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John,
Today we released the March issue of Health
Affairs.
The March issue of Health Affairs covers a broad range of topics, including hospital finances and billing, equity in clinical trials and HIV/AIDS prevention, the effects of providing people with a transportation benefit, and considerations in covering cancer screening.
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Hospitals
Jill Horwitz and Austin Nichols examine the relationship between hospital ownership type and which service lines hospitals offer. After controlling for market and hospital characteristics, they determine that although all types are more likely to offer a service if it is relatively profitable, “nonprofit hospitals offer relatively unprofitable services more than for-profit hospitals and less than government hospitals. Profitable services typically exhibit the opposite pattern.”
Andrew Beck and coauthors compare the experiences of low-income children referred to a medical-legal partnership at Cincinnati Children’s Hospital Medical Center with a matched cohort who were not referred and find that those who were referred had a one-third lower rate of hospitalization within one year.
The Furthering
Access to Stroke Telemedicine (FAST) Act expanded Medicare payment for telemedicine consultations for acute stroke, also known as “telestroke.” Andrew Wilcock and coauthors find that one year after implementation, Medicare billing for telestroke increased in urban and rural hospital emergency departments, but most hospitals that could have initiated a claim never did so—in part, say the authors, because of the complexity of the billing process.
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Equity
The Medicare Hospital Readmissions Reduction Program (HRRP) was modified in 2019 to stratify hospitals according to the proportion of their patients who are dual Medicare and Medicaid enrollees—a measure of social risk.
Sukruth Shashikumar and coauthors examine
the change in average annual penalty percentage among safety-net hospitals, rural hospitals, and hospitals with a large share of Black and Hispanic/ Latino patients. All three groups experienced a small reduction in penalties due to stratification, implying a “modest step toward equity within the HRRP.”
Pre-exposure prophylaxis (PrEP) is a highly effective method for preventing HIV transmission, but its adoption among at-risk populations has been slow.
Nina Harawa and coauthors find higher uptake rates for male than female California Medicaid enrollees and higher rates for White and Black men than for Hispanic men. However, when considering HIV risk, people who are
members of racial and ethnic minority groups have lower PrEP uptake than Whites.
In 2015 the Food and Drug Administration launched a plan aimed at improving the diversity of participants in clinical trials and the transparency of trial results for newly approved drugs. Angela Green and colleagues report that the initiative did not improve representation of Black relative to White participants, and only 20 percent of studies reporting results after the plan went into effect met a requirement to include race-specific reporting of benefits and side effects.
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Care Delivery
Thomas Tsai and coauthors find that about half of Affordable Care Act Marketplace enrollees live in counties where the health plan offering with the highest quality rating is three stars out of five, whereas 46 percent have access to a four or five-star-rated
plan. Overall, there are no disparities in access to high-rated plans in counties with a higher percentage of Black or Hispanic residents.
Hector Rodriguez and coauthors find that physician practices with robust capabilities across domains of technology, management, and patient-centered focus have lower total spending on Medicare fee-for-service beneficiaries compared to practices with more limited capabilities, with savings concentrated in outpatient spending.
Although Medicaid has provided a nonemergency medical transportation benefit for decades, health plans have begun to offer the benefit more recently.
Seth Berkowitz and coauthors find that participation in such a benefit in a Medicare accountable care organization is associated with 9.2 more outpatient visits and $4,420 in additional outpatient costs per person per year,
with no reductions in emergency department visits or inpatient admissions. Program users express high satisfaction, an easing of financial and personal burdens, and feelings of increased safety and empowerment.
Analyzing referrals of hospitalized patients with opioid use disorder (OUD) from a Boston, Massachusetts, safety-net hospital to post-acute care, Simeon Kimmel and coauthors determine that more than eight in ten are rejected.
“Referrals associated with OUD had more than double the odds of rejection compared with referrals not associated with an OUD diagnosis when adjusting for clinical and demographic confounders,” they conclude.
New multicancer early detection tests can screen for up to fifty cancers simultaneously, based on a simple blood draw. Patricia Deverka and colleagues argue in their Policy Insight piece for clarifying how payers evaluate the tests’ clinical validity, utility, and economic value. They also highlight the importance of systematic collection of real-world evidence.
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Join Health Affairs for a free virtual event! In addition to the new journal edition, we produce a
variety of events that relate to our research and bring health policy professionals up to speed on the latest in health policy research.
On March 22, join Seth Berkowitz from the University of North Carolina School of Medicine for a detailed discussion of his paper’s data, methods, and conclusions. Health Affairs Senior Editor Kathleen Haddad will host.
On March 28, join a Policy Spotlight event with HRSA Administrator Carole Johnson. On March 30, we are hosting a Lunch and Learn on population health and health spending.
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Listen to our new podcast series, Health Affairs Pathways.
Health Affairs Pathways explores the avenues and alleyways of the health care system through a variety of storytelling – from investigative journalism and health policy explainers to long-form interviews.
Unique series are created by fellows in the Health Affairs Podcast Fellowship Program, designed to support early to mid-stage professionals pursue an audio project, tell a unique health care story, and highlight voices that might not be heard otherwise.
The first season from Lalita Abhyankar, a physician and storyteller based in San Francisco, examined how consolidation in health care is affecting independent primary care.
The second
season – titled "While We Wait" – joins Avni Kulkarni and Sania Ali as they examine mental health boarding and its inefficiencies.
The second season will debut on March 9, 2022.
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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.
Project HOPE is a global health and humanitarian relief organization that places power in the hands of local health care workers to save lives across the globe. Project HOPE has published Health Affairs since 1981.
Copyright © Project HOPE: The People-to-People Health Foundation, Inc.
Health Affairs, 1220 19th Street, NW, Suite 800, Washington, DC 20036, United States
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