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The centers for medicare and medicaid services gap analysis

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In summary, patient portals were used to support patient-level care coordination and case management programs were in place to follow-up with patients. There were few examples of HIT tools that clinicians and patients could use together to tailor management. A respondent from a SNF in Interview 2 described an electronic tool from a commercial EHR company that helps to identify patients at high risk according to their symptoms. In summary, there were no examples of interoperability between an EHR and a computer system used by a community organization.

There were many examples of HIT tools to align system-level resources with high-risk patients or populations. Our literature search initially identified citations. Each citation was reviewed by two reviewers and conflicts were resolved by consensus. After title-abstract review, 54 articles were included for full article review by two reviewers. Of these articles, 44 were excluded prior to data extraction due to the fact that they were not studies of interventions to improve information exchange during care transitions see Additional file 2.

The ten remaining articles were abstracted according to a standard format. Three of the articles described non-HIT interventions to improve information transfer across settings [ 13 15 ]. We found seven articles which described the use of HIT for information transfer across care transitions [ 16 22 ]. None of these interventions leveraged interoperable computer systems. A detailed summary of the results is included in Additional file 2.

We have found few intervention studies of HIT-supported care coordination in the biomedical literature and the results of our qualitative study show that, while HIT is used for several care coordination activities, there are important gaps.

Studies from Europe show the advantages of HIT-supported care coordination [ 23 , 24 ]. In order to realize these advantages in the US, we must identify the care coordination domains with the highest potential for HIT. Our approach identifies weaknesses in processes of care coordination, which are variably amenable to improvement in HIT enablement. Not all processes of care coordination can or should be automated.

In addition to the provider-level domains which could be improved through EHR interoperability, there are several patient-level care coordination domains which could be improved through other types of HIT innovation. In addition to care coordination gaps related to the lack of interoperability, we also identified important gaps in communication with community organizations.

Therefore, HIT tools that link patients to community resources are needed to prevent readmissions. This qualitative study provides primary data about care coordination gaps across multiple regions, in diverse clinical settings, and across the disciplines of nursing and medicine. Despite these strengths, the study has several important limitations including a purposive sampling approach of innovative health systems in a small number of settings, limiting our ability to comment generally on the situation across the nation.

Also, we developed the interview guide to explore the use of HIT for care coordination quality measurement specifically. The main limitation of the literature review is that the search terms in all three databases do not accurately identify articles related to care transitions.

Despite these limitations, we found qualitative evidence that HIT is used for nine care coordination activities and we found ten intervention studies that yielded useful information about the impact of care coordination interventions on clinical outcomes.

Our collective focus on reducing readmissions has spurred innovation in HIT development to align resources with patient and population needs. The dataset supporting the conclusions of this article is available upon request as a page pdf document. What it will take to achieve the as-yet-unfulfilled promises of health information technology. Health Aff. Article Google Scholar. Meaningful use and quality of care.

Article PubMed Google Scholar. Care coordination atlas. Version 3. Health information technology to support care coordination and care transitions: Data needs, capabilities, technical and organizational barriers, and approaches to improvement.

Washington D. C: National Quality Forum; Google Scholar. Comprehensive discharge planning and home follow-up of hospitalized elders: A randomized clinical trial. The care transitions intervention: Results of a randomized controlled trial. Arch Intern Med. Richesson RL, Krischer J. Data standards in clinical research: Gaps, overlaps, challenges and future directions.

J Am Med Inform Assoc. The "medical neighborhood": Integrating primary and specialty care for ambulatory patients. Press MJ. Instant replay--a quarterback's view of care coordination. N Engl J Med. Clinical information technology capabilities in four U. Med Care. A patient-centered longitudinal care plan: Vision versus reality. Derivation and validation of an index to predict early death or unplanned readmission after discharge from hospital to the community.

