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BCM Health Policy Journal Club

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45 papers 0 to 25 followers Articles previously reviewed or considered for discussion during our monthly student health policy journal club at Baylor College of Medicine. Join us every first Tuesday of the month for discussion led by our clinical faculty with special interests in policy.
By Cedric Dark MD, MPH, FACEP, FAAEM
https://www.readbyqxmd.com/read/29505376/the-arc-of-history-bends-toward-coverage-health-policy-at-a-crossroads
#1
James A Morone, David Blumenthal
There is a formidable historical arc to health care policy: Every modern US president has sought to expand coverage. Democrats eagerly placed the issue on the agenda. Republicans vociferously opposed Democratic proposals but countered with creative ways to expand coverage on their own terms. Democrats eventually absorbed elements of the latest Republican plan-which Republicans, in turn, attacked, and the cycle began anew. The dynamic interaction between the parties slowly, often haphazardly, expanded health insurance as each sought to extend coverage in its own way...
March 2018: Health Affairs
https://www.readbyqxmd.com/read/29342379/elimination-of-cost-sharing-for-screening-mammography-in-medicare-advantage-plans
#2
COMPARATIVE STUDY
Amal N Trivedi, Bryan Leyva, Yoojin Lee, Orestis A Panagiotou, Issa J Dahabreh
BACKGROUND: The Affordable Care Act (ACA) required most insurers and the Medicare program to eliminate cost sharing for screening mammography. METHODS: We conducted a difference-in-differences study of biennial screening mammography among 15,085 women 65 to 74 years of age in 24 Medicare Advantage plans that eliminated cost sharing to provide full coverage for screening mammography, as compared with 52,035 women in 48 matched control plans that had and maintained full coverage...
January 18, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/29350511/a-cost-effectiveness-analysis-of-cardiology-econsults-for-medicaid-patients
#3
Daren Anderson, Victor Villagra, Emil N Coman, Ianita Zlateva, Alex Hutchinson, Jose Villagra, J Nwando Olayiwola
OBJECTIVES: To evaluate the cost-effectiveness of electronic consultations (eConsults) for cardiology compared with traditional face-to-face consults. STUDY DESIGN: Cost-effectiveness analysis for a subset of Medicaid-insured patients in a cluster-randomized trial of eConsults versus the traditional face-to-face consultation process in a statewide federally qualified health center. METHODS: A total of 369 Medicaid patients were referred for cardiology consultations by primary care providers who were randomly assigned to use either eConsults or their usual face-to-face referral process...
January 1, 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/29565664/impact-of-new-york-city-s-2014-increased-minimum-legal-purchase-age-on-youth-tobacco-use
#4
James Macinko, Diana Silver
OBJECTIVES: To assess the impact of New York City's (NYC's) 2014 increase of the minimum legal purchase age (MLPA) for tobacco and e-cigarettes from 18 to 21 years. METHODS: We performed a difference-in-differences analysis comparing NYC to the rest of New York State by using repeated cross-sections of the New York Youth Tobacco Survey (2008-2016) and to 4 Florida cities by using the Youth Risk Behavior Surveys (2007-2015). RESULTS: Adolescent tobacco use declined slightly in NYC after the policy change...
May 2018: American Journal of Public Health
https://www.readbyqxmd.com/read/29863941/the-effects-of-medicaid-expansion-under-the-aca-a-systematic-review
#5
Olena Mazurenko, Casey P Balio, Rajender Agarwal, Aaron E Carroll, Nir Menachemi
Expanding eligibility for Medicaid was a central goal of the Affordable Care Act (ACA), which continues to be debated and discussed at the state and federal levels as further reforms are considered. In an effort to provide a synthesis of the available research, we systematically reviewed the peer-reviewed scientific literature on the effects of Medicaid expansion on the original goals of the ACA. After analyzing seventy-seven published studies, we found that expansion was associated with increases in coverage, service use, quality of care, and Medicaid spending...
June 2018: Health Affairs
https://www.readbyqxmd.com/read/29633250/committee-representation-and-medicare-reimbursements-an-examination-of-the-resource-based-relative-value-scale
#6
Y Nina Gao
BACKGROUND: The Resource-Based Relative Value Scale Update Committee (RUC) submits recommended reimbursement values for physician work (wRVUs) under Medicare Part B. The RUC includes rotating representatives from medical specialties. OBJECTIVE: To identify changes in physician reimbursements associated with RUC rotating seat representation. DATA SOURCES: Relative Value Scale Update Committee members 1994-2013; Medicare Part B Relative Value Scale 1994-2013; Physician/Supplier Procedure Summary Master File 2007; Part B National Summary Data File 2000-2011...
April 6, 2018: Health Services Research
https://www.readbyqxmd.com/read/29461855/aca-marketplace-premiums-and-competition-among-hospitals-and-physician-practices
#7
Maria Polyakova, M Kate Bundorf, Daniel P Kessler, Laurence C Baker
OBJECTIVES: To examine the association between annual premiums for health plans available in Federally Facilitated Marketplaces (FFMs) and the extent of competition and integration among physicians and hospitals, as well as the number of insurers. STUDY DESIGN: We used observational data from the Center for Consumer Information and Insurance Oversight on the annual premiums and other characteristics of plans, matched to measures of physician, hospital, and insurer market competitiveness and other characteristics of 411 rating areas in the 37 FFMs...
February 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/29470120/racial-ethnic-variation-in-the-impact-of-the-affordable-care-act-on-insurance-coverage-and-access-among-young-adults
#8
Aurora VanGarde, Jangho Yoon, Jeff Luck, Carolyn A Mendez-Luck
OBJECTIVES: To examine the impact of the Affordable Care Act's (ACA's) 2010 parental insurance coverage extension to young adults aged 19 to 25 years on health insurance coverage and access to care, including racial/ethnic disparities. METHODS: We pooled data from the Behavioral Risk Factor Surveillance System for the periods 2007 to 2009 and 2011 to 2013 (n = 402 777). We constructed quasiexperimental difference-in-differences models in which adults aged 26 to 35 years served as a control group...
