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.
Medicare’s nationwide Quality Payment Program (QPP) aims to reward or penalize clinicians through reimbursement adjustments based on the value of care. The QPP offers two participation options – the Merit-Based Incentive Payment System (MIPS) track and the Advanced Alternative Payment Models (AAPM) track – that seek to shift clinicians and organizations towards value-based payments but differ with respect to program rules and requirements, financial risk, and organizational strategy. In this post, we aim to explain key features of MIPS scoring and how they could create sizeable differences between expected and actual payment adjustments.
We know that high deductibles have a significant effect on spending levels, but do they affect spending growth? In a recent National Bureau of Economic Research (NBER) working paper, LDI Associate Fellow Molly Frean and LDI Senior Fellow Mark Pauly found that spending growth was significantly lower in states where privately insured employees have higher deductibles. The authors analyzed state-specific data on deductibles and various categories of health care spending over 15 years (2002-2016), during which deductibles more than tripled in magnitude and spending growth exceeded 40%.
Just as Medicare launched its new voluntary bundled payment program, LDI Senior Fellows Amol Navathe, MD, PhD, and Ezekiel Emanuel, MD, PhD, hosted a forum in Washington, DC to discuss current evidence and best practices around payment transformation. The forum, Moving Forward with Bundled Payments, brought policymakers, policy advocates, researchers, health insurers, and health system leaders together to learn from each other’s experiences in implementing new payment models.
Novel gene and cell therapies hold out the promise of a cure for previously incurable conditions, often at eye-popping prices. Last month, more than 75 health policy and biomedical researchers, federal and state regulators, and clinicians convened at the Cost of a Cure Conference at the University of Pennsylvania to discuss key political, economic, and clinical challenges to the future of gene and cell therapies. The conference was hosted by the Leonard Davis Institute of Health Economics, the Penn Medicine Abramson Cancer Center, and the Penn Center for Cancer Care Innovation.
Following Medicaid expansion in Pennsylvania in 2015, more than one in five non-elderly adults in Philadelphia are now covered by Medicaid. This population faces unique challenges with accessing primary care, including fewer providers accepting Medicaid patients. On October 23rd, Philadelphia’s Department of Public Health released a report on access to primary care, which includes a specific look at the city’s Medicaid population. Our team contributed data and analyses to this report.
Recognizing that nations with strong primary care systems achieve better health outcomes, we have made important gains in the U.S. pediatric primary care over the past 10 years. In fact, primary care pediatricians are delivering more care to more children and adolescents than ever before. Importantly, we are not just providing more care, but improving access for minorities and impoverished children and addressing a growing range of complex chronic conditions and social problems, such as adverse childhood experiences. Even with these advances, we need continued innovation in pediatric primary care to deliver the best possible outcomes to children.
On September 13 and 14, 2018, more than 80 senior policymakers, researchers, and state health insurance exchange administrators and insurance commissioners gathered at the University of Pennsylvania Law School for the Sixth Annual Health Insurance Exchange Conference. Jointly hosted by Penn Law, Penn LDI, and Princeton University's Center for Health and Wellbeing, this year’s event focused on how states are pursuing different paths for the individual insurance market, from stabilization to segmentation to expansion. A number of key themes emerged from the two-day nonpartisan, off-the-record workshop.
Despite little evidence, some commentators and policymakers have argued that Medicaid expansion has fueled the opioid epidemic by increasing access to prescription opioids. But a growing number of studies refute this theory, and instead suggest that Medicaid expansion reduces mortality from drug overdoses and increases access to drug treatment.
Conflicts between clinicians and police are not uncommon. Emergency departments are arguably an epicenter of opportunity for this kind of conflict. It is in these clinical settings that intersections between health care and law enforcement activities are most frequent, for example, when police respond to medical emergencies or seek information to inform emerging criminal investigations. The challenge of these interactions is that clinicians and police have distinct professional priorities, and there is notable ambiguity in how best to interpret guiding policy and ethics.
A recent study in Health Affairs by CHERISH Research Affiliate Dr. Yuhua Bao and CHERISH investigators Dr. Zachary Meisel and Dr. Bruce Schackman examined the impact of prescription drug monitoring program policies on high-risk opioid prescriptions. They found that comprehensive use mandates requiring physician use of the PDMP were associated with a 9.2% reduction in the probability of overlapping opioid prescriptions, a 6.6% reduction in the probability of having three or more prescribers, and an 8% reduction in the probability of having overlapping opioid and benzodiazepine prescriptions.
In a new article in Health Care Management Review, LDI Senior Fellow Lawton R. Burns and colleagues examine how the structure of physician-hospital relationships--medical staff model, employment, and alliances--affects physician alignment and engagement with the hospital.
In a study in Geriatrics, my colleagues and I measured illness representation in nearly 200 outpatients with heart failure, kidney disease, and chronic obstructive pulmonary disease (COPD). We used their responses to create three distinct group “profiles” that reflect different perceptions of illness, self-care ability, and responses to hospitalizations.