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THE SEVENTH STARMUS FESTIVAL took place May 12-17 in Bratislava, Slovakia, and was a smashing success all around. Starmus stands for stars and music, and this celebration has grown into [...]

Despite being the only female ruler of the Habsburg dominions for 40 years, between 1740 and 1780, Maria Theresa's skills and experience as a ruler did not extend to that [...]

Do you remember the first time you truly discovered the universe? When I was a teenager, many moons ago, I bought my first telescope, a Celestron 8. I remember excitedly [...]

WHETHER YOU REALIZE IT OR NOT, YOU'RE PART OF A REVOLUTION. Let me explain. In the past, ideas to interpret the nature of things developed slowly. Before there was astronomy, [...]

Terminally ill individuals often desire to benefit the people and institutions they love by means of actionable and effective tax planning, even in the final period of their life. These [...]

Objective: To test the reliability of Medicare claims in measuring vertical integration. We assess the accuracy of a commonly used measure of integration, primary care physician (PCP) practices billing Medicare as a hospital outpatient department (HOPD) in claims. Data Sources and Study Setting: Medicare fee-for-service claims, IQVIA, and CPC+ practice surveys for this study. Study Design: We compare measures of integration from Medicare claims to self-reported indicators of integration from IQVIA and a survey of CPC+ participating practice sites. Data Collection/Extraction Methods: We measure integration by using site-of-service billing in the 100% sample of Medicare Carrier claims from 2017-2020. In the IQVIA SK&A (2017-2018), OneKey (2019-2020), and practice survey data (2017-2019), we use self-reported responses to measure integration. Principal Findings: We find that currently most PCP practices sites that report themselves as being integrated with a health system do not bill as an HOPD. In 2017,11% of CPC+ practices were identified as being vertically integrated in claims, while the equivalent numbers in SK&A and surveys were 52% and 54% integration, respectively. A t-test found that both datasets significantly differed from claims (Survey: 41.3%-45.1%; SK&A: 45.3%-51.1%); this gap persists in 2018-2019. Conclusion: Measuring physician-hospital vertical integration accurately is integral to determining consolidation. The overwhelming majority of PCP practice sites not billing as an HOPD may reflect Medicare regulatory changes that have reduced the financial incentives for doing so. These findings have implications for researchers that study the growth in PCP-hospital integration in health care markets. KEYWORDS health care organizations and systems, hospitals, ownership/governance, 1 | INTRODUCTION Vertical integration is an increasingly common feature of American health care. (1-4) Most vertical integration involves hospitals acquiring, or otherwise establishing tight co-management of physician practices (5,6) [...]

Objective: To examine racial/ethnic differences in emergency department (ED) transfers to public hospitals and factors explaining these differences. Data Sources and Study Setting: ED and inpatient data from the Healthcare Cost and Utilization Project for Florida (2010-2019); American Hospital Association Annual Survey (2009-2018). Study Design: Logistic regression examined race/ethnicity and payer on the likelihood of transfer to a public hospital among transferred ED patients. The base model was controlled for patient and hospital characteristics and year fixed effects. Models II and III added urbanicity and hospital referral region (HRR), respectively. Model IV used hospital fixed effects, which compares patients within the same hospital. Models V and VI stratified Model IV by payer and condition, respectively. Conditions were classified as emergency care sensitive conditions (ECSCs), where transfer is protocolized, and non-ECSCs. We reported marginal effects at the means. Data Collection/Extraction Methods: We examined 1,265,588 adult ED patients transferred from 187 hospitals. Principal Findings: Black patients were more likely to be transferred to public hospitals compared with White patients in all models except ECSC patients within the same initial hospital (except trauma). Black patients were 0.5-1.3 percentage points (pp) more likely to be transferred to public hospitals than White patients in the same hospital with the same payer. In the base model, Hispanic patients were more likely to be transferred to public hospitals compared with White patients, but this difference reversed after controlling for HRR. Hispanic patients were - 0.6 pp to -1.2 pp less likely to be transferred to public hospitals than White patients in the same hospital with the same payer. Conclusions: Large population-level differences in whether ED patients of different races/ethnicities were transferred to public hospitals were largely explained by hospital market and the initial hospital, suggesting that they may play a larger role in explaining differences in transfer to public hospitals, compared with other external factors. KEYWORDS disparities, emergency departments, public hospital, race and ethnicity, transfers, 1 | INTRODUCTION Access to hospital-based emergency care is an important population health metric, (1) but it is not equitable. Emergency department (ED) capability and capacity vary geographically, (2-4) with [...]

