Hospital interpretation and payment incentives

Access to interpreters improves health care and is generally required by law. Why then, is interpretation access hard to come by in hospitals? From a hospital staff perspective, appropriate policies may be in place, and hospital staff motivated to offer excellent patient care, but all the demands of providing medical care can lead to system breakdown.… Read More »

The childhood roots of health inequity: Part 1 – Dr. Paula Braveman

Children who grow up in stressful environments, without adequate adult support, are at much greater risk of developing heart disease, cancer, and many other diseases as adults. This is partly because of the coping behaviors that people use to deal with stress, but also because of the cumulative effects of toxic stress. Thus, many of… Read More »

Confusing the Confused: The impact of lacking professional interpretation services

Being hospitalized with a serious medical condition, surrounded by strange equipment, and listening to medical jargon you’ve never heard before is an intimidating situation for anyone. Compounding the uncertainty and stress of the situation would be not understanding the primary language spoken by your providers, not being able to read your procedure consents, and knowing… Read More »

APHA 2016 – One Student’s Experience

Posters and banners declaring “Creating the Healthiest Nation: Ensuring the Right to Health” were hung throughout the Colorado Convention Center in downtown Denver last month, celebrating the theme of the American Public Health Association’s (APHA) 144th Annual Meeting and Expo.  As a first time attendee, one of approximately 11,600 people, I was a bit overwhelmed;… Read More »

APHA 2016 – Editors’ Wrap-up

After a whirlwind APHA 2016 in Denver, we are back with a quick summary of the meeting and Medical Care Section events. There were about 11,600 conference registrants overall. We were impressed with the great turnout for Medical Care Section events. We had standing room only for the Special Invited Panel Session: The Childhood Roots of Health Inequity, a… Read More »

Healthcare Utilization Rates after Oregon’s 2008 Medicaid Expansion: The Long View

Expanding health insurance coverage may improve health care access [PDF] and reduce financial stress [PDF]. Ideally, having health insurance and the resultant access to care should improve health outcomes and well-being, although the evidence is complicated and mixed. One thing is sure: expanded insurance coverage typically leads to more utilization – a concern for policymakers and administrators because… Read More »

APHA16 Preview

In just a few days, thousands of public health practitioners, students, scholars, and activists will descend on Denver, Colorado for APHA 2016. This year, your faithful co-editors will be there, live-tweeting about sessions! So be sure to follow @MedCareBloggers for real-time updates. Here are just a few of the sessions we’re looking forward to this year:… Read More »

Health insurance access and State Innovation Waivers

A small section of the Affordable Care Act (ACA) packs a potentially big punch: State Innovation Waivers allow states to ask the federal government for authority to change parts of the ACA, namely the individual and employer mandates, establishment of state exchanges, and financial help to purchase insurance.  These waivers can be used by states… Read More »

Do financial incentives affect the delivery of mental health care?

Paying for value, rewarding high-value care, pay-for-performance—all are examples of terminology used to describe aligning financial incentives with clinical goals and processes. Essentially, these policies and programs seek to link quality to payment and their influence is growing, extending even to Medicare. While these concepts have been discussed repeatedly by many in healthcare, including the… Read More »

Hostility During Training: Primary Care Disparagement

The lack of primary care infrastructure in the U.S. has been blamed for our extremely high health expenditures, as we spend about 2.5 times what other comparable countries spend (OECD Health at a Glance) without better health outcomes. Increasing our primary care workforce is an important part of controlling health care costs while also providing… Read More »

Freezing or boiling? Measuring workplace climate in primary care

Provider burnout and turnover [PDF] is a major challenge for many community health centers. One factor contributing to this problem is workplace climate, or what the experience of working at the health center is like. As anyone in primary care will tell you, at times it can be overwhelming. Thus it was with great interest that… Read More »

Economic Burden of the Opioid Epidemic

According to the U.S. Department of Health & Human Services, in 2014, more than 240 million prescriptions were written for opioids, which is more than sufficient for each American adult to have one full bottle of opioids. Prescription drugs are second only to marijuana as the most abused category of drug in the United States. A recent article… Read More »

Could Pokémon Go be your new fitness tracker?

