Jay Bhattacharya

• MD, PhD
• Professor (Full) at Stanford University

As the number of refugees, asylum-seekers, displaced persons worldwide has constantly increased over time, researchers have questioned the effects of mass migration on the local economy (especially on the labour market and on economic growth). More recently, the health economics literature has also covered issues relating to the physical and mental...

Objective: To characterize the development and performance of a cataract surgery episode-based cost measure for the Medicare Quality Payment Program. Design: Claims-based analysis. Participants: Medicare clinicians with cataract surgery claims between June 1, 2016, and May 31, 2017. Methods: We limited the analysis to claims with procedure c...

During the first year of the pandemic, East Asian countries have reported fewer infections, hospitalizations, and deaths from COVID-19 disease than most countries in Europe and the Americas. Our goal in this paper is to generate and evaluate hypothesis that may explain this striking fact. We consider five possible explanations: (1) population age s...

Background Dementia and frailty often accompany one another in older age, requiring complex care and resources. Available projections provide little information on their joint impact on future health-care need from different segments of society and the associated costs. Using a newly developed microsimulation model, we forecast this situation in Ja...

Asia is home to the most rapidly aging populations in the world. This study focuses on two countries in Asia that are advanced in terms of their demographic transition: the Republic of Korea and Singapore. We developed a demographic and economic state-transition microsimulation model based on the Korean Longitudinal Study of Aging and the Singapore...

Background Rising drug costs have increased interest in performance-linked reimbursement (PLR) contracts that tie payment to patient outcomes. PLR is theoretically attractive to payers interested in reducing the risk of overpaying for expensive drugs, to manufacturers working to improve early drug adoption, and to patients seeking improved access....

Background: Under the Merit-based Incentive Payment System (MIPS), the U.S. Centers for Medicare and Medicaid Services (CMS) evaluate clinicians who manage Medicare patients on the basis of cost and quality outcomes. CMS contractor Acumen, LLC, convened an expert panel to develop a knee arthroplasty episode-based cost measure (EBCM) for use in the...

Background Within-country inequality has been rising worldwide rapidly since the 70s. An extensive literature has examined the effect of inequality on health, finding health outcomes to be worse in more unequal countries. Among the measures of health used are life expectancy, mental illness, obesity, infant mortality, teenage births, homicides, imp...

Background In 2020, early U.S. COVID‐19 testing sites offered diagnostic capacity to patients and were important sources of epidemiological data about the spread of the novel pandemic disease. However, little research has comprehensively described American testing sites’ distribution by race/ethnicity and sought to identify any relation to known di...

Throughout history, technological progress has transformed population health, but the distributional effects of these gains are unclear. New substitutes for older, more expensive health technologies can produce convergence in population health outcomes but may also be prone to elite capture and thus divergence. We study the case of penicillin using...

Objectives Policy makers have suggested increasing peritoneal dialysis (PD) would improve end-stage kidney disease (ESKD) outcomes and reduce Medicare spending compared with hemodialysis (HD). We compared mortality, hospitalizations, and Medicare spending between PD and HD among uninsured adults with incident ESKD. Methods Using an instrumental va...

Importance Prescription drug spending in the US requires policy intervention to control costs and improve the value obtained from pharmaceutical spending. One such intervention is to apply cost-effectiveness evidence to decisions regarding drug coverage and pricing, but this intervention depends on the existence of such evidence to guide decisions....

Importance The Merit-based Incentive Payment System (MIPS), established as part of the Quality Payment Program, is a Medicare value-based payment program that evaluates clinicians' performance across 4 categories: quality, cost, promoting interoperability, and improvement activities. The cost category includes novel episode-based measures designed...

In limiting the spread of COVID-19, contact tracing is an imperfect tool. Is it then useless? Emily Gurley et al. make the case that thinking so is not just wrongheaded; it is potentially deadly.

Background The objective of this analysis was to compare the performance sensitivity and specificity of manufacturer-recommended signal-to-cutoff (S/Co) thresholds with modified S/Co values to estimate the prevalence of SARS-CoV-2-specific antibodies in a cohort of firefighters with a known infection history. Methods Plasma venipuncture samples we...

While SARS-CoV-2 serologic testing is used to measure cumulative incidence of COVID-19, appropriate signal-to-cut off (S/Co) thresholds remain unclear. We demonstrate S/Co thresholds based on known negative samples significantly increases seropositivity and more accurately estimates cumulative incidence of disease compared to manufacturer-based thr...

We use administrative data from Medicare to document the massive consolidation of primary care physicians over the last decade and its impact on patient healthcare utilization. We first document that primary care organizations have consolidated all over the United States between 2008 and 2014. We then show that regions that experienced greater cons...

