Health affairs scholar最新文献_第4页

Transforming the future of health: building learning health systems across the globe. 改变卫生的未来：在全球建立学习型卫生系统。

Health affairs scholar Pub Date : 2025-05-21 eCollection Date: 2025-06-01 DOI: 10.1093/haschl/qxaf103

Sandra Yankah, Robert Saunders, Mark Tykocinski, Claudia Salzberg, Jonathan Gonzalez-Smith, Rachel Bonesteel, Cameron Joyce, Charles Kahn, Mark McClellan, Eyal Zimlichman

引用次数: 0

Merit-Based Incentive Payment System: longitudinal performance and uneven rewards for safety-net providers over 5 years. 基于绩效的激励支付制度：纵向绩效和5年以上安全网提供者的不均衡奖励。

Health affairs scholar Pub Date : 2025-05-21 eCollection Date: 2025-06-01 DOI: 10.1093/haschl/qxaf105

Meng-Yun Lin, Zhang Zhang, Kathleen Carey, Risha Gidwani, Amresh D Hanchate

{"title":"Merit-Based Incentive Payment System: longitudinal performance and uneven rewards for safety-net providers over 5 years.","authors":"Meng-Yun Lin, Zhang Zhang, Kathleen Carey, Risha Gidwani, Amresh D Hanchate","doi":"10.1093/haschl/qxaf105","DOIUrl":"10.1093/haschl/qxaf105","url":null,"abstract":"Introduction: Medicare Merit-based Incentive Payment System (MIPS), established by Centers for Medicare & Medicaid Services to transition Medicare reimbursement toward value-based care, has faced criticism for its administrative complexity and potential inequities affecting safety-net providers (SNPs).Methods: This study analyzed 5-year data (2018-2022) to evaluate the performance and financial outcomes of clinicians consistently participating in MIPS, focusing on disparities between SNPs and non-SNPs.Results: We found that safety-net specialists were 31% more likely than non-safety-net specialists to consistently receive positive payment adjustments and earned modestly higher average adjustment rates (0.35% points). However, despite this superior performance, safety-net specialists did not achieve greater cumulative financial rewards due to MIPS's percentage-based adjustment structure, which disadvantages clinicians with smaller billing volumes. Our analysis also showed that MIPS financial incentives were generally modest-ranging from $300 to $4000 over 5 years-far below the estimated $12 000 in annual administrative compliance costs per physician reported in prior research.Conclusion: To address these disparities and inefficiencies, policymakers should consider alternative models such as the American Medical Association's proposed Data-Driven Performance Payment System, which reduces administrative burden by simplifying the reporting process and ensures fairer financial rewards by uncoupling incentive payments from billing volume-thereby improving equity for safety-net clinicians.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 6","pages":"qxaf105"},"PeriodicalIF":0.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12152720/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144277057","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

Predictors of non-transport by emergency medical services after a nonfatal opioid overdose: a national analysis. 非致命性阿片类药物过量后紧急医疗服务非转运的预测因素：一项国家分析。

Health affairs scholar Pub Date : 2025-05-20 eCollection Date: 2025-05-01 DOI: 10.1093/haschl/qxaf101

Jirka Taylor, Sachini Bandara, Cindy Parks Thomas, Brendan Saloner, Peter James Fredericks, Karen Shen

{"title":"Predictors of non-transport by emergency medical services after a nonfatal opioid overdose: a national analysis.","authors":"Jirka Taylor, Sachini Bandara, Cindy Parks Thomas, Brendan Saloner, Peter James Fredericks, Karen Shen","doi":"10.1093/haschl/qxaf101","DOIUrl":"10.1093/haschl/qxaf101","url":null,"abstract":"Introduction: Emergency medical services (EMS) response to nonfatal overdoses represents an opportunity to provide linkage to services. However, patients may decline follow-on transportation. This paper examined predictors associated with non-transport after nonfatal opioid overdoses.Methods: We undertook a cross-sectional analysis of 2021-2022 data from the National EMS Information System. The outcome was a binary measure of declined transport. Predictors included age, gender, race/ethnicity, response time, EMS level of care, naloxone does, setting, urbanicity, region, time, and day.Results: We identified 710 263 nonfatal opioid overdose events, of which 12.4% ended in non-transport. Men were more likely to decline transport (average marginal effect [AME] 0.020 [95% CI, 0.019-0.022]), and Black patients were less likely to decline (AME -0.022 [95% CI, -0.024 to -0.021]). Compared with events involving an EMS-administered limited first dose (<2 mg), non-transports were more likely in events without naloxone administration (AME 0.075 [95% CI, 0.073-0.078]), with administration only by laypersons (AME 0.101 [95% CI, 0.096-0.107]), and when EMS administered higher first doses (2-4 mg AME 0.039 [95% CI, 0.037-0.041]; 4 mg+ AME 0.053 [95% CI, 0.049-0.056]).Conclusion: Efforts to improve post-overdose care should focus on groups who are more likely to decline transport and on appropriate naloxone dosing.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 5","pages":"qxaf101"},"PeriodicalIF":0.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12123062/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144201244","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

Post-release behavioral healthcare utilization and suicide risk among formerly incarcerated individuals. 出狱后行为保健利用与前监禁人员的自杀风险

Health affairs scholar Pub Date : 2025-05-17 eCollection Date: 2025-06-01 DOI: 10.1093/haschl/qxaf102

Min Jang, Anne Futterer, Shari Jager-Hyman, Patrick Kessel, Jaymes Fairfax-Columbo, Suet Lim, Molly Candon

