@article {696399,
	title = {A cohort study examining changes in treatment patterns for alcohol use disorder among commercially insured adults in the United States during the COVID-19 pandemic},
	journal = {J Subst Abuse Treat},
	volume = {144},
	year = {2023},
	month = {2023 Jan},
	pages = {108920},
	abstract = {INTRODUCTION: We know very little about how the pandemic impacted outpatient alcohol use disorder (AUD) care and the role of telemedicine.

METHODS: Using OptumLabs{\textregistered} Data Warehouse de-identified administrative claims, we identified AUD cohorts in 2018 (N~=~23,204) and 2019 (N~=~23,445) and examined outpatient visits the following year, focusing on week 12, corresponding to the March 2020 US COVID-19 emergency declaration, through week 52. Using multivariable logistic regression, we examined the association between patient demographic and clinical characteristics and receipt of any outpatient AUD visits in 2020 vs. 2019.

RESULTS: In 2020, weekly AUD visit utilization decreased maximally at the pandemic start (week 12) by 22.5~\% (2019: 3.8~\%, 2020: 3.0~\%, percentage point change [95~\% CI]~=~-0.86[-1.19, -0.05]) but was similar to 2019 utilization by mid-April 2020 (week 16). Telemedicine accounted for 50.1~\% of AUD visits by early July 2020 (week 27). Individual therapy returned to 2019 levels within 1~week (i.e., week 13) whereas group therapy did not consistently do so until mid-August 2020 (week 31). Further, individual therapy exceeded 2019 levels by as much as 50~\% starting mid-October 2020. The study found no substantial differences in visits by patient demographic or clinical characteristics.

CONCLUSIONS: Among patients with known AUD, initial outpatient care disruptions were relatively brief. However, substantial shifts occurred in care delivery-an embrace of telemedicine but also more pronounced, longer disruptions in group therapy vs. individual and an increase in individual therapy use. Further research needs to help us understand the implications of these findings for clinical outcomes.},
	keywords = {Adult, Alcoholism, Cohort Studies, Covid-19, Humans, Pandemics, Telemedicine, United States},
	issn = {1873-6483},
	doi = {10.1016/j.jsat.2022.108920},
	author = {Alisa B. Busch and Ateev Mehrotra and Greenfield, Shelly F and Uscher-Pines, Lori and Rose, Sherri and Huskamp, Haiden A.}
}
@article {696417,
	title = {Appropriateness of Telemedicine Versus In-Person Care: A Qualitative Exploration of Psychiatrists{\textquoteright} Decision Making},
	journal = {Psychiatr Serv},
	volume = {73},
	number = {8},
	year = {2022},
	month = {2022 Aug 01},
	pages = {849-855},
	abstract = {OBJECTIVE: With widespread adoption of telemedicine in response to the COVID-19 pandemic, psychiatrists must determine which visits are best conducted via telemedicine versus in person. Although some telepsychiatry guidelines and best practices have been developed, the literature has not described how psychiatrists make decisions about offering different care modalities. The authors explored how psychiatrists decide whether telemedicine is appropriate for a given patient.

METHODS: From June 25 to August 4, 2021, the authors conducted semistructured interviews with 20 outpatient psychiatrists. The authors used a critical incident technique and clinical vignettes to identify conscious and unconscious factors that influence psychiatrists{\textquoteright} decision to offer telemedicine. Using inductive thematic analysis, the authors analyzed interview data.

RESULTS: Psychiatrists perceived that most patients are good candidates for telemedicine visits in the context of hybrid care models. Patient preference and situational factors, such as access to private spaces, rather than any particular diagnosis or patient demographic characteristic, drove telemedicine versus in-person care. Psychiatrists described numerous factors affecting their decision to offer telemedicine, and they were driven to try telemedicine and adjust as needed to "meet patients where they are" and to improve engagement in care. Psychiatrists reported using telemedicine as a bargaining chip in negotiations with patients, leveraging the offer of telemedicine to improve treatment attendance and adherence.

CONCLUSIONS: This detailed assessment of how psychiatrists choose different care modalities can inform clinical practice guidelines and reimbursement policies that often mandate in-person visits. The results show that psychiatrists did not perceive intermittent in-person visits as essential for high-quality care.},
	keywords = {Covid-19, Decision Making, Humans, Pandemics, Psychiatry, Telemedicine},
	issn = {1557-9700},
	doi = {10.1176/appi.ps.202100519},
	author = {Uscher-Pines, Lori and Parks, Amanda M and Sousa, Jessica and Raja, Pushpa and Ateev Mehrotra and Huskamp, Haiden A. and Alisa B. Busch}
}
@article {696408,
	title = {Association Between Patient Demographic Characteristics and Devices Used to Access Telehealth Visits in a US Primary Care Network},
	journal = {JAMA Health Forum},
	volume = {3},
	number = {9},
	year = {2022},
	month = {2022 Sep 02},
	pages = {e222932},
	abstract = {This cross-sectional study assesses the association between patient characteristics and use of different devices to access telehealth visits during the COVID-19 pandemic.},
	keywords = {Covid-19, Demography, Humans, Primary Health Care, Telemedicine},
	issn = {2689-0186},
	doi = {10.1001/jamahealthforum.2022.2932},
	author = {Hare, Allison and Adusumalli, Srinath and Ateev Mehrotra and Bressman, Eric}
}
@article {696425,
	title = {Association Between Telemedicine Use in Nonmetropolitan Counties and Quality of Care Received by Medicare Beneficiaries With Serious Mental Illness},
	journal = {JAMA Netw Open},
	volume = {5},
	number = {6},
	year = {2022},
	month = {2022 Jun 01},
	pages = {e2218730},
	abstract = {IMPORTANCE: Access to specialty mental health care remains challenging for people with serious mental illnesses, such as schizophrenia and bipolar disorder. Whether expansion of telemedicine is associated with improved access and quality of care for these patients is unclear.

OBJECTIVE: To assess whether greater telemedicine use in a nonmetropolitan county is associated with quality measures, including use of specialty mental health care and medication adherence.

DESIGN, SETTING, AND PARTICIPANTS: In this cohort study, the variable uptake of telemental health visits was examined across a national sample of fee-for-service claims from Medicare beneficiaries in 2916 nonmetropolitan counties between January 1, 2010, and December 31, 2018. Beneficiaries with schizophrenia and related psychotic disorders and/or bipolar I disorder during the study period were included. For each year of the study, each county was categorized based on per capita telemental health service use (none, low, moderate, and high). The association between telemental health service use in the county and quality measures was tested using a multivariate model controlling for both patient characteristics and county fixed effects. Analyses were conducted from January 1 to April 11, 2022. Before the COVID-19 pandemic, telemedicine reimbursement was limited to nonmetropolitan beneficiaries.

MAIN OUTCOMES AND MEASURES: Receipt of a minimum of 2 specialty mental health service visits (telemedicine or in-person) in the year, number of months per year with medication, hospitalization rate, and outpatient follow-up visits after a mental health hospitalization in a year.

RESULTS: In 2018, there were 2916 counties with 118 170 patients (77 068 [65.2\%] men; mean [SD] age, 58.3 [15.6] years) in the sample. The fraction of counties that had high telemental health service use increased from 2\% in 2010 to 17\% in 2018. In 2018 there were 1.08 telemental health service visits per patient in the high telemental health counties. Compared with no telemental health care in the county, patients in high-use counties were 1.2 percentage points (95\% CI, 0.81-1.60 percentage points) (8.0\% relative increase) more likely to have a minimum number of specialty mental health service visits, 13.7 percentage points (95\% CI, 5.1-22.3 percentage points) (6.5\% relative increase) more likely to have outpatient follow-up within 7 days of a mental health hospitalization, and 0.47 percentage points (95\% CI, 0.25-0.69 percentage points) (7.6\% relative increase) more likely to be hospitalized in a year. Telemental health service use was not associated with changes in medication adherence.

CONCLUSIONS AND RELEVANCE: The findings of this study suggest that greater use of telemental health visits in a county was associated with modest increases in contact with outpatient specialty mental health care professionals and greater likelihood of follow-up after hospitalization. No substantive changes in medication adherence were noted and an increase in mental health hospitalizations occurred.},
	keywords = {Aged, Bipolar Disorder, Cohort Studies, Covid-19, Female, Humans, Male, Medicare, Middle Aged, Pandemics, Telemedicine, United States},
	issn = {2574-3805},
	doi = {10.1001/jamanetworkopen.2022.18730},
	author = {Wang, Bill and Huskamp, Haiden A. and Rose, Sherri and Alisa B. Busch and Uscher-Pines, Lori and Raja, Pushpa and Ateev Mehrotra}
}
@article {696433,
	title = {Association Between Telepsychiatry Capability and Treatment of Patients With Mental Illness in the Emergency Department},
	journal = {Psychiatr Serv},
	volume = {73},
	number = {4},
	year = {2022},
	month = {2022 Apr 01},
	pages = {403-410},
	abstract = {OBJECTIVE: Because of limited access to psychiatrists, patients with acute mental illness in some emergency departments (EDs) may wait days for a consultation in the ED or as a medical-surgical admission. The study assessed whether telepsychiatry improves access to care and decreases ED wait times and hospital admissions.

METHODS: ED visits with a primary diagnosis of mental illness were identified from 2010-2018 Medicare claims. A total of 134 EDs across 22 states that implemented telepsychiatry between 2013 and 2016 were matched 1:1 with control EDs without telepsychiatry on several characteristics, including availability of in-person psychiatrist consultations. Outcomes included patients{\textquoteright} likelihood of admission to a medical-surgical or psychiatric bed, mental illness spending, prolonged ED length of stay (LOS) (two or more midnights in the ED), 90-day mortality, and outpatient follow-up care. Using a difference-in-difference design, changes in outcomes between the 3 years before telepsychiatry adoption and the 2 years after were examined.

RESULTS: There were 172,708 ED mental illness visits across the 134 matched ED pairs in the study period. Telepsychiatry adoption was associated with increased admissions to a psychiatric bed (differential increase, 4.3 percentage points; p\&lt;0.001), decreased admissions to a medical-surgical bed (differential decrease, 2.0 percentage points; p\&lt;0.001), increased likelihood of a prolonged ED LOS (differential increase, 3.0 percentage points; p\&lt;0.001), and increased mental illness spending (differential increase, $292; p\&lt;0.01).

CONCLUSIONS: Telepsychiatry adoption was associated with a lower likelihood of admission to a medical-surgical bed but an increased likelihood of admission to a psychiatric bed and a prolonged ED LOS.},
	keywords = {Aged, Emergency Service, Hospital, Humans, Length of Stay, Medicare, Mental Disorders, Psychiatry, Telemedicine, United States},
	issn = {1557-9700},
	doi = {10.1176/appi.ps.202100145},
	author = {Patel, Sadiq Y and Huskamp, Haiden A. and Michael L. Barnett and Zubizarreta, Jos{\'e} R and Zachrison, Kori S and Alisa B. Busch and Wilcock, Andrew D and Ateev Mehrotra}
}
@article {696434,
	title = {Association of County-Level Prescriptions for Hydroxychloroquine and Ivermectin With County-Level Political Voting Patterns in the 2020 US Presidential Election},
	journal = {JAMA Intern Med},
	volume = {182},
	number = {4},
	year = {2022},
	month = {2022 Apr 01},
	pages = {452-454},
	abstract = {This cross-sectional study examines whether an association exists between US county-level prescription rates of hydroxychloroquine and ivermectin and how people voted in the 2020 US presidential election.},
	keywords = {Humans, Hydroxychloroquine, Ivermectin, Politics, Prescriptions, United States},
	issn = {2168-6114},
	doi = {10.1001/jamainternmed.2022.0200},
	author = {Michael L. Barnett and Gaye, Marema and Jena, Anupam B and Ateev Mehrotra}
}
@article {696428,
	title = {Building on the momentum: Sustaining telehealth beyond COVID-19},
	journal = {J Telemed Telecare},
	volume = {28},
	number = {4},
	year = {2022},
	month = {2022 May},
	pages = {301-308},
	abstract = {The 2019 coronavirus pandemic (COVID-19) has resulted in tremendous growth in telehealth services in Australia and around the world. The rapid uptake of telehealth has mainly been due to necessity - following social distancing requirements and the need to reduce the risk of transmission. Although telehealth has been available for many decades, the COVID-19 experience has resulted in heightened awareness of telehealth amongst health service providers, patients and society overall. With increased telehealth uptake in many jurisdictions during the pandemic, it is timely and important to consider what role telehealth will have post-pandemic. In this article, we highlight five key requirements for the long-term sustainability of telehealth. These include: (a) developing a skilled workforce; (b) empowering consumers; (c) reforming funding; (d) improving the digital ecosystems; and (e) integrating telehealth into routine care.},
	keywords = {Covid-19, Ecosystem, Humans, Pandemics, SARS-CoV-2, Telemedicine},
	issn = {1758-1109},
	doi = {10.1177/1357633X20960638},
	author = {Thomas, Emma E and Haydon, Helen M and Ateev Mehrotra and Caffery, Liam J and Snoswell, Centaine L and Banbury, Annie and Smith, Anthony C}
}
@article {696412,
	title = {Claims-Based Reporting of Post-Operative Visits for Procedures with 10- or 90-Day Global Periods: Updated Results Using Calendar Year 2019 Data},
	journal = {Rand Health Q},
	volume = {9},
	number = {4},
	year = {2022},
	month = {2022 Aug},
	pages = {7},
	abstract = {Medicare payments for most surgical procedures cover both procedures and post-operative visits occurring within a global period of either 10 or 90 days following procedures. There have been concerns that fewer post-operative visits are provided than the number of post-operative visits considered when the procedure was valued. To help inform accurate valuation of procedures with global periods, the Centers for Medicare \&amp; Medicaid Services (CMS) required select practitioners to report on post-operative visits after select procedures with 10- or 90-day global periods. The authors of this article summarize patterns of post-operative visits for procedures furnished during calendar year 2019, building on prior research that analyzed data for procedures furnished from July 1, 2017, through June 30, 2018, and for the entire 2018 calendar year. During calendar year 2019, 96.5 percent of procedures with 10-day global periods did not have an associated post-operative visit. Approximately two-thirds of procedures with 90-day global periods had an associated post-operative visit; however, the ratio of observed to expected post-operative visits provided for 90-day global period procedures was only 0.38. Underreporting of post-operative visits might be driving these low rates. However, in sensitivity analyses limited to practitioners who were actively reporting their post-operative visits, post-operative patterns were largely similar to the main analysis. Collectively, these findings suggest that many expected post-operative visits are not delivered and that underreporting is unlikely to fully explain the low ratio of expected post-operative visits provided.},
	issn = {2162-8254},
	author = {Crespin, Daniel J and Kranz, Ashley M and Ruder, Teague and Ateev Mehrotra and Mulcahy, Andrew W}
}
@article {696413,
	title = {Claims-Based Reporting of Post-Operative Visits for Procedures with 10- or 90-Day Global Periods: Updated Results Using Calendar Year 2018 Data},
	journal = {Rand Health Q},
	volume = {9},
	number = {4},
	year = {2022},
	month = {2022 Aug},
	pages = {6},
	abstract = {Medicare payments for most surgical procedures cover both procedures and post-operative visits occurring within a global period of either ten or 90 days following procedures. There have been concerns that fewer post-operative visits are provided than the number of post-operative visits considered when the procedure was valued. To help inform accurate valuation of procedures with global periods, the Centers for Medicare \&amp; Medicaid Services (CMS) required select practitioners to report on post-operative visits after select procedures with 10- or 90-day global periods. The authors of this article summarize patterns of post-operative visits for procedures furnished during calendar year 2018, building on prior research that analyzed data for procedures with July 1, 2017, through June 30, 2018, service dates. During calendar year 2018, 96.5 percent of procedures with 10-day global periods did not have an associated post-operative visit. Approximately two-thirds of procedures with 90-day global periods had an associated post-operative visit; however, the ratio of observed to expected post-operative visits provided for 90-day global period procedures was only 0.38. Underreporting of post-operative visits might be driving these low rates. However, in sensitivity analyses limited to practitioners who were actively reporting their post-operative visits, post-operative patterns were largely similar to the main analysis. Collectively, these findings suggest that a large share of expected post-operative visits are not delivered, and that underreporting is unlikely to fully explain the low ratio of expected post-operative visits provided.},
	issn = {2162-8254},
	author = {Crespin, Daniel J and Kranz, Ashley M and Ruder, Teague and Ateev Mehrotra and Mulcahy, Andrew W}
}
@article {696415,
	title = {Classifying unstructured electronic consult messages to understand primary care physician specialty information needs},
	journal = {J Am Med Inform Assoc},
	volume = {29},
	number = {9},
	year = {2022},
	month = {2022 Aug 16},
	pages = {1607-1617},
	abstract = {OBJECTIVE: Electronic consultation (eConsult) content reflects important information about referring clinician needs across an organization, but is challenging to extract. The objective of this work was to develop machine learning models for classifying eConsult questions for question type and question content. Another objective of this work was to investigate the ability to solve this task with constrained expert time resources.

MATERIALS AND METHODS: Our data source is the San Francisco Health Network eConsult system, with over 700~000 deidentified questions from the years 2008-2017, from gastroenterology, urology, and neurology specialties. We develop classifiers based on Bidirectional Encoder Representations from Transformers, experimenting with multitask learning to learn when information can be shared across classifiers. We produce learning curves to understand when we may be able to reduce the amount of human labeling required.

RESULTS: Multitask learning shows benefits only in the neurology-urology pair where they shared substantial similarities in the distribution of question types. Continued pretraining of models in new domains is highly effective. In the neurology-urology pair, near-peak performance is achieved with only 10\% of the urology training data given all of the neurology data.

DISCUSSION: Sharing information across classifier types shows little benefit, whereas sharing classifier components across specialties can help if they are similar in the balance of procedural versus cognitive patient care.

CONCLUSION: We can accurately classify eConsult content with enough labeled data, but only in special cases do methods for reducing labeling effort apply. Future work should explore new learning paradigms to further reduce labeling effort.},
	keywords = {electronics, Humans, Information Storage and Retrieval, Medicine, Physicians, Primary Care, Referral and Consultation},
	issn = {1527-974X},
	doi = {10.1093/jamia/ocac092},
	author = {Xiyu Ding and Michael Barnett and Ateev Mehrotra and Tuot, Delphine S and Bitterman, Danielle S and Miller, Timothy A}
}
@article {696441,
	title = {Disruptions in Care for Medicare Beneficiaries With Severe Mental Illness During the COVID-19 Pandemic},
	journal = {JAMA Netw Open},
	volume = {5},
	number = {1},
	year = {2022},
	month = {2022 Jan 04},
	pages = {e2145677},
	abstract = {IMPORTANCE: Little is known about changes in care for individuals with severe mental illness during the COVID-19 pandemic.

OBJECTIVE: To examine changes in mental health care during the pandemic and the use of telemedicine in outpatient care among Medicare beneficiaries with severe mental illness.

DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study included Medicare beneficiaries (age >=18 years) diagnosed with schizophrenia and schizophrenia-related disorders or bipolar I disorder. Care patterns during January to September 2020 for a cohort defined in 2019 were compared with those during January to September 2019 for a cohort defined in 2018.

EXPOSURES: Start of COVID-19 pandemic in the United States, defined as week 12 of 2020.

MAIN OUTCOMES AND MEASURES: Use of mental health-related outpatient visits, emergency department visits, inpatient care, and oral prescription fills for antipsychotics and mood stabilizers during 4-week intervals. Multivariable logistic regression analyses examined whether the pandemic was associated with differential changes in outpatient care across patient characteristics.

RESULTS: The 2019 cohort of 686 214 individuals included 389 245 (53.8\%) women, 114 073 (15.8\%) Black and 526 301 (72.8\%) White individuals, and 477 353 individuals (66.0\%) younger than 65 years; the 2020 cohort of 723 045 individuals included 367 140 (53.5\%) women, 106 699 (15.6\%) Black and 497 885 (72.6\%) White individuals, and 442 645 individuals (64.5\%) younger than 65 years. Compared with 2019, there were large decreases during the pandemic{\textquoteright}s first month (calendar weeks 12-15) in individuals with outpatient visits (265 169 [36.7\%] vs 200 590 [29.2\%]; 20.3\% decrease), with antipsychotic and mood stabilizer medication prescription fills (216 468 [29.9\%] vs 163 796 [23.9\%]; 20.3\% decrease), with emergency department visits (12 383 [1.7\%] vs 8503 [1.2\%]; 27.7\% decrease), and with hospital admissions (11 564 [1.6\%] vs 7912 [1.2\%]; 27.9\% decrease). By weeks 32 to 35 of 2020, utilization rebounded but remained lower than in 2019, ranging from a relative decrease of 2.5\% (outpatient visits) to 12.9\% (admissions). During the full pandemic period (weeks 12-39) in 2020, 1 556 403 of 2 743 553 outpatient visits (56.7\%) were provided via telemedicine. In multivariable analyses, outpatient visit use during weeks 12 to 25 of 2020 was lower among those with disability (odds ratio, 0.95; 95\% CI, 0.93-0.96), and during weeks 26 to 39 of 2020, it was lower among Black vs non-Hispanic White individuals (OR, 0.97; 95\% CI, 0.95-0.99) and those with dual Medicaid eligibility (OR, 0.96; 95\% CI, 0.95-0.98).

CONCLUSIONS AND RELEVANCE: In this cohort study, despite greater use of telemedicine, individuals with severe mental illness experienced large disruptions in care early in the pandemic. These narrowed but persisted through September 2020. Disruptions were greater for several disadvantaged populations.},
	keywords = {Adolescent, Adult, Aged, Cohort Studies, Covid-19, Female, Health Services Accessibility, Humans, Male, Medicare, Mental Disorders, Middle Aged, Pandemics, Patient Acceptance of Health Care, Patient Acuity, SARS-CoV-2, United States, Young Adult},
	issn = {2574-3805},
	doi = {10.1001/jamanetworkopen.2021.45677},
	author = {Alisa B. Busch and Huskamp, Haiden A. and Raja, Pushpa and Rose, Sherri and Ateev Mehrotra}
}
@article {696423,
	title = {The effect of a public transportation expansion on no-show appointments},
	journal = {Health Serv Res},
	volume = {57},
	number = {3},
	year = {2022},
	month = {2022 Jun},
	pages = {472-481},
	abstract = {OBJECTIVE: To test whether there were fewer missed medical appointments ("no-shows") for patients and clinics affected by a significant public transportation expansion.

STUDY SETTING: A new light rail line was opened in a major metropolitan area in June 2014. We obtained electronic health records data from an integrated health delivery system in the area with over three million appointments at 97 clinics between 2013 and 2016.

STUDY DESIGN: We used a difference-in-differences research design to compare whether no-show appointment rates differentially changed among patients and clinics located near versus far from the new light rail line after it opened. Models included fixed effects to account for underlying differences across clinics, patient zip codes, and time.

DATA EXTRACTION METHODS: We obtained data from an electronic health records system representing all appointments scheduled at 97 outpatient clinics in this system. We excluded same-day, urgent care, and canceled appointments.

PRINCIPAL FINDINGS: The probability of no-show visits differentially declined by 0.5 percentage points (95\% confidence interval [CI]: -0.9 to -0.1), or 4.5\% relative to baseline, for patients living near the new light rail compared to those living far from it, after the light rail opened. The effects were stronger among patients covered by Medicaid (-1.6 percentage points [95\% CI: -2.4 to -0.8] or 9.5\% relative to baseline).

CONCLUSIONS: Improvements to public transit may improve access to health care, especially for people with low incomes.},
	keywords = {Ambulatory Care, Appointments and Schedules, Humans, Medicaid, United States},
	issn = {1475-6773},
	doi = {10.1111/1475-6773.13899},
	author = {Smith, Laura Barrie and Yang, Zhiyou and Golberstein, Ezra and Huckfeldt, Peter and Ateev Mehrotra and Neprash, Hannah T}
}
@article {696403,
	title = {Effects of Real-time Prescription Benefit Recommendations on Patient Out-of-Pocket Costs: A Cluster Randomized Clinical Trial},
	journal = {JAMA Intern Med},
	volume = {182},
	number = {11},
	year = {2022},
	month = {2022 Nov 01},
	pages = {1129-1137},
	abstract = {IMPORTANCE: Rising drug costs contribute to medication nonadherence and adverse health outcomes. Real-time prescription benefit (RTPB) systems present prescribers with patient-specific out-of-pocket cost estimates and recommend lower-cost, clinically appropriate alternatives at the point of prescribing.

OBJECTIVE: To investigate whether RTPB recommendations lead to reduced patient out-of-pocket costs for medications.

DESIGN, SETTING, AND PARTICIPANTS: In this cluster randomized trial, medical practices in a large, urban academic health system were randomly assigned to RTPB recommendations from January 13 to July 31, 2021. Participants were adult patients receiving outpatient prescriptions during the study period. The analysis was limited to prescriptions for which RTPB could recommend an available alternative. Electronic health record data were used to analyze the intervention{\textquoteright}s effects on prescribing. Data analyses were performed from August 20, 2021, to June 8, 2022.

INTERVENTIONS: When a prescription was initiated in the electronic health record, the RTPB system recommended available lower-cost, clinically appropriate alternatives for a different medication, length of prescription, and/or choice of pharmacy. The prescriber could select either the initiated order or one of the recommended options.

MAIN OUTCOMES AND MEASURES: Patient out-of-pocket cost for a prescription. Secondary outcomes were whether a mail-order prescription and a 90-day supply were ordered.

RESULTS: Of 867 757 outpatient prescriptions at randomized practices, 36 419 (4.2\%) met the inclusion criteria of having an available alternative. Out-of-pocket costs were $39.90 for a 30-day supply in the intervention group and $67.80 for a 30-day supply in the control group. The intervention led to an adjusted 11.2\%; (95\% CI, -15.7\% to -6.4\%) reduction in out-of-pocket costs. Mail-order pharmacy use was 9.6\% and 7.6\% in the intervention and control groups, respectively (adjusted 1.9 percentage point increase; 95\% CI, 0.9 to 3.0). Rates of 90-day supply were not different. In high-cost drug classes, the intervention reduced out-of-pocket costs by 38.9\%; 95\% CI, -47.6\% to -28.7\%.

CONCLUSIONS AND RELEVANCE: This cluster randomized clinical trial showed that RTPB recommendations led to lower patient out-of-pocket costs, with the largest savings occurring for high-cost medications. However, RTPB recommendations were made for only a small percentage of prescriptions.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04940988; American Economic Association Registry: AEARCTR-0006909.},
	keywords = {Adult, Drug Costs, Health Expenditures, Humans, Insurance, Pharmaceutical Services, Pharmaceutical Services, Prescriptions, United States},
	issn = {2168-6114},
	doi = {10.1001/jamainternmed.2022.3946},
	author = {Desai, Sunita M and Chen, Alan Z and Wang, Jiejie and Chung, Wei-Yi and Stadelman, Jay and Mahoney, Chris and Szerencsy, Adam and Anzisi, Lisa and Ateev Mehrotra and Horwitz, Leora I}
}
@article {696439,
	title = {Estimated Population Access to Acute Stroke and Telestroke Centers in the US, 2019},
	journal = {JAMA Netw Open},
	volume = {5},
	number = {2},
	year = {2022},
	month = {2022 Feb 01},
	pages = {e2145824},
	abstract = {This cross-sectional study assesses US population access to emergency departments with acute stroke capabilities and telestroke capacity in 2019.},
	keywords = {Critical Care, Cross-Sectional Studies, Emergency Medical Services, Health Services Accessibility, Humans, Stroke, Telemedicine, United States},
	issn = {2574-3805},
	doi = {10.1001/jamanetworkopen.2021.45824},
	author = {Zachrison, Kori S and Cash, Rebecca E and Adeoye, Opeolu and Boggs, Krislyn M and Schwamm, Lee H and Ateev Mehrotra and Camargo, Carlos A}
}
@article {696437,
	title = {Estimation of Potential Savings Associated With Switching Medication Formulation},
	journal = {JAMA Health Forum},
	volume = {3},
	number = {2},
	year = {2022},
	month = {2022 Feb},
	pages = {e214823},
	abstract = {This cross-sectional study describes the price differences between capsule and tablet or ointment and cream forms of prescription drugs for insured patients.},
	keywords = {Cross-Sectional Studies, Humans, Prescription Drugs, Tablets},
	issn = {2689-0186},
	doi = {10.1001/jamahealthforum.2021.4823},
	author = {Desai, Sunita M and Wang, Jiejie and Ananthakrishnan, Uttara M and Ghai, Ishita and Ateev Mehrotra and Bhargava, Hemant K}
}
@article {696424,
	title = {Frequency Of Indirect Billing To Medicare For Nurse Practitioner And Physician Assistant Office Visits},
	journal = {Health Aff (Millwood)},
	volume = {41},
	number = {6},
	year = {2022},
	month = {2022 Jun},
	pages = {805-813},
	abstract = {Nurse practitioners (NPs) and physician assistants (PAs) represent a growing share of the health care workforce, but much of the care they provide cannot be observed in claims data because of indirect (or "incident to") billing, a practice in which visits provided by an NP or PA are billed by a supervising physician. If NPs and PAs bill directly for a visit, Medicare and many private payers pay 85~percent of what is paid to a physician for the same service. Some policy makers have proposed eliminating indirect billing, but the possible impact of such a change is unknown. Using a novel approach that relies on prescriptions to identify indirectly billed visits, we estimated that the number of all NP or PA visits in fee-for-service Medicare data billed indirectly was 10.9~million in 2010 and 30.6~million in 2018. Indirect billing was more common in states with laws restricting NPs{\textquoteright} scope of practice. Eliminating indirect billing would have saved Medicare roughly $194~million in 2018, with the greatest decrease in revenue seen among smaller primary care practices, which are more likely to use this form of billing.},
	keywords = {Aged, Humans, Medicare, Nurse Practitioners, Office Visits, Physician Assistants, Physicians, United States},
	issn = {1544-5208},
	doi = {10.1377/hlthaff.2021.01968},
	author = {Patel, Sadiq Y and Huskamp, Haiden A. and Frakt, Austin B and Auerbach, David I and Neprash, Hannah T and Michael L. Barnett and James, Hannah O and Ateev Mehrotra}
}
@article {696432,
	title = {Genome wide copy number variations using Porcine 60K SNP Beadchip in Landlly pigs},
	journal = {Anim Biotechnol},
	year = {2022},
	month = {2022 Apr 04},
	pages = {1-9},
	abstract = {In the present study, Porcine 60K SNP genotype data from 69 Landlly pigs were used to explore Copy Number Variations (CNVs) across the autosomes. A total of 386 CNVs were identified using Hidden Markov Model (HMM) in PennCNV software, which were subsequently aggregated to 115 CNV regions (CNVRs). Among the total detected CNVRs, 58 gain, 49 were loss type while remaining 8 events were both gain and loss types. Identified CNVRs covered 12.5 Mb (0.55\%) of Sus scrofa reference 11.1 genome. Comparison of our results with previous investigations on pigs revealed that approximately 75\% CNVRs were novel, which may be due to differences in genetic background, environment and implementation of artificial selection in Landlly pigs. Functional annotation and pathway analysis showed the significant enrichment of 267 well-annotated Sus scrofa genes in CNVRs. These genes were involved in different biological functions like sensory perception, meat quality traits, back fat thickness and immunity. Additionally, KIT and FUT1 were two major genes detected on CNVR in our population. This investigation provided a comprehensive overview of CNV distribution in the Indian porcine genome for the first time, which may be useful for further investigating the association of important quantitative traits in Landlly pigs.Highlights115 CNVRs were identified in 69 Landlly pig population.Approximately 75\% detected CNVRs were novel for Landlly population.Significant enrichment of 267 well-annotated Sus scrofa genes observed in these CNVRs.These genes were involved in different biological functions like sensory perception, meat quality traits, back fat thickness and immunity.Comprehensive CNV map in the Indian porcine genome developed for the first time.},
	issn = {1532-2378},
	doi = {10.1080/10495398.2022.2056047},
	author = {Panda, Snehasmita and Kumar, Amit and Gaur, Gyanendra Kumar and Ahmad, Sheikh Firdous and Chauhan, Anuj and Mehrotra, Arnav and Dutt, Triveni}
}
@article {696406,
	title = {How Emerging Telehealth Models Challenge Policymaking},
	journal = {Milbank Q},
	volume = {100},
	number = {3},
	year = {2022},
	month = {2022 Sep},
	pages = {650-672},
	abstract = {Policy Points Current telehealth policy discussions are focused on synchronous video and audio telehealth visits delivered by traditional providers and have neglected the growing number of alternative telehealth offerings. These alternative telehealth offerings range from simply supporting traditional brick-and-mortar providers to telehealth-only companies that directly compete with them. We describe policy challenges across this range of alternative telehealth offerings in terms of using the appropriate payment model, determining the payment amount, and ensuring the quality of care.},
	keywords = {Policy Making, Telemedicine},
	issn = {1468-0009},
	doi = {10.1111/1468-0009.12584},
	author = {Tang, Mitchell and Michael E. Chernew and Ateev Mehrotra}
}
@article {696431,
	title = {The Human Male Liver Is Predisposed to Inflammation  Enhanced Myeloid Responses to Inflammatory Triggers},
	journal = {Front Immunol},
	volume = {13},
	year = {2022},
	month = {2022},
	pages = {818612},
	abstract = {BACKGROUND \& AIM: Men have a higher prevalence of liver disease. Liver myeloid cells can regulate tissue inflammation, which drives progression of liver disease. We hypothesized that sex alters the responsiveness of liver myeloid cells, predisposing men to severe liver inflammation.

METHODS: Luminex was done on plasma from Hepatitis B Virus infected patients undergoing nucleoside analogue cessation in 45 male and female patients. We collected immune cells from the sinusoids of uninfected livers of 53 male and female donors. Multiparametric flow cytometry was used to phenotype and characterize immune composition. Isolated monocytes were stimulated with TLR ligands to measure the inflammatory potential and the expression of regulators of TLR signaling.

RESULTS: We confirmed that men experienced more frequent and severe liver damage upon Hepatitis B Virus reactivation, which was associated with inflammatory markers of myeloid activation. No differences were observed in the frequency or phenotype of sinusoidal myeloid cells between male and female livers. However, monocytes from male livers produced more inflammatory cytokines and chemokines in response to TLR stimulation than female monocytes. We investigated negative regulators of TLR signaling and found that TOLLIP was elevated in female liver-derived monocytes.

CONCLUSIONS: Our data show that enhanced responsiveness of myeloid cells from the male liver predisposes men to inflammation, which was associated with altered expression of negative regulators of TLR signaling.},
	keywords = {Cytokines, Female, Humans, Inflammation, Liver Diseases, Male, Monocytes},
	issn = {1664-3224},
	doi = {10.3389/fimmu.2022.818612},
	author = {Kuipery, Adrian and Mahamed, Deeqa and Nkongolo, Shirin and D{\textquoteright}Angelo, June Ann and Johnson Valiente, Alexandra and Mehrotra, Aman and Chapman, William C and Horton, Peter and McGilvray, Ian and Janssen, Harry L A and Gehring, Adam J}
}
@article {696404,
	title = {Impact of an educational program and decision tool on choice of maternity hospital: the delivery decisions randomized clinical trial},
	journal = {BMC Pregnancy Childbirth},
	volume = {22},
	number = {1},
	year = {2022},
	month = {2022 Oct 10},
	pages = {759},
	abstract = {BACKGROUND: Reducing cesarean rates is a public health priority. To help pregnant people select hospitals with lower cesarean rates, numerous organizations publish publically~hospital cesarean rate data. Few pregnant people use these data when deciding where to deliver. We sought to determine whether making cesarean rate data more accessible and understandable increases the likelihood of pregnant people selecting low-cesarean rate hospitals.

METHODS: We conducted a 1:1 randomized controlled trial in 2019-2021 among users of a fertility and pregnancy mobile application. Eligible participants were trying to conceive for fewer than five months or were 28-104~days into their pregnancies. Of 189,456 participants approached and enrolled, 120,621 participants met entry criteria and were included in analyses. The intervention group was offered an educational program explaining the importance of hospital cesarean rates and an interactive tool presenting hospital cesarean rates as 1-to-5-star ratings. Control group users were offered an educational program about hospital choice and a hospital choice tool without cesarean rate data. The primary outcome was the star rating of the hospital selected by each patient during pregnancy. Secondary outcomes were the importance of cesarean rates in choosing a hospital and delivery method (post-hoc secondary outcome).

RESULTS: Of 120,621 participants (mean [SD] age, 27.8 [7.9]), 12,284 (10.2\%) reported their choice of hospital during pregnancy, with similar reporting rates in the intervention and control groups. Intervention group participants selected hospitals with higher~star ratings (2.52 vs 2.16; difference, 0.37 [95\% CI, 0.32 to 0.43] p \&lt; 0.001)~and were more likely to believe that the hospitals they chose would impact their chances of having cesarean deliveries (38.5\% vs 33.1\%, p \&lt; 0.001) but did not assign higher priority to cesarean delivery rates when choosing their hospitals (76.2\% vs 74.3\%, p = 0.05). There was no difference in self-reported cesarean rates between the intervention and control groups (31.4\% vs 31.4\%, p = 0.98).

CONCLUSION: People offered an educational program and interactive tool to compare hospital cesarean rates were more likely to use cesarean data in selecting a hospital and selected hospitals with lower cesarean rates but were not less likely to have a cesarean.

CLINICAL TRIAL REGISTRATION: Registered December 9, 2016 at clinicaltrials.gov, First enrollment November 2019. ID NCT02987803, https://clinicaltrials.gov/ct2/show/NCT02987803.},
	keywords = {Adult, Cesarean Section, Female, Hospitals, Maternity, Humans, Pregnancy, Research Design},
	issn = {1471-2393},
	doi = {10.1186/s12884-022-05087-y},
	author = {Ateev Mehrotra and Wolfberg, Adam and Shah, Neel T and Plough, Avery and Weiseth, Amber and Blaine, Arianna I and Noddin, Katie and Nakamoto, Carter H and Richard, Jessica V and Bradley, Dani}
}
@article {696405,
	title = {Impact of respiratory infection and chronic comorbidities on early pediatric antibiotic dispensing in the United States},
	journal = {Clin Infect Dis},
	year = {2022},
	month = {2022 Oct 05},
	abstract = {BACKGROUND: In the United States, children under age 5 receive high volumes of antibiotics, which may contribute to antibiotic resistance. It has been unclear what role preventable illnesses and chronic comorbidities play in prompting antibiotic prescriptions.

METHODS: We conducted an observational study with a cohort of 124,759 children under age 5 born in the United States between 2008 and 2013 with private medical insurance. Study outcomes included the cumulative number of antibiotic courses dispensed per child by age 5 and the proportion of children for whom at least one antibiotic course was dispensed by age 5. We identified which chronic medical conditions predicted whether a child would be among the top 20\% of antibiotic recipients.

RESULTS: Children received a mean of 6.8 (95\% confidence interval [CI] 6.7, 6.9) antibiotic courses by age five, and 91\% (95\% CI 90, 92) of children had received at least one antibiotic course by age five. Most antibiotic courses (71\%, 95\% CI 70, 72) were associated with respiratory infections. Presence of a pulmonary/respiratory, otologic, and/or immunological comorbidity substantially increase a child{\textquoteright}s odds of being in the top 20\% of antibiotic recipients. Children with at least one of these conditions received a mean of 10.5 (95\% CI 10.4, 10.6) antibiotic courses by age 5.

CONCLUSIONS: Privately insured children in the US receive high volumes of antibiotics early in their lives, largely related to respiratory infections. Antibiotic dispensing is unequally distributed among children, with substantially more antibiotics dispensed to children with select comorbidities.},
	issn = {1537-6591},
	doi = {10.1093/cid/ciac811},
	author = {Kissler, Stephen M and Wang, Bill and Ateev Mehrotra and Michael Barnett and Yonatan H Grad}
}
@article {696442,
	title = {Impact of telelactation services on breastfeeding outcomes among Black and Latinx parents: protocol for the Tele-MILC randomized controlled trial},
	journal = {Trials},
	volume = {23},
	number = {1},
	year = {2022},
	month = {2022 Jan 03},
	pages = {5},
	abstract = {BACKGROUND: Breastfeeding offers many medical and neurodevelopmental advantages for birthing parents and infants; however, the majority of parents stop breastfeeding before it is recommended. Professional lactation support by the International Board Certified Lactation Consultants (IBCLCs) increases breastfeeding rates; however, many communities lack access to IBCLCs. Black and Latinx parents have lower breastfeeding rates, and limited access to professional lactation support may contribute to this disparity. Virtual "telelactation" consults that use two-way video have the potential to increase access to IBCLCs among disadvantaged populations. We present a protocol for the digital Tele-MILC trial, which uses mixed methods to evaluate the impact of telelactation services on breastfeeding outcomes. The objective of this pragmatic, parallel design randomized controlled trial is to assess the impact of telelactation on breastfeeding duration and exclusivity and explore how acceptability of and experiences with telelactation vary across Latinx, Black, and non-Black and non-Latinx parents to guide future improvement of these services.

METHODS: 2400 primiparous, pregnant individuals age \&gt; 18 who intend to breastfeed and live in the USA underserved by IBCLCs will be recruited. Recruitment will occur via Ovia, a pregnancy tracker mobile phone application (app) used by over one million pregnant individuals in the USA annually. Participants will be randomized to (1) on-demand telelactation video calls on personal devices or (2) ebook on infant care/usual care. Breastfeeding outcomes will be captured via surveys and interviews and compared across racial and ethnic groups. This study will track participants for 8 months (including 6 months postpartum). Primary outcomes include breastfeeding duration and breastfeeding exclusivity. We will quantify differences in these outcomes across racial and ethnic groups. Both intention-to-treat and as-treated (using instrumental variable methods) analyses will be performed. This study will also generate qualitative data on the experiences of different subgroups of parents with the telelactation intervention, including barriers to use, satisfaction, and strengths and limitations of this delivery model.

DISCUSSION: This is the first randomized study evaluating the impact of telelactation on breastfeeding outcomes. It will inform the design and implementation of future digital trials among pregnant and postpartum people, including Black and Latinx populations which are historically underrepresented in clinical trials.

TRIAL REGISTRATION: ClinicalTrials.gov NCT04856163. Registered on April 23, 2021.},
	keywords = {Adult, Breast Feeding, Female, Humans, Infant, Middle Aged, Parents, Postnatal Care, Postpartum Period, Pregnancy, Randomized Controlled Trials as Topic, Telemedicine},
	issn = {1745-6215},
	doi = {10.1186/s13063-021-05846-w},
	author = {Uscher-Pines, Lori and Demirci, Jill and Waymouth, Molly and Lawrence, Rebecca and Parks, Amanda and Ateev Mehrotra and Ray, Kristin and DeYoreo, Maria and Kapinos, Kandice}
}
@article {696430,
	title = {Improving Population Access to Stroke Expertise Via Telestroke: Hospitals to Target and the Potential Clinical Benefit},
	journal = {J Am Heart Assoc},
	volume = {11},
	number = {8},
	year = {2022},
	month = {2022 Apr 19},
	pages = {e025559},
	keywords = {Fibrinolytic Agents, Hospitals, Humans, Stroke, Telemedicine, Thrombolytic Therapy},
	issn = {2047-9980},
	doi = {10.1161/JAHA.122.025559},
	author = {Richard, Jessica V and Ateev Mehrotra and Schwamm, Lee H and Wilcock, Andrew D and Uscher-Pines, Lori and Majersik, Jennifer J and Zachrison, Kori S}
}
@article {696443,
	title = {Initiating Opioid Use Disorder Medication via Telemedicine During COVID-19: Implications for Proposed Reforms to the Ryan Haight Act},
	journal = {J Gen Intern Med},
	volume = {37},
	number = {1},
	year = {2022},
	month = {2022 Jan},
	pages = {162-167},
	abstract = {BACKGROUND: The Ryan Haight Act generally requires a clinician to conduct an in-person visit before prescribing an opioid use disorder (OUD) medication. This requirement has impeded use of telemedicine to expand OUD treatment, and many policymakers have called for its removal. During the COVID-19 pandemic, beginning March 16, 2020, the requirement was temporarily waived. It is unclear whether clinicians who treat OUD patients perceive telemedicine to be a safe and effective means of OUD medication initiation.

OBJECTIVE: To understand clinician use of and comfort level with using telemedicine to initiate patients on medication for opioid use disorder.

DESIGN: National survey administered electronically via WebMD/Medscape{\textquoteright}s online clinician panel in fall 2020.

PARTICIPANTS: A total of 602 clinicians (primary care providers, psychiatrists, nurse practitioners or certified nurse specialists, and physician assistants) participated in the survey.

MAIN MEASURES: Frequency of video, audio-only, and in-person visits for medication initiation, comfort level with using video for new patient visits with OUD.

KEY RESULTS: Clinicians varied substantially in their use of telemedicine for medication initiation. Approximately 25\% used telemedicine for most initiations while 40\% used only in-person visits. The majority (55.8\%) expressed at least some discomfort with using telemedicine for treating new OUD patients, although clinicians with more OUD patients were less likely to express such discomfort.

CONCLUSION: Findings suggest that a permanent relaxation of the Ryan Haight requirement may not result in widespread adoption of telemedicine for OUD medication initiation without additional supports or incentives.},
	keywords = {Covid-19, Humans, Opiate Substitution Treatment, Opioid-Related Disorders, Pandemics, SARS-CoV-2, Telemedicine},
	issn = {1525-1497},
	doi = {10.1007/s11606-021-07174-w},
	author = {Huskamp, Haiden A. and Riedel, Lauren and Uscher-Pines, Lori and Alisa B. Busch and Michael L. Barnett and Raja, Pushpa and Ateev Mehrotra}
}
@article {696435,
	title = {Legislation Increased Medicare Telestroke~Billing, But Underbilling And Erroneous Billing Remain Common},
	journal = {Health Aff (Millwood)},
	volume = {41},
	number = {3},
	year = {2022},
	month = {2022 Mar},
	pages = {350-359},
	abstract = {In the Furthering Access to Stroke Telemedicine (FAST) Act, passed as part of a budget omnibus in 2018, Congress permanently expanded Medicare payment for telemedicine consultations for acute stroke ("telestroke") from delivery only in rural areas to delivery in both urban and rural areas, effective January 1, 2019. Using a controlled time-series analysis, we found that one year after FAST Act implementation, billing for Medicare telestroke increased substantially in emergency departments at both directly affected urban hospitals and indirectly affected rural hospitals. However, at that time only a minority of hospitals with known telestroke capacity had ever billed Medicare for that service, and there was substantial billing inconsistent with Medicare requirements. As Congress considers options for Medicare telemedicine payment after the COVID-19 pandemic, our findings, which are consistent with confusion among providers regarding telemedicine billing requirements, suggest that simplified payment rules would help ensure that expanded reimbursement achieves its intended impact.},
	keywords = {Aged, Covid-19, Hospitals, Rural, Humans, Medicare, Pandemics, SARS-CoV-2, Stroke, Telemedicine, United States},
	issn = {1544-5208},
	doi = {10.1377/hlthaff.2021.00791},
	author = {Wilcock, Andrew D and Schwamm, Lee H and Zubizarreta, Jose R and Zachrison, Kori S and Uscher-Pines, Lori and Majersik, Jennifer J and Richard, Jessica V and Ateev Mehrotra}
}
@article {696418,
	title = {A methodology for identifying behavioral health advanced practice registered nurses in administrative claims},
	journal = {Health Serv Res},
	volume = {57},
	number = {4},
	year = {2022},
	month = {2022 Aug},
	pages = {973-978},
	abstract = {OBJECTIVE (STUDY QUESTION): Advanced practice registered nurses (APRNs) play an increased role in mental illness treatment. Health services research that uses claims to study mental health is often limited because behavioral health nurse practitioners (i.e., APRNs who specialize in mental illness, also known as psychiatric mental health APRNs) cannot be easily identified in claims data. We describe two methodologies to identify behavioral health APRNs in administrative claims. DATA SOURCES/STUDY SETTING (W/ HOSPITAL/INSTITUTION SETTING ANONYMIZED): We use 2010-2018 claims from the traditional Medicare fee-for-service program along with 2010-2019 commercial claims and Medicare Advantage data from the OptumLabs Data Warehouse (OLDW). Self-reported specialty data from the National Plan \&amp; Provider Enumeration System (NPPES) were used for validation.

STUDY DESIGN: For each APRN, we calculated the percentage of visit diagnoses and of prescriptions in each database that were for mental health and classified those with >=80\% as behavioral health APRNs. We validated our definition with NPPES self-reported specialty for Medicare data.

DATA COLLECTION/EXTRACTION METHODS: Not applicable.

PRINCIPAL FINDINGS: Among APRNs with 10+ visits, 10,978 (8.1\%) in Medicare and 9829 (11.7\%) in commercial claims data met our visit-based criteria as behavioral health APRNs. Among APRNs with 10+ prescriptions, 8160 (6.2\%) in Medicare and 16,538 (9.0\%) in commercial claims data met our prescription-based criteria as behavioral health APRNs. Among the APRNs who self-reported they were behavioral health APRNs, 92.8\% and 90.5\% met our visit-based and prescription-based criteria, respectively.

CONCLUSIONS: We present and validate two methods of identifying behavioral health APRNs in claims that can be used by other researchers.},
	keywords = {Advanced practice nursing, Aged, Humans, Medicare, Mental Disorders, Nurse Practitioners, Psychiatry, United States},
	issn = {1475-6773},
	doi = {10.1111/1475-6773.13974},
	author = {Richard, Jessica V and Huskamp, Haiden A. and Michael L. Barnett and Alisa B. Busch and Ateev Mehrotra}
}
@article {696420,
	title = {Non-aneurysmal subarachnoid hemorrhage: Is the deep venous system the hidden culprit?},
	journal = {Acta Neurochir (Wien)},
	volume = {164},
	number = {7},
	year = {2022},
	month = {2022 Jul},
	pages = {1827-1835},
	abstract = {AIM: The exact cause of bleeding in non-aneurysmal sub-arachnoid hemorrhage (SAH) is yet to be established. The present study intends to evaluate the morphological variants of deep cerebral venous drainage, especially basal veins of Rosenthal (BVR), and to correlate if such a venous anomaly is associated with increased incidence of non-aneurysmal SAH.

METHODS: A prospective analysis of all the patients of age more than 12~years with spontaneous non-aneurysmal SAH and undergone 4-vessel DSA for the diagnosis of the source of bleeding was included in the study (n = 59). The anatomy of the basal venous distribution was evaluated and was divided into 3 different types, namely normal (Type A), normal variant (Type B), and primitive (Type C), based on DSA findings. The follow-up of these cases was noted. The three groups were compared with one another.

RESULTS: The median age of presentation was 51~years with slight male predominance (52\%). Primitive venous drainage was associated with a poorer grade at presentation (p = 0.002), more severe bleed (p = 0.001), vasospasm (p = 0.045), and a poorer outcome at 6~months (p = 0.019). Hydrocephalous and vasospasm were seen in patients with primitive venous drainage. On multivariate regression analysis for poorer outcome, it was observed that a worse grade at presentation, extensive bleed, primitive venous drainage are independent predictors of an adverse outcome.

CONCLUSION: The presence of primitive venous drainage has a linear relationship with the development of non-aneurysmal SAH with multi-cisternal hemorrhage, worse grade at presentation, and unfavorable outcome.},
	keywords = {Cerebral Veins, Child, Female, Humans, Incidence, Male, Middle Aged, Subarachnoid Hemorrhage, Vasospasm, Intracranial},
	issn = {0942-0940},
	doi = {10.1007/s00701-022-05222-w},
	author = {Kanjilal, Soumen and Mehrotra, Anant and Singh, Vivek and Dikshit, Priyadarshi and Prasad, Surya Nandan and Kumar Verma, Pawan and Das, Kuntal Kanti and Bhaisora, Kamlesh and Kumar Jaiswal, Awadhesh and Behari, Sanjay and Kumar, Raj}
}
@article {696401,
	title = {Patient and Clinician Characteristics Associated with Use of Telemedicine for Buprenorphine Induction Among Medicare Beneficiaries},
	journal = {J Gen Intern Med},
	volume = {37},
	number = {14},
	year = {2022},
	month = {2022 Nov},
	pages = {3758-3761},
	keywords = {Aged, Buprenorphine, Humans, Medicare, Telemedicine, United States},
	issn = {1525-1497},
	doi = {10.1007/s11606-022-07633-y},
	author = {Patel, Sadiq Y and Ortiz, Esteban G and Barsky, Benjamin A and Huskamp, Haiden A. and Alisa B. Busch and Ateev Mehrotra}
}
@article {696438,
	title = {Paying patients to use lower-priced providers},
	journal = {Health Serv Res},
	volume = {57},
	number = {1},
	year = {2022},
	month = {2022 Feb},
	pages = {37-46},
	abstract = {OBJECTIVE: Many employers have introduced rewards programs as a new benefit design in which employees are paid $25-$500 if they receive care from lower-priced providers. Our goal was to assess the impact of the rewards program on procedure prices and choice of provider and how these outcomes vary by length of exposure to the program and patient population.

STUDY SETTING: A total of 87 employers from across the nation with 563,000 employees and dependents who have introduced the rewards program in 2017 and 2018.

STUDY DESIGN: Difference-in-difference analysis comparing changes in average prices and market share of lower-priced providers among employers who introduced the reward program to those that did not.

DATA COLLECTION METHODS: We used claims data for 3.9 million enrollees of a large health plan.

PRINCIPAL FINDINGS: Introduction of the program was associated with a 1.3\% reduction in prices during the first year and a 3.7\% reduction in the second year of access. Use of the program and price reductions are concentrated among magnetic resonance imaging (MRI) services, for which 30\% of patients engaged with the program, 5.6\% of patients received an incentive payment in the first year, and 7.8\% received an incentive payment in the second year. MRI prices were 3.7\% and 6.5\% lower in the first and second years, respectively. We did not observe differential impacts related to enrollment in a consumer-directed health plan or the degree of market-level price variation. We also did not observe a change in utilization.

CONCLUSIONS: The introduction of financial incentives to reward patients from receiving care from lower-priced providers is associated with modest price reductions, and savings are concentrated among MRI services.},
	keywords = {Adult, Cost Savings, Cost Sharing, Health Benefit Plans, Employee, Humans, Male, Motivation, Organizational Policy, Patient Participation, Patient Preference},
	issn = {1475-6773},
	doi = {10.1111/1475-6773.13711},
	author = {Whaley, Christopher and Sood, Neeraj and Michael Chernew and Metcalfe, Leanne and Ateev Mehrotra}
}
@article {696402,
	title = {Perspectives of Patients Receiving Telemedicine Services for Opioid Use Disorder Treatment: A Qualitative Analysis of User Experiences},
	journal = {J Addict Med},
	volume = {16},
	number = {6},
	year = {2022},
	month = {2022 Nov-Dec 01},
	pages = {702-708},
	abstract = {OBJECTIVE: Telemedicine for opioid use disorder (tele-OUD) has the potential to increase access to medications for OUD (MOUD). Fully virtual tele-OUD services, in which all care is provided via telemedicine, are increasingly common, yet few studies document the experiences of patients who use such services. Understanding patient perspectives is one of multiple considerations to inform the regulation and reimbursement of tele-OUD services.

METHODS: We conducted semi-structured interviews with 20 adults receiving care from one fully virtual tele-OUD service who had received 3 to 5 weeks of treatment. Analyses were conducted using an inductive and deductive approach informed by the modified Unified Theory of Acceptance and Use of Technology model.

RESULTS: Over three quarters of patients with past experience receiving in-person MOUD treatment described tele-OUD as more advantageous with its key strength being more patient centered. Over three quarters of patients said they felt tele-OUD helped to ameliorate social barriers to seeking treatment, and nearly all said they appreciated the speed at which they were able to initiate MOUD treatment via tele-OUD. Surprisingly, the pandemic was not among the factors that influenced patient interest in tele-OUD.

CONCLUSIONS: Patients engaged in one fully virtual tele-OUD service described unique advantages of tele-OUD. More research is needed to determine the appropriateness of tele-OUD for people in various stages of recovery, and data on long-term treatment outcomes are needed to inform decisions regarding the regulation and reimbursement of fully virtual and hybrid care models for OUD.},
	keywords = {Adult, Analgesics, Opioid, Buprenorphine, Humans, Opiate Substitution Treatment, Opioid-Related Disorders, Pandemics, Telemedicine},
	issn = {1935-3227},
	doi = {10.1097/ADM.0000000000001006},
	author = {Sousa, Jessica L and Raja, Pushpa and Huskamp, Haiden A. and Ateev Mehrotra and Alisa B. Busch and Michael L. Barnett and Uscher-Pines, Lori}
}
@article {696436,
	title = {Racial Disparities in Endovascular Thrombectomy: It{\textquoteright}s More Than Just Access},
	journal = {Stroke},
	volume = {53},
	number = {3},
	year = {2022},
	month = {2022 Mar},
	pages = {864-866},
	keywords = {Humans, Racial Groups, Thrombectomy},
	issn = {1524-4628},
	doi = {10.1161/STROKEAHA.121.037921},
	author = {Zachrison, Kori S and Cross, Danielle}
}
@article {696411,
	title = {Rapid Growth Of Remote Patient Monitoring Is Driven By A Small Number Of Primary Care Providers},
	journal = {Health Aff (Millwood)},
	volume = {41},
	number = {9},
	year = {2022},
	month = {2022 Sep},
	pages = {1248-1254},
	abstract = {Growing enthusiasm for remote patient monitoring has been motivated by the hope that it can improve care for patients with poorly controlled chronic illness. In a national commercially insured population in the US, we found that billing for remote patient monitoring increased more than fourfold during the first year of the COVID-19 pandemic. Most of this growth was driven by a small number of primary care providers. Among the patients of these providers with a high volume of remote patient monitoring, we did not observe substantial targeting of remote patient monitoring to people with greater disease burden or worse disease control. Further research is needed to identify which patients benefit from remote patient monitoring, to inform evidence-based use and coverage decisions. In the meantime, payers and policy makers should closely monitor remote patient monitoring use and spending.},
	keywords = {Covid-19, Humans, Monitoring, Physiologic, Pandemics, Primary Health Care},
	issn = {1544-5208},
	doi = {10.1377/hlthaff.2021.02026},
	author = {Tang, Mitchell and Ateev Mehrotra and Stern, Ariel D}
}
@article {696407,
	title = {Receipt of Out-of-State Telemedicine Visits Among Medicare Beneficiaries During the COVID-19 Pandemic},
	journal = {JAMA Health Forum},
	volume = {3},
	number = {9},
	year = {2022},
	month = {2022 Sep 02},
	pages = {e223013},
	abstract = {IMPORTANCE: Early in the COVID-19 pandemic, states implemented temporary changes allowing physicians without a license in their state to provide care to their residents. There is an ongoing debate at both the federal and state levels on whether to change licensure rules permanently to facilitate out-of-state telemedicine use.

OBJECTIVE: To describe out-of-state telemedicine use during the pandemic.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study of telemedicine visits included all patients with traditional Medicare from January through June 2021.

MAIN OUTCOMES AND MEASURES: Telemedicine visits from January through June 2021 where the patient{\textquoteright}s home address and the physician{\textquoteright}s practice address were in different states.

RESULTS: In describing which patients and specialties were using out-of-state telemedicine, we focused on the period between January to June 2021. We chose this period because it was after the turmoil of the early pandemic, when vaccines became widely available and the health care system had stabilized, but before many of the temporary licensing regulations began to lapse by mid-2021. In the first half of 2021, there were 8 392 092 patients with a telemedicine visit and, of these, 422 547 (5.0\%) had 1 or more out-of-state telemedicine visits. Those who lived in a county close to a state border (within 15 miles) accounted for 57.2\% of all out-of-state telemedicine visits. Among the out-of-state visits in this time period, 64.3\% were with a primary care or mental health clinician. For 62.6\% of all out-of-state visits, a prior in-person visit occurred between the same patient and clinician between March 2019 and the visit. The demographics and conditions treated were similar for within-state and out-of-state telemedicine visits, with several notable exceptions. Among those with a telemedicine visit, people in rural communities were more likely to receive out-of-state telemedicine care (33.8\% vs 21.0\%), and there was high of out-of-state telemedicine use for cancer care (9.8\% of all telemedicine visits for cancer care).

CONCLUSIONS AND RELEVANCE: The findings of this cross-sectional study suggest that licensure restrictions of out-of-state telemedicine would have had the largest effect on patients who lived near a state border, those in rural locales, and those who received primary care or mental health treatment.},
	keywords = {Aged, Covid-19, Cross-Sectional Studies, Humans, Medicare, Pandemics, Telemedicine, United States},
	issn = {2689-0186},
	doi = {10.1001/jamahealthforum.2022.3013},
	author = {Ateev Mehrotra and Huskamp, Haiden A. and Nimgaonkar, Alok and Krisda H Chaiyachati and Bressman, Eric and Richman, Barak}
}
@article {696421,
	title = {The Relative Survival Impact of Guideline-Concordant Clinical Staging and Stage-Appropriate Treatment of Potentially Curable Non-Small Cell Lung Cancer},
	journal = {Chest},
	volume = {162},
	number = {1},
	year = {2022},
	month = {2022 Jul},
	pages = {242-255},
	abstract = {BACKGROUND: Lung cancer management guidelines strive to improve outcomes. Theoretically, thorough staging promotes optimal treatment selection. We examined the association between guideline-concordant invasive mediastinal nodal staging, guideline-concordant treatment, and non-small cell lung cancer survival.

RESEARCH QUESTION: What is the current practice of invasive mediastinal nodal staging for patients with lung cancer in a structured multidisciplinary care environment? Is guideline-concordant staging associated with guideline-concordant treatment? How do they relate to survival?

STUDY DESIGN AND METHODS: We evaluated patients with nonmetastatic non-small cell lung cancer diagnosed from 2014 through 2019 in the Multidisciplinary Thoracic Oncology Program of the Baptist Cancer Center, Memphis, Tennessee. We examined patterns of mediastinal nodal staging and stage-stratified treatment, grouping patients into cohorts with guideline-concordant staging alone, guideline-concordant treatment alone, both, or neither. We evaluated overall survival with Kaplan-Meier curves and Cox proportional hazards models.

RESULTS: Of 882 patients, 456 (52\%) received any invasive mediastinal staging. Seventy-four percent received guideline-concordant staging; guideline-discordant staging decreased from 34\%~in 2014 to 18\%~in 2019 (P~\&lt; .0001). Recipients of guideline-concordant staging were more likely to receive guideline-concordant treatment (83\%~vs~66\%; P~\&lt; .0001). Sixty-one percent received both guideline-concordant invasive mediastinal staging and guideline-concordant treatment; 13\%~received guideline-concordant staging alone; 17\%~received guideline-concordant treatment alone; and 9\%~received neither. Survival was greatest in patients who received both (adjusted hazard ratio [aHR], 0.41; 95\%~CI, 0.26-0.63), followed by those who received guideline-concordant treatment alone (aHR, 0.60; 95\%~CI, 0.36-0.99), and those who received guideline-concordant staging alone (aHR, 0.64; 95\%~CI, 0.37-1.09) compared with neither (P~\&lt; .0001, log-rank test).

INTERPRETATION: Levels of guideline-concordant staging were high, were rising, and were associated with guideline-concordant treatment selection in this multidisciplinary care cohort. Guideline-concordant staging and guideline-concordant treatment were complementary in their association with improved survival, supporting the connection between these two processes and lung cancer outcomes.},
	keywords = {Carcinoma, Non-Small-Cell Lung, Humans, Lung Neoplasms, Lymph Nodes, Neoplasm Staging, Proportional Hazards Models, Retrospective Studies},
	issn = {1931-3543},
	doi = {10.1016/j.chest.2022.01.046},
	author = {Meadows-Taylor, Meghan B and Faris, Nicholas R and Smeltzer, Matthew P and Ray, Meredith A and Fehnel, Carrie and Akinbobola, Olawale and Ariganjoye, Folabi and Patel, Anita and Pacheco, Alicia and Mehrotra, Anurag and Fox, Roy and Optican, Robert and Tonkin, Keith and Machin, James and Wright, Jeffrey and Robbins, Edward T and Osarogiagbon, Raymond U}
}
@article {696414,
	title = {Reply to Hagiya et al},
	journal = {Clin Infect Dis},
	volume = {75},
	number = {1},
	year = {2022},
	month = {2022 Aug 24},
	pages = {177},
	issn = {1537-6591},
	doi = {10.1093/cid/ciab1012},
	author = {Shi, Zhuo and Ateev Mehrotra}
}
@article {696400,
	title = {Specialty care after transition to long-term care in nursing home},
	journal = {J Am Geriatr Soc},
	year = {2022},
	month = {2022 Nov 26},
	abstract = {BACKGROUND: Nursing home residents face many barriers to accessing specialist physician outpatient care. However, little data exists on how specialty care use changes when individuals transition to a nursing home in the US.

METHODS: We studied specialist outpatient visits for new long-term care (LTC) residents within 1 year before and after their transition to nursing home residence using the Minimum Data Set v3.0 (MDS) and a 20\% sample of Medicare fee-for-service claims in 2014-2018. To focus on residents requiring specialty care at baseline, we limited the cohort to residents with specialty care in the 13-24 months before LTC transition. We then measured the proportion of residents receiving at least one visit in the 12 months before the transition and the 12 months after the transition. We also examined subgroups of residents with a prior diagnosis likely requiring long-term specialty care (e.g., multiple sclerosis). Finally, we examined whether there was continuity of care within the same specialty care provider.

RESULTS: Among 39,288 new LTC transitions identified in 2016-2017, 17,877 (45.5\%) residents had a prior specialist visit 13-24 months before the transition. Among them, the proportion of residents with specialty visits decreased consistently in all specialties in the 12 months after the transition, ranging from a relative decrease of 14.4\% for orthopedics to 67.9\% for psychiatry. The relative decrease among patients with a diagnosis likely requiring specialty care ranged from 0.9\% for neurology in patients with multiple sclerosis to 67.1\% for psychiatry in patients with severe mental illness. Among residents who continued visiting a specialist, 78.9\% saw the same provider as before the transition.

CONCLUSIONS: The use of specialty care falls significantly after patients transition to a nursing home. Further research is needed to understand what drives this drop in use and whether interventions, such as telemedicine can ameliorate potential barriers to specialty care.},
	issn = {1532-5415},
	doi = {10.1111/jgs.18129},
	author = {Ulyte, Agne and Ateev Mehrotra and Huskamp, Haiden A. and Grabowski, David C and Michael L. Barnett}
}
@article {696426,
	title = {Telemedicine Visits to Children During the Pandemic: Practice-Based Telemedicine Versus Telemedicine-Only Providers},
	journal = {Acad Pediatr},
	year = {2022},
	month = {2022 May 16},
	abstract = {OBJECTIVE: In March 2020, regulatory and payment changes allowed "brick and mortar" pediatric practices to offer practice-based telemedicine for the first time, joining direct-to-consumer (DTC) telemedicine vendors in the ability to offer visits for common acute pediatric concerns via telemedicine. We sought to characterize the relative contribution of practice-based telemedicine versus commercial DTC telemedicine models in provision of children{\textquoteright}s telemedicine from 2018 through 2021.

METHODS: Using January 2018 to September 2021 data from Optum{\textquoteright}s de-identified Clinformatics{\textregistered} Data Mart Database, we identified telemedicine visits by children <=17, excluding preventive visits and visits to specialists, emergency departments, and urgent care. Among included visits, we defined "telemedicine-only" providers as those with >=80\% of visits via telemedicine and practice-based telemedicine providers as those with <=50\% of visits via telemedicine. We then described the telemedicine visit volume and diagnoses for these categories overall and per 1000 children per month.

RESULTS: From January 2018 to February 2020, telemedicine-only providers accounted for 57,815 telemedicine visits (90.8\%), while practice-based telemedicine accounted for 4192 telemedicine visits (6.6\%). From March 2020 to September 2021, telemedicine-only providers accounted for 38,282 telemedicine visits (6.1\%), while practice-based telemedicine accounted for 555,125 telemedicine visits (88.2\%). Per month, telemedicine visits to practice-based telemedicine providers increased from pre-pandemic to pandemic periods (0.1 vs 12.9 visits per 1000 children/month), while telemedicine visits to telemedicine-only providers occurred at a similar rate from pre-pandemic to pandemic periods (0.92 vs 0.96 visits per 1000 children/month).

CONCLUSIONS: We observed a large increase in telemedicine visits during the pandemic, with the growth in visits exclusively occurring among visits to practice-based telemedicine providers as opposed to telemedicine-only providers.},
	issn = {1876-2867},
	doi = {10.1016/j.acap.2022.05.010},
	author = {Ray, Kristin N and Wittman, Samuel R and Yabes, Jonathan G and Sabik, Lindsay M and Hoberman, Alejandro and Ateev Mehrotra}
}
@article {696444,
	title = {Thirteen-and-a-half Syndrome Secondary to the Brainstem Cavernoma},
	journal = {Neurol India},
	volume = {70},
	number = {1},
	year = {2022},
	month = {2022 Jan-Feb},
	pages = {355-358},
	abstract = {BACKGROUND: "Thirteen-and-a-half" is a newly described clinical syndrome characterized by the combination of the one-and-a-half syndrome with fifth and seventh cranial nerve nuclei involvement (11/2 + 5 + 7 = 131/2). To the authors{\textquoteright} knowledge, this is the first report of the thirteen-and-a-half syndrome secondary to pontine cavernoma and, overall, only the second reported case of this syndrome in the literature till date.

CASE REPORT: A 20-year-old man presented with the clinical features suggestive of the thirteen-and-a-half syndrome, explained radiologically by pontine cavernoma. We operated him using a suboccipital transvermian approach and he is doing well at 2.5 years follow-up. Interestingly, his one-and-a-half syndrome has partially improved to left horizontal gaze palsy.

CONCLUSION: The clinical appreciation of the thirteen-and-a-half syndrome precisely localizes the lesion to ipsilateral dorsal pontine tegmentum. Neurosurgeons must be aware of the newly described "one-and-a-half- plus" syndromes as they help in a better understanding of pathoanatomy caused by different disease processes in the brainstem.},
	keywords = {Adult, Brain Stem, Hemangioma, Cavernous, Humans, Male, Pons, Strabismus, Syndrome, Young Adult},
	issn = {1998-4022},
	doi = {10.4103/0028-3886.338728},
	author = {Gosal, Jaskaran Singh and Khatri, Deepak and Das, Kuntal Kanti and Gajbhiye, Sanjog and Mehrotra, Anant and Kumar Jaiswal, Awadhesh and Behari, Sanjay}
}
@article {696419,
	title = {Trends in characteristics of neurologists who provide stroke consultations in the USA, 2008-2021},
	journal = {Stroke Vasc Neurol},
	year = {2022},
	month = {2022 Jul 28},
	abstract = {INTRODUCTION: Patients with acute ischaemic strokes (AIS), on average, fare better with timely neurologist consultation, and a growing proportion of them receive one. However, little is known about trends in the characteristics of neurologists who treat AIS.

METHODS: We identified AIS and transient ischaemic attack (TIA) episodes with neurologist consults in fee-for-service Medicare from January 2008 to September 2021. For each episode, we determined whether the neurologist was a vascular neurologist, was a high-volume provider, whether the patient was transferred between hospitals and the distance between the patient{\textquoteright}s home and physician{\textquoteright}s practice.

RESULTS: From 2008 to 2021, the share of AIS/TIA episodes (n=5 073 294) with neurologist consults increased (52.9\% to 61.7\%). Among episodes with consults, the fraction conducted by a vascular neurologist (5.2\% to 13.7\%) or by a high-volume neurologist (13.2\% to 14.9\%) also increased. The fraction with the patient{\textquoteright}s home and neurologist greater than 100 miles apart (4.8\% to 9.6\%) or in different states (5.1\% to 8.1\%) increased, as did the fraction with transfers (4.2\% to 8.5\%).