As the training focus shifts from counterinsurgency (COIN) to large-scale combat operations (LSCO) in the near-peer strategic environment, a different set of dilemmas with legal implications will present themselves to [...]

In March 2014, Russian troops seized control of Crimea. (1) By May 2014, Russian-backed separatists in the eastern Donetsk and Luhansk regions of Ukraine had declared independence. (2) Shortly thereafter, [...]

CPAs are respected for their subject matter expertise and high ethical standards. In the past several years, however, the unethical behavior of some firm employees has led to increased public [...]

Innovation districts have emerged as a powerful force in the modern economy, fostering collaboration between businesses, research institutions and communities. These districts are defined as geographic areas where anchor university [...]

When physicists Lise Meitner and Otto Frisch discovered nuclear fission in December 1938, the possibility of an atomic weapon became a frightening reality. Scientists from several countries began work, seeking [...]

Objective: To describe common methodological problems that arise in comparisons of Medicare Advantage (MA) and Traditional Medicare (TM) and within-MA studies and provide suggestions of how researchers can address these issues. Study Setting: Published research evaluating Medicare coverage options in the United States. Study Design: We considered key conceptual challenges and promising solutions that have been used thus far and suggest additional directions. Data Collection: Not available. Principal Findings: Many existing studies of MA versus TM include significant limitations, such as failing to account for unobserved confounders driving both beneficiary coverage choice and health outcomes once enrolled, not accounting for variation in benefit generosity, provider networks, or plan design across MA plans, and/or having been conducted at a time when MA enrollment was less than a third of all Medicare beneficiaries. We provide a review of methods that can help researchers to overcome these weaknesses and suggest additional methods and data sources that may aid future research. Conclusions: The MA program is becoming an essential part of the US healthcare system. By accounting for non-random movement into and out of MA and studying the heterogeneity of beneficiary experience across plan and market characteristics, researchers can provide the high-quality evidence necessary for policymakers to design the program and reform TM in ways that maximize beneficiary outcomes. KEYWORDS insurance choice, Medicare, Medicare Advantage, study design What is known on this topic * When comparing outcomes across Medicare Advantage (MA) and Traditional Medicare (TM), researchers should be aware of several key challenges: non-random program participation, commonly known as selection effects; heterogeneity across plans within the MA program; varying coverage choices within TM; spillovers between the programs; and differential coding incentives. * However, many existing papers do not account for these challenges, limiting generalizability of findings. What this study adds * We describe the common conceptual challenges that researchers must confront when comparing Medicare coverage options and summarize methodological strategies that may help with these issues. * Designing studies that account for the issues raised in this paper will help researchers conduct rigorous evaluations of the MA program, providing important information to policymakers and Medicare beneficiaries about outcomes in MA versus TM., 1 | INTRODUCTION The Medicare Advantage (MA) program is rapidly growing, doubling in enrollment from 13 million beneficiaries in 2012 to 31 million beneficiaries in 2023, (1) with over half [...]

Enterprises that own multiple businesses often have a flawed approach to strategy: They focus too much on the makeup of their portfolios and too little on enhancing the businesses in them. Strategies for adding value to a corporation's businesses fall on a continuum. On one end the businesses in the portfolio are completely unrelated; at the other they have many similarities. Each place on the continuum requires a different kind of organizational structure and specific management processes to support it. To succeed at execution, you need to determine where on the spectrum your business falls and then align your portfolio selection, structure, and processes with your vision of how to add value. [ABSTRACT FROM AUTHOR]

I like to tell the joke that in about a hundred years from now we'll finally have flying cars, AI robots will be performing surgery, and we'll all still be [...]

Having established a strong Islamic foothold in the Iberian Peninsula, aspirations of territory and power north of the Pyrenees was perhaps a logical step to take. But the region between [...]