We are pleased to see the active discussion around our study on the relationship between mandatory stay‐ at‐ home and business closures and COVID‐19 spread.¹ In this response, we address issues raised in three letters.2–4 The claim that the study had sample size of n=10 countries is incorrect.² Each of the 16 regression models represented in Figure...

Background Gastrostomy tube (G-tube) placement for children with neurologic impairment with dysphagia has been suggested for pneumonia prevention. However, prior studies demonstrated an association between G-tube placement and increased risk of pneumonia. We evaluate the association between timing of G-tube placement and death or severe pneumonia i...

Background: The Merit-Based Incentive Payment System adjusts clinician payments based on a performance score that includes cost measures. With the Centers for Medicare & Medicaid Services, we developed a novel cost measure that compared interventional cardiologists on a targeted set of costs related to elective percutaneous coronary intervention (...

Background Measuring the seroprevalence of antibodies to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is central to understanding infection risk and fatality rates. We studied Coronavirus Disease 2019 (COVID-19)-antibody seroprevalence in a community sample drawn from Santa Clara County. Methods On 3 and 4 April 2020, we tested 332...

Background and Aims The most restrictive nonpharmaceutical interventions (NPIs) for controlling the spread of COVID‐19 are mandatory stay‐at‐home and business closures. Given the consequences of these policies, it is important to assess their effects. We evaluate the effects on epidemic case growth of more restrictive NPIs (mrNPIs), above and beyon...

Understanding the outbreak dynamics of the COVID-19 pandemic has important implications for successful containment and mitigation strategies. Recent studies suggest that the population prevalence of SARS-CoV-2 antibodies, a proxy for the number of asymptomatic cases, could be an order of magnitude larger than expected from the number of reported sy...

We estimate the economic surplus created by the Medicare Advantage program under its reformed competitive bidding rules. We use data on the universe of Medicare beneficiaries and develop a model of plan bidding that accounts for both market power and risk selection. We estimate that the Medicare Advantage program generates substantial surplus to pa...

Throughout the COVID-19 epidemic, public health authorities have promoted contact tracing as a key tool to combat the spread of the SARS-CoV-2 virus. Jay Bhattacharya and Mikko Packalen argue that contact tracing does not deserve the central place it has received in the tool kit public health authorities use to control the virus, and that, in some...

Medicare's Merit-based Incentive Payment System (MIPS) includes episode-based cost measures that evaluate Medicare expenditures for specific conditions and procedures. These measures compare clinicians' cost performance and, along with other MIPS category scores, determine Medicare Part B clinician payment adjustments. The measures do not include r...

Accurate future projections of population health are imperative to plan for the future healthcare needs of a rapidly aging population. Multistate‐transition microsimulation models, such as the U.S. Future Elderly Model, address this need but require high‐quality panel data for calibration. We develop an alternative method that relaxes this data req...

Background: Uninsured patients with end-stage renal disease face barriers to peritoneal dialysis (PD), a type of home dialysis that is associated with improved quality of life and reduced Medicare costs. Although uninsured patients using PD at dialysis start receive retroactive Medicare coverage for required predialysis services, coverage only app...

Background: Recent reports indicate racial disparities in the rates of infection and mortality from the 2019 novel coronavirus (coronavirus disease 2019 [COVID-19]). The aim of this study was to determine whether disparities exist in the levels of knowledge, attitudes and practices (KAPs) related to COVID-19. Methods: We analyzed data from 1216...

Understanding the outbreak dynamics of the COVID-19 pandemic has important implications for successful containment and mitigation strategies. Recent studies suggest that the population prevalence of SARS-CoV-2 antibodies, a proxy for the number of asymptomatic cases, could be an order of magnitude larger than expected from the number of reported sy...

The National Institutes of Health (NIH) plays a critical role in funding scientific endeavors in biomedicine. Funding innovative science is an essential element of the NIH’s mission, but many have questioned the NIH’s ability to fulfill this aim. Based on an analysis of a comprehensive corpus of published biomedical research articles, we measure wh...

Background Addressing COVID-19 is a pressing health and social concern. To date, many epidemic projections and policies addressing COVID-19 have been designed without seroprevalence data to inform epidemic parameters. We measured the seroprevalence of antibodies to SARS-CoV-2 in Santa Clara County. Methods On 4/3-4/4, 2020, we tested county residen...

