Research Roundup: Wait Times; Telemedicine For Mental Health; Medicaid Waivers

Health Affairs: Outpatient Office Wait Times And Quality Of Care For Medicaid Patients
We analyzed data on twenty-one million outpatient visits obtained from electronic health record systems, which allowed us to measure time spent in the waiting room beyond the scheduled appointment time. Median wait time was a little more than four minutes. Almost one-fifth of visits had waits longer than twenty minutes, and 10 percent were more than thirty minutes. Waits were shorter for early-morning appointments, for younger patients, and at larger practices. Median wait time was 4.1 minutes for privately insured patients and 4.6 minutes for Medicaid patients. After adjustment for patient and appointment characteristics, Medicaid patients were 20 percent more likely than the privately insured patients to wait longer than twenty minutes, with most of this disparity explained by differences in practices and providers they saw. (Oostrom, Einav and Finkelstein, 5/1)

Health Affairs: Rapid Growth In Mental Health Telemedicine Use Among Rural Medicare Beneficiaries, Wide Variation Across States
[W]e 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. ... 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. (Mehrotra et al., 5/1)

American Academy of Actuaries: How Changes to Health Insurance Market Rules Would Affect Risk Adjustment
Potential changes to the rules applying to the health insurance market have various implications for risk adjustment. Short of returning to the pre-ACA environment of underwriting and risk rating, risk adjustment would still be necessary to reduce incentives for insurers to avoid high-cost enrollees. Some changes, such as incorporating high-risk pooling and increasing flexibility in cost-sharing requirements, could require only adjustments to the risk adjustment design. Other changes, such as loosening or eliminating the EHB requirements and allowing sales across state lines could greatly complicate the design and effectiveness of a risk adjustment mechanism. If states have flexibility in setting benefit and rating rules, the risk adjustment models and payment transfer factors may need to vary by state. The administration of risk adjustment is complicated. Moving administration of a risk adjustment program from CMS to the states would require a significant investment of state resources. (5/10)

The Kaiser Family Foundation: Proposed Medicaid Section 1115 Waivers In Maine And Wisconsin
Section 1115 Medicaid demonstration waivers provide states with an avenue to test new approaches that further the objectives of the Medicaid program in ways that differ from what states can do under current law. On March 14, 2017, the Centers for Medicare and Medicaid Services (CMS) sent a letter to state governors that signaled a willingness to use Section 1115 authority to “support innovative approaches to increase employment and community engagement” and “align Medicaid and private insurance policies for non-disabled adults.” ... Wisconsin and Maine are seeking waiver authority to make significant changes to Medicaid that would affect non-expansion Medicaid populations. ... Wisconsin and Maine’s proposals include provisions that have not been approved in any state (such as work requirements, drug testing, and time limits). (Musumeci, Hinton and Rudowitz, 5/10)

American Journal of Managed Care: Battling The Chargemaster: A Simple Remedy To Balance Billing For Unavoidable Out-Of-Network Care
Chargemaster abuses from OON [out of network] and emergency care inflict serious financial harm to the most vulnerable while undercutting the functioning of healthcare markets and the creation of valuable insurance products. At the same time, they present straightforward questions of contract law and lead to a simple conclusion: providers are entitled only to collect prevailing negotiated prices for OON services, and patients and payers are under no legal obligation to pay higher chargemaster charges. Applying this interpretation of contract law will prevent providers from hiding behind a convoluted hospital pricing system, will encourage the development of attractive narrow network insurance offerings, and will shield urgently sick people from the dread of medical predation. State legislators ... should pursue court remedies that correct both the immediate and the long-term dynamic harms caused by chargemaster strategies. (Richman et al, 4/28)