Objective: To assess the validity of race/ethnicity coding in Medicare data and whether misclassification errors lead to biased outcome reporting by race/ethnicity among Medicare Advantage beneficiaries. Data Sources and Study Setting: In this national study of Medicare Advantage beneficiaries, we analyzed individual-level data from the Health Outcomes Survey (HOS) and the Consumer Assessment of Healthcare Providers and Systems (CAHPS), race/ethnicity codes from the Medicare Master Beneficiary Summary File (MBSF), and outcomes from the Medicare Provider Analysis and Review (MedPAR) files from 2015 to 2017. Study Design: We used self-reported beneficiary race/ethnicity to validate the Medicare Enrollment Database (EDB) and Research Triangle Institute (RTI) race/ethnicity codes. We measured the sensitivity, specificity, and positive and negative predictive values of the Medicare EDB and RTI codes compared to self-report. For outcomes, we compared annualized hospital admission, 30-day, and 90-day readmission rates. Data Collection/Extraction Methods: Data for Medicare Advantage beneficiaries who completed either the HOS or CAHPS survey were linked to MBSF and MedPAR files. Validity was assessed for both self-reported multiracial and single-race beneficiaries. Principal Findings: For beneficiaries enrolled in Medicare Advantage, the EDB and RTI race/ethnicity codes have high validity for identifying non-Hispanic White or Black beneficiaries, but lower sensitivity for beneficiaries self-reported Hispanic any race (EDB: 28.3%, RTI: 85.9%) or non-Hispanic Asian American or Native Hawaiian Pacific Islander (EDB: 56.1%, RTI: 72.1%). Only 8.7% of beneficiaries self-reported non-Hispanic American Indian Alaska Native are correctly identified by either Medicare code, resulting in underreported annualized hospitalization rates (EDB: 31.5%, RTI: 31.6% vs. self-report: 34.6%). We find variation in 30-day readmission rates for Hispanic beneficiaries across race categories, which is not measured by Medicare race/ethnicity coding. Conclusions: Current Medicare race/ethnicity codes misclassify and bias outcomes for non-Hispanic AIAN beneficiaries, who are more likely to select multiple racial identities. Revisions to race/ethnicity categories are needed to better represent multiracial/ethnic identities among Medicare Advantage beneficiaries. KEYWORDS ethnicity, health inequities, Medicare, minority health, racial groups, validation study What is known on this topic * Previous validation studies of single-race beneficiaries show that Medicare race/ethnicity codes perform well at identifying non-Hispanic White and non-Hispanic Black beneficiaries. * However, Medicare race/ethnicity codes perform worse for beneficiaries identifying as Hispanic any race, non-Hispanic Asian American or Native Hawaiian Pacific Islander (AANHPI), or non-Hispanic American Indian and Alaska Native (AIAN). What this study adds * For Medicare Advantage, which enrolls a greater proportion of racial/ethnic minorities than traditional Medicare, we find that race/ethnicity codes correctly identify only 8.7% of non-Hispanic AIAN beneficiaries in our study. * Beneficiaries who self-report multiple race categories, including 85% of the non-Hispanic AIAN beneficiaries in our study, are more likely to be misclassified by and have underreported hospitalization and readmission outcomes. * Current Medicare race/ethnicity coding combines Hispanic ethnicity with race categories and exclude multiracial identity, which masks variation in hospital admission and readmission outcomes among self-reported Hispanic beneficiaries by race., 1 | INTRODUCTION Recent Centers for Medicare and Medicaid Services (CMS) initiatives on health equity have centered around goals to reduce disparities and inequities in health outcomes among racial and [...]

Introduction The cost of education has more than doubled in the 21st century. (1) The yearly average total cost at a private university for tuition, room, and board is about [...]

'If you want to keep alive in the jungle, you must live as the jungle does.' --John Wyndham Introduction Dense vegetation, limited visibility, thick canopy, and highly restricted mobility corridors [...]

Ambitious imperialist expansion saw the Russian Empire straddle continents to stake its claim in North America. For the emerging United States, it was a threat to the 'Manifest Destiny' of [...]

Over the centuries many 'predictions' have been born out of the imaginations of creative minds: from a single disaster to the apocalyptic elimination of mankind, a dystopian society that turns [...]

