Association of Medicaid Eligibility With Surgical Readmission Among Medicare Beneficiaries

Cher, Benjamin A Y; Ryan, Andrew M.; Hoffman, Geoffrey J.; Sheetz, Kyle H.

doi:10.1001/jamanetworkopen.2020.7426

Cited by 12 publications

(12 citation statements)

References 24 publications

(107 reference statements)

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“…In general surgery populations, adjusting for DCI was associated with improved performance of the American College of Surgeons National Surgical Quality Improvement Program risk calculator, which is composed solely of clinical and demographic factors. 4,5 Notably, the application of the cost element of scoring was deferred in the first year of MIPS. An early analysis of the Comprehensive Joint Replacement program, a pilot of surgical bundled payment, demonstrated that cost savings were primarily achieved through reduced use of posthospital care, services that patients with low socioeconomic status required more frequently.…”

Section: Conflict Ofmentioning

confidence: 99%

Evaluation of the Merit-Based Incentive Payment System and Surgeons Caring for Patients at High Social Risk

Byrd

Chung

2021

JAMA Surg

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eaching hospitals, safety-net hospitals, and large hospitals are most likely to receive penalties under the Medicare Hospital Readmissions Reduction Program. 1 However, research suggests that adjusting for patients with low incomes would decrease the penalty for half of the analyzed hospitals. 2 This situation will persist in value-based payment initiatives if appropriate risk adjustment is not incorporated. After implementation of the US Centers for Medicare & Medicaid Services (CMS) value-based program, the Merit-Based Payment System (MIPS), a national survey of internal medicine physicians found that only 8% of physicians were familiar with its measures and incentives. On clarification of the metrics, 60% of respondents felt that MIPS would encourage physicians to avoid certain disadvantaged patients to improve metrics. 3 To date, few studies focus on the value-based care systems and surgeons and surgical patients. 4,5 Implementation of value-based care measures in the absence of adjustment for social risk has the potential to unfairly penalize surgeons serving populations at high social risk. Of 510 000 clinicians participating in the first year of MIPS implementation, those with patient caseloads in the highest quintile of social risk had a lower MIPS performance score than those in the lowest social risk quintile. 6 The MIPS scores can range from 0 to 100. For the first year, a score of less than 3 led to negative payment adjustment; a score of greater than 3 but less than 70 to a posi-IMPORTANCE The latest step in the Centers for Medicaid & Medicare transformation to pay-for-value is the Medicare Merit-Based Incentive Payment System (MIPS). Value-based payment designs often do not account for uncaptured clinical status and social determinants of health in patients at high social risk, and the consequences for clinicians and patients associated with their use have not been explored. OBJECTIVE To evaluate MIPS scoring of surgeons caring for patients at high social risk to determine whether this implementation threatens disadvantaged patients' access to surgical care. DESIGN, SETTING, AND PARTICIPANTSA retrospective cohort study of US general surgeons participating in MIPS during its first year in outpatient surgical practices across the US and territories.

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Section: Conflict Ofmentioning

confidence: 99%

Evaluation of the Merit-Based Incentive Payment System and Surgeons Caring for Patients at High Social Risk

Byrd

Chung

2021

JAMA Surg

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“…12 Our results are consistent with previous research that has shown poorer outcomes in DE patients. [7][8][9][10][11] Higher rates of complications and nonhome discharge have important implications for DE patients undergoing cancer treatment because previous research has shown these are risk factors for delayed chemotherapy and worse survival. [32][33][34] However, our analysis builds on these findings by examining the role of hos-pital quality in mitigating these disparities.…”

Section: Discussionmentioning

confidence: 99%

Association of Dual Medicare and Medicaid Eligibility With Outcomes and Spending for Cancer Surgery in High-Quality Hospitals

et al. 2022

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IMPORTANCEAlthough dual eligibility (DE) status for Medicare and Medicaid has been used for social risk stratification in value-based payment programs, little is known about the interplay between hospital quality and disparities in outcomes and spending by social risk. OBJECTIVE To assess whether treatment at high-quality hospitals mitigates DE-associated disparities in outcomes and spending for cancer surgery.

