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Medical Care Research and Review: MCRR

Jordan Everson, Julia Adler-Milstein, Andrew M Ryan, John M Hollingsworth
The strategies that hospitals participating in Medicare Accountable Care Organizations (ACOs) use to achieve quality and cost containment goals are poorly understood. One possibility is that participating hospitals could try to influence where their patients receive care. To test this hypothesis, we examined whether a hospital's participation in a Medicare ACO was associated with changes in its patterns of patient sharing with other hospitals. Between 2010 and 2014, patient sharing across hospitals increased 23...
December 13, 2018: Medical Care Research and Review: MCRR
Laurence C Baker, Michael Pesko, Patricia Ramsay, Lawrence P Casalino, Stephen M Shortell
Physician practices have been growing in size, and becoming more commonly owned by hospitals, over time. We use survey data on physician practices surveyed at two points in time, linked to Medicare claims data, to investigate whether changes in practice size or ownership are associated with changes in the use of care management, health information technology (HIT), or quality improvement processes. We find that practice growth and becoming hospital-owned are associated with adoption of more quality improvement processes, but not with care management or HIT...
November 22, 2018: Medical Care Research and Review: MCRR
Susan M Skillman, Arati Dahal, Bianca K Frogner, C Holly A Andrilla
Medical assistants (MAs) are a rapidly growing and increasingly important workforce. High MA turnover, however, is common and employers report applicants frequently do not meet their needs. We collected survey responses from a representative sample of 3,355 of Washington's MAs with certified status (MA-Cs) to understand their demographic, education, and employment backgrounds; job satisfaction; and career plans. Descriptive analyses showed 93.0% were female with a $19.91 mean hourly wage, and while generally satisfied, 56...
November 17, 2018: Medical Care Research and Review: MCRR
Weiwei Chen, Timothy F Page
High-deductible health plans (HDHPs) have become increasingly prevalent among employer-sponsored health plans and plans offered through the Health Insurance Marketplace in the United States. This study examined the impact of deductible levels on health care experiences in terms of care access, affordability, routine checkup, out-of-pocket cost, and satisfaction using data from the Health Reform Monitoring Survey. The study also tested whether the experiences of Marketplace enrollees differed from off-Marketplace individuals, controlling for deductible levels...
November 7, 2018: Medical Care Research and Review: MCRR
Lauren Hersch Nicholas, Shannon Wu
The majority of Medicare Advantage (MA) plans receive payments that exceed their costs of providing basic Medicare benefits. There is controversy about whether these payments are passed on to the enrollees as supplemental benefits or are retained by plans. We used survey data on MA beneficiaries' actual out-of-pocket (OOP) spending linked to MA payment information to test whether higher plan payments and rebates lowered enrollee OOP spending. We used instrumental variables regression models to address concerns that plan payments and rebates may reflect anticipation of enrollees with particular health-spending profiles...
November 1, 2018: Medical Care Research and Review: MCRR
Eileen T Lake, Douglas O Staiger, Emily Cramer, Linda A Hatfield, Jessica G Smith, Beatrice J Kalisch, Jeannette A Rogowski
The health outcomes of infants in neonatal intensive care units (NICUs) may be jeopardized when required nursing care is missed. This correlational study of missed care in a U.S. NICU sample adds national scope and an important explanatory variable, patient acuity. Using 2016 NICU registered nurse survey responses ( N = 5,861) from the National Database of Nursing Quality Indicators, we found that 36% of nurses missed one or more care activities on the past shift. Missed care prevalence varied widely across units...
October 26, 2018: Medical Care Research and Review: MCRR
Hyunjung Lee, Frank W Porell
Before the Affordable Care Act Medicaid expansion, nonelderly childless adults were not generally eligible for Medicaid regardless of their income, and Hispanics had much higher uninsured rates than other racial/ethnic subgroups. We estimated difference-in-differences models on Behavioral Risk Factor Surveillance data (2011-2016) to estimate the impacts of Medicaid expansion on racial/ethnic disparities in insurance coverage, access to care, and health status in this vulnerable subpopulation. Uninsured rates among all poor childless adults declined by roughly 9 percentage points more in states that expanded Medicaid...