DISCUSSION: Over the study period, the proportion of AIS/TIA episodes with consultations from neurologists with either vascular neurology certifications or high volumes increased substantially.},
	issn = {2059-8696},
	doi = {10.1136/svn-2022-001662},
	author = {Nakamoto, Carter H and Wilcock, Andrew D and Schwamm, Lee H and Majersik, Jennifer J and Zachrison, Kori S and Ateev Mehrotra}
}
@article {696410,
	title = {Trends In Mental Health Care Delivery By Psychiatrists And Nurse Practitioners In Medicare, 2011-19},
	journal = {Health Aff (Millwood)},
	volume = {41},
	number = {9},
	year = {2022},
	month = {2022 Sep},
	pages = {1222-1230},
	abstract = {The supply of psychiatrists in the United States is inadequate to address the unmet demand for mental health care. Psychiatric mental health nurse practitioners (PMHNPs) may fill the widening gap between supply of and demand for mental health specialists with prescribing privileges. Using Medicare claims for a 100~percent sample of fee-for-service beneficiaries (average age, sixty-one years) who had an office visit for either a psychiatrist or a PMHNP during the period 2011-19, we examined how the supply and use of psychiatrists and PMHNPs changed over time, and we compared their practice patterns. Psychiatrists and PMHNPs treated roughly comparable patient populations with similar services and prescriptions. From 2011 to 2019 the number of PMHNPs treating Medicare beneficiaries grew 162~percent, compared with a 6~percent relative decrease in the number of psychiatrists doing so. During the same period, total annual mental health office visits per 100 beneficiaries decreased 11.5~percent from 27.4 to 24.2, the net result of a 29.0~percent drop in psychiatrist visits being offset by a 111.3~percent increase in PMHNP visits. The proportion of all mental health prescriber visits provided by PMHNPs increased from 12.5~percent to 29.8~percent during 2011-19, exceeding 50~percent in rural, full-scope-of-practice regions. PMHNPs are a rapidly growing workforce that may be instrumental in improving mental health care access.},
	keywords = {Aged, Fee-for-Service Plans, Health Services Accessibility, Humans, Medicare, Middle Aged, Nurse Practitioners, Psychiatry, United States},
	issn = {1544-5208},
	doi = {10.1377/hlthaff.2022.00289},
	author = {Cai, Arno and Ateev Mehrotra and Germack, Hayley D and Alisa B. Busch and Huskamp, Haiden A. and Michael L. Barnett}
}
@article {696409,
	title = {Trends in Remote Patient Monitoring Use in Traditional Medicare},
	journal = {JAMA Intern Med},
	volume = {182},
	number = {9},
	year = {2022},
	month = {2022 Sep 01},
	pages = {1005-1006},
	abstract = {This cross-sectional study uses traditional Medicare claims data to assess trends in general remote patient monitoring from January 2018 through September 2021.},
	keywords = {Aged, Humans, Medicare, Monitoring, Physiologic, United States},
	issn = {2168-6114},
	doi = {10.1001/jamainternmed.2022.3043},
	author = {Tang, Mitchell and Nakamoto, Carter H and Stern, Ariel D and Ateev Mehrotra}
}
@article {696416,
	title = {Use of and Attitudes About Telelactation Services among New Parents},
	journal = {Telemed J E Health},
	year = {2022},
	month = {2022 Aug 05},
	abstract = {Background: We conducted a national, cross-sectional survey among new parents to explore use and acceptability of telelactation. Methods: Recruitment occurred between October 2021 and January 2022 on Ovia{\textquoteright}s parenting mobile phone application. Poststratification survey weights were used, and logistic and linear regression models estimated associations between demographics and telelactation use. Results: Among 1,617 respondents, 33.8\% had at least one telelactation visit. Odds of any telelactation visit(s) were greater for parents who gave birth in 2021 versus 2019 (odds ratio [OR]: 1.69, 95\% confidence interval [CI]: 1.26-2.25), insured by Medicaid (OR: 1.43, 95\% CI: 1.02-2.02), and younger parents (OR: 2.07, 95\% CI: 1.32-3.34). In total, 56.0\% agreed that they would be comfortable breastfeeding over video to get help, and 27.6\% agreed that lactation support over video is as good as in-person support. Conclusions: Telelactation is increasingly common and acceptable to many parents.},
	issn = {1556-3669},
	doi = {10.1089/tmj.2022.0159},
	author = {Uscher-Pines, Lori and Kapinos, Kandice A and Ateev Mehrotra and Demirci, Jill and Ray, Kristin N and Alvarado, Gabriela and DeYoreo, Maria}
}
@article {696440,
	title = {Use of Telemedicine for Buprenorphine Inductions in Patients With Commercial Insurance or Medicare Advantage},
	journal = {JAMA Netw Open},
	volume = {5},
	number = {1},
	year = {2022},
	month = {2022 Jan 04},
	pages = {e2142531},
	abstract = {This cross-sectional study examines the use of telemedicine for buprenorphine inductions among individuals with commercial insurance or Medicare Advantage during the temporary repeal of the Ryan Haight Act requirement of in-person evaluation before prescribing buprenorphine during to the COVID-19 pandemic.},
	keywords = {Adult, Aged, Aged, 80 and over, Buprenorphine, Covid-19, Cross-Sectional Studies, Drug Prescriptions, Female, Humans, Insurance Coverage, Legislation, Medical, Male, Medicare Part C, Middle Aged, Narcotic Antagonists, Opioid-Related Disorders, Pandemics, Practice Patterns, Physicians{\textquoteright}, Telemedicine, United States, Young Adult},
	issn = {2574-3805},
	doi = {10.1001/jamanetworkopen.2021.42531},
	author = {Barsky, Benjamin A and Alisa B. Busch and Patel, Sadiq Y and Ateev Mehrotra and Huskamp, Haiden A.}
}
@article {696422,
	title = {Using Claims-Based Estimates of Post-Operative Visits to Revalue Procedures with 10- and 90-Day Global Periods: Updated Results Using Calendar Year 2019 Data},
	journal = {Rand Health Q},
	volume = {9},
	number = {3},
	year = {2022},
	month = {2022 Jun},
	pages = {10},
	abstract = {Medicare payment for many health care procedures covers not only the procedure itself but also most post-operative care over a fixed period of time (the ""global period""). The Centers for Medicare \&amp; Medicaid Services (CMS) sets payment rates assuming that a certain number and type of post-operative visits specific to each procedure typically occur. This article describes how CMS might use claims-based data on the number of post-operative visits to adjust valuation for procedures with 10- and 90-day global periods. There are links between the number of bundled post-operative visits and the components of valuation addressed in this study: work, practice expense (PE), and malpractice relative value units (RVUs). There is some ambiguity regarding how a reduction in post-operative visits translates into changes in work RVUs. In contrast, a reduction in post-operative visits has clear implications on physician time and direct PE. Changes in physician work, physician time, and direct PE will, in turn, affect the allocation of pools of PE and malpractice RVUs to individual services. The idiosyncrasies of the resource-based relative value scale system used to determine payment for Medicare services result in some ambiguity about how procedures should be revalued to reflect reductions in post-operative visits. These results may inform further policy development around revaluation for global procedures.},
	issn = {2162-8254},
	author = {Mulcahy, Andrew W and Ruder, Teague and Lovejoy, Susan L and Crespin, Daniel J and Rasmussen, Petra and Merrell, Katie and Ateev Mehrotra}
}
@article {696427,
	title = {Variation in Estimated Surgical Procedure Times Across Patient Characteristics and Surgeon Specialty},
	journal = {JAMA Surg},
	volume = {157},
	number = {5},
	year = {2022},
	month = {2022 May 01},
	pages = {e220099},
	abstract = {IMPORTANCE: The time involved in performing a procedure is a key factor in determining physician payments by Medicare. However, there are long-standing concerns regarding the accuracy of the time estimates generated by the American Medical Association/Specialty Society Relative Value Scale Update Committee surveys that are used in the valuation process, and there have been calls to use other data sources to estimate procedure times.

OBJECTIVE: To compare estimated procedure times that come from claims with the times used in Medicare{\textquoteright}s valuation process.

DESIGN AND SETTING: Building off prior work using Medicare fee-for-service claims, procedure times were estimated from linked anesthesia claims data for 1349 different Current Procedure Terminology codes that are typically performed with anesthesia. All procedures in the nation performed in 2018 for Medicare fee-for-service beneficiaries were included in the analysis. These estimated times were compared with the times used in the valuation process. Analysis took place from February to November 2021.

MAIN OUTCOMES AND MEASURES: Estimated procedure times using anesthesia claims were compared with the procedure time used in valuation by calculating an estimated-to-valuation procedure time ratio for each code. The valuation procedure time is publicly reported by Medicare. The mean and median ratio are presented over all procedures and for select high-volume codes as well as by patient characteristics (age, sex, and risk score) and specialty of the physician performing the procedure.

RESULTS: Across 4.9 million procedures in this analysis, the mean estimated procedure time was 27\% lower than the time used in the valuation process. There were notable exceptions, for which the mean estimated procedure time equaled or exceeded the valuation time including total hip arthroplasty (5\% longer) and total knee arthroplasty (equal duration). Within a given code, older patients and those with more illness had longer procedure times. There was substantial variation across specialties in the percent difference between mean estimated and valuation procedure times ranging from gastroenterology (36\% shorter) and ophthalmology (35\% shorter) to cardiac surgery (2\% longer) and thoracic surgery (7\% longer).

CONCLUSIONS AND RELEVANCE: Claims-based procedure times could be used to improve the accuracy of valuations for procedures.},
	keywords = {Aged, Fee-for-Service Plans, Humans, Medicare, operative time, Relative Value Scales, Surgeons, United States},
	issn = {2168-6262},
	doi = {10.1001/jamasurg.2022.0099},
	author = {Crespin, Daniel J and Ruder, Teague and Mulcahy, Andrew W and Ateev Mehrotra}
}
@article {696429,
	title = {Which Medicare Beneficiaries Have Trouble Getting Places Like the Doctor{\textquoteright}s Office, and How Do They Do It?},
	journal = {J Gen Intern Med},
	year = {2022},
	month = {2022 Apr 25},
	issn = {1525-1497},
	doi = {10.1007/s11606-022-07615-0},
	author = {Ganguli, Ishani and Orav, E. John and Lii, Joyce and Ateev Mehrotra and Ritchie, Christine S}
}
@article {696474,
	title = {Are state telemedicine parity laws associated with greater use of telemedicine in the emergency department?},
	journal = {J Am Coll Emerg Physicians Open},
	volume = {2},
	number = {1},
	year = {2021},
	month = {2021 Feb},
	pages = {e212359},
	abstract = {BACKGROUND: Telemedicine is a valuable tool to improve access to specialty care in emergency departments (EDs), and states have passed telemedicine parity laws requiring insurers to reimburse for telemedicine visits. Our objective was to determine if there is an association between such laws and the use of telemedicine in an ED.

METHODS: As part of the 2016 and 2017 National ED Inventory-USA surveys, directors of all 5404 EDs in the United States were surveyed on the use of telemedicine. States were divided into those with any form of telemedicine parity law and those without (as of January 2016). We investigated the association between a telemedicine parity law and the use of telemedicine controlling for ED characteristics; state was included as a random intercept.

RESULTS: In 2016, among the 50 states and the District of Columbia (DC), 21 (41\%) had a telemedicine parity law, whereas 30 (59\%) did not. Among the 4418 ED respondents to the telemedicine question (82\% response rate), 2352 (53\%) received telemedicine. The proportion of EDs receiving telemedicine varied widely across the states and DC, ranging from 13\% in DC to 89\% in Maine. Neither the presence nor duration of state telemedicine parity laws were independently associated with ED receipt of telemedicine in 2016 nor the adoption of telemedicine from 2016 to 2017.

CONCLUSION: Telemedicine parity laws were not associated with use of telemedicine in the ED. These results suggest that other factors are driving the wide variation in ED use of telemedicine across states.},
	issn = {2688-1152},
	doi = {10.1002/emp2.12359},
	author = {Zachrison, Kori S and Boggs, Krislyn M and Cash, Rebecca E and Burton, Kyle R and Espinola, Janice A and Hayden, Emily M and Sauser, Joseph P and Ateev Mehrotra and Camargo, Carlos A}
}
@article {696468,
	title = {Assessment of Diagnosis and Triage in Validated Case Vignettes Among Nonphysicians Before and After Internet Search},
	journal = {JAMA Netw Open},
	volume = {4},
	number = {3},
	year = {2021},
	month = {2021 Mar 01},
	pages = {e213287},
	abstract = {IMPORTANCE: When confronted with new medical symptoms, many people turn to the internet to understand why they are ill as well as whether and where they should get care. Such searches may be harmful because they may facilitate misdiagnosis and inappropriate triage.

OBJECTIVE: To empirically measure the association of an internet search for health information with diagnosis, triage, and anxiety by laypeople.

DESIGN, SETTING, AND PARTICIPANTS: This survey study used a nationally representative sample of US adults who were recruited through an online platform between April 1, 2019, and April 15, 2019. A total of 48 validated case vignettes of both common (eg, viral illness) and severe (eg, heart attack) conditions were used. Participants were asked to relay their diagnosis, triage, and anxiety regarding 1 of these cases before and after searching the internet for health information.

EXPOSURES: Short, validated case vignettes written at or below the sixth-grade reading level randomly assigned to participants.

MAIN OUTCOMES AND MEASURES: Correct diagnosis, correct triage, and flipping (changing) or anchoring (not changing) diagnosis and triage decisions were the main outcomes. Multivariable modeling was performed to identify patient factors associated with correct triage and diagnosis.

RESULTS: Of the 5000 participants, 2549 were female (51.0\%), 3819 were White (76.4\%), and the mean (SD) age was 45.0 (16.9) years. Mean internet search time was 12.1 (95\% CI, 10.7-13.5) minutes per case. No difference in triage accuracy was found before and after search (74.5\% vs 74.1\%; difference, -0.4 [95\% CI, -1.4 to 0.6]; P = .06), but improved diagnostic accuracy was found (49.8\% vs 54.0\%; difference, 4.2\% [95\% CI, 3.1\%-5.3\%]; P \&lt; .001). Most participants (4254 [85.1\%]) were anchored on their diagnosis. Of the 14.9\% of participants (n = 746) who flipped their diagnosis, 9.6\% (n = 478) flipped from incorrect to correct and 5.4\% (n = 268) flipped from correct to incorrect. The following groups had an increased rate of correct diagnosis: adults 40 years or older (eg, 40-49 years: 5.1 [95\% CI, 0.8-9.4] percentage points better than those aged \&lt;30 years; P = .02), women (9.4 [95\% CI, 6.8-12.0] percentage points better than men; P \&lt; .001), and those with perceived poor health status (16.3 [95\% CI, 6.9-25.6] percentage points better than those with excellent status; P = .001) and with more than 2 chronic diseases (6.8 [95\% CI, 1.5-12.1] percentage points better than those with 0 conditions; P = .01).

CONCLUSIONS AND RELEVANCE: This study found that an internet search for health information was associated with small increases in diagnostic accuracy but not with triage accuracy.},
	keywords = {Anxiety Disorders, Female, Health Status, Humans, Internet, Male, Middle Aged, Reproducibility of Results, Surveys and Questionnaires, Triage},
	issn = {2574-3805},
	doi = {10.1001/jamanetworkopen.2021.3287},
	author = {Levine, David M and Ateev Mehrotra}
}
@article {696450,
	title = {Association of a Clinician{\textquoteright}s Antibiotic-Prescribing Rate With Patients{\textquoteright} Future Likelihood of Seeking Care and Receipt of Antibiotics},
	journal = {Clin Infect Dis},
	volume = {73},
	number = {7},
	year = {2021},
	month = {2021 Oct 05},
	pages = {e1672-e1679},
	abstract = {BACKGROUND: One underexplored driver of inappropriate antibiotic prescribing for acute respiratory illnesses (ARI) is patients{\textquoteright} prior care experiences. When patients receive antibiotics for an ARI, patients may attribute their clinical improvement to the antibiotics, regardless of their true benefit. These experiences, and experiences of family members, may drive whether patients seek care or request antibiotics for subsequent ARIs.

METHODS: Using encounter data from a national United States insurer, we identified patients \&lt;65 years old with an index ARI urgent care center (UCC) visit. We categorized clinicians within each UCC into quartiles based on their ARI antibiotic prescribing rate. Exploiting the quasi-random assignment of patients to a clinician within an UCC, we examined the association between the clinician{\textquoteright}s antibiotic prescribing rate to the patients{\textquoteright} and their spouses{\textquoteright} rates of ARI antibiotic receipt in the subsequent year.

RESULTS: Across 232,256 visits at 736 UCCs, ARI antibiotic prescribing rates were 42.1\% and 80.2\% in the lowest and highest quartile of clinicians, respectively. Patient characteristics were similar across the four quartiles. In the year after the index ARI visit, patients seen by the highest-prescribing clinicians received more ARI antibiotics (+3.0 fills/100 patients (a 14.6\% difference), 95\% CI 2.2-3.8, P \&lt; 0.001,) versus those seen by the lowest-prescribing clinicians. The increase in antibiotics was also observed among the patients{\textquoteright} spouses. The increase in patient ARI antibiotic prescriptions was largely driven by an increased number of ARI visits (+5.6 ARI visits/100 patients, 95\% CI 3.6-7.7, P \&lt; 0.001), rather than a higher antibiotic prescribing rate during those subsequent ARI visits.

CONCLUSIONS: Receipt of antibiotics for an ARI increases the likelihood that patients and their spouses will receive antibiotics for future ARIs.},
	keywords = {Acute Disease, Anti-Bacterial Agents, Humans, Inappropriate Prescribing, Middle Aged, Practice Patterns, Physicians{\textquoteright}, Respiratory Tract Infections, United States},
	issn = {1537-6591},
	doi = {10.1093/cid/ciaa1173},
	author = {Shi, Zhuo and Michael L. Barnett and Jena, Anupam B and Ray, Kristin N and Fox, Kathe P and Ateev Mehrotra}
}
@article {696455,
	title = {Association of Hospital Telestroke Adoption With Changes in Initial Hospital Presentation and Transfers Among Patients With Stroke and Transient Ischemic Attacks},
	journal = {JAMA Netw Open},
	volume = {4},
	number = {9},
	year = {2021},
	month = {2021 Sep 01},
	pages = {e2126612},
	abstract = {IMPORTANCE: It has been proposed that the implementation of telestroke services (a web-based approach to using video telecommunication to treat patients with stroke before hospital admission) changes where patients with stroke symptoms receive care, but this proposal has not been rigorously assessed.

OBJECTIVE: To assess whether the implementation of telestroke services is associated with changes in where and how patients initially present with stroke symptoms, in their decision to be transferred to another hospital, and which hospitals they are transferred to.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study compared changes in stroke systems of care between a sample of 593 US hospitals that adopted telestroke during the period from 2009 to 2016 but were not comprehensive stroke centers, major teaching hospitals, or thrombectomy-capable hospitals vs 593 matched control hospitals without telestroke based on rural location, critical access hospital status, bed size, primary stroke center status, presence of hospital alternatives in the community, hospital stroke volume, census region, and ownership. With the use of data on 100\% of Medicare fee-for-service beneficiaries, all stroke and transient ischemic attack admissions from 2008 to 2018 were identified.

EXPOSURES: For each hospital pair (telestroke plus matched control), the telestroke hospital{\textquoteright}s implementation date and difference-in-differences approach were used to quantify the association between telestroke implementation and changes in care from 2 years before implementation to 2 years after implementation. Models also controlled for differences in observed patient characteristics.

MAIN OUTCOMES AND MEASURES: Hospital stroke volume, patients{\textquoteright} ambulance transport distance to initial hospital, hospital case mix, interhospital transfer proportion, and size of the receiving hospital for transferred patients.

RESULTS: Of the 669 telestroke hospitals and 2143 potential control hospitals, 593 hospital pairs were matched; in each category, 261 hospitals (44.0\%) were located in a rural area, 179 (30.2\%) were primary stroke centers, and 130 (21.9\%) were critical access hospitals. The changes in the preimplementation to postimplementation period were similar at telestroke and control hospitals in mean annual stroke volume (telestroke hospitals, decreased from 79.6 to 76.3 patients; control hospitals, decreased from 78.8 to 75.5 patients [-3.3 patients per year for both; difference-in-differences, 0.009; P >= .99]). Similarly, no differences were seen in ambulance transport distance, case mix, interhospital transfers, or bed size of receiving hospitals among transferred patients.

CONCLUSIONS AND RELEVANCE: This study suggests that, across a national sample of hospitals implementing telestroke, no association between telestroke adoption and changes in stroke systems of care were found.},
	keywords = {Cross-Sectional Studies, Hospitals, Humans, Ischemic Attack, Transient, Organizational Innovation, Patient Transfer, Stroke, Telemedicine, United States},
	issn = {2574-3805},
	doi = {10.1001/jamanetworkopen.2021.26612},
	author = {Zachrison, Kori S and Richard, Jessica V and Wilcock, Andrew and Zubizarreta, Jose R and Schwamm, Lee H and Uscher-Pines, Lori and Ateev Mehrotra}
}
@article {696461,
	title = {Clinicians and Professional Societies COVID-19 Impact Assessment: Lessons Learned and Compelling Needs},
	journal = {NAM Perspect},
	volume = {2021},
	year = {2021},
	month = {2021},
	issn = {2578-6865},
	doi = {10.31478/202105b},
	author = {Madara, James and Miyamoto, Suzanne and Farley, Jason E and Gong, Michelle and Gorham, Millicent and Humphrey, Holly and Irons, Mira and Ateev Mehrotra and Resneck, Jack and Rushton, Cynda and Shanafelt, Tait}
}
@article {696446,
	title = {Clinicians{\textquoteright} Perceptions of Rapid Scale-up of Telehealth Services in Outpatient Mental Health Treatment},
	journal = {Telemed J E Health},
	volume = {27},
	number = {12},
	year = {2021},
	month = {2021 Dec},
	pages = {1399-1408},
	abstract = {Background: Little is known about specialty mental health and/or substance use disorder (MH/SUD) clinicians{\textquoteright} experiences transitioning from in-person to telehealth care, to treat a diagnostically diverse population during the COVID-19 pandemic. Methods: Survey of outpatient MH/SUD clinicians (psychiatrists, nurse practitioners, psychologists, and licensed clinical social workers; N = 107) at a psychiatric hospital. Clinician satisfaction and experiences using telehealth across a variety of services (individual, group or family therapy, initial assessments, evaluation and management, and neuropsychological assessment) were assessed using a mixed-methods approach. Results: Across services, a majority agreed/strongly agreed that telehealth provided an opportunity to build rapport with patients (67-88\%) and they could treat their patients{\textquoteright} needs well (71-88\%). The interest in continuing to use telehealth when in-person visits resume varied by type of service provided (50-71\%). Group therapy and initial assessment were lowest (50\% and 51\%, respectively). Clinicians noted telehealth improved access to care for patients with logistical barriers, competing demands, mobility difficulties, and medical concerns; but was more challenging to care for patients with certain psychiatric characteristics (e.g., psychosis, paranoia, catatonia, high distractibility, and avoidance), high symptom severity, or who needed to improve social skills. Telehealth influenced the therapeutic process (e.g., observations of family dynamic, increased patient/clinician therapeutic alliance). Discussion and Conclusions: MH/SUD clinicians who quickly transitioned to telehealth care during the pandemic were largely satisfied with telehealth, but also identified challenges related to specific patient characteristics, or types of MH/SUD services. These observations warrant additional study to better delineate the role for an expanded use of telehealth postpandemic.},
	keywords = {Covid-19, Humans, Mental Health, Outpatients, Pandemics, SARS-CoV-2, Telemedicine},
	issn = {1556-3669},
	doi = {10.1089/tmj.2020.0481},
	author = {Sugarman, Dawn E and Horvitz, Lisa E and Greenfield, Shelly F and Alisa B. Busch}
}
@article {696462,
	title = {Community Factors Associated With Telemedicine Use During the COVID-19 Pandemic},
	journal = {JAMA Netw Open},
	volume = {4},
	number = {5},
	year = {2021},
	month = {2021 May 03},
	pages = {e2110330},
	abstract = {This cross-sectional study investigates which community factors may be associated with the increase in telemedicine use during the COVID-19 pandemic.},
	keywords = {Covid-19, Cross-Sectional Studies, Health Services Accessibility, Humans, Income, Insurance, Health, Medicare Part C, Patient Acceptance of Health Care, Public Health, SARS-CoV-2, Telemedicine, United States},
	issn = {2574-3805},
	doi = {10.1001/jamanetworkopen.2021.10330},
	author = {Patel, Sadiq Y and Rose, Sherri and Michael L. Barnett and Huskamp, Haiden A. and Uscher-Pines, Lori and Ateev Mehrotra}
}
@article {696466,
	title = {A comparison study between metropolitan and rural hospital-based telehealth activity to inform adoption and expansion},
	journal = {J Telemed Telecare},
	year = {2021},
	month = {2021 Mar 26},
	pages = {1357633X21998201},
	abstract = {INTRODUCTION: In Queensland, Australia, the public hospital system has used telehealth for almost three decades. Although telehealth activity has been growing consistently, there are substantial variations across geographic regions. We explored factors which contribute to this variation in telehealth adoption.

METHODS: This was a multi-method comparative study of two matched metropolitan health services and two matched rural health services. The health services were matched according to the number of providers and hospitals but had different rates of telehealth use. Comparative rates of telehealth visits were analysed using descriptive statistics. Qualitative data was obtained from 63 semi-structured interviews with telehealth administrators, clinicians and senior managers involved in telehealth policies and procedures. Data were analysed using a framework analysis.

RESULTS: The metropolitan health service that had more telehealth use had greater investment in telehealth, higher population referral areas, highly developed communication strategies and understanding of the value proposition for telehealth, and reported fewer information technology and administration systems difficulties. In rural health services, telehealth activity was influenced by onboarding processes, clinician willingness to practice, strategic challenges and primary care activity.

DISCUSSION: Telehealth adoption can be influenced by funding, cross-organisational strategic policies and a multi-faceted approach to address clinician reluctance to use telehealth.},
	issn = {1758-1109},
	doi = {10.1177/1357633X21998201},
	author = {Banbury, Annie and Smith, Anthony C and Ateev Mehrotra and Page, Matthew and Caffery, Liam J}
}
@article {696451,
	title = {Diabetes Care and Glycemic Control During the COVID-19 Pandemic in the United States},
	journal = {JAMA Intern Med},
	volume = {181},
	number = {10},
	year = {2021},
	month = {2021 Oct 01},
	pages = {1412-1414},
	abstract = {This cohort study compares rates at which patients with type 2 diabetes received diabetes-related health services prior to and during the COVID-19 pandemic.},
	keywords = {Aged, Ambulatory Care, Covid-19, Diabetes Mellitus, Female, Glycemic Control, Humans, Male, Telemedicine, United States},
	issn = {2168-6114},
	doi = {10.1001/jamainternmed.2021.3047},
	author = {Patel, Sadiq Y and McCoy, Rozalina G and Michael L. Barnett and Shah, Nilay D and Ateev Mehrotra}
}
@article {696445,
	title = {The Growing Phenomenon of "Virtual-First" Primary Care},
	journal = {JAMA},
	volume = {326},
	number = {23},
	year = {2021},
	month = {2021 Dec 21},
	pages = {2365-2366},
	keywords = {Humans, Physicians, Primary Care, Primary Health Care, Telemedicine},
	issn = {1538-3598},
	doi = {10.1001/jama.2021.21169},
	author = {Whitehead, David C and Ateev Mehrotra}
}
@article {696459,
	title = {Hospital Responses to Incentives in Episode-Based Payment for Joint Surgery: A Controlled Population-Based Study},
	journal = {JAMA Intern Med},
	volume = {181},
	number = {7},
	year = {2021},
	month = {2021 Jul 01},
	pages = {932-940},
	abstract = {IMPORTANCE: Medicare{\textquoteright}s Comprehensive Care for Joint Replacement (CJR) model, initiated in 2016, is a national episode-based payment model for lower-extremity joint replacement (LEJR). Metropolitan statistical areas (MSAs) were randomly assigned to participation. In the third year of the program, Medicare made hospital participation voluntary in half of the MSAs and enabled LEJRs for knees to be performed in the outpatient setting without being subject to episode-based payment. How these changes affected program savings is unclear.

OBJECTIVE: To estimate savings from the CJR program over time and assess how responses by hospitals to changing incentives were associated with those savings.

DESIGN, PARTICIPANTS, AND SETTING: This controlled population-based study used Medicare claims data from January 1, 2014, to December 31, 2019, to analyze the spending for beneficiaries who received LEJR in 171 MSAs randomized to CJR vs typical payment. One-quarter of beneficiaries before and after the April 1, 2016, start date were excluded as a 6-month washout period (January 1 to June 30, 2016) to allow time in the evaluation period for hospitals to respond to the program rules.

MAIN OUTCOMES AND MEASURES: The main outcomes were episode spending and, starting in year 3 of the program, the hospitals{\textquoteright} decision to no longer participate in CJR and perform LEJRs in the outpatient setting.

RESULTS: Data from 1 087 177 patients (mean [SD] age, 74.4 [8.4] years; 692 604 women [63.7\%]; 980 635 non-Hispanic White patients [90.2\%]) were analyzed. Over the first 4 years of CJR, 321 038 LEJR episodes were performed at 702 CJR hospitals, and 456 792 episodes were performed at 826 control hospitals. From the second to the fourth year of the program, savings in CJR vs control MSAs diminished from -$976 per LEJR episode (95\% CI, -$1340 to -$612) to -$331 (95\% CI, -$792 to $130). In MSAs where hospital participation was made voluntary in the third year, more hospitals in the highest quartile of baseline spending dropped out compared with the lowest quartile (56 of 60 [93.3\%] vs 29 of 56 [51.8\%]). In MSAs where participation remained mandatory, CJR hospitals shifted fewer knee replacements to the outpatient setting in years 3 to 4 than controls (12 571 of 59 182 [21.2\%] vs 21 650 of 68 722 [31.5\%] of knee LEJRs). In these mandatory MSAs, 75\% of the reduction in savings per episode from years 1 to 2 to years 3 to 4 of the program ($455; 95\% CI, $137-$722) was attributable to CJR hospitals{\textquoteright} decision on which patients would undergo surgery or whether the surgical procedure would occur in the outpatient setting.

CONCLUSIONS AND RELEVANCE: This controlled population-based study found that savings observed in the second year of CJR largely dissipated by the fourth year owing to a combination of responses among hospitals to changes in the program. These results suggest a need for caution regarding the design of new alternative payment models.},
	keywords = {Aged, Aged, 80 and over, Arthroplasty, Replacement, Knee, Female, Humans, Male, Medicare, Reimbursement mechanisms, United States},
	issn = {2168-6114},
	doi = {10.1001/jamainternmed.2021.1897},
	author = {Wilcock, Andrew D and Michael L. Barnett and J. Michael McWilliams and Grabowski, David C and Ateev Mehrotra}
}
@article {696475,
	title = {Implications of Early Health Care Spending Reductions for Expected Spending as the COVID-19 Pandemic Evolves},
	journal = {JAMA Intern Med},
	volume = {181},
	number = {1},
	year = {2021},
	month = {2021 Jan 01},
	pages = {118-120},
	abstract = {This cohort study examines how early spending changes vary by incidence of coronavirus disease 2019 and how implementation of policies to limit transmission affect health care spending as the pandemic evolves.},
	keywords = {Ambulatory Care, Cohort Studies, Communicable Disease Control, Covid-19, Elective Surgical Procedures, Fee-for-Service Plans, Health Expenditures, Hospitalization, Humans, Insurance, Health, Medicare Part C, Physical Distancing, SARS-CoV-2, United States},
	issn = {2168-6114},
	doi = {10.1001/jamainternmed.2020.5333},
	author = {J. Michael McWilliams and Russo, Ali and Ateev Mehrotra}
}
@article {696456,
	title = {The Increasing Role of Physician Practices as Bill Collectors: Destined for Failure},
	journal = {JAMA},
	volume = {326},
	number = {8},
	year = {2021},
	month = {2021 Aug 24},
	pages = {695-696},
	keywords = {Cost Sharing, Deductibles and Coinsurance, Fees, Medical, Financial Management, Health Expenditures, Patient Credit and Collection, Physicians, Practice Management, Medical, United States},
	issn = {1538-3598},
	doi = {10.1001/jama.2021.12191},
	author = {Holmgren, A Jay and David Cutler and Ateev Mehrotra}
}
@article {696452,
	title = {National Trends in Telestroke Utilization in a US Commercial Platform Prior to the COVID-19 Pandemic},
	journal = {J Stroke Cerebrovasc Dis},
	volume = {30},
	number = {10},
	year = {2021},
	month = {2021 Oct},
	pages = {106035},
	abstract = {OBJECTIVES: Most data on telestroke utilization come from single academic hub-and-spoke telestroke networks. Our objective was to describe characteristics of telestroke consultations among a national sample of telestroke sites on one of the most commonly used common vendor platforms, prior to the COVID-19 public health emergency.

MATERIALS AND METHODS: A commercial telestroke vendor provided data on all telestroke consultations by two specialist provider groups from 2013-2019. Kendall{\textquoteright}s τ β nonparametric test was utilized to assess time trends. Generalized linear models were used to assess the association between hospital consult utilization and alteplase use adjusting for hospital characteristics.

RESULTS: Among 67,736 telestroke consultations to 132 spoke sites over the study period, most occurred in the emergency department (90\%) and for stroke indications (final clinical diagnoses: TIA 13\%, ischemic stroke 39\%, hemorrhagic stroke 2\%, stroke mimics 46\%). Stroke severity was low (median NIHSS 2, IQR 0-6). Alteplase was recommended for 23\% of ischemic stroke patients. From 2013 to 2019, times from ED arrival to NIHSS, CT scan, imaging review, consult, and alteplase administration all decreased (p\&lt;0.05 for all), while times from consult start to alteplase recommendation and bolus increased (p\&lt;0.01 for both). Transfer was recommended for 8\% of ischemic stroke patients. Number of patients treated with alteplase per hospital increased with increasing number of consults and hospital size and was also associated with US region in unadjusted and adjusted analyses. Longer duration of hospital participation in the network was associated with shorter hospital median door-to-needle time for alteplase delivery (39 min shorter per year, p=0.04).

CONCLUSIONS: Among spoke sites using a commercial telestroke platform over a seven-year time horizon, times to consult start and alteplase bolus decreased over time. Similar to academic networks, duration of telestroke participation in this commercial network was associated with faster alteplase delivery, suggesting practice improves performance.},
	keywords = {Aged, Aged, 80 and over, Covid-19, Databases, Factual, Female, Fibrinolytic Agents, Humans, Male, Middle Aged, Practice Patterns, Physicians{\textquoteright}, Quality Improvement, Quality Indicators, Health Care, Remote Consultation, Stroke, Thrombolytic Therapy, Time Factors, Time-to-Treatment, Tissue Plasminogen Activator, Treatment Outcome, United States},
	issn = {1532-8511},
	doi = {10.1016/j.jstrokecerebrovasdis.2021.106035},
	author = {Zachrison, Kori S and Sharma, Richa and Wang, Yulun and Ateev Mehrotra and Schwamm, Lee H}
}
@article {696469,
	title = {Online Advertising Increased New Hampshire Residents{\textquoteright} Use Of Provider Price Tool But Not Use Of Lower-Price Providers},
	journal = {Health Aff (Millwood)},
	volume = {40},
	number = {3},
	year = {2021},
	month = {2021 Mar},
	pages = {521-528},
	abstract = {Insurers and policy makers have created health care price transparency websites to facilitate price shopping and reduce spending. However, price transparency tools to date have been plagued by low use. It is unclear whether this low use reflects a lack of interest or a lack of awareness. We launched a large online advertising campaign to increase consumers{\textquoteright} awareness about insurer-specific negotiated price information available on New Hampshire{\textquoteright}s public price transparency website. Our campaign led to a more than 600~percent increase in visits to the website. However, in our analysis of health plan claims, this increased use of the website did not translate to increased use of lower-price providers. Our findings imply that the limited success to date of price transparency tools in reducing health care spending is driven by structural factors that limit consumers{\textquoteright} ability to use health care price information as opposed to only a lack of awareness about price transparency tools.},
	keywords = {Advertising, Delivery of Health Care, Humans, New Hampshire},
	issn = {1544-5208},
	doi = {10.1377/hlthaff.2020.01039},
	author = {Desai, Sunita M and Shambhu, Sonali and Ateev Mehrotra}
}
@article {696454,
	title = {Patients{\textquoteright} perceptions of telehealth services for outpatient treatment of substance use disorders during the COVID-19 pandemic},
	journal = {Am J Addict},
	volume = {30},
	number = {5},
	year = {2021},
	month = {2021 Sep},
	pages = {445-452},
	abstract = {BACKGROUND AND OBJECTIVES: The rapid scale-up of telehealth services for substance use disorders (SUDs) during the COVID-19 pandemic presented a unique opportunity to investigate patient experiences with telehealth. This study examined patient perceptions of telehealth in an outpatient SUD treatment program offering individual therapy, group therapy, and medication management.

METHODS: Two hundred and seventy adults receiving SUD outpatient treatment were eligible to complete a 23-item online survey distributed by clinicians; 58 patients completed/partially completed the survey. Data were summarized with descriptive statistics.

RESULTS: Participants were predominately male, White, and well-educated. The majority (86.2\%) were "very satisfied" or "satisfied" with the quality of telehealth care. "Very satisfied" ratings were highest for individual therapy (90\%), followed by medication management (75\%)~and group therapy (58\%). Top reasons for liking telehealth included the ability to do it from home (90\%) and not needing to spend time commuting (83\%). Top reasons for disliking telehealth were not connecting as well with other members in group therapy (28\%) and the ability for telehealth to be interrupted at home or work (26\%).

DISCUSSION AND CONCLUSIONS: Telehealth visits were a satisfactory treatment modality for most respondents receiving outpatient SUD care, especially those engaging in individual therapy. Challenges remain for telehealth group therapy.

SCIENTIFIC SIGNIFICANCE: This is the first study examining patients{\textquoteright} perceptions of telehealth for outpatient SUD treatment during the COVID-19 pandemic by treatment service type. Importantly, while many participants found telehealth more accessible than in-person treatment, there was variability with respect to the preferred mode of treatment delivery.},
	keywords = {Adult, Ambulatory Care, Covid-19, Female, Health Care Surveys, Humans, Male, Outpatients, Pandemics, Patient Satisfaction, Psychotherapy, Group, Substance-Related Disorders, Telemedicine},
	issn = {1521-0391},
	doi = {10.1111/ajad.13207},
	author = {Sugarman, Dawn E and Alisa B. Busch and McHugh, R Kathryn and Bogunovic, Olivera J and Trinh, Catherine D and Weiss, Roger D and Greenfield, Shelly F}
}
@article {696458,
	title = {Patterns of Mental Health Care Before Initiation of Telemental Health Services},
	journal = {Med Care},
	volume = {59},
	number = {7},
	year = {2021},
	month = {2021 Jul 01},
	pages = {572-578},
	abstract = {BACKGROUND: Use of telemental health has increased among rural Medicare beneficiaries, particularly among individuals with serious mental illness (SMI). Little is known about what leads to the initiation of telemental health.

OBJECTIVE: To categorize the different patterns of mental health care use before initiation of telemental health services among individuals with SMI.

METHODS: A cohort of rural beneficiaries with SMI (defined as schizophrenia/related psychotic disorders or bipolar disorder) with an index telemental health visit in 2010-2017 was built using claims for a 20\% random sample of fee-for-service Medicare beneficiaries. The authors used latent class analysis to identify classes of mental health care use in the 6 months before the index telemental health visits. Across the classes, the authors also described characteristics of index and subsequent mental health visits.

RESULTS: The cohort included 4930 rural Medicare beneficiaries with SMI. Three classes of mental health care use before initiation of telemental health were identified. The largest class (n=3066) had minimal use of primary care provider mental health care and the second largest class (n=1537) had minimal specialty mental health care. The smallest class (n=327) was characterized by recent hospitalization or emergency department care. In the overall cohort, index visits were frequently established visits and were often with specialty prescribers.

CONCLUSIONS: Our findings highlight 3 distinct patterns of care before telemental health initiation, providing insight into the role that telemedicine may play in mental health care for rural Medicare beneficiaries with SMI. Overall, telemental health was most often used to maintain care with existing providers.},
	keywords = {Adult, Cohort Studies, Drug Prescriptions, Emergency Service, Hospital, Female, Health Services Accessibility, Hospitalization, Humans, Male, Medicare, Mental Disorders, Primary Health Care, Rural Health Services, Rural Population, Telemedicine, United States},
	issn = {1537-1948},
	doi = {10.1097/MLR.0000000000001537},
	author = {McDowell, Alex and Huskamp, Haiden A. and Alisa B. Busch and Ateev Mehrotra and Rose, Sherri}
}
@article {696453,
	title = {Paying for Digital Health Care - Problems with the Fee-for-Service System},
	journal = {N Engl J Med},
	volume = {385},
	number = {10},
	year = {2021},
	month = {2021 Sep 02},
	pages = {871-873},
	keywords = {Capitation Fee, Fee-for-Service Plans, Fees and charges, Humans, Patient Portals, Telemedicine},
	issn = {1533-4406},
	doi = {10.1056/NEJMp2107879},
	author = {Adler-Milstein, Julia and Ateev Mehrotra}
}
@article {696472,
	title = {Paying for Telemedicine After the Pandemic},
	journal = {JAMA},
	volume = {325},
	number = {5},
	year = {2021},
	month = {2021 Feb 02},
	pages = {431-432},
	keywords = {Australia, Canada, Covid-19, Health Care Costs, Health Policy, Healthcare Disparities, Humans, Insurance, Health, Reimbursement, Telemedicine, United States},
	issn = {1538-3598},
	doi = {10.1001/jama.2020.25706},
	author = {Ateev Mehrotra and Bhatia, R Sacha and Snoswell, Centaine L}
}
@article {696471,
	title = {Randomized controlled study using text messages to help connect new medicaid beneficiaries to primary care},
	journal = {NPJ Digit Med},
	volume = {4},
	number = {1},
	year = {2021},
	month = {2021 Feb 15},
	pages = {26},
	abstract = {Accessing primary care is often difficult for newly insured Medicaid beneficiaries. Tailored text messages may help patients navigate the health system and initiate care with a primary care physician. We conducted a randomized controlled trial of tailored text messages with newly enrolled Medicaid managed care beneficiaries. Text messages included education about the importance of primary care, reminders to obtain an appointment, and resources to help schedule an appointment. Within 120 days of enrollment, we examined completion of at least one primary care visit and use of the emergency department. Within 1 year of enrollment, we examined diagnosis of a chronic disease, receipt of preventive care, and use of the emergency department. 8432 beneficiaries (4201 texting group; 4231 control group) were randomized; mean age was 37 years and 24\% were White. In the texting group, 31\% engaged with text messages. In the texting vs control group after 120 days, there were no differences in having one or more primary care visits (44.9\% vs. 45.2\%; difference, -0.27\%; p = 0.802) or emergency department use (16.2\% vs. 16.0\%; difference, 0.23\%; p = 0.771). After 1 year, there were no differences in diagnosis of a chronic disease (29.0\% vs. 27.8\%; difference, 1.2\%; p = 0.213) or appropriate preventive care (for example, diabetes screening: 14.1\% vs. 13.4\%; difference, 0.69\%; p = 0.357), but emergency department use (32.7\% vs. 30.2\%; difference, 2.5\%; p = 0.014) was greater in the texting group. Tailored text messages were ineffective in helping new Medicaid beneficiaries visit primary care within 120 days.},
	issn = {2398-6352},
	doi = {10.1038/s41746-021-00389-5},
	author = {Levine, David M and Pragya Kakani and Ateev Mehrotra}
}
@article {696464,
	title = {Reperfusion Treatment and Stroke Outcomes in Hospitals With Telestroke Capacity},
	journal = {JAMA Neurol},
	volume = {78},
	number = {5},
	year = {2021},
	month = {2021 May 01},
	pages = {527-535},
	abstract = {IMPORTANCE: Telestroke is increasingly used in hospital emergency departments, but there has been limited research on its impact on treatment and outcomes.

OBJECTIVE: To describe differences in care patterns and outcomes among patients with acute ischemic stroke who present to hospitals with and without telestroke capacity.

DESIGN, SETTING, AND PARTICIPANTS: Patients with acute ischemic stroke who first presented to hospitals with telestroke capacity were matched with patients who presented to control hospitals without telestroke capacity. All traditional Medicare beneficiaries with a primary diagnosis of acute ischemic stroke (approximately 2.5 million) who presented to a hospital between January 2008 and June 2017 were considered. Matching was based on sociodemographic and clinical characteristics, hospital characteristics, and month and year of admission. Hospitals included short-term acute care and critical access hospitals in the US without local stroke expertise. In 643 hospitals with telestroke capacity, there were 76 636 patients with stroke who were matched 1:1 to patients at similar hospitals without telestroke capacity. Data were analyzed in July 2020.

MAIN OUTCOMES AND MEASURES: Receipt of reperfusion treatment through thrombolysis with alteplase or thrombectomy, mortality at 30 days from admission, spending through 90 days from admission, and functional status as measured by days spent living in the community after discharge.

RESULTS: In the final sample of 153 272 patients, 88 386 (57.7\%) were female, and the mean (SD) age was 78.8 (10.4) years. Patients cared for at telestroke hospitals had higher rates of reperfusion treatment compared with those cared for at control hospitals (6.8\% vs 6.0\%; difference, 0.78 percentage points; 95\% CI, 0.54-1.03; P \&lt; .001) and lower 30-day mortality (13.1\% vs 13.6\%; difference, 0.50 percentage points; 95\% CI, 0.17-0.83, P = .003). There were no differences in days spent living in the community following discharge or in spending. Increases in reperfusion treatment were largest in the lowest-volume hospitals, among rural residents, and among patients 85 years and older.

CONCLUSIONS AND RELEVANCE: Patients with ischemic stroke treated at hospitals with telestroke capacity were more likely to receive reperfusion treatment and have lower 30-day mortality.},
	keywords = {Adult, Aged, Aged, 80 and over, Brain Ischemia, Female, Fibrinolytic Agents, Humans, Ischemic Stroke, Male, Middle Aged, Patient Discharge, Reperfusion, Stroke, Thrombolytic Therapy, Time Factors, Treatment Outcome, United States},
	issn = {2168-6157},
	doi = {10.1001/jamaneurol.2021.0023},
	author = {Wilcock, Andrew D and Schwamm, Lee H and Zubizarreta, Jose R and Zachrison, Kori S and Uscher-Pines, Lori and Richard, Jessica V and Ateev Mehrotra}
}
@article {696457,
	title = {Rising to the challenges of the pandemic: Telehealth innovations in U.S. emergency departments},
	journal = {J Am Med Inform Assoc},
	volume = {28},
	number = {9},
	year = {2021},
	month = {2021 Aug 13},
	pages = {1910-1918},
	abstract = {OBJECTIVE: During the first 9 months of the coronavirus disease 2019 (COVID-19) pandemic, many emergency departments (EDs) experimented with telehealth applications to reduce virus exposure, decrease visit volume, and conserve personal protective equipment. We interviewed ED leaders who implemented telehealth programs to inform responses to the ongoing COVID-19 pandemic and future emergencies.

MATERIALS AND METHODS: From September to November 2020, we conducted semi-structured interviews with ED leaders across the United States. We identified EDs with pandemic-related telehealth programs through literature review and snowball sampling. Maximum variation sampling was used to capture a range of experiences. We used standard qualitative analysis techniques, consisting of both inductive and deductive approaches to identify and characterize themes.

RESULTS: We completed 15 interviews with EDs leaders in 10 states. From March to November 2020, participants experimented with more than a dozen different types of telehealth applications including tele-isolation, tele-triage, tele-consultation, virtual postdischarge assessment, acute care in the home, and tele-palliative care. Prior experience with telehealth was key for implementation of new applications. Most new telehealth applications turned out to be temporary because they were no longer needed to support the response. The leading barriers to telehealth implementation during the pandemic included technology challenges and the need for "hands-on" implementation support in the ED.

CONCLUSIONS: In response to the COVID-19 pandemic, EDs rapidly implemented many telehealth innovations. Their experiences can inform future responses.},
	keywords = {Aftercare, Covid-19, Emergency Service, Hospital, Humans, Pandemics, Patient Discharge, SARS-CoV-2, Telemedicine, United States},
	issn = {1527-974X},
	doi = {10.1093/jamia/ocab092},
	author = {Uscher-Pines, Lori and Sousa, Jessica and Ateev Mehrotra and Schwamm, Lee H and Zachrison, Kori S}
}
@article {696460,
	title = {Telehealth use in emergency care during coronavirus disease 2019: a systematic review},
	journal = {J Am Coll Emerg Physicians Open},
	volume = {2},
	number = {3},
	year = {2021},
	month = {2021 Jun},
	pages = {e12443},
	abstract = {OBJECTIVE: The coronavirus disease 2019 pandemic has presented emergency departments (EDs) with many challenges to address the acute care needs of patients. Many EDs have leveraged telehealth to innovatively respond to these challenges. This review describes the landscape of telehealth initiatives in emergency care that have been described during the coronavirus disease 2019 pandemic.

METHODS: We conducted a comprehensive, systematic review of the literature using PubMed, supplemented by a review of the gray literature (ie, non-peer reviewed), with input from subject matter experts to identify telehealth initiatives in emergency care during coronavirus disease 2019. We categorized types of telehealth use based on purpose and user characteristics.

RESULTS: We included 27 papers from our review of the medical literature and another 8 sources from gray literature review. The vast majority of studies (32/35) were descriptive in nature, with the additional inclusion of 2 cohort studies and one randomized clinical trial. There were 5 categories of ED telehealth use during the pandemic: (1) pre-ED evaluation and screening, (2) within ED (including as a means of limiting staff and patient exposure and facilitating consultation with specialists), (3) post-ED discharge monitoring and treatment, (4) educating trainees and health care workers, and (5) coordinating resources and patient care.

CONCLUSION: Telehealth has been used in a variety of manners during the coronavirus disease 2019 pandemic, enabling innovation in emergency care delivery. The findings from this study can be used by institutions to consider how telehealth may address challenges in emergency care during the coronavirus disease 2019 pandemic and beyond. Because few studies included cost data and given the variability in institutional resources, how organizations implement telehealth programs will likely vary. Future work should further explore barriers and facilitators of innovation, and the impact on care delivery and patient outcomes.},
	issn = {2688-1152},
	doi = {10.1002/emp2.12443},
	author = {Jaffe, Todd A and Hayden, Emily and Uscher-Pines, Lori and Sousa, Jessica and Schwamm, Lee H and Ateev Mehrotra and Zachrison, Kori S}
}
@article {696470,
	title = {Telemedicine and Medical Licensure - Potential Paths for Reform},
	journal = {N Engl J Med},
	volume = {384},
	number = {8},
	year = {2021},
	month = {2021 Feb 25},
	pages = {687-690},
	keywords = {Covid-19, Federal Government, Government Regulation, Health Care Reform, Licensure, Medical, Specialty Boards, State Government, Telemedicine, United States},
	issn = {1533-4406},
	doi = {10.1056/NEJMp2031608},
	author = {Ateev Mehrotra and Nimgaonkar, Alok and Richman, Barak}
}
@article {696463,
	title = {Telemedicine for treating mental health and substance use disorders: reflections since the pandemic},
	journal = {Neuropsychopharmacology},
	volume = {46},
	number = {6},
	year = {2021},
	month = {2021 May},
	pages = {1068-1070},
	keywords = {Humans, Mental Disorders, Mental Health, Pandemics, Substance-Related Disorders, Telemedicine},
	issn = {1740-634X},
	doi = {10.1038/s41386-021-00960-4},
	author = {Alisa B. Busch and Sugarman, Dawn E and Horvitz, Lisa E and Greenfield, Shelly F}
}
@article {696467,
	title = {Trends in Outpatient Care Delivery and Telemedicine During the COVID-19 Pandemic in the US},
	journal = {JAMA Intern Med},
	volume = {181},
	number = {3},
	year = {2021},
	month = {2021 Mar 01},
	pages = {388-391},
	abstract = {This cohort study examines trends in the use of telemedicine and in-person outpatient visits in 2020 among a national sample of 16.7 million individuals with commercial or Medicare Advantage insurance.},
	keywords = {Ambulatory Care, Covid-19, Delivery of Health Care, Humans, Pandemics, Telemedicine, United States},
	issn = {2168-6114},
	doi = {10.1001/jamainternmed.2020.5928},
	author = {Patel, Sadiq Y and Ateev Mehrotra and Huskamp, Haiden A. and Uscher-Pines, Lori and Ganguli, Ishani and Michael L. Barnett}
}
@article {696449,
	title = {Trends in Outpatient Telemedicine Utilization Among Rural Medicare Beneficiaries, 2010 to 2019},
	journal = {JAMA Health Forum},
	volume = {2},
	number = {10},
	year = {2021},
	month = {2021 Oct},
	pages = {e213282},
	abstract = {IMPORTANCE: Little is known about how telemedicine use was evolving before the broad changes that occurred during the COVID-19 pandemic in 2020. Understanding prepandemic patterns of telemedicine use can inform ongoing debates on the future of telemedicine policy.

OBJECTIVE: To describe trends in telemedicine utilization among Medicare fee-for-service beneficiaries before the COVID-19 pandemic and the specialties of clinicians providing telemedicine.

DESIGN SETTING AND PARTICIPANTS: This was a cross-sectional study and descriptive analysis of telemedicine utilization by 10.4 million fee-for-service Medicare beneficiaries from 2010 to 2019. Data analysis was performed from June 6, 2019, to July 30, 2020.

MAIN OUTCOMES AND MEASURES: Rates of telemedicine utilization, characteristics of beneficiaries who received telemedicine in 2010 to 2019, and specialties of clinicians delivering telemedicine.

RESULTS: Of 10.4 million rural Medicare beneficiaries, telemedicine was used by 91 483 individuals (age >=65 years, 47 135 [51.5\%]; women, 51 476 [56.3\%]; and White, 76 467 [83.6\%] individuals) in 2019. In 2010 to 2019, telemedicine visits grew by 23.1\% annually. A total of 0.9\% of all fee-for-service rural beneficiaries had a telemedicine visit in 2019 compared with 0.2\% in 2010. In 2019, there were 257 979 telemedicine visits or 34.8 visits per 1000 rural beneficiaries and most (75.9\%) of these visits were for mental health conditions. Patients with bipolar disorder or schizophrenia (3.0\% of rural beneficiaries) received 40\% of all telemedicine visits in 2019. Some traditionally disadvantaged and underserved groups comprised a larger share of telemedicine users than nonusers in 2019, such as those dually insured with Medicaid (56.9\% of users vs 18.6\% of nonusers; adjusted odd ratio, 3.83; 95\% CI, 3.77-3.89). In 2010 to 2019, telemedicine for mental health conditions shifted away from psychiatrists (71.2\% to 35.8\% of all telemedicine visits) to nonphysician clinicians, eg, nurse practitioners, psychologists, and social workers (21.4\% to 57.2\%). There was wide variation in telemedicine utilization in 2019 across counties: median (IQR), 16.0 (2.5-51.4) telemedicine users per 1000 beneficiaries). In 891 counties (29\% of all US counties), at least 10\% of beneficiaries with bipolar disorder or schizophrenia used a telemedicine service in 2019.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of telemedicine utilization before the COVID-19 pandemic, there was sustained growth in telemedicine visits among rural beneficiaries covered by the Medicare program, especially care delivered by nurse practitioners and other nonphysician clinicians. The prepandemic model of telemedicine provided in local health care settings may be a viable modality to maintain in rural communities.},
	keywords = {Aged, Covid-19, Cross-Sectional Studies, Female, Humans, Medicare, Outpatients, Pandemics, Rural Population, Telemedicine, United States},
	issn = {2689-0186},
	doi = {10.1001/jamahealthforum.2021.3282},
	author = {Michael L. Barnett and Huskamp, Haiden A. and Alisa B. Busch and Uscher-Pines, Lori and Krisda H Chaiyachati and Ateev Mehrotra}
}
@article {696447,
	title = {Trends in Pediatric Primary Care Visits During the Coronavirus Disease of 2019 Pandemic},
	journal = {Acad Pediatr},
	volume = {21},
	number = {8},
	year = {2021},
	month = {2021 Nov-Dec},
	pages = {1426-1433},
	abstract = {OBJECTIVE: Months after the declaration of the coronavirus disease of 2019 (COVID-19) national emergency, visits among children remained suppressed for unclear reasons, which we sought to understand by examining child visit rates.

METHODS: Using de-identified claims data for children \&lt;18 years old from OptumLabs{\textregistered} Data Warehouse, a large commercial claims database, we compared monthly primary care visit and vaccination rates from January-October 2020 to January-October 2018 and 2019. Visit rates were analyzed by visit reason and by the month after (eg, month +1) the~COVID-19 public health emergency declaration using a series of child-level Poisson regression models.

RESULTS: There were 3.4, 3.4, and 3.1 million children in 2018, 2019, and 2020 cohorts, respectively. Compared to the same months in prior years, primary care visits in 2020 were 60\% lower in month +1 (incidence rate ratio [IRR] 0.40, 99\% confidence interval [CI] 0.40-0.40) and 17\% lower in month +7 (IRR 0.83, 99\% CI 0.83-0.83). Preventive visit rates were 53\% lower in month +1 (IRR 0.47, 99\% CI 0.47-0.47), but 8\% higher than prior years in month +7 (IRR 1.08, 99\% CI 1.08-1.08). Monthly rates of vaccine administration followed a similar pattern. Problem-focused visits remained 31\% lower in month +7 (IRR 0.69, 99\% CI 0.68-0.69), with notably fewer infection-related visits (acute respiratory tract infections IRR 0.37, 99\% CI 0.36-0.37; gastroenteritis IRR 0.20, 99\% CI 0.20-0.20).

CONCLUSION: Seven months after the COVID-19 emergency declaration, receipt of pediatric care remained suppressed due to fewer problem-focused visits, with notably fewer infection-related visits. By October 2020, rates of preventive visits and vaccination exceeded rates in prior years.},
	keywords = {Adolescent, Child, Covid-19, Emergency Service, Hospital, Humans, Pandemics, Primary Health Care, SARS-CoV-2},
	issn = {1876-2867},
	doi = {10.1016/j.acap.2021.04.031},
	author = {Schweiberger, Kelsey and Patel, Sadiq Y and Ateev Mehrotra and Ray, Kristin N}
}
@article {696465,
	title = {Urgent Care Centers Deter Some Emergency Department Visits But, On Net, Increase Spending},
	journal = {Health Aff (Millwood)},
	volume = {40},
	number = {4},
	year = {2021},
	month = {2021 Apr},
	pages = {587-595},
	abstract = {There is substantial interest in using urgent care centers to decrease lower-acuity emergency department (ED) visits. Using 2008-19 insurance claims and enrollment data from a national managed care plan, we examined the association within ZIP codes between changes in rates of urgent care center visits and rates of lower-acuity ED visits. We found that although the entry of urgent care deterred lower-acuity ED visits, the impact was small. We estimate that thirty-seven additional urgent care center visits were associated with a reduction of a single lower-acuity ED visit. In addition, each $1,646 lower-acuity ED visit prevented was offset by a $6,327 increase in urgent care center costs. Therefore, despite a tenfold higher price per visit for EDs compared with urgent care centers, use of the centers increased net overall spending on lower-acuity care at EDs and urgent care centers.},
	keywords = {Ambulatory Care, Ambulatory Care Facilities, Costs and Cost Analysis, Emergency Service, Hospital, Humans, Managed Care Programs},
	issn = {1544-5208},
	doi = {10.1377/hlthaff.2020.01869},
	author = {Wang, Bill and Ateev Mehrotra and Friedman, Ari B}
}
@article {696448,
	title = {Use of telemedicine for opioid use disorder treatment - Perceptions and experiences of opioid use disorder clinicians},
	journal = {Drug Alcohol Depend},
	volume = {228},
	year = {2021},
	month = {2021 Nov 01},
	pages = {108999},
	abstract = {OBJECTIVE: To understand clinician use of and opinions about telemedicine for opioid use disorder (tele-OUD) during the COVID-19 pandemic.

METHODS: An electronic national survey was administered in fall 2020 to 602 OUD clinicians recruited from WebMD/Medscape{\textquoteright}s online panel. The survey completion rate was 97.3 \%.

RESULTS: On average, clinicians reported that 56.9 \% of their visits in the last month were via telemedicine (20.3 \% via audio-only and 36.6 \% via video). Most respondents (N = 376, 62.5 \%) agreed that telemedicine has been as effective as in-person care. The majority (N = 535, 88.9 \%) were comfortable using video for clinically stable patients, while half (N = 297, 49.3 \%) were comfortable using video for patients who are not clinically stable. After the pandemic, most respondents (N = 422, 70.1 \%) preferred to return to in-person care for the majority of visits; however, 95.3 \% thought telemedicine should be offered in some form. Most (N = 481, 79.9 \%) would continue to offer telemedicine if reimbursement were the same as in-person, while 242 (40.2 \%) would continue if reimbursement were 25 \% lower. Clinicians with more OUD patients used more telemedicine and reported higher comfort levels treating clinically unstable patients, and clinicians with more Medicaid/uninsured patients used more audio-only and preferred to continue using telemedicine post-pandemic.

CONCLUSIONS: Telemedicine made up the majority of OUD visits provided by surveyed clinicians, and the vast majority of clinicians would like the option to offer telemedicine to at least some of their patients in the future if there is adequate reimbursement. These findings can help inform telemedicine{\textquoteright}s future role in the treatment of OUD.},
	keywords = {Covid-19, Humans, Opioid-Related Disorders, Pandemics, Perception, SARS-CoV-2, Telemedicine, United States},
	issn = {1879-0046},
	doi = {10.1016/j.drugalcdep.2021.108999},
	author = {Riedel, Lauren and Uscher-Pines, Lori and Ateev Mehrotra and Alisa B. Busch and Michael L. Barnett and Raja, Pushpa and Huskamp, Haiden A.}
}
@article {696473,
	title = {Variation In Telemedicine Use And Outpatient Care During The COVID-19 Pandemic In The United States},
	journal = {Health Aff (Millwood)},
	volume = {40},
	number = {2},
	year = {2021},
	month = {2021 Feb},
	pages = {349-358},
	abstract = {Coronavirus disease 2019 (COVID-19) spurred a rapid rise in telemedicine, but it is unclear how use has varied by clinical and patient factors during the pandemic. We examined the variation in total outpatient visits and telemedicine use across patient demographics, specialties, and conditions in a database of 16.7~million commercially insured and Medicare Advantage enrollees from January to June 2020. During the pandemic, 30.1~percent of all visits were provided via telemedicine, and the weekly number of visits increased twenty-three-fold compared with the prepandemic period. Telemedicine use was lower in communities with higher rates of poverty (31.9~percent versus 27.9~percent for the lowest and highest quartiles of poverty rate, respectively). Across specialties, the use of any telemedicine during the pandemic ranged from 68~percent of endocrinologists to 9~percent of ophthalmologists. Across common conditions, the percentage of visits provided during the pandemic via telemedicine ranged from 53~percent for depression to 3~percent for glaucoma. Higher rates of telemedicine use for common conditions were associated with smaller decreases in total weekly visits during the pandemic.},
	keywords = {Adult, Ambulatory Care, Covid-19, Female, Health Services Accessibility, Humans, Male, Medicare Part C, Middle Aged, Poverty, Primary Health Care, Telemedicine, United States},
	issn = {1544-5208},
	doi = {10.1377/hlthaff.2020.01786},
	author = {Patel, Sadiq Y and Ateev Mehrotra and Huskamp, Haiden A. and Uscher-Pines, Lori and Ganguli, Ishani and Barnett, Michael Lawrence}
}
@article {696486,
	title = {Adoption of telemedicine services by substance abuse treatment facilities in the U.S},
	journal = {J Subst Abuse Treat},
	volume = {117},
	year = {2020},
	month = {2020 Oct},
	pages = {108060},
	abstract = {OBJECTIVE: To describe trends in licensed substance use treatment facilities{\textquoteright} adoption of telemedicine and how adoption varies across local factors, including county-level drug overdose rates, urbanicity measures, and state policy laws.

METHODS: We analyzed data (2016-2019) from the National Directory of Drug and Alcohol Abuse Treatment Facilities. Our main outcome was telemedicine use by a treatment facility. We also captured independent variables from other datasets, including estimated county-level drug poisoning deaths and state-level telemedicine policies. We estimated a multivariable logistic regression model to determine which facility characteristics were associated with offering telemedicine.

RESULTS: From 2016 to 2019, an average of 12,334 treatment facilities were included. During this period, the unadjusted proportion of facilities offering telemedicine grew from 13.5\% to 17.4\% (p~\&lt;~0.001). In adjusted models, rural location; offering multiple treatment settings; offering pharmacotherapy; and serving both adult and pediatric patients were associated with greater telemedicine adoption (p~\&lt;~0.05 for all comparisons).

DISCUSSION: Use of telemedicine is increasing steadily among substance use disorder (SUD) treatment facilities; however, uptake is uneven and relatively low. As such, telemedicine may be an underutilized tool to expand access to care for patients with SUDs.},
	keywords = {Adult, Child, Health Facilities, Humans, Rural Population, Substance Abuse Treatment Centers, Substance-Related Disorders, Telemedicine},
	issn = {1873-6483},
	doi = {10.1016/j.jsat.2020.108060},
	author = {Uscher-Pines, Lori and Cantor, Jonathan and Huskamp, Haiden A. and Ateev Mehrotra and Busch, Alisa and Michael Barnett}
}
@article {696487,
	title = {Assessment of Disparities in Digital Access Among Medicare Beneficiaries and Implications for Telemedicine},
	journal = {JAMA Intern Med},
	volume = {180},
	number = {10},
	year = {2020},
	month = {2020 Oct 01},
	pages = {1386-1389},
	abstract = {This cross-sectional study uses data from the 2018 American Community Survey to assess disparities in digital access among Medicare beneficiaries by demographic and socioeconomic characteristics.},
	keywords = {Female, Health Services Accessibility, Healthcare Disparities, Humans, Male, Medicare, Poverty, Residence Characteristics, Socioeconomic Factors, Telemedicine, United States, Vulnerable Populations},
	issn = {2168-6114},
	doi = {10.1001/jamainternmed.2020.2666},
	author = {Roberts, Eric T and Ateev Mehrotra}
}
@article {696490,
	title = {Assessment of Telestroke Capacity in US Hospitals},
	journal = {JAMA Neurol},
	volume = {77},
	number = {8},
	year = {2020},
	month = {2020 Aug 01},
	pages = {1035-1037},
	abstract = {This study describes the growth of telestroke capacity in US hospitals and compares the characteristics of the hospitals with and without telestroke capacity.},
	keywords = {Disease Management, Health Services Research, Hospitals, Humans, Neurology, Stroke, Telemedicine, United States},
	issn = {2168-6157},
	doi = {10.1001/jamaneurol.2020.1274},
	author = {Richard, Jessica V and Wilcock, Andrew D and Schwamm, Lee H and Uscher-Pines, Lori and Zachrison, Kori S and Siddiqui, Arham and Ateev Mehrotra}
}
@article {696506,
	title = {Association Between Medicare{\textquoteright}s Mandatory Joint Replacement Bundled Payment Program and Post-Acute Care Use in Medicare Advantage},
	journal = {JAMA Surg},
	volume = {155},
	number = {1},
	year = {2020},
	month = {2020 Jan 01},
	pages = {82-84},
	abstract = {This study examines how the reduced use of institutional post{\textendash}acute care in Medicare{\textquoteright}s Comprehensive Care for Joint Replacement program affected patients who underwent lower extremity joint replacement.},
	keywords = {Aged, Arthroplasty, Replacement, Hospitalization, Humans, Medicare, Medicare Part C, Patient Care Bundles, Patient Discharge, rehabilitation, Subacute Care, United States},
	issn = {2168-6262},
	doi = {10.1001/jamasurg.2019.3957},
	author = {Wilcock, Andrew D and Michael L. Barnett and J. Michael McWilliams and Grabowski, David C and Ateev Mehrotra}
}
@article {696499,
	title = {Association of a national insurer{\textquoteright}s reference-based pricing program and choice of imaging facility, spending, and utilization},
	journal = {Health Serv Res},
	volume = {55},
	number = {3},
	year = {2020},
	month = {2020 Jun},
	pages = {348-356},
	abstract = {OBJECTIVE: To examine the association of a national insurer{\textquoteright}s reference-based pricing (RBP), program for outpatient advanced imaging-a benefit design to encourage patients to choose lower-price facilities.

DATA SOURCE/STUDY SETTING: Administrative and medical claims data for three self-insured employers that introduced RBP and a comparison group without RBP.

STUDY DESIGN: Difference-in-difference comparison of pre-RBP (2014) and post-RBP (2015-6) care between intervention and comparison groups.

DATA COLLECTION/EXTRACTION METHOD: We identified 137~680 imaging procedures (4602 intervention group; 133~078 comparison group) in 2014-2016.

PRINCIPAL FINDINGS: In the first post-RBP year (2015), there was no change in choice of facility; by the second year, RBP-exposed enrollees were 21.9~pp (95\% CI: 18.5, 25.3) more likely to choose a lower-priced facility and net prices were $101.05 (95\% CI: -$130.65, -$71.46), a difference of 8.1 percent lower. RBP was associated with higher patient out-of-pocket spending in the first post-RBP year ($31.82; 95\% CI: $10.91, $52.73). There was no change in utilization, and higher-priced providers did not lower prices in the postperiod. Net savings represented 0.3 percent of outpatient spending.

CONCLUSIONS: Reference-based pricing for advanced imaging was associated with a shift to lower-priced facilities, but net impact on outpatient spending was modest. Patients paid increased out-of-pocket costs, though the amount declined after the first year of the program.},
	keywords = {Adolescent, Adult, Cost Sharing, Costs and Cost Analysis, Diagnostic Imaging, Female, Health Expenditures, Humans, Insurance Carriers, Male, Middle Aged, Patient Acceptance of Health Care, Reference Standards, Residence Characteristics, Young Adult},
	issn = {1475-6773},
	doi = {10.1111/1475-6773.13279},
	author = {Anna D. Sinaiko and Ateev Mehrotra}
}
@article {696496,
	title = {Classifying Electronic Consults for Triage Status and Question Type},
	journal = {Proc Conf Assoc Comput Linguist Meet},
	volume = {2020},
	year = {2020},
	month = {2020 Jul},
	pages = {1-6},
	abstract = {Electronic consult (eConsult) systems allow specialists more flexibility to respond to referrals more efficiently, thereby increasing access in under-resourced healthcare settings like safety net systems. Understanding the usage patterns of eConsult system is an important part of improving specialist efficiency. In this work, we develop and apply classifiers to a dataset of eConsult questions from primary care providers to specialists, classifying the messages for how they were triaged by the specialist office, and the underlying type of clinical question posed by the primary care provider. We show that pre-trained transformer models are strong baselines, with improving performance from domain-specific training and shared representations.},
	issn = {0736-587X},
	doi = {10.18653/v1/2020.nlpmc-1.1},
	author = {Xiyu Ding and Michael L. Barnett and Ateev Mehrotra and Miller, Timothy A}
}
@article {696481,
	title = {Comparison of Direct-to-Consumer Telemedicine Visits With Primary Care Visits},
	journal = {JAMA Netw Open},
	volume = {3},
	number = {12},
	year = {2020},
	month = {2020 Dec 01},
	pages = {e2028392},
	abstract = {This cross-sectional study compares patients who used a direct-to-consumer telemedicine service with patients who used primary care visits in the 20 US states where the service was available.},
	keywords = {Adult, Ambulatory Care, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Patient Acceptance of Health Care, Primary Health Care, Telemedicine},
	issn = {2574-3805},
	doi = {10.1001/jamanetworkopen.2020.28392},
	author = {Jain, Tara and Ateev Mehrotra}
}
@article {696503,
	title = {Declining Use of Primary Care Among Commercially Insured Adults in the United States, 2008-2016},
	journal = {Ann Intern Med},
	volume = {172},
	number = {4},
	year = {2020},
	month = {2020 Feb 18},
	pages = {240-247},
	abstract = {BACKGROUND: Primary care is known to improve outcomes and lower health care costs, prompting recent U.S. policy efforts to expand its role. Nonetheless, there is early evidence of a decline in per capita primary care visit rates, and little is understood about what is contributing to the decline.

