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Media coverage of HCCI’s original research

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Sep
08

Health Affairs: Regulating Hospital Prices Based On Market Concentration Is Likely To Leave High-Price Hospitals Unaffected

Abstract Concern about high hospital prices for commercially insured patients has motivated several proposals to regulate these prices. Such proposals often limit regulations to highly concentrated hospital markets. Using a large sample of 2017 US commercial insurance claims, we demonstrate that under the market definition commonly used in these proposals, most high-price hospitals are in markets ...
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Aug
17

JAMA Internal Medicine: Association of Surprise-Billing Legislation with Prices Paid to In-Network and Out-of-Network Anesthesiologists in California, Florida, and New York: An Economic Analysis

Question  What is the association of state surprise-billing legislation with prices paid to anesthesiologists in hospital outpatient departments and ambulatory surgery centers? Findings  This retrospective economic analysis of more than 2.5 million claims filed for patients with private health insurance who received anesthesia services in hospital outpatient departments and ambulatory su...
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Aug
03

JAMA: Differences in Cancer Care Expenditures and Utilization for Surgery by Hospital Type Among Patients With Private Insurance

Question Are there differences in insurer spending and care utilization for patients with private insurance undergoing cancer surgery at National Cancer Institute (NCI) centers vs community hospitals? Findings In this cross-sectional study of 66 878 patients with breast, colon, or lung cancer, surgery at NCI centers, compared with community hospitals, was associated with higher insurer prices paid...
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Aug
01

Annals of Surgery: Opioid Fills in Children Undergoing Surgery From 2011 to 2014: A Retrospective Analysis of Relationships Among Age, Initial Days Supplied, and Refills

 Abstract Objective: The primary objective is to describe the relationship between the days supplied of postsurgical filled opioid prescriptions and refills. Background: The American College of Surgeons (ACS) has called for surgeons to alter opioid prescribing to counteract the opioid epidemic while simultaneously providing pain relief. However, there is insufficient evidence to inform periop...
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Jul
04

AJPM: Robust Prescription Monitoring Programs and Abrupt Discontinuation of Long-term Opioid Use

 Introduction This study assesses the associations between the recent implementation of robust features of state Prescription Drug Monitoring Programs and the abrupt discontinuation of long-term opioid therapies. Methods Data were from a national commercial insurance database and included privately insured adults aged 18–64 years and Medicare Advantage enrollees aged ≥65 years who initiated a...
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Jun
24

AJMC: Commercial and Medicare Advantage Payment for Anesthesiology Services

 ABSTRACT Objectives: Anesthesiology services are a focal point of policy making to address surprise medical billing. However, allowed amounts and charges for anesthesiology services have been understudied due to the specialty's unique conversion factor (CF) unit of payment and complex provider structures involving anesthesiologists and certified registered nurse anesthetists (CRNAs). This st...
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Jun
15

AJMC: Association Between Hospital-Insurer Contract Structure and Hospital Performance

ABSTRACT Objectives: To describe the association between the form of hospitals' contracts—either markup from a benchmark or a discount from a list price—and performance: price, charge, cost, and length of stay. Study Design: Retrospective observational study using administrative claims data matched with hospital characteristics from the American Hospital Association Annual Survey and the Healthcar...
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Jun
14

JAMA Network: Prescription Drug Monitoring Program Mandates and Opioids Dispensed Following Emergency Department Encounters for Patients With Sickle Cell Disease or Cancer With Bone Metastasis

Abstract: Patients with sickle cell disease (SCD) or cancer with bone metastasis often present to the emergency department (ED) for treatment of severe pain, and opioid analgesics remain first-line therapies for acute pain in the ED or after discharge. Policies aimed at improving the safety of opioid prescribing, such as state legislative mandates that prescribers register with or u...
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Jun
11

Real World Consequences of the Qualifying Payment Amount in the No Surprises Act

The United States Congress passed the No Surprises Act last year, offering several protections to consumers. Beginning in 2022, providers can no longer bill patients for more than their insurance's in-network cost sharing. The law also bans balance billing except in situations where a patient is notified in advance and their written consent is obtained. Independent dispute resolution between insur...
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May
28

JAMA Health Forum: Comparison of Anticancer Medication Use and Spending Under US Oncology Parity Laws With and Without Out-of-Pocket Spending Caps

Abstract:  IMPORTANCE  By 2020, nearly all states had adopted oncology parity laws in the US, ensuring that patients in fully insured private health plans pay no more for orally administered anticancer medications (OAMs) than infused therapies. Between 2013 and mid-2017, 11 states implemented parity with out-of-pocket spending caps, which may further reduce patient out-of-pocket spending...
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May
11

NYS Health Foundation: Variation in Health Care Prices: The Problem Starts at Birth

Summary The price of childbirth in New York City varies multifold, depending on where a woman delivers. This variation in price across boroughs, and across providers within boroughs, might make sense if it corresponded to higher-quality care. But higher prices do not always signify better quality. This report examines variation in what is paid for childbirth in each of the five boroughs of New Yor...
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May
05

Health Affairs: Private Equity In Dermatology: Effect On Price, Utilization, And Spending

Abstract: Private equity firms have increasingly acquired physician practices, and particularly dermatology practices. Analyzing commercial claims from the Health Care Cost Institute (2012–17), we used a difference-in-differences design within an event study framework to estimate the prevalence of private equity acquisitions and their impact on dermatologist prices, spending, utilization, and volu...
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Apr
16

