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.

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.

Social Vulnerability Postincarceration: Analyzing Social Networks, Social Integration, and Loneliness Among Older Adults.

Background And Objectives: This study examines how past incarceration affects social relationships in older adults to explore the relationship between past incarceration and the quality and quantity of social relationships among older adults.

Research Design And Methods: Cross-sectional analysis of 13,023 Americans aged 50 and older from the Health and Retirement Study (HRS). Participants self-reported their history of incarceration.

Long-Term Care Services and Supports Needed for Successful Aging-in-Place: A Critical Review.

We summarize the state of the evidence on the long-term services and supports infrastructure to support aging-in-place. We find an extensive literature describing the importance of affordable medical and social services delivered in the home, support for family caregivers, and the role of technology for improving communication among patients, caregivers, and health care teams to support aging-in-place. We identify gaps in access to affordable services and an inadequate workforce prepared to support aging-in-place, raising concerns about meeting the future needs of our aging population.

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.

Health care access, utilization, and quality for children in English versus Spanish-speaking households.

This study examines healthcare disparities affecting children from Spanish-speaking households in the United States, focusing on the relationship between primary language spoken at home and access to care, utilization of health services, and quality of care. Using data from the 2021 National Survey of Children's Health, we analyzed responses from English- and Spanish-speaking families to understand potential language-driven gaps in healthcare. The findings reveal that children in Spanish-speaking households are more likely to lack insurance, lack a usual source of care, and to forgo needed medical attention compared with their English-speaking peers.

Growth of the Program of All-Inclusive Care for the Elderly and the role of for-profit programs.

The Program of All-Inclusive Care for the Elderly (PACE) is a managed care program financed by capitated government payments that primarily serves adults aged 55 or older requiring nursing home level of care who are dual-eligible for Medicare and Medicaid. While PACE programs have historically been nonprofit entities, in 2016, a regulation change allowed for-profit PACE programs to help expand the program. We describe PACE program growth from 2010 to 2022.

Severe Maternal Morbidity Among Pregnant People With Opioid Use Disorder Enrolled in Medicaid.

Importance: Pregnant people with opioid use disorder (OUD) are at high risk for potentially avoidable maternal morbidity. The majority of pregnant people with OUD receive health insurance through state Medicaid programs, but there is little comprehensive data on the burden of severe maternal morbidity (SMM)-a composite measure of adverse maternal health outcomes-among this high-risk group.

Objective: To estimate rates of SMM among Medicaid-enrolled pregnant people with OUD from 2016 to 2018.

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.

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.

Evaluation of Low-Value Services Across Major Medicare Advantage Insurers and Traditional Medicare.

Importance: Compared with traditional Medicare (TM), Medicare Advantage (MA) insurers have greater financial incentives to reduce the delivery of low-value services (LVS); however, there is limited evidence at a national level on the prevalence of LVS utilization among MA vs TM beneficiaries and whether LVS utilization rates vary among the largest MA insurers.

Objective: To determine whether there are differences in the rates of LVS delivered to Medicare beneficiaries enrolled in MA vs TM, overall and by the 7 largest MA insurers.

Design, Setting, And Participants: This cross-sectional study included Medicare beneficiaries aged 65 years and older residing in the US in 2018 with complete demographic information.

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.

Impact of Nurse Residency Program on Time-to-Fill Nurse Vacancies at the Veterans Health Administration.

Background: The Department of Veterans Affairs (VA) offers a 1-year Post-Baccalaureate-Registered Nurse Residency (PB-RNR) Program. The impact of the PB-RNR program on local RN recruitment was unknown.

Objectives: We aimed to evaluate the effect of the size of the PB-RNR program at a VA facility on its time-to-fill RN vacancies.

Pay-for-Performance Incentives for Home Dialysis Use and Kidney Transplant.

Importance: The Centers for Medicare & Medicaid Services' mandatory End-Stage Renal Disease Treatment Choices (ETC) model, launched on January 1, 2021, randomly assigned approximately 30% of US dialysis facilities and managing clinicians to financial incentives to increase the use of home dialysis and kidney transplant.

Objective: To assess the ETC's association with use of home dialysis and kidney transplant during the model's first 2 years and examine changes in these outcomes by race, ethnicity, and socioeconomic status.

Design, Setting, And Participants: This retrospective cross-sectional study used claims and enrollment data for traditional Medicare beneficiaries with kidney failure from 2017 to 2022 linked to same-period transplant data from the United Network for Organ Sharing.