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Policy Prescriptions

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136 papers 0 to 25 followers Articles under review for www.policyrx.org -- a health policy and health services research literature review for clinicians, healthcare executives, and policymakers. Attend our Annual Symposium -- register at www.policyrx.com.
By Cedric Dark MD, MPH, FACEP, FAAEM
https://www.readbyqxmd.com/read/29936886/prices-for-physicians-services-in-medicare-advantage-and-commercial-plans
#1
Daria M Pelech
The prices that insurers pay physicians ultimately affect beneficiaries' health insurance premiums. Using 2014 claims data from three major insurers, we analyzed the prices insurers paid in their Medicare Advantage (MA) and commercial plans for 20 physician services, in and out of network, and compared those prices with estimated amounts that Medicare's fee-for-service (FFS) program would pay for the same service. MA prices paid by those insurers were close to Medicare FFS prices, varied minimally, and were similar in and out of network...
June 1, 2018: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/29200330/the-uninsured-do-not-use-the-emergency-department-more-they-use-other-care-less
#2
Ruohua Annetta Zhou, Katherine Baicker, Sarah Taubman, Amy N Finkelstein
There is a popular perception that insurance coverage will reduce overuse of the emergency department (ED). Both opponents and advocates of expanding insurance coverage under the Affordable Care Act (ACA) have made statements to the effect that EDs have been jammed with the uninsured and that paying for the uninsured population's emergency care has burdened the health care system as a result of the expense of that care. It has therefore been surprising to many to encounter evidence that insurance coverage increases ED use instead of decreasing it...
December 2017: Health Affairs
https://www.readbyqxmd.com/read/29806177/does-state-medicaid-coverage-of-smoking-cessation-treatments-affect-quitting
#3
Deliana Kostova, Xin Xu, Stephen Babb, Sara B McMenamin, Brian A King
OBJECTIVE: Cigarette smoking and smoking-related diseases disproportionately affect low-income populations. Health insurance coverage of smoking cessation treatments is increasingly used to encourage quitting. We assess the relationship between state Medicaid coverage of smoking cessation treatments and past-year quitting in adult Medicaid beneficiaries. DATA SOURCES: 2009-2014 National Health Interview Survey (NHIS); 2008-2013 indicators of state Medicaid coverage of smoking cessation treatments...
May 27, 2018: Health Services Research
https://www.readbyqxmd.com/read/29863931/frequent-emergency-department-users-a-statewide-comparison-before-and-after-affordable-care-act-implementation
#4
Shannon McConville, Maria C Raven, Sarah H Sabbagh, Renee Y Hsia
Frequent emergency department (ED) use often serves as a marker for poor access to non-ED ambulatory care. Policy makers and providers hoped that by expanding coverage, the Affordable Care Act (ACA) would curtail frequent ED use. We used data from California's Office of Statewide Health Planning and Development to compare the characteristics of frequent ED users among nonelderly adults in California before and after implementation of several major coverage expansion provisions in the ACA. Frequent users-patients with four or more annual ED visits-accounted for 7...
June 2018: Health Affairs
https://www.readbyqxmd.com/read/29985686/behavioral-health-coverage-in-the-individual-market-increased-after-aca-parity-requirements
#5
Alexander J Cowell, Shivaani Prakash, Emily Jones, Alan Barnosky, Brendan Wedehase
As of January 1, 2014, the Affordable Care Act designated mental health and substance use services as an essential health benefit in Marketplace plans and extended parity protections to the individual and small-group markets. We analyzed documents for seventy-eight individual and small-group plans in 2014 (after parity provisions took effect) and sixty comparison plans in 2013 (the year before parity provisions took effect) to understand the degree to which coverage for mental health and substance use care improved relative to medical/surgical benefits...
July 2018: Health Affairs
https://www.readbyqxmd.com/read/29851439/impact-of-emergency-physician-provided-patient-education-about-alternative-care-venues
#6
Pankaj B Patel, David R Vinson, Marla N Gardner, David A Wulf, Patricia Kipnis, Vincent Liu, Gabriel J Escobar
OBJECTIVES: Interventions that focus on educating patients appear to be the most effective in directing healthcare utilization to more appropriate venues. We sought to evaluate the effects of mailed information and a brief scripted educational phone call from an emergency physician (EP) on subsequent emergency department (ED) utilization by low-risk adults with a recent treat-and-release ED visit. STUDY DESIGN: Patients were randomized into 3 groups for post-ED follow-up: EP phone call with mailed information, mailed information only, and no educational intervention...
May 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/29985705/interruptions-in-private-health-insurance-and-outcomes-in-adults-with-type-1-diabetes-a-longitudinal-study
#7
Mary A M Rogers, Joyce M Lee, Renuka Tipirneni, Tanima Banerjee, Catherine Kim
Type 1 diabetes mellitus, which often originates during childhood, is a lifelong disease that requires intensive daily medical management. Because health care services are critical to patients with this disease, we investigated the frequency of interruptions in private health insurance, and the outcomes associated with them, for working-age adults with type 1 diabetes in the United States in the period 2001-15. We designed a longitudinal study with a nested self-controlled case series, using the Clinformatics Data Mart Database...
