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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results1 to 25 of 779 Research Studies Displayed
Mullens CL, Lussiez A, Scott JW
Association of health professional shortage area hospital designation with surgical outcomes and expenditures among Medicare beneficiaries.
This study’s objective was to compare surgical outcomes and expenditures at hospitals located in Health Professional Shortage Areas to nonshortage area designated hospitals among Medicare beneficiaries. This cross-sectional retrospective study used data from 842,787 Medicare beneficiary patient admissions to hospitals with and without Health Professional Shortage Area designations for common operations including appendectomy, cholecystectomy, colectomy, and hernia repair from 2014 to 2018. Primary outcomes measures were 30-day mortality, hospital readmissions, and 30-day surgical episode payments. Patients (mean age=75.6 years, males=44.4%) undergoing common surgical procedures in shortage area hospitals were less likely to be White (84.6% vs 88.4%) and less likely to have≥2 Elixhauser comorbidities (75.5% vs 78.2%). Patients undergoing surgery at Health Professional Shortage Area hospitals had lower risk-adjusted rates of 30-day mortality (6.05% vs 6.69%) and readmission (14.99% vs 15.74%). Medicare expenditures at Health Professional Shortage Area hospitals were also lower than nonshortage designated hospitals ($28,517 vs $29,685).
AHRQ-funded; HS028606; HS028672.
Citation: Mullens CL, Lussiez A, Scott JW . Association of health professional shortage area hospital designation with surgical outcomes and expenditures among Medicare beneficiaries. Ann Surg 2023 Oct 1; 278(4):e733-e39. doi: 10.1097/sla.0000000000005762..
Keywords: Hospitals, Surgery, Medicare, Healthcare Costs, Workforce, Outcomes
Scott JW, Neiman PU, Scott KW
High deductibles are associated with severe disease, catastrophic out-of-pocket payments for emergency surgical conditions.
This retrospective analysis of claims data examined the association of a high-deductible health insurance plan (HDHP) with severe disease and catastrophic out-of-pocket payments for emergency surgical conditions (e.g., appendicitis, cholecystitis, diverticulitis, and intestinal obstruction). Primary outcome was disease severity at presentation-determined using ICD-10-CM diagnoses codes and based on validated measures of anatomic severity (e.g., perforation, abscess, diffuse peritonitis). The secondary outcome was catastrophic out-of-pocket spending, defined by the World Health Organization as out-of-pocket spending >10% of annual income. Among 43,516 patients [mean age 48.4 years; 51% female], 41% were enrolled in HDHPs. Despite being younger, healthier, wealthier, and more educated, HDHP enrollees were more likely to present with more severe disease (28.5% vs 21.3%); even after adjusting for relevant demographics. HDHP enrollees were also more likely to incur 30-day out-of-pocket spending that exceeded 10% of annual income (20.8% vs 6.4%).
AHRQ-funded; HS027788; HS028672.
Citation: Scott JW, Neiman PU, Scott KW . High deductibles are associated with severe disease, catastrophic out-of-pocket payments for emergency surgical conditions. Ann Surg 2023 Oct 1; 278(4):e667-e74. doi: 10.1097/sla.0000000000005819..
Keywords: Health Insurance, Healthcare Costs, Payment, Surgery
Mellor JM, McInerney M, Garrow RC
The impact of Medicaid expansion on spending and utilization by older low-income Medicare beneficiaries.
This study examined indirect spillover effects of Affordable Care Act (ACA) Medicaid expansions to working-age adults on health care coverage, spending, and utilization by older low-income Medicare beneficiaries. The authors used data from the 2010-2018 Health and Retirement Study survey linked to annual Medicare beneficiary summary files. They estimated individual-level difference-in-differences models of total spending for inpatient, institutional outpatient, physician/professional provider services; inpatient stays, outpatient visits, physician visits; and Medicaid and Part A and B Medicare coverage. They also compared changes in outcomes before and after Medicaid expansion in expansion versus nonexpansion states. The sample included low-income respondents aged 69 and older with linked Medicare data, enrolled in full-year traditional Medicare, and living in the community. ACA Medicaid expansion was associated with a 9.8 percentage point increase in Medicaid coverage, a 4.4 percentage point increase in having any institutional outpatient spending, and a positive but statistically insignificant 2.4 percentage point change in Part B enrollment.