Patient callback program: A quality improvement, customer service, and marketing tool. J Health Care Mark. Care coordination for children with complex care needs significantly reduces hospital utilization. J Spec Pediatr Nurs. Lessons learned from implementation of postdischarge telephone calls at baylor health care system. J Nurs Adm. Redefining and redesigning hospital discharge to enhance patient care: A randomized controlled study. J Gen Intern Med. Is email an effective method for hospital discharge communication?

A randomized controlled trial to examine delivery of computer-generated discharge summaries by email, fax, post and patient hand delivery. Int J Med Inform. Patient and physician perceptions after software-assisted hospital discharge: Cluster randomized trial. J Hosp Med. Lessons learned from implementation of a computerized application for pending tests at hospital discharge. The perception of medical professionals and medical students on the usefulness of an emergency medical card and a continuity of care report in enhancing continuity of care.

Int J Med Informatics. To the hospital and back home again: a nurse practitioner-based transitional care program for hospitalized homebound people. J Am Geriatr Soc. Implementation of a web-based system to improve the transitional care of older adults.

J Nurs Care Qual. Bridging the gap: a virtual health record for integrated home care. Int J Integr Care. Blobel B. Interoperable healthcare information system components for continuity of care.

Clinician roles and responsibilities during care transitions of older adults. An automated model to identify heart failure patients at risk for day readmission or death using electronic medical record data. Envisioning a social-health information exchange as a platform to support a patient-centered medical neighborhood: A feasibility study.

Download references. Lipika Samal, Patricia C. Dykes, Jeffrey O. You can also search for this author in PubMed Google Scholar. Correspondence to Lipika Samal. LS and PCD conducted the interviews, analyzed the qualitative data and conducted the abstract review for the literature review. LS and JOG summarized the literature for the literature review.

All authors read and approved the final manuscript. Reprints and Permissions. Samal, L. Care coordination gaps due to lack of interoperability in the United States: a qualitative study and literature review. Experts suggest that daily reviews of antibiotic selection, until a definitive diagnosis and treatment duration are established, can optimize treatment.

Provider-led reviews of antibiotics can focus on four key questions 67 :. There are several effective approaches to properly assess penicillin allergies, including history and physical examination, challenge doses, and skin testing 69 , Nurses may be able to play an important role in improving penicillin allergy assessments The microbiology lab in consultation with the stewardship program often implement the following interventions:.

Measurement is critical to identify opportunities for improvement and to assess the impact of interventions. Measurement of antibiotic stewardship interventions may involve evaluation of both processes and outcomes. For example, a program will need to evaluate if policies and guidelines are being followed as expected processes and if interventions have improved patient outcomes and antibiotic use outcomes.

There are a variety of health information technology companies that can facilitate the reporting of antibiotic use data to the AU Option Stewardship programs can work with their information technology staff to explore options for reporting data to the AU Option. The NHSN AU Option provides rates of antibiotic use expressed as days of therapy DOTs per days present for nearly all antibiotics for individual inpatient care locations, select outpatient care locations e.

Days of therapy are the sum of days for which any amount of a specific antibiotic agent is administered to a patient. SAARs were developed for a variety of groups of antibiotics for both adult, pediatric and neonatal care locations in response to suggestions from stewardship experts on the types of data that would be most actionable Hospitals that are not yet reporting to the NHSN AU Option can often get antibiotic use data from their pharmacy record systems, usually either as days of therapy or as defined daily doses DDDs.

The DDD estimates antibiotic use in hospitals by aggregating the total number of grams of each antibiotic purchased, ordered, dispensed, or administered during a period of interest divided by the World Health Organization-assigned DDD United States guidelines recommend the use of days of therapy rather than DDDs as the preferred numerator metric for hospital antibiotic use Most acute care hospitals are already monitoring and reporting information on C.

Antibiotic Resistance. Improving antibiotic use is important to reduce antibiotic resistance and presents another option for measurement. The development and spread of antibiotic resistance is multi-factorial and studies assessing the impact of improved antibiotic use on resistance rates have shown mixed results 7 , 87 , The impact of stewardship interventions on resistance is best assessed when measurement is focused on pathogens that are recovered from patients after admission when they are under the influence of hospital stewardship interventions Monitoring resistance at the patient level i.

