Physician Services Research Articles

Testing for selection bias and moral hazard in private health insurance: Evidence from a mixed public-private health system.

Separating selection bias from moral hazard in private health insurance (PHI) markets has been a challenging task. We estimate selection bias and moral hazard in Australia's mixed public-private health system, where PHI premiums are community-rated rather than risk-rated. Using longitudinal cohort data, with fine-grained measures for medical services predominantly funded by PHI providers, we find consistent and robust estimates of advantageous selection among hospitalized cardiovascular disease (CVD) patients. Specifically, we show that in addition to their risk-averse attributes, CVD patients who purchase PHI use fewer services that are not covered by PHI providers (e.g., general practitioners and emergency departments) and have fewer comorbidities. Finally, unlike previous studies, we show that ex-post moral hazard exists in the use of specific "in-hospital" medical services such as specialist and physician services, miscellaneous diagnostic procedures, and therapeutic treatments. From the perspective of PHI providers, the annual cost of moral hazard translates to a lower bound estimate of $707 per patient, equivalent to a 3.03% reduction in their annual profits.

Understanding Gender Biases and Differences in Web-Based Reviews of Sanctioned Physicians Through a Machine Learning Approach: Mixed Methods Study

BackgroundPrevious studies have highlighted gender differences in web-based physician reviews; however, so far, no study has linked web-based ratings with quality of care.ObjectiveWe compared a consumer-generated measure of physician quality (web-based ratings) with a clinical quality outcome (sanctions for malpractice or improper behavior) to understand how patients’ perceptions and evaluations of physicians differ based on the physician’s gender.MethodsWe used data from a large web-based physician review website and the Federation of State Medical Boards. We implemented paragraph vector methods to identify words that are specific to and indicative of separate groups of physicians. Then, we enriched these findings by using the National Research Council Canada word-emotion association lexicon to assign emotional scores to reviews for different subpopulations according to gender, gender and sanction, and gender and rating.ResultsWe found statistically significant differences in the sentiment and emotion of reviews between male and female physicians. Numerical ratings are lower and sentiment in text reviews is more negative for women who will be sanctioned than for men who will be sanctioned; sanctioned male physicians are still associated with positive reviews.ConclusionsGiven the growing impact of web-based reviews on demand for physician services, understanding the different dynamics of reviews for male and female physicians is important for consumers and platform architects who may revisit their platform design.

Association between physician's case volume in prehospital advanced trauma care and 30-day mortality: A registry-based analysis of 4,032 patients.

Seriously injured patients may benefit from prehospital interventions provided by a critical care physician. The relationship between case volume and outcome has been established in trauma teams in hospitals, as well as in prehospital advanced airway management. In this study, we aimed to assess if a volume-outcome relationship exists in prehospital advanced trauma care. We performed a retrospective cohort study using the national helicopter emergency medical services database, including trauma patients escorted from scene to hospital by a helicopter emergency medical services physician during January 1, 2013, to August 31, 2019. In addition, similar cases during 2012 were used to determine case volumes. We performed a multivariate logistic regression analysis, with 30-day mortality as the outcome. Age, sex, Glasgow Coma Scale, shock index, mechanism of injury, time interval from alarm to the patient and duration of transport, level of receiving hospital, and physician's trauma case volume were used as covariates. On-scene times, interventions performed, and status at hospital arrival were assessed in patients who were grouped according to physician's case volume. In total, 4,032 escorted trauma patients were included in the study. The median age was 40.2 (22.9-59.3) years, and 3,032 (75.2%) were male. Within 30 days, 498 (13.2%) of these patients had died. In the highest case volume group, advanced interventions were performed more often, and patients were less often hypotensive at handover. Data for multivariate analysis were available for 3,167 (78.5%) of the patients. Higher case volume was independently associated with lower mortality (odds ratio, 0.59; 95% confidence interval, 0.38-0.89). When a prehospital physician's case volume is higher in high-risk prehospital trauma, this seems to be associated with more active practice patterns and significantly lower 30-day mortality. The quality of prehospital critical care could be increased by ensuring sufficient case volume for the providers of such care. Prognostic and Epidemiologic; Level III.

A column-generation-based approach for an integrated service planning and physician scheduling problem considering re-consultation

A column-generation-based approach for an integrated service planning and physician scheduling problem considering re-consultation

Goals, Expectations, and the Definition of Success for Neuromodulation for Pain According to Representatives of Neuromodulation Device Manufacturers.

