Relationship Between State Policies Targeting Unethical Treatment Practices and Opioid-Related Outcomes: An Event Study Analysis.

Objectives: To estimate the effect of the passage of state laws targeting patient brokering on opioid-related outcomes.

Background: In response to growing awareness of unethical substance use disorder (SUD) treatment practices, several states in the United States have passed laws targeting patient brokering and deceptive marketing. Patient brokering and deceptive marketing laws are intended to reduce the chances individuals with SUD interact with bad actors or suffer from adverse outcomes related to inappropriate SUD treatment, but the effectiveness of these laws is unknown.

Payment Source Shift for Surgical Care Among Veterans Enrolled in Medicare Advantage Plans.

Importance: There is growing concern that Medicare Advantage (MA) plans are shifting the costs of care to the Veterans Health Administration (VHA) for veterans dually enrolled in both systems, particularly in high-veteran MA plans that disproportionately enroll veterans. However, empirical evidence evaluating the sources of payment for veterans' surgical care is lacking.

Objective: To evaluate differences in payment sources for surgical care between high-veteran MA plans and other MA plans.

Home- and Community-Based Service Use Among Veterans: The National Landscape.

Background: The Veteran population is aging rapidly, with already higher rates of disability compared to non-Veteran peers. Consequently, demand for home- and community-based long-term services and supports (HCBS) is increasing. Understanding who needs and uses HCBS is particularly important in the Veterans Health Administration (VHA)-a payer for HCBS.

Accuracy of Medicare Information Provided by State Health Insurance Assistance Programs.

Importance: Medicare beneficiaries, particularly those dually eligible for Medicaid, must navigate complex coverage options. The State Health Insurance Assistance Program (SHIP) provides counseling on Medicare options, but little is known about the quality of counseling sessions.

Objective: To characterize experiences connecting to SHIP counselors, and to characterize the accuracy and completeness of information provided by counselors in response to questions about Medicare coverage options.

Characteristics and Benefit Design of Veteran Medicare Advantage Affinity Plans.

Importance: Recently, there has been an emergence of veteran Medicare Advantage affinity plans (VMAPs) marketing to veterans, including those dually covered by the Veterans Health Administration (VHA). To date, limited evidence exists characterizing what benefits VMAPs offer and their veteran enrollees.

Objective: To examine plan-level differences between VMAPs and other Medicare Advantage (MA) plans and characteristics of their veteran enrollees.

Physician Tenure and Clinical Productivity for Internal and External Hires: A Retrospective Cohort Study.

Background: New employees generally demonstrate lower productivity than experienced colleagues in non-healthcare sectors, but there is limited evidence on how tenure affects physician productivity.

Objective: To evaluate the association between tenure and clinical productivity for attending physicians in the Veterans Health Administration (VHA) and explore whether this relationship differs by prior VHA residency or fellowship training.

Design: Retrospective cohort evaluation.

Veterans May Be Seeing Lower-Quality Clinicians In The VHA Community Care Network.

With the rapid expansion of veterans' access to community care under the Veterans Affairs Maintaining Internal Systems and Strengthening Integrated Outside Networks (VA MISSION) Act of 2018, ensuring that veterans receive high-quality community care has become a national priority. Using Veterans Health Administration (VHA) data and Medicare performance scores, we assessed how clinicians' performance on quality measures differed between those who treated veterans within the VHA Community Care Network and those who did not. We found that in 2022, 66.

State-level actions targeting unethical substance use disorder treatment practices: A qualitative study.

Introduction: There has been increasing recognition of unethical practices occurring in substance use disorder (SUD) treatment, such as patient brokering and deceptive marketing. We conducted a qualitative study with key informants to characterize state actions that have been undertaken to target unethical practices and the context surrounding state-level actions, including barriers and facilitators to their implementation.

Methods: We recruited key informants at the state-level, as well as those from national organizations engaged in improving SUD treatment quality, who could provide perspectives on the scope of unethical practices in the field and ways in which states have sought to prevent unethical practices and improve the quality of SUD treatment.

Medicare Advantage Plans With High Numbers Of Veterans: Enrollment, Utilization, And Potential Wasteful Spending.

