There’s something unusual happening on patients’ 20th day in skilled nursing facilities (SNFs). In a JAMA Interal Medicine study, Paula Chatterjee, Norma Coe, Rachel Werner, and colleagues found that more people were discharged on day 20 of their SNF benefit period than days 19 or 21, which reflects how Medicare pays for postacute care at a SNF. While the findings raise more questions than answers, they do demonstrate a higher discharge rate among vulnerable patients when Medicare stops paying on day 20.
A state prescription drug policy first adopted in 1939, and last ended in 2004, appears to have influenced where Purdue Pharma chose to market its opioid drug OxyContin upon launch in 1996. The consequences of that decision reverberate to this day, according to a new NBER paper by LDI Senior Fellow Abby Alpert and colleagues, who estimate that states with the prescription policy had 11.4 fewer overdose deaths per 100,000 people in 2017.
Americans pay about 14% of prescription drug costs out of pocket. Although there are exceptions in very high deductible plans, most of these payments are relatively modest compared to the incomes of middle-class people. In the New York Times, Aaron Carroll recently repeated the common criticism that such cost sharing is “often preventing people from getting necessary care.” So why do people end up with insurance that encourages them to ignore their doctors’ orders and fail to adhere to prescribed medications? Poor people are covered by Medicaid which has almost no cost sharing, so this is much more likely to be an issue for those who are not poor. Before blaming employers and bureaucrats, however, we should ask ourselves—what would we want?
What if someone told you that the nurse who would be your main caregiver throughout your labor routinely missed necessary nursing care activities, like comforting or teaching patients? In a recent study, my colleagues Eileen Lake, Sindhu Srinivas, Kathleen O’Rourke, Jordan Sanders and I found that half of nurses surveyed who worked in labor and delivery in 247 hospitals in four large U.S. states had missed one or more care activities on their last shift. Although labor and delivery nurses are the frontline providers during labor, hospital organizational factors often prevent them from having sufficient time or resources to provide the care that is needed.
[cross posted from the Health Cents blog on philly.com] Two models for redesigning our health insurance system both involve replacing private insurance and out-of-pocket payments with public insurance subsidized by tax collections. Whether the solution is Medicare for All (with no explicit premium or out-of-pocket payments) or a more heavily subsidized Medicare-like public option added to Obamacare, these plans promise the eventual replacement of all or a large part of current privately insured payments by public ones, immediately or sometime in the future.
“How long do I have?” It is the first question many patients ask after a cancer diagnosis. It is also among the hardest to answer. For decades, predicting cancer survival was more art than science. But now, unprecedented computing power and access to digital health information offer a tantalizing opportunity: can machine learning (ML) algorithms succeed where others fail? A new study from LDI Fellows Ravi Parikh, Christopher Manz, Amol Navathe, Mitesh Patel and colleagues tackles the question head on.
Outside of the brick and mortar walls of academic institutions – and conferences attended by researchers -- there is an invisible conversation happening. Academic Twitter, as it’s affectionately known, is a world unto itself. Yet, it turns out, there are ways in which it bears a striking resemblance to the familiar “old boys’ club.”
[cross-posted with the University of Pennsylvania Law School] In a new article, University of Pennsylvania Law School Professor Allison Hoffman elucidates a fundamental problem afflicting health care in the United States: policymakers’ stubborn reliance on market-based theories and increased consumer choice to resolve the high spending and relatively poor health outcomes that have become endemic to the system. In “Health Care’s Market Bureaucracy,” forthcoming in the UCLA Law Review, Hoffman closely examines the economic theories underlying market-based health care policies, the empirical evidence demonstrating how such policies have failed in practice, and the regulatory infrastructure that has grown in an attempt to mitigate those failures.
Policies have reformed the health care system so that millions of Americans are able to access health coverage. However, for many, health coverage does not always translate to access to health care. The health care safety net plays a key role in filling coverage gaps that the traditional insurance system creates and ensures that health care is accessible and affordable for those who are uninsured or have high-deductible or high cost-sharing plans that leave them unable to access care. A new brief by Penn LDI and US of Care examines opportunities for the safety-net post-health reform.
There’s good news and bad news. The good news is Medicare drug plans are increasing coverage of newer, better drugs to prevent blood clots in people at risk. The bad news is that coverage comes with significant strings attached, including higher patient copayments that could prevent access to the newer, better drugs.
Health systems and practices are increasingly testing new approaches to integrated care that optimize the use of personnel by incorporating interdisciplinary teams of advanced practitioners and other community stakeholders. A number of initiatives at Penn Medicine showcase this approach.
What if patients could access behavioral health care through a regular visit to a primary care office or during a hospital stay? This is the premise of integrated care, a promising strategy for addressing shortcomings in the traditional model of behavioral health care provision. Though the concept of integrated care isn’t new, changes in reimbursement are hastening its implementation.
[cross-posted from the CHERISH site] More than 100 policymakers, practitioners, and researchers discussed and debated how payment policy can promote evidence-based, cost-effective substance use disorder treatment, in a recent workshop hosted by the Center for Health Economics of Treatment Interventions for Substance Use Disorder, HCV and HIV (CHERISH) and the Leonard Davis Institute of Health Economics at the University of Pennsylvania. By design, the workshop was highly interactive with roundtable discussions among panelists and participants. The day-long event took stock of the many ongoing efforts, examined the evidence, and explored promising models to achieve value in substance use disorder treatment.