Citation: Mellor JM, McInerney M, Garrow RC . The impact of Medicaid expansion on spending and utilization by older low-income Medicare beneficiaries. Health Serv Res 2023 Oct; 58(5):1024-34. doi: 10.1111/1475-6773.14155..
Keywords: Medicaid, Medicare, Low-Income, Healthcare Utilization, Healthcare Costs, Health Insurance
Jazowski SA, Vaidya AU, Donohue JM
Commercial health plan and enrollee out-of-pocket spending on accelerated approval products in 2019.
Accelerated approval products, including those of low or uncertain therapeutic value, have cost Medicare and Medicaid billions of dollars annually. The financial implications of this program for commercial payers is unknown. The purpose of this study was to estimate health plan and out-of-pocket spending on product indication pairs (products provided accelerated approval for specific indications) that did and did not confirm clinical benefit. The study found that commercial health plan spending on 93 product indication pairs totaled $1.3 billion in 2019. When this amount was extrapolated to all US ESI plans, the total equaled $9.0 billion. Health plans spent over double on product-indication pairs converted to full approval based on surrogate end points when compared to those based on clinical end points. Health plan expenditures on product-indication pairs not yet converted to full approval equaled $261.9 million ($1.9 billion for all US ESI plans). Sixty-nine percent of that amount was ascribed to those with post-marketing studies within FDA deadlines. Out-of-pocket spending totaled $17.5million, or $125.5 million for all US ESI enrollees. Fewer than one-fifth of enrollees pending was on product-indication pairs converted to full approval based on clinical end points. Of the $5.9 million spent on product-indication pairs not yet converted to full approval, 46%was ascribed to those with post-marketing studies within FDA deadlines.
Citation: Jazowski SA, Vaidya AU, Donohue JM . Commercial health plan and enrollee out-of-pocket spending on accelerated approval products in 2019. JAMA Intern Med 2023 Sep; 183(9):1016-18. doi: 10.1001/jamainternmed.2023.2381..
Keywords: Health Insurance, Healthcare Costs
Eddelbuettel JCP, Barry CL, Kennedy-Hendricks A
High-deductible health plans and nonfatal opioid overdose.
This study examined whether an employer offering a high-deductible health plan (HDHP) had an impact on nonfatal opioid overdose among commercially insured individuals with opioid use disorder (OUD) in the United States. The authors used deidentified insurance claims data from 2007 to 2017 with 97,788 person-years. They estimated the change in the probability of a nonfatal opioid overdose among enrollees with OUD whose employers began offering an HDHP insurance option during the study period compared with the change among those whose employer never offered an HDHP. Across both groups, 2% of the sample experienced a nonfatal opioid overdose during the study period. They found no association of HDHP with an observed increase in the probability of nonfatal opioid overdose among commercially insured person-years with OUD.
Citation: Eddelbuettel JCP, Barry CL, Kennedy-Hendricks A . High-deductible health plans and nonfatal opioid overdose. Med Care 2023 Sep; 61(9):601-04. doi: 10.1097/mlr.0000000000001886..
Keywords: Healthcare Costs, Health Insurance, Opioids, Substance Abuse, Behavioral Health
Anderson KE, DiStefano MJ, Liu A
Incorporating added therapeutic benefit and domestic reference pricing into Medicare payment for expensive part B drugs.
The objective of this retrospective analysis was to identify expensive Part B drugs and to consider the evidence for each drug's added benefit in order to model a reimbursement policy for Medicare that integrates added benefit assessment and domestic reference pricing. Data were taken from a nationally representative sample of traditional Medicare Part B claims. The analysis showed that more than one-third of the expensive Part B drugs prescribed in 2019 offered low added benefit. The authors concluded that reference pricing based on added benefit assessment could be used to address the launch prices for expensive Part B drugs with low added benefit.
Citation: Anderson KE, DiStefano MJ, Liu A . Incorporating added therapeutic benefit and domestic reference pricing into Medicare payment for expensive part B drugs. Value Health 2023 Sep; 26(9):1381-88. doi: 10.1016/j.jval.2023.05.018..