July 2018: Health Affairs
https://www.readbyqxmd.com/read/29771617/public-support-for-gun-violence-prevention-policies-among-gun-owners-and-non-gun-owners-in-2017
#8
Colleen L Barry, Daniel W Webster, Elizabeth Stone, Cassandra K Crifasi, Jon S Vernick, Emma E McGinty
OBJECTIVES: To compare public support for 24 different gun policies between gun owners and non-gun owners in 2017. METHODS: We fielded a national public opinion survey in January 2017 using an online panel to measure US adults' support for 24 gun policies. We compared support among gun owners and non-gun owners. RESULTS: For 23 of the 24 policies examined, most respondents supported restricting or regulating gun ownership. Only 8 of 24 policies had greater than a 10-point support gap between gun owners and non-gun owners...
July 2018: American Journal of Public Health
https://www.readbyqxmd.com/read/29771619/affordable-care-act-impact-in-kentucky-increasing-access-reducing-disparities
#9
Lynn A Blewett, Colin Planalp, Giovann Alarcon
OBJECTIVES: To examine health insurance disparities since Kentucky's implementation of the Affordable Care Act (ACA). METHODS: Using the American Community Survey, we estimated coverage rates by race/ethnicity before and after implementation of the ACA (2013 and 2015), and we estimated whether groups were over- or underrepresented among the uninsured, compared with their share of the state population. RESULTS: Kentucky's uninsurance rate declined from 14...
July 2018: American Journal of Public Health
https://www.readbyqxmd.com/read/29608348/the-complexity-of-billing-and-paying-for-physician-care
#10
Joshua D Gottlieb, Adam Hale Shapiro, Abe Dunn
The administrative costs of providing health insurance in the US are very high, but their determinants are poorly understood. We advance the nascent literature in this field by developing new measures of billing complexity for physician care across insurers and over time, and by estimating them using a large sample of detailed insurance "remittance data" for the period 2013-15. We found dramatic variation across different types of insurance. Fee-for-service Medicaid is the most challenging type of insurer to bill, with a claim denial rate that is 17...
April 2018: Health Affairs
https://www.readbyqxmd.com/read/29608372/effects-of-the-aca-s-health-insurance-marketplaces-on-the-previously-uninsured-a-quasi-experimental-analysis
#11
Anna L Goldman, Danny McCormick, Jennifer S Haas, Benjamin D Sommers
Descriptive studies have suggested that the Affordable Care Act's (ACA's) health insurance Marketplaces improved access to care. However, no evidence from quasi-experimental studies is available to support these findings. We used longitudinal survey data to compare previously uninsured adults with incomes that made them eligible for subsidized Marketplace coverage (138-400 percent of the federal poverty level) to those who had employer-sponsored insurance before the ACA with incomes in the same range. Among the previously uninsured group, the ACA led to a significant decline in the uninsurance rate, decreased barriers to medical care, increased the use of outpatient services and prescription drugs, and increased diagnoses of hypertension, compared to a control group with stable employer-sponsored insurance...
April 2018: Health Affairs
https://www.readbyqxmd.com/read/29629922/medicaid-managed-care-in-florida-and-racial-and-ethnic-disparities-in-preventable-emergency-department-visits
#12
Tianyan Hu, Karoline Mortensen, Jie Chen
BACKGROUND: In an effort to address health care spending growth, coordinate care, and improve access to primary care in the Medicaid program, Florida implemented the Statewide Mandatory Managed Care (SMMC) program in May of 2014. OBJECTIVES: The objective of this study is to investigate the impact of implementation of mandatory managed care in Medicaid on the preventable emergency department (ED) utilizations, with a focus on racial/ethnic minorities. RESEARCH DESIGN: The primary data source is the universe of Florida ED visit and inpatient discharge data from 2010 to 2015, maintained by the Florida Agency for Health Care Administration...
June 2018: Medical Care
https://www.readbyqxmd.com/read/29436247/comparing-the-value-of-nonprofit-hospitals-tax-exemption-to-their-community-benefits
#13
Bradley Herring, Darrell Gaskin, Hossein Zare, Gerard Anderson
The tax-exempt status of nonprofit hospitals has received increased attention from policymakers interested in examining the value they provide instead of paying taxes. We use 2012 data from the Internal Revenue Service (IRS) Form 990, Centers for Medicare and Medicaid Services (CMS) Hospital Cost Reports, and American Hospital Association's (AHA) Annual Survey to compare the value of community benefits with the tax exemption. We contrast nonprofit's total community benefits to what for-profits provide and distinguish between charity and other community benefits...
January 2018: Inquiry: a Journal of Medical Care Organization, Provision and Financing
https://www.readbyqxmd.com/read/29668214/financial-burden-of-healthcare-utilization-in-consumer-directed-health-plans
#14
Xinke Zhang, Erin Trish, Neeraj Sood
OBJECTIVES: To evaluate the impact of enrollment in a consumer-directed health plan (CDHP) on out-of-pocket (OOP) spending and on the financial burden associated with healthcare utilization. STUDY DESIGN: Using commercial claims data from 2011 through 2013, we estimated difference-in-differences models that compared changes in outcomes for individuals who switched to CDHPs (CDHP group) with outcome changes for individuals who remained in traditional plans (traditional plan group)...
