Policy and Statistical Briefs

Schroeder Center policy and statistical briefs provide an in-depth look at health-related policies and research on health and healthcare.

	Heart Attack Readmissions in Virginia Heart attack or acute myocardial infarction (AMI) is one of the most common diagnoses associated with inpatient hospitalizations among adults. Readmission to the hospital shortly after an initial heart attack hospitalization is fairly common. This brief examines the characteristics of patients admitted to Virginia acute care hospitals for AMI and then readmitted within 30 days during 2014. The brief’s findings show that in 2014, there were a total of 12,158 initial AMI hospitalizations of patients aged 40 and older that took place at short-term acute care hospitals participating in Medicare’s inpatient prospective payment system in Virginia. About 11% of hospitalizations resulted in a readmission within 30 days of the initial discharge. Readmissions related to AMI resulted in about $50.5 million in hospital charges, which equates to $11.7 million in costs to the healthcare system using hospital cost-to-charge ratios from the Centers for Medicare & Medicaid Services. Readmission rates for heart attack are higher for females, the elderly, patients who have other comorbid conditions, and those treated at hospitals in the Southwest, Northwest, and Central Virginia health planning regions. Comparing hospitalizations occurring to patients aged 40 and older, the brief reports that AMI patients are significantly younger than those with heart failure and pneumonia, and they are less likely to have certain comorbid conditions than those admitted with heart failure or pneumonia.
	Diabetes Hospitalizations in Virginia Diabetes is a very prominent disease in the U.S. According to a 2014 report from the Centers for Disease Control and Prevention (CDC), 29.1 million people or 9.3% of the U.S. population, have diabetes. This brief examines the characteristics of patients with diabetes admitted to Virginia hospitals in 2014, using a methodological approach used in a related nationwide analysis of inpatient hospitalizations of diabetic patients. The brief finds that nearly 24% of 850,195 hospitalizations that took place in Virginia involved patients with diabetes. The mean cost associated with hospitalization of a patient with diabetes was $9,670 in 2014 compared to $7,834 for a non-diabetic patient, and the average length of stay for patients hospitalized with diabetes was 5.3 days, nearly a day longer than the 4.6-day average stay for non-diabetic hospitalizations. For over 63% of patients with diabetes, the primary payer for hospitalizations was Medicare. Northern Virginia had the highest hospitalization rate for diabetes at 3143.3 per 100,000 persons, followed by the Northwest and Southwest areas of the state. Nearly 52% of hospitalizations for diabetes in Virginia involve patients also being treated for chronic cardiovascular disease, which is substantially higher than the rate of 22% among non-diabetic discharges.
	Do Physicians Respond to Their Peers' Treatment Styles? A Case Study of Cesarean Section in Virginia Evidence of geographic variations in healthcare utilization is widespread. Even upon accounting for differences in population age and other traits, healthcare spending per capita and the use of certain healthcare treatments is substantially higher in some areas than others. One potential explanation for these geographic differences in healthcare use is peer influence, or the idea that an individual physician’s treatment style is affected by that of his or her peers. To understand the degree to which physicians are influenced by the way their peers practice medicine, this study analyzes deliveries in Virginia from 2012 to 2014. The study measures each physician’s “treatment style” in a given year as her risk-adjusted propensity to perform cesarean section on her patients in that year. This study then examines the extent to which an individual physician’s treatment style is affected by the average treatment style of the physicians in her peer group. The main finding is that there are strong positive correlations between individual physicians’ treatment styles and those of their local and regional peers.
	Does Accounting for Socioeconomic Status Affect Whether Hospitals are Penalized for Readmissions? The Affordable Care Act created the Hospital Readmissions Reduction Program (HRRP), which requires the Centers for Medicare & Medicaid Services (CMS) to penalize hospitals with excess readmission rates for certain conditions. This brief summarizes a study that first seeks to determine the relationship between area-level socioeconomic status measures and the likelihood a patient is readmitted. Second, the brief examines how including area-level socioeconomic status measures in the risk adjustment process affects whether or not a hospital is predicted to pay a penalty under the HRRP. The research finds no evidence that area-level socioeconomic status influences the likelihood of readmission among Virginians age 65 and older with a principal diagnosis of acute myocardial infarction (AMI), or heart attack. In addition, the study suggests that the inclusion of area-level socioeconomic status measures in the calculation of risk-adjusted readmission rates does not substantially change whether or not a hospital is predicted to pay a penalty for having excess readmissions under the HRRP.
