Redaction of Substance Abuse Claims in Medicare Research Files Affects Spending Outcomes for Nearly One in Five Beneficiaries with Serious Mental Illness.

Abstract:

OBJECTIVE:To assess the impact of substance abuse claims redaction on Medicare spending estimates for beneficiaries with serious mental illness. DATA SOURCES:The 2012 claims and unredacted beneficiary-level Medicare spending totals from CMS's Chronic Conditions Warehouse. STUDY DESIGN:We identified beneficiaries with claims affected by the redaction by comparing claims-based spending estimates to unredacted spending totals. Differences in characteristics of beneficiaries with and without redacted claims were examined in bivariate analyses. PRINCIPAL FINDINGS:Claims-based spending totals differed from unredacted totals for 19.7 percent of the cohort. Part A spending for those with redacted claims was underreported by 57.0 percent. Characteristics of beneficiaries with and without redacted claims differed significantly. CONCLUSIONS:Researchers who rely on Medicare claims to analyze spending outcomes for beneficiaries with serious mental illness should be aware of the potential for bias due to nonrandom redaction of substance abuse data.

journal_name

Health Serv Res

journal_title

Health services research

authors

Roberto P,Brandt N,Onukwugha E,Stuart B

doi

10.1111/1475-6773.12528

subject

Has Abstract

pub_date

2017-06-01 00:00:00

pages

1239-1248

issue

3

eissn

0017-9124

issn

1475-6773

journal_volume

52

pub_type

杂志文章
  • Pay for Performance in Medicaid: Evidence from Three Natural Experiments.

    abstract:OBJECTIVE:To examine the impact of pay for performance in Medicaid on the quality and utilization of care. DATA SOURCES:Medicaid claims and encounter data in three intervention states (Pennsylvania, Minnesota, and Alabama) and three comparison states. STUDY DESIGN:Difference-in-difference analysis with propensity sco...

    journal_title:Health services research

    pub_type: 杂志文章

    doi:10.1111/1475-6773.12426

    authors: Rosenthal MB,Landrum MB,Robbins JA,Schneider EC

    更新日期:2016-08-01 00:00:00

  • The effects of primary care depression treatment on patients' clinical status and employment.

    abstract:OBJECTIVE:To evaluate the effects of depression treatment in primary care on patients' clinical status and employment, over six months. DATA SOURCES/STUDY SETTING:Data are from a randomized controlled trial of quality improvement for depression that included 938 adults with depressive disorder in 46 managed primary ca...

    journal_title:Health services research

    pub_type: 临床试验,杂志文章,多中心研究,随机对照试验

    doi:10.1111/1475-6773.01086

    authors: Schoenbaum M,Unützer J,McCaffrey D,Duan N,Sherbourne C,Wells KB

    更新日期:2002-10-01 00:00:00

  • Differences between generalists and mental health specialists in the psychiatric treatment of Medicare beneficiaries.

    abstract:OBJECTIVE:To examine differences between the general medical and mental health specialty sectors in the expenditure and treatment patterns of aged and disabled Medicare beneficiaries with a physician diagnosis of psychiatric disorder. DATA SOURCES:Based on 1991-1993 Medicare Current Beneficiary Survey data, linked to ...

    journal_title:Health services research

    pub_type: 杂志文章

    doi:

    authors: Ettner SL,Hermann RC,Tang H

    更新日期:1999-08-01 00:00:00

  • How state-funded home care programs respond to changes in Medicare home health care: resource allocation decisions on the front line.

    abstract:OBJECTIVE:To examine how case managers in a state-funded home care program allocate home care services in response to information about a client's Medicare home health care status, with particular attention to the influence of work environment. DATA SOURCES/STUDY SETTING:Primary data collected on 355 case managers and...

    journal_title:Health services research

    pub_type: 杂志文章

    doi:10.1111/1475-6773.00176

    authors: Corazzini K

    更新日期:2003-10-01 00:00:00

  • Racial and ethnic differences in parents' assessments of pediatric care in Medicaid managed care.

