Amidst an ongoing opioid crisis that claimed 47,600 lives in 2017, increasing the availability of the rescue medication naloxone is a high priority. Naloxone reverses an opioid overdose when given intranasally or intramuscularly. But to be effective, naloxone must be available at the time of overdose. Naloxone distribution to laypeople can save a life when first responders are not immediately available, or when people witnessing overdoses are unwilling or unable to call 911. Naloxone is increasingly available through some pharmacies under a standing order; however, even when available, cost and stigma barriers persist. This Issue Brief reviews recent evidence on the outcomes and cost-effectiveness of naloxone distribution strategies in community, pharmacy, and other health care settings.
[dropcap]A[/dropcap]bout 5.5 million older adults are living with dementia, a chronic, progressive disease characterized by severe cognitive decline. This number will likely grow significantly as the U.S. population ages, which has cost implications for the Medicare program. A full accounting of these additional expenses will help policymakers plan for them in their Medicare budgets. In this study, Norma Coe and colleagues examined survival and Medicare expenditures in older adults with and without dementia to estimate dementia’s incremental costs to Medicare in the five years after diagnosis.
Among high-risk Medicare Advantage members with congestive heart failure, a proactive outreach program driven by a claims-based predictive algorithm reduced the likelihood of an emergency department (ED) or specialist visit in one year by 20% and 21%, respectively. The average number of visits dropped as well, with a 40% reduction in the volume of ED visits and a 27% reduction in the volume of cardiology visits after the first year.
Growing concern about the affordability of health care and the cost burden imposed on working families frequently appears in public debate about the next phase of health care reform. In this second brief of our affordability series, Penn LDI and United States of Care adapt a national-level affordability index to provide state-level data on the cost burden faced by working families who have employer-sponsored insurance (ESI). We examine how this burden varies across states, and how it has changed within states from 2010 to 2016.
In this study of postacute care, more than 10% of Medicare skilled nursing facility (SNF) stays included no visit from
a physician or advanced practitioner. Of stays with visits, about half of initial assessments occurred within a day of
admission, and nearly 80% occurred within four days. Patients who did not receive a visit from a physician or advanced
practitioner were nearly twice as likely to be readmitted to a hospital (28%) or to die (14%) within 30 days of SNF
admission than patients who had an initial visit.
Patient Outcomes After Hospital Discharge to Home with Home Health Care vs to a Skilled Nursing Facility
In this study of more than 17 million Medicare hospitalizations between 2010 and 2016, patients discharged to home
health care had a 5.6 percent higher 30-day readmission rate than similar patients discharged to a skilled nursing facility
(SNF). There was no difference in mortality or functional outcomes between the two groups, but home health care was
associated with an average savings of $4,514 in total Medicare payments in the 60 days after the first hospital admission.
A surprise medical bill is a bill from an out-of-network provider that was not expected by or not chosen by the patient.To see whether consumers are more likely to switch hospitals after receiving a surprise bill, Benjamin Chartock and Sarah Schutz, and their co-author Christopher Garmon, analyzed nationwide employer-sponsored health insurance claims for labor and delivery services. Mothers who received a surprise out-of-network bill for their first delivery had 13% greater odds of switching hospitals for their second delivery compared to those who did not get a surprise bill.
In our initial report “Detecting BS in Health Care,” we identified our top ten BS concepts and trends within the health care industry, and encouraged our readers to hone their “BS detection skills.” Many of you have let us know that we “left some BS on the table.” This time around, we make bolder assertions about other possible forms of BS—including some sacred cows—that might make some readers uncomfortable.
To help the Pennsylvania Department of Human Services understand the likely impact of a proposed Medicaid work requirement, we analyzed the demographic, economic and health characteristics of working-age, non-disabled adults who receive Medicaid, and any issues or barriers this population may face in obtaining and maintaining employment.
Changes to Racial Disparities in Readmission Rates After Medicare’s Hospital Readmissions Reduction Program Within Safety-Net and Non-Safety-Net Hospitals
After the Medicare Hospital Readmissions Reduction Program began enforcing financial penalties, disparities in readmissions between white and black patients widened at safety-net hospitals for conditions not targeted by the program. Disparities were stable for conditions targeted by the program. At non-safety-net hospitals, disparities were unchanged for both targeted and non-targeted conditions.
In the past several months, we have observed several notable signs of deceptive, misleading, unsubstantiated, and foolish statements — what we will call “BS” — in the health care industry. Here we present our Top 10 BS candidates, in both pictures and words. First we present each picture, untitled and without text, thereby inviting readers to discern what the BS message is and engage them in the BS detection process. Then we offer an explanation of what the picture conveys. This will help the reader become a more skilled “BS Hunter.” We reserve the option to expound further as we step in more BS in the future.
Using advanced practice nurses to support high risk patients and their families to transition from hospital to home can reduce postacute care use and costs. A study comparing three evidence-based care management interventions for a population of hospitalized older adults with cognitive impairment found that the Transitional Care Model, which relies on advanced practice nurses to deliver services from hospital to home, was associated with lower postacute care costs when compared to two “hospital only” interventions.
In the report To Err is Human (1999), the National Academy of Medicine called for national action to improve patient safety in hospitals. The report concluded that improving nurse work environments—assuring adequate nurse staffing and supporting nurses’ ability to care for patients—was critical to these efforts. Two decades later, have nurse work environments improved, and has that had a noticeable impact on patient safety? To find out, a research team led by LDI Senior Fellow Linda Aiken, PhD, RN surveyed more than 800,000 patients and 53,000 nurses in 535 hospitals in 2005, and again in 2016.
Although the “affordability” of health care is a common concern, the term is rarely defined.This joint Penn LDI and United States of Care issue brief considers affordability as an economic concept, as a kitchen-table budget issue for individuals and families, and as a threshold in current policy. It reviews a range of measures that capture the cost burden for individuals and families with different forms of coverage, in different financial circumstances, and with different health concerns.
Supply of Primary Care Providers and Appointment Availability for Philadelphia's Medicaid Population
This brief analyzes the supply of primary care providers serving the Medicaid population in Philadelphia, and the geographic variability of this measure across the city. It also examines important measures of access – appointment availability and wait time for an initial appointment – that highlight challenges faced by Medicaid patients.