Medicare claims data enables broad characterization of United States (US) patients with Alzheimer’s disease and related dementias (ADRD). Resulting insights can be used as a reference to describe this population and as a benchmark for generalizability of patients with ADRD enrolled in clinical trials.

Following the unwinding of Medicaid’s continuous enrollment provision, states must redetermine Medicaid eligibility, creating uncertainty about coverage [1] and the widespread administrative removal of beneficiaries from rolls [2]…using the State of Washington, South Carolina, and North Dakota as examples, we applied LLMs to extract […]

Artificial intelligence (AI) holds significant promise for revolutionizing health care by enhancing diagnosis, treatment, and patients’ safety. However, the current disparity between the abundance of AI research and the scarcity of evidence on real-world impact underscores the urgent need for comprehensive clinical effectiveness evaluations.

Recognizing the impact of the social determinants of health (SDOH) on health outcomes, in 2016, the Centers for Medicare and Medicaid Services recommended the use of International Classification of Diseases, 10th Revision (ICD-10), Z-codes to capture patients’ health-related social needs. We examined changes in Z-code utilization to document health-related social […]

A growing range of policy discussions correctly assert that the current Centers for Medicare and Medicaid Services’ (CMS) risk-adjustment system needs modernization, reflecting its long history and evolution. While refined over time, the same CMS-Hierarchical Condition Categories (HCC) risk-adjustment model has been used for nearly 20 years.

Medicare Advantage (MA) has become increasingly popular over the past decade, with significant movement of beneficiaries away from traditional fee-for-service Medicare. While fee-for-service is still the option chosen by most beneficiaries (55 percent), some subsets of beneficiaries are much more likely to be enrolled in MA—specifically beneficiaries who are either […]

To examine variations in timing of lower-limb amputation (LLA) across race/ethnicity and sex among older adults with a diabetic foot ulcer (DFU). It was hypothesized Black/African Americans were more likely to have LLA post-DFU earlier compared with non-Hispanic/Whites, and more men would receive LLA earlier post-DFU compared with women.

While overall Medicare Part C (Medicare Advantage) enrollment has grown more rapidly than fee-for-service Medicare enrollment, changes in the growth and characteristics of different enrollee populations have not been examined.

The decision of the Centers for Medicare & Medicaid Services (CMS) to launch the mandatory Radiation Oncology (RO) model in 2022 will accelerate specialist enrollment in advanced alternative payments models, a decade-plus bipartisan policy objective that purports to constrain health inflation while improving quality. However, thanks to the late December […]

Doximity, Inc, the leading digital platform for U.S. medical professionals, released its fifth annual Physician Compensation Report. The study – which surveyed more than 46,000 full-time U.S. physicians for this year’s report – is the largest physician compensation data set in the United States.

The Veterans Health Administration COVID-19 (VACO) Index predicts 30-day all-cause mortality in patients with COVID-19 using age, sex and pre-existing comorbidity diagnoses. The VACO Index was initially developed and validated in a nationwide cohort of US veterans—we now assess its accuracy in an academic medical centre and a nationwide US […]