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National Trends in Billing Patient Portal Messages as E-Visit Services in Traditional Medicare 在传统医疗保险中将患者门户网站信息作为电子就诊服务计费的全国趋势

Health affairs scholar

Pub Date : 2024-04-03 DOI: 10.1093/haschl/qxae040

Terrence Liu, Ziwei Zhu, A. J. Holmgren, Chad Ellimoottil

引用次数: 0

Nursing home finances associated with real estate investment trust and private equity investments 与房地产投资信托和私募股权投资相关的养老院财务

Health affairs scholar

Pub Date : 2024-04-01 DOI: 10.1093/haschl/qxae037

Dunc Williams, Rahul Fernandez, David Stevenson, Mark Unruh, Robert Tyler Braun

In 2021, real estate investment trusts (REITs) and private equity (PE) held investments in 1915 (16%) and 1569 (13%) US nursing homes (NHs), respectively. We created a database of REIT and PE investments in NHs, merged it with Medicare Cost Report data (2011–2019), and used a difference-in-differences approach within an event-study framework to compare NH spending and financial performance before and after REIT or PE investment to NHs that did not receive REIT or PE investment. REIT investments were associated with higher total wages (3%), total nursing wages (3%; both logged, per resident day [PRD]), and current ratio (81%). PE investments were associated with lower net patient service revenue (7%), total expenses (7%), and total wages (8%; all logged, PRD). The impact of REIT and PE investments in NHs may vary in different market conditions, as may occur in the current environment of low, falling NH profits, potentially higher minimum staffing requirements, and rising interest rates. Therefore, it is important for stakeholders to understand the impact of these large, growing investments on the financial performance of NHs.

2021 年，房地产投资信托基金（REITs）和私募股权基金（PE）分别在 1915 家（16%）和 1569 家（13%）美国养老院（NHs）中持有投资。我们创建了一个房地产投资信托基金（REIT）和私募股权投资基金（PE）在养老院投资的数据库，将其与医疗保险成本报告数据（2011-2019 年）合并，并在事件研究框架内使用差分法，将房地产投资信托基金（REIT）或私募股权投资基金（PE）投资前后的养老院支出和财务表现与未获得房地产投资信托基金（REIT）或私募股权投资基金（PE）投资的养老院进行比较。房地产投资信托与较高的工资总额（3%）、护理工资总额（3%；均为对数，每住院日[PRD]）和流动比率（81%）相关。私募股权投资与较低的病人服务净收入（7%）、总支出（7%）和工资总额（8%；均按每住院日计算）相关。在不同的市场条件下，房地产投资信托基金和私募股权投资对公立医院的影响可能会有所不同，例如在当前公立医院利润低且不断下降、最低人员配备要求可能提高以及利率不断上升的环境下。因此，利益相关者必须了解这些不断增长的大型投资对养老院财务业绩的影响。

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引用次数: 0

Socioeconomic and fiscal returns of expanded investment in immunization: a case for life-course vaccination in Colombia 扩大免疫接种投资的社会经济和财政回报：哥伦比亚终生免疫接种案例

Health affairs scholar

Pub Date : 2024-04-01 DOI: 10.1093/haschl/qxae042

Jose Alejandro Soto-Moreno, Martha Coe, Cintia Parellada, Anupama Tantri, Maria Clara Angarita-Contreras, Paula Acosta

Despite the health, societal, and economic benefits of immunization, many countries focus primarily on childhood immunizations and lack robust policies and sufficient resources for immunizations that can benefit populations across the life course. While the benefits of childhood vaccination are well documented, there is limited evidence on the financial and social return on investment that policymakers can use to inform decisions around administering a life-course immunization program. We developed a cost-benefit model from a societal perspective to evaluate the inclusion of 5 vaccines across the life course in Colombia's national immunization program. This model estimated a return of US$1.3 per US$1.0 invested in the first 2 decades, increasing to US$3.9 after 60 years. Primary benefits were productivity gains, followed by fiscal savings and household averted expenditure on health care. Furthermore, vulnerable households are predicted to receive 3.2 times greater income protection than formally employed households under a life-course immunization program. Consequently, there is a potential to reduce Colombia's income inequality and poverty rate by increasing access to immunization for all ages.

