Category Archives: Healthcare costs & financing

Are DRG-based Reimbursements Appropriate for COVID-19?

By | August 7, 2020
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Current healthcare reimbursements may create incentives for excess use of ventilators to treat COVID-19 patients. Recent research has shown that healthcare providers, including hospitals, have experienced substantial financial losses as a result of the COVID-19 pandemic. Alternative, less-invasive treatments for critically ill COVID-19 patients could potentially improve patient outcomes. But these approaches expose hospitals to… Read More »

A story of primary care: neighborhood deprivation and health spending

By | July 2, 2020
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this image shows a blighted area of a downtown city, which is used to represent a neighborhood likely to be among the most deprived.

A new study out this month in Medical Care by Yongkang Zhang and colleagues finds that people in struggling neighborhoods have considerably higher spending on potentially preventable health care. While overall health care spending was similar between the most deprived areas and average communities, the finding about spending on potentially preventable health care tells an… Read More »

Options for Universal Coverage: Part 2 – Eligibility and Enrollment

By | June 25, 2020
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In this series on options for universal coverage, we explore elements of various reform proposals and evaluate their potential impact. Rather than examining complete proposals, we highlight specific policy elements that appear in one or more such proposals. The three we focus on in this series are: Part 1 – Eliminating Medicare Advantage (May 14,… Read More »

Medicare Advantage and Reimbursement to Address Social Risk Factors

By | June 22, 2020
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We don’t always think of health insurers as communicators. However, when insurers set reimbursement rates, they provide information that directly influences service delivery. When payors reimburse for certain services, they are informing providers these services are valued and providing these services is encouraged. When payors do not reimburse for services, or reimburse at lower rates,… Read More »

Deportation and the Traumatizing of a Generation

By | June 18, 2020
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With less than five weeks to go before welcoming a second child, the patient sat in my exam room in tears. By all accounts, this was a routine appointment at the end of a routine pregnancy. Except on this particular day, clutching family photos from their recent baby shower, the patient shared with me that… Read More »

Natural Experiments for Diabetes

By | June 7, 2020
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Over the past two decades, research has helped identify ways to reduce complications among people with diabetes and laid the foundation for primary prevention. However, prevention and treatments are still unequally applied, and social, economic, and age-related disparities persist. The June 2020 supplement issue of Medical Care argues for and presents the results of natural… Read More »

Options for Universal Coverage: Part 1 – Public vs. Private Provision

By | June 12, 2020
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With the 2020 US presidential election drawing near, debate about the options for universal coverage will ramp up. At the heart of this debate is the estimated 45% of US adults who are either uninsured or under-insured. They are at risk of experiencing financial hardship or going without needed care in a time when access to… Read More »

Local health departments and COVID-19

By | April 27, 2020
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Public Health Systems Say No to COVID-19

The rapid emergence of COVID-19 reminds us of the importance of the public health system. Local health departments (LHDs) play a central role in emergency preparedness and response. Effective epidemic response rests on the performance of the essential public health activities— assessment, policy development, and assurance—by LHDs. Evidence suggests that LHDs can improve population health… Read More »

Updated guidance on using telehealth during this public health emergency

By | April 15, 2020
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telehealth

Yesterday, the Centers for Medicare and Medicaid Services (CMS) unveiled new guidance about using telehealth during this public health emergency due to the coronavirus outbreak.  This guidance will help increase access to telehealth services.  In addition, this will help people receive care who may not be able to visit their providers in person.  While the… Read More »

Adjusting publicly reported performance measures for social risk factors

By | March 18, 2020
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With the current focus on social risk factors (SRFs) affecting health care, it is not surprising that methods for comparing hospital performance might do well to account for such factors in their assessment. If up to 70 percent of health outcomes are driven by factors beyond medical care, and measures used to compare hospitals focus… Read More »

Are Community Health Workers Worth It?

