Health Services Research © Health Research and Educational Trust DOI: 10.1111/1475-6773.12421 EDITORIAL
Editorial
Best of the 2015 AcademyHealth Annual Research Meeting In this issue of Health Services Research, we are pleased to publish the fourth installment of our featured section, “The Best of the 2015 AcademyHealth Annual Research Meeting (ARM).” We publish annually a set of articles based on abstracts submitted to the ARM and selected to be outstanding by both reviewers from the ARM theme groups and HSR’s own editorial staff and reviewers. HSR has been an official journal of AcademyHealth for many years, and this feature is one of the many successful collaborative efforts to showcase significant work in the field of health services research in a timely manner. Early in 2015, we requested from AcademyHealth staff members the highest scoring abstracts from each of the ARM themes whose author(s) had indicated an interest in “Best of ARM” publication. From the 38 submitted abstracts, the editors of HSR invited 15 authors to submit full manuscripts for consideration for publication. The submitted manuscripts went through expedited review, culminating in the five articles appearing in this issue. Three additional articles from “The Best of the 2015 ARM” were not quite ready for publication in this issue, but they may appear in forthcoming issues of HSR. With the implementation of the Patient Protection and Affordable Care Act (ACA), timely and high-quality health services research of the type reported here has never been more important. Several papers in this issue of HSR explore key questions related to health reform. Layton and Ryan (2015) studied the impact of the ACA’s Quality Bonus Payment Demonstration for Medicare Advantage, the market for private Medicare plans. They took advantage of the fact that plans in some counties were eligible for doublebonus payments relative to plans in other counties; these double-bonus payments were large enough to drive about $3 billion in extra spending by the Centers for Medicare & Medicaid Services (CMS) over 3 years. The authors report that the receipt of double-bonuses was not associated with an increase 1731
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in star ratings of plan quality, but it was associated with a 5.8 percent increase in the number of plans offered in eligible counties. These findings raise important questions about whether pay-for-performance in the Medicare Advantage program is working as Congress intended. Two other papers in this featured section explore the impact of state Medicaid expansions on behavioral health services and outcomes, which has become a critical question in the wake of the Supreme Court’s 2012 decision in National Federation of Independent Business (NFIB) versus Sebelius, and the subsequent refusal of 20 states to adopt the ACA’s Medicaid expansion. Wen, Druss, and Cummings (2015) analyzed 9 years (2004–2012) of individual-level data from the National Survey on Drug Use and Health and found that among low-income adults with serious psychological distress, Medicaid waiver expansions were associated with a 2.2 percentage point decrease in the probability of perceiving an unmet need for mental health treatment and a 1.5 percentage point increase in the probability of receiving mental health treatment. Among low-income adults with substance abuse disorders, Medicaid waiver expansions reduced the probability of perceiving an unmet need for substance abuse treatment by 1.3 percentage points. By contrast, Golberstein and Gonzales (2015) used data from the 1998–2011 Medical Expenditure Panel Survey and National Health Interview Survey to show that increasing income thresholds for Medicaid eligibility significantly increased health insurance coverage and reduced out-of-pocket spending on mental health services, without affecting overall use of mental health services by low-income adults. Adler-Milstein, Everson, and Lee (2015) tackled another controversial question in Federal health policy: Did the Health Information Technology for Economic and Clinical Health (HITECH) Act lead to improved performance at hospitals that met “meaningful use” criteria for implementation of electronic health record (EHR) systems? They report that higher levels of EHR adoption were associated with better performance on process adherence and patient satisfaction measures, but not on an efficiency measure. For all three outcomes, there was a more positive relationship between EHR adoption and performance in 2010/2011 compared to 2008/2009, suggesting that improvements in EHR software and user training may have enhanced the quality-related benefits of adopt-
Address correspondence to Patrick S. Romano, M.D., M.P.H., Professor of Medicine and Pediatrics, UC Davis School of Medicine, Center for Healthcare Policy and Research, 4150 V Street, PSSB Suite 2400, Sacramento, CA 95817; e-mail: [email protected]. Jacqueline S. Zinn, Ph.D., is with the Department of Risk, Insurance and Healthcare Management, Temple University, Philadelphia, PA.