尽管免疫接种对健康、社会和经济都有益处，但许多国家主要关注的是儿童免疫接种，缺乏健全的免疫接种政策和充足的免疫接种资源，从而使整个生命过程中的人群都能受益。虽然儿童接种疫苗的益处有据可查，但有关投资的经济和社会回报的证据却很有限，而决策者可以利用这些证据为实施终生免疫计划提供决策依据。我们从社会角度开发了一个成本效益模型，以评估将 5 种疫苗纳入哥伦比亚国家免疫计划的整个生命过程。该模型估计，在最初的 20 年中，每投资 1.0 美元可获得 1.3 美元的回报，60 年后将增至 3.9 美元。主要收益是生产率的提高，其次是财政节余和家庭避免的医疗支出。此外，根据预测，在终身免疫计划下，弱势家庭获得的收入保护是正式就业家庭的 3.2 倍。因此，通过增加所有年龄段的免疫接种机会，有可能减少哥伦比亚的收入不平等和贫困率。

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引用次数: 0

Decomposition of medical imaging spending growth between 2010 and 2021 in the US employer-insured population. 2010 年至 2021 年美国雇主参保人群医疗成像支出增长分解图。

Health affairs scholar

Pub Date : 2024-03-27 eCollection Date: 2024-03-01 DOI: 10.1093/haschl/qxae030

Michal Horný, Daniel Chang, Eric W Christensen, Elizabeth Y Rula, Richard Duszak

Medical imaging, identified as a potential driver of unsustainable US health care spending growth, was subject to policies to reduce prices and use in low-value settings. Meanwhile, the Affordable Care Act increased access to preventive services-many involving imaging-for employer-sponsored insurance (ESI) beneficiaries. We used a large insurance claims database to examine imaging spending trends in the ESI population between 2010 and 2021-a period of considerable policy and benefits changes. Nominal spending on imaging increased 35.9% between 2010 and 2021, but as a share of total health care spending fell from 10.5% to 8.9%. The 22.5% growth of nominal imaging prices was below inflation, 24.3%, as measured by the Consumer Price Index. Other key contributors to imaging spending growth were increased use (7.4 percentage points [pp]), shifts toward advanced modalities (4.0 pp), and demographic changes (3.5 pp). Shifts in care settings and provider network participation resulted in 2.5-pp and 0.3-pp imaging spending decreases, respectively. In sum, imaging spending decreased as a share of all health care spending and relative to inflation, as intended by concurrent cost-containment policies.

医学影像被认为是美国医疗支出不可持续增长的潜在驱动力，因此受到了降低价格和在低价值环境中使用的政策的影响。与此同时，《平价医疗法案》增加了雇主赞助保险（ESI）受益人获得预防性服务的机会，其中许多服务涉及影像检查。我们利用大型保险理赔数据库，研究了 2010 年至 2021 年期间 ESI 群体的影像学支出趋势--在此期间，政策和福利发生了巨大变化。2010 年至 2021 年期间，影像学的名义支出增长了 35.9%，但在医疗保健总支出中所占的比例却从 10.5% 降至 8.9%。成像名义价格增长 22.5%，低于消费价格指数衡量的通胀率 24.3%。造成成像支出增长的其他主要因素包括：使用量的增加（7.4 个百分点）、向先进模式的转变（4.0 个百分点）以及人口结构的变化（3.5 个百分点）。医疗机构和医疗服务提供者网络参与度的变化分别导致成像支出下降 2.5 个百分点和 0.3 个百分点。总之，影像学支出在所有医疗支出中所占的比例以及相对于通货膨胀率都有所下降，这也是同时实施的成本控制政策的初衷。

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引用次数: 0

Comparing HEDIS Performance of Dual Eligible Special Needs Plans to Other Coverage Types for Dually Eligible People 比较双合格特殊需求计划与其他双合格人群保险类型的 HEDIS 业绩

Health affairs scholar

Pub Date : 2024-03-20 DOI: 10.1093/haschl/qxae036

Amelia M Haviland, Megan Mathews, Steven C. Martino, Yvette Overton, Jacob W Dembosky, Jessica Maksut, Marc N. Elliott