Keywords: Medicare, Payment, Medication, Healthcare Costs
Landon BE, Lam MB, Landrum MB
Opportunities for savings in risk arrangements for oncologic care.
High spending for cancer care is a target for savings as the United States hastens adoption of alternative payment through global payment models such as Accountable Care Organizations (ACOs) or Medicare Advantage (MA). The purpose of this study was to quantify the level at which Accountable Care Organizations ACOs and other risk-bearing organizations operating in a specific geographic area could realize savings by directing patients to efficient medical oncology practices. The incident cohort included 1,309,825 patients Options for directing differed across markets; the top quartile market had 10 or more oncology practices, but the bottom quartile had 3 or fewer oncology practices. Total spending (including Medicare Part D) in the incident cohort increased from a mean of $57,314 in 2009 to 2010 to $66,028 in 2016 to 2017. Within markets, total spending for practices in the highest spending quartile was 19% greater than in the lowest quartile. Hospital spending was the single largest component of spending in both time periods followed by Part B (infused) chemotherapy. Correlations in practice-level spending between the first-year (2009) and second-year (2010) spending were high.
Citation: Landon BE, Lam MB, Landrum MB . Opportunities for savings in risk arrangements for oncologic care. JAMA Health Forum 2023 Sep; 4(9):e233124. doi: 10.1001/jamahealthforum.2023.3124..
Keywords: Cancer, Medicare, Healthcare Costs, Payment
MacDougall H, Hanson S, Interrante JD
Rural-urban differences in health care unaffordability during the postpartum period.
The purpose of this cross-sectional study was to explore health care unaffordability for rural and urban residents and by postpartum status. The study found that postpartum people reported statistically significantly higher rates of inability to pay medical bills when compared with non-postpartum people. Rural residents also reported higher rates of inability to pay their medical bills and having problems paying medical bills as compared with urban residents. In adjusted models, the predicted probability of being unable to pay medical bills among postpartum respondents was 12.8%, which was higher than among non-postpartum respondents. Similarly, postpartum respondents had higher predicted probabilities of reporting problems paying medical bills (18.4%) than compared with non-postpartum respondents. IN adjusted models, residency in a rural area was not significantly related with the health care unaffordability outcome measures.
Citation: MacDougall H, Hanson S, Interrante JD . Rural-urban differences in health care unaffordability during the postpartum period. Med Care 2023 Sep; 61(9):595-600. doi: 10.1097/mlr.0000000000001888..
Keywords: Rural Health, Urban Health, Rural/Inner-City Residents, Maternal Care, Healthcare Costs, Women, Access to Care
Tummalapalli SL, Struthers SA, White D
Optimal care for kidney health: development of a Merit-based Incentive Payment System (MIPS) value pathway.
This article detailed the iterative consensus-building process used by the American Society of Nephrology Quality Committee to develop the Optimal Care for Kidney Health Merit-based Incentive Payment System (MIPS) Value Pathway (MVP). The Optimal Care for Kidney Health MVP, published in the 2023 Medicare Physician Fee Schedule Final Rule, included measures related to angiotensin-converting enzyme inhibitor and angiotensin receptor blocker use, hypertension control, readmissions, acute kidney injury requiring dialysis, and advance care planning. The MVP nephrology’s goal was to streamline measure selection in MIPS and served as a case study of collaborative policymaking between one professional organization and national regulatory agencies.
Citation: Tummalapalli SL, Struthers SA, White D . Optimal care for kidney health: development of a Merit-based Incentive Payment System (MIPS) value pathway. J Am Soc Nephrol 2023 Aug; 34(8):1315-28. doi: 10.1681/asn.0000000000000163..
Keywords: Kidney Disease and Health, Payment, Healthcare Costs, Medicare
Decker SL, Zuvekas SH
AHRQ Author: Decker SL, Zuvekas SH
Primary care spending in the US population.