Background: The comparative effectiveness of non-vitamin K antagonist oral anticoagulants (NOACs) is uncertain, as they have not been compared directly in randomized trials. Previous observational comparisons of NOACs are likely to be biased by unmeasured confounders. We sought to compare the efficacy and safety of rivaroxaban and apixaban for str...

Background: Although most American patients with ESKD become eligible for Medicare by their fourth month of dialysis, some never do. Information about where patients with limited health insurance receive maintenance dialysis has been lacking. Methods: We identified patients initiating maintenance dialysis (2008-2015) from the US Renal Data Syste...

Objective: To evaluate the impact of the US government's Feed the Future initiative on nutrition outcomes in children younger than 5 years in sub-Saharan Africa. Design: Difference-in-differences quasi-experimental approach. Setting: Households in 33 low and lower middle income countries in sub-Saharan Africa. Population: 883 309 children ag...

The substantial social and economic burden attributable to smoking is well-known, with heavy smokers at higher risk of chronic disease and premature mortality than light smokers and nonsmokers. In aging societies with high rates of male smoking such as in East Asia, smoking is a leading preventable risk factor for extending lives (including work-li...

We investigate how the genetic risk of developing Alzheimer’s Disease (AD) relates to saving behavior. Using nationally representative data from the 1996–2014 Health and Retirement Study (HRS), we find that genetic predisposition for AD correlates with, but is not causally related to how older individuals’ hold wealth in different asset types. Peop...

Community-engaged adaptations of evidence-based interventions are needed to improve cancer care delivery for low-income and minority populations with cancer. The objective of this study was to adapt an intervention to improve end-of-life cancer care delivery using a community–partnered approach. We used a two-step formative research process to adap...

Purpose: Poor patient experiences and increasing costs from undertreated symptoms require approaches that improve patient-reported outcomes and lower expenditures. We developed and evaluated the effect of a lay health worker (LHW)-led symptom screening intervention on satisfaction, self-reported overall and mental health, health care use, total co...

Importance Multiple states publicly report a hospital’s risk-adjusted mortality rate for percutaneous coronary intervention (PCI) as a quality measure. However, whether reported annual PCI mortality is associated with a hospital’s future performance is unclear. Objective To evaluate the association between reported risk-adjusted hospital PCI-relat...

Background and aims: Although most large nonpedunculated colorectal lesions can be safely and efficaciously removed using EMR, the use of colectomy for benign colorectal lesions appears to be increasing. The reason(s) is unclear. We aimed to determine the use and adverse events of EMR in the United States. Methods: We used Optum's de-identified...

Objective To determine whether 30 day mortality, 30 day readmissions, and inpatient spending vary according to whether physicians were exposed to work hour reforms during their residency. Design Retrospective observational study. Setting US Medicare. Participants 20% random sample (n=485 685) of Medicare beneficiaries aged 65 years or more admit...

Background There is ongoing debate about whether education or socioeconomic status (SES) should be inputs into cardiovascular disease (CVD) prediction algorithms and clinical risk adjustment models. It is also unclear whether intervening on education will affect CVD, in part because there is controversy regarding whether education is a determinant...

The aging of the scientific workforce and graying of grant recipients are central policy concerns in biomedicine. These trends are potentially important because older scientists are often seen as less open to new ideas than younger scientists. In this paper, we put this hypothesis to an empirical test. Using a measure of new ideas derived from the...

6522 Background: To curb rising expenditures and improve patient-reported outcomes (PROs), we designed an intervention with patient, caregiver, provider, and payer input. The intervention is based on prior work using a lay health worker (LHW) to assess advanced cancer patients' symptoms. In this study, we trained the LHW to refer patients to pallia...

Importance Mergers and acquisitions among health care institutions are increasingly common, and dialysis markets have undergone several decades of mergers and acquisitions. Objective To examine the outcomes of hemodialysis facility acquisitions independent of associated changes in market competition resulting from acquisitions. Design, Setting, a...

We compare healthcare spending in public and private Medicare using newly available claims data from Medicare Advantage (MA) insurers. MA insurer revenues are 30 percent higher than their healthcare spending. Adjusting for enrollee mix, healthcare spending per enrollee in MA is 9 to 30 percent lower than in traditional Medicare (TM), depending on t...

Background: The Supplemental Nutrition Assistance Program (SNAP) expanded significantly after the Great Recession of 2008-2009, but no studies have characterized this new group of recipients. Few data sets provide details on whether an individual is a new or established recipient of SNAP. Objective: We sought to identify new and existing SNAP re...

Background: Thirty-day readmissions are common in patients receiving hemodialysis and costly to Medicare. Because patients on hemodialysis have a high background hospitalization rate, 30-day readmissions might be less likely related to the index hospitalization than in patients with other conditions. Methods: In adults with Medicare receiving he...

