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https://www.readbyqxmd.com/read/28632589/emergency-department-visits-following-elective-total-hip-and-knee-replacement-surgery-identifying-gaps-in-continuity-of-care
#1
Micaela A Finnegan, Robyn Shaffer, Austin Remington, Jereen Kwong, Catherine Curtin, Tina Hernandez-Boussard
BACKGROUND: Major joint replacement surgical procedures are common, elective procedures with a care episode that includes both inpatient readmissions and postoperative emergency department (ED) visits. Inpatient readmissions are well studied; however, to our knowledge, little is known about ED visits following these procedures. We sought to characterize 30-day ED visits following a major joint replacement surgical procedure. METHODS: We used administrative records from California, Florida, and New York, from 2010 through 2012, to identify adults undergoing total knee and hip arthroplasty...
June 21, 2017: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/28583963/identifying-policy-levers-and-opportunities-for-action-across-states-to-achieve-health-equity
#2
Julia Berenson, Yan Li, Julia Lynch, José A Pagán
In the United States, steps to advance health equity often take place at the state and local levels rather than the national level. Using publicly available data sources, we developed a scorecard for all fifty states and the District of Columbia that measures indicators of the use of five evidence-based policies to address domains related to health equity. The indicators are the cigarette excise tax rate, a state's Medicaid expansion status and the size of its coverage gap, percentage of four-year olds enrolled in state-funded pre-kindergarten, minimum wage level, and the presence of state-funded housing subsidy programs and homelessness prevention and rapid rehousing programs...
June 1, 2017: Health Affairs
https://www.readbyqxmd.com/read/28574234/effect-of-the-affordable-care-act-on-health-care-access
#3
Sherry Glied, Stephanie Ma, Anais A Borja
ISSUE: The Affordable Care Act's (ACA) coverage provisions have extended health insurance coverage to millions of Americans. While the effects of the Medicaid expansion and marketplace establishments on coverage have been well studied, the resulting effects of coverage on access to health care remain unclear. GOAL: To examine how the 2014 coverage expansions affected health care access following the first open enrollment period of October 2013 to March 2014. METHODS: Analysis of data from the National Health Interview Survey (NHIS) and the Behavioral Risk Factor Surveillance System (BRFSS)...
May 2017: Issue Brief of the Commonwealth Fund
https://www.readbyqxmd.com/read/28574233/the-impact-of-the-aca-s-medicaid-expansion-on-hospitals-uncompensated-care-burden-and-the-potential-effects-of-repeal
#4
David Dranove, Craig Gartwaite, Christopher Ody
ISSUE: By increasing health insurance coverage, the Affordable Care Act's Medicaid eligibility expansion was also expected to lessen the uncompensated care burden on hospitals. The expansion currently faces an uncertain future. GOAL: To compare the change in hospitals' uncompensated care burden in the 31 states (plus the District of Columbia) that chose to expand Medicaid to the changes in states that did not, and to estimate how these expenses would be affected by repeal or further expansion. METHODS: Analysis of uncompensated care data from Medicare Hospital Cost Reports from 2011 to 2015...
May 2017: Issue Brief of the Commonwealth Fund
https://www.readbyqxmd.com/read/28568245/quality-metrics-and-systems-transformation-are-we-advancing-alcohol-and-drug-screening-in-primary-care
#5
Traci Rieckmann, Stephanie Renfro, Dennis McCarty, Robin Baker, K John McConnell
OBJECTIVE: To examine the influence of Oregon's coordinated care organizations (CCOs) and pay-for-performance incentive model on completion of screening and brief intervention (SBI) and utilization of substance use disorder (SUD) treatment services. DATA SOURCES/STUDY SETTING: Secondary analysis of Medicaid encounter data from 2012 to 2015 and semiannual qualitative interviews with stakeholders in CCOs. STUDY DESIGN: Longitudinal mixed-methods design with simultaneous data collection with equal importance...
