2337_sejda-DYJ.pdf - Chapter 12 References Available at http/advances.sciencemag.org/content/1/1/e1400082.full(Accessed February 27 2018 Cook R J.S

2337_sejda-DYJ.pdf - Chapter 12 References Available at...

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Unformatted text preview: Chapter 12 References Available at: . (Accessed February 27, 2018). Cook, R., J.S. Touma, A. Beidler, and M. Strum. 2006. Preparing Highway Emissions Inventories for Urban Scale Modeling: A Case Study in Philadelphia. Transportation Research Part D: Transport and Environment 11(6):396–407. doi:10.1016/j.trd.2006.08.001. Cutter, L.S., B.J. Boruff, and W.L. Shirley. 2003. Social Vulnerability to Environmental Hazards. Social Science Quarterly 84(2):242-261. doi:10.1111/1540-6237.8402002. Cutter, S.L., W. Solecki, N. Bragado, J. Carmin, M. Fragkias, M. Ruth, and T.J. Wilbanks. 2014. Chapter. 11: Urban Systems, Infrastructure, and Vulnerability. Pgs. 282–296. In: Climate Change Impacts in the United States: The Third National Climate Assessment [Melillo, J.M., T.C. Richmond, and G.W. Yohe (Eds)]. U.S. Global Change Research Program. doi:10.7930/J0F769GR. Available at: . (Accessed: February 27, 2018). D’Amato, G., C.E. Baena-Cagnani, L. Cecchi, I. Annesi-Maesano, C. Nunes, I. Ansotegui, M. D’Amato, G. Liccardi, M. Sofia, and W.G. Canonica. 2013. Climate Change, Air Pollution and Extreme Events Leading to Increasing Prevalence of Allergic Respiratory Diseases. Multidisciplinary Respiratory Medicine 8(1):12. doi:10.1186/2049-6958-8-12. Available at: . (Accessed: February 27, 2018). Das, S. 2011. Life Cycle Assessment of Carbon Fiber-Reinforced Polymer Composites. International Journal of Life Cycle Assessment 16(3):268–282. doi:10.1007/s11367-011-0264-z. Das, S. 2014. Life Cycle Energy and Environmental Assessment of Aluminum-Intensive Vehicle Design. SAE International Journal of Material Manufacturing 7(3):588-595. doi:10.4271/2014-01-1004. Davis, S.C., S.E. Williams, and R.G. Boundy. 2016. Transportation Energy Data Book, 35th Edition, ”Table3_07” MS Excel workbook in “All Spreadsheets”. Oak Ridge National Laboratory: Oak Ridge, Tennessee. Available at: . (Accessed: February 15, 2017). Deichstetter, P. 2017. The Effect of Climate Change on Mosquito-borne Diseases. American Biology Teacher 79(3):169-173. doi:10.1525/abt.2017.79.3.169. Deign, J. 2017. 10 Battery Gigafactories Are Now in the Works. and Elon Musk May Add 4 More. Last revised: June 29, 2017. Available at: . (Accessed: February 16, 2018). Dell, J., S. Tierney, G. Franco, R.G. Newell, R. Richels, J. Weyant, and T.J. Wilbanks. 2014. Chapter 4: Energy Supply and Use. Pgs. 113–129. In: Climate Change Impacts in the United States: The Third National Climate Assessment. [Melillo, J.M., T.C. Richmond, and G. W. Yohe (Eds)]. U.S. Global Change Research Program. doi:10.7930/J0BG2KWD. Available at: . (Accessed: February 27, 2018). Delogu, M., F. Del Pero, F. Romoli, and M. Pierini. 2015. Life Cycle Assessment of a Plastic Air Intake Manifold. International Journal of Life Cycle Assessment, 20(10), 1429-1443. doi:10.1007/s11367015-0946-z.Depro, B., and C. Timmins. 2008. Mobility and Environmental Equity: Do Housing Choices 12-12 be complete (for example, we do not have good data on MA plans’ use of post-acute care); it is not possible to compare measures that MA collects by means of medical record sampling with FFS results unless there is a similar data collection process; and for measures that would have to be risk adjusted (such as mortality rates), differences in MA and FFS coding practices need to be taken into account. The wave of contract consolidations has reduced the ability to have valid comparisons among MA plans, particularly for measures based on medical record sampling. As contracts cover larger and larger geographic areas, contract-level samples of 411 records cannot be relied on to examine differences among MA plans because those samples represent different geographic areas and are not otherwise representative of the population served by a plan in a given area. With the current state of MA quality data, reliable information comparing FFS and MA, or comparing different MA plans in an area, is not available to an important audience—Medicare beneficiaries—as we show with an illustrative example (p. 370). The Commission’s March 2018 report to the Congress contains a detailed discussion of the difficulty of evaluating the quality of care within the MA sector and changes in MA quality from one year to the next. The current rating system uses a 5-star scale to determine performance at the level of individual quality measures (such as clinical quality measures and patient experience measures) and then determines an overall star rating that is the weighted average of up to 46 measure-level star ratings. The overall star rating is the basis for bonus payments in the MA quality bonus