Do you play Pokémon Go? Well if you don’t, I’m sure you know at least 2-3 other people who do.  Although I hadn’t ever played the game before writing this post, I can safely think of about 4 friends who have invested a significant amount of time and energy into their Pokémon collection thus far. If… Read More »

Bouncing up: women in academic medicine

Delivering the Olga M. Jonasson Lecture at the 101st Annual Clinical Congress of the American College of Surgeons in Chicago, IL in October 2015, Dr. Julie Ann Freischlag noted how difficult it is for women to break down barriers in many fields, especially in academic medicine. But Dr. Freischlag is no ordinary woman. Throughout her career, she… Read More »

The ACA vs. the doughnut hole: Medicare part D utilization and costs

President Obama’s Affordable Care Act (ACA) included provisions to gradually reduce the Medicare part D “doughnut hole” – a much-maligned gap in coverage that was an economizing feature of President Bush’s legislation. So, how have these changes affected drug use and spending by seniors? A new article in Medical Care provides insights. Under the standard part D benefit… Read More »

Gap in Payment for Medicare Cost Sharing Limits Access to Care for the Poor

Dual eligibility for Medicare and Medicaid is expected to improve access to care for low-income individuals who qualify for both programs, relative to eligibility for either program alone. Medicaid coverage of Medicare deductibles and co-payments can reduce the financial burdens that these cost sharing requirements may pose for low-income Medicare beneficiaries. These dual eligible beneficiaries… Read More »

Cost-Benefit Analysis of Community Health Workers

According to the 2013 Medical Expenditure Panel Survey, hospital inpatient expenses account for a large portion (nearly 30%) of total health care expenses and health care spending is highly concentrated among a relatively small proportion of individuals. The top 1% of spenders accounted for 21.5% of total expenditures while the lower 50% accounted for just… Read More »

How do Medical Errors Affect Healthcare Professionals?

In 1999, the Institute of Medicine released a report called To Err is Human. This report estimated that 44,000 to 98,000 hospitalized patients die each year as a result of preventable medical errors. But how do medical errors affect healthcare workers? A recent article by Van Gerven and colleagues, published ahead of print in Medical Care, addresses that… Read More »

Health care services use after Medicaid-to-dual transition for adults with mental illness

In 2013, there were 10.7 million people enrolled [PDF] in both Medicare and Medicaid. Dual eligibility depends on age, income, and disability. Dually enrolled beneficiaries are also responsible for a large share of program costs overall; 31% of Medicare fee-for-services spending for 18% of beneficiaries [PDF] who are dually enrolled. Given the additional health challenges [PDF] faced by dual eligibles, this… Read More »

Time for a vacation?

As I sat at my desk daydreaming about my family’s upcoming August beach vacation and remembering good times from last year’s beach trip with the kids, I began to feel the anxiety creeping in. I think you know the kind of anxiety I’m talking about: worry about falling behind on work, concern that my lack… Read More »

Tools to improve coordination in primary care

Last month, I left readers with a bit of cliffhanger: How do we actually improve care coordination? Last time, I suggested there were some great ideas, and now it’s time to delve into three promising strategies: 1) individualize and personalize the electronic medical record (EMR); 2. fix the hospital discharge process; and 3) make it a part of normal practice to measure care coordination. Read on for more about each of these tools…

Quality Measurement in Home Care: Avoiding Unintended Effects

In theory, quality measurement and reporting generally benefits patients and their families, as (PDF link) public data on quality increases transparency and provider accountability. It also may benefit providers as a tool for quality assurance and improvement; however, the evidence does not always provide a clear picture. Unique challenges exist for patients receiving home care… Read More »