Representatives of neuromodulation device manufacturers are expected to facilitate the relationship between patients and healthcare providers. Nevertheless, the goals, expectations, and definition of success for neuromodulation for pain have not yet been explored. Representatives present at the 2nd Joint Congress of the INS European Chapters in September 2021 completed a survey to ascertain their opinions about the goals to achieve with neuromodulation, the factors that they expect to change, and their definition of success for neuromodulation. In total, 39 representatives completed the survey. To provide excellent service for patients (22.4%), to become a trusted partner for physicians (21.5%), and to provide excellent service for physicians (20.7%) were the highest ranked goals. The most frequently reported factors that were expected to change were pain intensity (23.1%), patient satisfaction (19.7%), mobility/functioning (14.5%), and capacity to return to work (13.7%). Within the definitions of success, increased quality of life of the patient was stated in 21% of the definitions, closely followed by pain control (19.3%) and happiness/patient satisfaction (15.8%). The goals of representatives of neuromodulation device manufacturers seem to focus on ensuring a good relationship with physicians on the one hand and providing good service towards patients on the other hand, whereby pain control, quality of life, and patient satisfaction seem to be important for company representatives.

Rational medication management mode and its implementation effect for the elderly with multimorbidity: A prospective cohort study in China.

BackgroundAs one of the countries with the most serious degree of aging, the incidence of potentially inappropriate drug use among the elderly is as high as 30. 4% in Chinese communities, and the lack of effective medication management and poor medication compliance at home are the main factors. Given these situations, we constructed a Rational Medication Management Mode based on family physician service, carried out an empirical research and evaluated the implementation effect.MethodsA prospective cohort study was conducted from September to December 2021 to analyze the implementation effect of the Rational Medication Management Mode by comparing the outcome indicators between the intervention group and control group. The primary outcome of this study was medication number and polypharmacy (taking 5 or more medications) at 90 days. The secondary outcomes included the situation for behavioral self-management and knowledge-belief-behavior of rational medication use.ResultsA total of 618 elderly patients (309 in the intervention group and 309 in the control group) with multimorbidity were included in this study, those were all available at follow-up at 90 days. At 90 days, the number of medications was achieved by 3.88 (1.48), and patients with polypharmacy were reduced by 59.55% in the intervention group, having a significant difference compared with the control group (P < 0.001). Patients with medication reminders, intermittent medication and adverse drug reactions were achieved in 294 (95.15%), 47 (15.21%), and 51 (16.51%) respectively in the intervention group (P < 0.001). The knowledge, belief, behavior security and behavior compliance of rational medication use of elderly patients were all greatly improved in the intervention group at 90 days (P < 0.0001).ConclusionThe Rational Medication Management Mode based family physician service, which provides the support of manuals and pillboxes, can decrease the elderly patients' number of drugs with multimorbidity, reduce the incidence of polypharmacy, enhance behavioral self-management, increase the knowledge and belief of rational medication use, and improve the security and compliance of medication usage behavior. In order to provide a practical basis for rational medication management of elderly patients with multimorbidity under the background of long-term prescriptions in China.

Bone Stress Injuries And Associated Healthcare Utilization In Collegiate Student Athletes

