Category Archives: Health policy

Hitching our Wagon to the Stars: Making the Most of Quality Reporting

The Centers for Medicare and Medicaid Services (CMS) has a set of “Compare” websites – Hospital Compare, Nursing Home Compare, Home Health Compare, etc.; consumers and policymakers can compare physicians, long-term care hospitals, inpatient rehabilitation facilities, hospice care, and dialysis facilities today, and other settings may follow. Together with their associated health care quality measurement… Read More »

Improving the Patient Care Experience among Persons of Varying Race, Ethnicities, and Languages

Improving the overall patient care experience is an essential focus for organizations as healthcare delivery continues to evolve. The US Department of Health & Human Services Agency for Healthcare Research and Quality (AHRQ) notes patient experience as an integral component of healthcare quality, which includes “several aspects of healthcare delivery that patients value highly when… Read More »

Smoking in America: Medicaid, Quitting, and Income

Over the last few decades, cigarette smoking has become a health burden concentrated primarily among low-income individuals in the U.S. In our recently published research study, Medicaid coverage expansions and cigarette smoking cessation among low-income adults, we sought to determine the relationship between recent expansions of Medicaid coverage and smoking cessation for low-income adults. Demographics… Read More »

Addressing addiction at the local level

As the City of Worcester Commissioner of Health and Human Services, I have developed city-wide initiatives and worked on policy change to address three primary health issues prevalent in our community, those being addiction, mental health, and homelessness, which all tend to occur hand in hand. Addiction is the largest public health and public safety… Read More »

Barriers to Care Among American Indians

American Indians (AIs) typically have poorer health outcomes than any other racial or ethnic minority group in the United States. This includes an increased risk for cancer, diabetes, injury related mortality, and infant mortality.  AIs tend to have the highest rates of poverty and low rates of insurance coverage. Much of the AI population uses the Indian… Read More »

The Aging Physician

There are some occupations where employees are mandated to receive age-based skills and cognitive testing. For example, the National Business Aviation Association has a mandatory retirement age of 65 for airline pilots. Additionally, firefighters, employees of the Federal Bureau of Investigation, air traffic controllers, and nuclear material couriers are all subject to age-based regulations. These agencies impose age-based… Read More »

Promoting Primary Prevention of Neonatal Abstinence Syndrome

“Neonatal abstinence syndrome” (NAS) sounds deceptively innocuous, given that it is literally infant drug withdrawal. It is usually caused by prenatal exposure to opiates but can also result from maternal consumption of other substances, like alcohol and antianxiety medications. Common symptoms include excessive high-pitched crying, fever, sweating, irritability, vomiting, diarrhea, rapid breathing, sleep disturbances, and poor… Read More »

Preventing Health Care that Almost Nobody Needs

Medicine, alongside achievements in sanitation and public health, remains one of the major achievements of modern society. The reduction (or eradication) of many infectious diseases from the developed world, breakthroughs in anesthesiology and surgery, and advances in the care of chronic diseases (including HIV) are just a few of the multitudes of achievements. But these… Read More »

Reducing Ambulatory Malpractice and Safety Risk: Results of the Massachusetts PROMISES Project

Every physician fears being sued. Almost half of primary care doctors are subject to a malpractice lawsuit at some point in their careers. In some quarters, physicians are fatalistic about this fact. I have heard colleagues say: “It’s going to happen at some point, I know it.” But since the publication of the Institute of… Read More »

Universal Health Coverage? A Response

In a recent Health Affairs blog post, Universal Health Coverage? Why?, Walter McClure, Alain Enthoven, and Tim McDonald make a convincing case for expanding health insurance coverage in the United States. They argue that universal coverage is a “wise public investment” that “expands the workforce and makes it more productive,” similar to universal public education.… Read More »

Despite ACA mandates for states to streamline renewal, many beneficiaries still need assistance to retain Medicaid coverage

Enrollment in Medicaid has been shown to enhance access to health care for our nation’s most vulnerable citizens. Yet despite these benefits, a substantial number of beneficiaries lose coverage at the time of renewal. An article by Xu Ji and colleagues, published in this month’s issue of Medical Care, demonstrates how critical maintaining continuous Medicaid coverage… Read More »

Getting recommended preventive care: costs aren’t the only barrier

Annual routine check-ups, flu shots, and mammograms are among the basic preventive services for which the Patient Protection and Affordable Care Act of 2010 established a mandate for insurance plans: full coverage, with no out-of-pocket costs. In making it a little easier for some parts of the US population to access basic services, did the… Read More »

The Prevention and Public Health Fund: Investing in Health Equity

The pursuit of health equity – ensuring equal access to opportunities that enable all communities to lead healthy lives – is a critical task for the U.S. The direct and indirect medical costs associated with sickness and premature death resulting from health care inequities are enormous (estimated to be $230 billion and $1.24 trillion, respectively,… Read More »

The Past, Present, and Future of Risk Adjustment: An Interview with Arlene Ash

Recently, I sat down to talk with Arlene Ash, PhD about risk adjustment. Dr. Ash is Professor and Chief of the Division of Biostatistics and Health Services Research, Department of Quantitative Health Sciences at the University of Massachusetts Medical School. As a methods expert on risk adjustment in health services research, she has pioneered tools… Read More »

