Medicaid Population Research Articles

A comparison study of solid tumor, malignant hematology, and general medicine inpatient services.

e13532 Background: One of the most important cancer centers in Ohio experienced an explosive growth in the number of inpatient admissions, with numerous inpatient services created between 2010 and 2022. In this abstract, we present how some financial and quality measures performed during this rapid expansion. Methods: Slicer-Dicer aggregate data was used to compare financial performance and quality measures of oncologic and general medicine inpatient (IP) services over time. General medicine services do not include the cancer and the heart disease populations, but there might be a small overlap. The cancer population is served by 9 IP oncology services. The following SlicerDicer Filters were used. Population: IP admissions. Slices: populations include these study groups, 10 inpatient medical oncology (solid tumors) (MO), 6 inpatient malignant hematology (MH) (including 1 bone marrow transplant) services were compared to 10 general medicine (GM) services. Gynecologic and central nervous system tumors are served by other services and were excluded. Measures: number of admissions, median and total payments (actual payment received), median and total expected reimbursement (reimbursement expected for DRG), mortality, readmission rates, average length of stay (LOS), percentage of patients with Medicaid, percentage of patients with Medicare. Dates: from 2011 to 2022 data. For some measures, quarterly data is presented rather than yearly data for graph simplicity. Results: The number of inpatient admissions grew by 90.77%, 130.55%, and 105.58% for GM, MO, and MH, respectively. The total expected reimbursement increased by 6.22%, 13.56% and decreased by 17.14% for GM, MO and MH, respectively. The total payment received grew by 314.29%, 283.69%, 86.80%, for MO, MH, and GM, respectively. MO, GM, and HM had a median payment increase of 76.51%, 51.96%, 20.74%, respectively. Mortality dropped for MO by 32.11%, from 76.9% to 52.2%, for MH by 49.46%, from 55.6% to 28.1% and in GM by 73.80% from 35.5 % to 9.3%. The average length of stay was 1 to 2 days longer in the MH and GM (respectively) compared to MO, with an increase from 2011 to 2022 for GM and MO, but a decrease for MH. Readmission rates decreased from 17.4% to 15.1% for MO, 12.7% to 10.3% for MH, and 14.9 to 12.5% for GM. In 2014, the percentage of Medicaid population increased in GM, and decreased in the oncology services (MO and MH) reaching 35% and 14% of the admitted patient population in 2022, respectively. Percentage of Medicare patients increased from 36.9% to 52.9%, 39.6% to 44.9%, and remained stable for MO, HM, and GM, respectively. Hospice discharge fluctuated between 1.2-1.6%, 2.5-5%, 8-12.9% of the discharged patients in GM, MH, and MO, respectively. Conclusions: In this abstract, we present a decade-trend data of important measures of inpatient oncology units.

Outcomes of medicaid patients undergoing TJA with previous positive urine toxicology screens.

Previous studies have demonstrated that patients with positive preoperative urine toxicology (utox) screens prior to total joint arthroplasty (TJA) have higher readmission rates, greater complication rates, and longer hospital stays compared to patients with negative screens. The aim of this study was to investigate the effect of postponing surgery for patients with positive preoperative utox in the Medicaid population. This retrospective, observational study reviewed the Medicaid ambulatory database at a large, academic orthopedic specialty hospital for patients with a utox screen prior to TJA from 2012 to 2020. Patients were categorized into three groups: (1) controls with negative preoperative utox or a utox consistent with prescription medications (Utox-) with TJA completed as scheduled; (2) positive preoperative utox with TJA rescheduled and surgery completed on a later date (R-utox+); (3) positive preoperative utox inconsistent with prescription medications with TJA completed as scheduled (S-utox+). Primary outcomes included mortality, 90-day readmission rate, complication rate, and length of stay. Of the 300 records reviewed, 185 did not meet inclusion criteria. The remaining 115 patients included 80 (69.6%) Utox-, 5 (6.3%) R-utox+, and 30 (37.5%) S-utox+. Mean follow-up time was 49.6months. Hospital stays trended longer in the Utox- group (3.7 ± 2.0days vs. 3.1 ± 1.6 S-utox+ vs.2.5 ± 0.4 R-utox+, p = 0.20). Compared to the R-utox+group, the S-utox+ group trended toward lower home discharge rates (p = 0.20), higher in-hospital complication rates (p = 0.85), and more all-cause 90-day emergency department visits (p = 0.57). There were no differences in postoperative opioid utilization between groups (p = 0.319). Duration of postoperative narcotic use trended toward being longer in the Utox- patients (820.7 ± 1073.8days vs. 684.6 ± 1491.8 S-utox+ vs. 585.1 ± 948.3 R-utox+, p = 0.585). Surgical time (p = 0.045) and revision rates (p = 0.72) trended toward being higher in the S-utox+ group. Medicaid patients with positive preoperative utox who had surgeries postponed trended towards shorter hospital stays and greater home discharge rates. Larger studies should be conducted to analyze the implications of a positive preoperative utox on risk profiles and outcomes following TJA in the Medicaid population. Study design Retrospective cohort study.

