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Value-based Healthcare: The Politics of Value-based Care and its Impact on Orthopaedic Surgery

Lin, Eugenia; Sage, William M; Bozic, Kevin J; Jayakumar, Prakash
PMID: 33704105
ISSN: 1528-1132
CID: 4809392

Another Medical Malpractice Crisis?: Try Something Different

Sage, William M; Boothman, Richard C; Gallagher, Thomas H
PMID: 32940629
ISSN: 1538-3598
CID: 4593262

Assessing and Supporting Late Career Practitioners: Four Key Questions

White, Andrew A; Sage, William M; Mazor, Kathleen M; Gallagher, Thomas H
PMID: 32859507
ISSN: 1938-131x
CID: 4582592

Following the Money: The ACA's Fiscal-Political Economy and Lessons for Future Health Care Reform

Sage, William M; Westmoreland, Timothy M
It is no exaggeration to say that American health policy is frequently subordinated to budgetary policies and procedures. The Affordable Care Act (ACA) was undeniably ambitious, reaching health care services and underlying health as well as health insurance. Yet fiscal politics determined the ACA's design and guided its implementation, as well as sometimes assisting and sometimes constraining efforts to repeal or replace it. In particular, the ACA's vulnerability to litigation has been the price its drafters paid in exchange for fiscal-political acceptability. Future health care reformers should consider whether the nation is well served by perpetuating such an artificial relationship between financial commitments and health returns.
PMID: 33021177
ISSN: 1748-720x
CID: 4626782

Predictors of Multiple Emergency Department Utilization Among Frequent Emergency Department Users in 3 States

Giannouchos, Theodoros V; Washburn, David J; Kum, Hye-Chung; Sage, William M; Ohsfeldt, Robert L
BACKGROUND:Research on frequent emergency department (ED) use shows that a subgroup of patients visits multiple EDs. This study characterizes these individuals. OBJECTIVE:The objective of this study was to determine how many frequent ED users seek care at multiple EDs and to identify sociodemographic, clinical, and contextual factors associated with such behavior. RESEARCH DESIGN/METHODS:We used the 2011-2014 Healthcare Cost and Utilization Project State Emergency Department Databases data on all outpatient ED visits in New York, Massachusetts, and Florida. We studied all adult ED users with ≥5 visits in a year and defined multisite use as visits to ≥3 different sites. We estimated predictors of multisite use with multivariate logistic regressions. RESULTS:Across all 3 states, 1,033,626 frequent users accounted for 7,613,077 ED visits. Of frequent users, 25% were multisite users, accounting for 30% of the visits studied. Frequent users with at least 1 visit for mental health or substance use-related diagnosis were more likely to use multiple sites. Uninsured frequent users and those with public insurance were associated with less use of multiple EDs than those with private coverage while lacking consistent coverage by the same insurance within each year were associated with using multiple sites. CONCLUSIONS:Health policy interventions to reduce duplicative or unnecessary ED use should apply a population health perspective and engage multiple hospitals. Community-level preventive approaches and a stronger infrastructure for mental health and substance use are essential to mitigate multisite ED use.
PMID: 31651740
ISSN: 1537-1948
CID: 4322632

Malpractice Liability and Quality of Care: Clear Answer, Remaining Questions [Comment]

Sage, William M; Underhill, Kristen
PMID: 31990297
ISSN: 1538-3598
CID: 4322842

Trends in Medicare Payment Rates for Noninvasive Cardiac Tests and Association With Testing Location

