Health affairs scholar最新文献_第3页

Trends in utilization of remote monitoring in the United States. 美国使用远程监控的趋势。

Health affairs scholar Pub Date : 2025-06-06 eCollection Date: 2025-06-01 DOI: 10.1093/haschl/qxaf115

Joseph H Joo, Nadia Lieu, Yixin Tang, Danielle S Browne, Bethany Agusala, Joshua M Liao

{"title":"Trends in utilization of remote monitoring in the United States.","authors":"Joseph H Joo, Nadia Lieu, Yixin Tang, Danielle S Browne, Bethany Agusala, Joshua M Liao","doi":"10.1093/haschl/qxaf115","DOIUrl":"10.1093/haschl/qxaf115","url":null,"abstract":"Remote monitoring can help clinicians provide timely services and enable patients to engage in managing their medical conditions. Unfortunately, little is known about the national utilization of remote monitoring across the United States. Using 2019-2023 Medicare data encompassing 100% of professional services billed to and reimbursed by Medicare, we conducted a national analysis of remote-monitoring utilization. A total of 13 529 594 remote-monitoring services (remote patient monitoring and remote therapeutic monitoring), corresponding to $664 518 754, occurred between 2019 and 2023. Remote patient monitoring was most frequently delivered by primary care clinicians, accounting for 6 377 468 (48%) of all services, whereas remote therapeutic monitoring was most frequently delivered by other specialists, accounting for 173 621 (51%) services. With respect to place of service, most remote patient monitoring occurred in physician offices (12 135 569; 92%) compared with at home (540 219; 4%), or other care sites (515 302; 4%). Most remote therapeutic monitoring occurred in physician offices (322 156; 95%) compared with at home (12 560; 4%), or other care sites (3788; 1%). Our study results highlight the salient use of remote monitoring across clinical specialties and the need to address adoption barriers in certain care sites to further enhance utilization.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 6","pages":"qxaf115"},"PeriodicalIF":0.0,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12198758/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144510081","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

Medicare Advantage benefits design and access to surgeons. 医疗保险优势为设计和获得外科医生提供福利。

Health affairs scholar Pub Date : 2025-05-30 eCollection Date: 2025-06-01 DOI: 10.1093/haschl/qxaf112

Jessica I Billig, Michael Wu, Elsa Zhang, Changchuan Jiang, Joshua M Liao

引用次数: 0

Low participation in voluntary period for patient-reported outcome performance measures for hip and knee replacement. 髋关节和膝关节置换术患者报告的结果表现测量的自愿期参与率低。

Health affairs scholar Pub Date : 2025-05-30 eCollection Date: 2025-06-01 DOI: 10.1093/haschl/qxaf111

Nicholas L Berlin, Zoey Chopra, Caroline Thirukumaran, Thomas C Tsai, David W Bates, Andrea L Pusic, Jason B Liu

引用次数: 0

Geographic variation in Medicare Advantage nonemergency medical transportation benefits 2020-2024. 2020-2024年医疗保险优势非紧急医疗运输福利的地理差异。

Health affairs scholar Pub Date : 2025-05-30 eCollection Date: 2025-07-01 DOI: 10.1093/haschl/qxaf110

Chuan Angel Lu, Lesi He, Arthur S Hong, Megan A Mullins, Joshua M Liao, Changchuan Jiang

{"title":"Geographic variation in Medicare Advantage nonemergency medical transportation benefits 2020-2024.","authors":"Chuan Angel Lu, Lesi He, Arthur S Hong, Megan A Mullins, Joshua M Liao, Changchuan Jiang","doi":"10.1093/haschl/qxaf110","DOIUrl":"10.1093/haschl/qxaf110","url":null,"abstract":"Introduction: Nonemergency medical transportation (NEMT) is a supplemental benefit in Medicare Advantage (MA) plans that helps individuals overcome transportation barriers to healthcare services. It remains unclear whether these benefits are targeted to communities with greater needs.Methods: We analyzed MA plan benefit data from 2020 to 2024 across 2764 US counties. Transportation barriers were assessed using 5 indicators: vehicle ownership, income levels, self-reported health status, avoidable hospital visits, and access to primary care. We examined trends in NEMT availability and its alignment with county-level transportation need, considering MA plan penetration as a modifying factor.Results: Nonemergency medical transportation benefit prevalence in MA plans increased by 13.88% points from 2020 to 2024. In 2024, counties with the greatest transportation barriers had a 19.4% point higher prevalence of NEMT offerings compared to counties with the fewest barriers. Alignment was stronger in counties with higher MA plan penetration.Conclusion: Medicare Advantage plans increasingly offer NEMT benefits in areas with greater transportation challenges, especially where MA plan penetration is higher. These findings suggest responsiveness to social needs and the potential role of market dynamics. Policymakers can support equitable access by incorporating transportation needs into MA plan evaluations.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 7","pages":"qxaf110"},"PeriodicalIF":0.0,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12231549/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144585968","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

Comprehensive care management variation between rural and nonrural Maryland Primary Care Program (MDPCP) practices. 农村和非农村马里兰州初级保健计划（MDPCP）实践之间的综合护理管理差异。

Health affairs scholar Pub Date : 2025-05-29 eCollection Date: 2025-06-01 DOI: 10.1093/haschl/qxaf109

Kaitlynn S Robinson-Ector, Rozalina G McCoy, Kellee White Whilby, Dahai Yue, Dushanka V Kleinman, Shuo J Huang, Neil Jay Sehgal

