Jonathan S. Skinner

Journal of the American Geriatrics Society

Gregory M. Ouellet, John R. O'Leary, Christopher G. Leggett, Jonathan Skinner, Mary E. Tinetti, Andrew B. Cohen

Although the potential benefits of anticoagulation for AF diminish as individuals with dementia develop more profound cognitive and functional loss, guidelines currently provide little guidance about when to consider discontinuation. This study provides valuable information to clinicians and surrogate decision-makers as they discuss whether to continue anticoagulation in patients with advanced dementia, who have high dementia-related mortality and for whom the primary goal is most frequently comfort.

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Journal of the American Geriatrics

Lauren Gilstrap, Andrew Cohen, Gregory M. Ouellet, Parag Goyal, Barbara Gladders, Danette Flint, Jonathan Skinner

Background Contemporary patients with heart failure with reduced ejection fraction
(HFrEF) are older and have a higher prevalence of cognitive impairment than those
studied in trials. The risk/benefit trade-off of routine beta-blocker (BB) use in patients …

JAMA Network

Zack Cooper, Olivia Stiegman, Chima D. Ndumele, Becky Staiger, Jonathan Skinner

Little is known about small-area variations in health care spending and utilization across the 3 major funders of health care in the US: Medicare, Medicaid, and private insurers.

To measure regional health spending and utilization across Medicare, Medicaid, and the privately insured; to observe whether there are regions that are simultaneously low spending for all 3 payers; and to determine what factors are correlated with regional spending and utilization by payer.

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JAMA

Leila Agha, Jonathan Skinner, David Chan

The US health care system experiences wide variation in diagnosis rates forcommonconditions,muchof which is drivenby differences indiagnostic practice rather than byunderlyingpatient health.1 Diagnosis-related errors are common, and a report from 2014 estimated that 12 million patientsmayexperienceanoutpatient diagnostic error each year.2 To improve health outcomes and reduce unnecessaryspending,theUShealthsystemshouldmove toward greater efficiency in medical diagnosis.

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Obstet Gynecol

Kristen A. Gerjevic, Helen Newton, Christopher Leggett, Jonathan Skinner, Elisabeth Erekson, Kris Strohbehn

To measure geographic variation in rates of apical support procedures for the treatment of pelvic organ prolapse (POP) among female Medicare beneficiaries.

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Journal General Internal Medicine

Amber E. Barnato, Gregory R. Johnson, John D. Birkmeyer, Jonathan S. Skinner, Alistair James O’Malley, Nancy J. O. Birkmeyer

Black and Hispanic people aremore likely to contract COVID-19, require hospitalization, and die thanWhite people due to differences in exposures, comorbidity risk, and healthcare access.

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JAMA Neurology

Lauren Gilstrap, Weiping Zhou, Marcella Alsan, Anoop Nanda, Jonathan S. Skinner

Mortality rates from March through December 2020 were compared with those from March through December 2019. Excess mortality was calculated by comparing mortality rates in 2020 with rates in 2019 for specific, predetermined groups. Means were compared using t tests, and 95% CIs were estimated using the delta method.

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J A C C : Heart Failure

Emily P. Zeitler, Andrea M. Austin, Christopher G. Leggett, Lauren Gilstrap, Daniel J. Friedman, Jonathan S. Skinner, Sana M. Al-Khatib

Heart failure (HF) remains a fast-growing cardiovascular disease affecting the Medicare population in large numbers (1,2). Increasingly, HF is managed as a chronic disease, in part because of the incremental improvements achieved with medical and device-based therapies. Despite the large proportion of older patients with HF, clinical trials designed to assess HF interventions rarely include an adequate number of older patients...

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JAMA Health Forum

James N. Weinstein, William B. Weeks, Jonathan S. Skinner

In 1907, a financial collapse led to a major US national recession, a 17%decline in industrial output,1 and creation of the Federal Reserve system in 1913 to “provide a means by which periodic panics which shake the American Republic and do it enormous injury shall be stopped.”2 The current COVID-19 pandemic shares many of the same causes as the Panic of 1907: lack of a coordinated federal response, lax state-level regulations, and absence of clear strategies to respond and recover from the initial outbreak. Therefore, we propose a new entity paralleling the Federal Reserve —the Federal Health Authority (FHA)—to anticipate health shocks, coordinate future responses, and address longer-term problems in the nation’s health and health care. Just as the Federal Reserve is tasked with sustainably maximizing the nation’s financial health, the FHAwould be tasked with doing the same for the nation’s health.

READ MORE

Journal of the American Geriatrics Society

Lauren Gilstrap, Andrea M. Austin, Barbara Gladders, Parag Goyal, A. James O’Malley, Amber Barnato, Anna N.A, Tosteson, Jonathan S. Skinner

Neurohormonal therapy, which includes beta-blockers and angiotensin-converting enzyme inhibitor/angiotensin receptor blockers (ACEi/ARBs), is the cornerstone of heart failure with reduced ejection fraction (HFrEF) treatment. While neurohormonal therapies have demonstrated efficacy in randomized clinical trials, older patients, which now comprise the majority of HFrEF patients, were underrepresented in those original trials. This study aimed to determine the association between short- (30 day) and long-term (1 year) mortality and the use of neurohormonal therapy in HFrEF patients, across the age spectrum.

READ MORE

Journal of Economic Perspectives

Benjamin K. Couillard, Christopher L. Foote, Kavish Gandhi, Ellen Meara, and Jonathan Skinner

The 21st century has been a period of rising inequality in both income and health. In this paper, we find that geographic inequality in mortality for midlife Americans increased by about 70 percent between 1992 and 2016. This was not solely because of the increasing importance of “deaths of despair,” or by rising spatial income inequality during the same period. Instead, we find evidence that high-income states in 1992 were better able to enact public health strategies and adopt behaviors that, over the next quarter-century, resulted in pronounced relative declines in mortality. The substantial longevity gains in high-income states led to greater cross-state inequality in mortality.

READ MORE

Health Affairs (Millwood)

John D. Birkmeyer, Amber Barnato, Nancy Birkmeyer, Robert Kessler, Jonathan Skinner

Hospital admissions in the US fell dramatically with the onset of the coronavirus disease 2019 (COVID-19) pandemic. However, little is known about differences in admissions patterns among patient groups or the extent of the rebound. In this study of approximately one million medical admissions from a large, nationally representative hospitalist group, we found that declines in non-COVID-19 admissions from February to April 2020 were generally similar across patient demographic subgroups and exceeded 20 percent for all primary admission diagnoses. By late June/early July 2020, overall non-COVID-19 admissions had rebounded to 16 percent below prepandemic baseline volume (8 percent including COVID-19 admissions). Non-COVID-19 admissions were substantially lower for patients residing in majority-Hispanic neighborhoods (32 percent below baseline) and remained well below baseline for patients with pneumonia (−44 percent), chronic obstructive pulmonary disease/asthma (−40 percent), sepsis (−25 percent), urinary tract infection (−24 percent), and acute ST-elevation myocardial infarction (−22 percent). Health system leaders and public health authorities should focus on efforts to ensure that patients with acute medical illnesses can obtain hospital care as needed during the pandemic to avoid adverse outcomes.

