Medicare expenditures for residents in assisted living data from a national study
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MEDICARE EXPENDITURES FOR RESIDENTS IN ASSISTED LIVING: DATA FROM A NATIONAL STUDY. Phillips C 1 , Holan S 2 , Sherman M 2 , Spector W 3 , Hawes C 1 . Texas A&M University System Health Science Center 1 Texas A&M University 2 Agency for Healthcare Research and Quality 3. ACKNOWLEDGEMENTS.

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Medicare expenditures for residents in assisted living data from a national study

MEDICARE EXPENDITURES FOR RESIDENTS IN ASSISTED LIVING: DATA FROM A NATIONAL STUDY

Phillips C1, Holan S2, Sherman M2, Spector W3, Hawes C1.

Texas A&M University System Health Science Center1

Texas A&M University2

Agency for Healthcare Research and Quality3

ALFs and Medicare---DRAFT, NO CITATION OR QUOTATION


Acknowledgements

ACKNOWLEDGEMENTS DATA FROM A NATIONAL STUDY

Grant RO1-HS-10606 (C. Phillips, PI) from the Agency for Healthcare Research and Quality supported this research.

Collection of the resident and facility data was supported by contracts HHS-100-94-0024 and HHS-100-98-0013 from the Office of Disability, Aging, and Long-Term Care Policy, Office of the Assistant Secretary for Planning and Evaluation (ASPE), U.S. Department of Health and Human Services.

Claims data were provided by the Centers for Medicare and Medicaid Services.

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Research objectives
RESEARCH OBJECTIVES DATA FROM A NATIONAL STUDY

  • To investigate Medicare expenditures for assisted living facility (ALF) residents and

  • To investigate whether ALF characteristics were related to Medicare expenditures for ALF residents.

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A ssisted living in united states 1998

A DATA FROM A NATIONAL STUDY SSISTED LIVING IN UNITED STATES, 1998

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Defining assisted living
DEFINING ASSISTED LIVING DATA FROM A NATIONAL STUDY

  • “A congregate residential setting that provides or coordinates personal services, 24-hour supervision, and assistance (scheduled and unscheduled), activities, and health related services....” (ALQC, 1998)

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Alf philosophy
ALF “PHILOSOPHY” DATA FROM A NATIONAL STUDY

  • “…to minimize the need to move; …. to accommodate residents’ changing needs and preferences; …. to maximize residents’ dignity, autonomy, privacy, independence, and safety; and …. to encourage family and community involvement.” (ALQC, 1998)

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  • Hypothesized DATA FROM A NATIONAL STUDY Relationship Between Assisted Living and

  • Other Types of Residential Long-Term Care

  • ACUITY

  • High

  • Low

    • low $ AVERAGE MONTHLY CHARGE High $

  • Nursing Homes

    B&C Homes

    Assisted Living

    Congregate

    Living

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    Al industry in usa 1998
    AL INDUSTRY IN USA – 1998* DATA FROM A NATIONAL STUDY

    • CALLED ALFs, OR PROVIDE PERSONAL CARE, 24 HR. SUPERVISION, MORE THAN 10 BEDS

      • 11,459 ALFs operated nationwide

      • 611, 000 beds

      • 521,000 residents.

      • $1,600 most common monthly charge

      • Almost exclusively private-pay

      • 77% in metropolitan areas

      • Avg. number of units is 53

      • <50% of total units are apartments

      • 1/3 of ALF offer minimal service or privacy

        *Estimates based on national sample of 1,500 facilities

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    Alf residents and claims data
    ALF RESIDENTS AND CLAIMS DATA DATA FROM A NATIONAL STUDY

    • On-site data collection in facilities with either high services or high privacy --, those consistent with ALF philosophy (40% of 1,500; sample of 300 facilities; 1,500 residents)

    • Analyzed Medicare claims data for six months after baseline ($ paid)

    • Only for residents still in ALF at 7 month follow-up (n= 1,202)

    • Only 545 (46%) supplied HIC number that could be matched with claims data

    • Compared 545 with 1202 on 17 characteristics with only one significant difference (% w/ hospitalization in 12 months prior to baseline)

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    Medicare expenditures for individuals residing in alfs

    MEDICARE EXPENDITURES FOR INDIVIDUALS RESIDING IN ALFs DATA FROM A NATIONAL STUDY

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    Medicare expenditures
    MEDICARE EXPENDITURES DATA FROM A NATIONAL STUDY

    • On an annualized basis, average Medicare expenditures for an ALF resident were $4,782.

