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349 results on '"Regenbogen, Scott E."'

8. Impact of Medicare eligibility on informal caregiving for surgery and stroke

Author

Roo, Ana C. De, Ha, Jinkyung, Regenbogen, Scott E., and Hoffman, Geoffrey J.

Subjects
Medical research, Medicine, Experimental, Medicare -- Research, Caregivers -- Research, Postoperative care -- Research, Business, Health care industry
Abstract

Objective: To assess whether the intensity of family and friend care changes after older individuals enroll in Medicare at age 65. Data Sources: Health and Retirement Study survey data (1998-2018). Study Design: We compared informal care received by patients hospitalized for stroke, heart surgery, or joint surgery and who were stratified into propensityweighted pre- and post-Medicare eligibility cohorts. A regression discontinuity design compared the self-reported likelihood of any care receipt, weekly hours of overall informal care, and intensity of informal care (hours among those receiving any care) at Medicare eligibility. Data Collection: Not applicable. Principal Findings: A total of 2270 individuals were included; 1674 (73.7%) stroke, 240 (10.6%) heart surgery, and 356 (15.7%) joint surgery patients. Mean (SD) care received was 20.0 (42.1) weekly hours. Of the 1214 (53.5%) patients who received informal care, the mean (SD) care receipt was 37.4 (51.7) weekly hours. Mean (SD) overall weekly care received was 23.4 (45.5), 13.9 (35.8), and 7.8 (21.6) for stroke, heart surgery, and joint surgery patients, respectively. The onset of Medicare eligibility was associated with a 13.6 percentage-point decrease in the probability of informal care received for stroke patients (p = 0.003) but not in the other acute care cohorts. Men had a 16.8 percentage-point decrease (p = 0.002) in the probability of any care receipt. Conclusions: Medicare coverage was associated with a substantial decrease in family and friend caregiving use for stroke patients. Informal care may substitute for rather than complement restorative care, given that Medicare is known to expand the use of postacute care. The observed spillover effect of Medicare coverage on informal caregiving has implications for patient function and caregiver burden and should be considered in episode-based reimbursement models that alter professional rehabilitative care intensity. KEYWORDS caregiving, discontinuity, Medicare, stroke, surgery What is known * Family and friend care is received by millions of older Americans * Medicare spends $124 billion on surgical care, $30 billion on stroke care, and is known to increase the use of postacute services for new enrollees * Informal care can substitute for maintenance and well-being assistance requiring less skilled support What this study adds * Older Medicare beneficiaries receive substantial family and friend caregiving after acute health events * Medicare eligibility is associated with decreased informal caregiving use for those who experience a stroke * Ongoing restorative services for stroke patients may decrease the need for complementary support from family and friends, 1 | INTRODUCTION Each year, Medicare spends approximately $124 billion on surgical care, $30 billion on stroke care, and $60 billion on posthospital care. (1-4) It is well recognized that [...]

Published
2023
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14. Hospital Strategies in Commercial Episode-Based Reimbursement.

Author

Regenbogen, Scott E., Cocroft, Shelytia, Krein, Sarah L., and Thompson, Michael P.

Subjects
*HEALTH insurance reimbursement, *QUALITATIVE research, *INTERPROFESSIONAL relations, *COST analysis, *INTERVIEWING, *LEADERSHIP, *HEALTH insurance, *JUDGMENT sampling, *THEMATIC analysis, *RESEARCH methodology, *HOSPITAL health promotion programs, *QUALITY assurance
Abstract

OBJECTIVES: To understand hospitals' approaches to spending reduction in commercial episode-based payment programs and inform incentive design. STUDY DESIGN: Qualitative arm of an explanatory sequential mixed-methods study involving semistructured interviews with hospital leaders participating in a statewide quality improvement collaborative with novel episode-based incentive payments introduced by the state's largest commercial payer. METHODS: We recruited 21 leaders from 8 purposively selected, diverse hospitals with both high and low performance. Video teleconference--based interviews followed a standardized protocol and addressed 4 domains: choice of clinical condition for evaluation, strategies for episode spending reduction, best practices for success in earning incentives, and barriers to achievement. Rapid qualitative analysis with purposeful data reduction was employed to generate a matrix of key themes within the study domains. RESULTS: Strategies were similar between high- and low-performing hospitals. When selecting conditions, some hospitals focused on areas of underperformance, aiming for improvement opportunities, whereas others chose conditions already achieving highest efficiency. Many tried to synergize with other ongoing improvement initiatives and clinical areas with established leaders and champions. Key strategies included data-driven improvement, care standardization, and protocol dissemination. Best practices for success included readmission prevention and postacute care spending containment. CONCLUSIONS: The findings highlighted hospitals' most common strategies and approaches, providing several insights into optimal design of commercial episode-based incentives: They must be lucrative enough to earn attention or consistent with larger federal programs; hospitals need opportunities to succeed through both improved performance and sustained excellence; and programs may incur malalignment between hospitals and credentialed physicians. [ABSTRACT FROM AUTHOR]

Published
2024
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48. Impact of Medicare eligibility on informal caregiving for surgery and stroke.

Author

De Roo, Ana C., Ha, Jinkyung, Regenbogen, Scott E., and Hoffman, Geoffrey J.

Subjects
STROKE, REGRESSION discontinuity design, MEDICARE, OLDER people, BURDEN of care
Abstract

Objective: To assess whether the intensity of family and friend care changes after older individuals enroll in Medicare at age 65. Data Sources: Health and Retirement Study survey data (1998–2018). Study Design: We compared informal care received by patients hospitalized for stroke, heart surgery, or joint surgery and who were stratified into propensity‐weighted pre‐ and post‐Medicare eligibility cohorts. A regression discontinuity design compared the self‐reported likelihood of any care receipt, weekly hours of overall informal care, and intensity of informal care (hours among those receiving any care) at Medicare eligibility. Data Collection: Not applicable. Principal Findings: A total of 2270 individuals were included; 1674 (73.7%) stroke, 240 (10.6%) heart surgery, and 356 (15.7%) joint surgery patients. Mean (SD) care received was 20.0 (42.1) weekly hours. Of the 1214 (53.5%) patients who received informal care, the mean (SD) care receipt was 37.4 (51.7) weekly hours. Mean (SD) overall weekly care received was 23.4 (45.5), 13.9 (35.8), and 7.8 (21.6) for stroke, heart surgery, and joint surgery patients, respectively. The onset of Medicare eligibility was associated with a 13.6 percentage‐point decrease in the probability of informal care received for stroke patients (p = 0.003) but not in the other acute care cohorts. Men had a 16.8 percentage‐point decrease (p = 0.002) in the probability of any care receipt. Conclusions: Medicare coverage was associated with a substantial decrease in family and friend caregiving use for stroke patients. Informal care may substitute for rather than complement restorative care, given that Medicare is known to expand the use of postacute care. The observed spillover effect of Medicare coverage on informal caregiving has implications for patient function and caregiver burden and should be considered in episode‐based reimbursement models that alter professional rehabilitative care intensity. [ABSTRACT FROM AUTHOR]

Published
2023
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