READ MORE

American Geriatric Society

Amber E. Barnato, John D. Birkmeyer, Jonathan S. Skinner, A. James O’Malley, Nancy J. O. Birkmeyer

Background: We sought to determine whether dementia is associated with treatment intensity and

mortality in patients hospitalized with COVID-19.

Methods: Review of the medical records for patients > 60 years of age (n=5,394) hospitalized with

COVID-19 from 132 community hospitals between March and June, 2020. We examined the

relationships between dementia and treatment intensity (including intensive care unit admission (ICU)

and mechanical ventilation (MV) and care processes that may influence them, including advance care

planning (ACP) billing and do-not-resuscitate (DNR) orders) and in-hospital mortality adjusting for age,

sex, race/ethnicity, comorbidity, month of hospitalization, and clustering within hospital. We further

explored the effect of ACP conversations on the relationship between dementia and outcomes, both at

the individual patient level (effect of having ACP) and at the hospital level (effect of being treated at a

hospital with low: <10%, medium 10-20%, or high >20% ACP rates)…

READ MORE

JAMA Internal Medicine

Ezekiel J. Emanuel, Emily Gudbranson, Jessica Van Parys, et al

Question Are the health outcomes of White US citizens living in the 1% and 5% richest counties better than the health outcomes of average residents in other developed countries?

Findings In this comparative effectiveness study of 6 health outcomes, White US citizens in the 1% and 5% highest-income counties obtained better health outcomes than average US citizens but had worse outcomes for infant and maternal mortality, colon cancer, childhood acute lymphocytic leukemia, and acute myocardial infarction compared with average citizens of other developed countries.

Meaning For 6 health outcomes, the health outcomes of White US citizens living in the 1% and 5% richest counties are better than those of average US citizens but are not consistently better than those of average residents in many other developed countries, suggesting that in the US, even if everyone achieved the health outcomes of White US citizens living in the 1% and 5% richest counties, health indicators would still lag behind those in many other countries.

Abstract

Importance The average health outcomes in the US are not as good as the average health outcomes in other developed countries. However, whether high-income US citizens have better health outcomes than average individuals in other developed countries is unknown….

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Journal of General Internal Medicine

Olivia A Sacks, Amber E Barnato, Jonathan S Skinner, John D Birkmeyer, Annie Fowler, Nancy Birkmeyer

There have been numerous reports of SARS-CoV-2 infection among health care workers (HCWs) across the globe. However, data is lacking on risk of hospital vs. community COVID-19 exposure faced by US providers. We report COVID-19 infection rates for physicians (MDs) and advance practice providers (APPs) in hospital medicine and critical care at a national acute care medical practice between March and December 2020.

READ MORE

Journal of General Internal Medicine

Lauren Gilstrap, Andrea M Austin, Barbara Gladders, Parag Goyal, A James O'Malley, Amber Barnato, Anna NA Tosteson, Jonathan S Skinner

Background/Objectives

Neurohormonal therapy, which includes beta‐blockers and angiotensin‐converting enzyme inhibitor/angiotensin receptor blockers (ACEi/ARBs), is the cornerstone of heart failure with reduced ejection fraction (HFrEF) treatment. While neurohormonal therapies have demonstrated efficacy in randomized clinical trials, older patients, which now comprise the majority of HFrEF patients, were underrepresented in those original trials. This study aimed to determine the association between short‐ (30 day) and long‐term (1 year) mortality and the use of neurohormonal therapy in HFrEF patients, across the age spectrum.

Design/Setting/Participants

This is a population‐based, retrospective, cohort study between January 2008 and December 2015. We used 100% Medicare Parts A and B and a random 40% sample of Part D to create a cohort of 295,494 fee‐for‐service beneficiaries with at least …

READ MORE

Health Affairs

John D. Birkmeyer, Amber Barnato, Nancy Birkmeyer, Robert Bessler, and Jonathan Skinner

Hospital admissions in the US fell dramatically with the onset of the coronavirus disease 2019 (COVID-19) pandemic. However, little is known about differences in admissions patterns among patient groups or the extent of the rebound. In this study of approximately 1 million medical admissions from a large nationally representative hospitalist group, we found that declines in non-COVID-19 admissions from February to April 2020 were generally similar across patient demographic subgroups and exceeded 20% for all primary admission diagnoses. By late June/early July 2020, overall non-COVID-19 admissions had rebounded to 16% below pre-pandemic baseline volume (8% including COVID-19 admissions). Non-COVID-19 admissions were substantially lower for patients residing in majority-Hispanic neighborhoods (32% below baseline) and remained well below baseline for patients with pneumonia (−44%), COPD/asthma (−40%), sepsis (−25%), urinary tract infection (−24%) and acute ST-elevation myocardial infarction (STEMI), −22%). Health system leaders and public health authorities should focus on efforts to ensure that patients with acute medical illnesses can obtain hospital care as needed during the pandemic to avoid adverse outcomes.

READ MORE

JAMA Network

Weifeng Weng, PhD; Jessica Van Parys, PhD; Rebecca S. Lipner, PhD; Jonathan S. Skinner, PhD; Brenda E. Sirovich, MD, MS

Use of healthcare services and physician practice patterns have been shown to vary widely across the United States. Although practice patterns—in particular, physicians’ ability to provide high-quality, high-value care—develop during training, the association of a physician’s regional practice environment with that ability is less well understood.

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Military Medicine

William Patrick Luan, DrPH; LCDR Todd C. Leroux , MSC, USN; Cara Olsen, DrPH;
Lt. Gen. (Ret.) Douglas Robb , MC, USAF; Jonathan S. Skinner, PhD; Patrick Richard, PhD

Within the Military Health System (MHS), facilities have struggled to meet minimum recommended volume thresholds for certain procedures. Understanding variations in complication rates and cost can help policymakers tailor policy to target improvement. Our objective was to quantify the variation in bariatric surgery complication rates and costs across a sample of military hospitals. Materials and Methods: We study a retrospective cohort of 38 military surgeons practicing in 21 military treatment facilities from 2007 to 2014 who performed 1,277 bariatric surgeries. Data from the Centralized Credentials and Quality Assurance System, which provides education and training characteristics of physicians, were linked to patient encounter data from the MHS Data Repository. Physicians were included if they performed at least five bariatric surgeries over the study period. Patients were included if they had a diagnosis of obesity (body mass index > 30) and underwent a bariatric weight loss surgery. We calculated and summarized inpatient costs and complication rates across both surgeons and facilities using multivariable mixed-effects linear or logistic models. We used these models to calculate adjusted complication rates and average costs across both providers and hospitals to characterize variation in bariatric outcomes within the MHS. This study was considered exempt by the Uniformed Services University Institutional Review Board. Results: We find evidence of large variations in both complication rates and costs per admission. Overall, we found a 15.5% complication rate across the sample. When comparing averages across facilities, we find large variation in complications (49.4% coefficient of variation [CV]) and procedure costs (25.9% CV). Controlling for patient comorbidities, BMI, and year attenuates much of the variation (12.6% CV complications, 4.4% CV cost), but cannot completely explain differences across facilities. Our model suggests that complications cost 32% more than complication-free surgeries on average suggesting that quality improvement efforts could potentially yield large savings. Conclusions: We find large variations in complication rates even after controlling for patient health. Furthermore, surgical complications are a significant determinant of cost. Policymakers should target efforts to improve surgical quality across facilities and physicians. Surgical quality improvement initiatives could produce savings to the MHS through reduced complications and improved surgical readiness.