The Impact of COVID-19 on the Use of Preventive Health Care

Updated 4/16/2021 to include data through 12/30/2020. Since the original post on 9/9/2020, the data have been adjusted to account for claims submission lags. For more information, see Methods Note below. COVID-19 has had an extraordinary impact on the US health care system since its emergence in early 2020. One of the largest and most immediate impacts has been the death toll, with ...
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Apr
01

The Insanity of U.S. Health Care Pricing: An Early Look at Hospital Price Transparency Data

The numbers in this report have been updated to reflect the most recent pricing data made available by Sutter Health. While nearly all of the prices remained unchanged (93%), some, generally higher cost services were revised downward by Sutter. For example, in the initial report we found that C-section prices ranged from $7,634 to $89,244 across the Sutter system, whereas in the more recently avai...
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Mar
08

Daily Deaths During Coronavirus Pandemic by State

The staggering death toll of the novel coronavirus pandemic in the United States has been widely reported, surpassing 523,000 as of March 8, 2021. Over the course of the current pandemic a common method for measuring the probable number of deaths caused by COVID-19 has been comparing actual deaths in 2020 to the expected number of deaths in 2020 based on deaths in previous years. To add to the gro...
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Feb
24

Using Medicare Data to Improve Vaccine Targeting: Providers Serving Highest Risk Patients

As the production and distribution of SARS-CoV-2 vaccines ramps up in the United States, there is a need to ensure that communities at highest risk for severe COVID-19 morbidity and mortality are targeted. As of February 2021, the Pfizer/BioNTech and Moderna mRNA vaccines, which were approved by the U.S. Food and Drug Administration (FDA) under Emergency Use Authorization (EUA) in late 2020, remai...
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Feb
18

COVID-19 Disparities Persist in Community Health Centers' Vulnerable Populations

Community Health Centers (CHCs) serve over 29 million vulnerable patients, making the lack of data on COVID-19-related racial disparities in patients served in CHCs a critical knowledge gap in assessments of the pandemic's national impact. In rural and poor urban areas, CHCs may be the only accessible healthcare option. Even when other options exist, CHCs reduce barriers such as cost, lack of insu...
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Jan
25

When the Medicare Rate Isn’t the Medicare Rate: Analyzing Differences Between the Medicare Physician Fee Schedule and Payments Received by Physicians.

Increasingly, policymakers are considering proposals that tie payments made by private health insurers, in some way, to rates paid by Medicare. These proposals are inspired by the rising cost of health care and widespread variation in health care prices. For example, we recently found that the cost of the same service can vary by 5-fold, 10-fold or more within the same market among the commerciall...
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Dec
21

American Economic Review: Screening and Selection: The Case of Mammograms

Abstract: We analyze selection into screening in the context of recommendations that breast cancer screening start at age 40. Combining medical claims with a clinical oncology model, we document that compliers with the recommendation are less likely to have cancer than younger women who select into screening or women who never screen. We show this selection is quantitatively important: shifting th...
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Dec
09

How Differences Between Commercial, Medicare Professional Service Prices Could Result in Different Policy Impacts

 Introduction As rising health care costs force difficult choices for families, employers, and federal, state, and local governments, a range of policy proposals are emerging to address health care spending in the U.S. In this presidential election year, there has been heightened attention on lowering health care costs and making care more affordable, which will likely accelerate with the ele...
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Nov
12

Past the Healthy Marketplace Index, Volume II: Exploring Changes in Actual Prices Paid for Specific Services by Metro Area from 2013 to 2017

In the first brief of the Past the Healthy Marketplace Index series, we explored how prices compared across the country and found that, in 2017, health care prices for specific services varied by as much as 22-fold across metro areas and even up 40-fold within them. In this next brief, we looked at variation in price growth and examined if that variation was related to the substantial observed dif...
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Nov
12

Past the Healthy Marketplace Index, Volume I: Exploring Actual Prices Paid for Specific Services by Metro Area

How much people spend on health care from place to place reflects multiple, interwoven, and dynamic factors, such as the cost and use of services. Health care spending and its driving factors change over time, differ across geographies, and vary by type of service. The Health Care Cost Institute's (HCCI) Healthy Marketplace Index (HMI) provides a number of metrics illustrating how health care spen...
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Oct
14

Electronic Medical Record Data Suggest Disparities in COVID Incidence Persist Across Regions and Over Time

Since the onset of the COVID-19 pandemic, a growing body of research has found alarming disparities in rates of the virus among Black and Hispanic communities. For example, the CDC reports that "American Indian or Alaska Native, Non-Hispanic" people and "Hispanic or Latino" people each have 2.8 times as many COVID cases than white people, Black patients have 2.6 time as many, and Asian people have...
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Oct
14

The Impact of COVID-19 on Years of Life Lost

Summary: Since April, 1.9 million excess years of life have been lost, 13% above historical average. Over the course of the pandemic, we found age and sex contributions to excess YLL have shifted. Deaths among adults 65 and older accounted for 80% of excess YLL in April but only 36% of excess YLL in June. Since April, working age adults 20-64 have accounted for 47% of excess YLL, and males 20...
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Sep
11

American Journal of Managed Care: Policies to Address Surprise Billing Can Affect Health Insurance Premiums

 Abstract:  Objectives: To quantify the proportion of health plan spending on services for which surprise billing is common—provided by radiologists, anesthesiologists, pathologists, emergency physicians, emergency ground ambulances, and emergency outpatient facilities—and estimate the potential impact of proposed policies to address surprise billing on health insurance premiums. Study D...
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