People eligible for both Medicare and Medicaid coverage (“dually eligible individuals”) have lower levels of income and assets and often higher health care needs and costs than those eligible for Medicare but not Medicaid coverage. Their three most common Medicare coverage options are: Medicare Advantage (MA) Dual Eligible Special Needs Plans(D-SNP), non-D-SNP MA plans, and fee-for-service (FFS) Medicare with a stand-alone prescription drug plan. No prior study has examined clinical quality of care for dually eligible individuals across these three coverage types. To fill that void, we used logistic regression to compare these coverage types on six HEDIS measures of clinical quality of care that were available for both MA and FFS (constructed from claims files). D-SNP and non-D-SNP MA plans significantly outperformed FFS for all six measures for dually eligible individuals, by approximately 5 percentage points for two measures and by 18-34 percentage points for the other four measures. For the four measures with the greatest advantage over FFS, performance was 3-8 percentage points higher in D-SNP than in non-D-SNP MA plans.

与那些有资格享受 "医疗保险 "但不享受 "医疗补助计划 "的人员相比，同时有资格享受 "医疗保险 "和 "医疗补助计划 "的人员（"双重资格人员"）的收入和资产水平较低，医疗保健需求和费用通常较高。他们最常见的三种医疗保险选择是他们最常见的三种联邦医疗保险选择是：联邦医疗保险优势计划（MA）"双重资格特殊需求计划"（D-SNP）、非 "双重资格特殊需求计划 "MA 计划，以及带有独立处方药计划的付费服务（FFS）联邦医疗保险。此前还没有研究对这三种保险类型中符合双重资格者的临床护理质量进行过调查。为了填补这一空白，我们使用逻辑回归法对这些承保类型的六项 HEDIS 临床护理质量指标进行了比较，这六项指标同时适用于 MA 和 FFS（根据索赔档案构建）。对于符合双重资格的个人而言，D-SNP 和非 D-SNP 医保计划在所有六项指标上的表现均明显优于 FFS，其中两项指标优于 FFS 约 5 个百分点，其他四项指标优于 FFS 18-34 个百分点。在与 FFS 相比优势最大的四项指标中，D-SNP 的绩效比非 D-SNP MA 计划高出 3-8 个百分点。

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引用次数: 0

Re-evaluation of the methodology for estimating the U.S. specialty physician workforce 重新评估美国专科医生队伍的估算方法

Health affairs scholar

Pub Date : 2024-03-19 DOI: 10.1093/haschl/qxae033

W. S. Black-Schaffer, David J Gross, Z. Nouri, Aidan DeLisle, Michael Dill, Jason Y Park, James M Crawford, Michael B Cohen, Rebecca L Johnson, Donald S Karcher, Thomas M Wheeler, Stanley J Robboy

Increasing pursuit of subspecialized training has quietly revolutionized physician training, but the potential impact on physician workforce estimates has not previously been recognized. The Physicians Specialty Data Reports of the Association of American Medical Colleges, derived from specialty designations in the American Medical Association Physician Professional Data (PDP), are the reference source for US physician workforce estimates; by 2020 the report for pathologists is an undercount of 39% when compared to the PDP. Most of the difference was due to omission of pathology subspecialty designations. The rest resulted from reliance on only the first of the AMA Physician Professional Data’s two specialty data fields. Placement of specialty designation in these two fields is sensitive to sequence of training and is thus affected by multiple or intercalated (between years of residency training) fellowships. Both these phenomena have become progressively more common and are not unique to pathology. Our findings demonstrate the need to update definitions and methodology underlying estimates of the US physician workforce for pathology and suggest a like need in other specialties affected by similar trends.

