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The Latest Research, Commentary, And News From Health Affairs

April 25, 2021

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Dear John,

Read on for highlights from Health Affairs this week.

Care Delays As A Result Of COVID-19, Social Risk Adjustment & More

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The COVID-19 pandemic has prompted patients and providers to delay or
cancel a substantial share of medical care in the past year. In an
article published ahead of print
,
Kevin Callison and Jason Ward examined the socioeconomic and demographic
characteristics of patients who have been subject to these involuntary
care disruptions.

Using survey data from May through October 2020, they found that, "older
age, being in fair or poor health, greater education, the presence of a
work-limiting disability, and having health insurance coverage were
associated with greater likelihood of experiencing an involuntary
disruption in accessing medical care as a result of the COVID-19
pandemic."

Kathleen Yinran Li and coauthors sought to better understand the overall
costs associated with video-based, on-demand, patient-initiated
telemedicine for acute respiratory infections
.
They evaluated direct-to-consumer telemedicine claims from a large
commercial payer for 2016 to 2019 and found that 10.3 percent of these
telemedicine visits led to subsequent in-person visits, compared to only
5.9 percent of in-person encounters.

Ge Bai and colleagues compared charity care in 2018 across government,
nonprofit, and for-profit hospitals. They found that, among
Medicare-certified general acute care hospitals, the nonp
rofit
hospitals provided the least aggregated charity care. For every $100 of
expense incurred, nonprofit hospitals spent less on charity care ($2.3)
than for-profit hospitals ($3.8) or government hospitals ($4.1).

Providers are increasingly subject to payment policies based on their
performance, and there is consensus that we should consider clinical
factors, such as disease severity, when measuring the quality of a
provider's care. But adjusting for social risk factors, such as
poverty, remains controversial.

In an April 2021 paper as part of our Policy Insight series
,
David Nerenz and coauthors reviewed the arguments on both sides of this
debate and posed five questions that policy makers should consider when
making a determination for a particular quality measure. The authors
concluded that "social risk adjustment should be the default option,"
and that it can be an important tool for promoting health equity.

Using data from New York City on hospital readmissions, Matthew Baker
and coauthors compared condition-specific models that estimate
readmission rates currently used by the Centers for Medicare and
Medicaid Services with multiple alternative models for the same
patients, augmented with social determinants of health (SDOH) scores
.

This week on Health Affairs Blog, Katie Keith provided the latest on
2021 Affordable Care Act Marketplace enrollment, navigator funding, and
more
.  Keith
also summarized the latest in litigation over an Obama-era rule
implementing Section 1557
,
including at least two pending challenges to the Obama-era
interpretation of this provision.

Finally, in celebration of National Poetry Month, we're revisiting the
three poems that won the 2019 Narrative Matters poetry contest and were
featured in the April 2020 issue of Health Affairs: "The Headache
,"
"Epidemic
,"
and "Admission
."
Listen to the authors read their poems

on our Narrative Matters podcast.

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ACA Closed Health Coverage Gaps For Pregnant Women. There's Still A
Long Way To Go

Listen to Editor-in-Chief Alan Weil interview Emily Johnston from the
Health Policy Center at the Urban Institute. Johnston shares insights
from her latest research on women's loss of Medicaid in the weeks
before or after pregnancy.

Listen Here

Featured This Week

Associations Between Individual Demographic Characteristics And
Involuntary Health Care Delays As A Result Of COVID-19

Kevin Callison and Jason Ward

Direct-To-Consumer Telemedicine Visits For Acute Respiratory Infections
Linked To More Downstream Visits

Kathleen Yinran Li, Ziwei Zhu, Sophia Ng, and Chad Ellimoottil

Podcast: ACA Closed Health Coverage Gaps For Pregnant Women. There's
Still A Long Way To Go

Alan Weil and Emily Johnston

Analysis Suggests Government And Nonprofit Hospitals' Charity Care Is
Not Aligned With Their Favorable Tax Treatment

