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Analysis of Supply, Distribution, Demand, and Access Issues Associated with Immune Globulin Intravenous (IGIV)
(Report)
Final Report |
Author(s): Eastern Research Group |
IGIV is a plasma product that is used to treat patients with immune system disorders. A significant percentage of IGIV use is for off-label indications. Current conditions in the IGIV industry and market are complex and rapidly evolving. The growing demand for IGIV, supply capacity issues, changes in reimbursement, and the relocation of sites of service for large numbers of patients have combined to create difficulties with access to IGIV, as observed during the study period. Subsequent to the completion of data collection for the report, anecdotal reports have emerged that the supply of IGIV has increased. Due to the complexity of the IGIV market there is no simple solution to current access and supply issues. |
Published: February, 2007 |
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Examining Relationships in an Integrated Hospital System
(Report)
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Author(s): Barbara Gage, Melissa Morley, Roberta Constantine, Pamela Spain, Justine Allpress, Megan Garrity, Melvin Ingbe |
Organization(s): RTI International |
The Examining Relationships in an Integrated Hospital System research project with RTI explores whether an organizational link between a Medicare hospital and a Medicare post-acute care (PAC) setting, such as a long term care hospital, inpatient rehabilitation facility, skilled nursing facility, or home health agency, increases the likelihood of transfer to a Medicare PAC setting. RTI uses calendar year 2005 data to build patient-level episodes beginning with an acute hospital discharge and tracking patient transfer patterns across settings. The project provides information on the national distribution of Medicare acute and PAC providers and their organizational relationships, both formal and informal. The organizational relationships are defined as freestanding PAC providers, provider-based PAC, or co-located providers (i.e., those within 250 yards of other providers). The initial findings include multivariate analysis of the effects of these organizational relationships on PAC site of care choices. |
Published: March, 2008 |
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Performance Measurement in the Hospital Outpatient Setting: Final Report
(Report)
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Author(s): Stephanie Teleki, Melony Sorbero, Lee Hilborne, Susan Lovejoy , Lily Bradley, Ateev Mehrotra, and Cheryl Damberg |
Organization(s): RAND |
The Assistant Secretary for Planning and Evaluation in collaboration with the Centers for Medicare and Medicaid Services contracted with RAND to conduct an environmental scan of hospital outpatient performance measurement for visits, services, and procedures paid under the Medicare Outpatient Prospective Payment System. This report presents the results from the environmental scan including analysis of data to determine leading conditions and services/procedures provided in the outpatient setting and a scan of publicly available measures being used across a variety of settings to identify those that potentially apply to care delivered in the hospital outpatient setting and potential gaps. |
Published: December, 2007 |
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An Environmental Scan of Pay for Performance in the Hospital Setting: Final Report
(Report)
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Author(s): Chery Damberg, Melony Sorbero, Ateev Mehrotra, Stephanie Teleki, Susan Lovejoy, and Lily Bradley |
Organization(s): RAND |
Section 5001(b) of the Deficit Reduction Act of 2005 requires the Secretary to develop a plan to implement a value- based purchasing program for payments under Medicare for subsectioin (d) hospitals beginning with fiscal year 2009. To inform the development of the plan, the Assistant Secretary for Planning and Evaluation in collaboratioin with the Centers for Medicare and Medicaid Services contracted with RAND to conduct an environmental scan of hospital pay for performance programs. This report presents the results from the environmental scan, includes a review of the empirrical evidence about the impact of these hospital programs, a description of program design features and a summary of lessons learned from currently operating hospital programs. |
Published: November, 2007 |
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Prescription Drug Spending by Medicare Beneficiaries in Institutional and Residential Settings, 1998-2001
(Report)
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Author(s): Linda Simoni-Wastila, Bruce Stuart and Thomas Shaffer |
Organization(s): University of Maryland, Baltimore |
This study had three specific aims: (1) To prepare nationally-representative estimates of drug spending in long-term care (LTC) facilities; (2) To compare drug use and spending for beneficiaries in LTC facilities versus beneficiaries in the community; and (3) To examine medication use and spending by short-stay skilled nursing home facility residents who transition into LTC facilities. This report describes the processes and methods used to achieve these aims, an overview of the findings, and implications of the findings for CMS, Medicare beneficiaries, LTC providers, and taxpayers. Finally, it concludes with observations about future research steps and identification of priorities that can help support the Department of Health and Human Services in its implementation and evaluation of the Part D drug benefit. [62 PDF pages] |