The Intersection of Religion, Female Empowerment, and Access to Reproductive Healthcare

Reproductive rights have been a topic for policy making and legal jurisprudence throughout much of the past century. As the healthcare system of the United States continues to evolve, women’s health and reproductive rights remain central to the debate. A recent policy update by Aishwarya Rajagopalan and Lisa Lines here at The Medical Care Blog discusses… Read More »

POLICY UPDATE: Contraception Coverage

The burden of contraception falls primarily on women. In the United States, women need prescriptions for the majority of contraceptive methods, and so are vulnerable to changes in the healthcare system affecting access to care. Recently, President Trump has issued executive orders on religious liberty and related subjects that have paved the way for a rule… Read More »

Trying to Reduce Unnecessary Emergency Visits? First, Strengthen Our Primary Care System

Emergency departments (EDs) nationwide are busy places. In some locales they are overcrowded. In places like Los Angeles and other dense, urban areas with high poverty, they are over-capacity to such an extent that they can grind to a halt for all but the highest priority cases. In years past, it was not unheard of for… Read More »

Smoking cessation treatment among newly covered individuals under the ACA

Smoking cessation is not innovative or trendy or even particularly exciting, but as a primary care doctor, in most cases helping a patient quit smoking is the best thing that I can do to help that patient over their lifetime. Without question. And for that reason, I always make it a priority to talk about it… Read More »

The Political Context of Medicaid Expansion

Republican Congressional leaders are currently debating how to repeal the Affordable Care Act (ACA) as part of the budget reconciliation process. Much of the debate over the ACA has focused on the individual mandate (and here) and the affordability (here and here) of coverage in the state-based marketplaces. The House version of the legislation, however,… Read More »

The childhood roots of health inequity: Part 3 – Dr. Kerith Conron

This post is the third in our series focusing on presentations that were delivered at a special panel session at APHA16 on the childhood roots of health inequity [part 1, part 2]. Our third presenter, Kerith Conron, ScD, MPH, is currently the Blachford-Cooper Distinguished Scholar and Research Director at The Williams Institute of UCLA’s School… Read More »

How did Part D affect mortality among women with breast cancer?

Ten years ago, Medicare began publicly financing and subsidizing the prescription drug program for seniors known as Part D. Individuals over age 65 with incomes below poverty are dually eligible for both Medicaid and Medicare, and full-benefit dual enrollees are automatically enrolled in a subsidized prescription drug plan with minimal co-payments. Turns out, this policy intervention may have played… Read More »

Do Not Repeal the ACA Without a Comparable Replacement

I once saw a breast cancer so advanced that the tumor had eroded through the woman’s chest wall. This wasn’t in a foreign country with little access to healthcare – it was in the city where I attended medical school: New Haven, Connecticut. The patient worked a full-time job and raised a family, but did… Read More »

Lessons from Analyses of Health Insurance Expansions from the 1980s through 2012

In a recent Medical Care article, Guy and colleagues analyzed health insurance expansions among parents from 1999 through 2012 to assess the impacts of four different types of public and private expansions. They primarily examined changes in parents’ health insurance coverage, but they also analyzed whether expanding coverage for parents could “spill over” and raise coverage… Read More »

One Step Ahead: A Composite Measure to Capture Critical Hospice and Palliative Care Processes

The Centers for Medicare and Medicaid Services (CMS) wants to empower consumers to make informed healthcare decisions. CMS also wants providers to improve the quality of care they provide. One step towards accomplishing both of these goals is by public reporting of quality measures (QM). However, with multiple quality measures focusing on different care processes–all of which… Read More »

The HOSPITAL Score – A Prediction Tool for Potentially Preventable (and Therefore Costly) Readmissions

In the era of value-based care, caregivers and policymakers alike are intensely interested in strategies to reduce 30-day hospital readmissions. Researchers continue to offer up helpful tools in this effort. Recently published online ahead of print in Medical Care, Burke and colleagues make an important contribution with their article The Hospital Score Predicts Potentially Preventable 30-Day Readmissions… Read More »

Should Women Rush to Get IUDs Post-Election? They Should’ve Been Rushing all Along!

The unintended pregnancy rate (reflecting pregnancies that are unwanted or mistimed) for women in the U.S. has hovered at around 50% for the last 35 years.  Only recently has that rate dropped to 45%, but the burden continues to fall most heavily on poor, undereducated women, women from racial or ethnic minority backgrounds, and young women.  Much talk… Read More »

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 »

The Person-Centered Wellness Home: Reflections on a Conversation with Dr. Thelma Mielenz

With the mania of the presidential election in full tilt and the election just days away, it’s hard to have a rational public discussion about health care.  Supporters of the two presidential candidates have drawn a deep and divisive line (or rather a tectonic fissure) in the sand about health care reform.  This is due, in great part, to the bombastic, and ultimately… 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 »

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 »

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 »

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 »

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 »

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 »

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.