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Policy Prescriptions

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119 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/29608370/changes-in-hospital-utilization-three-years-into-maryland-s-global-budget-program-for-rural-hospitals
#1
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
#2
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
#3
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
#4
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
#5
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
#6
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
#7
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
#8
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
#9
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
#10
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
#11
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...
October 23, 2017: Health Services Research
https://www.readbyqxmd.com/read/28069138/disparities-in-access-to-trauma-care-in-the-united-states-a-population-based-analysis
#12
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
https://www.readbyqxmd.com/read/27974361/one-in-five-inpatient-emergency-department-cases-may-lead-to-surprise-bills
#13
Christopher Garmon, Benjamin Chartock
A surprise medical bill is a bill from an out-of-network provider that was not expected by the patient or that came from an out-of-network provider not chosen by the patient. In 2014, 20 percent of hospital inpatient admissions that originated in the emergency department (ED), 14 percent of outpatient visits to the ED, and 9 percent of elective inpatient admissions likely led to a surprise medical bill.
January 1, 2017: Health Affairs
https://www.readbyqxmd.com/read/28419487/the-effect-of-medicaid-physician-fee-increases-on-health-care-access-utilization-and-expenditures
#14
Kevin Callison, Binh T Nguyen
OBJECTIVE: To evaluate the effect of Medicaid fee changes on health care access, utilization, and spending for Medicaid beneficiaries. DATA SOURCE: We use the 2008 and 2012 waves of the Medical Expenditure Panel Survey linked to state-level Medicaid-to-Medicare primary care reimbursement ratios obtained through surveys conducted by the Urban Institute. We also incorporate data from the Current Population Survey and the Area Resource Files. STUDY DESIGN: Using a control group made up of the low-income privately insured, we conduct a difference-in-differences analysis to assess the relationship between Medicaid fee changes and access to care, utilization of health care services, and out-of-pocket medical expenditures for Medicaid enrollees...
April 2018: Health Services Research
https://www.readbyqxmd.com/read/29087158/the-effect-of-narrow-network-plans-on-out-of-pocket-cost
#15
Emily Meredith Gillen, Kristen Hassmiller Lich, Laurel Clayton Trantham, Morris Weinberger, Pam Silberman, Mark Holmes
OBJECTIVES: To estimate the effects of selecting a narrow provider network on outpatient utilization and outpatient out-of-pocket (OOP) expenditures among individuals who chose to enroll in a narrow network plan in 2014. STUDY DESIGN: Claims data from a large insurer in the southeastern United States. METHODS: The sample consisted of individuals continuously enrolled for 2 years (2013-2014) who had Affordable Care Act-compliant plans in 2014...
September 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28971921/high-deductible-health-plans-reduce-health-care-cost-and-utilization-including-use-of-needed-preventive-services
#16
Rajender Agarwal, Olena Mazurenko, Nir Menachemi
Enrollment in high-deductible health plans (HDHPs) has greatly increased in recent years. Policy makers and other stakeholders need the best available evidence about how these plans may affect health care cost and utilization, but the literature has not been comprehensively synthesized. We performed a systematic review of methodologically rigorous studies that examined the impact of HDHPs on health care utilization and costs. The plans were associated with a significant reduction in preventive care in seven of twelve studies and a significant reduction in office visits in six of eleven studies-which in turn led to a reduction in both appropriate and inappropriate care...
October 1, 2017: Health Affairs
https://www.readbyqxmd.com/read/29200347/the-effect-of-medicaid-on-medication-use-among-poor-adults-evidence-from-oregon
#17
Katherine Baicker, Heidi L Allen, Bill J Wright, Amy N Finkelstein
Oregon's 2008 Medicaid expansion significantly increased the use of prescription medications in 2009-10.
December 2017: Health Affairs
https://www.readbyqxmd.com/read/28884818/the-effect-of-medicaid-on-dental-care-of-poor-adults-evidence-from-the-oregon-health-insurance-experiment
#18
Katherine Baicker, Heidi L Allen, Bill J Wright, Sarah L Taubman, Amy N Finkelstein
OBJECTIVE: To evaluate the effect of Medicaid coverage on dental care outcomes, a major health concern for low-income populations. DATA SOURCES: Primary and secondary data on health care use and outcomes for participants in Oregon's 2008 Medicaid lottery. STUDY DESIGN: We used the lottery's random selection to gauge the causal effects of Medicaid on dental care needs, medication, and emergency department visits for dental care. DATA COLLECTION: Data were collected for lottery participants over 2 years, including mail surveys (N = 23,777) and in-person questionnaires (N = 12,229)...
September 8, 2017: Health Services Research
https://www.readbyqxmd.com/read/28874492/newly-eligible-enrollees-in-medicaid-spend-less-and-use-less-care-than-those-previously-eligible
#19
Paul D Jacobs, Genevieve M Kenney, Thomas M Selden
Understanding the health care spending and utilization of various types of Medicaid enrollees is important for assessing the budgetary implications of both expansion and contraction in Medicaid enrollment. Despite the intense debate surrounding the Affordable Care Act (ACA), however, little information is available on the spending and utilization patterns of the nonelderly adult enrollees who became newly eligible for Medicaid under the ACA. Using data for 2012-14 from the Medical Expenditure Panel Survey, we compared health care spending and utilization of newly eligible Medicaid enrollees with those of nondisabled adults who were previously eligible and enrolled...
September 1, 2017: Health Affairs
https://www.readbyqxmd.com/read/27521368/health-information-exchange-associated-with-improved-emergency-department-care-through-faster-accessing-of-patient-information-from-outside-organizations
#20
Jordan Everson, Keith E Kocher, Julia Adler-Milstein
Objective: To assess whether electronic health information exchange (HIE) is associated with improved emergency department (ED) care processes and utilization through more timely clinician viewing of information from outside organizations. Materials and Methods: Our data included 2163 patients seen in the ED of a large academic medical center for whom clinicians requested and viewed outside information from February 14, 2014, to February 13, 2015. Outside information requests w...
April 1, 2017: Journal of the American Medical Informatics Association: JAMIA
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