Nurses, care delivery, pharmaceuticals and more.
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Dear John,
The September issue of Health Affairs includes articles describing the
growing role of nurses in care delivery, the prevalence of low-value
care, the role of patient pharmaceutical assistance programs, the
effects of risk adjustment, and more.
Read The Issue
Nurses
Psychiatric mental health nurse practitioners (PMHNPs) are NPs with
additional education and certification related to mental health.
Arno Cai and coauthors report that the number of PMHNPs treating
Medicare beneficiaries increased by 162 percent
from 2011 to 2019 compared with a decrease of 6 percent for
psychiatrists during the same period.
The authors find that "the proportion of all mental health prescriber
visits provided by PMHNPs increased from 12.5 percent to 29.8 percent
during 2011-19, exceeding 50 percent in rural, full-scope-of-practice
regions."
Joanne Spetz and coauthors examine trends among providers able to
prescribe buprenorphine treatment
in office-based settings after federal action expanding access to
waivers permitting this practice.
The authors find that advanced practice nurses (APNs) "accounted for
the largest contribution to treatment capacity growth during the
pandemic," signaling that APNs could play a critical role in expanding
access to opioid-related care.
Read More
Care Delivery
Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs) are
designed to provide services to people who are eligible for both
Medicare and Medicaid.
Eric Roberts and Jennifer Mellor find that
"dual eligibles in D-SNPs generally had greater access to care, use of
preventive services, and satisfaction with care than dual eligibles in
traditional Medicare."
However, enrollment in D-SNPs "was associated with fewer and smaller
improvements in care among dual eligibles of color than among their
non-Hispanic White counterparts."
Mitchell Tang and colleagues determine that the use of general remote
patient monitoring increased
more than fourfold during the COVID-19 pandemic, with a small share of
primary care providers driving most of the use.
They estimate that full deployment of remote patient monitoring could
generate $175,000 in revenue per primary care provider per year.
Lauren Do and coauthors analyze the prevalence of twenty-three low-value
services
among a group of Medicare Advantage and commercial insurance enrollees.
They find that low-value cancer screening and preoperative testing had
the highest and second-highest rates of utilization, respectively, and
"the utilization rate of low-value care in states in the top decile
was more than twice that of states in the bottom decile."
The Comprehensive Primary Care Plus (CPC+) initiative, a multipayer
payment reform model, provided incentives for practices to lower
spending and improve quality.
Adam Markovitz and colleagues find that
CPC+ was neither "associated with reductions in total spending or most
components of spending" nor "associated with improvements in overall
quality performance" among enrollees in two large private health plans
in Michigan.
In the wake of growing acquisition of ambulatory surgical centers
(ASCs) by private equity firms, Joseph Bruch and coauthors find no
statistically significant differences in the seven-day unplanned
hospital visit rate, total costs of encounters, or volume of patient
encounters between ASCs that were and were not acquired by private
equity."
Read More
Pharmaceuticals
Under Medicare's Anti-Kickback Statute, drug manufacturers may donate
to patient financial assistance programs for specific diseases that
their drugs treat, so long as they are not directly covering
enrollees' out-of-pocket spending.
Leemore Dafny and coauthors investigate claims data for Medicare
Advantage enrollees
and conclude that these donations are likely profitable, "as average
assistance-eligible spending per patient nearly doubled [from 2010 to
2017,] while cost sharing per patient declined."
Richard Frank and coauthors hypothesize that positive confirmatory
trials
should increase the price of drugs that were originally approved on the
basis of limited evidence through the Food and Drug Administration's
accelerated approval process, as the efficacy of those drugs has now
been demonstrated.
Yet, analyzing Medicare Part B data, the authors find no price effect,
suggesting the existence of a market failure.
Read More
Risk Adjustment
Teresa Rogstad and coauthors assess studies involving Medicare's
Hospital Readmissions Reduction Program
,
a value-based payment structure that did not initially, but ultimately
did, take into account social risk factors.
Based on a systematic review of fourteen studies, the authors conclude
that "taking social risk factors into account has a meaningful impact
on hospitals' risk-adjusted readmission rates and penalties."
Natalia Festa and coauthors explore the effect of Medicare's
reintroduction of risk adjustment
for Alzheimer's disease and related dementias (ADRD) Hierarchical
Condition Categories, which created incentives for providers to increase
the use of these codes.
Comparing claims data with a clinical standard for ADRD, the authors
demonstrate that such an increase has occurred.
Read More
Order The Issue
Join Health Affairs Unlimited to access our current and past issues
.
Attend These Events
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This month, Health Affairs events will cover topics including remote
patient monitoring, physician burnout, workforce strain, and more.
Our special events for Health Affairs Insiders will include a Journal
Club on September 15 with authors Mitchell Tang and Ateev Mehrotra
and
a  Professional Development event on September 20 to discuss the peer
review process
at
the journal.
One of this month's highlights will include a Practice of Medicine
briefing
on
September 22 examining physician burnout, workforce strain, and lessons
from COVID-19. The event will be free and open for all to attend.
Additionally, we'll host a Policy Spotlight event
on September 23 with Jonathan Blum, the Principal Deputy Administrator
at the CMS.
To become an Insider and attend all virtual events, visit our membership
page
.
View Full Event Schedule
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Listen To This Podcast
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This month we're celebrating the 100th episode of A Health Podyssey!Â
Since the launch of the podcast, we have covered the stories behind the
research on topics like COVID-19
,
health services administration
,
behavioral health care
,
and more.
Our 100th episode features Leemore Dafny, an author from this month's
issue covering Medicare's Anti-Kickback Statute.
If you'd like to listen some (or all) of the 100 episodes of A Health
Podyssey, you can visit our website or subscribe on your preferred
podcast app.
Listen
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About Health Affairs
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at the intersection of health,
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