National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Access to Care (2)
- Domestic Violence (1)
- Elderly (1)
- Emergency Department (1)
- Healthcare Cost and Utilization Project (HCUP) (2)
- (-) Healthcare Costs (18)
- Health Insurance (8)
- Health Services Research (HSR) (2)
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- Long-Term Care (1)
- Medicaid (5)
- Medicare (9)
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- (-) Policy (18)
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- Quality of Care (1)
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- Sexual Health (1)
- Surgery (1)
- Women (1)
AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 18 of 18 Research Studies DisplayedSood N, Yang Z, Huckfeldt P
Geographic variation in Medicare fee-for-service health care expenditures before and after the passage of the Affordable Care Act.
This cross-section study examined geographic variation in Medicare fee-for-service health care expenditures before and after the passage of the Affordable Care Act. The study included all fee-for-service Medicare enrollees aged 65 and older from 2007 to 2018 using data from the Medicare Geographic Variation Public Use File. Hospital referral regions (HRRs) were grouped in each year into deciles (10 equal groups) based on per-beneficiary total spending. Geographic variation was stable from 2007 to 2011 and declined steadily from 2012 through 2018. In specific spending categories, only home health had statistically significant reductions in geographic variation. The ratio of home health spending among HRRs in the top to bottom deciles of total Medicare spending fell from 5.14 in 2007 to 3.45 in 2018.
AHRQ-funded; HS025394.
Citation: Sood N, Yang Z, Huckfeldt P .
Geographic variation in Medicare fee-for-service health care expenditures before and after the passage of the Affordable Care Act.
JAMA Health Forum 2021 Dec;2(12):e214122. doi: 10.1001/jamahealthforum.2021.4122..
Keywords: Medicare, Policy, Healthcare Costs, Payment
Jacobs PD, Kronick R
AHRQ Author: Jacobs PD
The effects of coding intensity in Medicare Advantage on plan benefits and finances.
The authors assessed how beneficiary premiums, expected out-of-pocket costs, and plan finances in the Medicare Advantage (MA) market are related to coding intensity. The study sample included beneficiaries enrolled in both MA and Part D from 2008-2015; Medicare claims and drug utilization data for Traditional Medicare beneficiaries were used to calibrate an independent measure of health risk. The authors found that, while coding intensity increased taxpayers' costs of the MA program, enrollees and plans both benefitted but with larger gains for plans. They concluded that the adoption of policies to adjust more completely for coding intensity would likely affect both beneficiaries and plan profits.
AHRQ-authored.
Citation: Jacobs PD, Kronick R .
The effects of coding intensity in Medicare Advantage on plan benefits and finances.
Health Serv Res 2021 Apr;56(2):178-87. doi: 10.1111/1475-6773.13591..
Keywords: Medicare, Health Insurance, Healthcare Costs, Policy
Chen G, Lewis VA, Gottlieb D
Estimating heterogeneous effects of a policy intervention across organizations when organization affiliation is missing for the control group: application to the evaluation of accountable care organizations.
This study looked at the effects of accountable care organizations (ACOs) on lowering health care costs and reducing the rate of hospital readmissions. The authors used Medicare fee-for-service claims data from 2009-2014 to estimate the heterogenous effects of Medicare ACO programs on hospital admissions across hospital referral regions and provider groups. The results suggested that the ACO programs reduced the rate of readmission to hospitals, and that the effect of joining an ACO varied considerably across medical groups.
AHRQ-funded; HS024075.
Citation: Chen G, Lewis VA, Gottlieb D .
Estimating heterogeneous effects of a policy intervention across organizations when organization affiliation is missing for the control group: application to the evaluation of accountable care organizations.
Health Serv Outcomes Res Methodol 2021 Mar;21(1):54-68. doi: 10.1007/s10742-020-00230-8..
Keywords: Medicare, Policy, Healthcare Costs, Hospital Readmissions, Health Insurance
Modi PK, Kaufman SR, Caram ME
Medicare Accountable Care Organizations and the adoption of new surgical technology.
