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American Journal of Public Health Dec 2023
Topics: Humans; Nutritional Status; Food Assistance; Food Supply
PubMed: 38118095
DOI: 10.2105/AJPH.2023.307483 -
Health Economics Sep 2023The Netherlands reformed its disability insurance (DI) scheme in 2006. Eligibility for DI became stricter, reintegration incentives became stronger, and DI benefits...
The Netherlands reformed its disability insurance (DI) scheme in 2006. Eligibility for DI became stricter, reintegration incentives became stronger, and DI benefits often became less generous. Based on administrative data on all individuals who reported sick shortly before and after the reform, difference-in-differences regressions show that the reform reduced DI receipt by 5.2 percentage points and increased labor participation and unemployment insurance (UI) receipt by 1.2 and 1.1 percentage points, respectively. It increased average monthly earnings and UI claims to overcompensate lost DI benefits. However, older individuals, women, individuals with temporary contracts, the unemployed, and low-wage earners did not compensate or compensated to a much smaller extent for the lost DI benefits. The effects are persistent during the 10 years after the reform.
Topics: Humans; Female; Insurance, Disability; Income; Insurance Benefits; Salaries and Fringe Benefits; Unemployment; Social Security
PubMed: 37209305
DOI: 10.1002/hec.4694 -
Neurologic Clinics Aug 2023Health care entities doing business with the federal government may run afoul of the False Claims Act and Anti-Kickback Statute not only when they directly submit... (Review)
Review
Health care entities doing business with the federal government may run afoul of the False Claims Act and Anti-Kickback Statute not only when they directly submit fraudulent claims for government reimbursement but also when they create schemes that manipulate others into submitting (whether knowingly or unknowingly) illegal claims. In recent years, the Department of Justice is deploying these statutes to ensure that electronic health records are built and maintained with appropriate cybersecurity protections.
Topics: United States; Humans; Medicaid; Medicare; Fraud
PubMed: 37407104
DOI: 10.1016/j.ncl.2023.03.006 -
Obstetrics and Gynecology Feb 2024To perform an environmental scan of the current status of reimbursement for obstetric and gynecology services and identify problematic issues and opportunities for...
PURPOSE
To perform an environmental scan of the current status of reimbursement for obstetric and gynecology services and identify problematic issues and opportunities for change. The areas that were evaluated include the American Medical Association (AMA) relative value unit assignment process, payer rates (where available), and trends in employment and salary determination for obstetrician-gynecologists (ob-gyns).
METHODS
This report was developed by members of the American College of Obstetricians and Gynecologists' (ACOG) Committee on Health Economics and Coding using public-facing payment data from the Medicare Physician Fee Schedule and state Medicaid programs, as well as published research and commentary on payment for physicians, maternal health, and gynecologic surgery. Data from the Centers for Disease Control and Prevention were used to describe typical patient characteristics, and practice survey reports from the AMA were analyzed. Finally, an anonymous online survey was distributed to 27,854 members of ACOG in March 2022, with a response rate of 10.8% (3,018 members) and a CI of ±1.7%.
FINDINGS
The evaluation found that payment for ob-gyns is heavily influenced by the values and rates set by third-party payers, a patient case-mix that includes a higher-than-average number of patients with Medicaid insurance, and the increase of employed physicians reliant on salary contracts that include productivity requirements and bonuses.
RECOMMENDATIONS
The Committee identified action items, including payment reform for obstetric services; advocating for gynecologic surgery time as a priority for hospital administration; developing resources to assist employed physicians with payment, practice, and business management; developing a business and coding curriculum for students and early-career physicians; and continued advocacy with private and public policymakers who influence physician payment.
Topics: Aged; Female; Humans; Pregnancy; Gynecology; Medicaid; Medicare; Obstetrics; Physicians; Surveys and Questionnaires; United States
PubMed: 38237166
DOI: 10.1097/AOG.0000000000005487 -
Journal of Palliative Medicine Dec 2023This report, signed by >170 scholars, clinicians, and researchers in palliative care and related fields, refutes the claims made by the previously published . That...
