Analysis of the California In-Home Supportive Services (IHSS) Plus Waiver Demonstration Program. Appendix E. Physician, Outpatient Department, and Emergency Room Use and Expenditures

07/01/2008

TABLE E-1: Adjusted Medicaid-Paid Medical Care Use, Excluding Emergency Room Use, by IHSS Recipients,a 2005
Predictors Age 3-17
n=11,002
Age 18-64
n=123,813
Age 65 or More
n=206,579
  Odds Ratio   95% CI   Odds Ratio   95% CI   Odds Ratio   95% CI
SOURCE: Unpublished tables derived from California Department of Health Care Services, Medicaid claims. Events shown under count actual use as they exclude stays paid for fully by non-Medicaid sources.
  1. Sample includes all eligible IHSS recipients, excluding those in managed care for one month or more in 2005. Any ER user counts were as follows: age 3-17, age 18-64, age 65+.
  2. Reference is White.
  3. Cognition is defined by: memory, orientation, and judgment. Each scored 1 independent; 2 able to perform, but needs verbal assistance such as reminders, guidance, or encouragement; 5 cannot perform without human assistance. Scores three and four not used. The measure is a dummy variable yes = have three cognitive measures each with a score five.
  4. ADLs refers to activities of daily living (i.e., bathing and grooming; dressing; transferring; bowel, bladder and menstrual; eating). Each task is scored on a four or five point scale: 1 and 2 as per above, 3 Can perform with some human direct physical assistance from the provider, 4 Can perform with a lot of human assistance, 5 cannot perform without human assistance. The measure is a dummy variable yes = have three or more ADLs each with a score of three or more indicating the need for human assistance.
  5. Breathing is scored 1 independent, 5 cannot perform without human assistance, 6 paramedical services needed. The measure is the presence/absence of a breathing item with a score of five or more.
  6. Unduplicated count of health conditions grouped into 23 subcategories using HCCs.
  7. Reference is Non-Relative provider, "na" means the provider type was not included in the model.
Recipient Characteristics
Female Recipient 0.94   0.76-1.15   0.95   0.90-1.01   0.94   0.91-0.98  
Hispanicb 1.23 0.96-1.57 1.12 1.04-1.20 0.99 0.94-1.03
Black 1.21 0.90-1.61 0.95 0.89-1.01 0.76 0.72-0.80
Asian/Other 1.08 0.75-1.54 1.23 1.11-1.36 0.99 0.95-1.04
Household size (1-5) 1.03 0.93-1.13 0.97 0.95-1.00 1.03 1.01-1.04
3+ Cognitive Limitationsc 1.41 1.07-1.86 0.98 0.88-1.09 0.98 0.88-1.09
3+ ADL Limitationsd 0.78 0.59-1.02 0.92 0.86-0.98 0.92 0.88-0.96
Respiratory Limitationse 0.71 0.52-0.98 0.85 0.76-0.96 0.83 0.77-0.90
Number Health Conditionsf   32.8 27.3-39.3 10.6 10.2-11.0 7.54 7.37-7.71
Provider Relationshipg
Spouse na na 1.99 1.69-2.33 1.48 1.29-1.71
Parent 1.73 1.35-2.22 0.86 0.80-0.93 na na
Other Relative 0.96 0.69-1.34 1.10 1.03-1.18 1.08 1.04-1.12
Total Authorized Hours 1.00 1.00-1.00 1.00 1.00-1.00 1.00 1.00-1.00
County Characteristics
Per Capita Income 0.98 0.97-1.00 0.99 0.99-0.99 1.00 1.00-1.00
New IHSS Recipients 0.12 0.09-0.17 0.06 0.06-0.07 0.04 0.04-0.04
Model Goodness of Fit
-2Log Likelihood 2728   35594   89729  
Maximum Rescaled R2 0.838   0.735   0.661  

 

