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Policy Prescriptions

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127 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/29608348/the-complexity-of-billing-and-paying-for-physician-care
#1
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
#2
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
#3
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
#4
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
#5
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
#6
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
#7
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
#8
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
#9
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
#10
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
#11
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
https://www.readbyqxmd.com/read/29261242/ed-based-care-coordination-reduces-costs-for-frequent-ed-users
#12
RANDOMIZED CONTROLLED TRIAL
Michelle P Lin, Bonnie B Blanchfield, Rose M Kakoza, Vineeta Vaidya, Christin Price, Joshua S Goldner, Michelle Higgins, Elisabeth Lessenich, Karl Laskowski, Jeremiah D Schuur
OBJECTIVES: We evaluated a pilot quality improvement intervention implemented in an urban academic medical center emergency department (ED) to improve care coordination and reduce ED visits and hospitalizations among frequent ED users. STUDY DESIGN: Randomized controlled trial. METHODS: We identified the most frequent ED users in both the 30 days prior to the intervention and the 12 months prior to the intervention. We randomized the top 72 patients to receive either our pilot intervention or usual care...
December 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28373333/small-decline-in-low-value-back-imaging-associated-with-the-choosing-wisely-campaign-2012-14
#13
Arthur S Hong, Dennis Ross-Degnan, Fang Zhang, J Frank Wharam
Choosing Wisely was launched by the American Board of Internal Medicine in April 2012 as a patient- and clinician-targeted campaign to reduce potentially unnecessary "low-value" medical services. The campaign's impact on low- and high-value care beyond its first year is unknown; furthermore, it is unknown whether some patients such as members of consumer-directed health plans and people residing in different US regions have responded more than others. To evaluate the impact of Choosing Wisely, we used commercial insurance claims to track changes in the use of low-value imaging (x-ray, computed tomography, and magnetic resonance imaging) for back pain before and after the campaign began, a period running from 2010 to 2014...
April 1, 2017: Health Affairs
https://www.readbyqxmd.com/read/29364736/medicaid-versus-marketplace-coverage-for-near-poor-adults-effects-on-out-of-pocket-spending-and-coverage
#14
Fredric Blavin, Michael Karpman, Genevieve M Kenney, Benjamin D Sommers
In states that expanded Medicaid eligibility under the Affordable Care Act, nonelderly near-poor adults-those with family incomes of 100-138 percent of the federal poverty level-are generally eligible for Medicaid, with no premiums and minimal cost sharing. In states that did not expand eligibility, these adults may qualify for premium tax credits to purchase Marketplace plans that have out-of-pocket premiums and cost-sharing requirements. We used data for 2010-15 to estimate the effects of Medicaid expansion on coverage and out-of-pocket expenses, compared to the effects of Marketplace coverage...
February 2018: Health Affairs
https://www.readbyqxmd.com/read/28928263/health-benefits-in-2017-stable-coverage-workers-faced-considerable-variation-in-costs
#15
Gary Claxton, Matthew Rae, Michelle Long, Anthony Damico, Heidi Whitmore, Gregory Foster
The annual Kaiser Family Foundation/Health Research and Educational Trust Employer Health Benefits Survey found that in 2017, average annual premiums (employer and worker contributions combined) rose 4 percent for single coverage, to $6,690, and 3 percent for family coverage, to $18,764. Covered workers contributed 18 percent of the premium for single coverage and 31 percent for family coverage, on average, although there was considerable variation around these averages. For covered workers in small firms, 10 percent did not make a premium contribution for family coverage, while 36 percent made a contribution of more than half of their premium...
October 1, 2017: Health Affairs
https://www.readbyqxmd.com/read/29355927/early-impact-of-the-affordable-care-act-coverage-expansion-on-safety-net-hospital-inpatient-payer-mix-and-market-shares
#16
Vivian Y Wu, Kathryn R Fingar, H Joanna Jiang, Raynard Washington, Andrew W Mulcahy, Eli Cutler, Gary Pickens
OBJECTIVE: To examine the impact of the Affordable Care Act's coverage expansion on safety-net hospitals (SNHs). STUDY SETTING: Nine Medicaid expansion states. STUDY DESIGN: Differences-in-differences (DID) models compare payer-specific pre-post changes in inpatient stays of adults aged 19-64 years at SNHs and non-SNHs. DATA COLLECTION METHODS: 2013-2014 Healthcare Cost and Utilization Project State Inpatient Databases...
January 21, 2018: Health Services Research
https://www.readbyqxmd.com/read/29181542/association-of-clinician-denial-of-patient-requests-with-patient-satisfaction
#17
Anthony Jerant, Joshua J Fenton, Richard L Kravitz, Daniel J Tancredi, Elizabeth Magnan, Klea D Bertakis, Peter Franks
Importance: Prior studies suggesting clinician fulfillment or denial of requests affects patient satisfaction included limited adjustment for patient confounders. The studies also did not examine distinct request types, yet patient expectations and clinician fulfillment or denial might vary among request types. Objective: To examine how patient satisfaction with the clinician is associated with clinician denial of distinct types of patient requests, adjusting for patient characteristics...
January 1, 2018: JAMA Internal Medicine
https://www.readbyqxmd.com/read/28873133/distribution-of-medical-education-debt-by-specialty-2010-2016
#18
Justin Grischkan, Benjamin P George, Krisda Chaiyachati, Ari B Friedman, E Ray Dorsey, David A Asch
No abstract text is available yet for this article.
October 1, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/29058316/does-enrollment-in-high-deductible-health-plans-encourage-price-shopping
#19
Xinke Zhang, Amelia Haviland, Ateev Mehrotra, Peter Huckfeldt, Zachary Wagner, Neeraj Sood
OBJECTIVE: To investigate whether enrollment in high-deductible health plans (HDHPs) led enrollees to choose lower-priced providers for office visits and laboratory tests. STUDY SETTING: Claims data from more than 40 large employers. STUDY DESIGN: We compared the change in price for office visits and laboratory tests for enrollees who switched to HDHPs versus enrollees who remained in traditional plans. We estimated separate models for enrollees who changed providers versus those who remained with the same provider to disentangle the effects of HDHPs on provider choice and negotiated prices...
August 2018: Health Services Research
https://www.readbyqxmd.com/read/28069138/disparities-in-access-to-trauma-care-in-the-united-states-a-population-based-analysis
#20
Brendan G Carr, Ariel J Bowman, Catherine S Wolff, Michael T Mullen, Daniel N Holena, Charles C Branas, Douglas J Wiebe
BACKGROUND: Injury is a major contributor to morbidity and mortality in the United States. Accordingly, expanding access to trauma care is a Healthy People priority. The extent to which disparities in access to trauma care exist in the US is unknown. Our objective was to describe geographic, demographic, and socioeconomic disparities in access to trauma care in the United States. METHODS: Cross-sectional study of the US population in 2010 using small units of geographic analysis and validated estimates of population access to a Level I or II trauma center within 60minutes via ambulance or helicopter...
February 2017: Injury
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