May 31, 2017: Health Services Research
https://www.readbyqxmd.com/read/28559508/contextualizing-the-first-round-failure-of-the-ahca-down-but-not-out
#6
REVIEW
Joshua A Hirsch, Andrew B Rosenkrantz, Greg N Nicola, H Benjamin Harvey, Richard Duszak, Ezequiel Silva, Robert M Barr, Richard P Klucznik, Allan L Brook, Laxmaiah Manchikanti
On 8 November 2016 the American electorate voted Donald Trump into the Presidency and a majority of Republicans into both houses of Congress. Since many Republicans ran for elected office on the promise to 'repeal and replace' Obamacare, this election result came with an expectation that campaign rhetoric would result in legislative action on healthcare. The American Health Care Act (AHCA) represented the Republican effort to repeal and replace the Affordable Care Act (ACA). Key elements of the AHCA included modifications of Medicaid expansion, repeal of the individual mandate, replacement of ACA subsidies with tax credits, and a broadening of the opportunity to use healthcare savings accounts...
June 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/28558067/impact-of-insurance-coverage-on-utilization-of-pre-exposure-prophylaxis-for-hiv-prevention
#7
Rupa R Patel, Leandro Mena, Amy Nunn, Timothy McBride, Laura C Harrison, Catherine E Oldenburg, Jingxia Liu, Kenneth H Mayer, Philip A Chan
Pre-exposure prophylaxis (PrEP) can reduce U.S. HIV incidence. We assessed insurance coverage and its association with PrEP utilization. We reviewed patient data at three PrEP clinics (Jackson, Mississippi; St. Louis, Missouri; Providence, Rhode Island) from 2014-2015. The outcome, PrEP utilization, was defined as patient PrEP use at three months. Multivariable logistic regression was performed to determine the association between insurance coverage and PrEP utilization. Of 201 patients (Jackson: 34%; St. Louis: 28%; Providence: 28%), 91% were male, 51% were White, median age was 29 years, and 21% were uninsured; 82% of patients reported taking PrEP at three months...
2017: PloS One
https://www.readbyqxmd.com/read/28557515/connected-care-improving-outcomes-for-adults-with-serious-mental-illness
#8
James M Schuster, Suzanne M Kinsky, Jung Y Kim, Jane N Kogan, Allison Hamblin, Cara Nikolajski, John Lovelace
OBJECTIVES: To evaluate the effectiveness of Connected Care-a care coordination effort of physical and behavioral health managed care partners in Pennsylvania-on acute service use among adult Medicaid beneficiaries with serious mental illness (SMI). STUDY DESIGN: We examined changes in service utilization using a difference-in-differences model, comparing study group with a comparison group, and conducted key informant interviews to better understand aspects of program implementation...
October 2016: American Journal of Managed Care
https://www.readbyqxmd.com/read/28555045/socioeconomic-geospatial-and-geopolitical-disparities-in-access-to-health-care-in-the-us-2011-2015
#9
Samuel D Towne
Individuals forgoing needed medical care due to barriers associated with cost are at risk of missing needed care that may be necessary for the prevention or maintenance of a chronic condition among other things. Thus, continued monitoring of factors associated with forgone medical care, especially among vulnerable populations, is critical. National survey data (2011-2015) for non-institutionalized adults residing in the USA were utilized to assess forgone medical care, defined as not seeking medical care when the individual thought it was necessary because of cost in the past 12 months...
May 29, 2017: International Journal of Environmental Research and Public Health
https://www.readbyqxmd.com/read/28552372/impact-of-medicaid-expansion-on-cardiac-surgery-volume-and-outcomes
#10
Eric J Charles, Lily E Johnston, Morley A Herbert, J Hunter Mehaffey, Kenan W Yount, Donald S Likosky, Patricia F Theurer, Clifford E Fonner, Jeffrey B Rich, Alan M Speir, Gorav Ailawadi, Richard L Prager, Irving L Kron
BACKGROUND: Thirty-one states approved Medicaid expansion after implementation of the Affordable Care Act. The objective of this study was to evaluate the effect of Medicaid expansion on cardiac surgery volume and outcomes comparing one state that expanded to one that did not. METHODS: Data from the Virginia (nonexpansion state) Cardiac Services Quality Initiative and the Michigan (expanded Medicaid, April 2014) Society of Thoracic and Cardiovascular Surgeons Quality Collaborative were analyzed to identify uninsured and Medicaid patients undergoing coronary bypass graft or valve operations, or both...