Ge Bai, Hossein Zare, Matthew D. Eisenberg, Daniel Polsky, and Gerard F.
Anderson

Adjusting Quality Measures For Social Risk Factors Can Promote Equity In
Health Care

David R. Nerenz, J. Matthew Austin, Daniel Deutscher, Karen E. Joynt
Maddox, Eugene J. Nuccio, Christie Teigland, Eric Weinhandl, and Laurent
G. Glance

Social Determinants Matter For Hospital Readmission Policy: Insights
From New York City

Matthew C. Baker, Philip M. Alberti, Tsu-Yu Tsao, Kyle Fluegge, Renata
E. Howland, and Merle Haberman

Podcast: Hospitals At Large Are Failing At Price Transparency

Leslie Erdelack and Rob Lott

The Headache

Anjali Jain

Epidemic

Ronald O. Valdiserri

Admission

Alex Sievert

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Request For Abstracts:
Racism And Health

Health Affairs is planning a theme issue on racism and health, with an
emphasis on structural racism, to be published in February 2022. We plan
to publish approximately twenty peer-reviewed articles-including
original research, analyses, commentaries, and Narrative Matters-from
a diverse group of researchers, scholars, and community health leaders,
among others.

We're looking for content to help shape future research and policy.

**Health Affairs** thanks the Robert Wood Johnson Foundation and the
Episcopal Health Foundation for their generous support of this issue.

Read More

On The Blog This Week

Addressing Social Risk Factors In Value-Based Payment: Adjusting Payment
Not Performance To Optimize Outcomes and Fairness

Jonathan B. Jaffery and Dana Gelb Safran

The Confident Generalist: Putting The Primary Care Physician Back At The
Center

Sachin H. Jain and Balu Gadhe

Medicine's Privileged Gatekeepers: Producing Harmful Ignorance About
Racism And Health

Nancy Krieger, Rhea Boyd, Fernando De Maio, and Aletha Maybank

No Patient Left Behind: Considering Equitable Distribution Of Telehealth

Rama A. Salhi, Mahshid Abir, and Bisan A. Salhi

ACA Litigation Round-Up, Part 2: Which 2019 Payment Rule Changes Were
Legal? Plus, More From Judge O'Connor On The ACA

Katie Keith

Creating An Agenda For Children's Resiliency And Health

Kara Odom Walker, Josh Rising, and Daniella Gratale

Marketplace Enrollment Tops 12 Million For 2021; Largest-Ever Funding
For Navigators

Katie Keith

Finding Effective Ways To Address Social Determinants Of Health

David Lakey, Elena Marks, and Eileen Nehme

Removing The X-Waiver Is One Small Step Toward Increasing Treatment Of
Opioid Use Disorder, But Great Leaps Are Needed

Erin J. Stringfellow, Keith Humphreys, and Mohammad S. Jalali

Better Care Teams: A Key Element Of Better Care Plans

John Toussaint, Stephen M. Shortell, and Peter A. Wadsworth

ACA Litigation Round-Up, Part 3: Section 1557, The ACA's Primary
Nondiscrimination Provision

Katie Keith

The Post-Market Surveillance System For Implanted Devices Is Broken.
Here's How CMS And The FDA Can Act Now To Fix It

Dan C. Krupka, Natalia A. Wilson, Amanda J. Reich, and Joel S. Weissman

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Hospitals At Large Are Failing At Price Transparency

Listen to Health Affairs' Leslie Erdelack and Rob Lott break down the
latest on the federal hospital pricing transparency rule and hospital
compliance.

Listen Here

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About Health Affairs

Health Affairs is the leading peer-reviewed journal
at the intersection of health,
health care, and policy. Published monthly by Project HOPE, the journal
is available in print and online. Late-breaking content is also found
through healthaffairs.org , Health Affairs Today
, and Health Affairs Sunday
Update .  

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health care workers to save lives across the globe. Project HOPE has
published Health Affairs since 1981.

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