Health affairs scholar最新文献

Availability of consistent, reliable, and actionable public data on US hospital administrative expenses. 关于美国医院管理费用的一致、可靠和可操作的公共数据的可用性。

Health affairs scholar Pub Date : 2025-05-22 eCollection Date: 2025-05-01 DOI: 10.1093/haschl/qxaf069

Nikhil R Sahni, Brooke Istvan, Heather Bello Thornhill, Karen E Joynt-Maddox, David Cutler, Ezekiel J Emanuel

{"title":"Availability of consistent, reliable, and actionable public data on US hospital administrative expenses.","authors":"Nikhil R Sahni, Brooke Istvan, Heather Bello Thornhill, Karen E Joynt-Maddox, David Cutler, Ezekiel J Emanuel","doi":"10.1093/haschl/qxaf069","DOIUrl":"10.1093/haschl/qxaf069","url":null,"abstract":"Health care spending continues to rise, and opportunities to decrease costs without negatively impacting patient care are a priority. Addressing administrative spending, approximately 25% of US health care spending, is an opportunity. To identify savings, hospitals and policymakers need data to quantify administrative expense categories and establish benchmarks for comparisons. However, it is unknown whether the Medicare Cost Reports-the only universal, public source for US hospital financials-accurately capture administrative expenses. We found that, at the national level, administrative expenses for 5639 hospitals were $166.1 billion, or 17.0% of total hospital expenses. A total of 4417 (78.3%) hospitals reported only a single overall \"administrative and general\" expense, averaging 18.9% (SD: 5.8%) of total hospital expenses, while 1222 (21.7%) provided detailed data on administrative expenses averaging 17.1% (SD: 5.0%) in sum. For those reporting subcategories, \"other administrative and general\" represented $37.6 billion (66.1%). Of the 3971 subcategories reported, 31.2% appeared mislabeled. In summary, hospitals report widely variable administrative expenses (7.0 percentage points between the 25th and 75th percentile), with few detailed, and often mislabeled, data to guide the identification of savings opportunities. As structured today, the Medicare Cost Reports are not a consistent, reliable, or actionable dataset to aid hospitals or policymakers in quantifying and addressing excess administrative spending.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 5","pages":"qxaf069"},"PeriodicalIF":0.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096959/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129756","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}

引用次数: 0

Measuring equitable care in multi-hospital markets: A Proportional Share Index Application in New York City. 衡量多医院市场的公平护理：比例份额指数在纽约市的应用。

Health affairs scholar Pub Date : 2025-05-21 eCollection Date: 2025-05-01 DOI: 10.1093/haschl/qxaf088

Duncan Maru, Deirdre Flynn, Laila Alsabahi, Ana Gallego, Emma Clippinger, Rebecca Friedman, Yogeeta Kuldip, Gavin Myers, Ese Oghenejobo, Amy Shah, Tsu-Yu Tsao, Ewa Wojas, Brian Yim, Michelle Morse

{"title":"Measuring equitable care in multi-hospital markets: A Proportional Share Index Application in New York City.","authors":"Duncan Maru, Deirdre Flynn, Laila Alsabahi, Ana Gallego, Emma Clippinger, Rebecca Friedman, Yogeeta Kuldip, Gavin Myers, Ese Oghenejobo, Amy Shah, Tsu-Yu Tsao, Ewa Wojas, Brian Yim, Michelle Morse","doi":"10.1093/haschl/qxaf088","DOIUrl":"10.1093/haschl/qxaf088","url":null,"abstract":"Community members, elected officials, and policy makers are increasingly calling attention to the issue of inequities in hospital utilization and resource allocation within consolidated multi-hospital markets in the United States. Innovative policy solutions are required to re-shape the incentives driving hospital business practices and behaviors that produce inequitable outcomes and to ensure that equity, as well as economics, drives these business decisions. New measures can drive evidence-informed policy making and track the impact of new laws, regulations, and practices. In this paper, we illustrate the development and potential applications of the Proportional Share Index (PSI) using New York City (NYC) as a case study, highlighting its ability to quantify and track equitable access to hospitals across multi-hospital markets. The PSI incorporates both a measure of those who are covered by Medicaid or who are self-pay (largely uninsured) and hospital capacity in determining whether a given hospital is providing its proportionate, fair amount of care to these populations. We discuss how the PSI and related measures may inform policy interventions aimed at mitigating health inequities.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 5","pages":"qxaf088"},"PeriodicalIF":0.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093469/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121760","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}

