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.
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.
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.
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.
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?
Although the phenomenon of “surprise billing” has become common, no research has examined how consumers respond to surprise bills and alter their health-seeking behavior. In our new study in Health Affairs, we investigate how mothers respond to receiving a surprise medical bill after delivering their first child. Those who received a surprise out-of-network bill for their first delivery had 13% greater odds of switching hospitals for their second delivery compared to those who did not get a surprise bill.
After delivering a keynote at the recent Wharton Health Care Business conference, Centers for Medicare and Medicaid Services Administrator (CMS) Seema Verma sat down with a group of LDI Senior Fellows to discuss current federal initiatives, understand relevant research and research gaps, and exchange ideas.
As the use of artificial intelligence (AI) in the form of machine learning and algorithms in health care increases, an unanswered question looms large: How should policymakers regulate AI? A new article from LDI Associate Fellow Ravi Parikh, Ziad Obermeyer, and LDI Senior Fellow Amol Navathe is a useful place to start. Writing in Science, they demystify and de-mythologize machine learning and AI and suggest some practical guidelines for regulating the rise of machine learning.
The Camden Coalition of Healthcare Providers (of hotspotting fame) has published some intriguing findings from a city-wide program to reduce rehospitalizations by linking hospitalized Medicaid patients to primary care follow-up within seven days of discharge. Patients who had a primary care appointment within seven days had reduced readmissions at both 30 and 90 days.
The durability and vulnerability of the Affordable Care Act (ACA) was on full display last year amidst the Administration’s efforts to undermine it, according to LDI Senior Fellow and law professor Allison Hoffman. In the Journal of Law, Medicine, and Ethics, she makes the case that recent experience demonstrates the shortcomings of market-based health policy and draws insights for future health reforms