Financial Impact. Stewardship programs can achieve significant cost savings, particularly drug cost savings. If hospitals monitor antibiotic costs, they should assess the pace at which antibiotic costs were rising before the start of the stewardship program After an initial period of marked savings, costs often stabilize. However, it is important to continue support for stewardship programs since costs can increase if programs are terminated Process measures can focus on the specific interventions being implemented at the hospital.

Priority process measures include:. Antibiotic stewardship programs should provide regular updates to prescribers, pharmacists, nurses, and leadership on process and outcome measures that address both national and local issues, including antibiotic resistance. Summary information on antibiotic use and resistance along with antibiotic stewardship program work should be shared regularly with hospital leadership and the hospital board.

Findings from medication use evaluations along with summaries of key issues that arise during prospective audit and feedback reviews and preauthorization requests can be especially useful to share with prescribers. Sharing facility-specific information on antibiotic use is a tool to motivate improved prescribing, particularly if wide variations in the patterns of use exist among similar patient care locations Provider specific reports with peer comparisons have been effective in improving antibiotic use in outpatient settings 95 , but there is limited experience with these reports for hospital-based providers.

CDC has a variety of educational resources, including a Training on Antibiotic Stewardship that includes a module focused on improving antibiotic use in hospitals Education is a key component of comprehensive efforts to improve hospital antibiotic use; however, education alone is not an effective stewardship intervention There are many options for providing education on antibiotic use such as didactic presentations, which can be done in formal and informal settings, messaging through posters, flyers and newsletters, or electronic communication to staff groups.

Education is most effective when paired with interventions and measurement of outcomes. Case-based education can be especially powerful, so prospective audit with feedback and preauthorization are both good methods to provide education on antibiotic use.

This can be especially effective when the feedback is provided in person, for example through handshake stewardship. Some hospitals review de-identified cases with providers to help identify changes in antibiotic therapy that could have been made. Education is most effective when tailored to the action s most relevant to the provider group, such as education on community acquired pneumonia guidelines for hospitalists or education on culture techniques for nurses.

They should be engaged in developing educational materials and educating patients about appropriate antibiotic use. Patient education is also an important focus for antibiotic stewardship programs. It is important for patients to know what antibiotics they are receiving and for what reason s.

They should also be educated about adverse effects and signs and symptoms that they should share with providers. Patients should be alerted to side effects that may occur after they have been discharged and even after they have stopped taking antibiotics.

Engaging patients in the development and review of educational materials can make these items more effective. Nurses are an especially important partner for patient education efforts.

The Core Elements of Hospital Antibiotic Stewardship Programs is one of a suite of documents intended to help improve the use of antibiotics across the spectrum of health care. Building upon the hospital Core Elements framework, CDC also developed guides for other healthcare settings:.

CDC will continue to use a variety of data sources, including the NHSN annual survey of hospital stewardship practices and AU Option, to find ways to optimize hospital antibiotic stewardship programs and practices. CDC will also continue to collaborate with an array of partners who share a common goal of improving antibiotic use. With stewardship programs now in place in most US hospitals, the focus is on optimizing these programs. CDC recognizes that research is essential to discover both more effective ways to implement proven stewardship practices as well as new approaches.

CDC will continue to support research efforts aimed at finding innovative solutions to stewardship challenges. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. They help us to know which pages are the most and least popular and see how visitors move around the site. All information these cookies collect is aggregated and therefore anonymous. If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance.

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Cookies used to enable you to share pages and content that you find interesting on CDC. These cookies may also be used for advertising purposes by these third parties. Thank you for taking the time to confirm your preferences. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. Skip directly to site content Skip directly to search. Minus Related Pages. On This Page. Treatment failures C. Core Elements Implementation.