{"title":"Post-release behavioral healthcare utilization and suicide risk among formerly incarcerated individuals.","authors":"Min Jang, Anne Futterer, Shari Jager-Hyman, Patrick Kessel, Jaymes Fairfax-Columbo, Suet Lim, Molly Candon","doi":"10.1093/haschl/qxaf102","DOIUrl":"10.1093/haschl/qxaf102","url":null,"abstract":"Introduction: Individuals who experience incarceration exhibit alarmingly high rates of suicide, particularly in the immediate post-release period. This study investigates the association between post-release behavioral healthcare utilization and suicide risk among individuals released from jail.Methods: Incarceration records for 61 438 individuals released from Philadelphia County jails between 2003 and 2016 were linked with administrative datasets, including the Medical Examiner's Office, involuntary commitment petitions, Medicaid enrollment and behavioral health claims, and emergency housing episodes. Using marginal structural Cox proportional hazards models, we examined the impact of post-release service engagement on suicide risk.Results: Sixty-five percent of formerly incarcerated individuals had behavioral health diagnoses. Only 27% used outpatient mental health services post-release, with 18% of these users engaging only once, and 28% used outpatient drug and alcohol services, with 21% of these users engaging only once. Low engagement in these services was associated with higher rates of suicide attempts and deaths.Conclusion: These results underscore the critical need for comprehensive systems that ensure smooth transitions from jail-based to community care to facilitate continuous service engagement. Implementing targeted interventions and policies to improve access to and sustained engagement with behavioral healthcare services is imperative to reduce suicide risk among individuals who experience incarceration.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 6","pages":"qxaf102"},"PeriodicalIF":0.0,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12128921/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217940","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

Policy changes to US federal infant feeding laws and regulations from 2014-2023: evidence that the 2022 infant formula shortage had a narrow policy impact. 2014-2023年美国联邦婴儿喂养法律法规的政策变化：2022年婴儿配方奶粉短缺对政策影响有限的证据

Health affairs scholar Pub Date : 2025-05-06 eCollection Date: 2025-06-01 DOI: 10.1093/haschl/qxaf096

Paige B Harrigan, Sarah A Misyak, Stella L Volpe, Valisa E Hedrick, Mingang Kim, Simin Zheng, Todd Schenk

{"title":"Policy changes to US federal infant feeding laws and regulations from 2014-2023: evidence that the 2022 infant formula shortage had a narrow policy impact.","authors":"Paige B Harrigan, Sarah A Misyak, Stella L Volpe, Valisa E Hedrick, Mingang Kim, Simin Zheng, Todd Schenk","doi":"10.1093/haschl/qxaf096","DOIUrl":"10.1093/haschl/qxaf096","url":null,"abstract":"In the spring and summer of 2022, an infant formula shortage in the United States received extensive media coverage, widespread social media engagement, and visible political attention. The purpose of this study was to explore changes to federal infant feeding policies in relation to the 2022 infant formula shortage to determine whether the shortage provoked policy change, and if so, the nature of those policy changes. A mapping of federal laws, regulations, and presidential documents passed or substantively amended between 2014 and 2023 was conducted to explore changes in US infant feeding policies prior to and following the shortage. Fisher's exact tests with post hoc comparisons were used to determine associations between policy topic areas and when policy changes occurred. Fifty-seven infant feeding policy changes met the inclusion criteria. There was a statistically significant relationship between the formula shortage and policies addressing infant formula supply, suggesting policy mobilization and attention from policymakers. There was no statistically significant change in policies on breastfeeding or other infant feeding dimensions associated with the timing of the shortage, suggesting that policymakers' attention was narrow in scope. It is unclear to what degree the policy changes will endure or prevent another infant formula shortage.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 6","pages":"qxaf096"},"PeriodicalIF":0.0,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12164579/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144304098","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

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

The financial impact of NIH's indirect cost cap on higher education research. 美国国立卫生研究院的间接成本上限对高等教育研究的财务影响。

Health affairs scholar Pub Date : 2025-05-02 eCollection Date: 2025-06-01 DOI: 10.1093/haschl/qxaf094

Eric W Ford, Timothy R Huerta

{"title":"The financial impact of NIH's indirect cost cap on higher education research.","authors":"Eric W Ford, Timothy R Huerta","doi":"10.1093/haschl/qxaf094","DOIUrl":"10.1093/haschl/qxaf094","url":null,"abstract":"On February 7, 2025, the National Institutes of Health (NIH) announced a policy setting all facilities and administrative (F&A) rates at 15% for grants awarded to Institutions of Higher Education (IHEs), replacing negotiated rates that often exceeded 50%. This change poses significant financial challenges for IHEs. On April 4, 2025, a permanent injunction was issued, preventing the NIH from implementing the new policy. To quantify the projected financial impact of the NIH's new F&A cap on U.S. IHEs and assess its broader implications for research sustainability. We analyzed NIH funding data from the NIH RePORTER database for Fiscal Year 2024 (FY2024). Institutions were categorized by public vs private status, and revenue losses under the new policy were calculated. State-level impacts were also assessed. NIH's F&A cap is projected to reduce IHE funding by $5.24B in FY2025. Public universities would lose $2.99B, while private universities face a $2.25B reduction. States with high research expenditures and historically high F&A rates would experience the greatest financial strains. The policy may weaken U.S. research capacity, disproportionately impact public institutions, and shift funding reliance toward state legislatures and private partnerships, with long-term consequences for biomedical innovation.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 6","pages":"qxaf094"},"PeriodicalIF":0.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12152721/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144277135","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