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JAGS

Amy S. Kelley, MD, MSHS, Kathleen McGarry, PhD, Evan Bollens-Lund, MA, Omari-Khalid Rahman, MA, Mohammed Husain, MA, Katelyn B. Ferreira, MPH, and Jonathan S. Skinner, PhD

Care for older adults with dementia during the final years of life is costly, and families shoulder much of this burden. We aimed to assess the financial burden of care for those with and without dementia, and to explore differences across residential settings.

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Circulation: Cardiovascular Quality and Outcomes

Lauren Gilstrap, MD, MPH, Jonathan S. Skinner, PhD, Barbara Gladders, MS, A. James O’Malley, PhD, Amber E. Barnato, MD,MPH, Anna N. A. Tosteson, ScD, Andrea M. Austin, PhD

To combat the high cost and increasing burden of quality reporting, the Medicare Payment Advisory (MedPAC) has recommended using claims data wherever possible to measure clinical quality. In this article, we use a cohort of Medicare beneficiaries with heart failure with reduced ejection fraction and existing quality metrics to explore the impact of changes in quality metric methodology on measured quality performance, the association with patient outcomes, and hospital rankings.

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Journal of Patient-Reported Outcomes

Paul J. Barr , Scott A. Berry , Wendolyn S. Gozansky , Deanna B. McQuillan , Colleen Ross , Don Carmichael, Andrea M. Austin , Travis D. Satterlund , Karen E. Schifferdecker , Lora Council , Michelle D. Dannenberg , Ariel T. Wampler , Eugene C. Nelson and Jonathan Skinner

Objective: It is unclear whether data from patient-reported outcome measures (PROMs) are captured and used by clinicians despite policy initiatives. We examined the extent to which fall risk and urinary incontinence (UI) reported on PROMS and provided to clinicians prior to a patient visit are subsequently captured in the electronic medical record (EMR). Additionally, we aimed to determine whether the use of PROMs and EMR documentation is higher for visits where PROM data was provided to clinicians.

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Journal of the American Geriatric Society
Kelley AS, McGarry K, Bollens-Lund E, Rahman OK, Husain M, Ferreira KB, Skinner JS.

Care for older adults with dementia during the final years of life is costly, and families shoulder much of this burden. We aimed to assess the financial burden of care for those with and without dementia, and to explore differences across residential settings. Using the Health and Retirement Study (HRS) and linked claims, we examined total healthcare spending and proportion by payer-Medicare, Medicaid, out-of-pocket, and calculated costs of informal caregiving-over the last 7 years of life, comparing those with and without dementia and stratifying by residential setting. We found that, consistent with prior studies, people with dementia experience significantly higher costs, with a disproportionate share falling on patients and families. This pattern is most striking among community residents with dementia, whose families shoulder 64% of total expenditures (including $176,180 informal caregiving costs and $55,550 out-of-pocket costs), compared with 43% for people with dementia residing in nursing homes ($60,320 informal caregiving costs and $105,590 out-of-pocket costs). These findings demonstrate disparities in financial burden shouldered by families of those with dementia, particularly among those residing in the community. They highlight the importance of considering the residential setting in research, programs, and policies.

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JAMA Health Forum

James N. Weinstein, William B. Weeks, Jonathan S. Skinner

In 1907, a financial collapse led to a major US national recession, a 17%decline in industrial output,1 and creation of the Federal Reserve system in 1913 to “provide a means by which periodic panics which shake the American Republic and do it enormous injury shall be stopped.”2 The current COVID-19 pandemic shares many of the same causes as the Panic of 1907: lack of a coordinated federal response, lax state-level regulations, and absence of clear strategies to respond and recover from the initial outbreak. Therefore, we propose a new entity paralleling the Federal Reserve —the Federal Health Authority (FHA)—to anticipate health shocks, coordinate future responses, and address longer-term problems in the nation’s health and health care. Just as the Federal Reserve is tasked with sustainably maximizing the nation’s financial health, the FHAwould be tasked with doing the same for the nation’s health.

READ MORE

Journal of the American Geriatrics Society

Lauren Gilstrap, Andrea M. Austin, Barbara Gladders, Parag Goyal, A. James O’Malley, Amber Barnato, Anna N.A, Tosteson, Jonathan S. Skinner

Neurohormonal therapy, which includes beta-blockers and angiotensin-converting enzyme inhibitor/angiotensin receptor blockers (ACEi/ARBs), is the cornerstone of heart failure with reduced ejection fraction (HFrEF) treatment. While neurohormonal therapies have demonstrated efficacy in randomized clinical trials, older patients, which now comprise the majority of HFrEF patients, were underrepresented in those original trials. This study aimed to determine the association between short- (30 day) and long-term (1 year) mortality and the use of neurohormonal therapy in HFrEF patients, across the age spectrum.

READ MORE

Journal of Economic Perspectives

Benjamin K. Couillard, Christopher L. Foote, Kavish Gandhi, Ellen Meara, and Jonathan Skinner

The 21st century has been a period of rising inequality in both income and health. In this paper, we find that geographic inequality in mortality for midlife Americans increased by about 70 percent between 1992 and 2016. This was not solely because of the increasing importance of “deaths of despair,” or by rising spatial income inequality during the same period. Instead, we find evidence that high-income states in 1992 were better able to enact public health strategies and adopt behaviors that, over the next quarter-century, resulted in pronounced relative declines in mortality. The substantial longevity gains in high-income states led to greater cross-state inequality in mortality.

READ MORE

Health Affairs (Millwood)

John D. Birkmeyer, Amber Barnato, Nancy Birkmeyer, Robert Kessler, Jonathan Skinner

Hospital admissions in the US fell dramatically with the onset of the coronavirus disease 2019 (COVID-19) pandemic. However, little is known about differences in admissions patterns among patient groups or the extent of the rebound. In this study of approximately one million medical admissions from a large, nationally representative hospitalist group, we found that declines in non-COVID-19 admissions from February to April 2020 were generally similar across patient demographic subgroups and exceeded 20 percent for all primary admission diagnoses. By late June/early July 2020, overall non-COVID-19 admissions had rebounded to 16 percent below prepandemic baseline volume (8 percent including COVID-19 admissions). Non-COVID-19 admissions were substantially lower for patients residing in majority-Hispanic neighborhoods (32 percent below baseline) and remained well below baseline for patients with pneumonia (−44 percent), chronic obstructive pulmonary disease/asthma (−40 percent), sepsis (−25 percent), urinary tract infection (−24 percent), and acute ST-elevation myocardial infarction (−22 percent). Health system leaders and public health authorities should focus on efforts to ensure that patients with acute medical illnesses can obtain hospital care as needed during the pandemic to avoid adverse outcomes.