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“…Although the direct cause of the association between primary JAMA Network Open | Surgery payer and risk of PPR cannot be ascertained using this data source, previous studies have shown that government-provided insurance through Medicare or Medicaid and lower socioeconomic status are markers of clinical risk but also of poorer access to primary care relative to those with private insurance. 6,[15][16][17][18][19][20] Future work must separate the association of increased clinical risk from the direct association of access to care and medical management with various insurance types. Together, our findings suggest that PPRs after surgery represent a significant burden to the US health care system and that interventions to improve PPR rates may be targeted to patients with significant underlying comorbidities as well as those undergoing high-risk operations.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Potentially Preventable Hospital Readmissions After Major Surgery and Association With Public vs Private Health Insurance and Comorbidities

et al. 2021

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IMPORTANCE Rehospitalization after major surgery is common and represents a significant cost to the health care system. Little is known regarding the causes of these readmissions and the degree to which they may be preventable.OBJECTIVE To evaluate the degree to which readmissions after major surgery are potentially preventable. DESIGN, SETTING, AND PARTICIPANTSThis retrospective cohort study used a weighted sample of 1 937 354 patients from the 2017 National Readmissions Database to evaluate all adult inpatient hospitalizations for 1 of 7 common major surgical procedures. Statistical analysis was performed from January 14 to November 30, 2020. MAIN OUTCOMES AND MEASURESThe study calculated 90-day readmission rates as well as rates of readmissions that were considered potentially preventable. Potentially preventable readmissions (PPRs) were defined as those with a primary diagnosis code for superficial surgical site infection, acute kidney injury, aspiration pneumonitis, or any of the Agency for Healthcare Research and Quality-defined ambulatory care sensitive conditions. Multivariable logistic regression was used to identify factors associated with PPRs. RESULTSA total weighted sample of 1 937 354 patients (1 048 046 women [54.1%]; mean age, 66.1 years [95% CI, 66.0-66.3 years]) underwent surgical procedures; 164 755 (8.5%) experienced a readmission within 90 days. Potentially preventable readmissions accounted for 29 321 (17.8%) of all 90-day readmissions, for an estimated total cost to the US health care system of approximately $296million. The most common reasons for PPRs were congestive heart failure exacerbation (34.6%), pneumonia (12.0%), and acute kidney injury (22.5%). In a multivariable model of adults aged 18 to 64 years, patients with public health insurance (Medicare or Medicaid) had more than twice the odds of PPR compared with those with private insurance (adjusted odds ratio, 2.09; 95% CI, 1.94-2.25).Among patients aged 65 years or older, patients with private insured had 18% lower odds of PPR compared with patients with Medicare as the primary payer (adjusted odds ratio, 0.82; 95% CI, 0.74-0.90). CONCLUSIONS AND RELEVANCEThis study suggests that nearly 1 in 5 readmissions after surgery are potentially preventable and account for nearly $300 million in costs. In addition to better inpatient care, improved access to ambulatory care may represent an opportunity to reduce costly readmissions among surgical patients.

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Association of Medicaid Eligibility With Surgical Readmission Among Medicare Beneficiaries

Cited by 12 publications

References 24 publications

Evaluation of the Merit-Based Incentive Payment System and Surgeons Caring for Patients at High Social Risk

Evaluation of the Merit-Based Incentive Payment System and Surgeons Caring for Patients at High Social Risk

Association of Dual Medicare and Medicaid Eligibility With Outcomes and Spending for Cancer Surgery in High-Quality Hospitals

Assessment of Potentially Preventable Hospital Readmissions After Major Surgery and Association With Public vs Private Health Insurance and Comorbidities

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