Antibiotic Stewardship and Sepsis There have been some misperceptions that antibiotic stewardship may hinder efforts to improve the management of sepsis in hospitals. Summary of Updates to the Core Elements of Hospital Antibiotic Stewardship Programs Optimizing the use of antibiotics is critical to effectively treat infections, protect patients from harms caused by unnecessary antibiotic use, and combat antibiotic resistance. Major updates to the hospital Core Elements include: Hospital Leadership Commitment: Dedicate necessary human, financial and information technology resources.

Priority examples of hospital leadership commitment emphasize the necessity of antibiotic stewardship programs leadership having dedicated time and resources to operate the program effectively, along with ensuring that program leadership has regularly scheduled opportunities to report stewardship activities, resources and outcomes to senior executives and hospital board.

Priority interventions include prospective audit and feedback, preauthorization, and facility-specific treatment recommendations. Facility-specific treatment guidelines can be important in enhancing the effectiveness of prospective audit and feedback and preauthorization.

The update emphasizes the importance of actions focused on the most common indications for hospital antibiotic use: lower respiratory tract infection e. The antibiotic timeout has been reframed as a useful supplemental intervention, but it should not be a substitute for prospective audit and feedback.

A new category of nursing-based actions was added to reflect the important role that nurses can play in hospital antibiotic stewardship efforts.

Priority process measures emphasize assessing the impact of the key interventions, including prospective audit and feedback, preauthorization, and facility-specific treatment recommendations.

The update points out the effectiveness of provider level data reporting, while acknowledging that this has not been well studied for hospital antibiotic use.

The update highlights that case-based education through prospective audit and feedback and preauthorization are effective methods to provide education on antibiotic use. This can be especially powerful when the case-based education is provided in person e.

The update also suggests engaging nurses in patient education efforts. Hospital Leadership Commitment Support from the senior leadership of the hospital, especially the chief medical officer, chief nursing officer, and director of pharmacy, is critical to the success of antibiotic stewardship programs.

Priority examples of leadership commitment include: Giving stewardship program leader s time to manage the program and conduct daily stewardship interventions. Providing resources, including staffing, to operate the program effectively. Reporting stewardship activities and outcomes including key success stories to senior leadership and the hospital board on a regular basis e.

Other examples of leadership commitment include: Integrating antibiotic stewardship activities into other quality improvement and patient safety efforts, such as sepsis management and diagnostic stewardship.

Having clear expectations for the leaders of the program on responsibilities and outcomes. Making formal statements of support for efforts to improve and monitor antibiotic use. Outlining stewardship-related duties in job descriptions and annual performance reviews for program leads and key support staff.

Supporting training and education for program leaders e. Supporting participation in local, state, and national antibiotic stewardship quality improvement collaboratives.

Ensuring that staff from key support departments outlined below have sufficient time to contribute to stewardship activities. Key Support Hospital leadership can help ensure that other groups and departments in the hospital are aware of stewardship efforts and collaborate with the stewardship program. Stewardship programs are greatly enhanced by strong support from the following groups: Clinicians : It is vital that all clinicians are fully engaged in and supportive of efforts to improve antibiotic use.

Help optimize empiric antibiotic prescribing by creating and interpreting a facility cumulative antibiotic resistance report or antibiogram.

Laboratory and stewardship personnel can work collaboratively to present data from lab reports in a way that supports optimal antibiotic use and is consistent with hospital guidelines. Guide discussions on the potential implementation of rapid diagnostic tests and new antibacterial susceptibility test interpretive criteria e.

Microbiology labs and stewardship programs can work together to optimize the use of such tests and the communication of results. Collaborate with stewardship program personnel to develop guidance for clinicians when changes in laboratory testing practices might impact clinical decision making Hospitals where microbiology services are contracted to an external organization should ensure that information is available to inform stewardship efforts.

