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Policy Prescriptions

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64 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
https://www.readbyqxmd.com/read/28615193/health-spending-by-state-1991-2014-measuring-per-capita-spending-by-payers-and-programs
#1
David Lassman, Andrea M Sisko, Aaron Catlin, Mary Carol Barron, Joseph Benson, Gigi A Cuckler, Micah Hartman, Anne B Martin, Lekha Whittle
As the US health sector evolves and changes, it is informative to estimate and analyze health spending trends at the state level. These estimates, which provide information about consumption of health care by residents of a state, serve as a baseline for state and national-level policy discussions. This study examines per capita health spending by state of residence and per enrollee spending for the three largest payers (Medicare, Medicaid, and private health insurance) through 2014. Moreover, it discusses in detail the impacts of the Affordable Care Act implementation and the most recent economic recession and recovery on health spending at the state level...
July 1, 2017: Health Affairs
https://www.readbyqxmd.com/read/28207333/handgun-legislation-and-changes-in-statewide-overall-suicide-rates
#2
Michael D Anestis, Joye C Anestis, Sarah E Butterworth
OBJECTIVES: To examine the extent to which 4 laws regulating handgun ownership were associated with statewide suicide rate changes. METHODS: To test between-group differences in statewide suicide rate changes between 2013 and 2014 in all 50 states and the District of Columbia with and without specific laws, we ran analyses of covariance. RESULTS: We found significant differences in suicide rate changes from 2013 to 2014 in states with mandatory waiting periods and universal background checks relative to states without such laws...
April 2017: American Journal of Public Health
https://www.readbyqxmd.com/read/28264946/oregon-s-medicaid-reform-and-transition-to-global-budgets-were-associated-with-reductions-in-expenditures
#3
K John McConnell, Stephanie Renfro, Richard C Lindrooth, Deborah J Cohen, Neal T Wallace, Michael E Chernew
In 2012 Oregon initiated an ambitious delivery system reform, moving the majority of its Medicaid enrollees into sixteen coordinated care organizations, a type of Medicaid accountable care organization. Using claims data, we assessed measures of access, appropriateness of care, utilization, and expenditures for five service areas (evaluation and management, imaging, procedures, tests, and inpatient facility care), comparing Oregon to the neighboring state of Washington. Overall, the transformation into coordinated care organizations was associated with a 7 percent relative reduction in expenditures across the sum of these services, attributable primarily to reductions in inpatient utilization...
March 1, 2017: Health Affairs
https://www.readbyqxmd.com/read/27534776/gaining-coverage-through-medicaid-or-private-insurance-increased-prescription-use-and-lowered-out-of-pocket-spending
#4
Andrew W Mulcahy, Christine Eibner, Kenneth Finegold
A growing body of literature describes how the Affordable Care Act (ACA) has expanded health insurance coverage. What is less well known is how these coverage gains have affected populations that are at risk for high health spending. To investigate this issue, we used prescription transaction data for a panel of 6.7 million prescription drug users to compare changes in coverage, prescription fills, plan spending, and out-of-pocket spending before and after the implementation of the ACA's coverage expansion...
September 1, 2016: Health Affairs
https://www.readbyqxmd.com/read/27702960/state-regulation-of-freestanding-emergency-departments-varies-widely-affecting-location-growth-and-services-provided
#5
Catherine Gutierrez, Rachel A Lindor, Olesya Baker, David Cutler, Jeremiah D Schuur
Freestanding emergency departments (EDs), which offer emergency medical care at sites separate from hospitals, are a rapidly growing alternative to traditional hospital-based EDs. We evaluated state regulations of freestanding EDs and describe their effect on the EDs' location, staffing, and services. As of December 2015, thirty-two states collectively had 400 freestanding EDs. Twenty-one states had regulations that allowed freestanding EDs, and twenty-nine states did not have regulations that applied specifically to such EDs (one state had hospital regulations that precluded them)...
October 1, 2016: Health Affairs
https://www.readbyqxmd.com/read/28515140/three-year-impacts-of-the-affordable-care-act-improved-medical-care-and-health-among-low-income-adults
#6
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/28520488/firearm-legislation-and-fatal-police-shootings-in-the-united-states
#7
Aaron J Kivisto, Bradley Ray, Peter L Phalen
OBJECTIVES: To examine whether stricter firearm legislation is associated with rates of fatal police shootings. METHODS: We used a cross-sectional, state-level design to evaluate the effect of state-level firearm legislation on rates of fatal police shootings from January 1, 2015, through October 31, 2016. We measured state-level variation in firearm laws with legislative scorecards from the Brady Center, and for fatal police shootings we used The Counted, an online database maintained by The Guardian...