OBJECTIVE: To describe primary care provider (PCP) visit trends among adults enrolled with a large, national, commercial insurer and assess factors underlying a potential decline in PCP visits.

DESIGN: Descriptive repeated cross-sectional study using 100\% deidentified claims data from the insurer, 2008-2016. A 5\% claims sample was used for Poisson regression models to quantify visit trends.

SETTING: National, population-based.

PARTICIPANTS: Adult health plan members aged 18 to 64 years.

MEASUREMENTS: PCP visit rates per 100 member-years.

RESULTS: In total, 142 million primary care visits among 94 million member-years were examined. Visits to PCPs declined by 24.2\%, from 169.5 to 134.3 visits per 100 member-years, while the proportion of adults with no PCP visits in a given year rose from 38.1\% to 46.4\%. Rates of visits addressing low-acuity conditions decreased by 47.7\% (95\% CI, -48.1\% to -47.3\%). The decline was largest among the youngest adults (-27.6\% [CI, -28.2\% to -27.1\%]), those without chronic conditions (-26.4\% [CI, -26.7\% to -26.1\%]), and those living in the lowest-income areas (-31.4\% [CI, -31.8\% to -30.9\%]). Out-of-pocket cost per problem-based visit rose by $9.4 (31.5\%). Visit rates to specialists remained stable (-0.08\% [CI, -0.56\% to 0.40\%]), and visits to alternative venues, such as urgent care clinics, increased by 46.9\% (CI, 45.8\% to 48.1\%).

LIMITATION: Data were limited to a single commercial insurer and did not capture nonbilled clinician-patient interactions.

CONCLUSION: Commercially insured adults have been visiting PCPs less often, and nearly one half had no PCP visits in a given year by 2016. Our results suggest that this decline may be explained by decreased real or perceived visit needs, financial deterrents, and use of alternative sources of care.

PRIMARY FUNDING SOURCE: None.},
	keywords = {Adolescent, Adult, Age Factors, Cross-Sectional Studies, Female, Humans, Insurance, Health, Male, Middle Aged, Patient Acceptance of Health Care, Poisson Distribution, Primary Health Care, Sex Factors, United States, Young Adult},
	issn = {1539-3704},
	doi = {10.7326/M19-1834},
	author = {Ganguli, Ishani and Shi, Zhuo and Orav, E. John and Rao, Aarti and Ray, Kristin N and Ateev Mehrotra}
}
@article {696484,
	title = {Disparities in outpatient visits for mental health and/or substance use disorders during the COVID surge and partial reopening in Massachusetts},
	journal = {Gen Hosp Psychiatry},
	volume = {67},
	year = {2020},
	month = {2020 Nov-Dec},
	pages = {100-106},
	abstract = {OBJECTIVE: To examine changes in outpatient visits for mental health and/or substance use disorders (MH/SUD) in an integrated healthcare organization during the initial Massachusetts COVID-19 surge and partial state reopening.

METHODS: Observational study of outpatient MH/SUD visits January 1st-June 30th, 2018-2020 by: 1) visit diagnosis group, 2) provider type, 3) patient race/ethnicity, 4) insurance, and 5) visit method (telemedicine vs. in-person).

RESULTS: Each year, January-June 52,907-73,184 patients were seen for a MH/SUD visit. While non-MH/SUD visits declined during the surge relative to 2020 pre-pandemic (-38.2\%), MH/SUD visits increased (9.1\%)-concentrated in primary care (35.3\%) and non-Hispanic Whites (10.5\%). During the surge, MH visit volume increased 11.7\% while SUD decreased 12.7\%. During partial reopening, while MH visits returned to 2020 pre-pandemic levels, SUD visits declined 31.1\%; MH/SUD visits decreased by Hispanics (-33.0\%) and non-Hispanic Blacks (-24.6\%), and among Medicaid (-19.4\%) and Medicare enrollees (-20.9\%). Telemedicine accounted for ~5\% of MH/SUD visits pre-pandemic and 83.3\%-83.5\% since the surge.

CONCLUSIONS: MH/SUD visit volume increased during the COVID surge and was supported by rapidly-scaled telemedicine. Despite this, widening diagnostic and racial/ethnic disparities in MH/SUD visit volume during the surge and reopening suggest additional barriers for these vulnerable populations, and warrant continued monitoring and research.},
	keywords = {Adolescent, Adult, Aged, Aged, 80 and over, Ambulatory Care, Black or African American, Covid-19, Female, Healthcare Disparities, Hispanic or Latino, Humans, Male, Massachusetts, Medicaid, Medicare, Mental Disorders, Mental Health Services, Middle Aged, Office Visits, Substance-Related Disorders, Telemedicine, United States, White People, Young Adult},
	issn = {1873-7714},
	doi = {10.1016/j.genhosppsych.2020.09.004},
	author = {Jie Yang and Mary Beth Landrum and Zhou, Li and Alisa B. Busch}
}
@article {696480,
	title = {Factors associated with emergency department adoption of telemedicine: 2014 to 2018},
	journal = {J Am Coll Emerg Physicians Open},
	volume = {1},
	number = {6},
	year = {2020},
	month = {2020 Dec},
	pages = {1304-1311},
	abstract = {OBJECTIVE: Telemedicine is used by emergency departments (EDs) to connect patients with specialty consultation and resources not available locally. Despite its utility, uptake of telemedicine in EDs has varied. We studied characteristics associated with telemedicine adoption during a 4-year period.

METHODS: We analyzed data from the 2014 National Emergency Department Inventory (NEDI)-New England survey and follow-up data from 2016 and 2017 NEDI-USA and 2018 NEDI-New England surveys, with data from the Center for Connected Health Policy. Among EDs not using telemedicine in 2014, we examined characteristics associated with adoption by 2018.

RESULTS: Of the 159 New England EDs with available data, 80 (50\%) and 125 (79\%) reported telemedicine receipt in 2014 and 2018, respectively. Among the 79 EDs without telemedicine in 2014, academic EDs were less likely to adopt by 2018 (odds ratio, 0.12; 95\% confidence interval, 0.03-0.46). State policy environment was not associated with likelihood of adoption. In 2018, all 7 freestanding EDs received telemedicine, whereas only 1 of 9 academic EDs (11\%) did.

CONCLUSIONS: Telemedicine use by EDs continues to grow rapidly and by 2018, \&gt;3 quarters of EDs in our sample were receiving telemedicine. From 2014 to 2018, the initiation of telemedicine receipt was less common among higher volume and academic EDs.},
	issn = {2688-1152},
	doi = {10.1002/emp2.12233},
	author = {Zachrison, Kori S and Boggs, Krislyn M and Hayden, Emily M and Cash, Rebecca E and Espinola, Janice A and Samuels-Kalow, Margaret E and Sullivan, Ashley F and Ateev Mehrotra and Camargo, Carlos A}
}
@article {696493,
	title = {Feasibility and Effectiveness of Telelactation Among Rural Breastfeeding Women},
	journal = {Acad Pediatr},
	volume = {20},
	number = {5},
	year = {2020},
	month = {2020 Jul},
	pages = {652-659},
	abstract = {OBJECTIVE: To evaluate the feasibility and impact of telelactation via personal electronic devices on breastfeeding duration and exclusivity among rural women.

METHODS: The Tele-MILC trial, a pragmatic, parallel design trial, recruited 203 women during their postpartum hospitalization in a critical access hospital in Pennsylvania and randomized them to receive telelactation (n = 102) or usual care (n = 101). We used intent-to-treat (ITT) and instrumental variable (IV) approaches to analyze study data for the 187 participants who completed follow-up. The primary outcomes were any breastfeeding and exclusive breastfeeding at 12 weeks postpartum.

RESULTS: Among participants in the telelactation arm, 50\% (47/94) reported participating in video calls. At 12 weeks, 71\% of participants in the telelactation arm versus 68\% of control participants were breastfeeding in the ITT model (3\% difference, P = .73), whereas 73\% of participants in the telelactation arm versus 68\% of control participants were breastfeeding in the IV model (5\% difference, P = .74). Among participants who were still breastfeeding at 12 weeks, 51\% participants in the telelactation arm were breastfeeding exclusively versus 46\% of control participants in the ITT model (5\% difference, P = .47), whereas 56\% of participants in the telelactation arm were breastfeeding exclusively versus 45\% of control participants in the IV model (11\% difference, P = .48). In all models, participants in the telelactation arm were breastfeeding at higher rates; however, differences were not statistically significant.

CONCLUSIONS: This trial demonstrated that telelactation can be implemented with a rural underserved population. Though this trial was not powered to detect differences in breastfeeding duration and exclusivity, and none were observed, telelactation remains a promising approach for further investigation. ClinicalTrials.gov Identifier: NCT02870413.},
	keywords = {Breast Feeding, Feasibility Studies, Female, Humans, Pennsylvania, Rural Population, Telemedicine},
	issn = {1876-2867},
	doi = {10.1016/j.acap.2019.10.008},
	author = {Uscher-Pines, Lori and Ghosh-Dastidar, Bonnie and Bogen, Debra L and Ray, Kristin N and Demirci, Jill R and Ateev Mehrotra and Kapinos, Kandice A}
}
@article {696491,
	title = {Health center implementation of telemedicine for opioid use disorders: A qualitative assessment of adopters and nonadopters},
	journal = {J Subst Abuse Treat},
	volume = {115},
	year = {2020},
	month = {2020 Aug},
	pages = {108037},
	abstract = {OBJECTIVE: Although use of telemedicine for the treatment of opioid use disorders (Tele-OUD) is growing, there is limited research on how it is actually being deployed in treatment. We explored how health centers across the U.S. are using tele-OUD in treatment as well as reasons for nonadoption.

METHODS: We used the 2018 SAMHSA Behavioral Health Treatment Services Locator database and literature review to create a sample of community mental health centers and federally qualified health centers with telemental health services. From this list of health centers, we ued maximum diversity sampling to identify and recruit health center leaders to participate in semistructured interviews. We used inductive and deductive approaches to develop site summaries.

RESULTS: Twenty-two health centers from 14 different states participated. Of these, 8 offered tele-OUD. Among centers with tele-OUD, medication management was the most common service provided via video. Typically, health centers offered telemedicine visits after an initial, in-person visit with a waivered (prescribing) provider. Some programs only offered counseling via telemedicine. Leading barriers to treatment that tele-OUD program representatives mentioned included regulations on the prescribing of controlled substances, including buprenorphine, and difficulties in sending lab results to distant (prescribing) providers. Nonadopters reported not offering tele-OUD due to regulations in controlled substance prescribing, complexities and regulatory barriers to offering group visits, and the belief that in-person OUD services were meeting patient need.

CONCLUSIONS: Tele-OUD is being deployed in a variety of ways. Describing current delivery models can inform strategies to promote and implement tele-OUD to combat the opioid epidemic.},
	keywords = {Analgesics, Opioid, Buprenorphine, Humans, Opiate Substitution Treatment, Opioid-Related Disorders, Telemedicine},
	issn = {1873-6483},
	doi = {10.1016/j.jsat.2020.108037},
	author = {Uscher-Pines, Lori and Raja, Pushpa and Ateev Mehrotra and Huskamp, Haiden A.}
}
@article {696485,
	title = {Patient Experience of Obstetric Care During the COVID-19 Pandemic: Preliminary Results From a Recurring National Survey},
	journal = {J Patient Exp},
	volume = {7},
	number = {5},
	year = {2020},
	month = {2020 Oct},
	pages = {653-656},
	abstract = {The experience of pregnant and postpartum patients continues to evolve during the COVID-19 pandemic. Limited clinical data and the unknown nature of the virus{\textquoteright} impact and transmission routes have forced constant changes to traditional care delivery. Dependence on telehealth technology such as telephonic and videoconferencing has surged, and patients{\textquoteright} willingness to visit traditional health care facilities has plummeted. We set out to create an ongoing surveillance system to monitor changes to prenatal and obstetric care and the patient experience during the COVID-19 pandemic.},
	issn = {2374-3735},
	doi = {10.1177/2374373520964045},
	author = {Bradley, Dani and Blaine, Arianna and Shah, Neel and Ateev Mehrotra and Gupta, Rahul and Wolfberg, Adam}
}
@article {696497,
	title = {Patterns of Postoperative Visits Among Medicare Fee-for-service Beneficiaries},
	journal = {Ann Surg},
	volume = {271},
	number = {6},
	year = {2020},
	month = {2020 Jun},
	pages = {1056-1064},
	abstract = {OBJECTIVE: To describe patterns of postoperative visits reported for Medicare fee-for-service (FFS) patients.

BACKGROUND: Payment for most surgical procedures bundles postoperative visits within a global period of either 10 or 90 days after a procedure. There is concern that payments for some procedures are excessive because the number of postoperative visits provided is less than the number of postoperative visits used to help determine payment. To obtain data to inform this concern, Medicare required select surgeons to report on their postoperative visits starting July 1, 2017.

METHODS: We analyzed Medicare FFS claims data from surgeons who billed Medicare for 1 or more of the 293 common procedure codes between July 1, 2017 and December 31, 2017 in the 9 states where surgeons were required to report postoperative visits. We examined the share of procedures with any reported postoperative visits and the proportion of expected postoperative visits provided. To address concerns about underreporting, we also examined procedures performed by a subset of surgeons actively reporting postoperative visits.

RESULTS: We linked 663,681 procedures to 422,432 postoperative visits. The share of procedures with any postoperative visits was higher for procedures with 90-day global periods (70.1\%) than for procedures with 10-day global periods (3.7\%). The proportions of expected postoperative visits provided for 90-day global and 10-day global periods were 0.37 and 0.04 respectively. Among surgeons actively reporting postoperative visits, the proportions of expected postoperative visits provided were modestly higher (procedures with 90-day global periods=0.46 and 10-day global periods=0.16).

CONCLUSIONS: The proportion of expected postoperative visits that were provided is low. These results support the need for a reassessment of payment for surgical procedures.},
	keywords = {Fee-for-Service Plans, Health Expenditures, Humans, Medicare, Office Visits, Postoperative Period, Retrospective Studies, Surgical Procedures, Operative, United States},
	issn = {1528-1140},
	doi = {10.1097/SLA.0000000000003168},
	author = {Kranz, Ashley M and Mulcahy, Andrew and Ruder, Teague and Lovejoy, Susan and Ateev Mehrotra}
}
@article {696505,
	title = {Payment for Services Rendered - Updating Medicare{\textquoteright}s Valuation of Procedures},
	journal = {N Engl J Med},
	volume = {382},
	number = {4},
	year = {2020},
	month = {2020 Jan 23},
	pages = {303-306},
	keywords = {Centers for Medicare and Medicaid Services, U.S., Medicare, Postoperative Care, Reimbursement mechanisms, Surgeons, Surgical Procedures, Operative, United States},
	issn = {1533-4406},
	doi = {10.1056/NEJMp1908706},
	author = {Mulcahy, Andrew W and Merrell, Katie and Ateev Mehrotra}
}
@article {696488,
	title = {Prevalence and Characteristics of Telehealth Utilization in the United States},
	journal = {JAMA Netw Open},
	volume = {3},
	number = {10},
	year = {2020},
	month = {2020 Oct 01},
	pages = {e2022302},
	abstract = {IMPORTANCE: Telehealth services, which allow patients to communicate with a remotely located clinician, are increasingly available; however, prevalence of telehealth use, including videoconferencing visits, remains unclear.

OBJECTIVE: To measure the use of and willingness to use telehealth modalities across the US population.

DESIGN, SETTING, AND PARTICIPANTS: This survey study, conducted between February 2019 and April 2019, asked participants about their use of different telehealth modalities, reasons for not using videoconferencing visits, and willingness to use videoconferencing visits. Questions were continuously posed to panel members and closed after 2555 responses were obtained, at which point 3932 panel members had been invited, for a 65.0\% response rate.

EXPOSURES: Demographic characteristics (ie, age, sex, race, rural/urban residency, education level, and income).

MAIN OUTCOMES AND MEASURES: Self-reported use of specific telehealth modalities, reasons for nonuse, and willingness to use videoconferencing in the future.

RESULTS: A total of 2555 individuals completed the survey with a mean (SD) age of 57.2 (14.2) years; 1453 respondents (weighted percentage, 51.9\%) were women, and 2043 (weighted percentage, 73.4\%) were White individuals. Overall, 1343 respondents (weighted percentage, 50.8\%) reported use of a nontelephone telehealth modality, ranging from 873 respondents (weighted percentage, 31.9\%) for patient portals and 89 respondents (weighted percentage, 4.2\%) for videoconferencing visits. Although 1309 respondents (weighted percentage, 49.2\%) overall answered that they were willing or very willing to use videoconferencing visits, respondents who were Black individuals (OR, 0.58; 95\% CI, 0.38-0.91), aged older than 65 years (OR, 0.51; 95\% CI, 0.40-0.66), or had less education (high school or less vs advanced degrees: OR, 0.37; 95\% CI, 0.25-0.56) were less likely to express willingness.

CONCLUSIONS AND RELEVANCE: Despite the focused policy attention on videoconferencing visits, the results of this survey study suggest that other forms of telehealth were more dominant prior to 2020. Targeted efforts may be necessary for videoconferencing visits to reach patient groups who are older or have less education, and payer policies supporting other forms of telemedicine may be appropriate to enhance access.},
	keywords = {Adult, Aged, Female, Humans, Male, Middle Aged, Patient Acceptance of Health Care, Prevalence, Surveys and Questionnaires, Telemedicine, United States},
	issn = {2574-3805},
	doi = {10.1001/jamanetworkopen.2020.22302},
	author = {Fischer, Shira H and Ray, Kristin N and Ateev Mehrotra and Bloom, Erika Litvin and Uscher-Pines, Lori}
}
@article {696502,
	title = {Prevalence of colorectal cancer and advanced adenoma in patients with acute diverticulitis: implications for follow-up colonoscopy},
	journal = {Gastrointest Endosc},
	volume = {91},
	number = {3},
	year = {2020},
	month = {2020 Mar},
	pages = {634-640},
	abstract = {BACKGROUND AND AIMS: Guidelines recommend colonoscopy after an episode of diverticulitis to exclude neoplasia but the effectiveness of testing is uncertain. Patients with complicated diverticulitis may be at higher risk for neoplasia, but most patients have uncomplicated disease. We examined the incidence of colorectal cancer (CRC) and advanced adenoma (AA) in patients with diverticulitis compared with patients undergoing screening colonoscopy.

METHODS: CT scans from January 1, 2008, to May 1, 2013, at the University of Pittsburgh Medical Center (UPMC) were reviewed to identify those with confirmed acute diverticulitis. Subsequent surgical, colonoscopy, and pathology reports were abstracted to identify those with a diagnosis of AA and CRC. The incidence of neoplasia was compared with that reported for screening colonoscopy from a meta-analysis (n~= 68,324), and from colonoscopy examinations at UPMC between 2013 and 2015 (n~= 28,573).

RESULTS: A total of 5167 abdominal/pelvic CT scan reports identified 978 patients with acute diverticulitis, among which 474 (48.5\%) patients had undergone at least 1 colonoscopy or gastrointestinal surgery to April 2015. The CRC rate in patients with diverticulitis (13/474, 2.7\%) was significantly higher (P~\&lt; .0001) compared with both the meta-analysis (0.8\%) and UPMC (0.3\%). The AA rate (19/474, 4.0\%) was similar to the rate in the meta-analysis (5.0\%, P~= .39) but significantly lower than at UPMC (7.7\%, P~= .003). The incidence of AA or CRC in complicated diverticulitis (10/141, 7.1\%) did not differ significantly (P~= .85) from the incidence of AA or CRC in uncomplicated diverticulitis (22/332, 6.6\%).

CONCLUSIONS: CRC after diverticulitis was significantly higher than that observed at screening colonoscopy and was not limited to complicated disease. Colonoscopy is advisable after the diagnosis of diverticulitis.},
	keywords = {Acute Disease, Adenoma, Aftercare, Colonoscopy, Colorectal Neoplasms, Diverticulitis, Colonic, Female, Humans, Male, Middle Aged, Pennsylvania, Prevalence, Retrospective Studies},
	issn = {1097-6779},
	doi = {10.1016/j.gie.2019.08.044},
	author = {Tehranian, Shahrzad and Klinge, Matthew and Saul, Melissa and Morris, Michele and Diergaarde, Brenda and Schoen, Robert E}
}
@article {696483,
	title = {Suddenly Becoming a "Virtual Doctor": Experiences of Psychiatrists Transitioning to Telemedicine During the COVID-19 Pandemic},
	journal = {Psychiatr Serv},
	volume = {71},
	number = {11},
	year = {2020},
	month = {2020 Nov 01},
	pages = {1143-1150},
	abstract = {OBJECTIVE: In response to the COVID-19 pandemic, many psychiatrists have rapidly transitioned to telemedicine. This qualitative study sought to understand how this dramatic change in delivery has affected mental health care, including modes of telemedicine psychiatrists used, barriers encountered, and future plans. The aim was to inform the ongoing COVID-19 response and pass on lessons learned to psychiatrists who are starting to offer telemedicine.

METHODS: From March 31 to April 9, 2020, semistructured interviews were conducted with 20 outpatient psychiatrists practicing in five U.S. states with significant early COVID-19 activity. Inductive and deductive approaches were used to develop interview summaries, and a matrix analysis was conducted to identify and refine themes.

RESULTS: At the time of the interviews, all 20 psychiatrists had been using telemedicine for 2-4 weeks. Telemedicine encompassed video visits, phone visits, or both. Although many continued to prefer in-person care and planned to return to it after the pandemic, psychiatrists largely perceived the transition positively. However, several noted challenges affecting the quality of provider-patient interactions, such as decreased clinical data for assessment, diminished patient privacy, and increased distractions in the patient{\textquoteright}s home setting. Several psychiatrists noted that their disadvantaged patients lacked reliable access to a smartphone, computer, or the Internet. Participants identified several strategies that helped them improve telemedicine visit quality.

CONCLUSIONS: The COVID-19 pandemic has driven a dramatic shift in how psychiatrists deliver care. Findings highlight that although psychiatrists expressed some concerns about the quality of these encounters, the transition has been largely positive for both patients and physicians.},
	keywords = {Coronavirus Infections, Covid-19, Delivery of Health Care, Humans, Interviews as Topic, Outpatients, Pandemics, Pneumonia, Viral, Psychiatry, Qualitative Research, Telemedicine, United States},
	issn = {1557-9700},
	doi = {10.1176/appi.ps.202000250},
	author = {Uscher-Pines, Lori and Sousa, Jessica and Raja, Pushpa and Ateev Mehrotra and Michael L. Barnett and Huskamp, Haiden A.}
}
@article {696498,
	title = {Telehealth for global emergencies: Implications for coronavirus disease 2019 (COVID-19)},
	journal = {J Telemed Telecare},
	volume = {26},
	number = {5},
	year = {2020},
	month = {2020 Jun},
	pages = {309-313},
	abstract = {The current coronavirus (COVID-19) pandemic is again reminding us of the importance of using telehealth to deliver care, especially as means of reducing the risk of cross-contamination caused by close contact. For telehealth to be effective as part of an emergency response it first needs to become a routinely used part of our health system. Hence, it is time to step back and ask why telehealth is not mainstreamed. In this article, we highlight key requirements for this to occur. Strategies to ensure that telehealth is used regularly in acute, post-acute and emergency situations, alongside conventional service delivery methods, include flexible funding arrangements, training and accrediting our health workforce. Telehealth uptake also requires a significant change in management effort and the redesign of existing models of care. Implementing telehealth proactively rather than reactively is more likely to generate greater benefits in the long-term, and help with the everyday (and emergency) challenges in healthcare.},
	keywords = {Betacoronavirus, Coronavirus Infections, Covid-19, Emergencies, Humans, Pandemics, Pneumonia, Viral, SARS-CoV-2, Telemedicine},
	issn = {1758-1109},
	doi = {10.1177/1357633X20916567},
	author = {Smith, Anthony C and Thomas, Emma and Snoswell, Centaine L and Haydon, Helen and Ateev Mehrotra and Clemensen, Jane and Caffery, Liam J}
}
@article {696494,
	title = {Telemedicine and Outpatient Subspecialty Visits Among Pediatric Medicaid Beneficiaries},
	journal = {Acad Pediatr},
	volume = {20},
	number = {5},
	year = {2020},
	month = {2020 Jul},
	pages = {642-651},
	abstract = {OBJECTIVE: Live interactive telemedicine is increasingly covered by state Medicaid programs, but whether telemedicine is improving equity in utilization of subspecialty care is not known. We examined patterns of telemedicine use for outpatient pediatric subspecialty care within the state Medicaid programs.

METHODS: We identified children <=17 years old in 2014 Medicaid Analysis eXtract data for 12 states. We identified telemedicine-using and telemedicine-nonusing medical and surgical subspecialists. Among children cared for by telemedicine-using subspecialists, we assessed child and subspecialist characteristics associated with any telemedicine visit using logistic regression with subspecialist-level random effects. Among children cared for by telemedicine-using and nonusing subspecialists, we compared visit rates across child characteristics by assessing negative binomial regression interaction terms.

RESULTS: Of 12,237,770 pediatric Medicaid beneficiaries, 2,051,690 (16.8\%) had >=1 subspecialist visit. Of 42,695 subspecialists identified, 146 (0.3\%) had >=1 telemedicine claim. Among children receiving care from telemedicine-using subspecialists, likelihood of any telemedicine use was increased for rural children (odds ratio [OR] 10.4, 95\% confidence interval [CI] 6.3-17.1 compared to large metropolitan referent group) and those \&gt;90 miles from the subspecialist (OR 13.4, 95\% CI 10.2-17.7 compared to 0-30 mile referent group). Compared to children receiving care from telemedicine-nonusing subspecialists, matched children receiving care from telemedicine-using subspecialists had larger differences in visit rates by distance to care, county rurality, ZIP code median income, and child race/ethnicity (P \&lt; .001 for interaction terms).

CONCLUSIONS: Children in rural communities and at distance to subspecialists had increased likelihood of telemedicine use. Use overall was low, and results indicated that early telemedicine policies and implementation did not close disparities in subspecialty visit rates by child geographic and sociodemographic characteristics.},
	keywords = {Adolescent, Ambulatory Care, Child, Female, Humans, Male, Medicaid, Outpatients, Pediatrics, Rural Population, Telemedicine, United States},
	issn = {1876-2867},
	doi = {10.1016/j.acap.2020.03.014},
	author = {Ray, Kristin N and Ateev Mehrotra and Yabes, Jonathan G and Kahn, Jeremy M}
}
@article {696504,
	title = {Telemedicine for Mental Health in the United States: Making Progress, Still a Long Way to Go},
	journal = {Psychiatr Serv},
	volume = {71},
	number = {2},
	year = {2020},
	month = {2020 Feb 01},
	pages = {197-198},
	keywords = {Hospitals, Psychiatric, Mental Health, Telemedicine, United States},
	issn = {1557-9700},
	doi = {10.1176/appi.ps.201900555},
	author = {Michael L. Barnett and Huskamp, Haiden A.}
}
@article {696489,
	title = {Telemental Health and US Rural-Urban Differences in Specialty Mental Health Use, 2010-2017},
	journal = {Am J Public Health},
	volume = {110},
	number = {9},
	year = {2020},
	month = {2020 Sep},
	pages = {1308-1314},
	abstract = {Objectives. To examine whether growing use of telemental health (TMH) has reduced the rural-urban gap in specialty mental health care use in the United States.Methods. Using 2010-2017 Medicare data, we analyzed trends in the rural-urban difference in rates of specialty visits (in-person and TMH).Results. Among rural beneficiaries diagnosed with schizophrenia or bipolar disorder, TMH use grew by 425\% over the 8 years and, in higher-use rural areas, accounted for one quarter of all specialty mental health visits in 2017. Among patients with schizophrenia or bipolar disorder, TMH visits differentially grew in rural areas by 0.14 visits from 2010 to 2017. This growth partially offset the 0.42-visit differential decline in in-person visits in rural areas. In net, the gap between rural and urban patients in specialty visits was larger by 2017.Conclusions. TMH has improved access to specialty care in rural areas, particularly for individuals diagnosed with schizophrenia or bipolar disorder. While growth in TMH use has been insufficient to eliminate the overall rural-urban difference in specialty care use, this difference may have been larger if not for TMH.Public Health Implications. Targeted policy to extend TMH to underserved areas may help offset declines in in-person specialty care.},
	keywords = {Adult, Aged, Aged, 80 and over, Bipolar Disorder, Female, Humans, Male, Medicare, Middle Aged, Rural Population, Schizophrenia, Telemedicine, United States, Urban Population},
	issn = {1541-0048},
	doi = {10.2105/AJPH.2020.305657},
	author = {Patel, Sadiq Y and Huskamp, Haiden A. and Alisa B. Busch and Ateev Mehrotra}
}
@article {696492,
	title = {Treating Patients With Opioid Use Disorder in Their Homes: An Emerging Treatment Model},
	journal = {JAMA},
	volume = {324},
	number = {1},
	year = {2020},
	month = {2020 Jul 07},
	pages = {39-40},
	keywords = {Betacoronavirus, Buprenorphine, Coronavirus Infections, Covid-19, Drug and Narcotic Control, Health Expenditures, Health Services Accessibility, Home Care Services, Humans, Narcotic Antagonists, Opioid-Related Disorders, Pandemics, Pharmaceutical Services, Online, Pneumonia, Viral, Rural Health Services, SARS-CoV-2, smartphone, Telemedicine, Transportation of Patients},
	issn = {1538-3598},
	doi = {10.1001/jama.2020.3940},
	author = {Uscher-Pines, Lori and Huskamp, Haiden A. and Ateev Mehrotra}
}
@article {696478,
	title = {Treatment of Opioid Use Disorder Among Commercially Insured Patients in the Context of the COVID-19 Pandemic},
	journal = {JAMA},
	volume = {324},
	number = {23},
	year = {2020},
	month = {2020 Dec 15},
	pages = {2440-2442},
	abstract = {This study uses commercial and Medicare Advantage claims data to compare medication fills, outpatient visits, and urine tests for opioid use disorder in January-May 2020 vs 2019.},
	keywords = {Adolescent, Adult, Buprenorphine, Covid-19, Drug Prescriptions, Drug Utilization, Female, Humans, Insurance Coverage, Male, Medicare, Middle Aged, Narcotic Antagonists, Opioid-Related Disorders, Pandemics, United States, Young Adult},
	issn = {1538-3598},
	doi = {10.1001/jama.2020.21512},
	author = {Huskamp, Haiden A. and Alisa B. Busch and Uscher-Pines, Lori and Michael L. Barnett and Riedel, Lauren and Ateev Mehrotra}
}
@article {696482,
	title = {Treatment of opioid use disorder during COVID-19: Experiences of clinicians transitioning to telemedicine},
	journal = {J Subst Abuse Treat},
	volume = {118},
	year = {2020},
	month = {2020 Nov},
	pages = {108124},
	abstract = {OBJECTIVE: The COVID-19 pandemic has transformed care delivery for patients with opioid use disorder (OUD); however, little is known about the experiences of front-line clinicians in the transition to telemedicine. This study described how, in the context of the early stages of the pandemic, clinicians used telemedicine for OUD in conjunction with in-person care, barriers encountered, and implications for quality of care.

METHODS: In April 2020, we conducted semistructured interviews with clinicians waivered to prescribe buprenorphine. We used maximum variation sampling. We used standard qualitative analysis techniques, consisting of both inductive and deductive approaches, to identify and characterize themes.

RESULTS: Eighteen clinicians representing 10 states participated. Nearly all interview participants were doing some telemedicine, and more than half were only doing telemedicine visits. Most participants reported changing their typical clinical care patterns to help patients remain at home and minimize exposure to COVID-19. Changes included waiving urine toxicology screening, sending patients home with a larger supply of OUD medications, and requiring fewer visits. Although several participants were serving new patients via telemedicine during the early weeks of the pandemic, others were not. Some clinicians identified positive impacts of telemedicine on the quality of their patient interactions, including increased access for patients. Others noted negative impacts including less structure and accountability, less information to inform clinical decision-making, challenges in establishing a connection, technological challenges, and shorter visits.

CONCLUSIONS: In the context of the pandemic, buprenorphine prescribers quickly transitioned to providing telemedicine visits in high volume; nonetheless, there are still many unknowns, including the quality and safety of widespread use of telemedicine for OUD treatment.},
	keywords = {Buprenorphine, Clinical Decision-Making, Coronavirus Infections, Covid-19, Delivery of Health Care, Health Personnel, Humans, Interviews as Topic, Opiate Substitution Treatment, Opioid-Related Disorders, Pandemics, Pneumonia, Viral, Substance Abuse Detection, Telemedicine},
	issn = {1873-6483},
	doi = {10.1016/j.jsat.2020.108124},
	author = {Uscher-Pines, Lori and Sousa, Jessica and Raja, Pushpa and Ateev Mehrotra and Michael Barnett and Huskamp, Haiden A.}
}
@article {696495,
	title = {Trends Among Rural and Urban Medicare Beneficiaries in Care Delivery and Outcomes for Acute Stroke and Transient Ischemic Attacks, 2008-2017},
	journal = {JAMA Neurol},
	volume = {77},
	number = {7},
	year = {2020},
	month = {2020 Jul 01},
	pages = {863-871},
	abstract = {IMPORTANCE: Over the last decade or so, there have been substantial investments in the development of stroke systems of care to improve access and quality of care in rural communities. Whether these have narrowed rural-urban disparities in care is unclear.

OBJECTIVE: To describe trends among rural and urban patients with acute ischemic stroke or transient ischemic attack in the type of health care centers to which patients were admitted, what care was provided, and the outcomes patients experienced.

DESIGN, SETTING, AND PARTICIPANTS: This descriptive observational study included 100\% claims for beneficiaries of traditional fee-for-service Medicare from 2008 through 2017. All rural and urban areas in the US were included, defined by whether a beneficiary{\textquoteright}s residential zip code was in a metropolitan or nonmetropolitan area. All admissions in the US among patients with traditional Medicare who had a transient ischemic attack or acute stroke (N = 4.01 million) were eligible to be included in this study. Admissions for beneficiaries with end-stage kidney disease (n = 85 927 [2.14\%]), beneficiaries with unidentified Rural-Urban Commuting Area codes (n = 12 797 [0.32\%]), and beneficiaries not continuously enrolled in traditional Medicare in the 12 months before and 3 months after their admission (n = 442 963 [11.0\%]) were excluded.

EXPOSURES: Residence in an urban or rural area; admission to a hospital with a transient ischemic attack or acute stroke.

MAIN OUTCOMES AND MEASURES: Discharge from a certified stroke center, receiving a neurology consultation during admission, treatment with alteplase, days institutionalized, and 90-day mortality.

RESULTS: The final sample included 3.47 million admissions from 2008 through 2017. In this sample, 2.01 million patients (58.0\%) were female, and the mean (SD) age was 78.6 (10.5) years. In 2008, 24 681 patients (25.2\%) and 161 217 patients (60.6\%) in rural and urban areas, respectively, were cared for at a certified stroke center (disparity, -35.4\%). By 2017, this disparity was -26.6\%, having narrowed by 8.7 percentage points (95\% CI, 6.6-10.8 percentage points). There was also narrowing in the rural-urban disparity in neurologist evaluation during admission (6.3\% [95\% CI, 4.2\%-8.4\%]). However, the rural-urban disparity widened or was similar with regard to receiving alteplase (0.5\% [95\% CI, 0.1\%-0.8\%]), mean days in an institution from admission (0.5 [95\% CI, 0.2-0.8] days), and mortality at 90 days (0.3\% [95\% CI, -0.02\% to 0.6\%]), respectively.

CONCLUSIONS AND RELEVANCE: In the last decade, care for rural residents with acute ischemic stroke and transient ischemic attack has shifted to certified stroke centers and now more likely includes neurologist input. However, disparities in access to treatments, such as alteplase, and outcomes persist, highlighting that work still is needed to extend improvements in stroke care to all US residents.},
	keywords = {Aged, Aged, 80 and over, Cohort Studies, Female, Healthcare Disparities, Humans, Ischemic Attack, Transient, Ischemic Stroke, Male, Medicare, Rural Population, United States, Urban Population},
	issn = {2168-6157},
	doi = {10.1001/jamaneurol.2020.0770},
	author = {Wilcock, Andrew D and Zachrison, Kori S and Schwamm, Lee H and Uscher-Pines, Lori and Zubizarreta, Jose R and Ateev Mehrotra}
}
@article {696501,
	title = {Trends in Pediatric Primary Care Visits Among Commercially Insured US Children, 2008-2016},
	journal = {JAMA Pediatr},
	volume = {174},
	number = {4},
	year = {2020},
	month = {2020 Apr 01},
	pages = {350-357},
	abstract = {IMPORTANCE: Primary care is the foundation of pediatric care. While policy interventions have focused on improving access and quality of primary care, trends in overall use of primary care among children have not been described.

OBJECTIVE: To assess trends in primary care visit rates and out-of-pocket costs, to examine variation in these trends by patient and visit characteristics, and to assess shifts to alternative care options (eg, retail clinics, urgent care, and telemedicine).

DESIGN, SETTING, AND PARTICIPANTS: Observational cohort study of claims data from 2008 to 2016 for children 17 years and younger covered by a large national commercial health plan. Visit rate per 100 child-years was determined for each year overall, by child and geographic characteristics, and by visit type (eg, primary diagnosis), and trends were assessed with a series of child-year Poisson models. Data were analyzed from November 2017 to September 2019.

MAIN OUTCOMES AND MEASURES: Visits to primary care and other settings.

RESULTS: This cohort study included more than 71 million pediatric primary care visits over 29 million pediatric child-years (51\% male in 2008 and 2016; 37\% between 12-17 years in 2008 and 38\% between 12-17 years in 2016). Unadjusted results for primary care visit rates per 100 child-years decreased from 259.6 in 2008 to 227.2 in 2016, yielding a regression-estimated change in primary care visits across the 9 years of -14.4\% (95\% CI, -15.0\% to -13.9\%; absolute change: -32.4 visits per 100 child-years). After controlling for shifts in demographics, the relative decrease was -12.8\% (95\% CI, -13.3\% to -12.2\%). Preventive care visits per 100 child-years increased from 74.9 in 2008 to 83.2 visits in 2016 (9.9\% change in visit rate; 95\% CI, 9.0\%-10.9\%; absolute change: 8.3 visits per 100 child-years), while problem-based visits per 100 child-years decreased from 184.7 in 2008 to 144.1 in 2016 (-24.1\%; 95\% CI, -24.6\% to -23.5\%; absolute change: -40.6 visits per 100 child-years). Visit rates decreased for all diagnostic groups except for the behavioral and psychiatric category. Out-of-pocket costs for problem-based primary care visits increased by 42\% during the same period. Per 100 child-years, visits to other acute care venues increased from 21.3 to 27.6 (30.3\%; 95\% CI, 28.5\% to 32.1\%; absolute change: 6.3 visits per 100 child-years) and visits to specialists from 45.2 to 53.5 (16.4\%; 95\% CI, 14.8\% to 18.0\%, absolute change: 8.3 visits per 100 child-years).

CONCLUSIONS AND RELEVANCE: Primary care visit rates among commercially insured children decreased over the last decade. Increases in out-of-pocket costs and shifts to other venues appear to explain some of this decrease.},
	keywords = {Adolescent, Child, Child, Preschool, Female, Humans, Infant, Infant, Newborn, Insurance Coverage, Male, Office Visits, Pediatrics, Primary Health Care, United States},
	issn = {2168-6211},
	doi = {10.1001/jamapediatrics.2019.5509},
	author = {Ray, Kristin N and Shi, Zhuo and Ganguli, Ishani and Rao, Aarti and Orav, E. John and Ateev Mehrotra}
}
@article {696476,
	title = {Use of Telemedicine for Emergency Triage in an Independent Senior Living Community: Mixed Methods Study},
	journal = {J Med Internet Res},
	volume = {22},
	number = {12},
	year = {2020},
	month = {2020 Dec 17},
	pages = {e23014},
	abstract = {BACKGROUND: Older, chronically ill individuals in independent living communities are frequently transferred to the emergency department (ED) for acute issues that could be managed in lower-acuity settings. Triage via telemedicine could deter unnecessary ED transfers.

OBJECTIVE: We examined the effectiveness of a telemedicine intervention for emergency triage in an independent living community.

METHODS: In the intervention community, a 950-resident independent senior living community, when a resident called for help, emergency medical technician-trained staff could engage an emergency medicine physician via telemedicine to assist with management and triage. We compared trends in the proportion of calls resulting in transport to the ED (ie, primary outcome) in the intervention community to two control communities. Secondary outcomes were telemedicine use and posttransport disposition. Semistructured focus groups of residents and staff were conducted to examine attitudes toward the intervention. Qualitative data analysis used thematic analysis.

RESULTS: Although the service was offered at no cost to residents, use was low and we found no evidence of fewer ED transfers. The key barrier to program use was resistance from frontline staff members, who did not view telemedicine triage as a valuable tool for emergency response, instead perceiving it as time-consuming and as undermining their independent judgment.

CONCLUSIONS: Engagement of, and acceptance by, frontline providers is a key consideration in using telemedicine triage to reduce unnecessary ED transfers.},
	keywords = {Emergency Service, Hospital, Female, Humans, Independent Living, Male, Telemedicine, Triage},
	issn = {1438-8871},
	doi = {10.2196/23014},
	author = {Carolan, Kelsi and Grabowski, David C and Ateev Mehrotra and Hatfield, Laura A}
}
@article {696500,
	title = {Use of Tele-Mental Health in Conjunction With In-Person Care: A Qualitative Exploration of Implementation Models},
	journal = {Psychiatr Serv},
	volume = {71},
	number = {5},
	year = {2020},
	month = {2020 May 01},
	pages = {419-426},
	abstract = {OBJECTIVE: Although use of tele-mental health services is growing, there is limited research on how tele-mental health is deployed. This project aimed to describe how health centers use tele-mental health in conjunction with in-person care.

METHODS: The 2018 Substance Abuse and Mental Health Services Administration Behavioral Health Treatment Services Locator database was used to identify community mental health centers and federally qualified health centers with telehealth capabilities. Maximum diversity sampling was applied to recruit health center leaders to participate in semistructured interviews. Inductive and deductive approaches were used to develop site summaries, and a matrix analysis was conducted to identify and refine themes.

RESULTS: Twenty health centers in 14 states participated. All health centers used telepsychiatry for diagnostic assessment and medication prescribing, and 10 also offered therapy via telehealth. Some health centers used their own staff to provide tele-mental health services, whereas others contracted with external providers. In most health centers, tele-mental health was used as an adjunct to in-person care. In choosing between tele-mental health and in-person care, health centers often considered patient preference, patient acuity, and insurance status or payer. Although most health centers planned to continue offering tele-mental health, participants noted drawbacks, including less patient engagement, challenges sharing information within the care team, and greater inefficiency.

CONCLUSIONS: Tele-mental health is generally used as an adjunct to in-person care. The results of this study can inform policy makers and clinicians regarding the various delivery models that incorporate tele-mental health.},
	keywords = {Attitude of Health Personnel, Humans, Interviews as Topic, Mental Health Services, Models, Psychological, Qualitative Research, Substance Abuse Treatment Centers, Telemedicine, United States, United States Substance Abuse and Mental Health Services Administration},
	issn = {1557-9700},
	doi = {10.1176/appi.ps.201900386},
	author = {Uscher-Pines, Lori and Raja, Pushpa and Qureshi, Nabeel and Huskamp, Haiden A. and Alisa B. Busch and Ateev Mehrotra}
}
@article {696479,
	title = {What Drives Greater Assimilation of Telestroke in Emergency Departments?},
	journal = {J Stroke Cerebrovasc Dis},
	volume = {29},
	number = {12},
	year = {2020},
	month = {2020 Dec},
	pages = {105310},
	abstract = {OBJECTIVE: Although many emergency departments (EDs) have telestroke capacity, it is unclear why some EDs consistently use telestroke and others do not. We compared the characteristics and practices of EDs with robust and low assimilation of telestroke.

METHODS: We conducted semi-structured interviews with representatives of EDs that received telestroke services from 10 different networks and had used telestroke for a minimum of two years. We used maximum diversity sampling to select EDs for inclusion and applied a positive deviance approach, comparing programs with robust and low assimilation. Data collection was informed by the Consolidated Framework for Implementation Research. For the qualitative analysis, we created site summaries and conducted a supplemental matrix analysis to identify themes.

RESULTS: Representatives from 21 EDs with telestroke, including 11 with robust assimilation and 10 with low assimilation, participated. In EDs with robust assimilation, telestroke workflow was highly protocolized, programs had the support of leadership, telestroke use and outcomes were measured, and individual providers received feedback about their telestroke use. In EDs with low assimilation, telestroke was perceived to increase complexity, and ED physicians felt telestroke did not add value or had little value beyond a telephone consult. EDs with robust assimilation identified four sets of strategies to improve assimilation: strengthening relationships between stroke experts and ED providers, improving and standardizing processes, addressing resistant providers, and expanding the goals and role of the program.

CONCLUSION: Greater assimilation of telestroke is observed in EDs with standardized workflow, leadership support, ongoing evaluation and quality improvement efforts, and mechanisms to address resistant providers.},
	keywords = {Attitude of Health Personnel, Clinical Protocols, Delivery of Health Care, Integrated, Emergency Service, Hospital, Health Knowledge, Attitudes, Practice, Humans, Interviews as Topic, leadership, Practice Patterns, Physicians{\textquoteright}, Quality Improvement, Quality Indicators, Health Care, Referral and Consultation, Stroke, Telemedicine, Workflow},
	issn = {1532-8511},
	doi = {10.1016/j.jstrokecerebrovasdis.2020.105310},
	author = {Uscher-Pines, Lori and Sousa, Jessica and Zachrison, Kori and Guzik, Amy and Schwamm, Lee and Ateev Mehrotra}
}
@article {696477,
	title = {Where Virtual Care Was Already a Reality: Experiences of a Nationwide Telehealth Service Provider During the COVID-19 Pandemic},
	journal = {J Med Internet Res},
	volume = {22},
	number = {12},
	year = {2020},
	month = {2020 Dec 15},
	pages = {e22727},
	abstract = {BACKGROUND: The COVID-19 pandemic has led to an increase in the use of and demand for telehealth services.

OBJECTIVE: Here, we describe the utilization of telehealth services provided by Doctor On Demand, Inc., a well-known telehealth company in the United States, before and during the COVID-19 pandemic. We also explore how the number of virtual visits, reasons for visits, and patients served changed over time.

METHODS: We reported data as a percentage change from the baseline week during 2 distinct time periods: February-June 2019 and February-June 2020 based on 4 categories of visits: respiratory illness, unscheduled behavioral health, scheduled behavioral health, and chronic illness.

RESULTS: In 2020, the total visit volume increased considerably from March through April 7, 2020 (59\% above the baseline) and then declined through the week of June 2 (15\% above the baseline). Visits for respiratory illnesses increased through the week of March 24 (30\% above the baseline) and then steadily declined through the week of June 2 (65\% below the baseline). Higher relative increases were observed for unscheduled behavioral health and chronic illness visits through April (109\% and 131\% above the baseline, respectively) before a decline through the week of June 2 (69\% and 37\% above the baseline, respectively). Increases in visit volume among rural residents were slightly higher than those among urban residents (peak at 64\% vs 58\% above the baseline, respectively).

CONCLUSIONS: Although this telehealth service provider observed a substantial increase in the volume of visits during the COVID-19 pandemic, it is interesting to note that this growth was not fueled by COVID-19 concerns but by visits for behavioral health and chronic illness. Telehealth services may play a role as a "safety valve" for patients who have difficulty accessing care during a public health emergency.},
	keywords = {Covid-19, Humans, Pandemics, SARS-CoV-2, Telemedicine, United States},
	issn = {1438-8871},
	doi = {10.2196/22727},
	author = {Uscher-Pines, Lori and Thompson, James and Taylor, Prentiss and Dean, Kristin and Yuan, Tony and Tong, Ian and Ateev Mehrotra}
}
@article {635793,
	title = {Paying Patients to Switch: Impact of a Rewards Program on Choice of Providers, Prices, and Utilization},
	journal = {Health Aff (Millwood) },
	volume = {38},
	number = {3},
	year = {2019},
	pages = {440-447},
	abstract = {\&nbsp;Employers and insurers are experimenting with benefit strategies that encourage\&nbsp;patients\&nbsp;to\&nbsp;switch\&nbsp;to lower-price\&nbsp;providers. One increasingly popular strategy is to financially reward\&nbsp;patients\&nbsp;who receive care from such\&nbsp;providers. We evaluated the\&nbsp;impact\&nbsp;of a\&nbsp;rewards\&nbsp;programimplemented in 2017 by twenty-nine employers with 269,875 eligible employees and dependents. For 131 elective services,\&nbsp;patients\&nbsp;who received care from a designated lower-price provider received a check ranging from $25 to $500, depending on the provider{\textquoteright}s price and service. In the first twelve months of the\&nbsp;program\&nbsp;we found a 2.1\&nbsp;percent reduction in\&nbsp;prices\&nbsp;paid for services targeted by the\&nbsp;rewardsprogram. The reductions in price resulted in savings of $2.3\&nbsp;million, or roughly $8 per person, per year. These effects were primarily seen in magnetic resonance imaging and ultrasounds, with no observed price reduction among surgical procedures.},
	author = {Whaley C and Sood S and Chernew M and Vu L and Metcalfe L and Mehrotra A}
}
@article {635790,
	title = {Does comparing cesarean delivery rates influence women{\textquoteright}s choice of obstetric hospital?},
	journal = {AM J Manag Care },
	volume = {25},
	number = {2},
	year = {2019},
	pages = {e33-e38},
	abstract = {OBJECTIVES:Despite public reporting of wide variation in\&nbsp;hospital\&nbsp;cesarean\&nbsp;delivery\&nbsp;rates, few women access this information when deciding where to deliver. We hypothesized that making\&nbsp;cesarean\&nbsp;delivery\&nbsp;rate data more easily accessible and understandable would increase the likelihood of women selecting a\&nbsp;hospital\&nbsp;with a low\&nbsp;cesarean\&nbsp;delivery\&nbsp;rate.STUDY DESIGN:We conducted a randomized controlled trial of 18,293 users of the Ovia Health mobile apps in 2016-2017. All enrollees were given an explanation of\&nbsp;cesarean\&nbsp;delivery\&nbsp;rate data, and those randomized to the intervention group were also given an interactive tool that presented those data for the 10 closest hospitals with\&nbsp;obstetric\&nbsp;services. Our outcome measures were enrollees{\textquoteright} self-reported\&nbsp;deliveryhospital\&nbsp;and views on\&nbsp;cesarean\&nbsp;delivery\&nbsp;rates.METHODS:Intent-to-treat analysis using 2-sided Pearson{\textquoteright}s χ2 tests.RESULTS:There was no significant difference across the experimental groups in the proportion of women who selected hospitals with low\&nbsp;cesarean\&nbsp;delivery\&nbsp;rates\&nbsp;(7.0\% control vs 6.8\% intervention; P = .54). Women in the intervention group were more likely to believe that hospitals in their community had differing\&nbsp;cesarean\&nbsp;delivery\&nbsp;rates\&nbsp;(66.9\% vs 55.9\%; P \&lt;.001) and to report that they looked at\&nbsp;cesareandelivery\&nbsp;rates\&nbsp;when choosing their\&nbsp;hospital\&nbsp;(44.5\% vs 33.9\%; P \&lt;.001).CONCLUSIONS:Providing women with an interactive tool to compare\&nbsp;cesarean\&nbsp;delivery\&nbsp;rates\&nbsp;across hospitals in their community improved\&nbsp;women{\textquoteright}s\&nbsp;familiarity with variation in\&nbsp;cesarean\&nbsp;delivery\&nbsp;rates\&nbsp;but did not increase their likelihood of selecting hospitals with lower\&nbsp;rates.},
	author = {Gourevitch RA and Mehrotra A and Galvin G and Plough AC and Shah NT}
}
@article {635789,
	title = {Why Aren{\textquoteright}t More Employers Implementing Reference-Based Pricing Benefit Design?},
	journal = {American Journal of Managed Care },
	volume = {25},
	number = {2},
	year = {2019},
	pages = {85-88},
	abstract = {OBJECTIVES:There is robust evidence that implementation of\&nbsp;reference-based\&nbsp;pricing\&nbsp;(RBP)\&nbsp;benefit\&nbsp;design\&nbsp;decreases spending. This paper investigates employer adoption of RBP as a strategy to improve the value of patients{\textquoteright} healthcare choices, as well as facilitators and barriers to the adoption of RBP by\&nbsp;employers.STUDY\&nbsp;DESIGN:We conducted a qualitative study using 12 in-depth interviews with human resources executives or their representatives at large- or medium-sized self-insured\&nbsp;employers.METHODS:Interviews were conducted and recorded over the phone between March 2017 and May 2017. Interviewees were asked about their adoption of RBP and facilitators and barriers to adoption. We applied thematic\&nbsp;analysis\&nbsp;to the transcripts.RESULTS:Despite broad employer awareness of RBP{\textquoteright}s potential for\&nbsp;cost\&nbsp;savings, few\&nbsp;employers\&nbsp;are including RBP in their\&nbsp;benefit\&nbsp;design. The major barriers to RBP adoption were the complexity of RBP\&nbsp;benefit\&nbsp;design, concern that employees could face catastrophic out-of-pocket\&nbsp;costs, lack of a business case for implementation, and concern that RBP could hurt the employer{\textquoteright}s competitiveness in the labor market. The few\&nbsp;employers\&nbsp;that have adopted RBP have implemented extensive, year-round employee education campaigns and invested in multipronged and proactive decision support to help employees navigate their choices.CONCLUSIONS:Unless several fundamental barriers are addressed, uptake of RBP will likely continue to be low. Our findings suggest that simplifying\&nbsp;benefit\&nbsp;design, providing employees protection against very high out-of-pocket\&nbsp;costs, understanding which decision-support strategies are most effective, and enhancing the business case could facilitate wider employer adoption of RBP.},
	author = {Sinaiko A and Mehrotra A}
}
@article {635788,
	title = {Two-Year Evaluation of Mandatory Bundled Payments for Joint Replacement},
	journal = {N Engl J Med },
	volume = {380},
	number = {3},
	year = {2019},
	pages = {252-262},
	abstract = {BACKGROUND:In 2016, Medicare implemented Comprehensive Care for\&nbsp;Joint\&nbsp;Replacement\&nbsp;(CJR), a national\&nbsp;mandatory\&nbsp;bundled-payment model for hip or knee\&nbsp;replacement\&nbsp;in randomly selected metropolitan statistical areas. Hospitals in such areas receive bonuses or pay penalties based on Medicare spending per hip- or knee-replacement\&nbsp;episode (defined as the hospitalization plus 90 days after discharge).METHODS:We conducted difference-in-differences analyses using Medicare claims from 2015 through 2017, encompassing the first 2 years of\&nbsp;bundled\&nbsp;payments\&nbsp;in the CJR program. We evaluated hip- or knee-replacement\&nbsp;episodes in 75 metropolitan statistical areas randomly assigned to\&nbsp;mandatory\&nbsp;participation in the CJR program (bundled-payment metropolitan statistical areas, hereafter referred to as "treatment" areas) as compared with those in 121 control areas, before and after implementation of the CJR model. The primary outcomes were institutional spending per hip- or knee-replacement\&nbsp;episode (i.e., Medicare\&nbsp;payments\&nbsp;to institutions, primarily to hospitals and post-acute care facilities), rates of postsurgical complications, and the percentage of "high-risk" patients (i.e., patients for whom there was an elevated risk of spending - a measure of patient selection). Analyses were adjusted for the hospital and characteristics of the patients and procedures.RESULTS:From 2015 through 2017, there were 280,161 hip- or knee-replacement\&nbsp;procedures in 803 hospitals in treatment areas and 377,278 procedures in 962 hospitals in control areas. After the initiation of the CJR model, there were greater decreases in institutional spending per\&nbsp;joint-replacement\&nbsp;episode in treatment areas than in control areas (differential change [i.e., the between-group difference in the change from the period before the CJR model], -$812, or a -3.1\% differential decrease relative to the treatment-group baseline; P\&lt;0.001). The differential reduction was driven largely by a 5.9\% relative decrease in the percentage of episodes in which patients were discharged to post-acute care facilities. The CJR program did not have a significant differential effect on the composite rate of complications (P=0.67) or on the percentage of\&nbsp;joint-replacement\&nbsp;procedures performed in high-risk patients (P=0.81).CONCLUSIONS:In the first 2 years of the CJR program, there was a modest reduction in spending per hip- or knee-replacement\&nbsp;episode, without an increase in rates of complications. (Funded by the Commonwealth Fund and the National Institute on Aging of the National Institutes of Health.).},
	author = {Ml, Barnett and Wilcock A and McWilliams JM and Epstein AM and Joynt Maddox KE and Orav EJ and Grabowski DC and Mehrotra A}
}
@article {635787,
	title = {Use of Commercial Direct-to-Consumer Telemedicine by Children},
	journal = {Acad Pediatr},
	volume = {S1876-2859},
	number = {18},
	year = {2019},
	pages = {30517-5},
	abstract = {OBJECTIVE:In\&nbsp;commercial\&nbsp;direct-to-consumer\&nbsp;(DTC)\&nbsp;telemedicine, physicians outside of the medical home treat common, acute complaints through real-time, audio-visual conferencing using telephones and personal computers. There has been little examination of the use of DTC\&nbsp;telemedicine\&nbsp;by\&nbsp;children. We describe trends in DTC\&nbsp;telemedicine\&nbsp;use and DTC\&nbsp;telemedicine\&nbsp;visit characteristics.METHODS:Using 2011-2016 claims from a large national health plan, we identified pediatric acute visits to DTC\&nbsp;telemedicine\&nbsp;and to primary care providers (PCPs). We examined DTC\&nbsp;telemedicine\&nbsp;visit trends and compared DTC\&nbsp;telemedicine\&nbsp;and acute PCP visit diagnoses and patient characteristics.RESULTS:From 2011 through 2016, pediatric DTC\&nbsp;telemedicine\&nbsp;visits increased from 38 to 24,409 visits annually. In 2015 and 2016, the most common primary diagnoses for DTC\&nbsp;telemedicine\&nbsp;visits (n = 42,072) were infections of the nose/sinuses (24\%), mouth/throat (16\%), and ear (9\%), which were also the most common diagnoses for acute PCP visits (n = 6,917,976). Odds of DTC\&nbsp;telemedicine\&nbsp;use were higher for\&nbsp;children\&nbsp;in non-metropolitan communities (odds ratio [OR], 1.45; 95\% confidence interval [CI], 1.40-1.51) and\&nbsp;children\&nbsp;without preventive visits (OR, 1.08; 95\% CI, 1.06-1.11). Compared to\&nbsp;children\&nbsp;receiving acute PCP care,\&nbsp;children\&nbsp;with DTC\&nbsp;telemedicine\&nbsp;visits were also more likely to have had urgent care (17\% vs 10\%; P \&lt; .001) and emergency department visits (21\% vs 19\%; P \&lt; .001) during the study period.CONCLUSIONS:The use of\&nbsp;commercial\&nbsp;DTC\&nbsp;telemedicine\&nbsp;visits for\&nbsp;children\&nbsp;is growing rapidly, primarily for acute respiratory infections. Compared to\&nbsp;children\&nbsp;who did not use DTC\&nbsp;telemedicine\&nbsp;for acute care,\&nbsp;children\&nbsp;using DTC\&nbsp;telemedicine\&nbsp;were also more likely to use other venues for acute care outside of the medical home.},
	author = {Ray KN and Shi Z and Poon SJ and Uscher-Pines L and Mehrotra A}
}
@article {635795,
	title = {Common Laboratory Results Frequently Misunderstood by a Sample of Mechanical Turk Users},
	journal = {Appl Clin Inform},
	volume = {10},
	number = {2},
	year = {2019},
	pages = {175-179},
	abstract = {OBJECTIVES:  More patients are receiving their test\&nbsp;results\&nbsp;via patient portals. Given test\&nbsp;results\&nbsp;are written using medical jargon, there has been concern that patients may misinterpret these\&nbsp;results. Using\&nbsp;sample\&nbsp;colonoscopy and Pap smear\&nbsp;results, our objective was to assess how\&nbsp;frequently\&nbsp;people can identify the correct diagnosis and when a patient should follow up with a provider.METHODS:  We used\&nbsp;Mechanical\&nbsp;Turk-a crowdsourcing tool run by Amazon that enables easy and fast gathering of\&nbsp;users\&nbsp;to perform tasks like answering questions or identifying objects-to survey individuals who were shown six\&nbsp;sample\&nbsp;test\&nbsp;results\&nbsp;(three colonoscopy, three Pap smear) ranging in complexity. For each case, respondents answered multiple choice questions on the correct diagnosis and recommended return time.RESULTS:  Among the three colonoscopy cases (n = 642) and three Pap smear cases (n = 642), 63\% (95\% confidence interval [CI]: 60-67\%) and 53\% (95\% CI: 49-57\%) of the respondents chose the correct diagnosis, respectively. For the most complex colonoscopy and Pap smear cases, only 29\% (95\% CI: 23-35\%) and 9\% (95\% CI: 5-13\%) chose the correct diagnosis.CONCLUSION:  People\&nbsp;frequently\&nbsp;misinterpret colonoscopy and Pap smear test\&nbsp;results. Greater emphasis needs to be placed on assisting patients in interpretation.},
	author = {Qureshi N and Mehrotra A and Rudin RS and Fischer SH}
}
@article {635794,
	title = {The Impact of Conversion From an Urgent Care Center to a Freestanding Emergency Department on Patient Population, Conditions Managed, and Reimbursement},
	journal = {J Emerg Med},
	volume = {S0736-4679},
	number = {18},
	year = {2019},
	pages = {31202-2},
	abstract = {BACKGROUND:Freestanding\&nbsp;emergency\&nbsp;departments (FSEDs), EDs not attached to acute\&nbsp;care\&nbsp;hospitals, are expanding. One key question is whether FSEDs are more similar to higher-cost hospital-based EDs or to lower-cost\&nbsp;urgent\&nbsp;care\&nbsp;centers (UCCs).OBJECTIVE:Our aim was to determine whether there was a change in\&nbsp;patient\&nbsp;population,\&nbsp;conditions\&nbsp;managed, and\&nbsp;reimbursement\&nbsp;among three facilities that converted from a UCC to an FSED.METHODS:Using insurance claims from Blue Cross Blue Shield of Texas, we compared outcomes of interest for three facilities that converted from a UCC to an FSED for 1\&nbsp;year before and after\&nbsp;conversion.RESULTS:There was no significant change in age, sex, and comorbidities among patients treated after\&nbsp;conversion.\&nbsp;Conditions\&nbsp;were similar after\&nbsp;conversion, though there was a small increase in visits for potentially more severe\&nbsp;conditions. For example, the most common diagnoses before and after\&nbsp;conversion\&nbsp;were upper respiratory infections (42.8\% of UCC visits, 26.0\% of FSED visits), while chest pain increased from rank 30 to 10 (0.5\% of UCC visits, 2.3\% of FSED visits). Yearly number of visits decreased after\&nbsp;conversion, while median\&nbsp;reimbursement\&nbsp;per visit increased (facility A: $148 to $2,153; facility B: $137 to $1,466; and facility C: $131 to $1,925) and total revenue increased (facility A: $1,389,590 to $1,486,203; facility B: $896,591 to $4,294,636; and facility C: $637,585 to $8,429,828).CONCLUSIONS:After three UCCs converted to FSEDs,\&nbsp;patient\&nbsp;volume decreased and\&nbsp;reimbursement\&nbsp;per visit increased, despite no change in\&nbsp;patient\&nbsp;characteristics and little change in\&nbsp;conditions\&nbsp;managed. These case studies suggest that some FSEDs are similar to UCCs in\&nbsp;patient\&nbsp;mix and\&nbsp;conditions\&nbsp;treated.},
	author = {Poon SJ and Vu L and Metcalfe L and Baker O and Mehrotra A and Schuur JD}
}
@article {635786,
	title = {The Impact of Conversion From an Urgent Care Center to a Freestanding Emergency Department on Patient Population, Conditions Managed, and Reimbursement},
	journal = {J Emerg Med},
	volume = {S0736-4679},
	number = {18},
	year = {2019},
	pages = {31202-2},
	abstract = {BACKGROUND:Freestanding\&nbsp;emergency\&nbsp;departments (FSEDs), EDs not attached to acute\&nbsp;care\&nbsp;hospitals, are expanding. One key question is whether FSEDs are more similar to higher-cost hospital-based EDs or to lower-cost\&nbsp;urgent\&nbsp;care\&nbsp;centers (UCCs).OBJECTIVE:Our aim was to determine whether there was a change in\&nbsp;patient\&nbsp;population,\&nbsp;conditions\&nbsp;managed, and\&nbsp;reimbursement\&nbsp;among three facilities that converted from a UCC to an FSED.METHODS:Using insurance claims from Blue Cross Blue Shield of Texas, we compared outcomes of interest for three facilities that converted from a UCC to an FSED for 1\&nbsp;year before and after\&nbsp;conversion.RESULTS:There was no significant change in age, sex, and comorbidities among patients treated after\&nbsp;conversion.\&nbsp;Conditions\&nbsp;were similar after\&nbsp;conversion, though there was a small increase in visits for potentially more severe\&nbsp;conditions. For example, the most common diagnoses before and after\&nbsp;conversion\&nbsp;were upper respiratory infections (42.8\% of UCC visits, 26.0\% of FSED visits), while chest pain increased from rank 30 to 10 (0.5\% of UCC visits, 2.3\% of FSED visits). Yearly number of visits decreased after\&nbsp;conversion, while median\&nbsp;reimbursement\&nbsp;per visit increased (facility A: $148 to $2,153; facility B: $137 to $1,466; and facility C: $131 to $1,925) and total revenue increased (facility A: $1,389,590 to $1,486,203; facility B: $896,591 to $4,294,636; and facility C: $637,585 to $8,429,828).CONCLUSIONS:After three UCCs converted to FSEDs,\&nbsp;patient\&nbsp;volume decreased and\&nbsp;reimbursement\&nbsp;per visit increased, despite no change in\&nbsp;patient\&nbsp;characteristics and little change in\&nbsp;conditions\&nbsp;managed. These case studies suggest that some FSEDs are similar to UCCs in\&nbsp;patient\&nbsp;mix and\&nbsp;conditions\&nbsp;treated.},
	author = {Poon SJ and Vu L and Baker O and Mehrotra A and Schuur JD}
}
@article {696523,
	title = {Antibiotic Prescribing During Pediatric Direct-to-Consumer Telemedicine Visits},
	journal = {Pediatrics},
	volume = {143},
	number = {5},
	year = {2019},
	month = {2019 May},
	abstract = {BACKGROUND AND OBJECTIVES: Use of commercial direct-to-consumer (DTC) telemedicine outside of the pediatric medical home is increasing among children, and acute respiratory infections (ARIs) are the most commonly diagnosed condition at DTC telemedicine visits. Our objective was to compare the quality of antibiotic prescribing for ARIs among children across 3 settings: DTC telemedicine, urgent care, and the primary care provider (PCP) office.

METHODS: In a retrospective cohort study using 2015-2016 claims data from a large national commercial health plan, we identified ARI visits by children (0-17 years old), excluding visits with comorbidities that could affect antibiotic decisions. Visits were matched on age, sex, chronic medical complexity, state, rurality, health plan type, and ARI diagnosis category. Within the matched sample, we compared the percentage of ARI visits with any antibiotic prescribing and the percentage of ARI visits with guideline-concordant antibiotic management.

RESULTS: There were 4604 DTC telemedicine, 38 408 urgent care, and 485 201 PCP visits for ARIs in the matched sample. Antibiotic prescribing was higher for DTC telemedicine visits than for other settings (52\% of DTC telemedicine visits versus 42\% urgent care and 31\% PCP visits; P \&lt; .001 for both comparisons). Guideline-concordant antibiotic management was lower at DTC telemedicine visits than at other settings (59\% of DTC telemedicine visits versus 67\% urgent care and 78\% PCP visits; P \&lt; .001 for both comparisons).

CONCLUSIONS: At DTC telemedicine visits, children with ARIs were more likely to receive antibiotics and less likely to receive guideline-concordant antibiotic management compared to children at PCP visits and urgent care visits.},
	keywords = {Adolescent, Ambulatory Care, Ambulatory Care Facilities, Anti-Bacterial Agents, Child, Child, Preschool, Cohort Studies, Direct-to-Consumer Advertising, Drug Prescriptions, Female, Humans, Infant, Infant, Newborn, Male, Pediatrics, Retrospective Studies, Telemedicine},
	issn = {1098-4275},
	doi = {10.1542/peds.2018-2491},
	author = {Ray, Kristin N and Shi, Zhuo and Gidengil, Courtney A and Poon, Sabrina J and Uscher-Pines, Lori and Ateev Mehrotra}
}
@article {696526,
	title = {Antibiotic Prescribing During Pediatric Direct-to-Consumer Telemedicine Visits},
	journal = {Pediatrics},
	volume = {143},
	number = {5},
	year = {2019},
	month = {2019 May},
	abstract = {BACKGROUND AND OBJECTIVES: Use of commercial direct-to-consumer (DTC) telemedicine outside of the pediatric medical home is increasing among children, and acute respiratory infections (ARIs) are the most commonly diagnosed condition at DTC telemedicine visits. Our objective was to compare the quality of antibiotic prescribing for ARIs among children across 3 settings: DTC telemedicine, urgent care, and the primary care provider (PCP) office.

METHODS: In a retrospective cohort study using 2015-2016 claims data from a large national commercial health plan, we identified ARI visits by children (0-17 years old), excluding visits with comorbidities that could affect antibiotic decisions. Visits were matched on age, sex, chronic medical complexity, state, rurality, health plan type, and ARI diagnosis category. Within the matched sample, we compared the percentage of ARI visits with any antibiotic prescribing and the percentage of ARI visits with guideline-concordant antibiotic management.

RESULTS: There were 4604 DTC telemedicine, 38 408 urgent care, and 485 201 PCP visits for ARIs in the matched sample. Antibiotic prescribing was higher for DTC telemedicine visits than for other settings (52\% of DTC telemedicine visits versus 42\% urgent care and 31\% PCP visits; P \&lt; .001 for both comparisons). Guideline-concordant antibiotic management was lower at DTC telemedicine visits than at other settings (59\% of DTC telemedicine visits versus 67\% urgent care and 78\% PCP visits; P \&lt; .001 for both comparisons).

CONCLUSIONS: At DTC telemedicine visits, children with ARIs were more likely to receive antibiotics and less likely to receive guideline-concordant antibiotic management compared to children at PCP visits and urgent care visits.},
	keywords = {Adolescent, Ambulatory Care, Ambulatory Care Facilities, Anti-Bacterial Agents, Child, Child, Preschool, Cohort Studies, Direct-to-Consumer Advertising, Drug Prescriptions, Female, Humans, Infant, Infant, Newborn, Male, Pediatrics, Retrospective Studies, Telemedicine},
	issn = {1098-4275},
	doi = {10.1542/peds.2018-2491},
	author = {Ray, Kristin N and Shi, Zhuo and Gidengil, Courtney A and Poon, Sabrina J and Uscher-Pines, Lori and Ateev Mehrotra}
}
@article {696509,
	title = {Association Between Broadband Internet Availability and Telemedicine Use},
	journal = {JAMA Intern Med},
	volume = {179},
	number = {11},
	year = {2019},
	month = {2019 Nov 01},
	pages = {1580-1582},
	abstract = {This population-based study examines the availability of broadband in local communities for telemedicine.},
	issn = {2168-6114},
	doi = {10.1001/jamainternmed.2019.2234},
	author = {Wilcock, Andrew D and Rose, Sherri and Alisa B. Busch and Huskamp, Haiden A. and Uscher-Pines, Lori and Bruce Landon and Ateev Mehrotra}
}
@article {696520,
	title = {Association Between Endoscopist Personality and Rate of Adenoma Detection},
	journal = {Clin Gastroenterol Hepatol},
	volume = {17},
	number = {8},
	year = {2019},
	month = {2019 Jul},
	pages = {1571-1579.e7},
	abstract = {BACKGROUND \& AIMS: There is significant variation among endoscopists in their adenoma detection rates (ADRs). We explored associations between ADR and characteristics of endoscopists, including personality traits and financial incentives.