对亚专业化培训的日益追求已悄然为医生培训带来了革命性的变化，但其对医生队伍估算的潜在影响却尚未被认识到。美国医学院协会的医生专业数据报告来自美国医学会医生专业数据（PDP）中的专业名称，是美国医生劳动力估算的参考来源；到 2020 年，病理学家的报告与 PDP 相比少计了 39%。大部分差异是由于遗漏了病理学亚专业名称。其余的原因则是只依赖 AMA 医生专业数据的两个专业数据字段中的第一个字段。这两个字段中的专科指定位置对培训顺序很敏感，因此会受到多重或插班（住院医师培训的间隔年）研究金的影响。这两种现象已变得越来越普遍，并非病理学所独有。我们的研究结果表明，有必要更新美国病理学医生队伍的定义和估算方法，并表明受类似趋势影响的其他专科也有同样的需求。

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引用次数: 0

Domestic violence: prevention past due. 家庭暴力：预防逾期。

Health affairs scholar

Pub Date : 2024-03-19 eCollection Date: 2024-04-01 DOI: 10.1093/haschl/qxae034

Debbie I Chang

In May 2023, the White House released the National Plan to End Gender-Based Violence, which includes intimate partner or domestic violence (DV). Based on 20 years of experience in California, this commentary provides detailed examples of 2 DV prevention strategies: interrupting intergenerational transmission and addressing macrolevel drivers. Family-strengthening approaches to prevention and justice and increasing economic security are key. Insight into regional policies and programs can inform implementation of the national plan and DV prevention in other states and localities.

2023 年 5 月，白宫发布了《结束性别暴力国家计划》，其中包括亲密伴侣或家庭暴力 (DV)。根据加利福尼亚州 20 年的经验，本评论提供了 2 个家庭暴力预防战略的详细示例：阻断代际传播和解决宏观层面的驱动因素。加强家庭的预防和司法方法以及提高经济安全是关键。对地区政策和计划的深入了解可以为国家计划的实施以及其他州和地方的家庭暴力预防工作提供参考。

引用次数: 0

Locations and characteristics of pharmacy deserts in the United States: A geospatial study 美国药房沙漠的位置和特征：地理空间研究

Health affairs scholar

Pub Date : 2024-03-16 DOI: 10.1093/haschl/qxae035

R. Wittenauer, P. Shah, J. Bacci, Andy Stergachis

Pharmacies are important healthcare access points, but no national map currently exists of where pharmacy deserts are located. This cross-sectional study used pharmacy address data and Census Bureau surveys to define pharmacy deserts at the census tract level in all 50 US States and DC. We also compared sociodemographic characteristics of pharmacy desert vs. non-pharmacy desert communities. Nationally, 15.8 million (4.7%) of all people in the US live in pharmacy deserts, spanning urban and rural settings in all 50 states. On average, communities that are pharmacy deserts have a higher proportion of people who: have a high school education or less, have no health insurance, have low self-reported English ability, have an ambulatory disability, and identify as a racial or ethnic minority. While, on average, pharmacies are the most accessible healthcare setting in the US, many people still do not have access to them. Further, the people living in pharmacy deserts are often marginalized groups who have historically faced structural barriers to healthcare. This study demonstrates a need to improve access to pharmacies and pharmacy services to advance health equity.

药房是重要的医疗保健接入点，但目前还没有全国性的药房荒漠分布图。这项横断面研究利用药店地址数据和人口普查局调查，在美国 50 个州和华盛顿特区的人口普查区一级界定了药店荒。我们还比较了药店荒与非药店荒社区的社会人口特征。从全国范围来看，美国有 1580 万人（4.7%）生活在药荒地区，遍布 50 个州的城市和农村。平均而言，药房荒漠社区中以下人群的比例较高：高中或以下学历、没有医疗保险、自我报告的英语能力较低、有行动障碍以及被认定为少数种族或少数族裔。虽然平均而言，药房是美国最方便的医疗机构，但仍有许多人无法获得药房服务。此外，生活在药房沙漠中的人往往是边缘化群体，他们历来面临着医疗保健的结构性障碍。这项研究表明，有必要改善药房和药房服务的可及性，以促进健康公平。

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引用次数: 0

The Highest Cost Medicaid Enrollees with Sickle Cell Disease Had Annual Health Care Expenditures Nearing $200 000 费用最高的镰状细胞病医疗补助计划参保者每年的医疗支出接近 200 000 美元