Bone stress injuries (BSI) occur frequently in runners and females. However, their occurrence in other sports, time-lost (TL) status, and associated healthcare utilization is unclear. PURPOSE: To describe bone stress injuries and associated healthcare utilization in a population of collegiate student athletes. METHODS: A descriptive epidemiology design utilizing de-identified electronic medical records from all sponsoring institutions in one NCAA conference was used. Injury occurrences were collected from August 2017 - March 2020, representing 810 team-seasons (351 men’s and 459 women’s). Injuries were identified by onset (acute or overuse) and stratified as TL or non-time-loss (NTL). Lower extremity injury location and injury type were identified. Associated healthcare utilization, including athletic training services (ATS) provided, and injuries resulting in one or more physician encounters (PE), prescribed medication, diagnostic test, procedure, or surgery were determined. Mean BSI per team per season were calculated. RESULTS: A total of 501 BSI were captured, representing 2.5% of all injuries/illnesses in the time period (n = 20080). The majority (n = 341, 68.1%) were in women’s teams. Overuse-NTL BSI comprised 13.8% of the sample (n = 69). The foot was the most frequent location (n = 164, 68.3%). Women’s track and field (n = 106, 21.2%, 2.9) and women’s cross country (n = 86, 17.2%, 2.4) reported the highest occurrence of BSI by sport and highest occurrence per team per season. BSI necessitated 13907 ATS, and 462 BSI required PE, resulting in medications prescribed in 54, tests in 458, procedures in 8, and surgeries in 74 cases. Of ATS, 65% (n = 9056) were for overuse injuries, with women utilizing 77.7% (n = 7037) of them. CONCLUSIONS: Women experienced the majority of BSI, concentrated in running sports. Most BSI in men and women were designated as overuse and resulted in TL, but almost 14% were managed as overuse-NTL. BSI required substantial AT and physician services, and prevention may be possible with data-driven programs. This project was supported by the Pac-12 Conference’s Student-Athlete Health and Well-Being Initiative. The content of this abstract is solely the responsibility of the authors and does not necessarily represent the official views of the Pac-12 Conference, or its members.

Moving Forward: 2022 Committee on Professional Diversity's 2nd Virtual Doctors Back to School Program

Committee News| September 2022 Moving Forward: 2022 Committee on Professional Diversity's 2nd Virtual Doctors Back to School Program Christine Vo, MD; Christine Vo, MD Search for other works by this author on: This Site PubMed Google Scholar Odmara L. Barreto Chang, MD, PhD Odmara L. Barreto Chang, MD, PhD Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor September 2022, Vol. 86, 32–33. https://doi.org/10.1097/01.ASM.0000874272.69789.72 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Cite Icon Cite Get Permissions Search Site Citation Christine Vo, Odmara L. Barreto Chang; Moving Forward: 2022 Committee on Professional Diversity's 2nd Virtual Doctors Back to School Program. ASA Monitor 2022; 86:32–33 doi: https://doi.org/10.1097/01.ASM.0000874272.69789.72 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsASA Monitor Search Advanced Search Topics: continuing professional development, teachers June 7, 2022, marked the sixth time the ASA Committee on Professional Diversity (CPD) embarked on community outreach efforts inspired by the American Medical Association's (AMA's) Doctors Back to School™ Program (DBTS) (asamonitor.pub/3AFs5FH). Our primary goal was to reach out to kids from communities with minority populations who are underrepresented in medicine. By promoting interactions between students early in their academic pursuits and health care professionals with similar backgrounds, we hoped to bring to the forefront of their developing minds the message from our first virtual DBTS: “there is potential in you, and we are proof that you, too, can succeed and be part of our health profession” (ASA Monitor 2021;85:32). Why is it imperative for ASA to participate in health care pipeline efforts involving underrepresented minorities? AMA released data showing that “demand for physician services is projected to grow by 138,900 FTEs from 2019-2034... You do not currently have access to this content.

Summer 2022 Regulatory Affairs and Quality Measure Update

Quality & Regulatory| September 2022 Summer 2022 Regulatory Affairs and Quality Measure Update Matthew Goldan; Matthew Goldan Search for other works by this author on: This Site PubMed Google Scholar Claire Ostarello; Claire Ostarello Search for other works by this author on: This Site PubMed Google Scholar Matthew T. Popovich, PhD Matthew T. Popovich, PhD Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor September 2022, Vol. 86, 19–20. https://doi.org/10.1097/01.ASM.0000874232.52262.3f Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Cite Icon Cite Get Permissions Search Site Citation Matthew Goldan, Claire Ostarello, Matthew T. Popovich; Summer 2022 Regulatory Affairs and Quality Measure Update. ASA Monitor 2022; 86:19–20 doi: https://doi.org/10.1097/01.ASM.0000874232.52262.3f Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsASA Monitor Search Advanced Search Topics: quality indicators Summertime is an active season for ASA physicians and staff who review and respond to regulatory proposals. The ASA Department of Quality and Regulatory Affairs works with physician committees and leadership to ensure our member priorities are heard among federal regulators. Each year, the Centers for Medicare & Medicaid Services (CMS) releases its Inpatient Prospective Payment System (IPPS) proposed rule that sets forth yearly policy on Medicare Part A and hospital-level initiatives. This year, CMS included a broad range of proposals and requests for information (RFIs) on issues directly affecting ASA members, from the COVID-19 Public Health Emergency (PHE) to maternal health quality measures to climate change. In a letter to CMS, ASA took the opportunity to advocate strongly for physician-led anesthesia care while sharing the anesthesiologist's perspective in key issues in patient care and departmental administration. A significant focus of ASA's letter targeted the Anesthesia Services Physician Supervision Rule... You do not currently have access to this content.

