Impact of Site-Neutral Payments for Commercial and Employer-Sponsored Plans.

Site-neutral payment is a policy created by federal rule making and implemented by the Centers for Medicare and Medicaid Services (CMS) that aims to reduce healthcare costs by aligning payment rates for certain services provided in multiple care settings. Site-neutral payments are intended to eliminate the incentive for providers to acquire facilities, such as physician offices or ambulatory surgical centers (ASCs), that Medicare reimburses at the lower non-facility rate and convert those settings into hospital outpatient departments (HOPDs), where Medicare reimburses at the higher facility rate. Although initiated by Congress to address payment disparities in Medicare, similar payment discrepancies can be seen in the commercial market where individual and employer-sponsored health plans often pay more for certain outpatient services depending on their location.

Reimagining Patient Data Access for Researchers.

Objectives: Widespread use of electronic health records (EHRs) now makes it feasible to expand beyond health insurance claims data to include full EHR data for health economics and outcomes research (HEOR) studies. We seek to develop ways to maximize researcher access to such data while strongly protecting patients' privacy rights.

Methods: We analyzed alternative organizational structures and intellectual property rights assignments as they now exist and compared these with structures and intellectual property rights assignments that would maximize access to data for HEOR studies and minimize transactions costs.

Estimating the Impact of New Health Price Transparency Policies.

This analysis investigates and scores the impact of new health price transparency rules. Using a set of novel data sources, we estimate substantial savings are possible following the implementation of the insurer price transparency rule. Specifically, we estimate annual savings to consumers, employers, and insurers by 2025, assuming a robust set of tools to allow consumers to purchase medical services.

Comparing spending across Medicare programs.

As Medicare Advantage increasingly becomes the dominant form of Medicare, meaningful and accurate comparisons with traditional fee-for-service Medicare will be increasingly important for both beneficiaries and policy makers. Recent debate among policy experts, government advisory bodies, and health plans highlights the need to create standardized comparison between the 2 Medicare programs. Supplemental benefits, Part B cost-sharing differences, and prescription drug benefits should be valued with a series of structured comparisons.

Assessment of the Provider Relief Fund Distribution for Treatment of Uninsured Patients With COVID-19.

This cross-sectional study uses US Health Resources and Services Administration data to assess the distribution of claims reimbursement funds to health care professionals and facilities for uninsured patients with COVID-19.

Returns to specialization: Evidence from the outpatient surgery market.

Technological changes in medicine have created new opportunities to provide surgical care in lower cost, specialized facilities. This paper examines patient outcomes in ambulatory surgery centers (ASCs), which were developed as a low-cost alternative to outpatient surgery in hospitals. Because we are concerned that selection into ASCs may bias estimates of facility quality, we use predicted changes in federally set Medicare facility payment rates as an instrument for ASC utilization to estimate the effect of location of treatment on patient outcomes.

Does primary care diabetes management provided to Medicare patients differ between primary care physicians and nurse practitioners?

Aims: The aim of this study was to answer the overall question: Does primary care diabetes management for Medicare patients differ in scope and outcomes by provider type (physician or nurse practitioner)?

Background: In the USA as well as globally, there is a pressing need to address high healthcare costs while improving healthcare outcomes. Primary health care is one area where healthcare reform has received considerable attention, in part because of continued projections of primary care physician shortages. Many argue that nurse practitioners are one solution to ease the consequences of the projected shortage of primary care physicians in the USA as well as other developed countries.

Wage Growth for the Health Care Workforce: Projecting the Affordable Care Act Impact.

Objective: To predict changes in wage growth for health care workers based on projections of insurance enrollment from the Affordable Care Act (ACA).

Data Sources: Enrollment data came from three large employers and a sampling of premiums from ehealthinsurance.com.

Prices For Common Medical Services Vary Substantially Among The Commercially Insured.

Using a national multipayer commercial claims database containing allowed amounts, we examined variations in the prices for 242 common medical services in forty-one states and the District of Columbia. Ratios of average state prices to national prices ranged from a low of 0.79 in Florida to a high of 2.

Improving medication adherence among kidney transplant recipients: Findings from other industries, patient engagement, and behavioral economics-A scoping review.

The immune system is a powerful barrier to successful organ transplantation, but one that has been routinely thwarted through modern pharmacotherapeutics. Despite the benefits of immunosuppressive therapy, medication non-adherence leads to an increased risk of graft rejection, higher hospital utilization and costs, and poor outcomes. We conduct a scoping review following Arksey and O'Malley's five-stage framework methodology to identify established or novel interventions that could be applied to kidney transplant recipients to improve medication adherence.