Published: June, 2007 |
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A National Comparison of Prescription Drug Expenditures by Medicare Beneficiaries Living in the Community and Long-Term Care Facility Settings
(Policy Brief)
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Author(s): Linda Simoni-Wastila, Thomas Shaffer and Bruce Stuart |
Organization(s): University of Maryland, Baltimore |
This Policy Brief provides a snapshot of prescription drug use and spending in 2001, the latest year for which complete community and long-term care facility drug data are available. For this analysis, the authors present summary findings of: (1) characteristics of Medicare beneficiaries residing in long-term care facilities and the community; (2) overview of prescription drug utilization and expenditures in aggregate and by therapeutic category; and (3) prescription drug expenditures by source of prescription coverage and Medicare eligibility status. [19 PDF pages] |
Published: February, 2007 |
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Drug Use and Spending for Medicare Beneficiaries During Part A Qualifying Skilled Nursing Facility Stays and Non-Qualifying Long-Term Care Facility Stays
(Policy Brief)
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Author(s): Bruce Stuart, Linda Simoni-Wastila and Thomas Shaffer |
Organization(s): University of Maryland, Baltimore |
This Policy Brief helps fill an important gap in our understanding of medication patterns in long-term care facilities (LTCFs) by comparing use and spending for prescription and over-the-counter drugs during skilled nursing facility (SNF) stays and related non-qualifying long-term care facility episodes. Its first aim is to characterize Medicare-qualified SNF stays in relation to other episodes of long-term institutional care that beneficiaries may experience. The second aim is to learn more about patterns of medication use and spending during SNF stays. The third aim of this Brief is to compare drug use and spending during SNF and non-qualified LTCF stays for Medicare beneficiaries who experience both types of episodes. [26 PDF pages] |
Published: February, 2007 |
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An Overview of the US Health System Chart Book
(Report)
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Author(s): George Greenberg and Nancy DeLew |
Organization(s): In House Research |
This chart book provides data on various aspects of the US health system including public and private health care coverage, provider data, and international comparisons of the US to OECD countries. |
Published: January, 2007 |
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Toward an Evaluation of the Quality Improvement Organization Program:
(Report)
Beyond the 8th Scope of Work |
Author(s): Janet P. Sutton, Lauren Silver, Lucia Hammer, Alycia Infante |
Organization(s): NORC |
This project developed an inventory of Quality Improvement Program (QIO) activities and then proposed methodologies to evaluate Medicare's QIO in the future. The contractor gathered information from publicly available sources, from CMS data when available, and from nine site visits to a variety of QIOs. Based on the findings, NORC developed a list of potential projects to evaluate the QIO program. These were presented to a Technical Expert Panel, who provided input on their feasibility and priority. NORC used this information to prepare a report describing potential evaluation approaches. |
Published: January, 2007 |
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A Study of Stroke Post-Acute Care Costs and Outcomes: Final Report
(Report)
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Author(s): Andrew Kramer and Danielle Holthaus |
Organization(s): University of Colorado, Denver |
This study compared the cost and outcomes of post acute care services after a hospitalization for stroke. After hospitalization, over a third of Medicare beneficiaries use post acute care services, including skilled nursing facilities, inpatient rehabilitation, long-term care hospital, home health care services or outpatient services. We know little about the effectiveness of these settings. Researchers identified the functional status of the person before the stroke, at the beginning of post acute care services, and 90 days after the start of those services. Most patients experienced multiple post acute care settings which added to the overall costs to Medicare.
Patients who went to an inpatient rehabilitation facility and then to a skilled nursing facility had the same outcomes as patients who went directly to a skilled nursing facility, but cost three times as much. Patients using (clinic/hospital based) outpatient therapy received more therapy services and had better outcomes than patients receiving services at home. While home health service had higher total costs and Medicare costs, out-of-pocket costs to beneficiaries were substantially higher for patients using outpatient therapy than home health. This study provided essential information to help reform the post acute care system. [225 PDF pages] |
Published: December, 2006 |
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