METHODS: We collected electronic health record data from October 2013 through September 2015 and calculated ADRs for physicians from 4 health systems. ADRs were risk-adjusted for differences in patient populations. Physicians were surveyed to assess financial motivations, knowledge and perceptions about colonoscopy quality, and personality traits. Of 140 physicians sent the survey, 117 responded.

RESULTS: The median risk-adjusted ADR for all surveyed physicians was 29.3\% (interquartile range, 24.1\%-35.5\%). We found no significant association between ADR and financial incentives, malpractice concerns, or physicians{\textquoteright} perceptions of ADR as a quality metric. ADR was associated with the degree of self-reported compulsiveness relative to peers: among endoscopists who described themselves as much more compulsive, the ADR was 33.1\%; among those who described themselves as somewhat more compulsive, the ADR was 32.9\%; among those who described themselves as about the same as others, the ADR was 26.4\%; and among those who described themselves as somewhat less compulsive, the ADR was 27.3\%) (P~= .0019). ADR was also associated with perceived thoroughness (much more thorough than peers, ADR~= 31.5\%; somewhat more, 31.9\%; same/somewhat less, 27.1\%; P~= .0173). Physicians who reported feeling rushed, having difficulty pacing themselves, or having difficulty in accomplishing goals had higher ADRs. A secondary analysis found the same associations between personality and adenomas per colonoscopy.

CONCLUSIONS: We found no significant association between ADR and financial incentives, malpractice concerns, or perceptions of ADR as a quality metric. However, ADRs were higher among physicians who described themselves as more compulsive or thorough, and among those who reported feeling rushed or having difficulty accomplishing goals.},
	keywords = {Adenoma, Colonic Neoplasms, Colonoscopy, Early Detection of Cancer, Female, Follow-Up Studies, Humans, Incidence, Male, Personality, Physicians, Quality Indicators, Health Care, Retrospective Studies, United States},
	issn = {1542-7714},
	doi = {10.1016/j.cgh.2018.10.019},
	author = {Ezaz, Ghideon and Leffler, Daniel A and Beach, Scott and Schoen, Robert E and Crockett, Seth D and Gourevitch, Rebecca A and Rose, Sherri and Morris, Michele and Carrell, David S and Greer, Julia B and Ateev Mehrotra}
}
@article {696524,
	title = {Association of Characteristics of Psychiatrists With Use of Telemental Health Visits in the Medicare Population},
	journal = {JAMA Psychiatry},
	volume = {76},
	number = {6},
	year = {2019},
	month = {2019 Jun 01},
	pages = {654-657},
	abstract = {This observational study of Medicare fee-for-service claims data evaluates demographic characteristics of psychiatrists who deliver telemental health visits in the Medicare population.},
	keywords = {Humans, Medicare, Psychiatry, Telemedicine, United States},
	issn = {2168-6238},
	doi = {10.1001/jamapsychiatry.2019.0052},
	author = {Choi, Suyoung and Wilcock, Andrew D and Alisa B. Busch and Huskamp, Haiden A. and Uscher-Pines, Lori and Shi, Zhuo and Ateev Mehrotra}
}
@article {696522,
	title = {Association of Characteristics of Psychiatrists With Use of Telemental Health Visits in the Medicare Population},
	journal = {JAMA Psychiatry},
	volume = {76},
	number = {6},
	year = {2019},
	month = {2019 Jun 01},
	pages = {654-657},
	abstract = {This observational study of Medicare fee-for-service claims data evaluates demographic characteristics of psychiatrists who deliver telemental health visits in the Medicare population.},
	keywords = {Humans, Medicare, Psychiatry, Telemedicine, United States},
	issn = {2168-6238},
	doi = {10.1001/jamapsychiatry.2019.0052},
	author = {Choi, Suyoung and Wilcock, Andrew D and Alisa B. Busch and Huskamp, Haiden A. and Uscher-Pines, Lori and Shi, Zhuo and Ateev Mehrotra}
}
@article {696511,
	title = {Association Of Medicare{\textquoteright}s Annual Wellness Visit With Cancer Screening, Referrals, Utilization, And Spending},
	journal = {Health Aff (Millwood)},
	volume = {38},
	number = {11},
	year = {2019},
	month = {2019 Nov},
	pages = {1927-1935},
	abstract = {Medicare{\textquoteright}s annual wellness visit was introduced in 2011 to promote evidence-based preventive care and identify risk factors and undiagnosed conditions in aging adults. Use of the visit has risen steadily since then, yet its benefits remain unclear. Using national Medicare data for 2008-15, we examined claims from fee-for-service Medicare beneficiaries attributed to practices that did or did not adopt the visit. We performed difference-in-differences analysis to compare differential changes in appropriate and low-value cancer screening, functional and neuropsychiatric care, emergency department visits, hospitalizations, and total spending. Examining 17.8~million beneficiary-years, we found modest differential improvements in rates of evidence-based screening and declines in emergency department visits. However, when we accounted for trends that predated the introduction of the visit, none of these benefits persisted. In sum, we found no substantive association between annual wellness visits and improvements in care.},
	keywords = {Aged, Early Detection of Cancer, Emergency Service, Hospital, Fee-for-Service Plans, Female, Health Expenditures, Humans, Insurance Claim Review, Medicare Part A, Medicare Part B, Middle Aged, Office Visits, Patient Acceptance of Health Care, Referral and Consultation, United States},
	issn = {1544-5208},
	doi = {10.1377/hlthaff.2019.00304},
	author = {Ganguli, Ishani and Souza, Jeffrey and J. Michael McWilliams and Ateev Mehrotra}
}
@article {696518,
	title = {Authors{\textquoteright} Response},
	journal = {Pediatrics},
	volume = {144},
	number = {2},
	year = {2019},
	month = {2019 Aug},
	keywords = {Algorithms, Anti-Bacterial Agents, Child, Humans, Telemedicine},
	issn = {1098-4275},
	doi = {10.1542/peds.2019-1786C},
	author = {Ray, Kristin N and Uscher-Pines, Lori and Ateev Mehrotra}
}
@article {696529,
	title = {Common Laboratory Results Frequently Misunderstood by a Sample of Mechanical Turk Users},
	journal = {Appl Clin Inform},
	volume = {10},
	number = {2},
	year = {2019},
	month = {2019 Mar},
	pages = {175-179},
	abstract = {OBJECTIVES: More patients are receiving their test results via patient portals. Given test results are written using medical jargon, there has been concern that patients may misinterpret these results. Using sample colonoscopy and Pap smear results, our objective was to assess how frequently people can identify the correct diagnosis and when a patient should follow up with a provider.

METHODS: We used Mechanical Turk-a crowdsourcing tool run by Amazon that enables easy and fast gathering of users to perform tasks like answering questions or identifying objects-to survey individuals who were shown six sample test results (three colonoscopy, three Pap smear) ranging in complexity. For each case, respondents answered multiple choice questions on the correct diagnosis and recommended return time.

RESULTS: Among the three colonoscopy cases (n = 642) and three Pap smear cases (n = 642), 63\% (95\% confidence interval [CI]: 60-67\%) and 53\% (95\% CI: 49-57\%) of the respondents chose the correct diagnosis, respectively. For the most complex colonoscopy and Pap smear cases, only 29\% (95\% CI: 23-35\%) and 9\% (95\% CI: 5-13\%) chose the correct diagnosis.

CONCLUSION: People frequently misinterpret colonoscopy and Pap smear test results. Greater emphasis needs to be placed on assisting patients in interpretation.},
	keywords = {Adolescent, Adult, Clinical Laboratory Techniques, Colonoscopy, Crowdsourcing, Diagnostic Tests, Routine, Female, Humans, Male, Papanicolaou Test, Young Adult},
	issn = {1869-0327},
	doi = {10.1055/s-0039-1679960},
	author = {Qureshi, Nabeel and Ateev Mehrotra and Rudin, Robert S and Fischer, Shira H}
}
@article {696512,
	title = {Did Hospital Readmissions Fall Because Per Capita Admission Rates Fell?},
	journal = {Health Aff (Millwood)},
	volume = {38},
	number = {11},
	year = {2019},
	month = {2019 Nov},
	pages = {1840-1844},
	abstract = {Recent reductions in hospital readmission rates have been attributed to the Hospital Readmissions Reduction Program. However, admission rates also declined during the same period. We found that because the probability of an admission occurring soon after another is lower when there are fewer admissions per patient, the reduction in admission rates may explain much of the reduction in readmission rates.},
	keywords = {Databases, Factual, Fee-for-Service Plans, Hospitals, Humans, Patient Readmission, United States},
	issn = {1544-5208},
	doi = {10.1377/hlthaff.2019.00411},
	author = {J. Michael McWilliams and Michael L. Barnett and Roberts, Eric T and Hamed, Pasha and Ateev Mehrotra}
}
@article {696533,
	title = {Does comparing cesarean delivery rates influence women{\textquoteright}s choice of obstetric hospital?},
	journal = {Am J Manag Care},
	volume = {25},
	number = {2},
	year = {2019},
	month = {2019 Feb 01},
	pages = {e33-e38},
	abstract = {OBJECTIVES: Despite public reporting of wide variation in hospital cesarean delivery rates, few women access this information when deciding where to deliver. We hypothesized that making cesarean delivery rate data more easily accessible and understandable would increase the likelihood of women selecting a hospital with a low cesarean delivery rate.

STUDY DESIGN: We conducted a randomized controlled trial of 18,293 users of the Ovia Health mobile apps in 2016-2017. All enrollees were given an explanation of cesarean delivery rate data, and those randomized to the intervention group were also given an interactive tool that presented those data for the 10 closest hospitals with obstetric services. Our outcome measures were enrollees{\textquoteright} self-reported delivery hospital and views on cesarean delivery rates.

METHODS: Intent-to-treat analysis using 2-sided Pearson{\textquoteright}s χ2 tests.

RESULTS: There was no significant difference across the experimental groups in the proportion of women who selected hospitals with low cesarean delivery rates (7.0\% control vs 6.8\% intervention; P = .54). Women in the intervention group were more likely to believe that hospitals in their community had differing cesarean delivery rates (66.9\% vs 55.9\%; P \&lt;.001) and to report that they looked at cesarean delivery rates when choosing their hospital (44.5\% vs 33.9\%; P \&lt;.001).

CONCLUSIONS: Providing women with an interactive tool to compare cesarean delivery rates across hospitals in their community improved women{\textquoteright}s familiarity with variation in cesarean delivery rates but did not increase their likelihood of selecting hospitals with lower rates.},
	keywords = {Adult, Cesarean Section, Choice Behavior, Female, Hospitals, Special, Humans, Obstetrics, Patient Preference, Pregnancy, United States},
	issn = {1936-2692},
	doi = {10.1371/journal.pone.0057817},
	author = {Gourevitch, Rebecca A and Ateev Mehrotra and Galvin, Grace and Plough, Avery C and Shah, Neel T}
}
@article {696515,
	title = {Does Scheduling a Postdischarge Visit with a Primary Care Physician Increase Rates of Follow-up and Decrease Readmissions?},
	journal = {J Hosp Med},
	volume = {14},
	year = {2019},
	month = {2019 Sep 18},
	pages = {E37-E42},
	abstract = {BACKGROUND: Driven in part by Medicare{\textquoteright}s Hospital Readmissions Reduction Program, hospitals are focusing on improving the transition from inpatient to outpatient care with particular emphasis on early follow-up with a primary care physician (PCP).

OBJECTIVE: To assess whether the implementation of a scheduling assistance program changes rates of PCP follow-up or readmissions.

DESIGN: Retrospective cohort study.

SETTING: An urban tertiary care center PATIENTS: A total of 20,918 adult patients hospitalized and discharged home between September 2008 and October 2015.

INTERVENTION: A postdischarge appointment service to facilitate early PCP follow-up.

MAIN MEASURES: Primary outcomes were rates of follow-up visits with a PCP within seven days of discharge and hospital readmission within 30 days of discharge. Our first analysis assessed differences in outcomes among patients with and without the use of the service. In a second analysis, we exploited the fact that the service was not available on weekends and conducted an instrumental variable analysis that used the interaction between the intervention and day of the week of admission.

RESULTS: In our multivariable analysis, use of the appointment service was associated with much higher rates of PCP follow-up (+31.9 percentage points, 95\% CI: 30.2, 33.6; P \&lt; .01) and a decrease in readmission (-3.8 percentage points, 95\% CI: -5.2, -2.4; P \&lt; .01). In the instrumental variable analysis, use of the service also increased the likelihood of a PCP follow-up visit (33.4 percentage points, 95\% CI: 7.9, 58.9; P = .01) but had no significant impact on readmissions (-2.5 percentage points, 95\% CI: -22.0, 17.0; P = .80).

CONCLUSIONS: The postdischarge appointment service resulted in a substantial increase in timely PCP followup, but its impact on the readmission rate was less clear.},
	issn = {1553-5606},
	doi = {10.12788/jhm.3309},
	author = {Marcondes, Felippe O and Punjabi, Paawan and Doctoroff, Lauren and Tess, Anjala and O{\textquoteright}Neill, Sarah and Timothy Layton and Quist, Kramer and Ateev Mehrotra}
}
@article {696513,
	title = {Evidence and Implications Behind a National Decline in Primary Care Visits},
	journal = {J Gen Intern Med},
	volume = {34},
	number = {10},
	year = {2019},
	month = {2019 Oct},
	pages = {2260-2263},
	abstract = {Primary care is the foundation of the health care system and the basis for new payment and delivery reforms in the USA. Yet since 2008, primary care visit rates dropped by 6-25\% across a range of populations in five sources of national survey and administrative data. We hypothesize three likely mechanisms behind the decline: decreases in patients{\textquoteright} ability, need, or desire to seek primary care; changes in primary care practice such as greater use of teams and non-face-to-face care; and replacement of in-person primary care visits with alternatives such as specialist, retail clinic, and commercial telemedicine visits. These mechanisms require further investigation. In the meantime, the trend prompts us to optimize the primary care visit and embrace the growth of alternatives while preserving the fundamental benefits of primary care.},
	keywords = {Humans, Office Visits, Primary Health Care, United States},
	issn = {1525-1497},
	doi = {10.1007/s11606-019-05104-5},
	author = {Ganguli, Ishani and Lee, Thomas H and Ateev Mehrotra}
}
@article {696530,
	title = {The Impact of Conversion From an Urgent Care Center to a Freestanding Emergency Department on Patient Population, Conditions Managed, and Reimbursement},
	journal = {J Emerg Med},
	volume = {56},
	number = {3},
	year = {2019},
	month = {2019 Mar},
	pages = {352-358},
	abstract = {BACKGROUND: Freestanding emergency departments (FSEDs), EDs not attached to acute care hospitals, are expanding. One key question is whether FSEDs are more similar to higher-cost hospital-based EDs or to lower-cost urgent care centers (UCCs).

OBJECTIVE: Our aim was to determine whether there was a change in patient population, conditions managed, and reimbursement among three facilities that converted from a UCC to an FSED.

METHODS: Using insurance claims from Blue Cross Blue Shield of Texas, we compared outcomes of interest for three facilities that converted from a UCC to an FSED for 1~year before and after conversion.

RESULTS: There was no significant change in age, sex, and comorbidities among patients treated after conversion. Conditions were similar after conversion, though there was a small increase in visits for potentially more severe conditions. For example, the most common diagnoses before and after conversion were upper respiratory infections (42.8\% of UCC visits, 26.0\% of FSED visits), while chest pain increased from rank 30 to 10 (0.5\% of UCC visits, 2.3\% of FSED visits). Yearly number of visits decreased after conversion, while median reimbursement per visit increased (facility A: $148 to $2,153; facility B: $137 to $1,466; and facility C: $131 to $1,925) and total revenue increased (facility A: $1,389,590 to $1,486,203; facility B: $896,591 to $4,294,636; and facility C: $637,585 to $8,429,828).

CONCLUSIONS: After three UCCs converted to FSEDs, patient volume decreased and reimbursement per visit increased, despite no change in patient characteristics and little change in conditions managed. These case studies suggest that some FSEDs are similar to UCCs in patient mix and conditions treated.},
	keywords = {Ambulatory Care, Emergency Service, Hospital, Humans, Insurance, Health, Reimbursement, Organizational Innovation, Population Surveillance, Texas},
	issn = {0736-4679},
	doi = {10.1016/j.jemermed.2018.12.011},
	author = {Poon, Sabrina J and Vu, Lan and Metcalfe, Leanne and Baker, Olesya and Ateev Mehrotra and Schuur, Jeremiah D}
}
@article {696510,
	title = {National Trends in Primary Care Visit Use and Practice Capabilities, 2008-2015},
	journal = {Ann Fam Med},
	volume = {17},
	number = {6},
	year = {2019},
	month = {2019 Nov},
	pages = {538-544},
	abstract = {PURPOSE: Recent evidence shows a national decline in primary care visit rates over the last decade. It is unclear how changes in practice-including the use and content of primary care visits-may have contributed.

METHODS: We analyzed nationally representative data of adult visits to primary care physicians (PCPs) and physician practice characteristics from 2007-2016 (National Ambulatory Medical Care Survey). United States census estimates were used to calculate visits per capita. Measures included visit rates per person year; visit duration; number of medications, diagnoses, and preventive services per visit; percentage of visits with scheduled follow-up; and percentage of physicians with practice capabilities including an electronic medical record (EMR).

RESULTS: Our weighted sample represented 3.2 billion visits (83,368 visits, unweighted). Visits per capita declined by 20\% (-0.25 visits per person, 95\% CI, -0.32 to -0.19) during this time, while visit duration increased by 2.4 minutes per visit (95\% CI, 1.1-3.8). Per visit, PCPs addressed 0.30 more diagnoses (95\% CI, 0.16-0.43) and 0.82 more medications (95\% CI, 0.59-1.1), and provided 0.24 more preventive services (95\% CI, 0.12-0.36). Visits with scheduled PCP followup declined by 6.0\% (95\% CI, -12.4 to 0.46), while PCPs reporting use of EMR increased by 44.3\% (95\% CI, 39.1-49.5) and those reporting use of secure messaging increased by 60.9\% (95\% CI, 27.5-94.3).

CONCLUSION: From 2008 to 2015, primary care visits were longer, addressed more issues per visit, and were less likely to have scheduled follow-up for certain patients and conditions. Meanwhile, more PCPs offered non-face-to-face care. The decline in primary care visit rates may be explained in part by PCPs offering more comprehensive in-person visits and using more non-face-to-face care.},
	keywords = {Adolescent, Adult, Aged, Aged, 80 and over, Ambulatory Care, Female, Health Care Surveys, Humans, Male, Middle Aged, Office Visits, Practice Patterns, Physicians{\textquoteright}, Primary Health Care, United States, Young Adult},
	issn = {1544-1717},
	doi = {10.1370/afm.2474},
	author = {Rao, Aarti and Shi, Zhuo and Ray, Kristin N and Ateev Mehrotra and Ganguli, Ishani}
}
@article {696531,
	title = {Paying Patients To Switch: Impact Of A Rewards Program On Choice Of Providers, Prices, And Utilization},
	journal = {Health Aff (Millwood)},
	volume = {38},
	number = {3},
	year = {2019},
	month = {2019 Mar},
	pages = {440-447},
	abstract = {Employers and insurers are experimenting with benefit strategies that encourage patients to switch to lower-price providers. One increasingly popular strategy is to financially reward patients who receive care from such providers. We evaluated the impact of a rewards program implemented in 2017 by twenty-nine employers with 269,875 eligible employees and dependents. For 131 elective services, patients who received care from a designated lower-price provider received a check ranging from $25 to $500, depending on the provider{\textquoteright}s price and service. In the first twelve months of the program we found a 2.1~percent reduction in prices paid for services targeted by the rewards program. The reductions in price resulted in savings of $2.3~million, or roughly $8 per person, per year. These effects were primarily seen in magnetic resonance imaging and ultrasounds, with no observed price reduction among surgical procedures.},
	keywords = {Adult, Consumer Behavior, Cost Savings, Female, Health Benefit Plans, Employee, Health Care Costs, Humans, Male, Motivation},
	issn = {1544-5208},
	doi = {10.1377/hlthaff.2018.05068},
	author = {Whaley, Christopher M and Vu, Lan and Sood, Neeraj and Michael E. Chernew and Metcalfe, Leanne and Ateev Mehrotra}
}
@article {696519,
	title = {Postacute Care - The Piggy Bank for Savings in Alternative Payment Models?},
	journal = {N Engl J Med},
	volume = {381},
	number = {4},
	year = {2019},
	month = {2019 Jul 25},
	pages = {302-303},
	keywords = {Accountable Care Organizations, Cost Control, Cost Savings, Economics, Hospital, Health Expenditures, Medicaid, Medicare, Medicare Part C, Patient Discharge, Reimbursement mechanisms, Subacute Care, United States},
	issn = {1533-4406},
	doi = {10.1056/NEJMp1901896},
	author = {Michael L. Barnett and Ateev Mehrotra and Grabowski, David C}
}
@article {696516,
	title = {Prescriptions on Demand: The Growth of Direct-to-Consumer Telemedicine Companies},
	journal = {JAMA},
	volume = {322},
	number = {10},
	year = {2019},
	month = {2019 Sep 10},
	pages = {925-926},
	issn = {1538-3598},
	doi = {10.1001/jama.2019.9889},
	author = {Jain, Tara and Lu, Richard J and Ateev Mehrotra}
}
@article {696508,
	title = {Response to: "Comment on Patterns of Postoperative Visits Among Medicare Fee-for-Service Beneficiaries{\textquoteright}},
	journal = {Ann Surg},
	volume = {270},
	number = {6},
	year = {2019},
	month = {2019 Dec},
	pages = {e145},
	keywords = {Fee-for-Service Plans, Health Expenditures, Medicare, United States},
	issn = {1528-1140},
	doi = {10.1097/SLA.0000000000003565},
	author = {Kranz, Ashley M and Mulcahy, Andrew and Ateev Mehrotra}
}
@article {696507,
	title = {Response to Comment on "Patterns of Postoperative Visits Among Medicare Fee-for-service Beneficiaries"},
	journal = {Ann Surg},
	volume = {270},
	number = {6},
	year = {2019},
	month = {2019 Dec},
	pages = {e113},
	keywords = {Fee-for-Service Plans, Health Expenditures, Medicare, United States},
	issn = {1528-1140},
	doi = {10.1097/SLA.0000000000003339},
	author = {Kranz, Ashley M and Mulcahy, Andrew and Ateev Mehrotra}
}
@article {696514,
	title = {A Study of Telecontraception},
	journal = {N Engl J Med},
	volume = {381},
	number = {13},
	year = {2019},
	month = {2019 Sep 26},
	pages = {1287-1288},
	keywords = {Commerce, Contraceptives, Oral, Contraindications, Drug, Electronic Prescribing, Female, Guideline Adherence, Health Services Accessibility, Humans, Practice Guidelines as Topic, Telemedicine, United States},
	issn = {1533-4406},
	doi = {10.1056/NEJMc1907545},
	author = {Jain, Tara and Schwarz, Eleanor B and Ateev Mehrotra}
}
@article {696534,
	title = {Two-Year Evaluation of Mandatory Bundled Payments for Joint Replacement},
	journal = {N Engl J Med},
	volume = {380},
	number = {3},
	year = {2019},
	month = {2019 Jan 17},
	pages = {252-262},
	abstract = {BACKGROUND: In 2016, Medicare implemented Comprehensive Care for Joint Replacement (CJR), a national mandatory bundled-payment model for hip or knee replacement in randomly selected metropolitan statistical areas. Hospitals in such areas receive bonuses or pay penalties based on Medicare spending per hip- or knee-replacement episode (defined as the hospitalization plus 90 days after discharge).

METHODS: We conducted difference-in-differences analyses using Medicare claims from 2015 through 2017, encompassing the first 2 years of bundled payments in the CJR program. We evaluated hip- or knee-replacement episodes in 75 metropolitan statistical areas randomly assigned to mandatory participation in the CJR program (bundled-payment metropolitan statistical areas, hereafter referred to as "treatment" areas) as compared with those in 121 control areas, before and after implementation of the CJR model. The primary outcomes were institutional spending per hip- or knee-replacement episode (i.e., Medicare payments to institutions, primarily to hospitals and post-acute care facilities), rates of postsurgical complications, and the percentage of "high-risk" patients (i.e., patients for whom there was an elevated risk of spending - a measure of patient selection). Analyses were adjusted for the hospital and characteristics of the patients and procedures.

RESULTS: From 2015 through 2017, there were 280,161 hip- or knee-replacement procedures in 803 hospitals in treatment areas and 377,278 procedures in 962 hospitals in control areas. After the initiation of the CJR model, there were greater decreases in institutional spending per joint-replacement episode in treatment areas than in control areas (differential change [i.e., the between-group difference in the change from the period before the CJR model], -$812, or a -3.1\% differential decrease relative to the treatment-group baseline; P\&lt;0.001). The differential reduction was driven largely by a 5.9\% relative decrease in the percentage of episodes in which patients were discharged to post-acute care facilities. The CJR program did not have a significant differential effect on the composite rate of complications (P=0.67) or on the percentage of joint-replacement procedures performed in high-risk patients (P=0.81).

CONCLUSIONS: In the first 2 years of the CJR program, there was a modest reduction in spending per hip- or knee-replacement episode, without an increase in rates of complications. (Funded by the Commonwealth Fund and the National Institute on Aging of the National Institutes of Health.).},
	keywords = {Arthroplasty, Replacement, Hip, Arthroplasty, Replacement, Knee, Episode of Care, Health Expenditures, Humans, Medicare, Reimbursement mechanisms, United States},
	issn = {1533-4406},
	doi = {10.1056/NEJMsa1809010},
	author = {Michael L. Barnett and Wilcock, Andrew and J. Michael McWilliams and Arnold M. Epstein and Joynt Maddox, Karen E and Orav, E. John and Grabowski, David C and Ateev Mehrotra}
}
@article {696517,
	title = {Use of Commercial Direct-to-Consumer Telemedicine by Children},
	journal = {Acad Pediatr},
	volume = {19},
	number = {6},
	year = {2019},
	month = {2019 Aug},
	pages = {665-669},
	abstract = {OBJECTIVE: In commercial direct-to-consumer (DTC) telemedicine, physicians outside of the medical home treat common, acute complaints through real-time, audio-visual conferencing using telephones and personal computers. There has been little examination of the use of DTC telemedicine by children. We describe trends in DTC telemedicine use and DTC telemedicine visit characteristics.

METHODS: Using 2011-2016 claims from a large national health plan, we identified pediatric acute visits to DTC telemedicine and to primary care providers (PCPs). We examined DTC telemedicine visit trends and compared DTC telemedicine and acute PCP visit diagnoses and patient characteristics.

RESULTS: From 2011 through 2016, pediatric DTC telemedicine visits increased from 38 to 24,409 visits annually. In 2015 and 2016, the most common primary diagnoses for DTC telemedicine visits (n = 42,072) were infections of the nose/sinuses (24\%), mouth/throat (16\%), and ear (9\%), which were also the most common diagnoses for acute PCP visits (n = 6,917,976). Odds of DTC telemedicine use were higher for children in non-metropolitan communities (odds ratio [OR], 1.45; 95\% confidence interval [CI], 1.40-1.51) and children without preventive visits (OR, 1.08; 95\% CI, 1.06-1.11). Compared to children receiving acute PCP care, children with DTC telemedicine visits were also more likely to have had urgent care (17\% vs 10\%; P \&lt; .001) and emergency department visits (21\% vs 19\%; P \&lt; .001) during the study period.

CONCLUSIONS: The use of commercial DTC telemedicine visits for children is growing rapidly, primarily for acute respiratory infections. Compared to children who did not use DTC telemedicine for acute care, children using DTC telemedicine were also more likely to use other venues for acute care outside of the medical home.},
	keywords = {Adolescent, Ambulatory Care, Child, Child, Preschool, Female, Humans, Infant, Male, Patient Acceptance of Health Care, Pediatrics, Respiratory Tract Infections, Telemedicine, United States},
	issn = {1876-2867},
	doi = {10.1016/j.acap.2018.11.016},
	author = {Ray, Kristin N and Shi, Zhuo and Poon, Sabrina J and Uscher-Pines, Lori and Ateev Mehrotra}
}
@article {696521,
	title = {What are the potential savings from steering patients to lower-priced providers? a static analysis},
	journal = {Am J Manag Care},
	volume = {25},
	number = {7},
	year = {2019},
	month = {2019 Jul 01},
	pages = {e204-e210},
	abstract = {OBJECTIVES: Healthcare payers are increasingly using price transparency and benefit design to encourage patients to choose lower-priced providers. We quantify potential savings from shifting patients to lower-priced providers. If there is limited price variation or if higher-priced providers command little market share, savings could be minimal.

STUDY DESIGN: Using 2013-2014 commercial claims for 697,381 enrollees in California, we characterized within-market price variation and the relationship between providers{\textquoteright} market shares and relative prices for 3 nonemergent, shoppable outpatient services: laboratory tests, imaging services, and durable medical equipment (DME). In a stylized policy simulation that holds provider price and utilization constant, we computed potential savings if patients who visited providers with prices above the median price shifted to the median-priced provider in their geographic market for the same service.

METHODS: Observational analyses.

RESULTS: Of the service categories examined, laboratory tests had greatest within-market price variation (median coefficient of variation of 100\% vs 87\% for imaging services and 43\% for DME). Roughly half of services (53\%, 47\%, and 54\% for laboratory tests, imaging services, and DME, respectively) were billed by providers with prices above their market median. Shifting these patients to the median-priced provider in their markets could save 42\%, 45\%, and 15\% of spending on laboratory tests, imaging services, and DME, respectively, together representing savings of 11\% of total outpatient spending and 7\% of the sum of inpatient and outpatient spending.

CONCLUSIONS: Steering patients from higher- to lower-priced providers within geographic markets in targeted service categories could generate substantial healthcare savings.},
	keywords = {Adult, Aged, Aged, 80 and over, California, Commerce, Cost Savings, Delivery of Health Care, Female, Humans, Male, Middle Aged, Referral and Consultation},
	issn = {1936-2692},
	author = {Desai, Sunita M and Hatfield, Laura A and Hicks, Andrew L and Michael E. Chernew and Ateev Mehrotra and Anna D. Sinaiko}
}
@article {696528,
	title = {What Type of Price Transparency Do We Need in Health Care?},
	journal = {Ann Intern Med},
	volume = {170},
	number = {8},
	year = {2019},
	month = {2019 Apr 16},
	pages = {561-562},
	keywords = {Disclosure, Fees, Medical, Health Care Costs, Health Expenditures, Hospital Costs, Humans, Medicare, Patient Care Bundles, United States},
	issn = {1539-3704},
	doi = {10.7326/M19-0534},
	author = {Austin Frakt and Ateev Mehrotra}
}
@article {696525,
	title = {What Type of Price Transparency Do We Need in Health Care?},
	journal = {Ann Intern Med},
	volume = {170},
	number = {8},
	year = {2019},
	month = {2019 Apr 16},
	pages = {561-562},
	keywords = {Disclosure, Fees, Medical, Health Care Costs, Health Expenditures, Hospital Costs, Humans, Medicare, Patient Care Bundles, United States},
	issn = {1539-3704},
	doi = {10.7326/M19-0534},
	author = {Austin Frakt and Ateev Mehrotra}
}
@article {696532,
	title = {Why aren{\textquoteright}t more employers implementing reference-based pricing benefit design?},
	journal = {Am J Manag Care},
	volume = {25},
	number = {2},
	year = {2019},
	month = {2019 Feb},
	pages = {85-88},
	abstract = {OBJECTIVES: There is robust evidence that implementation of reference-based pricing (RBP) benefit design decreases spending. This paper investigates employer adoption of RBP as a strategy to improve the value of patients{\textquoteright} healthcare choices, as well as facilitators and barriers to the adoption of RBP by employers.

STUDY DESIGN: We conducted a qualitative study using 12 in-depth interviews with human resources executives or their representatives at large- or medium-sized self-insured employers.

METHODS: Interviews were conducted and recorded over the phone between March 2017 and May 2017. Interviewees were asked about their adoption of RBP and facilitators and barriers to adoption. We applied thematic analysis to the transcripts.

RESULTS: Despite broad employer awareness of RBP{\textquoteright}s potential for cost savings, few employers are including RBP in their benefit design. The major barriers to RBP adoption were the complexity of RBP benefit design, concern that employees could face catastrophic out-of-pocket costs, lack of a business case for implementation, and concern that RBP could hurt the employer{\textquoteright}s competitiveness in the labor market. The few employers that have adopted RBP have implemented extensive, year-round employee education campaigns and invested in multipronged and proactive decision support to help employees navigate their choices.

CONCLUSIONS: Unless several fundamental barriers are addressed, uptake of RBP will likely continue to be low. Our findings suggest that simplifying benefit design, providing employees protection against very high out-of-pocket costs, understanding which decision-support strategies are most effective, and enhancing the business case could facilitate wider employer adoption of RBP.},
	keywords = {Cost Control, Health Benefit Plans, Employee, Health Care Costs, Health Expenditures, Humans, United States},
	issn = {1936-2692},
	author = {Anna D. Sinaiko and Alidina, Shehnaz and Ateev Mehrotra}
}
@article {635791,
	title = {Antibiotic Prescribing During Pediatric Direct-to-Consumer Telemedicine Visits},
	journal = {Pediatrics },
	volume = {143},
	number = {5},
	year = {2019},
	pages = {e20190631},
	abstract = {BACKGROUND AND OBJECTIVES:Use of commercial\&nbsp;direct-to-consumer\&nbsp;(DTC)\&nbsp;telemedicine\&nbsp;outside of the\&nbsp;pediatric\&nbsp;medical home is increasing among children, and acute respiratory infections (ARIs) are the most commonly diagnosed condition at DTC\&nbsp;telemedicine\&nbsp;visits. Our objective was to compare the quality of\&nbsp;antibiotic\&nbsp;prescribing\&nbsp;for ARIs among children across 3 settings: DTC\&nbsp;telemedicine, urgent care, and the primary care provider (PCP) office.METHODS:In a retrospective cohort study using 2015-2016 claims data from a large national commercial health plan, we identified ARI\&nbsp;visitsby children (0-17 years old), excluding\&nbsp;visits\&nbsp;with comorbidities that could affect\&nbsp;antibiotic\&nbsp;decisions.\&nbsp;Visits\&nbsp;were matched on age, sex, chronic medical complexity, state, rurality, health plan type, and ARI diagnosis category. Within the matched sample, we compared the percentage of ARI\&nbsp;visits\&nbsp;with any\&nbsp;antibiotic\&nbsp;prescribing\&nbsp;and the percentage of ARI\&nbsp;visits\&nbsp;with guideline-concordant\&nbsp;antibiotic\&nbsp;management.RESULTS:There were 4604 DTC\&nbsp;telemedicine, 38 408 urgent care, and 485 201 PCP\&nbsp;visits\&nbsp;for ARIs in the matched sample.\&nbsp;Antibioticprescribing\&nbsp;was higher for DTC\&nbsp;telemedicine\&nbsp;visits\&nbsp;than for other settings (52\% of DTC\&nbsp;telemedicine\&nbsp;visits\&nbsp;versus 42\% urgent care and 31\% PCP\&nbsp;visits;\&nbsp;P\&nbsp;\&lt; .001 for both comparisons). Guideline-concordant\&nbsp;antibiotic\&nbsp;management was lower at DTC\&nbsp;telemedicine\&nbsp;visits\&nbsp;than at other settings (59\% of DTC\&nbsp;telemedicine\&nbsp;visits\&nbsp;versus 67\% urgent care and 78\% PCP\&nbsp;visits;\&nbsp;P\&nbsp;\&lt; .001 for both comparisons).CONCLUSIONS:At DTC\&nbsp;telemedicine\&nbsp;visits, children with ARIs were more likely to receive antibiotics and less likely to receive guideline-concordant\&nbsp;antibiotic\&nbsp;management compared to children at PCP\&nbsp;visits\&nbsp;and urgent care\&nbsp;visits.},
	author = {Ray KN and Shi Z and Gidengil CA and Poon SJ and Uscher-Pines L and Mehrotra A}
}
@article {635803,
	title = {How Is Telemedicine Being Used In Opioid And Other Substance Use Disorder Treatment?},
	journal = {Health Affairs },
	volume = {37},
	number = {12},
	year = {2018},
	pages = {1940-1947},
	abstract = {Only a small proportion of people with a\&nbsp;substance\&nbsp;use\&nbsp;disorder\&nbsp;(SUD) receive\&nbsp;treatment. The shortage of SUD\&nbsp;treatment\&nbsp;providers, particularly in rural areas, is an important driver of this\&nbsp;treatment\&nbsp;gap.\&nbsp;Telemedicine\&nbsp;could be a means of expanding access to\&nbsp;treatment. However, several key regulatory and reimbursement barriers to greater use of\&nbsp;telemedicine\&nbsp;for SUD (tele-SUD) exist, and both Congress and the states are considering or have recently passed legislation to address them. To inform these efforts, we describe how tele-SUD is being used. Using claims data for 2010-17 from a large commercial insurer, we identified characteristics of tele-SUD users and examined how tele-SUD is being used in conjunction with in-person SUD care. Despite a rapid increase in tele-SUD over the study period, we found low use rates overall, particularly relative to the growth in telemental health. Tele-SUD is primarily used to complement in-person care and is disproportionately used by those with relatively severe SUD. Given the severity of the\&nbsp;opioid\&nbsp;epidemic, low rates of tele-SUD use represent a missed opportunity. As tele-SUD becomes more available, it will be important to monitor closely which tele-SUD delivery models are being used and their impact on access and outcomes.},
	author = {Huskamp HA and Busch AB and Souza J and Uscher-Pines L and Rose S and Wilcock A and Landon BE and Mehrotra A}
}
@article {635802,
	title = {Quality of care for acute respiratory infections during direct-to-consumer telemedicine visits for adults},
	journal = {Health Affairs },
	volume = {37},
	number = {12},
	year = {2018},
	pages = {2014-2023},
	abstract = {In\&nbsp;direct-to-consumer\&nbsp;telemedicine, physicians treat patients through real-time audiovisual conferencing for common conditions such as\&nbsp;acuterespiratory\&nbsp;infections. Early studies had mixed findings on the\&nbsp;quality\&nbsp;of\&nbsp;care\&nbsp;provided during\&nbsp;direct-to-consumer\&nbsp;telemedicine\&nbsp;and were limited by small sample sizes and narrow geographic scopes. Using claims data for 2015-16 from a large national commercial insurer, we examined the\&nbsp;quality\&nbsp;of antibiotic management in\&nbsp;adults\&nbsp;with\&nbsp;acute\&nbsp;respiratory\&nbsp;infection diagnoses at 38,839\&nbsp;direct-to-consumer\&nbsp;telemedicinevisits, compared to the\&nbsp;quality\&nbsp;at 942,613 matched primary\&nbsp;care\&nbsp;visits\&nbsp;and 186,016 matched urgent\&nbsp;care\&nbsp;visits. In the matched analyses, we found clinically similar rates of antibiotic use, broad-spectrum antibiotic use, and guideline-concordant antibiotic management. However,\&nbsp;direct-to-consumer\&nbsp;telemedicine\&nbsp;visits\&nbsp;had less appropriate streptococcal testing and a higher frequency of follow-up\&nbsp;visits. These results suggest specific opportunities for improvement in\&nbsp;direct-to-consumer\&nbsp;telemedicine\&nbsp;quality.},
	author = {Shi Z and Mehrotra A and Gidengil C and Poon SJ and Uscher-Pines L and Ray KN}
}
@article {635801,
	title = {Trends in Telemedicine Use in a Large Commercially Insured Population, 2005-2017},
	journal = {JAMA Internal Medicine },
	volume = {320},
	number = {20},
	year = {2018},
	pages = {2147-2149},
	author = {Ml, Barnett and Ray KN and Souza J and Mehrotra A}
}
@article {635823,
	title = {Association between endoscopist personality and rate of adenoma detection},
	journal = {Clin Gastroenterol Hepatol},
	volume = {S1542-3565},
	number = {18},
	year = {2018},
	pages = {31140-6},
	abstract = {BACKGROUND \&amp; AIMS:There is significant variation among endoscopists in their\&nbsp;adenoma\&nbsp;detection\&nbsp;rates (ADRs). We explored associations between ADR and characteristics of endoscopists, including\&nbsp;personality\&nbsp;traits and financial incentives.METHODS:We collected electronic health record data from October 2013 through September 2015 and calculated ADRs for physicians from 4 health systems. ADRs were risk-adjusted for differences in patient populations. Physicians were surveyed to assess financial motivations, knowledge and perceptions about colonoscopy quality, and\&nbsp;personality\&nbsp;traits. Of 140 physicians sent the survey, 117 responded.RESULTS:The median risk-adjusted ADR for all surveyed physicians was 29.3\% (interquartile range, 24.1\%-35.5\%). We found no significant\&nbsp;association\&nbsp;between ADR and financial incentives, malpractice concerns, or physicians{\textquoteright} perceptions of ADR as a quality metric. ADR was associated with the degree of self-reported compulsiveness relative to peers: among endoscopists who described themselves as much more compulsive, the ADR was 33.1\%; among those who described themselves as somewhat more compulsive, the ADR was 32.9\%; among those who described themselves as about the same as others, the ADR was 26.4\%; and among those who described themselves as somewhat less compulsive, the ADR was 27.3\%) (P\&nbsp;= .0019). ADR also associated with perceived thoroughness (much more thorough than peers, ADR\&nbsp;= 31.5\%; somewhat more, 31.9\%; same/somewhat less, 27.1\%; P\&nbsp;= .0173). Physicians who reported feeling rushed, having difficulty pacing themselves, or having difficulty in accomplishing goals had higher ADRs. A secondary analysis found the same associations between\&nbsp;personality\&nbsp;and adenomas per colonoscopy.CONCLUSIONS:In a survey of endoscopists and comparison of results with ADRs, we found no significant\&nbsp;association\&nbsp;between ADR and financial incentives, malpractice concerns, or perceptions of ADR as a quality metric. However, ADRs were higher among physicians who described themselves as more compulsive or thorough, and among those who reported feeling rushed or having difficulty accomplishing goals.},
	author = {Ezaz G and Leffler DA and Beach S and Schoen RE and Crockett SD and Gourevitch RA and Rose S and Morris M and Carrell DS and Greer JB and Mehrotra A}
}
@article {635819,
	title = {Evaluation of Artificial Intelligence-Based Grading of Diabetic Retinopathy in Primary Care},
	journal = {JAMA Netw Open },
	volume = {1},
	number = {5},
	year = {2018},
	pages = {e182665},
	abstract = {IMPORTANCE:There has been wide interest in using\&nbsp;artificial\&nbsp;intelligence (AI)-based\&nbsp;grading\&nbsp;of retinal images to identify\&nbsp;diabetic\&nbsp;retinopathy, but such a system has never been deployed and evaluated in clinical practice.OBJECTIVE:To describe the performance of an AI system for\&nbsp;diabetic\&nbsp;retinopathy\&nbsp;deployed in a\&nbsp;primary\&nbsp;care\&nbsp;practice.DESIGN, SETTING, AND PARTICIPANTS:Diagnostic study of patients with diabetes seen at a\&nbsp;primary\&nbsp;care\&nbsp;practice with 4 physicians in Western Australia between December 1, 2016, and May 31, 2017. A total of 193 patients consented for the study and had retinal photographs taken of their eyes. Three hundred eighty-six images were evaluated by both the AI-based system and an ophthalmologist.MAIN OUTCOMES AND MEASURES:Sensitivity and specificity of the AI system compared with the gold standard of ophthalmologist\&nbsp;evaluation.RESULTS:Of the 193 patients (93 [48\%] female; mean [SD] age, 55 [17] years [range, 18-87 years]), the AI system judged 17 as having\&nbsp;diabetic\&nbsp;retinopathy\&nbsp;of sufficient severity to require referral. The system correctly identified 2 patients with true disease and misclassified 15 as having disease (false-positives). The resulting specificity was 92\% (95\% CI, 87\%-96\%), and the positive predictive value was 12\% (95\% CI, 8\%-18\%). Many false-positives were driven by inadequate image quality (eg, dirty lens) and sheen reflections.CONCLUSIONS AND RELEVANCE:The results demonstrate both the potential and the challenges of using AI systems to identify\&nbsp;diabeticretinopathy\&nbsp;in clinical practice. Key challenges include the low incidence rate of disease and the related high false-positive rate as well as poor image quality. Further evaluations of AI systems in\&nbsp;primary\&nbsp;care\&nbsp;are needed.},
	author = {Kanagasingam Y and Xiao D and Vignarajan J and Preetham A and Tay-Kearney ML and Mehrotra A}
}
@article {635785,
	title = {Practices Caring For The Underserved Are Less Likely To Adopt Medicare{\textquoteright}s Annual Wellness Visit},
	journal = {Health Aff (Millwood)},
	volume = {37},
	number = {2},
	year = {2018},
	pages = {283-291},
	abstract = {In 2011 Medicare introduced the annual wellness visit to help address the health risks of aging adults. The visit also offers primary care practices an opportunity to generate revenue, and may allow practices in accountable care organizations to attract healthier patients while stabilizing patient-practitioner assignments. However, uptake of the visit has been uneven. Using national Medicare data for the period 2008-15, we assessed practices{\textquoteright} ability and motivation to adopt the visit. In 2015, 51.2\&nbsp;percent of practices provided no annual wellness visits (nonadopters), while 23.1\&nbsp;percent provided visits to at least a quarter of their eligible beneficiaries (adopters). Adopters replaced problem-based visits with annual wellness visits and saw increases in primary care revenue. Compared to nonadopters, adopters had more stable patient assignment and a slightly healthier patient mix. At the same time, visit rates were lower among practices caring for underserved populations (for example, racial minorities and those dually enrolled in Medicaid), potentially worsening disparities. Policy makers should consider ways to encourage uptake of the visit or other mechanisms to promote preventive care in underserved populations and the practices that serve them.},
	author = {Ganguli I and Souza J and McWilliams JM and Mehrotra A}
}
@article {696553,
	title = {Adenoma Detection Rate Falls at the End of the Day in a Large Multi-site Sample},
	journal = {Dig Dis Sci},
	volume = {63},
	number = {4},
	year = {2018},
	month = {2018 Apr},
	pages = {856-859},
	abstract = {BACKGROUND: There is concern that mental and physical fatigue among endoscopists over the course of the day will lead to lower adenoma detection rate (ADR). There are mixed findings in the prior literature on whether such an association exists.

AIMS: The aim of this study was to measure the association between the number of colonoscopies performed in a day and ADR and withdrawal time.

METHODS: We analyzed 86,624 colonoscopy and associated pathology reports between October 2013 and September 2015 from 131 physicians at two medical centers. A previously validated natural language processing program was used to abstract relevant data. We identified the order of colonoscopies performed in the physicians{\textquoteright} schedule and calculated the ADR and withdrawal time for each colonoscopy position.

RESULTS: The ADR for our overall sample was 29.9 (CI 29.6-30.2). The ADR for colonoscopies performed at the 9th~+~position was significantly lower than those at the 1st-4th or 5th-8th position, 27.2 (CI 25.8-28.6) versus 29.9 (CI 29.5-30.3), 30.2 (CI 29.6-30.9), respectively. Withdrawal time steadily decreased by colonoscopy position going from 11.6 (CI 11.4-11.9)~min for the 1st colonoscopy to 9.6 (8.9-10.3)~min for the 9th colonoscopy.

CONCLUSION: In our study population, ADR and withdrawal time decrease by roughly 7 and 20\%, respectively, by the end of the day. Our results imply that rather than mental or physical fatigue, lower ADR at the end of the day might be driven by endoscopists rushing.},
	keywords = {Adenoma, Clinical Competence, Colonic Neoplasms, Colonoscopy, fatigue, Humans, Natural Language Processing, operative time, Predictive Value of Tests, Reproducibility of Results, Retrospective Studies, Time Factors, Workload},
	issn = {1573-2568},
	doi = {10.1007/s10620-018-4947-1},
	author = {Marcondes, Felippe O and Gourevitch, Rebecca A and Schoen, Robert E and Crockett, Seth D and Morris, Michele and Ateev Mehrotra}
}
@article {696556,
	title = {Changes in Health Care Use Associated With the Introduction of Hospital Global Budgets in Maryland},
	journal = {JAMA Intern Med},
	volume = {178},
	number = {2},
	year = {2018},
	month = {2018 Feb 01},
	pages = {260-268},
	abstract = {IMPORTANCE: In 2014, the State of Maryland placed the majority of its hospitals under all-payer global budgets for inpatient, hospital outpatient, and emergency department care. Goals of the program included reducing unnecessary hospital utilization and encouraging greater use of primary care.

OBJECTIVE: To compare changes in hospital and primary care use through the first 2 years of Maryland{\textquoteright}s hospital global budget program among fee-for-service Medicare beneficiaries in Maryland vs matched control areas.

DESIGN, SETTING, AND PARTICIPANTS: We matched 8 Maryland counties (94 967 beneficiaries) with hospitals in the program to 27 non-Maryland control counties (206 389 beneficiaries). Using difference-in-differences analysis, we compared changes in hospital and primary care use in Maryland vs the control counties from before (2009-2013) to after (2014-2015) the payment change, using 2 different assumptions. First, we assumed that preintervention differences between Maryland and the control counties would have remained constant past 2014 had Maryland not implemented global budgets (parallel trend assumption). Second, we assumed that differences in preintervention trends would have continued without the payment change (differential trend assumption).

MAIN OUTCOMES AND MEASURES: Hospital stays (defined as admissions and observation stays); return hospital stays within 30 days of a prior hospital stay; emergency department visits that did not result in admission; price-standardized hospital outpatient department (HOPD) utilization; and visits with primary care physicians (overall and within 7 days of a hospital stay).

RESULTS: We matched 8 Maryland counties with hospitals in the program (94 967 beneficiaries; 41.8\% male; mean [SD] age, 72.3 [12.2] years) to 27 non-Maryland control counties (206 389 beneficiaries; 42.8\% male; mean [SD] age, 71.7 [12.5] years). Assuming parallel trends, we estimated a differential change in Maryland of -0.47 annual hospital stays per 100 beneficiaries (95\% CI, -1.65 to 0.72; P = .43) from the preintervention period (2009-2013) to 2015, but assuming differential trends, we estimated a differential change in Maryland of -1.24 stays per 100 beneficiaries (95\% CI, -2.46 to -0.02; P = .047). Assuming parallel trends, we found a significant increase in primary care visits (+10.6 annual visits/100 beneficiaries; 95\% CI, 4.6 to 16.6 annual visits/100 beneficiaries; P = .001), but assuming differential trends, we found no change (-0.8 visits/100 beneficiaries; 95\% CI, -10.6 to 9.0 visits/100 beneficiaries; P = .87). Comparing estimates with both trend assumptions, we found no consistent changes in emergency department visits, return hospital stays, HOPD use, or posthospitalization primary care visits associated with Maryland{\textquoteright}s program.

CONCLUSIONS AND RELEVANCE: We did not find consistent evidence that Maryland{\textquoteright}s hospital global budget program was associated with reductions in hospital use or increases in primary care visits among fee-for-service Medicare beneficiaries after 2 years. Evaluations over longer periods should be pursued.},
	keywords = {Aged, Aged, 80 and over, Fee-for-Service Plans, Female, Financial Management, Hospital, Health Expenditures, Hospitals, Humans, Inpatients, Male, Maryland, Medicare, United States},
	issn = {2168-6114},
	doi = {10.1001/jamainternmed.2017.7455},
	author = {Roberts, Eric T and J. Michael McWilliams and Hatfield, Laura A and Gerovich, Sule and Michael E. Chernew and Gilstrap, Lauren G and Ateev Mehrotra}
}
@article {696550,
	title = {Changes in hospital bond ratings after the transition to a new electronic health record},
	journal = {J Am Med Inform Assoc},
	volume = {25},
	number = {5},
	year = {2018},
	month = {2018 May 01},
	pages = {572-574},
	abstract = {OBJECTIVE: To assess the impact of electronic health record (EHR) implementation on hospital finances.

MATERIALS AND METHODS: We analyzed the impact of EHR implementation on bond ratings and net income from service to patients (NISP) at 32 hospitals that recently implemented a new EHR and a set of controls.

RESULTS: After implementing an EHR, 7 hospitals had a bond downgrade, 7 had a bond upgrade, and 18 had no changes. There was no difference in the likelihood of bond rating changes or in changes to NISP following EHR go-live when compared to control hospitals.

DISCUSSION: Most hospitals in our analysis saw no change in bond ratings following EHR go-live, with no significant differences observed between EHR implementation and control hospitals. There was also no apparent difference in NISP.

CONCLUSIONS: Implementation of an EHR did not appear to have an impact on bond ratings at the hospitals in our analysis.},
	keywords = {Economics, Hospital, Electronic Health Records, Financial Management, Hospital, Kaplan-Meier Estimate, United States},
	issn = {1527-974X},
	doi = {10.1093/jamia/ocy007},
	author = {McEvoy, Dustin and Michael L. Barnett and Sittig, Dean F and Aaron, Skye and Ateev Mehrotra and Wright, Adam}
}
@article {696552,
	title = {Changes In Hospital Utilization Three Years Into Maryland{\textquoteright}s Global Budget Program For Rural Hospitals},
	journal = {Health Aff (Millwood)},
	volume = {37},
	number = {4},
	year = {2018},
	month = {2018 Apr},
	pages = {644-653},
	abstract = {In a substantial shift in payment policy, the State of Maryland implemented a global budget program for acute care hospitals in 2010. Goals of the program include controlling hospital use and spending. Eight rural hospitals entered the program in 2010, while urban and suburban hospitals joined in 2014. Prior analyses, which focused on urban and suburban hospitals, did not find consistent evidence that Maryland{\textquoteright}s program had contributed to changes in hospital use after two years. However, these studies were limited by short follow-up periods, may have failed to isolate impacts of Maryland{\textquoteright}s payment change from other state trends, and had limited generalizability to rural settings. To understand the effects of Maryland{\textquoteright}s global budget program on rural hospitals, we compared changes in hospital use among Medicare beneficiaries served by affected rural hospitals versus an in-state control population from before to after 2010. By 2013-three years after the rural program began-there were no differential changes in acute hospital use or price-standardized hospital spending among beneficiaries served by the affected hospitals, versus the within-state control group. Our results suggest that among Medicare beneficiaries, global budgets in rural Maryland hospitals did not reduce hospital use or price-standardized spending as policy makers had anticipated.},
	keywords = {Adult, Aged, Aged, 80 and over, Budgets, Economics, Hospital, Female, Hospitalization, Hospitals, Rural, Humans, Male, Maryland, Medicare, Middle Aged, Reimbursement mechanisms, United States},
	issn = {1544-5208},
	doi = {10.1377/hlthaff.2018.0112},
	author = {Roberts, Eric T and Hatfield, Laura A and J. Michael McWilliams and Michael E. Chernew and Done, Nicolae and Gerovich, Sule and Gilstrap, Lauren and Ateev Mehrotra}
}
@article {696546,
	title = {Does Enrollment in High-Deductible Health Plans Encourage Price Shopping?},
	journal = {Health Serv Res},
	volume = {53 Suppl 1},
	number = {Suppl Suppl 1},
	year = {2018},
	month = {2018 Aug},
	pages = {2718-2734},
	abstract = {OBJECTIVE: To investigate whether enrollment in high-deductible health plans (HDHPs) led enrollees to choose lower-priced providers for office visits and laboratory tests.

STUDY SETTING: Claims data from more than 40 large employers.

STUDY DESIGN: We compared the change in price for office visits and laboratory tests for enrollees who switched to HDHPs versus enrollees who remained in traditional plans. We estimated separate models for enrollees who changed providers versus those who remained with the same provider to disentangle the effects of HDHPs on provider choice and negotiated prices.

DATA COLLECTION: Claims data from 2004 to 2010 on 1.8 million enrollees.

PRINCIPAL FINDINGS: After enrollment in HDHPs, 28 percent of enrollees changed physicians for office visits (compared to 19 percent in the Traditional Plan group, p~\&lt;~.01); however, this did not result in a statistically significant reduction in price for office visits. About 25 percent of enrollees changed providers for laboratory tests (compared to 23 percent in the Traditional Plan group, p~\&lt;~.01), resulting in savings of about $2.09 or a 12.8 percent reduction in price per laboratory test. We found that HDHPs had lower negotiated prices for office visits but not for laboratory tests.

CONCLUSIONS: High-deductible health plan enrollment may shift enrollees to lower cost providers, resulting in modest savings.},
	keywords = {Adult, Choice Behavior, Commerce, Cost Savings, Deductibles and Coinsurance, Diagnostic Techniques and Procedures, Female, Health Benefit Plans, Employee, Humans, Insurance Claim Review, Longitudinal Studies, Male, Middle Aged, Office Visits, United States},
	issn = {1475-6773},
	doi = {10.1111/1475-6773.12784},
	author = {Zhang, Xinke and Haviland, Amelia and Ateev Mehrotra and Huckfeldt, Peter and Wagner, Zachary and Sood, Neeraj}
}
@article {696548,
	title = {The Effect of Telehealth on Spending: Thinking Through the Numbers},
	journal = {Ann Intern Med},
	volume = {168},
	number = {10},
	year = {2018},
	month = {2018 May 15},
	pages = {737-738},
	keywords = {Facilities and Services Utilization, Health Expenditures, Health Services Accessibility, Humans, Office Visits, Telemedicine},
	issn = {1539-3704},
	doi = {10.7326/M17-3070},
	author = {Licurse, Adam M and Ateev Mehrotra}
}
@article {696539,
	title = {Endoscopist factors that influence serrated polyp detection: a multicenter study},
	journal = {Endoscopy},
	volume = {50},
	number = {10},
	year = {2018},
	month = {2018 Oct},
	pages = {984-992},
	abstract = {BACKGROUND: Serrated polyps are important colorectal cancer precursors that are variably detected during colonoscopy. We measured serrated polyp detection rate (SPDR) in a large, multicenter, cross-sectional study of colonoscopy quality to identify drivers of SPDR variation.

METHODS: Colonoscopy and pathology reports were collected for a 2-year period (10/2013-9/2015) from four sites across the United States. Data from reports, including size, location, and histology of polyps, were abstracted using a validated natural language processing algorithm. SPDR was defined as the proportion of colonoscopies with >= 1 serrated polyp (not including hyperplastic polyps). Multivariable logistic regression was performed to determine endoscopist characteristics associated with serrated polyp detection.

RESULTS: A total of 104 618 colonoscopies were performed by 201 endoscopists who varied with respect to specialty (86 \% were gastroenterologists), sex (18 \% female), years in practice (range 1 - 51), and number of colonoscopies performed during the study period (range 30 - 2654). The overall mean SPDR was 5.1 \% (SD 3.8 \%, range 0 - 18.8 \%). In multivariable analysis, gastroenterology specialty training (odds ratio [OR] 1.89, 95 \% confidence interval [CI] 1.33 - 2.70), fewer years in practice (<= 9 years vs. >= 27 years: OR 1.52, 95 \%CI 1.14 - 2.04)], and higher procedure volumes (highest vs. lowest quartile: OR 1.77, 95 \%CI 1.27 - 2.46)] were independently associated with serrated polyp detection.

CONCLUSIONS: Gastroenterology specialization, more recent completion of training, and greater procedure volume are associated with serrated polyp detection. These findings imply that both repetition and training are likely to be important contributors to adequate detection of these important cancer precursors. Additional efforts to improve SPDR are needed.},
	keywords = {Clinical Competence, Colonic Polyps, Colonoscopy, Colorectal Surgery, Cross-Sectional Studies, Family Practice, Female, Gastroenterology, General Surgery, Humans, Male, Specialization, Thoracic Surgery},
	issn = {1438-8812},
	doi = {10.1055/a-0597-1740},
	author = {Crockett, Seth D and Gourevitch, Rebecca A and Morris, Michele and Carrell, David S and Rose, Sherri and Shi, Zhuo and Greer, Julia B and Schoen, Robert E and Ateev Mehrotra}
}
@article {696542,
	title = {Evaluation of Artificial Intelligence-Based Grading of Diabetic Retinopathy in Primary Care},
	journal = {JAMA Netw Open},
	volume = {1},
	number = {5},
	year = {2018},
	month = {2018 Sep 07},
	pages = {e182665},
	abstract = {IMPORTANCE: There has been wide interest in using artificial intelligence (AI)-based grading of retinal images to identify diabetic retinopathy, but such a system has never been deployed and evaluated in clinical practice.

OBJECTIVE: To describe the performance of an AI system for diabetic retinopathy deployed in a primary care practice.

DESIGN, SETTING, AND PARTICIPANTS: Diagnostic study of patients with diabetes seen at a primary care practice with 4 physicians in Western Australia between December 1, 2016, and May 31, 2017. A total of 193 patients consented for the study and had retinal photographs taken of their eyes. Three hundred eighty-six images were evaluated by both the AI-based system and an ophthalmologist.

MAIN OUTCOMES AND MEASURES: Sensitivity and specificity of the AI system compared with the gold standard of ophthalmologist evaluation.

RESULTS: Of the 193 patients (93 [48\%] female; mean [SD] age, 55 [17] years [range, 18-87 years]), the AI system judged 17 as having diabetic retinopathy of sufficient severity to require referral. The system correctly identified 2 patients with true disease and misclassified 15 as having disease (false-positives). The resulting specificity was 92\% (95\% CI, 87\%-96\%), and the positive predictive value was 12\% (95\% CI, 8\%-18\%). Many false-positives were driven by inadequate image quality (eg, dirty lens) and sheen reflections.

CONCLUSIONS AND RELEVANCE: The results demonstrate both the potential and the challenges of using AI systems to identify diabetic retinopathy in clinical practice. Key challenges include the low incidence rate of disease and the related high false-positive rate as well as poor image quality. Further evaluations of AI systems in primary care are needed.},
	keywords = {Adolescent, Adult, Aged, Aged, 80 and over, Artificial Intelligence, Diabetic Retinopathy, Female, Humans, Male, Middle Aged, Primary Health Care, Research Design, Sensitivity and Specificity, Western Australia},
	issn = {2574-3805},
	doi = {10.1001/jamanetworkopen.2018.2665},
	author = {Kanagasingam, Yogesan and Xiao, Di and Vignarajan, Janardhan and Preetham, Amita and Tay-Kearney, Mei-Ling and Ateev Mehrotra}
}
@article {696543,
	title = {A Health Plan{\textquoteright}s Formulary Led To Reduced Use Of Extended-Release Opioids But Did Not Lower Overall Opioid Use},
	journal = {Health Aff (Millwood)},
	volume = {37},
	number = {9},
	year = {2018},
	month = {2018 Sep},
	pages = {1509-1516},
	abstract = {Many insurers are using formulary design to influence opioid prescribing, but it is unclear if these changes lead to reduced use or just substitution between opioids. We evaluated the effect of a new prior authorization process implemented in July~2015 for extended-release (ER) oxycodone by Blue Shield of California. Compared to other commercially insured Californians, among 880,000 Blue Shield enrollees, there was a 36~percent drop in monthly rates of ER opioid initiation relative to control-group members, driven entirely by decreases in ER oxycodone initiation and without any substitution toward other ER opioids. This reduction was offset by a 1.4~percent relative increase in the rate of short-acting opioid fills. There was no significant change in the overall use of any opioids prescribed, measured as morphine milligram equivalents. This suggests that though insurers can play a meaningful role in reducing the prescribing of high-risk ER opioids, a formulary change focused on ER opioids alone is insufficient to decrease total opioid prescribing.},
	keywords = {Analgesics, Opioid, California, Chronic Pain, Drug Prescriptions, Female, Humans, Insurance, Health, Male, Middle Aged, Oxycodone, Practice Patterns, Physicians{\textquoteright}},
	issn = {1544-5208},
	doi = {10.1377/hlthaff.2018.0391},
	author = {Michael L. Barnett and Olenski, Andrew R and Thygeson, N Marcus and Ishisaka, Denis and Wong, Salina and Jena, Anupam B and Ateev Mehrotra}
}
@article {696536,
	title = {How Is Telemedicine Being Used In Opioid And Other Substance Use Disorder Treatment?},
	journal = {Health Aff (Millwood)},
	volume = {37},
	number = {12},
	year = {2018},
	month = {2018 Dec},
	pages = {1940-1947},
	abstract = {Only a small proportion of people with a substance use disorder (SUD) receive treatment. The shortage of SUD treatment providers, particularly in rural areas, is an important driver of this treatment gap. Telemedicine could be a means of expanding access to treatment. However, several key regulatory and reimbursement barriers to greater use of telemedicine for SUD (tele-SUD) exist, and both Congress and the states are considering or have recently passed legislation to address them. To inform these efforts, we describe how tele-SUD is being used. Using claims data for 2010-17 from a large commercial insurer, we identified characteristics of tele-SUD users and examined how tele-SUD is being used in conjunction with in-person SUD care. Despite a rapid increase in tele-SUD over the study period, we found low use rates overall, particularly relative to the growth in telemental health. Tele-SUD is primarily used to complement in-person care and is disproportionately used by those with relatively severe SUD. Given the severity of the opioid epidemic, low rates of tele-SUD use represent a missed opportunity. As tele-SUD becomes more available, it will be important to monitor closely which tele-SUD delivery models are being used and their impact on access and outcomes.},
	keywords = {Adolescent, Adult, Aged, Analgesics, Opioid, Child, Female, Health Services Accessibility, Hospitalization, Humans, Insurance Claim Review, Male, Medicare Part C, Middle Aged, Private Sector, Retrospective Studies, Substance-Related Disorders, Telemedicine, United States, Young Adult},
	issn = {1544-5208},
	doi = {10.1377/hlthaff.2018.05134},
	author = {Huskamp, Haiden A. and Alisa B. Busch and Souza, Jeffrey and Uscher-Pines, Lori and Rose, Sherri and Wilcock, Andrew and Landon, Bruce E and Ateev Mehrotra}
}
@article {696549,
	title = {Impact of Implementation of Electronically Transmitted Referrals on Pediatric Subspecialty Visit Attendance},
	journal = {Acad Pediatr},
	volume = {18},
	number = {4},
	year = {2018},
	month = {2018 May-Jun},
	pages = {409-417},
	abstract = {OBJECTIVE: One barrier to timely access to outpatient pediatric subspecialty care is the complexity of scheduling processes. We evaluated the impact of implementing electronically transmitted referrals on subspecialty visit attendance.

METHODS: Through collaboration with stakeholders, an electronically transmitted referral order system was designed, piloted, and implemented in 15 general pediatrics practices, with 24 additional practices serving as controls. We used statistical process control methods and difference-in-differences analysis to examine visits attended, appointments scheduled, appointment nonattendance, and referral volume. Electronically transmitted referrals then were expanded to all 39 practices. We surveyed referring pediatricians at all practices before and after implementation.

RESULTS: From April 2015 through September 2016 there were 33,485 referral orders across all practices (7770 before the pilot, 11,776 during the pilot, 13,939 after full implementation). At pilot practices, there was a significant and sustained improvement in subspecialty visits attended within 4 weeks of referral (10.9\% to 20.0\%; P \&lt; .001). Relative to control practices, pilot practices experienced an 8.6\% improvement (P = .001). After implementation at control practices, rates of visits attended also improved but to a smaller degree: 11.8\% to 14.7\% (P \&lt; .001). In survey responses, referring pediatricians noted improved scheduling processes but had continued concerns with appointment availability and referral tracking.

CONCLUSIONS: While electronically transmitted referrals improved visit attendance after pediatric subspecialty referral, the sizable percentage of children without attended visits, the muted effect at control practices, and pediatrician survey responses indicate that additional work is needed to address barriers to pediatric subspecialty care.},
	keywords = {Adolescent, Ambulatory Care, Appointments and Schedules, Child, Child, Preschool, Computer Communication Networks, Delivery of Health Care, Female, Humans, Infant, Infant, Newborn, Male, No-Show Patients, Pediatrics, Pilot Projects, Referral and Consultation},
	issn = {1876-2867},
	doi = {10.1016/j.acap.2017.12.008},
	author = {Ray, Kristin N and Drnach, Michael and Ateev Mehrotra and Suresh, Srinivasan and Docimo, Steven G}
}
@article {696540,
	title = {Incidence of interval colorectal cancer attributable to an endoscopist in clinical practice},
	journal = {Gastrointest Endosc},
	volume = {88},
	number = {4},
	year = {2018},
	month = {2018 Oct},
	pages = {705-711.e1},
	abstract = {BACKGROUND AND AIMS: Endoscopists who encounter an interval colorectal cancer (I-CRC) may be concerned about the implications because I-CRCs may represent a lapse in colonoscopy quality and a missed opportunity for prevention. We wanted to determine the I-CRC rate per colonoscopy examination and to examine the effect of colonoscopy volume and adenoma detection rate (ADR) on the number of I-CRCs attributable to an endoscopist.

METHODS: We determined the rate of I-CRC diagnosis per outpatient colonoscopy examination by measuring the incidence of CRC diagnosis in practice and by assessing, via literature review, the percentage of cancers that are interval. We also estimated the number of attributable I-CRCs as a function of ADR and colonoscopy volume.

RESULTS: Among 93,562 colonoscopies performed in 2013 to 2015 by 120 physicians in 4 diverse U.S. medical centers, 526 CRCs were diagnosed (.6\%). Of 149,556 CRCs in the published literature, 7958 were I-CRCs (5.25\% {\textpm} .94\%). With rates of .6\% (CRC per colonoscopy) and 5.25\% (I-CRC per CRC), the rate of I-CRC is 1 per 3174 colonoscopies (95\% confidence interval, 1 per 2710 to 1 per 3875). An endoscopist at the median of outpatient colonoscopy volume (316/year) in the lowest ADR quintile of detection (7\%-19\%) would have an I-CRC attributed every 8.2 years, or 4.2 I-CRCs in a 35-year career, versus every 16.7 years, or 2.0 I-CRCs in a 35-year career, for an endoscopist in the highest ADR quintile (33\%-52\%).

CONCLUSIONS: An average-volume endoscopist will have 2 to 4 attributable I-CRCs in a 35-year career, but the frequency will vary depending on colonoscopy volume and ADR.},
	keywords = {Adenoma, Adult, Aged, Carcinoma, Colonoscopy, Colorectal Neoplasms, Early Detection of Cancer, Female, Gastroenterology, Humans, Incidence, Male, Middle Aged, Quality Indicators, Health Care},
	issn = {1097-6779},
	doi = {10.1016/j.gie.2018.05.012},
	author = {Ertem, Furkan U and Ladabaum, Uri and Ateev Mehrotra and Tehranian, Shahrzad and Shi, Zhuo and Saul, Melissa and Morris, Michele and Crockett, Seth D and Schoen, Robert E}
}
@article {696538,
	title = {Maryland{\textquoteright}s Hospital Global Budget Program},
	journal = {JAMA},
	volume = {320},
	number = {19},
	year = {2018},
	month = {2018 Nov 20},
	pages = {2040},
	keywords = {Budgets, Financial Management, Hospital, Maryland},
	issn = {1538-3598},
	doi = {10.1001/jama.2018.14370},
	author = {Roberts, Eric T and Ateev Mehrotra and Michael E. Chernew}
}
@article {696545,
	title = {National Rates of Initiation and Intensification of Antidiabetic Therapy Among Patients With Commercial Insurance},
	journal = {Diabetes Care},
	volume = {41},
	number = {8},
	year = {2018},
	month = {2018 Aug},
	pages = {1776-1782},
	abstract = {OBJECTIVE: Prompt initiation and intensification of antidiabetic therapy can delay or prevent complications from diabetes. We sought to understand the rates of and factors associated with the initiation and intensification of antidiabetic therapy among commercially insured patients in the U.S.

