State-level actions targeting unethical substance use disorder treatment practices: A qualitative study.

Introduction: There has been increasing recognition of unethical practices occurring in substance use disorder (SUD) treatment, such as patient brokering and deceptive marketing. We conducted a qualitative study with key informants to characterize state actions that have been undertaken to target unethical practices and the context surrounding state-level actions, including barriers and facilitators to their implementation.

Methods: We recruited key informants at the state-level, as well as those from national organizations engaged in improving SUD treatment quality, who could provide perspectives on the scope of unethical practices in the field and ways in which states have sought to prevent unethical practices and improve the quality of SUD treatment.

Evaluation of Low-Value Services Across Major Medicare Advantage Insurers and Traditional Medicare.

Importance: Compared with traditional Medicare (TM), Medicare Advantage (MA) insurers have greater financial incentives to reduce the delivery of low-value services (LVS); however, there is limited evidence at a national level on the prevalence of LVS utilization among MA vs TM beneficiaries and whether LVS utilization rates vary among the largest MA insurers.

Objective: To determine whether there are differences in the rates of LVS delivered to Medicare beneficiaries enrolled in MA vs TM, overall and by the 7 largest MA insurers.

Design, Setting, And Participants: This cross-sectional study included Medicare beneficiaries aged 65 years and older residing in the US in 2018 with complete demographic information.

State Policies Targeting Patient Brokering and Deceptive Marketing of Substance Use Disorder Treatment.

Objectives: To characterize state laws targeting patient brokering and deceptive marketing of substance use disorder (SUD) treatment.

Background: Patient brokering and deceptive marketing of SUD treatment leads to poor outcomes for individuals with SUD, including relapse- or overdose-related hospitalizations, ED visits, or death. In response, several states within the United States have passed laws targeting unethical practices of SUD treatment in recent years.

Medical training program size and clinical staff productivity and turnover.

Objective: The objective of this analysis was to evaluate the effect of resident program training size on clinician productivity and turnover in the Veterans Health Administration (VHA), the largest education and training platform for medical professionals in the United States.

Data Sources: We retrieved administrative data on training programs and training facilities from the VA Office of Academic Affiliations and the VHA Corporate Data Warehouse. Data on primary care physician shortage areas were retrieved from the Health Resources and Services Administration.

Impact of Nurse Residency Program on Time-to-Fill Nurse Vacancies at the Veterans Health Administration.

Background: The Department of Veterans Affairs (VA) offers a 1-year Post-Baccalaureate-Registered Nurse Residency (PB-RNR) Program. The impact of the PB-RNR program on local RN recruitment was unknown.

Objectives: We aimed to evaluate the effect of the size of the PB-RNR program at a VA facility on its time-to-fill RN vacancies.

Pay-for-Performance Incentives for Home Dialysis Use and Kidney Transplant.

Importance: The Centers for Medicare & Medicaid Services' mandatory End-Stage Renal Disease Treatment Choices (ETC) model, launched on January 1, 2021, randomly assigned approximately 30% of US dialysis facilities and managing clinicians to financial incentives to increase the use of home dialysis and kidney transplant.

Objective: To assess the ETC's association with use of home dialysis and kidney transplant during the model's first 2 years and examine changes in these outcomes by race, ethnicity, and socioeconomic status.

Design, Setting, And Participants: This retrospective cross-sectional study used claims and enrollment data for traditional Medicare beneficiaries with kidney failure from 2017 to 2022 linked to same-period transplant data from the United Network for Organ Sharing.

Access to insurance navigation support through the State Health Insurance Assistance Program (SHIP).

Medicare enrollment is complex, particularly for low-income individuals who are dually eligible for Medicare and Medicaid, and the wrong plan choice can adversely impact beneficiaries' out-of-pocket costs and access to providers and medications. The State Health Insurance Assistance Program (SHIP) is a federal program that provides counseling on Medicare coverage, but the degree to which SHIP services are accessible to low-income beneficiaries is unknown. We interviewed SHIP counselors and coordinators to characterize factors affecting access to and quality of SHIP services for low-income beneficiaries.

Effect of mental health staffing inputs on initiation of care among recently separated Veterans.

