Health Affairs’ April Issue: Maternity Coverage, Children, Disability & More
Bethesda, MD - The April issue of Health Affairs, a variety issue, contains studies about hospital pricing, health coverage for pregnant immigrant women, seat-belt use in the United States, and the amount of US physicians’ clinical time spent on computer-related tasks.
Hospital chargemasters: how much do they affect what patients and insurers actually pay?
Over the past few decades, researchers have noted a widening gap between official hospital list prices and the amounts actually paid by patients and insurers. To better understand the role of the chargemaster, Michael Batty of the Federal Reserve Board and Benedic Ippolito at the American Enterprise Institute examined data covering the period 2002–14. According to the authors, basic hospital characteristics were strong predictors of which hospitals set higher list prices: A large, for-profit, urban hospital that was a member of a chain had list price markups that were 360 percent higher than those of a small independent, rural, nonprofit hospital. The authors found that higher list prices were also correlated with higher payments from the uninsured and privately insured patients. In the case of the uninsured, they used the passage of California’s Hospital Fair Pricing Act to provide causal evidence that hospitals with higher list prices generated higher payments from patients. The authors found that list prices are an increasingly important indicator of which hospitals ultimately receive higher payments—which suggests potential causal channels for this relationship.
Effects of insurance coverage for pregnant immigrant women in the United States.
Despite federal restrictions on coverage for recent immigrants and undocumented immigrants in the United States, the 2002 Children’s Health Insurance Program (CHIP) unborn child option allowed states to use federal funding to provide health services to mothers during pregnancy and delivery-related care regardless of their immigration or legal status. Laura Wherry of the University of California, Los Angeles, and coauthors used 1998–2013 data from the National Center for Health Statistics to compare pregnancy-related care and infant health outcomes in states expanding coverage for pregnant immigrant women with those in states that did not. The study found an approximately one-third decrease in the share of immigrant women with low education who received no prenatal care in states expanding access to care compared to states that did not. However, the authors did not find significant changes in the incidence of low birthweight, preterm birth, being small for gestational age, or infant death when comparing the same groups. They conclude that the results do not rule out the possibility of longer-term improvements in the health of these children and that the goal of achieving sustained health improvements may benefit from other programmatic tactics.
Also of interest:
PRACTICE OF MEDICINE: Half of physicians’ clinical time spent on computer tasks.
Measuring how physicians spend their clinical time is essential in making clinic staffing decisions and improving the accuracy of payment for physician services. Ming Tai-Seale of the Palo Alto Medical Foundation Research Institute and coauthors analyzed electronic health record (EHR) data for the period 2011–14 from nearly 500 physicians in a community-based health care system in one of the first studies using such data to understand how physicians spend their time. The authors found that each day the physicians logged an average of 3.08 hours on face-to-face office visits (49 percent of their time) and 3.17 hours (51 percent of their time) on desktop medicine activities, which included communicating online with patients, ordering tests, reviewing test results, sending staff messages, and other tasks (see the exhibit below). Since physicians are reimbursed for office visits, lab work, and medical procedures but not for desktop medicine tasks, the authors suggest that their findings highlight the misalignment of the current fee-for-service payment policy and the potential for physician burnout with EHR use. This study is the first of Health Affairs’ new series, The Practice Of Medicine, which explores the broad practice environment and how features of that environment affect practitioners. The series is supported by the Physicians Foundation.