Projected US Imaging Utilization, 2025 to 2055.

To date, SEER-Medicare analyses focused on Medicare Fee for Service (FFS) patients due to data availability. The rising enrollment in Medicare Advantage (MA) underscores the necessity of including these patients in cancer research. We examined transitions between FFS and MA among older adults diagnosed with cancer and explored factors associated with coverage by FFS, MA, or transitions between these types of insurance. From the time of diagnosis to end of follow-up, 62.3% were continuously enrolled in FFS, 21.3% were continuously enrolled in MA, 11.8% transitioned from MA to FFS, and 4.5% transitioned from FFS to MA. Continuous enrollment in MA was more common among women (Odds Ratio (OR) =1.25, 95% Confidence Interval (CI):1.22-1.28), Hispanic (OR=2.21, 95%CI: 2.14-2.28) and Black adults (OR=1.79, 95% CI: 1.74-1.85) and less likely among older adults ≥74 (OR=0.85, 95%CI: 0.83-0.86), unmarried people (OR=0.85, 95%CI:0.83-0.87), and people with brain, lung, and ovary cancer relative to prostate cancer (OR ranges: 0.35-0.46). Factors associated with transitioning from MA to FFS after a cancer diagnosis included age ≥74 (OR: 1.82; 95%CI: 1.77-1.86), Hispanic (OR: 1.98; 95%CI: 1.91-2.60) and Black adults (OR=1.56, 95%CI:1.91-2.06), or having a diagnosis of colorectal, leukemia, lung, lymphoma, multiple myeloma, oral cavity, ovary, and brain cancer relative to prostate cancer (OR range: 1.96-3.69). Black (OR=2.20, 95%CI:2.09-2.33) and Hispanic (OR=1.70, 95%CI:1.60-2.33) adults were more likely to transition from FFS to MA. Understanding reasons for switching types of Medicare insurance among patients with cancer may be important for interpreting studies of social determinants of health using SEER-Medicare data.

As value-based care reshapes the landscape of orthopedic surgery, understanding how insurance type influences patient-reported outcomes (PROMs) after total knee arthroplasty (TKA) is increasingly important. While Traditional Medicare (TM) and Medicare Advantage (MA) differ significantly in structure and access, limited data exist comparing functional outcomes between these groups. This retrospective cohort study used a prospectively collected institutional registry to evaluate 6,010 Medicare beneficiaries who underwent primary TKA between 2016 and 2023. Patients were categorized by insurance type (TM or MA) at the time of surgery. Primary PROMs included the KOOS pain, physical function shortform (PS), and Joint Replacement (JR) subscales. Clinically meaningful improvement was assessed using minimal clinically important difference (MCID), substantial clinical benefit (SCB), and Patient Acceptable Symptom State (PASS) thresholds. Multivariable logistic regression was performed to evaluate the independent association between insurance type and each outcome, adjusting for demographic, clinical, and socioeconomic covariates. At baseline, MA patients had significantly lower KOOS pain, PS, and JR (p < 0.001). However, by 1-year follow-up, both groups achieved similar KOOS pain and PS scores, and comparable PROM improvements from baseline. MA patients had slightly lower KOOS JR scores (p = 0.006) at 1-year, but equivalent odds of achieving MCID, PASS, and SCB thresholds across all KOOS domains after multivariable adjustment. Patient satisfaction at 1 year also did not differ by Medicare plan type (p = 0.729). Despite presenting with worse baseline functional status, MA patients achieved similar postoperative outcomes, PROM gains, and satisfaction as their TM counterparts. These findings suggest that MA enrollment does not negatively impact patient-perceived benefit after TKA and may not warrant differential risk-adjustment in PROM-based value assessments.

