Emerging Lessons and Policy Options for Sexually Transmitted Infection Telehealth Payment: A Narrative Review.

ABSTRACT: Long before the SARS-CoV-2 (hereafter COVID-19) pandemic, sexually transmitted infection (STI) prevention and control was underresourced in the United States, leading to large and sustained increases in reportable STIs and harmful sequelae of these infections. The abrupt disruption associated with the national shutdown of many public services in early 2020 forced STI clinics and programs to rapidly adopt new models of care, including the greatly increased use of telehealth services. Federal policy makers took actions to relax many requirements in Medicare and other programs that previously impeded the use of telehealth. Numerous states also adopted emergency policies to facilitate the delivery of telehealth services through Medicaid, many of which are related to payment for services. It is unresolved whether and which policies will or should be extended after the public health emergency. How these services are financed and reimbursed underpins the ability to effectively prevent and treat STIs and improve public health. Ultimately, payment systems need to support the solvency and stability of sexual health clinics and other health care services organizations in ways that support providers and that also improve patient satisfaction and retention in care. The Centers for Disease Control and Prevention and state/local health departments have important roles to play in supporting the dialogue needed to create new payment models and facilitate communication and technical assistance across public health and insurance systems. Sexual health providers must be engaged in iterative processes that continue to evolve and can be evaluated over time.

Evidence that collaborative action between local health departments and nonprofit hospitals helps foster healthy behaviors in communities: a multilevel study.

BACKGROUND: The Patient Protection and Affordable Care Act of 2010 (ACA) encouraged nonprofit hospitals to collaborate with local public health experts in the conduct of community health needs assessments (CHNAs) for the larger goal of improving community health. Yet, little is known about whether collaborations between local health departments and hospitals may be beneficial to community health. In this study, we investigated whether individuals residing in communities with stronger collaboration between nonprofit hospitals and local public health departments (LHDs) reported healthier behaviors. We further explored whether social capital acts as a moderating factor of these relationships. METHODS: We used multilevel cross-sectional models, controlling for both individual and community-level factors to explore LHD-hospital collaboration (measured in the National Association of County and City Health Officials (NACCHO) Forces of Change Survey), in relation to individual-level health behaviors in 56,826 adults living in 32 metropolitan and micropolitan statistical areas, captured through the 2015 Behavioral Risk Factor Surveillance System (BRFSS) SMART dataset. Nine health behaviors were examined including vigorous exercise, eating fruits and vegetables, smoking and binge drinking. Social capital, measured using an index developed by the Northeast Regional Center for Rural Development, was also explored as an effect modifier of these relationships. RESULTS: Stronger collaboration between nonprofit hospitals and LHDs was associated with not smoking (odds ratio, OR 1.32, 95% CI 1.11 to 1.58), eating vegetables daily (OR 1.29; 95% CI 1.06 to 1.57), and vigorous exercise (OR 1.17; 95% CI 1.05 to 1.30). The presence of higher social capital also strengthened the relationships between LHD-hospital collaborations and wearing a seatbelt (p for interaction = 0.01) and general exercise (p for interaction = 0.03). CONCLUSIONS: Stronger collaboration between nonprofit hospitals and LHDs was positively associated with healthier individual-level behaviors. Social capital may also play a moderating role in improving individual and population health.

Exploring the Association Between the Quality of HIV Care in Nursing Homes and Hospitalization.

ABSTRACT: Persons living with HIV/AIDS (PLWH) are living long enough to need age-related and HIV-related nursing home (NH) care. Nursing home quality of care has been associated with risk for hospitalization, but it is unknown if quality of HIV care in NHs affects hospitalization in this population. We assessed HIV care quality with four national measures adapted for the NH setting. We applied the measures to 2011-2013 Medicare claims linked to Minimum Data Set assessments of resident health, prescription dispensing data, and national reports of NH characteristics. Cox proportional hazards models calculated the risk of all-cause and HIV/AIDS-related hospitalization by HIV care compliance. We identified 1,246 PLWH in 201 NHs with 382 all-cause and 63 HIV/AIDS-related hospitalizations. Nursing home HIV care compliance varied from 24.9% to 64.7%. After regression adjustment, we could detect no difference in all-cause or HIV/AIDS-related hospitalizations by NH HIV care compliance. We postulate that the lack of association may be due to inappropriate HIV care quality measures that do not accurately represent NHs ability to care for PLWH. There is urgent need to create valid NH HIV care quality measures.

