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Objective: To quantify the degree to which health care service area (HCSA) definitions captured hospitalizations and heterogeneity in social determinants of health (SDOH). Data Sources and Study Setting: Geospatial data from the Centers for Medicare and Medicaid Services, the Census Bureau, and the Dartmouth Institute. Drive-time isochrones from MapBox. Area Deprivation Index (ADI) data. 2017 inpatient discharge data from Arizona, Florida, Iowa, Maryland, Nebraska, New Jersey, New York, and Wisconsin, State Emergency Department Databases and State Inpatient Databases, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality; and Fee-For-Service Medicare data in 48 states. Study Design: Cross-sectional, descriptive analysis. Data Collection/Extraction Methods: The capture rate was the percentage of inpatient discharges occurring in the same HCSA as the hospital. We compared capture rates for each HCSA definition for different populations and by hospital type. We measured SDOH heterogeneity using the coefficient of variation of the ADI among ZIP codes within each HCSA. Principal Findings: HCSA definitions captured a wide range of inpatient discharges, ranging from 20% to 50% for Public Use Microdata Areas (PUMAs) to 93%-97% for Metropolitan Statistical Areas (MSAs). Three-quarters of inpatient discharges were from facilities within the same county as the patient's residential ZIP code, while nearly two-thirds were within the same Hospital Service Area. From the hospital perspective, 74.7% of inpatient discharges originated from within a 30-min drive and 90.1% within a 60-min drive. Capture rates were the lowest for teaching hospitals. PUMAs and drive-time-based HCSAs encompassed more homogenous populations while MSAs, Commuting Zones, and Hospital Referral Regions captured the most variation. Conclusions: The proportion of hospital discharges captured by each HCSA varied, with MSAs capturing the highest proportion of discharges and PUMAs capturing the lowest. Additionally, researchers face a trade-off between capture rate and population homogeneity when deciding which HCSA to use. KEYWORDS access/demand/utilization of services, geographic/spatial factors/small-area variations, hospitals, social determinants of health, 1 | INTRODUCTION The geography of health care utilization is important to the substance, methods, and impact of health policy and health services research. For example, geographic service area boundaries [...]

Although the federal government has allowed opioid treatment programs (OTPs) to treat patients with methadone by mobile vans for three years (see ADAWhttps://onlinelibrary.wiley.com/doi/10.1002/adaw.33120), pickup by the states has been slow. The innovation makes it much easier for patients in rural areas, and patients without access to transportation, to receive treatment. But unless it's put into practice, it won't work to increase treatment rates and reduce the opioid overdose crisis. [ABSTRACT FROM AUTHOR]

States that enacted Medicaid expansion have seen an increase in the likelihood that outpatients with opioid use disorder (OUD) receive one of the evidence‐based medication treatments. The magnitude of the increase suggests, however, that Medicaid expansion alone has not been a sufficient strategy for realizing the potential of medications for OUD (MOUD). [ABSTRACT FROM AUTHOR]

Virginia leaders have publicly released a free resource designed to shift the conversation about mental health toward the social factors that drive both wellness and illness. Those who are promoting the Virginia Wellbeing Dashboard hope their efforts will ultimately encourage more funding support for initiatives targeting social determinants of health. [ABSTRACT FROM AUTHOR]

The article focuses on the importance of advance care planning for end-of-life decisions, particularly after the COVID-19 pandemic. Topics include the benefits of discussing end-of-life care early, how physicians can be paid for these conversations through Medicare, and the significance of documentation for ensuring patient wishes are respected.

