Surgical patients age 65 and over with Alzheimer’s disease and related dementias (ADRD) were more likely to die within 30 days of admission and to die after a complication than those without ADRD. Having better-educated nurses in the hospital improved the likelihood of good outcomes for all surgical patients, but had a much greater effect in individuals with ADRD. Specifically, a 10% increase in the proportion of nurses with a Bachelor of Science in Nursing (BSN) degree or higher was associated with 10% lower odds of death and 10% lower odds of dying after a complication for surgical patients with ADRD.
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.
Prior Authorization Requirements for Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitors Across US Private and Public Payers
A comprehensive review of prior authorization (PA) requirements for a new class of expensive cholesterol-lowering drugs known as proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors has found unusually complex and burdensome demands across public and private insurance plans in the United States. These findings raise concerns that current policies may create undue barriers to care even in medically appropriate patients, particularly since requirements were just as stringent for patients with a genetic condition that creates more clear-cut eligibility for PCSK9 inhibitor treatment.
Do Changes in Post-Acute Care Use at Hospitals Participating in an Accountable Care Organization Spillover to All Medicare Beneficiaries?
Abtract [from journal]
While early evidence suggests that Medicare accountable care organizations (ACOs) may reduce post-acute care (PAC) utilization for attributed beneficiaries, whether these effects spill over to all beneficiaries admitted to hospitals participating in ACOs stray is unknown.
The objective of this study was to evaluate whether changes in PAC use and Medicare spending spill over to all beneficiaries admitted to hospitals participating in the Medicare
Abstract [from journal]
Practice transformation and payment reform are defining features of contemporary health policy debates. The story goes like this: new provider organizations, such as Accountable Care Organizations (ACOs) are transforming care delivery from fragmented and volume driven to integrated and optimized for quality; meanwhile, innovative payment models, such as bundled payments and risk-based contracting, herald a national transition from fee-for-service (FFS) to value-based payments.
Characteristics of Hospitals Earning Savings in the First Year of Mandatory Bundled Payment for Hip and Knee Surgery
In JAMA, Amol Navathe and LDI colleagues Joshua Liao, Paula Chatterjee, Dan Polsky, and Ezekiel Emanuel examine hospital savings and quality results for the first year of the Comprehensive Care for Joint Replacement (CJR) bundled payment program. Since April 2016, Medicare has bundled payments for hip and knee replacements at 799 hospitals through CJR. The program incentivizes quality and cost containment by providing retrospective bonus payments that increase as hospitals exceed their cost and quality benchmarks, or imposing penalties if hospitals fall short. While the CJR...
The Effect of Integration of Hospitals and Post-Acute Care Providers on Medicare Payment and Patient Outcomes
Vertical integration between hospitals and skilled nursing facilities (SNFs) increases Medicare payments for the ﬁrst 60 days of care by $2,424 (17%), compared to hospital-SNF pairs that are not vertically integrated. These integrated hospital–SNF pairs also experience a decline in 30-day rates of rehospitalization or death of 5 percentage points on a base rate of 31.3%. Vertical integration between hospitals and home health agencies (HHAs) has little effect on Medicare payments and patient outcomes, nor does informal integration in either setting.
As the Centers for Medicare & Medicaid Services (CMS) implement nearly $1.6 billion in cuts to the 340B Drug Pricing Program, a new study 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.
The concern that value-based payments will worsen health disparities is not new. Much ink has been spilled about the best way to avoid penalizing hospitals that care for disproportionately poor populations, without rewarding poor performance. The big question has been whether and how to adjust value-based payments for socioeconomic factors.
A Qualitative Exploration of Co-location as an Intervention to Strengthen Home Visiting Implementation in Addressing Maternal Child Health
Abstract [from journal]
Objectives: The aim of this paper is to explore the process and impact of co-locating evidence-based maternal and child service models to inform future implementation efforts.
Methods: As part of a state-wide evaluation of maternal and child home visiting programs, we conducted semi-structured interviews with administrators and home visitors from home visiting agencies across Pennsylvania. We collected 33 interviews from 4 co-located agencies. We used the Consolidated Framework for...
The Association Between Obesity and Disability in Survivors of Joint Surgery: Analysis of the Health and Retirement Study
Abstract [from journal]
Obesity is associated with osteoarthritis and the need for joint surgery. Obese patients who undergo joint surgery may have a higher risk of morbidity compared with normal or overweight patients but less is known about their risk of postoperative disability. The primary objective of our study was to determine the association between obesity and the development of new dependence in activities of daily living within 2 years after joint surgery.
Exploring Opportunities to Prevent Cirrhosis Admissions in the Emergency Department: A Multicenter Multidisciplinary Survey
In Hepatology Communications, Shazia Mehmood Siddique and colleagues investigate nonmedical factors that influence inpatient admission for patients with cirrhosis who present to the emergency department. They also explore provider perspectives on patients presenting to the emergency department with low-acuity conditions, such as ascites and hepatic encephalopathy. The authors survey emergency medicine and hepatology providers, including attending physicians, house staff, and advanced practitioners, in four liver transplant centers.
From the 186 responses analyzed, they...
In Health Affairs, Rebecca Onie and colleagues, including Risa Lavizzo-Mourey, conduct a twenty-year qualitative case study of Health Leads, an organization that partners with health care institutions and communities to address patients’ basic resource needs, and its funders. The case study demonstrates the successful stages of diffusion, defined as the process by which an innovation is communicated over time within a social system, leading to increased exposure and adoption. The authors segmented the process for Health Leads into five distinct phases:
- Testing and ...