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.

 

Hospital Service Offerings Still Differ Substantially by Ownership Type
Horwitz JR, Nichols A. Health Affairs 41(3), March 2022.

 

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