引用次数: 0

Physician mergers involve 38% of doctors, substantial health system participation, and frequent serial acquisition. 医师合并涉及38%的医生，大量的卫生系统参与，以及频繁的连续收购。

Health affairs scholar Pub Date : 2025-05-19 eCollection Date: 2025-05-01 DOI: 10.1093/haschl/qxaf061

Daniel Deibler, Daniel Hosken, Thomas Koch, Marshall Thomas

{"title":"Physician mergers involve 38% of doctors, substantial health system participation, and frequent serial acquisition.","authors":"Daniel Deibler, Daniel Hosken, Thomas Koch, Marshall Thomas","doi":"10.1093/haschl/qxaf061","DOIUrl":"10.1093/haschl/qxaf061","url":null,"abstract":"We describe the incidence of mergers between US physician firms. We considered the role of health systems in physician merger activity and the extent to which individual firms engage in multiple acquisitions, or \"roll-up\" behavior. We used a unique collection of subpoenaed data from 6 insurers in 15 states, which account for approximately 80% of commercially insured members in those states between 2015 and 2020. Over 6 years, we observed 2019 mergers between physician firms that spanned from small single-specialty practices to large groups affiliated with health systems. Approximately 20% of the roughly 15 000 firms were involved in a merger. Of the nearly 400 000 doctors in our sample, 38% were employed by firms involved in a merger, although only 3.8% of the doctors were part of an acquired group. Sixty-three firms made more than 5 acquisitions, and 3 made more than 20 acquisitions. Health care systems, responsible for approximately 40% of mergers, frequently engaged in serial acquisitions. Acquired physician firms are typically small (<10 doctors), and much smaller than the acquiring firm. We document that many physician mergers occurred in 15 states over 5 years. A significant fraction of the physician mergers we identified, especially those involving health systems, exhibited characteristics that could indicate the potential for competitive harm. Our results suggest that researchers should examine the degree to which these competitively suspect mergers have affected competition.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 5","pages":"qxaf061"},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12086535/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103430","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}

引用次数: 0

Insulin rationing in states with and without insulin copay caps: a cross-sectional study. 有和没有胰岛素共同支付上限的州的胰岛素配给：一项横断面研究。

Health affairs scholar Pub Date : 2025-05-08 eCollection Date: 2025-05-01 DOI: 10.1093/haschl/qxaf100

Tiffany Enxia Jiang, Reshma Ramachandran, Kasia Lipska, Joseph Solomon Ross

引用次数: 0

Artificial Intelligence-augmented public health interventions in India. 印度人工智能增强的公共卫生干预措施。

Health affairs scholar Pub Date : 2025-05-07 eCollection Date: 2025-05-01 DOI: 10.1093/haschl/qxaf097

Shekar Sivasubramanian, Alpan Raval

引用次数: 0

Beyond community benefit: Unveiling hospitals' comprehensive efforts to improve community health. 超越社区利益：揭示医院为改善社区健康所做的全面努力。

Health affairs scholar Pub Date : 2025-05-05 eCollection Date: 2025-05-01 DOI: 10.1093/haschl/qxaf062