This report, signed by >170 scholars, clinicians, and researchers in palliative care and related fields, refutes the claims made by the previously published . That report attempted to argue that structural vulnerability was not a concern in the provision of assisted dying (AD) by a selective review of evidence in medical literature and population studies. It claimed that palliative care has its own safety concerns, and that "misuse" of palliative care led to reports of wrongful death. We and our signatories do not feel that the conclusions reached are supported by the evidence provided in the contested report. The latter concluded that the logical policy response would be to address the root causes of structural vulnerability rather than restrict access to AD. Our report, endorsed by an international community of palliative care professionals, believes that public policy should aim to reduce structural vulnerability and, at the same time, respond to evidence-based cautions about AD given the potential harm.
Topics: Humans; Palliative Care; Suicide, Assisted; Research Design; Medical Assistance
PubMed: 37955548
DOI: 10.1089/jpm.2023.0581 -
Public Health Nutrition Nov 2023Evaluation of California Department of Public Health's three-year social marketing campaign () to encourage healthy eating and water consumption among Supplemental...
California's Supplemental Nutrition Assistance Program-Education (SNAP-Ed) social marketing campaign: mothers' fruit and vegetable consumption and facilitation of children's healthy behaviours.
OBJECTIVE
Evaluation of California Department of Public Health's three-year social marketing campaign () to encourage healthy eating and water consumption among Supplemental Nutrition Assistance Program-Education (SNAP-Ed) California mothers. Andreasen's social marketing framework was used to outline the development and evaluation of the campaign.
DESIGN
Quantitative, pre-post cross-sectional study with three cohorts nested within survey years. Generalised estimating equation modeling was used to obtain population estimates of campaign reach and changes in mothers' fruit and vegetable (FV) consumption and facilitative actions towards their children's health behaviours.
SETTING
Healthy Living (California's SNAP-Ed).
PARTICIPANTS
Three separate cohorts of SNAP mothers were surveyed (pre, post) between 2016 and 2018 inclusive. A total of 2229 mothers (ages 18-59) self-identified as White, Latina, African American or Asian/Pacific Islander participated.
RESULTS
Approximately 82 percent of surveyed mothers were aware of the campaign as assessed by measures of recall and recognition. Ad awareness was positively associated with mothers' FV consumption (R = 0·45), with the proportion of FV on plates and with behaviours that facilitate children's FV consumption and limit unhealthy snacks and sugary drinks ( ranged from 0·1 to 0·7).
CONCLUSIONS
The campaign successfully reached 82 percent of surveyed mothers. Positive associations between California's campaign and targeted health behaviours were observed, although the associations varied by year and media channel (i.e. television, radio, billboards and digital). Most associations between ad awareness and outcomes were noted in years two and three of the campaign, suggesting that more than 1 year of campaign exposure was necessary for associations to emerge.
Topics: Female; Humans; Child; Vegetables; Fruit; Child Health; Food Assistance; Social Marketing; Cross-Sectional Studies; Health Behavior; California
PubMed: 37424282
DOI: 10.1017/S1368980023001301 -
JAMA Internal Medicine Mar 2024
Topics: Humans; United States; Insurance, Health; Medicare; Insurance Coverage
PubMed: 38252444
DOI: 10.1001/jamainternmed.2023.7112 -
Journal of Health Politics, Policy and... Dec 2023The Medicare Advantage program was created to expand beneficiary choice and to reduce spending through capitated payment to private insurers. However, many stakeholders...
The Medicare Advantage program was created to expand beneficiary choice and to reduce spending through capitated payment to private insurers. However, many stakeholders now argue that Medicare Advantage is failing to deliver on its promise to reduce spending. Three problematic design features in Medicare Advantage payment policy have received particular scrutiny: (1) how baseline payments to insurers are determined, (2) how variation in patient risk affects insurer payment, and (3) how payments to insurers are adjusted for quality performance. The authors analyze the statute underlying these three design features and explore legislative and regulatory strategies for improving Medicare Advantage. They conclude that regulatory approaches for improving risk adjustment and for recouping overpayments from risk-score gaming have the highest potential impact and are the most feasible improvement measures to implement.
