"The association between medicare eligibility and gains in access to rehabilitative care: A national regression discontinuity assessment of patients ages 64 Versus 65 Years" by Cheryl K Zogg

Article

The association between medicare eligibility and gains in access to rehabilitative care: A national regression discontinuity assessment of patients ages 64 Versus 65 Years

Annals of surgery

Cheryl K Zogg, Harvard Medical School, Harvard T.H. Chan School of Public Health,Brigham & Women's Hospital, Boston
John W. Scott, Harvard Medical School, Harvard T.H. Chan School of Public Health,Brigham & Women's Hospital, Boston
David Metcalfe, Harvard Medical School, Harvard T.H. Chan School of Public Health,Brigham & Women's Hospital, Boston
Anupamaa J. Seshadri, Brigham & Women's Hospital, Boston
Thomas C Tsai, Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston
W. Austin Davis, Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston
John A. Rose Jr, Harvard Medical School, Harvard T.H. Chan School of Public Health,Brigham & Women's Hospital, Boston
Olubode A. Olufajo, Harvard Medical School, Harvard T.H. Chan School of Public Health,Brigham & Women's Hospital, Boston
Syed Nabeel Zafar, Howard University College of Medicine, Washington
Adil H Haider, Harvard Medical School, Harvard T.H. Chan School of Public Health,Brigham & Women's Hospital, Boston

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Publication Date

4-1-2017

Document Type

Article

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Abstract

Objectives: The aims of this study were to assess for changes in uninsured rates among trauma patients at age 64 versus 65 years and whether there are associated changes in post-discharge rehabilitation; determine whether changes are driven by rehabilitation provided at home, skilled nursing facilities (SNFs), or acute inpatient facilities; and determine whether changes vary among stratified subgroups of trauma-related "best-practice" factors.
Summary background data: Rehabilitation is an important component of high-quality trauma systems with access heavily influenced by insurance status. In the wake of policy changes affecting insurance coverage, it remains unknown the extent to which insurance changes associate with variations in rehabilitation access/use among otherwise similar patients.
Methods: Regression discontinuity models were used to assess for changes in insurance status and rehabilitation at age 64 versus 65 years among adults ages 54 to 75 years (±10 years age-related Medicare eligibility). Data were extracted from the 2007-2012 National Trauma Data Bank.
Results: A total of 305,198 patients were included; 40.1% were discharged to rehabilitation. Medicare eligibility was associated with an abrupt 6.4 (95% confidence interval: 5.8-7.0) percentage-point decline in uninsured and a 9.6 (95% confidence interval: 6.5-12.6) percentage-point increase in rehabilitation at age 64 versus 65 years, enabling an additional 1-in-10 patients to access rehabilitation. Differences were driven by SNF use and were greatest among patients with less-severe clinical presentations. Restriction based on Medicare-payment eligibility to patients with length of stay ≥3days (SNF requirement) and ≥1 "presumptive diagnosis codes" (inpatient facilities' 60% rule) demonstrated abrupt gains in both SNF and inpatient care.
Conclusions: The results reveal the magnitude of changes in access to rehabilitation associated with changes in insurance coverage at age 65 years. Use of quasi experimental models enabled meaningful consideration of health-policy change.

Comments

This work was published before the author joined Aga Khan University

Citation Information

Cheryl K Zogg, John W. Scott, David Metcalfe, Anupamaa J. Seshadri, et al.. "The association between medicare eligibility and gains in access to rehabilitative care: A national regression discontinuity assessment of patients ages 64 Versus 65 Years" Annals of surgery Vol. 265 Iss. 4 (2017) p. 734 - 742
Available at: http://works.bepress.com/adil_haider/312/