Objective: To estimate a causal relationship between mental health staffing and time to initiation of mental health care for new patients.

Data Sources And Study Setting: As the largest integrated health care delivery system in the United States, the Veterans Health Administration (VHA) provides a unique setting for isolating the effects of staffing on initiation of mental health care where demand is high and out-of-pocket costs are not a relevant confounder. We use data from the Department of Defense and VHA to obtain patient and facility characteristics and health care use.

Effect of the Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act Scribes Trial on Emergency Department Provider Productivity and Patient Throughput Times.

Background: To help improve access to care, section 507 of the VA MISSION (Maintaining Internal Systems and Strengthening Integrated Outside Networks) Act of 2018 mandated a 2-year trial of medical scribes in the Veterans Health Administration (VHA).

Objective: The impact of scribes on provider productivity and patient throughput time in VHA emergency departments (EDs) was evaluated.

Methods: A clustered randomized trial was designed using intent-to-treat difference-in-differences analysis.

Association between physician-hospital integration and inpatient care delivery in accountable care organizations: An instrumental variable analysis.

Objective: To investigate the relationship between physician-hospital integration within accountable care organizations (ACOs) and inpatient care utilization and expenditure.

Data Sources: The primary data were Massachusetts All-Payer Claims Database (2009-2013).

Study Setting: Fifteen provider organizations that entered a commercial ACO contract with a major private payer in Massachusetts between 2009 and 2013.

Restrictiveness of Medicare Advantage provider networks across physician specialties.

Objective: The objective was to measure specialty provider networks in Medicare Advantage (MA) and examine associations with market factors.

Data Sources And Study Setting: We relied on traditional Medicare (TM) and MA prescription drug event data from 2011 to 2017 for all Medicare beneficiaries in the United States as well as data from the Area Health Resources File.

Study Design: Relying on a recently developed and validated prediction model, we calculated the provider network restrictiveness of MA contracts for nine high-prescribing specialties.

The effects of the Veterans Health Administration's Referral Coordination Initiative on referral patterns and waiting times for specialty care.

Objective: To investigate whether the Veterans Health Administration's (VA) 2019 Referral Coordination Initiative (RCI) was associated with changes in the proportion of VA specialty referrals completed by community-based care (CC) providers and mean appointment waiting times for VA and CC providers.

Data Sources/study Settings: Monthly facility level VA data for 3,097,366 specialty care referrals for eight high-volume specialties (cardiology, dermatology, gastroenterology, neurology, ophthalmology, orthopedics, physical therapy, and podiatry) from October 1, 2019 to May 30, 2022.

Study Design: We employed a staggered difference-in-differences approach to evaluate RCI's effects on referral patterns and wait times.

Costs and Productivity Benefits of the Department of Veterans Affairs Maintaining Internal Systems and Strengthening Integrated Outside Networks Act Scribes Trial.

Objectives: To improve access, the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act of 2018 mandated a 2-year study of medical scribes in Veterans Health Administration specialty clinics and emergency departments. Medical scribes are employed in clinical settings with the goals of increasing provider productivity and satisfaction by minimizing physicians' documentation burden. Our objective is to quantify the economic outcomes of the MISSION Act scribes trial.

Impact of Medical Training Programs on Time-to-Fill Physician Vacancies at the Veterans Health Administration.

Background: The Department of Veterans Affairs (VA) provides the largest Graduate Medical Education (GME) training platform for health professionals in the United States. Studies on the impact of VA GME programs on physician recruitment were lacking.

Objectives: To examine the impact of the size of residency training programs at a VA facility on the facility's time-to-fill physician vacancies, and whether the impact differs by the socioeconomic deprivation and public school quality of the geographic area.

Measuring restrictiveness of Medicare Advantage networks: A claims-based approach.

Objective: To develop and validate a measure of provider network restrictiveness in the Medicare Advantage (MA) population.

Data Sources: Prescription drug event data and beneficiary information for Part D enrollees from the Center for Medicare and Medicaid Services, along with prescriber identifiers; geographic variables from the Area Health Resources Files.

Study Design: A prediction model was used to predict the unique number of primary care providers that would have been seen by MA beneficiaries absent network restrictions.