TABLE E-2: Mean Medicaid-Paid Physician Expenditures by IHSS Recipients,a 2005
Variable Age 3-17 Age 18-64 Age 65 or More
n Mean Std Dev n Mean Std Dev n   Mean   Std Dev
SOURCE: Derived from the California Department of Health Care Services, Medicaid claims, vendor group 5 (physicians, and physician groups, nurse practitioner, surgi-centers, rural health clinics).
  1. Sample includes all eligible IHSS recipients, excluding those in managed care for one month or more in 2005. The number of care recipients does not equal the number of eligible recipients due to the absence of vendor group 5 claims.
All Recipients   8,534         102,857         161,276      
Grand Total     1,057     2,379       1,126     2,884     317   1,391  
  Average $/month   110 343   136 458   35 188
Spouse na     5,804     3,543    
  Period Mean Total $   na na   1,240 3,556   415 1,747
  Average $/month   na na   148 474   48 242
Parent 6,424     13,010     na    
  Period Mean Total $   1,104 2,483   754 2,007   na na
  Average $/month   111 362   81 258   na na
Other Relative 992     34,881     84,007    
  Period Mean Total $   944 1,829   1,227 3,159   311 1,350
  Average $/month   96 211   143 474   35 193
Non-Relative 1,118     49,162     73,726    
  Period Mean Total $   887 2,179   1,139 2,779   319 1,418
  Average $/month   112 324   145 485   35 179
Continuing Recipients 7,566     87,634     145,053    
Grand Total   1,085 2,381   1,120 2,815   316 1,407
  Average $/month   106 332   121 419   32 172
Spouse na     4,928     2,996    
  Period Mean Total $   na na   1,198 3,422   414 1,809
  Average $/month   na na   128 441   41 167
Parent 5,768     11,933     na    
  Period Mean Total $   1,131 2,492   730 1,943   na na
  Average $/month   108 359   73 232   na na
Other Relative 863     29,133     74,883    
  Period Mean Total $   948 1,742   1,225 3,073   306 1,346
  Average $/month   91 176   128 444   31 169
Non-Relative 935     41,640     67,174    
  Period Mean Total $   927 2,176   1,148 2,748   322 1,452
  Average $/month   101 262   129 439   33 175
New IHSS Recipients 968     15,223     16,223    
Grand Total   838 2,349   1,161 3,254   329 1,240
  Average $/month   142 415   224 631   62 296
Spouse na     876     547    
  Period Mean Total $   na na   1,475 4,230   416 1,359
  Average $/month   na na   255 617   86 475
Parent 656     1,077     na    
  Period Mean Total $   866 2,396   1,019 2,600   na na
  Average $/month   138 385   169 446   na na
Other Relative 129     5,748     9,124    
  Period Mean Total $   917 2,336   1,236 3,563   350 1,381
  Average $/month   129 367   214 596   63 330
Non-Relative 183     7,522     6,552    
  Period Mean Total $   682 2,187   1,087 2,941   293 997
  Average $/month   167 535   235 678   59 215

 

TABLE E-3: Mean Medicaid-Paid Outpatient Department Expenditures by IHSS Recipients,a 2005
Variable Age 3-17 Age 18-64 Age 65 or More
n   Mean     Std Dev   n   Mean     Std Dev   n   Mean     Std Dev  
SOURCE: Derived from the California Department of Health Care Services, Medicaid claims, vendor group 6 (hospital outpatient departments, organized outpatient clinics).
  1. Sample includes all eligible IHSS recipients, excluding those in managed care for one month or more in 2005. The number of care recipients does not equal the number of eligible recipients due to the absence of vendor group 6 claims.
All Recipients   6,476         72,861         98,875      
Grand Total   965 8,633   574 2,856   179 628
  Average $/month   95 740   67 322   20 77
Spouse na     4,141     2,402    
  Period Mean Total $   na na   613 1,911   219 903
  Average $/month   na na   69 216   25 97
Parent 4,974     8,397     na    
  Period Mean Total $   1,037 9,783   596 6,154   na na
  Average $/month   99 831   64 567   na na
Other Relative 700     23,456     49,490    
  Period Mean Total $   772 1,807   600 2,220   176 567
  Average $/month   75 199   67 264   19 73
Non-Relative 802     36,867     46,983    
  Period Mean Total $   686 2,277   548 1,987   180 670
  Average $/month   87 308   68 286   20 80
Continuing Recipients 5,853     62,189     87.846    
Grand Total   985 9,060   566 2,936   179 635
  Average $/month   91 769   58 295   18 75
Spouse na     3,518     1,999    
  Period Mean Total $   na na   582 1,811   206 887
  Average $/month   na na   57 169   20 81
Parent 4,534     7,676     na    
  Period Mean Total $   1,062 10,231   590 6,389   na na
  Average $/month   97 867   58 561   na na
Other Relative 633     19,706     43,475    
  Period Mean Total $   748 1,664   588 2,143   175 556
  Average $/month   69 164   59 223   18 69
Non-Relative 686     31,289     42,372    
  Period Mean Total $   699 2,402   544 1,964   182 693
  Average $/month   72 242   59 247   19 81
New IHSS Recipients 623     10,672     11,029    
Grand Total   774 1,865   621 2,335   176 569
  Average $/month   131 351   120 443   32 93
Spouse na     623     403    
  Period Mean Total $   na na   789 2,393   284 978
  Average $/month   na na   136 379   50 150
Parent 440     721     na    
  Period Mean Total $   784 1,802   664 2,554   na na
  Average $/month   119 267   132 616   na na
Other Relative 67     3,750     6,015    
  Period Mean Total $   994 2,834   663 2,587   183 640
  Average $/month   132 398   113 415   31 99
Non-Relative 116     5,578     4,611    
  Period Mean Total $   610 1,318   569 2,108   158 395
  Average $/month   176 549   120 441   31 77

 

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