Inpatient prescribing patterns of long-acting injectables and their oral or short-acting injectable equivalent formulations.

Background: Long-acting injectable (LAI) antipsychotics (APs) each have an oral equivalent formulation, while aripiprazole, olanzapine, and ziprasidone each also have a short-acting injectable (SAI) equivalent formulation. Inpatient prescribing patterns of LAIs and their oral/SAI equivalents are less characterized in populations other than Medicaid, Medicare, and Veterans Affairs populations. Mapping out inpatient prescribing patterns remains an important first step to ensure appropriate use of antipsychotics during this critical juncture of patient care prior to discharge. This study determined inpatient prescribing patterns of first- (FGA) and second-generation antipsychotic (SGA) LAIs and their oral/SAI formulations. Methods: This was a large retrospective study using the Cerner Health Facts® database. Hospital admissions due to schizophrenia, schizoaffective disorder, or bipolar disorder from 2010 to 2016 were identified. AP utilization was defined as the proportion of inpatient stays during which at least 1 AP was administered to the total number of inpatient visits over the observed period. Descriptive analyses were used to determine prescribing patterns for APs. Chi-square tests were used to determine utilization differences across years. Results: 94,989 encounters were identified. Encounters during which oral/SAI of SGA LAIs were administered were most common (n = 38,621, 41%). Encounters during which FGA LAIs or SGA LAIs were administered were the least common (n = 1,047, 1.1%). Prescribing patterns differed across years (p < 0.05) within the SGA LAI subgroup analysis (N = 6,014). Paliperidone palmitate (63%, N = 3,799) and risperidone (31%, N = 1,859) were the most frequently administered. Paliperidone palmitate utilization increased from 30% to 72% (p < 0.001), while risperidone utilization decreased from 70% to 18% (p < 0.001). Conclusions: Compared with their oral or SAI formulations, LAIs were underutilized from 2010 to 2016. Among SGA LAIs, the prescribing patterns of paliperidone palmitate and risperidone changed significantly.

Reducing costs of referrals for non-neonatal circumcision in Florida Medicaid population

Florida Medicaid will only cover a non-neonatal circumcision if it meets the specified Medicaid medical indications or the patient is 3 years or older and has failed a 6-week trial of topical steroid therapy (TST). Referral of children who do not meet guideline criteria results in unnecessary costs. We sought to evaluate the cost savings if the initial evaluation and management were performed by the primary care provider (PCP) with referral to a pediatric urologist of only those males meeting the guidelines. An institutional review board-approved retrospective chart review of all male pediatric patients ≥3 years of age presenting for phimosis/circumcision from September 2016 to September 2019 at our institution was performed. Data extracted included (1) presence of phimosis, (2) presence of medical indication for circumcision on presentation, (3) circumcision performed without meeting criteria, (4) use of topical steroid therapy prior to referral. The population was stratified into 2 groups based on whether criteria were met at the time of referral. Those with a defined medical indication on presentation were excluded from cost analysis. Cost savings were based on costs incurred for PCP visit(s) versus initial referral to a urologist using estimated Medicaid reimbursement rates. Of the 763 males, 76.1% (581) did not meet Medicaid criteria for circumcision on presentation. Of these, 67 had a retractable foreskin with no medical indication, 514 had phimosis with no documented topical steroid therapy (TST) failure. A savings of $95,704.16 would have been incurred if the PCP initiated the evaluation and management and referred only those who met the criteria (Table 2). These savings would only be feasible if there were proper education of PCPs in the evaluation of phimosis and the role of TST. Limitations are assuming cost savings in the setting of well-educated pediatricians for clinical exam and believing they are aware of and comply with the guidelines. Education of PCPs on the role of TST in phimosis and current Medicaid guidelines may reduce unnecessary office visits, health care costs, and family burden. The most impactful method to reduce the cost of non-neonatal circumcision would be for states that do not currently cover neonatal circumcision to acknowledge affirmative policies from the American Academy of Pediatrics regarding circumcision and realize the cost savings associated with providing coverage for neonatal circumcision and reducing significantly the number of more expensive non-neonatal circumcisions.

