{"id":6928,"date":"2022-10-14T12:05:36","date_gmt":"2022-10-14T16:05:36","guid":{"rendered":"http:\/\/chirblog.org\/?p=6928"},"modified":"2022-10-14T12:05:36","modified_gmt":"2022-10-14T16:05:36","slug":"september-research-roundup-reading-3","status":"publish","type":"post","link":"https:\/\/chirblog.org\/september-research-roundup-reading-3\/","title":{"rendered":"September Research Roundup: What We’re Reading"},"content":{"rendered":"
By Emma Walsh-Alker<\/em><\/p>\n It’s officially fall, and along with the new season came an autumnal bounty of new health policy research. This month, we reviewed studies on the connection between medical debt and social determinants of health, private equity acquisition of physician practices, and controlling health care costs through state surprise billing laws.<\/p>\n David U. Himmelstein, Samuel L. Dickman, Danny McCormick, David H. Bor, Adam Gaffney, Steffie Woolhandler, Prevalence and Risk Factors for Medical Debt and Subsequent Changes in Social Determinants of Health in the US<\/a>, JAMA Network Open, September 16, 2022. Using data from the Census Bureau\u2019s Survey of Income and Program Participation<\/a> (SIPP) for the years 2017-2019, researchers evaluated risk factors for experiencing medical debt using a nationally representative sample of adults in the U.S.<\/p>\n What it Finds<\/em><\/p>\n Why it Matters<\/em> Yashaswini Singh, Zirui Song, Daniel Polsky, Joseph D. Bruch, Jane M. Zhu, Association of Private Equity Acquisition of Physician Practices with Changes in Health Care Spending and Utilization<\/a>, JAMA Health Forum, September 2, 2022. To identify if and how spending and utilization metrics shift after private equity (PE) acquisition of physician practices, researchers looked at 578 practices bought by PE firms between 2016-2020 across three specialty fields with particularly high rates of private equity acquisition (dermatology, gastroenterology, and ophthalmology) before and after acquisition, and compared PE-acquired practices with independent practices.<\/p>\n What it Finds<\/em><\/p>\n Why it Matters<\/em> Aliza S. Gordon, Ying Liu, Benjamin L. Chartock, Winnie C. Chi, Provider Charges and State Surprise Billing Laws: Evidence From New York and California<\/a>, Health Affairs, September 2022. Under the No Surprises Act (NSA), new federal protections<\/a> against surprise medical billing hold consumers harmless from some common out-of-network charges. The NSA provides a default arbitration process for determining payments if providers and insurers cannot agree on the out-of-network payment rate. However, some states set different standards for provider payments when balance billing protections apply, and the NSA does not displace these state-specific policies as they apply to fully insured plans. To understand the impact of different state approaches to this aspect of surprise billing regulation, researchers examined how New York and California\u2019s distinct methods of resolving payment disputes impacted provider charges in surprise billing scenarios involving nonemergency inpatient hospitalization between 2011-2020. New York\u2019s law uses an independent dispute resolution<\/a> (IDR) process tied to provider charges. California determines provider payments based on a payment standard tied to in-network prices instead of billed charges. Outcomes in both states were compared to a group of states with no state-level payment standards (Kentucky, Ohio, Wisconsin, Indiana, Georgia, Virginia, and Colorado).<\/p>\n What it Finds<\/em><\/p>\n Why it Matters<\/em> It’s officially fall, and along with the new season came an autumnal bounty of new health policy research. This month, we reviewed studies on the connection between medical debt and social determinants of health, private equity acquisition of physician practices, and controlling health care costs through state surprise billing laws.<\/p>\n","protected":false},"author":36,"featured_media":509,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[8,1],"tags":[248,755,728,739,464],"_links":{"self":[{"href":"https:\/\/chirblog.org\/wp-json\/wp\/v2\/posts\/6928"}],"collection":[{"href":"https:\/\/chirblog.org\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/chirblog.org\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/chirblog.org\/wp-json\/wp\/v2\/users\/36"}],"replies":[{"embeddable":true,"href":"https:\/\/chirblog.org\/wp-json\/wp\/v2\/comments?post=6928"}],"version-history":[{"count":1,"href":"https:\/\/chirblog.org\/wp-json\/wp\/v2\/posts\/6928\/revisions"}],"predecessor-version":[{"id":6929,"href":"https:\/\/chirblog.org\/wp-json\/wp\/v2\/posts\/6928\/revisions\/6929"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/chirblog.org\/wp-json\/wp\/v2\/media\/509"}],"wp:attachment":[{"href":"https:\/\/chirblog.org\/wp-json\/wp\/v2\/media?parent=6928"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/chirblog.org\/wp-json\/wp\/v2\/categories?post=6928"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/chirblog.org\/wp-json\/wp\/v2\/tags?post=6928"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}\n
\nAlthough previous<\/a> research<\/a> has established the urgency of the medical debt crisis in the United States, this study offers stakeholders a new way to approach medical debt as a social determinant of health that is associated with adverse health outcomes. Individuals who are hospitalized or people with disabilities are especially vulnerable to oppressive medical debt, even if they have health insurance. The researchers point to plan benefit designs as a key determinant of medical debt, noting that enrollees in private high deductible plans are often exposed to higher out-of-pocket medical costs than those in Medicaid. A recent study by the Commonwealth Fund<\/a> found that 23 percent of working age adults in the United States were \u201cunderinsured\u201d in 2022, and many people skipped or delayed care or took on medical debt due to high out-of-pocket costs. Studies like this demonstrate the need for more robust policy solutions that tackle not only uninsurance but high out-of-pocket costs and aggressive<\/a> debt collection practices.<\/p>\n\n
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\nPE acquisitions of physician practices have become increasingly common<\/a>, prompting questions about the impact of these acquisitions on health care spending and utilization. As this study demonstrates, increases in health care spending and utilization are consistent with the underlying goal of PE firms to maximize returns on their investment in physician practices. However, the application of this profit-driven model to health care services has sparked pushback from patient advocates and other stakeholders. This year, both the Biden administration and Congress have cited PE involvement in health care as a cause for concern<\/a>. Although PE-funded practices are seeing more patients, spending is increasing with little evidence of better-quality care. Additional research suggests that PE acquisition of nursing homes<\/a> leads to increased costs for residents and simultaneous decreases in quality of care. More regulation<\/a> of PE involvement in the health care sector is needed to contain costs and protect patient interests.<\/p>\n\n
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\nWhile this study was limited to claims data from one payer (Elevance Health, formerly Anthem), it demonstrates that different methods of resolving a surprise medical bill can impact provider charges in surprise billing scenarios, with New York\u2019s IDR process associated with an increase in provider charges. Under the NSA, arbitrators are not allowed<\/a> to consider a provider\u2019s billed charge during the IDR process in states using the federal default process. Policymakers in states with payment rules that differ from the federal IDR process should look to the growing<\/a> body<\/a> of evidence on how considering billed charges during arbitration can lead to inflation in out-of-network costs.<\/p>\n","protected":false},"excerpt":{"rendered":"