The liberation of numerous organic and inorganic chemicals derived from numerous industries, such as tanneries, textiles, agro-based industries, pharmaceuticals, and petrochemicals, has been identified to produce several pollutants that could constitute several hazards to the environment and humans. Different types of technology and processes such as advanced oxidation techniques physical and chemical processes are utilized for the management of these contaminants. However, there are several drawbacks associated with these techniques, and the majority of the end products are also poisonous in nature. Hence, there is a need to identify sustainable and eco-friendly techniques that could lead to the maintenance of a cleaner environment which is economical feasible, non-poisonous, and without any adverse effect. The utilization of these beneficial microorganisms has been identified as a sustainable biotechnological technique that could lead to the maintenance of a healthy environment. These microorganisms portend capability to reduce these contaminates into non-toxic components. Therefore, this chapter intends to provide detailed information on the application of beneficial microorganism for the achievement of environmental sustainability. Special emphasis was laid on some specific examples of sustainable biotechnology techniques that could lead to the maintenance of a cleaner environment. The different types of beneficial microorganisms are also highlighted.

The introduction of biosimilars and novel delivery devices between 2014 and 2019 may have changed the utilization of granulocyte colony-stimulating factors (G-CSF). To assess utilization trends of G-CSFs for primary prophylaxis of febrile neutropenia (FN) among patients with cancer receiving myelosuppressive chemotherapy with commercial or Medicare insurance. This cross-sectional study assessed G-CSF utilization trends overall and stratified by regimen febrile neutropenia risk level. Associations between patient characteristics and G-CSF use were evaluated. Patients with cancer, including breast, lung, colorectal, esophageal and gastric, pancreatic, prostate, ovarian, and non-Hodgkin lymphomas, initiating myelosuppressive chemotherapy courses were included from the 2014 to 2019 commercial insurance and 2014 to 2018 Medicare fee-for-service claims databases. Data were analyzed from March to June 2021. Year of chemotherapy initiation. The main outcomes were use and trends of G-CSFs for primary prophylaxis, from completion to 3 days after in the first chemotherapy cycle. In total, 86 731 chemotherapy courses (mean [SD] age, 57.7 [11.5] years; 57 838 [66.7%] women and 28 893 [33.3%] men) were identified from 82 410 patients in the commercial insurance database and 32 398 chemotherapy courses (mean [SD] age, 71.8 [8.3] years; 18 468 [57.0%] women and 13 930 [43.0%] men) were identified from 30 279 patients in the Medicare database. Among the commercially insured population, 39 639 patients (45.7%) received G-CSFs, and 12 562 patients (38.8%) received G-CSFs among Medicare insured patients. Overall G-CSF use increased significantly throughout the study period in both populations, from 45.1% (95% CI, 44.4%-45.7%) of patients in 2014 to 47.5% (95% CI, 46.5%-48.5%) of patients in 2019 (P = .001) in the commercially insured population and from 36.0% (95% CI, 34.2%-38.0%) of patients in 2014 to 39.1% (95% CI, 38.1%-40.1%) of patients in 2018 (P < .001) in the Medicare population. The greatest increases in G-CSF use were observed among patients with high FN risk, from 75.0% (95% CI, 74.1%-76.0%) of patients to 83.2% (95% CI, 82.0%-84.2%) of patients (P < .001) among the commercially insured population and 75.3% (95% CI, 71.8%-78.6%) of patients to 86.2% (95% CI, 84.7%-87.6%) of patients (P < .001) among the Medicare population. Use of G-CSFs decreased in the commercially insured population among patients with intermediate FN risk (from 27.5% [95% CI, 26.4%-28.5%] of patients to 20.4% [95% CI, 19.1%-21.7%] of patients; P < .001) or low FN risk (from 19.3% [95% CI, 18.3%-20.4%] of patients to 16.3% [95% CI, 14.7%-18.0%] of patients; P < .001) and remained stable in the Medicare population (intermediate risk: from 26.4% [95% CI, 23.8%-29.2%] of patients to 28.4% [95% CI, 27.0%-29.8%] of patients; P = .35; low risk: from 19.6% [95% CI, 17.0%-22.4%] of patients to 20.9% [95% CI, 19.6%-22.3%] of patients; P = .58). Factors associated with increased odds of G-CSF use included older age (commercial insurance: adjusted odds ratio [aOR], 1.50 [95% CI, 1.41-1.59]; Medicare: aOR, 1.36 [95% CI, 1.08-1.71]), receiving a regimen with high FN risk (commercial insurance: aOR, 16.01 [95% CI, 15.17-16.90]; Medicare: aOR, 17.17 [95% CI, 15.76-18.71]), and history of neutropenia (commercial insurance: 3.90 (3.67-4.15); Medicare: 3.82 (3.50-4.18). This cross-sectional study found that utilization of G-CSFs increased among patients with cancer with high FN risk in both a commercially and Medicare-insured population, but 14% to 17% of patients still did not receive preventive treatment.