This AHRQ-authored research letter describes an analysis of primary care spending estimates in the US population using MEPS data. This survey study looked at the entire population, regardless of insurance source. The authors reported 2019 estimates of primary care spending, total medical spending, percentage of medical spending on primary care visits, and percentage with 0 spending on primary care visits. They analyzed race and ethnicity data to test whether primary care spending was greater in some groups compared with others. A total of 28,512 MEPS participants were included in the sample with a mean age of 38.6 and weighted percentages of 51.1% female, 18.5% Hispanic, 12.3% non-Hispanic Black, 59.7% non-Hispanic White, and 9.6% non-Hispanic individuals of other races and ethnicities. Primary care spending totaled $439 per person in 2019. Spending was highest for the Medicare population, Hispanics (52.7%), non-Hispanic Black (49.0%), and non-Hispanic other (44.3%), 79.9% for uninsured individuals and lowest for the uninsured. Average spending was $461 for those with group private insurance. The percentage of medical spending on primary care was 7.0% for the population and was lower for those younger than age 65 (5.1%), those in worse health (5.6%), and those with Medicare (5.3%). Almost 41% of the population had no primary care spending.
Citation: Decker SL, Zuvekas SH . Primary care spending in the US population. JAMA Intern Med 2023 Aug; 183(8):880-81. doi: 10.1001/jamainternmed.2023.1551..
Keywords: Medical Expenditure Panel Survey (MEPS), Healthcare Costs, Primary Care
Sharma H, Xu L
Use of intergovernmental transfers-based Medicaid supplemental payments to boost nursing home finances: evidence from Indiana nursing homes.
The objective of this study was to estimate the effect of participation in the intergovernmental transfers-based Medicaid supplemental payment program on nursing home revenue and expenditures. Data was taken from all Medicare and Medicaid-certified nursing homes in Indiana from 2009-17. The findings indicated that nursing homes owned or operated by nonstate governmental organizations received a fraction of the total supplemental payments on average, but the authors observed increased payments in later years. Participating nursing homes did not increase clinical expenses. The authors concluded that these findings raised questions regarding the transparency of financing arrangements between nonstate governmental organizations and nursing homes and the need to link supplemental payments to clinical expenses.
Citation: Sharma H, Xu L . Use of intergovernmental transfers-based Medicaid supplemental payments to boost nursing home finances: evidence from Indiana nursing homes. Med Care 2023 Aug; 61(8):546-53. doi: 10.1097/mlr.0000000000001875..
Keywords: Nursing Homes, Medicare, Medicaid, Healthcare Costs
Ganguli I, Crawford ML, Usadi B
Who's accountable? Low-value care received by Medicare beneficiaries outside of their attributed health systems.
This study examined where and from whom Medicare beneficiaries aged 65 and older received forty low-value services during 2017-18 and identified factors associated with out-of-system receipt. The authors used national Medicare data for fee-for-service beneficiaries aged sixty-five and older and attributed to 595 US health systems for 2017 and 2018. Almost half (43%) of low-value services received by attributed beneficiaries originated from out-of-system clinicians: 38 percent from specialists, 4 percent from primary care physicians, and 1 percent from advanced practice clinicians. Recipients of low-value care were more likely to obtain care out of system if age 75 or older, male, non-Hispanic white, rural dwelling, more medically complex, or experiencing lower continuity of care. Out-of-system receipt was not associated with recipients' health systems' accountable care organization status.
Citation: Ganguli I, Crawford ML, Usadi B . Who's accountable? Low-value care received by Medicare beneficiaries outside of their attributed health systems. Health Aff 2023 Aug; 42(8):1128-39. doi: 10.1377/hlthaff.2022.01319..
Keywords: Medicare, Healthcare Costs
Hill SC, Jacobs PD, Johnson CA
AHRQ Author: Hill SC, Jacobs PD
Availability of off-marketplace plans with lower premiums for higher-income families.
