2023
Trends in Spending and Claims for P2Y12 Inhibitors by Medicare and Medicaid From 2015 to 2020
Essa M, Ross J, Dhruva S, Desai N, Yeh R, Faridi K. Trends in Spending and Claims for P2Y12 Inhibitors by Medicare and Medicaid From 2015 to 2020. Journal Of The American Heart Association 2023, 12: e028869. PMID: 37042289, PMCID: PMC10227267, DOI: 10.1161/jaha.122.028869.Peer-Reviewed Original Research
2022
Spending by the Centers for Medicare & Medicaid Services Before and After Confirmation of Benefit for Drugs Granted US Food and Drug Administration Accelerated Approval, 2012 to 2017
Skydel JJ, Egilman AC, Wallach JD, Ramachandran R, Gupta R, Ross JS. Spending by the Centers for Medicare & Medicaid Services Before and After Confirmation of Benefit for Drugs Granted US Food and Drug Administration Accelerated Approval, 2012 to 2017. JAMA Health Forum 2022, 3: e221158. PMID: 35977252, PMCID: PMC9142876, DOI: 10.1001/jamahealthforum.2022.1158.Peer-Reviewed Original ResearchConceptsSurrogate end pointsCross-sectional studyClinical benefitConfirmation of benefitEnd pointOriginal indicationClinical outcomesUS FoodConfirmatory trialsMedicaid ServicesPrimary end pointUnproven clinical benefitsTrial end pointsClinical trial resultsTypes of drugsPostapproval trialsAccelerated approvalClinical trialsMAIN OUTCOMEDrug AdministrationMedicare Part BStandard approvalConversion statusSupplemental indicationsTrial resultsIn Medicaid Managed Care Networks, Care Is Highly Concentrated Among A Small Percentage Of Physicians
Ludomirsky AB, Schpero WL, Wallace J, Lollo A, Bernheim S, Ross JS, Ndumele CD. In Medicaid Managed Care Networks, Care Is Highly Concentrated Among A Small Percentage Of Physicians. Health Affairs 2022, 41: 760-768. PMID: 35500192, DOI: 10.1377/hlthaff.2021.01747.Peer-Reviewed Original ResearchConceptsCare plansPercent of specialistsOutpatient primary carePrimary care physiciansManaged Care NetworkCare physiciansPrimary careMedicaid patientsMedicaid beneficiariesPhysicians' willingnessSpecialist physiciansPhysiciansCare networkMedicaid ServicesCareMedicaid participationOne-thirdNetwork adequacy standardsSmall percentagePercentBeneficiary preferencesPatientsAssociation of Psychiatric Diagnoses and Medicaid Coverage with Length of Stay Among Inpatients Discharged to Skilled Nursing Facilities
Bartlett VL, Ross JS, Balasuriya L, Rhee TG. Association of Psychiatric Diagnoses and Medicaid Coverage with Length of Stay Among Inpatients Discharged to Skilled Nursing Facilities. Journal Of General Internal Medicine 2022, 37: 3070-3079. PMID: 35048298, PMCID: PMC9485316, DOI: 10.1007/s11606-021-07320-4.Peer-Reviewed Original ResearchConceptsSkilled nursing facilitiesLength of staySubstance use diagnosesPsychiatric diagnosisHospital stayDischarge diagnosisPrimary payorUse diagnosesNursing facilitiesMedicaid coverageRetrospective cross-sectional study designPrimary discharge diagnosisCross-sectional study designNational Inpatient SampleDiagnosis-related groupsMultivariable adjustmentGeometric mean lengthMedian lengthInpatient hospitalizationInpatient SampleMedicaid patientsMedicare patientsInpatient dischargesMAIN OUTCOMEPatients
2021
Identification of Hospitals That Care for a High Proportion of Patients With Social Risk Factors
Matty R, Heckmann R, George E, Barthel AB, Suter LG, Ross JS, Bernheim SM. Identification of Hospitals That Care for a High Proportion of Patients With Social Risk Factors. JAMA Health Forum 2021, 2: e211323. PMID: 35977204, PMCID: PMC8796989, DOI: 10.1001/jamahealthforum.2021.1323.Peer-Reviewed Original ResearchConceptsSocial risk factorsIdentification of hospitalsProportion of patientsRisk factorsCross-sectional studyHospital performance measuresPatient populationHospital Readmissions Reduction ProgramAfrican American raceProportion of hospitalsDisadvantaged patient populationsReadmissions Reduction ProgramHigher proportionSocioeconomic status scoresSame hospitalStatus scoreCrowded householdsMAIN OUTCOMEMedicaid coverageAmerican racePatientsHospitalHealthcare ResearchDisadvantaged populationsSuch hospitalsEffects of forced disruption in Medicaid managed care on children with asthma
