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Mehrotra, Ateev

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Mehrotra

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Mehrotra, Ateev
Author's Publications: search.filters.isAuthorOfPublication.0602166d-d26f-4969-9bb8-dcd72ab36122

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    Impact of Race/Ethnicity and Socioeconomic Status on Risk-Adjusted Readmission Rates: Implications for the Hospital Readmissions Reduction Program
    (SAGE Publications, 2016) Martsolf, Grant R.; Barrett, Marguerite L.; Weiss, Audrey J.; Washington, Raynard; Steiner, Claudia A.; Mehrotra, Ateev; Coffey, Rosanna M.
    Under the Hospital Readmissions Reduction Program (HRRP) of the Centers for Medicare & Medicaid Services (CMS), hospitals with excess readmissions for select conditions and procedures are penalized. However, readmission rates are not risk adjusted for socioeconomic status (SES) or race/ethnicity. We examined how adding SES and race/ethnicity to the CMS risk-adjustment algorithm would affect hospitals’ excess readmission ratios and potential penalties under the HRRP. For each HRRP measure, we compared excess readmission ratios with and without SES and race/ethnicity included in the CMS standard risk-adjustment algorithm and estimated the resulting effects on overall penalties across a number of hospital characteristics. For the 5 HRRP measures (heart failure, acute myocardial infarction, chronic obstructive pulmonary disease, pneumonia, and total hip or knee arthroplasty), we used data from the Healthcare Cost and Utilization Project’s State Inpatient Databases for 2011-2012 to calculate the excess readmission ratio with and without SES and race/ethnicity included in the model. With these ratios, we estimated the impact on HRRP penalties and found that risk adjusting for SES and race/ethnicity would affect Medicare payments for 83.8% of hospitals. The effect on the size of HRRP penalties ranged from −14.4% to 25.6%, but the impact on overall Medicare base payments was small—ranging from −0.09% to 0.06%. Including SES and race/ethnicity in the calculation had a disproportionately favorable effect on safety-net and rural hospitals. Any financial effects on hospitals and on the Medicare program of adding SES and race/ethnicity to the HRRP risk-adjustment calculation likely would be small.
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    Use Patterns of a State Health Care Price Transparency Web Site: What Do Patients Shop For?
    (SAGE Publications, 2014) Mehrotra, Ateev; Brannen, Tyler; Sinaiko, Anna
    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’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’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.
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    Who Uses a Price Transparency Tool? Implications for Increasing Consumer Engagement
    (SAGE Publications, 2017) Gourevitch, Rebecca; Desai, Sunita; Hicks, Andrew; Hatfield, Laura; Chernew, Michael; Mehrotra, Ateev
    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.
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    On call at the mall: a mixed methods study of U.S. medical malls
    (BioMed Central, 2013) Uscher-Pines, Lori; Mehrotra, Ateev; Chari, Ramya
    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.
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    Direct Release of Test Results to Patients Increases Patient Engagement and Utilization of Care
    (Public Library of Science, 2016) Pillemer, Francesca; Price, Rebecca Anhang; Paone, Suzanne; Martich, G. Daniel; Albert, Steve; Haidari, Leila; Updike, Glenn; Rudin, Robert; Liu, Darren; Mehrotra, Ateev
    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.
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    Patient Use of Cost and Quality Data When Choosing a Joint Replacement Provider in the Context of Reference Pricing
    (SAGE Publications, 2015) Kandrack, Ryan; Mehrotra, Ateev; DeVries, Andrea; Wu, Sze-jung; SooHoo, Nelson F.; Martsolf, Grant R.
    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’ 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.
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    Evaluation of symptom checkers for self diagnosis and triage: audit study
    (BMJ Publishing Group Ltd., 2015) Semigran, Hannah; Linder, Jeffrey A; Gidengil, Courtney; Mehrotra, Ateev
    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<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.