Burden of Crohn’s Disease in the United States Medicaid Population, 2010–2019

Twenty-five percent of the United States population is enrolled in Medicaid. Rates of Crohn's disease (CD) have not been estimated in the Medicaid population since the Affordable Care Act expansion in 2014. We aimed to estimate the incidence and prevalence of CD by age, sex, and race. We identified all 2010-2019 Medicaid CD encounters using codes from the International Classification of Diseases, Clinical Modification versions 9 and 10. Individuals with ≥2 CD encounters were included. Sensitivity analyses were performed on other definitions (eg, ≥1 CD encounter). Incidence required ≥1 year of Medicaid eligibility prior to first CD encounter date (2013-2019). We calculated CD prevalence and incidence using the entire Medicaid population as the denominator. Rates were stratified by calendar year, age, sex, and race. Poisson regression models examined CD-associated demographic characteristics. We compared demographics and treatments of the entire Medicaid population with the multiple CD case definitions using percent and median. A total of 197,553 beneficiaries had ≥2 CD encounters. The CD point prevalence per 100,000 persons rose from 56 (2010) to 88 (2011) to 165 (2019). CD incidence per 100,000 person-years was 18 (2013) and 13 (2019). Higher incidence and prevalence rates correlated with female, white, or multiracial beneficiaries. Prevalence rates rose in later years. Incidence decreased over time. From 2010 to 2019, Medicaid population CD prevalence increased while incidence decreased from 2013 to 2019. Overall Medicaid CD incidence and prevalence ranges align with prior large administrative database studies.

Social Vulnerability and Initiation of Pharmacotherapy for Gestational Diabetes Mellitus in a Medicaid Population.

Our study examines the association between social vulnerability index (SVI) and pharmacotherapy initiation for gestational diabetes mellitus (GDM). We studied a retrospective cohort of pregnant patients with GDM, enrolled in Tennessee Medicaid, who gave birth between 2007 and 2019. Enrollment files were linked to birth and death certificates, state hospitalization registries, and pharmacy claims. SVI, measured at the community level and determined by residential census tract, ranged from 0 to 100 (low to high vulnerability). Multivariable logistic regression assessed the association between SVI and the odds of initiating the most common pharmacotherapies for GDM-insulin, glyburide, or metformin-and adjusted for relevant covariates. SVI was modeled with restricted cubic splines to account for nonlinear associations, using the median Tennessee SVI as a reference. Secondary analysis assessed associations with the SVI subthemes. Among 33,291 patients with GDM, 21.7% (7,209) initiated pharmacotherapy during pregnancy. Patients from areas with higher SVI were more likely to be non-Hispanic Black with higher body mass index, whereas those with lower SVI were more likely to be nulliparous. Multivariable modeling demonstrated a complex nonlinear association between SVI and GDM pharmacotherapy initiation, relative to the reference. Higher SVI was associated with elevated odds of GDM pharmacotherapy initiation (e.g., odds ratio 1.11 [95% confidence interval 1.02-1.22] for SVI 80) and low to medium SVI had variable nonsignificant associations with GDM pharmacotherapy initiation, relative to the reference (lower odds of initiation for values 25-50, higher odds of initiation for values<25). Secondary analysis demonstrated a nonlinear association between subtheme 3 and the odds of GDM pharmacotherapy initiation. Social vulnerability is associated with initiation of pharmacotherapy for GDM, highlighting the possible role of social determinants of health in achieving glycemic control.

The Burden of Neuropsychiatric Disorders in Medicaid Patients Living With HIV-1 Treated With Integrase Inhibitor or Protease Inhibitor Antiretroviral Therapies.