Medicare Advantage (MA) plans are increasingly enrolling veterans. Because MA plans receive full capitated payments regardless of whether or not veterans use Medicare services, the federal government can incur substantial duplicative, wasteful spending if veterans in MA plans predominantly seek care through the Veterans Health Administration (VHA) system. The recent growth of MA plans that disproportionately enroll veterans could further exacerbate such wasteful spending.

State Policies Targeting Patient Brokering and Deceptive Marketing of Substance Use Disorder Treatment.

Objectives: To characterize state laws targeting patient brokering and deceptive marketing of substance use disorder (SUD) treatment.

Background: Patient brokering and deceptive marketing of SUD treatment leads to poor outcomes for individuals with SUD, including relapse- or overdose-related hospitalizations, ED visits, or death. In response, several states within the United States have passed laws targeting unethical practices of SUD treatment in recent years.

Medical training program size and clinical staff productivity and turnover.

Objective: The objective of this analysis was to evaluate the effect of resident program training size on clinician productivity and turnover in the Veterans Health Administration (VHA), the largest education and training platform for medical professionals in the United States.

Data Sources: We retrieved administrative data on training programs and training facilities from the VA Office of Academic Affiliations and the VHA Corporate Data Warehouse. Data on primary care physician shortage areas were retrieved from the Health Resources and Services Administration.

No Association Between Medicare Advantage Providers' Network Restrictiveness and Star Rating Between 2013 and 2017: An Observational Study.

Background: Medicare beneficiaries are increasingly enrolling in Medicare Advantage (MA), which employs a wide range of practices around restriction of the networks of providers that beneficiaries visit. Though Medicare beneficiaries highly value provider choice, it is unknown whether the MA contract quality metrics which beneficiaries use to inform their contract selection capture the restrictiveness of contracts' provider networks.

Objective: We evaluated whether there are meaningful associations between provider network restrictiveness (across primary care, psychiatry, and endocrinology providers) and contracts' overall star quality rating, as well as between network restrictiveness and contracts' performance on access to care measures from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey.

Access to insurance navigation support through the State Health Insurance Assistance Program (SHIP).

Medicare enrollment is complex, particularly for low-income individuals who are dually eligible for Medicare and Medicaid, and the wrong plan choice can adversely impact beneficiaries' out-of-pocket costs and access to providers and medications. The State Health Insurance Assistance Program (SHIP) is a federal program that provides counseling on Medicare coverage, but the degree to which SHIP services are accessible to low-income beneficiaries is unknown. We interviewed SHIP counselors and coordinators to characterize factors affecting access to and quality of SHIP services for low-income beneficiaries.

The effects of the Veterans Health Administration's Referral Coordination Initiative on referral patterns and waiting times for specialty care.

Objective: To investigate whether the Veterans Health Administration's (VA) 2019 Referral Coordination Initiative (RCI) was associated with changes in the proportion of VA specialty referrals completed by community-based care (CC) providers and mean appointment waiting times for VA and CC providers.

Data Sources/study Settings: Monthly facility level VA data for 3,097,366 specialty care referrals for eight high-volume specialties (cardiology, dermatology, gastroenterology, neurology, ophthalmology, orthopedics, physical therapy, and podiatry) from October 1, 2019 to May 30, 2022.

Study Design: We employed a staggered difference-in-differences approach to evaluate RCI's effects on referral patterns and wait times.

Potential inequities in access to in-person SHIP counseling services.

Objectives: Counseling and education on Medicare coverage options are available through the federal State Health Insurance Assistance Program (SHIP), but little is known about the population that SHIP reaches.

Study Design: Cross-sectional study.

Methods: Using a novel data source on SHIP counseling site locations, we characterized the availability of in-person SHIP counseling by zip code tabulation area (ZCTA) and used linear regression and t tests to evaluate whether SHIP counseling sites are disproportionately located in higher-income communities.

Measuring restrictiveness of Medicare Advantage networks: A claims-based approach.

Objective: To develop and validate a measure of provider network restrictiveness in the Medicare Advantage (MA) population.

Data Sources: Prescription drug event data and beneficiary information for Part D enrollees from the Center for Medicare and Medicaid Services, along with prescriber identifiers; geographic variables from the Area Health Resources Files.

Study Design: A prediction model was used to predict the unique number of primary care providers that would have been seen by MA beneficiaries absent network restrictions.