Medicare Eligibility, Enrollment, and Coverage

Scala-Foley, Marisa A.; Caruso, Judith T.; Ramos, Ruchel; Reinhard, Susan C.

doi:10.1097/00000446-200402000-00028

Cited by 2 publications

(4 citation statements)

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“…Medicare is a federally funded insurance program that covers legal residents in the United States aged ≥65 years and individuals with certain disabilities. 15 The Medicare claims data contain information on demographics, enrollment start and end dates, dispensed medications and performed procedures, and medical diagnoses.…”

Section: Methodsmentioning

confidence: 99%

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Patient Characteristics Associated With Using Transcatheter Left Atrial Appendage Occlusion Versus Oral Anticoagulants for Atrial Fibrillation

Lin,

Singer,

Avorn

et al. 2024

Circ: Cardiovascular Quality and Outcomes

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BACKGROUND: Transcatheter left atrial appendage occlusion (LAAO) is an alternative to oral anticoagulants (OACs) for stroke prevention in patients with atrial fibrillation, but the predictors of LAAO use in routine care are unclear. We aimed to assess the utilization trends of LAAO and compare the change in characteristics of LAAO users versus OACs since its marketing. METHODS: Using the US Medicare claims database (March 15, 2015, to December 31, 2020), we identified patients with atrial fibrillation, ≥65 years, and CHA 2 DS 2 -VASc score ≥2 (men) or ≥3 (women), with either first implantation of an LAAO device or initiation of OACs, including apixaban, dabigatran, rivaroxaban, edoxaban, or warfarin. Patient characteristics, measured 365 days before the first LAAO or OAC use date, were compared using logistic regression. RESULTS: There were 30 058 LAAO recipients (mean age, 77.74 years; female, 42.1%) and 792 600 OAC initiators (mean age, 78.48; female, 53.3%). In 2020, patients had higher odds of initiating LAAO use than in 2015 (0.52 versus 9.32%; adjusted odds ratio [aOR], 13.64 [95% CI, 12.56–14.81]). Old age (ie, >85 versus 65–75 years; aOR, 0.84 [95% CI, 0.80–0.88]), female sex (aOR, 0.74 [95% CI, 0.71–0.76]), Black race (aOR, 0.63 [95% CI, 0.58–0.68]) versus White race, and Medicaid eligibility (aOR, 0.61 [95% CI, 0.58–0.64]) were associated with lower odds of receiving LAAO. Among clinical characteristics, frailty, cancer, fractures, and venous thromboembolism were associated with lower odds of LAAO use, while history of intracranial and extracranial bleeding, coagulopathy, and falls were associated with higher odds of receiving LAAO. CONCLUSIONS: Among patients with atrial fibrillation receiving stroke-preventive therapy, LAAO use increased rapidly from 2015 to 2020 and was positively associated with the risk factors for OAC complications but negatively associated with old age, advanced frailty, and cancer. Black race and female sex were associated with a lower likelihood of receiving LAAO.

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Section: Methodsmentioning

confidence: 99%

“…WHAT THE STUDY ADDS against the clinical measurement of frailty parameters [21][22][23][24] Based on the literature, we used claims-based frailty index <0. 15 to define older adults as robust, 0.15-0.24 as prefrail, 0.25-0.34 as mildly frail, and ≥0.35 as moderate-to-severely frail. [21][22][23][24]…”

Section: What Is Knownmentioning

confidence: 99%

Patient Characteristics Associated With Using Transcatheter Left Atrial Appendage Occlusion Versus Oral Anticoagulants for Atrial Fibrillation

Lin,

Singer,

Avorn

et al. 2024

Circ: Cardiovascular Quality and Outcomes

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“…The EHR data were linked longitudinally with Medicare fee‐for‐service (FFS) administrative claims data and the linkage spanned from January 1, 2007, to December 31, 2017. Medicare FFS is a federally funded insurance program that covers legal residents in the United States aged 65 years and older and individuals with certain disabilities 7 . For the MA EHR‐Medicaid cohort, we used EHR data from the same network as the MA EHR‐Medicare cohort, but the EHR data were linked longitudinally with Medicaid administrative claims data and the linkage spanned from January 1, 2007, to December 31, 2014.…”

Section: Methodsmentioning

confidence: 99%

“…Medicare FFS is a federally funded insurance program that covers legal residents in the United States aged 65 years and older and individuals with certain disabilities. 7 For the MA EHR-Medicaid cohort, we used EHR data from the same network as the MA EHR-Medicare cohort, but the EHR data were linked longitudinally with Medicaid administrative claims data and the linkage spanned from January 1, 2007, to December 31, 2014. Medicaid is a joint federal and state program designed for low to moderate income legal residents in the United States without a specific age requirement.…”

Section: Data Sourcementioning

confidence: 99%

Comparison of EHR Data‐Completeness in Patients with Different Types of Medical Insurance Coverage in the United States

Anand,

Zhang,

Merola

et al. 2023

Clin Pharma and Therapeutics

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Prior studies have demonstrated that misclassification of study variables due to electronic health record (EHR)‐discontinuity can be mitigated by restricting EHR‐based analyses to subjects with high predicted EHR‐continuity based on a simple algorithm. In this study, we compared EHR continuity in populations covered by Medicare, Medicaid, or commercial insurance.Using claims linked EHRs from a multi‐center network in Massachusetts, including Medicare (MA EHR‐Medicare cohort) and Medicaid (MA EHR‐Medicaid cohort) claims data; and TriNetX (TriNetX cohort) claims linked EHR data from 11 US based healthcare organizations, we assessed (1) EHR‐continuity quantified by proportion of encounters captured by EHR (capture proportion, CP); (2) area under receiver operating curve (AUROC) of previously validated model to identify patients with high EHR‐continuity (CP>0.6); (3) misclassification of 40 patient characteristics, quantified by average standardized absolute mean difference (ASAMD). Study participants were ≥65 years (Medicare) or ≥18 years (Medicaid, TriNetX) with ≥365 days of continuous insurance enrollment overlapping with an EHR encounter. We found that the mean CP was 0.30, 0.18 and 0.19 and AUROC of the prediction model to identify patients with high EHR‐continuity was 0.92, 0.89 and 0.77 in the MA EHR‐Medicare, MA EHR‐Medicaid and TriNetX cohorts, respectively. Restricting to patients with predicted EHR‐continuity percentile of top 20%, 50%, and 50% in MA EHR‐Medicare, MA EHR‐Medicaid, and TriNetX cohorts resulted in acceptable levels of misclassification (ASAMD <0.1). Using a prediction model to identify cohorts with high EHR‐continuity can improve validity, but cut‐offs to achieve this goal vary by populations.

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Medicare Eligibility, Enrollment, and Coverage

Cited by 2 publications

References 0 publications

Patient Characteristics Associated With Using Transcatheter Left Atrial Appendage Occlusion Versus Oral Anticoagulants for Atrial Fibrillation

Patient Characteristics Associated With Using Transcatheter Left Atrial Appendage Occlusion Versus Oral Anticoagulants for Atrial Fibrillation

Comparison of EHR Data‐Completeness in Patients with Different Types of Medical Insurance Coverage in the United States

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