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.
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.
Families spend thousands of dollars per year on treatments for their children’s autism spectrum disorder (ASD). Forty-eight states have passed laws that require insurers to cover the longstanding gaps in insurance coverage for ASD treatment to help alleviate the financial burdens that many families face. Mandates have already been linked to an increase in total spending on ASD-specific services, which prompts the question: do mandates increase out-of-pocket (OOP) spending as well?
Everyone wants a dignified death – yet few actually experience one. Despite preferring to remain at home, most older adults spend their final days in hospitals, where they often undergo medical care that neither improves survival, quality of life, nor satisfaction and is often incongruent with their wishes and goals. A new study in the Journal of the American Geriatrics Society describes these problems in end of life care in nearly 500 U.S. hospitals, from the perspective of nearly 13,000 bedside nurses who work in them.
In a New England Journal of Medicine Perspective, the principal investigators of the independent academic team evaluating Kentucky’s 1115 Medicaid waiver, Kristen Underhill of Columbia University and Atheen Venkataramani and Kevin Volpp of the University of Pennsylvania, note that rigorous evaluations of untested policies, such as work requirements, are needed to produce meaningful evidence and yield useful lessons for Medicaid program design.
Medicaid, since 1966, has provided non-emergency transportation (NEMT) to medical appointments for free or at a heavily subsidized rate. Some state governments are seeking leeway to drop that benefit, because of persistent budget constraints and a view that NEMT is ineffective. In a recent article, LDI Senior Fellow Krisda Chaiyachati and colleagues argue such restrictions are premature and potential harmful. Instead, they call for a focus on evidence first.
At some point in our lives, each of us will need care, or be asked to provide or arrange care for a loved one. Historically, we have relied on unpaid or poorly paid labor, largely delivered by women and minorities, to fill these needs; however, current arrangements are neither fair nor feasible. To get the conversation started, I have organized After the Care Crisis, a conference and documentary screening at Penn that will convene academics, activists, and policymakers to discuss the current organization of domestic/care work and consider alternatives that both improve workers’ ability to make a living providing care, and access to care for those who need it.
In a recent post, we described nuances in MIPS scoring that can ultimately lead to discrepancies between frequently referenced and actual professional fee reimbursement adjustments. In this post, we describe the implications for clinician engagement in value-based payments.