JAMA Health Forum最新文献

{"title":"The Future of Medicare Advantage-Assessing Current Debates and the Likelihood of Near-Term Reforms.","authors":"Benedic Ippolito","doi":"10.1001/jamahealthforum.2025.3042","DOIUrl":"10.1001/jamahealthforum.2025.3042","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 8","pages":"e253042"},"PeriodicalIF":11.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144857028","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":"Variations in Psychiatric Emergency Department Boarding for Medicaid-Enrolled Youths.","authors":"K John McConnell, Thomas H A Meath, Lindsay N Overhage","doi":"10.1001/jamahealthforum.2025.3177","DOIUrl":"10.1001/jamahealthforum.2025.3177","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 8","pages":"e253177"},"PeriodicalIF":11.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12357182/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144857032","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":"Projected Savings From Reducing Low-Value Services in Medicare.","authors":"David D Kim, A Mark Fendrick","doi":"10.1001/jamahealthforum.2025.3050","DOIUrl":"10.1001/jamahealthforum.2025.3050","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 8","pages":"e253050"},"PeriodicalIF":11.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12317346/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144762323","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":"Patient Repayment of US Hospital Bills From 2018 to 2024.","authors":"Benedic Ippolito, Erin Trish, Erin L Duffy, Boris Vabson","doi":"10.1001/jamahealthforum.2025.2284","DOIUrl":"10.1001/jamahealthforum.2025.2284","url":null,"abstract":"<p><strong>Importance: </strong>Patient cost sharing liability has risen in recent years, increasing the costs associated with care for patient households and imposing collections challenges for hospitals and clinicians.</p><p><strong>Objective: </strong>To measure patient repayment of cost sharing over recent years, and how that varies across patient, hospital, and service characteristics.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional study of billing and payment data from a revenue cycle management company examined patient accounts at 217 US hospitals from 2018 to 2024. Participants included 24.5 million and 6.2 million patient episodes of care with positive patient out-of-pocket liability for individuals with private insurance and Medicare Advantage, respectively.</p><p><strong>Main outcomes and measures: </strong>Percentage of owed patient cost sharing actually paid among patients with private insurance and Medicare Advantage measured over time, for inpatient and outpatient care and by bill size.</p><p><strong>Results: </strong>Across the full sample of 217 US hospitals (30.7 million patient episodes), mean (SD) patient liability per person, including those with no liability, was higher for individuals with private insurance ($375.41 [$51.55]) than those with Medicare Advantage ($172.50 [$14.84]). Consistent with high-deductible plan design with annual resetting, mean patient liability was higher for visits in January than December, particularly among the privately insured (eg, mean [SD] patient liability for visits among the privately insured in January: $479.44 [$29.21] vs December: $321.63 [$14.29]). Prior to the COVID-19 pandemic (January 2018-February 2020), mean repayment rates were 53.9% and 54.0% for patients with private or Medicare Advantage insurance, respectively, and repayment rates declined in more recent years. Across the entire sample, patients with private or Medicare Advantage insurance paid either 0% or 100% of their owed cost sharing in 92.2% and 94.1% of cases, respectively. Repayment rates varied by bill size with lower repayment rates on the largest bills and the smallest bills, and higher repayment rates on midsized bills.</p><p><strong>Conclusions and relevance: </strong>This cross-sectional study found that patient cost sharing repayments were incomplete and have fallen in more recent years, which result in both medical debts for patients and collections shortfalls for hospitals and clinicians. These findings suggest that changes to insurance plan design or the treatment of medical debt are among several factors that may contribute to observed results; if declines in cost sharing repayment continue, hospitals and clinicians may increasingly seek payment of cost sharing ahead of service, when allowable.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 8","pages":"e252284"},"PeriodicalIF":11.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12334956/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144800904","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":"Early Recalls and Clinical Validation Gaps in Artificial Intelligence-Enabled Medical Devices.","authors":"Branden Lee, Patrick Kramer, Sara Sandri, Ritika Chanda, Crystal Favorito, Olivia Nasef, Joseph S Ross, Joshua Sharfstein, Tinglong Dai","doi":"10.1001/jamahealthforum.2025.3172","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.3172","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 8","pages":"e253172"},"PeriodicalIF":11.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12374217/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144978267","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":"Financial Incentives to Increase Diversity of Older Participants in a Memory Concerns Registry: A Randomized Clinical Trial.","authors":"Mireille Jacobson, Doris Molina-Henry, Tom Y Chang, Gustavo A Jimenez-Maggiora, Rajiv Pramanik, Samir B Shah, Paul S Aisen","doi":"10.1001/jamahealthforum.2025.2273","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.2273","url":null,"abstract":"<p><strong>Importance: </strong>Persons from marginalized racial and ethnic groups and of low socioeconomic status are at high risk of dementia but are underrepresented in clinical trials. Financial incentives may improve representation.