Compensation Rates for Pediatric Otolaryngology Procedures Under the Medicare Physician Fee Schedule in 2021.

The Medicare Physician Fee Schedule (PFS) is the basis for physician reimbursement by public and private payers. The PFS values physician services according to the estimated time and intensity required to perform them; intensity reflects the summation of technical skill, cognitive load, and risk-related stress. The fee schedule uses relative value units (RVUs) as a metric that permits comparison across procedures. Recent debate has focused on whether the methods by which the Centers for Medicare & Medicaid Services (CMS) estimate procedural intensity are valid. We therefore sought to investigate current CMS estimates of intensity (RVUs/min) for surgical procedures performed by pediatric otolaryngologists. We performed a retrospective, cross-sectional analysis of fiscal year 2021 PFS valuations for pediatric otolaryngology key indicator procedures specified by the Accreditation Council for Graduate Medical Education. We additionally examined general otolaryngology procedures, including adenotonsillectomy and tympanostomy tube insertion. We utilized the 2021 Medicare PFS conversion factor of $34.89/RVU to convert intensity (wRVUs/min) to a compensation rate ($/min). Primary outcomes were: (1) total compensation rate and (2) intraservice (i.e., incision-to-closure) compensation rate for each studied procedure. Our study sample included 167 unique procedures. The mean (standard deviation) total compensation rate for all included procedures was $1.35/min ($0.29/min) and the mean intraservice rate was $1.71/min ($0.89/min). Intraservice compensation rates ranged from $-1.50/min (drainage of throat abscess) to $4.75/min (pediatric tracheostomy). Total and intraservice compensation rates under the Medicare PFS vary widely for surgical procedures performed by pediatric otolaryngologists. Further investigation is necessary to examine the validity of assumptions underlying these procedural intensity valuations. NA Laryngoscope, 133:1739-1744, 2023.

The same, only different: Using physician billing data from four provincial payment systems to describe family physician practice patterns in Canada.

ObjectivesIn Canada physician payment systems and associated billing data vary across provinces. We used linked billing data to develop comparable measures of family physician (FP) service volume, continuity, and comprehensiveness in each of four provinces, with the goal of describing changing patterns over time, relevant to workforce planning policy. ApproachWe accessed linked population and physician registry data, vital statistics, physician billing data, hospital and emergency department records, and (where available) laboratory and prescription drug records in four Canadian provinces from 1996/7 to 2017/8. We tracked changes in primary care physician service volume (patient visits), continuity, and comprehensiveness over two decades, and explored the impacts of career stage and graduation cohort on patterns observed. We also quantified changes in the volume of services that required FP coordination, review, administration, and/or follow-up, reporting changes in service volume per-capita, per community-based family physician and per physician visit. ResultsVisit volume and continuity per provider fell over time in the four provinces examined. Visits increased with years in practice until mid-to-late-career and declined into end-of-career. We found no relationship between graduation cohort and practice volume, continuity, or comprehensiveness of care. Over this time period, the number of FPs per-capita has grown, but the number in comprehensive, community-based practice has remained constant. While primary care visits have declined, the number of prescriptions, lab tests, emergency department visits, and specialist visits per capita have all increased. When expressed per community-based FP, and particularly per community-based FP patient visit, the increases in workload range from 36.1% for lab tests to 55.0% for ED follow-up. Increases in service volume are greatest among patients ages 80 and older, a rapidly-growing population segment. ConclusionLinked data capturing changes in practice patterns and workload suggest that even with an increasing per-capita supply of family physicians, additional resources will be needed to ensure all patients can access comprehensive primary care. Information on the various roles family physicians fill and demographic change will strengthen workforce planning.

Predicting Surgical Service Demands: A Modeling challenge using Administrative Data.

