Health affairs scholar最新文献_第7页

Examining the use of telehealth to initiate buprenorphine for opioid use disorder treatment. 研究利用远程医疗启动丁丙诺啡治疗阿片类药物使用障碍。

Health affairs scholar Pub Date : 2024-11-02 eCollection Date: 2024-11-01 DOI: 10.1093/haschl/qxae137

Yimin Ge, Matthew D Eisenberg, Emma E McGinty, Jiani Yu, Kayla N Tormohlen

引用次数: 0

Medicare Part D beneficiaries' self-reported barriers to switching plans and making plan comparisons at all. 医疗保险 D 部分受益人自述在转换计划和进行计划比较时遇到的障碍。

Health affairs scholar Pub Date : 2024-11-02 eCollection Date: 2024-11-01 DOI: 10.1093/haschl/qxae141

Wändi Bruine de Bruin, Nathan Hodson, Lila Rabinovich, Daniel Czarnowske, Florian Heiss, Joachim Winter, Amelie Wuppermann, Daniel McFadden

{"title":"Medicare Part D beneficiaries' self-reported barriers to switching plans and making plan comparisons at all.","authors":"Wändi Bruine de Bruin, Nathan Hodson, Lila Rabinovich, Daniel Czarnowske, Florian Heiss, Joachim Winter, Amelie Wuppermann, Daniel McFadden","doi":"10.1093/haschl/qxae141","DOIUrl":"10.1093/haschl/qxae141","url":null,"abstract":"In the United States, individuals with disabilities and those aged ≥65 can supplement their Medicare with so-called stand-alone Medicare Part D prescription drug plans. Beneficiaries can switch their stand-alone prescription drug plans annually, but most do not. Indirect evidence has raised concerns that non-switchers do not even make plan comparisons (labeled \"inattention\"), but direct evidence is scarce. Therefore, we surveyed 439 beneficiaries of Medicare Part D plans from a nationally representative adult sample after the 2024 open-enrollment period. Overall, 53% self-reported making no comparisons. Of those who did not compare, 98% did not switch (vs 67% of those who did compare). Multinomial regressions revealed that beneficiaries who neither compared nor switched were more likely than switchers to report difficulties with comparing and switching, experiencing no plan-related discontinuation, changes, or dissatisfaction, not using advisors or the plan-finder website, and receiving potentially confusing mailings. Non-switchers who did compare were similar to switchers in reporting few difficulties and relying on advisors and the plan-finder website, but they were less likely than switchers to report plan-related changes, discontinuation, or dissatisfaction, while being more likely to report receiving mailings and having no college degree. We discuss insights for policy-making.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"2 11","pages":"qxae141"},"PeriodicalIF":0.0,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11574620/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142678158","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 inpatient hospital price growth driven by system affiliation and nonprofit-status hospitals. 系统附属医院和非营利性医院推动了商业住院价格的增长。

Health affairs scholar Pub Date : 2024-11-01 DOI: 10.1093/haschl/qxae140

Jessica Y Chang, Kathryn Martin

{"title":"Commercial inpatient hospital price growth driven by system affiliation and nonprofit-status hospitals.","authors":"Jessica Y Chang, Kathryn Martin","doi":"10.1093/haschl/qxae140","DOIUrl":"10.1093/haschl/qxae140","url":null,"abstract":"As policymakers continue to grapple with rising health care costs and prices, understanding trends and variations in inpatient prices among hospital characteristics is an important benchmark to allow policymakers to craft targeted policies. In this study, we provide descriptive trends on variation in inpatient prices paid by commercial health plans stratified by hospital characteristics using data from Health Care Cost Institute's employer-sponsored insured claims data. Our analyses found evidence of considerable variation among inpatient price levels and growth among system affiliation and profitability. Prices among system-affiliated hospitals grew from $14 281.74 in 2012 to $20 731.95 in 2021, corresponding to a 45.2% increase during this period. On the other hand, prices among independent hospitals grew more slowly, from $13 460.50 in 2012 to $18 196.90 in 2021, corresponding to a 35.2% increase. We did not observe a similar trend in growth rates among case mix index by hospital characteristics, implying that differential inpatient price growth is not driven by changes in case mix by hospital characteristics. Heterogeneity in hospital prices and price growth by type of hospital suggests that public and private policymakers aiming to rein in health spending should consider policies that address this variation.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"2 11","pages":"qxae140"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11559425/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142635085","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

Association between discontinuity in clinicians and outcomes of nursing home residents. 临床医生的不连续性与疗养院居民疗效之间的关系。