Introduction:: Despite advancements in cancer care, persistent gaps remain in the delivery of high-value end-of-life cancer care. The aim of this study was to examine views of health care payer organization stakeholders on approaches to the redesign of end-of-life cancer care delivery strategies to improve care. Methods:: We conducted semistruct...

Background & aims: Use of direct-acting oral anticoagulants (DOACs) is increasing, but little is known about the associated risks in patients undergoing colonoscopy with polypectomy. We aimed to determine the risk of post-polypectomy complications in patients prescribed DOACs. Methods: We performed a retrospective analysis using Optum's de-ident...

Objectives: Low back pain (LBP) is a common and expensive clinical problem, resulting in tens of billions of dollars of direct medical expenditures in the United States each year. Although expensive imaging tests are commonly used, they do not improve outcomes when used in the initial management of idiopathic LBP. We estimated 1-year medical costs...

Background: The United States lung allocation system prioritizes allocation based on medical urgency and benefit but does not address a federal mandate for broader geographic organ sharing. It is unknown whether broader geographic sharing of donor lungs would improve lung transplant waitlist outcomes. Methods: A discrete event microsimulation mo...

Throughout history, technological progress has profoundly transformed population health, but the distributional effects of these gains are unclear. New substitutes for older, more expensive health technologies can produce convergence in population health outcomes, but may also be prone to "elite capture" (leading to divergence). This paper studies...

Study design: Retrospective longitudinal cohort analysis of patients diagnosed in 2010, with continuous enrollment six months prior to and 12 months following the initial visit. Objective: To determine whether provider specialty influences patterns of opiate utilization long after initial diagnosis. Summary of background data: Patients with lo...

Importance Although lay health workers (LHWs) improve cancer screening and treatment adherence, evidence on whether they can enhance other aspects of care is limited. Objective To determine whether an LHW program can increase documentation of patients’ care preferences after cancer diagnosis. Design, Setting, and Participants Randomized clinical...

Background: It is uncertain whether consolidation in health care markets affects the quality of care provided and health outcomes. Objectives: To examine whether changes in market competition resulting from acquisitions by two large national for-profit dialysis chains were associated with patient mortality. Methods: We identified patients init...

The aim of this study was to assess: (1) the proportion of youth with special health care needs (YSHCN) with adequate transition preparation, (2) whether transition preparation differs by individual, condition-related and health care system-related factors, and (3) whether specific components of the medical home are associated with adequate transit...

Objective: To examine whether market competition is associated with improved health outcomes in hemodialysis. Data sources: Secondary analysis of data from a national dialysis registry between 2001 and 2011. Study design: We conducted one- and two-part linear regression models, using each hospital service area (HSA) as its own control, to exam...

Objective: Better identification of at-risk groups could benefit HIV-1 care programmes. We systematically identified HIV-1 risk factors in two nationally representative cohorts of women in the Demographic and Health Surveys. Methods: We identified and replicated the association of 1415 social, economic, environmental, and behavioral factors with...

Objective: The purpose of this study was to evaluate the impact of objective isolation and loneliness on Medicare spending and outcomes. Method: We linked Health and Retirement Study data to Medicare claims to analyze objective isolation (scaled composite of social contacts and network) and loneliness (positive response to three-item loneliness sca...

Background: The United States lung transplant registry data demonstrate differences in adult waitlist mortality by race/ethnicity. It is unknown whether these differences persist after risk adjustment or occur secondary to disparities in disease severity at the time of listing. Methods: Adult lung transplant waitlist candidates between May 4, 20...

Importance: Visual dysfunction and poor cognition are highly prevalent among older adults; however, the relationship is not well defined. Objective: To evaluate the association of measured and self-reported visual impairment (VI) with cognition in older US adults. Design, setting, and participants: Cross-sectional analysis of 2 national data s...

In response to rising Medicare costs, Congress passed the Medicare Access and Children's Health Insurance Program Reauthorization Act in 2015. The law fundamentally changes the way that health care providers are reimbursed by implementing a pay for performance system that rewards providers for high-value health care. As of the beginning of 2017, pr...

OBJECTIVE Orthopedic procedures are an important focus in efforts to reduce surgical site infections (SSIs). In 2008, the Centers for Medicare and Medicaid (CMS) stopped reimbursements for additional charges associated with serious hospital-acquired conditions, including SSI following certain orthopedic procedures. We aimed to evaluate the CMS poli...