October 26, 2018: Medical Care Research and Review: MCRR
Aig Unuigbe
The Affordable Care Act has put in place policies to gradually close the Medicare Part D coverage gap (donut hole). I examine the effect of this gradual closure on total and out-of-pocket prescription drug expenditures, as well as the number of prescriptions filled. The analysis shows a general increase in prescription use. There are also heterogeneous effects, with higher total expenditure groups seeing a decrease in their out-of-pocket prescription expenditures. This suggests that closure of the "donut hole" has led to an increase in prescription use that was previously curtailed and had an impact on the financial risk faced by Medicare recipients...
October 18, 2018: Medical Care Research and Review: MCRR
Brian K Finch, Ann Haas, Amelia M Haviland, Jacob W Dembosky, Sarah Gaillot, Marc N Elliott
While lower educational attainment is associated with worse health status, education may also affect one's ability to identify need for urgent care. Using data from the 2010 Medicare CAHPS survey, we estimated multivariate logistic models to test the relationship between self-reported educational attainment and the perceived need for urgent care, controlling for health status and other factors. As expected, lower educational attainment was associated with greater reported need for urgent care in bivariate analyses because of poorer health...
October 8, 2018: Medical Care Research and Review: MCRR
Mark Schlesinger, Rachel Grob, Dale Shaller, Steven C Martino, Andrew M Parker, Lise Rybowski, Melissa L Finucane, Jennifer L Cerully
Patient narratives have emerged as promising vehicles for making health care more responsive by helping clinicians to better understand their patients' expectations, perceptions, or concerns and encouraging consumers to engage with information about quality. A growing number of websites incorporate patients' comments. But existing comments have fragmentary content, fail to represent less vocal patients, and can be manipulated to "manage" providers' reputations. In this article, we offer the first empirical test of the proposition that patient narratives can be elicited rigorously and reliably using a five-question protocol that can be incorporated into large-scale patient experience surveys...
October 6, 2018: Medical Care Research and Review: MCRR
Amelia M Haviland, Cheryl L Damberg, Megan Mathews, Susan M Paddock, Marc N Elliott
Comparative quality information on health plan and provider performance is increasingly available in the form of quality report cards, but consumers rarely make use of these passively provided decision support tools. In 2012-2013, the Centers for Medicare & Medicaid Services (CMS) initiated quality-based nudges designed to encourage beneficiaries to move into higher quality Medicare Advantage (MA) plans. We assess the impacts of CMS' targeted quality-based nudges with longitudinal analysis of 2009-2014 MA plan enrollment trends...
September 26, 2018: Medical Care Research and Review: MCRR
Jo E Rodgers, Emily M Thudium, Hadi Beyhaghi, Carla A Sueta, Khalid A Alburikan, Anna M Kucharska-Newton, Patricia P Chang, Sally C Stearns
The aging population routinely has comorbid conditions requiring complicated medication regimens, yet nonadherence can preclude optimal outcomes. This study explored the association of adherence in the elderly with demographic, socioeconomic, and disease burden measures. Data were from the fifth visit (2011-2013) for 6,538 participants in the Atherosclerosis Risk in Communities Study, conducted in four communities. The Morisky-Green-Levine Scale measured self-reported adherence. Forty percent of respondents indicated some nonadherence, primarily due to poor memory...
December 2018: Medical Care Research and Review: MCRR
Jeffrey Swanson, William G Weissert
Case management programs often designate a nurse or social worker to take responsibility for guiding care when patients are expected to be expensive or risk a major decline. We hypothesized that though an intuitively appealing idea, careful program design and faithful implementation are essential if case management programs are to succeed. We employed two theory perspectives, principal-agent framework and street-level bureaucratic theory to describe the relationship between program designers (principals) and case managers (agents/street-level bureaucrats) to review 65 case management studies...
October 2018: Medical Care Research and Review: MCRR
Renuka Tipirneni, Karin V Rhodes, Rodney A Hayward, Richard L Lichtenstein, HwaJung Choi, Emily K Arntson, Jessica M Landgraf, Matthew M Davis
Coverage and access have improved under the Affordable Care Act, yet it is unclear whether recent gains have reached those regions within states that were most in need of improved access to care. We examined geographic variation in Medicaid acceptance among Michigan primary care practices before and after Medicaid expansion in the state, using data from a simulated patient study of primary care practices. We used logistic regression analysis with time indicators to assess regional changes in Medicaid acceptance over time...