Cherie Conley, Aiden Swanson, Simone R Singh

{"title":"Beyond community benefit: Unveiling hospitals' comprehensive efforts to improve community health.","authors":"Cherie Conley, Aiden Swanson, Simone R Singh","doi":"10.1093/haschl/qxaf062","DOIUrl":"https://doi.org/10.1093/haschl/qxaf062","url":null,"abstract":"Calls for nonprofit hospitals to clearly make their case for tax exemption are increasing. Most published research on nonprofit hospitals' provision of community benefit relies on data reported in Internal Revenue Service (IRS) Form 990 Schedule H. This study leverages insight from hospital leaders to better understand the types of initiatives, beyond community benefit, that hospitals engage in to benefit their communities. We conducted 17 semi-structured interviews with a total of 34 hospital representatives. Three themes were identified: (1) the current IRS Form 990 Schedule H provides only limited insights into hospitals' investments into communities, (2) health systems engage in a variety of diverse activities that benefit communities and address social determinants of health, and (3) health systems use a variety of communication channels outside of Form 990 and Schedule H to raise awareness about their contributions to community health. These findings suggest that IRS reports alone do not fully illustrate the scope of hospital initiatives to benefit communities. Internal changes in hospital practices and procedures, and external policy levers, may provide a more comprehensive picture of benefits and opportunities for improvement.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 5","pages":"qxaf062"},"PeriodicalIF":0.0,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12050685/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060616","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}

引用次数: 0

Institutional support for navigating abortion bans in pulmonary and critical care: a multistate qualitative study. 在肺部和重症监护中导航堕胎禁令的机构支持：一项多州定性研究。

Health affairs scholar Pub Date : 2025-05-02 eCollection Date: 2025-05-01 DOI: 10.1093/haschl/qxaf095

Katrina E Hauschildt, Avnee J Kumar, Elizabeth M Viglianti, Kelly C Vranas, Taylor Bernstein, Leslie Moroz, Theodore J Iwashyna

{"title":"Institutional support for navigating abortion bans in pulmonary and critical care: a multistate qualitative study.","authors":"Katrina E Hauschildt, Avnee J Kumar, Elizabeth M Viglianti, Kelly C Vranas, Taylor Bernstein, Leslie Moroz, Theodore J Iwashyna","doi":"10.1093/haschl/qxaf095","DOIUrl":"10.1093/haschl/qxaf095","url":null,"abstract":"Abortion bans enacted by numerous US states between 2022 and 2024 offered little guidance to health care systems on pragmatic implementation. Early studies identified meaningful impacts to obstetric and gynecological patients and clinicians and strategies for institutions to support clinicians in these specialties. There is widespread concern regarding the legal implications of these bans on all specialties, and the impact of institutional responses to abortion bans on clinicians outside of obstetrics and gynecology is unknown. We conducted semi-structured interviews with 29 physicians in pulmonary and/or critical care medicine-another specialty whose patients have acute, life-threatening conditions precipitated or complicated by reduced access to reproductive care-about institutional responses to abortion restrictions. Physicians reported 5 areas in which institutional responses varied: legal interpretation of bans, policy and procedural changes, communication with physicians about changes, public statements about bans, and harm-mitigation strategies. Health care organization responses to abortion bans considered most helpful shared key features, including unambiguous guidance, institutional support for physicians, and demonstrated commitment to patient-first care. Our findings suggest promising potential strategies for health care organizations to minimize impacts of abortion restrictions on clinicians and support them in providing the highest level of patient-centered care possible in the post-Dobbs era.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 5","pages":"qxaf095"},"PeriodicalIF":0.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12089030/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144113068","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}

引用次数: 0

Impact of a multi-payer full-risk model on preserving primary care access for traditional medicare beneficiaries. 多支付方全风险模式对保留传统医疗保险受益人获得初级保健的影响。

Health affairs scholar Pub Date : 2025-04-30 eCollection Date: 2025-05-01 DOI: 10.1093/haschl/qxaf093