Objective: Data are scarce regarding the incidence of neuropsychiatric events (NPEs) in people living with human immunodeficiency virus (HIV)-1 taking integrase inhibitor (INI)- or protease inhibitor (PI)-based regimens. This study evaluated the prevalence, incidence, and economic burden of NPEs among people living with HIV-1 who were newly treated with INI- or PI-based regimens in a Medicaid population.Methods: A retrospective cohort study was conducted using administrative claims from the IBM MarketScan Multi-State Medicaid Database (January 1, 2014-December 31, 2018). Treatment-naive and treatment-experienced adults with HIV-1 newly treated with an INI- or PI-based regimen were included. Outcomes included NPE prevalence during the 12-month baseline period, prevalence of existing and incidence of new-onset NPEs during the 6-month post-index period, and total all-cause and NPE-related costs between treatment cohorts. Baseline characteristics between the 2 cohorts were balanced using inverse probability treatment weighting.Results: In the INI (n = 3,929) and PI (n = 3,916) cohorts, mean (SD) ages were 44.87 (12.81) and 44.36 (11.85) years, and 41.7% and 41.3% were female, respectively. High proportions of patients in both cohorts had NPEs during the 12-month baseline period. Among patients with no baseline NPEs, adjusted NPE incident rate ratios (95% CIs) during the post-index period were as follows: any, 1.15 (1.00-1.33); chronic, 1.18 (0.98-1.42); and acute, 1.16 (0.96-1.39). Mean all-cause and NPE-related costs were similar between cohorts.Conclusions: In this study of the Medicaid population, the prevalence and incidence of NPEs, as well as health care costs, were similar among people living with HIV-1 newly treated with an INI- or PI-based regimen.

MP12-15 DISPARITIES IN PROSTATE CANCER SCREENING AND DIAGNOSIS AMONG PATIENTS WITH MEDICAID

You have accessJournal of UrologyCME1 Apr 2023MP12-15 DISPARITIES IN PROSTATE CANCER SCREENING AND DIAGNOSIS AMONG PATIENTS WITH MEDICAID Henry Gold, Andrew Stevens, Tasha Posid, Dairon Denis-Diaz, Hafsa Asif, Aliza Khuhro, and Shawn Dason Henry GoldHenry Gold More articles by this author , Andrew StevensAndrew Stevens More articles by this author , Tasha PosidTasha Posid More articles by this author , Dairon Denis-DiazDairon Denis-Diaz More articles by this author , Hafsa AsifHafsa Asif More articles by this author , Aliza KhuhroAliza Khuhro More articles by this author , and Shawn DasonShawn Dason More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003227.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Medicaid patients with prostate cancer are four times more likely to present with metastatic disease and twice as likely to die of their cancer compared to patients with private insurance. Medicaid participation is related to other factors that limit healthcare access, including socioeconomic status (18,000/year individual income limit in Ohio) and race (48% of Medicaid enrollees are black in our county vs. 24% of population). We hypothesize that adverse prostate cancer outcomes in the Medicaid population relate to limited access to both PSA screening and evaluation of abnormal results. We reviewed our institutional triage process for patients referred for an abnormal prostate cancer screen with the goal of ensuring equitable intake processes based on payor status. METHODS: This is a retrospective study of patients who presented to our institution with an elevated PSA or an abnormal prostate exam from 2012-2021. Initial data on demographics, payor status, time to first appointment, screening history, and diagnostic testing are reported. Statistical analysis was performed with SPSS (IBM Inc.). Means were compared with the student’s t-test and logistic regression was used for correlative analysis with two-tailed p values <0.05 considered significant. RESULTS: Our initial analysis cohort included 149 patients who were predominantly Caucasian (58.0%) and had a mean age of 67.5 years (SD=9.11). Mean income based on home address zip code was $83,726 (SD=$30,488) and patients had a mean of 2.91 (SD=1.2) prior PSAs. We had a much lower proportion of patients with Medicaid status (6.7%) than expected based on our overall departmental payor mix and the size of the Medicaid population in our catchment area. Patients with Medicaid were almost 10 times more likely to not show up to their first appointment than those with other insurance types (p=0.014). Medicaid patients were also less likely to receive a biopsy (p=0.07) and had a lower number of PSA tests prior to referral (p=0.08). A zip code with lower mean income negatively predicted receipt of MRI prior to a biopsy (p=0.02). Times between referral, scheduling, and appointment were not impacted by payor status or zip code. CONCLUSIONS: Our data confirm disparities in several factors in our prostate cancer screening referrals known to relate to prostate cancer outcomes. To address this, we are implementing a Medicaid-focused program at our institution to improve on “No-show” rates and optimize guideline concordant care. Outreach to primary care providers with a large Medicaid patient population is also critical in promoting equity in PSA screening. Source of Funding: Ohio State University Patient Care Innovation Award © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e139 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Henry Gold More articles by this author Andrew Stevens More articles by this author Tasha Posid More articles by this author Dairon Denis-Diaz More articles by this author Hafsa Asif More articles by this author Aliza Khuhro More articles by this author Shawn Dason More articles by this author Expand All Advertisement PDF downloadLoading ...

Tobacco use in Crohn's disease patients and association with disease outcomes in the United States Medicaid population, 2010-2019.