	The Impact of Alcohol License Density on Alcoholic Liver Disease (ALD) Hospitalization Rates in Virginia This brief summarizes a study that describes the relationship between alcohol license density and the hospitalization rate for alcoholic liver disease (ALD) in the Commonwealth of Virginia to help policymakers assess the benefits of increased alcohol regulation. This brief presents evidence of a positive association between the density of alcohol licenses and the hospitalization rate for alcoholic liver disease within Virginia’s localities; however, the brief provides additional evidence that suggests this relationship is not causal and is, perhaps, attributable instead to multiple, unobserved factors influencing both the ALD disease rate and alcohol license density.
	Effects of the ACA Dependent Coverage Expansion on Virginia's Young Adults This brief presents new research findings on the impact of the Affordable Care Act's (ACA’s) dependent coverage mandate on Virginia’s young adults and their use of inpatient hospital care for all non-birth related admissions as well as mental illness and substance abuse admissions. Analysis of hospital discharge data from 2008-2014 shows that the ACA’s dependent coverage mandate increased all non-emergency admissions as well as mental illness and substance abuse admissions. Additional evidence shows that the dependent coverage mandate reduced the share of young adults hospital admissions paid by Medicaid and increased the share of admissions paid by private insurance. The dependent coverage mandate also led to an increase in treatment intensity among hospitalized persons, defined as increased lengths of stay and total charges for non-birth admissions.
	Measuring the Health of the Historic Triangle This brief summarizes what available health data can tell us about the health of the Historic Triangle of Virginia, a community consisting of James City County, York County, and the City of Williamsburg. Findings summarized in this brief are from “Health Outcomes and Health Determinants in the Historic Triangle,” a report that inventories and reviews existing data on health outcomes and health factors for the Historic Triangle. A Guide to Community Health Data in Virginia can be used as a supplement to this brief. Read the full report. This brief was prepared by Jennifer M. Mellor (Ph.D.) and Elizabeth Vestal (J.D., M.P.P.) and funded by a generous grant from the Williamsburg Health Foundation.
	A Guide to Community Health Data in Virginia The term “community health data” refers to various indicators or metrics that can be used to describe the health of a population living in a single community. These measures include summary measures of health status, such as average life expectancy and all-cause mortality, and determinants of health, such as the use of preventive care and the prevalence of behavioral risk factors that contribute to premature death. In this brief, you will find types of available community health data for Virginia localities and what users should know about using these community health data. This brief was prepared by Jennifer M. Mellor (Ph.D.) and Elizabeth Vestal (J.D., M.P.P.) and funded by a generous grant from the Williamsburg Health Foundation.
	Recessions and Seniors' Health This brief summarizes a study that provides a comprehensive look at the effects of recessions on seniors’ health and health-related behaviors. The study, by economists at William & Mary’s Department of Economics and Schroeder Center for Health Policy, adds to the recessions and health literature by using data from a more recent time period that includes the beginning of the Great Recession. This study also extends the literature by focusing exclusively on the senior population given the importance of this age group in explaining prior patterns of procyclical mortality.
	Medicare’s OPPS and Hospital Outpatient Volume Effective August 1, 2000, the Outpatient Prospective Payment System (OPPS) greatly changed the way hospitals were reimbursed for outpatient services provided to Medicare beneficiaries. This brief summarizes research on Medicare’s OPPS by economists at William & Mary's Department of Economics and Schroeder Center for Health Policy. In a 2012 Journal of Health Economics article, Daifeng He and Jennifer M. Mellor examine the effect of OPPS-induced payment rate reductions on hospital outpatient volume.
	Taxes and Zoning to Address Obesity The increasing percentage of overweight and obese Americans threatens the health of millions and significantly contributes to rising healthcare costs in the U.S. Policymakers continue to search for solutions to this health problem. Most recently, New York City Mayor made headlines by calling for a ban on the sale of large servings of soda. This policy brief, by Elizabeth Vestal (J.D., M.P.P.), is a discussion of taxing and zoning options, focusing specifically on soda taxes, restrictive fast-food restaurant zoning, and healthy food enterprise initiatives as obesity prevention policy options.