Affiliates' Research in Medical Journals, Summer 2022

Telemedicine Catches On: Changes in the Utilization of Telemedicine Services during the COVID-19 Pandemic
Friedman AB, Gervasi S, Song H, Bond AM, Chen AT, Bergman A, David G, Bailey JM, Brooks R, Smith-McLallen A. American Journal of Managed Care 28(1), January 2022, e1−e6.
To determine the degree of telemedicine expansion during the COVID-19 pandemic overall and across patient subpopulations and diagnoses, researchers examined health insurance claims for 1,589,777 telemedicine visits from January 1, 2018 through March 10, 2020 (the prepandemic period), and March 11, 2020 through October 31, 2020 (the pandemic period). Claims were submitted to Independence Blue Cross from both telemedicine-only providers and providers who traditionally deliver care in person. Telemedicine increased rapidly during the pandemic across a broad range of clinical conditions and demographics, from a mean (standard deviation) of 773 (155) weekly visits in prepandemic 2020 to 45,632 (19,937) weekly visits in the pandemic period. This increase was facilitated by individual behavioral changes, state stay-at-home orders, and expanded reimbursement by insurers for telemedicine. During the pandemic period, a greater proportion of telemedicine users were older, had Medicare Advantage insurance plans, had existing chronic conditions, or resided in predominantly non-Hispanic Black or African American Census tracts compared with during the prepandemic period. A significant increase in telemedicine claims containing a mental-health-related diagnosis was observed. Although levels declined later in 2020, telemedicine utilization remained markedly higher than 2019 and 2018 levels.
This study documents persistent differences in the service offerings of nonprofit, for-profit, and government hospitals, and relates those differences to the relative profitability of the services. Using data on urban, acute care hospitals from the American Hospital Association annual member surveys from 1994 to 2019, the researchers examined the likelihood that hospitals with different ownership statuses offer different types of services, while adjusting for hospital and market factors. All hospitals responded to relative profitability in choosing which services to offer, but for-profit hospitals were more responsive than other types of hospitals. Nonprofit hospitals were more likely than for-profit hospitals, and less likely than government hospitals, to offer services that are considered relatively unprofitable, such as psychiatric emergency services. The opposite pattern emerged for services that are considered profitable, such as adult cardiac surgery. The researchers also examined patterns for services for which relative profitability has varied over time, and found that for-profit hospitals are more likely than nonprofit hospitals to adjust their service offerings in response to changes in profitability, while nonprofits are more likely to do so than government hospitals. These patterns are consistent with those found prior to the passage of the Affordable Care Act, in spite of the associated changes in insurance coverage over time.
Health Care Utilization and Spending in Medicare Advantage vs Traditional Medicare: A Difference-in-Difference Analysis
Schwartz AL, Zlaoui K, Foreman RP, Brennan TA, Newhouse JP. JAMA Health Forum 2(12), December 2021.
This retrospective cohort study compared changes in health care utilization and spending after initial Medicare enrollment for beneficiaries enrolling in Medicare Advantage (MA) and beneficiaries enrolling in traditional Medicare (TM) with a Medicare supplemental plan. Participants included beneficiaries aged 65 to 70 years who remained enrolled with a large insurer when transitioning from commercial insurance to Medicare between June 2018 and December 2018. Propensity score matching was used to perform a difference-in-differences analysis of 1,082 Medicare beneficiaries (541 joining MA, 541 joining TM with a supplemental plan). Outcomes included use of, and spending on, institutional (Part A) and professional (Part B) medical services, including inpatient stays, inpatient days, physician visits, and injectable drug administrations. In the year prior to Medicare enrollment, there was no statistically significant difference in outcome trends between the MA and TM groups. The first year of MA enrollment was associated with a large differential reduction in institutional (Part A) spending of $95 (95 percent CI, $7–$183) per member per month. The differential reduction in institutional spending was large compared with baseline levels and corresponded with large reductions in admissions, suggesting that utilization rather than prices was a substantial driver of the result. MA enrollment was associated with a differential reduction in total spending (Parts A and B) of $142 (95 percent CI, $0–$282) per member per month, which represented 36 percent of total spending in TM. There was no statistically significant differential reduction in professional (Part B) spending per member per month. These findings suggest that private MA plans may lower inpatient spending and utilization relative to TM during the first year of Medicare coverage.
Association of Children’s Hospital Status with Value for Common Surgical Conditions
Raval MV, Reiter AJ, McCarthy IM. JAMA Network Open 5(6), June 2022, e2218348.
Effect of Integrating Access to a Prescription Drug Monitoring Program within the Electronic Health Record on the Frequency of Queries by Primary Care Clinicians: A Cluster Randomized Clinical Trial
Neprash HT, Vock DM, Hanson A, Elert B, Short S, Karaca-Mandic P, Rothman AJ, Melton GB, Satin D, Markowitz R, Golberstein E. JAMA Health Forum 3(6), June 2022, e221852.
COVID-19 Vaccination Mandates and Vaccine Uptake
Karaivanov A, Kim D, Lu SE, Shigeoka H. Nature Human Behaviour, June 2022.