To identify demographic factors associated with tobacco use in Crohn's disease (CD) patients in the US Medicaid population and examine how tobacco use affects disease outcomes. We included Medicaid-eligible patients who had ≥1 ICD code for CD, and 1 year of eligibility before and after the initial encounter. We used ICD codes to identify tobacco use with respect to the time of diagnosis and used logistic regression to identify the association between age, sex, and race with tobacco use at any point before diagnosis and after diagnosis, and determine the association of tobacco use before and after diagnosis on disease outcomes. We identified 98 176 eligible patients; 74.5% had no documented use of tobacco and 25.5% used tobacco at some point; 21.1% had used tobacco before their CD diagnosis and 11.8% had used tobacco after diagnosis. The population that used tobacco had a higher proportion of women, those who were White, non-Hispanic, and those in their middle ages (21-60) than the group that did not use tobacco. Tobacco use before diagnosis resulted in higher risk of hospitalization and surgery (OR: 1.85 and 1.36, respectively). Within the CD Medicaid population, tobacco use is more common in women than men, which differs from the general population, which is possibly a result of using diagnostic codes rather than survey data. Smoking cessation efforts should especially be directed at younger people who are at risk for CD, due to increased risk for more adverse outcomes among those who use tobacco before diagnosis.

More Than Words? How Highlighting Target Populations Affects Public Opinion about the Medicaid Program.

The Medicaid program provides health insurance coverage to a diverse set of demographics. We know little about how the policy community describes these populations (e.g., on Medicaid-related websites or in public opinion polls and policy writings) or whether and how these descriptions may affect perceptions of the program, its beneficiaries, and potential policy changes. To investigate this issue, we developed and fielded a nationally representative survey of 2,680 Americans that included an experiment for priming respondents by highlighting different combinations of target populations of the Medicaid program as found in the Medicaid policy discourse. Overall, we find that Americans view Medicaid and its beneficiaries rather favorably. However, there are marked differences based on partisanship and racial animosity. Emphasizing citizenship and residency requirements at times improved these perceptions. Racial perceptions and partisanship are important correlates in Americans' views about Medicaid and its beneficiaries. However, perceptions are not immutable. In general, the policy community should shift toward using more comprehensive descriptions of the Medicaid population that go beyond the focus on low income and that include citizenship and residency requirements. Future research should expand this work by studying descriptions in the broader public discourse.

All Children Deserve to Be Safe, Mothers Too: Evidence and Rationale Supporting Continuous Glucose Monitoring Use in Gestational Diabetes Within the Medicaid Population.

Gestational diabetes mellitus (GDM) is a common metabolic disease of pregnancy that threatens the health of several million women and their offspring. The highest prevalence of GDM is seen in women of low socioeconomic status. Women with GDM are at increased risk of adverse maternal outcomes, including increased rates of Cesarean section delivery, preeclampsia, perineal tears, and postpartum hemorrhage. However, of even greater concern is the increased risk to the fetus and long-term health of the child due to elevated glycemia during pregnancy. Although the use of continuous glucose monitoring (CGM) has been shown to reduce the incidence of maternal and fetal complications in pregnant women with type 1 diabetes and type 2 diabetes, most state Medicaid programs do not cover CGM for women with GDM. This article reviews current statistics relevant to the incidence and costs of GDM among Medicaid beneficiaries, summarizes key findings from pregnancy studies using CGM, and presents a rationale for expanding and standardizing CGM coverage for GDM within state Medicaid populations.

The Influence of Social Determinants on Cancer Screening in a Medicaid Sample

Little attention has been paid to the influence of individually measured social determinants of health on cancer screening tests in the Medicaid population. Analysis was conducted on 2015-2020 claims data from a subgroup of Medicaid enrollees from the District of Columbia Medicaid Cohort Study (N=8,943) who were eligible for colorectal (n=2,131), breast (n=1,156), and cervical cancer (n= 5,068) screening. Participants were grouped into four distinct social determinants of health groups on the basis of their responses to social determinants of health questionnaire. This study estimated the influence of the four social determinants of health groups on the receipt of each screening test using log-binomial regression adjusted for demographics, illness severity, and neighborhood-level deprivation. The receipt of cancer screening tests was 42%, 58%, and 66% for colorectal, cervical, and breast cancer, respectively. Those in the most disadvantaged social determinants of health group were less likely to receive a colonoscopy/sigmoidoscopy than those in the least disadvantaged one (adjusted RR=0.70, 95% CI=0.54, 0.92). The pattern for mammograms and Pap smears was similar (adjusted RR=0.94, 95% CI=0.80, 1.11 and adjusted RR=0.90, 95% CI=0.81, 1.00, respectively). In contrast, participants in the most disadvantaged social determinants of health group were more likely to receive fecal occult blood test than those in the least disadvantaged one (adjusted RR=1.52, 95% CI=1.09, 2.12). Severe social determinants of health measured at the individual level are associated with lower cancer preventive screening. A targeted approach that addresses the social and economic adversities that affect cancer screening could result in higher preventive screening rates in this Medicaid population.

