Adam Atherly

Potentially Avoidable Hospitalizations of Nursing Home Residents: Frequency, Causes, and Costs

OBJECTIVES: To examine the frequency and reasons for potentially avoidable hospitalizations of nursing home (NH) residents.

Supplemental Insurance: Medicare’s Accidental Stepchild

The majority of Medicare beneficiaries supplement the basic Medicare benefit package with additional insurance. This article reviews the literature on Medicare supplemental insurance. Supplemental insurance plays a significant role in protecting Medicare beneficiaries from financial risk. The two major sources of coverage for beneficiaries—former employers and individual purchase—differ in benefit structure and characteristics of policy holders. Employer-sponsored policies tend to provide broader coverage with more cost sharing than individually purchased policies, and holders of employer policies tend to be younger, wealthier, healthier, and better educated. Supplemental insurance policies have been shown to be associated with higher Medicare expenditures, but there is no consensus on the cause of the higher expenditures. Some studies attribute the increase to adverse selection of policies; other studies point to the moral hazard effect of insurance.

Prescription Opioid Usage and Abuse Relationships: An Evaluation of State Prescription Drug Monitoring Program Efficacy

Context The dramatic rise in the use of prescription opioids to treat non-cancer pain has been paralleled by increasing prescription opioid abuse. However, detailed analyses of these trends and programs to address them are lacking. Objective To study the association between state shipments of prescription opioids for medical use and prescription opioid abuse admissions and to assess the effects of state prescription drug monitoring programs (PDMPs) on prescription opioid abuse admissions. Design and Setting A retrospective ecological cohort study comparing state prescription opioid shipments (source: Automation of Reports and Consolidated Orders Systems database) and inpatient admissions for prescription opioid abuse (source: Treatment Episode Data Set) in 14 states with PDMPs (intervention group) and 36 states without PDMPs (control group) for the period 1997–2003. Results From 1997 to 2003, oxycodone, morphine, and hydrocodone shipments increased by 479%, 100%, and 148% respectively. Increasing prescription oxycodone shipments were significantly associated with increasing prescription opioid admission rates (p < 0.001). PDMP states had significantly lower oxycodone shipments than the control group. PDMP states had less increase in prescription opioid admissions per year (p = 0.063). A patient admitted to an inpatient drug abuse rehabilitation program in a PDMP state was less likely to be admitted for prescription opioid drug abuse (Odds ratio = 0.775, 95% Confidence Interval 0.764–0.785). Conclusions PDMPs appear to decrease the quantity of oxycodone shipments and the prescription opioid admission rate for states with these programs. Overall, opioid shipments rose significantly in PDMP states during the study period indicating a negligible “chilling effect” on physician prescribing.

The Effect of Medicare Supplemental Insurance on Medicare Expenditures

This study estimated the effect of Medicare supplemental insurance plans on Medicare expenditures, controlling for unobserved selection. For employer-sponsored policies, there was significant unobserved favorable selection into plans with and without prescription drug coverage. For individual plans, there was unobserved adverse selection into plans with drug benefits and unobserved favorable selection into plans without. Individual supplemental plans without prescription drugs increased Medicare expenditures by

A Longitudinal Analysis of the Lifetime Cost of Dementia

914 annually, while those with drugs increased Medicare expenditures by

The Cost Effectiveness of Direct to Consumer Advertising for Prescription Drugs

491. Employer policies also significantly increased Medicare expenditures (

What is the Cost to Employers of Direct Medical Care for Chronic Obstructive Pulmonary Disease

207 without drug coverage and

Using Structured Implicit Review to Assess Quality of Care in the Program of All-inclusive Care for the Elderly (PACE)

447 with drug coverage), but the increase was less than that associated with individual policies.

Medical Costs of Fatal and Nonfatal Falls in Older Adults

OBJECTIVE Estimate the lifetime cost of dementia to Medicare and Medicaid. DATA SOURCE 1997-2005 Medicare Current Beneficiary Survey. STUDY DESIGN A multistage analysis was conducted to first predict the probability of developing dementia by age and then predict the annual Medicare/Medicaid expenditures conditional on dementia status. A cohort-based simulation was conducted to estimate the lifetime cost of dementia. PRINCIPAL FINDINGS The average lifetime cost of dementia per patient for Medicare is approximately

Medical Utilization Among Wellness Consumers

12,000 (2005 dollars) and for Medicaid about