Lower Revenue Surplus in Medicare Advantage Versus Private Commercial Insurance for Total Joint Arthroplasty: An Analysis of a Single Payor Source at One Institution

e18789 Background: Patients with hematologic or STM may be at increased risk for COVID-19 and severe clinical and economic outcomes. This study estimates the incidence rate (IR) of COVID-19 in patients with hematologic and STM and evaluates the associated HCRU and costs. Methods: Patients with hematologic or STM were retrospectively identified from the HealthCore Integrated Research Database between 4/1/2018 and 3/31/2022 (study end date). The first cancer diagnosis date or 4/1/2020 was set as the index date, whichever came last. Patients were enrolled in a commercial or Medicare Advantage insurance plan for 1 year prior to index and followed until disenrollment in the health plan, study end date or death, whichever came first. COVID-19 was identified through outpatient laboratory results and diagnosis codes on medical claims. IRs were calculated for COVID-19. Hospitalized patients were classified as severe (evidence of an intensive care unit stay with noninvasive high flow oxygen or invasive respiratory/cardiovascular support or discharge status of expired) or moderate (all other hospitalizations); length of stay (LOS) and inpatient costs were calculated. Those with only a COVID-related emergency room, outpatient claim or a positive outpatient COVID-19 test were classified as mild/asymptomatic. All-cause HCRU and costs were calculated for the 30 days pre/post-COVID-19 infection. Results: In total, 895,861 patients were identified with a hematologic or STM (mean age: 63 years; 48% male) and followed for 17 months on average. Prior to index, 10% of patients were on immunosuppressive treatments. During follow up, 10% of the hematologic or STM patients developed COVID-19. The overall IR was 72.9 per 1,000 patient years, with IRs of 57.4, 8.9, and 6.6 per 1,000 patient years for mild/asymptomatic, moderate, and severe COVID-19, respectively. Among the 17% of hematologic or STM patients hospitalized for COVID-19, 43% had severe infection with a mean LOS of 13 days and total cost of $43,229, while 57% had moderate infection with a LOS of 8 days and total cost of $20,046. Total mean all-cause cost among patients with hematologic or STM who developed COVID-19 increased from $3,410 pre-infection to $9,207 post-infection, which was predominately driven by increased inpatient costs post-infection. Conclusions: Among patients with hematologic or STM, the IR of mild COVID-19 was highest (49.5 per 1,000 patient years); however, those with moderate and severe COVID-19 had high costs associated with hospitalization ($20,046 and $43,229, respectively). These findings illustrate high burden of managing moderate and severe COVID-19, as well as opportunities to improve prevention and care of COVID-19 for patients with hematologic or STM for better clinical and economic outcomes.

