JAMA Health Forum最新文献

{"title":"Potential Factors Associated With Commercial-to-Medicare Relative Prices at the Substate Level.","authors":"Fredric Blavin, John Holahan","doi":"10.1001/jamahealthforum.2025.1640","DOIUrl":"10.1001/jamahealthforum.2025.1640","url":null,"abstract":"<p><strong>Importance: </strong>There is a growing consensus that commercial prices vary in ways that do not reflect quality of care and are a key factor in high health care spending in the US.</p><p><strong>Objective: </strong>To assess the geographic variation in commercial prices relative to Medicare rates for both hospital and professional services at the state and substate levels, estimate the change in these prices and determine which characteristics are associated with higher hospital prices.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional study analyzed deidentified aggregated health care claims data for 2 time frames of service, from January 1, 2020, through December 31, 2020, and from June 1, 2022, through May 31, 2023, to construct commercial-to-Medicare price ratios for hospital and professional services at the state and geozip levels (491 geozips correspond to combinations of zip codes in 50 states and the District of Columbia). Multivariable regression models were estimated to assess the association between commercial-to-Medicare relative hospital prices and various market characteristics at the geozip level. Data analysis was conducted from July through November 2024.</p><p><strong>Exposures: </strong>Exposures defined at the geozip level included hospital and insurer market concentrations, the share of hospitals beds associated with nonprofit hospitals, the share of beds associated with health systems, the presence of a major teaching hospital, mean household income, the share of the population who had public health insurance, and the share who were uninsured.</p><p><strong>Main outcomes and measures: </strong>Commercial prices relative to Medicare rates for inpatient, outpatient, combined hospital, and professional services.</p><p><strong>Results: </strong>This cross-sectional study of 1.2 billion claim lines in 2020 and 1.5 billion claim lines from June 2022 through May 2023 found that private insurers' in-network allowed amounts were 246% (ratio [SD], 2.46 [0.6]) of the Medicare rates for hospital services and 124% (ratio [SD], 1.24 [0.3]) of the Medicare rates for professional services. The mean commercial-to-Medicare price ratio for professional services slightly declined from 2020 to 2022-2023, while the mean (SD) price ratio for hospital services increased by 5.5%, from 2.34 (0.5) in 2020 to 2.46 (0.6) in 2022-2023. There was substantial variation in the commercial-to-Medicare price ratios across states and geozips. Geozips with very high hospital market concentration levels (Herfindahl-Hirschman Index [HHI]>3500) were associated with a commercial-to-Medicare price ratio higher by 0.21 (95% CI, 0.02-0.39; P = .03) relative to geozips with HHI levels lower than 1500, which represents an 8.4% increase above the 2022-2023 mean. High insurer concentration was negatively associated with the commercial-to-Medicare hospital price ratios (-0.13; 95% CI, -0.26 to 0.01; P = .04), whereas having a major ","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 7","pages":"e251640"},"PeriodicalIF":9.5,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12232185/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144555710","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}

{"title":"Error in Funding/Support.","authors":"","doi":"10.1001/jamahealthforum.2025.2950","DOIUrl":"10.1001/jamahealthforum.2025.2950","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 7","pages":"e252950"},"PeriodicalIF":9.5,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12254885/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610310","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}