ObjectivePublicly funded healthcare delivery systems use projections to ensure the availability of adequate future service delivery. Planning cycles need to consider infrastructure, human resources, and other essential requirements with an adequate lead time. Projections are fraught with challenges due to multiple unknowns but new developments in modeling may be useful. ApproachWe explored the available data to determine the best approach to modeling surgical demand. The Manitoba Population Research Data Repository includes 90+ databases linkable at the person level over time. These include the population registry which includes all Manitobans registered for the universal healthcare benefit. Hospital discharge abstracts include over 20 relevant diagnoses (ICD10) and procedure codes for each admission. Medical services claims include all physician services provides with ICD 9CM codes. Fee-for-service physicians are paid based on these and alternate funded physicians are required to submit shadow claims. ResultsWe found 349,171 orthopedic procedures of which 18.1% were absent from the Medical claims files and 551,508 medical claims of which 27.5% lacked a corresponding hospital abstract. We also identified 230,717 ophthalmologic procedures in the hospital data of which 2.5% had no corresponding medical claim; of the 648,826 medical claims 66.2% had no matching hospital abstract. Resource requirements of procedures are reflected in the number and complexity of each procedure performed. Historical changes over time reflect changing demand (population growth and aging) balanced by available resources. Available resources cannot be predicted via modelling. The best fit based on the validation dataset was a Seasonal Autoregressive Integrated Moving Average model with a Mean Absolute Percentage Error (MAPE) of 5.327%. which translates to 94.7% accuracy. ConclusionDespite the limitations of modeling based on past behavior, we were able to predict surgical demand with 95% accuracy. These projections are valid partly due to the persistence of historical constraints through the validation period. Policies that address these service provision limitations would precipitate a need to adjust the model.

Primary Care Physician Use and Frequency of Visits Among Physicians in Ontario, Canada

Maintaining a healthy physician workforce includes the routine use of primary care physician (PCP) services; however, physicians may face barriers to attaining formal care. To analyze access to and frequency of visits to PCPs among physicians compared with nonphysicians. This population-based, retrospective cohort study used registration data from the College of Physicians and Surgeons of Ontario, Canada, from January 1, 1990, to March 31, 2018. Data for all newly practicing physicians as of March 31, 2018, were linked to Ontario health administrative databases. Data were analyzed from August 25, 2020, to August 6, 2021. The main outcomes were enrollment in a PCP practice and visits with a PCP. Generalized estimating equations compared primary care visits between physicians and nonphysicians, matched 1:5 based on age, sex, neighborhood income quintile, and health region. Among 19 581 physicians (mean [SD] age, 43.99 [8.94] years; 53.27% male) matched to 97 905 nonphysicians, physicians were less likely to be enrolled with a PCP than were nonphysicians (81.8% vs 86.4%; absolute difference, 4.6%; adjusted odds ratio [OR], 0.75; 95% CI, 0.72-0.79) and had fewer primary care visits during the preceding 2 years (median [IQR], 2 [0-4] vs 4 [1-7]; adjusted relative rate ratio [RRR], 0.59; 95% CI, 0.58-0.60). Physicians aged 40 years or older and male physicians were less likely to be rostered (ages 40-44 years: OR, 0.70 [95% CI, 0.64-0.77]; male: OR, 0.60 [95% CI, 0.57-0.63]) and more likely to have a lower frequency of PCP visits (ages 40-44 years: RRR, 0.53 [95% CI, 0.51-0.56]; male: RRR, 0.50 [95% CI, 0.50-0.51]) compared with nonphysicians. In this retrospective cohort study, enrollment with a PCP practice and frequency of visits were lower among physicians compared with a matched general population of nonphysicians. Individual, system, and medical cultural factors associated with these results need to be better understood so that physicians can take better care of themselves and their patients.

Real-world Medicare Healthcare Costs of Patients with Dupuytren's Contracture Treated with Collagenase or Fasciectomy.

