JAMA Health ForumPub Date : 2025-04-04DOI: 10.1001/jamahealthforum.2025.1567
Sara N Bleich, Cindy W Leung, Rita Hamad
{"title":"Implications of Recent Federal Actions on Food Assistance Programs.","authors":"Sara N Bleich, Cindy W Leung, Rita Hamad","doi":"10.1001/jamahealthforum.2025.1567","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.1567","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 4","pages":"e251567"},"PeriodicalIF":9.5,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JAMA Health ForumPub Date : 2025-04-04DOI: 10.1001/jamahealthforum.2025.0768
Simeng Wang, Katherine Arnow, Mason M Sakamoto, Lisa Marie Knowlton
{"title":"Medicaid Enrollment After Hospital Presumptive Eligibility in the Emergency Department.","authors":"Simeng Wang, Katherine Arnow, Mason M Sakamoto, Lisa Marie Knowlton","doi":"10.1001/jamahealthforum.2025.0768","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.0768","url":null,"abstract":"<p><strong>Importance: </strong>Hospital presumptive eligibility (HPE) is an emergency Medicaid program enabling eligible uninsured patients to temporarily access Medicaid benefits during hospital encounters. It provides a pathway to long-term Medicaid coverage, but this feature may be underutilized among patients who received HPE in the emergency department (ED) and were discharged immediately thereafter.</p><p><strong>Objective: </strong>To characterize if 6-month Medicaid enrollment rates varied by patient demographics and ED encounter characteristics and identify factors that potentially impact enrollment.</p><p><strong>Design, setting, and participants: </strong>A retrospective cohort study analyzing data from HPE-participating EDs in California between January 1, 2016, and December 31, 2021, was carried out from January 2024 to November 2024. Unadjusted differences in 6-month Medicaid enrollment rates among patient groups were analyzed with χ2 tests. Multivariable logistic regression was used to evaluate the adjusted odds of enrollment by different demographic and encounter characteristics. Patients aged 19 to 64 years who were uninsured, were treated and released from ED, and received HPE during the encounter were included.</p><p><strong>Exposures: </strong>Receiving HPE during ED encounters.</p><p><strong>Main outcomes: </strong>The primary outcome was Medicaid enrollment within 6 months after receiving HPE in ED.</p><p><strong>Results: </strong>Of the 585 693 patients who received HPE during ED treat-and-release encounters, 175 495 were of Hispanic ethnicity (30.0%), 73 518 were White (12.6%), 33 829 were Black (5.8%), 12 824 were Asian or Pacific Islanders (2.2%), 1685 were Alaskan Native or American Indian (0.003%), 27 610 were of other race and ethnicity (0.05%), and 260 732 did not report race and ethnicity (44.5%). A total of 217 430 (37.1%) of 585 693 patientsof the total study population who received HPE during ED treat-and-release encounters enrolled in Medicaid by 6 months. In the regression model, male (adjusted odds ratio [aOR] 0.74; 95% CI, 0.72-0.76; P < .001), Hispanic (vs White: aOR, 0.94; 95% CI, 0.90-0.98; P = .007), and Spanish speaking (vs English speaking: aOR, 0.72; 95% CI, 0.68-0.77; P < .001) patients were less likely to enroll in Medicaid coverage. Annual enrollment rates declined notably following the onset of the COVID-19 pandemic (40.6% to 29.8%). Weekend encounters were more likely to have lower enrollment (vs weekday: aOR, 0.95; 95% CI, 0.93-0.97; P < .001). EDs in public hospitals (vs nonprofit: aOR, 1.27; 95% CI, 1.04-1.55; P = .02) or large hospitals (vs small: aOR, 1.13; 95% CI, 1.00-1.27; P = .04) were more likely to have higher enrollment. There was variable enrollment across different regions of California (27.3%-47.2%).</p><p><strong>Conclusions and relevance: </strong>In this cohort study, Medicaid enrollment rates after receiving HPE in ED varied across different patient, facility, and geographic ch","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 4","pages":"e250768"},"PeriodicalIF":9.5,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12032561/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144025566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JAMA Health ForumPub Date : 2025-04-04DOI: 10.1001/jamahealthforum.2025.0423
Eugene Lin, Khristina I Lung, Derick Rapista, Leane S Kuo, Darius Lakdawalla, Desi Peneva, Karen Van Nuys