Topics: Aged; Humans; United States; Medicare Part C; Policy
PubMed: 37497876
DOI: 10.1215/03616878-10852628 -
The American Journal of Managed Care Nov 2023To measure the prevalence of non-Medicare value-based contracting and participation in contracts with downside risk among organizations participating in the Medicare...
OBJECTIVES
To measure the prevalence of non-Medicare value-based contracting and participation in contracts with downside risk among organizations participating in the Medicare Shared Savings Program (MSSP).
STUDY DESIGN
Cross-sectional analysis of 2022 accountable care organization (ACO) survey.
METHODS
The author analyzed surveys from 100 organizations participating in the MSSP that reported the number of covered lives they have in value-based contracts in traditional Medicare (ACOs), Medicare Advantage (MA), commercial payers, Medicaid managed care organizations, Medicaid, and direct-to-employer arrangements. We analyzed the distribution of covered lives across shared-savings, shared-risk, and full-risk contracts and analyzed changes between 2018 and 2022.
RESULTS
Respondents reported 15.5 million covered lives in value-based contracts. All respondents have Medicare ACO contracts, and roughly 75% reported value-based contracts with commercial and MA plans. Approximately one-third reported such contracts with Medicaid managed care plans. Seventy percent of covered lives in respondents' Medicare ACO contracts included downside risk for losses compared with 51% of lives in commercial plans and 45% in MA plans. Compared with a similar 2018 survey, the proportion of respondents in value-based MA contracts doubled, and the proportion in commercial contracts rose by half.
CONCLUSIONS
Organizations that participate in Medicare ACO models have substantially increased their participation in value-based contracts with other payers. They reported a higher proportion of Medicare ACO covered lives in downside risk arrangements than in commercial or MA contracts.
Topics: Aged; Humans; United States; Medicare; Cross-Sectional Studies; Medicaid; Accountable Care Organizations; Contracts; Cost Savings
PubMed: 37948647
DOI: 10.37765/ajmc.2023.89456 -
Journal of the American Academy of... May 2024Medicare's legacy quality reporting programs were consolidated into the Merit-Based Incentive Payment System (MIPS) in 2015.
BACKGROUND
Medicare's legacy quality reporting programs were consolidated into the Merit-Based Incentive Payment System (MIPS) in 2015.
PURPOSE
The DataDerm registry of the American Academy of Dermatology was examined to understand the potential for and subsequent rate of improvement across 23 performance measures.
METHODS
We examined the level of performance across 23 performance measures with at least 20 clinicians reporting on at least 50 patients' experience. We calculated the following values: the aggregate performance rate for each measure and the overall aggregate performance rate.
RESULTS
The aggregate performance rate for each measure ranged from 20.4% for AAD 1 (Psoriasis: Assessment of Disease Activity), to 99.9% for measure ACMS 1 (Avoidance of Opioid Prescriptions for Reconstruction After Skin Resection). Three of 23 measures had an aggregate performance over 95%. The overall aggregate performance rate across all 23 measures was 81.2%, indicating an aggregate potential for improvement of 18.8% across the 23 measures. Nine performance measures reported across the first five years of DataDerm's existence were tracked through time to understand trends in performance through time. The performance across the nine performance measures meeting the inclusion criteria consistently improved in the initial years (2016 through 2018) of DataDerm participation and showed some variation in 2019 and 2020.
CONCLUSIONS
These data provide evidence that the very act of participation in a multi-institutional registry and tracking compliance with performance measures can lead to improvements in compliance with the performance measures and therefore improvements in quality of care.
Topics: Aged; Humans; United States; Medicare; Reimbursement, Incentive; Health Facilities; Motivation
PubMed: 38135157
DOI: 10.1016/j.jaad.2023.11.059