READ MORE

American Geriatric Society

Amber E. Barnato, John D. Birkmeyer, Jonathan S. Skinner, A. James O’Malley, Nancy J. O. Birkmeyer

Background: We sought to determine whether dementia is associated with treatment intensity and

mortality in patients hospitalized with COVID-19.

Methods: Review of the medical records for patients > 60 years of age (n=5,394) hospitalized with

COVID-19 from 132 community hospitals between March and June, 2020. We examined the

relationships between dementia and treatment intensity (including intensive care unit admission (ICU)

and mechanical ventilation (MV) and care processes that may influence them, including advance care

planning (ACP) billing and do-not-resuscitate (DNR) orders) and in-hospital mortality adjusting for age,

sex, race/ethnicity, comorbidity, month of hospitalization, and clustering within hospital. We further

explored the effect of ACP conversations on the relationship between dementia and outcomes, both at

the individual patient level (effect of having ACP) and at the hospital level (effect of being treated at a

hospital with low: <10%, medium 10-20%, or high >20% ACP rates)…

READ MORE

JAMA Internal Medicine

Ezekiel J. Emanuel, Emily Gudbranson, Jessica Van Parys, et al

Question Are the health outcomes of White US citizens living in the 1% and 5% richest counties better than the health outcomes of average residents in other developed countries?

Findings In this comparative effectiveness study of 6 health outcomes, White US citizens in the 1% and 5% highest-income counties obtained better health outcomes than average US citizens but had worse outcomes for infant and maternal mortality, colon cancer, childhood acute lymphocytic leukemia, and acute myocardial infarction compared with average citizens of other developed countries.

Meaning For 6 health outcomes, the health outcomes of White US citizens living in the 1% and 5% richest counties are better than those of average US citizens but are not consistently better than those of average residents in many other developed countries, suggesting that in the US, even if everyone achieved the health outcomes of White US citizens living in the 1% and 5% richest counties, health indicators would still lag behind those in many other countries.

Abstract

Importance The average health outcomes in the US are not as good as the average health outcomes in other developed countries. However, whether high-income US citizens have better health outcomes than average individuals in other developed countries is unknown….

READ MORE

Journal of General Internal Medicine

Olivia A Sacks, Amber E Barnato, Jonathan S Skinner, John D Birkmeyer, Annie Fowler, Nancy Birkmeyer

There have been numerous reports of SARS-CoV-2 infection among health care workers (HCWs) across the globe. However, data is lacking on risk of hospital vs. community COVID-19 exposure faced by US providers. We report COVID-19 infection rates for physicians (MDs) and advance practice providers (APPs) in hospital medicine and critical care at a national acute care medical practice between March and December 2020.

READ MORE

Journal of General Internal Medicine

Lauren Gilstrap, Andrea M Austin, Barbara Gladders, Parag Goyal, A James O'Malley, Amber Barnato, Anna NA Tosteson, Jonathan S Skinner

Background/Objectives

Neurohormonal therapy, which includes beta‐blockers and angiotensin‐converting enzyme inhibitor/angiotensin receptor blockers (ACEi/ARBs), is the cornerstone of heart failure with reduced ejection fraction (HFrEF) treatment. While neurohormonal therapies have demonstrated efficacy in randomized clinical trials, older patients, which now comprise the majority of HFrEF patients, were underrepresented in those original trials. This study aimed to determine the association between short‐ (30 day) and long‐term (1 year) mortality and the use of neurohormonal therapy in HFrEF patients, across the age spectrum.

Design/Setting/Participants

This is a population‐based, retrospective, cohort study between January 2008 and December 2015. We used 100% Medicare Parts A and B and a random 40% sample of Part D to create a cohort of 295,494 fee‐for‐service beneficiaries with at least …

READ MORE

JAMA Neurology

Research Letter

Li J, Skinner JS, McGarry K, Nicholas LH, Wang SP, Bollens-Lund E, Kelley AS.

This case-control study uses Health and Retirement Study data to examine the trajectories of wealth among US older adults at risk of dementia.

READ MORE

Social Science & Medicine

A. James O’Malley, Thomas A. Bubolz, Jonathan S. Skinner

Many studies have examined the diffusion of health care innovations but less is known about the diffusion of health care fraud. In this paper, we consider the diffusion of potentially fraudulent Medicare home health care billing in the United States during 2002-16, with a focus on the 21 hospital referral regions (HRRs) covered by local Department of Justice anti-fraud “strike force” offices. We hypothesize that patient-sharing across home health care agencies provides a mechanism for the rapid diffusion of fraudulent strategies; we measure such activity using a novel bipartite mixture (or BMIX) network index. First, we find a remarkable increase in home health care activity between 2002 and 2009 in some but not all regions; average billing per Medicare enrollees in McAllen TX and Miami increased by $2,127 and $2,422 compared to a $289 increase in other HRRs not targeted by the Department of Justice. Second, we establish that the HRR-level BMIX (but not other network measures) was a strong predictor of above-average home care expenditures across HRRs. Third, within HRRs, agencies sharing more patients with other agencies were predicted to increase spending the following year. Finally, the initial 2002 BMIX index was a strong predictor of subsequent changes in HRR-level home health billing during 2002-9. These results highlight the importance of bipartite network structure in diffusion and in infection models more generally.

READ MORE

Journal of Palliative Medicine

Meredith A. MacMartin, Olivia A. Sacks, Andrea M. Austin,Gouri Chakraborti,Elizabeth A. Stedina,Jonathan S. Skinner, Amber E. Barnato

Palliative care units (PCUs) are devoted to intensive management of symptoms and other palliative care needs. We examined the association between opening a PCU and acute care processes at a single U.S. academic medical center.

We retrospectively compared acute care processes for seriously ill patients admitted before and after the opening of a PCU at a single academic medical center. Outcomes included rates of change in code status to do-not-resuscitate (DNR) and comfort measures only (CMO) status, and time to DNR and CMO. We calculated unadjusted and adjusted rates and used logistic regression to assess interaction between care period and palliative care consultation.

READ MORE

The Journal of the Economics of Ageing

Judith Bom, Pieter Bakx, Eddy van Doorslaer, Mette Gørtz, Jonathan Skinner

The share of older adults residing in a nursing home is much higher in the Netherlands and Denmark than in the US, while in the US, perhaps surprisingly, individuals are much more likely to be admitted to a nursing home. We explore reasons for the higher US admission rates and aim to understand to what extent these differences are due to (i) differences in the composition of the population aged 65+ or (ii) differences in LTC system features.

READ MORE

JAMA Neurology

Research Letter

Li J, Skinner JS, McGarry K, Nicholas LH, Wang SP, Bollens-Lund E, Kelley AS.

