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.
Biomedical advances in genomics and oncology, combined with rising costs for targeted cancer therapies, challenge the way we currently deliver and pay for cancer care. To foster the economic sustainability of targeted therapies, the University of Pennsylvania convened the Gant Family Precision Cancer Medicine Consortium, a multidisciplinary work group of experts from health care economics, policy, law, regulation, biomedical research, patient advocacy, and the pharmaceutical and insurance industry. Co-chaired by LDI Senior Fellows Justin Bekelman and Steven Joffe, the committee met regularly in 2016-2017 to identify ways to promote economically viable targeted cancer therapies. Dr. Bekelman and Joffe recently published their own conclusions in a JAMA viewpoint, and a new LDI report synthesizes the consortium’s discussions.
While Congressional efforts to repeal the Affordable Care Act (ACA) have stalled, the Administration has made many modifications to one of the law’s key creations: the health insurance exchanges, through which most people buying their own health insurance get coverage. The flurry of new information around the individual market paints a mixed picture of the outlook for 2019. On September 13 and 14, the University of Pennsylvania Law School, Penn LDI, and Princeton University's Center for Health and Wellbeing will host the Sixth Annual Health Insurance Exchange Conference to bring together senior state policymakers and researchers to discuss the latest research on the exchanges and current challenges.
Amidst an unprecedented opioid epidemic, two Congressional committees have led the federal legislative response to the crisis. In a new analysis in JAMA, Matthew McCoy and Genevieve Kanter find that a majority of members on these two committees received campaign contributions from political action committees associated with pharmaceutical manufacturers and distributors being investigated by state or federal officials for having contributed to the crisis.
If value-based payment models can work in Medicare, can they also work in Medicaid? Not without significant changes, according to LDI Senior Fellows Joshua Liao and Amol Navathe and colleague Benjamin Sommers in a NEJMPerspective. In Medicare’s predominant value-based payment models, such as bundled payments and accountable care organizations (ACOs), providers bear a certain amount of financial risk based on cost and quality targets. Liao and colleagues recommend ways to adapt these models to meet the needs of Medicaid’s socioeconomically vulnerable patients.
The opioid epidemic carries with it another epidemic, this one of infants born with neonatal abstinence syndrome (NAS), stemming from in utero exposure to opioids. NAS is characterized by withdrawal symptoms such as tremors, irritability, poor feeding, respiratory distress, and seizures. In a recent day-long course at Penn sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA), health professionals came together to learn how to screen for, diagnose, and treat pregnant women with opioid use disorder (OUD) and their infants with NAS.
There has been considerable consumer and policymaker concern about the rising prices of some prescription drugs, from the thousands-percent increases in the price of generics like Turing Pharmaceuticals’ Daraprim to the average 8.8% increase by Pfizer for a large sample of its brand name drugs. Attributing price increases to a toxic mix of corporate welfare in the form of government-enforced protection for products and unmitigated greed by the stockholders of brand name drug firms (including many of us) misses an important question whose answer has been little studied. What is the cause of each price increase?
In a recent Scattergood Foundation report, LDI Senior Fellow Dominic Sisti and I tackle the curious case of the “institutions for mental diseases” (IMD) exclusion in Medicaid. For non-elderly adults, the national IMD exclusion prevents Medicaid from paying for inpatient care in institutions with more than 16 beds that primarily provide care for persons with “mental diseases” other than dementia or intellectual disabilities. In the wake of the opioid epidemic, mass incarceration, and shortages of behavioral health care capacity, the IMD exclusion has come under renewed scrutiny.
The Centers for Medicare and Medicaid Services has rolled out a number of bundled payment programs in the hopes that they will help to control costs and improve coordination and quality of care. A focus of these programs is the care delivered by skilled nursing facilities (SNFs) – a post-acute care setting that currently accounts for a significant portion of cost variation and spending in Medicare. In a new paper published in Health Affairs, we conducted semi-structured interviews of administrators and executives in 22 hospitals and health systems across 10 markets to understand how hospitals are thinking about SNF care for lower extremity joint replacement patients.
As the country faces an unprecedented opioid epidemic, there’s an active national conversation about how inappropriate prescribing contributes to chronic opioid use, misuse, and addiction. Evidence is rapidly evolving to inform the policy debate, especially regarding best practices for prescribing in acutely painful conditions, like an injury or surgery, but the evidence is less clear on the best policy solutions. Two new publications by LDI Fellows highlight issues around opioid ‘overprescribing’ and efforts to curb it.
In a recent study in Health Affairs, we compare the scope of primary care physician participation in the Marketplace with employer-sponsored insurance (ESI) and Medicaid. We assessed the in-network rate, which measures the share of physicians that accepted at least one insurance plan, and the appointment availability rate, which measures the rate of in-network offices that successfully scheduled new patient appointments with simulated patients. Across our ten-state sample, we found a clear pattern of access across insurance types: in-network rates and appointment availability rates for Marketplace plans fell between employer-sponsored insurance and Medicaid.
In a study in Health Affairs, LDI Senior Fellow Joshua Liaoand colleagues report on what physicians think about Medicare’s new payment program, the Merit-based Incentive Payment System (MIPS). The authors found that in the first year, few physicians reported being familiar with the new payment policy designed to shift compensation from volume to value, and when informed, nearly 60 percent believed it would reduce or have no effect on the value of care.
In two new papers, "The Economics of Patient-Centered Care" in the Journal of Health Economics and “The Impact of Patient-Centered Medical Homes on Medication Adherence” forthcoming in Health Economics, LDI Senior Fellow Guy David and coauthors untangle the complexities of patient-centered medical homes, demonstrating that the PCMH model is implemented differently across practices. In the first paper, David and coauthors Philip Saynisch and Aaron Smith-McLallen show how these differences drive variation in health care utilization and spending. In the second, David, Saynisch and Smith-McLallen, along with Spencer Luster and Ravi Chawla, explore the impact of variation in PCMH implementation on medication adherence.