    abstract:OBJECTIVE:This study examines whether parents' reports and ratings of pediatric health care vary by race/ethnicity and language in Medicaid managed care. DATA SOURCES:The data analyzed are from the National Consumer Assessment of Health Plans (CAHPS) Benchmarking Database 1.0 and consist of 9,540 children enrolled in ...

    journal_title:Health services research

    pub_type: 杂志文章,多中心研究

    doi:

    authors: Weech-Maldonado R,Morales LS,Spritzer K,Elliott M,Hays RD

    更新日期:2001-07-01 00:00:00

  • Social determinants of tooth loss.

    abstract:OBJECTIVES:To quantify racial and socioeconomic status (SES) disparities in oral health, as measured by tooth loss, and to determine the role of dental care use and other factors in explaining disparities. DATA SOURCES/STUDY SETTING:The Florida Dental Care Study, comprising African Americans (AAs) and non-Hispanic whi...

    journal_title:Health services research

    pub_type: 杂志文章

    doi:10.1111/j.1475-6773.2003.00205.x

    authors: Gilbert GH,Duncan RP,Shelton BJ

    更新日期:2003-12-01 00:00:00

  • The effects of a prepaid group practice on mental health outcomes.

    abstract::Does a prepaid group practice relative to comparable fee-for-service plans lead to different mental health outcomes for its beneficiaries? To answer this question, we used data from the RAND Health Insurance Experiment. We observed no statistically significant or clinically meaningful differences in mental health outc...

    journal_title:Health services research

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:

    authors: Wells KB,Manning WG Jr,Valdez RB

    更新日期:1990-10-01 00:00:00

  • Intelligent information: a national system for monitoring clinical performance.

    abstract:OBJECTIVE:To use statistical process control charts to monitor in-hospital outcomes at the hospital level for a wide range of procedures and diagnoses. DATA SOURCES:Routine English hospital admissions data. STUDY DESIGN:Retrospective analysis using risk-adjusted log-likelihood cumulative sum (CUSUM) charts, comparing...

    journal_title:Health services research

    pub_type: 杂志文章

    doi:10.1111/j.1475-6773.2007.00742.x

    authors: Bottle A,Aylin P

    更新日期:2008-02-01 00:00:00

  • Incidence and duration of hospitalizations among persons with AIDS: an event history approach.

    abstract:OBJECTIVE:To analyze hospitalization patterns of persons with AIDS (PWAs) in a multi-state/multi-episode continuous time duration framework. DATA SOURCES:PWAs on Medicaid identified through a match between the state's AIDS Registry and Medicaid eligibility files; hospital admission and discharge dates identified throu...

    journal_title:Health services research

    pub_type: 杂志文章

    doi:

    authors: Crystal S,Lo Sasso AT,Sambamoorthi U

    更新日期:1999-02-01 00:00:00

  • The effects of predetermined payment rates for Medicare home healthcare.

    abstract:OBJECTIVE:To assess the effects of an alternative method of paying home health agencies for services to Medicare beneficiaries, based on a demonstration program. DATA SOURCES/STUDY SETTING:Primary and secondary data collected on participating home health agencies in five states and their patients during the three-year...

    journal_title:Health services research

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:

    authors: Brown R,Phillips B,Bishop C,Thornton C,Ritter G,Klein A,Schochet P,Skwara K

    更新日期:1997-10-01 00:00:00

  • Developing criteria for quality of assessment: effect of the Delphi technique.

    abstract::We examined the effect of the Delphi iteration procedure in developing explicit criteria for ambulatory care assessment. Practicing internists chose items they believed to be essential with regard to the care of certain specified conditions. The initial responses were tabulated and "fed-back" to the participants. The ...