October 2018: Medical Care Research and Review: MCRR
Eva H DuGoff, Juhee Cho, Yajuan Si, Craig Evan Pollack
Care coordination may be more challenging when the specific physicians with whom primary care physicians (PCPs) are expected to coordinate care change over time. Using Medicare data on physician patient-sharing relationships and the Dartmouth Atlas, we explored the extent to which PCPs tend to share patients with other physicians over time. We found that 70.7% of ties between PCPs and other physicians that were present in 2012 persisted in 2013, and additional shared patients in 2012 increased the odds of being connected in 2013...
October 2018: Medical Care Research and Review: MCRR
Alexander F Pimperl, Hector P Rodriguez, Julie A Schmittdiel, Stephen M Shortell
Performance management systems (PMSYS) aid in improving the quality and efficiency of care, but little is known about factors that influence more robust PMSYS among physician organizations. Using a nationally representative survey of U.S. medical practices, we examined the extent to which organizational capabilities and external factors were associated with more developed PMSYS. Linear regression estimated the relative impact of these factors on PMSYS. On average, practices implemented a minority (32 points out of 100) of the PMSYS processes assessed...
October 2018: Medical Care Research and Review: MCRR
Scott Feyereisen, Joseph P Broschak, Beth Goodrick
We further our understanding of jurisdictional disputes between established professional groups through a 10-year longitudinal analysis of the differential adoption by U.S. states of policies expanding Certified Registered Nurse Anesthetists' (CRNAs) autonomy. In the United States, CRNAs are trained to deliver anesthetics to patients in the same way as physician anesthesiologists but have more restrictions in practice. Following a 2001 federal decision regarding Medicare reimbursement, states were permitted but not required to allow CRNAs to practice without physician supervision, potentially reducing health care costs...
October 2018: Medical Care Research and Review: MCRR
Olga Yakusheva, Geoffrey J Hoffman
This study aimed (1) to estimate the impact of an incremental reduction in excess readmissions on a hospital's Medicare reimbursement revenue, for hospitals subject to penalties under the Medicare's Hospital Readmissions Reduction Program and (2) to evaluate the economic case for an investment in a readmission reduction program. For 2,465 hospitals with excess readmissions in the Fiscal Year 2016 Hospital Compare data set, we (1) used the Hospital Readmissions Reduction Program statute to estimate hospital-specific Medicare reimbursement gains per an avoided readmission and (2) carried out a pro forma analysis of investment in a broad-scale readmission reduction program under conservative assumptions regarding program effectiveness and using program costs from earlier studies...
August 24, 2018: Medical Care Research and Review: MCRR
Geoffrey J Hoffman, Sibyl Tilson, Olga Yakusheva
We examined the financial incentives to avoid readmissions under Medicare's Hospital Readmission Reduction Program for safety-net hospitals (SNHs) and teaching hospitals (THs) compared with other hospitals. Using Medicare's FY2016 Hospital Compare and readmissions data for 2,465 hospitals, we tested for differential revenue gains for SNHs ( n = 658) relative to non-SNHs ( n = 1,807), and for major ( n = 231) and minor ( n = 591) THs relative to non-THs ( n = 1,643). We examined hospital-level factors predicting differences in revenue gains by hospital type...
August 24, 2018: Medical Care Research and Review: MCRR
Timothy T Brown, Chaoran Guo, Christopher Whaley
This study examines how reference-based benefits (RBB) affect patient out-of-pocket payments across outpatient procedures. The California Public Employees' Retirement System (CalPERS) implemented RBB asymmetrically for outpatient procedures in 2012, only applying RBB to outpatient procedures performed in a hospital outpatient department (HOPD), and not applying RBB to outpatient procedures performed in a lower cost ambulatory surgery center. Using claims data (2009-2013) on arthroscopy and colonoscopy services, we found that for colonoscopy, CalPERS patients paid an average of 63...
August 13, 2018: Medical Care Research and Review: MCRR
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