program, with bonuses available when the overall star rating is 4 stars or higher. What has made this system unreliable as a basis for evaluating quality is that collection and reporting of each of the 46 measure results, and the determination of the overall star rating, occurs at the level of the MA contract. Under current rules, an MA contract can include any number of geographic areas, and there is no requirement that the areas be contiguous. In 2018, about 40 percent of MA enrollees were in HMO or local PPO contracts that drew a substantial number of enrollees from contract service areas consisting of noncontiguous states. The largest MA contract, with 1.3 million enrollees as of July 2018, had over 1,000 enrollees in each of 45 states and over 20,000 enrollees in each of 18 states. The top five states in enrollment for this contract had 47 percent of the plan’s enrollment: Alabama, California, Georgia, Illinois, and North Carolina. In 2010, given how much the quality of care can vary from one local area to another, the Commission recommended that CMS change to reporting at the local market area level (suggesting the use of metropolitan statistical areas and, in nonmetropolitan areas, groupings based on the patterns of where beneficiaries received care). This recommendation was repeated in our March 2018 report to the Congress. The Commission’s repeating of the 2010 recommendation was prompted by another issue that the Commission has examined extensively, which is the practice of consolidating contracts to achieve higher star ratings. CMS has encouraged sponsors to consolidate their MA contracts to streamline program administration for CMS and for plan sponsors. Through 2019, the rules for determining star ratings, and therefore eligibility for bonus payments, provided plan sponsors with the opportunity to use the contract consolidation strategy to obtain unwarranted bonus payments. A sponsor is permitted to consolidate two or more contracts and choose which contract would be the “surviving” contract. The star rating of the surviving contract applies to the “consumed” contract(s) immediately—both for purposes of bonus payments and the star rating appearing on the Medicare Plan Finder site that beneficiaries can use to choose among plans. For 2019, plan sponsors have used this strategy to move about 550,000 enrollees from nonbonus contracts to bonus-level contracts, resulting in unwarranted bonus payments in the range of $200 million in 2019. In the preceding five years, over 4 million enrollees were moved from nonbonus plans to bonus plans, including situations in which surviving contracts that fell below 4 stars underwent subsequent consolidations and were consumed by bonus-level contracts. Effective 2020, the Bipartisan Budget Act of 2018 changes the policy on plan consolidations. For new consolidations, the star rating of the surviving contract will be the enrollment-weighted average of the quality results for the contracts being merged. While this change in policy will prevent sponsors from obtaining unwarranted bonus payments when a small, highly rated contract absorbs a larger nonbonus contract, sponsors will still be able to obtain unwarranted bonus payments by consolidating contracts when they can be assured that the weighted average results from combining nonbonus and bonus-level contracts will produce a bonus-level star rating for the surviving contract. Report to the Congress: Medicare Payment Policy  |  March 2019 369 Chapter 12 References Determine Exposure to Air Pollution? North Carolina State University and RTI International, Duke University and NBER. Available at: . (Accessed: May 31, 2018). Dhingra, R., J.G. Overly, G.A. Davis, S. Das, S. Hadley, and B. Tonn. 2000. A Life-Cycle-Based Environmental Evaluation: Materials in New Generation Vehicles. SAE Technical Paper 2000-010595. doi: 10.4271/2000-01-0595. DOD (Department of Defense). 2014. Quadrennial Defense Review 2014. U. S. Department of Defense. Washington, D.C. Available at: . (Accessed: February 27, 2018). DOD. 2015. National Security Implications of Climate-Related Risks and a Changing Climate. Published May 2015. RefID: 8-6475571. Available at: . (Accessed: February 27, 2018). DOE. 2008. DOE Actively Engaged in Investigating the Role of Biofuels in Greenhouse Gas Emissions from Indirect Land Use Change. Available at: . (Accessed: March 21, 2018). DOE. 2013a. Clean Cities Guide to Alternative Fuel and Advanced Medium- and Heavy-Duty Vehicles. DOE/GO-102013-3624. August 2013. U.S. Department of Energy, Energy Efficiency and Renewable Energy. Prepared by the National Renewable Energy Laboratory (NREL), Office of Energy Efficiency and Renewable Energy. Available at: . (Accessed: February 27, 2018). DOE. 2013b. Handbook for Handling, Storing, and Dispensing E85 and Other Ethanol-Gasoline Blends. DOE/Go-102016-4854. February 2016. U.S. Department of Energy, Office of Energy Efficiency and Renewable Energy. Available at: . (Accessed: February 27, 2018). DOE. 2013c. U.S. Energy Sector Vulnerabilities to Climate Change and Extreme Weather. DOE/Pl-0013. July 2013. U.S. Department of Energy. Available at: . (Accessed: February 27, 2018). DOE. 2013c. citing Sailor, D.J., M. Smith, and M. Hart. 2008. Climate change implications for wind power resources in the Northwest United States. Renewable Energy 33(11): 2393-2406. doi:10.1016/j.renene.2008.01.007. DOE. 2013d. Workshop Report: Light-Duty Vehicles Technical Requirements and Gaps for Lightweight and Propulsion Materials. Available at: . (Accessed: June 21, 2018). 