May 26, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28537963/out-of-pocket-spending-under-the-affordable-care-act-for-patients-with-cancer
#11
Matthew S Dixon, Ashley L Cole, Stacie B Dusetzina
The Patient Protection and Affordable Care Act (ACA) included several key provisions aimed at lowering the out-of-pocket cost burden for patients. In this review, we summarize the effect of 3 provisions under Medicaid, Medicare, and commercial insurance, respectively: expansion of Medicaid eligibility, closing the doughnut hole for Medicare Part D beneficiaries, and requiring an annual limit on out-of-pocket spending for commercially insured patients. Through this review, we find early evidence that these 3 ACA provisions have reduced the out-of-pocket burden or increased access to health insurance for many patients...
May 2017: Cancer Journal
https://www.readbyqxmd.com/read/28537962/effects-of-affordable-care-act-marketplaces-and-medicaid-eligibility-expansion-on-access-to-cancer-care
#12
John A Graves, Katherine Swartz
PURPOSE: The aim of this study was to inform oncologists about how repealing the Affordable Care Act (ACA) may affect their ability to provide cancer therapies for people with cancer enrolled in ACA health plans and why proposals to change Medicaid funding may make it even more difficult for Medicaid beneficiaries to access cancer treatments. METHODS: We examined the regulations and provisions of the ACA related to how health insurance impacts access to diagnostic testing and treatments for people with cancer, including access to clinical trials...
May 2017: Cancer Journal
https://www.readbyqxmd.com/read/28537961/the-affordable-care-act-and-cancer-care-delivery
#13
Gabriel A Brooks, J Russell Hoverman, Carrie H Colla
The Affordable Care Act (ACA) has reformed US health care delivery through insurance coverage expansion, experiments in payment design, and funding for patient-centered clinical and health care delivery research. The impact on cancer care specifically has been far reaching, with new ACA-related programs that encourage coordinated, patient-centered, cost-effective care. Insurance expansions through private exchanges and Medicaid, along with preexisting condition clauses, have helped more than 20 million Americans gain health care coverage...
May 2017: Cancer Journal
https://www.readbyqxmd.com/read/28529137/medicaid-participation-among-liver-transplant-candidates-after-the-affordable-care-act-medicaid-expansion
#14
Dmitry Tumin, Eliza W Beal, Khalid Mumtaz, Don Hayes, Joseph D Tobias, Timothy M Pawlik, W Kenneth Washburn, Sylvester M Black
BACKGROUND: The 2014 Medicaid expansion in participating states increased insurance coverage among people with chronic health conditions, but its implications for access to surgical care remain unclear. We investigated how Medicaid expansion influenced the insurance status of candidates for liver transplantation (LT) and transplant center payor mix. STUDY DESIGN: Data on LT candidates age 18-64 years in 2012-2013 (pre-expansion) and 2014-2015 (post-expansion) were obtained from the United Network for Organ Sharing registry...
May 18, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28520483/effect-of-the-affordable-care-act-on-disparities-in-breastfeeding-the-case-of-maine
#15
Summer Sherburne Hawkins, Alice Noble, Christopher F Baum
OBJECTIVES: To evaluate the Affordable Care Act (ACA) breastfeeding provision and test whether changes in coverage affected women differently according to health insurance status. METHODS: We used the All-Payer Claims Database from Maine (2012-2014) to compare health insurance claims for lactation classes and breast pumps between women with private insurance and women with Medicaid (1) before the ACA breastfeeding provision, (2) after the provision came into effect, and (3) after health insurance expansion through the Marketplace...