Last month's sudden closure of a venture capital‐fueled company that had rapidly become one of Minnesota's most prominent providers of peer recovery support services has left clients and peer specialists scrambling, and has community leaders wondering if industry reforms could prevent similar crises in the future. [ABSTRACT FROM AUTHOR]

The Texas Medical Association (TMA) has successfully appealed a surprise billing rule case, with the court ruling that certain provisions unfairly favor health plans. TMA has sued federal regulators multiple times to ensure a fair dispute resolution process. Aetna will correct low payments made to physicians for certain claims following TMA's advocacy. Physicians can now access their final scores for Medicare's Merit-Based Incentive Payment System (MIPS) and should check for errors. The U.S. Department of Health and Human Services (HHS) has implemented a rule to hold healthcare professionals accountable for information blocking, which TMA has expressed concerns about. TMA has added expert consultants to its Committee on Health Information Technology (HIT) to address the impact of AI on patient care. The FTC has amended its Health Breach Notification Rule to require vendors of personal health records to notify individuals, the FTC, and the media in the event of a breach. TMA supports this requirement. The NASEM has created a consensus definition for long COVID to provide a consistent framework for diagnosis and treatment. [Extracted from the article]

Health systems and hospitals create more than 275,000 jobs in North Carolina, making them one of the 10 largest employers in 92 out of the state's 100 counties, and one [...]

Objective: To measure differences in access to contraceptive services based on history of incarceration and its intersections with race/ethnicity and insurance status. Data Sources and Study Setting: Primary data were collected from telephone calls to physician offices in Alabama, Louisiana, and Mississippi in 2021. Study Design: We deployed a field experiment. The outcome variables were appointment offers, wait days, and questions asked of the caller. The independent variables were callers' incarceration history, race/ethnicity, and insurance. Data Collection Methods: Using standardized scripts, Black, Hispanic, and White female research assistants called actively licensed primary care physicians and Obstetrician/Gynecologists asking for the next available appointment for a contraception prescription. Physicians were randomly selected and randomly assigned to callers. In half of calls, callers mentioned recent incarceration. We also varied insurance status. Principal Findings: Appointment offer rates were five percentage points lower (95% CI: -0.10 to 0.01) for patients with a history of incarceration and 11 percentage points lower (95% CI: -0.15 to -0.06) for those with Medicaid. We did not find significant differences in appointment offer rates or wait days when incarceration status was interacted with race or insurance. Schedulers asked questions about insurance significantly more often to recently incarcerated Black patients and recently incarcerated patients who had Medicaid. Conclusions: Women with a history of incarceration have less access to medical appointments; this access did not vary by race or insurance status among women with a history of incarceration. KEYWORDS access to care, African Americans/Blacks, contraception, Hispanics/Latinas, insurance, prisoners, 1 | INTRODUCTION Reproductive autonomy is an important aspect of the transition out of incarceration. As women establish or continue romantic relationships, care for their children, work toward economic security, [...]

Sign up for (https://co.chalkbeat.org/newsletters/subscribe) Chalkbeat Colorado's free daily newsletter to get the latest reporting from us, plus curated news from other Colorado outlets, delivered to your inbox. This fall, fewer [...]

Long Beach, California-based Molina Healthcare, Inc. (https://www.barchart.com/stocks/quotes/moh/overview) provides managed healthcare services to low-income families and individuals under the Medicaid and Medicare programs and through the state insurance marketplaces. With a [...]

The Biden-Harris Administration has proposed a new rule to expand coverage of anti-obesity medications for Americans with Medicare and Medicaid, sending the shares of Wegovy maker Novo Nordisk (NVO) and [...]

Maryland’s 226 skilled nursing facilities, like nearly 15,000 similar centers nationwide, are often a lifeline for their communities. Particularly for Medicaid recipients, these nursing homes provide essential care, helping patients [...]

Trump said he plans to change the Affordable Care Act, which provides healthcare for 45 million Americans. His past actions include ACA opposition. He has flip-flopped on Medicaid and Medicare [...]

While many tech VCs are optimistic about Trump's second term, some healthcare investors feel stuck. They're torn between the promise of long-awaited exits and potential threats to healthcare access. Trump [...]

Mark Farrah Associates (MFA) reported it has released a year-over-year comparison for health insurance segment enrollment. According to a release, MFA assessed membership between 2Q23 and 2Q24 to provide greater [...]

DarioHealth announced a new contract with a regional health plan in the Medicaid space, which has launched with the full suite of cardiometabolic solutions. The launch with this new health [...]

Citi lowered the firm's price target on Evolent Health to $33 from $35 and keeps a Buy rating on the shares as part of a Q3 earnings preview. The firm [...]

