Last week LDI hosted a day-long conference on Medicare for All & Beyond. Our goal was to participate in one of today’s most pressing conversations in health care—how to expand health insurance to the 28 million people in the United States who are currently uninsured. We welcomed close to 300 people from across the spectrum to participate in this conversation, to consider the critical questions underlying today’s debate, and to look in depth at the challenges we face in expanding insurance coverage in our country. The conference gave us all plenty to mull over.
In the longest and largest study to date, hospital participation in Medicare’s bundled payments program for four medical conditions was associated with a 1-2% savings over three years, with no change in mortality. The savings were primarily achieved through reduced spending on skilled nursing care and greater spending on home health in the 90 days after hospital admission for acute myocardial infarction, congestive heart failure, chronic obstructive pulmonary disease, or pneumonia.
In October 2018, the Centers for Medicare & Medicaid Services (CMS) launched the Bundled Payments for Care Improvement Advanced (BPCI Advanced) program to continue expanding bundled payments nationwide. Participating hospitals and physician group practices are eligible for financial incentives if they meet quality and cost benchmarks for 90-day episodes beginning with either a hospital admission or an outpatient procedure. In a previous post and article, we described the 832 hospitals that began participating in October 2018.
Each year there are approximately 400,000 children in the child welfare system in the United States. Children in foster care represent a critically vulnerable population. Nothing illustrates this more than findings from our recent JAMA Pediatrics study, through which we found that children in foster care were 42% more likely to die compared to children in the general population and the difference has increased over time.
A new study suggests that hospitals, payers, and patients might learn something useful about the quality of skilled nursing facilities (SNFs) by checking online Yelp reviews. These reviews could provide important information beyond publicly reported ratings to inform decisions about postacute care.
In response to the coronavirus pandemic, almost every U.S. state has imposed lockdown orders. But as some states begin to relax their lockdown orders, policymakers need to consider both how reopening affects the economy and how it affects public health. To date, there’s been very little interdisciplinary work quantifying this tradeoff between economic and epidemiological outcomes. We at the Penn Wharton Budget Model are rolling out a new analysis to inform policymakers of these tradeoffs. Our integrated model captures both sides of the economic-public health equation for each state, as well as the nation as a whole. Here are 5 key takeaways our analysis.
An opioid overdose is significantly more than an isolated event. Patients who present to the emergency department (ED) with overdose have a 6 percent risk of dying in the following year. As with other high-risk acute conditions, we expect patients who survive overdose to receive evidence-based treatment after leaving the hospital. Whether the overdose was due to prescription opioids or injection drugs, the first occurrence or recurrent, in people with diagnosed opioid use disorder (OUD) or not - we know that timely follow-up care can save lives. But our recent national study showed that just 16% of privately insured patients obtain that essential care.
To address the global health crisis of COVID-19 and its effects on the practice of oral and maxillofacial surgery (OMS), Penn Dental Medicine held a virtual OMS COVID-19 Response Conference on April 9, 2020. The event, organized by Drs. Anh Le and Neeraj Panchal of Penn OMS, featured leading oral and maxillofacial surgeons and administrators from multiple institutions discussing how COVID-19 has transformed the specialty. We recently published proceedings from the conference in the Journal of Oral and Maxillofacial Surgery.
Some states, mostly in the south and Midwest, have been gingerly moving toward reopening restaurants with sit-down dining. You would be separated from other tables (no more din) and your server will look creepy with a mask, but at least you will be able to get out of your home and have someone else cook and wait on you. There has of course been considerable controversy over whether relaxing government rules to permit this activity is safe, and many states, such as Pennsylvania, are not there yet statewide and will change by county if they do. What is the solution to the problem when some people want to emerge from lockdown even though they might infect others? (reposted from the Philadelphia Inquirer)
As we speak, researchers are studying the efficacy of various state interventions in response to the Covid-19 pandemic. How different would deaths have been in New York if only schools were closed, while the rest of the economy remained open? How different would hospitalizations have been had California not locked down? These questions are inherently causal, as they require a comparison of outcomes across “alternate realities” where everything but the policy intervention remains the same. Given that hopping between parallel universes is impossible (for now), statistical methods – such as matching, regression adjustment, inverse-probability weighting, difference-in-differences, and instrumental variables – rely on important assumptions. For instance, all causal methods rely on ignorability assumptions. Ignorability requires that after adjusting for various observed differences at, say, the state level, some other state that did not lock down is “comparable” to California. This allows us to estimate a counterfactual hospitalization rate that would have occurred in absence of lockdown using data from this comparable state.
Accountable care organizations (ACOs) are the largest experiment in payment reforms, but the incentive structure may lead participating physician groups to select fewer vulnerable patients. In a new study in JAMA Network Open, my colleagues and I tested whether physician groups changed their proportions of black patients and patients with low socioeconomic status after joining the Medicare ACO, and found that – in general – they did not. These results are reassuring, although continued monitoring is needed.
In the wake of apandemic that has decimated many hospitals’ budgets, many industry insiders foresee a spike in mergers and acquisitions, in both the for-profit and nonprofit sector. How should anti-trust regulators weigh the costs and benefits of this consolidation for consumers? A recent study by Guy David and colleagues suggests that profit status should not be a factor in regulatory decisions.