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BCM Health Policy Journal Club

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36 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/29181542/association-of-clinician-denial-of-patient-requests-with-patient-satisfaction
#1
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
#2
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
#3
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
#4
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
#5
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
#6
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
#7
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/28234756/a-comparison-of-nurse-practitioners-physician-assistants-and-primary-care-physicians-patterns-of-practice-and-quality-of-care-in-health-centers
#8
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
#9
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
#10
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
#11
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
https://www.readbyqxmd.com/read/28419487/the-effect-of-medicaid-physician-fee-increases-on-health-care-access-utilization-and-expenditures
#12
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/28385030/consumer-directed-health-plans-do-doctors-and-nurses-buy-in
#13
Lucinda B Leung, José J Escarce
OBJECTIVES: Aiming to increase healthcare value, consumer-directed health plans (CDHPs)-high-deductible health insurance plus a personal spending account-equip enrollees with decision-support tools and expose them to the financial implications of their medical decisions. This study examines whether medically knowledgeable consumers are more or less likely to select a CDHP than individuals without medical knowledge. STUDY DESIGN: Using University of California Los Angeles (UCLA) human resources data, our observational cross-sectional study analyzed the health plan enrollment choices of 3552 faculty and 8429 staff employees...
March 1, 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28002205/the-role-of-public-and-private-insurance-expansions-and-premiums-for-low-income-parents-lessons-from-state-experiences
#14
Gery P Guy, Emily M Johnston, Patricia Ketsche, Peter Joski, E Kathleen Adams
BACKGROUND: Numerous states have implemented policies expanding public insurance eligibility or subsidizing private insurance for parents. OBJECTIVES: To assess the impact of parental health insurance expansions from 1999 to 2012 on the likelihood that parents are insured; their children are insured; both the parent and child within a family unit are insured; and the type of insurance. DESIGN: Cross-sectional analysis of the 2000-2013 March supplements to the Current Population Survey, with data from the Medical Expenditure Panel Survey-Insurance Component and the Area Resource File...
March 2017: Medical Care
https://www.readbyqxmd.com/read/27815451/financial-incentives-to-encourage-value-based-health-care
#15
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...
February 2018: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/27524767/indirect-referral-of-orthopaedic-patients-to-a-safety-net-hospital
#16
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/27385230/marketplace-subsidies-changing-the-family-glitch-reduces-family-health-spending-but-increases-government-costs
#17
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
#18
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/27534776/gaining-coverage-through-medicaid-or-private-insurance-increased-prescription-use-and-lowered-out-of-pocket-spending
#19
COMPARATIVE STUDY
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/27813058/resolving-malpractice-claims-after-tort-reform-experience-in-a-self-insured-texas-public-academic-health-system
#20
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
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