Quality of Opioid Use Disorder Treatment for Persons With and Without Disabling Conditions

Adverse outcomes associated with opioid use disorder (OUD) are disproportionately high among people with disabilities (PWD) compared with those without disability. A gap remains in understanding the quality of OUD treatment for people with physical, sensory, cognitive, and developmental disabilities, specifically regarding medications for OUD (MOUD), a foundation of treatment. To examine the use and quality of OUD treatment in adults with diagnosed disabling conditions, compared with adults without these diagnoses. This case-control study used Washington State Medicaid data from 2016 to 2019 (for use) and 2017 to 2018 (for continuity). Data were obtained for outpatient, residential, and inpatient settings with Medicaid claims. Participants included Washington State full-benefit Medicaid enrollees aged 18 to 64 years, continuously eligible for 12 months, with OUD during the study years and not enrolled in Medicare. Data analysis was performed from January to September 2022. Disability status, including physical (spinal cord injury or mobility impairment), sensory (visual or hearing impairments), developmental (intellectual or developmental disability or autism), and cognitive (traumatic brain injury) disabilities. The main outcomes were National Quality Forum-endorsed quality measures: (1) use of MOUD (buprenorphine, methadone, or naltrexone) during each study year and (2) 6-month continuity of treatment (for those taking MOUD). A total of 84 728 Washington Medicaid enrollees had claims evidence of OUD, representing 159 591 person-years (84 762 person-years [53.1%] for female participants, 116 145 person-years [72.8%] for non-Hispanic White participants, and 100 970 person-years [63.3%] for participants aged 18-39 years); 15.5% of the population (24 743 person-years) had evidence of a physical, sensory, developmental, or cognitive disability. PWD were 40% less likely than those without a disability to receive any MOUD (adjusted odds ratio [AOR], 0.60; 95% CI, 0.58-0.61; P < .001). This was true for each disability type, with variations. Individuals with a developmental disability were least likely to use MOUD (AOR, 0.50; 95% CI, 0.46-0.55; P < .001). Of those using MOUD, PWD were 13% less likely than people without disability to continue MOUD for 6 months (adjusted OR, 0.87; 95% CI, 0.82-0.93; P < .001). In this case-control study of a Medicaid population, treatment differences were found between PWD and people without these disabilities; these differences cannot be explained clinically and highlight inequities in treatment. Policies and interventions to increase MOUD access are critical to reducing morbidity and mortality among PWD. Potential solutions include improved enforcement of the Americans with Disabilities Act, workforce best practice training, and addressing stigma, accessibility, and the need for accommodations to improve OUD treatment for PWD.

The Association of Socioeconomic Vulnerability and Race and Ethnicity With Disease Burden Among Children in a Statewide Medicaid Population.

Individuals enrolled in Medicaid have disproportionately worse health outcomes due to challenges related to Social Determinants of Health. We aim to examine the prevalence of 3 childhood conditions (asthma, type 2 diabetes, and attention deficit hyperactivity disorder [ADHD]) in children within the Texas Medicaid system. In order to recognize the layers of vulnerability, we examine prevalence at the intersection of socioeconomic status with race and ethnicity within this economically challenged population. Children ages 0 to 17 were identified from claims and encounter data for all children enrolled in Texas Medicaid in 2017 for at least 6 months. All children were placed into one of 5 quintiles based on their census tract socioeconomic vulnerability. The Rate Ratio statistical test was employed to identify the statistical significance of the disparity in health outcomes related to higher neighborhood vulnerability within each racial or ethnic group. Asthma for each race and ethnicity group was significantly more prevalent in the higher vulnerability census tracts. Increased vulnerability related to significant increase in type 2 diabetes for Hispanic children, but not for other groups. Diagnosed ADHD prevalence was significantly higher in less vulnerable non-Hispanic white children compared to more vulnerable. This study found that even among children who receive Medicaid and are thus economically disadvantaged, socioeconomic vulnerability applies an additional burden within racial and ethnic groups to produce disparities in health-related burden. However, the trend of the relationship varied by race and ethnicity group and health condition.

Data Challenges in Identifying Patients Due for Colorectal Cancer Screening in Rural Clinics.

