The Association of Readmission Reduction Activities with Primary Care Practice Readmission Rates.

BACKGROUND: A great deal of research has focused on how hospitals influence readmission rates. While hospitals play a vital role in reducing readmissions, a significant portion of the work also falls to primary care practices. Despite this critical role of primary care, little empirical evidence has shown what primary care characteristics or activities are associated with reductions in hospital admissions. OBJECTIVE: To examine the relationship between practices' readmission reduction activities and their readmission rates. DESIGN, SETTING, AND PARTICIPANTS: A retrospective study of 1,788 practices who responded to the National Survey of Healthcare Organizations and Systems (fielded 2017-2018) and 415,663 hospital admissions for Medicare beneficiaries attributed to those practices from 2016 100% Medicare claims data. We constructed mixed-effects logistic regression models to estimate practice-level readmission rates and a linear regression model to evaluate the association between practices' readmission rates with their number of readmission reduction activities. INTERVENTIONS: Standardized composite score, ranging from 0 to 1, representing the number of a practice's readmission reduction capabilities. The composite score was composed of 12 unique capabilities identified in the literature as being significantly associated with lower readmission rates (e.g., presence of care manager, medication reconciliation, shared-decision making, etc.). MAIN OUTCOMES AND MEASURES: Practices' readmission rates for attributed Medicare beneficiaries. KEY RESULTS: Routinely engaging in more readmission reduction activities was significantly associated (P < .05) with lower readmission rates. On average, practices experienced a 0.05 percentage point decrease in readmission rates for each additional activity. Average risk-standardized readmission rates for practices performing 10 or more of the 12 activities in our composite measure were a full percentage point lower than risk-standardized readmission rates for practices engaging in none of the activities. CONCLUSIONS: Primary care practices that engaged in more readmission reduction activities had lower readmission rates. These findings add to the growing body of evidence suggesting that engaging in multiple activities, rather than any single activity, is associated with decreased readmissions.

The Ten Years' War: Politics, Partisanship, And The ACA.

After decades of failed efforts to overhaul American health care, the Affordable Care Act's 2010 enactment was the most important health reform achievement since Medicare and Medicaid's passage. But ten years later, ACA politics are more tenuous than triumphal, and the ACA has not escaped the controversy that surrounded its enactment. This article explores why the ACA has been so divisive despite its considerable accomplishments. The ACA contains an array of controversial policies that contravene policy principles and political priorities held by the contemporary Republican party. It also imposes costs on stakeholder groups whose opposition, in many cases, to measures that altered the status quo has never ceased. Moreover, ACA benefits often have been obscured, partly because of the law's complex structure and incoherent programmatic identity. Additionally, the ACA's performance on its central promise-to make health insurance affordable-has been mixed. The law also confers benefits on populations that command less political sympathy than those previously favored with public coverage, and it has surfaced perennial racial/ethnic tensions related to who receives government benefits. I argue that the ACA's turbulent political journey ultimately reflects the larger trends in American politics of growing partisanship and polarization that continue to shape US health policy.

Challenges To Medicare For All Remain Daunting.

Medicare for All plans have many advantages over the status quo. Yet the challenges facing such plans are immense, reflecting their ambitions to achieve universal coverage through a single federal plan and their disruption to existing insurance and financing arrangements. Medicare for All will not become viable unless it can meet the daunting political, economic, and administrative realities that govern US health care.

Lessons From the Long and Winding Road to Medicare for All.

Recently there has been a surge in political attention to Medicare for all, the latest chapter in a long history of conflict over national health insurance in the United States. This essay places the current Medicare for all debate in historical perspective.My aim is to illuminate past struggles over single-payer reform, explore the genesis and evolution of Medicare, and analyze the implications for contemporary health politics of the public and private insurance arrangements developed by the United States over the past century.The history of US health reform provides critical lessons for understanding the enduring appeal of single-payer models as well as the formidable political obstacles to transforming Medicare for all from an aspiration into a legislative reality.

Navigating the Shifting Terrain of US Health Care Reform-Medicare for All, Single Payer, and the Public Option.

Policy Points "Medicare for All" is an increasingly common term in US health care reform debates, yet widespread confusion exists over its meaning. The various meanings of Medicare for All and other related terms reflect divergent political and philosophical assumptions about the preferred direction of health care reform, as well as the hybrid structure of the current Medicare program.

Impact of Medicare Part D on mental health treatment and outcomes for dual eligible beneficiaries with HIV.

Depression is common among women with HIV and untreated depression can result in poor quality of life and worsen HIV outcomes. Women with HIV who are dually enrolled in Medicaid and Medicare faced a potential disruption in medication access when Medicare Part D was implemented in 2006. The goal of this study was to estimate the effects of Medicare Part D implementation on antidepressant use, depressive symptoms, and hospitalization in Medicaid-Medicare dual eligible women with HIV. This study used 2003-2008 data from the Women's Interagency HIV Study. The effects of Medicare Part D were estimated using a difference-in-differences approach, adjusting for temporal trends using a matched control group of Medicaid-only enrollees. Before Medicare Part D implementation, dual eligibles differed from Medicaid-only enrollees in antidepressant use and hospitalization, despite having identical prescription drug coverage through Medicaid. For dual enrollees, the transition to Medicare Part D was not associated with changes in antidepressant use, depressive symptoms, or hospitalization. We did not find disruptive effects on antidepressant use and related outcomes among dual eligibles in this study. Stable antidepressant use may be due to better access to medical care for dual eligibles through Medicare both before and after Medicare Part D implementation, which may have eclipsed any effects of the transition. It may also signal that classification of antidepressants as a protected drug class under Medicare Part D was effective in preventing psychiatric medication disruption.

Collision course? Donald Trump, Paul Ryan, and the fate of Medicare.

The election of Donald Trump as president of the United States raises questions about the future of Medicare. How will Medicare fare under Republican-led government? There are several compelling reasons that the Trump administration and Congressional Republicans might avoid Medicare reform, including the political risks of taking on a popular program, the difficulties the party has encountered in trying to dismantle the Patient Protection and Affordable Care Act (ACA), the importance of older Americans to the GOP coalition, and President Trump's views about Medicare. However, because of fiscal pressures and the commitment of Speaker of the House Paul Ryan and other Republicans to entitlement reform, the GOP nonetheless could end up attempting to make major changes in Medicare. Alternatively, Republican efforts to repeal and undermine the ACA could unintentionally enhance the political fortunes of proposals to expand Medicare. Consequently, the fate of Medicare during the Trump administration remains highly uncertain.