Background:Our study aimed to compare real-world healthcare resource utilization (HRU) and healthcare cost (HC) of Medicare-insured patients (≥65 years old) with Dupuytren’s contracture (DC) treated with Clostridium histolyticum (collagenase) or fasciectomy.Methods:DC patients treated with collagenase or fasciectomy between July 2011 and June 2017 were identified using the IBM MarketScan Medicare Supplemental Database. The index date was the date of the first procedure. Demographic characteristics were captured on the index date, and comorbidities were assessed during the 24-month preindex period. HRU and HC were analyzed throughout the 12-month postindex period. Patients were matched using propensity score weights. Gamma log-linked generalized linear models were used to evaluate HC drivers.Results:Out of 37,374 DC patients, 2911 received collagenase, while 6258 underwent fasciectomy. Postmatching, the total average annual HC was similar between collagenase and fasciectomy ($7271 versus $6220, P = 0.357). When HCs were stratified by the service provider, outpatient facility and physician office costs were lower in the collagenase cohort ($850 versus $1284, P = 0.047 and $546 versus $1001, P < 0.001). The costs of professional services were significantly higher than in the fasciectomy cohort due to the cost of collagenase injection ($1682 versus $629, P < 0.001). The HRU was similar between cohorts, except for more frequent outpatient facility visits in fasciectomy patients (12.3 versus 22.9, P < 0.001). Generalized linear model revealed Charlson comorbidity index, plan type, patients’ residence region, sleep disorder, and hyperlipidemia as significant predictors of total HC.Conclusion:This study found comparable total annual HC and HRU between collagenase- and fasciectomy-treated Medicare patients.

The Interplay of Work, Digital Health Usage, and the Perceived Effects of Digitalization on Physicians' Work: Network Analysis Approach.

In health care, the benefits of digitalization need to outweigh the risks, but there is limited knowledge about the factors affecting this balance in the work environment of physicians. To achieve the benefits of digitalization, a more comprehensive understanding of this complex phenomenon related to the digitalization of physicians' work is needed. The aim of this study was to examine physicians' perceptions of the effects of health care digitalization on their work and to analyze how these perceptions are associated with multiple factors related to work and digital health usage. A representative sample of 4630 (response rate 24.46%) Finnish physicians (2960/4617, 64.11% women) was used. Statements measuring the perceived effects of digitalization on work included the patients' active role, preventive work, interprofessional cooperation, decision support, access to patient information, and faster consultations. Network analysis of the perceived effects of digitalization and factors related to work and digital health usage was conducted using mixed graphical modeling. Adjusted and standardized regression coefficients are denoted by b. Centrality statistics were examined to evaluate the relative influence of each variable in terms of node strength. Nearly half of physicians considered that digitalization has promoted an active role for patients in their own care (2104/4537, 46.37%) and easier access to patient information (1986/4551, 43.64%), but only 1 in 10 (445/4529, 9.82%) felt that the impact has been positive on consultation times with patients. Almost half of the respondents estimated that digitalization has neither increased nor decreased the possibilities for preventive work (2036/4506, 45.18%) and supportiveness of clinical decision support systems (1941/4458, 43.54%). When all variables were integrated into the network, the most influential variables were purpose of using health information systems, employment sector, and specialization status. However, the grade given to the electronic health record (EHR) system that was primarily used had the strongest direct links to faster consultations (b=0.32) and facilitated access to patient information (b=0.28). At least 6 months of use of the main EHR was associated with facilitated access to patient information (b=0.18). The results highlight the complex interdependence of multiple factors associated with the perceived effects of digitalization on physicians' work. It seems that a high-quality EHR system is critical for promoting smooth clinical practice. In addition, work-related factors may influence other factors that affect digital health success. These factors should be considered when developing and implementing new digital health technologies or services for physicians' work. The adoption of digital health is not just a technological project but a project that changes existing work practices.

Medical School Without Walls: 50 Years of Regional Campuses at Indiana University School of Medicine.

The history of Indiana University School of Medicine (IUSM) dates to 1871, when Indiana Medical College entered into an affiliation with Indiana University in Bloomington to offer medical education. In 1971, the Indiana General Assembly passed a bill to create and fund a distributed model for medical education for which IUSM was responsible, an innovative approach to implementing a statewide medical education program. IUSM became one of the first U.S. medical schools to implement what is today known as a regional medical campus model. This regional medical campus system has permitted IUSM to expand enrollment based on national and local concerns about physician shortages, increase access to care locally, support expansion of graduate medical education, and provide opportunities for research and scholarship by faculty and students statewide. This effort was made possible by partnerships with other universities and health care systems across the state and the support of local community and state leaders. The model is a forward-thinking and cost-effective way to educate physicians for service in the state of Indiana and is applicable to others. This article highlights milestones in IUSM's 50-year history of regional medical education, describes the development of the regional medical campus model, recognizes significant achievements over the years, shares lessons learned, and discusses considerations for the future of medical education.