Autism and iPads: An Interview with Speech Language Pathologist Lauren Ross

In 2014 the Centers for Disease Control and Prevention reported that one in every 68 children have autism spectrum disorder (ASD). Consequently, there is a lot of discussion regarding potential causes of autism. However, for this post, I wanted to move away from this more commonly discussed topic and focus instead on how assistive technology (specifically iPads) are being… Read More »

Call for Contributors

The Medical Care Blog is always looking for new contributors! We’re especially interested in people who can commit to writing one blog post per month or every 3 months. We are open to contributors at all stages of career development. Prior blogging experience preferred, but not required. Our posts cover a wide range of topics. Many… Read More »

Seeking Clarity on Opiod Prescribing

According to the National Institutes of Health (NIH), more than 18,000 people died from overdoses of prescription opioids in 2014. This is more than the number of overdose deaths attributed to heroin (10,854) and cocaine (5,415) combined. Opioids are pain relievers that are chemically similar to morphine. Existing clinical guidelines recommend against exceeding a threshold… Read More »

Affordable Care Act reduced cost-sharing for long-acting reversible contraceptive methods

Since January 2013, most private insurance plans have been required to cover contraceptive services without patient cost-sharing. While health insurance plans have covered some methods of contraception with low cost-sharing, not all plans or methods have been covered equally. This is particularly the case of long-acting reversible contraceptive (LARC) methods, intrauterine devices (IUDs) and implants,… Read More »

Broadening participation in clinical trials

Diversity in clinical trials is critically important. Each new treatment needs to be tested in a broad, diverse population, because men and women of different ancestries have different responses to both diseases and treatments.  If only certain groups of people participate in clinical trials, it can increase disparities and worsen outcomes for people underrepresented in the clinical trial data. Until… Read More »

All Falls Are Not Equal

All falls are not equal, nor is the financial impact of how Medicare defines fall-related injuries (FRI). In a new Medical Care article published ahead of print, I worked with colleagues at UCLA’s Fielding School of Public Health to explore whether Medicare expenditures associated with fall-related injuries (FRI) depend on how FRIs are identified in… Read More »

Is Care Coordination the Magic Bullet in Primary Care?

Decades of thoughtful research into how we design health care systems has shown that primary care is essential.  We know enough to confidently say that systems responsible for the overall health of patients (like health insurance plans or the Veterans Administration) that choose to skimp on primary care do so at their own peril.  But in a time… Read More »

Why aren’t you wearing your Fitbit?

Nobody can deny that the market for consumer wearable devices (such as Fitbit and Jawbone) is booming.  In 2015, a research firm estimated the number of activity trackers sold in the US to be over 13 million. Personally, I followed the fitness tracker trend and bought a Fitbit for both my husband and father as… Read More »

Which Bias is Which?

Comparative Effectiveness Research (CER) seeks to compare alternative treatments and ways to deliver healthcare to inform healthcare decisions. It can provide evidence of the harms, benefits, and effectiveness of different treatment options. As the number of studies in CER continues to grow, it is vitally important that the types of bias that exist as a function of the study design be explained. In a Medical Care article published in April, Dr. Sebastien Haneuse lays out definitions and examples of selection bias and confounding bias in CER, with a particular emphasis on distinguishing between the two.

