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.
LDI Senior Fellows Zack Meisel, Benjamin Sun, and colleagues have a striking and sobering chart in a recent Annals of Emergency Medicine article on initial opioid prescriptions in the emergency department. They tracked how many “opioid-naïve” patients (i.e., those without a record of opioid use in the previous year) had persistent or high-risk opioid prescription use in the subsequent year.
[cross posted from the PolicyLab blog] In 2016, my colleagues and I found that parents with employer-sponsored insurance (ESI) were increasingly turning to public insurance to cover their kids through Medicaid and the Children’s Health Insurance Program (CHIP)—and we wanted to learn more. What about where parents worked? We conducted a national study, published in Health Affairs, of working families and looked at their employers. We also looked at income levels, including families in the study who were making more than 100% of the federal poverty level (FPL). What we saw was a concrete shift in how working families were insuring their children, and that they were more dependent on Medicaid and CHIP than ever before.
Hospitals designated as non-profits received tax-benefits valued at over $24 billion annually in 2011. Non-profit hospitals justify their tax-exempt status by providing “community benefits” in the form of free and subsidized care, investments in public health, and community-based initiatives intended to address the social determinants of health, such as food or housing insecurity. Whether non-profit hospitals truly benefit their communities has been dogged by controversy and calls for reform. Many observers assert that hospitals avoid making sustained community investments in favor of counting millions of dollars of “discounts” to low-income patients as community benefits while aggressively pursuing unpaid bills.Two recent papers by LDI Senior Fellows Krisda Chaiyachati and Rachel Werner provide new data to inform the debate: detailed estimates of how much hospitals spend on different types of community benefits, whether community benefits are matched to local need, and what impacts community benefits have on health outcomes.
A voluntary UnitedHealthcare program to reduce oncologists’ financial incentives to prescribe brand-name anticancer drugs failed to increase prescribing of generic equivalents. This could be an early warning sign about the limitations of voluntary payment reforms, according to a new study by Laura Yasaitis, Atul Gupta, Justin Bekelman, and colleagues in Health Affairs.
Add this to the expanding list of the benefits of the ACA’s Medicaid expansion. In JAMA Cardiology, a new study by LDI Associate Fellow Sameed Khatana and colleagues finds that Medicaid expansion was associated with lower cardiovascular mortality in adults aged 45-64.
“Medications for opioid use disorder saves lives.” That’s the title and conclusion of a recent report by the National Academies of Sciences, Engineering and Medicine, based on a review of the scientific evidence. In a new study in Drug and Alcohol Dependence, CHERISH investigators Jake Morgan, Bruce Schackman and Benjamin Linas add to this evidence base by examining the real-world effectiveness of medications in preventing overdoses once treatment for opioid use disorder has begun.
If I needed a cardiac procedure, I might look for a hospital designated as a cardiac “center of excellence” (COE) by my insurer. I might assume that the hospital delivers higher quality care and achieves better outcomes than other hospitals. But that assumption might be wrong, according to a new study by LDI Associate Fellow Sameed Khatana and colleagues in JAMA Internal Medicine.
JUUL recently launched a new ad campaign made for adults, which encourages adult smokers to “Make the Switch,” as JUUL was designed with smokers in mind. This is just the latest effort by JUUL to try to convince policymakers, health professionals and anti-smoking advocates that their product is for adults, rather than for the millions of teens across the country who have become addicted to the tobacco device. And yet, new research from Stanford University has confirmed what many have accused the company of doing for years: JUUL intentionally targeted and marketed their products to teens.
An important, yet often overlooked aspect of comprehensive health care for a “graying” U.S. population is dental health. In a new commentary, Tim Wang, Mark Wolff, and Neeraj Panchal bring attention to the oral health needs of a growing geriatric population in the U.S., and suggest practical ways to prepare providers to meet the challenge of treating this unique group.
At first glance, it appears that the new Veterans Affairs (VA) Center for Innovation for Care and Payment shares much in common with the Center for Medicare and Medicaid Innovation (CMMI). Both are charged with implementing payment and care models that address rising costs, while maintaining or improving quality of care. But Adjunct Senior Fellow Liao and colleagues point out that the new VA Center will (and should) have different priorities, test different models of payment, and target different clinical conditions than those implemented by CMMI.
Public reporting of cardiovascular outcomes remains controversial, 20 years after New York became the first state to mandate reporting of mortality data for percutaneous coronary intervention (PCI). It has been associated with a lower likelihood of performing potentially lifesaving procedures, perhaps reflecting an avoidance of intervening in high-risk cases. It’s possible that public reporting may also impact decisions to perform nonreported but related cardiovascular procedures. In a new study, my colleagues and I looked at how public reporting of PCI outcomes influenced the decision to provide out-of-hospital cardiac arrest (OHCA) patients with a coronary angiography.