Payment & Delivery

How insurers and providers are organized and paid to deliver care. Research by LDI Senior Fellows examines the shift from fee-for-service payments to newer models of paying for and delivering value, such as Accountable Care Organizations and Patient-Centered Medical Homes.

State Laws And Nonprofit Hospital Community Benefit Spending

Aug. 1, 2019

Emily K. Johnson, Rose Hardy, Tatiane Santos, Jonathon P. Leider, Richard C. Lindrooth, Gregory J. Tung

Abstract [from jorunal]

Objective: To determine the association of state laws on nonprofit hospital community benefit spending.

Design: We used multivariate models to estimate the association between different types of state-level community benefit laws and nonprofit hospital community benefit spending from tax filings.

Setting: All 50 US states.

Participants: A total of 2421 nonprofit short-term acute care hospital organizations that filled an internal revenue service


Understanding Financial Toxicity in Head and Neck Cancer Survivors

Leila J. Mady, MD, PhD, MPH
Jun. 28, 2019

Leila J. Mady, Lingyun Lyu, Maryanna S. Owoc, Shyamal D. Peddada, Teresa H. Thomas, Lindsay M. Sabik, Jonas T. Johnson, Marci L. Nilsen

Abstract [from journal]

Objectives: (1) Describe financial toxicity (FT) in head and neck cancer (HNC) survivors and assess its association with personal/health characteristics and health-related quality of life (HRQOL); (2) examine financial coping mechanisms (savings/loans); (3) assess relationship between COmprehensive Score for financial Toxicity (COST) and Financial Distress Questionnaire (FDQ).

Patients and methods: Cross-sectional survey from January - April 2018 of insured patients at a tertiary


Five-Year Cost of Dementia: Medicare

Research Brief
Apr. 29, 2019

[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.

Medicaid and Nursing Home Choice: Why Do Duals End Up in Low-Quality Facilities?

Apr. 17, 2019

Hari Sharma, Marcelo Coca Perraillon, Rachel M. Werner, David C. Grabowski, R. Tamara Konetzka


We provide empirical evidence on the relative importance of specific observable factors that can explain why individuals enrolled in both Medicare and Medicaid (duals) are concentrated in lower quality nursing homes, relative to those not on Medicaid. Descriptive results show that duals are 9.7 percentage points more likely than nonduals to be admitted to a low-quality (1-2 stars) nursing home. Using the Blinder–Oaxaca decomposition approach in a multivariate framework, we find that 35.4% of the difference in admission to low-quality nursing homes can be...

US Nationwide Disclosure of Industry Payments and Public Trust in Physicians

Apr. 12, 2019

Genevieve P. Kanter, Daniel Carpenter, Lisa S. Lehmann, Michelle M. Mello

Abstract [from journal]

Importance: Transparency of industry payments to physicians could engender greater public trust in physicians but might also lead to greater mistrust of physicians and the medical profession, adversely affecting the patient-physician relationship.

Objective: To examine the association between nationwide public disclosure of industry payments and Americans’ trust in their physicians and trust in the medical profession.

Design, Setting, and Participants: Survey study using...

The Effect of Predictive Analytics-Driven Interventions on Healthcare Utilization

Research Brief
Apr. 3, 2019

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.

Assessing First Visits By Physicians To Medicare Patients Discharged To Skilled Nursing Facilities

Research Brief
Kira Rysinka, MD
Apr. 1, 2019

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.

Do Longer Shifts Affect Residents’ Sleep or Patient Safety?

Mar. 25, 2019

Do residents need more sleep? Two new studies in the New England Journal of Medicine compare the effects of standard versus flexible duty-hours on residents’ sleep and patient safety.

The iCOMPARE trial randomized 63 internal medicine residency programs, consisting of over 5,000 trainees, to standard duty-hour policies or flexible policies. All programs were held to an 80-hour work week, but flexible policies had no limits on shift lengths and did not mandate time off between shifts.

Patient Outcomes After Hospital Discharge to Home with Home Health Care vs to a Skilled Nursing Facility

Research Brief
Mar. 11, 2019

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.