July 2017: American Journal of Public Health
https://www.readbyqxmd.com/read/28598891/effect-of-direct-to-consumer-advertising-on-statin-use-in-the-united-states
#8
Hsien-Yen Chang, Irene Murimi, Matthew Daubresse, Dima M Qato, Sherry L Emery, G Caleb Alexander
IMPORTANCE: The value of direct-to-consumer advertising (DTCA) of prescription drugs is widely debated, as is the effect of DTCA on prescription sales and health care utilization. OBJECTIVE: We examined the association between DTCA intensity for statin medications and prescription sales and cholesterol-related health care utilization. DESIGN, SETTING, AND PARTICIPANTS: We conducted an ecological study for 75 designated market areas from 2005 to 2009 in the United States using linked data regarding televised DTCA volume, non-DTCA marketing and promotion, retail, mail order and long-term care prescription drug sales, prescription drug and ambulatory care health care utilization, and contextual factors such as health care density and socioeconomic status...
August 2017: Medical Care
https://www.readbyqxmd.com/read/28556857/emergency-health-care-professionals-understanding-of-the-costs-of-care-in-the-emergency-department
#9
Kevin A Hoffman, Michelino Mancini
Background: Efficiency and fiscal responsibility are important to the equal, safe, and effective delivery of care in the emergency department, where all presenting patients must be evaluated for emergent conditions. Health care professionals' understanding of the costs of care is a first step to developing rational approaches for the efficient distribution of the finite resources hospitals and emergency departments have at their disposal to reduce costs to patients and health care systems...
June 1, 2017: Journal of the American Osteopathic Association
https://www.readbyqxmd.com/read/28439903/did-health-care-reform-help-kentucky-address-disparities-in-coverage-and-access-to-care-among-the-poor
#10
Joseph A Benitez, E Kathleen Adams, Eric E Seiber
OBJECTIVE: To evaluate the impact of Kentucky's full rollout of the Affordable Care Act on disparities in access to care due to poverty. DATA SOURCE: Restricted version of the Behavioral Risk Factor Surveillance System (BRFSS) for Kentucky and years 2011-2015. STUDY DESIGN: We use a difference-in-differences framework to compare trends before and after implementation of the Affordable Care Act (ACA) in health insurance coverage, several access measures, and health care utilization for residents in higher versus lower poverty ZIP codes...
April 25, 2017: Health Services Research
https://www.readbyqxmd.com/read/28264952/synthesis-of-research-on-patient-centered-medical-homes-brings-systematic-differences-into-relief
#11
Anna D Sinaiko, Mary Beth Landrum, David J Meyers, Shehnaz Alidina, Daniel D Maeng, Mark W Friedberg, Lisa M Kern, Alison M Edwards, Signe Peterson Flieger, Patricia R Houck, Pamela Peele, Robert J Reid, Katharine McGraves-Lloyd, Karl Finison, Meredith B Rosenthal
The patient-centered medical home (PCMH) model emphasizes comprehensive, coordinated, patient-centered care, with the goals of reducing spending and improving quality. To evaluate the impact of PCMH initiatives on utilization, cost, and quality, we conducted a meta-analysis of methodologically standardized findings from evaluations of eleven major PCMH initiatives. There was significant heterogeneity across individual evaluations in many outcomes. Across evaluations, PCMH initiatives were not associated with changes in the majority of outcomes studied, including primary care, emergency department, and inpatient visits and four quality measures...
March 1, 2017: Health Affairs
https://www.readbyqxmd.com/read/28373331/electronic-health-record-logs-indicate-that-physicians-split-time-evenly-between-seeing-patients-and-desktop-medicine
#12
Ming Tai-Seale, Cliff W Olson, Jinnan Li, Albert S Chan, Criss Morikawa, Meg Durbin, Wei Wang, Harold S Luft
Time spent by physicians is a key resource in health care delivery. This study used data captured by the access time stamp functionality of an electronic health record (EHR) to examine physician work effort. This is a potentially powerful, yet unobtrusive, way to study physicians' use of time. We used data on physicians' time allocation patterns captured by over thirty-one million EHR transactions in the period 2011-14 recorded by 471 primary care physicians, who collectively worked on 765,129 patients' EHRs...
April 1, 2017: Health Affairs
https://www.readbyqxmd.com/read/28264950/direct-to-consumer-telehealth-may-increase-access-to-care-but-does-not-decrease-spending
#13
J Scott Ashwood, Ateev Mehrotra, David Cowling, Lori Uscher-Pines
The use of direct-to-consumer telehealth, in which a patient has access to a physician via telephone or videoconferencing, is growing rapidly. A key attraction of this type of telehealth for health plans and employers is the potential savings involved in replacing physician office and emergency department visits with less expensive virtual visits. However, increased convenience may tap into unmet demand for health care, and new utilization may increase overall health care spending. We used commercial claims data on over 300,000 patients from three years (2011-13) to explore patterns of utilization and spending for acute respiratory illnesses...
