The American journal of managed care
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Average length of stay (ALOS) is used as a measure of the effectiveness of care delivery and therefore is an important operational measure when evaluating both the hospitalist group and individual hospitalist performance. No metric within the control of the individual hospitalist has been identified to support the individual hospitalist's contribution to the hospitalist group's ALOS goals. This study's objective was to evaluate the correlation between the follow-up to discharge ratio (F:D ratio) and ALOS and assess the relationship between F:D ratio and hospitalist experience. ⋯ A strong linear relationship exists between the F:D ratio and ALOS. Additionally, the F:D ratio improves with experience. Provider-level billing data applied as the F:D ratio can be used as a hospitalist management and assessment tool.
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It is unclear on what basis Medicare drug plans impose coverage restrictions on orphan drugs. This study aims to investigate the factors associated with utilization controls in Medicare fee-for-service Part D formularies. ⋯ Plans are making evidence-based decisions by rewarding more clinically effective and safer orphan drugs. They are penalizing drugs with multiple indications. Surprisingly, plans place fewer restrictions on orphan drugs that have a generic equivalent, which may further discourage generic entry into the orphan space, where competition is already sparse.
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With a "new normal" level of care going forward post coronavirus disease 2019 (COVID-19), the key will be to invest in high-value services while deterring a resurgence of low-value care.
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To mark the 25th anniversary of the journal, each issue in 2020 will include an interview with a health care thought leader. The September issue features a conversation with Georges C. Benjamin, MD, executive director of the American Public Health Association.
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Per capita spending on specialty drugs increased 55% between 2014 and 2018. Individuals aged 55 to 75 years using specialty drugs make the transition from employer-sponsored insurance (ESI) to Medicare Part D coverage. We compared out-of-pocket (OOP) spending across ESI, Medicare fee-for-service (FFS), and Medicare Advantage (MA) prescription drug plans to examine the impact of benefit design on OOP spending. ⋯ OOP spending was substantially higher for Medicare enrollees compared with ESI enrollees as a result of the Part D benefit structure.