Preview

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.

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.”

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.

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.

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.

This month we're celebrating the 100th episode of A Health Podyssey! 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.

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.

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