12-13 TABLE 13–8 In 2017, fee-for-service and Medicare Advantage Consumer Assessment of Health Providers and Systems® performance rates were simlar CAHPS measure FFS MA Getting needed care and seeing specialists 84% 84% Getting appointments and care quickly 77 78 Care coordination 86 86 Rating of health plan 83 86 Rating of health care quality 85 86 Annual influenza vaccine 74 73 Note: CAHPS® (Consumer Assessment of Healthcare Providers and Systems®), FFS (fee-for-service), MA (Medicare Advantage). The MA rate is the enrollment-weighted average rate for all MA contract types other than cost-reimbursed HMOs. Other than the influenza vaccination rate, rates are case-mix adjusted for response bias. Source: MA CAHPS based on MedPAC analysis of 2018 plan ratings. FFS CAHPS mean scores provided by CMS. Comparing MA and FFS quality As we have noted, currently, there is only one source of data provided to beneficiaries through the Medicare. gov website that can be used for a direct comparison of MA and FFS, which is the patient experience measures and the influenza vaccination rates collected through the Consumer Assessment of Healthcare Providers and Systems® (CAHPS®). At a national average level, in 2018, there was little difference between MA and FFS results, though the influenza vaccination rate is lower among MA enrollees in HMOs as compared with the national average FFS rate (Table 13-8). The 2018 results are similar to past years’ results (see, for example, the 2015 results in the Commission’s March 2017 report to the Congress, where the only meaningful differences were in the influenza vaccination rates, with HMOs and FFS at about the same level (72 percent) and local PPOs at 74 percent (Medicare Payment Advisory Commission 2017). There may be some value in having information about a national-level comparison of MA and FFS performance, but of greater importance to beneficiaries—and, arguably, to policymakers— is to have market-level comparisons. While the Medicare Plan Finder website provides beneficiaries with the CAHPS information by MA contract and for FFS by geographic area, a specific example we discuss below illustrates the issues with the current method of collecting and reporting data as it affects comparisons of MA plans and an MA-to-FFS comparisons. The issues are common to both the CAHPS data and the other quality measures that plans report. 370 The Medicare Advantage program: Status report In our illustrative example, a beneficiary residing in Phoenix, AZ, is looking to enroll in an MA plan in 2019 and wishes to compare MA results with FFS results. For the influenza vaccination rate reported through CAHPS, the FFS rate is a statewide rate for all of Arizona (74 percent). For the MA plans available in Phoenix in the Plan Finder results for the 2019 enrollment period, reported influenza vaccination rates range from 55 percent to 79 percent. However, the contract with the 79 percent rate had no enrollees in Arizona at the time the vaccination rates were determined. The 79 percent rate is based on enrollment in a contract that drew one-third of its enrollment from Hawaii, nearly half from Iowa, and nearly 20 percent from Nebraska. This contract is present in the Phoenix market in 2019 as a result of a contract consolidation whereby this sponsor’s 2018 Arizona contract (with a star rating below bonus status) was absorbed by the Hawaii-Iowa-Nebraska contract (with a bonus-level star rating), thereby enabling the sponsor’s Arizona enrollees to be in a contract with a bonus-level star rating for 2019 payments. The Arizona contract absorbed by the Hawaii-Iowa-Nebraska contract was itself the product of a consolidation into a contract that originally served the contiguous states of Missouri and Kansas and then absorbed five single-state contracts in Colorado, Illinois, New Mexico, and Texas, in addition to an Arizona contract. A within-Arizona comparison of MA and FFS results on the influenza vaccination measure is possible because there are MA contracts in Arizona that in 2018 only ...
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  • Fall '19
  • Influenza vaccine, 2010s, Life cycle assessment

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