Utilization Trends in Noncardiac Thoracic Imaging, 2002-2014

This study compared the hospitalization expenses of patients with chronic bronchitis in a central province (Province A) in China to estimate the direct medical cost of the family. Our data included hospitalization records of 30,341 patients with chronic bronchitis from five urban general hospitals in Province A. Using descriptive statistics and regression analysis, we explored the relevant factors affecting hospitalization expenses. Our study results have indicated that from 2016 to 2020, the medical expenditure of patients with chronic bronchitis increased annually, with an average annual growth rate of 22.65%. Among all kinds of expenses, the hospitalization expenses, drug cost, bed cost, test cost and other cost of UEMI (Urban Employee Medical Insurance) are higher than that of other types of medical insurance. The check-up fees of CMI (Commercial Insurance) are lower than that of other types of insurance. Between 2016 and 2019, the average medical expenses per patient with chronic bronchitis increased by 44%, which is the highest average medical expenses among patients aged 60–70. And the highest average medical expenditure emerged when the number of service days is between 5 and 10 days. The increase in expenditure could be attributed to the rapid development of medical technology and the increasing medical demand of the people. Overall, the results of our study implied a significant increase in medical expenses for patients with chronic bronchitis from 2015 to 2020, indicating that chronic bronchitis could bring heavy economic pressures to patients, their families and society.

Disparities in Absolute Denial of Modern Hepatitis C TherapybyType of Insurance.

The age adjustment of stroke mortality rates may obscure the impact of population changes on the total burden of disease. Deaths from ischemic stroke may rise unless future declines in stroke death rates offset the projected growth in high-risk populations. Using data on ischemic stroke mortality from the National Center of Health Statistics for 1979 to 1998, we fit a logistic model to predict changes in stroke death rates as a function of time for each of 42 sex-race-age groups. Using population projections from the US Census Bureau, we then calculated the expected number of deaths in the United States from ischemic stroke over the next 30 years on the basis of age, sex, and race. Models generally fit historical data well (median R2=0.81; interquartile range, 0.43 to 0.97) and consistently predicted small declines in future death rates. The total predicted number of stroke deaths increased by 98% from 139,000 in 2002 to 275,000 in 2032, whereas the total US population was projected to increase by only 27% in the same period. The largest percentage increases in stroke deaths were predicted to occur in blacks (134%) and nonwhite, nonblack races (221%). If recent trends in ischemic stroke mortality continue, increases in US stroke deaths will outpace overall population growth, with a doubling in deaths over the next 30 years.

Preterm infants screened for retinopathy of prematurity (ROP) are at risk for heterogenous neurodevelopment outcomes that are difficult to predict. To characterize the potential association between socioeconomic and clinical risk factors and neurodevelopmental outcomes in a diverse, multicenter cohort of premature neonates screened for ROP. This was a retrospective cohort study using electronic medical records and US Census Bureau income data. This study was performed at academic (University of California, Los Angeles [UCLA] Mattel Children's Hospital and UCLA Santa Monica Hospital), community (Cedars-Sinai Medical Center), and LA county (Harbor-UCLA Medical Center) neonatal intensive care units. Participants included infants who met American Academy of Pediatrics guidelines for ROP screening and had records from at least 1 Bayley Scales of Infant and Toddler Development (BSID) neurodevelopment assessment between 0 and 36 months of adjusted age. Data analyses were conducted from January 1, 2011, to September 1, 2022. Demographic and clinical information, proxy household income, and health insurance type were collected as risk factors. Neurodevelopmental outcomes in the cognitive, language, and motor domains measured via BSID were the primary outcomes. A total of 706 infants (mean [SD] age, 28.6 [2.4] weeks; 375 male [53.1%]) met inclusion criteria. In a multivariable model, which included adjustments for birth weight, sex, insurance type, intraventricular hemorrhage (IVH), and age at assessment, public health insurance was associated with a 4-fold increased risk of moderate to severe neurodevelopmental impairment (NDI) in cognitive and language domains (cognitive, odds ratio [OR], 3.65; 95% CI, 2.28-5.86; P = 8.1 × 10-8; language, OR, 3.96; 95% CI, 2.61-6.02; P = 1.0 × 10-10) and a 3-fold increased risk in the motor domain (motor, OR, 2.60; 95% CI, 1.59-4.24; P = 1.4 × 10-4). In this adjusted model, clinical factors that were associated with an increased risk of moderate to severe NDI included lower birth weight, diagnosis of IVH, male sex, and older age at time of Bayley assessment. In unadjusted analyses, infants who received either laser or anti-VEGF treatment, compared with infants without treatment-requiring ROP, had lower BSID scores in multiple domains at 0 to 12 months, 12 to 24 months, and 24 to 36 months (DATA). In the multivariable model, treatment type was no longer associated with worse neurodevelopmental outcomes in any domain. Study results suggest an association between public insurance type and NDI in a diverse population screened for ROP, indicating the complexities of neurodevelopment. This study also supports the early neurodevelopmental safety of anti-VEGF treatment, as anti-VEGF therapy was not found to be independently associated with worse NDI in any domain.

