Health affairs scholar最新文献_第9页

Changes in institution for mental diseases (IMD) ownership status and insurance acceptance over time. 精神病院（IMD）所有权状况和保险接受程度随时间的变化。

Health affairs scholar Pub Date : 2024-01-16 eCollection Date: 2024-01-01 DOI: 10.1093/haschl/qxad089

Mara A G Hollander, Alexandra Patton, Morgan C Shields

{"title":"Changes in institution for mental diseases (IMD) ownership status and insurance acceptance over time.","authors":"Mara A G Hollander, Alexandra Patton, Morgan C Shields","doi":"10.1093/haschl/qxad089","DOIUrl":"10.1093/haschl/qxad089","url":null,"abstract":"<p><p>State Medicaid programs are prohibited from using federal dollars to pay institutions for mental diseases (IMDs)-freestanding psychiatric facilities with more than 16 beds. Increasingly, regulatory mechanisms have made payment of treatment in these settings substantially more feasible. This study evaluates if changing financial incentives are associated with increases in for-profit ownership among IMD facilities relative to non-IMD facilities, as well as greater increases in Medicaid acceptance among for-profit IMD facilities relative to for-profit non-IMD facilities. We used data from the 2014-2020 National Mental Health Services Surveys and examined 11 945 facility-years. Relative to non-IMDs, the increase in for-profit ownership among IMDs was 6.6 percentage points greater. The largest proportional change in Medicaid acceptance occurred among for-profit IMD facilities relative to for-profit non-IMDs (18.5 percentage points). Existing research is mixed on the quality of inpatient and residential psychiatric care provided in for-profit vs nonprofit and public facilities, as well as in IMD relative to non-IMD facilities. As payment policy increasingly incentivizes for-profit facilities to enter the psychiatric care space, we should be mindful of the impact of these decisions on patient safety.</p>","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10790904/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139486414","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

Telehealth Use During the Early COVID-19 Public Health Emergency and Subsequent Health Care Costs and Utilization COVID-19 公共卫生突发事件早期的远程医疗使用情况及其后的医疗成本和使用情况

Health affairs scholar Pub Date : 2024-01-16 DOI: 10.1093/haschl/qxae001

Jun Soo Lee, Ami Bhatt, Lisa M Pollack, Sandra L. Jackson, Ji Eun Chang, Xin Tong, Feijun Luo

{"title":"Telehealth Use During the Early COVID-19 Public Health Emergency and Subsequent Health Care Costs and Utilization","authors":"Jun Soo Lee, Ami Bhatt, Lisa M Pollack, Sandra L. Jackson, Ji Eun Chang, Xin Tong, Feijun Luo","doi":"10.1093/haschl/qxae001","DOIUrl":"https://doi.org/10.1093/haschl/qxae001","url":null,"abstract":"\u0000 Telehealth utilization increased during the COVID-19 pandemic, yet few studies have documented associations of telehealth use with subsequent medical costs and health care utilization. We examined associations of telehealth use during the early COVID-19 public health emergency (March–June 2020) with subsequent total medical costs and health care utilization among people with heart disease (HD). We created a longitudinal cohort of individuals with HD using MarketScan Commercial Claims data (2018–2022). We used difference-in-difference methodology adjusting for patients’ characteristics, comorbidities, COVID-19 infection status, and number of in-person visits. We found that using telehealth during the stay-at-home order period was associated with a reduction in total medical costs (by -$1814 per person), number of emergency department visits (by -88.6 per 1,000 persons), and inpatient admissions (by -32.4 per 1,000 persons). Telehealth use increased per-person per-year pharmacy prescription claims (by 0.514) and average number of days’ drug supply (by.773 days). These associated benefits of telehealth use can inform decision makers, insurance companies, and health care professionals, especially in the context of disrupted health care access.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139528304","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}

引用次数: 0

Factors affecting ACOs’ decisions to remain in or exit the Medicare Shared Savings Program following Pathways to Success 影响 ACO 在 "通往成功之路 "之后决定继续参与或退出 "医疗保险共同储蓄计划 "的因素