This case-control study uses Health and Retirement Study data to examine the trajectories of wealth among US older adults at risk of dementia.

READ MORE

Social Science & Medicine

A. James O’Malley, Thomas A. Bubolz, Jonathan S. Skinner

Many studies have examined the diffusion of health care innovations but less is known about the diffusion of health care fraud. In this paper, we consider the diffusion of potentially fraudulent Medicare home health care billing in the United States during 2002-16, with a focus on the 21 hospital referral regions (HRRs) covered by local Department of Justice anti-fraud “strike force” offices. We hypothesize that patient-sharing across home health care agencies provides a mechanism for the rapid diffusion of fraudulent strategies; we measure such activity using a novel bipartite mixture (or BMIX) network index. First, we find a remarkable increase in home health care activity between 2002 and 2009 in some but not all regions; average billing per Medicare enrollees in McAllen TX and Miami increased by $2,127 and $2,422 compared to a $289 increase in other HRRs not targeted by the Department of Justice. Second, we establish that the HRR-level BMIX (but not other network measures) was a strong predictor of above-average home care expenditures across HRRs. Third, within HRRs, agencies sharing more patients with other agencies were predicted to increase spending the following year. Finally, the initial 2002 BMIX index was a strong predictor of subsequent changes in HRR-level home health billing during 2002-9. These results highlight the importance of bipartite network structure in diffusion and in infection models more generally.

READ MORE

Journal of Palliative Medicine

Meredith A. MacMartin, Olivia A. Sacks, Andrea M. Austin,Gouri Chakraborti,Elizabeth A. Stedina,Jonathan S. Skinner, Amber E. Barnato

Palliative care units (PCUs) are devoted to intensive management of symptoms and other palliative care needs. We examined the association between opening a PCU and acute care processes at a single U.S. academic medical center.

We retrospectively compared acute care processes for seriously ill patients admitted before and after the opening of a PCU at a single academic medical center. Outcomes included rates of change in code status to do-not-resuscitate (DNR) and comfort measures only (CMO) status, and time to DNR and CMO. We calculated unadjusted and adjusted rates and used logistic regression to assess interaction between care period and palliative care consultation.

READ MORE

The Journal of the Economics of Ageing

Judith Bom, Pieter Bakx, Eddy van Doorslaer, Mette Gørtz, Jonathan Skinner

The share of older adults residing in a nursing home is much higher in the Netherlands and Denmark than in the US, while in the US, perhaps surprisingly, individuals are much more likely to be admitted to a nursing home. We explore reasons for the higher US admission rates and aim to understand to what extent these differences are due to (i) differences in the composition of the population aged 65+ or (ii) differences in LTC system features.

READ MORE

JAMA Neurology

Research Letter

Li J, Skinner JS, McGarry K, Nicholas LH, Wang SP, Bollens-Lund E, Kelley AS.

This case-control study uses Health and Retirement Study data to examine the trajectories of wealth among US older adults at risk of dementia.

READ MORE

Social Science & Medicine

A. James O’Malley, Thomas A. Bubolz, Jonathan S. Skinner

Many studies have examined the diffusion of health care innovations but less is known about the diffusion of health care fraud. In this paper, we consider the diffusion of potentially fraudulent Medicare home health care billing in the United States during 2002-16, with a focus on the 21 hospital referral regions (HRRs) covered by local Department of Justice anti-fraud “strike force” offices. We hypothesize that patient-sharing across home health care agencies provides a mechanism for the rapid diffusion of fraudulent strategies; we measure such activity using a novel bipartite mixture (or BMIX) network index. First, we find a remarkable increase in home health care activity between 2002 and 2009 in some but not all regions; average billing per Medicare enrollees in McAllen TX and Miami increased by $2,127 and $2,422 compared to a $289 increase in other HRRs not targeted by the Department of Justice. Second, we establish that the HRR-level BMIX (but not other network measures) was a strong predictor of above-average home care expenditures across HRRs. Third, within HRRs, agencies sharing more patients with other agencies were predicted to increase spending the following year. Finally, the initial 2002 BMIX index was a strong predictor of subsequent changes in HRR-level home health billing during 2002-9. These results highlight the importance of bipartite network structure in diffusion and in infection models more generally.

READ MORE

Journal of Palliative Medicine

Meredith A. MacMartin, Olivia A. Sacks, Andrea M. Austin,Gouri Chakraborti,Elizabeth A. Stedina,Jonathan S. Skinner, Amber E. Barnato

Palliative care units (PCUs) are devoted to intensive management of symptoms and other palliative care needs. We examined the association between opening a PCU and acute care processes at a single U.S. academic medical center.

We retrospectively compared acute care processes for seriously ill patients admitted before and after the opening of a PCU at a single academic medical center. Outcomes included rates of change in code status to do-not-resuscitate (DNR) and comfort measures only (CMO) status, and time to DNR and CMO. We calculated unadjusted and adjusted rates and used logistic regression to assess interaction between care period and palliative care consultation.

READ MORE

The Journal of the Economics of Ageing

Judith Bom, Pieter Bakx, Eddy van Doorslaer, Mette Gørtz, Jonathan Skinner

The share of older adults residing in a nursing home is much higher in the Netherlands and Denmark than in the US, while in the US, perhaps surprisingly, individuals are much more likely to be admitted to a nursing home. We explore reasons for the higher US admission rates and aim to understand to what extent these differences are due to (i) differences in the composition of the population aged 65+ or (ii) differences in LTC system features.

READ MORE

JAMA Neurology

Research Letter

Li J, Skinner JS, McGarry K, Nicholas LH, Wang SP, Bollens-Lund E, Kelley AS.

This case-control study uses Health and Retirement Study data to examine the trajectories of wealth among US older adults at risk of dementia.

READ MORE

Social Science & Medicine

A. James O’Malley, Thomas A. Bubolz, Jonathan S. Skinner

Many studies have examined the diffusion of health care innovations but less is known about the diffusion of health care fraud. In this paper, we consider the diffusion of potentially fraudulent Medicare home health care billing in the United States during 2002-16, with a focus on the 21 hospital referral regions (HRRs) covered by local Department of Justice anti-fraud “strike force” offices. We hypothesize that patient-sharing across home health care agencies provides a mechanism for the rapid diffusion of fraudulent strategies; we measure such activity using a novel bipartite mixture (or BMIX) network index. First, we find a remarkable increase in home health care activity between 2002 and 2009 in some but not all regions; average billing per Medicare enrollees in McAllen TX and Miami increased by $2,127 and $2,422 compared to a $289 increase in other HRRs not targeted by the Department of Justice. Second, we establish that the HRR-level BMIX (but not other network measures) was a strong predictor of above-average home care expenditures across HRRs. Third, within HRRs, agencies sharing more patients with other agencies were predicted to increase spending the following year. Finally, the initial 2002 BMIX index was a strong predictor of subsequent changes in HRR-level home health billing during 2002-9. These results highlight the importance of bipartite network structure in diffusion and in infection models more generally.