Comparing efficiency of health systems across industrialized countries: a panel analysis.

Background: Rankings from the World Health Organization (WHO) place the US health care system as one of the least efficient among Organization for Economic Cooperation and Development (OECD) countries. Researchers have questioned this, noting simplistic or inappropriate methodologies, poor measurement choice, and poor control variables. Our objective is to re-visit this question by using newer modeling techniques and a large panel of OECD data.

Overcoming barriers to a research-ready national commercial claims database.

Objectives: Billions of dollars have been spent on the goal of making healthcare data available to clinicians and researchers in the hopes of improving healthcare and lowering costs. However, the problems of data governance, distribution, and accessibility remain challenges for the healthcare system to overcome.

Study Design: In this study, we discuss some of the issues around holding, reporting, and distributing data, including the newest "big data" challenge: making the data accessible to researchers and policy makers.

The demand for health care workers post-ACA.

Concern abounds about whether the health care workforce is sufficient to meet changing demands spurred by the Affordable Care Act (ACA). We project that by 2022 the health care industry needs three to four million additional workers, forty percent of which is related to demand growth under the ACA. We project faster job growth in the ambulatory care sector, especially in home health care.

Procedures take less time at ambulatory surgery centers, keeping costs down and ability to meet demand up.

During the past thirty years outpatient surgery has become an increasingly important part of medical care in the United States. The number of outpatient procedures has risen dramatically since 1981, and the majority of surgeries performed in the United States now take place in outpatient settings. Using data on procedure length, we show that ambulatory surgery centers (ASCs) provide a lower-cost alternative to hospitals as venues for outpatient surgeries.

Scope-of-practice laws for nurse practitioners limit cost savings that can be achieved in retail clinics.

Retail clinics have the potential to reduce health spending by offering convenient, low-cost access to basic health care services. Retail clinics are often staffed by nurse practitioners (NPs), whose services are regulated by state scope-of-practice regulations. By limiting NPs' work scope, restrictive regulations could affect possible cost savings.

Trends underlying employer-sponsored health insurance growth for Americans younger than age sixty-five.

Little is known about the trends in health care spending for the 156 million Americans who are younger than age sixty-five and enrolled in employer-sponsored health insurance. Using a new source of health insurance claims data, we estimated per capita spending, utilization, and prices for this population between 2007 and 2011. During this period per capita spending on employer-sponsored insurance grew at historically slow rates, but still faster than per capita national health expenditures.

Measuring medical productivity to gauge the value of Medicare.

Having a measure of productivity that relates funds and effort spent on medical treatment to health outcomes could help policymakers better understand whether they are getting value for the money spent on public health insurance programs. This article describes such a metric, the medical productivity index (MPI), and illustrates how it was used to analyze a sampling of Medicare claims from 2007 through 2009.

Microsimulation of private health insurance and medicaid take-up following the U.S. Supreme court decision upholding the Affordable Care Act.

Objective: To predict take-up of private health insurance and Medicaid following the U.S. Supreme Court decision upholding the Affordable Care Act (ACA).

Competitive bidding for health insurance contracts: lessons from the online HMO auctions.

Healthcare is an important social and economic component of modern society, and the effective use of information technology in this industry is critical to its success. As health insurance premiums continue to rise, competitive bidding may be useful in generating stronger price competition and lower premium costs for employers and possibly, government agencies. In this paper, we assess an endeavor by several Fortune 500 companies to reduce healthcare procurement costs for their employees by having HMOs compete in open electronic auctions.

Measuring inappropriate medical diagnosis and treatment in survey data: The case of ADHD among school-age children.

We exploit the discontinuity in age when children start kindergarten generated by state eligibility laws to examine whether relative age is a significant determinant of ADHD diagnosis and treatment. Using a regression discontinuity model and exact dates of birth, we find that children born just after the cutoff, who are relatively old-for-grade, have a significantly lower incidence of ADHD diagnosis and treatment compared with similar children born just before the cutoff date, who are relatively young-for-grade. Since ADHD is an underlying neurological problem where incidence rates should not change dramatically from one birth date to the next, these results suggest that age relative to peers in class, and the resulting differences in behavior, directly affects a child's probability of being diagnosed with and treated for ADHD.