Health affairs scholar Pub Date : 2024-01-05 DOI: 10.1093/haschl/qxad093

Meiling Ying, Jane H Forman, Sitara Murali, Lauren E Gauntlett, Sarah L Krein, Brent K Hollenbeck, John M Hollingsworth

{"title":"Factors affecting ACOs’ decisions to remain in or exit the Medicare Shared Savings Program following Pathways to Success","authors":"Meiling Ying, Jane H Forman, Sitara Murali, Lauren E Gauntlett, Sarah L Krein, Brent K Hollenbeck, John M Hollingsworth","doi":"10.1093/haschl/qxad093","DOIUrl":"https://doi.org/10.1093/haschl/qxad093","url":null,"abstract":"\u0000 The Medicare Shared Savings Program (MSSP) is an alternative payment model launched in 2012, creating accountable care organizations (ACOs) to improve quality and lower costs for Traditional Medicare patients. Most MSSP participants were expected to shift from bearing no financial risk to a two-sided risk model (i.e., bonus if spending reduced below historical benchmarks, penalty if not), yet fewer than 20% did. Therefore, in 2019 the Centers for Medicare and Medicaid Services (CMS) launched the Pathways to Success program, which required shifting to a two-sided model within 12 months. For the first time, more ACOs exited than entered the MSSP. To understand these participation decisions, we conducted qualitative interviews with ACO leaders. Pathways caused ACOs to: reassess their potential shared savings versus losses, particularly in light of benchmarking methodology changes, reconsider perceived non-revenue benefits, and reassess participation in the MSSP vs. other programs. As ACOs, particularly those assuming downside risk, have contained costs and enhanced care quality, policymakers should strive to improve MSSP enrollment rates in downside-risk models through strategies that allow ACOs to achieve shared-savings and deliver accountable care.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139383925","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}

引用次数: 0

Programmatic Quality Measures: A new model to promote surgical quality 计划性质量措施：提高手术质量的新模式

Health affairs scholar Pub Date : 2024-01-03 DOI: 10.1093/haschl/qxad094

Xane Peters, Jill Sage, Courtney Collins, Frank Opelka, Clifford Ko

{"title":"Programmatic Quality Measures: A new model to promote surgical quality","authors":"Xane Peters, Jill Sage, Courtney Collins, Frank Opelka, Clifford Ko","doi":"10.1093/haschl/qxad094","DOIUrl":"https://doi.org/10.1093/haschl/qxad094","url":null,"abstract":"\u0000 Healthcare performance metrics are offered predominantly in terms of outcomes, processes, or structural components of healthcare delivery. However, measurement is limited by variability in data sources, definitions, and workarounds. The American College of Surgeons has recently developed a new type of performance metric known as a programmatic measure. These metrics align structures, processes, and outcomes to better coordinate quality measurement with support of frontline care teams. In this multifaceted way, these measures differ from current ‘single’ measures such as targeting surgical site infection (SSI). The thematic focus of these measures and alignment of structure-resource components to support processes and outcomes also sets these measures apart from contemporary composite measures. Importantly, structural elements of these measures reflect minimum resources required for patient care, addressing staffing and resource barriers felt by local institutions in addressing numerous existing quality metrics. These metrics will streamline quality reporting to improve care navigation for patients. Clinicians will find more appropriately aligned goals and responsibilities, resulting in increased teamwork and communication. These measures are designed to address the current burdens of overabundant metrics, priority misalignment, and low resources in a patient centric fashion to better align healthcare quality and measurement.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139389651","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}

引用次数: 0

Six months, strong impact. 六个月，影响巨大。

Health affairs scholar Pub Date : 2024-01-03 eCollection Date: 2024-01-01 DOI: 10.1093/haschl/qxad087

Kathryn A Phillips

引用次数: 0

The association of safety net program participation with government perceptions, welfare stigma, and discrimination 安全网计划的参与与政府观念、福利耻辱感和歧视的关系