RESEARCH DESIGN AND METHODS: Using 2008-2015 commercial claims linked with laboratory and pharmacy data, we created an initiation cohort with no prior antidiabetic drug use and an HbA1c >=8\% (64 mmol/mol) and an intensification cohort of patients with an HbA1c >=8\% (64 mmol/mol) who were on a stable dose of one noninsulin diabetes drug. Using multivariable logistic regression, we determined the rates of and factors associated with initiation and intensification. In addition, we determined the percent of variation in treatment patterns explained by measurable patient factors.

RESULTS: In the initiation cohort (n = 9,799), 63\% of patients received an antidiabetic drug within 6 months of the elevated HbA1c test. In the intensification cohort (n = 10,941), 82\% had their existing antidiabetic therapy intensified within 6 months of the elevated HbA1c test. Higher HbA1c levels, lower generic drug copayments, and more frequent office visits were associated with higher rates of both initiation and intensification. Better patient adherence prior to the elevated HbA1c level, existing therapy with a second-generation antidiabetic drug, and lower doses of existing therapy were also associated with intensification. Patient factors explained 7.96\% of the variation in initiation and 7.35\% of the variation in intensification.

CONCLUSIONS: Approximately two-thirds of patients were newly initiated on antidiabetic therapy, and four-fifths of those already receiving antidiabetic therapy had it intensified within 6 months of an elevated HbA1c in a commercially insured population. Patient factors explain 7-8\% of the variation in diabetes treatment patterns.},
	keywords = {Adolescent, Adult, Aged, Diabetes Mellitus, Type 2, Dose-Response Relationship, Drug, Drug Therapy, Combination, Female, Glycated Hemoglobin, Humans, Hypoglycemic Agents, Insurance, Male, Metformin, Middle Aged, Retrospective Studies, United States, Young Adult},
	issn = {1935-5548},
	doi = {10.2337/dc17-2585},
	author = {Gilstrap, Lauren G and Ateev Mehrotra and Barbara Bai and Rose, Sherri and Blair, Rachel A and Michael E. Chernew}
}
@article {696555,
	title = {Physician characteristics associated with higher adenoma detection rate},
	journal = {Gastrointest Endosc},
	volume = {87},
	number = {3},
	year = {2018},
	month = {2018 Mar},
	pages = {778-786.e5},
	abstract = {BACKGROUND AND AIMS: Patients who receive a colonoscopy from a physician with a low adenoma detection rate (ADR) are at higher risk of subsequent colorectal cancer. It is unclear what drives the variation across physicians in ADR. We describe physician characteristics associated with higher ADR.

METHODS: In this retrospective cohort study a natural language processing system was used to analyze all outpatient colonoscopy examinations and their associated pathology reports from October 2013 to September 2015 for adults age 40 years and older across physicians from 4 diverse health systems. Physician performance on ADR was risk adjusted for differences in patient population and procedure indication. Our sample included 201 physicians performing at least 30 colonoscopy examinations during the study period, totaling 104,618 colonoscopy examinations.

RESULTS: The mean ADR was 33.2\% (range, 6.3\%-58.7\%). Higher ADR was seen among female physicians (4.2 percentage points higher than men, P~= .020), gastroenterologists (9.4 percentage points higher than nongastroenterologists, P~\&lt; .001), and physicians with~<=9 years since their residency completion (6.0 percentage points higher than physicians who have had 27-51 years of practice, P~= .004).

CONCLUSIONS: Gastroenterologists, female physicians, and more recently trained physicians had higher performance in adenoma detection.},
	keywords = {Adenoma, Adult, Aged, Clinical Competence, Cohort Studies, Colonoscopy, Colorectal Neoplasms, Female, Humans, Male, Middle Aged, Natural Language Processing, Physicians, Registries, Retrospective Studies},
	issn = {1097-6779},
	doi = {10.1016/j.gie.2017.08.023},
	author = {Ateev Mehrotra and Morris, Michele and Gourevitch, Rebecca A and Carrell, David S and Leffler, Daniel A and Rose, Sherri and Greer, Julia B and Crockett, Seth D and Baer, Andrew and Schoen, Robert E}
}
@article {696557,
	title = {Practices Caring For The Underserved Are Less Likely To Adopt Medicare{\textquoteright}s Annual Wellness Visit},
	journal = {Health Aff (Millwood)},
	volume = {37},
	number = {2},
	year = {2018},
	month = {2018 Feb},
	pages = {283-291},
	abstract = {In 2011 Medicare introduced the annual wellness visit to help address the health risks of aging adults. The visit also offers primary care practices an opportunity to generate revenue, and may allow practices in accountable care organizations to attract healthier patients while stabilizing patient-practitioner assignments. However, uptake of the visit has been uneven. Using national Medicare data for the period 2008-15, we assessed practices{\textquoteright} ability and motivation to adopt the visit. In 2015, 51.2~percent of practices provided no annual wellness visits (nonadopters), while 23.1~percent provided visits to at least a quarter of their eligible beneficiaries (adopters). Adopters replaced problem-based visits with annual wellness visits and saw increases in primary care revenue. Compared to nonadopters, adopters had more stable patient assignment and a slightly healthier patient mix. At the same time, visit rates were lower among practices caring for underserved populations (for example, racial minorities and those dually enrolled in Medicaid), potentially worsening disparities. Policy makers should consider ways to encourage uptake of the visit or other mechanisms to promote preventive care in underserved populations and the practices that serve them.},
	keywords = {Health Promotion, Humans, Insurance Claim Review, Medicare, Preventive Health Services, Primary Health Care, United States, Vulnerable Populations},
	issn = {1544-5208},
	doi = {10.1377/hlthaff.2017.1130},
	author = {Ganguli, Ishani and Souza, Jeffrey and J. Michael McWilliams and Ateev Mehrotra}
}
@article {696547,
	title = {Primary Care Practitioners{\textquoteright} Perceptions of Electronic Consult Systems: A Qualitative Analysis},
	journal = {JAMA Intern Med},
	volume = {178},
	number = {6},
	year = {2018},
	month = {2018 Jun 01},
	pages = {782-789},
	abstract = {IMPORTANCE: Safety-net health systems across the country are implementing electronic consult (eConsult) systems in which primary care practitioners (PCPs) submit all requests for specialty assistance electronically to be reviewed and discussed with specialists. Evidence suggests that eConsult systems can make significant improvements in specialty access, but the outcomes of these systems for frontline PCPs is poorly understood.

OBJECTIVE: To understand PCP perceptions of the results of eConsult initiation on PCP workflow, specialist access, and patient care.

DESIGN, SETTING, AND PARTICIPANTS: Qualitative interviews were conducted from December 1, 2016, to April 15, 2017, with 40 safety-net PCPs in Los Angeles County who use the Los Angeles County Department of Health Services (DHS) eConsult system. Interviewees were recruited to include diversity in PCP type, practice setting, and employer (DHS employed vs DHS affiliated). Participants were interviewed about their perceptions of clinical workflow, access to specialists, relationships with specialists, and referral decision making.

MAIN OUTCOMES AND MEASURES: Perceptions of the results of eConsult, including positive and negative themes and remaining perceived gaps in specialty care.

RESULTS: Of the 40 participants, 27 (68\%) were women; 24 (60\%) PCPs performed 5 or more eConsults per week. Primary care practitioners{\textquoteright} perceptions of eConsult clustered around 4 main themes: access and timeliness of specialty care, shift of work to PCPs, relationships with specialists, and eConsult interface issues. Many PCPs praised the improved timeliness of specialist input with eConsult, as well as the added clinical and educational value of dialogue with specialists, particularly compared with the limitations of the prior referral process. However, PCPs also consistently perceived that eConsult shifted some of the work of specialty care to them. Many PCPs believed that this extra burden was worth the effort given the benefits of eConsult, such as improved timeliness of care and ability to manage specialty conditions. In contrast, others were frustrated by the increased administrative burden, broadened clinical responsibility, and restructuring of specialty care delivery.

CONCLUSIONS AND RELEVANCE: While associated with improved specialty care access, eConsult systems simultaneously created new challenges for PCPs, such as an increased burden of work in providing specialty care. Primary care practitioners varied in their enthusiasm for these workflow changes with diverging perceptions of the same processes. Our findings provide insights on challenges future primary care transformation efforts may face.},
	keywords = {Attitude of Health Personnel, Female, Humans, Male, Primary Health Care, Remote Consultation},
	issn = {2168-6114},
	doi = {10.1001/jamainternmed.2018.0738},
	author = {Lee, Michelle S and Ray, Kristin N and Ateev Mehrotra and Giboney, Paul and Yee, Hal F and Michael L. Barnett}
}
@article {696551,
	title = {Promise and Reality of Price Transparency},
	journal = {N Engl J Med},
	volume = {378},
	number = {14},
	year = {2018},
	month = {2018 Apr 05},
	pages = {1348-1354},
	keywords = {Commerce, Cost Savings, Cost Sharing, Deductibles and Coinsurance, Health Care Costs, Insurance, Health, United States},
	issn = {1533-4406},
	doi = {10.1056/NEJMhpr1715229},
	author = {Ateev Mehrotra and Michael E. Chernew and Anna D. Sinaiko}
}
@article {696535,
	title = {Quality Of Care For Acute Respiratory Infections During Direct-To-Consumer Telemedicine Visits For Adults},
	journal = {Health Aff (Millwood)},
	volume = {37},
	number = {12},
	year = {2018},
	month = {2018 Dec},
	pages = {2014-2023},
	abstract = {In direct-to-consumer telemedicine, physicians treat patients through real-time audiovisual conferencing for common conditions such as acute respiratory infections. Early studies had mixed findings on the quality of care provided during direct-to-consumer telemedicine and were limited by small sample sizes and narrow geographic scopes. Using claims data for 2015-16 from a large national commercial insurer, we examined the quality of antibiotic management in adults with acute respiratory infection diagnoses at 38,839 direct-to-consumer telemedicine visits, compared to the quality at 942,613 matched primary care visits and 186,016 matched urgent care visits. In the matched analyses, we found clinically similar rates of antibiotic use, broad-spectrum antibiotic use, and guideline-concordant antibiotic management. However, direct-to-consumer telemedicine visits had less appropriate streptococcal testing and a higher frequency of follow-up visits. These results suggest specific opportunities for improvement in direct-to-consumer telemedicine quality.},
	keywords = {Adult, Ambulatory Care, Anti-Bacterial Agents, Delivery of Health Care, Female, Health Services Accessibility, Humans, Insurance Claim Review, Male, Middle Aged, Practice Patterns, Physicians{\textquoteright}, Primary Health Care, Quality of Health Care, Remote Consultation, Respiratory Tract Infections, Retrospective Studies, Young Adult},
	issn = {1544-5208},
	doi = {10.1377/hlthaff.2018.05091},
	author = {Shi, Zhuo and Ateev Mehrotra and Gidengil, Courtney A and Poon, Sabrina J and Uscher-Pines, Lori and Ray, Kristin N}
}
@article {696537,
	title = {Trends in Telemedicine Use in a Large Commercially Insured Population, 2005-2017},
	journal = {JAMA},
	volume = {320},
	number = {20},
	year = {2018},
	month = {2018 Nov 27},
	pages = {2147-2149},
	keywords = {Humans, Medicare Part C, Mental Health Services, Physicians, Primary Health Care, Regression Analysis, Telemedicine, United States},
	issn = {1538-3598},
	doi = {10.1001/jama.2018.12354},
	author = {Michael L. Barnett and Ray, Kristin N and Souza, Jeff and Ateev Mehrotra}
}
@article {696541,
	title = {Trends in Visits to Acute Care Venues for Treatment of Low-Acuity Conditions in the United States From 2008 to 2015},
	journal = {JAMA Intern Med},
	volume = {178},
	number = {10},
	year = {2018},
	month = {2018 Oct 01},
	pages = {1342-1349},
	abstract = {IMPORTANCE: Over the past 2 decades, a variety of new care options have emerged for acute care, including urgent care centers, retail clinics, and telemedicine. Trends in the utilization of these newer care venues and the emergency department (ED) have not been characterized.

OBJECTIVE: To describe trends in visits to different acute care venues, including urgent care centers, retail clinics, telemedicine, and EDs, with a focus on visits for treatment of low-acuity conditions.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used deidentified health plan claims data from Aetna, a large, national, commercial health plan, from January 1, 2008, to December 31, 2015, with approximately 20 million insured members per study year. Descriptive analysis was performed for health plan members younger than 65 years. Data analysis was performed from December 28, 2016, to February 20, 2018.

MAIN OUTCOMES AND MEASURES: Utilization, inflation-adjusted price, and spending associated with visits for treatment of low-acuity conditions. Low-acuity conditions were identified using diagnosis codes and included acute respiratory infections, urinary tract infections, rashes, and musculoskeletal strains.

RESULTS: This study included 20.6 million acute care visits for treatment of low-acuity conditions over the 8-year period. Visits to the ED for the treatment of low-acuity conditions decreased by 36\% (from 89 visits per 1000 members in 2008 to 57 visits per 1000 members in 2015), whereas use of non-ED venues increased by 140\% (from 54 visits per 1000 members in 2008 to 131 visits per 1000 members in 2015). There was an increase in visits to all non-ED venues: urgent care centers (119\% increase, from 47 visits per 1000 members in 2008 to 103 visits per 1000 members in 2015), retail clinics (214\% increase, from 7 visits per 1000 members in 2008 to 22 visits per 1000 members in 2015), and telemedicine (from 0 visits in 2008 to 6 visits per 1000 members in 2015). Utilization and spending per person per year for low-acuity conditions had net increases of 31\% (from 143 visits per 1000 members in 2008 to 188 visits per 1000 members in 2015) and 14\% ($70 per member in 2008 to $80 per member in 2015), respectively. The increase in spending was primarily driven by a 79\% increase in price per ED visit for treatment of low-acuity conditions (from $914 per visit in 2008 to $1637 per visit in 2015).

CONCLUSIONS AND RELEVANCE: From 2008 to 2015, total acute care utilization for the treatment of low-acuity conditions and associated spending per member increased, and utilization of non-ED acute care venues increased rapidly. These findings suggest that patients are more likely to visit urgent care centers than EDs for the treatment of low-acuity conditions.},
	keywords = {Acute Disease, Adolescent, Adult, Ambulatory Care Facilities, Child, Child, Preschool, Emergency Service, Hospital, Female, Humans, Infant, Infant, Newborn, Insurance, Health, Male, Middle Aged, Patient Acceptance of Health Care, Telemedicine, United States, Young Adult},
	issn = {2168-6114},
	doi = {10.1001/jamainternmed.2018.3205},
	author = {Poon, Sabrina J and Schuur, Jeremiah D and Ateev Mehrotra}
}
@article {696554,
	title = {Variation in Pathologist Classification of Colorectal Adenomas and Serrated Polyps},
	journal = {Am J Gastroenterol},
	volume = {113},
	number = {3},
	year = {2018},
	month = {2018 Mar},
	pages = {431-439},
	abstract = {OBJECTIVES: Endoscopist quality measures such as adenoma detection rate (ADR) and serrated polyp detection rates (SPDRs) depend on pathologist classification of histology. Although variation in pathologic interpretation is recognized, we add to the literature by quantifying the impact of pathologic variability on endoscopist performance.

METHODS: We used natural language processing to abstract relevant data from colonoscopy and related pathology reports performed over 2 years at four clinical sites. We quantified each pathologist{\textquoteright}s likelihood of classifying polyp specimens as adenomas or serrated polyps. We estimated the impact on endoscopists{\textquoteright} ADR and SPDR of sending their specimens to pathologists with higher or lower classification rates.

RESULTS: We observed 85,526 colonoscopies performed by 119 endoscopists; 50,453 had a polyp specimen, which were analyzed by 48 pathologists. There was greater variation across pathologists in classification of serrated polyps than in classification of adenomas. We estimate the endoscopist{\textquoteright}s average SPDR would be 0.5\% if all their specimens were analyzed by the pathologist in our sample with the lowest classification rate and 12.0\% if all their specimens were analyzed by the pathologist with the highest classification rate. In contrast, the endoscopist{\textquoteright}s average ADR would be 28.5\% and 42.4\% if their specimens were analyzed by the pathologist with lowest and highest classification rate, respectively.

CONCLUSIONS: There is significant variation in pathologic interpretation, which more substantially affects endoscopist SPDR than ADR.},
	issn = {1572-0241},
	doi = {10.1038/ajg.2017.496},
	author = {Gourevitch, Rebecca A and Rose, Sherri and Crockett, Seth D and Morris, Michele and Carrell, David S and Greer, Julia B and Pai, Reetesh K and Schoen, Robert E and Ateev Mehrotra}
}
@article {635807,
	title = {Variation in Pathologist Classification of Colorectal Adenomas and Serrated Polyps},
	journal = {Am J Gastroenterol},
	volume = {113},
	number = {3},
	year = {2018},
	pages = {431-439},
	abstract = {OBJECTIVES:Endoscopist quality measures such as\&nbsp;adenoma\&nbsp;detection rate (ADR) and\&nbsp;serrated\&nbsp;polyp detection rates (SPDRs) depend on\&nbsp;pathologist\&nbsp;classification\&nbsp;of histology. Although\&nbsp;variation\&nbsp;in pathologic interpretation is recognized, we add to the literature by quantifying the impact of pathologic variability on endoscopist performance.METHODS:We used natural language processing to abstract relevant data from colonoscopy and related pathology reports performed over 2 years at four clinical sites. We quantified each\&nbsp;pathologist{\textquoteright}s likelihood of classifying polyp specimens as\&nbsp;adenomas\&nbsp;or\&nbsp;serrated\&nbsp;polyps. We estimated the impact on endoscopists{\textquoteright} ADR and SPDR of sending their specimens to\&nbsp;pathologists\&nbsp;with higher or lower\&nbsp;classification\&nbsp;rates.RESULTS:We observed 85,526 colonoscopies performed by 119 endoscopists; 50,453 had a polyp specimen, which were analyzed by 48\&nbsp;pathologists. There was greater\&nbsp;variation\&nbsp;across\&nbsp;pathologists\&nbsp;in\&nbsp;classification\&nbsp;of\&nbsp;serrated\&nbsp;polyps\&nbsp;than in\&nbsp;classification\&nbsp;of\&nbsp;adenomas. We estimate the endoscopist{\textquoteright}s average SPDR would be 0.5\% if all their specimens were analyzed by the\&nbsp;pathologist\&nbsp;in our sample with the lowest\&nbsp;classification\&nbsp;rate and 12.0\% if all their specimens were analyzed by the\&nbsp;pathologist\&nbsp;with the highest\&nbsp;classification\&nbsp;rate. In contrast, the endoscopist{\textquoteright}s average ADR would be 28.5\% and 42.4\% if their specimens were analyzed by the\&nbsp;pathologist\&nbsp;with lowest and highest\&nbsp;classification\&nbsp;rate, respectively.CONCLUSIONS:There is significant\&nbsp;variation\&nbsp;in pathologic interpretation, which more substantially affects endoscopist SPDR than ADR.},
	author = {137.	Gourevitch RA, Rose S, Crockett SD, Morris M, Carrell DS, Greer JB, Pai RK, Schoen RE, Mehrotra A}
}
@article {696544,
	title = {Virtual First Responders: the Role of Direct-to-Consumer Telemedicine in Caring for People Impacted by Natural Disasters},
	journal = {J Gen Intern Med},
	volume = {33},
	number = {8},
	year = {2018},
	month = {2018 Aug},
	pages = {1242-1244},
	keywords = {Cyclonic Storms, Disaster medicine, Emergency Responders, Humans, Natural Disasters, Telemedicine},
	issn = {1525-1497},
	doi = {10.1007/s11606-018-4440-8},
	author = {Uscher-Pines, Lori and Fischer, Shira and Tong, Ian and Ateev Mehrotra and Malsberger, Rosalie and Ray, Kristin}
}
@article {635816,
	title = {Virtual First Responders: the Role of Direct-to-Consumer Telemedicine in Caring for People Impacted by Natural Disasters},
	journal = {J Gen Intern Med },
	volume = {33},
	number = {8},
	year = {2018},
	pages = {1242-1244},
	author = {146.	Uscher-Pines L, Fischer S, Tong I, Mehrotra A, Malsberger R, Ray K}
}
@article {635809,
	title = {Adenoma Detection Rate Falls at the End of the Day in a Large Multi-site Sample},
	journal = {Dig Dis Sci},
	volume = {63},
	number = {4},
	year = {2018},
	pages = {856-859},
	abstract = {BACKGROUND:There is concern that mental and physical fatigue among endoscopists over the course of the\&nbsp;day\&nbsp;will lead to lower\&nbsp;adenoma\&nbsp;detection\&nbsp;rate\&nbsp;(ADR). There are mixed findings in the prior literature on whether such an association exists.AIMS:The aim of this study was to measure the association between the number of colonoscopies performed in a\&nbsp;day\&nbsp;and ADR and withdrawal time.METHODS:We analyzed 86,624 colonoscopy and associated pathology reports between October 2013 and September 2015 from 131 physicians at two medical centers. A previously validated natural language processing program was used to abstract relevant data. We identified the order of colonoscopies performed in the physicians{\textquoteright} schedule and calculated the ADR and withdrawal time for each colonoscopy position.RESULTS:The ADR for our overall\&nbsp;sample\&nbsp;was 29.9 (CI 29.6-30.2). The ADR for colonoscopies performed at the 9th\&nbsp;+\&nbsp;position was significantly lower than those at the 1st-4th or 5th-8th position, 27.2 (CI 25.8-28.6) versus 29.9 (CI 29.5-30.3), 30.2 (CI 29.6-30.9), respectively. Withdrawal time steadily decreased by colonoscopy position going from 11.6 (CI 11.4-11.9)\&nbsp;min for the 1st colonoscopy to 9.6 (8.9-10.3)\&nbsp;min for the 9th colonoscopy.CONCLUSION:In our study population, ADR and withdrawal time decrease by roughly 7 and 20\%, respectively, by the\&nbsp;end\&nbsp;of the\&nbsp;day. Our results imply that rather than mental or physical fatigue, lower ADR at the\&nbsp;end\&nbsp;of the\&nbsp;day\&nbsp;might be driven by endoscopists rushing.},
	author = {Marcondes FO and Gourevitch RA and Schoen RE and Crockett SD and Morris M and Mehrotra A}
}
@article {635805,
	title = {Changes in Health Care Use Associated With the Introduction of Hospital Global Budgets in Maryland},
	journal = {JAMA Internal Medicine },
	volume = {178},
	number = {2},
	year = {2018},
	pages = {260-268},
	abstract = {IMPORTANCE:In 2014, the State of\&nbsp;Maryland\&nbsp;placed the majority of its hospitals under all-payer\&nbsp;global\&nbsp;budgets\&nbsp;for inpatient,\&nbsp;hospitaloutpatient, and emergency department\&nbsp;care. Goals of the program included reducing unnecessary\&nbsp;hospital\&nbsp;utilization and encouraging greater use of primary\&nbsp;care.OBJECTIVE:To compare\&nbsp;changes\&nbsp;in\&nbsp;hospital\&nbsp;and primary\&nbsp;care\&nbsp;use through the first 2 years of\&nbsp;Maryland{\textquoteright}s\&nbsp;hospital\&nbsp;global\&nbsp;budget program among fee-for-service Medicare beneficiaries in\&nbsp;Maryland\&nbsp;vs matched control areas.DESIGN, SETTING, AND PARTICIPANTS:We matched 8\&nbsp;Maryland\&nbsp;counties (94 967 beneficiaries) with hospitals in the program to 27 non-Maryland\&nbsp;control counties (206 389 beneficiaries). Using difference-in-differences analysis, we compared\&nbsp;changes\&nbsp;in\&nbsp;hospital\&nbsp;and primary\&nbsp;care\&nbsp;use in\&nbsp;Maryland\&nbsp;vs the control counties from before (2009-2013) to after (2014-2015) the payment change, using 2 different assumptions. First, we assumed that preintervention differences between\&nbsp;Maryland\&nbsp;and the control counties would have remained constant past 2014 had\&nbsp;Maryland\&nbsp;not implemented\&nbsp;global\&nbsp;budgets\&nbsp;(parallel trend assumption). Second, we assumed that differences in preintervention trends would have continued without the payment change (differential trend assumption).MAIN OUTCOMES AND MEASURES:Hospital\&nbsp;stays (defined as admissions and observation stays); return\&nbsp;hospital\&nbsp;stays within 30 days of a prior\&nbsp;hospital\&nbsp;stay; emergency department visits that did not result in admission; price-standardized\&nbsp;hospital\&nbsp;outpatient department (HOPD) utilization; and visits with primary\&nbsp;care\&nbsp;physicians (overall and within 7 days of a\&nbsp;hospital\&nbsp;stay).RESULTS:We matched 8\&nbsp;Maryland\&nbsp;counties with hospitals in the program (94 967 beneficiaries; 41.8\% male; mean [SD] age, 72.3 [12.2] years) to 27 non-Maryland\&nbsp;control counties (206 389 beneficiaries; 42.8\% male; mean [SD] age, 71.7 [12.5] years). Assuming parallel trends, we estimated a differential change in\&nbsp;Maryland\&nbsp;of -0.47 annual\&nbsp;hospital\&nbsp;stays per 100 beneficiaries (95\% CI, -1.65 to 0.72; P = .43) from the preintervention period (2009-2013) to 2015, but assuming differential trends, we estimated a differential change in\&nbsp;Maryland\&nbsp;of -1.24 stays per 100 beneficiaries (95\% CI, -2.46 to -0.02; P = .047). Assuming parallel trends, we found a significant increase in primary\&nbsp;care\&nbsp;visits (+10.6 annual visits/100 beneficiaries; 95\% CI, 4.6 to 16.6 annual visits/100 beneficiaries; P = .001), but assuming differential trends, we found no change (-0.8 visits/100 beneficiaries; 95\% CI, -10.6 to 9.0 visits/100 beneficiaries; P = .87). Comparing estimates with both trend assumptions, we found no consistent\&nbsp;changes\&nbsp;in emergency department visits, return\&nbsp;hospital\&nbsp;stays, HOPD use, or posthospitalization primary\&nbsp;care\&nbsp;visits\&nbsp;associated\&nbsp;with\&nbsp;Maryland{\textquoteright}s program.CONCLUSIONS AND RELEVANCE:We did not find consistent evidence that\&nbsp;Maryland{\textquoteright}s\&nbsp;hospital\&nbsp;global\&nbsp;budget program was\&nbsp;associated\&nbsp;with reductions in\&nbsp;hospital\&nbsp;use or increases in primary\&nbsp;care\&nbsp;visits among fee-for-service Medicare beneficiaries after 2 years. Evaluations over longer periods should be pursued.},
	author = {Roberts ET and McWilliams JM and Hatfield LA and Gerovich S and Chernew ME and Gilstrap LG and Mehrotra A}
}
@article {635812,
	title = {Changes in hospital bond ratings after the transition to a new electronic health record},
	journal = {J Am Med Inform Assoc},
	volume = {25},
	number = {5},
	year = {2018},
	pages = {572-574},
	abstract = {OBJECTIVE:To assess the impact of\&nbsp;electronic\&nbsp;health\&nbsp;record\&nbsp;(EHR) implementation on\&nbsp;hospital\&nbsp;finances.MATERIALS AND METHODS:We analyzed the impact of EHR implementation on\&nbsp;bond\&nbsp;ratings\&nbsp;and net income from service to patients (NISP) at 32 hospitals that recently implemented a\&nbsp;new\&nbsp;EHR and a set of controls.RESULTS:After\&nbsp;implementing an EHR, 7 hospitals had a\&nbsp;bond\&nbsp;downgrade, 7 had a\&nbsp;bond\&nbsp;upgrade, and 18 had no\&nbsp;changes. There was no difference in the likelihood of\&nbsp;bond\&nbsp;rating\&nbsp;changes\&nbsp;or in\&nbsp;changes\&nbsp;to NISP following EHR go-live when compared to control hospitals.DISCUSSION:Most hospitals in our analysis saw no change in\&nbsp;bond\&nbsp;ratings\&nbsp;following EHR go-live, with no significant differences observed between EHR implementation and control hospitals. There was also no apparent difference in NISP.CONCLUSIONS:Implementation of an EHR did not appear to have an impact on\&nbsp;bond\&nbsp;ratings\&nbsp;at the hospitals in our analysis.},
	author = {McEvoy D and Ml, Barnett and Sittig DF and Aaron S and Mehrotra A and Wright A}
}
@article {635815,
	title = {Does Enrollment in High-Deductible Health Plans Encourage Price Shopping?.},
	journal = {Heatlh Serv Res },
	volume = {53},
	number = {Suppl 1},
	year = {2018},
	pages = {2718-2734},
	abstract = {OBJECTIVE:To investigate whether\&nbsp;enrollment\&nbsp;in\&nbsp;high-deductible\&nbsp;health plans\&nbsp;(HDHPs) led enrollees to choose lower-priced providers for office visits and laboratory tests.STUDY SETTING:Claims data from more than 40 large employers.STUDY DESIGN:We compared the change in\&nbsp;price\&nbsp;for office visits and laboratory tests for enrollees who switched to HDHPs versus enrollees who remained in traditional\&nbsp;plans. We estimated separate models for enrollees who changed providers versus those who remained with the same provider to disentangle the effects of HDHPs on provider choice and negotiated prices.DATA COLLECTION:Claims data from 2004 to 2010 on 1.8 million enrollees.PRINCIPAL FINDINGS:After\&nbsp;enrollment\&nbsp;in HDHPs, 28 percent of enrollees changed physicians for office visits (compared to 19 percent in the Traditional Plan group, p\&nbsp;\&lt;\&nbsp;.01); however, this did not result in a statistically significant reduction in\&nbsp;price\&nbsp;for office visits. About 25 percent of enrollees changed providers for laboratory tests (compared to 23 percent in the Traditional Plan group, p\&nbsp;\&lt;\&nbsp;.01), resulting in savings of about $2.09 or a 12.8 percent reduction in\&nbsp;price\&nbsp;per laboratory test. We found that HDHPs had lower negotiated prices for office visits but not for laboratory tests.CONCLUSIONS:High-deductible\&nbsp;health\&nbsp;plan\&nbsp;enrollment\&nbsp;may shift enrollees to lower cost providers, resulting in modest savings.},
	author = {Zhang X and Haviland A and Mehrotra A and Huckfeldt P and Wagner Z and Sood N}
}
@article {635813,
	title = {The Effect of Telehealth on Spending: Thinking Through the Numbers},
	journal = {Ann Internal Med },
	volume = {168},
	number = {10},
	year = {2018},
	pages = {737-738},
	author = {Licurse AM and Mehrotra A}
}
@article {635820,
	title = {Endoscopist factors that influence serrated polyp detection: a multicenter study. Endoscopy},
	journal = {Endoscopy},
	volume = {50},
	number = {10},
	year = {2018},
	pages = {984-992},
	abstract = {BACKGROUND:Serrated\&nbsp;polyps\&nbsp;are important colorectal cancer precursors that are variably detected during colonoscopy. We measured\&nbsp;serrated\&nbsp;polyp\&nbsp;detection\&nbsp;rate (SPDR) in a large, multicenter, cross-sectional study of colonoscopy quality to identify drivers of SPDR variation.METHODS:Colonoscopy and pathology reports were collected for a 2-year period (10/2013-9/2015) from four sites across the United States. Data from reports, including size, location, and histology of\&nbsp;polyps, were abstracted using a validated natural language processing algorithm. SPDR was defined as the proportion of colonoscopies with >= 1\&nbsp;serrated\&nbsp;polyp\&nbsp;(not including hyperplastic\&nbsp;polyps). Multivariable logistic regression was performed to determine\&nbsp;endoscopist\&nbsp;characteristics associated with\&nbsp;serrated\&nbsp;polyp\&nbsp;detection.RESULTS:A total of 104 618 colonoscopies were performed by 201 endoscopists who varied with respect to specialty (86 \% were gastroenterologists), sex (18 \% female), years in practice (range 1 - 51), and number of colonoscopies performed during the study period (range 30 - 2654). The overall mean SPDR was 5.1 \% (SD 3.8 \%, range 0 - 18.8 \%). In multivariable analysis, gastroenterology specialty training (odds ratio [OR] 1.89, 95 \% confidence interval [CI] 1.33 - 2.70), fewer years in practice (<= 9 years vs. >= 27 years: OR 1.52, 95 \%CI 1.14 - 2.04)], and higher procedure volumes (highest vs. lowest quartile: OR 1.77, 95 \%CI 1.27 - 2.46)] were independently associated with\&nbsp;serrated\&nbsp;polyp\&nbsp;detection.CONCLUSIONS:Gastroenterology specialization, more recent completion of training, and greater procedure volume are associated with\&nbsp;serrated\&nbsp;polyp\&nbsp;detection. These findings imply that both repetition and training are likely to be important contributors to adequate\&nbsp;detection\&nbsp;of these important cancer precursors. Additional efforts to improve SPDR are needed.},
	author = {Crockett SD and Gourevitch RA and Morris M and Carrell DS and Rose S and Shi Z and Greer JB and Schoen RE and Mehrotra A}
}
@article {635818,
	title = {A Health Plan{\textquoteright}s Formulary Led To Reduced Use Of Extended-Release Opioids But Did Not Lower Overall Opioid Use},
	journal = {Health Aff (Millwood)},
	volume = {37},
	number = {9},
	year = {2018},
	pages = {1509-1516},
	abstract = {Many insurers are using\&nbsp;formulary\&nbsp;design to influence\&nbsp;opioid\&nbsp;prescribing, but it is unclear if these changes lead to\&nbsp;reduced\&nbsp;use or just substitution between\&nbsp;opioids. We evaluated the effect of a new prior authorization process implemented in July\&nbsp;2015 for\&nbsp;extended-release(ER) oxycodone by Blue Shield of California. Compared to other commercially insured Californians, among 880,000 Blue Shield enrollees, there was a 36\&nbsp;percent drop in monthly rates of ER\&nbsp;opioid\&nbsp;initiation relative to control-group members, driven entirely by decreases in ER oxycodone initiation and without any substitution toward other ER\&nbsp;opioids. This reduction was offset by a 1.4\&nbsp;percent relative increase in the rate of short-acting\&nbsp;opioid\&nbsp;fills. There was no significant change in the overall use of any\&nbsp;opioids\&nbsp;prescribed, measured as morphine milligram equivalents. This suggests that though insurers can play a meaningful role in reducing the prescribing of high-risk ER\&nbsp;opioids, a\&nbsp;formularychange focused on ER\&nbsp;opioids\&nbsp;alone is insufficient to decrease total\&nbsp;opioid\&nbsp;prescribing.},
	author = {Ml, Barnett and Olenski AR and Thygeson NM and Ishisaka D and Wong S and Jena AB and Mehrotra A}
}
@article {635811,
	title = {Impact of Implementation of Electronically Transmitted Referrals on Pediatric Subspecialty Visit Attendance},
	journal = {Acad Pediatr},
	volume = {18},
	number = {4},
	year = {2018},
	pages = {409-417},
	abstract = {OBJECTIVE:One barrier to timely access to outpatient\&nbsp;pediatric\&nbsp;subspecialty\&nbsp;care is the complexity of scheduling processes. We evaluated the\&nbsp;impact\&nbsp;of implementing\&nbsp;electronically\&nbsp;transmitted\&nbsp;referrals\&nbsp;on\&nbsp;subspecialty\&nbsp;visit\&nbsp;attendance.METHODS:Through collaboration with stakeholders, an\&nbsp;electronically\&nbsp;transmitted\&nbsp;referral order system was designed, piloted, and implemented in 15 general pediatrics practices, with 24 additional practices serving as controls. We used statistical process control methods and difference-in-differences analysis to examine visits attended, appointments scheduled, appointment nonattendance, and referral volume.\&nbsp;Electronically\&nbsp;transmitted\&nbsp;referrals\&nbsp;then were expanded to all 39 practices. We surveyed referring pediatricians at all practices before and after\&nbsp;implementation.RESULTS:From April 2015 through September 2016 there were 33,485 referral orders across all practices (7770 before the pilot, 11,776 during the pilot, 13,939 after full\&nbsp;implementation). At pilot practices, there was a significant and sustained improvement in\&nbsp;subspecialty\&nbsp;visits attended within 4 weeks of referral (10.9\% to 20.0\%; P \&lt; .001). Relative to control practices, pilot practices experienced an 8.6\% improvement (P = .001). After\&nbsp;implementation\&nbsp;at control practices, rates of visits attended also improved but to a smaller degree: 11.8\% to 14.7\% (P \&lt; .001). In survey responses, referring pediatricians noted improved scheduling processes but had continued concerns with appointment availability and referral tracking.CONCLUSIONS:While\&nbsp;electronically\&nbsp;transmitted\&nbsp;referrals\&nbsp;improved\&nbsp;visit\&nbsp;attendance\&nbsp;after\&nbsp;pediatric\&nbsp;subspecialty\&nbsp;referral, the sizable percentage of children without attended visits, the muted effect at control practices, and pediatrician survey responses indicate that additional work is needed to address barriers to\&nbsp;pediatric\&nbsp;subspecialty\&nbsp;care.Copyright {\textcopyright} 2018 Academic\&nbsp;Pediatric\&nbsp;Association. Published by Elsevier Inc. All rights reserved.},
	author = {Ray KN and Drnach M and Mehrotra A and Suresh S and Docimo SG}
}
@article {635808,
	title = {In Hospital Utilization Three Years Into Maryland{\textquoteright}s Global Budget Program For Rural Hospitals},
	journal = {Health Aff (Millwood)},
	volume = {37},
	number = {4},
	year = {2018},
	pages = {664-653},
	abstract = {In a substantial shift in payment policy, the State of Maryland implemented a\&nbsp;global\&nbsp;budget\&nbsp;program\&nbsp;for acute care\&nbsp;hospitals\&nbsp;in 2010. Goals of the\&nbsp;program\&nbsp;include controlling\&nbsp;hospital\&nbsp;use and spending. Eight\&nbsp;rural\&nbsp;hospitals\&nbsp;entered the\&nbsp;program\&nbsp;in 2010, while urban and suburban\&nbsp;hospitals\&nbsp;joined in 2014. Prior analyses, which focused on urban and suburban\&nbsp;hospitals, did not find consistent evidence that\&nbsp;Maryland{\textquoteright}sprogram\&nbsp;had contributed to changes in\&nbsp;hospital\&nbsp;use after two\&nbsp;years. However, these studies were limited by short follow-up periods, may have failed to isolate impacts of\&nbsp;Maryland{\textquoteright}s\&nbsp;payment change from other state trends, and had limited generalizability to\&nbsp;rural\&nbsp;settings. To understand the effects of\&nbsp;Maryland{\textquoteright}s\&nbsp;global\&nbsp;budget\&nbsp;program\&nbsp;on\&nbsp;rural\&nbsp;hospitals, we compared changes in\&nbsp;hospital\&nbsp;use among Medicare beneficiaries served by affected\&nbsp;rural\&nbsp;hospitals\&nbsp;versus an in-state control population from before to after 2010. By 2013-three\&nbsp;years\&nbsp;after the\&nbsp;rural\&nbsp;program\&nbsp;began-there were no differential changes in acute\&nbsp;hospital\&nbsp;use or price-standardized\&nbsp;hospital\&nbsp;spending among beneficiaries served by the affected\&nbsp;hospitals, versus the within-state control group. Our results suggest that among Medicare beneficiaries,\&nbsp;global\&nbsp;budgets in\&nbsp;rural\&nbsp;Maryland\&nbsp;hospitals\&nbsp;did not reduce\&nbsp;hospital\&nbsp;use or price-standardized spending as policy makers had anticipated.},
	author = {Roberts ET and Hatfield LA and McWilliams JM and Chernew ME and Done N and Gerovich S and Gilstrap L and Mehrotra A}
}
@article {635821,
	title = {Incidence of interval colorectal cancer attributable to an endoscopist in clinical practice},
	journal = {Gastrointest Endosc},
	volume = {88},
	number = {4},
	year = {2018},
	pages = {705-711},
	abstract = {BACKGROUND AND AIMS:Endoscopists who encounter an\&nbsp;interval\&nbsp;colorectal\&nbsp;cancer\&nbsp;(I-CRC) may be concerned about the implications because I-CRCs may represent a lapse in colonoscopy quality and a missed opportunity for prevention. We wanted to determine the I-CRC rate per colonoscopy examination and to examine the effect of colonoscopy volume and adenoma detection rate (ADR) on the number of I-CRCs\&nbsp;attributable\&nbsp;to an\&nbsp;endoscopist.METHODS:We determined the rate of I-CRC diagnosis per outpatient colonoscopy examination by measuring the\&nbsp;incidence\&nbsp;of CRC diagnosis in\&nbsp;practice\&nbsp;and by assessing, via literature review, the percentage of cancers that are\&nbsp;interval. We also estimated the number of\&nbsp;attributable\&nbsp;I-CRCs as a function of ADR and colonoscopy volume.RESULTS:Among 93,562 colonoscopies performed in 2013 to 2015 by 120 physicians in 4 diverse U.S. medical centers, 526 CRCs were diagnosed (.6\%). Of 149,556 CRCs in the published literature, 7958 were I-CRCs (5.25\% {\textpm} .94\%). With rates of .6\% (CRC per colonoscopy) and 5.25\% (I-CRC per CRC), the rate of I-CRC is 1 per 3174 colonoscopies (95\% confidence\&nbsp;interval, 1 per 2710 to 1 per 3875). An\&nbsp;endoscopist\&nbsp;at the median of outpatient colonoscopy volume (316/year) in the lowest ADR quintile of detection (7\%-19\%) would have an I-CRC attributed every 8.2 years, or 4.2 I-CRCs in a 35-year career, versus every 16.7 years, or 2.0 I-CRCs in a 35-year career, for an\&nbsp;endoscopist\&nbsp;in the highest ADR quintile (33\%-52\%).CONCLUSIONS:An average-volume\&nbsp;endoscopist\&nbsp;will have 2 to 4\&nbsp;attributable\&nbsp;I-CRCs in a 35-year career, but the frequency will vary depending on colonoscopy volume and ADR.},
	author = {Ertem FU and Ladabaum U and Mehrotra A and Tehranian S and Shi Z and Saul M and Morris M and Crockett SD and Schoen RE}
}
@article {635817,
	title = {National Rates of Initiation and Intensification of Antidiabetic Therapy Among Patients With Commercial Insurance},
	journal = {Diabetes Care },
	volume = {41},
	number = {8},
	year = {2018},
	pages = {1776-1782},
	abstract = {OBJECTIVE:Prompt\&nbsp;initiation\&nbsp;and\&nbsp;intensification\&nbsp;of\&nbsp;antidiabetic\&nbsp;therapy\&nbsp;can delay or prevent complications from diabetes. We sought to understand the\&nbsp;rates\&nbsp;of and factors associated with the\&nbsp;initiation\&nbsp;and\&nbsp;intensification\&nbsp;of\&nbsp;antidiabetic\&nbsp;therapy\&nbsp;among commercially insured\&nbsp;patients\&nbsp;in the U.S.RESEARCH DESIGN AND METHODS:Using 2008-2015\&nbsp;commercial\&nbsp;claims linked with laboratory and pharmacy data, we created an\&nbsp;initiation\&nbsp;cohort with no prior\&nbsp;antidiabetic\&nbsp;drug use and an HbA1c\&nbsp;>=8\% (64 mmol/mol) and an\&nbsp;intensification\&nbsp;cohort of\&nbsp;patients\&nbsp;with an HbA1c>=8\% (64 mmol/mol) who were on a stable dose of one noninsulin diabetes drug. Using multivariable logistic regression, we determined the\&nbsp;rates\&nbsp;of and factors associated with\&nbsp;initiation\&nbsp;and\&nbsp;intensification. In addition, we determined the percent of variation in treatment patterns explained by measurable patient factors.RESULTS:In the\&nbsp;initiation\&nbsp;cohort (n\&nbsp;= 9,799), 63\% of\&nbsp;patients\&nbsp;received an\&nbsp;antidiabetic\&nbsp;drug within 6 months of the elevated HbA1c\&nbsp;test. In the\&nbsp;intensification\&nbsp;cohort (n\&nbsp;= 10,941), 82\% had their existing\&nbsp;antidiabetic\&nbsp;therapy\&nbsp;intensified within 6 months of the elevated HbA1c\&nbsp;test. Higher HbA1c\&nbsp;levels, lower generic drug copayments, and more frequent office visits were associated with higher\&nbsp;rates\&nbsp;of both\&nbsp;initiation\&nbsp;and\&nbsp;intensification. Better patient adherence prior to the elevated HbA1c\&nbsp;level, existing\&nbsp;therapy\&nbsp;with a second-generation\&nbsp;antidiabetic\&nbsp;drug, and lower doses of existing\&nbsp;therapy\&nbsp;were also associated with\&nbsp;intensification. Patient factors explained 7.96\% of the variation in\&nbsp;initiation\&nbsp;and 7.35\% of the variation in\&nbsp;intensification.CONCLUSIONS:Approximately two-thirds of\&nbsp;patients\&nbsp;were newly initiated on\&nbsp;antidiabetic\&nbsp;therapy, and four-fifths of those already receiving\&nbsp;antidiabetic\&nbsp;therapy\&nbsp;had it intensified within 6 months of an elevated HbA1c\&nbsp;in a commercially insured population. Patient factors explain 7-8\% of the variation in diabetes treatment patterns.},
	author = {Gilstrap LG and Mehrotra A and Bai B and Rose S and Blair RA and Chernew ME}
}
@article {635804,
	title = {Patterns of Postoperative Visits Among Medicare Fee-for-Service Beneficiaries},
	journal = {Ann Surg },
	volume = {Epub ahead of print},
	year = {2018},
	abstract = {OBJECTIVE:To describe\&nbsp;patterns\&nbsp;of\&nbsp;postoperative\&nbsp;visits\&nbsp;reported for\&nbsp;Medicare\&nbsp;fee-for-service\&nbsp;(FFS) patients.BACKGROUND:Payment for most surgical procedures bundles\&nbsp;postoperative\&nbsp;visits\&nbsp;within a global\&nbsp;period\&nbsp;of either 10 or 90 days after a procedure. There is concern that payments for some procedures are excessive because the number of\&nbsp;postoperative\&nbsp;visits\&nbsp;provided is less than the number of\&nbsp;postoperative\&nbsp;visits\&nbsp;used to help determine payment. To obtain data to inform this concern,\&nbsp;Medicare\&nbsp;required select surgeons to report on their\&nbsp;postoperative\&nbsp;visits\&nbsp;starting July 1, 2017.METHODS:We analyzed\&nbsp;Medicare\&nbsp;FFS claims data from surgeons who billed\&nbsp;Medicare\&nbsp;for 1 or more of the 293 common procedure codes between July 1, 2017 and December 31, 2017 in the 9 states where surgeons were required to report\&nbsp;postoperative\&nbsp;visits. We examined the share of procedures with any reported\&nbsp;postoperative\&nbsp;visits\&nbsp;and the proportion of expected\&nbsp;postoperative\&nbsp;visits\&nbsp;provided. To address concerns about underreporting, we also examined procedures performed by a subset of surgeons actively reporting\&nbsp;postoperative\&nbsp;visits.RESULTS:We linked 663,681 procedures to 422,432\&nbsp;postoperative\&nbsp;visits. The share of procedures with any\&nbsp;postoperative\&nbsp;visits\&nbsp;was higher for procedures with 90-day global periods (70.1\%) than for procedures with 10-day global periods (3.7\%). The proportions of expected\&nbsp;postoperative\&nbsp;visits\&nbsp;provided for 90-day global and 10-day global periods were 0.37 and 0.04 respectively. Among surgeons actively reporting\&nbsp;postoperative\&nbsp;visits, the proportions of expected\&nbsp;postoperative\&nbsp;visits\&nbsp;provided were modestly higher (procedures with 90-day global periods=0.46 and 10-day global periods=0.16).CONCLUSIONS:The proportion of expected\&nbsp;postoperative\&nbsp;visits\&nbsp;that were provided is low. These results support the need for a reassessment of payment for surgical procedures.},
	author = {Kranz AM and Mulcahy A and Ruder T and Lovejoy S and Mehrotra A}
}
@article {635806,
	title = {Physician characteristics associated with higher adenoma detection rate},
	journal = {Gastrointest Endosc},
	volume = {87},
	number = {3},
	year = {2018},
	pages = {778-786},
	abstract = {BACKGROUND AND AIMS:Patients who receive a colonoscopy from a\&nbsp;physician\&nbsp;with a low\&nbsp;adenoma\&nbsp;detection\&nbsp;rate\&nbsp;(ADR) are at\&nbsp;higher\&nbsp;risk of subsequent colorectal cancer. It is unclear what drives the variation across\&nbsp;physicians\&nbsp;in ADR. We describe\&nbsp;physician\&nbsp;characteristicsassociated\&nbsp;with\&nbsp;higher\&nbsp;ADR.METHODS:In this retrospective cohort study a natural language processing system was used to analyze all outpatient colonoscopy examinations and their\&nbsp;associated\&nbsp;pathology reports from October 2013 to September 2015 for adults age 40 years and older across\&nbsp;physicians\&nbsp;from 4 diverse health systems.\&nbsp;Physician\&nbsp;performance on ADR was risk adjusted for differences in patient population and procedure indication. Our sample included 201\&nbsp;physicians\&nbsp;performing at least 30 colonoscopy examinations during the study period, totaling 104,618 colonoscopy examinations.RESULTS:The mean ADR was 33.2\% (range, 6.3\%-58.7\%).\&nbsp;Higher\&nbsp;ADR was seen among female\&nbsp;physicians\&nbsp;(4.2 percentage points\&nbsp;higherthan men, P\&nbsp;= .020), gastroenterologists (9.4 percentage points\&nbsp;higher\&nbsp;than nongastroenterologists, P\&nbsp;\&lt; .001), and\&nbsp;physicians\&nbsp;with\&nbsp;<=9 years since their residency completion (6.0 percentage points\&nbsp;higher\&nbsp;than\&nbsp;physicians\&nbsp;who have had 27-51 years of practice, P\&nbsp;= .004).CONCLUSIONS:Gastroenterologists, female\&nbsp;physicians, and more recently trained\&nbsp;physicians\&nbsp;had\&nbsp;higher\&nbsp;performance in\&nbsp;adenomadetection.},
	author = {Mehrotra A and Morris M and Gourevitch RA and Carrell DS and Leffler DA and Rose S and Greer JB and Crockett SD and Baer A and Schoen RE}
}
@article {635814,
	title = {Primary Care Practitioners{\textquoteright} Perceptions of Electronic Consult Systems: A Qualitative Analysis},
	journal = {JAMA Internal Medicine },
	volume = {178},
	number = {6},
	year = {2018},
	pages = {782-789},
	abstract = {IMPORTANCE:Safety-net health\&nbsp;systems\&nbsp;across the country are implementing\&nbsp;electronic\&nbsp;consult\&nbsp;(eConsult)\&nbsp;systems\&nbsp;in which\&nbsp;primary\&nbsp;carepractitioners (PCPs) submit all requests for specialty assistance electronically to be reviewed and discussed with specialists. Evidence suggests that eConsult\&nbsp;systems\&nbsp;can make significant improvements in specialty access, but the outcomes of these\&nbsp;systems\&nbsp;for frontline PCPs is poorly understood.OBJECTIVE:To understand PCP\&nbsp;perceptions\&nbsp;of the results of eConsult initiation on PCP workflow, specialist access, and patient\&nbsp;care.DESIGN, SETTING, AND PARTICIPANTS:Qualitative\&nbsp;interviews were conducted from December 1, 2016, to April 15, 2017, with 40 safety-net PCPs in Los Angeles County who use the Los Angeles County Department of Health Services (DHS) eConsult system. Interviewees were recruited to include diversity in PCP type, practice setting, and employer (DHS employed vs DHS affiliated). Participants were interviewed about their\&nbsp;perceptions\&nbsp;of clinical workflow, access to specialists, relationships with specialists, and referral decision making.MAIN OUTCOMES AND MEASURES:Perceptions\&nbsp;of the results of eConsult, including positive and negative themes and remaining perceived gaps in specialty\&nbsp;care.RESULTS:Of the 40 participants, 27 (68\%) were women; 24 (60\%) PCPs performed 5 or more eConsults per week.\&nbsp;Primary\&nbsp;carepractitioners{\textquoteright}\&nbsp;perceptions\&nbsp;of eConsult clustered around 4 main themes: access and timeliness of specialty\&nbsp;care, shift of work to PCPs, relationships with specialists, and eConsult interface issues. Many PCPs praised the improved timeliness of specialist input with eConsult, as well as the added clinical and educational value of dialogue with specialists, particularly compared with the limitations of the prior referral process. However, PCPs also consistently perceived that eConsult shifted some of the work of specialty\&nbsp;care\&nbsp;to them. Many PCPs believed that this extra burden was worth the effort given the benefits of eConsult, such as improved timeliness of\&nbsp;care\&nbsp;and ability to manage specialty conditions. In contrast, others were frustrated by the increased administrative burden, broadened clinical responsibility, and restructuring of specialty\&nbsp;care\&nbsp;delivery.CONCLUSIONS AND RELEVANCE:While associated with improved specialty\&nbsp;care\&nbsp;access, eConsult\&nbsp;systems\&nbsp;simultaneously created new challenges for PCPs, such as an increased burden of work in providing specialty\&nbsp;care.\&nbsp;Primary\&nbsp;care\&nbsp;practitioners varied in their enthusiasm for these workflow changes with diverging\&nbsp;perceptions\&nbsp;of the same processes. Our findings provide insights on challenges future\&nbsp;primarycare\&nbsp;transformation efforts may face.},
	author = {Lee MS and Ray KN and Mehrotra A and Giboney P and Yee HF Jr and Ml, Barnett}
}
@article {635810,
	title = {Promise and Reality of Price Transparency},
	journal = {N Engl J Med },
	volume = {378},
	number = {14},
	year = {2018},
	pages = {1348-1354},
	author = {Mehrotra A and Chernew ME and Sinaiko AD}
}
@article {635822,
	title = {Trends in Visits to Acute Care Venues for Treatment of Low-Acuity Conditions in the United States From 2008 to 2015},
	journal = {JAMA Internal Medicine },
	volume = {178},
	number = {10},
	year = {2018},
	pages = {1342-1349},
	abstract = {IMPORTANCE:Over the past 2 decades, a variety of new\&nbsp;care\&nbsp;options have emerged for\&nbsp;acute\&nbsp;care, including urgent\&nbsp;care\&nbsp;centers, retail clinics, and telemedicine.\&nbsp;Trends\&nbsp;in the utilization of these newer\&nbsp;care\&nbsp;venues\&nbsp;and the emergency department (ED) have not been characterized.OBJECTIVE:To describe\&nbsp;trends\&nbsp;in\&nbsp;visits\&nbsp;to different\&nbsp;acute\&nbsp;care\&nbsp;venues, including urgent\&nbsp;care\&nbsp;centers, retail clinics, telemedicine, and EDs, with a focus on\&nbsp;visits\&nbsp;for\&nbsp;treatment\&nbsp;of\&nbsp;low-acuity\&nbsp;conditions.DESIGN, SETTING, AND PARTICIPANTS:This cohort study used deidentified health plan claims data from Aetna, a large, national, commercial health plan, from January 1,\&nbsp;2008, to December 31,\&nbsp;2015, with approximately 20 million insured members per study year. Descriptive analysis was performed for health plan members younger than 65 years. Data analysis was performed from December 28, 2016, to February 20, 2018.MAIN OUTCOMES AND MEASURES:Utilization, inflation-adjusted price, and spending associated with\&nbsp;visits\&nbsp;for\&nbsp;treatment\&nbsp;of\&nbsp;low-acuityconditions.\&nbsp;Low-acuity\&nbsp;conditions\&nbsp;were identified using diagnosis codes and included\&nbsp;acute\&nbsp;respiratory infections, urinary tract infections, rashes, and musculoskeletal strains.RESULTS:This study included 20.6 million\&nbsp;acute\&nbsp;care\&nbsp;visits\&nbsp;for\&nbsp;treatment\&nbsp;of\&nbsp;low-acuity\&nbsp;conditions\&nbsp;over the 8-year period.\&nbsp;Visits\&nbsp;to the ED for the\&nbsp;treatment\&nbsp;of\&nbsp;low-acuity\&nbsp;conditions\&nbsp;decreased by 36\% (from 89\&nbsp;visits\&nbsp;per 1000 members in\&nbsp;2008\&nbsp;to 57\&nbsp;visits\&nbsp;per 1000 members in\&nbsp;2015), whereas use of non-ED\&nbsp;venues\&nbsp;increased by 140\% (from 54\&nbsp;visits\&nbsp;per 1000 members in\&nbsp;2008\&nbsp;to 131\&nbsp;visits\&nbsp;per 1000 members in\&nbsp;2015). There was an increase in\&nbsp;visits\&nbsp;to all non-ED\&nbsp;venues: urgent\&nbsp;care\&nbsp;centers (119\% increase, from 47\&nbsp;visits\&nbsp;per 1000 members in\&nbsp;2008\&nbsp;to 103\&nbsp;visits\&nbsp;per 1000 members in\&nbsp;2015), retail clinics (214\% increase, from 7\&nbsp;visits\&nbsp;per 1000 members in\&nbsp;2008\&nbsp;to 22\&nbsp;visits\&nbsp;per 1000 members in\&nbsp;2015), and telemedicine (from 0\&nbsp;visits\&nbsp;in\&nbsp;2008\&nbsp;to 6\&nbsp;visits\&nbsp;per 1000 members in\&nbsp;2015). Utilization and spending per person per year for\&nbsp;low-acuity\&nbsp;conditions\&nbsp;had net increases of 31\% (from 143\&nbsp;visits\&nbsp;per 1000 members in\&nbsp;2008\&nbsp;to 188\&nbsp;visits\&nbsp;per 1000 members in\&nbsp;2015) and 14\% ($70 per member in\&nbsp;2008\&nbsp;to $80 per member in\&nbsp;2015), respectively. The increase in spending was primarily driven by a 79\% increase in price per ED visit for\&nbsp;treatment\&nbsp;of\&nbsp;low-acuity\&nbsp;conditions\&nbsp;(from $914 per visit in\&nbsp;2008\&nbsp;to $1637 per visit in\&nbsp;2015).CONCLUSIONS AND RELEVANCE:From\&nbsp;2008\&nbsp;to\&nbsp;2015, total\&nbsp;acute\&nbsp;care\&nbsp;utilization for the\&nbsp;treatment\&nbsp;of\&nbsp;low-acuity\&nbsp;conditions\&nbsp;and associated spending per member increased, and utilization of non-ED\&nbsp;acute\&nbsp;care\&nbsp;venues\&nbsp;increased rapidly. These findings suggest that patients are more likely to visit urgent\&nbsp;care\&nbsp;centers than EDs for the\&nbsp;treatment\&nbsp;of\&nbsp;low-acuity\&nbsp;conditions.},
	author = {Poon SJ and Schurr JD and Mehrotra A}
}
@article {696563,
	title = {Americans Support Price Shopping For Health Care, But Few Actually Seek Out Price Information},
	journal = {Health Aff (Millwood)},
	volume = {36},
	number = {8},
	year = {2017},
	month = {2017 Aug 01},
	pages = {1392-1400},
	abstract = {The growing awareness of the wide variation in health care prices, increased availability of price data, and increased patient cost sharing are expected to drive patients to shop for lower-cost medical services. We conducted a nationally representative survey of 2,996 nonelderly US adults who had received medical care in the previous twelve months to assess how frequently patients are price shopping for care and the barriers they face in doing so. Only 13~percent of respondents who had some out-of-pocket spending in their last health care encounter had sought information about their expected spending before receiving care, and just 3~percent had compared costs across providers before receiving care. The low rates of price shopping do not appear to be driven by opposition to the idea: The majority of respondents believed that price shopping for care is important and did not believe that higher-cost providers were of higher quality. Common barriers to shopping included difficulty obtaining price information and a desire not to disrupt existing provider relationships.},
	keywords = {Adult, Choice Behavior, Commerce, Delivery of Health Care, Female, Health Expenditures, Humans, Male, Middle Aged, Surveys and Questionnaires, United States},
	issn = {1544-5208},
	doi = {10.1377/hlthaff.2016.1471},
	author = {Ateev Mehrotra and Dean, Katie M and Anna D. Sinaiko and Sood, Neeraj}
}
@article {516761,
	title = {Association Between the Opening of Retail Clinics and Low-Acuity Emergency Department Visits},
	journal = {Ann Emerg Med},
	volume = {69},
	number = {4},
	year = {2017},
	month = {2017 Apr},
	pages = {397-403.e5},
	abstract = {STUDY OBJECTIVE: We assess whether the opening of retail clinics near emergency departments (ED) is associated with decreased ED utilization for low-acuity conditions.

METHODS: We used data from the Healthcare Cost and Utilization Project State Emergency Department Databases for 2,053 EDs in 23 states from 2007 to 2012. We used Poisson regression models to examine the association between retail clinic penetration and the rate of ED visits for 11 low-acuity conditions. Retail clinic "penetration" was measured as the percentage of the ED catchment area that overlapped with the 10-minute drive radius of a retail clinic. Rate ratios were calculated for a 10-percentage-point increase in retail clinic penetration per quarter. During the course of a year, this represents the effect of an increase in retail clinic penetration rate from 0\% to 40\%, which was approximately the average penetration rate observed in~2012.

RESULTS: Among all patients, retail clinic penetration was not associated with a reduced rate of low-acuity ED visits (rate ratio=0.999; 95\% confidence interval=0.997 to 1.000). Among patients with private insurance, there was a slight decrease in low-acuity ED visits (rate ratio=0.997; 95\% confidence interval=0.994 to 0.999). For the average ED in a given quarter, this would equal a 0.3\% reduction (95\% confidence interval 0.1\% to 0.6\%) in low-acuity ED visits among the privately insured if retail clinic penetration rate increased by 10 percentage points per quarter.

CONCLUSION: With increased patient demand resulting from the expansion of health insurance coverage, retail clinics may emerge as an important care location, but to date, they have not been associated with a meaningful reduction in low-acuity ED visits.},
	keywords = {Ambulatory Care Facilities, Databases, Factual, Emergency Service, Hospital, Geography, Health Services Misuse, Health Services Needs and Demand, Humans, Insurance, Health, Medically Uninsured, United States},
	issn = {1097-6760},
	doi = {10.1016/j.annemergmed.2016.08.462},
	author = {Martsolf, Grant and Fingar, Kathryn R and Coffey, Rosanna and Kandrack, Ryan and Charland, Tom and Eibner, Christine and Elixhauser, Anne and Steiner, Claudia and Ateev Mehrotra}
}
@article {696561,
	title = {Challenges in adapting existing clinical natural language processing systems to multiple, diverse health care settings},
	journal = {J Am Med Inform Assoc},
	volume = {24},
	number = {5},
	year = {2017},
	month = {2017 Sep 01},
	pages = {986-991},
	abstract = {OBJECTIVE: Widespread application of clinical natural language processing (NLP) systems requires taking existing NLP systems and adapting them to diverse and heterogeneous settings. We describe the challenges faced and lessons learned in adapting an existing NLP system for measuring colonoscopy quality.

MATERIALS AND METHODS: Colonoscopy and pathology reports from 4 settings during 2013-2015, varying by geographic location, practice type, compensation structure, and electronic health record.

RESULTS: Though successful, adaptation required considerably more time and effort than anticipated. Typical NLP challenges in assembling corpora, diverse report structures, and idiosyncratic linguistic content were greatly magnified.

DISCUSSION: Strategies for addressing adaptation challenges include assessing site-specific diversity, setting realistic timelines, leveraging local electronic health record expertise, and undertaking extensive iterative development. More research is needed on how to make it easier to adapt NLP systems to new clinical settings.

CONCLUSIONS: A key challenge in widespread application of NLP is adapting existing systems to new clinical settings.},
	keywords = {Colonoscopy, Data Collection, Early Detection of Cancer, Electronic Health Records, Humans, Information Dissemination, Medical Records Systems, Computerized, Natural Language Processing, Pathology, Clinical},
	issn = {1527-974X},
	doi = {10.1093/jamia/ocx039},
	author = {Carrell, David S and Schoen, Robert E and Leffler, Daniel A and Morris, Michele and Rose, Sherri and Baer, Andrew and Crockett, Seth D and Gourevitch, Rebecca A and Dean, Katie M and Ateev Mehrotra}
}
@article {516731,
	title = {Direct-To-Consumer Telehealth May Increase Access To Care But Does Not Decrease Spending},
	journal = {Health Aff (Millwood)},
	volume = {36},
	number = {3},
	year = {2017},
	month = {2017 Mar 01},
	pages = {485-491},
	abstract = {The use of direct-to-consumer telehealth, in which a patient has access to a physician via telephone or videoconferencing, is growing rapidly. A key attraction of this type of telehealth for health plans and employers is the potential savings involved in replacing physician office and emergency department visits with less expensive virtual visits. However, increased convenience may tap into unmet demand for health care, and new utilization may increase overall health care spending. We used commercial claims data on over 300,000 patients from three years (2011-13) to explore patterns of utilization and spending for acute respiratory illnesses. We estimated that 12~percent of direct-to-consumer telehealth visits replaced visits to other providers, and 88~percent represented new utilization. Net annual spending on acute respiratory illness increased $45 per telehealth user. Direct-to-consumer telehealth may increase access by making care more convenient for certain patients, but it may also increase utilization and health care spending.},
	keywords = {Delivery of Health Care, Health Services Accessibility, Humans, Insurance Claim Review, Physicians, Telemedicine, United States},
	issn = {1544-5208},
	doi = {10.1377/hlthaff.2016.1130},
	author = {Ashwood, J Scott and Ateev Mehrotra and Cowling, David and Uscher-Pines, Lori}
}
@article {696564,
	title = {The emergence and promise of telelactation},
	journal = {Am J Obstet Gynecol},
	volume = {217},
	number = {2},
	year = {2017},
	month = {2017 Aug},
	pages = {176-178.e1},
	abstract = {Although professional breastfeeding support positively influences breastfeeding behaviors, access to International Board-Certified Lactation Consultants (IBCLCs) is limited in many communities. Recognizing their unique role in the provision of breastfeeding support, the Surgeon General{\textquoteright}s Call to Action to Support Breastfeeding identifies increasing access to IBCLCs as a policy priority. Since 2015, a number of direct-to-consumer telelactation services have emerged to increase convenient access to professional breastfeeding support. This innovation in healthcare delivery allows IBCLCs to connect with breastfeeding mothers in their homes through 2-way video on personal devices such as tablets and smartphones. In this Viewpoint, we discuss the recent emergence of this form of lactation support, describe the offerings, and discuss the potential of telelactation to transform the delivery of professional breastfeeding support.},
	keywords = {Breast Feeding, Female, Humans, Infant, Infant, Newborn, Social Support, Telemedicine},
	issn = {1097-6868},
	doi = {10.1016/j.ajog.2017.04.043},
	author = {Uscher-Pines, Lori and Ateev Mehrotra and Bogen, Debra L}
}
@article {516861,
	title = {Estimating Surgical Procedure Times Using Anesthesia Billing Data and Operating Room Records},
	journal = {Health Serv Res},
	volume = {52},
	number = {1},
	year = {2017},
	month = {2017 Feb},
	pages = {74-92},
	abstract = {OBJECTIVE: The median time required to perform a surgical procedure is important in determining payment under Medicare{\textquoteright}s physician fee schedule. Prior studies have demonstrated that the current methodology of using physician surveys to determine surgical times results in overstated times. To measure surgical times more accurately, we developed and validated a methodology using available data from anesthesia billing data and operating room (OR) records.

DATA SOURCES: We estimated surgical times using Medicare 2011 anesthesia claims and New York Statewide Planning and Research Cooperative System 2011 OR times. Estimated times were validated using data from the National Surgical Quality Improvement Program. We compared our time estimates to those used by Medicare in the fee schedule.

STUDY DESIGN: We estimate surgical times via piecewise linear median regression models.

PRINCIPAL FINDINGS: Using 3.0~million observations of anesthesia and OR times, we estimated surgical time for 921 procedures. Correlation between these time estimates and directly measured surgical time from the validation database was 0.98. Our estimates of surgical time were shorter than the Medicare fee schedule estimates for 78 percent of procedures.

CONCLUSIONS: Anesthesia and OR times can be used to measure surgical time and thereby improve the payment for surgical procedures in the Medicare fee schedule.},
	keywords = {Anesthesia, Documentation, Fees, Medical, Humans, Medicare, new york, Operating Rooms, operative time, Surgical Procedures, Operative, United States},
	issn = {1475-6773},
	doi = {10.1111/1475-6773.12474},
	author = {Burgette, Lane F and Mulcahy, Andrew W and Ateev Mehrotra and Ruder, Teague and Wynn, Barbara O}
}
@article {696558,
	title = {Family Perspectives on Telemedicine for Pediatric Subspecialty Care},
	journal = {Telemed J E Health},
	volume = {23},
	number = {10},
	year = {2017},
	month = {2017 Oct},
	pages = {852-862},
	abstract = {BACKGROUND: Children often have difficulty accessing subspecialty care, and telemedicine may improve access to subspecialty care, but information is lacking on how best to implement telemedicine programs to maximize acceptance and, ultimately, maximize impact for patients and their families.

METHODS AND MATERIALS: To understand how subspecialty telemedicine is perceived and to identify design elements with the potential to improve telemedicine uptake and impact, we conducted and analyzed semi-structured interviews with 21 informants, including parents and caregivers of children with subspecialty care needs and adolescent and young adult patients with subspecialty care needs.

RESULTS: Although informants saw the potential value of using telemedicine to replace in-person subspecialty visits, they were more enthusiastic about using telemedicine to complement rather than replace in-person visits. For example, they described the potential to use telemedicine to facilitate previsit triage encounters to assess whether the patient was being scheduled with the correct subspecialist and with the appropriate level of urgency. They also felt that telemedicine would be useful for communication with subspecialists after scheduled in-person visits for follow-up questions, care coordination, and to discuss changes in health status. Informants felt that it was important for telemedicine programs to have transparent and reliable scheduling, same-day scheduling options, continuity of care with trusted providers, clear guidelines on when to use telemedicine, and preservation of parent choice regarding method of care delivery.

