Mental Health Support for First Responders Provided Outside of California's Workers' Compensation System.

Objective: Concern about psychiatric injuries for first responders has grown. We examine alternatives to workers' compensation (WC).

Method: We conducted 15 interviews across 5 California departments contracted with non-WC mental health (MH) providers.

Upcoding Linked To Up To Two-Thirds Of Growth In Highest-Intensity Hospital Discharges In 5 States, 2011-19.

Diagnosis-based payment systems can create incentives to upcode patients to a higher level of severity to increase payment. In some instances, upcoding can be a form of fraud if providers code patients to a higher complexity than is appropriate, whereas in other instances, upcoding can accurately reflect patient acuity. We estimated the increase in Medicare Severity Diagnosis-Related Group (MS-DRG) upcoding during the period 2011-19, using all-payer discharge-level data from five states.

America's Opioid Ecosystem: How Leveraging System Interactions Can Help Curb Addiction, Overdose, and Other Harms.

Opioids play an outsized role in America's drug problems, but they also play a critically important role in medicine. Thus, they deserve special attention. Illegally manufactured opioids (such as fentanyl) are involved in a majority of U.

The Impact of Nurse Practitioner-Led Primary Care on Quality and Cost for Medicaid-Enrolled Patients in States With Pay Parity.

Studies have established that nurse practitioners (NPs) deliver primary care comparable to physicians in quality and cost, but most focus on Medicare, a program that reimburses NPs less than physicians. In this retrospective cohort study, we evaluated the quality and cost implications of receiving primary care from NPs compared to physicians in 14 states that reimburse NPs at the Medicaid fee-for-service (FFS) physician rate (i.e.

U.S. Department of Defense Disability Compensation Under a Fitness-for-Duty Evaluation Approach.

The joint U.S. Department of Defense (DoD) - Department of Veterans Affairs (VA) Integrated Disability Evaluation System is the process by which DoD determines fitness for duty and separation or retirement of service members because of disability.

The quality of occupational healthcare for carpal tunnel syndrome, healthcare expenditures, and disability outcomes: A prospective observational study.

Introduction/aims: In prior work, higher quality care for work-associated carpal tunnel syndrome (CTS) was associated with improved symptoms, functional status, and overall health. We sought to examine whether quality of care is associated with healthcare expenditures or disability.

Methods: Among 343 adults with workers' compensation claims for CTS, we created patient-level aggregate quality scores for underuse (not receiving highly beneficial care) and overuse (receiving care for which risks exceed benefits).

The Demand for Insurance and Rationale for a Mandate: Evidence from Workers' Compensation Insurance.

Workers' compensation insurance, which provides no-fault coverage for work-related injuries, is mandatory in nearly all states. We use administrative data from a unique market without a coverage mandate to estimate the demand for workers' compensation insurance, leveraging regulatory premium updates for identification. We find that a 1 percent increase in premiums leads to approximately a 0.

Use of Telehealth Across Pediatric Subspecialties Before and During the COVID-19 Pandemic.

Importance: The identification of variation in health care is important for quality improvement. Little is known about how different pediatric subspecialties are using telehealth and what is driving variation.

Objective: To characterize trends in telehealth use before and during the COVID-19 pandemic across pediatric subspecialties and the association of delivery change with no-show rates and access disparities.

The Frequency and Economic Impact of Musculoskeletal Disorders for California Firefighters: Trends and Outcomes over the Past Decade.

Musculoskeletal disorders (MSDs) are the most common type of occupational injury or illness suffered by firefighters, so there is considerable interest among policymakers and stakeholders about how best to monitor, prevent, and treat firefighter MSDs. In this study, the authors update analyses from a 2010 RAND study on firefighters in California and consider the impacts of the 2013 workers' compensation reforms and the economic shocks of the late 2000s on outcomes for firefighters with MSDs. The California Department of Industrial Relations requested that the authors address a wide range of specific research questions on various aspects of firefighters' injury risk and outcomes in the workers' compensation system, from case mix and economic consequences to permanent disability rating and medical treatment patterns.

The quality of electrodiagnostic tests for carpal tunnel syndrome: Implications for surgery, outcomes, and expenditures.

Introduction: The quality of electrodiagnostic tests may influence treatment decisions, particularly regarding surgery, affecting health outcomes and health-care expenditures.

Methods: We evaluated test quality among 338 adults with workers' compensation claims for carpal tunnel syndrome. Using simulations, we examined how it influences the appropriateness of surgery.

Changes in hospital service demand, cost, and patient illness severity following health reform.

Objective: To estimate the effects of the health insurance exchange and Medicaid coverage expansions on hospital inpatient and emergency department (ED) utilization rates, cost, and patient illness severity, and also to test the association between changes in outcomes and the size of the uninsured population eligible for coverage in states.

Data Sources: Healthcare Cost and Utilization Project State Inpatient and Emergency Department Databases, 2011-2015, Nielsen Demographic Data, and the American Community Survey.

Study Design: Retrospective study using fixed-effects regression to estimate the effects in expansion and nonexpansion states by age/sex demographic groups.

Veterans' Health Insurance Coverage Under the Affordable Care Act and Implications of Repeal for the Department of Veterans Affairs.

This article describes the Affordable Care Act's (ACA's) effects on nonelderly veterans' insurance coverage and demand for Department of Veterans Affairs (VA) health care and assesses the coverage and VA utilization changes that could result from repealing the ACA. Although prior research has shown that the number of uninsured veterans fell after the ACA took effect, the implications of ACA repeal for veterans and, especially, for VA have received less attention. Besides providing a new coverage option to veterans who are not enrolled in VA, the ACA also had the potential to affect health care use among VA patients.

Quality of care and patient-reported outcomes in carpal tunnel syndrome: A prospective observational study.

Introduction: Higher quality care for carpal tunnel syndrome (CTS) may be associated with better outcomes.

Methods: This prospective observational study recruited adults diagnosed with CTS from 30 occupational health centers, evaluated physicians' adherence to recommended care processes, and assessed results of the Boston Carpal Tunnel Questionnaire (BCTQ) and Short Form Health Survey version 2 (SF-12v2) at recruitment and at 18 months.

Results: Among 343 individuals, receiving better care (80th vs.

Changes in Hospital Inpatient Utilization Following Health Care Reform.

Objective: To estimate the effects of 2014 Medicaid expansions on inpatient outcomes.

Data Sources: Health Care Cost and Utilization Project State Inpatient Databases, 2011-2014; population and unemployment estimates.

Study Design: Retrospective study estimating effects of Medicaid expansions using difference-in-differences regression.

Quality of Care for Work-Associated Carpal Tunnel Syndrome.

Objective: To evaluate the quality of care provided to individuals with workers' compensation claims related to Carpal tunnel syndrome (CTS) and identify patient characteristics associated with receiving better care.

Methods: We recruited subjects with new claims for CTS from 30 occupational clinics affiliated with Kaiser Permanente Northern California. We applied 45 process-oriented quality measures to 477 subjects' medical records, and performed multivariate logistic regression to identify patient characteristics associated with quality.

Assessing the Value of High-Quality Care for Work-Associated Carpal Tunnel Syndrome in a Large Integrated Health Care System: Study Design.

Context: Little is known about quality of care for occupational health disorders, although it may affect worker health and workers' compensation costs. Carpal tunnel syndrome (CTS) is a common work-associated condition that causes substantial disability.

Objective: To describe the design of a study that is assessing quality of care for work-associated CTS and associations with clinical outcomes and costs.