Coverage May Not Solve Disparities in Delayed or Forgone Care Due to Cost

In a new Medical Care article published ahead of print, Cheryl R. Clark, MD, ScD, and colleagues, of Brigham and Women’s Hospital and Harvard, provide pre-ACA implementation estimates of income-based disparities in delayed or forgone care due to cost by race/ethnicity, by state-level Medicaid expansion status. Reforms can be unevenly implemented even if they address the primary causes of… Read More »

Pressure ulcers: risk factors and the power of policy

Medical Care has recently published two papers on the topic of pressure ulcers — costly, painful, largely preventable infections associated with poorer quality care. In the first, from researchers at the University of Manitoba, York University, and the University of British Columbia, lead author Malcolm Doupe, PhD and colleagues focus on the risk of developing stage… Read More »

The Impact of Gasoline Costs on the Healthcare Industry

The higher the cost of gasoline, the higher the healthcare costs for the treatment of injuries caused by motorcycle crashes. In an article published ahead of print in Medical Care this week, He Zhu and colleagues discuss the association between gas prices in the United States, hospital costs, and utilization for both motorcycle and non-motorcycle related injuries. Remember… Read More »

Death is not always an adverse event

Quality in healthcare can be a slippery concept. But in general, our medical system treats mortality as the ultimate adverse event. Higher mortality is thought to indicate poorer quality care. But what if death were the appropriate and preferred outcome for an individual? Consider the hypothetical case of an 87-year-old man named Philip. Philip has a living… Read More »

Factors associated with better performance on quality indicators for ACOs

Accountable Care Organizations (ACOs) are groups of health care providers, including doctors, hospitals, and other service providers, who provide coordinated care, reducing the need for patients to manage coordination of their own care. These organizations receive incentives from Medicare when they deliver care to patients efficiently. Providers make more money if they keep their patients healthy. Medicare… Read More »

The Health Plans of the Democratic Presidential Candidates and How They May Affect Primary Care

Nearly halfway through the primaries, the Democratic primary contest between Hillary Clinton and Bernie Sanders continues. And perhaps nothing sets these candidates further apart in the progressiveness of their agenda than their approaches to health care. In this post, let’s take a look at the vastly different approaches to health care proposed by candidates Clinton and Sanders, with a particular focus on primary care.

Who Treats Medicaid Patients?

Who treats Medicaid patients? And is the quality of care provided by these individuals the same as you might expect from a clinician who takes only private insurance? An article in the April 2016 issue of Medical Care sought to answer these questions.

Although more than 92% of physicians reported seeing at least one Medicaid patient in 2011, the median proportion of Medicaid patients, for both PCPs and specialists, was less than 6%. This suggests that a small group of providers is responsible for seeing the majority of patients with Medicaid coverage…

As a current medical student, this research struck a nerve, particularly because of the emphasis on IMGs and medical school ranking. … What is more important to me is to understand what I, as a future primary care provider, can do. How do I ensure that people with Medicaid coverage get timely and appropriate referrals to specialty care? How can I expand my provider network to better equip them with the tools they need to ensure their long-term, lasting health?

Racial and Ethnic Disparities after the ACA: Good News and Bad

The major goal of the Affordable Care Act was to expand health insurance coverage. The Department of Health and Human Services will tell you that the Affordable Care Act is working: more Americans are insured. About 16.4 million people gained insurance in the past five years. What do these numbers mean for racial and ethnic minorities who… Read More »

The Use of Clinical Preventive Services under the Affordable Care Act

Increased use of recommended clinical preventive services among adults, such as colorectal and breast cancer screening and influenza vaccination, may save up to 100,000 lives per year and vastly improve life expectancy among the US population. Despite these benefits, recommended preventive services have been underused. In this post, I focus on colorectal cancer screening among adults… Read More »

Measuring Cost-related Medication Burden

As readers of Medical Care are no doubt aware, prescription drug expenditures for Medicare beneficiaries are high – nearly $90 billion in 2012.  There is some evidence that Medicare Part D has reduced financial burdens, at least among some beneficiaries, but recent surveys suggest that around 4.4% of individuals ages 65 and older (including those not on… Read More »

Racial Disparities in Ambulatory Care Sensitive Admissions

Using 2003-2009 Agency for Healthcare Research and Quality (AHRQ) hospital discharge data from 6 geographically and demographically diverse states, Mukamel and colleagues found that African Americans continue to experience poorer quality primary care, especially for chronic conditions.