CONCLUSIONS: Parents and patients articulated preferences regarding pediatric subspecialty telemedicine in this qualitative, hypothesis-generating study. Understanding and responding to patient and caregiver perceptions and preferences will be crucial to ensure that telemedicine drives true innovation in care delivery rather than simply recapitulating prior models of care.},
	keywords = {Adolescent, Adult, Aged, Appointments and Schedules, Caregivers, Child, Child, Preschool, Communication, Female, Humans, Infant, Infant, Newborn, Interviews as Topic, Male, Middle Aged, Parents, Pediatrics, Perception, Qualitative Research, Socioeconomic Factors, Specialization, Telemedicine, Young Adult},
	issn = {1556-3669},
	doi = {10.1089/tmj.2016.0236},
	author = {Ray, Kristin N and Ashcraft, Laura Ellen and Ateev Mehrotra and Elizabeth Miller and Kahn, Jeremy M}
}
@article {696569,
	title = {High-Price And Low-Price Physician Practices Do Not Differ Significantly On Care Quality Or Efficiency},
	journal = {Health Aff (Millwood)},
	volume = {36},
	number = {5},
	year = {2017},
	month = {2017 May 01},
	pages = {855-864},
	abstract = {Consolidation of physician practices has intensified concerns that providers with greater market power may be able to charge higher prices without having to deliver better care, compared to providers with less market power. Providers have argued that higher prices cover the costs of delivering higher-quality care. We examined the relationship between physician practice prices for outpatient services and practices{\textquoteright} quality and efficiency of care. Using commercial claims data, we classified practices as being high- or low-price. We used national data from the Consumer Assessment of Healthcare Providers and Systems survey and linked claims for Medicare beneficiaries to compare high- and low-price practices in the same geographic area in terms of care quality, utilization, and spending. Compared with low-price practices, high-price practices were much larger and received 36~percent higher prices. Patients of high-price practices reported significantly higher scores on some measures of care coordination and management but did not differ meaningfully in their overall care ratings, other domains of patient experiences (including physician ratings and access to care), receipt of preventive services, acute care use, or total Medicare spending. This suggests an overall weak relationship between practice prices and the quality and efficiency of care and calls into question claims that high-price providers deliver substantially higher-value care.},
	keywords = {Aged, Ambulatory Care, Commerce, Female, Humans, Insurance Claim Review, Male, Medicare, Physicians, Private Sector, Quality of Health Care, United States},
	issn = {1544-5208},
	doi = {10.1377/hlthaff.2016.1266},
	author = {Roberts, Eric T and Ateev Mehrotra and J. Michael McWilliams}
}
@article {696566,
	title = {Home-to-Home Time - Measuring What Matters to Patients and Payers},
	journal = {N Engl J Med},
	volume = {377},
	number = {1},
	year = {2017},
	month = {2017 Jul 06},
	pages = {4-6},
	keywords = {Aftercare, Health Care Costs, Hospitalization, Humans, Length of Stay, Medicare, Reimbursement mechanisms, Skilled Nursing Facilities, Treatment Outcome, United States},
	issn = {1533-4406},
	doi = {10.1056/NEJMp1703423},
	author = {Michael L. Barnett and Grabowski, David C and Ateev Mehrotra}
}
@article {516741,
	title = {How do pregnant women use quality measures when choosing their obstetric provider?},
	journal = {Birth},
	volume = {44},
	number = {2},
	year = {2017},
	month = {2017 Jun},
	pages = {120-127},
	abstract = {BACKGROUND: Given increased public reporting of the wide variation in hospital obstetric quality, we sought to understand how women incorporate quality measures into their selection of an obstetric hospital.

METHODS: We surveyed 6141 women through Ovia Pregnancy, an application used by women to track their pregnancy. We used t tests and chi-square tests to compare response patterns by age, parity, and risk status.

RESULTS: Most respondents (73.2\%) emphasized their choice of obstetrician/midwife over their choice of hospital. Over half of respondents (55.1\%) did not believe that their choice of hospital would affect their likelihood of having a cesarean delivery. While most respondents (74.9\%) understood that quality of care varied across hospitals, few prioritized reported hospital quality metrics. Younger women and nulliparous women were more likely to be unfamiliar with quality metrics. When offered a choice, only 43.6\% of respondents reported that they would be willing to travel 20 additional miles farther from their home to deliver at a hospital with a 20 percentage point lower cesarean delivery rate.

DISCUSSION: Women{\textquoteright}s lack of interest in available quality metrics is driven by differences in how women and clinicians/researchers conceptualize obstetric quality. Quality metrics are reported at the hospital level, but women care more about their choice of obstetrician and the quality of their outpatient prenatal care. Additionally, many women do not believe that a hospital{\textquoteright}s quality score influences the care they will receive. Presentations of hospital quality data should more clearly convey how hospital-level characteristics can affect women{\textquoteright}s experiences, including the fact that their chosen obstetrician/midwife may not deliver their baby.},
	keywords = {Adolescent, Adult, Age Factors, Cesarean Section, Choice Behavior, Female, Humans, Nurse Midwives, Obstetrics, Parity, Pregnancy, Pregnant Women, Prenatal Care, Quality of Health Care, United States, Young Adult},
	issn = {1523-536X},
	doi = {10.1111/birt.12273},
	author = {Gourevitch, Rebecca A and Ateev Mehrotra and Galvin, Grace and Karp, Melinda and Plough, Avery and Shah, Neel T}
}
@article {516801,
	title = {The Impact of Using Mid-level Providers in Face-to-Face Primary Care on Health Care Utilization},
	journal = {Med Care},
	volume = {55},
	number = {1},
	year = {2017},
	month = {2017 Jan},
	pages = {12-18},
	abstract = {BACKGROUND: There has been concern that greater use of nurse practitioners (NP) and physician assistants (PA) in face-to-face primary care may increase utilization and spending.

OBJECTIVE: To evaluate a natural experiment within Kaiser Permanente in Georgia in the use of NP/PA in primary care.

STUDY DESIGN: From 2006 through early 2008 (the preperiod), each NP or PA was paired with a physician to manage a patient panel. In early 2008, NPs and PAs were removed from all face-to-face primary care. Using the 2006-2010 data, we applied a difference-in-differences analytic approach at the clinic level due to patient triage between a NP/PA and a physician. Clinics were classified into 3 different groups based on the percentage of visits by NP/PA during the preperiod: high (over 20\% in-person primary care visits attended by NP/PAs), medium (5\%-20\%), and low (\&lt;5\%) NP/PA model clinics.

MEASURES: Referrals to specialist physicians; emergency department visits and inpatient admissions; and advanced diagnostic imaging services.

RESULTS: Compared with the low NP/PA model, the high NP/PA model and the medium NP/PA model were associated with 4.9\% and 5.1\% fewer specialist referrals, respectively (P\&lt;0.05 for both estimates); the high NP/PA model and the medium NP/PA model also showed fewer hospitalizations and emergency department visits and fewer advanced diagnostic imaging services, but none of these was statistically significant.

CONCLUSIONS: We find no evidence to support concerns that under a physician{\textquoteright}s supervision, NPs and PAs increase utilization and spending.},
	keywords = {Adolescent, Adult, Ambulatory Care, Female, Georgia, Humans, Male, Middle Aged, Nurse Practitioners, Patient Acceptance of Health Care, Physician Assistants, Primary Health Care, Referral and Consultation, Young Adult},
	issn = {1537-1948},
	doi = {10.1097/MLR.0000000000000590},
	author = {Liu, Hangsheng and Robbins, Michael and Ateev Mehrotra and Auerbach, David and Robinson, Brandi E and Cromwell, Lee F and Roblin, Douglas W}
}
@article {696573,
	title = {Incorrect Conclusions Concerning Antibiotics and Asthma Exacerbation-Reply},
	journal = {JAMA Intern Med},
	volume = {177},
	number = {4},
	year = {2017},
	month = {2017 Apr 01},
	pages = {598-599},
	keywords = {Anti-Bacterial Agents, Asthma, Disease Progression, Humans},
	issn = {2168-6114},
	doi = {10.1001/jamainternmed.2017.0113},
	author = {Ateev Mehrotra and Linder, Jeffrey A}
}
@article {516756,
	title = {Leveraging Telehealth to Bring Volunteer Physicians Into Underserved Communities},
	journal = {Telemed J E Health},
	volume = {23},
	number = {6},
	year = {2017},
	month = {2017 Jun},
	pages = {533-535},
	abstract = {Many disadvantaged communities lack sufficient numbers of local primary care and specialty physicians. Yet tens of thousands of physicians, in particular those who are retired or semiretired, desire meaningful volunteer opportunities. Multiple programs have begun to use telehealth to bridge the gap between volunteer physicians and underserved patients. In this brief, we describe programs that are using this model and discuss the promise and pitfalls. Physician volunteers in these programs report that the work can be fulfilling and exciting, a cutting-edge yet convenient way to remain engaged and contribute. Given the projected shortfall of physicians in the United States, recruiting retired and semiretired physicians to provide care through telehealth increases the total supply of active physicians and the capacity of the existing workforce. However, programs typically use volunteers in a limited capacity because of uncertainty about the level and duration of commitment. Acknowledging this reality, most programs only use volunteer physicians for curbside consults rather than fully integrating them into longitudinal patient care. The part-time availability of volunteers may also be difficult to incorporate into the workflow of busy safety net clinics. As more physicians volunteer in a growing number of telehealth programs, the dual benefits of enriching the professional lives of volunteers and improving care for underserved communities will make further development of these programs worthwhile.},
	keywords = {Health Services Accessibility, Health Workforce, Humans, Medically Underserved Area, Physicians, Primary Health Care, Rural Health Services, Telemedicine, Time Factors, United States, Volunteers},
	issn = {1556-3669},
	doi = {10.1089/tmj.2016.0174},
	author = {Uscher-Pines, Lori and Rudin, Robert and Ateev Mehrotra}
}
@article {696571,
	title = {Limitations of Study on Symptom Checkers-Reply},
	journal = {JAMA Intern Med},
	volume = {177},
	number = {5},
	year = {2017},
	month = {2017 May 01},
	pages = {741},
	keywords = {Diagnosis},
	issn = {2168-6114},
	doi = {10.1001/jamainternmed.2017.0351},
	author = {Ateev Mehrotra and Semigran, Hannah L and Levine, David M and Nundy, Shantanu}
}
@article {696560,
	title = {The long term effects of "Consumer-Directed" health plans on preventive care use},
	journal = {J Health Econ},
	volume = {55},
	year = {2017},
	month = {2017 Sep},
	pages = {61-75},
	abstract = {"Consumer-Directed" Health Plans (CDHPs), those with high deductibles and personal medical accounts, have been shown to reduce health care spending. The impact of CDHPs on preventive care is unclear. On the one hand CDHPs might increase use of preventive care as such care is exempt from the deductible. However, CDHPs also decrease visits to physicians which might results in less screening. Prior research has found conflicting results. In this study, using data from 37 employers we examine the effects of CDHPs on the use of cancer screenings up to three years after the initial CDHP offering with ITT and LATE approaches. Being offered a CDHP or enrolling in a CDHP had little or no effect on cancer screening rates but individuals increase screenings prior to enrolling in a CDHP. Our findings suggest the importance of examining CDHP effects on periodic care over the longer-term and carefully controlling for anticipatory stockpiling.},
	keywords = {Adult, Breast Neoplasms, Colonic Neoplasms, Early Detection of Cancer, Female, Health Expenditures, Humans, Insurance, Health, Male, Middle Aged, Preventive Medicine, Uterine Cervical Neoplasms},
	issn = {1879-1646},
	doi = {10.1016/j.jhealeco.2017.06.008},
	author = {Eisenberg, Matthew D and Haviland, Amelia M and Ateev Mehrotra and Huckfeldt, Peter J and Sood, Neeraj}
}
@article {516726,
	title = {Los Angeles Safety-Net Program eConsult System Was Rapidly Adopted And Decreased Wait Times To See Specialists},
	journal = {Health Aff (Millwood)},
	volume = {36},
	number = {3},
	year = {2017},
	month = {2017 Mar 01},
	pages = {492-499},
	abstract = {Lack of timely access to specialty care is a significant problem among disadvantaged populations, such as those served by the Los Angeles County Department of Health Services. In 2012 the department implemented an electronic system for the provision of specialty care called the eConsult system, in which all requests from primary care providers for specialty assistance were reviewed by specialists. In many cases, the specialist can address the primary care provider{\textquoteright}s question via an electronic dialogue, thereby eliminating the need for the patient to see a specialist in person. We observed rapid growth in the use of eConsult: By 2015 the system was in use by over 3,000 primary care providers, and 12,082 consultations were taking place per month, compared to 86 in the third quarter of 2012. The median time to an electronic response from a specialist was one day, and 25~percent of eConsults were resolved without a specialist visit. Three to four years after implementation, the median time to a specialist appointment decreased significantly, while the volume of visits remained stable. eConsult systems are a promising and sustainable intervention that could improve access to specialist care for underserved patients.},
	keywords = {Health Services, Health Services Accessibility, Humans, Los Angeles, Primary Health Care, Remote Consultation, Retrospective Studies, Safety-net Providers, Specialization, Vulnerable Populations},
	issn = {1544-5208},
	doi = {10.1377/hlthaff.2016.1283},
	author = {Michael L. Barnett and Yee, Hal F and Ateev Mehrotra and Giboney, Paul}
}
@article {696565,
	title = {Offering A Price Transparency Tool Did Not Reduce Overall Spending Among California Public Employees And Retirees},
	journal = {Health Aff (Millwood)},
	volume = {36},
	number = {8},
	year = {2017},
	month = {2017 Aug 01},
	pages = {1401-1407},
	abstract = {Insurers, employers, and states increasingly encourage price transparency so that patients can compare health care prices across providers. However, the evidence on whether price transparency tools encourage patients to receive lower-cost care and reduce overall spending remains limited and mixed. We examined the experience of a large insured population that was offered a price transparency tool, focusing on a set of "shoppable" services (lab tests, office visits, and advanced imaging services). Overall, offering the tool was not associated with lower shoppable services spending. Only 12~percent of employees who were offered the tool used it in the first fifteen months after it was introduced, and use of the tool was not associated with lower prices for lab tests or office visits. The average price paid for imaging services preceded by a price search was 14~percent lower than that paid for imaging services not preceded by a price search. However, only 1~percent of those who received advanced imaging conducted a price search. Simply offering a price transparency tool is not sufficient to meaningfully decrease health care prices or spending.},
	keywords = {Access to Information, California, Commerce, Cost Savings, Delivery of Health Care, Female, Health Expenditures, Humans, Male, Middle Aged},
	issn = {1544-5208},
	doi = {10.1377/hlthaff.2016.1636},
	author = {Desai, Sunita and Hatfield, Laura A and Hicks, Andrew L and Anna D. Sinaiko and Michael E. Chernew and Cowling, David and Gautam, Santosh and Wu, Sze-Jung and Ateev Mehrotra}
}
@article {696568,
	title = {Patients{\textquoteright} views on price shopping and price transparency},
	journal = {Am J Manag Care},
	volume = {23},
	number = {6},
	year = {2017},
	month = {2017 Jun 01},
	pages = {e186-e192},
	abstract = {OBJECTIVES: Driven by the growth of high deductibles and price transparency initiatives, patients are being encouraged to search for prices before seeking care, yet few do so. To understand why this is the case, we interviewed individuals who were offered access to a widely used price transparency website through their employer.

STUDY DESIGN: Qualitative interviews.

METHODS: We interviewed individuals enrolled in a preferred provider organization product through their health plan about their experience using the price transparency tool (if they had done so), their past medical experiences, and their opinions on shopping for care. All interviews were transcribed and manually coded using a thematic coding guide.

RESULTS: In general, respondents expressed frustration with healthcare costs and had a positive opinion of the idea of price shopping in theory, but 2 sets of barriers limited their ability to do so in reality. The first was the salience of searching for price information. For example, respondents recognized that due to their health plan benefits design, they would not save money by switching to a lower-cost provider. Second, other factors were more important than price for respondents when choosing a provider, including quality and loyalty to current providers.

CONCLUSIONS: We found a disconnect between respondents{\textquoteright} enthusiasm for price shopping and their reported use of a price transparency tool to shop for care. However, many did find the tool useful for other purposes, including checking their claims history. Addressing the barriers to price shopping identified by respondents can help inform ongoing and future price transparency initiatives.},
	keywords = {Access to Information, Attitude to Health, California, Consumer Behavior, Cost Savings, Delivery of Health Care, Evaluation Studies as Topic, Health Care Costs, Humans, Interviews as Topic, Value-Based Purchasing},
	issn = {1936-2692},
	author = {Semigran, Hannah L and Gourevitch, Rebecca and Anna D. Sinaiko and Cowling, David and Ateev Mehrotra}
}
@article {696572,
	title = {Provider type and management of common visits in primary care},
	journal = {Am J Manag Care},
	volume = {23},
	number = {4},
	year = {2017},
	month = {2017 Apr},
	pages = {225-231},
	abstract = {OBJECTIVES: Debate continues on whether nurse practitioners (NPs) and physician assistants (PAs) are more likely to order ancillary services, or order more costly services among alternatives, than primary care physicians (PCPs). We compared prescription medication and diagnostic service orders associated with NP/PA versus PCP visits for management of neck or back (N/B) pain or acute respiratory infection (ARI).

STUDY DESIGN: Retrospective, observational study of visits from January 2006 through March 2008 in the adult primary care practice of Kaiser Permanente in Atlanta, Georgia.

METHODS: Data were obtained from electronic health records. NP/PA and PCP visits for N/B pain or ARI were propensity score matched on patient age, gender, and comorbidities.

RESULTS: On propensity score-matched N/B pain visits (n = 6724), NP/PAs were less likely than PCPs to order a computed tomography (CT)/magnetic resonance image (MRI) scan (2.1\% vs 3.3\%, respectively) or narcotic analgesic (26.9\% vs 28.5\%) and more likely to order a nonnarcotic analgesic (13.5\% vs 8.5\%) or muscle relaxant (45.8\% vs 42.5\%) (all P <=.05). On propensity score-matched ARI visits (n = 24,190), NP/PAs were more likely than PCPs to order any antibiotic medication (73.7\% vs 65.8\%), but less likely to order an x-ray (6.3\% vs 8.6\%), broad-spectrum antibiotic (41.5\% vs 42.5\%), or rapid strep test (6.3\% vs 9.7\%) (all P <=.05).

CONCLUSIONS: In the multidisciplinary primary care practice of this health maintenance organization, NP/PAs attending visits for N/B pain or ARI were less likely than PCPs to order advanced diagnostic radiology imaging services, to prescribe narcotic analgesics, and/or to prescribe broad-spectrum antibiotics.},
	keywords = {Back Pain, Georgia, Humans, Neck Pain, Nurse Practitioners, Physician Assistants, Physicians, Primary Care, Practice Patterns, Nurses{\textquoteright}, Practice Patterns, Physicians{\textquoteright}, Primary Health Care, Respiratory Tract Infections, Retrospective Studies},
	issn = {1936-2692},
	author = {Roblin, Douglas W and Liu, Hangsheng and Cromwell, Lee F and Robbins, Michael and Robinson, Brandi E and Auerbach, David and Ateev Mehrotra}
}
@article {696559,
	title = {Raising the Bar in Attribution},
	journal = {Ann Intern Med},
	volume = {167},
	number = {6},
	year = {2017},
	month = {2017 Sep 19},
	pages = {434-435},
	keywords = {Costs and Cost Analysis, Economics, Medical, Health Care Costs, Humans, Medicare, Organizational Objectives, Reimbursement mechanisms, United States, United States Dept. of Health and Human Services},
	issn = {1539-3704},
	doi = {10.7326/M17-0655},
	author = {Ateev Mehrotra and Burstin, Helen and Raphael, Carol}
}
@article {696570,
	title = {Rapid Growth In Mental Health Telemedicine Use Among Rural Medicare Beneficiaries, Wide Variation Across States},
	journal = {Health Aff (Millwood)},
	volume = {36},
	number = {5},
	year = {2017},
	month = {2017 May 01},
	pages = {909-917},
	abstract = {Congress and many state legislatures are considering expanding access to telemedicine. To inform this debate, we analyzed Medicare fee-for-service claims for the period 2004-14 to understand trends in and recent use of telemedicine for mental health care, also known as telemental health. The study population consisted of rural beneficiaries with a diagnosis of any mental illness or serious mental illness. The number of telemental health visits grew on average~45.1~percent annually, and by 2014 there were 5.3 and 11.8 telemental health visits per 100 rural beneficiaries with any mental illness or serious mental illness, respectively. There was notable variation across states: In 2014 nine had more than twenty-five visits per 100 beneficiaries with serious mental illness, while four states and the District of Columbia had none. Compared to other beneficiaries with mental illness, beneficiaries who received a telemental health visit were more likely to be younger than sixty-five, be eligible for Medicare because of disability, and live in a relatively poor community. States with a telemedicine parity law and a pro-telemental health regulatory environment had significantly higher rates of telemental health use than those that did not.},
	keywords = {Adult, Fee-for-Service Plans, Female, Humans, Male, Medicare, Mental Disorders, Mental Health, Middle Aged, Rural Population, Telemedicine, United States},
	issn = {1544-5208},
	doi = {10.1377/hlthaff.2016.1461},
	author = {Ateev Mehrotra and Huskamp, Haiden A. and Souza, Jeffrey and Uscher-Pines, Lori and Rose, Sherri and Landon, Bruce E and Jena, Anupam B and Alisa B. Busch}
}
@article {696574,
	title = {Testing New Codes to Capture Post-Operative Care},
	journal = {Rand Health Q},
	volume = {7},
	number = {1},
	year = {2017},
	month = {2017 Jan},
	pages = {3},
	abstract = {The Centers for Medicare \&amp; Medicaid Services (CMS) uses the resource-based relative value system to determine payment for physicians and nonphysician practitioners for their professional services. For many surgeries and other types of procedures, Medicare payment includes pre- and post-operative visits delivered during a global period of 10 or 90 days. Congress mandated that CMS collect data on the "number and level" of visits in the global period from a representative sample of physicians beginning January 1, 2017. At CMS{\textquoteright}s request, RAND developed a new set of nonpayment codes that could be used to capture the number and level of visits. In July 2016, CMS issued a proposed rule that included a slightly modified version of the codes developed by RAND and proposed to require their use by practitioners. Given that these codes had never been tested or used by practitioners, CMS asked RAND to pilot the proposed codes to determine whether practitioners understood and could accurately apply the codes. RAND{\textquoteright}s approach was to create a series of vignettes and to test the use of these vignettes using semi-structured interviews with a small set of physicians, followed by more-extensive testing through surveys with a larger group of physicians. This study provides recommendations on how to use vignettes to test new codes and uncover questions about such codes. Such input could be used to help refine instructions for using codes, as well as to potentially refine the codes themselves.},
	issn = {2162-8254},
	author = {Gidengil, Courtney A and Ateev Mehrotra and Kranz, Ashley M and Butcher, Emily and Hilborne, Lee H and Wynn, Barbara O}
}
@article {696567,
	title = {Trends in Use of the US Medicare Annual Wellness Visit, 2011-2014},
	journal = {JAMA},
	volume = {317},
	number = {21},
	year = {2017},
	month = {2017 Jun 06},
	pages = {2233-2235},
	abstract = {This study uses Medicare claims data to describe the use of annual wellness visits among Medicare beneficiaries in the United States from 2011 through 2014.},
	keywords = {Adult, Aged, Aged, 80 and over, Female, Humans, Male, Medicare, Middle Aged, Preventive Health Services, Primary Health Care, United States, Young Adult},
	issn = {1538-3598},
	doi = {10.1001/jama.2017.4342},
	author = {Ganguli, Ishani and Souza, Jeffrey and J. Michael McWilliams and Ateev Mehrotra}
}
@article {696562,
	title = {Trends in Visits to Specialist Physicians Involving Nurse Practitioners and Physician Assistants, 2001 to 2013},
	journal = {JAMA Intern Med},
	volume = {177},
	number = {8},
	year = {2017},
	month = {2017 Aug 01},
	pages = {1213-1216},
	abstract = {This study describes the roles of nurse practitioners and physician assistants in providing care to specialist physicians{\textquoteright} patients.},
	keywords = {Ambulatory Care, Health Services Accessibility, Humans, Nurse Practitioners, Physician Assistants, Physicians, Primary Care, Primary Health Care, Professional Role, Specialization},
	issn = {2168-6114},
	doi = {10.1001/jamainternmed.2017.1630},
	author = {Ray, Kristin N and Martsolf, Grant R and Ateev Mehrotra and Michael L. Barnett}
}
@article {516746,
	title = {Variation in dermatologist visits by sociodemographic characteristics},
	journal = {J Am Acad Dermatol},
	volume = {76},
	number = {5},
	year = {2017},
	month = {2017 May},
	pages = {918-924},
	abstract = {BACKGROUND: Access to dermatologists is an ongoing concern for Medicaid enrollees. Understanding current use is a key step toward designing and implementing policies to improve access.

OBJECTIVE: We sought to quantify how often Medicaid enrollees visit dermatologists and receive treatment for skin-related conditions compared with patients with other coverage or without health insurance.

METHODS: We conducted a retrospective cross-sectional analysis of multiyear federal survey data (Medical Expenditure Panel Survey). The sample included Medical Expenditure Panel Survey respondents younger than 65~years from 2008 to 2012.

RESULTS: In unadjusted comparisons, we found that 1.4\% of Medicaid enrollees had an ambulatory visit to a dermatologist annually, compared with 1.2\% of uninsured individuals and 5.5\% of individuals with private coverage. In adjusted models, we found that health insurance source, age, sex, race/ethnicity, and geography are associated with the likelihood of having visits to a dermatologist. Compared with individuals with private coverage, Medicaid enrollees are less likely to receive a diagnosis for a skin condition by any provider and are less than half as likely to have skin-related diagnoses made by dermatologists.

LIMITATIONS: We have relatively few Medical Expenditure Panel Survey respondents for a subset of specific diagnoses.

CONCLUSIONS: Our findings emphasize the need for efforts to reduce disparities in access to dermatologists.},
	keywords = {Adolescent, Adult, Age Factors, Child, Child, Preschool, Cross-Sectional Studies, Dermatology, Female, Humans, Infant, Infant, Newborn, Insurance, Health, Male, Medicaid, Medically Uninsured, Middle Aged, Office Visits, Racial Groups, Retrospective Studies, Sex Factors, Skin Diseases, Surveys and Questionnaires, United States, Young Adult},
	issn = {1097-6787},
	doi = {10.1016/j.jaad.2016.10.045},
	author = {Mulcahy, Andrew and Ateev Mehrotra and Edison, Karen and Uscher-Pines, Lori}
}
@article {516736,
	title = {Walk-in clinics versus physician offices and emergency rooms for urgent care and chronic disease management},
	journal = {Cochrane Database Syst Rev},
	volume = {2},
	number = {2},
	year = {2017},
	month = {2017 Feb 17},
	pages = {CD011774},
	abstract = {BACKGROUND: Walk-in clinics are growing in popularity around the world as a substitute for traditional medical care delivered in physician offices and emergency rooms, but their clinical efficacy is unclear.

OBJECTIVES: To assess the quality of care and patient satisfaction of walk-in clinics compared to that of traditional physician offices and emergency rooms for people who present with basic medical complaints for either acute or chronic issues.

SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, six other databases, and two trials registers on 22 March 2016 together with reference checking, citation searching, and contact with study authors to identify additional studies. We applied no restrictions on language, publication type, or publication year.

SELECTION CRITERIA: Study design: randomized trials, non-randomized trials, and controlled before-after studies.

POPULATION: standalone physical clinics not requiring advance appointments or registration, that provided basic medical care without expectation of follow-up. Comparisons: traditional primary care practices or emergency rooms.

DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane and the Cochrane Effective Practice and Organisation of Care (EPOC) Group.

MAIN RESULTS: The literature search identified 6587 citations, of which we considered 65 to be potentially relevant. We reviewed the abstracts of all 65 potentially relevant studies and retrieved the full texts of 12 articles thought to fit our study criteria. However, following independent author assessment of the full texts, we excluded all 12 articles.

AUTHORS{\textquoteright} CONCLUSIONS: Controlled trial evidence about the mortality, morbidity, quality of care, and patient satisfaction of walk-in clinics is currently not available.},
	keywords = {Ambulatory Care, Ambulatory Care Facilities, Chronic Disease, Disease Management, Emergency Service, Hospital, Humans, Physicians{\textquoteright} Offices, Quality of Health Care},
	issn = {1469-493X},
	doi = {10.1002/14651858.CD011774.pub2},
	author = {Chen, Connie E and Chen, Christopher T and Hu, Jia and Ateev Mehrotra}
}
@article {696575,
	title = {Who Uses a Price Transparency Tool? Implications for Increasing Consumer Engagement},
	journal = {Inquiry},
	volume = {54},
	year = {2017},
	month = {2017 Jan 01},
	pages = {46958017709104},
	abstract = {Despite the recent proliferation of price transparency tools, consumer use and awareness of these tools is low. Better strategies to increase the use of price transparency tools are needed. To inform such efforts, we studied who is most likely to use a price transparency tool. We conducted a cross-sectional study of use of the Truven Treatment Cost Calculator among employees at 2 large companies for the 12 months following the introduction of the tool in 2011-2012. We examined frequency of sign-ons and used multivariate logistic regression to identify which demographic and health care factors were associated with greater use of the tool. Among the 70 408 families offered the tool, 7885 (11\%) used it at least once and 854 (1\%) used it at least 3 times in the study period. Greater use of the tool was associated with younger age, living in a higher income community, and having a higher deductible. Families with moderate annual out-of-pocket medical spending ($1000-$2779) were also more likely to use the tool. Consistent with prior work, we find use of this price transparency tool is low and not sustained over time. Employers and payers need to pursue strategies to increase interest in and engagement with health care price information, particularly among consumers with higher medical spending.},
	keywords = {Adolescent, Adult, Commerce, Consumer Behavior, Cost Savings, Cross-Sectional Studies, Delivery of Health Care, Disclosure, Health Care Costs, Humans, Middle Aged},
	issn = {1945-7243},
	doi = {10.1177/0046958017709104},
	author = {Gourevitch, Rebecca A and Desai, Sunita and Hicks, Andrew L and Hatfield, Laura A and Michael E. Chernew and Ateev Mehrotra}
}
@article {516901,
	title = {Access and Quality of Care in Direct-to-Consumer Telemedicine},
	journal = {Telemed J E Health},
	volume = {22},
	number = {4},
	year = {2016},
	month = {2016 Apr},
	pages = {282-7},
	abstract = {BACKGROUND: Direct-to-consumer (DTC) telemedicine serves millions of patients; however, there is limited research on the care provided. This study compared the quality of care at Teladoc ( www.teladoc.com ), a large DTC telemedicine company, with that at physician offices and compared access to care for Teladoc users and nonusers.

MATERIALS AND METHODS: Claims from all enrollees 18-64 years of age in the California Public Employees{\textquoteright} Retirement System health maintenance organization between April 2012 and October 2013 were analyzed. We compared the performance of Teladoc and physician offices on applicable Healthcare Effectiveness Data and Information Set measures. Using geographic information system analyses, we compared Teladoc users and nonusers with respect to rural location and available primary care physicians.

RESULTS: Of enrollees offered Teladoc (n = 233,915), 3,043 adults had a total of 4,657 Teladoc visits. For the pharyngitis performance measure (ordering strep test), Teladoc performed worse than physician offices (3\% versus 50\%, p \&lt; 0.01). For the back pain measure (not ordering imaging), Teladoc and physician offices had similar performance (88\% versus 79\%, p = 0.20). For the bronchitis measure (not ordering antibiotics), Teladoc performed worse than physician offices (16.7 versus 27.9\%, p \&lt; 0.01). In adjusted models, Teladoc users were not more likely to be located within a healthcare professional shortage area (odds ratio = 1.12, p = 0.10) or rural location (odds ratio = 1.0, p = 0.10).

CONCLUSIONS: Teladoc providers were less likely to order diagnostic testing and had poorer performance on appropriate antibiotic prescribing for bronchitis. Teladoc users were not preferentially located in underserved communities. Short-term needs include ongoing monitoring of quality and additional marketing and education to increase telemedicine use among underserved patients.},
	keywords = {Adolescent, Adult, California, Diagnostic Techniques and Procedures, Female, Geographic Information Systems, Humans, Internet, Male, Middle Aged, Office Visits, Quality Indicators, Health Care, Quality of Health Care, Rural Population, Telemedicine, Time Factors, Travel, Young Adult},
	issn = {1556-3669},
	doi = {10.1089/tmj.2015.0079},
	author = {Uscher-Pines, Lori and Mulcahy, Andrew and Cowling, David and Hunter, Gerald and Burns, Rachel and Ateev Mehrotra}
}
@article {516791,
	title = {Adverse inpatient outcomes during the transition to a new electronic health record system: observational study},
	journal = {BMJ},
	volume = {354},
	year = {2016},
	month = {2016 Jul 28},
	pages = {i3835},
	abstract = {OBJECTIVE: ~To assess the short term association of inpatient implementation of electronic health records (EHRs) with patient outcomes of mortality, readmissions, and adverse safety events.

DESIGN: ~Observational study with difference-in-differences analysis.

SETTING: ~Medicare, 2011-12.

PARTICIPANTS: ~Patients admitted to 17 study hospitals with a verifiable "go live" date for implementation of inpatient EHRs during 2011-12, and 399 control hospitals in the same hospital referral region.

MAIN OUTCOME MEASURES: ~All cause readmission within 30 days of discharge, all cause mortality within 30 days of admission, and adverse safety events as defined by the patient safety for selected indicators (PSI)-90 composite measure among Medicare beneficiaries admitted to one of these hospitals 90 days before and 90 days after implementation of the EHRs (n=28 235 and 26 453 admissions), compared with the control group of all contemporaneous admissions to hospitals in the same hospital referral region (n=284 632 and 276 513 admissions). Analyses were adjusted for beneficiaries{\textquoteright} sociodemographic and clinical characteristics.

RESULTS: ~Before and after implementation, characteristics of admissions were similar in both study and control hospitals. Among study hospitals, unadjusted 30 day mortality (6.74\% to 7.15\%, P=0.06) and adverse safety event rates (10.5 to 11.4 events per 1000 admissions, P=0.34) did not significantly change after implementation of EHRs. There was an unadjusted decrease in 30 day readmission rates, from 19.9\% to 19.0\% post-implementation (P=0.02). In difference-in-differences analysis, however, there was no significant change in any outcome between pre-implementation and post-implementation periods (all P>=0.13).

CONCLUSIONS: ~Despite concerns that implementation of EHRs might adversely impact patient care during the acute transition period, we found no overall negative association of such implementation on short term inpatient mortality, adverse safety events, or readmissions in the Medicare population across 17 US hospitals.},
	keywords = {Aged, Aged, 80 and over, Electronic Health Records, Female, Health Plan Implementation, Humans, Inpatients, Male, Medicare, Patient Discharge, Patient Readmission, Patient Transfer, United States},
	issn = {1756-1833},
	doi = {10.1136/bmj.i3835},
	author = {Michael L. Barnett and Ateev Mehrotra and Jena, Anupam B}
}
@article {516836,
	title = {Association Between Availability of a Price Transparency Tool and Outpatient Spending},
	journal = {JAMA},
	volume = {315},
	number = {17},
	year = {2016},
	month = {2016 May 03},
	pages = {1874-81},
	abstract = {IMPORTANCE: There is increasing interest in using price transparency tools to decrease health care spending.

OBJECTIVE: To measure the association between offering a health care price transparency tool and outpatient spending.

DESIGN, SETTING, AND PARTICIPANTS: Two large employers represented in multiple market areas across the United States offered an online health care price transparency tool to their employees. One introduced it on April 1, 2011, and the other on January 1, 2012. The tool provided users information about what they would pay out of pocket for services from different physicians, hospitals, or other clinical sites. Using a matched difference-in-differences design, outpatient spending among employees offered the tool (n=148,655) was compared with that among employees from other companies not offered the tool (n=295,983) in the year before and after it was introduced.

EXPOSURE: Availability of a price transparency tool.

MAIN OUTCOMES AND MEASURES: Annual outpatient spending, outpatient out-of-pocket spending, use rates of the tool.

RESULTS: Mean outpatient spending among employees offered the tool was $2021 in the year before the tool was introduced and $2233 in the year after. In comparison, among controls, mean outpatient spending changed from $1985 to $2138. After adjusting for demographic and health characteristics, being offered the tool was associated with a mean $59 (95\% CI, $25-$93) increase in outpatient spending. Mean outpatient out-of-pocket spending among those offered the tool was $507 in the year before introduction of the tool and $555 in the year after. Among the comparison group, mean outpatient out-of-pocket spending changed from $490 to $520. Being offered the price transparency tool was associated with a mean $18 (95\% CI, $12-$25) increase in out-of-pocket spending after adjusting for relevant factors. In the first 12 months, 10\% of employees who were offered the tool used it at least once.

CONCLUSIONS AND RELEVANCE: Among employees at 2 large companies, offering a price transparency tool was not associated with lower health care spending. The tool was used by only a small percentage of eligible employees.},
	keywords = {Adolescent, Adult, Child, Child, Preschool, Community Participation, Cost Sharing, Delivery of Health Care, Disclosure, Female, Health Benefit Plans, Employee, Health Care Costs, Health Expenditures, Humans, Infant, Infant, Newborn, Male, Middle Aged, Outpatients, United States},
	issn = {1538-3598},
	doi = {10.1001/jama.2016.4288},
	author = {Desai, Sunita and Hatfield, Laura A and Hicks, Andrew L and Michael E. Chernew and Ateev Mehrotra}
}
@article {516771,
	title = {Care At Retail Clinics: The Author Replies},
	journal = {Health Aff (Millwood)},
	volume = {35},
	number = {10},
	year = {2016},
	month = {2016 Oct 01},
	pages = {1935},
	keywords = {Ambulatory Care Facilities, Health Services Accessibility, Humans},
	issn = {1544-5208},
	doi = {10.1377/hlthaff.2016.0938},
	author = {Scott Ashwood, J and Ateev Mehrotra}
}
@article {516766,
	title = {Comparison of Physician and Computer Diagnostic Accuracy},
	journal = {JAMA Intern Med},
	volume = {176},
	number = {12},
	year = {2016},
	month = {2016 Dec 01},
	pages = {1860-1861},
	keywords = {Clinical Competence, Computers, Diagnosis, Computer-Assisted, Diagnosis, Differential, Diagnostic Self Evaluation, Humans, Physicians, Reproducibility of Results},
	issn = {2168-6114},
	doi = {10.1001/jamainternmed.2016.6001},
	author = {Semigran, Hannah L and Levine, David M and Nundy, Shantanu and Ateev Mehrotra}
}
@article {516796,
	title = {A CONVERSATION WITH ATEEV MEHROTRA, MD. Convenience Rules in Health Care: Will Quality Suffer During Its Reign?},
	journal = {Manag Care},
	volume = {25},
	number = {6},
	year = {2016},
	month = {2016 Jun},
	pages = {32-5},
	keywords = {Ambulatory Care Facilities, Commerce, Health Services Accessibility, Quality of Health Care, United States},
	issn = {1062-3388},
	author = {Ateev Mehrotra and Wehrwen, Peter}
}
@article {516891,
	title = {Cost-Sharing Obligations, High-Deductible Health Plan Growth, and Shopping for Health Care: Enrollees With Skin in the Game},
	journal = {JAMA Intern Med},
	volume = {176},
	number = {3},
	year = {2016},
	month = {2016 Mar},
	pages = {395-7},
	keywords = {Attitude, Cost Sharing, Deductibles and Coinsurance, Health Benefit Plans, Employee, Health Care Costs, Humans, Insurance Coverage, Logistic Models, Quality of Health Care, United States},
	issn = {2168-6114},
	doi = {10.1001/jamainternmed.2015.7554},
	author = {Anna D. Sinaiko and Ateev Mehrotra and Sood, Neeraj}
}
@article {516811,
	title = {Direct Release of Test Results to Patients Increases Patient Engagement and Utilization of Care},
	journal = {PLoS One},
	volume = {11},
	number = {6},
	year = {2016},
	month = {2016},
	pages = {e0154743},
	abstract = {An important focus for meaningful use criteria is to engage patients in their care by allowing them online access to their health information, including test results. There has been little evaluation of such initiatives. Using a mixed methods analysis of electronic health record data, surveys, and qualitative interviews, we examined the impact of allowing patients to view their test results via patient portal in one large health system. Quantitative data were collected for new users and all users of the patient portal. Qualitative interviews occurred with patients who had received an HbA1c or abnormal Pap result. Survey participants were active patient portal users. Our main measures were patient portal usage, factors associated with viewing test results and utilizing care, and patient and provider experiences with patient portal and direct release. Usage data show 80\% of all patient portal users viewed test results during the year. Of survey respondents, 82.7\% noted test results to be a very useful feature and 70\% agreed that patient portal has made their provider more accessible to them. Interviewed patients reported feeling they should have direct access to test results and identified the ability to monitor results over time and prepare prior to communicating with a provider as benefits. In interviews, both patients and physicians reported instances of test results leading to unnecessary patient anxiety. Both groups noted the benefits of results released with provider interpretation. Quantitative data showed patient utilization to increase with viewing test results online, but this effect is mitigated when results are manually released by physicians. Our findings demonstrate that patient portal access to test results was highly valued by patients and appeared to increase patient engagement. However, it may lead to patient anxiety and increase rates of patient visits. We discuss how such unintended consequences can be addressed and larger implications for meaningful use criteria.},
	keywords = {Access to Information, Adult, Aged, Female, Humans, Internet, Male, Middle Aged, Patient Acceptance of Health Care, Patient Access to Records, Surveys and Questionnaires, Truth Disclosure, User-Computer Interface},
	issn = {1932-6203},
	doi = {10.1371/journal.pone.0154743},
	author = {Pillemer, Francesca and Price, Rebecca Anhang and Paone, Suzanne and Martich, G Daniel and Albert, Steve and Haidari, Leila and Updike, Glenn and Rudin, Robert and Liu, Darren and Ateev Mehrotra}
}
@article {516866,
	title = {Do "Consumer-Directed" health plans bend the cost curve over time?},
	journal = {J Health Econ},
	volume = {46},
	year = {2016},
	month = {2016 Mar},
	pages = {33-51},
	abstract = {"Consumer-Directed" Health Plans (CDHPs), those with high deductibles and personal medical accounts, are intended to reduce health care spending through greater patient cost exposure. Prior research agrees that in the first year, CDHPs reduce spending. There is little research and in it results are mixed regarding the impact of CDHPs over the longer term. We add to this literature with an intent-to-treat, difference-in-differences analysis of health care spending over up to three years post CDHP offer among 13 million person-years of data from 54 large US firms, half of which offered CDHPs. To strengthen the identification, we balance observables over time within firm, by developing weights through a machine learning algorithm, generalized boosted regression. We find that spending is reduced for those in firms offering CDHPs in all three years post offer relative to firms continuing to offer lower-deductible plans. The reductions are driven by spending decreases in outpatient care and pharmaceuticals, with no evidence of increases in emergency department or inpatient care over the three-year window.},
	keywords = {Community Participation, Cost Control, Deductibles and Coinsurance, Health Benefit Plans, Employee, Health Care Costs, Insurance Coverage, United States},
	issn = {1879-1646},
	doi = {10.1016/j.jhealeco.2016.01.001},
	author = {Haviland, Amelia M and Eisenberg, Matthew D and Ateev Mehrotra and Huckfeldt, Peter J and Sood, Neeraj}
}
@article {516876,
	title = {Drowning in a Sea of Paperwork: Toward a More Patient-Centered Billing System in the United States},
	journal = {Ann Intern Med},
	volume = {164},
	number = {9},
	year = {2016},
	month = {2016 May 03},
	pages = {611-2},
	keywords = {Emergency Service, Hospital, Health Care Reform, Hospitalization, Humans, Patient Credit and Collection, Practice Management, Medical, Reimbursement mechanisms, United States},
	issn = {1539-3704},
	doi = {10.7326/M15-2283},
	author = {Semigran, Hannah L and Ateev Mehrotra and Hwang, Ann}
}
@article {516826,
	title = {Effect of Teledermatology on Access to Dermatology Care Among Medicaid Enrollees},
	journal = {JAMA Dermatol},
	volume = {152},
	number = {8},
	year = {2016},
	month = {2016 Aug 01},
	pages = {905-12},
	abstract = {IMPORTANCE: Access to specialists such as dermatologists is often limited for Medicaid enrollees. Teledermatology has been promoted as a potential solution; however, its effect on access to care at the population level has rarely been assessed.

OBJECTIVES: To evaluate the effect of teledermatology on the number of Medicaid enrollees who received dermatology care and to describe which patients were most likely to be referred to teledermatology.

DESIGN, SETTING, AND PARTICIPANTS: Claims data from a large California Medicaid managed care plan that began offering teledermatology as a covered service in April 2012 were analyzed. The plan enrolled 382 801 patients in California{\textquoteright}s Central Valley, including 108 480 newly enrolled patients who obtained coverage after the implementation of the Affordable Care Act. Rates of dermatology visits by patients affiliated with primary care practices that referred patients to teledermatology and those that did not were compared. Data were collected from April 1, 2012, through December 31, 2014, and assessed from March 1 to October 15, 2015.

MAIN OUTCOMES AND MEASURES: The percentage of patients with at least 1 visit to a dermatologist (including in-person and teledermatology visits) and total visits with dermatologists (including in-person and teledermatology visits) per 1000 patients.

RESULTS: Of the 382 801 patients enrolled for at least 1 day from 2012 to 2014, 8614 (2.2\%) had 1 or more visits with a dermatologist. Of all patients who visited a dermatologist, 48.5\% received care via teledermatology. Among the patients newly enrolled in Medicaid, 75.7\% (1474 of 1947) of those who visited a dermatologist received care via teledermatology. Primary care practices that engaged in teledermatology had a 63.8\% increase in the fraction of patients visiting a dermatologist (vs 20.5\% in other practices; P \&lt; .01). Compared with in-person dermatology, teledermatology served more patients younger vs older than 17 years (2600 of 4427 [58.7\%] vs 1404 of 4187 [33.5\%]), male patients (1849 of 4427 [41.8\%] vs 1526 of 4187 [36.4\%]), nonwhite patients (2779 of 4188 [66.4\%] vs 1844 of 3478 [53.0\%]), and individuals without comorbid conditions (1795 of 2464 [72.8\%] vs 1978 of 3024 [65.4\%]) (P \&lt; .001 for all comparisons). Conditions managed across settings varied; teledermatology physicians were more likely to care for viral skin lesions and acne (3405 of 7287 visits [46.7\%]), whereas in-person dermatologists were more likely to care for psoriasis and skin neoplasms (10 062 of 27 347 visits [36.8\%]).

CONCLUSIONS AND RELEVANCE: The offering of teledermatology appeared to improve access to dermatology care among Medicaid enrollees and played an especially important role for the newly enrolled.},
	keywords = {Administrative Claims, Healthcare, Adolescent, Adult, California, Child, Dermatology, Female, Health Services Accessibility, Humans, Male, Medicaid, Middle Aged, Office Visits, Primary Health Care, Referral and Consultation, Telemedicine, United States, Young Adult},
	issn = {2168-6084},
	doi = {10.1001/jamadermatol.2016.0938},
	author = {Uscher-Pines, Lori and Malsberger, Rosalie and Burgette, Lane and Mulcahy, Andrew and Ateev Mehrotra}
}
@article {516816,
	title = {Family Perspectives on High-Quality Pediatric Subspecialty Referrals},
	journal = {Acad Pediatr},
	volume = {16},
	number = {6},
	year = {2016},
	month = {2016 Aug},
	pages = {594-600},
	abstract = {OBJECTIVE: Although children are frequently referred to subspecialist physicians, many inadequacies in referral processes have been identified from physician and system perspectives. Little is known, however, about how to comprehensively measure or improve the quality of the referral systems from a family-centered perspective. To foster family-centered improvements to pediatric subspecialty referrals, we sought to develop a framework for high-quality, patient-centered referrals from the perspectives of patients and their families.

METHODS: We used stakeholder-informed qualitative analysis of parent, caregiver, and patient interviews to identify outcomes, processes, and structures of high-quality pediatric subspecialty referrals as perceived by patients and their family members.

RESULTS: We interviewed 21 informants. Informants identified 5 desired outcomes of subspecialty referrals: improved functional status or symptoms; improved long-term outcomes; improved knowledge of their disease; informed expectations; and reduced anxiety about the child{\textquoteright}s health status. Processes that informants identified as supporting these outcomes centered around 6 key steps in subspecialty referrals, including the referral decision, previsit information transfer, appointment scheduling, subspecialist visit, postvisit information transfer, and ongoing care integration and communication. Health care delivery structures identified by informants as supporting these processes included physical infrastructure, human resources, and information technology systems.

CONCLUSIONS: We identified family-centered outcomes, processes, and structures of high-quality pediatric subspecialty referrals. These domains can be used not only to improve measurement of the quality of existing referral systems but also to inform future interventions to improve patient-centered outcomes for children in need of specialty care.},
	keywords = {Adolescent, Adult, Aged, Attitude to Health, Child, Child, Preschool, Female, Humans, Infant, Infant, Newborn, Male, Middle Aged, Outcome Assessment, Health Care, Parents, Pediatrics, Qualitative Research, Quality of Health Care, Referral and Consultation, Specialization, Young Adult},
	issn = {1876-2867},
	doi = {10.1016/j.acap.2016.05.147},
	author = {Ray, Kristin N and Ashcraft, Laura Ellen and Kahn, Jeremy M and Ateev Mehrotra and Elizabeth Miller}
}
@article {516886,
	title = {The Future Ecology of Care},
	journal = {Ann Intern Med},
	volume = {164},
	number = {8},
	year = {2016},
	month = {2016 Apr 19},
	pages = {560-1},
	keywords = {Delivery of Health Care, ecology, Forecasting, Humans, Patient Acceptance of Health Care, Self Care, United States, User-Computer Interface},
	issn = {1539-3704},
	doi = {10.7326/M15-1978},
	author = {West, Jacob and Ateev Mehrotra}
}
@article {516786,
	title = {Impact of Race/Ethnicity and Socioeconomic Status on Risk-Adjusted Hospital Readmission Rates Following Hip and Knee Arthroplasty},
	journal = {J Bone Joint Surg Am},
	volume = {98},
	number = {16},
	year = {2016},
	month = {2016 Aug 17},
	pages = {1385-91},
	abstract = {BACKGROUND: Readmission rates following total hip arthroplasty (THA) and total knee arthroplasty (TKA) are increasingly used to measure hospital performance. Readmission rates that are not adjusted for race/ethnicity and socioeconomic status, patient risk factors beyond a hospital{\textquoteright}s control, may not accurately reflect a hospital{\textquoteright}s performance. In this study, we examined the extent to which risk-adjusting for race/ethnicity and socioeconomic status affected hospital performance in terms of readmission rates following THA and TKA.

METHODS: We calculated 2 sets of risk-adjusted readmission rates by (1) using the Centers for Medicare \&amp; Medicaid Services standard risk-adjustment algorithm that incorporates patient age, sex, comorbidities, and hospital effects and (2) adding race/ethnicity and socioeconomic status to the model. Using data from the Healthcare Cost and Utilization Project, 2011 State Inpatient Databases, we compared the relative performances of 1,194 hospitals across the 2 methods.

RESULTS: Addition of race/ethnicity and socioeconomic status to the risk-adjustment algorithm resulted in (1) little or no change in the risk-adjusted readmission rates at nearly all hospitals; (2) no change in the designation of the readmission rate as better, worse, or not different from the population mean at \&gt;99\% of the hospitals; and (3) no change in the excess readmission ratio at \&gt;97\% of the hospitals.

CONCLUSIONS: Inclusion of race/ethnicity and socioeconomic status in the risk-adjustment algorithm led to a relative-performance change in readmission rates following THA and TKA at \&lt;3\% of the hospitals. We believe that policymakers and payers should consider this result when deciding whether to include race/ethnicity and socioeconomic status in risk-adjusted THA and TKA readmission rates used for hospital accountability, payment, and public reporting.

LEVEL OF EVIDENCE: Prognostic Level III. See instructions for Authors for a complete description of levels of evidence.},
	keywords = {Adolescent, Adult, Aged, Aged, 80 and over, Arthroplasty, Replacement, Hip, Arthroplasty, Replacement, Knee, ethnicity, Female, Humans, Male, Middle Aged, Patient Readmission, Postoperative Complications, Risk Assessment, Risk Factors, Social Class, Socioeconomic Factors, Young Adult},
	issn = {1535-1386},
	doi = {10.2106/JBJS.15.00884},
	author = {Martsolf, Grant R and Barrett, Marguerite L and Weiss, Audrey J and Kandrack, Ryan and Washington, Raynard and Steiner, Claudia A and Ateev Mehrotra and SooHoo, Nelson F and Coffey, Rosanna}
}
@article {516896,
	title = {Implementation Science Workshop: Implementation of an Electronic Referral System in a Large Academic Medical Center},
	journal = {J Gen Intern Med},
	volume = {31},
	number = {3},
	year = {2016},
	month = {2016 Mar},
	pages = {343-52},
	keywords = {Academic Medical Centers, Education, Electronic Health Records, Humans, Referral and Consultation, smartphone},
	issn = {1525-1497},
	doi = {10.1007/s11606-015-3516-y},
	author = {Michael L. Barnett and Ateev Mehrotra and Joseph P. Frolkis and Spinks, Melissa and Steiger, Casey and Hehir, Brandon and Jeffrey O. Greenberg and Singh, Hardeep}
}
@article {516751,
	title = {Patients Who Choose Primary Care Physicians Based On Low Office Visit Price Can Realize Broader Savings},
	journal = {Health Aff (Millwood)},
	volume = {35},
	number = {12},
	year = {2016},
	month = {2016 Dec 01},
	pages = {2319-2326},
	abstract = {Price transparency initiatives encourage patients to save money by choosing physicians with a relatively low price per office visit. Given that the price of such visits represents a small fraction of total spending, the extent of the savings from choosing such physicians has not been clear. Using a national sample of commercial claims data, we compared the care received by patients of high- and low-price primary care physicians. The median price for an established patient{\textquoteright}s office visit was $60 among low-price physicians and $86 among high-price physicians (price was calculated as reimbursement plus out-of-pocket spending). Patients of low-price physicians also received, on average, relatively low-price lab tests, imaging, and other procedures. Total spending per year among patients cared for by low-price physicians was $690 less than spending among patients cared for by high-price physicians. There were no consistent differences in patients{\textquoteright} use of services between high- and low-price physicians. Despite modest differences in physicians{\textquoteright} office visit prices, patients of low-price physicians had substantively lower overall spending, compared to patients of high-price physicians.},
	keywords = {Adolescent, Adult, Aged, Child, Child, Preschool, Commerce, Cost Savings, Female, Health Expenditures, Humans, Infant, Infant, Newborn, Insurance, Health, Reimbursement, Middle Aged, Office Visits, Physicians, Primary Care, United States},
	issn = {1544-5208},
	doi = {10.1377/hlthaff.2016.0408},
	author = {Ateev Mehrotra and Huckfeldt, Peter J and Haviland, Amelia M and Gascue, Laura and Sood, Neeraj}
}
@article {516871,
	title = {The Relative Importance of Post-Acute Care and Readmissions for Post-Discharge Spending},
	journal = {Health Serv Res},
	volume = {51},
	number = {5},
	year = {2016},
	month = {2016 Oct},
	pages = {1919-38},
	abstract = {OBJECTIVE: To understand what patterns of health care use are associated with higher post-hospitalization spending.

DATA SOURCES: Medicare hospital, skilled nursing, inpatient rehabilitation, and home health agency claims, and Medicare enrollment data from 2007 and 2008.

STUDY DESIGN: For 10 common inpatient conditions, we calculated variation across hospitals in price-standardized and case mix-adjusted Medicare spending in the 30~days following hospital discharge. We estimated the fraction of spending differences between low- and high-spending hospitals attributable to readmissions versus post-acute care, and within post-acute care between inpatient rehabilitation facility (IRF) versus skilled nursing facility (SNF) use. For each service, we distinguished between differences in probability of use and spending conditional on use.

DATA EXTRACTION METHODS: We identified index hospital claims and examined hospital and post-acute care occurring within a 30-day period following hospital discharge. For each Medicare Severity Diagnosis-Related Group (MS-DRG) at each hospital, we calculated average price-standardized Medicare payments for readmissions, SNFs, IRFs, and post-acute care overall (also including home health agencies and long-term care hospitals).

PRINCIPAL FINDINGS: There was extensive variation across hospitals in Medicare spending in the 30~days following hospital discharge. For example, the interquartile range across hospitals ranged from $1,245 for chronic obstructive pulmonary disease to over $4,000 for myocardial infarction MS-DRGs. The proportion of differences attributable to readmissions versus post-acute care differed across conditions. For myocardial infarction, 74 to 93 percent of the variation was due to readmissions. For hip and femur procedures and joint replacement, 72 to 92 percent of the variation was due to differences in post-acute care spending. There was also variation in the relative importance of the type of post-acute spending. For hip and femur procedures, joint replacement, and stroke, whether patients received IRF was the key driver of variation in post-acute care spending In contrast, for pneumonia and heart failure, whether patients received SNF care was the key driver of variation in post-acute spending.

CONCLUSIONS: Through initiatives such as bundled payment, hospitals are financially responsible for spending in the post-hospitalization period. The key driver of variation in post-hospitalization spending varied greatly across conditions. For some conditions, the key driver was having a readmission, for others it was whether patients receive any post-acute care, and for others the key driver was the type of post-acute care. These findings may help hospitals implement strategies to reduce post-discharge spending.},
	keywords = {Aged, Aged, 80 and over, Continuity of Patient Care, Cross-Sectional Studies, Diagnosis-Related Groups, Health Expenditures, Hospitalization, Humans, Medicare, Patient Discharge, Patient Readmission, United States},
	issn = {1475-6773},
	doi = {10.1111/1475-6773.12448},
	author = {Huckfeldt, Peter J and Ateev Mehrotra and Hussey, Peter S}
}
@article {516856,
	title = {Retail Clinic Visits For Low-Acuity Conditions Increase Utilization And Spending},
	journal = {Health Aff (Millwood)},
	volume = {35},
	number = {3},
	year = {2016},
	month = {2016 Mar},
	pages = {449-55},
	abstract = {Retail clinics have been viewed by policy makers and insurers as a mechanism to decrease health care spending, by substituting less expensive clinic visits for more expensive emergency department or physician office visits. However, retail clinics may actually increase spending if they drive new health care utilization. To assess whether retail clinic visits represent new utilization or a substitute for more expensive care, we used insurance claims data from Aetna for the period 2010-12 to track utilization and spending for eleven low-acuity conditions. We found that 58~percent of retail clinic visits for low-acuity conditions represented new utilization and that retail clinic use was associated with a modest increase in spending, of $14 per person per year. These findings do not support the idea that retail clinics decrease health care spending.},
	keywords = {Acute Disease, Ambulatory Care Facilities, Cost Savings, Cross-Sectional Studies, Female, Health Care Costs, Humans, Insurance Claim Reporting, Male, Marketing of Health Services, Severity of Illness Index, United States},
	issn = {1544-5208},
	doi = {10.1377/hlthaff.2015.0995},
	author = {Ashwood, J Scott and Gaynor, Martin and Setodji, Claude M and Reid, Rachel O and Weber, Ellerie and Ateev Mehrotra}
}
@article {516881,
	title = {Should Patients Have Periodic Health Examinations?: Grand Rounds Discussion From Beth Israel Deaconess Medical Center},
	journal = {Ann Intern Med},
	volume = {164},
	number = {3},
	year = {2016},
	month = {2016 Feb 02},
	pages = {176-83},
	abstract = {Physicians and patients have come to expect that periodic health examinations (PHEs) are a standard part of comprehensive ongoing medical care. However, considerable research has not demonstrated a substantial benefit of the PHE. Given this lack of benefit and the high total cost of PHE to the health care system, the American Board of Internal Medicine (ABIM) Foundation and the Society of General Internal Medicine (SGIM) have identified "routine health checks in asymptomatic patients" as something of low value that physicians and patients should question, as a part of the Choosing Wisely campaign. Two discussants review the debate about PHE and consider the value of PHE for a healthy 70-year-old woman who appreciates seeing her physician annually.},
	keywords = {Aged, Female, Guideline Adherence, Health Care Costs, Humans, Physical Examination, Practice Guidelines as Topic, Primary Health Care, Risk Assessment, Time Factors},
	issn = {1539-3704},
	doi = {10.7326/M15-2885},
	author = {Reynolds, Eileen E and Heffernan, James and Ateev Mehrotra and Libman, Howard}
}
@article {516776,
	title = {Tipping the Balance Toward Fewer Antibiotics},
	journal = {JAMA Intern Med},
	volume = {176},
	number = {11},
	year = {2016},
	month = {2016 Nov 01},
	pages = {1649-1650},
	keywords = {Anti-Bacterial Agents},
	issn = {2168-6114},
	doi = {10.1001/jamainternmed.2016.6254},
	author = {Ateev Mehrotra and Linder, Jeffrey A}
}
@article {516781,
	title = {Trends in Access to Primary Care for Children in the United States, 2002-2013},
	journal = {JAMA Pediatr},
	volume = {170},
	number = {10},
	year = {2016},
	month = {2016 Oct 01},
	pages = {1023-1025},
	keywords = {Adolescent, Child, Child Health Services, Child, Preschool, Health Services Accessibility, Humans, Infant, Infant, Newborn, Primary Health Care, United States},
	issn = {2168-6211},
	doi = {10.1001/jamapediatrics.2016.0985},
	author = {Ray, Kristin N and Ateev Mehrotra}
}
@article {516806,
	title = {Use of Adult-Trained Medical Subspecialists by Children Seeking Medical~Subspecialty Care},
	journal = {J Pediatr},
	volume = {176},
	year = {2016},
	month = {2016 Sep},
	pages = {173-181.e1},
	abstract = {OBJECTIVES: To quantify the use of adult-trained medical subspecialists by children and to determine the association between geographic access to pediatric subspecialty care and the use of adult-trained subspecialists. Children with limited access to pediatric subspecialty care may seek care from adult-trained subspecialists, but data on this practice are limited.

STUDY DESIGN: We identified children aged \&lt;16~years in 2007-2012 Pennsylvania Medicaid claims. We categorized outpatient visits to 9 selected medical subspecialties as either pediatric or adult-trained subspecialty visits. We used multinomial logistic regression to examine the adjusted association between travel times to pediatric referral centers and use of pediatric vs adult-trained medical subspecialists for children with and without complex chronic conditions (CCCs).

RESULTS: Among 1.1 million children, 8\% visited the examined medical subspecialists, with 10\% of these children using adult-trained medical subspecialists. Compared with children with a <=30-minute travel time to a pediatric referral center, children with a \&gt;90-minute travel time were more likely to use adult-trained subspecialists (without CCCs: relative risk ratio [RRR], 1.94, 95\% CI, 1.79-2.11; with CCCs: RRR, 2.33; 95\% CI, 2.10-2.59) and less likely to use pediatric subspecialists (without CCCs: RRR, 0.66; 95\% CI, 0.63-0.68; with CCCs: RRR, 0.76, 95\% CI, 0.73-0.79).

CONCLUSION: Among medical subspecialty fields with pediatric and adult-trained subspecialists, adult-trained subspecialists provided 10\% of care to children overall and 18\% of care to children living \&gt;90~minutes from pediatric referral centers. Future studies should examine consequences of adult-trained medical subspecialist use on pediatric health outcomes and identify strategies to increase access to pediatric subspecialists.},
	keywords = {Adolescent, Adult, Age Factors, Child, Child, Preschool, Female, Health Services Accessibility, Humans, Infant, Male, Medicine, Pediatrics, Pennsylvania},
	issn = {1097-6833},
	doi = {10.1016/j.jpeds.2016.05.073},
	author = {Ray, Kristin N and Kahn, Jeremy M and Elizabeth Miller and Ateev Mehrotra}
}
@article {516831,
	title = {Use Of Retail Clinics: The Authors Reply},
	journal = {Health Aff (Millwood)},
	volume = {35},
	number = {5},
	year = {2016},
	month = {2016 May 01},
	pages = {938},
	keywords = {Ambulatory Care Facilities, Commerce, Health Services Accessibility, Humans, United States},
	issn = {1544-5208},
	doi = {10.1377/hlthaff.2016.0373},
	author = {Ateev Mehrotra and Ashwood, J Scott}
}
@article {516841,
	title = {Using Clinical Vignettes to Assess Quality of Care for Acute Respiratory Infections},
	journal = {Inquiry},
	volume = {53},
	year = {2016},
	month = {2016},
	abstract = {Overprescribing of antibiotics for acute respiratory infections (ARIs) is common. Our objective was to develop and validate a vignette-based method to estimate clinician ARI antibiotic prescribing. We surveyed physicians (n = 78) and retail clinic clinicians (n = 109) between January and September 2013. We surveyed clinicians using a set of ARI vignettes and linked the responses to electronic health record data for all ARI visits managed by these clinicians during 2012. We then created a new measure of antibiotic prescribing, the comprehensive ARI management rate. This was defined as not prescribing antibiotics for antibiotic-inappropriate diagnoses and prescribing guideline-concordant antibiotics for antibiotic-appropriate diagnoses (and also included appropriate use of streptococcal testing for the pharyngitis vignettes). We compared the vignette-based and chart-based comprehensive ARI management at the clinician level. We then identified the combination of vignettes that best predicted comprehensive ARI management rates, using a partitioning algorithm. Responses to 3 vignettes partitioned clinicians into 4 groups with chart-based comprehensive ARI management rates of 61\% (n = 121), 50\% (n = 47), 31\% (n = 12), and 22\% (n = 7). Responses to 3 clinical vignettes can identify clinicians with relatively poor quality ARI antibiotic prescribing. Vignettes may be a mechanism to target clinicians for quality improvement efforts.},
	keywords = {Acute Disease, Anti-Bacterial Agents, Electronic Health Records, Health Services Research, Humans, Practice Patterns, Physicians{\textquoteright}, Primary Health Care, Quality of Health Care, Reproducibility of Results, Respiratory Tract Infections, Surveys and Questionnaires},
	issn = {1945-7243},
	doi = {10.1177/0046958016636531},
	author = {Gidengil, Courtney A and Linder, Jeffrey A and Beach, Scott and Setodji, Claude M and Hunter, Gerald and Ateev Mehrotra}
}
@article {516821,
	title = {Utilization of Telemedicine Among Rural Medicare Beneficiaries},
	journal = {JAMA},
	volume = {315},
	number = {18},
	year = {2016},
	month = {2016 May 10},
	pages = {2015-6},
	keywords = {Aged, Aged, 80 and over, Female, Humans, Male, Medicare, Middle Aged, Rural Population, Telemedicine, United States},
	issn = {1538-3598},
	doi = {10.1001/jama.2016.2186},
	author = {Ateev Mehrotra and Jena, Anupam B and Alisa B. Busch and Souza, Jeffrey and Uscher-Pines, Lori and Landon, Bruce E}
}
@article {516851,
	title = {Variation in Quality of Urgent Health Care Provided During Commercial Virtual Visits},
	journal = {JAMA Intern Med},
	volume = {176},
	number = {5},
	year = {2016},
	month = {2016 May 01},
	pages = {635-42},
	abstract = {IMPORTANCE: Commercial virtual visits are an increasingly popular model of health care for the management of common acute illnesses. In commercial virtual visits, patients access a website to be connected synchronously-via videoconference, telephone, or webchat-to a physician with whom they have no prior relationship. To date, whether the care delivered through those websites is similar or quality varies among the sites has not been assessed.

OBJECTIVE: To assess the variation in the quality of urgent health care among virtual visit companies.

DESIGN, SETTING, AND PARTICIPANTS: This audit study used 67 trained standardized patients who presented to commercial virtual visit companies with the following 6 common acute illnesses: ankle pain, streptococcal pharyngitis, viral pharyngitis, acute rhinosinusitis, low back pain, and recurrent female urinary tract infection. The 8 commercial virtual visit websites with the highest web traffic were selected for audit, for a total of 599 visits. Data were collected from May 1, 2013, to July 30, 2014, and analyzed from July 1, 2014, to September 1, 2015.

MAIN OUTCOMES AND MEASURES: Completeness of histories and physical examinations, the correct diagnosis (vs an incorrect or no diagnosis), and adherence to guidelines of key management decisions.

RESULTS: Sixty-seven standardized patients completed 599 commercial virtual visits during the study period. Histories and physical examinations were complete in 417 visits (69.6\%; 95\% CI, 67.7\%-71.6\%); diagnoses were correctly named in 458 visits (76.5\%; 95\% CI, 72.9\%-79.9\%), and key management decisions were adherent to guidelines in 325 visits (54.3\%; 95\% CI, 50.2\%-58.3\%). Rates of guideline-adherent care ranged from 206 visits (34.4\%) to 396 visits (66.1\%) across the 8 websites. Variation across websites was significantly greater for viral pharyngitis and acute rhinosinusitis (adjusted rates, 12.8\% to 82.1\%) than for streptococcal pharyngitis and low back pain (adjusted rates, 74.6\% to 96.5\%) or ankle pain and recurrent urinary tract infection (adjusted rates, 3.4\% to 40.4\%). No statistically significant variation in guideline adherence by mode of communication (videoconference vs telephone vs webchat) was found.

CONCLUSIONS AND RELEVANCE: Significant variation in quality was found among companies providing virtual visits for management of common acute illnesses. More variation was found in performance for some conditions than for others, but no variation by mode of communication.},
	keywords = {Acute Disease, Ambulatory Care, California, Communication, Diagnosis, Female, Guideline Adherence, Humans, Male, Medical Audit, Physician-Patient Relations, Practice Guidelines as Topic, Quality of Health Care, Telemedicine, User-Computer Interface},
	issn = {2168-6114},
	doi = {10.1001/jamainternmed.2015.8248},
	author = {Schoenfeld, Adam J and Davies, Jason M and Marafino, Ben J and Dean, Mitzi and DeJong, Colette and Bardach, Naomi S and Kazi, Dhruv S and Boscardin, W John and Lin, Grace A and Duseja, Reena and Mei, Y John and Ateev Mehrotra and Dudley, R Adams}
}
@article {516846,
	title = {What Drives Variation in Antibiotic Prescribing for Acute Respiratory Infections?},
	journal = {J Gen Intern Med},
	volume = {31},
	number = {8},
	year = {2016},
	month = {2016 Aug},
	pages = {918-24},
	abstract = {BACKGROUND: Acute respiratory infections are the most common symptomatic reason for seeking care among patients in the US, and account for the majority of all antibiotic prescribing, yet a large fraction of antibiotic prescriptions are inappropriate.

OBJECTIVE: We sought to identify the underlying factors driving variation in antibiotic prescribing across clinicians and settings.

DESIGN, PARTICIPANTS: Using electronic health data for adult ambulatory visits for acute respiratory infections to a retail clinic chain and primary care practices from an integrated healthcare system, we identified a random sample of clinicians for survey.

MAIN MEASURES: We evaluated independent predictors of overall prescribing and imperfect antibiotic prescribing, controlling for clinician and site of care. We defined imperfect antibiotic prescribing as prescribing for non-antibiotic-appropriate diagnoses, failure to prescribe for an antibiotic-appropriate diagnosis, or prescribing a non-guideline-concordant antibiotic.

KEY RESULTS: Response rates were 34~\% for retail clinics and 24~\% for physicians{\textquoteright} offices (N = 187). Clinicians in physicians{\textquoteright} offices prescribed antibiotics less often than those in retail clinics (53~\% versus 67~\%; p \&lt; 0.01), but had a higher imperfect antibiotic prescribing rate (65~\% versus 31~\%; p \&lt; 0.01). Feeling rushed was associated with higher antibiotic prescribing (OR 1.34; 95~\% CI 1.03, 1.75). Antibiotic prescribing was also associated with clinician disagreement that antibiotics are overused (OR 1.60, 95~\% CI, 1.16, 2.20). Imperfect antibiotic prescribing was associated with receiving antibiotic prescribing feedback (OR 1.35, 95~\% CI 1.04, 1.75) and disagreement that patient demand was a problem (OR 1.66, 95~\% CI 1.00, 2.73). Imperfect antibiotic prescribing was less common with clinicians who perceived that they prescribed antibiotics less often than their peers (OR 0.63, 95~\% CI 0.46, 0.87).