April 1, 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/29863916/tv-advertising-volumes-were-associated-with-insurance-marketplace-shopping-and-enrollment-in-2014
#15
Sarah E Gollust, Andrew Wilcock, Erika Franklin Fowler, Colleen L Barry, Jeff Niederdeppe, Laura Baum, Pinar Karaca-Mandic
The effectiveness of health insurance advertising has gained renewed attention following the Trump administration's decision to reduce the marketing budget for the federal Marketplace. Yet there is limited evidence on the relationship between advertising and enrollment behavior. This study combined survey data from the 2014 National Health Interview Survey on adults ages 18-64 with data on volumes of televised advertisements aired in respondents' counties of residence during the 2013-14 open enrollment period...
June 2018: Health Affairs
https://www.readbyqxmd.com/read/29708053/racial-and-ethnic-differences-in-medicaid-acceptance-by-primary-care-physicians-a-geospatial-analysis
#16
Michael R Daly, Jennifer M Mellor
Physician acceptance is an important dimension of access to care, especially for Medicaid patients. We constructed two new measures to quantify primary care physician (PCP) acceptance of Medicaid patients using geocoded Virginia physician addresses and population data and geospatial methods. For each Census block group, we measured the shares of "accessible PCPs" accepting any Medicaid patients or new Medicaid patients. Accessible PCPs were defined as those located within 30-minute travel from patient locations and patient locations were proxied by Census block group geographic centroids...
April 1, 2018: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/29128869/association-of-the-hospital-readmissions-reduction-program-implementation-with-readmission-and-mortality-outcomes-in-heart-failure
#17
Ankur Gupta, Larry A Allen, Deepak L Bhatt, Margueritte Cox, Adam D DeVore, Paul A Heidenreich, Adrian F Hernandez, Eric D Peterson, Roland A Matsouaka, Clyde W Yancy, Gregg C Fonarow
Importance: Public reporting of hospitals' 30-day risk-standardized readmission rates following heart failure hospitalization and the financial penalization of hospitals with higher rates have been associated with a reduction in 30-day readmissions but have raised concerns regarding the potential for unintended consequences. Objective: To examine the association of the Hospital Readmissions Reduction Program (HRRP) with readmission and mortality outcomes among patients hospitalized with heart failure within a prospective clinical registry that allows for detailed risk adjustment...
January 1, 2018: JAMA Cardiology
https://www.readbyqxmd.com/read/29608370/changes-in-hospital-utilization-three-years-into-maryland-s-global-budget-program-for-rural-hospitals
#18
Eric T Roberts, Laura A Hatfield, J Michael McWilliams, Michael E Chernew, Nicolae Done, Sule Gerovich, Lauren Gilstrap, Ateev Mehrotra
In a substantial shift in payment policy, the State of Maryland implemented a global budget program for acute care hospitals in 2010. Goals of the program include controlling hospital use and spending. Eight rural hospitals entered the program in 2010, while urban and suburban hospitals joined in 2014. Prior analyses, which focused on urban and suburban hospitals, did not find consistent evidence that Maryland's program had contributed to changes in hospital use after two years. However, these studies were limited by short follow-up periods, may have failed to isolate impacts of Maryland's payment change from other state trends, and had limited generalizability to rural settings...
April 2018: Health Affairs
https://www.readbyqxmd.com/read/29039720/trends-in-the-contribution-of-emergency-departments-to-the-provision-of-hospital-associated-health-care-in-the-usa
#19
David Marcozzi, Brendan Carr, Aisha Liferidge, Nicole Baehr, Brian Browne
Traditional approaches to assessing the health of populations focus on the use of primary care and the delivery of care through patient-centered homes, managed care resources, and accountable care organizations. The use of emergency departments (EDs) has largely not been given consideration in these models. Our study aimed to determine the contribution of EDs to the health care received by Americans between 1996 and 2010 and to compare it with the contribution of outpatient and inpatient services using National Hospital Ambulatory Medical Care Survey and National Hospital Discharge Survey databases...
April 2018: International Journal of Health Services: Planning, Administration, Evaluation
https://www.readbyqxmd.com/read/29470111/long-acting-reversible-contraception-free-of-charge-method-initiation-and-abortion-rates-in-finland
#20
Frida Gyllenberg, Mikael Juselius, Mika Gissler, Oskari Heikinheimo
OBJECTIVES: To evaluate whether a public program providing long-acting reversible contraceptive (LARC) methods free of charge increases the LARC initiation rate and reduces the unintended pregnancy rate in the general population. METHODS: Since 2013, all women in Vantaa, Finland, have been entitled to 1 LARC method free of charge. With time-series analysis between 2000 and 2015, we assessed whether this public program was associated with changes in steady-state mean rates of LARC initiation and abortions...
April 2018: American Journal of Public Health
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