ALFs and Medicare---DRAFT, NO CITATION OR QUOTATION 1 MEDICARE EXPENDITURES FOR RESIDENTS IN...
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Transcript of ALFs and Medicare---DRAFT, NO CITATION OR QUOTATION 1 MEDICARE EXPENDITURES FOR RESIDENTS IN...
ALFs and Medicare---DRAFT, NALFs and Medicare---DRAFT, NO CITATION OR QUOTATIONO CITATION OR QUOTATION
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MEDICARE EXPENDITURES FOR MEDICARE EXPENDITURES FOR RESIDENTS IN ASSISTED RESIDENTS IN ASSISTED LIVING: DATA FROM A LIVING: DATA FROM A
NATIONAL STUDY NATIONAL STUDY Phillips CPhillips C11, Holan S, Holan S22, Sherman M, Sherman M22, Spector , Spector
WW33, Hawes C, Hawes C11..
Texas A&M University System Health Texas A&M University System Health Science CenterScience Center11
Texas A&M UniversityTexas A&M University22
Agency for Healthcare Research and Agency for Healthcare Research and QualityQuality33
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ACKNOWLEDGEMENTSACKNOWLEDGEMENTS
Grant RO1-HS-10606 (C. Phillips, PI) Grant RO1-HS-10606 (C. Phillips, PI) from the Agency for Healthcare from the Agency for Healthcare
Research and Quality supported this Research and Quality supported this research. research.
Collection of the resident and facility Collection of the resident and facility data was supported by contracts HHS-data was supported by contracts HHS-
100-94-0024 and HHS-100-98-0013 100-94-0024 and HHS-100-98-0013 from the Office of Disability, Aging, and from the Office of Disability, Aging, and
Long-Term Care Policy, Office of the Long-Term Care Policy, Office of the Assistant Secretary for Planning and Assistant Secretary for Planning and
Evaluation (ASPE), U.S. Department of Evaluation (ASPE), U.S. Department of Health and Human Services. Health and Human Services.
Claims data were provided by the Claims data were provided by the Centers for Medicare and Medicaid Centers for Medicare and Medicaid
Services.Services.
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RESEARCH OBJECTIVESRESEARCH OBJECTIVES
To investigate Medicare To investigate Medicare expenditures for assisted living expenditures for assisted living facility (ALF) residents and facility (ALF) residents and
To investigate whether ALF To investigate whether ALF characteristics were related to characteristics were related to Medicare expenditures for ALF Medicare expenditures for ALF residents.residents.
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AASSISTED LIVING IN SSISTED LIVING IN UNITED STATES, 1998UNITED STATES, 1998
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DEFINING ASSISTED LIVINGDEFINING ASSISTED LIVING
““A congregate residential setting A congregate residential setting that provides or coordinates personal that provides or coordinates personal services, 24-hour supervision, and services, 24-hour supervision, and assistance (scheduled and assistance (scheduled and unscheduled), activities, and health unscheduled), activities, and health related services....” (ALQC, 1998)related services....” (ALQC, 1998)
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ALF “PHILOSOPHY”ALF “PHILOSOPHY”
“…“…to minimize the need to move; …. to minimize the need to move; …. to accommodate residents’ changing to accommodate residents’ changing needs and preferences; …. to needs and preferences; …. to maximize residents’ dignity, maximize residents’ dignity, autonomy, privacy, independence, autonomy, privacy, independence, and safety; and …. to encourage and safety; and …. to encourage family and community involvement.” family and community involvement.” (ALQC, 1998)(ALQC, 1998)
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Hypothesized Relationship Between Assisted Living andOther Types of Residential Long-Term Care
ACUITY High
Low low $ AVERAGE MONTHLY CHARGE
High $
CongregateLiving
Nursing Homes
B&C Homes
Assisted Living
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AL INDUSTRY IN USA – AL INDUSTRY IN USA – 1998*1998*
