices of rural Medicare beneficiaries. The model included independent variables to control for patients' and hospitals' attributes and the distance to hospital alternatives. Principal Findings The empirical results show strong preferences of aged patients for closer hospitals and those of greater scale and service capacity. Patients with complex acute medical conditions and those with more resources were more likely to bypass their closest rural hospitals. Beneficiaries were more likely to bypass their closest rural hospital if they had no regular physician, had a shorter patient–physician tie, were dissatisfied with the availability of health care, and had a longer travel time to their physician's office. Conclusions The significant influences of patients' socioeconomic, health, and functional status, their satisfaction with and access to primary care, and their strong preferences for certain hospital attributes should inform federal program initiatives about the likely impacts of policy changes on hospital bypassing behavior. PMID:15533193

Medicaid program; freedom of choice: waivers of and exceptions to state plan requirements--Health Care Financing Administration. Interim final rule with comment period.

PubMed

1981-10-01

This regulation implements section 2175 of the Omnibus Budget Reconciliation Act of 1981 (Pub. L. 97-35). It revises in several ways the current requirements regarding a Medicaid beneficiary's right to choose among participating providers of covered items or services: (1) A State will not be found out of compliance with otherwise applicable requirements if it enters into certain arrangements to purchase laboratory services or medical devices through competitive bids, or if, under certain circumstances, it restricts for a reasonable period of time a specific beneficiary's choice of providers or the participation of a specific provider. (2) States may also request the Secretary to waive statutory requirements, as necessary, in order to: (a) implement a primary care case management system. (b) allow a locality to act as a central broker in aiding beneficiaries to select among competing health care plans, (c) share with beneficiaries, through provision of additional services, savings resulting from beneficiary use of more cost effective medical care, and (d) restrict beneficiaries to receive services (other than in emergency circumstances) only from efficient and cost-effective providers or practitioners. The purpose of these regulations is to provide States with increased flexibility in administering their Medicaid programs, in order that they may increase the efficiency and effectiveness of the delivery of health care services, and reduce their costs.

78 FR 31584 - Notice of Proposed Amendment to Prohibited Transaction Exemption 80-26 (PTE 80-26) For Certain...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-24

...This document contains a notice of pendency before the Department of Labor (the Department) of a proposed amendment to PTE 80- 26. PTE 80-26 is a class exemption that permits parties in interest with respect to employee benefit plans to make certain interest free loans and extensions of credit to such plans, provided the conditions of the exemption are met. The proposed amendment, if adopted, would give retroactive and temporary exemptive relief for certain guarantees of the payment of debits to plan investment accounts (including IRAs) by parties in interest to such plans as well as certain loans and loan repayments made pursuant to such guarantees. The proposed amendment would affect employee benefit plans described in section 3(3) of the Employee Retirement Income Security Act of 1974, as amended (ERISA or the Act), and plans described in section 4975(e)(1) of the Internal Revenue Code of 1986, as amended (the Code), the participants and beneficiaries of such plans, and parties in interest with respect to those plans engaging in the described transactions.

Cross-Sectional Analysis of Per Capita Supply of Doctors of Chiropractic and Opioid Use in Younger Medicare Beneficiaries.

PubMed

Weeks, William B; Goertz, Christine M

2016-05-01

The purpose of this study was to determine whether the per-capita supply of doctors of chiropractic (DCs) or Medicare spending on chiropractic care was associated with opioid use among younger, disabled Medicare beneficiaries. Using 2011 data, at the hospital referral region level, we correlated the per-capita supply of DCs and spending on chiropractic manipulative therapy (CMT) with several measures of per-capita opioid use by younger, disabled Medicare beneficiaries. Per-capita supply of DCs and spending on CMT were strongly inversely correlated with the percentage of younger Medicare beneficiaries who had at least 1, as well as with 6 or more, opioid prescription fills. Neither measure was correlated with mean daily morphine equivalents per opioid user or per chronic opioid user. A higher per-capita supply of DCs and Medicare spending on CMT were inversely associated with younger, disabled Medicare beneficiaries obtaining an opioid prescription. However, neither measure was associated with opioid dosage among patients who obtained opioid prescriptions. Copyright © 2016. Published by Elsevier Inc.