During the American Civil War, astronomy played a significant role. In 1863, President Abraham Lincoln visited the U.S. Naval Observatory to indulge his interest in astronomy and seek a reprieve from the war. The observatory was manned by a young astronomer named Asaph Hall, who would later discover the two moons of Mars. The war was also marked by celestial events, such as the appearance of the Great Comet of 1861 and an aurora after the Battle of Fredericksburg. Additionally, the accidental shooting of Confederate General Stonewall Jackson in the moonlight during the Battle of Chancellorsville was recently explained by astronomers. The era of the Civil War also witnessed the rise of astrophysics. [Extracted from the article]

For centuries Japan had looked inward rather than out into the wider world. There had been relative peace, and a way of life that enabled a thriving population to feel [...]

50 YEARS IN MID-SEPTEMBER 1982, I arrived at our little stone building at AstroMedia Corp. in Milwaukee for my first day of work. I had no idea what adventures awaited. [...]

On May 18, 2023, the AICPA Tax Executive Committee unanimously approved revisions to the AICPA's Statements on Standards for Tax Services (SSTSs). These revisions, the most significant updates since 2009, [...]

The world of the 15th century had become a powder keg of ideas, commerce, invention and renaissance in the arts. The old world was being left behind as a new, [...]

Explorers and settlers from Europe had been travelling to North America, intentionally or not, to seek refuge and new opportunities for centuries before the first colonies were established. The Vikings [...]

Objective: To inform efforts to improve equity in the quality of behavioral health care by examining income-related differences in performance on HEDIS behavioral health measures in Medicare Advantage (MA) plans. Data Sources and Study Setting: Reporting Year 2019 MA HEDIS data were obtained and analyzed. Study Design: Logistic regression models were used to estimate differences in performance related to enrollee income, adjusting for sex, age, and race-and-ethnicity. Low-income enrollees were identified by Dual Eligibility for Medicare and Medicaid or receipt of the Low-Income Subsidy (DE/LIS). Models without and with random effects for plans were used to estimate overall and within-plan differences in measure performance. Heterogeneity by race-and-ethnicity in the associations of low-income with behavioral health quality were examined using models with interaction terms. Data Collection/Extraction Methods: Data were included for all MA contracts in the 50 states and the District of Columbia that collect HEDIS data. Principal Findings: For six of the eight measures, enrollees with DE/LIS coverage were more likely to have behavioral health conditions that qualify for HEDIS measures than higher income enrollees. In mixed-effects logistic regression models, DE/LIS coverage was associated with statistically significantly worse overall performance on five measures, with four large (>5 percentage point) differences (-7.5 to -11.1 percentage points) related to follow-up after hospitalization and avoidance of drug-disease interactions. Where the differences were large, they were primarily within-plan rather than between-plan. Interactions between DE/LIS and race-and-ethnicity were statistically significant (p < 0.05) for all measures; income-based quality gaps were larger for White enrollees than for Black or Hispanic enrollees. Conclusions: Low income is associated with lower performance on behavioral health HEDIS measures in MA, but these associations differ across racial-and-ethnic groups. Improving care integration and addressing barriers to care for low-income enrollees may improve equity across income levels in behavioral health care. KEYWORDS health care disparities, managed care organizations, Medicare, mental health, quality of care What is known on this topic * Higher-quality behavioral healthcare is associated with positive health outcomes, including improved mental health status and reduced risk of hospitalization. * Patients with limited income and resources face numerous barriers that can contribute to poorer quality care. * Prior research has found that Black and Hispanic Medicare Advantage enrollees receive lower-quality behavioral healthcare than White enrollees, but differences related to income have yet to be examined. What this study adds * Overall performance was statistically significantly lower for low-income enrollees than for higher income enrollees for five of eight measures examined, with large differences of 7.5-11.1 percentage points for four measures, * Large differences in performance were found for measures of follow-up after hospitalization and avoidance of drug-disease interactions, implicating coordination of care across multiple providers. * Income-related differences in performance varied across racial/ethnic groups, with larger deficits in performance among White enrollees than among Black or Hispanic enrollees., 1 | INTRODUCTION The use of behavioral health treatment has increased steadily over time, (1) but significant challenges remain with respect to the quality of care that patients receive as [...]

