Who Visits Relatives in Nursing Homes? Predictors of at Least Weekly Visiting.

Objectives: Within the context of a single study, assess the relative importance of the 6 factors identified in a 2019 systematic review as associated with the likelihood that family members will visit nursing home residents.

Design: Retrospective statistical analysis of an existing survey data set.

Settings And Participants: A national survey conducted with 4350 relatives of long-term nursing home residents.

Families' and Residents' Perspectives of the Quality of Nursing Home Care: Implications for Composite Quality Measures.

Objectives: To assess (1) the relationship of consumers' assessment of overall nursing home quality to their assessment of specific dimensions of quality; and (2) the implications of this relationship for composite quality measures in Nursing Home Compare.

Design: A survey conducted in 2017 elicited respondents' assessments of the quality of overall care and 13 specific dimensions of care.

Settings And Participants: The sample consisted of 4449 respondents who either resided in a nursing home or had a family member who resided in a nursing home during the 6 months before the survey.

Going the Extra Mile? How Provider Network Design Increases Consumer Travel Distance, Particularly for Rural Consumers.

Context: The practical accessibility to medical care facilitated by health insurance plans depends not just on the number of providers within their networks but also on distances consumers must travel to reach the providers. Long travel distances inconvenience almost all consumers and may substantially reduce choice and access to providers for some.

Methods: The authors assess mean and median travel distances to cardiac surgeons and pediatricians for participants in (1) plans offered through Covered California, (2) comparable commercial plans, and (3) unrestricted open-network plans.

Comparison of Consumer Rankings With Centers for Medicare & Medicaid Services Five-Star Rankings of Nursing Homes.

Importance: The Centers for Medicare & Medicaid Services (CMS) Five-Star measure for nursing homes is designed with input from expert panels about the importance of multiple quality indicators. Consumers may assign different values to these indicators, creating different 5-star ratings.

Objective: To compare nursing homes' rankings based on the CMS Five-Star measure with rankings based on consumers' judgment about the importance of the same quality indicators.

Net Benefits of Recovery High Schools: Higher Cost but Increased Sobriety and Educational Attainment.

Background: Recovery high schools (RHS) provide a supportive educational and therapeutic environment for students subsequent to treatment for substance use disorders (SUDs). Most students served by RHSs have concurrent mental health disorders and are at risk for school failure or dropout and substance use relapse.

Aims Of The Study: The central question addressed is whether RHSs are economically efficient alternatives to other high school settings for students in recovery.

A Consumer-Centric Approach To Network Adequacy: Access To Four Specialties In California's Marketplace.

We assessed the effect of provider networks on access to four medical specialties for Affordable Care Act Marketplace enrollees in California. Our approach incorporated a crucial consumer-focused attribute, travel distance, and identified the restrictions on provider access resulting from network design. Our analysis indicated that Marketplace plan networks are narrower than their commercial plan counterparts and feature just over half as many providers.

A Knotty Problem: Consumer Access and the Regulation of Provider Networks.

In order to increase access to medical services, expanding coverage has long been the preferred solution of policy makers and advocates alike. The calculus appeared straightforward: provide individuals with insurance, and they will be able to see a provider when needed. However, this line of thinking overlooks a crucial intermediary step: provider networks.

Using contingent valuation to develop consumer-based weights for health quality report cards.

Objective: The current 5-Star composite measure for nursing homes uses expert-driven weights to combine elements of quality into a single score. We assessed the feasibility of using the contingent valuation method (CVM) to derive consumers' preference-based weights for the Nursing Home Compare report card as a potential alternative approach.

Data Sources: Survey of 4310 adults with nursing home experience (residents or family members of a resident) administered between September 25 and October 9, 2017.

Examination of the New Short-Stay Nursing Home Quality Measures: Rehospitalizations, Emergency Department Visits, and Successful Returns to the Community.

In 2016, the Centers for Medicare & Medicaid Services (CMS) introduced 3 new quality measures (QMs) to its report card, Nursing Home Compare (NHC). These measures-rehospitalizations, emergency department visits, and successful discharges to the community-focus on short-stay residents. We offer a first analysis of nursing homes' performance in terms of these new measures.

Hospital Discharge and Selecting a Skilled Nursing Facility: A Comparison of Experiences and Perspectives of Patients and Their Families.

Purpose Of Study: A currently proposed rule by the Centers for Medicare & Medicaid Services would require providers to devote more resources to discharge planning from hospitals to ensure the prioritization of patient preferences and goals in the discharge planning process. Annually, more than 3 million persons enter a nursing home in the United States, with the vast majority of patients coming directly from hospitals. Although early evidence suggests more family involvement than patient involvement in the discharge process, most of this work has relied on retrospective reports of the decision-making process postplacement.

Personalizing Nursing Home Compare and the Discharge from Hospitals to Nursing Homes.

Objective: To test whether use of a personalized report card, Nursing Home Compare Plus (NHCPlus), embedded in a reengineered discharge process, can lead to better outcomes than the usual discharge process from hospitals to nursing homes.

Data Sources/setting: Primary data collected in the Departments of Medicine and Surgery at a University Medical Center between March 2014 and August 2015.

Study Design: A randomized controlled trial in which patients in the intervention group were given NHCPlus.

Secret Shoppers Find Access To Providers And Network Accuracy Lacking For Those In Marketplace And Commercial Plans.