Piwnica‐Worms K, Staiger B, Ross JS, Rosenthal MS, Ndumele CD. Effects of forced disruption in Medicaid managed care on children with asthma. Health Services Research 2021, 56: 668-676. PMID: 33624290, PMCID: PMC8313960, DOI: 10.1111/1475-6773.13643.Peer-Reviewed Original ResearchConceptsPrimary care providersPersistent asthmaCare plansOutpatient visitsCare utilizationCare administrative claims dataEmergency department utilizationHealth care utilizationAdministrative claims dataIndicators of asthmaProportion of childrenPatients outpatientHealth utilizationAdministrative claimsAsthmaCare providersClaims dataNumber of childrenConsistent associationMedicaidVisitsChildrenOutpatientsPercentage point decreaseEnrollment data
2020
Transparency and Accountability of Medicaid Section 1115 Waiver Demonstration Programs Under the Affordable Care Act
Lopez L, Silvestri D, Ross JS. Transparency and Accountability of Medicaid Section 1115 Waiver Demonstration Programs Under the Affordable Care Act. JAMA Network Open 2020, 3: e2022035. PMID: 33104203, PMCID: PMC7588940, DOI: 10.1001/jamanetworkopen.2020.22035.Peer-Reviewed Original ResearchAssessment of Health Status and Barriers to Employment Among Medicaid Beneficiaries Not Meeting Work Requirements After Accounting for State Medical Frailty Exemptions
Silvestri DM, Gluck AR, Ross JS. Assessment of Health Status and Barriers to Employment Among Medicaid Beneficiaries Not Meeting Work Requirements After Accounting for State Medical Frailty Exemptions. JAMA Internal Medicine 2020, 180: 1008-1010. PMID: 32364563, PMCID: PMC7199172, DOI: 10.1001/jamainternmed.2020.1039.Peer-Reviewed Original ResearchProstaglandin Coverage and Costs to Medicare and Medicare Beneficiaries, 2009-2017
Bartlett VL, Liu P, Dhruva SS, Shah ND, Bollinger KE, Ross JS. Prostaglandin Coverage and Costs to Medicare and Medicare Beneficiaries, 2009-2017. Journal Of Managed Care & Specialty Pharmacy 2020, 26: 10.18553/jmcp.2020.26.4.562. PMID: 32223594, PMCID: PMC10391193, DOI: 10.18553/jmcp.2020.26.4.562.Peer-Reviewed Original ResearchThe Human Costs of Medicare Fraud and Abuse
Ross JS. The Human Costs of Medicare Fraud and Abuse. JAMA Internal Medicine 2020, 180: 69-69. PMID: 31657845, DOI: 10.1001/jamainternmed.2019.5004.Commentaries, Editorials and Letters
2019
Association Between Insurance Status and Access to Hospital Care in Emergency Department Disposition
Venkatesh AK, Chou SC, Li SX, Choi J, Ross JS, D’Onofrio G, Krumholz HM, Dharmarajan K. Association Between Insurance Status and Access to Hospital Care in Emergency Department Disposition. JAMA Internal Medicine 2019, 179: 686-693. PMID: 30933243, PMCID: PMC6503571, DOI: 10.1001/jamainternmed.2019.0037.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedAsthmaCritical CareCross-Sectional StudiesDatabases, FactualEmergency Service, HospitalFemaleHealth Services AccessibilityHospitalizationHumansInsurance CoverageInsurance, HealthLung DiseasesMaleMedicaidMedically UninsuredMiddle AgedPatient DischargePatient TransferPneumoniaPulmonary Disease, Chronic ObstructiveUnited StatesConceptsNational Emergency Department SampleEmergency Department SampleCommon medical conditionsUninsured patientsCritical care capabilitiesED dischargeED visitsED transfersPulmonary diseaseCare capabilitiesInsurance statusHigher oddsMedicaid beneficiariesMedical conditionsChronic obstructive pulmonary diseaseAcute pulmonary diseaseEmergency department transfersAdult ED visitsHospital admission ratesObstructive pulmonary diseaseEmergency department dispositionPatient insurance statusPatient case mixHospital ownership statusIntensive care capabilities
2018
State-Level Population Estimates of Individuals Subject to and Not Meeting Proposed Medicaid Work Requirements.