Some examples include: Embedding relevant information and protocols at the point of care e. Implementing clinical decision support for antibiotic use and creating prompts for action to review antibiotics in key situations. Nurses can play an especially important role in: Optimizing testing, or diagnostic stewardship. For example, nurses can inform decisions about whether or not a patient has symptoms that might justify a urine culture.

Assuring that cultures are performed correctly before starting antibiotics. Prompting discussions of antibiotic treatment, indication, and duration. Improving the evaluation of penicillin allergies. Accountability The antibiotic stewardship program must have a designated leader or co-leaders who are accountable for program management and outcomes. Antibiotic Stewards.

Pharmacy Expertise. Action Antibiotic stewardship interventions improve patient outcomes 7 , 9. Priority Interventions to Improve Antibiotic Use Stewardship programs should choose interventions that will best address gaps in antibiotic prescribing and consider prioritizing prospective audit and feedback, preauthorization and facility-specific treatment guidelines.

Common Infection-based Interventions More than half of all antibiotics given to treat active infections in hospitals are prescribed for three infections where there are important opportunities to improve use: lower respiratory tract infection e. Table 1. Community-acquired pneumonia 54 Review cases after initiation of therapy to confirm pneumonia diagnosis versus non-infectious etiology.

Guidelines suggest that in adults, most cases of uncomplicated pneumonia can be treated for 5 days when a patient has a timely clinical response 55 , Urinary tract infection UTI Implement criteria for ordering urine cultures to ensure that positive cultures are more likely to represent infection than bladder colonization Examples include: Order a urine culture only if the patient has signs and symptoms consistent with UTI such as urgency, frequency, dysuria, suprapubic pain, flank pain, pelvic discomfort or acute hematuria.

Establish criteria to distinguish between asymptomatic and symptomatic bacteriuria. Use the shortest duration of antibiotic therapy that is clinically appropriate. Skin and soft tissue infection Develop diagnostic criteria to distinguish purulent and non-purulent infections and severity of illness i. Guidelines suggest that most cases of uncomplicated bacterial cellulitis can be treated for 5 days if the patient has a timely clinical response Show More.

Other Infection-based Interventions Sepsis: Early administration of effective antibiotics is lifesaving in sepsis. Important issues to address are: Developing antibiotic recommendations for sepsis that are based on local microbiology data. Ensuring protocols are in place to administer antibiotics quickly in cases of suspected sepsis.

Ensuring there are mechanisms in place to review antibiotics started for suspected sepsis so that therapy can be tailored or stopped if deemed unnecessary. Provider-led reviews of antibiotics can focus on four key questions 67 : Does this patient have an infection that will respond to antibiotics?

Have proper cultures and diagnostic tests been performed? How long should the patient receive the antibiotic s , considering both the hospital stay and any post-discharge therapy? Automatic changes from intravenous to oral antibiotic therapy: This change can improve patient safety by reducing the need for intravenous access in appropriate situations and for antibiotics with good absorption.

Dose adjustments: when needed, such as in cases of organ dysfunction, especially renal, or based on therapeutic drug monitoring. Dose optimization: for example, extended-infusion administration of beta-lactams, particularly for patients who are critically-ill and patients infected with drug-resistant pathogens.

Duplicative therapy alerts : Alerts in situations where therapy might be unnecessarily duplicative including simultaneous use of multiple agents with overlapping spectra e. Time-sensitive automatic stop orders: for specified antibiotic prescriptions, especially antibiotics administered for surgical prophylaxis. Detection and prevention of antibiotic-related drug-drug interactions: for example, interactions between some orally administered fluoroquinolones and certain vitamins.

Microbiology-based Interventions The microbiology lab in consultation with the stewardship program often implement the following interventions: Selective reporting of antimicrobial susceptibility testing results: tailoring hospital susceptibility reports to show antibiotics that are consistent with hospital treatment guidelines or recommended by the stewardship program 75 Comments in microbiology reports: for example, to help providers know which pathogens might represent colonization or contamination Nursing-based interventions Bedside nurses often initiate the following interventions: Optimizing microbiology cultures: Knowing proper techniques to reduce contamination and indications for when to obtain cultures, especially urine cultures Intravenous to oral transitions: Nurses are most aware of when patients are able to tolerate oral medications and can initiate discussions on switching to oral antibiotics.