Colorectal cancer (CRC) incidence and mortality are disproportionately high among rural residents despite the availability of effective screening methods. Outreach activities can improve CRC screening rates but rely on accurate identification of patients due for screening. We report on data challenges in rural clinics and Medicaid health plans in Oregon in identifying patients eligible for CRC screening, in a large project implementing mailed fecal immunochemical tests (FIT) and patient navigation. We analyzed data from clinic intake surveys and administrative claims. Clinics were asked to identify total population numbers relevant to CRC screening and follow-up. Health plans also identified enrollees eligible for CRC screening in Spring, 2021. Clinic staff validated patient lists for eligibility using their electronic health records (EHR). EHR features varied across the 29 participating and 28 responding clinics. Among the 28 responding clinics, 21 were able to report their Medicaid population (75%), 19 reported the number of patients aged 50 to 75 (68%) and the number screened for CRC in the last year (68%). Only 8 (29%) were able to report screening details such as number screened by FIT and 9 were able to report on patients with an abnormal FIT or colonoscopy completed after FIT (32%). Health plans had challenges properly identifying where enrollees received care and had missing data for race and ethnicity (range 22 to 34% unknown race, <1% to 24% unknown ethnicity). Most participating rural primary care clinics and Medicaid health plans experienced challenges identifying the population due for a CRC screening outreach program. Better EHR functionality and data reporting capabilities could help rural clinics apply population-based strategies and ultimately attenuate disparities in cancer screening and follow-up.

Does Medicaid cover artificial urinary sphincter and male urethral sling surgery?-a state-by-state analysis.

Information regarding the Medicaid coverage of artificial urinary sphincter (AUS) and male suburethral slings (MS) placement in the United States (US) is not readily available. In this manuscript, we seek to elucidate the state-by-state Medicaid coverage of these two procedures in the US. State Medicaid websites were utilized to access publicly available physician fee schedules for the calendar year 2020. Fee schedules were searched for current procedural terminology (CPT) codes. CPT codes representing insertion of tandem cuff, insertion of AUS, removal of AUS, removal and replacement AUS, sling operation for correction of male stress urinary incontinence (SUI), and removal or revision of sling for male SUI were utilized. Data were recorded by the procedure for each device, including the coverage status and physician fees. Of the 50 US states analyzed, 49 publish publicly accessible physician fee schedules. All 49 of these states reported coverage for removal with and without revision of the AUS, and 48 states reported coverage for insertion of an AUS, and insertion of a tandem cuff. The median reimbursement for each AUS related procedure was $624.00 ($181.84-$10,960.90) for tandem cuff, $665.54 ($199.89-$11,949.86) for AUS insertion, $528.03 ($146.90-$1,893.12) for AUS removal, and $630.29 ($208.55-$11,586.74) for AUS revision. All 49 states reported coverage for placement of MS, and 48 states reported coverage for removal or revision of MS. The median reimbursement was $652.57 ($198.00-$5,237.35) for MS placement and $554.47 ($104.27-$2,288.93) for MS revision. AUS and MS procedures in the Medicaid population are covered by nearly all states. Therefore, surgical treatment of SUI may be offered to Medicaid patients in most states without reimbursement concerns.

Trends and Patterns of Social History Data Collection Within an Electronic Health Record.

There is increased acceptance that social and behavioral determinants of health (SBDH) impact health outcomes, but electronic health records (EHRs) are not always set up to capture the full range of SBDH variables in a systematic manner. The purpose of this study was to explore rates and trends of social history (SH) data collection-1 element of SBDH-in a structured portion of an EHR within a large academic integrated delivery system. EHR data for individuals with at least 1 visit in 2017 were included in this study. Completeness rates were calculated for how often SBDH variable was assessed and documented. Logistic regressions identified factors associated with assessment rates for each variable. A total of 44,166 study patients had at least 1 SH variable present. Tobacco use and alcohol use were the most frequently captured SH variables. Black individuals were more likely to have their alcohol use assessed (odds ratio [OR] 1.21) compared with White individuals, whereas White individuals were more likely to have their "smokeless tobacco use" assessed (OR 0.92). There were also differences between insurance types. Drug use was more likely to be assessed in the Medicaid population for individuals who were single (OR 0.95) compared with the commercial population (OR 1.05). SH variable assessment is inconsistent, which makes use of EHR data difficult to gain better understanding of the impact of SBDH on health outcomes. Standards and guidelines on how and why to collect SBDH information within the EHR are needed.

Centralization of Initial Care and Improved Survival of Poor Patients With Breast Cancer.

