External Research
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AJPM: Robust Prescription Monitoring Programs and Abrupt Discontinuation of Long-term Opioid Use
Read more: AJPM: Robust Prescription Monitoring Programs and Abrupt Discontinuation of Long-term Opioid UseIntroduction This study assesses the associations between the recent implementation of robust features of state Prescription Drug Monitoring Programs and the abrupt discontinuation of long-term opioid therapies. Methods Data were from a national commercial insurance database and included privately insured adults aged 18–64 years and Medicare Advantage enrollees aged ≥65 years who initiated a long-term…
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AJMC: Commercial and Medicare Advantage Payment for Anesthesiology Services
Read more: AJMC: Commercial and Medicare Advantage Payment for Anesthesiology ServicesABSTRACT Objectives: Anesthesiology services are a focal point of policy making to address surprise medical billing. However, allowed amounts and charges for anesthesiology services have been understudied due to the specialty’s unique conversion factor (CF) unit of payment and complex provider structures involving anesthesiologists and certified registered nurse anesthetists (CRNAs). This study compares payments for…
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AJMC: Association Between Hospital-Insurer Contract Structure and Hospital Performance
Read more: AJMC: Association Between Hospital-Insurer Contract Structure and Hospital PerformanceABSTRACT Objectives: To describe the association between the form of hospitals’ contracts—either markup from a benchmark or a discount from a list price—and performance: price, charge, cost, and length of stay. Study Design: Retrospective observational study using administrative claims data matched with hospital characteristics from the American Hospital Association Annual Survey and the Healthcare Cost…
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JAMA Network: Prescription Drug Monitoring Program Mandates and Opioids Dispensed Following Emergency Department Encounters for Patients With Sickle Cell Disease or Cancer With Bone Metastasis
Read more: JAMA Network: Prescription Drug Monitoring Program Mandates and Opioids Dispensed Following Emergency Department Encounters for Patients With Sickle Cell Disease or Cancer With Bone MetastasisAbstract: Patients with sickle cell disease (SCD) or cancer with bone metastasis often present to the emergency department (ED) for treatment of severe pain, and opioid analgesics remain first-line therapies for acute pain in the ED or after discharge. Policies aimed at improving the safety of opioid prescribing, such as state legislative mandates that prescribers register with or…
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JAMA Health Forum: Comparison of Anticancer Medication Use and Spending Under US Oncology Parity Laws With and Without Out-of-Pocket Spending Caps
Tags: SpendingRead more: JAMA Health Forum: Comparison of Anticancer Medication Use and Spending Under US Oncology Parity Laws With and Without Out-of-Pocket Spending CapsAbstract: IMPORTANCE By 2020, nearly all states had adopted oncology parity laws in the US, ensuring that patients in fully insured private health plans pay no more for orally administered anticancer medications (OAMs) than infused therapies. Between 2013 and mid-2017, 11 states implemented parity with out-of-pocket spending caps, which may further reduce patient out-of-pocket spending….
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NYS Health Foundation: Variation in Health Care Prices: The Problem Starts at Birth
Tags: Maternal HealthRead more: NYS Health Foundation: Variation in Health Care Prices: The Problem Starts at BirthSummary The price of childbirth in New York City varies multifold, depending on where a woman delivers. This variation in price across boroughs, and across providers within boroughs, might make sense if it corresponded to higher-quality care. But higher prices do not always signify better quality. This report examines variation in what is paid for…
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Health Affairs: Private Equity In Dermatology: Effect On Price, Utilization, And Spending
Read more: Health Affairs: Private Equity In Dermatology: Effect On Price, Utilization, And SpendingAbstract: Private equity firms have increasingly acquired physician practices, and particularly dermatology practices. Analyzing commercial claims from the Health Care Cost Institute (2012–17), we used a difference-in-differences design within an event study framework to estimate the prevalence of private equity acquisitions and their impact on dermatologist prices, spending, utilization, and volume of patients. By 2017…
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American Economic Review: Screening and Selection: The Case of Mammograms
Tags: MammogramsRead more: American Economic Review: Screening and Selection: The Case of MammogramsAbstract: We analyze selection into screening in the context of recommendations that breast cancer screening start at age 40. Combining medical claims with a clinical oncology model, we document that compliers with the recommendation are less likely to have cancer than younger women who select into screening or women who never screen. We show this…
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American Journal of Managed Care: Policies to Address Surprise Billing Can Affect Health Insurance Premiums
Read more: American Journal of Managed Care: Policies to Address Surprise Billing Can Affect Health Insurance PremiumsAbstract: Objectives: To quantify the proportion of health plan spending on services for which surprise billing is common—provided by radiologists, anesthesiologists, pathologists, emergency physicians, emergency ground ambulances, and emergency outpatient facilities—and estimate the potential impact of proposed policies to address surprise billing on health insurance premiums. Study Design: Analysis of 2017 commercial claims data from…
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PNAS: Randomized trial shows healthcare payment reform has equal-sized spillover effects on patients not targeted by reform
Read more: PNAS: Randomized trial shows healthcare payment reform has equal-sized spillover effects on patients not targeted by reformAbstract: Changes in the way health insurers pay healthcare providers may not only directly affect the insurer’s patients but may also affect patients covered by other insurers. We provide evidence of such spillovers in the context of a nationwide Medicare bundled payment reform that was implemented in some areas of the country but not in others,…