Regional associations between medicare advantage penetration and administrative claims-based measures of hospital outcomes

Medical Care

Volumn 50, Issue 5, 2012, Pages 406-409

  Kulkarni, Vivek T ^a   Shah, Sachin J ^b   Bernheim, Susannah M ^c   Wang, Yongfei ^a,c   Normand, Sharon Lise T ^d,e   Han, Lein F ^f   Rapp, Michael T ^f,g   Drye, Elizabeth E ^a,c   Krumholz, Harlan M ^a,c,h  

^a YALE UNIVERSITY SCHOOL OF MEDICINE   (United States)

^b MASSACHUSETTS GENERAL HOSPITAL   (United States)

^c YALE NEW HAVEN HOSPITAL   (United States)

^d HARVARD MEDICAL SCHOOL   (United States)

^e HARVARD SCHOOL OF PUBLIC HEALTH   (United States)

^f CENTERS FOR MEDICARE AND MEDICAID SERVICES   (United States)

^g GEORGE WASHINGTON UNIVERSITY SCHOOL OF MEDICINE AND HEALTH SCIENCES   (United States)

^h Robert Wood Johnson Clinical Scholars Program   (United States)

Author keywords

heart failure; Medicare; mortality; outcomes assessment; pneumonia; readmissions; risk adjustment; Words: acute MI

Indexed keywords

ACUTE HEART INFARCTION; ARTICLE; BILLING AND CLAIMS; CONTROLLED STUDY; HEALTH INSURANCE; HEALTH SERVICE; HEART FAILURE; HOSPITAL; HOSPITAL READMISSION; HUMAN; LINEAR REGRESSION ANALYSIS; MEDICAID; MEDICAL FEE; MEDICARE; OUTCOME ASSESSMENT; PNEUMONIA; POPULATION RISK; PRIORITY JOURNAL; RETROSPECTIVE STUDY; STANDARDIZED MORTALITY RATIO;

FEE-FOR-SERVICE PLANS; HEART FAILURE; HOSPITAL MORTALITY; HOSPITALS; HUMANS; INSURANCE CLAIM REVIEW; MEDICARE PART C; MYOCARDIAL INFARCTION; OUTCOME ASSESSMENT (HEALTH CARE); PATIENT READMISSION; PNEUMONIA; QUALITY INDICATORS, HEALTH CARE; RESIDENCE CHARACTERISTICS; RETROSPECTIVE STUDIES; RISK FACTORS; UNITED STATES;

EID: 84862823368     PISSN: 00257079     EISSN: 15371948     Source Type: Journal    
DOI: 10.1097/MLR.0b013e318245a0f9     Document Type: Article

References (18)

1. Krumholz HM, Wang Y, Mattera JA, et al. An administrative claims model suitable for profiling hospital performance based on 30-day mortality rates among patients with acute myocardial infarction. Circulation. 2006;113:1683-1692.
2. Keenan PS, Normand SL, Lin Z, et al. An administrative claims measure suitable for profiling hospital performance on the basis of 30-day all-cause readmission rates among patients with heart failure. Circ Cardiovasc Qual Outcomes. 2008;1:29-37.
3. United States Government Printing Office. Public Law 111-148-Patient Protection and Affordable Care Act. United States Government Printing Office, 2010. Available at: http://www.gpo.gov/fdsys/pkg/PLAW-111 publ148/pdf/PLAW- 111publ148.pdf. Accessed June 29, 2010.
4. Gold M, Phelps D, Jacobson G, et al. Medicare Advantage 2010 Data Spotlight: Plan Enrollment Patterns and Trends [Henry J. Kaiser Family Foundation web site]. June 22, 2010. Available at: http://www.kff.org/medicare/ upload/8080.pdf. Accessed June 29, 2010.
5. Friedman B, Jiang HJ, Russo CA. Medicare Hospital Stays: Comparisons between the Fee-for-Service Plan and Alternative Plans, 2006. HCUP Statistical Brief #66. January 2009. Agency for Healthcare Research and Quality, Rockville, MD. Available at: http://www.hcup-us. ahrq.gov/reports/statbriefs/sb66.pdf. Accessed June 29, 2010.
6. US Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Professions. Area Resource File (ARF). Rockville, MD: US Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Professions; 2007-2008.
7. Lindenauer PK, Bernheim SM, Grady JN, et al. The performance of US hospitals as reflected in risk-standardized 30-day mortality and readmission rates for Medicare beneficiaries with pneumonia. J Hosp Med. 2010;5:E12-E18.
8. Krumholz HM, Zhenqiu L, Drye EE, et al. An administrative claims measure suitable for profiling hospital performance based on 30-day all cause readmission rates among patients with acute myocardial infarction. Circ Cardiovasc Qual Outcomes. 2011;4:243-252.
9. Krumholz HM,Wang Y, Mattera JA, et al. An administrative claims model suitable for profiling hospital performance based on 30-day mortality rates among patients with heart failure. Circulation. 2006;113:1693-1701.
10. Bratzler DW, Normand SL, Wang Y, et al. An administrative claims model for profiling hospital 30-day mortality rates for pneumonia patients. PLoS ONE. 2011;6:e17401.
11. Bernheim SM, Grady JN, Lin Z, et al. National patterns of riskstandardized mortality and readmission for acute myocardial infarction and heart failure. Update on publicly reported outcomes measures based on the 2010 release. Circ Cardiovasc Qual Outcomes. 2010;3:459-467.
12. The Dartmouth Institute for Health Policy and Clinical Practice. The Dartmouth Atlas of Health Care [database online]. Lebanon, NH: The Dartmouth Institute for Health Policy and Clinical Practice; 2010.
13. Nallamothu BK, Rogers MA, Chernew ME, et al. Opening of specialty cardiac hospitals and use of coronary revascularization in Medicare beneficiaries. JAMA. 2007;297:998-999.
14. Fisher ES, Wennberg JE, Stukel TA, et al. Associations among hospital capacity, utilization, and mortality of US Medicare beneficiaries, controlling for sociodemographic factors. Health Serv Res. 2000;34: 1351-1362. (Pubitemid 30075414)
15. Skinner J, Weinstein J, Sporer SM, et al. Racial, ethnic, and geographic disparities in rates of knee arthroplasty among Medicare patients. N Engl J Med. 2003;349:1350-1359. (Pubitemid 37186214)
16. United States Census Bureau. Census 2000 Summary File 100-Percent Data [computer file]. Washington, DC: United States Census Bureau. Available at: http://factfinder.census.gov/servlet/MetadataBrowserServ let?type = dataset&id = DEC-2000-SF1-U&-lang = en. Accessed June 29, 2010; 2000.
17. The Dartmouth Institute for Health Policy and Clinical Practice. HRR Geographic Boundary File [computer file]. Lebanon, NH: The Dartmouth Institute for Health Policy and Clinical Practice. Available at: http://www. dartmouthatlas.org/downloads/geography/hrr-bdry.zip. Accessed June 29, 2010; 2010.
18. The Annual Survey of Hospitals Database: Documentation for 2008 Data. Chicago: American Hospital Association; 2008.