Stephens raised the firm's price target on Molina Healthcare (MOH) to $345 from $335 and keeps an Equal Weight rating on the shares. The firm notes that against the backdrop [...]

RBC Capital analyst Ben Hendrix lowered the firm's price target on Elevance Health to $478 from $585 and keeps an Outperform rating on the shares after its Q3 earnings miss [...]

As previously reported, Argus downgraded Elevance Health to Hold from Buy with no price target. Given the headwinds of higher medical costs, the company's profit margins in the Medicaid and [...]

Voters in multiple states will be weighing in on a host of health-related issues, including measures that impact Medicaid and ban assisted suicide. While abortion has dominated headlines when it [...]

Elevance Health ((https://www.kiplinger.com/tfn/ticker.html?ticker=ELV) ELV) stock is one of the worst S&P 500 stocks in Thursday's session. The selloff comes after the health insurance company missed bottom-line expectations for its third [...]

Stephens analyst Jeff Garro notes Evolent Health (EVH) is trading down about 6% intra-day, which the firm sees being based on Elevance Health (ELV) and UnitedHealth (UNH) citing elevated Medicaid [...]

Reports Q3 revenue $44.7B, consensus $43.37B. 'We remain confident in the long-term earnings potential of our diverse businesses as we navigate a dynamic operating environment and unprecedented challenges in the [...]

Helius Medical Technologies announced that the Centers for Medicare & Medicaid Services - CMS - posted final Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies fee schedule payment rates for [...]

In July, the Centers for Medicare & Medicaid Services introduced significant changes to the Staffing Five-Star domain, impacting how staffing adjustments are made in relation to resident acuity. Previously, these [...]

Aetna, a CVS Health company, announced the State of Michigan has recommended the company for a new contract to serve MI Coordinated Health beneficiaries who are eligible for both Medicare [...]

Akebia Therapeutics announced that the Center for Medicare & Medicaid Services has determined that Vafseo meets the criteria for the Transitional Drug Add-On Payment Adjustment in the anemia management end-stage [...]

With only a few weeks left until the election, there are still some large policy gaps remaining in both candidates' health platforms. As the nation enters the final weeks before [...]

RedHill Biopharma announced the renewal of its contract with Medi-Cal, California's Medicaid healthcare program, to maintain Talicia's first-line position on the Medi-Cal Fee-For-Service, FFS, Contract Drug List, CDL, with no [...]

By many measures, policy leaders in Kentucky have taken important steps to combat opioid overdose deaths and related challenges. State leaders embraced Medicaid expansion, in a region of the country where several holdout states remain. Regulations that would have severely limited access to care during the COVID‐19 pandemic were lifted. A record number of syringe services programs statewide have made a difference in curbing infectious disease transmission. [ABSTRACT FROM AUTHOR]

The article discusses the transformation of New Mexico's Medicaid Management Information System (MMIS) through the MMISR program. The program aims to improve service delivery and the health and well-being of New Mexicans by implementing a modular solution aligned with guidance from the Centers for Medicare and Medicaid Services. The article highlights the progress made in implementing various modules of the MMISR program and the challenges faced during the transformation. It also emphasizes the importance of collaboration, flexibility, and a people-centric approach in achieving the goals of the program. The article concludes by envisioning the creation of a cohesive health and human services neighborhood in New Mexico. [Extracted from the article]

The article discusses the potential benefits of unlocking Medicaid access for individuals in the criminal justice system. It highlights the high prevalence of health and behavioral health needs among incarcerated individuals and the strain it places on correctional staff. The article emphasizes the importance of providing continuity of care between corrections and the community to improve health outcomes and enhance public safety. It also mentions recent policy changes that allow for Medicaid coverage and connections to care upon reentry. The authors call for collaboration between jail administrators, health care officials, and state Medicaid partners to implement these changes effectively. [Extracted from the article]

Michael Langer, Single State Authority (SSA) for Washington State, first intended in 1986 to, as he put it, "help out for a couple of months." His expertise was alcohol and drugs. Shortly after he joined, crack cocaine became a huge public issue; then there was the federal drug omnibus bill, and Washington followed up with its own omnibus bill in 1988. Should anyone forget, this was a time of significant growth and public investment in treatment, prevention, and recovery support services in the state. [ABSTRACT FROM AUTHOR]