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ing an EHR system. Finally, by increasing the demand for health services, the ACA is challenging policy makers to reconsider scope-of-practice regulations and especially the roles of nurse practitioners and physician assistants. Intrator et al. (2015) report that the proportion of American nursing homes using any NPs or PAs increased from 20.4 percent in 2000 to 35.0 percent in 2010—a finding that has significant implications for health workforce planning in an aging society. We would like to thank AcademyHealth staff, particularly Andrea Fendt, for their assistance in enabling this special feature, as well as our own editorial staff and reviewers in expediting the review process for these manuscripts. Authors who would like to be considered for HSR’s Best of ARM publication in 2016 should consult the instructions provided with the 2016 ARM abstract solicitation from AcademyHealth. We hope that our readers find value in this journal feature and we look forward to future contributions. Patrick S. Romano Jacqueline S. Zinn
REFERENCES Adler-Milstein, J., J. Everson, and S. D. Lee. 2015. “Electronic Health Records Adoption and Hospital Performance: Time-Related Effects.” Health Services Research 50 (6 Pt 1): 1751–71. Golberstein, E., and G. Gonzales. 2015. “The Effects of Medicaid Eligibility on Mental Health Services and Out-of-Pocket Spending for Mental Health Services.” Health Services Research 50 (6 Pt 1): 1734–50. Intrator, O., E. A. Miller, E. Gadbois, J. K. Acquah, R. Makineni, and D. Tyler. 2015. “Trends in Nurse Practitioner and Physician Assistant Practice in Nursing Homes, 2000-2010.” Health Services Research 50 (6 Pt 1): 1772–86. Layton, T. J., and A. M. Ryan. 2015. “Higher Incentive Payments in Medicare Advantage’s Pay-for-Performance Program Did Not Improve Quality, But Did Increase Plan Offerings.” Health Services Research 50 (6 Pt 1): 1810–28. Wen, H., B. G. Druss, and J. R. Cummings. 2015. “Effect of Medicaid Expansions on Health Insurance Coverage & Access to Care among Low-Income Adults with Behavioral Health Conditions.” Health Services Research 50 (6 Pt 1): 1787–809.
S UPPORTING I NFORMATION Additional supporting information may be found in the online version of this article: Appendix SA1: Author Matrix.
Editorial
Best of the 2015 AcademyHealth Annual Research Meeting In this issue of Health Services Research, we are pleased to publish the fourth installment of our featured section, “The Best of the 2015 AcademyHealth Annual Research Meeting (ARM).” We publish annually a set of articles based on abstracts submitted to the ARM and selected to be outstanding by both reviewers from the ARM theme groups and HSR’s own editorial staff and reviewers. HSR has been an official journal of AcademyHealth for many years, and this feature is one of the many successful collaborative efforts to showcase significant work in the field of health services research in a timely manner. Early in 2015, we requested from AcademyHealth staff members the highest scoring abstracts from each of the ARM themes whose author(s) had indicated an interest in “Best of ARM” publication. From the 38 submitted abstracts, the editors of HSR invited 15 authors to submit full manuscripts for consideration for publication. The submitted manuscripts went through expedited review, culminating in the five articles appearing in this issue. Three additional articles from “The Best of the 2015 ARM” were not quite ready for publication in this issue, but they may appear in forthcoming issues of HSR. With the implementation of the Patient Protection and Affordable Care Act (ACA), timely and high-quality health services research of the type reported here has never been more important. Several papers in this issue of HSR explore key questions related to health reform. Layton and Ryan (2015) studied the impact of the ACA’s Quality Bonus Payment Demonstration for Medicare Advantage, the market for private Medicare plans. They took advantage of the fact that plans in some counties were eligible for doublebonus payments relative to plans in other counties; these double-bonus payments were large enough to drive about $3 billion in extra spending by the Centers for Medicare & Medicaid Services (CMS) over 3 years. The authors report that the receipt of double-bonuses was not associated with an increase 1731
1732
HSR: Health Services Research 50:6 (December 2015)