Dissemination of new surgical technology is a major contributor to healthcare spending growth. Accountable care organization (ACO) policy aims to control spending while maintaining quality. As a result, ACOs provide incentive for hospitals to selectively adopt newer procedures with high value. In this retrospective cohort study the investigators concluded that despite ACO policy incentives to selectively adopt newer surgical technology, ACO participation was not associated with differences in rate of surgery or use of newer surgical technology for 6 major surgical procedures.
AHRQ-funded; HS025707.
Citation: Modi PK, Kaufman SR, Caram ME .
Medicare Accountable Care Organizations and the adoption of new surgical technology.
J Am Coll Surg 2021 Feb;232(2):138-45.e2. doi: 10.1016/j.jamcollsurg.2020.10.016..
Keywords: Medicare, Surgery, Policy, Healthcare Costs
Polsky D, Wu B
Provider networks and health plan premium variation.
The purpose of this study was to examine how plan premiums are associated with physician network breadth, hospital network breadth, and hospital network quality on the Affordable Care Act's Health Insurance Marketplaces in all 50 states and the DC in 2016. The investigators concluded that physician network breadth and hospital network breadth contributed positively to plan premiums.
AHRQ-funded; HS025976.
Citation: Polsky D, Wu B .
Provider networks and health plan premium variation.
Health Serv Res 2021 Feb;56(1):16-24. doi: 10.1111/1475-6773.13447..
Keywords: Health Insurance, Healthcare Costs, Policy, Access to Care
Fung V, Price M, Hull P
Assessment of the Patient Protection and Affordable Care Act's increase in fees for primary care and access to care for dual-eligible beneficiaries.
The purpose of this study was to examine the association between the Affordable Care Act (ACA) fee bump and primary care visits for dual-eligible Medicare and Medicaid beneficiaries. Medicare claims data from 2012 to 2016 was used. Findings showed that the ACA fee bump was not associated with increases in primary care visits for dual-eligible Medicare and Medicaid beneficiaries. Additionally, visits for dual-eligible beneficiaries with primary care physicians decreased after the ACA, a decrease that was partially offset by increases in visits with nonphysician clinicians.
AHRQ-funded; HS024725; HS025378.
Citation: Fung V, Price M, Hull P .
Assessment of the Patient Protection and Affordable Care Act's increase in fees for primary care and access to care for dual-eligible beneficiaries.
JAMA Netw Open 2021 Jan;4(1):e2033424. doi: 10.1001/jamanetworkopen.2020.33424..
Keywords: Access to Care, Medicaid, Medicare, Health Insurance, Healthcare Costs, Policy
Coupet E, Karp D, Wiebe DJ
Shift in U.S. payer responsibility for the acute care of violent injuries after the Affordable Care Act: Implications for prevention.
In this study, the investigators determined the total annual charges for the acute care of injuries from interpersonal violence and the shift in financial responsibility for these charges after the Medicaid expansion from the Affordable Care Act in 2014. After Medicaid expansion, taxpayers are now accountable for nearly half of the $10.7 billion in annual charges for the acute care of violent injury in the U.S. The investigators suggest that these findings highlight the benefit to state Medicaid programs of preventing interpersonal violence.
AHRQ-funded; HS000028.
Citation: Coupet E, Karp D, Wiebe DJ .
Shift in U.S. payer responsibility for the acute care of violent injuries after the Affordable Care Act: Implications for prevention.
Am J Emerg Med 2018 Dec;36(12):2192-96. doi: 10.1016/j.ajem.2018.03.070..
Keywords: Domestic Violence, Emergency Department, Healthcare Costs, Policy, Healthcare Cost and Utilization Project (HCUP), Medicaid
Makam AN, Nguyen OK, Kirby B
Effect of site-neutral payment policy on long-term acute care hospital use.
The purpose of this study was to assess the projected effect of the Centers for Medicare and Medicaid Services new site-neutral payment policy, which aims to decrease unnecessary long-term acute care hospital (LTACH) admissions by reducing reimbursements for less-ill individuals by 2020. The investigators concluded that the site-neutral payment policy may limit LTACH access in existing LTAC-scarce markets, with potential adverse implications for recovery of hospitalized older adults.
AHRQ-funded; HS022418.
Citation: Makam AN, Nguyen OK, Kirby B .
Effect of site-neutral payment policy on long-term acute care hospital use.
