Abstract
Background
Medicare beneficiaries hospitalized under observation status are subject to cost-sharing
with no spending limit under Medicare Part B. Because low-income status is associated
with increased hospital use, there is concern that such beneficiaries may be at increased
risk for high use and out-of-pocket costs related to observation care. Our objective
was to determine whether low-income Medicare beneficiaries are at risk for high use
and high financial liability for observation care compared with higher-income beneficiaries.
Methods
We performed a retrospective, observational analysis of Medicare Part B claims and
US Census Bureau data from 2013. Medicare beneficiaries with Part A and B coverage
for the full calendar year, with 1 or more observation stay(s), were included in the
study. Beneficiaries were divided into quartiles representing poverty level. The associations
between poverty quartile and high use of observation care and between poverty quartile
and high financial liability for observation care were evaluated.
Results
After multivariate adjustment, the risk of high use was higher for beneficiaries in
the poor (Quartile 3) and poorest (Quartile 4) quartiles compared with those in the
wealthiest quartile (Quartile 1) (adjusted odds ratio [AOR], 1.21; 95% confidence
interval [CI], 1.13-1.31; AOR, 1.24; 95% CI, 1.16-1.33). The risk of high financial
liability was higher in every poverty quartile compared with the wealthiest and peaked
in Quartile 3, which represented the poor but not the poorest beneficiaries (AOR,
1.17; 95% CI, 1.10-1.24).
Conclusions
Poverty predicts high use of observation care. The poor or near poor may be at highest
risk for high liability.
Keywords
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Article info
Publication history
Published online: July 31, 2017
Footnotes
Prior Presentations: This work was presented at: the Society of General Internal Medicine Annual Meeting, April 19-22, 2017, Washington, DC.
Funding: LSH is supported by an Institutional Development Award from the National Institute of General Medical Sciences of the National Institutes of Health under grant number U54-GM104941 (PI: Binder-Macleod).
Conflicts of Interest: JNG: None; ZZ: None; LSH: None; JSS has received consultancy fees from Bayer, Pfizer, Takeda, The Blue Cross Blue Shield Association, and the Agency for Healthcare Research and Quality, unrelated to the content of this study.
Authorship: All authors had access to the data and played a role in writing this manuscript.
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