Health affairs scholar Pub Date : 2024-11-01 DOI: 10.1093/haschl/qxae139

Hyunkyung Yun, Mark Aaron Unruh, Kira L Ryskina, Hye-Young Jung

{"title":"Association between discontinuity in clinicians and outcomes of nursing home residents.","authors":"Hyunkyung Yun, Mark Aaron Unruh, Kira L Ryskina, Hye-Young Jung","doi":"10.1093/haschl/qxae139","DOIUrl":"10.1093/haschl/qxae139","url":null,"abstract":"Little is known about the impact of clinician discontinuity on quality of care for nursing home residents. We examined the association between clinician discontinuity and outcomes of residents with long-term care stays up to 3 years using claims for a national 20% sample of Medicare fee-for-service beneficiaries from 2014 through 2019. We used an event study analysis that accounted for staggered treatment timing. Estimates were adjusted for resident, clinician, and nursing home characteristics. Three sensitivity analyses were conducted. The first excluded small nursing homes, which were in the lowest quartile based on the number of beds. The second attributed residents to clinician practices rather than individual clinicians. The third removed the 3-year long-term care stay restriction. We found that, compared to residents who did not experience a clinician change, those with a clinician change had a 0.7 percentage point higher likelihood of an ambulatory care sensitive hospitalization in a given quarter (a 36.8% relative increase). Clinician discontinuity was not associated with ambulatory care sensitive emergency department visits. Results from our 3 sensitivity analyses were consistent with those from the primary analysis. Policymakers may consider using continuity in clinicians as a marker of nursing home quality.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"2 11","pages":"qxae139"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11562128/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142635056","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 transitional care management services' association with readmissions and mortality. 医疗保险过渡性护理管理服务与再入院和死亡率的关系。

Health affairs scholar Pub Date : 2024-10-28 eCollection Date: 2024-11-01 DOI: 10.1093/haschl/qxae135

Rachel O Reid, Neeraj Sood, Ruolin Lu, Cheryl L Damberg

{"title":"Medicare transitional care management services' association with readmissions and mortality.","authors":"Rachel O Reid, Neeraj Sood, Ruolin Lu, Cheryl L Damberg","doi":"10.1093/haschl/qxae135","DOIUrl":"10.1093/haschl/qxae135","url":null,"abstract":"In 2013, the Centers for Medicare and Medicaid Services (CMS) introduced codes to reimburse outpatient providers for post-discharge transitional care management (TCM). Understanding the implications of TCM reimbursement on outcomes is crucial for evaluating CMS's investment and guiding future policy. We analyzed the association between physician organization (PO) TCM code use and post-discharge readmissions and mortality using 100% fee-for-service Medicare claims. Using a difference-in-differences approach we compared 1131 \"high-TCM\" POs (top quartile of TCM code use from 2015-2017) to 1133 \"low-TCM\" POs (bottom quartile) from before (2012) and after (2015-2017) TCM code implementation, controlling for PO and beneficiary attributes and readmission risk. TCM code use was associated with decreased 30- and 90-day readmissions (-0.31 [95%CI: -0.52, -0.09] and -0.42 [95% CI: -0.71, -0.14] percentage points, respectively), but no significant difference in mortality. Year-by-year, 2017 saw greatest readmission reduction, with a slight mortality reduction in that year only. Readmission reductions were greatest in POs not affiliated with health systems, Accountable Care Organizations (ACOs), or academic medical centers, and least in those with fewer primary care physicians. Narrow, indirect interventions like fee-for-service TCM billing code reimbursement may have limited potential to improve post-discharge outcomes overall. However, small independent practices may derive somewhat greater benefit from this support for post-discharge care.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"2 11","pages":"qxae135"},"PeriodicalIF":0.0,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11578547/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683898","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 opioid industry's use of scientific evidence to advance claims about prescription opioid safety and effectiveness. 阿片类药物行业利用科学证据来宣传处方阿片类药物的安全性和有效性。

Health affairs scholar Pub Date : 2024-10-24 eCollection Date: 2024-10-01 DOI: 10.1093/haschl/qxae119

Ravi Gupta, Jason Chernesky, Anna Lembke, David Michaels, Cecilia Tomori, Jeremy A Greene, G Caleb Alexander, Adam D Koon