{"title":"Comprehensive care management variation between rural and nonrural Maryland Primary Care Program (MDPCP) practices.","authors":"Kaitlynn S Robinson-Ector, Rozalina G McCoy, Kellee White Whilby, Dahai Yue, Dushanka V Kleinman, Shuo J Huang, Neil Jay Sehgal","doi":"10.1093/haschl/qxaf109","DOIUrl":"10.1093/haschl/qxaf109","url":null,"abstract":"Primary care-based care management services are effective ways to care for high-needs and high-risk patients. Despite experiencing higher chronic disease burden, rural Medicare beneficiaries have decreased access to primary care. The Maryland Primary Care Program (MDPCP) is the nation's largest voluntary state-led Medicare demonstration seeking to improve primary care infrastructure and chronic disease prevention and management. With varying access to primary care resources and health care needs among rural and nonrural Medicare beneficiaries, it is important to assess whether there is variation in the implementation of MDPCP care management among rural and nonrural practices. The analyses used Centers for Medicare and Medicaid (CMS) Claims and Claim Line Feed data, MDPCP data, and care transformation requirement reports from 2020-2023 to examine rural and nonrural differences in MDPCP primary care practice-based care management comprehensiveness. MDPCP primary care practice rural status was associated with providing more comprehensive care management services when compared with nonrural primary care practices. Rural MDPCP primary care practices also experienced a greater increase in the comprehensiveness of the care management services provided over time. These results demonstrate how state-led Medicare demonstration programs, such as the MDPCP, can improve rural primary care infrastructure and increase access to care management services.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 6","pages":"qxaf109"},"PeriodicalIF":0.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12202992/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531961","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

Evaluating the normative implications of national and international artificial intelligence policies for Sustainable Development Goal 3: good health and well-being. 评估国家和国际人工智能政策对可持续发展目标3：良好健康和福祉的规范影响。

Health affairs scholar Pub Date : 2025-05-29 eCollection Date: 2025-06-01 DOI: 10.1093/haschl/qxaf108

Francesca Mazzi

{"title":"Evaluating the normative implications of national and international artificial intelligence policies for Sustainable Development Goal 3: good health and well-being.","authors":"Francesca Mazzi","doi":"10.1093/haschl/qxaf108","DOIUrl":"10.1093/haschl/qxaf108","url":null,"abstract":"Introduction: Artificial intelligence (AI) has transformative potential in healthcare, promising advancements in diagnostics, treatment, and patient management, attracting significant investments and policy efforts globally. Effective AI governance, comprising guidelines, policy papers, and regulations, is crucial for its successful integration.Methods: This study evaluates 10 AI policies, namely focusing on 5 international organizations: the United Nations, the Organisation for Economic Co-operation and Development (OECD), the Council of Europe, the G20, and UNESCO, and 5 regional/national entities: Brazil, the United States, the European Union (EU), China, and the United Kingdom, to highlight the implications of AI governance for healthcare.Results: The EU AI Act focuses on risk management and individual protection while fostering innovation aligned with European values. The United Kingdom and the United States adopt a more flexible approach, offering guidelines to stimulate rapid AI integration and innovation without imposing strict regulations. Brazil shows a convergence toward the EU's risk-based approach.Conclusions: The study explores the normative implications of these varied approaches. The EU's stringent regulations may ensure higher safety and ethical standards, potentially setting a global benchmark, but they could also hinder innovation and pose compliance challenges. The United Kingdom's lenient approach may drive faster AI adoption and competitiveness but risks inconsistencies in safety and ethics. The study concludes by offering recommendations for future research.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 6","pages":"qxaf108"},"PeriodicalIF":0.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12202991/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531963","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

Early estimates of awareness and uptake of over-the-counter naloxone. 对非处方纳洛酮的认识和摄取的早期估计。

Health affairs scholar Pub Date : 2025-05-26 eCollection Date: 2025-06-01 DOI: 10.1093/haschl/qxaf107

Mireille Jacobson, David Powell

引用次数: 0

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

What is driving 340B growth: utilization or price? 是什么推动了340B的增长：利用率还是价格？

Health affairs scholar Pub Date : 2025-05-21 eCollection Date: 2025-06-01 DOI: 10.1093/haschl/qxaf104

Shanyue Zeng, William Sarraille, Rory Martin

{"title":"What is driving 340B growth: utilization or price?","authors":"Shanyue Zeng, William Sarraille, Rory Martin","doi":"10.1093/haschl/qxaf104","DOIUrl":"10.1093/haschl/qxaf104","url":null,"abstract":"In 2023, the 340B Drug Pricing Program (\"340B program\") saw a 24% year-over-year growth, with the Health Resources and Services Administration (HRSA), the federal agency responsible for the program, announcing that 340B discounted purchases had reached $66 billion. Despite the program's growth, size, and impact, there is little published research on the factors causing 340B growth, with different stakeholders offering divergent explanations. Program advocates contend that manufacturer price increases are the primary driver of 340B growth, while program critics argue that 340B hospitals are driving utilization. This study used price-volume-mix decomposition to examine the relative importance of price vs utilization for 340B growth using a national sample of over 28 000 National Drug Code drugs. From 2018 to 2024, utilization accounted for an average of 79.6% of 340B growth based on list price, and close to 100% of growth based on 340B discount prices. Utilization also accounted for the majority of 340B growth for the top 10 drugs reported by HRSA and for the segment of drugs with price increases above inflation. These findings show that utilization increases, not manufacturer pricing decisions, are the main driver of 340B growth, a conclusion that may have significant public policy implications.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 6","pages":"qxaf104"},"PeriodicalIF":0.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12188212/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144499940","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