Precision of provider licensure data for mapping member accessibility to Medicaid managed care provider networks

Evolution of Pediatric Critical Care Medicine Physicians Clinical and Academic Profile by Gender

OBJECTIVES

To examine career trajectory and academic profile of Pediatric Critical Care Medicine (PCCM) physicians, with special focus on gender differences.

DESIGN

Observational cross-sectional study of PCCM fellowship graduates using publicly available data.

SETTING

Publicly available databases including National Provider Identifier registry, American Board of Pediatrics, Doximity, official hospital websites, and Scopus.

SUBJECTS

Two thousand one hundred twenty-nine PCCM fellowship graduates employed in clinical positions in U.S. practice locations.

INTERVENTION

None.

MEASUREMENTS AND MAIN RESULTS

Physician demographic characteristics included gender and time since fellowship completion. Current career and academic characteristics included employment data, publication productivity (h-index), and academic rank. Data from 2129 career PCCM physicians was included, with recent graduates showing a notable increase in female representation. Workplace characteristics revealed that most PCCM physicians worked in university-affiliated hospitals, with higher percentages of female physicians working in university-affiliated hospitals compared with male physicians. The study also highlighted significant gender disparities in academic metrics, with male physicians having higher h-indices (3 vs. 2; p < 0.001) and more publications (6 vs. 4; p < 0.001) than their female counterparts across various career phases. Additionally, the analysis showed gender differences in academic rank, with a higher proportion of female faculty holding assistant and associate professor ranks (58.2% vs. 47.5%; p < 0.001), while a greater percentage of male faculty held the rank of professor (20.2% vs. 11.1%; p < 0.001). Multiple variable regression analysis identified both male gender and time since fellowship graduation as independently associated with a physician's h-index, while only time since fellowship graduation was linked to current academic rank.

CONCLUSIONS

This is the first analysis of career and academic characteristics of practicing PCCM physicians, additionally studying the association of gender and career trajectory. Gender discrepancy was seen in employment hospital characteristics, h-indices, and academic rank. Additional studies are required to further explore the impact of gender on career trajectory.

Silver diamine fluoride-associated delays in procedural sedation in young children: A retrospective cohort study

BACKGROUND

This analysis evaluated the time to first sedation or general anesthesia (GA) encounter for children treated with and without silver diamine fluoride (SDF).

METHODS

This retrospective cohort study used dental claims of privately insured children from birth through age 71 months with a sedation or GA claim from 2016 through 2020. The exposure was SDF use (yes, no). The outcome was time to first sedation or GA. Descriptive and multivariable negative binomial analysis was performed. The analysis tested the hypothesis that among children who received sedation or GA for their caries treatment, those who received SDF would show a longer time to first sedation or GA than children who did not.

RESULTS

Among 175,824 children included, SDF use increased the time to first sedation or GA encounter by 63 days when treated by different dentists (405 days vs 342 days; P < .001) and by 91 days when treated by the same dentist (337 days vs 246 days; P < .001), after controlling for the effects of age at first encounter, sex, and region of the country.

CONCLUSION

Children treated with SDF had a longer time to first sedation or GA, which was magnified when treatment was performed by the same dentist.

PRACTICAL IMPLICATIONS

Within an individualized caries management plan, SDF could provide benefits for patients, dental offices, and health systems.

Association of rural location and long acting reversible contraceptive use among Oregon Medicaid recipients

OBJECTIVE

To evaluate whether the use of long-acting, reversible contraception (LARC) is equitably accessible to Medicaid recipients in rural and urban areas. We also determined whether women's health specialists' availability was associated with the type of LARC used.

STUDY DESIGN

We used claims data for 242,057 adult women who were continuously enrolled in Oregon Medicaid for at least one year and at risk of pregnancy from January 1, 2015, through December 31, 2017 to assess the association between LARC utilization and (1) rurality and (2) provider supply. Our primary analysis included 430,918 person-years. Regression models adjusted for patient age, whether the patient was newly eligible for Medicaid due to Medicaid expansion, and health status. We also examined differences in the caseload of implants and IUD by provider type (women's health specialist vs other).

RESULTS

Among all women, 11.6% had at least one claim indicating LARC use. There was no significant difference in overall LARC use by location (urban residence +0.66%, 95% CI [-0.12%, 1.43%]), although urban residents were slightly more likely to have an IUD (+0.72%, 95% CI [0.11%, 1.33%]). An increase of one women's health specialty provider per 10,000 women was associated with a 0.14 percentage point increase in the rate of IUD utilization (95% CI: 0.02, 0.26). Compared to other providers, women's health specialty providers supplied 62% of all IUDs and 43% of all implants.

CONCLUSION

Among Oregon's Medicaid enrollees, LARC is equitably used in rural areas; however, IUD use is slightly more frequent in urban areas.

The Misclassification of Behavior Analysts: How National Provider Identifiers (NPIs) Fail to Adequately Capture the Scope of the Field

To remain in compliance with the Health Insurance Portability and Accountability Act of 1996, U.S. health care providers are required to register for a National Provider Identifier (NPI). When applying for an NPI, providers must select the Healthcare Provider Taxonomy Code(s) that most closely describes the services they offer. Three distinct taxonomies describe the services offered by behavior analysts. Two of these codes, the Behavior Analyst (103K00000X) and the Assistant Behavior Analyst (106E00000X) taxonomies, specify that the health care provider must hold either a certification from the Behavior Analyst Certification Board or a state-issued credential to practice behavior analysis. The purpose of this study was to investigate the concordance between health care providers who utilize these behavior-analytic NPI taxonomy classifications and health care providers who meet the credential qualifications specified in the code descriptions. Results indicated that there are potentially more than 20,000 U.S. health care providers who do not hold the behavior analyst credentials specified in the taxonomy descriptions linked to their accounts. The implications of providers being mistakenly classified as credentialed behavior analysts and credentialed assistant behavior analysts in federal data and how the field should respond are discussed.

Medicaid Managed Care's Effects on Costs, Access, and Quality: An Update

Medicaid is integral to public health because it insures one in five Americans and half of the nation's births. Nearly two-thirds of all Medicaid recipients are currently enrolled in a health maintenance organization (HMO). Proponents of HMOs argue that they can lower costs while maintaining access and quality. We critically reviewed 32 studies on Medicaid managed care (2011-2019). Authors reported state-specific cost savings and instances of increased access or quality with implementation or redesign of Medicaid managed-care programs. Studies on high-risk populations (e.g., disabled) found improvements in quality specific to a state or a high-risk population. A unique model of managed care (i.e., the Oregon Health Plan) was associated with reduced costs and improved access and quality, but results varied by comparison state. New trends in the literature focused on analysis of auto-assignment algorithms, provider networks, and plan quality. More analysis of costs jointly with access/quality is needed, as is research on managing long-term care among elderly and disabled Medicaid recipients.