The 2024 legislative session in Minnesota saw the approval of several priorities for the Minnesota Medical Association (MMA), including prior authorization reform, physician well-being, and addressing addiction through harm reduction. However, there were also measures that did not have MMA support. The session also involved other healthcare-related legislation, such as prohibiting insurers from forcing patients to switch medications midyear and increasing reimbursement for mental health services. The MMA determines its legislative priorities based on input from physician members and advocates for these priorities during the session. [Extracted from the article]

The article focuses on the urgent need for legislative reforms to address cuts in Medicare physician payments, which threaten the viability of medical practices. Topics include proposals for inflationary updates to physician payments, reforms to the Merit-Based Incentive Payment System (MIPS), and the importance of permanent telehealth payment parity to support physicians and patients.

Colorado's community mental health providers say they are experiencing many of the downsides that can come with a period of dizzying change. Facing declining Medicaid rolls, a shifting payment model and no prospects for new state funding to support restructuring, the state's provider community is calling the current environment a "perfect storm" of crisis that could engulf patient care. [ABSTRACT FROM AUTHOR]

Patients with insurance coverage under Medicare — in particular, Medicare Advantage — or Medicaid are less likely to receive medications for opioid use disorder (MOUD) because providers are just unwilling to treat them, according to a report released last month by the federal Department of Health and Human Services (HHS) Office of Inspector General (OIG). The report repeatedly refers to "behavioral health," so in this article, we do too. [ABSTRACT FROM AUTHOR]

People with opioid use disorder (OUD) who are referred to treatment by the criminal justice system are less likely than they should be to receive medication treatment, a study has found. According to the study, "Disparities in Medication Use for Criminal Justice System –Referred Opioid Use Disorder Treatment," by J. Travis Donahoe, Ph.D., with Brendan K. Saloner, Ph.D., as lead author, other referral sources do refer to medications for opioid use disorder (MOUD), but the criminal justice system is less likely to. [ABSTRACT FROM AUTHOR]

In 2023, Governor Brian Kemp of Georgia implemented a strict work requirement for Medicaid as a way to provide healthcare coverage, despite the state's refusal to expand the program under the Affordable Care Act. However, only 5,118 people were enrolled in the program by October, far below the projected numbers. Georgia's work requirement is particularly harsh, applying to a wide range of individuals and lacking flexibility compared to other states. The state has spent nearly $58 million on the program, mostly on administration and consulting fees, rather than medical expenses. Expanding Medicaid would have been a more cost-effective and inclusive solution, but a proposal to do so was defeated by state lawmakers. The high cost and inefficiency of the work-requirement plan mirror similar programs in other states, which have not significantly impacted employment or improved access to healthcare. [Extracted from the article]

This quantitative study explored whether using an electronic health record affected inpatient nurses' perception of presence in the nursepatient relationship. Researchers administered the Presence of Nursing Scale-Registered Nurse and collected demographic data. Study results revealed nurses who identified as younger and with less experience reported a decreased perception of presence with patients as it relates to electronic health record utilization. Keywords: presence, electronic health record, EHR, nurse-patient relationship, PONS-RN, The electronic health record (EHR) collects patient care data and improves communication among healthcare providers across disciplines. The Centers for Medicare and Medicaid Services (CMS) define the EHR as: An [...]

The expanded scope of the Medicaid program has accomplished a great deal in bolstering substance use treatment, but further progress will depend on correcting deficiencies in non‐expansion states and within Medicaid managed care entities, a newly published commentary suggests. [ABSTRACT FROM AUTHOR]

The question of whether state‐mandated licensure would serve as an ideal vehicle for guaranteeing that recovery community organizations (RCOs) meet accepted standards for delivering peer recovery support is about to receive a thorough examination in Pennsylvania. State Rep. Tarik Khan of Philadelphia is gathering co‐sponsor support in advance of introducing a bill that would require any RCO that receives public funds to be licensed, in a measure that also would designate RCO services as Medicaid‐reimbursable. [ABSTRACT FROM AUTHOR]