Objective: To understand differences in financial performance, quality performance, supplemental benefits provision, and enrollee composition between integrated and non-integrated plans in the Medicare Advantage (MA) program. Data Sources: We used data from the Center for Medicare and Medicaid Services for 2015-2017. We included 156 integrated MA plans (31 unique contracts) and 2096 non-integrated MA plans (392 unique contracts). Study Design: We estimated linear probably models for financial performance, quality performance, supplemental benefits provision, and enrollee composition with state fixed effects and contract random effects. We adjusted for county-level market structure-related factors, cost-related factors, and demand-related factors. Our primary independent variable was an indicator of plan-provider integration. Principal Findings: Integrated MA plans were associated with $19.4 (95% CI: 9.2, 29.7) and $16.6 (95% CI: 10.3, 22.9) higher Part C and Part D monthly premiums, but were associated with higher star quality ratings. There were no significant differences in revenues and plan payments per enrollee between integrated and non-integrated MA plans. Integrated MA plans were associated with $40.5 (95% CI: -54.0, -26.9) lower non-claims costs than non-integrated MA plans. There was limited evidence that integrated MA plans provided more generous supplemental benefits than non-integrated MA plans. Enrollment rates in integrated MA plans were particularly low among socially marginalized groups (3.4 [95% CI: -5.9, -1.0], 4.7 [95% CI: -8.5, -0.9], and 4.4 [95% CI: -6.4, -2.4] percentage points lower among non-Hispanic Black, Medicare-Medicaid dual eligible, and the disabled). Conclusions: Our findings suggest that integrated MA plans may achieve higher efficiency and quality, but these benefits may not be experienced by all beneficiaries due to disparities in enrollment. As these models continue to spread, it is critical to develop policies to ensure that MA enrollees have equal access to integrated plans. KEYWORDS disparity, enrollee composition, financial performance, integration, Medicare Advantage, quality performance, supplemental benefits What is known on this topic * Around a fifth of Medicare Advantage plans are vertically integrated with health systems. * Prior research found that integrated MA plans are associated with higher premiums and quality. * However, less is known about their financial and clinical performance, supplemental benefits provision, and enrollee composition. What this study adds * We find that integrated plans were associated with $19.4 and $16.6 higher monthly premiums for Part C and D, but were also associated with higher star quality ratings. * While there were no differences in revenues and plan payments per enrollee, integrated plans were associated with $40.5 lower non-claims costs than non-integrated plans, suggesting operational efficiency. * Integrated plans did not necessarily provide more supplemental benefits than non-integrated plans, but enrollment rates in integrated plans were comparatively low among socially marginalized groups., 1 | INTRODUCTION In a competitive health care environment, health systems in the United States (US) are frequently looking for ways to align financial incentives and to improve efficiency. To [...]

In life, some people are blessed with tremendous athletic skills, some with artistic expertise, and some with business acumen. I'm blessed (or cursed) with the ability to smell BS a [...]

Working people had gathered enormous momentum by the early part of the 19th century. Cities and towns with their factories and mills devoured the landscape, with a huge volume of [...]

MEASURED by time's hourglass, Frank Herbert's Dune has already been adapted for the screen more frequently than any other science fiction classic, and the third go-round, even at the half-way [...]

Over centuries of war, betrayal, family infighting, and political manoeuvring, the Islamic stronghold on the doorstep of Christian Europe had gradually eroded. For almost 800 years the rich and refined [...]

Following the rise of Covid-19, the global nonwoven business now faces the challenge of managing the pandemic's decline. Hopefully gone are the discussions on face masks, quarantines, lockdowns, hospitalizations, respirators, [...]

WHAT IF Anne Rice's foundational novel Interview with the Vampire had never, never been published? That's one of the more audacious conceits of AMC's new series Anne Rice's Interview with [...]

As someone who has just moved to Arizona during the summertime, I'm getting to know the Sun pretty well these days. Although storms bubble up during this so-called monsoon season, [...]

One of the most exciting experiences for an amateur astronomer is when we get a new telescope or pair of binoculars and get a 'new view' of the universe. I [...]

Follow Dave on Facebook: facebook.com/davidjohneicher X (formerly Twitter): @deicherstar Instagram: eicher.david It's always an electric feeling standing under the Moon's shadow. A solar eclipse is a big-time astronomical event like [...]

Over my career, I've led remote teams at several companies even before the COVID-19 pandemic compelled many of us into working from home and onto Zoom or other videoconferencing software [...]

Politicians in any era of history often attract controversy, or even scandal, polarising the views of those around them. Alexander Hamilton was no exception; a man whose character, behaviour and [...]