Featured Post
July 16, 2019
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.
June 4, 2019
“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.
May 20, 2019
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.
May 17, 2019
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.
May 7, 2019
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.
April 26, 2019
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.
April 26, 2019
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.
April 12, 2019
The world of health care is divided into many areas of specialization. Not all of us realize that – in addition to specializing in organ systems or diseases – clinicians can devote their practice to providing general care to patients in a specific setting. A recent illustration of this concept is nursing homes specialists, or ‘SNFists,’ who focus on caring for patients in nursing homes (skilled nursing facilities).
[cross posted from the Health Affairs blog] Political debate over the Affordable Care Act has defined the health policy political landscape for nearly a decade. The impassioned back and forth over whether to “repeal and replace” or strengthen and defend the law has been a focus of multiple election cycles and millions of dollars in political ad spending. Amidst this ongoing discourse, it is easy to overlook the law’s important reforms to employer-sponsored insurance (ESI), which covers the majority of nonelderly Americans. The escalating costs faced by individuals and families with ESI have received far less attention than costs on the individual market or in public programs, but affordability concerns for this group are no less important.
March 25, 2019
Do residents need more sleep? Two new studies in the New England Journal of Medicine compare the effects of standard versus flexible duty-hours on residents’ sleep and patient safety.
March 14, 2019
A new study in BMJ Open led by LDI Senior Fellow Genevieve Kanter, in collaboration with colleagues Michelle Mello at Stanford, Daniel Carpenter at Harvard, and Lisa Lehmann at the Veterans Health Administration, finds that the Open Payments program has had little success in improving public awareness and knowledge of industry payments.
March 13, 2019
Every day, we hear about the staggering toll of the opioid overdose crisis. Despite effective medications for opioid use disorder, such as buprenorphine and methadone, few people receive treatment. The ongoing challenge is to expand access to these lifesaving treatments to people who need them the most. Emergency departments, which treat patients 24/7 and provide an entry point into the health system, are a promising place to start. With my colleagues Kit Delgado, Austin Kilaru, Jeanmarie Perrone, Zack Meisel, Jessica Hemmons, and Dina Abdel Rahman, I surveyed emergency medicine physicians in two Penn Medicine hospitals to understand the barriers and facilitators to starting buprenorphine in the emergency department.
March 6, 2019
It’s a policy decision with direct life-and-death consequences. Should naloxone, the prescription rescue medication that reverses the effects of an opioid overdose, be sold over the counter? As deaths from opioid overdoses continue to increase, consensus is building on the need to make life-saving naloxone more readily available. The question is, will selling naloxone over the counter (OTC) improve access, even if the out-of-pocket price for consumers goes up because some insurers will no longer cover it?