</p><p><strong>Objective: </strong>To evaluate the effect of financial incentives on enrollment of county health system patients into a memory concerns registry.</p><p><strong>Design, setting, and participants: </strong>Between March 1, 2024, and April 24, 2024, patients 50 years and older without a dementia diagnosis within a single integrated county health system that includes a hospital and 9 outpatient health centers were invited to enroll in the Alzheimer Prevention Trials (APT) Webstudy, an online observational study aimed at accelerating enrollment into Alzheimer disease clinical trials.</p><p><strong>Interventions: </strong>Patients were randomized 1:1:1 to an invitation message (arm 1), a message with a small ($25) enrollment incentive (arm 2), or a message with an enrollment incentive of entry into a $2500 lottery with 1 in 100 odds of award (arm 3).</p><p><strong>Main outcomes and measures: </strong>The primary outcome was enrollment, defined as APT Webstudy registration and completion of at least 1 of 2 remote cognitive assessments. Outcomes were measured through April 30, 2024.</p><p><strong>Results: </strong>Of 44 844 patients invited to the APT Webstudy, the mean (SD) age was 64.7 (10.1) years, 25 447 (56.8%) were women, 25 044 (55.8%) had Medicaid insurance, 11 347 (25.3%) were Hispanic/Latino, 9526 (21.2%) were non-Hispanic Asian, 6044 (13.5%) were non-Hispanic Black, and 12 109 (27%) were non-Hispanic White. A total of 401 participants (0.9%) enrolled in the APT Webstudy. Relative to the message-only arm, participants randomized to the small incentive arm were more likely to enroll (adjusted odds ratio [OR], 1.39; 95% CI, 1.09-1.76; P = .008) in the APT Webstudy while those in the prize incentive arm were not more likely to enroll (adjusted OR, 1.08; 95% CI, 0.84-1.39; P > .99). Enrollment in the prize incentive arm was lower relative to the small incentive arm (adjusted OR, 0.78; 95% CI, 0.61-0.98; P = .04). Secondary heterogeneity analyses indicated that patients of White race (adjusted OR, 1.61; 95% CI, 1.15-2.25; P = .006) and male sex (adjusted OR, 2.40; 95% CI, 1.55-3.75; P < .001) were most responsive to the small $25 incentive relative to the message-only arm.</p><p><strong>Conclusions and relevance: </strong>In this randomized clinical trial, relative to message invitations, invitations with guaranteed, small financial incentives but not lottery incentives increased enrollment of economically but not necessarily racially or ethnically diverse participants to a study that aimed to increase enrollment in clinical studies.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT06033066.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 8","pages":"e252273"},"PeriodicalIF":11.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12374222/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144978330","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":"Clinicians Who Practice Primarily in Nursing Homes and the Quality of Care for Residents With Alzheimer Disease and Related Dementias.","authors":"Hyunkyung Yun, Mark Aaron Unruh, Yuting Qian, Yongkang Zhang, Hye-Young Jung","doi":"10.1001/jamahealthforum.2025.2465","DOIUrl":"10.1001/jamahealthforum.2025.2465","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;The number of physicians and advanced practitioners (APs) whose care is concentrated in nursing homes (often referred to as nursing home or skilled nursing facility specialists [SNFists]) has increased rapidly. Therefore, whether these clinicians provide better care is important.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To examine the association between SNFist care and outcomes of long-stay nursing home (NH) residents with Alzheimer disease and related dementias (ADRD).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;In this retrospective cohort study of 417 378 residents with ADRD in US NHs, claims for a 20% national sample of Medicare fee-for-service beneficiaries between 2013 and 2019 were analyzed. Adjusted estimates were based on a machine learning approach that incorporated a doubly robust procedure using a generalized estimating equation with inverse probability treatment weighting. Three secondary analyses were conducted: (1) stratified analyses for physicians and APs, (2) inclusion of physicians of any specialty and APs, and (3) use of proxy outcomes for in-place deaths. Data were analyzed from June 1, 2024, to May 3, 2025.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Intervention: &lt;/strong&gt;Receipt of care from a SNFist; SNFists included generalist physicians and APs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Hospitalizations and emergency department (ED) visits for ambulatory care-sensitive (ACS) conditions. Death without an ACS hospitalization and death without any hospitalization were used in secondary analyses.