Assessment of Perioperative Outcomes among Surgeons Who Operated the Night Before
Sun EC, Mello MM, Vaughn MT, Kheterpal S, Hawn MT, Dimick JB, Jena AB. JAMA Internal Medicine, May 2022.
Projecting Prevalence of Frailty and Dementia and the Economic Cost of Care in Japan from 2016 to 2043: A Microsimulation Modelling Study
Kasajima M, Eggleston K, Kusaka S, Matsui H, Tanaka T, Son BK, Iijima K, Goda K, Kitsuregawa M, Bhattacharya J, Hashimoto H. The Lancet Public Health 7(5), May 2022, pp. e458−e468.
Trends in Medical Debt during the COVID-19 Pandemic
Guttman-Kenney B, Kluender R, Mahoney N, Wong F, Xia X, Yin W. JAMA Health Forum 3(5), May 2022, e221031.
United States Preterm Birth Rate and COVID-19
Dench D, Joyce T, Minkoff H. Pediatrics 149(5), May 2022, e2021055495.
Impact of Aeroplane Noise on Mental and Physical Health: A Quasi-experimental Analysis
Wang SS, Glied S, Williams S, Will B, Muennig PA. BMJ Open 12(5), May 2022, e057209.
Use of Neuroimaging for Patients with Dizziness Who Present to Outpatient Clinics versus Emergency Departments in the US
Adams ME, Karaca-Mandic P, Marmor S. JAMA Otolaryngology-Head & Neck Surgery 148(5), April 2022, pp. 465−473.
Evaluation of Claims-Based Ascertainment of Alzheimer Disease and Related Dementias across Health Care Settings
Festa N, Price M, Moura LMVR, Blacker D, Normand SL, Newhouse JP, Hsu J. JAMA Health Forum 3(4), April 2022, e220653.
Financial Incentives, Not Behavioral Nudges, Led to Optimized HIV Testing among Pregnant Women in a High-Burden Urban Population in Ecuador
Grunauer M, Gutierrez E, Izurieta R, Macis M, Phan P, Rosas C, Teran E. The American Journal of Tropical Medicine and Hygiene 106(6), April 2022, pp. 1703–1710.
Innovations in Care Delivery for Patients with Serious Mental Illness among Accountable Care Organizations
Newton H, Busch SH, Brunette MF, Maust DT, O’Malley AJ, Meara E. Psychiatric Services, April 2022.
Geographic Access to Federally Qualified Health Centers before and after the Affordable Care Act
Behr CL, Hull P, Hsu J, Newhouse JP, Fung V. BMC Health Services Research 22(1), March 2022, 385.
FDA Safety Warnings and Trends in Testosterone Marketing to Physicians
Togun AT, Sankar A, Karaca-Mandic P. American Journal of Managed Care 28(3), March 2022.
Access to Mental Health Support Services in Accountable Care Organizations: A National Survey
Busch SH, Tomaino M, Newton H, Meara E. Healthcare 10(1), March 2022, 1006132022D.
Childbirths at Home and in Birthing Centers Rose during COVID-19: Oregon 2020 vs Prior Years
Smith AJB, Zhou RA, Sites E, Hallvik SE, Cutler DM, Chien AT. American Journal of Obstetrics and Gynecology, March 2022.
The Unintended Consequences of Medicare’s Wage Index Adjustment on Device-Intensive Hospital Procedures
David G, Gunnarsson C, Laine L, Ryan M, Clancy S, Gunnarsson G, Moore K, Irish W. The American Journal of Managed Care 28(3), March 2022.
Trends in Engagement with Opioid Use Disorder Treatment among Medicaid Beneficiaries during the COVID-19 Pandemic
Tilhou AS, Dague L, Saloner B, Beemon D, Burns M. JAMA Health Forum 3(3), March 2022, e220093.
Trends in Disenrollment and Reenrollment within US Commercial Health Insurance Plans, 2006−2018
Fang H, Frean M, Sylwestrzak G, Ukert B. JAMA Network Open 5(2), February 2022, e220320.
Anti–SARS-CoV-2 Monoclonal Antibody Distribution to High−Risk Medicare Beneficiaries, 20202021
Behr CL, Maddox KEJ, Meara E, Epstein AM, Orav J, Barnett ML. JAMA 327(10), February 2022, pp. 980−983.
Difficulty Obtaining Behavioral Health Services for Children: A National Survey of Multiphysician Practices
Chien AT, Leyenaar JA, Tomaino M, Woloshin S, Leininger L, Barnett ER, McLaren JL, Meara E. The Annals of Family Medicine 20(1), Jan-Feb 2022, pp. 42−50.
Does It Matter Who Decides? Outcomes of Surrogate Decision-Making for Community-Dwelling, Cognitively Impaired Older Adults Near the End of Life
Baum MY, Gallo JJ, Nolan MT, Langa KM, Halpern SD, Macis M, Nicholas LH. Journal of Pain and Symptom Management 62(6), December 2021, pp. 1126−1134.