{"title":"Health and Economic Impact of Periodic Hepatitis C Virus Testing Among People Who Inject Drugs.","authors":"Lin Zhu, Nathan W Furukawa, William W Thompson, Marissa B Reitsma, Liisa M Randall, Michelle Van Handel, Alice K Asher, Eduardo Valverde, Benjamin P Linas, Joshua A Salomon","doi":"10.1001/jamahealthforum.2025.1870","DOIUrl":"10.1001/jamahealthforum.2025.1870","url":null,"abstract":"<p><strong>Importance: </strong>Periodic hepatitis C virus (HCV) testing is recommended for people who inject drugs (PWID), but the optimal testing frequency remains unknown.</p><p><strong>Objective: </strong>To evaluate the health benefits, costs, and cost-effectiveness of alternative HCV testing frequencies for PWID.</p><p><strong>Design, setting, and participants: </strong>This cost-effectiveness analysis extended a previously published agent-based network simulation model of HCV transmission through the sharing of injection equipment among PWID. Network-based HCV transmission was calibrated to longitudinal data from the Social Networks Among Appalachian People study and published literature on PWID networks in the US to evaluate HCV testing strategies in both a sparse PWID network setting with lower HCV transmission and a dense network setting with higher HCV transmission. Data were collected from November 2008 to August 2010, and data were analyzed from September 2017 to December 2019.</p><p><strong>Exposures: </strong>Periodic HCV testing and treatment, with alternative average testing frequencies among PWID who have access to and use HCV care.</p><p><strong>Main outcomes and measures: </strong>Changes in cumulative quality-adjusted life-years (QALYs) and health care costs over 60 years (in 2021 US dollars) and incremental cost-effectiveness ratios (ICERs) discounted at 3% annually.</p><p><strong>Results: </strong>The mean initial age of 1552 simulated PWID was 32 years. Compared with no testing, HCV testing and treatment among PWID over a 10-year intervention period increased QALYs by 2.5% to 4.6% and costs by 0.5% to 2.3% across average testing frequencies ranging from once every 2 years to once monthly. In a lower transmission setting, testing every 2 years was weakly dominated by more frequent testing strategies; testing every year, every 6 months, every 3 months, and every month had ICERs of $6000 per QALY, $9300 per QALY, $24 200 per QALY, and $138 400 per QALY, respectively. In a higher transmission setting, testing every 2 years and every year were both weakly dominated, while testing every 6 months, every 3 months, and every month had ICERs of $14 000 per QALY, $30 100 per QALY, and $93 300 per QALY, respectively. Results were sensitive to risks of primary infection and reinfection as well as access to and utilization of HCV testing services among PWID.</p><p><strong>Conclusions and relevance: </strong>In this economic evaluation study, based on common benchmarks for cost-effectiveness, frequent HCV testing among PWID was cost-effective in both lower and higher transmission settings.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 7","pages":"e251870"},"PeriodicalIF":9.5,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12232219/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144555708","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}

{"title":"A Harm Reduction Response to Bans on Gender-Affirming Care.","authors":"Harry Barbee, Joanne Rosen","doi":"10.1001/jamahealthforum.2025.2264","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.2264","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 7","pages":"e252264"},"PeriodicalIF":9.5,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144555697","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}

{"title":"Cost-Sharing and Buprenorphine Prescription Dispensing.","authors":"Thuy D Nguyen, Rena M Conti, Pooja Lagisetty, Amy S B Bohnert, Ushapoorna Nuliyalu, Kao-Ping Chua","doi":"10.1001/jamahealthforum.2025.1913","DOIUrl":"10.1001/jamahealthforum.2025.1913","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 7","pages":"e251913"},"PeriodicalIF":9.5,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12232175/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144555706","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}

{"title":"Reevaluating State Medicaid Waivers Targeting the Reentry Population.","authors":"Benjamin A Barsky, James René Jolin, Meredith B Rosenthal","doi":"10.1001/jamahealthforum.2025.2625","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.2625","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 7","pages":"e252625"},"PeriodicalIF":9.5,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610313","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}

{"title":"Savings Associated With Bundled Payments for Outpatient Spine Surgery Among Medicare Beneficiaries.","authors":"Austin S Kilaru, Grace Y Ng, Erkuan Wang, Erin Huang, Aidan P Crowley, Jingsan Zhu, Joshua M Liao, Said Ibrahim, Torrey Shirk, Deborah S Cousins, Neil R Malhotra, Amol S Navathe","doi":"10.1001/jamahealthforum.2025.1907","DOIUrl":"10.1001/jamahealthforum.2025.1907","url":null,"abstract":"<p><strong>Importance: </strong>Few value-based payment programs have targeted outpatient surgery, although these procedures comprise most surgeries performed in hospitals. In 2018, the Centers for Medicare and Medicaid Services introduced Bundled Payments for Care Improvement Advanced (BPCI Advanced), the first episode-based payment model to include an outpatient surgical condition-spine surgery. It is not known whether bundled payments reduce spending or improve quality for outpatient surgery, despite plans to expand outpatient episodes in future models.</p><p><strong>Objective: </strong>To determine whether hospital participation in the first year of BPCI Advanced for outpatient and inpatient spine surgery (back and neck except spinal fusion procedures [BNESF]) was associated with changes in spending and quality.</p><p><strong>Design, setting, and participants: </strong>A retrospective cohort study using Medicare claims and differences-in-differences analysis adjusting for patient and market characteristics was conducted comparing outcomes for patients receiving outpatient and inpatient BNESF from hospitals that participated in BPCI Advanced vs those receiving these procedures from a matched comparison group of nonparticipating hospitals. Medicare beneficiaries receiving outpatient and inpatient BNESF between 2013 and 2019 were included. Analyses were conducted between March 2023 and February 2024.</p><p><strong>Exposures: </strong>Hospital participation in BPCI Advanced.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was total episode spending, including spending incurred for the index procedure and 90-day follow-up period. Secondary outcomes included 90-day return inpatient admissions, emergency department visits, and mortality.</p><p><strong>Results: </strong>Among 14 280 patients who received outpatient BNESF, hospital participation in BPCI Advanced was associated with a differential reduction in total episode spending (-$1201; 95% CI, -2184 to -219) and return inpatient admissions (-2.2 percentage points; 95% CI, -4.2 to -0.1). For outpatient procedures, the mean (SD) age was 71.8 (8.6) years; 43.9% were women, 3.9% were Black; and 3.2% were Hispanic. Among 23 440 patients who received inpatient BNESF, hospital participation in BPCI Advanced was not associated with differential changes in total episode spending or return inpatient admissions. There were no significant changes for emergency department visits or mortality for either group.</p><p><strong>Conclusions and relavance: </strong>In this cohort study, participation in the first year of a bundled payment program for outpatient spine surgery was associated with nearly 10% lower spending. No changes in spending were observed for similar inpatient spine surgery procedures. Further evaluation of bundled payments for outpatient surgical conditions and associated changes in care delivery is needed to inform plans to include these episodes in future models.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 7","pages":"e251907"},"PeriodicalIF":9.5,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12254892/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610314","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}

