“There is a long history of policy analyses of the use of the 3-day prior hospital stay rule. It was introduced very early in the history of the Medicare SNF [skilled nursing facility] benefit at a time when most nursing homes (NHs) offered primarily custodial care and extended hospital stays were common. To ensure an adequate medical evaluation, hospitalization was deemed critical, so direct admissions to SNF for medical treatment were considered inappropriate. Direct admissions from home to NHs were for custodial care and not post short-term care, and when long-stay NH residents became sick, the lack of available resources in … Read More
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“When I first started out in addiction medicine to now, I thought that this made sense as a last-ditch approach [involuntary commitment]. But my thinking has changed as I’ve seen the clear evidence of its lack of benefit and heard stories and observed data indicating its harm. I also know intimately the feeling of powerlessness that comes with being a close family member to someone dealing with addiction. When I see medical professionals and loved ones reaching to involuntary treatment as a solution, I know it is out of a desperate wish to do something, anything, to respond to the … Read More
“Well intentioned as the [proposed menthol-flavored cigarette] ban may be, it has angered some Black leaders, including a group of ministers who have rallied against Ms. Hochul’s proposal because they worry it could increase encounters between Black people and the police if menthol cigarettes were to go underground and authorities crack down on sellers. Other Black opponents of the ban suggest it may be discriminatory, a heavy-handed crackdown on the preferred nicotine fix of Black smokers, even if African American men have the highest rates of lung cancer, according to the Centers for Disease Control and Prevention. Some smokers said that if the … Read More
“The effects of social determinants of health (SDOH) on health outcomes have been extensively evaluated and described. Efforts to elucidate the impact of specific unmet health-related social needs (HRSN), such as food insecurity and lack of transportation, on specific outcome measures can help pinpoint necessary interventions and policy changes. [..] In recent years, the Centers for Medicare &Medicaid Services (CMS) have placed higher priority on addressing health equity, including directly addressing unmet HRSN and accounting for social risk in Medicare payments. For payments, a growing body of literature has demonstrated that health care systems caring for patients with higher social … Read More
“Sun et al studied more than 8000 cigarette-naive youths from [Population Assessment on Tobacco Use and Health (PATH)] waves 3 to 5. They found that youths who had used e-cigarettes at baseline (wave 3) had higher odds of continued cigarette smoking, but the absolute risks of continued smoking at wave 5 were very small and did not significantly differ by baseline e-cigarette use. Moreover, the prevalence of frequent smoking, defined as 20 or more days in the past 30 days, 2 years later (wave 5) was so low (0.2%), the authors could not model this outcome due to its rarity. In … Read More
“The concept of cardiovascular health (CVH) was proposed by the American Heart Association (AHA) in 2010 and is composed of both lifestyle factors and biological metrics. The original algorithm for evaluating CVH was the Life’s Simple 7 (LS7) score. In 2022, the AHA published the new algorithm for evaluating CVH, the Life’s Essential 8 (LE8) score, on the basis of feedback on the LS7 score and new evidence. The LE8 score adopts a new scoring algorithm and incorporates sleep health into CVH.8 Intriguingly, previous studies have shown that having a higher CVH level was not only associated with a lower … Read More
“The high cost of health insurance and health care services now affects not only the uninsured but also middle-class Americans with employment-based health insurance (ESI), enrollees in the Affordable Care Act exchanges, and Medicare beneficiaries. A popular concept in health policy discussions is the “iron triangle”: here, here, here, here, and here. These authors posit that it is impossible to increase access and quality of care while simultaneously reducing spending. That idea warrants further scrutiny. [..] evidence suggests that failure to improve affordability is primarily due not to a mathematical “iron triangle” constraint, but an “iron curtain” of stakeholders who are aware of promising alternatives but oppose their … Read More
“The twenty-two-member council is a nonpartisan, multidisciplinary expert working group under the leadership of cochairs William Frist [former US Senate majority leader] and Margaret Hamburg [former commissioner of the Food and Drug Administration]. This report contains the council’s recommendations. [..] The goal of the recommendations in this report is to achieve higher-value health care spending and growth in the US. The mechanism for achieving this goal involves four levers: The council examined literature and received input from experts in its inquiry into drivers of spending and growth that met the following criteria: a meaningful amount of money is potentially at … Read More
“The perpetual diet wars between factions promoting low-carbohydrate, keto, paleo, high-protein, low-fat, plant-based, vegan, and a seemingly endless list of other diets have led to substantial public confusion and mistrust in nutrition science. While debate rages about the relative merits and demerits of various so-called healthy diets, less attention is paid to the fact that otherwise diverse diet recommendations often share a common piece of advice: avoid ultra-processed foods. [..] The rise in obesity and type 2 diabetes prevalence occurred in parallel with an increasingly industrialized food system characterized by large-scale production of high-yield, inexpensive, agricultural “inputs” (primarily corn, soy, … Read More
Select Key Findings Policy Issues Debating the Future: Does H@H Save Costs and Improve Patient Care? “[..] Recent studies of cost savings from H@H programs range from 20 percent (Reese 2021) to 40 percent (Brigham and Women’s Hospital in Boston, Levine et al. 2020). But these findings are not generalizable as they are based entirely on single case studies of highly structured programs involving small samples of very carefully selected patients. For example, the study of Brigham and Women’s program examined 91 adults who were admitted to the hospital’s ED and randomly assigned to the hospital vs home for treatment. [..] While … Read More