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.
[cross-posted from the Health Affairs Blog] The push to discharge more patients directly home after hospitalization may seem preferable in some circumstances. In addition to being financially sensible by decreasing spending on postacute care, patients might prefer to be discharged home rather than to an institutional setting. In this way, getting patients home may represent a rare opportunity to align goals across patients, payers, and health systems. However, these gains must be viewed in the context of the costs borne by those who care for patients once they are discharged home—informal caregivers.
[cross posted from the Health Cents blog on philly.com]Perhaps you caught the recent two-page spread in the New York Times (August 13) in which health policy experts weighed in on what they thought should be part of the Democrats’ Medicare for All. Ignoring the fact that this speculation will only become relevant if the Democrats capture the presidency and a filibuster-proof majority in the Senate, (we can dream, can’t we?), what might you learn from reading this?
[cross-posted from the CHERISH site] In 2018, the state of Louisiana spent approximately $35 million to treat 1,000 individuals with chronic Hepatitis C Virus (HCV). Unfortunately, these 1,000 treated individuals comprise only about 1% of the state’s 90,000 individuals living with HCV, including about 39,000 covered by the state’s Medicaid program or prison system. Treating everyone would cost more than “the state spends on K-12 education, Veteran’s Affairs, and Corrections combined,” according to the Secretary of the Louisiana Department of Health, University of Pennsylvania Alumna Dr. Rebekah Gee, in an article for Health Affairs.
[cross posted from the Health Affairs Blog] On July 10, 2019, the Centers for Medicare and Medicaid Services (CMS) announced a proposal to test bundled payments for radiation oncology services for 17 types of cancer. Although it shares features with existing bundled payment programs, the Radiation Oncology (RO) Model is positioned to launch CMS payment policy forward with novel features aimed at curbing known inefficiencies in spending on radiation therapy.
Imagine being discharged from the hospital to a two-room apartment badly in need of repair. Your electricity has been cut off and you can barely remember the discharge instructions. You were told to see a specialist in a week, but it will take you 90 minutes one-way on public transportation to get there. Confused about follow-up and juggling the complexities of life, what do you do?
[cross posted from the Health Cents blog on philly.com] One of the few issues in health policy on which there is bipartisan agreement is that it would be nice to lower the prices for patented brand name drugs. It would be even nicer if this could be done without reducing the flow of profits to drug companies that incentivize them to invest in research on new and better products. One way the Trump administration seeks to pull off this trick is by focusing on other developed countries (think France) who, in the President’s opinion, are freeloading on American taxpayers and consumers. Secretary of Health and Human Services Alex Azar, provided the economics and political science for this outrage: “The American senior and the American patient have too long been asked to overpay for drugs to subsidize the socialist system of Europe.” If Europeans would just pay more, Americans would pay less, and justice would be served. But is this diagnosis correct, and what other remedies are available to us?
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.