3548 Background: With MA plans covering over half of Medicare beneficiaries, concerns remain about their ability to manage complex cancer care due to pre-authorization and limited provider network. This study evaluates MA versus Traditional Medicare (TM) regarding timely initiation of Pembrolizumab for dMMR/MSI-H colorectal cancer (CRC), following its 2020 FDA approval. Methods: This study utilized nationwide Flatiron Health Electronic Health Record-derived de-identified database. We included patients diagnosed with dMMR/MSI-H CRC from 2020 onward, aged ≥65 years, who had at least one clinic visit within six months of diagnosis and were insured under MA or TM. The primary endpoint was initiation of Pembrolizumab within 30-, 45-, and 90-days post-diagnosis. Multivariable logistic regression with Inverse Probability Weighting, adjusted for SES (defined by Yost score), age, race, ECOG, practice type and diagnosis year, evaluated impact of insurance type on timely treatment initiation. Results: Out of 597 dMMR/MSI-H metastatic CRC patients identified since 2020, 219 had at least one clinical visit under MA (N = 86) or TM (N = 133) plans. Predominantly, patients in our cohort were non-Hispanic White (72%), with higher SES (59%), diagnosed with de novo dMMR/MSI-H (59%), and treated in community hospitals (86%). Of 95 patients who commenced pembrolizumab as initial therapy, 62 (65%) had TM and 33 (35%) had MA. The adjusted analysis revealed that MA patients were significantly less likely to start pembrolizumab within 90 days of diagnosis compared to TM patients (OR: 0.58; 95% CI: 0.34-0.97; P: 0.04). There were no statistical differences in starting treatment at 30 (OR: 0.79; 95% CI: 0.39-1.56; P: 0.5) or 45 days (OR: 0.87; 95% CI: 0.48-1.57; P: 0.7). Subgroup analysis indicated substantial delays in pembrolizumab initiation within 90 days among lowest SES (OR: 0.31; 95% CI: 0.13-0.71; P: 0.007; P-interaction: 0.087) and those treated in community hospitals (OR: 0.49; 95% CI: 0.27-0.87; P: 0.016; P-interaction: 0.095). Conclusions: Patients with TM were more likely to initiate pembrolizumab earlier than those with MA. This underscores necessity to scrutinize the influence of MA on cancer delivery, especially for patients with lower SES. Baseline characteristics. Variable TM MA P Age 0.4 &gt;=65 66 (50%) 40 (47%) &gt;=75 67 (50%) 45 (52%) &gt;=85 0 (0%) 1 (1%) Race 1 NHW 97 (73%) 62 (72%) Non-NHW 36 (27%) 24 (28%) ECOG 0.7 0/1 95 (71%) 68 (79%) 2 18 (14%) 8 (9%) 3/4 8 (6%) 4 (5%) Unknown 12 (9%) 6 (7%) SES 0.04 0/1 38 (29%) 36 (42%) 3/4/5 88 (66%) 42 (49%) Unknown 7 (5%) 8 (9%) Diagnosis Year 0.5 2020 36 (27%) 22 (26%) 2021 41 (31%) 34 (40%) 2022 39 (29%) 18 (21%) 2023 17 (13%) 12 (14%) DeNovo 0.7 Yes 80 (60%) 49 (57%) No 53 (40%) 37 (43%) Practice 0.4 Academic 16 (12%) 15 (17%) Community 117 (88%) 71 (83%) Time to Pembrolizumab Initiation (days) OR (95CI) P 30 1 0.79 (0.39-1.56) 0.50 45 1 0.87 (0.48-1.57) 0.66 90 1 0.58 (0.34-0.97) 0.04