April 2018: American Journal of Public Health
https://www.readbyqxmd.com/read/29553277/overuse-and-insurance-plan-type-in-a-privately-insured-population
#9
Meredith B Rosenthal, Carrie H Colla, Nancy E Morden, Thomas D Sequist, Alexander J Mainor, Zhonghe Li, Kevin H Nguyen
OBJECTIVES: A substantial portion of healthcare spending is wasted on services that do not directly improve patient health and that cause harm in some cases. Features of health insurance coverage, including enrollment in high-deductible health plans (HDHPs) or health maintenance organizations (HMOs), may provide financial and nonfinancial mechanisms to potentially reduce overuse of low-value healthcare services. STUDY DESIGN: Using 2009 to 2013 administrative data from 3 large commercial insurers, we examined patient characteristics and health insurance plan types associated with overuse of 6 healthcare services identified by the Choosing Wisely campaign...
March 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/29181542/association-of-clinician-denial-of-patient-requests-with-patient-satisfaction
#10
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/28373333/small-decline-in-low-value-back-imaging-associated-with-the-choosing-wisely-campaign-2012-14
#11
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/28873133/distribution-of-medical-education-debt-by-specialty-2010-2016
#12
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/28928263/health-benefits-in-2017-stable-coverage-workers-faced-considerable-variation-in-costs
#13
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/29128869/association-of-the-hospital-readmissions-reduction-program-implementation-with-readmission-and-mortality-outcomes-in-heart-failure
#14
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/29114831/factors-associated-with-increases-in-us-health-care-spending-1996-2013
#15
Joseph L Dieleman, Ellen Squires, Anthony L Bui, Madeline Campbell, Abigail Chapin, Hannah Hamavid, Cody Horst, Zhiyin Li, Taylor Matyasz, Alex Reynolds, Nafis Sadat, Matthew T Schneider, Christopher J L Murray
Importance: Health care spending in the United States increased substantially from 1995 to 2015 and comprised 17.8% of the economy in 2015. Understanding the relationship between known factors and spending increases over time could inform policy efforts to contain future spending growth. Objective: To quantify changes in spending associated with 5 fundamental factors related to health care spending in the United States: population size, population age structure, disease prevalence or incidence, service utilization, and service price and intensity...
November 7, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/29058316/does-enrollment-in-high-deductible-health-plans-encourage-price-shopping
#16
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/28234756/a-comparison-of-nurse-practitioners-physician-assistants-and-primary-care-physicians-patterns-of-practice-and-quality-of-care-in-health-centers
#17
COMPARATIVE STUDY
Ellen T Kurtzman, Burt S Barnow
BACKGROUND: Under the Affordable Care Act, the number and capacity of community health centers (HCs) is growing. Although the majority of HC care is provided by primary care physicians (PCMDs), a growing proportion is delivered by nurse practitioners (NPs) and physician assistants (PAs); yet, little is known about how these clinicians' care compares in this setting. OBJECTIVES: To compare the quality of care and practice patterns of NPs, PAs, and PCMDs in HCs. RESEARCH DESIGN: Using 5 years of data (2006-2010) from the HC subsample of the National Ambulatory Medical Care Survey and multivariate regression analysis, we estimated the impact of receiving NP-delivered or PA-delivered care versus PCMD-delivered care...
June 2017: Medical Care
https://www.readbyqxmd.com/read/28228484/in-mexico-evidence-of-sustained-consumer-response-two-years-after-implementing-a-sugar-sweetened-beverage-tax
#18
M Arantxa Colchero, Juan Rivera-Dommarco, Barry M Popkin, Shu Wen Ng
Mexico implemented a 1 peso per liter excise tax on sugar-sweetened beverages on January 1, 2014, and a previous study found a 6 percent reduction in purchases of taxed beverages in 2014. In this study we estimated changes in beverage purchases for 2014 and 2015. We used store purchase data for 6,645 households from January 2012 to December 2015. Changes in purchases of taxed and untaxed beverages in the study period were estimated using two models, which compared 2014 and 2015 purchases with predicted (counterfactual) purchases based on trends in 2012-13...
March 1, 2017: Health Affairs
https://www.readbyqxmd.com/read/28554214/battling-the-chargemaster-a-simple-remedy-to-balance-billing-for-unavoidable-out-of-network-care
#19
Barak D Richman, Nick Kitzman, Arnold Milstein, Kevin A Schulman
OBJECTIVES: To develop an effective legal mechanism to combat chargemaster abuses and to facilitate price transparency. STUDY DESIGN: Applying legal doctrines to out-of-network (OON) billing disputes. METHODS: We reviewed rudimentary contract law and examined the law's handling of contracts where prices have not been specified in advance. These cases are the controlling authority to guide courts, handling of surprise and OON billing problems...
April 1, 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28341637/the-tax-exclusion-for-employer-sponsored-insurance-is-not-regressive-but-what-is-it
#20
Joseph White
Conventional wisdom says that the tax exclusion for employer-sponsored health insurance (ESI) is "regressive and therefore unfair." Yet, by the standard definition of regressive tax policy, the conventional view is almost certainly false. It confuses the absolute size of the tax exclusion with its proportional effect on income. The error results from paying attention only to the marginal tax rate applied to ESI benefits as a portion of income and ignoring the fact that benefits are normally a much larger share of income for people with lower wages...
March 24, 2017: Journal of Health Politics, Policy and Law
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