Abstract
The past decade witnessed a dramatic increase in inpatient hospital payment rates for patients with private insurance relative to payment rates for those covered by Medicare. A natural question is whether the widening private-Medicare payment rate difference had implications for the hospital care received by patients just before and after turning 65—the age at which there is a substantial shift from private to Medicare coverage. Using a large discharge dataset covering the period 2001–2011, we tracked changes at age 65 in the following dimensions of hospital care: overall hospitalization rates, case mix, referral-sensitive surgeries, length of stay, full established charges, number of procedures, mortality, and composite measures of inpatient quality and patient safety. In all cases we found either no change or a change that was small and inconsistent with payment rate changes during the study period.
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Notes
Estimates from the American Hospital Association Annual Survey of Hospitals show very similar trends for all hospital care (American Hospital Association 2015), and recent cross-sectional analyses provide corroborating evidence of historically large private-Medicare payment rate differences (Ginsburg 2010; Baker et al. 2016; Philipson et al. 2010; Cooper et al. 2015).
We chose to end the analysis in 2011, because of a change in the design of the NIS data effective with the 2012 data (Houchens et al. 2014).
To develop these measures, we regressed (1) all-cause in-hospital mortality and (2) hospital charges on indicators for age, CCS conditions, and ECI conditions. The estimated model was then used to predict mortality and charges for our sample with age set at 65—yielding a (cardinal) mortality-weighted and charge-related measure of primary CCS conditions and ECI comorbidities. Both indices were normalized to average 100 in our sample.
We used Inpatient Quality Indicators (IQI #90) detailed in Agency for Healthcare Research and Quality (2015c).
We used Inpatient Quality Indicators (IQI #91) detailed in Agency for Healthcare Research and Quality (2015d).
We used Patient Safety Indicator (PSI #90) detailed in Agency for Healthcare Research and Quality (2015e).
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Acknowledgements
The authors appreciate the helpful comments of Joel Cohen of the Agency for Healthcare Research and Quality (AHRQ) and Mark Miller and Jeffrey Stensland of the Medicare Payment Advisory Commission. The authors acknowledge the voluntary participation of the state partner organizations and their provision of databases used in the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample in 2000–2011. The views expressed in this article are those of the authors, and no official endorsement by the Department of Health and Human Services or AHRQ is intended or should be inferred.
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Selden, T.M., Karaca, Z. & Decker, S. Has inpatient hospital treatment before and after age 65 changed as the difference between private and Medicare payment rates has widened?. Int J Health Econ Manag. 18, 409–423 (2018). https://doi.org/10.1007/s10754-018-9240-5
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DOI: https://doi.org/10.1007/s10754-018-9240-5