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of the total 417 378 residents, 242 540 received care from SNFists (mean [SD] age, 83.5 [8.7] years), and 174 838 never received care from SNFists (mean [SD] age, 84.8 [8.5] years). Compared with the residents who never received care from SNFists, the residents who received care from SNFists were more likely to be Black (12.6% vs 9.4%; P &lt; .001), dually eligible (77.5% vs 73.1%; P &lt; .001), and have more chronic conditions (eg, anemia, 60.9% vs 57.6%). Compared with non-SNFist clinicians, the SNFist clinicians were more likely to be female (physicians, 37.1% vs 23.3%; APs, 88.1% vs 85.1%), practice at more facilities (mean [SD] number of facilities, 9.4 [8.7] for SNFist physicians vs 6.4 [6.1] for non-SNFist physicians; 8.6 [8.1] for SNFist APs vs 7.1 [6.8] for non-SNFist APs), and less likely to practice in rural areas (physicians, 9.3% vs 25.4%; APs, 8.1% vs 20.2%). In adjusted analyses, receiving care from a SNFist vs non-SNFist was associated with 7% lower odds of an ACS hospitalization (odds ratio [OR], 0.93; 95% CI, 0.90-0.96) and 7% lower odds of an ACS ED visit (OR, 0.93; 95% CI, 0.90-0.96). In stratified analyses, receiving care from a SNFist physician vs a non-SNFist physician was associated with 13% lower odds (OR, 0.87; 95% CI, 0.83-0.90) of an ACS hospitalization and 7% lowers odds of an ACS ED visit (OR, 0.93, 95% CI, 0.88-0.97); comparisons of SNFist APs vs non-SNFist","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 8","pages":"e252465"},"PeriodicalIF":11.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12357189/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144857024","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":"The Worst Piece of Health Care Legislation Ever.","authors":"David M Cutler","doi":"10.1001/jamahealthforum.2025.4626","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.4626","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 8","pages":"e254626"},"PeriodicalIF":11.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144978289","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":"Easing Cash Assistance Rules and Breastfeeding.","authors":"Emily C Dore, Daniel F Collin, David W Rothwell, Rita Hamad","doi":"10.1001/jamahealthforum.2025.2999","DOIUrl":"10.1001/jamahealthforum.2025.2999","url":null,"abstract":"<p><strong>Importance: </strong>Temporary Assistance for Needy Families (TANF) is a major federal cash assistance program for low-income families, but the program has strict eligibility criteria, meager cash benefits, and cumbersome administrative burdens that limit its effect. However, during the COVID-19 pandemic state TANF programs implemented policy changes to expand program access, including relaxed work requirements and additional income. Few studies have examined the association of these policy changes with health outcomes.</p><p><strong>Objective: </strong>To analyze the association between TANF policy changes during the COVID-19 pandemic and breastfeeding initiation and duration.</p><p><strong>Design, setting, and participants: </strong>This study used serial cross-sectional national data from the Pregnancy Risk Assessment Monitoring System (2017-2020) and a quasi-experimental difference-in-differences analysis to examine whether TANF policy changes affected breastfeeding behaviors among likely TANF participants compared with likely nonparticipants. Multivariable linear regression analyses were conducted that adjusted for individual and state-level covariates. The study was conducted between November 2024 and May 2025.</p><p><strong>Exposures: </strong>Gave birth in a state that implemented TANF policy changes (eg, 1-time cash payments, waiving in-person interviews and work requirements, and extending time limits).</p><p><strong>Main outcomes and measures: </strong>Self-reported measures of whether breastfeeding was initiated and breastfeeding duration in weeks.</p><p><strong>Results: </strong>The sample included 138 700 individuals; the likely TANF participants were less likely to be White (~33%) or married (~37%), were younger (~29% were 20-24 years of age), had lower incomes (~$30 000), and were more likely to have 2 or more previous births (~39%) compared with the likely nonparticipants. The TANF policy changes that expanded eligibility and decreased administrative burdens were associated with increased breastfeeding initiation and duration; eg, waiving sanctions was associated with increased breastfeeding initiation (2.59 percentage points [95% CI, 0.13-5.06 percentage points]) and automatic recertification was associated with increased breastfeeding duration (0.49 weeks [95% CI, 0.04-0.94 weeks]). Providing 1-time cash payments was also associated with increased breastfeeding duration (1 week [95% CI, 0.42-1.58 weeks]). These positive associations were found across all racial and ethnic groups, although some 95% CIs included the null.</p><p><strong>Conclusions and relevance: </strong>In this quasi-experimental study, state TANF policies that expanded eligibility, increased cash payments, and decreased administrative burdens were associated with increased breastfeeding initiation and duration. These findings inform active policymaking on antipoverty policies.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 8","pages":"e252999"},"PeriodicalIF":11.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12334963/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144800902","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":"Financial Health After Private Equity Hospitals Are Sold.","authors":"Sneha Kannan, Zirui Song","doi":"10.1001/jamahealthforum.2025.3217","DOIUrl":"10.1001/jamahealthforum.2025.3217","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 8","pages":"e253217"},"PeriodicalIF":11.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12334948/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144800903","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}