Changes in Dental Benefits and Use of Emergency Departments for Nontraumatic Dental Conditions in Massachusetts.

OBJECTIVES: Research examining the effect of changes in Medicaid dental benefits on emergency department (ED) use for dental conditions has had mixed results. We examined the effect of changes in Medicaid dental benefits on ED use for nontraumatic dental conditions (NTDCs) among adults in Massachusetts before and after Medicaid dental benefits for adults were eliminated (July 2010) and partially restored (January 2013). METHODS: We used 2009-2013 data from the Massachusetts All-Payer Claims Database. The study population included Medicaid enrollees aged ≥21 who made a visit to the ED for an NTDC that was paid for by Medicaid during the study period. We used an interrupted time-series study design and segmented regression model to assess the effect of the policy changes on ED use for NTDCs. We also conducted a subanalysis by patient age, sex, and geographic location. RESULTS: During the study period, 21 731 Medicaid enrollees aged ≥21 made 35 660 NTDC ED visits. Eliminating comprehensive dental benefits led to a significant increase in the use of EDs for NTDCs. This increase occurred over time (11% increase at 15 months after elimination of comprehensive dental benefits; estimate, 0.64 [95% CI, 0.07-1.21]; P = .03) rather than immediately after the policy change took effect. The partial restoration of certain dental benefits led to a significant decrease in the rate of ED visits for NTDCs over time (15.7% decrease at 5 months after partial restoration of certain dental benefits; estimate, -0.97 [95% CI, -1.83 to -0.11]; P = .03). CONCLUSION: Strengthening dental coverage policies for adult Medicaid enrollees could decrease their reliance on EDs for NTDCs.

Assessing the Quality of Human Immunodeficiency Virus Care in Nursing Homes.

BACKGROUND: Quality of human immunodeficiency virus (HIV) care in nursing homes (NHs) has never been measured. DESIGN: A cross-sectional study. SETTING: NHs. PARTICIPANTS: A total of 203 NHs and 1375 persons living with HIV. MEASUREMENTS: Medicare claims from 2011 to 2013 were linked to assessments of resident health, prescription dispensing data, and national reports of NH characteristics. Five nationally validated HIV care quality measures (prescription of antiretroviral therapy; CD4/viral load monitoring; frequency of medical visits; gaps in medical visits; and Pneumocystis pneumonia prophylaxis) were adapted and applied to NHs. Logistic regression predicted compliance by organizational factors. Random intercept logistic regression predicted if persons living with HIV received care by person and organizational factors. RESULTS: Compliance ranged from 43.3% (SD = 31.1%) for CD4/viral load monitoring to 92.4% (SD = 13.6%) for gaps in medical visits. More substantiated complaints against an NH decreased the likelihood of high compliance with CD4/viral load monitoring (odds ratio [OR] = 0.846; 95% confidence interval [CI] = 0.726-0.986), while NH-reported incidents increased the likelihood of high compliance with pneumocystis pneumonia prophylaxis (OR = 1.173; 95% CI = 1.044-1.317). Differences between NHs explained 21.2% or less of variability in receipt of care. CONCLUSIONS: Since 2013, the population with HIV and NH HIV care quality has inevitably evolved; however, this study provides previously unknown baseline metrics on NH HIV care quality and highlights significant challenges when measuring HIV care in NHs. J Am Geriatr Soc 68:1226-1234, 2020.

Emergency department revisits for nontraumatic dental conditions in Massachusetts.