READ MORE

Journal of Palliative Medicine

Meredith A. MacMartin, Olivia A. Sacks, Andrea M. Austin,Gouri Chakraborti,Elizabeth A. Stedina,Jonathan S. Skinner, Amber E. Barnato

Palliative care units (PCUs) are devoted to intensive management of symptoms and other palliative care needs. We examined the association between opening a PCU and acute care processes at a single U.S. academic medical center.

We retrospectively compared acute care processes for seriously ill patients admitted before and after the opening of a PCU at a single academic medical center. Outcomes included rates of change in code status to do-not-resuscitate (DNR) and comfort measures only (CMO) status, and time to DNR and CMO. We calculated unadjusted and adjusted rates and used logistic regression to assess interaction between care period and palliative care consultation.

READ MORE

The Journal of the Economics of Ageing

Judith Bom, Pieter Bakx, Eddy van Doorslaer, Mette Gørtz, Jonathan Skinner

The share of older adults residing in a nursing home is much higher in the Netherlands and Denmark than in the US, while in the US, perhaps surprisingly, individuals are much more likely to be admitted to a nursing home. We explore reasons for the higher US admission rates and aim to understand to what extent these differences are due to (i) differences in the composition of the population aged 65+ or (ii) differences in LTC system features.

READ MORE

JAMA Neurology

Research Letter

Li J, Skinner JS, McGarry K, Nicholas LH, Wang SP, Bollens-Lund E, Kelley AS.

This case-control study uses Health and Retirement Study data to examine the trajectories of wealth among US older adults at risk of dementia.

READ MORE

Social Science & Medicine

A. James O’Malley, Thomas A. Bubolz, Jonathan S. Skinner

Many studies have examined the diffusion of health care innovations but less is known about the diffusion of health care fraud. In this paper, we consider the diffusion of potentially fraudulent Medicare home health care billing in the United States during 2002-16, with a focus on the 21 hospital referral regions (HRRs) covered by local Department of Justice anti-fraud “strike force” offices. We hypothesize that patient-sharing across home health care agencies provides a mechanism for the rapid diffusion of fraudulent strategies; we measure such activity using a novel bipartite mixture (or BMIX) network index. First, we find a remarkable increase in home health care activity between 2002 and 2009 in some but not all regions; average billing per Medicare enrollees in McAllen TX and Miami increased by $2,127 and $2,422 compared to a $289 increase in other HRRs not targeted by the Department of Justice. Second, we establish that the HRR-level BMIX (but not other network measures) was a strong predictor of above-average home care expenditures across HRRs. Third, within HRRs, agencies sharing more patients with other agencies were predicted to increase spending the following year. Finally, the initial 2002 BMIX index was a strong predictor of subsequent changes in HRR-level home health billing during 2002-9. These results highlight the importance of bipartite network structure in diffusion and in infection models more generally.

READ MORE

Journal of Palliative Medicine

Meredith A. MacMartin, Olivia A. Sacks, Andrea M. Austin,Gouri Chakraborti,Elizabeth A. Stedina,Jonathan S. Skinner, Amber E. Barnato

Palliative care units (PCUs) are devoted to intensive management of symptoms and other palliative care needs. We examined the association between opening a PCU and acute care processes at a single U.S. academic medical center.

We retrospectively compared acute care processes for seriously ill patients admitted before and after the opening of a PCU at a single academic medical center. Outcomes included rates of change in code status to do-not-resuscitate (DNR) and comfort measures only (CMO) status, and time to DNR and CMO. We calculated unadjusted and adjusted rates and used logistic regression to assess interaction between care period and palliative care consultation.

READ MORE

The Journal of the Economics of Ageing

Judith Bom, Pieter Bakx, Eddy van Doorslaer, Mette Gørtz, Jonathan Skinner

The share of older adults residing in a nursing home is much higher in the Netherlands and Denmark than in the US, while in the US, perhaps surprisingly, individuals are much more likely to be admitted to a nursing home. We explore reasons for the higher US admission rates and aim to understand to what extent these differences are due to (i) differences in the composition of the population aged 65+ or (ii) differences in LTC system features.

READ MORE

JAMA Neurology

Research Letter

Li J, Skinner JS, McGarry K, Nicholas LH, Wang SP, Bollens-Lund E, Kelley AS.

This case-control study uses Health and Retirement Study data to examine the trajectories of wealth among US older adults at risk of dementia.

READ MORE

Social Science & Medicine

A. James O’Malley, Thomas A. Bubolz, Jonathan S. Skinner

Many studies have examined the diffusion of health care innovations but less is known about the diffusion of health care fraud. In this paper, we consider the diffusion of potentially fraudulent Medicare home health care billing in the United States during 2002-16, with a focus on the 21 hospital referral regions (HRRs) covered by local Department of Justice anti-fraud “strike force” offices. We hypothesize that patient-sharing across home health care agencies provides a mechanism for the rapid diffusion of fraudulent strategies; we measure such activity using a novel bipartite mixture (or BMIX) network index. First, we find a remarkable increase in home health care activity between 2002 and 2009 in some but not all regions; average billing per Medicare enrollees in McAllen TX and Miami increased by $2,127 and $2,422 compared to a $289 increase in other HRRs not targeted by the Department of Justice. Second, we establish that the HRR-level BMIX (but not other network measures) was a strong predictor of above-average home care expenditures across HRRs. Third, within HRRs, agencies sharing more patients with other agencies were predicted to increase spending the following year. Finally, the initial 2002 BMIX index was a strong predictor of subsequent changes in HRR-level home health billing during 2002-9. These results highlight the importance of bipartite network structure in diffusion and in infection models more generally.

READ MORE

Journal of Palliative Medicine

Meredith A. MacMartin, Olivia A. Sacks, Andrea M. Austin,Gouri Chakraborti,Elizabeth A. Stedina,Jonathan S. Skinner, Amber E. Barnato

Palliative care units (PCUs) are devoted to intensive management of symptoms and other palliative care needs. We examined the association between opening a PCU and acute care processes at a single U.S. academic medical center.

We retrospectively compared acute care processes for seriously ill patients admitted before and after the opening of a PCU at a single academic medical center. Outcomes included rates of change in code status to do-not-resuscitate (DNR) and comfort measures only (CMO) status, and time to DNR and CMO. We calculated unadjusted and adjusted rates and used logistic regression to assess interaction between care period and palliative care consultation.

READ MORE

The Journal of the Economics of Ageing

Judith Bom, Pieter Bakx, Eddy van Doorslaer, Mette Gørtz, Jonathan Skinner

The share of older adults residing in a nursing home is much higher in the Netherlands and Denmark than in the US, while in the US, perhaps surprisingly, individuals are much more likely to be admitted to a nursing home. We explore reasons for the higher US admission rates and aim to understand to what extent these differences are due to (i) differences in the composition of the population aged 65+ or (ii) differences in LTC system features.