J Am Geriatr Soc 2018 Nov;66(11):2104-11. doi: 10.1111/jgs.15539..
Keywords: Policy, Hospitalization, Payment, Long-Term Care, Healthcare Costs, Medicare, Elderly, Hospitals
Pelech D
Paying more for less? Insurer competition and health plan generosity in the Medicare Advantage program.
This paper explored the relationship between insurer competition and health plan benefit generosity by examining the impact of a regulatory change that caused the cancellation of 40% of the private plans in Medicare. The investigator found that insurers in markets affected by cancellation reduced the benefit generosity of the plans remaining in the market.
AHRQ-funded; HS023477; HS000055.
Citation: Pelech D .
Paying more for less? Insurer competition and health plan generosity in the Medicare Advantage program.
J Health Econ 2018 Sep;61:77-92. doi: 10.1016/j.jhealeco.2018.07.002..
Keywords: Healthcare Costs, Health Insurance, Medicare, Policy
Trish E, Herring B
Does limiting allowable rating variation in the small group health insurance market affect employer self-insurance?
This study evaluated the impact of limiting allowable rating variation on employer self-insurance across industries with varied health risk. The investigators found that lower-risk employers subject to laws limiting allowable premium rating variation had a predicted probability of self-insurance that was about 18 percentage points higher than otherwise-similar higher-risk employers, suggesting that selection concerns are warranted.
AHRQ-funded; HS000046.
Citation: Trish E, Herring B .
Does limiting allowable rating variation in the small group health insurance market affect employer self-insurance?
J Risk Insur 2018 Sep;85(3):607-33. doi: 10.1111/jori.12184.
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Keywords: Healthcare Costs, Health Insurance, Policy
Decker SL
AHRQ Author: Decker SL
No association found between the Medicaid primary care fee bump and physician-reported participation in Medicaid.
The Affordable Care Act required states in 2013 and 2014 to raise Medicaid payment rates to primary care physicians for certain services to the level of Medicare rates. The result was an average 73 percent increase in primary care Medicaid payments for qualifying physicians. This study used nationally representative data to examine the association between this Medicaid "fee bump" and physician-reported measures of participation in Medicaid. No such association was found. The lack of a sizable change in measures of physician participation in Medicaid may have been due to the temporary nature of the fee bump.
AHRQ-authored.
Citation: Decker SL .
No association found between the Medicaid primary care fee bump and physician-reported participation in Medicaid.
Health Aff 2018 Jul;37(7):1092-98. doi: 10.1377/hlthaff.2018.0078..
Keywords: Healthcare Costs, Payment, Medicaid, Policy, Primary Care
Heisel E, Kolenic GE, Moniz MM
Intrauterine device insertion before and after mandated health care coverage: the importance of baseline costs.
This study evaluated changes in out-of-pocket cost for intrauterine device (IUD) placement before and after mandated coverage of contraceptive services and examined how changes in out-of-pocket cost influenced IUD insertion as a function of baseline cost. It concluded that women in plans with the greatest reduction in out-of-pocket cost after mandated coverage of contraception had the greatest gains in IUD insertion.
AHRQ-funded; HS023784.
Citation: Heisel E, Kolenic GE, Moniz MM .
Intrauterine device insertion before and after mandated health care coverage: the importance of baseline costs.
Obstet Gynecol 2018 May;131(5):843-49. doi: 10.1097/aog.0000000000002567.
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Keywords: Sexual Health, Women, Policy, Healthcare Costs
Springer R, Marino M, O'Malley JP
Oregon Medicaid Expenditures after the 2014 Affordable Care Act Medicaid expansion: over-time differences among new, returning, and continuously insured enrollees.
This study assessed health care expenditures among Medicaid enrollees in the 24 months after Oregon's 2014 Medicaid expansions and examine whether expenditure patterns were different among the newly, returning, and continuously insured (CI). After initial increases, newly and returning insured (RI) outpatient expenditures dropped below CI. Expenditures for emergency department and dental services among the RI remained higher than among the newly insured.
AHRQ-funded; HS024270.
Citation: Springer R, Marino M, O'Malley JP .