Tracking Measurement is critical to identify opportunities for improvement and to assess the impact of interventions. Outcome measures C. Process Measures for Quality Improvement Process measures can focus on the specific interventions being implemented at the hospital. Priority process measures include: Tracking the types and acceptance of recommendations from prospective audit and feedback interventions, which can identify areas where more education or additional focused interventions might be useful.

Monitoring of preauthorization interventions by tracking agents that are being requested for certain conditions and ensuring that preauthorization is not creating delays in therapy. Monitoring adherence to facility-specific treatment guidelines. If feasible, consider tracking adherence by each prescriber.

Additional process measures for quality improvement include: Monitoring the performance of antibiotic timeouts to assess how often they are preformed and if opportunities to improve use are being identified and acted on.

Performing a medication use evaluation to assess courses of therapy for select antibiotics or infections to identify opportunities to improve use.

Standardized tools or antibiotic audit forms can assist in these reviews 92 Monitoring how often patients are converted from intravenous to oral therapy to identify missed opportunities to convert. Assessing how often patients are prescribed unnecessary duplicate therapy, for example if a patient is prescribed two antibiotics to treat anaerobes.

Assessing how often patients are discharged on the correct antibiotics for the recommended duration. Open All Close All. Intensive care medicine. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis. Fridkin SK, Baggs J.

Antimicrobial resistance and infection control. Hospital ward antibiotic prescribing and the risks of Clostridium difficile infection. Interventions to improve antibiotic prescribing practices for hospital inpatients. The Cochrane database of systematic reviews. Antimicrobial agents and chemotherapy. Effect of antibiotic stewardship on the incidence of infection and colonisation with antibiotic-resistant bacteria and Clostridium difficile infection: a systematic review and meta-analysis.

The Lancet Infectious diseases. Centers for Disease Control and Prevention. Antimicrobial stewardship at a large tertiary care academic medical center: cost analysis before, during, and after a 7-year program.

Infection control and hospital epidemiology : the official journal of the Society of Hospital Epidemiologists of America. Department of Veterans Affairs. Clinical therapeutics. Srinivasan A. Engaging hospitalists in antimicrobial stewardship: the CDC perspective.

Journal of hospital medicine : an official publication of the Society of Hospital Medicine. Antimicrobial stewardship and infection prevention-leveraging the synergy: A position paper update.

American journal of infection control. Antimicrobial stewardship: a collaborative partnership between infection preventionists and health care epidemiologists. The effect of molecular rapid diagnostic testing on clinical outcomes in bloodstream infections: A systematic review and meta-analysis.

Clinical Infectious Diseases. Journal of infection prevention. Guidance for the knowledge and skills required for antimicrobial stewardship leaders.

And medicaid centers analysis gap the for medicare services kaiser permanente ga locations