CALLED ALFs, OR PROVIDE PERSONAL CARE, 24 CALLED ALFs, OR PROVIDE PERSONAL CARE, 24 HR. SUPERVISION, MORE THAN 10 BEDSHR. SUPERVISION, MORE THAN 10 BEDS 11,459 ALFs operated nationwide11,459 ALFs operated nationwide 611, 000 beds 611, 000 beds 521,000 residents. 521,000 residents. $1,600 most common monthly charge $1,600 most common monthly charge Almost exclusively private-payAlmost exclusively private-pay 77% in metropolitan areas77% in metropolitan areas Avg. number of units is 53Avg. number of units is 53 <50% of total units are apartments<50% of total units are apartments 1/3 of ALF offer minimal service or privacy1/3 of ALF offer minimal service or privacy*Estimates based on national sample of 1,500 facilities*Estimates based on national sample of 1,500 facilities
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ALF RESIDENTS AND CLAIMS ALF RESIDENTS AND CLAIMS DATADATA
On-site data collection in facilities with either high On-site data collection in facilities with either high services or high privacy --, those consistent with services or high privacy --, those consistent with ALF philosophy (40% of 1,500; sample of 300 ALF philosophy (40% of 1,500; sample of 300 facilities; 1,500 residents)facilities; 1,500 residents)
Analyzed Medicare claims data for six months Analyzed Medicare claims data for six months after baseline ($ paid)after baseline ($ paid)
Only for residents still in ALF at 7 month follow-up Only for residents still in ALF at 7 month follow-up (n= 1,202)(n= 1,202)
Only 545 (46%) supplied HIC number that could Only 545 (46%) supplied HIC number that could be matched with claims databe matched with claims data
Compared 545 with 1202 on 17 characteristics Compared 545 with 1202 on 17 characteristics with only one significant difference (% w/ with only one significant difference (% w/ hospitalization in 12 months prior to baseline)hospitalization in 12 months prior to baseline)
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ALF RESIDENT CHARACTERISTICS AT BASELINE (N=66,092 ; n=545)
Age 84
Female 76%
Married 13%
Some ADL assistance 18%
Intact or Mild Cognitive Impairment 82%
Never Incontinent of urine 67%
Length of stay in facility 2-3
ER visit in last year 25%
Hospital stay in last year 38%*
Multi-level campus 64%
Full-time nurse on staff 71%
High privacy 66%
Average Price $1,757
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MEDICARE EXPENDITURES MEDICARE EXPENDITURES FOR INDIVIDUALS FOR INDIVIDUALS RESIDING IN ALFsRESIDING IN ALFs
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MEDICARE EXPENDITURES FOR ALF RESIDENTS, 1998 (N=66,092 ; n=545)
Acute/post-acute
Outpatient Total
Six MonthMean (Std. Error)
$1,507($237)
$883($99)
$2,391($286)
Annualized Mean $3,014 $1,764 $4,782
Residents With Claims 22.12% 84.42% 84.62%
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MEDICARE EXPENDITURESMEDICARE EXPENDITURES
On an annualized basis, average On an annualized basis, average Medicare expenditures for an ALF Medicare expenditures for an ALF resident were $4,782.resident were $4,782.
1996 average Medicare expenditures 1996 average Medicare expenditures for community-dwelling beneficiaries for community-dwelling beneficiaries adjusted for two years of inflation are adjusted for two years of inflation are $4,465. $4,465.
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MEDICARE EXPENDITURESMEDICARE EXPENDITURES
In 1997, the 15% of beneficiaries In 1997, the 15% of beneficiaries incurred annual Medicare costs of $10,000 or incurred annual Medicare costs of $10,000 or
greater,greater, received over 75% of total Medicare expenditures received over 75% of total Medicare expenditures
Among AL residents, in six months of data, Among AL residents, in six months of data, 14.8% of the residents 14.8% of the residents had Medicare claims that totaled $5,000 or more. had Medicare claims that totaled $5,000 or more. represented 78% of Medicare expenditures for the represented 78% of Medicare expenditures for the
sample. sample.