Oregon Medicaid Expenditures after the 2014 Affordable Care Act Medicaid expansion: over-time differences among new, returning, and continuously insured enrollees.
Med Care 2018 May;56(5):394-402. doi: 10.1097/mlr.0000000000000907.
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Keywords: Healthcare Costs, Policy, Health Services Research (HSR), Medicaid
Henke RM, Karaca Z, Gibson TB
AHRQ Author: Karaca Z, Wong HS
Medicare Advantage penetration and hospital costs before and after the Affordable Care Act.
This study investigated the relationship between Medicare Advantage (MA) program growth and inpatient hospital costs and utilization before and after the ACA. Its results suggest that MA enrollment growth is associated with diminished spillover reductions in hospital admission costs after the ACA. Researchers did not observe a strong relationship between MA enrollment and inpatient days per enrollee
AHRQ-authored; AHRQ-funded; 290201300002C.
Citation: Henke RM, Karaca Z, Gibson TB .
Medicare Advantage penetration and hospital costs before and after the Affordable Care Act.
Med Care 2018 Apr;56(4):321-28. doi: 10.1097/mlr.0000000000000885.
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Keywords: Healthcare Costs, Policy, Healthcare Cost and Utilization Project (HCUP), Hospitalization, Medicare
Alderwick H, Shortell SM, Briggs ADM
Can accountable care organisations really improve the English NHS? Lessons from the United States.
The authors summarize evidence on accountable care organizations in the US - including what they look like, their effect on the quality and cost of healthcare, and how they are redesigning care. Recognizing major differences in context, they offer lessons from the US experience for National Health Service policy makers as they consider the future of similar ventures in England.
AHRQ-funded; HS022241; HS024075.
Citation: Alderwick H, Shortell SM, Briggs ADM .
Can accountable care organisations really improve the English NHS? Lessons from the United States.
BMJ 2018 Mar 2;360:k921. doi: 10.1136/bmj.k921.
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Keywords: Healthcare Costs, Quality of Care, Health Services Research (HSR), Policy
Lewis VA, D'Aunno T, Murray GF
The hidden roles that management partners play in accountable care organizations.
This study sought to understand the prevalence of nonprovider management partners' involvement in accountable care organizations (ACOs), the services these partners provide, and the structure of ACOs that have such partners. It found that 37 percent of ACOs reported having a management partner, and two-thirds of these ACOs reported that the partner shared in the financial risks or rewards..
AHRQ-funded; HS024075.
Citation: Lewis VA, D'Aunno T, Murray GF .
The hidden roles that management partners play in accountable care organizations.
Health Aff 2018 Feb;37(2):292-98. doi: 10.1377/hlthaff.2017.1025.
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Keywords: Medicare, Policy, Health Insurance, Healthcare Costs
Ho V
Refinement of the Affordable Care Act.
This article begins by listing some of the major reasons critics dislike the Affordable Care Act (ACA), then discusses the validity of these concerns from an economics perspective. Suggestions for refining the ACA and its market-based insurance system are then offered, with the goals of lowering insurance premiums, improving coverage rates, and/or addressing the concerns of ACA critics.
AHRQ-funded; HS024727.
Citation: Ho V .
Refinement of the Affordable Care Act.
Annu Rev Med 2018 Jan 29;69:19-28. doi: 10.1146/annurev-med-052616-044854..
Keywords: Policy, Health Insurance, Healthcare Costs
Lindrooth RC, Perraillon MC, Hardy RY
Understanding the relationship between Medicaid expansions and hospital closures.
The investigators hypothesized that Medicaid expansion of eligibility for childless adults prevents hospital closures because increased Medicaid coverage for previously uninsured people reduces uncompensated care expenditures and strengthens hospitals' financial position. They tested this hypothesis using data for the period 2008-16 on hospital closures and financial performance and discuss their findings in this paper.
AHRQ-funded; HS024959; HS025208.
Citation: Lindrooth RC, Perraillon MC, Hardy RY .
Understanding the relationship between Medicaid expansions and hospital closures.
Health Aff 2018 Jan;37(1):111-20. doi: 10.1377/hlthaff.2017.0976..
Keywords: Healthcare Costs, Policy, Hospitals, Medicaid, Rural Health