Prior to 2021, families with incomes above 400% of the federal poverty level were ineligible for marketplace premium tax credits and may again be after 2025. This income cap was temporarily removed by current laws, but some higher-income families still receive zero tax credits because credits limit out-of-pocket premiums for a reference plan as a portion of income. The purpose of this study was to quantify 2 variables: 1) premium variations between on- and off-marketplace plans and 2) the relationship between these premium variations and state decisions to finance cost-sharing reductions (CSRs) for lower-income families. The researchers developed a comprehensive database of on- and off-marketplace plans in each county and compared on- and off-marketplace plan premiums in 2020 and the rates of growth in the numbers of plans. The study found that in 2020, 89% of the United States population lived in counties with an availability of plans offered only off-marketplace. In those counties premiums for the lowest-cost off-marketplace plans averaged 11.3% less than premiums for the lowest-cost on-marketplace plans. In comparison the lowest-cost off-marketplace plans were more expensive on average. Silver plan premiums were 6.1% higher off-marketplace than on-marketplace in states that loaded CSRs on all silver plans, and 13.5% lower in states that loaded CSRs only on on-marketplace silver plans.
Citation: Hill SC, Jacobs PD, Johnson CA . Availability of off-marketplace plans with lower premiums for higher-income families. Am J Manag Care 2023 Jul; 29(7):371-76. doi: 10.37765/ajmc.2023.89397..
Keywords: Health Insurance, Healthcare Costs
Leininger LJ, Tomaino M, Meara E
Health-related quality of life in high-cost, high-need populations.
This retrospective longitudinal study examined health care utilization, expenditures, and patient-reported health for high-cost, high-need (HCHN) populations comparing a baseline (year 1) and follow-up year (year 2). The sample included adults (n = 46,934) participating in the Medical Expenditure Panel Survey between 2011 and 2016. The authors estimated health-related quality of life (HRQOL) for each sample member using the physical and mental health scales from the Medical Outcomes Study Short Form 12. They compared HRQOL stratified by HCHN, defined as patients whose baseline (year 1) demographics, utilization, and clinical characteristics predicted top decile health spending in year 2. The physical health scale exhibited robust measure validity, reliability, and responsiveness, but the mental health scale did not. Mean physical health was 1.25 SDs lower in HCHN vs other patients (37.9 vs 51.0 on a 0-100 scale increasing in self-perceived health). Patient-reported health outcomes continued to remain poor in HCHN populations, even after health care utilization recedes.
Citation: Leininger LJ, Tomaino M, Meara E . Health-related quality of life in high-cost, high-need populations. Am J Manag Care 2023 Jul; 29(7):362-68. doi: 10.37765/ajmc.2023.89396..
Keywords: Medical Expenditure Panel Survey (MEPS), Quality of Life, Healthcare Costs
Oke I, Lutz SM, Hunter DG
Use and costs of instrument-based vision screening for US children aged 12 to 36 months.
This research letter describes a cohort study that examined patterns and out-of-pocket costs of instrument-based vision screening among US children 12 to 36 months. The authors used 2018 MarketScan Commerical Claims and Encounters data as of January 1, 2018 and excluded those with fewer than 12 months of continuous insurance coverage, enrollment in capitated insurance plans, no preventive care encounters, or missing data on residents. The study included 246,077 children. Instrument-based vision screening was received by 19.5% (n = 48,101) of children during 2018. Median (IQR) practitioner payment for instrument-based vision screening claims was $13. Screening incurred out-of-pocket expenses for 7% of children; 30% of these children had expenses related to co-payment, 20.2% to coinsurance, and 50.7% to deductibles. Median (IQR) out-of-pocket expense was $11. Increased odds of vision screening were associated with older age, high-deductible plan enrollment, having more than 1 preventative visit, and receiving care within an area in the highest quartile of practitioner payment. This study was limited by use of commercial claims data, which excluded 45% of children with public or no coverage. Nationwide prevalence of vision screening therefore may differ for the general population.
Citation: Oke I, Lutz SM, Hunter DG . Use and costs of instrument-based vision screening for US children aged 12 to 36 months. JAMA Pediatr 2023 Jul; 177(7):728-30. doi: 10.1001/jamapediatrics.2023.0808..
Keywords: Newborns/Infants, Eye Disease and Health, Screening, Prevention, Healthcare Costs
Cusick MM, Tisdale RL, Chertow GM
Population-wide screening for chronic kidney disease : a cost-effectiveness analysis.