CONCLUSIONS: Poor-quality antibiotic prescribing was associated with feeling rushed, believing less strongly that antibiotics were overused, and believing that patient demand was not an issue, factors that can be assessed and addressed in future interventions.},
	keywords = {Acute Disease, Adolescent, Adult, Aged, Anti-Bacterial Agents, Attitude of Health Personnel, Drug Prescriptions, Electronic Health Records, Female, Humans, Male, Middle Aged, Respiratory Tract Infections, Young Adult},
	issn = {1525-1497},
	doi = {10.1007/s11606-016-3643-0},
	author = {Gidengil, Courtney A and Ateev Mehrotra and Beach, Scott and Setodji, Claude and Hunter, Gerald and Linder, Jeffrey A}
}
@article {516966,
	title = {Antibiotic Prescribing for Acute Respiratory Infections in Direct-to-Consumer Telemedicine Visits},
	journal = {JAMA Intern Med},
	volume = {175},
	number = {7},
	year = {2015},
	month = {2015 Jul},
	pages = {1234-5},
	keywords = {Adult, Anti-Bacterial Agents, Female, Humans, Inappropriate Prescribing, Male, Middle Aged, Practice Patterns, Physicians{\textquoteright}, Respiratory Tract Infections, Telemedicine},
	issn = {2168-6114},
	doi = {10.1001/jamainternmed.2015.2024},
	author = {Uscher-Pines, Lori and Mulcahy, Andrew and Cowling, David and Hunter, Gerald and Burns, Rachel and Ateev Mehrotra}
}
@article {516961,
	title = {Antibiotic prescribing for respiratory infections at retail clinics, physician practices, and emergency departments},
	journal = {Am J Manag Care},
	volume = {21},
	number = {4},
	year = {2015},
	month = {2015 Apr},
	pages = {294-302},
	abstract = {OBJECTIVES: To compare antibiotic prescribing among retail clinics, primary care practices, and emergency departments (EDs) for acute respiratory infections (ARIs): antibiotics-may-be-appropriate ARIs (eg, sinusitis) and antibiotics-never-appropriate ARIs (eg, acute bronchitis).

STUDY DESIGN: We analyzed retail clinic data from the electronic health records of the 3 largest retail clinic chains in the United States, and data on visits to primary care practices and EDs from the nationally representative National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey.

METHODS: Using multivariate models, we estimated an adjusted antibiotic prescribing rate for each site of care, controlling for differences in patient characteristics and diagnosis.

RESULTS: From 2007 to 2009 in the United States, there were 3 million, 167 million, and 29 million ARI visits at retail clinics, primary care practices, and EDs, respectively. For all ARI visits, the adjusted antibiotic prescribing rate at retail clinics (58\%) was similar to the rate at primary care practices (62\%; P=.09) and EDs (59\%; P=.48). For antibiotics-may-be-appropriate ARI visits, the adjusted antibiotic prescribing rate (95\%) at retail clinics was higher than at primary care practices (85\%; P\&lt;.01) and EDs (83\%; P\&lt;.01). For antibiotics-never-appropriate ARI visits, the adjusted antibiotic prescribing rate (34\%) at retail clinics was lower than at primary care practices (51\%; P\&lt;.01) and EDs (48\%; P\&lt;.01).

CONCLUSIONS: Compared with primary care practices and EDs, there was no difference at retail clinics in overall ARI antibiotic prescribing. At retail clinics, antibiotic prescribing was more diagnosis-appropriate.},
	keywords = {Ambulatory Care Facilities, Anti-Bacterial Agents, Drug Utilization, Emergency Service, Hospital, Health Care Surveys, Humans, Inappropriate Prescribing, Practice Patterns, Physicians{\textquoteright}, Primary Health Care, Respiratory Tract Infections, United States},
	issn = {1936-2692},
	author = {Ateev Mehrotra and Gidengil, Courtney A and Setodji, Claude M and Burns, Rachel M and Linder, Jeffrey A}
}
@article {516951,
	title = {Development of a Model for the Validation of Work Relative Value Units for the Medicare Physician Fee Schedule},
	journal = {Rand Health Q},
	volume = {5},
	number = {1},
	year = {2015},
	month = {2015 Jul 15},
	pages = {5},
	abstract = {The Centers for Medicare \&amp; Medicaid Services (CMS) uses the resource-based relative value scale to pay physicians and other practitioners for professional services. The work values measure the relative levels of professional time and intensity (physical effort, skills, and stress) associated with providing services. CMS asked RAND to develop a model to validate the work values using external data sources. RAND{\textquoteright}s goal was to test the feasibility of using external data and regression analysis to create prediction models to validate work values. Data availability limited the models to surgical procedures and selected medical procedures typically performed in an operating room. Key findings from the study include the following: RAND estimates of intra-service time using external data are typically shorter than the current CMS estimates. Model assumptions about how shorter intra-service times affect procedure intensity have implications for the work estimates. RAND estimates for work on average were similar to current work values if shorter intra-service time is assumed to increase procedure intensity and were on average up to 10 percent lower than current work values if shorter intra-service time is assumed to not impact on procedure intensity. The RAND estimates could be used for two key applications: CMS could flag codes as potentially misvalued if the RAND estimates are notably different from the current CMS values. CMS could also use the RAND estimates as an independent estimate of the work values. In some cases, further review will identify a clinical rationale for why a code is valued differently than the RAND model predictions.},
	issn = {2162-8254},
	author = {Wynn, Barbara O and Burgette, Lane F and Mulcahy, Andrew W and Okeke, Edward N and Brantley, Ian and Iyer, Neema and Ruder, Teague and Ateev Mehrotra}
}
@article {516911,
	title = {Disparities in Time Spent Seeking Medical Care in the United States},
	journal = {JAMA Intern Med},
	volume = {175},
	number = {12},
	year = {2015},
	month = {2015 Dec},
	pages = {1983-6},
	keywords = {Adolescent, Adult, Aged, Female, Health Status Disparities, Healthcare Disparities, Humans, Male, Middle Aged, Patient Acceptance of Health Care, Population Surveillance, Quality Assurance, Health Care, Time Factors, United States, Young Adult},
	issn = {2168-6114},
	doi = {10.1001/jamainternmed.2015.4468},
	author = {Ray, Kristin N and Chari, Amalavoyal V and Engberg, John and Bertolet, Marnie and Ateev Mehrotra}
}
@article {516956,
	title = {Early Marketplace Enrollees Were Older And Used More Medication Than Later Enrollees; Marketplaces Pooled Risk},
	journal = {Health Aff (Millwood)},
	volume = {34},
	number = {6},
	year = {2015},
	month = {2015 Jun},
	pages = {1049-56},
	abstract = {Little is known about the health status of the 7.3 million Americans who enrolled in insurance plans through the Marketplaces established by the Affordable Care Act in 2014. Medication use may provide an early indicator of the health needs and access to care among Marketplace enrollees. We used data from January-September 2014 on more than one million Marketplace enrollees from Express Scripts, the largest pharmacy benefit management company in the United States. We compared the characteristics and medication use between early and late Marketplace enrollees and between all Marketplace enrollees and enrollees with employer-sponsored insurance. Among Marketplace enrollees, we found that those who enrolled earlier (October 2013-February 2014) were older and used more medication than later enrollees. Marketplace enrollees, as a whole, had lower average drug spending and were less likely to use most medication classes than the employer-sponsored comparison group. However, Marketplace enrollees were more likely to use medicines for hepatitis C and particularly for HIV.},
	keywords = {Adolescent, Adult, Age Factors, Child, Child, Preschool, Female, Health Care Reform, Health Care Surveys, Health Insurance Exchanges, Humans, Infant, Infant, Newborn, Insurance, Health, Longitudinal Studies, Male, Middle Aged, Patient Protection and Affordable Care Act, Prescription Drugs, United States, Young Adult},
	issn = {1544-5208},
	doi = {10.1377/hlthaff.2015.0016},
	author = {Donohue, Julie M and Papademetriou, Eros and Henderson, Rochelle R and Frazee, Sharon Glave and Eibner, Christine and Mulcahy, Andrew W and Ateev Mehrotra and Bharill, Shivum and Cui, Can and Stein, Bradley D and Gellad, Walid F}
}
@article {516996,
	title = {Ensuring excellence in centers of excellence programs},
	journal = {Ann Surg},
	volume = {261},
	number = {2},
	year = {2015},
	month = {2015 Feb},
	pages = {237-9},
	abstract = {Studies have found associations between better outcomes and a variety of structural and process criteria that help explain the wide outcome variations that occur across hospitals. In response, Centers of Excellence programs have been developed by multiple third parties. Despite this, programs have yielded disappointing results and can have unintended consequences. To outweigh potential harms, outcomes at Centers of Excellence must be clearly superior. We need to change how hospitals are designated and provide evidence that Centers of Excellence are truly excellent.},
	keywords = {Hospitals, Humans, Outcome and Process Assessment, Health Care, Program Evaluation, Quality Improvement, United States},
	issn = {1528-1140},
	doi = {10.1097/SLA.0000000000001071},
	author = {Ateev Mehrotra and Dimick, Justin B}
}
@article {516946,
	title = {Evaluation of symptom checkers for self diagnosis and triage: audit study},
	journal = {BMJ},
	volume = {351},
	year = {2015},
	month = {2015 Jul 08},
	pages = {h3480},
	abstract = {OBJECTIVE: To determine the diagnostic and triage accuracy of online symptom checkers (tools that use computer algorithms to help patients with self diagnosis or self triage).

DESIGN: Audit study.

SETTING: Publicly available, free symptom checkers.

PARTICIPANTS: 23 symptom checkers that were in English and provided advice across a range of conditions. 45 standardized patient vignettes were compiled and equally divided into three categories of triage urgency: emergent care required (for example, pulmonary embolism), non-emergent care reasonable (for example, otitis media), and self care reasonable (for example, viral upper respiratory tract infection).

MAIN OUTCOME MEASURES: For symptom checkers that provided a diagnosis, our main outcomes were whether the symptom checker listed the correct diagnosis first or within the first 20 potential diagnoses (n=770 standardized patient evaluations). For symptom checkers that provided a triage recommendation, our main outcomes were whether the symptom checker correctly recommended emergent care, non-emergent care, or self care (n=532 standardized patient evaluations).

RESULTS: The 23 symptom checkers provided the correct diagnosis first in 34\% (95\% confidence interval 31\% to 37\%) of standardized patient evaluations, listed the correct diagnosis within the top 20 diagnoses given in 58\% (55\% to 62\%) of standardized patient evaluations, and provided the appropriate triage advice in 57\% (52\% to 61\%) of standardized patient evaluations. Triage performance varied by urgency of condition, with appropriate triage advice provided in 80\% (95\% confidence interval 75\% to 86\%) of emergent cases, 55\% (47\% to 63\%) of non-emergent cases, and 33\% (26\% to 40\%) of self care cases (P\&lt;0.001). Performance on appropriate triage advice across the 23 individual symptom checkers ranged from 33\% (95\% confidence interval 19\% to 48\%) to 78\% (64\% to 91\%) of standardized patient evaluations.

CONCLUSIONS: Symptom checkers had deficits in both triage and diagnosis. Triage advice from symptom checkers is generally risk averse, encouraging users to seek care for conditions where self care is reasonable.},
	keywords = {Consumer Health Information, Health Literacy, Humans, Information Seeking Behavior, Medical Audit, Patient Education as Topic, Quality of Health Care, Self Care, Triage},
	issn = {1756-1833},
	doi = {10.1136/bmj.h3480},
	author = {Semigran, Hannah L and Linder, Jeffrey A and Gidengil, Courtney and Ateev Mehrotra}
}
@article {516976,
	title = {Hospital and regional variation in Medicare payment for inpatient episodes of care},
	journal = {JAMA Intern Med},
	volume = {175},
	number = {6},
	year = {2015},
	month = {2015 Jun},
	pages = {1056-7},
	keywords = {Economics, Hospital, Hospitalization, Humans, Inpatients, Insurance, Health, Reimbursement, Medicare, United States},
	issn = {2168-6114},
	doi = {10.1001/jamainternmed.2015.0674},
	author = {Hussey, Peter S and Huckfeldt, Peter and Hirshman, Samuel and Ateev Mehrotra}
}
@article {516941,
	title = {How will provider-focused payment reform impact geographic variation in Medicare spending?},
	journal = {Am J Manag Care},
	volume = {21},
	number = {6},
	year = {2015},
	month = {2015 Jun 01},
	pages = {e390-8},
	abstract = {OBJECTIVES: The Institute of Medicine has recently argued against a value index as a mechanism to address geographic variation in spending and instead promoted payment reform targeted at individual providers. It is unknown whether such provider-focused payment reform reduces geographic variation in spending.

STUDY DESIGN: We estimated the potential impact of 3 Medicare provider-focused payment policies-pay-for-performance, bundled payment, and accountable care organizations-on geographic variation in Medicare spending across Hospital Referral Regions (HRRs). We compared geographic variation in spending, measured using the coefficient of variation (CV) across HRRs, between the baseline case and a simulation of each of the 3 policies.

METHODS: Policy simulation based on 2008 national Medicare data combined with other publicly available data.

RESULTS: Compared with the baseline (CV, 0.171), neither pay-for-performance nor accountable care organizations would change geographic variation in spending (CV, 0.171), while bundled payment would modestly reduce geographic variation (CV, 0.165).

CONCLUSIONS: In our models, the bundled payment for inpatient and post acute care services in Medicare would modestly reduce geographic variation in spending, but neither accountable care organizations nor pay-for-performance appear to have an impact.},
	keywords = {Accountable Care Organizations, Health Care Reform, Humans, Medicare, Reimbursement, Incentive, United States},
	issn = {1936-2692},
	author = {Auerbach, David and Ateev Mehrotra and Hussey, Peter and Huckfeldt, Peter J and Alpert, Abby and Lau, Christopher and Shier, Victoria}
}
@article {516921,
	title = {The impact of exclusion criteria on a physician{\textquoteright}s adenoma detection rate},
	journal = {Gastrointest Endosc},
	volume = {82},
	number = {4},
	year = {2015},
	month = {2015 Oct},
	pages = {668-75},
	abstract = {BACKGROUND: The adenoma detection rate (ADR) is a validated and widely used measure of colonoscopy quality. There is uncertainty in the published literature as to which colonoscopy examinations should be excluded when measuring a physician{\textquoteright}s ADR.

OBJECTIVE: To examine the impact of varying the colonoscopy exclusion criteria on physician ADR.

DESIGN: We applied different exclusion criteria used in 30 previous studies to a dataset of endoscopy and pathology reports. Under each exclusion criterion, we calculated physician ADR.

SETTING: A private practice colonoscopy center affiliated with the University of Illinois College of Medicine.

PATIENTS: Data on 20,040 colonoscopy examinations performed by 11 gastroenterologists from July 2009 to May 2013 and associated pathology notes.

MAIN OUTCOME MEASUREMENTS: ADRs across all colonoscopy examinations, each physician{\textquoteright}s ADR, and ADR ranking.

RESULTS: There were 28 different exclusion criteria used when measuring the ADR. Each study used a different combination of these exclusion criteria. The proportion of all colonoscopy examinations in the dataset excluded under these combinations of exclusion criteria ranged from 0\% to 92.2\%. The mean ADR across all colonoscopy examinations was 39.1\%. The change in mean ADR after applying the 28 exclusion criteria ranged from -5.5 to +3.0 percentage points. However, the exclusion criteria affected each physician{\textquoteright}s ADR relatively equally, and therefore physicians{\textquoteright} rankings via the ADR were stable.

LIMITATIONS: ADR assessment was limited to a single private endoscopy center.

CONCLUSION: There is wide variation in the exclusion criteria used when measuring the ADR. Although these exclusion criteria can affect overall ADRs, the relative rankings of physicians by ADR were stable. A consensus definition of which exclusion criteria are applied when measuring ADR is needed.},
	keywords = {Adenoma, Adolescent, Adult, Aged, Aged, 80 and over, Clinical Competence, Colonoscopy, Colorectal Neoplasms, Female, Gastroenterology, Humans, Male, Middle Aged, Patient Selection, Quality Indicators, Health Care, Young Adult},
	issn = {1097-6779},
	doi = {10.1016/j.gie.2014.12.056},
	author = {Marcondes, Felippe O and Dean, Katie M and Schoen, Robert E and Leffler, Daniel A and Rose, Sherri and Morris, Michele and Ateev Mehrotra}
}
@article {516906,
	title = {Improving Value in Health Care--Against the Annual Physical},
	journal = {N Engl J Med},
	volume = {373},
	number = {16},
	year = {2015},
	month = {2015 Oct 15},
	pages = {1485-7},
	keywords = {Adult, Contraindications, Humans, Insurance, Health, Reimbursement, Physical Examination, Physician-Patient Relations, Preventive Medicine, Primary Health Care, Quality of Health Care, United States},
	issn = {1533-4406},
	doi = {10.1056/NEJMp1507485},
	author = {Ateev Mehrotra and Prochazka, Allan}
}
@article {516981,
	title = {Including physicians in bundled hospital care payments: time to revisit an old idea?},
	journal = {JAMA},
	volume = {313},
	number = {19},
	year = {2015},
	month = {2015 May 19},
	pages = {1907-8},
	keywords = {Diagnosis-Related Groups, Economics, Hospital, Health Policy, Medicare, Physicians, Prospective Payment System, Reimbursement mechanisms, United States},
	issn = {1538-3598},
	doi = {10.1001/jama.2015.3359},
	author = {Ateev Mehrotra and Hussey, Peter}
}
@article {516926,
	title = {Inclusion of Physicians in Bundled Hospital Payments--Reply},
	journal = {JAMA},
	volume = {314},
	number = {11},
	year = {2015},
	month = {2015 Sep 15},
	pages = {1178-9},
	keywords = {Diagnosis-Related Groups, Economics, Hospital, Physicians, Prospective Payment System},
	issn = {1538-3598},
	doi = {10.1001/jama.2015.9722},
	author = {Ateev Mehrotra and Hussey, Peter}
}
@article {516986,
	title = {Medicare{\textquoteright}s step back from global payments--unbundling postoperative care},
	journal = {N Engl J Med},
	volume = {372},
	number = {15},
	year = {2015},
	month = {2015 Apr 09},
	pages = {1385-7},
	keywords = {Centers for Medicare and Medicaid Services, U.S., Fee-for-Service Plans, Humans, Income, Medicare, Patient Care Bundles, Physicians, Postoperative Care, Reimbursement mechanisms, Surgical Procedures, Operative, United States},
	issn = {1533-4406},
	doi = {10.1056/NEJMp1415483},
	author = {Mulcahy, Andrew W and Wynn, Barbara and Burgette, Lane and Ateev Mehrotra}
}
@article {516931,
	title = {Opportunity costs of ambulatory medical care in the United States},
	journal = {Am J Manag Care},
	volume = {21},
	number = {8},
	year = {2015},
	month = {2015 Aug},
	pages = {567-74},
	abstract = {OBJECTIVES: The typical focus in discussions of healthcare spending is on direct medical costs such as physician reimbursement. The indirect costs of healthcare-patient opportunity costs associated with seeking care, for example-have not been adequately quantified. We aimed to quantify the opportunity costs for adults seeking medical care for themselves or others.

STUDY DESIGN: Secondary analysis of the 2003-2010 American Time Use Survey (ATUS).

METHODS: We used the nationally representative 2003-2010 ATUS to estimate opportunity costs associated with ambulatory medical visits. We estimated opportunity costs for employed adults using self-reported hourly wages and for unemployed adults using a Heckman selection model. We used the Medical Expenditure Panel Survey to compare opportunity costs with direct costs (ie, patient out-of-pocket, provider reimbursement) in 2010.

RESULTS: Average total time per visit was 121 minutes (95\% CI, 118-124), with 37 minutes (95\% CI, 36-39) of travel time and 84 minutes (95\% CI, 81-86) of clinic time. The average opportunity cost per visit was $43, which exceeds the average patient{\textquoteright}s out-of-pocket payment. Total opportunity costs per year for all physician visits in the United States were $52 billion in 2010. For every dollar spent in visit reimbursement, an additional 15 cents were spent in opportunity costs.

CONCLUSIONS: In the United States, opportunity costs associated with ambulatory medical care are substantial. Accounting for patient opportunity costs is important for examining US healthcare system efficiency and for evaluating methods to improve the efficient delivery of patient-centered care.},
	keywords = {Adolescent, Adult, Aged, Ambulatory Care, Efficiency, Female, Health Care Surveys, Humans, Male, Middle Aged, Time Factors, United States, Young Adult},
	issn = {1936-2692},
	author = {Ray, Kristin N and Chari, Amalavoyal V and Engberg, John and Bertolet, Marnie and Ateev Mehrotra}
}
@article {517011,
	title = {The opportunity costs of informal elder-care in the United States: new estimates from the American Time Use Survey},
	journal = {Health Serv Res},
	volume = {50},
	number = {3},
	year = {2015},
	month = {2015 Jun},
	pages = {871-82},
	abstract = {OBJECTIVES: To provide nationally representative estimates of the opportunity costs of informal elder-care in the United States.

DATA SOURCES: Data from the 2011 and 2012 American Time Use Survey.

STUDY DESIGN: Wage is used as the measure of an individual{\textquoteright}s value of time (opportunity cost), with wages being imputed for nonworking individuals using a selection-corrected regression methodology.

PRINCIPAL FINDINGS: The total opportunity costs of informal elder-care amount to $522 billion annually, while the costs of replacing this care by unskilled and skilled paid care are $221 billion and $642 billion, respectively.

CONCLUSIONS: Informal caregiving remains a significant phenomenon in the United States with a high opportunity cost, although it remains more economical (in the aggregate) than skilled paid care.},
	keywords = {Age Factors, Aged, Caregivers, Cost of Illness, Educational Status, Employment, Female, Home Care Services, Humans, Male, Middle Aged, Models, Econometric, Racial Groups, Sex Factors, Time Factors, United States},
	issn = {1475-6773},
	doi = {10.1111/1475-6773.12238},
	author = {Chari, Amalavoyal V and Engberg, John and Ray, Kristin N and Ateev Mehrotra}
}
@article {516971,
	title = {Optimizing Telehealth Strategies for Subspecialty Care: Recommendations from Rural Pediatricians},
	journal = {Telemed J E Health},
	volume = {21},
	number = {8},
	year = {2015},
	month = {2015 Aug},
	pages = {622-9},
	abstract = {BACKGROUND: Telehealth offers strategies to improve access to subspecialty care for children in rural communities. Rural pediatrician experiences and preferences regarding the use of these telehealth strategies for children{\textquoteright}s subspecialty care needs are not known. We elicited rural pediatrician experiences and preferences regarding different pediatric subspecialty telehealth strategies.

MATERIALS AND METHODS: Seventeen semistructured telephone interviews were conducted with rural pediatricians from 17 states within the United States. Interviewees were recruited by e-mails to a pediatric rural health listserv and to rural pediatricians identified through snowball sampling. Themes were identified through thematic analysis of interview transcripts. Institutional Review Board approval was obtained.

RESULTS: Rural pediatricians identified several telehealth strategies to improve access to subspecialty care, including physician access hotlines, remote electronic medical record access, electronic messaging systems, live video telemedicine, and telehealth triage systems. Rural pediatricians provided recommendations for optimizing the utility of each of these strategies based on their experiences with different systems. Rural pediatricians preferred specific telehealth strategies for specific clinical contexts, resulting in a proposed framework describing the complementary role of different telehealth strategies for pediatric subspecialty care. Finally, rural pediatricians identified additional benefits associated with the use of telehealth strategies and described a desire for telehealth systems that enhanced (rather than replaced) personal relationships between rural pediatricians and subspecialists.

CONCLUSIONS: Rural pediatricians described complementary roles for different subspecialty care telehealth strategies. Additionally, rural pediatricians provided recommendations for optimizing individual telehealth strategies. Input from rural pediatricians will be crucial for optimizing specific telehealth strategies and designing effective telehealth systems.},
	keywords = {Attitude of Health Personnel, Child, Child Health Services, Electronic Health Records, Female, Health Services Accessibility, Hotlines, Humans, Interviews as Topic, Male, Pediatricians, Practice Patterns, Physicians{\textquoteright}, Rural Health Services, Specialization, United States},
	issn = {1556-3669},
	doi = {10.1089/tmj.2014.0186},
	author = {Ray, Kristin N and Demirci, Jill R and Bogen, Debra L and Ateev Mehrotra and Elizabeth Miller}
}
@article {696576,
	title = {Patient Use of Cost and Quality Data When Choosing a Joint Replacement Provider in the Context of Reference Pricing},
	journal = {Health Serv Res Manag Epidemiol},
	volume = {2},
	year = {2015},
	month = {2015 Jan-Dec},
	pages = {2333392815598310},
	abstract = {Health plans are encouraging consumerism among joint replacement patients by reporting information on hospital costs and quality. Little is known about how the proliferation of such initiatives impacts patients{\textquoteright} selection of a surgeon and hospital. We performed a qualitative analysis of semistructured interviews with 13 patients who recently received a hip or knee replacement surgery. Patients focused on the choice of a surgeon as opposed to a hospital, and the surgeon choice was primarily made based on reputation. Most patients had long-standing relationships with an orthopedic surgeon and tended to stay with that surgeon for their replacement. Despite growing availability of cost and quality information, patients almost never used such information to make a decision.},
	issn = {2333-3928},
	doi = {10.1177/2333392815598310},
	author = {Kandrack, Ryan and Ateev Mehrotra and DeVries, Andrea and Wu, Sze-Jung and SooHoo, Nelson F and Martsolf, Grant R}
}
@article {516916,
	title = {Public reporting of colonoscopy quality is associated with an increase in endoscopist adenoma detection rate},
	journal = {Gastrointest Endosc},
	volume = {82},
	number = {4},
	year = {2015},
	month = {2015 Oct},
	pages = {676-82},
	abstract = {BACKGROUND: Colonoscopy is the predominant method for colorectal cancer screening in the United States. Previous studies have documented variation across physicians in colonoscopy quality as measured by the adenoma detection rate (ADR). ADR is the primary quality measure of colonoscopy examinations and an indicator of the likelihood of subsequent colorectal cancer. There is interest in mechanisms to improve the ADR. In Central Illinois, a local employer and a quality improvement organization partnered to publically report physician colonoscopy quality.

OBJECTIVE: We assessed whether this initiative was associated with an improvement in the ADR.

DESIGN: We compared ADRs before and after public reporting at a private practice endoscopy center with 11 gastroenterologists in Peoria, Illinois, who participated in the initiative. To generate the ADR, colonoscopy and pathology reports from examinations performed over 4 years at the endoscopy center were analyzed by using previously validated natural language processing software.

SETTING: A central Illinois endoscopy center.

RESULTS: The ADR in the pre-public reporting period was 34.3\% and 39.2\% in the post-public reporting period (an increase of 4.9\%, P \&lt; .001). The increase in the right-sided ADR was 5.1\% (P \&lt; .01), whereas the increase in the left-sided ADR was 2.1\% (P \&lt; .05). The increase in the ADR was 7.8\% for screening colonoscopies (P \&lt; 0.05) and 3.5\% for nonscreening colonoscopies (P \&lt; .05). All but 1 physician{\textquoteright}s ADR increased (range -2.7\% to 10.5\%). There was no statistically significant change in the advanced ADR (increase of 0.8\%, P = .22).

LIMITATIONS: There was no concurrent control group to assess whether the increased ADR was due to a secular trend.

CONCLUSION: A public reporting initiative on colonoscopy quality was associated with an increase in ADR.},
	keywords = {Access to Information, Adenoma, Adult, Aged, Aged, 80 and over, Colonoscopy, Colorectal Neoplasms, Early Detection of Cancer, Female, Humans, Illinois, Information Dissemination, Male, Middle Aged, Program Evaluation, Quality Improvement, Quality Indicators, Health Care, Retrospective Studies},
	issn = {1097-6779},
	doi = {10.1016/j.gie.2014.12.058},
	author = {Abdul-Baki, Heitham and Schoen, Robert E and Dean, Katie and Rose, Sherri and Leffler, Daniel A and Kuganeswaran, Eliathamby and Morris, Michele and Carrell, David and Ateev Mehrotra}
}
@article {516991,
	title = {The volume-quality relationship in antibiotic prescribing: when more isn{\textquoteright}t better},
	journal = {Inquiry},
	volume = {52},
	year = {2015},
	month = {2015},
	abstract = {For many surgeries and high-risk medical conditions, higher volume providers provide higher quality care. The impact of volume on more common medical conditions such as acute respiratory infections (ARIs) has not been examined. Using electronic health record data for adult ambulatory ARI visits, we divided primary care physicians into ARI volume quintiles. We fitted a linear regression model of antibiotic prescribing rates across quintiles to assess for a significant difference in trend. Higher ARI volume physicians had lower quality across a number of domains, including higher antibiotic prescribing rates, higher broad-spectrum antibiotic prescribing, and lower guideline concordance. Physicians with a higher volume of cases manage ARI very differently and are more likely to prescribe antibiotics. When they prescribe an antibiotic for a diagnosis for which an antibiotic may be indicated, they are less likely to prescribe guideline-concordant antibiotics. Given that high-volume physicians account for the bulk of ARI visits, efforts targeting this group are likely to yield important population effects in improving quality.},
	keywords = {Acute Disease, Adult, Ambulatory Care, Anti-Bacterial Agents, Guideline Adherence, Humans, Medical Records Systems, Computerized, Practice Patterns, Physicians{\textquoteright}, Quality of Health Care, Respiratory Tract Infections, United States},
	issn = {1945-7243},
	doi = {10.1177/0046958015571130},
	author = {Gidengil, Courtney A and Linder, Jeffrey A and Hunter, Gerald and Setodji, Claude and Ateev Mehrotra}
}
@article {517031,
	title = {Analysis of Teladoc use seems to indicate expanded access to care for patients without prior connection to a provider},
	journal = {Health Aff (Millwood)},
	volume = {33},
	number = {2},
	year = {2014},
	month = {2014 Feb},
	pages = {258-64},
	abstract = {Despite the potential benefits of telehealth applications, little is known about their overall impact on care. This is critical because rising health care costs and a shortage of primary care providers make it likely that telehealth services will play an increasingly important role in health care delivery. To help fill this gap in knowledge, we describe early experiences with Teladoc, one of the largest telemedicine providers in the United States, which provides care directly to patients over the telephone or via the Internet. We analyzed claims data for a large California agency serving public employees that recently offered Teladoc as a covered service. The 3,701 Teladoc "visits" we studied were for a broad range of diagnostic categories, the most common of which were acute respiratory conditions, urinary tract infections, and skin problems. Compared to patients who visited a physician{\textquoteright}s office for a similar condition, adult Teladoc users were younger and less likely to have used health care before the introduction of Teladoc. Patients who used Teladoc were less likely to have a follow-up visit to any setting, compared to those patients who visited a physician{\textquoteright}s office or emergency department. Teladoc appears to be expanding access to patients who are not connected to other providers. Future research should assess the impact of Teladoc and other telehealth interventions on the quality and cost of care.},
	keywords = {California, Cost Savings, Delivery of Health Care, Female, Health Care Costs, Health Care Reform, Health Personnel, Health Services Accessibility, Humans, Male, Medicare, Outcome Assessment, Health Care, Practice Patterns, Physicians{\textquoteright}, Reimbursement mechanisms, Technology Assessment, Biomedical, Telemedicine, United States},
	issn = {1544-5208},
	doi = {10.1377/hlthaff.2013.0989},
	author = {Uscher-Pines, Lori and Ateev Mehrotra}
}
@article {696577,
	title = {Antibiotic prescribing for adults with acute bronchitis in the United States, 1996-2010},
	journal = {JAMA},
	volume = {311},
	number = {19},
	year = {2014},
	month = {2014 May 21},
	pages = {2020-2},
	keywords = {Acute Disease, Adolescent, Anti-Bacterial Agents, Bronchitis, Female, Guideline Adherence, Humans, Male, Middle Aged, Practice Guidelines as Topic, Practice Patterns, Physicians{\textquoteright}, United States, Young Adult},
	issn = {1538-3598},
	doi = {10.1001/jama.2013.286141},
	author = {Michael L. Barnett and Linder, Jeffrey A}
}
@article {696578,
	title = {Antibiotic prescribing to adults with sore throat in the United States, 1997-2010},
	journal = {JAMA Intern Med},
	volume = {174},
	number = {1},
	year = {2014},
	month = {2014 Jan},
	pages = {138-40},
	keywords = {Adolescent, Adult, Aged, Anti-Bacterial Agents, Female, Humans, Male, Middle Aged, Pharyngitis, Practice Patterns, Physicians{\textquoteright}, United States, Young Adult},
	issn = {2168-6114},
	doi = {10.1001/jamainternmed.2013.11673},
	author = {Michael L. Barnett and Linder, Jeffrey A}
}
@article {517041,
	title = {Do we really need more physicians? Responses to predicted primary care physician shortages},
	journal = {Med Care},
	volume = {52},
	number = {2},
	year = {2014},
	month = {2014 Feb},
	pages = {95-6},
	abstract = {Predicted primary care shortages have spurred action to increase the number of primary care physicians. However, simply increasing the number of primary care providers is not the only solution to resolving the imbalance between the supply of primary care physicians and the demand for primary care services. In this point-counterpoint, we highlight the limitations of existing primary care shortage predictions and discuss strategies to deliver primary care services without necessarily increasing the number of primary care physicians for a given population. Innovative solutions can be used to reduce or even eliminate projected primary care shortages while changing the prevailing paradigm of primary care.},
	keywords = {Delivery of Health Care, Health Services Needs and Demand, Humans, Models, Statistical, Physicians, Primary Care, Primary Health Care, United States, Workforce},
	issn = {1537-1948},
	doi = {10.1097/MLR.0000000000000046},
	author = {Chen, Peggy Guey-Chi and Ateev Mehrotra and Auerbach, David I}
}
@article {517016,
	title = {Geographic variation in receipt of psychotherapy in children receiving attention-deficit/hyperactivity disorder medications},
	journal = {JAMA Pediatr},
	volume = {168},
	number = {11},
	year = {2014},
	month = {2014 Nov},
	pages = {1074-6},
	keywords = {Adolescent, Attention Deficit Disorder with Hyperactivity, Child, Child, Preschool, Combined Modality Therapy, Female, Humans, Infant, Infant, Newborn, Male, Psychotherapy, United States},
	issn = {2168-6211},
	doi = {10.1001/jamapediatrics.2014.1647},
	author = {Gellad, Walid F and Stein, Bradley D and Ruder, Teague and Henderson, Rochelle and Frazee, Sharon G and Ateev Mehrotra and Donohue, Julie M}
}
@article {517021,
	title = {Impact of a patient incentive program on receipt of preventive care},
	journal = {Am J Manag Care},
	volume = {20},
	number = {6},
	year = {2014},
	month = {2014 Jun},
	pages = {494-501},
	abstract = {OBJECTIVES: Patient financial incentives are being promoted as a mechanism to increase receipt of preventive care, encourage healthy behavior, and improve chronic disease management. However, few empirical evaluations have assessed such incentive programs.

STUDY DESIGN: In South Africa, a private health plan has introduced a voluntary incentive program which costs enrollees approximately $20 per month. In the program, enrollees earn points when they receive preventive care. These points translate into discounts on retail goods such as airline tickets, movie tickets, or cell phones.

METHODS: We chose 8 preventive care services over the years 2005 to 2011 and compared the change between those who entered the incentive program and those that did not. We used multivariate regression models with individual random effects to try to address selection bias.

RESULTS: Of the 4,186,047 unique individuals enrolled in the health plan, 65.5\% (2,742,268) voluntarily enrolled in the incentive program. Joining the incentive program was associated with statistically higher odds of receiving all 8 preventive care services. The odds ratio (and estimated percentage point increase) for receipt of cholesterol testing was 2.70 (8.9\%); glucose testing 1.51 (4.7\%); glaucoma screening 1.34 (3.9\%); dental exam 1.64 (6.3\%); HIV test 3.47 (2.6\%); prostate specific antigen testing 1.39 (5.6\%); Papanicolaou screening 2.17 (7.0\%); and mammogram 1.90 (3.1\%) (P \&lt; .001 for all 8 services). However, preventive care rates among those in the incentive program was still low.

CONCLUSIONS: Voluntary participation in a patient incentive program was associated with a significantly higher likelihood of receiving preventive care, though receipt of preventive care among those in the program was still lower than ideal.},
	keywords = {Adolescent, Adult, Aged, Case-Control Studies, Child, Child, Preschool, Female, Humans, Male, Mass Screening, Middle Aged, Preventive Health Services, Reimbursement, Incentive, South Africa, Young Adult},
	issn = {1936-2692},
	author = {Ateev Mehrotra and An, Ruopeng and Patel, Deepak N and Sturm, Roland}
}
@article {517001,
	title = {Paying for telemedicine},
	journal = {Am J Manag Care},
	volume = {20},
	number = {12},
	year = {2014},
	month = {2014},
	pages = {983-5},
	keywords = {Fee-for-Service Plans, Humans, Models, Economic, Monitoring, Physiologic, Reimbursement mechanisms, Telemedicine, United States, Videoconferencing},
	issn = {1936-2692},
	author = {Rudin, Robert S and Auerbach, David and Zaydman, Mikhail and Ateev Mehrotra}
}
@article {516936,
	title = {Post-acute referral patterns for hospitals and implications for bundled payment initiatives},
	journal = {Healthc (Amst)},
	volume = {2},
	number = {3},
	year = {2014},
	month = {2014 Sep},
	pages = {190-5},
	abstract = {BACKGROUND: Under new bundled payment models, hospitals are financially responsible for post-acute care delivered by providers such as skilled nursing facilities (SNFs) and home health agencies (HHAs). The hope is that hospitals will use post-acute care more prudently and better coordinate care with post-acute providers. However, little is known about existing patterns in hospitals׳ referrals to post-acute providers.

METHODS: Post-acute provider referrals were identified using SNF and HHA claims within 14 days following hospital discharge. Hospital post-acute care network size and concentration were estimated across hospital types and regions. The 2008 Medicare Provider Analysis and Review claims for acute hospitals and SNFs, and the 100\% HHA Standard Analytic Files were used.

RESULTS: The mean post-acute care network size for U.S. hospitals included 57.9 providers with 37.5 SNFs and 23.4 HHAs. The majority of these providers (65.7\% of SNFs, 60.9\% of HHAs) accounted for 1 percent or less of a hospital׳s referrals and classified as "low-volume". Other post-acute providers we classified as routine. The mean network size for routine providers was greater for larger hospitals, teaching hospitals and in regions with higher per capita post-acute care spending.

CONCLUSIONS: The average hospital works with over 50 different post-acute providers. Moreover, the size of post-acute care networks varies considerably geographically and by hospital characteristics. These results provide context on the complex task hospitals will face in coordinating care with post-acute providers and cutting costs under new bundled payment models.},
	issn = {2213-0772},
	doi = {10.1016/j.hjdsi.2014.05.004},
	author = {Lau, Christopher and Alpert, Abby and Huckfeldt, Peter and Hussey, Peter and Auerbach, David and Liu, Hangsheng and Sood, Neeraj and Ateev Mehrotra}
}
@article {517036,
	title = {Reducing unnecessary antibiotics prescribed to children: what next?},
	journal = {Pediatrics},
	volume = {133},
	number = {3},
	year = {2014},
	month = {2014 Mar},
	pages = {533-4},
	keywords = {Ambulatory Care, Anti-Bacterial Agents, Drug Utilization, Female, Humans, Insurance, Health, Male},
	issn = {1098-4275},
	doi = {10.1542/peds.2013-4016},
	author = {Ateev Mehrotra}
}
@article {517046,
	title = {Response: effectiveness in primary care is paramount, but need not come at the expense of efficiency},
	journal = {Med Care},
	volume = {52},
	number = {2},
	year = {2014},
	month = {2014 Feb},
	pages = {99-100},
	abstract = {Effective primary care is vital to sustainable provision of primary care for the US population. However, efficiency and effectiveness go hand-in-hand. Effective care is that which enables a health system to optimize the performance of all care providers while eliminating wasteful practices. If high-quality patient care and strengthened patient-provider relationships are to occur outside of isolated pockets of innovation and spread to the populace as a whole, each primary care physician must work within a system that affords the tools, opportunity, and support needed to optimally manage a growing number of patients with mounting health care needs. The expectation that primary care physicians must come into direct contact with each and every patient, no matter the acuity or chief complaint, no longer meets the expectations of patients or those whom we would attract to enter the field of primary care. We can no longer repair the faults in our primary care workforce by simply increasing the number of providers working in exactly the same way primary care physicians have always worked. A modern workforce will require efficient practices to produce the most effective health care for the population.},
	keywords = {Humans, Physicians, Primary Care, Primary Health Care},
	issn = {1537-1948},
	doi = {10.1097/MLR.0000000000000048},
	author = {Chen, Peggy Guey-Chi and Ateev Mehrotra and Auerbach, David I}
}
@article {517026,
	title = {Supply and utilization of pediatric subspecialists in the United States},
	journal = {Pediatrics},
	volume = {133},
	number = {6},
	year = {2014},
	month = {2014 Jun},
	pages = {1061-9},
	abstract = {OBJECTIVE: The wide geographic variation in pediatric subspecialty supply in the United States has been a source of concern. Whether children in areas with decreased supply receive less subspecialty care or have worse outcomes has not been adequately evaluated. Among children with special health care needs, we examined the association between pediatric subspecialty supply and subspecialty utilization, need, child disease burden, and family disease burden.

METHODS: We measured pediatric subspecialist supply as pediatric subspecialists per capita in each residential county. By using the 2009-2010 National Survey of Children With Special Health Care Needs and controlling for many potential confounders, we examined the association between quintile of pediatric subspecialty supply and parent-reported subspecialty utilization, perceived subspecialty need, and child and family disease burden.

RESULTS: County-level pediatric subspecialty supply ranged from a median of 0 (lowest quintile) to 59 (highest quintile) per 100 000 children. In adjusted results, compared with children in the highest quintile, children in the lowest quintile of supply were 4.8\% less likely to report ambulatory subspecialty visits (P \&lt; .001), 5.3\% less likely to perceive subspecialty care needs (P \&lt; .001), and 2.3\% more likely to report emergency department visits (P = .018). There were no meaningful differences between pediatric subspecialty supply quintiles for other measures of child or family disease burden.

CONCLUSIONS: Children living in counties with the lowest supply of pediatric subspecialists had both decreased perceived need for subspecialty care and decreased utilization of subspecialists. However, the differences in supply were not associated with meaningful differences in child or family disease burden.},
	keywords = {Adolescent, Child, Child, Preschool, Chronic Disease, Cost of Illness, Disabled Children, Emergency Service, Hospital, Female, Health Services Accessibility, Health Services Needs and Demand, Humans, Infant, Male, Medically Underserved Area, Pediatrics, Specialization, United States, Utilization Review, Workforce},
	issn = {1098-4275},
	doi = {10.1542/peds.2013-3466},
	author = {Ray, Kristin N and Bogen, Debra L and Bertolet, Marnie and Forrest, Christopher B. and Ateev Mehrotra}
}
@article {517006,
	title = {Use patterns of a state health care price transparency web site: what do patients shop for?},
	journal = {Inquiry},
	volume = {51},
	year = {2014},
	month = {2014},
	abstract = {To help people shop for lower cost providers, several states have created their own price transparency Web sites or passed legislation mandating health plans provide such information. New Hampshire{\textquoteright}s HealthCost Web site is on the forefront of such initiatives. Despite the growing interest in price transparency, little is known about such efforts, including how often these tools are used and for what reason. We examined the use of New Hampshire HealthCost over a 3-year period. Approximately 1\% of the state{\textquoteright}s residents used the Web site, and the most common searches were for outpatient visits, magnetic resonance imaging (MRI) or computed tomography (CT) scans, and emergency department visits. The results provide a cautionary note on the level of potential interest among consumers in this information but may guide others on practically what are the most "shop-able" services for patients.},
	keywords = {Community Participation, Delivery of Health Care, Disclosure, Economics, Hospital, Humans, Internet, Marketing of Health Services, Massachusetts, United States},
	issn = {1945-7243},
	doi = {10.1177/0046958014561496},
	author = {Ateev Mehrotra and Brannen, Tyler and Anna D. Sinaiko}
}
@article {517071,
	title = {Accountable care organization formation is associated with integrated systems but not high medical spending},
	journal = {Health Aff (Millwood)},
	volume = {32},
	number = {10},
	year = {2013},
	month = {2013 Oct},
	pages = {1781-8},
	abstract = {Medicare{\textquoteright}s approximately 250 accountable care organizations (ACOs) care for a growing portion of all fee-for-service beneficiaries across the United States. We examined where ACOs have formed and what regional factors are predictive of ACO formation. Understanding these factors could help policy makers foster growth in areas with limited ACO development. We found wide variation in ACO formation, with large areas, such as the Northwest, essentially empty of ACOs, and others, such as the Northeast and Midwest, dense with the organizations. Key regional factors associated with ACO formation include a greater fraction of hospital risk sharing (capitation), larger integrated hospital systems, and primary care physicians practicing in large groups. Area income, Medicare per capita spending, Medicare Advantage enrollment rates, and physician density were not associated with ACO formation. Together, these results imply that underlying provider integration in a region may help drive the formation of ACOs.},
	keywords = {Accountable Care Organizations, Cost Control, Delivery of Health Care, Integrated, Health Expenditures, Humans, Medicare, United States},
	issn = {1544-5208},
	doi = {10.1377/hlthaff.2013.0372},
	author = {Auerbach, David I and Liu, Hangsheng and Hussey, Peter S and Lau, Christopher and Ateev Mehrotra}
}
@article {517111,
	title = {The association between health care quality and cost: a systematic review},
	journal = {Ann Intern Med},
	volume = {158},
	number = {1},
	year = {2013},
	month = {2013 Jan 01},
	pages = {27-34},
	abstract = {BACKGROUND: Although there is broad policy consensus that both cost containment and quality improvement are critical, the association between costs and quality is poorly understood.

PURPOSE: To systematically review evidence of the association between health care quality and cost.

DATA SOURCES: Electronic literature search of PubMed, EconLit, and EMBASE databases for U.S.-based studies published between 1990 and 2012.

STUDY SELECTION: Title, abstract, and full-text review to identify relevant studies.

DATA EXTRACTION: Two reviewers independently abstracted data with differences reconciled by consensus. Studies were categorized by level of analysis, type of quality measure, type of cost measure, and method of addressing confounders.

DATA SYNTHESIS: Of 61 included studies, 21 (34\%) reported a positive or mixed-positive association (higher cost associated with higher quality); 18 (30\%) reported a negative or mixed-negative association; and 22 (36\%) reported no difference, an imprecise or indeterminate association, or a mixed association. The associations were of low to moderate clinical significance in many studies. Of 9 studies using instrumental variables analysis to address confounding by unobserved patient health status, 7 (78\%) reported a positive association, but other characteristics of these studies may have affected their findings.

LIMITATIONS: Studies used widely heterogeneous methods and measures. The review is limited by the quality of underlying studies.

CONCLUSION: Evidence of the direction of association between health care cost and quality is inconsistent. Most studies have found that the association between cost and quality is small to moderate, regardless of whether the direction is positive or negative. Future studies should focus on what types of spending are most effective in improving quality and what types of spending represent waste.

PRIMARY FUNDING SOURCE: Robert Wood Johnson Foundation.},
	keywords = {Confounding Factors, Epidemiologic, Cost Control, Health Care Costs, Health Policy, Quality Improvement, Quality of Health Care, United States},
	issn = {1539-3704},
	doi = {10.7326/0003-4819-158-1-201301010-00006},
	author = {Hussey, Peter S and Wertheimer, Samuel and Ateev Mehrotra}
}
@article {517056,
	title = {On call at the mall: a mixed methods study of U.S. medical malls},
	journal = {BMC Health Serv Res},
	volume = {13},
	year = {2013},
	month = {2013 Nov 09},
	pages = {471},
	abstract = {BACKGROUND: The decline of the traditional U.S. shopping mall and a focus on more consumer- centered care have created an opportunity for "medical malls". Medical malls are defined as former retail spaces repurposed for healthcare tenants or mixed-use medical/retail facilities.We aimed to describe the current reach of healthcare services in U.S. malls, characterize the medical mall model and emerging trends, and assess the potential of these facilities to serve low-income populations.

METHODS: We used a mixed methods approach which included a comprehensive literature review, key informant interviews, and a descriptive analysis of the Directory of Major Malls, an online retail database.

RESULTS: Six percent (n = 89) of large, enclosed shopping malls in the U.S. include at least one non-optometry or dental healthcare tenant. We identified a total of 28 medical malls across the U.S., the majority of which opened in the past five years and serve middle or high income populations. Stakeholders felt the key strengths of medical malls were more convenient access including public transportation, greater familiarity for patients, and "one stop shopping" for primary care and specialty services as well as retail needs.

CONCLUSIONS: While medical malls currently account for a small fraction of malls in the US, they are a new model for healthcare with significant potential for growth.},
	keywords = {Commerce, Delivery of Health Care, Health Facilities, Health Services Accessibility, Humans, Poverty, United States},
	issn = {1472-6963},
	doi = {10.1186/1472-6963-13-471},
	author = {Uscher-Pines, Lori and Ateev Mehrotra and Chari, Ramya}
}
@article {517091,
	title = {Characteristics of patients who seek care via eVisits instead of office visits},
	journal = {Telemed J E Health},
	volume = {19},
	number = {7},
	year = {2013},
	month = {2013 Jul},
	pages = {515-9},
	abstract = {PURPOSE: There is growing recognition that many physician-patient encounters do not require face-to-face contact. The availability of secure Internet portals creates the opportunity for online eVisits. Increasing numbers of health systems provide eVisits, and many health plans reimburse for eVisits. However, little is known on who chooses to seek care via an eVisit.

MATERIALS AND METHODS: At four primary care practices, we used the electronic medical record to identify all eVisits and office visits for sinusitis and urinary tract infections (UTIs) between January 2010 and May 2011. From the electronic medical record we abstracted the necessary information on patient demographics. The population studied included 5,165 sinusitis visits (9\% of which were eVisits) and 2,954 UTI visits (3\% eVisits).

RESULTS: In multivariate models controlling for other patient factors, the variables most strongly associated with a patient initiating an eVisit versus an office visit were age (18-44 years of age versus 65 years of age and older: sinusitis, odds ratio 1.65 [0.97-2.81]; UTI, 2.97 [1.03-8.62]) and longer travel distance to clinic (\&gt;10 miles from patient home to clinic versus 0-5 miles: sinusitis, odds ratio 6.54 [4.68-9.16]; UTI, odds ratio 3.25 [1.74-6.07]). Higher income was not associated with higher eVisit use.

CONCLUSIONS: At these four primary care practices, eVisits accounted for almost 7\% of visits for sinusitis and UTI. eVisits attract a younger patient population who might use eVisits for convenience reasons.},
	keywords = {Adolescent, Adult, Age Factors, Aged, Female, Health Services Accessibility, Humans, Male, Middle Aged, Multivariate Analysis, Office Visits, Patient Acceptance of Health Care, Pennsylvania, Primary Health Care, Sinusitis, Telecommunications, Urinary Tract Infections, Young Adult},
	issn = {1556-3669},
	doi = {10.1089/tmj.2012.0221},
	author = {Ateev Mehrotra and Paone, Suzanne and Martich, G Daniel and Albert, Steven M and Shevchik, Grant J}
}
@article {517101,
	title = {A comparison of care at e-visits and physician office visits for sinusitis and urinary tract infection},
	journal = {JAMA Intern Med},
	volume = {173},
	number = {1},
	year = {2013},
	month = {2013 Jan 14},
	pages = {72-4},
	keywords = {Anti-Bacterial Agents, Electronic Health Records, Humans, Internet, Office Visits, Outcome and Process Assessment, Health Care, Physical Examination, Physician-Patient Relations, Practice Patterns, Physicians{\textquoteright}, Primary Health Care, Product Line Management, Remote Consultation, Sinusitis, Urinary Tract Infections},
	issn = {2168-6114},
	doi = {10.1001/2013.jamainternmed.305},
	author = {Ateev Mehrotra and Paone, Suzanne and Martich, G Daniel and Albert, Steven M and Shevchik, Grant J}
}
@article {517131,
	title = {Computer-assisted provision of hormonal contraception in acute care settings},
	journal = {Contraception},
	volume = {87},
	number = {2},
	year = {2013},
	month = {2013 Feb},
	pages = {242-50},
	abstract = {BACKGROUND: We evaluated whether computerized counseling about contraceptive options and screening for contraindications increased women{\textquoteright}s subsequent knowledge and use of hormonal contraception.

METHODS: For the study 814 women aged 18-45 years were recruited from the waiting rooms of three emergency departments and an urgent care clinic staffed by non-gynecologists and asked to use a randomly selected computer module before seeing a clinician.

RESULTS: Women in the intervention group were more likely to report receiving a contraceptive prescription when seeking acute care than women in the control group (16\% vs. 1\%, p=.001). Women who requested contraceptive refills were not less likely than women requesting new prescriptions to have potential contraindications to estrogen (75\% of refills vs. 52\% new, p=.23). Three months after visiting the clinic, women in the intervention group tended to be more likely to have used contraception at last intercourse (71\% vs. 65\%, p=.91) and to correctly answer questions about contraceptive effectiveness, but these differences were not statistically significant.

CONCLUSION: Patient-facing computers appear to increase access to prescription contraception for women seeking acute care.},
	keywords = {Adolescent, Adult, Ambulatory Care Facilities, Computers, Contraception Behavior, Contraceptive Agents, Female, Drug Therapy, Computer-Assisted, Emergency Service, Hospital, Female, Health Education, Health Services Accessibility, Humans, Prescription Drugs},
	issn = {1879-0518},
	doi = {10.1016/j.contraception.2012.07.003},
	author = {Schwarz, Eleanor B and Burch, Elizabeth J and Parisi, Sara M and Tebb, Kathleen P and Daniel Grossman and Ateev Mehrotra and Gonzales, Ralph}
}
@article {517076,
	title = {The convenience revolution for treatment of low-acuity conditions},
	journal = {JAMA},
	volume = {310},
	number = {1},
	year = {2013},
	month = {2013 Jul 03},
	pages = {35-6},
	keywords = {Acute Disease, Commerce, Community Health Services, Cost Control, Delivery of Health Care, Emergency Medical Services, Health Services Needs and Demand, Humans, Internet, Practice Guidelines as Topic, Primary Health Care, Private Sector, United States, Waiting Lists},
	issn = {1538-3598},
	doi = {10.1001/jama.2013.6825},
	author = {Ateev Mehrotra}
}
@article {517106,
	title = {Emergency department visits for nonurgent conditions: systematic literature review},
	journal = {Am J Manag Care},
	volume = {19},
	number = {1},
	year = {2013},
	month = {2013 Jan},
	pages = {47-59},
	abstract = {BACKGROUND: A large proportion of all emergency department (ED) visits in the United States are for nonurgent conditions. Use of the ED for nonurgent conditions may lead to excessive healthcare spending, unnecessary testing and treatment, and weaker patient-primary care provider relationships.

OBJECTIVES: To understand the factors influencing an individual{\textquoteright}s decision to visit an ED for a nonurgent condition.

METHODS: We conducted a systematic literature review of the US literature. Multiple databases were searched for US studies published after 1990 that assessed factors associated with nonurgent ED use. Based on those results we developed a conceptual framework.

RESULTS: A total of 26 articles met inclusion criteria. No 2 articles used the same exact definition of nonurgent visits. Across the relevant articles, the average fraction of all ED visits that were judged to be nonurgent (whether prospectively at triage or retrospectively following ED evaluation) was 37\% (range 8\%-62\%). Articles were heterogeneous with respect to study design, population, comparison group, and nonurgent definition. The limited evidence suggests that younger age, convenience of the ED compared with alternatives, referral to the ED by a physician, and negative perceptions about alternatives such as primary care providers all play a role in driving nonurgent ED use.

CONCLUSIONS: Our structured overview of the literature and conceptual framework can help to inform future research and the development of evidence-based interventions to reduce nonurgent ED use.},
	keywords = {Emergency Service, Hospital, Health Services Misuse, Humans},
	issn = {1936-2692},
	author = {Uscher-Pines, Lori and Pines, Jesse and Kellermann, Arthur and Gillen, Emily and Ateev Mehrotra}
}
@article {517081,
	title = {Evaluation of a center of excellence program for spine surgery},
	journal = {Med Care},
	volume = {51},
	number = {8},
	year = {2013},
	month = {2013 Aug},
	pages = {748-57},
	abstract = {BACKGROUND: The Centers for Medicare and Medicaid Services and many private health plans are encouraging patients to seek orthopedic care at hospitals designated as centers of excellence. No evaluations have been conducted to compare patient outcomes and costs at centers of excellence versus other hospitals. The objective of our study was to assess whether hospitals designated as spine surgery centers of excellence by a group of over 25 health plans provided higher quality care.

METHODS: Claims representing approximately 54 million commercially insured individuals were used to identify individuals aged 18-64 years with 1 of 3 types of spine surgery in 2007-2009: 1-level or 2-level cervical fusion (referred to as cervical simple fusion), 1-level or 2-level lumbar fusion (referred to as lumbar simple fusion), or lumbar discectomy and/or decompression without fusion. The primary outcomes were any complication (7 complications were captured) and 30-day readmission. The multivariate models controlled for differences in age, sex, and comorbidities between the 2 sets of hospitals.

RESULTS: A total of 29,295 cervical simple fusions, 27,214 lumbar simple fusions, and 28,911 lumbar discectomy/decompressions were identified, of which 42\%, 42\%, and 47\%, respectively, were performed at a hospital designated as a spine surgery center of excellence. Designated hospitals had a larger number of beds and were more likely to be an academic center. Across the 3 types of spine surgery (cervical fusions, lumbar fusions, or lumbar discectomies/decompressions), there was no difference in the composite complication rate [OR 0.90 (95\% CI, 0.72-1.12); OR 0.98 (95\% CI, 0.85-1.13); OR 0.95 (95\% CI, 0.82-1.07), respectively] or readmission rate [OR 1.03 (95\% CI, 0.87-1.21); OR 1.01 (95\% CI, 0.89-1.13); OR 0.91 (95\%, CI 0.79-1.04), respectively] at designated hospitals compared with other hospitals.

CONCLUSIONS: On average, spine surgery centers of excellence had similar complication rates and readmission rates compared with other hospitals. These results highlight the importance of empirical evaluations of centers of excellence programs.},
	keywords = {Adolescent, Adult, Centers for Medicare and Medicaid Services, U.S., Diskectomy, Hospital Bed Capacity, Hospitals, High-Volume, Hospitals, Special, Humans, Insurance Claim Review, Middle Aged, Patient Readmission, Postoperative Complications, Quality Indicators, Health Care, Quality of Health Care, Spinal Fusion, United States, Young Adult},
	issn = {1537-1948},
	doi = {10.1097/MLR.0b013e31829b091d},
	author = {Ateev Mehrotra and Sloss, Elizabeth M and Hussey, Peter S and Adams, John L and Lovejoy, Susan and SooHoo, Nelson F}
}
@article {517116,
	title = {Evaluation of centers of excellence program for knee and hip replacement},
	journal = {Med Care},
	volume = {51},
	number = {1},
	year = {2013},
	month = {2013 Jan},
	pages = {28-36},
	abstract = {BACKGROUND: Medicare and private plans are encouraging individuals to seek care at hospitals that are designated as centers of excellence. Few evaluations of such programs have been conducted. This study examines a large national initiative that designated hospitals as centers of excellence for knee and hip replacement.

OBJECTIVE: Comparison of outcomes and costs associated with knee and hip replacement at designated hospitals and other hospitals.

RESEARCH DESIGN: Retrospective claims analysis of approximately 54 million enrollees.

STUDY POPULATION: Individuals with insurance from one of the sponsors of this centers of excellence program who underwent a primary knee or hip replacement in 2007-2009.

OUTCOMES: Primary outcomes were any complication within 30 days of discharge and costs within 90 days after the procedure.

RESULTS: A total of 80,931 patients had a knee replacement and 39,532 patients had a hip replacement of which 52.2\% and 56.5\%, respectively, were performed at a designated hospital. Designated hospitals had a larger number of beds and were more likely to be an academic center. Patients with a knee replacement at designated hospitals did not have a statistically significantly lower overall complication rate with an odds ratio of 0.90 (P=0.08). Patients with hip replacement treated at designated hospitals had a statistically significant lower risk of complications with an odds ratio of 0.80 (P=0.002). There was no significant difference in 90-day costs for either procedure.

CONCLUSIONS: Hospitals designated as joint replacement centers of excellence had lower rates of complications for hip replacement, but there was no statistically significant difference for knee replacement. It is important to validate the criteria used to designate centers of excellence.},
	keywords = {Adolescent, Adult, Arthroplasty, Replacement, Hip, Arthroplasty, Replacement, Knee, Comorbidity, Female, Hospital Bed Capacity, Hospital Charges, Hospitals, Humans, Insurance Claim Review, Male, Middle Aged, Postoperative Complications, Quality Indicators, Health Care, Retrospective Studies, Treatment Outcome, United States, Young Adult},
	issn = {1537-1948},
	doi = {10.1097/MLR.0b013e3182699407},
	author = {Ateev Mehrotra and Sloss, Elizabeth M and Hussey, Peter S and Adams, John L and Lovejoy, Susan and SooHoo, Nelson F}
}
@article {517096,
	title = {Impact of socioeconomic adjustment on physicians{\textquoteright} relative cost of care},
	journal = {Med Care},
	volume = {51},
	number = {5},
	year = {2013},
	month = {2013 May},
	pages = {454-60},
	abstract = {BACKGROUND: Ongoing efforts to profile physicians on their relative cost of care have been criticized because they do not account for differences in patients{\textquoteright} socioeconomic status (SES). The importance of SES adjustment has not been explored in cost-profiling applications that measure costs using an episode of care framework.

OBJECTIVES: We assessed the relationship between SES and episode costs and the impact of adjusting for SES on physicians{\textquoteright} relative cost rankings.

RESEARCH DESIGN: We analyzed claims submitted to 3 Massachusetts commercial health plans during calendar years 2004 and 2005. We grouped patients{\textquoteright} care into episodes, attributed episodes to individual physicians, and standardized costs for price differences across plans. We accounted for differences in physicians{\textquoteright} case mix using indicators for episode type and a patient{\textquoteright}s severity of illness. A patient{\textquoteright}s SES was measured using an index of 6 indicators based on the zip code in which the patient lived. We estimated each physician{\textquoteright}s case mix-adjusted average episode cost and percentile rankings with and without adjustment for SES.

RESULTS: Patients in the lowest SES quintile had $80 higher unadjusted episode costs, on average, than patients in the highest quintile. Nearly 70\% of the variation in a physician{\textquoteright}s average episode cost was explained by case mix of their patients, whereas the contribution of SES was negligible. After adjustment for SES, only 1.1\% of physicians changed relative cost rankings \&gt;2 percentiles.

CONCLUSIONS: Accounting for patients{\textquoteright} SES has little impact on physicians{\textquoteright} relative cost rankings within an episode cost framework.},
	keywords = {Adult, Disease Management, Episode of Care, Female, Health Services Research, Humans, Male, Massachusetts, Physicians, Practice Patterns, Physicians{\textquoteright}, Regression Analysis, Severity of Illness Index, Social Class},
	issn = {1537-1948},
	doi = {10.1097/MLR.0b013e31828d1251},
	author = {Timbie, Justin W and Hussey, Peter S and Adams, John L and Ruder, Teague W and Ateev Mehrotra}
}
@article {517061,
	title = {Nurse-managed health centers and patient-centered medical homes could mitigate expected primary care physician shortage},
	journal = {Health Aff (Millwood)},
	volume = {32},
	number = {11},
	year = {2013},
	month = {2013 Nov},
	pages = {1933-41},
	abstract = {Numerous forecasts have predicted shortages of primary care providers, particularly in light of an expected increase in patient demand resulting from the Affordable Care Act. Yet these forecasts could be inaccurate because they generally do not allow for changes in the way primary care is delivered. We analyzed the impact of two emerging models of care--the patient-centered medical home and the nurse-managed health center--both of which use a provider mix that is richer in nurse practitioners and physician assistants than today{\textquoteright}s predominant models of care delivery. We found that projected physician shortages were substantially reduced in plausible scenarios that envisioned greater reliance on these new models, even without increases in the supply of physicians. Some less plausible scenarios even eliminated the shortage. All of these scenarios, however, may require additional changes, such as liberalized scope-of-practice laws; a larger supply of medical assistants, licensed practical nurses, and aides; and payment changes that reward providers for population health management.},
	keywords = {Delivery of Health Care, Health Services Needs and Demand, Humans, Nurse Practitioners, Patient-Centered Care, Physician Assistants, Physicians, Primary Care, Primary Health Care, United States, Workforce},
	issn = {1544-5208},
	doi = {10.1377/hlthaff.2013.0596},
	author = {Auerbach, David I and Chen, Peggy G and Friedberg, Mark W and Reid, Rachel and Lau, Christopher and Buerhaus, Peter I and Ateev Mehrotra}
}
@article {517051,
	title = {Primary care practice response to retail clinics},
	journal = {Virtual Mentor},
	volume = {15},
	number = {11},
	year = {2013},
	month = {2013 Nov 01},
	pages = {937-42},
	keywords = {Ambulatory Care Facilities, Commerce, Humans, Primary Health Care},
	issn = {1937-7010},
	doi = {10.1001/virtualmentor.2013.15.11.ecas3-1311},
	author = {Reid, Rachel O and Ateev Mehrotra}
}
@article {517066,
	title = {Primary care technicians: a solution to the primary care workforce gap},
	journal = {Health Aff (Millwood)},
	volume = {32},
	number = {11},
	year = {2013},
	month = {2013 Nov},
	pages = {1893-8},
	abstract = {Efforts to close the primary care workforce gap typically employ one of three basic strategies: train more primary care physicians; boost the supply of nurse practitioners or physician assistants, or both; or use community health workers to extend the reach of primary care physicians. In this article we briefly review each strategy and the barriers to its success. We then propose a new approach adapted from the widely accepted model of emergency medical services. Translating this model to primary care and leveraging the capabilities of modern health information technology, it should be possible to create primary care technicians who can dramatically expand the impact and reach of patient-centered medical homes by providing basic preventive, minor illness, and stable chronic disease care in rural and resource-deprived communities.},
	keywords = {Allied Health Personnel, Community Health Workers, Emergency Medical Technicians, Humans, Models, Organizational, Nurse Practitioners, Patient Protection and Affordable Care Act, Physician Assistants, Physicians, Primary Health Care, Public Policy, United States, Workforce},
	issn = {1544-5208},
	doi = {10.1377/hlthaff.2013.0481},
	author = {Kellermann, Arthur L and Saultz, John W and Ateev Mehrotra and Jones, Spencer S and Dalal, Siddartha}
}
@article {696579,
	title = {Provincial screening rates for chronic diseases of lifestyle, cancers and HIV in a health-insured population},
	journal = {S Afr Med J},
	volume = {103},
	number = {5},
	year = {2013},
	month = {2013 May},
	pages = {309-12},
	abstract = {BACKGROUND: Screening for asymptomatic diseases can reduce the burden of morbidity and mortality in all population groups. There is widespread geographical variation in the quality of care. Few data are available on national screening rates in South Africa and how these vary across the provinces.

OBJECTIVE: To examine screening rates for chronic diseases of lifestyle (CDL), HIV and cancer in a privately insured population for a single insurer across all nine provinces in South Africa, and to determine whether or not there are any differences between the provinces.

METHOD: Screening rates were calculated as the proportion of eligible members who had received screening tests during 2011 in each province. Mean screening rates were compared between Gauteng and the other eight provinces.

RESULTS: Nationwide screening rates were 20.5\% for CDL, 8.2\% for HIV and 31.9\% for cancer. Despite similar insurance coverage, screening rates ranged from 0.3\% to 0.95\% lower in other provinces compared with Gauteng. Of all the provinces, Gauteng had the highestannual screening rates for CDL, breast cancer, prostate cancer and HIV (p \&lt; 0.001), while the Western Cape had the highest rate for cervical cancer (p \&lt; 0.001).

CONCLUSION: There is much variation in preventive care utilisation across the provinces within this health-insured population. Provinces with more abundant healthcare resources have higher screening rates. Further research is required to understand the reasons for the variation, given equal payment access.},
	keywords = {Asymptomatic Diseases, Diabetes Mellitus, Diagnostic Tests, Routine, Female, Glaucoma, HIV Infections, Humans, Insurance, Health, Life Style, Male, Mass Screening, Neoplasms, Osteoporosis, Practice Patterns, Physicians{\textquoteright}, South Africa},
	issn = {0256-9574},
	doi = {10.7196/samj.6686},
	author = {Adonis, L and An, R and J. Luiz and Mehrotra, A and Patel, D. and Basu, D and Sturm, R}
}
@article {517086,
	title = {Reliability of utilization measures for primary care physician profiling},
	journal = {Healthc (Amst)},
	volume = {1},
	number = {1-2},
	year = {2013},
	month = {2013 Jun},
	pages = {22-9},
	abstract = {BACKGROUND: Given rising health care costs, there has been a renewed interest in using utilization measures to profile physicians. Despite the measures{\textquoteright} common use, few studies have examined their reliability and whether they capture true differences among physicians.

METHODS: A local health improvement organization in New York State used 2008-2010 claims data to create 11 utilization measures for feedback to primary care physicians (PCP). The sample consists of 2938 PCPs in 1546 practices who serve 853,187 patients. We used these data to measure reliability of these utilization measures using two methods (hierarchical model versus test-retest). For each PCP and each practice, we estimate each utilization measure{\textquoteright}s reliability, ranging from 0 to 1, with 0 indicating that all differences in utilization are due to random noise and 1 indicating that all differences are due to real variation among physicians.

RESULTS: Reliability varies significantly across the measures. For 4 utilization measures (PCP visits, specialty visits, PCP lab tests (blood and urine), and PCP radiology and other tests), reliability was high (mean\&gt;0.85) at both the physician and the practice level. For the other 7 measures (professional therapeutic visits, emergency room visits, hospital admissions, readmissions, skilled nursing facility days, skilled home care visits, and custodial home care services), there was lower reliability indicating more substantial measurement error.

CONCLUSIONS: The results illustrate that some utilization measures are suitable for PCP and practice profiling while caution should be used when using other utilization measures for efforts such as public reporting or pay-for-performance incentives.},
	issn = {2213-0764},
	doi = {10.1016/j.hjdsi.2013.04.002},
	author = {Yu, Hao and Ateev Mehrotra and Adams, John}
}
@article {517126,
	title = {Retail clinic visits and receipt of primary care},
	journal = {J Gen Intern Med},
	volume = {28},
	number = {4},
	year = {2013},
	month = {2013 Apr},
	pages = {504-12},
	abstract = {BACKGROUND: An increasing number of patients are visiting retail clinics for simple acute conditions. Physicians worry that visits to retail clinics will interfere with primary care relationships. No prior study has evaluated the impact of retail clinics on receipt of primary care.

OBJECTIVE: To assess the association between retail clinic use and receipt of key primary care functions.

DESIGN: We performed a retrospective cohort analysis using commercial insurance claims from 2007 to 2009.

PATIENTS: We identified patients who had a visit for a simple acute condition in 2008, the "index visit". We divided these 127,358 patients into two cohorts according to the location of that index visit: primary care provider (PCP) versus retail clinic.

MAIN MEASURES: We evaluated three functions of primary care: (1) where patients first sought care for subsequent simple acute conditions; (2) continuity of care using the Bice-Boxerman index; and (3) preventive care and diabetes management. Using a difference-in-differences approach, we compared care received in the 365 days following the index visit to care received in the 365 days prior, using propensity score weights to account for selection bias.

KEY RESULTS: Visiting a retail clinic instead of a PCP for the index visit was associated with a 27.7 visits per 100 patients differential reduction (p \&lt; 0 .001) in subsequent PCP visits for new simple acute conditions. Visiting a retail clinic instead of a PCP was also associated with decreased subsequent continuity of care (10.9 percentage-point differential reduction in Bice-Boxerman index, p \&lt; 0 .001). There was no differential change between the cohorts in receipt of preventive care or diabetes management.