{"title":"Care Continuity, Nephrologists' Dialysis Facility Preferences, and Outcomes.","authors":"Eugene Lin, Khristina I Lung, Derick Rapista, Leane S Kuo, Darius Lakdawalla, Desi Peneva, Karen Van Nuys","doi":"10.1001/jamahealthforum.2025.0423","DOIUrl":"10.1001/jamahealthforum.2025.0423","url":null,"abstract":"<p><strong>Importance: </strong>Patients may initiate dialysis at their predialysis nephrologists' primary facilities (ie, where the nephrologist saw the most patients) to preserve continuity of care, even if the facilities are of low quality. Patients from minoritized racial and ethnic groups may be the most negatively impacted.</p><p><strong>Objective: </strong>To examine starts at nephrologists' primary facilities, downstream outcomes, and racial disparities in dialysis start quality.</p><p><strong>Design, setting, and participants: </strong>This cohort study used Medicare administrative data of patients initiating dialysis at freestanding US dialysis facilities from January 1, 2015, to October 31, 2020, with 1 year of follow-up (ending October 31, 2021). Analyses concluded January 26, 2025. Participants were adults with fee-for-service Medicare initiating dialysis.</p><p><strong>Exposures: </strong>Quality of nephrologists' primary facilities (using publicly available 5-star ratings) and primary facilities' proximity to patients.</p><p><strong>Main outcomes and measures: </strong>The primary outcomes were starting dialysis at the nephrologist's primary facility (ie, primary facility starts), whether the starting facility was high quality (ie, 4-star or 5-star ratings), mortality and hospitalization rates, and racial and ethnic disparities in high-quality primary facilities and in starting dialysis at high-quality facilities. Analyses used multivariable linear and Poisson regression with hospital service area fixed effects (unique intercepts for each area).</p><p><strong>Results: </strong>Of 143 776 adults (median [IQR] age, 73 [67-79] years; 64 447 female [45%]; 4989 Asian [3%]; 28 515 Black [20%]; 11 296 Hispanic [8%]; 96 639 non-Hispanic White [67%]), 64 186 (45%) had managing nephrologists with high-quality primary facilities. Primary facility starts were lower as the primary facility's quality increased (0.5 percentage points [pp] lower for every 1-star increase in rating; 95% CI, 0.1-0.8 pp; P = .03). In contrast, primary facility starts were 33.9 pp (95% CI, 33.0-34.9 pp; P < .001) more likely when primary facilities were close to patients than when distant. Each additional quality star in nephrologists' primary facility was associated with more 4-star or 5-star facility starts (7.4 pp; 95% CI, 6.9-7.9 pp) and 4.5 fewer hospitalizations per 100 person-years (95% CI, 2.8-6.1 hospitalizations per 100 person-years). Compared with White patients, Black patients were 2.8 pp (95% CI, 1.7-3.9 pp) less likely to start at 4-star or 5-star facilities and 2.0 pp (95% CI, 1.0-3.0 pp) less likely to be treated by nephrologists with 4-star or 5-star primary facilities.</p><p><strong>Conclusions and relevance: </strong>Primary facility starts were common even when they were low quality, and outcomes were worse when nephrologists had low-quality primary facilities. Black patients disproportionately start dialysis at low-quality facilities and are less ","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 4","pages":"e250423"},"PeriodicalIF":9.5,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11992609/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144043041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JAMA Health ForumPub Date : 2025-04-04DOI: 10.1001/jamahealthforum.2025.0142
Priyanka A Abraham, Jacob T Kannarkat, Dima Mazen Qato
{"title":"Reforming Markets to Strengthen Independent Pharmacies.","authors":"Priyanka A Abraham, Jacob T Kannarkat, Dima Mazen Qato","doi":"10.1001/jamahealthforum.2025.0142","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.0142","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 4","pages":"e250142"},"PeriodicalIF":9.5,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JAMA Health ForumPub Date : 2025-04-04DOI: 10.1001/jamahealthforum.2025.0650
{"title":"Error in Supplement 1.","authors":"","doi":"10.1001/jamahealthforum.2025.0650","DOIUrl":"10.1001/jamahealthforum.2025.0650","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 4","pages":"e250650"},"PeriodicalIF":9.5,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11971661/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JAMA Health ForumPub Date : 2025-04-04DOI: 10.1001/jamahealthforum.2025.1034
{"title":"Error in Supplement 1.","authors":"","doi":"10.1001/jamahealthforum.2025.1034","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.1034","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 4","pages":"e251034"},"PeriodicalIF":9.5,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11992598/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144018154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JAMA Health ForumPub Date : 2025-04-04DOI: 10.1001/jamahealthforum.2025.0383
Kyle J Moon, Katherine E M Miller, Sandro Galea, Catherine K Ettman