Silvestri DM, Holland ML, Ross JS. State-Level Population Estimates of Individuals Subject to and Not Meeting Proposed Medicaid Work Requirements. JAMA Internal Medicine 2018, 178: 1552-1555. PMID: 30208409, PMCID: PMC6248197, DOI: 10.1001/jamainternmed.2018.4196.Peer-Reviewed Original ResearchThe Early Impact of Medicaid Expansion on Uninsured Patients Undergoing Emergency General Surgery
Chiu AS, Jean RA, Ross JS, Pei KY. The Early Impact of Medicaid Expansion on Uninsured Patients Undergoing Emergency General Surgery. Journal Of Surgical Research 2018, 232: 217-226. PMID: 30463721, DOI: 10.1016/j.jss.2018.06.037.Peer-Reviewed Original ResearchConceptsEmergency general surgeryNational Inpatient SampleMedicaid expansionEGS patientsUninsured patientsGeneral surgeryPercentage of patientsCost burdenFederal poverty levelAffordable Care ActInpatient SampleInsurance typeMedicaid coveragePatientsInsurance coverageCare ActRepresentative estimatesSurgeryEGS operationsFirst yearEarly impactAdultsBurdenNetwork Optimization And The Continuity Of Physicians In Medicaid Managed Care
Ndumele CD, Staiger B, Ross JS, Schlesinger MJ. Network Optimization And The Continuity Of Physicians In Medicaid Managed Care. Health Affairs 2018, 37: 929-935. PMID: 29863934, DOI: 10.1377/hlthaff.2017.1410.Peer-Reviewed Original ResearchMeSH KeywordsChronic DiseaseContinuity of Patient CareCost ControlDatabases, FactualDelivery of Health CareFemaleHealth ExpendituresHealth Maintenance OrganizationsHealth Services AccessibilityHumansMaleManaged Care ProgramsMedicaidPhysiciansPractice Patterns, Physicians'Retrospective StudiesUnited States
2017
Hospital Characteristics Associated With Risk-standardized Readmission Rates
Horwitz LI, Bernheim SM, Ross JS, Herrin J, Grady JN, Krumholz HM, Drye EE, Lin Z. Hospital Characteristics Associated With Risk-standardized Readmission Rates. Medical Care 2017, 55: 528-534. PMID: 28319580, PMCID: PMC5426655, DOI: 10.1097/mlr.0000000000000713.Peer-Reviewed Original Research
2013
Hospital Discharge and the Transition Home for Poor Patients: “I Knew I Couldn’t Do What They Were Asking Me”
Bernheim SM, Ross JS. Hospital Discharge and the Transition Home for Poor Patients: “I Knew I Couldn’t Do What They Were Asking Me”. Journal Of General Internal Medicine 2013, 29: 269-270. PMID: 24327310, PMCID: PMC3912274, DOI: 10.1007/s11606-013-2698-4.Commentaries, Editorials and Letters
2012
State Medicaid Programs Did Not Make Use Of Prior Authorization To Promote Safer Prescribing After Rosiglitazone Warning
Ross JS, Jackevicius C, Krumholz HM, Ridgeway J, Montori VM, Alexander GC, Zerzan J, Fan J, Shah ND. State Medicaid Programs Did Not Make Use Of Prior Authorization To Promote Safer Prescribing After Rosiglitazone Warning. Health Affairs 2012, 31: 188-198. PMID: 22232110, PMCID: PMC3319744, DOI: 10.1377/hlthaff.2011.1068.Peer-Reviewed Original ResearchConceptsState Medicaid programsPreferred drugDrug listPrior authorizationMedicaid programSafety warningsPrior authorization programHigh-cost drugsDiabetes medicationsPrescribing ratesEffective prescribingSafe prescribingMedicaid beneficiariesDiabetes drugsPrescribingState MedicaidHeart attackRosiglitazoneDrug availabilityDrugsAuthorization programPrescriptionMinimal changesMedicationsProviders
2010
Who is missing from the measures? Trends in the proportion and treatment of patients potentially excluded from publicly reported quality measures
Bernheim SM, Wang Y, Bradley EH, Masoudi FA, Rathore SS, Ross JS, Drye E, Krumholz HM. Who is missing from the measures? Trends in the proportion and treatment of patients potentially excluded from publicly reported quality measures. American Heart Journal 2010, 160: 943-950.e5. PMID: 21095284, PMCID: PMC3319386, DOI: 10.1016/j.ahj.2010.06.046.Peer-Reviewed Original ResearchMeSH KeywordsAdrenergic beta-AntagonistsAgedAngiotensin-Converting Enzyme InhibitorsCross-Sectional StudiesFemaleHospitalizationHumansMaleMedicaidMedicareMyocardial InfarctionOutcome and Process Assessment, Health CarePlatelet Aggregation InhibitorsPrognosisQuality ImprovementQuality Indicators, Health CareRetrospective StudiesUnited StatesConceptsAcute myocardial infarctionProportion of patientsRelative contraindicationAngiotensin-converting enzyme inhibitorTreatment of patientsMedicaid Services core measuresQuality improvement projectPublic reportingCross-sectional analysisMyocardial infarctionMedicare patientsHospital careΒ-blockersAMI admissionsPatientsInsufficient evidenceEnzyme inhibitorsTreatment ratesBetter careContraindicationsMedicaid ServicesData cohortCore measuresTreatmentImprovement project
2008
Influence of Patients’ Socioeconomic Status on Clinical Management Decisions: A Qualitative Study
Bernheim SM, Ross JS, Krumholz HM, Bradley EH. Influence of Patients’ Socioeconomic Status on Clinical Management Decisions: A Qualitative Study. The Annals Of Family Medicine 2008, 6: 53-59. PMID: 18195315, PMCID: PMC2203396, DOI: 10.1370/afm.749.Peer-Reviewed Original ResearchConceptsClinical management decisionsPatients' socioeconomic statusClinical managementSocioeconomic statusPatient sPatient outcomesPrimary care physiciansStandard of careInfluence of patientLow socioeconomic statusVaried practice settingsHealth care qualitySES influencesCare physiciansHispanic ethnicityPhysician perspectivesPractice settingsCare qualityPatientsPhysiciansPatient interestMinority racial backgroundsInterview guideFinancial strainOutcomes