READ MORE

JAMA Neurology

Research Letter

Li J, Skinner JS, McGarry K, Nicholas LH, Wang SP, Bollens-Lund E, Kelley AS.

This case-control study uses Health and Retirement Study data to examine the trajectories of wealth among US older adults at risk of dementia.

READ MORE

Social Science & Medicine

A. James O’Malley, Thomas A. Bubolz, Jonathan S. Skinner

Many studies have examined the diffusion of health care innovations but less is known about the diffusion of health care fraud. In this paper, we consider the diffusion of potentially fraudulent Medicare home health care billing in the United States during 2002-16, with a focus on the 21 hospital referral regions (HRRs) covered by local Department of Justice anti-fraud “strike force” offices. We hypothesize that patient-sharing across home health care agencies provides a mechanism for the rapid diffusion of fraudulent strategies; we measure such activity using a novel bipartite mixture (or BMIX) network index. First, we find a remarkable increase in home health care activity between 2002 and 2009 in some but not all regions; average billing per Medicare enrollees in McAllen TX and Miami increased by $2,127 and $2,422 compared to a $289 increase in other HRRs not targeted by the Department of Justice. Second, we establish that the HRR-level BMIX (but not other network measures) was a strong predictor of above-average home care expenditures across HRRs. Third, within HRRs, agencies sharing more patients with other agencies were predicted to increase spending the following year. Finally, the initial 2002 BMIX index was a strong predictor of subsequent changes in HRR-level home health billing during 2002-9. These results highlight the importance of bipartite network structure in diffusion and in infection models more generally.

READ MORE

Journal of Palliative Medicine

Meredith A. MacMartin, Olivia A. Sacks, Andrea M. Austin,Gouri Chakraborti,Elizabeth A. Stedina,Jonathan S. Skinner, Amber E. Barnato

Palliative care units (PCUs) are devoted to intensive management of symptoms and other palliative care needs. We examined the association between opening a PCU and acute care processes at a single U.S. academic medical center.

We retrospectively compared acute care processes for seriously ill patients admitted before and after the opening of a PCU at a single academic medical center. Outcomes included rates of change in code status to do-not-resuscitate (DNR) and comfort measures only (CMO) status, and time to DNR and CMO. We calculated unadjusted and adjusted rates and used logistic regression to assess interaction between care period and palliative care consultation.

READ MORE

The Journal of the Economics of Ageing

Judith Bom, Pieter Bakx, Eddy van Doorslaer, Mette Gørtz, Jonathan Skinner

The share of older adults residing in a nursing home is much higher in the Netherlands and Denmark than in the US, while in the US, perhaps surprisingly, individuals are much more likely to be admitted to a nursing home. We explore reasons for the higher US admission rates and aim to understand to what extent these differences are due to (i) differences in the composition of the population aged 65+ or (ii) differences in LTC system features.

READ MORE

JAMA Neurology

Research Letter

Li J, Skinner JS, McGarry K, Nicholas LH, Wang SP, Bollens-Lund E, Kelley AS.

This case-control study uses Health and Retirement Study data to examine the trajectories of wealth among US older adults at risk of dementia.

READ MORE

Social Science & Medicine

A. James O’Malley, Thomas A. Bubolz, Jonathan S. Skinner

Many studies have examined the diffusion of health care innovations but less is known about the diffusion of health care fraud. In this paper, we consider the diffusion of potentially fraudulent Medicare home health care billing in the United States during 2002-16, with a focus on the 21 hospital referral regions (HRRs) covered by local Department of Justice anti-fraud “strike force” offices. We hypothesize that patient-sharing across home health care agencies provides a mechanism for the rapid diffusion of fraudulent strategies; we measure such activity using a novel bipartite mixture (or BMIX) network index. First, we find a remarkable increase in home health care activity between 2002 and 2009 in some but not all regions; average billing per Medicare enrollees in McAllen TX and Miami increased by $2,127 and $2,422 compared to a $289 increase in other HRRs not targeted by the Department of Justice. Second, we establish that the HRR-level BMIX (but not other network measures) was a strong predictor of above-average home care expenditures across HRRs. Third, within HRRs, agencies sharing more patients with other agencies were predicted to increase spending the following year. Finally, the initial 2002 BMIX index was a strong predictor of subsequent changes in HRR-level home health billing during 2002-9. These results highlight the importance of bipartite network structure in diffusion and in infection models more generally.

READ MORE

Journal of Palliative Medicine

Meredith A. MacMartin, Olivia A. Sacks, Andrea M. Austin,Gouri Chakraborti,Elizabeth A. Stedina,Jonathan S. Skinner, Amber E. Barnato

Palliative care units (PCUs) are devoted to intensive management of symptoms and other palliative care needs. We examined the association between opening a PCU and acute care processes at a single U.S. academic medical center.

We retrospectively compared acute care processes for seriously ill patients admitted before and after the opening of a PCU at a single academic medical center. Outcomes included rates of change in code status to do-not-resuscitate (DNR) and comfort measures only (CMO) status, and time to DNR and CMO. We calculated unadjusted and adjusted rates and used logistic regression to assess interaction between care period and palliative care consultation.

READ MORE

The Journal of the Economics of Ageing

Judith Bom, Pieter Bakx, Eddy van Doorslaer, Mette Gørtz, Jonathan Skinner

The share of older adults residing in a nursing home is much higher in the Netherlands and Denmark than in the US, while in the US, perhaps surprisingly, individuals are much more likely to be admitted to a nursing home. We explore reasons for the higher US admission rates and aim to understand to what extent these differences are due to (i) differences in the composition of the population aged 65+ or (ii) differences in LTC system features.

READ MORE

JAMA Neurology

Research Letter

Li J, Skinner JS, McGarry K, Nicholas LH, Wang SP, Bollens-Lund E, Kelley AS.

This case-control study uses Health and Retirement Study data to examine the trajectories of wealth among US older adults at risk of dementia.

READ MORE

Social Science & Medicine

A. James O’Malley, Thomas A. Bubolz, Jonathan S. Skinner

Many studies have examined the diffusion of health care innovations but less is known about the diffusion of health care fraud. In this paper, we consider the diffusion of potentially fraudulent Medicare home health care billing in the United States during 2002-16, with a focus on the 21 hospital referral regions (HRRs) covered by local Department of Justice anti-fraud “strike force” offices. We hypothesize that patient-sharing across home health care agencies provides a mechanism for the rapid diffusion of fraudulent strategies; we measure such activity using a novel bipartite mixture (or BMIX) network index. First, we find a remarkable increase in home health care activity between 2002 and 2009 in some but not all regions; average billing per Medicare enrollees in McAllen TX and Miami increased by $2,127 and $2,422 compared to a $289 increase in other HRRs not targeted by the Department of Justice. Second, we establish that the HRR-level BMIX (but not other network measures) was a strong predictor of above-average home care expenditures across HRRs. Third, within HRRs, agencies sharing more patients with other agencies were predicted to increase spending the following year. Finally, the initial 2002 BMIX index was a strong predictor of subsequent changes in HRR-level home health billing during 2002-9. These results highlight the importance of bipartite network structure in diffusion and in infection models more generally.