{"title":"Medical Debt and Forgone Mental Health Care Due to Cost Among Adults.","authors":"Kyle J Moon, Katherine E M Miller, Sandro Galea, Catherine K Ettman","doi":"10.1001/jamahealthforum.2025.0383","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.0383","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 4","pages":"e250383"},"PeriodicalIF":9.5,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12008752/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144042188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JAMA Health ForumPub Date : 2025-04-04DOI: 10.1001/jamahealthforum.2025.0452
Jillian S Caldwell, Xingxing S Cheng, Eran Bendavid, Glenn M Chertow, Darius N Lakdawalla, Eugene Lin
{"title":"Calcimimetic Prescriptions in Fee-for-Service Medicare Beneficiaries Undergoing Dialysis.","authors":"Jillian S Caldwell, Xingxing S Cheng, Eran Bendavid, Glenn M Chertow, Darius N Lakdawalla, Eugene Lin","doi":"10.1001/jamahealthforum.2025.0452","DOIUrl":"10.1001/jamahealthforum.2025.0452","url":null,"abstract":"<p><strong>Importance: </strong>Calcimimetics are a mainstay of treatment for secondary hyperparathyroidism (sHPT), a ubiquitous condition in end-stage kidney disease (ESKD) associated with fractures, cardiovascular events, and mortality. In 2018, Medicare implemented the Transitional Drug Add-On Payment Adjustment (TDAPA), which shifted calcimimetic coverage from Part D prescription drug plans to Part B. Prior to TDAPA, Medicare beneficiaries with ESKD faced varying out-of-pocket costs for calcimimetics at the point of pharmacy depending on presence and magnitude of low-income subsidies (LISs). TDAPA differentially alleviated barriers to filling these costly medications.</p><p><strong>Objective: </strong>To assess whether calcimimetic prescriptions increased post-TDAPA among patients subject to high out-of-pocket costs prior to the policy change (patients with Part D coverage without LIS and those lacking Part D coverage).</p><p><strong>Design, setting, and participants: </strong>In this longitudinal cohort study, a difference-in-differences analysis was performed at the patient-quarter level. The sample included adult Medicare fee-for-service beneficiaries undergoing maintenance dialysis between July 1, 2016, and December 31, 2020, at US outpatient dialysis facilities. The US Renal Data System, a national registry of patients with ESKD, was used to collect patient, facility, and claims data. The data analysis occurred between May 2023 and October 2024.</p><p><strong>Exposures: </strong>LIS extent for patients with Part D coverage (fully subsidized, partially subsidized, not subsidized); presence of Medicare Part D coverage; and whether the patient-quarter was before/after TDAPA implementation.</p><p><strong>Main outcomes and measures: </strong>The main outcome was having 1 or more filled calcimimetic prescriptions per quarter of the study period. A linear regression model was estimated, adjusting for demographics, dialysis modality and access, comorbidities, and facility characteristics, with 2-way fixed effects at the patient and quarter level.</p><p><strong>Results: </strong>A total of 509 765 adult Medicare fee-for-service beneficiaries were included in the analysis. The cohort had a mean (SD) age of 64 (14) years, was 57% male, 4% Asian, 38% Black, 15% Hispanic, 41% non-Hispanic White, and 3% other race and ethnicity. In adjusted difference-in-differences models, TDAPA's estimated effect was an absolute increase of 9.8 percentage points (pp) (95% CI, 9.3-10.2 pp) in calcimimetic prescriptions for patients with Part D but no subsidy and a 2.2 pp (95% CI, 1.8-2.6 pp) increase for patients with partial LIS compared to patients with full LIS.</p><p><strong>Conclusions and relevance: </strong>The results of this longitudinal cohort study showed that after transitioning calcimimetic coverage from Part D to Part B via TDAPA, calcimimetic prescriptions increased in a graded manner, with the largest increases experienced by patients previously subje","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 4","pages":"e250452"},"PeriodicalIF":9.5,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12008760/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JAMA Health ForumPub Date : 2025-04-04DOI: 10.1001/jamahealthforum.2025.0168
Terrence Liu, Matthias Kirch, Erica Solway, Dianne C Singer, J Scott Roberts, Jeffrey T Kullgren, Tammy Chang
{"title":"Use of Patient Portal Messaging and Self-Reported Copays Among US Adults 50 Years or Older.","authors":"Terrence Liu, Matthias Kirch, Erica Solway, Dianne C Singer, J Scott Roberts, Jeffrey T Kullgren, Tammy Chang","doi":"10.1001/jamahealthforum.2025.0168","DOIUrl":"10.1001/jamahealthforum.2025.0168","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 4","pages":"e250168"},"PeriodicalIF":9.5,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11971665/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}