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Policy Prescriptions

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56 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/28556857/emergency-health-care-professionals-understanding-of-the-costs-of-care-in-the-emergency-department
#1
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
#2
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
#3
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
#4
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
#5
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
#6
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
#7
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
#8
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
#9
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
#10
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
#11
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
#12
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
https://www.readbyqxmd.com/read/27385230/marketplace-subsidies-changing-the-family-glitch-reduces-family-health-spending-but-increases-government-costs
#13
Matthew Buettgens, Lisa Dubay, Genevieve M Kenney
Under the Affordable Care Act, if one family member has an employer offer of single coverage deemed to be affordable-that is, costing less than 9.66 percent of family income in 2016-then all family members are ineligible for tax credits for Marketplace coverage, even if the cost of providing coverage to the whole family is greater than 9.66 percent of income. More than six million people live in such families and as a result are ineligible for premium tax credits. These families face premiums that can amount to 15...
July 1, 2016: Health Affairs
https://www.readbyqxmd.com/read/27322350/pharmaceutical-industry-sponsored-meals-and-physician-prescribing-patterns-for-medicare-beneficiaries
#14
Colette DeJong, Thomas Aguilar, Chien-Wen Tseng, Grace A Lin, W John Boscardin, R Adams Dudley
IMPORTANCE: The association between industry payments to physicians and prescribing rates of the brand-name medications that are being promoted is controversial. In the United States, industry payment data and Medicare prescribing records recently became publicly available. OBJECTIVE: To study the association between physicians' receipt of industry-sponsored meals, which account for roughly 80% of the total number of industry payments, and rates of prescribing the promoted drug to Medicare beneficiaries...
August 1, 2016: JAMA Internal Medicine
https://www.readbyqxmd.com/read/28213393/the-racial-divide-in-state-medicaid-expansions
#15
Colleen M Grogan, Sunggeun Ethan Park
This study considers five important questions related to the role of race in state-level public support for the Medicaid expansion: (1) whether public support for the Medicaid expansion varies across the American states; (2) whether public support is positively related to state adoption; (3) whether this support is racialized; (4) whether, if racialized, there is evidence of more state responsiveness to white support than to nonwhite (black and/or Latino) support; and (5) does the size of the nonwhite population matter more when white support is relatively low? Our findings suggest that while public support for the Medicaid expansion is high at the state level, especially in comparison to public support for the ACA, there are important variations across the states...
June 2017: Journal of Health Politics, Policy and Law
https://www.readbyqxmd.com/read/27569108/increased-emergency-department-use-in-illinois-after-implementation-of-the-patient-protection-and-affordable-care-act
#16
Scott M Dresden, Emilie S Powell, Raymond Kang, Megan McHugh, Andrew J Cooper, Joe Feinglass
STUDY OBJECTIVE: We examine emergency department (ED) use and hospitalizations through the ED after Patient Protection and Affordable Care Act (ACA) health insurance expansion in Illinois, a Medicaid expansion state. METHODS: Using statewide hospital administrative data from 2011 through 2015 from 201 nonfederal Illinois hospitals for patients aged 18 to 64 years, mean monthly ED visits were compared before and after ACA implementation by disposition from the ED and primary payer...
February 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/28264943/innovative-home-visit-models-associated-with-reductions-in-costs-hospitalizations-and-emergency-department-use
#17
Sarah Ruiz, Lynne Page Snyder, Christina Rotondo, Caitlin Cross-Barnet, Erin Murphy Colligan, Katherine Giuriceo
While studies of home-based care delivered by teams led by primary care providers have shown cost savings, little is known about outcomes when practice-extender teams-that is, teams led by registered nurses or lay health workers-provide home visits with similar components (for example, care coordination and education). We evaluated findings from five models funded by Health Care Innovation Awards of the Centers for Medicare and Medicaid Services. Each model used a mix of different components to strengthen connections to primary care among fee-for-service Medicare beneficiaries with multiple chronic conditions; these connections included practice-extender home visits...
March 1, 2017: Health Affairs
https://www.readbyqxmd.com/read/27442786/-i-broke-my-ankle-access-to-orthopedic-follow-up-care-by-insurance-status
#18
Laura N Medford-Davis, Fred Lin, Alexandra Greenstein, Karin V Rhodes
OBJECTIVES: While the Affordable Care Act seeks to reduce emergency department (ED) visits for outpatient-treatable conditions, it remains unclear whether Medicaid patients or the uninsured have adequate access to follow-up care. The goal of this study was to determine the availability of follow-up orthopedic care by insurance status. METHODS: Using simulated patient methodology, all 102 eligible general orthopedic practices in Dallas-Fort Worth, Texas, were contacted twice by a caller requesting follow-up for an ankle fracture diagnosed in a local ED using a standardized script that differed by insurance status...
January 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28207344/the-future-of-the-affordable-care-act-and-insurance-coverage
#19
Sherry Glied, Adlan Jackson
We describe the patterns of coverage gains associated with the Affordable Care Act (ACA) expansions and use these patterns to assess the potential impact of alternative repeal or repeal and replace strategies because Congress and the president are weighing options to repeal or replace the ACA. We find that specific provisions of the ACA, including the Medicaid expansion and the structure of premium subsidies, have been associated with large and robust gains in insurance coverage. We evaluate the impact of retaining dependent coverage and high-risk pool provisions and show, on the basis of the ACA experience, that these provisions would have little effect on coverage...
April 2017: American Journal of Public Health
https://www.readbyqxmd.com/read/27856648/in-new-survey-of-eleven-countries-us-adults-still-struggle-with-access-to-and-affordability-of-health-care
#20
Robin Osborn, David Squires, Michelle M Doty, Dana O Sarnak, Eric C Schneider
Surveys of patients' experiences with health care services can reveal how well a country's health system is meeting the needs of its population. Using data from a 2016 survey conducted in eleven countries-Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States-we found that US adults reported poor health and well-being and were the most likely to experience material hardship. The United States trailed other countries in making health care affordable and ranked poorly on providing timely access to medical care (except specialist care)...
December 1, 2016: Health Affairs
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