The Effect of Benefits, Premiums, and Health Risk on Health Plan Choice in the Medicare Program

PubMed Central

Atherly, Adam; Dowd, Bryan E; Feldman, Roger

2004-01-01

Objective To estimate the effect of Medicare+Choice (M+C) plan premiums and benefits and individual beneficiary characteristics on the probability of enrollment in a Medicare+Choice plan. Data Source Individual data from the Medicare Current Beneficiary Survey were combined with plan-level data from Medicare Compare. Study Design Health plan choices, including the Medicare+Choice/Fee-for-Service decision and the choice of plan within the M+C sector, were modeled using limited information maximum likelihood nested logit. Principal Findings Premiums have a significant effect on plan selection, with an estimated out-of-pocket premium elasticity of −0.134 and an insurer-perspective elasticity of −4.57. Beneficiaries are responsive to plan characteristics, with prescription drug benefits having the largest marginal effect. Sicker beneficiaries were more likely to choose plans with drug benefits and diabetics were more likely to pick plans with vision coverage. Conclusions Plan characteristics significantly impact beneficiaries' decisions to enroll in Medicare M+C plans and individuals sort themselves systematically into plans based on individual characteristics. PMID:15230931

Supplemental Coverage Associated With More Rapid Spending Growth For Medicare Beneficiaries

PubMed Central

Golberstein, Ezra; Walsh, Kayo; He, Yulei; Chernew, Michael E.

2013-01-01

Lowering both Medicare spending and the rate of Medicare spending growth is important for the nation’s fiscal health. Policy makers in search of ways to achieve these reductions have looked at the role that supplemental coverage for Medicare beneficiaries plays in Medicare spending. Supplemental coverage makes health care more affordable for beneficiaries but also makes beneficiaries insensitive to the cost of their care, thereby increasing the demand for care. Ours is the first empirical study to investigate whether supplemental Medicare coverage is associated with higher rates of spending growth over time. We found that supplemental insurance coverage was associated with significantly higher rates of overall spending growth. Specifically, employer-sponsored and self-purchased supplemental coverage were associated with annual total spending growth rates of 7.17 percent and 7.18 percent, respectively, compared to 6.08 percent annual growth for beneficiaries without supplemental coverage. Results for Medicare program spending were more equivocal, however. Our results are consistent with the belief that current trends away from generous employer-sponsored supplemental coverage and efforts to restrict the generosity of supplemental coverage may slow spending growth. PMID:23650320

42 CFR 433.37 - Reporting provider payments to Internal Revenue Service.

Code of Federal Regulations, 2010 CFR

2010-10-01

... identification of providers by— (1) Social security number if— (i) The provider is in solo practice; or (ii) The... security number or employer identification number. ... identification number for all other providers. (c) Compliance with section 6041 of the Internal Revenue Code. The...

Factors Affecting Differences in Medicare Reimbursements for Physicians' Services

PubMed Central

Gornick, Marian; Newton, Marilyn; Hackerman, Carl

1980-01-01

Under Medicare's Part B program, wide variations are found in average reimbursements for physicians' services by demographic and geographic characteristics of the beneficiaries. Average reimbursements per beneficiary enrolled In the program depend upon the percentage of enrolled persons who exceed the deductible and receive reimbursements, the average allowed charge per service, and the number of services used. This study analyzes differences in average reimbursements per beneficiary for physicians' services In 1975 and discusses allowed charges and use factors that affect average reimbursements. Differences in the level of allowed charges and their impact on meeting the annual deductible are also discussed. The study indicates that average reimbursements per beneficiary are likely to continue to vary significantly year after year under the present Part B cost-sharing and reimbursement mechanisms. PMID:10309221

38 CFR 17.106 - VA response to disruptive behavior of patients.

Code of Federal Regulations, 2011 CFR

2011-07-01

... AFFAIRS MEDICAL Disciplinary Control of Beneficiaries Receiving Hospital, Domiciliary Or Nursing Home Care... heading “Disciplinary Control of Beneficiaries Receiving Hospital, Domiciliary or Nursing Home Care...

27 CFR 555.109 - Identification of explosive materials.

Code of Federal Regulations, 2010 CFR

2010-04-01

.... (5) If licensed manufacturers or licensed importers desire to use a coding system and omit printed... this section, they must file with ATF a letterhead application displaying the coding that they plan to... proposed coding can be used. (d) Exceptions—(1) Blasting caps. Licensed manufacturers or licensed importers...

Opening a dialog: communicating with retirees about Medicare+Choice.

PubMed

Maeyer, M M; Marlowe, J F

1999-01-01

In October 1998, the Health Care Financing Administration sent information to 38 million Medicare beneficiaries in five pilot states, consisting of a comprehensive handbook entitled Medicare and You. The purpose of the handbook is to clarify new options under Medicare+Choice to participants. Such clarification is bound to initiate contact by Medicare beneficiaries to former employers/unions. This article addresses employers' need to develop a communication strategy for beneficiaries and suggests a methodology and possible questions that may arise.