    journal_title:Health services research

    pub_type: 杂志文章

    doi:

    authors: Romm FJ,Hulka BS

    更新日期:1979-01-01 00:00:00

  • Impact of generalist care managers on patients with diabetes.

    abstract:OBJECTIVE:To determine how the addition of generalist care managers and collaborative information technology to an ambulatory team affects the care of patients with diabetes. STUDY SETTING:Multiple ambulatory clinics within Intermountain Health Care (IHC), a large integrated delivery network. STUDY DESIGN:A retrospec...

    journal_title:Health services research

    pub_type: 杂志文章

    doi:10.1111/j.1475-6773.2005.00423.x

    authors: Dorr DA,Wilcox A,Donnelly SM,Burns L,Clayton PD

    更新日期:2005-10-01 00:00:00

  • Comparing aggregate estimates of derived thresholds for clinical decisions.

    abstract::Thresholds for medical decision making are the probabilities of disease at which clinicians choose to initiate testing or therapy. A descriptive analysis of clinicians' decision making can derive their test and test-treatment thresholds and has the potential to explain variations in test utilization. A previously desc...

    journal_title:Health services research

    pub_type: 杂志文章

    doi:

    authors: Young MJ,Eisenberg JM,Williams SV,Hershey JC

    更新日期:1986-02-01 00:00:00

  • Impact of Enroll America on the Number of Individuals Covered through the Federally Facilitated Marketplace.

    abstract:OBJECTIVE:To assess the impact of Enroll America's field outreach activities on the number of individuals enrolled in Marketplace coverage during the first open enrollment period. DATA SOURCES/STUDY SETTING:Marketplace enrollment for the initial open enrollment period linked with data on Enroll America's field activit...

    journal_title:Health services research

    pub_type: 杂志文章

    doi:10.1111/1475-6773.12630

    authors: Orzol S,Hula L

    更新日期:2018-02-01 00:00:00

  • Health system affiliation of physician organizations and quality of care for Medicare beneficiaries who have high needs.

    abstract:OBJECTIVE:To test the hypothesis that health systems provide better care to patients with high needs by comparing differences in quality between system-affiliated and nonaffiliated physician organizations (POs) and to examine variability in quality across health systems. DATA SOURCES:2015 Medicare Data on Provider Pra...

    journal_title:Health services research

    pub_type: 杂志文章

    doi:10.1111/1475-6773.13570

    authors: Kranz AM,DeYoreo M,Eshete-Roesler B,Damberg CL,Totten M,Escarce JJ,Timbie JW

    更新日期:2020-12-01 00:00:00

  • Impact of public reporting on quality of postacute care.

    abstract:OBJECTIVE:Evidence supporting the use of public reporting of quality information to improve health care quality is mixed. While public reporting may improve reported quality, its effect on quality of care more broadly is uncertain. This study tests whether public reporting in the setting of nursing homes resulted in im...

    journal_title:Health services research

    pub_type: 杂志文章

    doi:10.1111/j.1475-6773.2009.00967.x

    authors: Werner RM,Konetzka RT,Stuart EA,Norton EC,Polsky D,Park J

    更新日期:2009-08-01 00:00:00

  • Are health systems redesigning how health care is delivered?

    abstract:OBJECTIVE:To explore why and how health systems are engaging in care delivery redesign (CDR)-defined as the variety of tools and organizational change processes health systems use to pursue the Triple Aim. STUDY SETTING:A purposive sample of 24 health systems across 4 states as part of the Agency for Healthcare Resear...

    journal_title:Health services research

    pub_type: 杂志文章

    doi:10.1111/1475-6773.13585

    authors: Scanlon DP,Harvey JB,Wolf LJ,Vanderbrink JM,Shaw B,Shi Y,Mahmud Y,Ridgely MS,Damberg CL

    更新日期:2020-12-01 00:00:00

  • Multiple chronic conditions and disabilities: implications for health services research and data demands.