READ MORE

Journal of Palliative Medicine

Meredith A. MacMartin, Olivia A. Sacks, Andrea M. Austin,Gouri Chakraborti,Elizabeth A. Stedina,Jonathan S. Skinner, Amber E. Barnato

Palliative care units (PCUs) are devoted to intensive management of symptoms and other palliative care needs. We examined the association between opening a PCU and acute care processes at a single U.S. academic medical center.

We retrospectively compared acute care processes for seriously ill patients admitted before and after the opening of a PCU at a single academic medical center. Outcomes included rates of change in code status to do-not-resuscitate (DNR) and comfort measures only (CMO) status, and time to DNR and CMO. We calculated unadjusted and adjusted rates and used logistic regression to assess interaction between care period and palliative care consultation.

READ MORE

The Journal of the Economics of Ageing

Judith Bom, Pieter Bakx, Eddy van Doorslaer, Mette Gørtz, Jonathan Skinner

The share of older adults residing in a nursing home is much higher in the Netherlands and Denmark than in the US, while in the US, perhaps surprisingly, individuals are much more likely to be admitted to a nursing home. We explore reasons for the higher US admission rates and aim to understand to what extent these differences are due to (i) differences in the composition of the population aged 65+ or (ii) differences in LTC system features.

READ MORE

JAMA Neurology

Research Letter

Li J, Skinner JS, McGarry K, Nicholas LH, Wang SP, Bollens-Lund E, Kelley AS.

This case-control study uses Health and Retirement Study data to examine the trajectories of wealth among US older adults at risk of dementia.

READ MORE

Social Science & Medicine

A. James O’Malley, Thomas A. Bubolz, Jonathan S. Skinner

Many studies have examined the diffusion of health care innovations but less is known about the diffusion of health care fraud. In this paper, we consider the diffusion of potentially fraudulent Medicare home health care billing in the United States during 2002-16, with a focus on the 21 hospital referral regions (HRRs) covered by local Department of Justice anti-fraud “strike force” offices. We hypothesize that patient-sharing across home health care agencies provides a mechanism for the rapid diffusion of fraudulent strategies; we measure such activity using a novel bipartite mixture (or BMIX) network index. First, we find a remarkable increase in home health care activity between 2002 and 2009 in some but not all regions; average billing per Medicare enrollees in McAllen TX and Miami increased by $2,127 and $2,422 compared to a $289 increase in other HRRs not targeted by the Department of Justice. Second, we establish that the HRR-level BMIX (but not other network measures) was a strong predictor of above-average home care expenditures across HRRs. Third, within HRRs, agencies sharing more patients with other agencies were predicted to increase spending the following year. Finally, the initial 2002 BMIX index was a strong predictor of subsequent changes in HRR-level home health billing during 2002-9. These results highlight the importance of bipartite network structure in diffusion and in infection models more generally.

READ MORE

Journal of Palliative Medicine

Meredith A. MacMartin, Olivia A. Sacks, Andrea M. Austin,Gouri Chakraborti,Elizabeth A. Stedina,Jonathan S. Skinner, Amber E. Barnato

Palliative care units (PCUs) are devoted to intensive management of symptoms and other palliative care needs. We examined the association between opening a PCU and acute care processes at a single U.S. academic medical center.

We retrospectively compared acute care processes for seriously ill patients admitted before and after the opening of a PCU at a single academic medical center. Outcomes included rates of change in code status to do-not-resuscitate (DNR) and comfort measures only (CMO) status, and time to DNR and CMO. We calculated unadjusted and adjusted rates and used logistic regression to assess interaction between care period and palliative care consultation.

READ MORE

The Journal of the Economics of Ageing

Judith Bom, Pieter Bakx, Eddy van Doorslaer, Mette Gørtz, Jonathan Skinner

The share of older adults residing in a nursing home is much higher in the Netherlands and Denmark than in the US, while in the US, perhaps surprisingly, individuals are much more likely to be admitted to a nursing home. We explore reasons for the higher US admission rates and aim to understand to what extent these differences are due to (i) differences in the composition of the population aged 65+ or (ii) differences in LTC system features.

READ MORE

JAMA Neurology

Research Letter

Li J, Skinner JS, McGarry K, Nicholas LH, Wang SP, Bollens-Lund E, Kelley AS.

This case-control study uses Health and Retirement Study data to examine the trajectories of wealth among US older adults at risk of dementia.

READ MORE

Social Science & Medicine

A. James O’Malley, Thomas A. Bubolz, Jonathan S. Skinner

Many studies have examined the diffusion of health care innovations but less is known about the diffusion of health care fraud. In this paper, we consider the diffusion of potentially fraudulent Medicare home health care billing in the United States during 2002-16, with a focus on the 21 hospital referral regions (HRRs) covered by local Department of Justice anti-fraud “strike force” offices. We hypothesize that patient-sharing across home health care agencies provides a mechanism for the rapid diffusion of fraudulent strategies; we measure such activity using a novel bipartite mixture (or BMIX) network index. First, we find a remarkable increase in home health care activity between 2002 and 2009 in some but not all regions; average billing per Medicare enrollees in McAllen TX and Miami increased by $2,127 and $2,422 compared to a $289 increase in other HRRs not targeted by the Department of Justice. Second, we establish that the HRR-level BMIX (but not other network measures) was a strong predictor of above-average home care expenditures across HRRs. Third, within HRRs, agencies sharing more patients with other agencies were predicted to increase spending the following year. Finally, the initial 2002 BMIX index was a strong predictor of subsequent changes in HRR-level home health billing during 2002-9. These results highlight the importance of bipartite network structure in diffusion and in infection models more generally.

READ MORE

Journal of Palliative Medicine

Meredith A. MacMartin, Olivia A. Sacks, Andrea M. Austin,Gouri Chakraborti,Elizabeth A. Stedina,Jonathan S. Skinner, Amber E. Barnato

Palliative care units (PCUs) are devoted to intensive management of symptoms and other palliative care needs. We examined the association between opening a PCU and acute care processes at a single U.S. academic medical center.

We retrospectively compared acute care processes for seriously ill patients admitted before and after the opening of a PCU at a single academic medical center. Outcomes included rates of change in code status to do-not-resuscitate (DNR) and comfort measures only (CMO) status, and time to DNR and CMO. We calculated unadjusted and adjusted rates and used logistic regression to assess interaction between care period and palliative care consultation.

READ MORE

The Journal of the Economics of Ageing

Judith Bom, Pieter Bakx, Eddy van Doorslaer, Mette Gørtz, Jonathan Skinner

The share of older adults residing in a nursing home is much higher in the Netherlands and Denmark than in the US, while in the US, perhaps surprisingly, individuals are much more likely to be admitted to a nursing home. We explore reasons for the higher US admission rates and aim to understand to what extent these differences are due to (i) differences in the composition of the population aged 65+ or (ii) differences in LTC system features.

READ MORE