    • 1996 average Medicare expenditures for community-dwelling beneficiaries adjusted for two years of inflation are $4,465.

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    Medicare expenditures1
    MEDICARE EXPENDITURES DATA FROM A NATIONAL STUDY

    • In 1997, the 15% of beneficiaries

      • incurred annual Medicare costs of $10,000 or greater,

      • received over 75% of total Medicare expenditures

    • Among AL residents, in six months of data, 14.8% of the residents

      • had Medicare claims that totaled $5,000 or more.

      • represented 78% of Medicare expenditures for the sample.

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    Medicare expenditures2
    MEDICARE EXPENDITURES DATA FROM A NATIONAL STUDY

    • For those beneficiaries using services, the annual average is approximately $5,800.

    • The average Medicare program payment for aged beneficiaries served in calendar year 1999 was $5,635

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    Factors associated with medicare expenditures for alf residents

    FACTORS ASSOCIATED WITH MEDICARE EXPENDITURES DATA FROM A NATIONAL STUDY FOR ALF RESIDENTS

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    Two part utilization model
    TWO-PART UTILIZATION MODEL DATA FROM A NATIONAL STUDY

    • Logistic regression

      • Inpatient $, outpatient $, total $

      • Individual characteristics

      • Facility characteristics

    • OLS regression

      • Inpatient $, outpatient $, total $ (logged)

      • Individual characteristics

      • Facility characteristics

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    Results for logistic regression for all residents
    RESULTS FOR LOGISTIC REGRESSION FOR ALL RESIDENTS DATA FROM A NATIONAL STUDY

    • INDIVIDUAL CHARACTERISTICS

    • Variables with significant effects (p<.05) -- age, ADL status, incontinence

    • Variables without significant effects (p>.05) – gender, cognitive function, marital status, length of stay, hospitalization in prior year, ER visit in prior year

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    Results for logistic regression for all residents1
    RESULTS FOR LOGISTIC REGRESSION FOR ALL RESIDENTS DATA FROM A NATIONAL STUDY

    • FACILITY CHARACTERISTICS

    • Variables with significant effects (p<.05) – none

    • Variables without significant effects (p>.05) – ownership, size, occupancy, multi-level campus, privacy level, service level, price, and location

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    Ols results for residents utilizing services
    OLS RESULTS FOR RESIDENTS UTILIZING SERVICES DATA FROM A NATIONAL STUDY

    • INDIVIDUAL CHARACTERISTICS

    • Variables with significant effects (p<.05) – cognitive status, ADL status, length of stay

    • Variables without significant effects (p>.05) – gender, age, marital status, incontinence, hospitalization in prior year, ER visit in prior year

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    Ols results for residents utilizing services1
    OLS RESULTS FOR RESIDENTS UTILIZING SERVICES DATA FROM A NATIONAL STUDY

    • FACILITY CHARACTERISTICS

    • Variables with significant effects (p<.05) – size, occupancy

    • Variables without significant effects (p>.05) – ownership, multi-level campus, privacy level, service level, price, and location

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    Conclusions

    CONCLUSIONS DATA FROM A NATIONAL STUDY

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    • Medicare expenditures for individuals in assisted living are very similar to those of other community-dwelling elderly

    • Medicare expenditures for ALF residents are largely driven by individuals characteristics

    • Facility size may affect the level of Medicare expenditures for those using services -- lower expenditures for residents in smaller facilities

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