By | February 2, 2022
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Patients are sometimes referred to as “frequent flyers” when they visit an emergency department multiple times for the same issue. Often this is because discharged patients miss necessary follow-up care. This results in further worsening health, and may contribute to the frequent flying. To address this cycle, patients may be referred to a community health… Read More »

What presidential candidates say about healthcare: 2020 edition

By | February 12, 2020
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Health care is on everyone’s mind. Here’s what presidential candidates say about healthcare: the 2020 edition. We are two weeks into the 2020 presidential primary season. On the Democratic side, muddled results in Iowa and very close results in New Hampshire have sprung some surprises. Currently at the top of the Democratic field are Pete… Read More »

Bundled Payment for Maternal Health: An Opportunity to Change Healthcare Financing

By | January 24, 2020
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The need for a comprehensive payment approach that supports the entire maternity care experience from prenatal, labor, and delivery, to postnatal care, is critical for both maternal and child health outcomes. Aligning payment to reward better birth outcomes is becoming more widespread. A handful of states are experimenting with bundled payments to advance value-based payment… Read More »

Timing is Everything: Defining the Serious Illness Population for Palliative Care

By | January 13, 2020
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The current healthcare system is not built for individuals with serious illnesses. These individuals can benefit from palliative care, which focuses on quality of life and symptom relief. Alternative payment models that incorporate palliative care are in development. Yet, the challenges of expanding these models of care are substantial. Betsy recently died after a sixteen-year… Read More »

ACO Implementation: Current evidence and a way forward

By | January 5, 2020
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Over the past eight years, the US health care system has seen the widespread implementation of Accountable Care Organizations (ACOs) as a way to move from volume to value. What are ACOs? ACOs are groups of providers that are collectively accountable for the cost and quality of care for a defined patient population. Examples include… Read More »

The Changing Telehealth Policy Landscape

By | December 18, 2019
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The telehealth policy landscape is changing

Although telehealth has been in use for quite some time, uptake has been low. In particular, an inconsistent policy landscape presents a number of obstacles, such as site restrictions on where telehealth can be delivered, provider restrictions on who can deliver services, and reimbursement restrictions around payment for services. However, some recently developed policies aim… Read More »

School Health Policy Series: Part 2 – Athletic Trainers in Schools: An Unexpected Battleground for Scope of Practice

By | December 2, 2019
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It is impossible to bring up a discussion of school sports without mentioning the great bogeyman of sports-related injuries: concussions. The number of concussions has been on the decline in recent years. But a recent estimate suggests that there are still about 4 concussions per 10,000 athletic exposures in high schools. An athletic exposure is… Read More »

Using Telehealth to Deliver Care to Patients When and Where They Need It

By | September 24, 2019
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Displays stethoscope and laptop to illustrate virtual care

Many issues affect the delivery of care to patients who are most in need. Particularly, those who live in rural areas or those who need specialized care may not have access to the care they need.  Patients whose care transitions across acute care and long-term/post-acute care (LTPAC) settings may have additional challenges in receiving coordinated… Read More »

Two Approaches to Value in Health Policy Reform

By | September 16, 2019
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Drawing of shopping cart with medical icons inside

VBID and alternative payment models comprise two approaches to reform with different incentives that influence underlying motives. The underlying principle of Value-Based Insurance Design (VBID) is to align patient out-of-pocket costs, or cost-sharing (deductibles, co-pays, etc.), with clinical value of services. Decreasing cost-sharing for high-value services and increasing cost-sharing for low-value services is the goal of… Read More »

At 5 Years: Great Blog Posts That (Almost) Nobody Read

By | September 12, 2019
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We announced last week that The Medical Care Blog has reached its 5-year milestone. As part of the editorial team, I’m excited to pause briefly and reflect on some great blog posts about healthcare that I think deserve to have been more widely read. Contributions from our authors have helped us reach more than 80,000… Read More »