in star ratings of plan quality, but it was associated with a 5.8 percent increase in the number of plans offered in eligible counties. These findings raise important questions about whether pay-for-performance in the Medicare Advantage program is working as Congress intended. Two other papers in this featured section explore the impact of state Medicaid expansions on behavioral health services and outcomes, which has become a critical question in the wake of the Supreme Court’s 2012 decision in National Federation of Independent Business (NFIB) versus Sebelius, and the subsequent refusal of 20 states to adopt the ACA’s Medicaid expansion. Wen, Druss, and Cummings (2015) analyzed 9 years (2004–2012) of individual-level data from the National Survey on Drug Use and Health and found that among low-income adults with serious psychological distress, Medicaid waiver expansions were associated with a 2.2 percentage point decrease in the probability of perceiving an unmet need for mental health treatment and a 1.5 percentage point increase in the probability of receiving mental health treatment. Among low-income adults with substance abuse disorders, Medicaid waiver expansions reduced the probability of perceiving an unmet need for substance abuse treatment by 1.3 percentage points. By contrast, Golberstein and Gonzales (2015) used data from the 1998–2011 Medical Expenditure Panel Survey and National Health Interview Survey to show that increasing income thresholds for Medicaid eligibility significantly increased health insurance coverage and reduced out-of-pocket spending on mental health services, without affecting overall use of mental health services by low-income adults. Adler-Milstein, Everson, and Lee (2015) tackled another controversial question in Federal health policy: Did the Health Information Technology for Economic and Clinical Health (HITECH) Act lead to improved performance at hospitals that met “meaningful use” criteria for implementation of electronic health record (EHR) systems? They report that higher levels of EHR adoption were associated with better performance on process adherence and patient satisfaction measures, but not on an efficiency measure. For all three outcomes, there was a more positive relationship between EHR adoption and performance in 2010/2011 compared to 2008/2009, suggesting that improvements in EHR software and user training may have enhanced the quality-related benefits of adopt-
Address correspondence to Patrick S. Romano, M.D., M.P.H., Professor of Medicine and Pediatrics, UC Davis School of Medicine, Center for Healthcare Policy and Research, 4150 V Street, PSSB Suite 2400, Sacramento, CA 95817; e-mail: [email protected]. Jacqueline S. Zinn, Ph.D., is with the Department of Risk, Insurance and Healthcare Management, Temple University, Philadelphia, PA.
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ing an EHR system. Finally, by increasing the demand for health services, the ACA is challenging policy makers to reconsider scope-of-practice regulations and especially the roles of nurse practitioners and physician assistants. Intrator et al. (2015) report that the proportion of American nursing homes using any NPs or PAs increased from 20.4 percent in 2000 to 35.0 percent in 2010—a finding that has significant implications for health workforce planning in an aging society. We would like to thank AcademyHealth staff, particularly Andrea Fendt, for their assistance in enabling this special feature, as well as our own editorial staff and reviewers in expediting the review process for these manuscripts. Authors who would like to be considered for HSR’s Best of ARM publication in 2016 should consult the instructions provided with the 2016 ARM abstract solicitation from AcademyHealth. We hope that our readers find value in this journal feature and we look forward to future contributions. Patrick S. Romano Jacqueline S. Zinn
REFERENCES Adler-Milstein, J., J. Everson, and S. D. Lee. 2015. “Electronic Health Records Adoption and Hospital Performance: Time-Related Effects.” Health Services Research 50 (6 Pt 1): 1751–71. Golberstein, E., and G. Gonzales. 2015. “The Effects of Medicaid Eligibility on Mental Health Services and Out-of-Pocket Spending for Mental Health Services.” Health Services Research 50 (6 Pt 1): 1734–50. Intrator, O., E. A. Miller, E. Gadbois, J. K. Acquah, R. Makineni, and D. Tyler. 2015. “Trends in Nurse Practitioner and Physician Assistant Practice in Nursing Homes, 2000-2010.” Health Services Research 50 (6 Pt 1): 1772–86. Layton, T. J., and A. M. Ryan. 2015. “Higher Incentive Payments in Medicare Advantage’s Pay-for-Performance Program Did Not Improve Quality, But Did Increase Plan Offerings.” Health Services Research 50 (6 Pt 1): 1810–28. Wen, H., B. G. Druss, and J. R. Cummings. 2015. “Effect of Medicaid Expansions on Health Insurance Coverage & Access to Care among Low-Income Adults with Behavioral Health Conditions.” Health Services Research 50 (6 Pt 1): 1787–809.
S UPPORTING I NFORMATION Additional supporting information may be found in the online version of this article: Appendix SA1: Author Matrix.