{"title":"The opioid industry's use of scientific evidence to advance claims about prescription opioid safety and effectiveness.","authors":"Ravi Gupta, Jason Chernesky, Anna Lembke, David Michaels, Cecilia Tomori, Jeremy A Greene, G Caleb Alexander, Adam D Koon","doi":"10.1093/haschl/qxae119","DOIUrl":"https://doi.org/10.1093/haschl/qxae119","url":null,"abstract":"It is widely recognized that pharmaceutical marketing contributed to the ongoing US opioid epidemic, but less is understood about how the opioid industry used scientific evidence to generate product demand, shape opioid regulation, and change clinician behavior. In this qualitative study, we characterize select scientific articles used by industry to support safety and effectiveness claims and use a novel database, the Opioid Industry Documents Archive, to determine notable elements of industry and non-industry documents citing the scientific articles to advance each claim. We found that 15 scientific articles were collectively mentioned in 3666 documents supporting 5 common, inaccurate claims: opioids are effective for treatment of chronic, non-cancer pain; opioids are \"rarely\" addictive; \"pseudo-addiction\" is due to inadequate pain management; no opioid dose is too high; and screening tools can identify those at risk of developing addiction. The articles contributed to the eventual normalization of these claims by symbolically associating the claims with scientific evidence, building credibility, expanding and diversifying audiences and the parties asserting the claims, and obfuscating conflicts of interest. These findings have implications for regulators of industry products and corporate activity and can inform efforts to prevent similar public health crises.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"2 10","pages":"qxae119"},"PeriodicalIF":0.0,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11500661/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515297","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

Trends in workplace violence for health care occupations and facilities over the last 10 years. 过去10年保健职业和设施的工作场所暴力趋势。

Health affairs scholar Pub Date : 2024-10-23 eCollection Date: 2024-12-01 DOI: 10.1093/haschl/qxae134

Brianna Lombardi, Todd Jensen, Evan Galloway, Erin Fraher

{"title":"Trends in workplace violence for health care occupations and facilities over the last 10 years.","authors":"Brianna Lombardi, Todd Jensen, Evan Galloway, Erin Fraher","doi":"10.1093/haschl/qxae134","DOIUrl":"10.1093/haschl/qxae134","url":null,"abstract":"Issues of workplace violence (WPV) in health care have garnered increasing attention due to the impact on the health care worker's well-being and retention. Yet, our understanding of whether and how WPV rates vary between health care facilities and occupations is limited, particularly information on growth over time. This information is needed to develop and target policies and interventions toward health care workers and settings most at risk. We examined trends in WPV among health care occupations and facilities over the past decade (2011-2021/2022), utilizing data from the Bureau of Labor Statistics' Survey of Occupational Injuries and Illness. Findings reveal a 30% increase in WPV across all health care facility types between 2011 and 2021/2022; however, there was no difference in the average rate of WPV for health care occupations over the same time period. The increase in WPV for health care facilities began long before the pandemic, suggesting larger systemic issues are likely driving WPV. Existing state and organizational efforts aim to mitigate WPV, yet targeted interventions are crucial. Understanding variations across occupations and facilities will inform tailored strategies to safeguard health care workers.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"2 12","pages":"qxae134"},"PeriodicalIF":0.0,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11630250/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142815290","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

Medigap-guaranteed issue associated with Medicare Advantage disenrollment for beneficiaries administered a part B drug. 与 B 部分药物受益人退出 Medicare Advantage 相关的 Medigap 保证问题。

Health affairs scholar Pub Date : 2024-10-23 eCollection Date: 2024-11-01 DOI: 10.1093/haschl/qxae136

Angela Liu, David Pittman, Gerard Anderson, Jianhui Xu

{"title":"Medigap-guaranteed issue associated with Medicare Advantage disenrollment for beneficiaries administered a part B drug.","authors":"Angela Liu, David Pittman, Gerard Anderson, Jianhui Xu","doi":"10.1093/haschl/qxae136","DOIUrl":"10.1093/haschl/qxae136","url":null,"abstract":"While many Medicare beneficiaries are enrolling in Medicare Advantage (MA), some beneficiaries may want to return to traditional Medicare and purchase Medigap, especially beneficiaries who have greater medical needs. Beyond minimal federal regulations, states impose additional regulations that impact Medigap affordability. Beneficiaries in some states have greater difficulty obtaining Medigap coverage because the states where they live allow Medigap insurers to experience rate the beneficiary, which can make Medigap insurance prohibitively expensive. We examined beneficiaries who received physician-administered drugs, which can be expensive and subject to high cost sharing, to see if disenrollment from MA for these beneficiaries was greater in states with Medigap consumer protection policy levels. In 2020, we find a 1.0% average baseline average probability of MA disenrollment. For beneficiaries who received a physician-administered drug in our sample, the probability of MA disenrollment is 3.7 (95% CI, 2.6-4.8; P < .001) percentage points higher in Medigap-guaranteed issue states compared with states with no protections. We find a greater association between MA disenrollment and Medigap protection policies with higher cost drugs. These findings suggest that beneficiaries who receive a high-volume and high-spending physician-administered drug are more likely to disenroll from MA back to traditional Medicare when Medigap is more affordable.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"2 11","pages":"qxae136"},"PeriodicalIF":0.0,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11538962/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142591562","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