Taking Stock of Blockchain in Healthcare, Part 2

By | August 21, 2019
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In Part I, we touched on how healthcare stakeholders like clinical researchers, doctors, pharmacists, and other providers can and are implementing blockchain technology to facilitate the collaborative exchange of research and data. In this installment, we discuss the business case for blockchain in healthcare. Policies and implementation regarding exchanging patient medical data among providers vary… Read More »

Veteran Access to Hepatitis C Treatment

By | May 10, 2019
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Hepatitis C treatment has gone through a revolution in the last 5 years. Treatment durations have dropped from 48 to 12 weeks, and success rates have improved dramatically. However, treatment costs have sky-rocketed accordingly, and access to care has become a significant issue, particularly for lower socioeconomic individuals and groups. Eligible veterans should have access… Read More »

Tailoring VA primary care to address the social determinants of health

By | March 14, 2019
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Tailoring the primary care medical home model improves the care experience for US Department of Veterans Affairs (VA) patients with homelessness experience, according to a recent study by Dr. Audrey Jones and colleagues in the journal Medical Care. Researchers from the VA’s Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center and Center for Health Equity Research… Read More »

Health Care Revolt–Reflections on Democracy and Medicine

By | March 2, 2021
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“A book lying idle on the shelf is wasted ammunition.” – Henry Miller, The Books in My Life (1952) The Medical Care Blog is home to many strong opinions.  In the last year, contributors have written provocatively about the political determinants of health, highlighted the per-mile cost of President Trump’s wall in numbers of children who… Read More »

Hospitalizations of Individuals Experiencing Homelessness Driven by Behavioral Health Concerns

By | February 6, 2019
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Individuals experiencing homelessness are among the most medically, socially, economically, and politically vulnerable in our society. Because of this, patterns of service use by these individuals can often serve as indicators of the safety net capacity and overall wellness of the systems of care we have in place – like “canaries in the coal mine.”… Read More »

What’s Happening with Medicare for All?

By | January 31, 2019
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It’s a new season. The federal government re-opened this week after a record-breaking shut-down.  Democrats gained control of the U.S. House of Representatives, feeling newly emboldened after the dispute about a border wall.  A gaggle of 2020 presidential hopefuls has revealed themselves in recent weeks, lining up to be, arguably, the most liberal class of… Read More »

In Massachusetts, primary care sensitive emergency department use persists 5 years after health reform

By | July 24, 2019
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Primary care sensitive (PCS) emergency department (ED) use is a measure that highlights the connection between primary and emergency care. The right care, for the right person, in the right place, at the right time is a reasonable goal of a high-quality health system. In the US, however, many people go to the emergency department… Read More »

Instead of Building a Wall, Let’s Insure America’s Children

By | January 7, 2019
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President Trump wants $5 billion right now for his border wall, and another $7 billion (or maybe $13 billion) later on to finish the project. What else could we do with that kind of money? Here’s an idea: with $12 billion we could cover ALL 3.9 million uninsured children in the US today, and still have a… Read More »

The Link Between Prescription Copayments, Contraceptive Adherence, and Unintended Pregnancy in the United States

By | December 12, 2018
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There are approximately 61 million women of reproductive age (15-44 years) in the United States, and at any given time, 70% of them are at risk of unintended pregnancy—that is, they are sexually active but do not want to become pregnant. About 72% of women who currently use contraception use non-permanent methods, such as the… Read More »

Including Social Risk Factors in Performance Measurement: Methods Matter

By | September 26, 2019
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Going to the hospital is more than a drag. For patients, it can be a frightening experience, dangerous to one’s health, a burden on family and caregivers, and very expensive. Policies to reduce preventable return visits to the hospital are good for patients – and good for Medicare’s bottom line. Medicare’s Hospital Readmission Reduction Program… Read More »