{"title":"Packaging Regulations Needed to Mitigate THC Ingestions in Children.","authors":"Hannah Zwiebel, Ran D Goldman, David Greenky","doi":"10.1001/jamahealthforum.2025.2628","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.2628","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 7","pages":"e252628"},"PeriodicalIF":9.5,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661062","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}

{"title":"Practice-Level Spending Variation for Radiation Treatment Episodes Among Older Adults With Cancer.","authors":"Miranda B Lam, Mary Beth Landrum, J Michael McWilliams, Benjamin Buzzee, Alexi A Wright, Nancy L Keating, Bruce E Landon","doi":"10.1001/jamahealthforum.2025.1952","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.1952","url":null,"abstract":"<p><strong>Importance: </strong>Radiation treatments are an essential but expensive component of cancer care.</p><p><strong>Objective: </strong>To elucidate trends in radiation spending and identify factors associated with practice-level variations across the US health care system to inform alternative payment model design.</p><p><strong>Design, setting, and participants: </strong>This population-based cross-sectional study analyzed fee-for-service Medicare beneficiaries from 2009 to 2020. Patients were continuously enrolled in fee-for-service Medicare Parts A and B during the 1 year prior through 28 days after a radiation treatment episode. Data were analyzed from January 2023 to September 2024.</p><p><strong>Exposures: </strong>Medicare beneficiaries with cancer who received radiation therapy.</p><p><strong>Main outcomes and measures: </strong>Radiation treatment-specific standardized spending and utilization during 90-day treatment episodes were examined and characterized by radiation type (conformal, intensity modulated, stereotactic, proton, or brachytherapy) and number of fractions. Linear regression models with practice random effects to understand practice-level variation in standardized radiation spending were estimated. Variables were added to adjust for year, patient demographics, cancer type, geography, radiation technology, and number of fractions per episode.</p><p><strong>Results: </strong>From 2009 to 2020, 1 898 864 beneficiaries with cancer (mean [SD] age, 74 [8.4] years; 48.5% female) initiated 2 149 385 radiation treatment episodes at 2150 practices. Mean (SD) 90-day standardized radiation treatment-specific spending was $13 683 ($8628). Practice-level per-episode radiation-specific spending variation was high (SD after adjusting for year, $4121). It remained high even after adjusting for patient demographic characteristics, cancer type, geography, radiation technology, and number of fractions (SD, $1487). From 2009 to 2020, unadjusted per-episode standardized radiation-specific spending increased slightly from $12 978 to $13 689 (P = .04). During this time, the median (IQR) number of fractions per episode decreased from 25 (10-33) to 16 (5-29) (P < .001), while the proportion of radiation episodes using intensity-modulated or proton radiation treatment increased (from 5% to 18% and 0.4% to 2%, respectively [both P < .001]) and use of conformal radiation treatment decreased from 61% to 38% (P < .001).</p><p><strong>Conclusions and relevance: </strong>In this cross-sectional study, there was substantial variation in practice-level radiation spending and number of fractions for older patients with cancer undergoing radiation treatment both within and across health care markets. This practice-level variation suggests that there may be opportunities for savings under population-based payment models.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 7","pages":"e251952"},"PeriodicalIF":9.5,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661063","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}

{"title":"Unanswered Questions on Private Equity in Gastroenterology.","authors":"Jane M Zhu","doi":"10.1001/jamahealthforum.2025.1491","DOIUrl":"10.1001/jamahealthforum.2025.1491","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 6","pages":"e251491"},"PeriodicalIF":9.5,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144334397","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}