Benjamin S Kornitzer, Aaron Yao, Deborah N Peikes, Karthik Rao

{"title":"Impact of a multi-payer full-risk model on preserving primary care access for traditional medicare beneficiaries.","authors":"Benjamin S Kornitzer, Aaron Yao, Deborah N Peikes, Karthik Rao","doi":"10.1093/haschl/qxaf093","DOIUrl":"https://doi.org/10.1093/haschl/qxaf093","url":null,"abstract":"Introduction: Amid growing primary care shortages and increased use of value-based care (VBC), we evaluated whether adopting a multipayer, full-risk VBC model for Traditional Medicare (TM) and Medicare Advantage beneficiaries-supported by an enablement organization-affected primary care providers' (PCPs) acceptance of new patients with TM insurance.Methods: Using a difference-in-differences analysis of 2019-2023 claims, we compared 2 groups of PCPs with at least 50 TM patients in their panels: 208 PCPs who received support to adopt a VBC model for TM and Medicare Advantage patients in 2022, and 3657 similar PCPs who maintained their existing payment models.Between the preadoption period and 2023, access to new patient visits for patients with TM insurance declined more for nonadopters than adopters.Results: Primary care providers' in the VBC group saw, on average, 8 more new TM patients annually than nonadopters. This change is sizable relative to their 22.6 new TM patients in 2023. Additionally, the VBC group kept their panels open to new patients with TM insurance for 0.7 more months per year, on average, than nonadopters, relative to preadoption.Conclusion: These findings suggest that a VBC model with support may help sustain access to primary care for TM beneficiaries, even as overall availability declines.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 5","pages":"qxaf093"},"PeriodicalIF":0.0,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12065130/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144046242","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}

引用次数: 0

Commercial price variation for common imaging studies. 普通成像研究的商业价格变化。

Health affairs scholar Pub Date : 2025-04-30 eCollection Date: 2025-05-01 DOI: 10.1093/haschl/qxaf092

Alexander P Philips, Christopher Whaley

{"title":"Commercial price variation for common imaging studies.","authors":"Alexander P Philips, Christopher Whaley","doi":"10.1093/haschl/qxaf092","DOIUrl":"10.1093/haschl/qxaf092","url":null,"abstract":"Introduction: Commercial insurance payment rates for imaging studies have significant price variation, yet understanding this variation has been limited by lack of transparency and data limitations.Methods: Using newly available Transparency-in-Coverage insurer-posted data on negotiated rates, we analyzed price variation for the 2023 contract year across four major commercial insurers (Blue Cross Blue Shield, United, Cigna, and Aetna) for 30 imaging studies. Our analysis encompassed 12.7 million professional fee price points and 239 969 facility fee price points.Results: Our analysis revealed substantial variation in reimbursement rates. Key findings include greater variation in facility fees compared to professional fees, with facility coefficients of variation often 3 to 6 times higher than professional components. There was also substantial and inconsistent variation by payer. Geographic analysis revealed significant state-level variation, particularly in facility fees.Conclusion: These findings highlight the complex interplay of market dynamics and negotiating strategies in determining healthcare prices, with implications for policymakers, purchasers, and clinicians guiding patient care decisions.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 5","pages":"qxaf092"},"PeriodicalIF":0.0,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12097484/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129781","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}

引用次数: 0

Medicaid expansion increased income among newly eligible adults. 医疗补助计划的扩大增加了新合格成年人的收入。

Health affairs scholar Pub Date : 2025-04-28 eCollection Date: 2025-05-01 DOI: 10.1093/haschl/qxaf091

Stacy Chen, Becky Staiger

{"title":"Medicaid expansion increased income among newly eligible adults.","authors":"Stacy Chen, Becky Staiger","doi":"10.1093/haschl/qxaf091","DOIUrl":"10.1093/haschl/qxaf091","url":null,"abstract":"The Affordable Care Act's Medicaid expansion improved health care access for low-income Americans; however, its impact on economic outcomes-particularly income-is less clear. We used US Census administrative income data that tracked 6120 cohorts covering 84% of working-age adults from 2005 to 2019. Using difference-in-differences, we compared changes in income among low-income adults living in expansion states, before and after expansion, with changes in income in low-income adults living in non-expansion states. Low-income adults living in Medicaid-expansion states experienced an average 9.5% relative increase in income in the 5 years after expansion. This impact was concentrated among adults who were likely newly eligible for Medicaid after the expansion. These adults experienced a 9.6% relative increase in income, as well as a 2.1 percentage point (7.3%) relative higher likelihood of having income in the 40th income percentile or higher. We found suggestive evidence that a reduction in unpaid time off from work drove a small part of this relative income increase among those newly eligible. While Medicaid funding faces substantial political uncertainty, this evidence suggests that welfare gains to newly eligible individuals include economic, as well as health, improvements.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 5","pages":"qxaf091"},"PeriodicalIF":0.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096067/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129764","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}

引用次数: 0