Important Things to Know about Medicare is a series of 10 publications that will cover the most common Medicare concerns. The series will provide general information about Medicare, including the four major plans, supplemental policies, interactions with different types of insurance, and assistance programs.&#x0D; As an older adult citizen of the United States, it is important to understand the structure of Medicare and how it affects you. The information in this series is based on the most current data available and includes several changes with the implementation of the Affordable Care Act. This guide was also written using Florida guidelines when appropriate. Please bear in mind that your personal situation may vary from the examples in the series, and always contact your local Medicare representative for questions regarding your own circumstances.&#x0D; Written by Amanda Terminello and Martie Gillen, and published by the UF Department of Family, Youth and Community Sciences, September 2013.

U.S. adults with diagnosed diabetes enrolled in Medicare by age and insurance type.

&lt;p&gt; &lt;/p&gt; &lt;p&gt;&lt;strong&gt;Objective:&lt;/strong&gt; To characterize trends in clinical complexity, treatment burden, healthcare utilization, and diabetes-related outcomes among adults with diabetes.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Research Design and Methods: &lt;/strong&gt;A nationwide claims database was used to identify enrollees in commercial and Medicare Advantage plans who met claims criteria for diabetes between 01/01/2006 and 03/31/2019 and to quantify annual trends in clinical complexity (e.g., active health conditions), treatment burden (e.g., medications), healthcare utilization (e.g., ambulatory, emergency department [ED], and hospital visits), and diabetes-related outcomes (e.g., hemoglobin A1c [HbA1c] levels) between 2006 and 2018. &lt;/p&gt; &lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 1,470,799 commercially-insured patients, the proportion with ≥10 active health conditions increased from 33.3% (95% CI 33.1%-33.4%) in 2006 to 38.9% (38.8%-39.1%) in 2018 (p=0.001), and the proportion taking ≥3 glucose-lowering medications increased from 11.6% (11.5%-11.7%) to 23.1% (22.9%-23.2%), (p=0.007). The proportion with HbA1c ≥8.0% (≥64 mmol/mol) increased from 28.0% (27.7%-28.3%) in 2006 to 30.5% (30.2%-30.7%) in 2015, decreasing to 27.8% (27.5%-28.0%) in 2018 (overall trend p=0.04). Number of ambulatory visits per patient/year decreased from 6.86 (6.84-6.88) to 6.19 (6.17-6.21), (p=0.001), while ED visits increased from 0.26 (0.257-0.263) to 0.29 (0.287-0.293), (p=0.001). Among 1,311,903 Medicare Advantage enrollees, the proportion with ≥10 active conditions increased from 51.6% (51.2%-52.0%) to 65.1% (65.0%-65.2%), (p&lt;0.001), the proportion taking ≥3 glucose-lowering medications was stable at 16.6% (16.3%-16.9%) and 18.1% (18.0%-18.2%), (p=0.98), and the proportion with HbA1c ≥8.0% increased from 17.4% (16.7%-18.1%) to 18.6% (18.4%-18.7%), (p=0.008). Ambulatory visits per patient per year remained stable at 8.01 (7.96-8.06) and 8.17 (8.16-9.19), (p=0.23), but ED visits increased from 0.41 (0.40-0.42) to 0.66 (0.66-0.66), (p&lt;0.001).&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Patients with diabetes are becoming increasingly complex over time, have higher treatment burden, and experience more ED visits for potentially low acuity conditions.&lt;/p&gt;