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MEDICARE EXPENDITURESMEDICARE EXPENDITURES
For those beneficiaries using For those beneficiaries using services, the annual average is services, the annual average is approximately $5,800. approximately $5,800.
The average Medicare program The average Medicare program payment for aged beneficiaries payment for aged beneficiaries served in calendar year 1999 was served in calendar year 1999 was $5,635$5,635
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FACTORS ASSOCIATED FACTORS ASSOCIATED WITH MEDICARE WITH MEDICARE EXPENDITURESEXPENDITURES
FOR ALF RESIDENTSFOR ALF RESIDENTS
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TWO-PART UTILIZATION TWO-PART UTILIZATION MODELMODEL
Logistic regression Logistic regression Inpatient $, outpatient $, total $Inpatient $, outpatient $, total $ Individual characteristicsIndividual characteristics Facility characteristicsFacility characteristics
OLS regression OLS regression Inpatient $, outpatient $, total $ (logged)Inpatient $, outpatient $, total $ (logged) Individual characteristicsIndividual characteristics Facility characteristicsFacility characteristics
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RESULTS FOR LOGISTIC RESULTS FOR LOGISTIC REGRESSION FOR ALL REGRESSION FOR ALL
RESIDENTSRESIDENTS INDIVIDUAL CHARACTERISTICSINDIVIDUAL CHARACTERISTICS
Variables with significant effects (p<.05) Variables with significant effects (p<.05) -- age, ADL status, incontinence-- age, ADL status, incontinence
Variables without significant effects Variables without significant effects (p>.05) – gender, cognitive function, (p>.05) – gender, cognitive function, marital status, length of stay, marital status, length of stay, hospitalization in prior year, ER visit in hospitalization in prior year, ER visit in prior yearprior year
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RESULTS FOR LOGISTIC RESULTS FOR LOGISTIC REGRESSION FOR ALL REGRESSION FOR ALL
RESIDENTSRESIDENTS FACILITY CHARACTERISTICSFACILITY CHARACTERISTICS
Variables with significant effects (p<.05) – Variables with significant effects (p<.05) – nonenone
Variables without significant effects (p>.05) Variables without significant effects (p>.05) – ownership, size, occupancy, multi-level – ownership, size, occupancy, multi-level campus, privacy level, service level, price, campus, privacy level, service level, price, and locationand location
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OLS RESULTS FOR RESIDENTS OLS RESULTS FOR RESIDENTS UTILIZING SERVICESUTILIZING SERVICES
INDIVIDUAL CHARACTERISTICSINDIVIDUAL CHARACTERISTICS
Variables with significant effects (p<.05) – Variables with significant effects (p<.05) – cognitive status, ADL status, length of staycognitive status, ADL status, length of stay
Variables without significant effects (p>.05) Variables without significant effects (p>.05) – gender, age, marital status, incontinence, – gender, age, marital status, incontinence, hospitalization in prior year, ER visit in prior hospitalization in prior year, ER visit in prior yearyear
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OLS RESULTS FOR RESIDENTS OLS RESULTS FOR RESIDENTS UTILIZING SERVICESUTILIZING SERVICES
FACILITY CHARACTERISTICSFACILITY CHARACTERISTICS
Variables with significant effects (p<.05) – Variables with significant effects (p<.05) – size, occupancysize, occupancy
Variables without significant effects (p>.05) Variables without significant effects (p>.05) – ownership, multi-level campus, privacy – ownership, multi-level campus, privacy level, service level, price, and locationlevel, service level, price, and location
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CONCLUSIONSCONCLUSIONS
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Medicare expenditures for individuals in Medicare expenditures for individuals in assisted living are very similar to those of assisted living are very similar to those of other community-dwelling elderlyother community-dwelling elderly
Medicare expenditures for ALF residents are Medicare expenditures for ALF residents are largely driven by individuals characteristicslargely driven by individuals characteristics
Facility size may affect the level of Facility size may affect the level of Medicare expenditures for those using Medicare expenditures for those using services -- lower expenditures for residents services -- lower expenditures for residents in smaller facilitiesin smaller facilities