The purpose of this study was to assess the cost-effectiveness of adding population-wide screening for chronic kidney disease (CKD), specifically; screening for albuminuria with and without adding Sodium-glucose cotransporter-2 (SGLT2) inhibitors to the current standard of care for CKD. The study found that one-time CKD screening at the age 55 years had an ICER of $86,300 per QALY gained by increasing costs from $249,800 to $259,000 and increasing QALYs from 12.61 to 12.72; this result was accompanied by a decrease in the incidence of kidney failure requiring dialysis or kidney transplant of 0.29 percentage points and an increase in life expectancy from 17.29 to 17.45 years. In the group aged 35 to 75 years, screening one time prevented dialysis or transplant in 398, 000 people and screening every 10 years until age the age of 75 years cost less than $100,000 per QALY gained. The study’s sensitivity analysis found that when SGLT2 inhibitors were 30% less effective, screening every 10 years during ages 35 to 75 years cost between $145,400 and $182,600 per QALY gained, and decreases in the price would be necessary for screening to be cost-effective.
Citation: Cusick MM, Tisdale RL, Chertow GM . Population-wide screening for chronic kidney disease : a cost-effectiveness analysis. Ann Intern Med 2023 Jun; 176(6):788-97. doi: 10.7326/m22-3228..
Keywords: Kidney Disease and Health, Screening, Healthcare Costs, Chronic Conditions
Kannan S, Song Z
Changes in out-of-pocket costs for US hospital admissions between December and January every year.
Out-of-pocket costs for ICU care may be large at the beginning of the year due to high insurance deductibles that reset every year for US patients, and the expensive nature of ICU care. The purpose of this cross-sectional study was to explore cost-sharing changes from December to January for ICU admissions and non -ICU admissions among adults with employer-sponsored insurance. Among aggregate ICU hospitalizations, total cost-sharing averaged $1079 in December and $1871 in January, a 73.4% increase. Among non-ICU hospitalizations, total cost-sharing averaged $1043 in December and $1683 in January, a 61.3% increase. These increases and differences between ICU and non-ICU hospitalizations were greater among patients with high deductible health plans (HDHPs). For patients with HDHPs requiring an ICU stay, cost-sharing averaged $3093 per hospitalization in January vs $1301 in December.
Citation: Kannan S, Song Z . Changes in out-of-pocket costs for US hospital admissions between December and January every year. JAMA Health Forum 2023 May 5; 4(5):e230784. doi: 10.1001/jamahealthforum.2023.0784..
Keywords: Healthcare Costs, Hospitals, Hospitalization, Intensive Care Unit (ICU)
Jazowski SA, Samuel-Ryals CA, Wood WA
Association between low-income subsidies and inequities in orally administered antimyeloma therapy use.
This study’s goal was to determine the association between low-income subsidies and inequities in orally administered antimyeloma therapy use. This retrospective cohort study used Surveillance, Epidemiology, and End Results-Medicare data to identify beneficiaries diagnosed with multiple myeloma between 2007 and 2015. The authors examined therapy initiation in the 30, 60, and 90 days following diagnosis and adherence to and discontinuation of treatment in the 180 days following initiation. They found that receipt of full subsidies was not associated with earlier initiation of or improved adherence to orally administered antimyeloma therapy. Full-subsidy enrollees were 22% more likely to experience earlier treatment discontinuation than nonsubsidy enrollees. Black full-subsidy and nonsubsidy enrollees were 14% less likely than their White counterparts to ever initiate treatment.
Citation: Jazowski SA, Samuel-Ryals CA, Wood WA . Association between low-income subsidies and inequities in orally administered antimyeloma therapy use. Am J Manag Care 2023 May; 29(5):246-54. doi: 10.37765/ajmc.2023.89357..
Keywords: Healthcare Costs, Medication, Low-Income
Lyu PF, Chernew ME, McWilliams JM
Benchmarking changes and selective participation in the Medicare shared savings program.
In 2017 the Medicare Shared Savings Program (MSSP) began including regional spending into accountable care organization (ACO) benchmarks, demonstrating a preference for the participation of those ACOs and practices with lower baseline spending than their region. The purpose of this study was to isolate changes in spending due to changes in the mix of ACOs and practices participating in the MSSP as a method for characterizing providers' responses to these incentives. After 2017, the composition of the MSSP increasingly shifted to providers with lower preexisting levels of spending relative to their region, consistent with a selection response. Changes took place through the entry of new ACOs with lower baseline spending, the exit of higher-spending ACOs, and the reconfiguration of participant lists favoring lower-spending practices within continuing ACOs. The study found that although compositional changes could not be clearly tied to changes in benchmarking, the disproportionate participation of providers with lower baseline spending suggests sizable costs and the need for reforms in ACO benchmarking.