Masoudi, Frederick A; Viragh, Timea; Magid, David J; Moghtaderi, Ali; Schilsky, Samantha; Sage, William M; Goodrich, Glenn; Newton, Katherine M; Smith, David H; Black, Bernard
Importance/UNASSIGNED:To control spending, the Centers for Medicare & Medicaid Services reduced Medicare fee-for-service (FFS) payments for noninvasive cardiac tests (NCTs) performed in provider-based office settings (ambulatory offices not administratively affiliated with hospitals) starting in 2005. Contemporaneously, payments for hospital-based outpatient testing increased. The association between differential payments by site and test location is unknown. Objectives/UNASSIGNED:To quantify trends in differential Medicare FFS payments for NCTs performed in hospital-based and provider-based settings, determine the association between the hospital-based outpatient testing to provider-based office testing payment ratio and the proportion of hospital-based NCTs, and to examine trends in test location between Medicare FFS and 3 Medicare Advantage health maintenance organizations for which Centers for Medicare & Medicaid Services payments do not depend on testing location. Design, Setting, and Participants/UNASSIGNED:This observational claims-based study used Medicare FFS claims from 1999 to 2015 (5% random sample) and Medicare Advantage claims from 3 large health maintenance organizations (2005-2015) among Medicare FFS beneficiaries aged 65 years or older and a health maintenance organization control group. Statistical analysis was performed from May 1, 2017, to July 15, 2019. Exposures/UNASSIGNED:The weighted mean payment ratio of Medicare FFS hospital-based outpatient testing to provider-based office testing for outpatient NCTs. Main Outcomes and Measures/UNASSIGNED:Proportion of outpatient NCTs performed in the hospital-based setting and Medicare FFS costs. Results/UNASSIGNED:The data included a mean of 1.72 million patient-years annually in Medicare FFS (mean age, 75.2 years; 57.3% female in 2015) and a mean of 142 230 patient-years annually in the managed care control group (mean age, 74.8 years; 56.2% female in 2015). The Medicare payment ratio of FFS hospital-based outpatient testing to provider-based office testing increased from 1.05 in 2005 to 2.32 in 2015. The FFS hospital-based outpatient testing proportion increased from 21.1% in 2008 to 43.2% in 2015 and was correlated with the payment ratio (correlation coefficient with a 1-year lag, 0.767; P < .001). In contrast, the hospital-based outpatient testing proportion for the control group declined from 16.6% in 2008 to 15.2% in 2015 (correlation coefficient, -0.024, P = .95). The estimated extra costs owing to tests shifting to the hospital-based outpatient setting in the Medicare FFS group was $661 million in 2015, including $161 million in patient out-of-pocket costs. Conclusions and Relevance/UNASSIGNED:In settings in which reimbursement depends on test location, increasing hospital-based payments correlated with greater proportions of outpatient NCTs performed in the hospital-based outpatient setting. Site-neutral payments may offer an incentive for testing to be performed in the more efficient location.
PMID: 31609397
ISSN: 2168-6114
CID: 4322622

The social construction of disability and the capabilities approach: Implications for nursing

Thurman, Whitney A; Harrison, Tracie C; Garcia, Alexandra A; Sage, William M
PROBLEM/OBJECTIVE:Improving the health and well-being of people with disabilities (PWD) should be included any strategies aimed at eliminating health disparities and achieving health equity in the United States. However, practitioners and policymakers often overlook disability when considering health equity. This is problematic because structural injustices including social and environmental barriers frequently worsen health for PWD. A commitment to social justice, however, dictates that everyone should have equitable opportunities to participate in chosen aspects of life to the best of their abilities and desires. METHODS:We use a critical commentary to provide suggestions for the nursing discipline. Specifically, we 1) position the disparities in health and well-being experienced by PWD as matters of equity and social justice, 2) describe Amartya Sen's capabilities approach, and 3) provide suggestions for incorporating tenets of the capabilities approach into nursing practice, research, and policy. CONCLUSION/CONCLUSIONS:The capabilities approach can provide a useful framework to guide nursing practice, research, and policy in order to advance social justice for PWD.
PMID: 31559644
ISSN: 1744-6198
CID: 4322542

Patient safety and the ageing physician: a qualitative study of key stakeholder attitudes and experiences

White, Andrew A; Sage, William M; Osinska, Paulina H; Salgaonkar, Monica J; Gallagher, Thomas H
BACKGROUND:Unprecedented numbers of physicians are practicing past age 65. Unlike other safety-conscious industries, such as aviation, medicine lacks robust systems to ensure late-career physician (LCP) competence while promoting career longevity. OBJECTIVE:To describe the attitudes of key stakeholders about the oversight of LCPs and principles that might shape policy development. DESIGN:Thematic content analysis of interviews and focus groups. PARTICIPANTS:40 representatives of stakeholder groups including state medical board leaders, institutional chief medical officers, senior physicians (>65 years old), patient advocates (patients or family members in advocacy roles), nurses and junior physicians. Participants represented a balanced sample from all US regions, surgical and non-surgical specialties, and both academic and non-academic institutions. RESULTS:Stakeholders describe lax professional self-regulation of LCPs and believe this represents an important unsolved challenge. Patient safety and attention to physician well-being emerged as key organising principles for policy development. Stakeholders believe that healthcare institutions rather than state or certifying boards should lead implementation of policies related to LCPs, yet expressed concerns about resistance by physicians and the ability of institutions to address politically complex medical staff challenges. Respondents recommended a coaching and professional development framework, with environmental changes, to maximise safety and career longevity of physicians as they age. CONCLUSIONS:Key stakeholders express a desire for wider adoption of LCP standards, but foresee significant culture change and practical challenges ahead. Participants recommended that institutions lead this work, with support from regulatory stakeholders that endorse standards and create frameworks for policy adoption.
PMID: 30237318
ISSN: 2044-5423
CID: 4321822

Letter to the Editor. Reducing EVD-related infections [Letter]

Dapaah, Andrew; Sage, William; Ingale, Harshal
PMID: 30771776
ISSN: 1933-0693
CID: 4094202