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.
Medicaid’s federal-state partnership structure has long permitted states to adopt modifications to coverage design, including benefits and cost-sharing. That structure, combined with an Administration signaling its support for greater state flexibility and funding constraints, could produce substantial shifts in state Medicaid policy.
Several states, including some that reluctantly implemented Medicaid expansion and some contemplating it, have asked for federal permission to link Medicaid eligibility to labor force participation—working or looking for work. As with everything in health policy these days, this idea is controversial, with disagreement even about the facts but more fundamentally about subjective social values.
LDI Senior Fellow Julie A. Fairman, PhD, RN, FAAN made history last week as she became the first nurse to deliver the prestigious Garrison lecture at the American Association for the History of Medicine’s 91st annual meeting in Los Angeles.
Family caregivers of hospitalized patients will get much needed support and guidance in the 39 U.S. states and territories that have enacted versions of the Caregiver Advise, Record, Enable (CARE) Act. To achieve the intended public health outcomes, however, the needs of diverse communities, such as Latinos, immigrants, and other marginalized groups, must be considered as these policies are implemented.
On May 2 and 3, the School of Nursing sponsored a multidisciplinary “Think Tank” devoted to improving care for older adults with chronic illness. Led by Mary Naylor and Nancy Hodgson, it drew more than 40 external thought leaders, who joined Penn experts from across the University. You’ll be hearing much more in the coming weeks about the Think Tank’s recommendations, but from a policy perspective, it could not have come at a better time.
For the nearly 30 million people in the U.S. who have no health insurance, gaining access to care and paying for that care can be a challenge. A new “secret shopper” study explores whether the uninsured can get a new primary care appointment, and at what price. To understand what it’s like to be uninsured, a new Bloomberg News project provides the personal stories behind the statistics, highlighting why and how some Americans are going without health insurance.
The American Dental Association (ADA) recently announced a new policy on opioid prescription. This is the latest in a series of ADA statements in response to the prominent role of dentistry in the opioid epidemic. In addition to mandatory continuing education and prescription limits, the ADA indicated its support for “dentists registering with and utilizing prescription drug monitoring programs to promote the appropriate use of opioids and deter misuse and abuse.”
Engaging patients, families, and independent experts in policymaking is a laudable goal, but the process of doing so isn’t necessarily straightforward. If efforts to introduce patient and public perspectives also introduce bias, they may do more harm than good. In JAMA Internal Medicine, Matthew McCoy, Genevieve Kanter, and colleagues raise concerns that FDA public engagement is rife with conflicts of interest), which are frequently undisclosed.
Our health and social systems are ill-equipped to meet the needs of the growing population of older adults with chronic conditions and their family caregivers. We are living longer, but are we living better? A new invitational “Think Tank,” led by Mary Naylor, PhD, RN and Nancy Hodgson, PhD, RN and sponsored by Penn’s School of Nursing, is looking to address these needs through the leadership and skills of the largest and most trusted segment of the health care workforce: nurses.
Spending on cancer drugs in the U.S. has nearly doubled in the past five years and continues to grow, imposing substantial financial burden on patients with cancer. One of the biggest drivers of this growth is targeted cancer drugs – small molecules, monoclonal antibodies, and other therapies for cancer that target specific genomic aberrations. LDI Senior Fellows Justin Bekelman and Steve Joffe propose three solutions to maximize the clinical benefit and affordability of targeted cancer drugs.
As the largest single source of health care spending, hospitals have drawn considerable attention from policymakers. Efforts to reduce costs have led to decreased lengths of hospital stays, but far less attention has been paid to where those patients go immediately after discharge. Medicare payment reforms implemented in the wake of the Affordable Care Act have made hospitals accountable for care beyond their walls, including institutional post-acute care. In a new Research Letter in JAMA, Rachel Werner and R. Tamara Konetzka assess how post-acute care has changed for Medicare beneficiaries from 2000-2015.
Tradition can be a great thing, but we need to re-evaluate how the practices and lessons of the past apply to the present. That was one message stressed by Dr. Mark Smith as he delivered Penn LDI’s Charles C. Leighton, MD Memorial Lecture. Dr. Smith, an internal medicine physician, Wharton School and Penn Robert Wood Johnson Clinical Scholars Program alumnus, and co-chair of the Guiding Committee of the Health Care Payment Learning and Action Network, shared his insights about what patient “engagement” means in the 21st century. His talk contained more than a few pearls of wisdom.