Health affairs scholar Pub Date : 2023-12-21 DOI: 10.1093/haschl/qxad084

Richard Pulvera, Kaitlyn Jackson, Wendi Gosliner, Rita Hamad, Lia Fernald

{"title":"The association of safety net program participation with government perceptions, welfare stigma, and discrimination","authors":"Richard Pulvera, Kaitlyn Jackson, Wendi Gosliner, Rita Hamad, Lia Fernald","doi":"10.1093/haschl/qxad084","DOIUrl":"https://doi.org/10.1093/haschl/qxad084","url":null,"abstract":"\u0000 Safety net programs in the United States offered critical support to counter food insecurity and poverty during the first year of the COVID-19 pandemic. The Supplemental Nutrition Assistance Program (SNAP) and the Earned Income Tax Credit (EITC) are both means-tested programs with significant benefits. Take-up of SNAP and EITC is lower in California than nationwide and reasons for this difference are unclear. We examined associations of participation in SNAP and receipt of the EITC and perceptions of the US government, two types of welfare stigma (program stigma and social stigma), and perceived discrimination. We interviewed a sample of 497 caregivers of young children from families with low income in California between August 2020 and May 2021. We found that participation in SNAP (OR = 1.24 [1.05, 1.47]) and receiving the EITC (OR = 1.39 [1.05, 1.84]) were both associated with greater reported perceptions of social stigma, but not with perceptions of government, program stigma, or discrimination. Among food insecure respondents, we found that participation in SNAP was additionally associated with program stigma and discrimination. These findings suggest that perceived social stigma may be a reason that people with low income may not participate in programs for which they are eligible.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138950377","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}

引用次数: 0

Hospital Use of Common Z-Codes for Medicare Fee-for-Service Beneficiaries 2017-2021 2017-2021 年医疗保险付费服务受益人常用 Z 编码的医院使用情况

Health affairs scholar Pub Date : 2023-12-14 DOI: 10.1093/haschl/qxad086

Ji E Chang, Nate Smith, Zoe Lindenfeld, William B Weeks

引用次数: 0

What is a star worth to Medicare beneficiaries? A discrete choice experiment of hospital quality ratings 对于医疗保险受益人来说，一颗星值多少钱？医院质量评级的离散选择实验

Health affairs scholar Pub Date : 2023-12-12 DOI: 10.1093/haschl/qxad085

L. Trenaman, Mark Harrison, Jeffrey S Hoch

{"title":"What is a star worth to Medicare beneficiaries? A discrete choice experiment of hospital quality ratings","authors":"L. Trenaman, Mark Harrison, Jeffrey S Hoch","doi":"10.1093/haschl/qxad085","DOIUrl":"https://doi.org/10.1093/haschl/qxad085","url":null,"abstract":"\u0000 Hospital quality ratings are widely available to help Medicare beneficiaries make an informed choice about where to receive care. However, how beneficiaries trade-off between different quality domains (clinical outcomes, patient experience, safety, efficiency) and other considerations (out of pocket cost, travel distance) is not well understood. We sought to study how beneficiaries make trade-offs when choosing a hypothetical hospital. We administered an online survey that included a discrete choice experiment to a nationally representative sample of one thousand and twenty-five Medicare beneficiaries. On average, beneficiaries were willing to pay $1,698 more for a hospital with a one-star higher rating on clinical outcomes. This was over twice the value of the patient experience ($691) and safety domains ($615) and nearly eight times the value of the efficiency domain ($218). We also found that the value of a one-star improvement depends not only on the quality domain, but also the baseline level of performance of the hospital. Generally, it is more valuable for low performing hospitals to achieve average performance than for average hospitals to achieve excellence.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139008550","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}

引用次数: 0

Interpreting 340B Contract Pharmacy Growth: Who really benefits? 解读 340B 合同药房的增长：谁能真正受益？

Health affairs scholar Pub Date : 2023-12-09 DOI: 10.1093/haschl/qxad076

T. J. Mattingly II

引用次数: 0

340B Contract Pharmacy Growth by Pharmacy Ownership: 2009-2022 按药房所有权划分的 340B 合同药房增长情况：2009-2022 年

Health affairs scholar Pub Date : 2023-12-09 DOI: 10.1093/haschl/qxad075

Claire McGlave, John P Bruno, Elizabeth Watts, S. Nikpay

引用次数: 0