Ojo de alcon movie Whether, and to what extent, these actions are implemented and extend Medicaid to people currently in the coverage gap will be a key policy issue for the upcoming year. In addition, because several states that have not expanded Medicaid have large populations of people of color, state decisions not to expand their programs disproportionately affect people benefits code carefirst color, particularly Black Americans. Microbiology labs and stewardship programs can work together to optimize the use of such tests and the communication of results. Priority interventions include prospective audit and feedback, preauthorization, and facility-specific treatment recommendations. Common Infection-based Interventions More than half of all antibiotics given to treat active infections in hospitals are prescribed for three infections where there are important opportunities to improve use: lower respiratory tract infection e.
How the tuskegee syphilis study changed healthcare research Sears, James, and Kalman Rupp. If they remain uninsured, adults in the coverage gap are likely to face barriers to needed health services or, if they do require and receive medical care, potentially serious financial consequences. To summarize, we highlight three points here: 1 SSI involvement or the lack of is the principal determinant of the level of public health insurance coverage during a roughly 2-year period after the first month of first disability benefit coverage for all subgroups; 2 the lead cenhers the SSI -only group in public health coverage disappears after the first 24 months of disability benefit coverage, and in contrast to all of the other longitudinal pattern groups, a small portion stays without either Medicaid or Medicare coverage thereafter; and 3 people who are involved with both the SSI and DI programs at some point have are ahc adventist health care criticism access to public health insurance compared with the DI -only group for analyxis reasons. Ensuring there are mechanisms in place to review antibiotics started for suspected sepsis so that therapy can be tailored or stopped if deemed unnecessary. Additional file 2: A file containing the literature review methods and results. Some people may be gzp for just click for source DI and SSI cash benefits on a monthly basis, resulting in dual eligibility for both Medicare and Medicaid in many cases. Our objective was to identify intervention studies conducted to improve transfer of mfdicare during transitions medicwre care, with a focus on HIT interventions.
The centers for medicare and medicaid services gap analysis Anyone you share the following link with will be able to read this content:. For early results, think, fairmont humane society hope Weathers and others By definition, people in the coverage gap have limited family income and servicse below the poverty level. Quality improvement, patient safety and regulatory staff can help advocate for adequate resources and integrate stewardship interventions into other quality improvement efforts, especially sepsis management. Table A Two studies have mediczre these two interventions directly and found prospective audit and feedback to be more effective than preauthorization 42 The data for months 2 through 72 reflect only survivors younger than age 65 at given month.
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Medicare is funded primarily from general revenues 43 percent , payroll taxes 36 percent , and beneficiary premiums 15 percent Figure 7. Figure 7: Sources of Medicare Revenue, The solvency of Medicare in this context is measured by the level of assets in the Part A trust fund. In years when annual income to the trust fund exceeds benefits spending, the asset level increases, and when annual spending exceeds income, the asset level decreases.

When spending exceeds income and the assets are fully depleted, Medicare will not have sufficient funds to pay all Part A benefits. In the Medicare Trustees report, the actuaries projected that the Part A trust fund will be depleted in , the same year as their projection and three years earlier than their projection Figure 8.

The actuaries estimate that Medicare will be able to cover 89 percent of Part A costs from payroll tax revenue in In the and Medicare Trustees reports, the actuaries attributed the earlier depletion date to several factors, including legislative changes enacted since the report that will reduce revenues to the Part A trust fund and increase Part A spending:. Part B and Part D do not have financing challenges similar to Part A, because both are funded by beneficiary premiums and general revenues that are set annually to match expected outlays.

Expected future increases in spending under Part B and Part D, however, will require increases in general revenue funding and higher premiums paid by beneficiaries. Although Medicare spending is on a slower upward trajectory now than in past decades, total and per capita annual growth rates are trending higher than their historically low levels of the past few years.

The aging of the population, growth in Medicare enrollment due to the baby boom generation reaching the age of eligibility, and increases in per capita health care costs are leading to growth in overall Medicare spending. A number of changes to Medicare have been proposed in the past to address the fiscal challenges posed by the aging of the population and rising health care costs. Lately, policymakers have been focused more narrowly on policy options to control Medicare prescription drug spending , rather than on broader proposals to reduce the growth in Medicare spending.

Meanwhile, Medicare has featured prominently in the presidential campaign, with proposals from some Democratic candidates to expand on it as part of a Medicare-for-all plan , and ideas from others to allow people to buy into it. Key Facts Medicare spending was 15 percent of total federal spending in , and is projected to rise to 18 percent by Based on the latest projections in the Medicare Trustees report, the Medicare Hospital Insurance Part A trust fund is projected to be depleted in , the same as the projection.

