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.
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.
Researchers are discovering that social media offers a window into the lived experience of patients and their caregivers. Using Yelp reviews about US hospitals, our team at Penn’s Center for Health Care Innovation attempted to give voice to these experiences related to pain management and opioids during recent hospital visits.
A new study in Health Services Research from Penn MSHP alumna Kristin Rising, Penn LDI Adjunct Senior Fellow Brendan Carr, and their colleagues at Jefferson University quantifies something that seems like common sense – patients don’t stick to just one health system for emergency care.
If you want to start an intense debate within the medical community, just talk about duty-hours – the length of a physician-in-training’s shift. Krisda Chaiyachati describes the findings of a new study in the New England Journal of Medicine examining how shift length affects medical trainees' time spent on education, direct patient care, and overall satisfaction. He reflects on his own time as an internal medicine chief resident, and suggests new ways to improve training for medical residents.
As policymakers debate the best way to address pressing health care challenges, one ‘opinion’ that is sometimes drowned out is that of the public. At a recent Penn LDI seminar, Mollyann Brodie, PhD, MS, Senior Vice President for Executive Operations and Executive Director of Public Opinion and Survey Research at the Kaiser Family Foundation (KFF), underscored the value of public polling when it comes to health care policy and politics.
As part of a campus-wide, week-long ‘Teach-In,’ Penn LDI and the Penn Injury Science Center are co-hosting a session on Firearm Violence: Science, Policy, & Politics. In preparation for the event, our experts provided a “reading list” of studies that focus on the causes and effects of firearm violence in the United States. Together, they represent a good, quick overview of the evidence base that can inform firearm policy. Or at least the conversation about it.
Black men in the United States are disproportionately affected by traumatic injuries. Understanding the emotional consequences of injuries among this population is important for addressing the mental health challenges that may arise after injury. A study from the University of Pennsylvania School of Nursing that was recently published in Injury examines how urban Black men described their emotional responses in the three months after acute traumatic injury.
Practice transformation and payment reform are defining features of contemporary health policy debates. But a new article in Milbank Quarterly by LDI Senior Fellows Lawton R. Burns and Mark V. Pauly poses an uncomfortable question: what if transformation is simply hype?
The concern that value-based payments will worsen health disparities is not new. Much ink has been spilled about the best way to avoid punishing hospitals that care for disproportionately poor populations, without rewarding poor performance. Two new perspective pieces take a fresh look at the issue, highlighting the potential for value-based payments to reduce disparities rather than to exacerbate them.
As the Centers for Medicare & Medicaid Services implement nearly $1.6 billion in cuts to the 340B Drug Pricing Program, a new study by Penn LDI PhD alumna Sunita Desai looks at the consequences of the program, and questions whether it has had its intended effect of helping safety-net hospitals serve poor and vulnerable populations.