March 1, 2017: Health Affairs
https://www.readbyqxmd.com/read/27813058/resolving-malpractice-claims-after-tort-reform-experience-in-a-self-insured-texas-public-academic-health-system
#14
William M Sage, Molly Colvard Harding, Eric J Thomas
OBJECTIVE: To describe the litigation experience in a state with strict tort reform of a large public university health system that has committed to transparency with patients and families in resolving medical errors. DATA SOURCES/STUDY SETTING: Secondary data collected from The University of Texas System, which self-insures approximately 6,000 physicians at six health campuses across the state. We obtained internal case management data for all medical malpractice claims closed during 1 year before and 6 recent years following the enactment of state tort reform legislation...
December 2016: Health Services Research
https://www.readbyqxmd.com/read/28288072/dissecting-leapfrog-how-well-do-leapfrog-safe-practices-scores-correlate-with-hospital-compare-ratings-and-penalties-and-how-much-do-they-matter
#15
Shawna N Smith, Heidi A Reichert, Jessica M Ameling, Jennifer Meddings
BACKGROUND: Voluntary Leapfrog Safe Practices Score (SPS) measures were among the first public reports of hospital performance. Recently, Medicare's Hospital Compare website has reported compulsory measures. Leapfrog's Hospital Safety Score (HSS) grades incorporate SPS and Medicare measures. We evaluate associations between Leapfrog SPS and Medicare measures, and the impact of SPS on HSS grades. METHODS: Using 2013 hospital data, we linked Leapfrog HSS data with central line-associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI) standardized infection ratios (SIRs), and Hospital Readmission and Hospital-Acquired Condition (HAC) Reduction Program penalties incorporating 2013 performance...
June 2017: Medical Care
https://www.readbyqxmd.com/read/28167720/grandfathered-grandmothered-and-aca-compliant-health-plans-have-equivalent-premiums
#16
Heidi Whitmore, Jon R Gabel, Jennifer L Satorius, Matthew Green
Many small employers offer employees health plans that are not fully compliant with Affordable Care Act (ACA) provisions such as covering preventive services without cost sharing. These "grandfathered" and "grandmothered" plans accounted for about 65 percent of enrollment in the small-group market in 2014. Premium costs for these and ACA-compliant plans were equivalent.
February 1, 2017: Health Affairs
https://www.readbyqxmd.com/read/28146644/per-capita-caps-in-medicaid-lessons-from-the-past
#17
Andrew J Goodman-Bacon, Sayeh S Nikpay
In the summer of 2016, Representative Paul Ryan (R-WI) released "A Better Way," a wide-ranging proposal that included a plan for reforming Medicaid. Its fate depended heavily on the presidential election, and now that Republicans hold majorities in both the Senate and the House of Representatives..
March 16, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/27815451/financial-incentives-to-encourage-value-based-health-care
#18
REVIEW
Anthony Scott, Miao Liu, Jongsay Yong
This article reviews the literature on the use of financial incentives to improve the provision of value-based health care. Eighty studies of 44 schemes from 10 countries were reviewed. The proportion of positive and statistically significant outcomes was close to .5. Stronger study designs were associated with a lower proportion of positive effects. There were no differences between studies conducted in the United States compared with other countries; between schemes that targeted hospitals or primary care; or between schemes combining pay for performance with rewards for reducing costs, relative to pay for performance schemes alone...
November 3, 2016: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/27524767/indirect-referral-of-orthopaedic-patients-to-a-safety-net-hospital
#19
Laura N Medford-Davis, Michelle Phelps, Paul Hausknecht, Zachary F Meisel, Charles Reitman, Angela S Fisher
OBJECTIVE: Patients seen in emergency departments (EDs) not requiring admission are typically discharged with appropriate follow-up. Sometimes hospitals indirectly refer, or redirect, patients to a different hospital's ED. Anecdotally, indirect referrals are commonly received in safety-net hospitals. This study characterizes the types of patients and hospitals affected and the cost of indirect referral in the orthopaedic trauma population. METHODS: A retrospective cross-sectional chart review was conducted of 1,162 consecutive adult patients receiving orthopaedic care in an urban public hospital ED over a six-month period in 2011...
2016: Journal of Health Care for the Poor and Underserved
https://www.readbyqxmd.com/read/28176307/do-people-with-health-insurance-coverage-who-live-in-areas-with-high-uninsurance-rates-pay-more-for-emergency-department-visits
#20
James B Kirby, Joel W Cohen
OBJECTIVE: To investigate the relationship between the percent uninsured in a county and expenditures associated with the typical emergency department visit. DATA SOURCES: The Medical Expenditure Panel Survey linked to county-level data from the American Community Survey, the Healthcare Cost and Utilization Project, and the Area Health Resources Files. STUDY DESIGN: We use a nationally representative sample of emergency department visits that took place between 2009 and 2013 to estimate the association between the percent uninsured in counties and the amount paid for a typical visit...
February 7, 2017: Health Services Research
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