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BCM Health Policy Journal Club

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22 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
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
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
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
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
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
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
John W Scott, John A Rose, Thomas C Tsai, Cheryl K Zogg, Mark G Shrime, Benjamin D Sommers, Ali Salim, Adil H Haider
BACKGROUND: The 2010 Dependent Coverage Provision (DCP) of the Affordable Care Act allowed young adults to remain on their parents' health insurance plans until age 26 years. Although the provision improved coverage and survey-reported access to care, little is known regarding its impact on timely access for acute conditions. This study aims to assess changes in insurance coverage and perforation rates among young adults with acute appendicitis-an established metric for population-level health care access-after the DCP...
September 2016: Medical Care
Hangsheng Liu, Michael Robbins, Ateev Mehrotra, David Auerbach, Brandi E Robinson, Lee F Cromwell, Douglas W Roblin
BACKGROUND: There has been concern that greater use of nurse practitioners (NP) and physician assistants (PA) in face-to-face primary care may increase utilization and spending. OBJECTIVE: To evaluate a natural experiment within Kaiser Permanente in Georgia in the use of NP/PA in primary care. STUDY DESIGN: From 2006 through early 2008 (the preperiod), each NP or PA was paired with a physician to manage a patient panel. In early 2008, NPs and PAs were removed from all face-to-face primary care...
January 2017: Medical Care
Jeremiah D Schuur, Olesya Baker, Jaclyn Freshman, Michael Wilson, David M Cutler
STUDY OBJECTIVE: We determine the number and location of freestanding emergency departments (EDs) across the United States and determine the population characteristics of areas where freestanding EDs are located. METHODS: We conducted a systematic inventory of US freestanding EDs. For the 3 states with the highest number of freestanding EDs, we linked demographic, insurance, and health services data, using the 5-digit ZIP code corresponding to the freestanding ED's location...
April 2017: Annals of Emergency Medicine
Benjamin D Sommers, Robert J Blendon, E John Orav, Arnold M Epstein
Importance: Under the Affordable Care Act (ACA), more than 30 states have expanded Medicaid, with some states choosing to expand private insurance instead (the "private option"). In addition, while coverage gains from the ACA's Medicaid expansion are well documented, impacts on utilization and health are unclear. Objective: To assess changes in access to care, utilization, and self-reported health among low-income adults in 3 states taking alternative approaches to the ACA...
October 1, 2016: JAMA Internal Medicine
Glenn A Melnick, Lois Green, Jeremy Rich
In 2009 HealthCare Partners Affiliates Medical Group, based in Southern California, launched House Calls, an in-home program that provides, coordinates, and manages care primarily for recently discharged high-risk, frail, and psychosocially compromised patients. Its purpose is to reduce preventable emergency department visits and hospital readmissions. We present data over time from this well-established program to provide an example for other new programs that are being established across the United States to serve this population with complex needs...
January 2016: Health Affairs
Renuka Tipirneni, Karin V Rhodes, Rodney A Hayward, Richard L Lichtenstein, HwaJung Choi, Elyse N Reamer, Matthew M Davis
OBJECTIVES: With insurance enrollment greater than expected under the Affordable Care Act, uncertainty about the availability and timeliness of healthcare services for newly insured individuals has increased. We examined primary care appointment availability and wait times for new Medicaid and privately insured patients before and after Medicaid expansion in Michigan. STUDY DESIGN: Simulated patient ("secret shopper") study. METHODS: Extended follow-up of a previously reported simulated patient ("secret shopper") study assessing accessibility of routine new patient appointments in a stratified proportionate random sample of Michigan primary care practices before versus 4, 8, and 12 months after Medicaid expansion...
June 2016: American Journal of Managed Care
Barack Obama
IMPORTANCE: The Affordable Care Act is the most important health care legislation enacted in the United States since the creation of Medicare and Medicaid in 1965. The law implemented comprehensive reforms designed to improve the accessibility, affordability, and quality of health care. OBJECTIVES: To review the factors influencing the decision to pursue health reform, summarize evidence on the effects of the law to date, recommend actions that could improve the health care system, and identify general lessons for public policy from the Affordable Care Act...
August 2, 2016: JAMA: the Journal of the American Medical Association
Stacey McMorrow, Sharon K Long, Genevieve M Kenney, Nathaniel Anderson
No abstract text is available yet for this article.
October 2015: Health Affairs
Jennifer Prah Ruger, Theodore W Ruger, George J Annas
Is there a right to health care in the United States? No U.S. Supreme Court decision has ever interpreted the Constitution as guaranteeing a right to health care for all Americans. The Constitution does not contain the words "health," "health care," "medical care," or "medicine." But if we look..
June 25, 2015: New England Journal of Medicine
David Blumenthal, Melinda Abrams, Rachel Nuzum
Just over 5 years ago, on March 23, 2010, President Barack Obama signed the Affordable Care Act (ACA) into law. Its enactment may constitute the most important event of the Obama presidency and could fundamentally affect the future of health care in the United States. From a historical perspective,..
June 18, 2015: New England Journal of Medicine
Richard T Griffey, Jesse M Pines, Heather L Farley, Michael P Phelan, Christopher Beach, Jeremiah D Schuur, Arjun K Venkatesh
Performance measures are increasingly important to guide meaningful quality improvement efforts and value-based reimbursement. Populations included in most current hospital performance measures are defined by recorded diagnoses using International Classification of Diseases, Ninth Revision codes in administrative claims data. Although the diagnosis-centric approach allows the assessment of disease-specific quality, it fails to measure one of the primary functions of emergency department (ED) care, which involves diagnosing, risk stratifying, and treating patients' potentially life-threatening conditions according to symptoms (ie, chief complaints)...
April 2015: Annals of Emergency Medicine
John K Iglehart
For more than three decades, administrations from that of Republican Ronald Reagan (1981–1989) to Democrat Barack Obama have proposed sharp reductions in the robust support by Medicare of graduate medical education (GME) programs. Teaching hospitals, the major recipients of an annual federal GME..
January 22, 2015: New England Journal of Medicine
Candice Chen, Stephen Petterson, Robert Phillips, Andrew Bazemore, Fitzhugh Mullan
IMPORTANCE: Graduate medical education training may imprint young physicians with skills and experiences, but few studies have evaluated imprinting on physician spending patterns. OBJECTIVE: To examine the relationship between spending patterns in the region of a physician's graduate medical education training and subsequent mean Medicare spending per beneficiary. DESIGN, SETTING, AND PARTICIPANTS: Secondary multilevel multivariable analysis of 2011 Medicare claims data (Part A hospital and Part B physician) for a random, nationally representative sample of family medicine and internal medicine physicians completing residency between 1992 and 2010 with Medicare patient panels of 40 or more patients (2851 physicians providing care to 491,948 Medicare beneficiaries)...
December 10, 2014: JAMA: the Journal of the American Medical Association
Adam S Wilk, David K Jones
Policy makers and researchers are eager to learn the effects of the Patient Protection and Affordable Care Act of 2010 (ACA) and its many provisions, but to date, they have been frustrated by the dearth of robust evidence on the ACA's true impacts on important health care and patient outcomes (e.g., access to primary care services). The present limitations of evidence, often a consequence of delays and inconsistencies in the law's implementation, have begun to affect policy making in the ACA's wake. In this article, we consider the debates among state and federal policy makers about whether to extend the ACA's so-called fee bump provision, whereby Medicaid fees for primary care services were increased to 100 percent of Medicare levels during 2013 and 2014...
December 2014: Journal of Health Politics, Policy and Law
2014-11-20 00:15:21
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