July 2017: American Journal of Public Health
https://www.readbyqxmd.com/read/28517042/the-impact-of-the-aca-medicaid-expansions-on-health-insurance-coverage-through-2015-and-coverage-disparities-by-age-race-ethnicity-and-gender
#16
George L Wehby, Wei Lyu
OBJECTIVE: Examine the ACA Medicaid expansion effects on Medicaid take-up and private coverage through 2015 and coverage disparities by age, race/ethnicity, and gender. DATA SOURCES: 2011-2015 American Community Survey for 3,137,989 low-educated adults aged 19-64 years. STUDY DESIGN: Difference-in-differences regressions accounting for national coverage trends and state fixed effects. PRINCIPAL FINDINGS: Expansion effects doubled in 2015 among low-educated adults, with a nearly 8 percentage-point increase in Medicaid take-up and 6 percentage-point decline in uninsured rate...
May 18, 2017: Health Services Research
https://www.readbyqxmd.com/read/28515140/three-year-impacts-of-the-affordable-care-act-improved-medical-care-and-health-among-low-income-adults
#17
Benjamin D Sommers, Bethany Maylone, Robert J Blendon, E John Orav, Arnold M Epstein
Major policy uncertainty continues to surround the Affordable Care Act (ACA) at both the state and federal levels. We assessed changes in health care use and self-reported health after three years of the ACA's coverage expansion, using survey data collected from low-income adults through the end of 2016 in three states: Kentucky, which expanded Medicaid; Arkansas, which expanded private insurance to low-income adults using the federal Marketplace; and Texas, which did not expand coverage. We used a difference-in-differences model with a control group and an instrumental variables model to provide individual-level estimates of the effects of gaining insurance...
June 1, 2017: Health Affairs
https://www.readbyqxmd.com/read/28513249/medicaid-expansion-produces-long-term-impact-on-insurance-coverage-rates-in-community-health-centers
#18
Nathalie Huguet, Megan J Hoopes, Heather Angier, Miguel Marino, Heather Holderness, Jennifer E DeVoe
BACKGROUND: It is crucial to understand the impact of the Affordable Care Act (ACA). This study assesses changes in insurance status of patients visiting community health centers (CHCs) comparing states that expanded Medicaid to those that did not. METHODS: Electronic health record data on 875,571 patients aged 19 to 64 years with ≥ 1 visit between 2012 and 2015 in 412 primary care CHCs in 9 expansion and 4 nonexpansion states. We assessed changes in rates of total, uninsured, Medicaid-insured, and privately insured primary care and preventive care visits; immunizations administered, and medications ordered...
May 1, 2017: Journal of Primary Care & Community Health
https://www.readbyqxmd.com/read/28483811/expanding-medicaid-expanding-the-electorate-the-affordable-care-act-s-short-term-impact-on-political-participation
#19
Jake Haselswerdt
The Affordable Care Act is a landmark piece of social legislation with the potential to reshape health care in the United States. Its potential to reshape politics is also considerable, but existing scholarship suggests conflicting expectations about the law's policy feedbacks, especially given uneven state-level implementation. In this article I focus on the policy feedbacks of the law's Medicaid expansion on political participation, using district-level elections data for 2012 and 2014 US House races and cross-sectional survey data from 2014...
May 8, 2017: Journal of Health Politics, Policy and Law
https://www.readbyqxmd.com/read/28483807/closing-kynect-and-restructuring-medicaid-threaten-kentucky-s-health-and-economy
#20
Charles B Wright, Nathan L Vanderford
Following passage of the Patient Protection and Affordable Care Act (ACA) in the United States, the Kentucky Health Benefit Exchange, Kynect, began operating in Kentucky in October 2013. Kentucky expanded Medicaid eligibility in January 2014. Together, Kynect and Medicaid expansion provided access to affordable health care coverage to hundreds of thousands of individuals in Kentucky. However, following the Kentucky gubernatorial election in 2015, the newly inaugurated governor moved to dismantle Kynect and restructure the Medicaid expansion, jeopardizing public health gains and the state economy...
May 8, 2017: Journal of Health Politics, Policy and Law
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