    abstract::Increasing numbers of Americans are living with multiple chronic conditions (MCCs) and disabilities. Addressing health care needs of persons with MCCs or disabilities presents challenges on many levels. For health services researchers, priorities include (1) considering MCCs and disabilities in comparative effectivene...

    journal_title:Health services research

    pub_type: 杂志文章

    doi:10.1111/j.1475-6773.2010.01145.x

    authors: Iezzoni LI

    更新日期:2010-10-01 00:00:00

  • Where You Live Matters: Quality and Racial/Ethnic Disparities in Schizophrenia Care in Four State Medicaid Programs.

    abstract:OBJECTIVE:To determine whether (a) quality in schizophrenia care varies by race/ethnicity and over time and (b) these patterns differ across counties within states. DATA SOURCES:Medicaid claims data from California, Florida, New York, and North Carolina during 2002-2008. STUDY DESIGN:We studied black, Latino, and whi...

    journal_title:Health services research

    pub_type: 杂志文章

    doi:10.1111/1475-6773.12296

    authors: Horvitz-Lennon M,Volya R,Garfield R,Donohue JM,Lave JR,Normand SL

    更新日期:2015-10-01 00:00:00

  • The role of product design in consumers' choices in the individual insurance market.

    abstract:OBJECTIVE:To evaluate the role of health plan benefit design and price on consumers' decisions to purchase health insurance in the nongroup market and their choice of plan. DATA SOURCES AND STUDY SETTING:Administrative data from the three largest nongroup insurers in California and survey data about those insured in t...

    journal_title:Health services research

    pub_type: 杂志文章

    doi:10.1111/j.1475-6773.2007.00726.x

    authors: Marquis MS,Buntin MB,Escarce JJ,Kapur K

    更新日期:2007-12-01 00:00:00

  • Provider Experience and the Comparative Safety of Laparoscopic and Open Colectomy.

    abstract:OBJECTIVE:To evaluate the comparative safety of laparoscopic and open colectomy across surgeons varying in experience with laparoscopy. DATA SOURCES:National Medicare data (2008-2010) for beneficiaries undergoing laparoscopic or open colectomy. STUDY DESIGN:Using instrumental variable methods to address selection bia...

    journal_title:Health services research

    pub_type: 杂志文章

    doi:10.1111/1475-6773.12482

    authors: Sheetz KH,Norton EC,Birkmeyer JD,Dimick JB

    更新日期:2017-02-01 00:00:00

  • The Impact of Nursing Home Pay-for-Performance on Quality and Medicare Spending: Results from the Nursing Home Value-Based Purchasing Demonstration.

    abstract:OBJECTIVE:To evaluate the impact of the Nursing Home Value-Based Purchasing demonstration on quality of care and Medicare spending. DATA SOURCES/STUDY SETTING:Administrative and qualitative data from Arizona, New York, and Wisconsin nursing homes over the base-year (2008-2009) and 3-year (2009-2012) demonstration peri...

    journal_title:Health services research

    pub_type: 杂志文章,随机对照试验

    doi:10.1111/1475-6773.12538

    authors: Grabowski DC,Stevenson DG,Caudry DJ,O'Malley AJ,Green LH,Doherty JA,Frank RG

    更新日期:2017-08-01 00:00:00

  • Committee Representation and Medicare Reimbursements-An Examination of the Resource-Based Relative Value Scale.

    abstract:BACKGROUND:The Resource-Based Relative Value Scale Update Committee (RUC) submits recommended reimbursement values for physician work (wRVUs) under Medicare Part B. The RUC includes rotating representatives from medical specialties. OBJECTIVE:To identify changes in physician reimbursements associated with RUC rotating...

    journal_title:Health services research

    pub_type: 杂志文章

    doi:10.1111/1475-6773.12857

    authors: Gao YN

    更新日期:2018-12-01 00:00:00

  • Measurement issues in health disparities research.