The adequacy of provider networks for plans sold through insurance Marketplaces established under the Affordable Care Act has received much scrutiny recently. Various studies have established that networks are generally narrow. To learn more about network adequacy and access to care, we investigated two questions.

Substance Use Screening, Brief Intervention, and Referral to Treatment Among Medicaid Patients in Wisconsin: Impacts on Healthcare Utilization and Costs.

Unhealthy substance use in the USA results in significant mortality and morbidity. This study measured the effectiveness of paraprofessional-administered substance use screening, brief intervention, and referral to treatment (SBIRT) services on subsequent healthcare utilization and costs. The pre-post with comparison group study design used a population-based sample of Medicaid patients 18-64 years receiving healthcare services from 33 clinics in Wisconsin.

When Patients Customize Nursing Home Ratings, Choices And Rankings Differ From The Government's Version.

Report cards currently published by the Centers for Medicare and Medicaid Services (CMS) offer composite (summary) quality measures based on a five-star ratings system, such as the one featured on the Nursing Home Compare website. These ratings are "one size fits all patients" measures. Nursing Home Compare Plus is an alternative that allows patients and their families to create their own composite scores based on their own preferences and medical needs.

Rationale and study protocol for the Nursing Home Compare Plus (NHCPlus) randomized controlled trial: A personalized decision aid for patients transitioning from the hospital to a skilled-nursing facility.

Background: Annually more than 3 million people are admitted to one of the 15,965 skilled nursing facilities (SNFs) in the United States, with 90% of admissions occurring from a hospital. Although the Centers for Medicare and Medicaid Services (CMS) publishes several internet-based report cards, including one for nursing homes (Nursing Home Compare, NHC), they are not widely used. This is due, in part, to the complexity of the information available and the fact that the choice of nursing homes is typically made while in the hospital without access to the web-based NHC.

California hospital networks are narrower in Marketplace than in commercial plans, but access and quality are similar.

Do insurance plans offered through the Marketplace implemented by the State of California under the Affordable Care Act restrict consumers' access to hospitals relative to plans offered on the commercial market? And are the hospitals included in Marketplace networks of lower quality compared to those included in the commercial plans? To answer these questions, we analyzed differences in hospital networks across similar plan types offered both in the Marketplace and commercially, by region and insurer. We found that the common belief that Marketplace plans have narrower networks than their commercial counterparts appears empirically valid. However, there does not appear to be a substantive difference in geographic access as measured by the percentage of people residing in at least one hospital market area.

You Can't Make Me Do It, but I Could Be Persuaded: A Federalism Perspective on the Affordable Care Act.

The Affordable Care Act (ACA) seeks to change fundamentally the US health care system. The responses of states have been diverse and changing. What explains these diverse and dynamic responses? We examine the decision making of states concerning the creation of Pre-existing Condition Insurance Plan programs and insurance marketplaces and the expansion of Medicaid in historical context.

The Thin Reed: Accommodating Weak Evidence for Critical Parameters in Cost-Benefit Analysis.

Policy analysis often demands quantitative prediction-especially cost-benefit analysis, which requires the comprehensive quantification and monetization of all valued impacts. Using parameter estimates and their precisions, analysts can apply Monte Carlo simulation to create distributions of net benefits that convey the levels of certainty about the fundamental question of interest: Will net benefits be positive if the policy is adopted? An inappropriate focus on hypothesis testing of parameters rather than prediction sometimes leads analysts to treat statistically insignificant coefficients as if they, and their standard errors, are zero. One alternative method is to use all estimates and their standard errors whether or not the estimates are statistically significant.

Top-down and bottom-up approaches to health care quality: the impacts of regulation and report cards.

The high cost of the US health care system does not buy uniformly high quality of care. Concern about low quality has prompted two major types of public policy responses: regulation, a top-down approach, and report cards, a bottom-up approach. Each can result in either functional provider responses, which increase quality, or dysfunctional responses, which may lower quality.

What factors contribute to successful appeals of nursing homes' deficiencies in the informal dispute resolution process?

Objectives: To determine what factors contribute to successful appeals of nursing home deficiencies in the Informal Dispute Resolution (IDR) process.

Design: We merged Centers for Medicare and Medicaid Services' data about IDRs with Online Survey, Certification, and Reporting data about nursing home characteristics. We performed multivariate statistical analyses to predict successful appeals as a function of characteristics of the deficiency being appealed, the survey that triggered the deficiency, characteristics of the nursing home, and the state.

The effect of state regulatory stringency on nursing home quality.

Objective: To test the hypothesis that more stringent quality regulations contribute to better quality nursing home care and to assess their cost-effectiveness.

Data Sources/setting: Primary and secondary data from all states and U.S.

Nursing homes appeals of deficiencies: the informal dispute resolution process.

Objective: Nursing homes that are not meeting quality standards are cited for deficiencies. Before 1995, the only recourse for a nursing home was a formal appeal process, which is lengthy and costly. In 1995, the Centers for Medicare & Medicaid Services instituted the Informal Dispute Resolution (IDR) process.

Addressing the shortage of kidneys for transplantation: purchase and allocation through chain auctions.

Transplantation is generally the treatment of choice for those suffering from kidney failure. Not only does transplantation offer improved quality of life and increased longevity relative to dialysis, it also reduces end-stage renal disease program expenditures, providing savings to Medicare. Unfortunately, the waiting list for kidney transplants is long, growing, and unlikely to be substantially reduced by increases in the recovery of cadaveric kidneys.