Health affairs scholar

Pub Date : 2024-03-11 DOI: 10.1093/haschl/qxae029

Junelle Speller, Sarah Rayel, Kristen Hayashi, Michaela Kirby, Dianne Munevar, A. Hartzman, Kevin Dietz

Sickle cell disease (SCD) is a painful chronic blood disorder that causes serious complications and comorbidities, often leading to premature death. SCD impacts millions of people worldwide, including an estimated 100 000 in the United States, most of whom are Black or Latino. We analyzed Medicaid enrollment, claims, and encounter data via the Transformed Medicaid Statistical Information System (T-MSIS) to examine the 2021 health care utilization and spending of Medicaid enrollees with SCD. Our analysis found that Medicaid enrollees with SCD have high annual medical and pharmacy expenditures that are not evenly distributed across the population. Among the most severe, clinical trial eligible enrollees, those in the top 5% of health care spending incurred, on average, nearly $200 000 per year for this chronic condition.

镰状细胞病 (SCD) 是一种令人痛苦的慢性血液疾病，会引起严重的并发症和合并症，通常会导致患者过早死亡。SCD 影响着全球数百万人，包括美国约 10 万人，其中大部分是黑人或拉丁裔。我们通过 "转型医疗补助统计信息系统"（T-MSIS）分析了医疗补助的注册、报销和就诊数据，以检查患有 SCD 的医疗补助注册者 2021 年的医疗保健使用和支出情况。我们的分析发现，患有 SCD 的医疗补助参保者每年的医疗和药房支出很高，而这些支出在整个人群中的分布并不均匀。在病情最严重、符合临床试验条件的参保者中，医疗保健支出最高的 5%的参保者平均每年因这一慢性病花费近 20 万美元。

引用次数: 0

Unmet need for mental health care is common across insurance market segments in the United States. 在美国，未得到满足的心理健康护理需求在各个保险细分市场都很普遍。

Health affairs scholar

Pub Date : 2024-03-08 eCollection Date: 2024-03-01 DOI: 10.1093/haschl/qxae032

Mark K Meiselbach, Catherine K Ettman, Karen Shen, Brian C Castrucci, Sandro Galea

A substantial proportion of individuals with depression in the United States do not receive treatment. While access challenges for mental health care have been documented, few recent estimates of unmet mental health needs across insurance market segments exist. Using nationally representative survey data with participant-reported depression symptom severity and mental health care use collected in Spring 2023, we assessed access to mental health care among individuals with similar levels of depression symptom severity with commercial, Medicare, Medicaid, and no insurance. Among individuals who reported symptoms consistent with moderately severe to severe depression, 37.8% did not have a diagnosis for depression (41.0%, 28.1%, 33.6%, and 56.3% with commercial, Medicare, Medicaid, and no insurance), 51.9% did not see a mental health specialist (49.7%, 51.7%, 44.9%, and 91.8%), and 32.4% avoided mental health care due to affordability in the past 12 months (30.2%, 34.0%, 21.1%, and 54.8%). There was substantial unmet need for mental health treatment in all insurance market segments, but especially among individuals without insurance.

在美国，有相当一部分抑郁症患者没有接受治疗。虽然心理健康医疗的可及性问题已被记录在案，但最近很少有关于各保险细分市场未满足的心理健康需求的估算。我们使用 2023 年春季收集的具有全国代表性的调查数据，包括参与者报告的抑郁症状严重程度和心理保健使用情况，评估了具有相似抑郁症状严重程度的个人在商业保险、医疗保险、医疗补助和无保险情况下获得心理保健的情况。在报告症状符合中度至重度抑郁症的人群中，37.8% 的人没有抑郁症诊断（41.0%、28.1%、33.6% 和 56.3%，包括商业保险、医疗保险、医疗补助和无保险），51.9% 的人没有看心理健康专科医生（49.7%、51.7%、44.9% 和 91.8%），32.4% 的人在过去 12 个月中因经济能力问题而避免了心理健康护理（30.2%、34.0%、21.1% 和 54.8%）。在所有的保险市场细分中，都有大量的心理健康治疗需求没有得到满足，尤其是在没有保险的个人中。

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