Should developing countries ban dual practice by physicians? Analysis under mixed hospital competition.

Dual practice, where physicians work both in public and private hospitals, is a widely observed phenomenon, particularly in developing countries. This paper studies a multi-stage game where hospitals compete for physicians as well as patients and, the service provided by physicians endogenously depends on the competitive setting in which hospitals operate. Specifically, we examine the impact of allowing dual practice on hospital payoffs, physician's service and societal welfare. We find that dual practice is socially desirable, since it softens the competition for physician's exclusive service while also increasing the amount of their service. However, if the degree of competition between the hospitals is significant, dual practice may not yield the highest payoffs for both public and private hospitals.

Economic burden of chronic pain in Alberta, Canada.

Although chronic pain (CP) is common, little is known about its economic burden in Alberta, Canada. To estimate incremental (as compared to the general population or people without CP) societal (healthcare and lost productivity) costs of CP in Alberta. We applied the prevalence estimated from the Canadian Community Health Survey data to the population retrieved from the Statistics Canada to estimate the number of people with CP in Alberta in 2019. We analyzed the Alberta Health administrative databases to estimate the healthcare costs of person with CP. Finally, we multiplied the number of people with the cost per person. The prevalence of any CP was 20.1% and of activity-preventing CP was 14.5% among people aged > = 12 years. Incremental cost per person with CP per year was CA$2,217 for healthcare services (among people aged > = 12 years) and CA$8,412 for productivity losses (among people aged 18-64 years). Of the healthcare cost, prescription drugs accounted for the largest share (32.8%), followed by inpatient services (31.0%), outpatient services (13.1%), physician services (9.8%), other services (7.4%), and diagnostic imaging (5.8%). Provincially, total incremental cost of CP ranges from CA$1.2 to 1.7 billion for healthcare services (6% to 8% of total provincial health expenditure); and CA$3.4 to 4.7 billion for productivity losses. Considering costs for long-term care services, the total societal cost of CP in Alberta was CA$6.3 to 8.3 billion per year, reflecting 2.0% to 2.7% of Alberta's GDP. Interventions improving CP prevention and management to reduce this substantial economic burden are urgently needed.

The Explosive Growth of Telehealth Throughout the COVID-19 Pandemic and Beyond

The Explosive Growth of Telehealth Throughout the COVID-19 Pandemic and Beyond

Effects of Medicaid expansion on insurance coverage and health services use among adults with disabilities newly eligible for Medicaid.

To estimate the effects of Affordable Care Act (ACA) Medicaid expansion on insurance and health services use for adults with disabilities who were newly eligible for Medicaid. 2008-2018 Medical Expenditure Panel Survey data. We used the Agency for Healthcare Research and Quality (AHRQ) PUBSIM model to identify adults aged 26-64 years with disabilities who were newly Medicaid-eligible in expansion states or would have been eligible in non-expansion states had those states opted to expand. Outcomes included insurance coverage; access to care; receipt of primary care, outpatient specialty physician services, and preventive services; and out-of-pocket health care spending. To estimate the effects of Medicaid expansion, we used two-way fixed effects models and a triple differences framework to compare pre-post changes in each outcome in expansion and non-expansion states for adults with and without disabilities. We simulated Medicaid eligibility with the AHRQ PUBSIM model, which uses state-specific Medicaid rules and MEPS data on family relationships, state of residence, and income. Among adults with disabilities who were newly eligible for Medicaid, Medicaid expansion was associated with significant increases in full-year Medicaid coverage (35.9 percentage points [pp], p < 0.001), receipt of primary care (15.5pp, p < 0.01), and receipt of flu shots (19.2pp, p < 0.01), and a significant decrease in out-of-pocket spending (-$457, p < 0.01). There were larger improvements for adults with disabilities compared to those without disabilities in full-year Medicaid coverage (11.0pp, p < 0.01) and receipt of flu shots (18.0pp, p < 0.05). Medicaid expansion was associated with improvements in full-year insurance coverage, receipt of primary and preventive care, and out-of-pocket spending for adults with disabilities who were newly eligible for Medicaid. For insurance coverage, preventive care, and some primary care measures, there were differentially larger improvements for adults with disabilities than for those without disabilities.