Increased spending on low-value care during the COVID-19 pandemic in Virginia. 弗吉尼亚州 COVID-19 大流行期间低价值护理支出的增加。

Health affairs scholar Pub Date : 2024-10-23 eCollection Date: 2024-11-01 DOI: 10.1093/haschl/qxae133

Michelle S Rockwell, Sitaram Vangala, Jillian Rider, Beth Bortz, Kyle Russell, Marcos Dachary, Lauryn Walker, A Mark Fendrick, John N Mafi

{"title":"Increased spending on low-value care during the COVID-19 pandemic in Virginia.","authors":"Michelle S Rockwell, Sitaram Vangala, Jillian Rider, Beth Bortz, Kyle Russell, Marcos Dachary, Lauryn Walker, A Mark Fendrick, John N Mafi","doi":"10.1093/haschl/qxae133","DOIUrl":"10.1093/haschl/qxae133","url":null,"abstract":"Characterizing the value and equity of care delivered during the COVID-19 pandemic is crucial to uncovering health system vulnerabilities and informing postpandemic recovery. We used insurance claims to evaluate low-value (no clinical benefit, potentially harmful) and clinically indicated utilization of a subset of 11 ambulatory services within a cohort of ∼2 million Virginia adults during the first 2 years of the pandemic (March 1, 2020-December 31, 2021). In 2020, low-value and clinically indicated utilization decreased similarly, while in 2021, low-value and clinically indicated utilization were 7% higher and 4% lower, respectively, than prepandemic rates. Extrapolated to Virginia's population of insured adults, ∼$1.3 billion in spending was associated with low-value utilization of the 11 services during the study period, with 2021 spending rates 6% higher than prepandemic rates. During March 1, 2020-December 31, 2021, low-value and clinically indicated utilization were 15% and 16% lower, respectively, than pre-pandemic rates among patients with the greatest socioeconomic deprivation but similar to prepandemic rates among patients with the least socioeconomic deprivation. These results highlight widening healthcare disparities and underscore the need for policy-level efforts to address the complex drivers of low-value care and equitably redistribute expenditures to services that enhance health.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"2 11","pages":"qxae133"},"PeriodicalIF":0.0,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11549685/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142635088","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

Learning from employer experiences with paid leave policy expansions during the COVID-19 pandemic. 从 COVID-19 大流行期间扩大带薪休假政策的雇主经验中学习。

Health affairs scholar Pub Date : 2024-10-21 eCollection Date: 2024-10-01 DOI: 10.1093/haschl/qxae122

William H Dow, Julia M Goodman, Paloma Lin, Paige Park

{"title":"Learning from employer experiences with paid leave policy expansions during the COVID-19 pandemic.","authors":"William H Dow, Julia M Goodman, Paloma Lin, Paige Park","doi":"10.1093/haschl/qxae122","DOIUrl":"10.1093/haschl/qxae122","url":null,"abstract":"The United States does not have a federal policy offering employees paid leave. We study employer attitudes toward the Families First Coronavirus Response Act (FFCRA) federal emergency paid leave policies temporarily adopted during the COVID-19 pandemic to draw lessons for proposed permanent federal paid leave policies. We analyzed a 2021 survey of 300 San Francisco Bay Area employers to examine employers' experiences with paid sick leave (PSL) and paid family leave (PFL) policies during the COVID-19 pandemic, along with their attitudes regarding FFCRA paid leave. Most firms reported that it was not difficult to comply with or seek reimbursement for FFCRA leave. Nevertheless, most smaller firms did report difficulty in understanding policy details, and many reported being unaware of FFCRA paid leave availability. FFCRA paid leave was broadly popular among firms aware of it: 64% supported (9% opposed) the PSL provisions, and 52% supported (12% opposed) PFL. However, support for permanent extension dropped to just over 40%, despite this Bay Area sample having long familiarity with California's state paid leave policies. We conclude that federal pandemic paid leave offers a potential model that could be refined for future paid leave policies, but support is mixed.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"2 10","pages":"qxae122"},"PeriodicalIF":0.0,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11493094/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484126","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