BACKGROUND: Inadequate access to oral health care and palliative care provided in the emergency department (ED) creates a pattern of repeat nontraumatic dental condition (NTDC) ED visits. The authors examined NTDC ED revisits and assessed the determinants associated with these visits in Massachusetts. METHODS: The authors examined NTDC ED revisits in Massachusetts during 2013 using the Massachusetts All-Payer Claims Database. The authors report patient characteristics of those who made a single NTDC ED visit and of those who made NTDC ED revisits within 30 days of the index NTDC ED visit. The authors used a multilevel logistic regression model to examine the determinants associated with NTDC ED repeat visits. RESULTS: In 2013, 21.5% of NTDC ED visits were revisits. Men from 26 through 35 years of age who were enrolled in Medicaid and who did not make an outpatient dental office visit within 30 days of the index NTDC ED visit had increased odds of repeat visits. CONCLUSIONS: The sizable proportion of NTDC ED repeat visits indicates that certain patients in Massachusetts experience consistent and systematic barriers in accessing appropriate and timely oral health care. PRACTICAL IMPLICATIONS: Prioritizing young adults and Medicaid enrollees for ED diversion programs and setting up a formal referral process via connecting patients to dental offices and community health centers after an NTDC ED visit may reduce NTDC ED revisits and provide appropriate oral health care to these patients.

Determinants of emergency department utilization for non-traumatic dental conditions in Massachusetts.

OBJECTIVES: To study the determinants of emergency department (ED) utilization for non-traumatic dental conditions (NTDCs) by adults in Massachusetts. METHODS: We analyzed patient-level factors associated with ED utilization for NTDCs in Massachusetts during 2013, using the Massachusetts All Payer Claims Dataset. The primary independent variables of interest were use of preventive dental service in the year preceding the ED visit and dental insurance coverage. Key covariates included age, gender, income, day of the ED visit, payer type, and residing in a geographically designated dental health professional shortage area (DHPSA). A multilevel logistic regression model was used to estimate the odds of NTDC ED visits as compared to two other categories of ED visits. RESULTS: 1.1 percent of all ED visits in Massachusetts were for NTDCs in 2013. Preventive dental service use in the preceding year decreased the odds (OR = 0.72) of a NTDC ED visit, whereas having dental insurance coverage increased the odds (OR = 1.1) of a NTDC ED visit. Other patient-level characteristics that significantly increased odds of a NTDC ED visit included being between 26 and 35 years of age (OR = 1.2), male (OR = 1.3), uninsured (OR = 1.7) or enrolled in Medicaid (OR = 1.2), and visiting on a weekend (OR = 1.3). CONCLUSIONS: Increased access to preventive dental services may lower likelihood of ED use for NTDCs. Interventions that target younger adults, Medicaid enrollees, and the uninsured, may be the most efficient way to lower NTDC ED use.

People Living With HIV in U.S. Nursing Homes in the Fourth Decade of the Epidemic.

As the number of persons living with HIV (PLWH) will continue to increase in the coming years, it is critical to understand factors influencing appropriate nursing home (NH) care planning. This study described the sociodemographic characteristics as well as the antiretroviral therapy treatment and physical and mental health among Medicare-eligible PLWH in NHs. Persons living with HIV were identified and summarized using a 2011-2013 nationwide data set of Medicare claims linked to NH resident health assessments and a prescription dispensing database, comparing new admissions in 2011-2013 with those from 1998 to 2000. We identified 7,188 PLWH from 2011 to 2013 in NHs of whom 4,031 were newly admitted. Of the total, 79% were prescribed antiretroviral therapy. Most were male (73%), Black/African American (51.1%), and a plurality resided in southern NHs (47%). Comparing the data sets, new admissions were older (60 vs. 44), had higher prevalence of viral hepatitis (16.2% vs. 7.5%), and anemia (31.1% vs. 25.1%) but had less pneumonia (11.0% vs. 13.6%) and dementia (8.7% vs. 21.0%). NH nurses can better anticipate health care needs of PLWH using these health profiles, understanding that there have been changes in the health of PLWH at admission over time.