Bang for the Buck: Positive Airway Pressure Devices

By | September 19, 2018
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Over a third of all Americans are at an increased risk for chronic conditions such as heart attack, stroke, cancer, and diabetes due to their lack of sleep. Key disorders, such as obstructive sleep apnea, which now afflicts 30 million adults in the United States, are some of the primary causes of the morbidity and… Read More »

Bang for the Buck: Tobacco Dependence Treatment Services

By | September 14, 2018
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Welcome to the Bang for the Buck series! In this series, we will look at the most recent cost and cost-effectiveness research on public health methods and technology and discuss their potential for policy and implementation within the current health care system. As the costs of treating diseases continue to rise faster than inflation, prevention… Read More »

Medication-Assisted Treatment: A Vital Player in the Opioid Epidemic

By | August 15, 2018
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For two years in a row, the United States has experienced a decrease in life expectancy, which researchers have largely attributed to the opioid epidemic. Life expectancy for the United States population was 78.6 years in 2016, a decrease of 0.1 year from 2015 [PDF]. Age-specific death rates between 2015 and 2016 increased for younger… Read More »

Champagne Budget, Beer Taste: We Are Getting Ripped Off by the US Healthcare System

By | June 20, 2018
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Readers of The Medical Care Blog know that the United States spends more money than any other country on healthcare. Currently, the US spends about 18% of its gross domestic product on health care, and it is predicted to grow to nearly 20% by 2026 [PDF]. While the growth rate in spending remains near historical… Read More »

Policy Analysis: Balancing Religious Freedom with the Right to Reproductive Healthcare

By | June 8, 2018
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Reproductive rights have been a topic for policy making and legal jurisprudence throughout much of the past century. As the healthcare system of the United States continues to evolve, women’s health and reproductive rights remain central to the debate. I previously authored a post here at The Medical Care Blog which discussed religion-restricted healthcare and… Read More »

The curious case of fibromyalgia: Overdiagnosed, underdiagnosed, and misunderstood

By | June 21, 2018
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Fibromyalgia is a debilitating centralized pain condition experienced by millions of Americans. “Centralized” refers to origination or amplification of pain by a sufferer’s central nervous system. It is, in a true sense, pain that is “in one’s head” — but nevertheless as real and noxious as any other pain. Ultimately, pain is always something experienced… Read More »

BRIEF: Out-of-pocket costs for Alzheimer’s disease

By | July 26, 2018
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Alzheimer’s disease and related dementias (ADRD) affect about 5.7 million people in the US. Although most of those affected are covered by Medicare, many of the medical costs are not covered by insurance and must be borne by patients and their families. Total costs of care for ADRD have been estimated at more than $277… Read More »

What is the role of health insurance in cancer suvivorship care?

By | March 8, 2018
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A fundamental question in health reform is how changes to insurance policy affect health insurance coverage. Since the passage of the Affordable Care Act (ACA) in 2010, research has demonstrated that the ACA reduced the uninsured rate across the country [pdf]. By expanding eligibility for the Medicaid program, establishing marketplaces for the purchase of private insurance, providing… Read More »

Opportunistic Salpingectomy: How is this Not Totally a Thing?

By | September 18, 2019
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The name doesn’t exactly help. But before we discuss rebranding, a brief introduction to the concept . . . Salpingectomy refers to surgical removal of one (unilateral) or both (bilateral) fallopian tubes. It is thus a surgical option for female sterilization—but also drastically reduces a woman’s risk of ovarian cancer. This is huge. Ovarian cancer… Read More »

Why Aren’t We Expanding Medicaid to Address the Opioid Epidemic?