Average annual growth in Medicare per capita spending was 1. Medicare per capita spending is projected to grow at an average annual rate of 5. Overview of Medicare Spending Medicare plays a major role in the health care system, accounting for 20 percent of total national health spending in , 30 percent of spending on retail sales of prescription drugs, 25 percent of spending on hospital care, and 23 percent of spending on physician services.

CMS officials attributed the increase to their leadership's commitment to promoting competition for all CMS contracts. CMS's fiscal year competition rate is higher than the government-wide rate of 63 percent and the civilian agency rate of 81 percent.

The Federal Acquisition Regulation provides for these types of contracts, stating they are appropriate to use when uncertainties in the scope of the work, cost of services, or level of labor effort needed prevent the use of contract types in which prices are fixed. However, the Office of Management and Budget considers these types of contracts high risk because they carry significant potential risk of overspending.

CMS officials stated that they are looking for opportunities to use more fixed-price contracts to minimize financial risk, but noted that much of CMS's work is appropriate for cost-reimbursement contracts due to uncertainties in the requirements.

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The solvency of Medicare in this context is measured by the level of assets in the Part A trust fund. In years when annual income to the trust fund exceeds benefits spending, the asset level increases, and when annual spending exceeds income, the asset level decreases.

When spending exceeds income and the assets are fully depleted, Medicare will not have sufficient funds to pay all Part A benefits. In the Medicare Trustees report, the actuaries projected that the Part A trust fund will be depleted in , the same year as their projection and three years earlier than their projection Figure 8.

The actuaries estimate that Medicare will be able to cover 89 percent of Part A costs from payroll tax revenue in In the and Medicare Trustees reports, the actuaries attributed the earlier depletion date to several factors, including legislative changes enacted since the report that will reduce revenues to the Part A trust fund and increase Part A spending:.

Part B and Part D do not have financing challenges similar to Part A, because both are funded by beneficiary premiums and general revenues that are set annually to match expected outlays. Expected future increases in spending under Part B and Part D, however, will require increases in general revenue funding and higher premiums paid by beneficiaries.

Although Medicare spending is on a slower upward trajectory now than in past decades, total and per capita annual growth rates are trending higher than their historically low levels of the past few years. The aging of the population, growth in Medicare enrollment due to the baby boom generation reaching the age of eligibility, and increases in per capita health care costs are leading to growth in overall Medicare spending.

A number of changes to Medicare have been proposed in the past to address the fiscal challenges posed by the aging of the population and rising health care costs.

Lately, policymakers have been focused more narrowly on policy options to control Medicare prescription drug spending , rather than on broader proposals to reduce the growth in Medicare spending. Meanwhile, Medicare has featured prominently in the presidential campaign, with proposals from some Democratic candidates to expand on it as part of a Medicare-for-all plan , and ideas from others to allow people to buy into it.

Key Facts Medicare spending was 15 percent of total federal spending in , and is projected to rise to 18 percent by Based on the latest projections in the Medicare Trustees report, the Medicare Hospital Insurance Part A trust fund is projected to be depleted in , the same as the projection.

Average annual growth in Medicare per capita spending was 1. Medicare per capita spending is projected to grow at an average annual rate of 5. Overview of Medicare Spending Medicare plays a major role in the health care system, accounting for 20 percent of total national health spending in , 30 percent of spending on retail sales of prescription drugs, 25 percent of spending on hospital care, and 23 percent of spending on physician services.

Topics Medicare. Also of Interest An Overview of Medicare. However, the Office of Management and Budget considers these types of contracts high risk because they carry significant potential risk of overspending. CMS officials stated that they are looking for opportunities to use more fixed-price contracts to minimize financial risk, but noted that much of CMS's work is appropriate for cost-reimbursement contracts due to uncertainties in the requirements.

CMS uses an extensive network of private contractors to help carry out its responsibilities, including benefit delivery, program administration, management, and oversight. These contractors perform a variety of functions such as handling claims under the Medicare program and maintaining information technology systems.

This report identifies what federal procurement data show regarding recent CMS contracting in areas such as total spending, competition rates, and contract types.