Poor women with breast cancer have worse survival than others, and are more likely to undergo surgery in low-volume facilities. We leveraged a natural experiment to study the effectiveness of a policy intervention undertaken by New York (NY) state in 2009 that precluded payment for breast cancer surgery for NY Medicaid beneficiaries treated in facilities performing fewer than 30 breast cancer surgeries annually. We identified 37,822 women with stage I-III breast cancer during 2004-2008 or 2010-2013 and linked them to NY hospital discharge data. A multivariable difference-in-differences approach compared mortality of Medicaid insured patients with that of commercially or otherwise insured patients unaffected by the policy. Women treated during the postpolicy years had slightly lower 5-year overall mortality than those treated prepolicy; the survival gain was significantly larger for Medicaid patients (P = .018). Women enrolled in Medicaid had a greater reduction than others in breast cancer-specific mortality (P = .005), but no greater reduction in other causes of death (P = .50). Adjusted breast cancer mortality among women covered by Medicaid declined from 6.6% to 4.5% postpolicy, while breast cancer mortality among other women fell from 3.9% to 3.8%. A similar effect was not observed among New Jersey Medicaid patients with breast cancer treated during the same years. A statewide centralization policy discouraging initial care for breast cancer in low-volume facilities was associated with better survival for the Medicaid population targeted. Given these impressive results and those from prior research, other policymakers should consider adopting comparable policies to improve breast cancer outcomes.[Media: see text].

Race, Insurance, and Sex-Based Disparities in Access to High-Volume Centers for Pancreatectomy

BackgroundWith a large body of literature demonstrating positive volume-outcome relationships for most major operations, minimum volume requirements have been suggested for concentration of cases to high-volume centers (HVCs). However, data are limited regarding disparities in access to these hospitals for pancreatectomy patients.MethodsThe 2005–2018 National Inpatient Sample (NIS) was queried for all elective adult hospitalizations for pancreatectomy. Hospitals performing more than 20 annual cases were classified as HVCs. Mixed-multivariable regression models were developed to characterize the impact of demographic factors and case volume on outcomes of interest.ResultsOf an estimated 127,527 hospitalizations, 79.8% occurred at HVCs. Patients at these centers were more frequently white (79.0 vs 70.8%; p < 0.001), privately insured (39.4 vs 34.2%; p < 0.001), and within the highest income quartile (30.5 vs 25.0%; p < 0.001). Adjusted analysis showed that operations performed at HVCs were associated with reduced odds of in-hospital mortality (adjusted odds ratio [AOR], 0.43; 95% confidence interval [CI], 0.34–0.55), increased odds of discharge to home (AOR, 1.17; 95% CI, 1.04–1.30), shorter hospital stay (β, −0.81 days; 95% CI, −1.2 to −0.40 days), but similar costs. Patients who were female (AOR, 0.88; 95% CI, 0.79–0.98), non-white (black: AOR, 0.66; 95% CI, 0.59–0.75; Hispanic: AOR, 0.56; 95% CI, 0.47–0.66; reference, white), insured by Medicaid (AOR, 0.63; 95% CI, 0.56–0.72; reference, private), and within the lowest income quartile (AOR, 0.73; 95% CI, 0.59–0.90; reference, highest) had decreased odds of treatment at an HVC.ConclusionsFor those undergoing pancreatectomies, HVCs realize superior clinical outcomes but treat lower proportions of female, non-white, and Medicaid populations. These findings may have implications for improving access to high-quality centers.

Implementing Change Using Best Practice Program Design Principles

Nico P. Pronk, Ph.D., FACSM, FAWHP,is president of the HealthPartners Institute and chief science officer at HealthPartners in Minneapolis, MN. Dr. Pronk is an affiliate full professor of Health Policy and Management at the University of Minnesota School of Public Health and a visiting scientist at the Harvard University T.H. Chan School of Public Health. He is a past president of the International Association for Worksite Health Promotion (IAWHP), coauthor of the IAWHP Online Certificate Course, editor of ACSM's Worksite Health Handbook, 2nd edition, and associate editor for ACSM's Health & Fitness Journal®. Joel B. Spoonheim, MUP,is the senior director of Worksite Health & Population Well-Being for HealthPartners. As part of an integrated health plan and care delivery system, the department delivers in-person care, virtual care, and well-being improvement solutions in new ways to make health care simpler and more affordable. Joel's teams serve customers ranging from small to Fortune 500 employers, individual consumers, Medicare and Medicaid populations, and individual patients. DisclosureThe authors declare no conflict of interest and do not have any financial disclosures.