CONCLUSIONS: Retail clinics may disrupt two aspects of primary care: whether patients go to a PCP first for new conditions and continuity of care. However, they do not negatively impact preventive care or diabetes management.},
	keywords = {Acute Disease, Adolescent, Adult, Ambulatory Care, Ambulatory Care Facilities, Child, Child, Preschool, Chronic Disease, Commerce, Community Health Centers, Continuity of Patient Care, Diabetes Mellitus, Female, Health Services Accessibility, Humans, Male, Middle Aged, Preventive Health Services, Primary Health Care, Retrospective Studies, Socioeconomic Factors, United States, Young Adult},
	issn = {1525-1497},
	doi = {10.1007/s11606-012-2243-x},
	author = {Reid, Rachel O and Ashwood, J Scott and Friedberg, Mark W and Weber, Ellerie S and Setodji, Claude M and Ateev Mehrotra}
}
@article {517146,
	title = {Applying a natural language processing tool to electronic health records to assess performance on colonoscopy quality measures},
	journal = {Gastrointest Endosc},
	volume = {75},
	number = {6},
	year = {2012},
	month = {2012 Jun},
	pages = {1233-9.e14},
	abstract = {BACKGROUND: Gastroenterology specialty societies have advocated that providers routinely assess their performance on colonoscopy quality measures. Such routine measurement has been hampered by the costs and time required to manually review colonoscopy and pathology reports. Natural language processing (NLP) is a field of computer science in which programs are trained to extract relevant information from text reports in an automated fashion.

OBJECTIVE: To demonstrate the efficiency and potential of NLP-based colonoscopy quality measurement.

DESIGN: In a cross-sectional study design, we used a previously validated NLP program to analyze colonoscopy reports and associated pathology notes. The resulting data were used to generate provider performance on colonoscopy quality measures.

SETTING: Nine hospitals in the University of Pittsburgh Medical Center health care system.

PATIENTS: Study sample consisted of the 24,157 colonoscopy reports and associated pathology reports from 2008 to 2009.

MAIN OUTCOME MEASUREMENTS: Provider performance on 7 quality measures.

RESULTS: Performance on the colonoscopy quality measures was generally poor, and there was a wide range of performance. For example, across hospitals, the adequacy of preparation was noted overall in only 45.7\% of procedures (range 14.6\%-86.1\% across 9 hospitals), cecal landmarks were documented in 62.7\% of procedures (range 11.6\%-90.0\%), and the adenoma detection rate was 25.2\% (range 14.9\%-33.9\%).

LIMITATIONS: Our quality assessment was limited to a single health care system in western Pennsylvania.

CONCLUSIONS: Our study illustrates how NLP can mine free-text data in electronic records to measure and report on the quality of care. Even within a single academic hospital system, there is considerable variation in the performance on colonoscopy quality measures, demonstrating the need for better methods to regularly and efficiently assess quality.},
	keywords = {Adenoma, Adolescent, Adult, Aged, Aged, 80 and over, Cecum, Colonic Neoplasms, Colonoscopy, Cross-Sectional Studies, Data Mining, Electronic Health Records, Female, Humans, Informed Consent, Male, Middle Aged, Natural Language Processing, Quality Indicators, Health Care, Software, Time Factors, Young Adult},
	issn = {1097-6779},
	doi = {10.1016/j.gie.2012.01.045},
	author = {Ateev Mehrotra and Dellon, Evan S and Schoen, Robert E and Saul, Melissa and Bishehsari, Faraz and Farmer, Carrie and Harkema, Henk}
}
@article {517151,
	title = {Consumers{\textquoteright} and providers{\textquoteright} responses to public cost reports, and how to raise the likelihood of achieving desired results},
	journal = {Health Aff (Millwood)},
	volume = {31},
	number = {4},
	year = {2012},
	month = {2012 Apr},
	pages = {843-51},
	abstract = {There is tremendous interest in different approaches to slowing the rise in US per capita health spending. One approach is to publicly report on a provider{\textquoteright}s costs--also called efficiency, resource use, or value measures--with the hope that consumers will select lower-cost providers and providers will be encouraged to decrease spending. In this paper we explain why we believe that many current cost-profiling efforts are unlikely to have this intended effect. One of the reasons is that many consumers believe that more care is better and that higher-cost providers are higher-quality providers, so giving them information that some providers are lower cost may have the perverse effect of deterring them from accessing these providers. We suggest changes that can be made to content and design of public cost reports to increase the intended consumer and provider response.},
	keywords = {Choice Behavior, Community Participation, Disclosure, Feasibility Studies, Health Care Costs, Information Dissemination, Mandatory Programs, United States},
	issn = {1544-5208},
	doi = {10.1377/hlthaff.2011.1181},
	author = {Ateev Mehrotra and Hussey, Peter S and Arnold Milstein and Hibbard, Judith H}
}
@article {517141,
	title = {The growth of retail clinics in vaccination delivery in the U.S},
	journal = {Am J Prev Med},
	volume = {43},
	number = {1},
	year = {2012},
	month = {2012 Jul},
	pages = {63-6},
	abstract = {BACKGROUND: Retail clinics are a promising venue in which to promote and administer vaccinations; however, little is known about who receives vaccinations at a retail clinic.

PURPOSE: The aim of this paper was to describe the use of retail clinics in the delivery of recommended vaccinations.

METHODS: The three largest retail clinic operators in the U.S.--MinuteClinic, TakeCare, and LittleClinic--provided de-identified clinic data for 2007-2009. Descriptive statistics were generated in 2011 on visit type, type of vaccination, patient age, and payment method.

RESULTS: From 2007 to 2009, there were 8.9 million retail clinic visits across the three largest clinic operators. In 2009, vaccinations were administered at 1,952,610 visits, up from 469,330 visits in 2007. Visits in which vaccinations were administered accounted for 39.9\%, 36.4\%, and 42.0\% of total visits in 2007, 2008, and 2009, respectively. In 2009, 1.8 million influenza vaccinations (including seasonal and H1N1 vaccinations) were administered by the two largest retail clinic operators (94\% of all vaccination visits). Pneumococcal vaccination was administered at 59,849 visits (3\% of all vaccination visits). In 2009, vaccinations were also administered in 0.8\% of acute care visits (n=18,807); 0.8\% of chronic care visits (n=261); and 1.3\% of general medical exams (n=2497).

CONCLUSIONS: Results suggest that retail clinics play a growing role in vaccination delivery, and vaccinations constitute a substantial share of the business conducted by retail clinics. As such, retail clinics have the potential to play an important role in vaccination delivery in the U.S. Retail clinics potentially could deliver more vaccinations if they reviewed vaccination histories and counseled patients regarding the benefits of vaccination during acute care visits.},
	keywords = {Adolescent, Adult, Aged, Child, Child, Preschool, Health Services Accessibility, Humans, Immunization Programs, Infant, Influenza A Virus, H1N1 Subtype, Influenza, Human, Measles, Middle Aged, Pneumococcal Infections, Poliomyelitis, Tetanus, United States, Young Adult},
	issn = {1873-2607},
	doi = {10.1016/j.amepre.2012.02.024},
	author = {Uscher-Pines, Lori and Harris, Katherine M and Burns, Rachel M and Ateev Mehrotra}
}
@article {517156,
	title = {Physician Cost Profiling-Reliability and Risk of Misclassification: Detailed Methodology and Sensitivity Analyses},
	journal = {Rand Health Q},
	volume = {2},
	number = {1},
	year = {2012},
	month = {2012 Spring},
	pages = {3},
	abstract = {This article describes the methods and sensitivity analyses used by the authors in an article published in the New England Journal of Medicine. Purchasers are experimenting with a variety of approaches to control health care costs, including limiting network contracts to lower-cost physicians and offering patients differential copayments to encourage them to visit "high-performance" (i.e., higher-quality, lower-cost) physicians. These approaches require a method for analyzing physicians{\textquoteright} costs and a classification system for determining which physicians have lower relative costs. There has been little analysis of the reliability of such methods. Reliability is determined by three factors: the number of observations, the variation between physicians in their use of resources, and random variation in the scores. A study of claims data from four Massachusetts health plans demonstrates that, according to the current methods of physician cost profiling, the majority of physicians did not have cost profiles that met common reliability thresholds and, importantly, reliability varied significantly by specialty. Low reliability results in a substantial chance that a given physician will be misclassified as lower-cost when he or she is not, or vice versa. Such findings raise concerns about the use of cost profiling tools and the utility of their results. It also explains the relationship between reliability measurement and misclassification for physician quality and cost measures in health care. It provides details and a practical method to calculate reliability and misclassification from the data typically available to health plans. This article builds on other RAND work on reliability and misclassification and has two main goals. First, it can serve as a tutorial for measuring reliability and misclassification. Second, it will describe the likelihood of misclassification in a situation not addressed in our prior work in which physicians are categorized using statistical testing. For any newly proposed system, the methods presented here should enable an evaluator to calculate the reliabilities and, consequently, the misclassification probabilities. It is our hope that knowing these misclassification probabilities will increase transparency about profiling methods and stimulate an informed debate about the costs and benefits of alternative profiling systems.},
	author = {Adams, John L and Ateev Mehrotra and Thomas, J William and McGlynn, Elizabeth A and Adams, John L and Ateev Mehrotra and McGlynn, Elizabeth A}
}
@article {517121,
	title = {Physicians with the least experience have higher cost profiles than do physicians with the most experience},
	journal = {Health Aff (Millwood)},
	volume = {31},
	number = {11},
	year = {2012},
	month = {2012 Nov},
	pages = {2453-63},
	abstract = {Health plans and Medicare are using cost profiles to identify which physicians account for more health care spending than others. By identifying the costliest physicians, health plans and Medicare hope to craft policy interventions to reduce total health care spending. To identify which physician types, if any, might be costlier than others, we analyzed cost profiles created from health plan claims for physicians in Massachusetts. We found that physicians with fewer than ten years of experience had 13.2 percent higher overall costs than physicians with forty or more years of experience. We found no association between costs and other physician characteristics, such as having had malpractice claims or disciplinary actions, board certification status, and the size of the group in which the physician practices. Although winners and losers are inevitable in any cost-profiling effort, physicians with less experience are more likely to be negatively affected by policies that use cost profiles, unless they change their practice patterns. For example, these physicians could be excluded from high-value networks or receive lower payments under Medicare{\textquoteright}s planned value-based payment program. We cannot fully explain the mechanism by which more-experienced physicians have lower costs, but our results suggest that the more costly practice style of newly trained physicians may be a driver of rising health care costs overall.},
	keywords = {Adult, Clinical Competence, Databases, Factual, Delivery of Health Care, Female, Health Care Costs, Health Expenditures, Humans, Linear Models, Male, Massachusetts, Medicare, Middle Aged, Multivariate Analysis, Practice Patterns, Physicians{\textquoteright}, Quality Control, United States},
	issn = {1544-5208},
	doi = {10.1377/hlthaff.2011.0252},
	author = {Ateev Mehrotra and Reid, Rachel O and Adams, John L and Friedberg, Mark W and McGlynn, Elizabeth A and Hussey, Peter S}
}
@article {517136,
	title = {Visits to retail clinics grew fourfold from 2007 to 2009, although their share of overall outpatient visits remains low},
	journal = {Health Aff (Millwood)},
	volume = {31},
	number = {9},
	year = {2012},
	month = {2012 Sep},
	pages = {2123-9},
	abstract = {Retail clinics have rapidly become a fixture of the US health care delivery landscape. We studied visits to retail clinics and found that they increased fourfold from 2007 to 2009, with an estimated 5.97 million retail clinic visits in 2009 alone. Compared with retail clinic patients in 2000-06, patients in 2007-09 were more likely to be age sixty-five or older (14.7 percent versus 7.5 percent). Preventive care-in particular, the influenza vaccine-was a larger component of care for patients at retail clinics in 2007-09, compared to patients in 2000-06 (47.5 percent versus 21.8 percent). Across all retail clinic visits, 44.4 percent in 2007-09 were on the weekend or during weekday hours when physician offices are typically closed. The rapid growth of retail clinics makes it clear that they are meeting a patient need. Convenience and after-hours accessibility are possible drivers of this growth. However, retail clinics make up a small share of overall visits in the outpatient setting, which include 117 million visits to emergency departments and 577 million visits to physician offices annually.},
	keywords = {Adolescent, Adult, After-Hours Care, Aged, Ambulatory Care Facilities, Child, Child, Preschool, Commerce, Female, Health Services Accessibility, Humans, Insurance Claim Reporting, Male, Medical Audit, Middle Aged, United States, Young Adult},
	issn = {1544-5208},
	doi = {10.1377/hlthaff.2011.1128},
	author = {Ateev Mehrotra and Lave, Judith R}
}
@article {517166,
	title = {Developing a natural language processing application for measuring the quality of colonoscopy procedures},
	journal = {J Am Med Inform Assoc},
	volume = {18 Suppl 1},
	number = {Suppl 1},
	year = {2011},
	month = {2011 Dec},
	pages = {i150-6},
	abstract = {OBJECTIVE: The quality of colonoscopy procedures for colorectal cancer screening is often inadequate and varies widely among physicians. Routine measurement of quality is limited by the costs of manual review of free-text patient charts. Our goal was to develop a natural language processing (NLP) application to measure colonoscopy quality.

MATERIALS AND METHODS: Using a set of quality measures published by physician specialty societies, we implemented an NLP engine that extracts 21 variables for 19 quality measures from free-text colonoscopy and pathology reports. We evaluated the performance of the NLP engine on a test set of 453 colonoscopy reports and 226 pathology reports, considering accuracy in extracting the values of the target variables from text, and the reliability of the outcomes of the quality measures as computed from the NLP-extracted information.

RESULTS: The average accuracy of the NLP engine over all variables was 0.89 (range: 0.62-1.0) and the average F measure over all variables was 0.74 (range: 0.49-0.89). The average agreement score, measured as Cohen{\textquoteright}s κ, between the manually established and NLP-derived outcomes of the quality measures was 0.62 (range: 0.09-0.86).

DISCUSSION: For nine of the 19 colonoscopy quality measures, the agreement score was 0.70 or above, which we consider a sufficient score for the NLP-derived outcomes of these measures to be practically useful for quality measurement.

CONCLUSION: The use of NLP for information extraction from free-text colonoscopy and pathology reports creates opportunities for large scale, routine quality measurement, which can support quality improvement in colonoscopy care.},
	keywords = {Colonoscopy, Computer Systems, Data Mining, Humans, Natural Language Processing, Quality of Health Care},
	issn = {1527-974X},
	doi = {10.1136/amiajnl-2011-000431},
	author = {Harkema, Henk and Chapman, Wendy W. and Saul, Melissa and Dellon, Evan S and Schoen, Robert E and Ateev Mehrotra}
}
@article {517181,
	title = {Dropping the baton: specialty referrals in the United States},
	journal = {Milbank Q},
	volume = {89},
	number = {1},
	year = {2011},
	month = {2011 Mar},
	pages = {39-68},
	abstract = {CONTEXT: In the United States, more than a third of patients are referred to a specialist each year, and specialist visits constitute more than half of outpatient visits. Despite the frequency of referrals and the importance of the specialty-referral process, the process itself has been a long-standing source of frustration among both primary care physicians (PCPs) and specialists. These frustrations, along with a desire to lower costs, have led to numerous strategies to improve the specialty-referral process, such as using gatekeepers and referral guidelines.

METHODS: This article reviews the literature on the specialty-referral process in order to better understand what is known about current problems with the referral process and what solutions have been proposed. The article first provides a conceptual framework and then reviews prior literature on the referral decision, care coordination including information transfer, and access to specialty care.

FINDINGS: PCPs vary in their threshold for referring a patient, which results in both the underuse and the overuse of specialists. Many referrals do not include a transfer of information, either to or from the specialist; and when they do, it often contains insufficient data for medical decision making. Care across the primary-specialty interface is poorly integrated; PCPs often do not know whether a patient actually went to the specialist, or what the specialist recommended. PCPs and specialists also frequently disagree on the specialist{\textquoteright}s role during the referral episode (e.g., single consultation or continuing co-management).

CONCLUSIONS: There are breakdowns and inefficiencies in all components of the specialty-referral process. Despite many promising mechanisms to improve the referral process, rigorous evaluations of these improvements are needed.},
	keywords = {Decision Making, Health Services Accessibility, Humans, Interprofessional Relations, Physicians, Primary Care, Referral and Consultation, Specialization, United States},
	issn = {1468-0009},
	doi = {10.1111/j.1468-0009.2011.00619.x},
	author = {Ateev Mehrotra and Forrest, Christopher B. and Lin, Caroline Y}
}
@article {517186,
	title = {The impact of health plan physician-tiering on access to care},
	journal = {J Gen Intern Med},
	volume = {26},
	number = {4},
	year = {2011},
	month = {2011 Apr},
	pages = {440-5},
	abstract = {BACKGROUND: In an attempt to improve quality and control costs, health plans are creating tiered products that encourage enrollees to seek care from "high-value" physicians. However, tiered products may limit access to care because patients may have to travel unreasonable distances to visit the nearest high-value physician.

OBJECTIVE: To assess geographic access to high-value physicians, particularly for disadvantaged populations.

DESIGN: Cross-sectional observational study.

PARTICIPANTS: Physicians and adult patients in Massachusetts.

MAIN MEASURES: Travel time from census block centroid to nearest physician address under two scenarios: patients can see (1) any physician or (2) only high-value physicians.

KEY RESULTS: Among the physicians, 768 (20.9\%) primary care physicians (PCPs), 225 (26.6\%) obstetricians/gynecologists, 69 (10.3\%) cardiologists, and 31 (6.0\%) general surgeons met the definition of high-value. Statewide mean travel times to the nearest PCP, obstetrician/gynecologist, cardiologist, or general surgeon under the two scenarios (any physician vs. only high-value physicians) were 2.8 vs. 4.8, 6.0 vs. 7.2, 7.0 vs. 12.4, and 6.6 vs. 14.8 minutes, respectively. Across the four specialties, between 89.4\%-99.4\% of the population lived within 30 minutes of the nearest high-value physician. Rural populations had considerably longer travel times to see high-value physicians, but other disadvantaged populations generally had shorter travel times than comparison groups.

CONCLUSIONS: Most patients in Massachusetts are likely to have reasonable geographic access to high-value physicians in tiered health plans. However, local demographics, especially rural residence, should be taken into consideration when applying tiered health plans broadly. Future work should investigate whether patients can and will switch to receive care from high-value physicians.},
	keywords = {Adolescent, Adult, Cross-Sectional Studies, Health Services Accessibility, Humans, Managed Care Programs, Massachusetts, Middle Aged, Physicians, Quality of Health Care, Young Adult},
	issn = {1525-1497},
	doi = {10.1007/s11606-010-1607-3},
	author = {Tackett, Sean and Stelzner, Chuck and McGlynn, Elizabeth and Ateev Mehrotra}
}
@article {517171,
	title = {Policy Implications of the Use of Retail Clinics},
	journal = {Rand Health Q},
	volume = {1},
	number = {3},
	year = {2011},
	month = {2011 Fall},
	pages = {9},
	abstract = {Retail clinics, located within larger retail stores, treat a limited number of acute conditions and offer a small set of preventive services. Although there are nearly 1,200 such clinics in the United States, a great deal about their utilization, relationships with other parts of the health care system, and quality of care remains unknown. The federal government has taken only limited action regarding retail clinics, and little evidence exists about the potential costs and benefits of integrating retail clinics into federal programs and initiatives. Through a literature review, semistructured interviews, and a panel of experts, the authors show that retail clinics have established a niche in the health care system based on their convenience and customer service. Levels of patient satisfaction and of the quality and appropriateness of care appear comparable to those of other provider types. However, we know little about the effects of retail clinic use on preventive services, care coordination, and care continuity. As clinics begin to expand into other areas of care, including chronic disease management, and as the number of patients with insurance increases and the shortage of primary care physicians continues, answering outstanding questions about retail clinics{\textquoteright} role in the health care system will become even more important. These changes will create new opportunities for health policy to influence both how retail clinics function and the ways in which their care is integrated with that of other providers.},
	author = {Weinick, Robin M and Pollack, Craig Evan and Fisher, Michael P and Gillen, Emily M and Ateev Mehrotra}
}
@article {517176,
	title = {Renewing calls for better cost profiling of providers},
	journal = {Manag Care},
	volume = {20},
	number = {2},
	year = {2011},
	month = {2011 Feb},
	pages = {20-2, 24},
	keywords = {Costs and Cost Analysis, Delivery of Health Care, Humans, Managed Care Programs, Patient Protection and Affordable Care Act, Physicians, Professional Practice, Quality Assurance, Health Care, United States},
	issn = {1062-3388},
	author = {Ateev Mehrotra}
}
@article {517161,
	title = {Trends in retail clinic use among the commercially insured},
	journal = {Am J Manag Care},
	volume = {17},
	number = {11},
	year = {2011},
	month = {2011 Nov},
	pages = {e443-448},
	abstract = {OBJECTIVES: To describe trends in retail clinic use among commercially insured patients and to identify which patient characteristics predict retail clinic use.

STUDY DESIGN: Retrospective cohort analysis of commercial insurance claims sampled from a population of 13.3 million patients in 22 markets in 2007 to 2009.

METHODS: We identified 11 simple acute conditions that can be managed at a retail clinic and described trends in retail clinic utilization for these conditions. We used multiple logistic regressions to identify predictors of retail clinic versus another care site for these conditions and assessed whether those predictors changed over time.

RESULTS: Retail clinic use increased 10-fold from 2007 to 2009. By 2009, 6.9\% of all visits for the 11 conditions were to a retail clinic. Proximity to a retail clinic was the strongest predictor of use. Patients living within 1 mile of a retail clinic were 7.5\% more likely to use one than those living 10 to 20 miles away (P \&lt;.001). Women (+0.9\%, P \&lt;.001), young adults (+1.6\%, P \&lt;.001), patients without a chronic condition (+0.9\%, P \&lt;.001), and patients with high incomes (+2.6\%, P \&lt;.001) were more likely to use retail clinics. All these associations became stronger over time. There was no association between primary care physician availability and retail clinic use.

CONCLUSIONS: If these trends continue, health plans will see a dramatic increase in retail clinic utilization. While use is increasing on average, it is particularly increasing among young, healthy, and higher income patients living close to retail clinics.},
	keywords = {Acute Disease, Community Health Centers, Confidence Intervals, For-Profit Insurance Plans, Health Services Accessibility, Health Services Needs and Demand, Humans, Insurance Coverage, Logistic Models, Multivariate Analysis, Retrospective Studies, Statistics as Topic, United States},
	issn = {1936-2692},
	author = {Ashwood, J Scott and Reid, Rachel O and Setodji, Claude M and Weber, Ellerie and Gaynor, Martin and Ateev Mehrotra}
}
@article {517191,
	title = {Associations between physician characteristics and quality of care},
	journal = {Arch Intern Med},
	volume = {170},
	number = {16},
	year = {2010},
	month = {2010 Sep 13},
	pages = {1442-9},
	abstract = {BACKGROUND: Information on physicians{\textquoteright} performance on measures of clinical quality is rarely available to patients. Instead, patients are encouraged to select physicians on the basis of characteristics such as education, board certification, and malpractice history. In a large sample of Massachusetts physicians, we examined the relationship between physician characteristics and performance on a broad range of quality measures.

METHODS: We calculated overall performance scores on 124 quality measures from RAND{\textquoteright}s Quality Assessment Tools for each of 10,408 Massachusetts physicians using claims generated by 1.13 million adult patients. The patients were continuously enrolled in 1 of 4 Massachusetts commercial health plans from 2004 to 2005. Physician characteristics were obtained from the Massachusetts Board of Registration in Medicine. Associations between physician characteristics and overall performance scores were assessed using multivariate linear regression.

RESULTS: The mean overall performance score was 62.5\% (5th to 95th percentile range, 48.2\%-74.9\%). Three physician characteristics were independently associated with significantly higher overall performance: female sex (1.6 percentage points higher than male sex; P \&lt; .001), board certification (3.3 percentage points higher than noncertified; P \&lt; .001), and graduation from a domestic medical school (1.0 percentage points higher than international; P \&lt; .001). There was no significant association between performance and malpractice claims (P = .26).

CONCLUSIONS: Few characteristics of individual physicians were associated with higher performance on measures of quality, and observed associations were small in magnitude. Publicly available characteristics of individual physicians are poor proxies for performance on clinical quality measures.},
	keywords = {Adolescent, Adult, Aged, Clinical Competence, Female, Humans, Linear Models, Male, Massachusetts, Middle Aged, Practice Patterns, Physicians{\textquoteright}, Quality of Health Care},
	issn = {1538-3679},
	doi = {10.1001/archinternmed.2010.307},
	author = {Reid, Rachel O and Friedberg, Mark W and Adams, John L and McGlynn, Elizabeth A and Ateev Mehrotra}
}
@article {517201,
	title = {Cost profiles: should the focus be on individual physicians or physician groups?},
	journal = {Health Aff (Millwood)},
	volume = {29},
	number = {8},
	year = {2010},
	month = {2010 Aug},
	pages = {1532-8},
	abstract = {In an effort to rein in rising health care costs, health plans are using physician cost profiles as the basis for tiered networks that give patients incentives to visit low-cost physicians. Because physician cost profiles are often statistically unreliable some experts have argued that physician groups should be profiled instead. Using Massachusetts data, we evaluate the two options empirically. Although we find that physician-group profiles are statistically more reliable, the group profile is not a good predictor of individual physician performance within the group. Better methods for creating provider cost profiles are needed.},
	keywords = {Cost Savings, Group Practice, Humans, Massachusetts, Private Practice, Quality of Health Care},
	issn = {1544-5208},
	doi = {10.1377/hlthaff.2009.1091},
	author = {Ateev Mehrotra and Adams, John L and Thomas, J William and McGlynn, Elizabeth A}
}
@article {517246,
	title = {Does price transparency legislation allow the uninsured to shop for care?},
	journal = {J Gen Intern Med},
	volume = {25},
	number = {2},
	year = {2010},
	month = {2010 Feb},
	pages = {110-4},
	abstract = {BACKGROUND: The majority of states have enacted price transparency laws to allow patients to shop for care and to prevent price discrimination of the uninsured. In California, hospitals must provide a price estimate to a requesting uninsured patient and cannot bill for an amount greater than the reimbursement the hospital would receive from a government payer.

OBJECTIVE: To assess the response rate of California hospitals to a patient price request and to compare the price estimates received to Medicare reimbursement.

DESIGN: We sent letters to California acute-care hospitals from a fictional uninsured patient requesting an estimate for one of three common elective procedures: a laparoscopic cholecystectomy, a hysterectomy, or routine screening colonoscopy.

PARTICIPANTS: Three hundred and fifty-three hospitals in California.

MEASUREMENTS: Hospital response rates, difference between price estimates received, and Medicare reimbursement for equivalent procedures.

RESULTS: Only 28\% (98/353) of hospitals responded and their response varied in content. Of the 98 responses, 15 (15\%) did not provide a quote and instead asked for more information such as the billing code, 55 (56\%) provided a price estimate for hospital services only, 10 (10\%) included both physician and hospital services, and 18 (18\%) did not specify what was covered. The median discounted price estimate was higher than Medicare reimbursement rates for all procedures: hysterectomy ($17,403 vs. $5,569; p\&lt;0.001), cholecystectomy ($14,014 vs. $7,196; p\&lt;0.001) and colonoscopy ($2,017 vs. $216; p\&lt;0.001).

CONCLUSIONS: Current California legislation fails to meet its objective of enabling uninsured patients to compare prices for hospital-based health care services.},
	keywords = {California, Consumer Health Information, Delivery of Health Care, Health Expenditures, Humans, Insurance, Health, Reimbursement, Medically Uninsured, Medicare, United States},
	issn = {1525-1497},
	doi = {10.1007/s11606-009-1176-5},
	author = {Farrell, Kate Stockwell and Finocchio, Leonard J and Trivedi, Amal N and Ateev Mehrotra}
}
@article {517211,
	title = {The effect of different attribution rules on individual physician cost profiles},
	journal = {Ann Intern Med},
	volume = {152},
	number = {10},
	year = {2010},
	month = {2010 May 18},
	pages = {649-54},
	abstract = {BACKGROUND: Some health plans profile physicians on the basis of their relative costs and use these profiles to assign physicians to cost categories. Physician organizations have questioned whether the rules used to attribute costs to a physician affect the cost category to which that physician is assigned.

OBJECTIVE: To evaluate the effect of 12 different attribution rules on physician cost profiles.

DESIGN: Under each of the 12 attribution rules, a cost profile was created for the physicians in the aggregated claims database and the physicians were assigned to a cost category (high cost, average cost, low cost, or low sample size). The attribution rules differed by unit of analysis, signal for responsibility, number of physicians who can be assigned responsibility, and threshold value for assigning responsibility.

SETTING: Four commercial health plans in Massachusetts.

PATIENTS: 1.1 million adults continuously enrolled in 4 commercial health plans in 2004 and 2005.

MEASUREMENTS: Percentage of all episodes assigned to any physician and percentage of costs billed by a physician that were included in his or her own profile were calculated under each rule. The cost category assignments from a commonly used default rule were compared with those from each of the other 11 attribution rules and the rate of disagreement was calculated.

RESULTS: Percentage of episodes that could be assigned to a physician varied substantially across the 12 rules (range, 20\% to 69\%), as did the mean percentage of costs billed by a physician that were included in that physician{\textquoteright}s own cost profile (range, 13\% to 60\%). Depending on the alternate rule used, between 17\% and 61\% of physicians would be assigned to a different cost category than that assigned by using the default rule.

LIMITATION: Results might differ if data from another state or from Medicare were used.

CONCLUSION: The choice of attribution rule affects how costs are assigned to a physician and can substantially affect the cost category to which a physician is assigned.

PRIMARY FUNDING SOURCE: U.S. Department of Labor.},
	keywords = {Costs and Cost Analysis, Health Care Costs, Humans, Insurance Claim Review, Insurance, Health, Massachusetts, Physicians},
	issn = {1539-3704},
	doi = {10.7326/0003-4819-152-10-201005180-00005},
	author = {Ateev Mehrotra and Adams, John L and Thomas, J William and McGlynn, Elizabeth A}
}
@article {517221,
	title = {Estimating the costs of medicalization},
	journal = {Soc Sci Med},
	volume = {70},
	number = {12},
	year = {2010},
	month = {2010 Jun},
	pages = {1943-1947},
	abstract = {Medicalization is the process by which non-medical problems become defined and treated as medical problems, usually as illnesses or disorders. There has been growing concern with the possibility that medicalization is driving increased health care costs. In this paper we estimate the medical spending in the U.S. of identified medicalized conditions at approximately $77 billion in 2005, 3.9\% of total domestic expenditures on health care. This estimate is based on the direct costs associated with twelve medicalized conditions. Although due to data limitations this estimate does not include all medicalized conditions, it can inform future debates about health care spending and medicalization.},
	keywords = {Cost of Illness, Costs and Cost Analysis, Female, Health Care Costs, Health Expenditures, Humans, Male, Pregnancy, United States},
	issn = {1873-5347},
	doi = {10.1016/j.socscimed.2010.02.019},
	author = {Conrad, Peter and Mackie, Thomas and Ateev Mehrotra}
}
@article {517216,
	title = {The growth of retail clinics and the medical home: two trends in concert or in conflict?},
	journal = {Health Aff (Millwood)},
	volume = {29},
	number = {5},
	year = {2010},
	month = {2010 May},
	pages = {998-1003},
	abstract = {There has been growing interest in the patient-centered medical home as a way to provide coordinated, high-quality primary care. At the same time, the number of retail clinics has increased dramatically. Many are concerned that retail clinics undermine the medical home by fragmenting care. In this article we explore the juxtaposition of these trends, highlighting shared characteristics and sources of tension. We describe three types of relationships between retail clinics and primary care providers. We argue that for some relationships there is no conflict, and we describe areas of potential concern for others.},
	keywords = {Ambulatory Care Facilities, Commerce, Conflict of Interest, Economic Competition, Humans, Ownership, Patient-Centered Care, United States},
	issn = {1544-5208},
	doi = {10.1377/hlthaff.2010.0089},
	author = {Pollack, Craig E and Gidengil, Courtney and Ateev Mehrotra}
}
@article {517231,
	title = {Incorporating statistical uncertainty in the use of physician cost profiles},
	journal = {BMC Health Serv Res},
	volume = {10},
	year = {2010},
	month = {2010 Mar 05},
	pages = {57},
	abstract = {BACKGROUND: Physician cost profiles (also called efficiency or economic profiles) compare the costs of care provided by a physician to his or her peers. These profiles are increasingly being used as the basis for policy applications such as tiered physician networks. Tiers (low, average, high cost) are currently defined by health plans based on percentile cut-offs which do not account for statistical uncertainty. In this paper we compare the percentile cut-off method to another method, using statistical testing, for identifying high-cost or low-cost physicians.

METHODS: We created a claims dataset of 2004-2005 data from four Massachusetts health plans. We employed commercial software to create episodes of care and assigned responsibility for each episode to the physician with the highest proportion of professional costs. A physicians{\textquoteright} cost profile was the ratio of the sum of observed costs divided by the sum of expected costs across all assigned episodes. We discuss a new method of measuring standard errors of physician cost profiles which can be used in statistical testing. We then assigned each physician to one of three cost categories (low, average, or high cost) using two methods, percentile cut-offs and a t-test (p-value \&lt; or = 0.05), and assessed the level of disagreement between the two methods.

RESULTS: Across the 8689 physicians in our sample, 29.5\% of physicians were assigned a different cost category when comparing the percentile cut-off method and the t-test. This level of disagreement varied across specialties (17.4\% gastroenterology to 45.8\% vascular surgery).

CONCLUSIONS: Health plans and other payers should incorporate statistical uncertainty when they use physician cost-profiles to categorize physicians into low or high-cost tiers.},
	keywords = {Cost-Benefit Analysis, Delivery of Health Care, Diagnosis-Related Groups, Episode of Care, Humans, Massachusetts, Utilization Review},
	issn = {1472-6963},
	doi = {10.1186/1472-6963-10-57},
	author = {Adams, John L and McGlynn, Elizabeth A and Thomas, J William and Ateev Mehrotra}
}
@article {517196,
	title = {Many emergency department visits could be managed at urgent care centers and retail clinics},
	journal = {Health Aff (Millwood)},
	volume = {29},
	number = {9},
	year = {2010},
	month = {2010 Sep},
	pages = {1630-6},
	abstract = {Americans seek a large amount of nonemergency care in emergency departments, where they often encounter long waits to be seen. Urgent care centers and retail clinics have emerged as alternatives to the emergency department for nonemergency care. We estimate that 13.7-27.1 percent of all emergency department visits could take place at one of these alternative sites, with a potential cost savings of approximately $4.4 billion annually. The primary conditions that could be treated at these sites include minor acute illnesses, strains, and fractures. There is some evidence that patients can safely direct themselves to these alternative sites. However, more research is needed to ensure that care of equivalent quality is provided at urgent care centers and retail clinics compared to emergency departments.},
	keywords = {Ambulatory Care Facilities, Commerce, Cost Savings, Emergency Service, Hospital, Humans, Outpatient Clinics, Hospital, Safety Management},
	issn = {1544-5208},
	doi = {10.1377/hlthaff.2009.0748},
	author = {Weinick, Robin M and Burns, Rachel M and Ateev Mehrotra}
}
@article {517226,
	title = {Physician cost profiling--reliability and risk of misclassification},
	journal = {N Engl J Med},
	volume = {362},
	number = {11},
	year = {2010},
	month = {2010 Mar 18},
	pages = {1014-21},
	abstract = {BACKGROUND: Insurance products with incentives for patients to choose physicians classified as offering lower-cost care on the basis of cost-profiling tools are increasingly common. However, no rigorous evaluation has been undertaken to determine whether these tools can accurately distinguish higher-cost physicians from lower-cost physicians.

METHODS: We aggregated claims data for the years 2004 and 2005 from four health plans in Massachusetts. We used commercial software to construct clinically homogeneous episodes of care (e.g., treatment of diabetes, heart attack, or urinary tract infection), assigned each episode to a physician, and created a summary profile of resource use (i.e., cost) for each physician on the basis of all assigned episodes. We estimated the reliability (signal-to-noise ratio) of each physician{\textquoteright}s cost-profile score on a scale of 0 to 1, with 0 indicating that all differences in physicians{\textquoteright} cost profiles are due to a lack of precision in the measure (noise) and 1 indicating that all differences are due to real variation in costs of services (signal). We used the reliability results to estimate the proportion of physicians in each specialty whose cost performance would be classified inaccurately in a two-tiered insurance product in which the physicians with cost profiles in the lowest quartile were labeled as "lower cost."

RESULTS: Median reliabilities ranged from 0.05 for vascular surgery to 0.79 for gastroenterology and otolaryngology. Overall, 59\% of physicians had cost-profile scores with reliabilities of less than 0.70, a commonly used marker of suboptimal reliability. Using our reliability results, we estimated that 22\% of physicians would be misclassified in a two-tiered system.

CONCLUSIONS: Current methods for profiling physicians with respect to costs of services may produce misleading results.},
	keywords = {Costs and Cost Analysis, Episode of Care, Health Care Costs, Humans, Insurance Claim Review, Massachusetts, Physicians, Professional Practice, Reproducibility of Results},
	issn = {1533-4406},
	doi = {10.1056/NEJMsa0906323},
	author = {Adams, John L and Ateev Mehrotra and Thomas, J William and McGlynn, Elizabeth A}
}
@article {517241,
	title = {Sociodemographic characteristics of communities served by retail clinics},
	journal = {J Am Board Fam Med},
	volume = {23},
	number = {1},
	year = {2010},
	month = {2010 Jan-Feb},
	pages = {42-8},
	abstract = {PURPOSE: As a rapidly growing new health care delivery model in the United States, retail clinics have been the subject of much debate and controversy. Located physically within a retail store, retail clinics provide simple acute and preventive services for a fixed price and without an appointment. Some hope that retail clinics can be a new safety-net provider for the poor and those without a primary care physician. To better understand the potential for retail clinics to achieve this goal, we describe the sociodemographic characteristics of the communities in which they operate.

METHODS: We created an inventory of all retail clinics in the United States and determined the proportion that are in a health professional shortage area (HPSA). We defined each retail clinic{\textquoteright}s catchment area as all census blocks that were less than a 5-minute driving distance from the clinic. We compared the sociodemographic characteristics of the population within and outside of these retail clinic catchment areas.

RESULTS: Of the 982 clinics in 32 states, 88.4\% were in an urban area and 12.5\% were in an HPSA (20.9\% of the US population lives within an HPSA). Compared with the rest of the urban population, the population living within a retail clinic catchment area has a higher median household income ($52,849 vs $46,080), is better educated (32.6\% vs 24.9\% with a college degree), and is as likely to be uninsured (17.7\% vs 17.0\%). In a multivariate model, the census block{\textquoteright}s median household income had the strongest association with whether the census block was in a retail clinic catchment area (odds ratio, 3.63; 95\% CI, 3.26-4.05; median income, \&gt; or =$54,779 vs \&lt;$30,781, respectively).

CONCLUSIONS: We found that relatively few retail clinics are located in HPSAs and that, compared with the rest of the urban population, the population living in close proximity to a retail clinic has a higher income.},
	keywords = {Ambulatory Care Facilities, Catchment Area, Health, Censuses, Delivery of Health Care, Educational Status, Geographic Information Systems, Health Services Accessibility, Health Services Research, Humans, Income, Insurance Coverage, Medically Underserved Area, Multivariate Analysis, Needs Assessment, Practice Patterns, Nurses{\textquoteright}, Rural Health, Socioeconomic Factors, Software, United States, Urban Health},
	issn = {1558-7118},
	doi = {10.3122/jabfm.2010.01.090033},
	author = {Rudavsky, Rena and Ateev Mehrotra}
}
@article {517206,
	title = {Using the lessons of behavioral economics to design more effective pay-for-performance programs},
	journal = {Am J Manag Care},
	volume = {16},
	number = {7},
	year = {2010},
	month = {2010 Jul},
	pages = {497-503},
	abstract = {OBJECTIVES: To describe improvements in the design of pay-for-performance (P4P) programs that reflect the psychology of how people respond to incentives.

STUDY DESIGN: Investigation of the behavioral economics literature.

METHODS: We describe 7 ways to improve P4P program design in terms of frequency and types of incentive payments. After discussing why P4P incentives can have unintended adverse consequences, we outline potential ways to mitigate these.

RESULTS: Although P4P incentives are increasingly popular, the healthcare literature shows that these have had minimal effect. Design improvements in P4P programs can enhance their effectiveness.

CONCLUSION: Lessons from behavioral economics may greatly enhance the design and effectiveness of P4P programs in healthcare, but future work is needed to demonstrate this empirically.},
	keywords = {Behavior, Medicare, Models, Economic, Quality Assurance, Health Care, Reimbursement, Incentive, United States},
	issn = {1936-2692},
	author = {Ateev Mehrotra and Sorbero, Melony E S and Damberg, Cheryl L}
}
@article {517236,
	title = {Why do patients seek care at retail clinics, and what alternatives did they consider?},
	journal = {Am J Med Qual},
	volume = {25},
	number = {2},
	year = {2010},
	month = {2010 Mar-Apr},
	pages = {128-34},
	abstract = {Retail clinics are an increasingly popular new model of ambulatory care. To understand why patients seek care at these clinics and what their experiences were like, the authors interviewed 61 patients at 6 retail clinics. Patients were satisfied with the overall experience and were attracted to retail clinics because of their convenient locations and fixed, transparent pricing. Patients who had a primary care physician (PCP) sought care at these clinics primarily because their PCPs were not available in a timely manner. If retail clinics had not been available, a quarter of patients report they would have gone to the emergency department. Retail clinics appear to be responding to the need for convenient, affordable, and consumer-centered care.},
	keywords = {Adult, Aged, California, Choice Behavior, Commerce, Female, Health Services Accessibility, Humans, Interviews as Topic, Male, Middle Aged, Patient Preference, Primary Health Care, Young Adult},
	issn = {1555-824X},
	doi = {10.1177/1062860609353201},
	author = {Margaret C. Wang and Ryan, Gery and McGlynn, Elizabeth A and Ateev Mehrotra}
}
@article {517271,
	title = {Alternative vaccination locations: who uses them and can they increase flu vaccination rates?},
	journal = {Vaccine},
	volume = {27},
	number = {32},
	year = {2009},
	month = {2009 Jul 09},
	pages = {4252-6},
	abstract = {Since many unvaccinated individuals do not regularly contact the traditional health care system, we sought to determine the role that alternative vaccination locations (e.g., workplaces and retail clinics) could play in increasing influenza vaccination coverage. Between February 14, 2008 and March 10, 2008, a 25-question influenza vaccine questionnaire was administered to a nationally representative, stratified sample of panelists. Our results found that while alternative locations are covering some segments not captured by the traditional health care system (e.g., younger, working, white individuals in metropolitan areas), they are not serving many other segments (e.g., minority, rural, or lower income patients).},
	keywords = {Adolescent, Adult, Aged, Aged, 80 and over, Female, Humans, Influenza Vaccines, Influenza, Human, Male, Middle Aged, Patient Acceptance of Health Care, Surveys and Questionnaires, Vaccination, Young Adult},
	issn = {1873-2518},
	doi = {10.1016/j.vaccine.2009.04.055},
	author = {Lee, Bruce Y and Ateev Mehrotra and Burns, Rachel M and Harris, Katherine M}
}
@article {517256,
	title = {Comparing costs and quality of care at retail clinics with that of other medical settings for 3 common illnesses},
	journal = {Ann Intern Med},
	volume = {151},
	number = {5},
	year = {2009},
	month = {2009 Sep 01},
	pages = {321-8},
	abstract = {BACKGROUND: Retail clinics are an increasingly popular source for medical care. Concerns have been raised about the effect of these clinics on the cost, quality, and delivery of preventive care.

OBJECTIVE: To compare the care received at retail clinics for 3 acute conditions with that received at other care settings.

DESIGN: Claims data from 2005 and 2006 from the health plan were aggregated into care episodes (units that included initial and follow-up visits, pharmaceuticals, and ancillary tests). After 2100 episodes (700 each) were identified in which otitis media, pharyngitis, and urinary tract infection (UTI) were treated first in retail clinics, these episodes were matched with other episodes in which these illnesses were treated first in physician offices, urgent care centers, or emergency departments.

SETTING: Enrollees of a large Minnesota health plan.

PATIENTS: Enrollees who received care for otitis media, pharyngitis, or UTI.

MEASUREMENTS: Costs per episode, performance on 14 quality indicators, and receipt of 7 preventive care services at the initial appointment or subsequent 3 months.

RESULTS: Overall costs of care for episodes initiated at retail clinics were substantially lower than those of matched episodes initiated at physician offices, urgent care centers, and emergency departments ($110 vs. $166, $156, and $570, respectively; P \&lt; 0.001 for each comparison). Prescription costs were similar in retail clinics, physician offices, and urgent care centers ($21, $21, and $22), as were aggregate quality scores (63.6\%, 61.0\%, and 62.6\%) and patient{\textquoteright}s receipt of preventive care (14.5\%, 14.2\%, and 13.7\%) (P \&gt; 0.05 vs. retail clinics). In emergency departments, average prescription costs were higher and aggregate quality scores were significantly lower than in other settings.

LIMITATIONS: A limited number of quality measures and preventive care services were studied. Despite matching, patients at different care sites might differ in their severity of illness.

CONCLUSION: Retail clinics provide less costly treatment than physician offices or urgent care centers for 3 common illnesses, with no apparent adverse effect on quality of care or delivery of preventive care.

PRIMARY FUNDING SOURCE: California HealthCare Foundation.},
	keywords = {Adult, Aged, Ambulatory Care Facilities, Child, Child, Preschool, Commerce, Cross-Sectional Studies, Fees, Medical, Female, Health Services Accessibility, Humans, Infant, Insurance, Health, Male, Medicare, Middle Aged, Ownership, Preventive Health Services, Quality Assurance, Health Care, United States, Young Adult},
	issn = {1539-3704},
	doi = {10.7326/0003-4819-151-5-200909010-00006},
	author = {Ateev Mehrotra and Liu, Hangsheng and Adams, John L and Margaret C. Wang and Lave, Judith R and Thygeson, N Marcus and Solberg, Leif I and McGlynn, Elizabeth A}
}
@article {517251,
	title = {Episode-based performance measurement and payment: making it a reality},
	journal = {Health Aff (Millwood)},
	volume = {28},
	number = {5},
	year = {2009},
	month = {2009 Sep-Oct},
	pages = {1406-17},
	abstract = {Proposals to use episodes of care as a basis for payment and performance measurement are largely conceptual at this stage, with little empirical work or experience in applied settings to guide their design. Based on analyses of Medicare data, we identified key issues that will need to be considered related to defining episodes and determining which provider is accountable for an episode. We suggest a number of applied studies and demonstrations that would facilitate more rapid movement of episode-based approaches from concept to implementation.},
	keywords = {Episode of Care, Health Services Research, Humans, Medicare, Quality Indicators, Health Care, Reimbursement mechanisms, United States},
	issn = {1544-5208},
	doi = {10.1377/hlthaff.28.5.1406},
	author = {Hussey, Peter S and Sorbero, Melony E and Ateev Mehrotra and Liu, Hangsheng and Damberg, Cheryl L}
}
@article {517261,
	title = {The geographic distribution, ownership, prices, and scope of practice at retail clinics},
	journal = {Ann Intern Med},
	volume = {151},
	number = {5},
	year = {2009},
	month = {2009 Sep 01},
	pages = {315-20},
	abstract = {BACKGROUND: Retail clinics are clinics within a retail store that provide simple acute and preventive care services for a fixed price without an appointment.

OBJECTIVE: To describe characteristics of retail clinics, including their location, scope of practice, prices, acceptance of insurance, and ownership, and to estimate the proportion of the U.S. population that lives within a short driving distance of such a clinic.

DESIGN: Cross-sectional descriptive study.

SETTING: United States.

PARTICIPANTS: All 982 retail clinics operating as of August 2008.

MEASUREMENTS: Population living within a 5- and 10-minute driving distance of a retail clinic.

RESULTS: In August 2008, 42 operators ran 982 clinics in 33 states; 88.4\% were located in urban areas. Nearly half (44\%) of all clinics were located in 5 states (Florida, California, Texas, Minnesota, and Illinois). All offered sore throat treatment (average price, $78) and more than 95\% offered treatment of skin conditions, immunizations, pregnancy testing, and lipid or diabetes screening. Almost all (97\%) accepted private insurance and Medicare fee-for-service (93\%). Among 42 clinic operators, 25 are existing health care companies that operate 11\% of the clinics, and 3 are for-profit retail chains that operate 73\% of the clinics. An estimated 10.6\% of the total U.S. and 13.4\% of the urban U.S. population lives within a 5-minute driving distance of a retail clinic, whereas 28.7\% (total) and 35.8\% (urban) live within a 10-minute driving distance.

LIMITATION: Our inventory of clinics stopped in August 2008 and estimates of proximity are based on 2000 census data.

CONCLUSION: Retail clinics are positioned to provide immunizations and care for simple acute conditions for a substantial segment of the urban U.S. population.

PRIMARY FUNDING SOURCE: California Healthcare Foundation.},
	keywords = {Ambulatory Care Facilities, Commerce, Cross-Sectional Studies, Delivery of Health Care, Fees, Medical, Health Services Accessibility, Humans, Insurance, Health, Medicare, Ownership, United States},
	issn = {1539-3704},
	doi = {10.7326/0003-4819-151-5-200909010-00005},
	author = {Rudavsky, Rena and Pollack, Craig Evan and Ateev Mehrotra}
}
@article {517281,
	title = {Pay for performance in the hospital setting: what is the state of the evidence?},
	journal = {Am J Med Qual},
	volume = {24},
	number = {1},
	year = {2009},
	month = {2009 Jan-Feb},
	pages = {19-28},
	abstract = {More than 40 private sector hospital pay-for-performance (P4P) programs now exist, and Congress is considering initiating a Medicare hospital P4P program. Given the growing interest in hospital P4P, this systematic review of the literature examines the current state of knowledge about the effect of P4P on clinical process measures, patient outcomes and experience, safety, and resource utilization. Little formal evaluation of hospital P4P has occurred, and most of the 8 published studies have methodological flaws. The most rigorous studies focus on clinical process measures and demonstrate that hospitals participating in the Centers for Medicare and Medicaid Services-Premier Hospital Quality Incentive Demonstration, a P4P program, had a 2- to 4-percentage point greater improvement than the improvement observed in control hospitals. There is a need for more systematic evaluation of hospital P4P to understand its effect and whether the benefits of investing in P4P outweigh the associated costs.},
	keywords = {Hospitals, Private, Physician Incentive Plans, Quality Assurance, Health Care, United States},
	issn = {1062-8606},
	doi = {10.1177/1062860608326634},
	author = {Ateev Mehrotra and Damberg, Cheryl L and Sorbero, Melony E S and Teleki, Stephanie S}
}
@article {517266,
	title = {Racial and ethnic disparities in pneumonia treatment and mortality},
	journal = {Med Care},
	volume = {47},
	number = {9},
	year = {2009},
	month = {2009 Sep},
	pages = {1009-17},
	abstract = {BACKGROUND: The extent to which racial/ethnic disparities in pneumonia care occur within or between hospitals is unclear.

OBJECTIVE: Examine within and between-hospital racial/ethnic disparities in quality indicators and mortality for patients hospitalized for pneumonia.

RESEARCH DESIGN: Retrospective cohort study.

SUBJECTS: A total of 1,183,753 non-Hispanic white, African American, and Hispanic adults hospitalized for pneumonia between January 2005 and June 2006.

MEASURES: Eight pneumonia care quality indicators and in-hospital mortality.

RESULTS: Performance rates for the 8 quality indicators ranged from 99.4\% (oxygenation assessment within 24 hours) to 60.2\% (influenza vaccination). Overall hospital mortality was 4.1\%. African American and Hispanic patients were less likely to receive pneumococcal and influenza vaccinations, smoking cessation counseling, and first dose of antibiotic within 4 hours than white patients at the same hospital (ORs = 0.65-0.95). Patients at hospitals with the racial composition of those attended by average African Americans and Hispanics were less likely to receive all indicators except blood culture within 24 hours than patients at hospitals with the racial composition of those attended by average whites. Hospital mortality was higher for African Americans (OR = 1.05; 95\% CI = 1.02, 1.09) and lower for Hispanics (OR = 0.85; 95\% CI = 0.81, 0.89) than for whites within the same hospital. Mortality for patients at hospitals with the racial composition of those attended by average African Americans (OR = 1.21; 95\% CI = 1.18, 1.25) or Hispanics (OR = 1.18; 95\% CI = 1.14, 1.23) was higher than for patients at hospitals with the racial composition of those attended by average whites.

CONCLUSIONS: Racial/ethnic disparities in pneumonia treatment and mortality are larger and more consistent between hospitals than within hospitals.},
	keywords = {Aged, Aged, 80 and over, Black or African American, Cohort Studies, Female, Healthcare Disparities, Hispanic or Latino, Hospital Mortality, Humans, Male, Middle Aged, Pennsylvania, Pneumonia, Quality Indicators, Health Care, Retrospective Studies},
	issn = {1537-1948},
	doi = {10.1097/MLR.0b013e3181a80fdc},
	author = {Hausmann, Leslie R M and Ibrahim, Said A and Ateev Mehrotra and Nsa, Wato and Bratzler, Dale W and Mor, Maria K and Fine, Michael J}
}
@article {517276,
	title = {Reporting hospitals{\textquoteright} antibiotic timing in pneumonia: adverse consequences for patients?},
	journal = {Am J Manag Care},
	volume = {15},
	number = {2},
	year = {2009},
	month = {2009 Feb},
	pages = {137-44},
	abstract = {OBJECTIVE: To determine whether publicly reporting hospital scores on antibiotic timing in pneumonia (percentage of patients with pneumonia receiving antibiotics within 4 hours) has led to unintended adverse consequences for patients.

STUDY DESIGN: Retrospective analyses of 13,042 emergency department (ED) visits by adult patients with respiratory symptoms in the National Hospital Ambulatory Medical Care Survey, 2001-2005.

METHODS: Rates of pneumonia diagnosis, antibiotic use, and waiting times to see a physician were compared before and after public reporting, using a nationally representative hospital sample. These outcomes also were compared between hospitals with different antibiotic timing scores.

RESULTS: There were no differences in rates of pneumonia diagnosis (10\% vs 11\% of all ED visits, P = .72) or antibiotic administration (34\% vs 35\%, P = .21) before and after antibiotic timing score reporting. Mean waiting times to be seen by a physician increased similarly for patients with and without respiratory symptoms (11-minute vs 6-minute increase, respectively; P = .29). After adjustment for confounders, hospitals with higher 2005 antibiotic timing scores had shorter mean waiting times for all patients, but there were no significant score-related trends for rates of pneumonia diagnosis or antibiotic use.

CONCLUSION: Despite concerns, public reporting of hospital antibiotic timing scores has not led to increased pneumonia diagnosis, antibiotic use, or a change in patient prioritization.},
	keywords = {Anti-Bacterial Agents, Chi-Square Distribution, Drug Utilization, Emergency Service, Hospital, Female, Humans, Logistic Models, Male, Pneumonia, Retrospective Studies, Time Factors, Waiting Lists},
	issn = {1936-2692},
	author = {Friedberg, Mark W and Ateev Mehrotra and Linder, Jeffrey A}
}
@article {517291,
	title = {Implementing open-access scheduling of visits in primary care practices: a cautionary tale},
	journal = {Ann Intern Med},
	volume = {148},
	number = {12},
	year = {2008},
	month = {2008 Jun 17},
	pages = {915-22},
	abstract = {BACKGROUND: Open-access scheduling (also known as advanced access or same-day access) is a popular tool for improving patient access to primary care appointments.

OBJECTIVE: To assess the effect of open-access scheduling and describe the barriers to implementing the open-access scheduling model in primary care.

DESIGN: Case series.

SETTING: Boston, Massachusetts, metropolitan area.

PARTICIPANTS: 6 primary care practices studied from October 2003 through June 2006.

INTERVENTION: Implementation of open-access scheduling.

MEASUREMENTS: Time to third available appointments, no-show rates, and patient and staff satisfaction with appointment availability.

RESULTS: 5 of 6 practices were able to implement open-access scheduling. Within 4 months of implementation, these 5 practices substantially reduced their mean wait for third available appointments from 21 to 8 days for 15-minute visits and from 39 to 14 days for 30-minute visits. However, none of the 5 practices attained the goal of same-day access, and waits for third available appointments increased during 2 years of follow-up. No consistent changes in patient or staff satisfaction or patient no-show rates were found. Barriers to implementation included decreases in appointment supply from provider leaves of absence and departures and increases in appointment demand when practices reopened to new patients after initial implementation of open-access scheduling.

LIMITATIONS: The study lacked control practices. The small number of practices and providers precluded formal statistical comparisons.

CONCLUSION: In 5 of 6 primary care practices, implementation of open-access scheduling improved appointment access in some practices. However, none was able to achieve same-day access and patient and staff satisfaction and patient no-show rates were unchanged. Broader evaluation of open-access scheduling in primary care is needed.},
	keywords = {Appointments and Schedules, Boston, Health Services Accessibility, Humans, Job Satisfaction, Office Management, Patient Satisfaction, Primary Health Care, Time Factors},
	issn = {1539-3704},
	doi = {10.7326/0003-4819-148-12-200806170-00004},
	author = {Ateev Mehrotra and Keehl-Markowitz, Lori and John Z. Ayanian}
}
@article {517286,
	title = {Retail clinics, primary care physicians, and emergency departments: a comparison of patients{\textquoteright} visits},
	journal = {Health Aff (Millwood)},
	volume = {27},
	number = {5},
	year = {2008},
	month = {2008 Sep-Oct},
	pages = {1272-82},
	abstract = {In this study we compared the demographics of and reasons for visits in national samples of visits to retail clinics, primary care physicians (PCPs), and emergency departments (EDs). We found that retail clinics appear to be serving a patient population that is underserved by PCPs. Ten clinical problems such as sinusitis and immunizations encompass more than 90 percent of retail clinic visits. These same ten clinical problems make up 13 percent of adult PCP visits, 30 percent of pediatric PCP visits, and 12 percent of ED visits. Whether there will be a future shift of care from EDs or PCPs to retail clinics is unknown.},
	keywords = {Adult, Ambulatory Care Facilities, Child, Commerce, Emergency Service, Hospital, Family Practice, Humans, Office Visits, Physicians, Primary Care, United States},
	issn = {1544-5208},
	doi = {10.1377/hlthaff.27.5.1272},
	author = {Ateev Mehrotra and Margaret C. Wang and Lave, Judith R and Adams, John L and McGlynn, Elizabeth A}
}
@article {517296,
	title = {Congestive heart failure disease management in Medicare-managed care},
	journal = {Am Heart J},
	volume = {154},
	number = {6},
	year = {2007},
	month = {2007 Dec},
	pages = {1153-9},
	abstract = {BACKGROUND: In 2001, the Center for Medicare and Medicaid Services began 2 initiatives that encouraged Medicare-managed care plans to introduce congestive heart failure (CHF) disease management programs. Our study was designed to describe the use, structure, and content of these programs.

METHODS: In 2003 to 2004, we invited the representatives of Medicare-managed care plans with \&gt; or = 750 enrollees to participate in a survey by mail or telephone.

RESULTS: Representatives of 120 plans, 84 (70\%) responded. Of the plans, 92\% had CHF programs, 45\% of which were instituted in 2001 or later, and 42\% of which were handled externally by commercial vendors. Vendor use was more common in large programs (\&gt; 30,000 Medicare enrollees) than in small programs (\&lt; 15,000 Medicare enrollees) (57\% vs 24\%, P = .05), in national than local programs (50\% vs 21\%, P = .03), and in for-profit than not-for-profit programs (45\% vs 21\%, P = .03). Although 87\% of CHF programs focused on improving patient self-management, a smaller fraction engaged practicing physicians (eg, 23\% provided feedback to physicians concerning whether care was consistent with CHF guidelines).

CONCLUSIONS: In Medicare-managed care plans, there is widespread use of CHF disease management. However, the programs used primarily focus on patient self-management and not on engaging physicians on medication management and compliance with guidelines. Our findings raise the concern that these programs will not be able to achieve the quality improvement and cost savings previously demonstrated in clinical trials of CHF disease management.},
	keywords = {Cost Savings, Disease Management, Health Care Surveys, Heart Failure, Humans, Managed Care Programs, Medicare, Quality of Health Care, United States},
	issn = {1097-6744},
	doi = {10.1016/j.ahj.2007.07.024},
	author = {Ateev Mehrotra and McNeil, Barbara J and Landon, Bruce E}
}
@article {517301,
	title = {Preventive health examinations and preventive gynecological examinations in the United States},
	journal = {Arch Intern Med},
	volume = {167},
	number = {17},
	year = {2007},
	month = {2007 Sep 24},
	pages = {1876-83},
	abstract = {BACKGROUND: Preventive health examinations (PHEs) are controversial, and limited data are available on their use and content.

METHODS: We conducted a retrospective analysis of 8413 ambulatory visits from January 1, 2002, to December 31, 2004, for PHEs and preventive gynecological examinations (PGEs) by adults in the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey. Population estimates were obtained from the Current Population Survey. We estimated rates of PHEs and PGEs by patients{\textquoteright} demographic characteristics, the frequency of 8 preventive services provided at these visits, and total costs of PHEs and PGEs at Medicare reimbursement rates.

RESULTS: An estimated 44.4 million adults per year (20.9\%; 95\% confidence interval [CI], 18.2\%-23.6\%) received a PHE, and 19.4 million women per year (17.7\% of adult women; 95\% CI, 14.9\%-20.4\%) received a PGE, together accounting for 8.0\% of all ambulatory visits. The PHE rates varied by region (Northeast vs West: relative risk, 1.58; 95\% CI, 1.17-2.14) and insurance type (those without vs those with private insurance or Medicare: relative risk, 0.51; 95\% CI, 0.40-0.65). Preventive services occurred at 52.9\% (95\% CI, 48.8\%-57.0\%) of PHEs and 83.5\% (95\% CI, 80.7\%-86.3\%) of PGEs, but only 19.9\% (95\% CI, 18.4\%-21.5\%) of 8 preventive services occurred at a PHE or PGE. The annual costs of these visits were approximately $7.8 billion.

CONCLUSIONS: PHEs and PGEs are among the most common reasons adults see a physician. These visits frequently include preventive services, but most preventive services are provided at other visits. These findings provide a foundation for continuing national deliberations about the use and content of PHEs and PGEs.},
	keywords = {Adolescent, Adult, Aged, Female, Humans, Male, Middle Aged, Office Visits, Physical Examination, Preventive Health Services, Retrospective Studies, United States, Women{\textquoteright}s Health Services},
	issn = {0003-9926},
	doi = {10.1001/archinte.167.17.1876},
	author = {Ateev Mehrotra and Zaslavsky, Alan M and John Z. Ayanian}
}
@article {517306,
	title = {The response of physician groups to P4P incentives},
	journal = {Am J Manag Care},
	volume = {13},
	number = {5},
	year = {2007},
	month = {2007 May},
	pages = {249-55},
	abstract = {OBJECTIVES: Despite substantial enthusiasm among insurers and federal policy makers for pay-for-performance incentives, little is known about the current scope of these incentives or their influence on the delivery of care. To assess the scope and magnitude of pay-for-performance (P4P) incentives among physician groups and to examine whether such incentives are associated with quality improvement initiatives.

STUDY DESIGN: Structured telephone survey of leaders of physician groups delivering primary care in Massachusetts. ASSESSED METHODS: Prevalence of P4P incentives among physician groups tied to specific measures of quality or utilization and prevalence of physician group quality improvement initiatives.

RESULTS: Most group leaders (89\%) reported P4P incentives in at least 1 commercial health plan contract. Incentives were tied to performance on Health Employer Data and Information Set (HEDIS) quality measures (89\% of all groups), utilization measures (66\%), use of information technology (52\%), and patient satisfaction (37\%). Among the groups with P4P and knowledge of all revenue streams, the incentives accounted for 2.2\% (range, 0.3\%-8.8\%) of revenue. P4P incentives tied to HEDIS quality measures were positively associated with groups{\textquoteright} quality improvement initiatives (odds ratio, 1.6; P = .02). Thirty-six percent of group leaders with P4P incentives reported that they were very important or moderately important to the group{\textquoteright}s financial success.

CONCLUSIONS: P4P incentives are now common among physician groups in Massachusetts, and these incentives most commonly reward higher clinical quality or lower utilization of care. Although the scope and magnitude of incentives are still modest for many groups, we found an association between P4P incentives and the use of quality improvement initiatives.},
	keywords = {Fees and charges, Group Practice, Humans, Interviews as Topic, Logistic Models, Managed Care Programs, Massachusetts, Motivation, Physician Incentive Plans, Physicians, Quality Assurance, Health Care, Reimbursement, Incentive},
	issn = {1936-2692},
	author = {Ateev Mehrotra and Pearson, Steven D and Coltin, Kathryn L and Kleinman, Ken P. and Singer, Janice A and Rabson, Barbra and Schneider, Eric C.}
}
@article {517311,
	title = {Do integrated medical groups provide higher-quality medical care than individual practice associations?},
	journal = {Ann Intern Med},
	volume = {145},
	number = {11},
	year = {2006},
	month = {2006 Dec 05},
	pages = {826-33},
	abstract = {BACKGROUND: The association between the organizational structure of physician groups and health care quality has never been evaluated empirically.

OBJECTIVE: To examine whether integrated medical groups (IMGs) provide higher-quality primary care than individual practice associations (IPAs).

DESIGN: Cross-sectional study.

SETTING: PacifiCare, a large health maintenance organization.

PARTICIPANTS: Approximately 1.7 million enrollees of PacifiCare cared for by 119 California physician groups between July 1999 and June 2000.

MEASUREMENTS: The percentage of eligible PacifiCare enrollees who received mammography, Papanicolaou smear screening, chlamydia screening, diabetic eye examination, an asthma controller medication, or a beta-blocker after acute myocardial infarction.

RESULTS: Physician groups identified as IMGs, compared with those identified as IPAs, had higher rates of mammography (relative risk, 1.15 [95\% CI, 1.01 to 1.33]), Papanicolaou smear screening (relative risk, 2.29 [CI, 1.53 to 3.42]), chlamydia screening (relative risk, 2.17 [CI, 1.04 to 4.55]), and diabetic eye screening (relative risk, 1.55 [CI, 1.28 to 1.88]). Leaders of IMGs were more likely to report using EMRs (37\% vs. 2\%; P \&lt; 0.001) and quality improvement strategies, but these characteristics explained little of the quality differences between IMGs and IPAs.

LIMITATIONS: Organizational characteristics, including group type, were reported by physician group leaders and not directly assessed. Patient characteristics that could have accounted for some of the observed differences also were not assessed.

CONCLUSIONS: Patients cared for in IMGs generally received higher-quality primary care than those cared for in IPAs. Having an EMR and implementation of quality improvement strategies did not explain the differences in quality. These findings suggest that physician group type influences health care quality.},
	keywords = {California, Cross-Sectional Studies, Health Maintenance Organizations, Humans, Independent Practice Associations, Medical Records Systems, Computerized, Quality of Health Care},
	issn = {1539-3704},
	doi = {10.7326/0003-4819-145-11-200612050-00007},
	author = {Ateev Mehrotra and Arnold M. Epstein and Meredith B. Rosenthal}
}
@article {517316,
	title = {The relationship between health plan advertising and market incentives: evidence of risk-selective behavior},
	journal = {Health Aff (Millwood)},
	volume = {25},
	number = {3},
	year = {2006},
	month = {2006 May-Jun},
	pages = {759-65},
	abstract = {Medicare beneficiaries are now facing advertising from an unprecedented number of health plans that are offering prescription drug coverage. Previous Medicare managed care efforts have been undermined by risk selection, the practice of enrolling healthier and therefore less costly patients. In this study we explore how the content of health plan advertising is related to the competitiveness of the health plan market. We find that increased competition is associated with greater use of advertising that targets healthier patients.},
	keywords = {Advertising, Aged, Drug Prescriptions, Economic Competition, Health Care Sector, Health Status, Humans, Insurance Selection Bias, Insurance, Pharmaceutical Services, Medicare, Privatization, United States},
	issn = {1544-5208},
	doi = {10.1377/hlthaff.25.3.759},
	author = {Ateev Mehrotra and Grier, Sonya and Dudley, R Adams}
}
@article {517321,
	title = {Employers{\textquoteright} efforts to measure and improve hospital quality: determinants of success},
	journal = {Health Aff (Millwood)},
	volume = {22},
	number = {2},
	year = {2003},
	month = {2003 Mar-Apr},
	pages = {60-71},
	abstract = {We examined eleven communities in which an employer coalition created a report card to compare the performance of the community{\textquoteright}s hospitals. After interviewing employer coalition and hospital representatives from each community, we found great variability in report cards{\textquoteright} capacity to prompt quality improvement. Although some were successful, others had less impact because of conflicts between employer coalitions and hospitals. Areas of disagreement included selection of appropriate goals, methodology of quality measurement, whether report cards should be publicly released, and the use of economic incentives to improve quality. We describe these conflicts and offer recommendations for future hospital report cards.},
	keywords = {Attitude of Health Personnel, Benchmarking, Databases as Topic, Disclosure, Health Care Coalitions, Hospitals, Community, Humans, Information Dissemination, Interviews as Topic, Qualitative Research, Quality Assurance, Health Care, Quality Indicators, Health Care, United States},
	issn = {0278-2715},
	doi = {10.1377/hlthaff.22.2.60},
	author = {Ateev Mehrotra and Bodenheimer, Thomas and Dudley, R Adams}
}
@article {517326,
	title = {What{\textquoteright}s behind the health expenditure trends?},
	journal = {Annu Rev Public Health},
	volume = {24},
	year = {2003},
	month = {2003},
	pages = {385-412},
	abstract = {In this paper, we review the literature on a number of the potential explanations for the rise in health care expenditures in the United States: the aging population, the costs of dying, technology, physician incomes, administrative costs, prescription drugs, managed care, and the underfunding of public health. Our goal is not to pass definitive judgment on the force(s) driving health care costs, but rather to make the reader a more educated consumer of these widely cited data. We place special emphasis on how health expenditures are measured and the inherent weaknesses in the methodology. We find that frequently it is difficult to accurately estimate how individual forces influence total health care expenditures. Moreover, we conclude that interpreting the causes of the rise in expenditures goes beyond simple observations of trends and depends on how we value various segments and aspects of health and health care.},
	keywords = {Health Care Reform, Health Expenditures, Humans, National Health Insurance, United States, Population Dynamics, Public Health, United States},
	issn = {0163-7525},
	doi = {10.1146/annurev.publhealth.24.100901.141008},
	author = {Ateev Mehrotra and Dudley, R Adams and Luft, Harold S}
}
@article {696580,
	title = {Jail inmates and HIV care: provision of antiretroviral therapy and Pneumocystis carinii pneumonia prophylaxis},
	journal = {Int J STD AIDS},
	volume = {12},
	number = {6},
	year = {2001},
	month = {2001 Jun},
	pages = {380-5},
	abstract = {The objective of this study was to examine prescription and acceptance of antiretroviral therapy (ART) and Pneumocystis carinii pneumonia (PCP) prophylaxis in jail and at release. A retrospective cross sectional design was used, by record review, of 77 inmates receiving HIV-related care in the San Francisco City and County Jail and released to the community in 1997. Average CD4 cell count was 335/microl. Fifteen had undectable HIV RNA, and average viral load was 19,826 copies/ml. Fifty-eight per cent were put on ART in jail. Lower CD4 cell count was associated with ART (P=0.017). All inmates with CD4 cell counts less than 200/microl received PCP prophylaxis. According to 1996 guidelines, 72\% of those eligible for ART were on therapy. Of 24 inmates released on ART, 71\% followed medical advice and picked up medication at release. HIV care in the San Francisco Jail met high standards and exceeded levels reported in other populations.},
	keywords = {Adult, Aged, Anti-HIV Agents, CD4 Lymphocyte Count, Cross-Sectional Studies, Female, Health Services, HIV Infections, Humans, Male, Middle Aged, Patient Acceptance of Health Care, Pneumonia, Pneumocystis, Prisoners, Retrospective Studies, San Francisco, Viral Load},
	issn = {0956-4624},
	doi = {10.1258/0956462011923327},
	author = {White, M C and Mehrotra, A and Menendez, E and Estes, M and Goldenson, J and Tulsky, J P}
}