By | February 10, 2022
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[Editors’ note: This post was originally published on Feb. 7, 2018.] Now more than ever, we need a sensible, unified, national response to the opioid epidemic; a response that recognizes the gravity of the situation and the reality that opioid use disorder (OUD) is a chronic – and treatable – condition. While there are many… Read More »

Impact of Medication Adherence on Health Services Utilization in Medicaid

By | January 31, 2018
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Medication is an essential aspect of tertiary prevention, as it often addresses symptoms, may restore function, and minimizes adverse consequences associated with chronic conditions. Medication adherence is most often studied in the context of Medicare Part D. In a newly published Medical Care article, Drs. Roebuck, Kaestner, and Dougherty, instead measure the associations between medication… Read More »

The Effect of Co-Payments on Incarcerated Women

By | January 11, 2018
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Prisoners have a fundamental right to receive health care while incarcerated, a right that is mandated by the US Supreme Court. However, negligent care in prisons persists and is often an issue of limited access due to cost mitigating policies. Since the 1990’s, prison systems have integrated managed care strategies, like co-payments, to mitigate increasing… Read More »

Three Reasons Why the Pro-ACA Resistance Should Take Heart

By | February 25, 2019
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The Affordable Care Act (ACA) had a roller-coaster of a year.  It began with threats of almost certain repeal, followed by effort after unsuccessful effort to dismantle it. Then in the last days of 2017, there was the successful repeal of the individual mandate penalty. This was brazen politics, suspenseful and often agonizing.   It… Read More »

Smoking in America: Medicaid, Quitting, and Income

By | November 20, 2017
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Over the last few decades, cigarette smoking has become a health burden concentrated primarily among low-income individuals in the U.S. In our recently published research study, Medicaid coverage expansions and cigarette smoking cessation among low-income adults, we sought to determine the relationship between recent expansions of Medicaid coverage and smoking cessation for low-income adults. Demographics… Read More »

Preventing Health Care that Almost Nobody Needs

By | September 28, 2017
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Medicine, alongside achievements in sanitation and public health, remains one of the major achievements of modern society. The reduction (or eradication) of many infectious diseases from the developed world, breakthroughs in anesthesiology and surgery, and advances in the care of chronic diseases (including HIV) are just a few of the multitudes of achievements. But these… Read More »

Universal Health Coverage? A Response

By | August 15, 2017
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In a recent Health Affairs blog post, Universal Health Coverage? Why?, Walter McClure, Alain Enthoven, and Tim McDonald make a convincing case for expanding health insurance coverage in the United States. They argue that universal coverage is a “wise public investment” that “expands the workforce and makes it more productive,” similar to universal public education.… Read More »

Despite ACA mandates for states to streamline renewal, many beneficiaries still need assistance to retain Medicaid coverage

By | August 10, 2017
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Enrollment in Medicaid has been shown to enhance access to health care for our nation’s most vulnerable citizens. Yet despite these benefits, a substantial number of beneficiaries lose coverage at the time of renewal. An article by Xu Ji and colleagues, published in this month’s issue of Medical Care, demonstrates how critical maintaining continuous Medicaid coverage… Read More »

Getting recommended preventive care: costs aren’t the only barrier

By | August 3, 2017
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Annual routine check-ups, flu shots, and mammograms are among the basic preventive services for which the Patient Protection and Affordable Care Act of 2010 established a mandate for insurance plans: full coverage, with no out-of-pocket costs. In making it a little easier for some parts of the US population to access basic services, did the… Read More »

The Prevention and Public Health Fund: Investing in Health Equity

By | July 27, 2017
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The pursuit of health equity – ensuring equal access to opportunities that enable all communities to lead healthy lives – is a critical task for the U.S. The direct and indirect medical costs associated with sickness and premature death resulting from health care inequities are enormous (estimated to be $230 billion and $1.24 trillion, respectively,… Read More »

New methods in risk modeling: does adding EHR data improve predictions?

By | July 20, 2017
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One of the challenges in delivering efficient medical care is identifying people who are at risk of a negative outcome, so we can focus our efforts on screening and treating those at elevated risk. We do this in individual face-to-face encounters through clinical, diagnostic processes: taking a patient’s history, performing a physical examination, recording signs… Read More »