Citation: Lyu PF, Chernew ME, McWilliams JM . Benchmarking changes and selective participation in the Medicare shared savings program. Health Aff 2023 May; 42(5):622-31. doi: 10.1377/hlthaff.2022.01061..
Keywords: Medicare, Healthcare Costs
Carlton EF, Becker NV, Moniz MH
Out-of-pocket spending for non-birth-related hospitalizations of privately insured US children, 2017 to 2019.
This study’s goal was to estimate out-of-pocket spending for non-birth pediatric hospitalizations of privately insured children from 2017 to 2019. This study used data from the IBM MarketScan Commercial Database. Among 183,780 hospitalizations, half were for female children, with a median age of 12 (4-16) years. Most (79.0%) hospitalizations were for children with a chronic condition and 24.1% were covered by a high-deductible health plan. Mean (SD) and median (IQR) out-of-pocket spending per hospitalization was $1313 and $656 respectively. Out-of-pocket spending exceeded $3000 for 14.0% of hospitalizations. Factors associated with higher out-of-pocket spending included hospitalization in quarter 1 compared with quarter 4 (average marginal effect [AME], $637) and lack of chronic conditions compared with having a complex chronic condition (AME, $732). Hospitalizations covered by the least generous plans (deductible of $3000 or more and coinsurance of 20% or more) found mean out-of-pocket spending was $1974, while the most generous plans (deductible less than $1000 and coinsurance of 1-19%), mean out-of-pocket spending was found to be $826.
AHRQ-funded; HS025465; HS028817.
Citation: Carlton EF, Becker NV, Moniz MH . Out-of-pocket spending for non-birth-related hospitalizations of privately insured US children, 2017 to 2019. JAMA Pediatr 2023 May; 177(5):516-25. doi: 10.1001/jamapediatrics.2023.0130..
Keywords: Children/Adolescents, Healthcare Costs, Hospitalization, Health Insurance
Becker NV, Carlton EF, Iwashyna TJ
Patient adverse financial outcomes before and after COVID-19 infection.
This study’s goal was to assess whether more adverse financial outcomes occurred after COVID-19 infection and hospitalization compared to those who were not hospitalized with COVID-19. The authors used credit report data from 132,109 commercially insured COVID-19 survivors to compare the rates of adverse financial outcomes for two cohorts of individuals with credit outcomes measured before and after COVID-19 infection, using an interaction term between cohort and hospitalization to test whether adverse credit outcomes changed more for hospitalized than nonhospitalized COVID-19 patients. There were greater adverse financial outcomes among persons hospitalized with COVID-19 (5-8 percentage points) than non-hospitalized COVID-19 patients (1-3 percentage points).
AHRQ-funded; HS028672; HS028817.
Citation: Becker NV, Carlton EF, Iwashyna TJ . Patient adverse financial outcomes before and after COVID-19 infection. J Hosp Med 2023 May; 18(5):424-28. doi: 10.1002/jhm.13105..
Keywords: COVID-19, Healthcare Costs, Hospitalization
Bond AM, Dean EB, Desai SM
The role of financial incentives in biosimilar uptake in Medicare: Evidence from the 340b program.
This study’s goal was to investigate whether the 340B Drug Pricing Program, which offers eligible hospitals substantial discounts on drug purchases, inhibits biosimilar uptake. Almost one-third of eligible US hospitals participate in the program. The authors used regression discontinuity design and two high-volume biologics with biosimilar competitors, filgrastim and infliximab to estimate that 340B program eligibility was associated with a 22.9-percentage-point reduction in biosimilar adoption. Additionally, 340B program eligibility was associated with 13.3 more biologic administrations annually per hospital and $17,919 more biologic revenue per hospital. The effect was found to be that it inhibited biosimilar uptake, possibly because of financial incentives that make reference drugs more profitable than biosimilar medications.
