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ions.Coronavirus disease 2019 (COVID-19) has challenged us to incorporate technology into engaging, interacting with, and caring for patients, using televisits and video conferencing in ways that have previously been resisted or derided.Our hospital is a primary hospital in Chengdu, China. Since February 5, our hospital has been listed as the primary designated medical unit for treating new patients with coronavirus disease 2019 (COVID-19) in Jinniu District. In this letter, we share our COVID-19 experience with readers.

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

Analysis of 2017 commercial claims data from the Health Care Cost Institute, comprising 568.5 million claims from 44.8 million covered lives in 3 large US insurers UnitedHealthcare, Aetna, and Humana.

We calculate the share of total health plan claims spending attributable to ancillary and emergency services. Next, we estimate the premium impact of proposed federal policies to address surprise billing, which, by removing provider leverage stemming from the ability to surprise-bill, could reduce in- and out-of-network payments for these services, in turn affecting premiums. Specifically, we model the premium impact of reducing payment for these services (1) by 15% and (2) to 150% of traditional Medicare payment rates.

More than 10% of health plan spending is attributable to ancillary and emergency services that commonly surprise-bill. Reducing payment for these services by 15% would reduce premiums by 1.6% ($67 per member per year), and reducing average payment to 150% of traditional Medicare rates-the high end of payments to other specialists-would reduce premiums by 5.1% ($212 per member per year). These savings would reduce aggregate premiums for the nation's commercially insured population by approximately $12 billion and $38 billion, respectively.

Addressing surprise billing could substantially affect commercial insurance premiums.

Addressing surprise billing could substantially affect commercial insurance premiums.

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. selleck compound This study's objective was to evaluate the correlation between the follow-up to discharge ratio (FD ratio) and ALOS and assess the relationship between FD ratio and hospitalist experience.

We systematically evaluated the relationship between hospitalist-level billing data for daily inpatient follow-up encounters and discharge visits (FD ratio) and the attributed ALOS across consecutive hospitalist encounters at a tertiary care center.

Over the study period of 10 quarters from 2017 to 2019, there were 103,080 follow-up or discharge inpatient encounters. The mean (SD) provider FD ratio and ALOS were 3.94 (0.36) and 4.45 (0.24) days, respectively. The mean (SD) case mix index (CMI) was 1.68 (0.04). There was a strong linear relationship between the FD ratio and both ALOS and CMI-adjusted ALOS (r = 0.807; P = .014; and r = 0.814; P = .001, respectively). The mean (SD) FD ratio for hospitalists with 1 year or less of experience compared with those with more than 1 year of experience was 4.23 (0.80) vs 3.88 (0.39), respectively (P = .012).

A strong linear relationship exists between the FD ratio and ALOS. Additionally, the FD ratio improves with experience. Provider-level billing data applied as the FD ratio can be used as a hospitalist management and assessment tool.

A strong linear relationship exists between the FD ratio and ALOS. Additionally, the FD ratio improves with experience. Provider-level billing data applied as the FD ratio can be used as a hospitalist management and assessment tool.

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.

Analyses consisted of Truven MarketScan and Medicare Part D prescription drug claims from 2013 to 2017 for individuals enrolled in ESI, FFS, and MA drug plans taking at least 1 drug among the top 4 specialty drug classes rheumatoid arthritis (RA), multiple sclerosis (MS), cancer, and hepatitis C.

Multivariate regression analyses with fixed effects were used to assess whether there are differences in OOP spending by insurance type and the impact of benefit design differences. A secondary outcome was drug choice within a therapeutic class.

There were small differences in drug choice between Medicare and ESI but significant differences in OOP spending. Monthly OOP spending for ESI relative to FFS was $108 less for RA drugs, $288 less for MS drugs, $504 less for cancer drugs, and $1437 less for hepatitis C drugs. Spending was slightly greater for beneficiaries in MA plans compared with FFS. Higher Medicare spending was driven by gaps in coverage in the Part D benefit phases because beneficiaries pay a percentage of list price.

OOP spending was substantially higher for Medicare enrollees compared with ESI enrollees as a result of the Part D benefit structure.

OOP spending was substantially higher for Medicare enrollees compared with ESI enrollees as a result of the Part D benefit structure.

To examine the effect of a patient activation intervention with financial incentives to promote switching to a thiazide in patients with controlled hypertension using calcium channel blockers (CCBs).

The Veterans Affairs Project to Implement Diuretics, a randomized clinical trial, was conducted at 13 Veterans Affairs primary care clinics.

Patients (n = 236) with hypertension previously controlled using CCBs were randomized to a control group (n = 90) or 1 of 3 intervention groups designed to activate patients to talk with their primary care providers about switching to thiazides Group A (n = 53) received an activation letter, group B (n = 42) received a letter plus a financial incentive to discuss switching from a CCB to a thiazide, and group C (n = 51) received a letter, a financial incentive, and a telephone call encouraging patients to speak with their primary care providers. The primary outcome was thiazide prescribing at the index visit.

At the index visit, the rate of switching to a thiazide was 1.