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.
With the ongoing measles outbreak in Washington, there has been increasing national attention to real-life consequences of vaccine-preventable diseases and vaccine hesitancy. Most of cases in this recent outbreak have been among unvaccinated individuals and children between the ages of 1 and 10 years. In the first month of 2019, the US has already seen 101 measles cases, on pace to exceed the 372 cases in 2018 and 120 cases in 2017. Studies have shown that states that have more lenient immunization laws generally have higher nonmedical exemption and disease rates compared to states with stricter exemption laws.
A new study from LDI Senior Fellow Abby Alpert (Wharton), David Powell (RAND), and Rosalie Pacula (RAND) links OxyContin reformulation to a national epidemic of hepatitis C, which kills more than 20,000 Americans a year and infects tens of thousands more.
Should providers participating in accountable care organizations (ACOs) be exempt from existing regulations that prevent financial conflicts of interest in physician referrals? On the one hand, these regulations, collectively known as the Stark Law, can impede efforts to coordinate care across providers and facilities. On the other hand, ACOs and other alternative payment and delivery models do not necessarily obviate the need for regulations that prohibit physician kickbacks or self-referrals. In a New England Journal of Medicine Perspective, Genevieve Kanter and Mark Pauly argue that exemptions are not the answer to the tension between ACOs and conflict-of-interest laws. Instead, they call for a reevaluation of both care coordination efforts and the Stark law.
Payment for research participation can raise ethical concerns and legal issues. But it can also raise scientific problems if it causes participants to lie about their eligibility or other things, like adverse events. In our new study in JAMA Network Open, my colleagues and I wanted to see whether payment causes deception about study eligibility, and if so, whether more payment results in more deception. We found the answer to the first question was yes – but contrary to what one might expect, payment amount didn’t matter.
E-cigarettes have exploded in popularity among teens over the last decade, making them the most common tobacco product used by youth. According to 2018 data, 1 in 5 high school students and 1 in 20 middle school students currently use e-cigarettes, a 75 percent increase from 2017. In order to look more closely at what the U.S. Surgeon General has deemed an “epidemic,” I worked alongside my colleagues as part of the American Academy of Pediatrics’ (AAP) Section on Tobacco Control to draft a new policy statement, “E-Cigarettes and Similar Devices,” summarizing the latest evidence on the health harms of e-cigarettes and supporting both clinical interventions for pediatricians and policy strategies to protect youth from the dangers of e-cigarette use.
Health system reforms, such as value-based payment, can worsen or improve existing health care disparities, even if policy changes do not target the disparities themselves. A new study by Rachel Werner, Genevieve Kanter, and Daniel Polsky adds to our understanding of how Medicare’s accountable care organizations (ACOs) interact with existing disparities, and its findings are reassuring.
Late last year, the Centers for Disease Control and Prevention (CDC) announced that more than 70,000 people died from drug overdoses in 2017, a 9.6% increase from 2016. Deaths continue to soar, even as states and health systems implement policies to curb the overprescribing of opioids that led to the epidemic in the first place. It’s hard not to be discouraged by these numbers and our failure to reduce overdose deaths. To fully appreciate the shifting dynamics of the opioid crisis, we need to understand both the nature of the policies we are implementing as well as their likely short- and long-term effects.
Why do studies on the same topic reach different conclusions? In my course on health care research methods, we explore the different choices made along the way and how they lead to different results. Recently, studies have reached different conclusions about the impact on mortality of Medicare’s Hospital Readmissions Reduction Program [see box]—and one of those papers is mine. As I prepare for teaching, I’ve made some notes that I thought I’d share.
2018 was a year that defies easy categorization. In health policy, deep cynicism and hyperpartisanship often made evidence seem almost passé, a quaint paean to a time when research and data might contribute to thoughtful national debate. But if you listened closely, you also heard not-so-faint rumblings of a desire to get past slogans and bitter divides, to find areas of common ground, and to use evidence to improve health and health care, even if only incrementally. In 2018, people flocked to LDI in record numbers, with more than 550,000 page views on our web site. Our most popular content reflects this yin and yang of cynicism and hopefulness. If eyes (clicks) on the page are any indication, readers looked to LDI for straight talk about what is possible and likely in our present policy environment. Here we present our Top 10 reads of 2018.
One key strategy in reducing deaths from the opioid epidemic is to improve access to existing evidence-based treatments. Two new economic studies by CHERISH Investigators Drs. Sean Murphy, Kathryn McCollister, and Bruce Schackman can help providers, patients, and payers sort through alternative pharmacotherapies to prevent opioid relapse.