    abstract:BACKGROUND:Racial and ethnic disparities in health and health care have been documented; the elimination of such disparities is currently part of a national agenda. In order to meet this national objective, it is necessary that measures identify accurately the true prevalence of the construct of interest across diverse...

    journal_title:Health services research

    pub_type: 杂志文章,评审

    doi:10.1111/j.1475-6773.2005.00450.x

    authors: Ramírez M,Ford ME,Stewart AL,Teresi JA

    更新日期:2005-10-01 00:00:00

  • Experiences of Agency for Healthcare Research and Quality-funded projects that implemented practices for safer patient care.

    abstract:OBJECTIVES:To synthesize lessons learned from the experiences of Agency for Healthcare Research and Quality-funded patient safety projects in implementing safe practices. DATA SOURCES:Self-reported data from individual and group interviews with Original, Challenge, and Partnerships in Implementing Patient Safety (PIPS...

    journal_title:Health services research

    pub_type: 杂志文章

    doi:10.1111/j.1475-6773.2008.00929.x

    authors: Taylor SL,Ridgely MS,Greenberg MD,Sorbero ME,Teleki SS,Damberg CL,Farley DO

    更新日期:2009-04-01 00:00:00

  • Does information matter? Competition, quality, and the impact of nursing home report cards.

    abstract:OBJECTIVE:We evaluate the effects of the Nursing Home Quality Initiative (NHQI), which introduced quality measures to the Centers for Medicare and Medicaid Services' Nursing Home Compare website, on facility performance and consumer demand for services. DATA SOURCES:The nursing home Minimum Data Set facility reports f...

    journal_title:Health services research

    pub_type: 杂志文章

    doi:10.1111/j.1475-6773.2011.01298.x

    authors: Grabowski DC,Town RJ

    更新日期:2011-12-01 00:00:00

  • Use of nursing homes by a high-risk long-term care population.

    abstract::Limited information exists concerning lifetime use of nursing home services by the aged. This article examines the longitudinal experience, over four years, of elderly individuals at high risk of institutionalization, and develops a simple model of nursing home use based on these observations. This model allows us to ...

    journal_title:Health services research

    pub_type: 杂志文章

    doi:

    authors: Manheim LM,Hughes SL

    更新日期:1986-06-01 00:00:00

  • Impact of administrative technology on acute care bed need.

    abstract::This article reports an evaluation of the impact of three administrative technologies--Admission Scheduling (AS) Systems, Outpatient Surgery (OPS) Programs, and Preadmission Testing (PAT) Programs--on the number of acute care beds required by a hospital. The evaluation mechanism reported here is called the ADTECH Comp...

    journal_title:Health services research

    pub_type: 杂志文章

    doi:

    authors: Martin JB,Dahlstrom GA,Johnston CM

    更新日期:1985-04-01 00:00:00

  • Implementation of a model for census prediction and control.

    abstract::A model is described that predicts hospital census and computes, for each day, the number of elective admissions that will maximize the census over the short run, subject to constraints on the probability of overflow. Where a computer is available the model provides detailed predictions of census in units as small as ...

    journal_title:Health services research

    pub_type: 杂志文章

    doi:

    authors: Swain RW,Kilpatrick KE,Marsh JJ 3rd

    更新日期:1977-01-01 00:00:00

  • Geographic and racial disparities in breast cancer-related outcomes in Georgia.

    abstract:OBJECTIVE:To measure the effects of race/ethnicity, area measures of socioeconomic status (SES) and geographic residency status, and health care supply (HCS) characteristics on breast cancer (BC)-related outcomes. DATA SOURCES/STUDY SETTING:Female patients in Georgia diagnosed with BC in the years 2000-2009. STUDY DE...

    journal_title:Health services research

    pub_type: 杂志文章

    doi:10.1111/1475-6773.12096

    authors: Markossian TW,Hines RB,Bayakly R

    更新日期:2014-04-01 00:00:00