Citation: Bond AM, Dean EB, Desai SM . The role of financial incentives in biosimilar uptake in Medicare: Evidence from the 340b program. Health Aff 2023 May; 42(5):632-41. doi: 10.1377/hlthaff.2022.00812..
Keywords: Medicare, Medication, Healthcare Costs
Time to publication of cost-effectiveness analyses for medical devices.
This study examined the availability of cost-effectiveness analyses for medical devices, in terms of both the number of studies and when studies are published. The longer the time between FDA approval/clearance and publication of cost-effectiveness analyses of medical devices, the longer that decision makers will not have the evidence they and their patients need when making initial decisions related to newly available medical devices. An analysis was conducted using the Tufts University Cost-Effectiveness Analysis Registry to identify studies of medical devices that were linked to FDA databases. The years between FDA approval/clearance and publication of cost-effectiveness analyses were calculated. The authors identified a total of 218 cost-effectiveness analyses of medical devices in the United States published between 2002 and 2020. Of those studies, 39.4% were linked to FDA databases. Studies examining devices approved via premarket approval were published a mean of 6.0 years after the device received FDA approval, whereas studies examining devices that were cleared via the 510(k) process were published a mean of 6.5 years after the device received FDA clearance.
Citation: Everhart AO . Time to publication of cost-effectiveness analyses for medical devices. Am J Manag Care 2023 May; 29(5):265-68. doi: 10.37765/ajmc.2023.89359..
Keywords: Medical Devices, Healthcare Costs
Rao Rao, Akrobetu DJ, Dickert NW
Deciding whether to take sacubitril/valsartan: how cardiologists and patients discuss out-of-pocket costs.
The purpose of this study was to characterize patient-cardiologist discussions concerning out-of-pocket costs associated with sacubitril/valsartan during the early post-approval period. Researchers conducted a content analysis of 222 deidentified transcripts of audio-recorded outpatient encounters in which cardiologists and patients discussed whether to initiate, continue, or discontinue sacubitril/valsartan. Issues of cost occurred in nearly half the discussions, but the researchers note that cost conversations were generally superficial, rarely addressing affordability or cost-value judgments. Cardiologists frequently provided patients with free sacubitril/valsartan samples with no plan to address costs after the sample course ran out.
Citation: Rao Rao, Akrobetu DJ, Dickert NW . Deciding whether to take sacubitril/valsartan: how cardiologists and patients discuss out-of-pocket costs. J Am Heart Assoc 2023 Apr 4; 12(7):e028278. doi: 10.1161/jaha.122.028278..
Keywords: Decision Making, Medication, Cardiovascular Conditions, Healthcare Costs
Ganguli I, Ying W, Shakley T
Cascade services and spending following low-value imaging for uncomplicated low back pain among commercially insured adults.
The purpose of this study was to examine the impact of low-value imaging on cascade services and spending in commercially-insured adults with uncomplicated acute low back pain. The researchers analyzed medical claims from Blue Cross Blue Shield of Massachusetts members aged 18-50 years who received a 2018 diagnosis of uncomplicated low back pain, for which imaging was considered inappropriate according to the National Committee for Quality Assurance Healthcare Effectiveness Data and Information Set (HEDIS) criteria. In 2018, 30,892 members were eligible for low-value imaging. Of these, 6009 (19.5%) received low-value imaging: 5091 (16.5%) X-ray and 787 (2.5%) MRI. The study found that when compared to patients without low-value imaging, those with low-value X-ray or MRI had higher adjusted probabilities of receiving cascade services and greater adjusted total spending at 3, 6, and 12 months. These results were robust to falsification testing. Members with high deductible health plans (HDHP) had higher narrowly defined cascade-associated out-of-pocket spending than those in other plans. The most common sources of narrowly defined cascade-associated spending were physical therapy, office visits, radiology studies, laboratory studies, and surgery.
J Gen Intern Med 2023 Mar;38(4):1102-05. doi: 10.1007/s11606-022-07829-2
Citation: Ganguli I, Ying W, Shakley T . Cascade services and spending following low-value imaging for uncomplicated low back pain among commercially insured adults. .
Keywords: Imaging, Back Health and Pain, Pain, Healthcare Costs