Background HIV-1 remains the leading cause of death among adults in Sub-Saharan Africa, and over 1 million people are infected annually. Better identification of at-risk groups could benefit prevention and treatment programmes. We systematically identified factors related to HIV-1 infection in two nationally representative cohorts of women that par...

Purpose: Evaluate self-reported adherence to diabetic retinopathy screening exams among diabetics DESIGN: Retrospective, population-based cross-sectional study. Methods: Medical Expenditures Panel Survey (MEPS) consolidated full year and prescribed drugs data from 2002-2013 were reviewed; multivariable logistic regression was used to identify pa...

Rationale: Prior sepsis studies evaluating antibiotic timing have shown mixed results. Objective: To evaluate the association between antibiotic timing and mortality among sepsis patients receiving antibiotics within 6 hours of emergency department registration. Methods and measurements: Retrospective study of 35,000 randomly selected sepsis i...

Purpose: We examined the impact of intensity modulated radiation therapy (IMRT) on hospitalization rates in the Surveillance, Epidemiology, and End Results (SEER)-Medicare population with anal squamous cell carcinoma (SCC). Methods and materials: We performed a retrospective cohort study using the SEER-Medicare database. We identified patients w...

Objectives: To determine whether electronic health record (EHR) access influences the number of laboratory and imaging tests ordered, which is a frequently cited mechanism for EHR-enabled cost savings. Study design: We analyzed data on non-federally employed office-based physicians from the 2008 to 2012 Electronic Health Medical Records Survey,...

Background Twenty-eight states have passed breast density notification laws, which require physicians to inform women of a finding of dense breasts on mammography. Objective To evaluate changes in breast cancer stage at diagnosis after enactment of breast density notification legislation. DesignUsing a difference-in-differences analysis, we examine...

Background: In 2004, the Centers for Medicare & Medicaid Services changed reimbursement for physicians and advanced practitioners caring for patients receiving hemodialysis from a capitated to a tiered fee-for-service system, encouraging increased face-to-face visits. This early version of a pay-for-performance initiative targeted a care process:...

The Medicare program insures >80% of patients with ESRD in the United States. An emphasis on reducing outpatient dialysis costs has motivated consolidation among dialysis providers, with two for-profit corporations now providing dialysis for >70% of patients. It is unknown whether industry consolidation has affected patients' ability to choose amon...

The ranking of scientific journals is important because of the signal it sends to scientists about what is considered most vital for scientific progress. Existing ranking systems focus on measuring the influence of a scientific paper (citations)—these rankings do not reward journals for publishing innovative work that builds on new ideas. We propos...

Objectives: Unwarranted geographic variation in spending has received intense scrutiny in the United States. However, few studies have compared variation in spending and surgical outcomes between the United States healthcare system and those of other nations. In this study, we compare the geographic variation in postsurgical outcomes and cost betw...

Japan has experienced pronounced population aging, and now has the highest proportion of elderly adults in the world. Yet few projections of Japan’s future demography go beyond estimating population by age and sex to forecast the complex evolution of the health and functioning of the future elderly. This study estimates a new state-transition micro...

Objectives: Patients with end-stage renal disease can receive dialysis at home or in-center. In 2004, CMS reformed physician payment for in-center hemodialysis care from a capitated to a tiered fee-for-service model, augmenting physician payment for frequent in-center visits. We evaluated whether payment reform influenced dialysis modality assignm...

Background: Preterm/very low birth weight infants may suffer neurodevelopmental delays. Pediatricians should monitor neurodevelopment and pursue timely referrals. Yet, parents who speak non-English primary languages (NEPL) report worse healthcare communication and fewer appropriate specialty referrals for their children. Objective: To determine...

Rationale: While lung transplant recipient survival is better at higher volume centers, the effect of center volume on admission cost and early hospital readmission is unknown. Objectives: To understand the association between transplant center volume and recipient risk-adjusted transplant admission cost, in-hospital mortality, and early hospita...

Study question: Is a higher use of resources by physicians associated with a reduced risk of malpractice claims? Methods: Using data on nearly all admissions to acute care hospitals in Florida during 2000-09 linked to malpractice history of the attending physician, this study investigated whether physicians in seven specialties with higher avera...

Background: The Affordable Care Act (ACA) eliminated cost-sharing for evidence-based preventive services in an effort to encourage use. Objective: To evaluate use of colorectal cancer (CRC) screening in a national population-based sample before and after implementation of the ACA. Design: Repeated cross-sectional analysis of the Medical Expend...

Reforms introduced by the Affordable Care and Patient Protection Act (ACA) build new sources of coverage around employment-based health insurance. But what if firms find it cheaper to have their employees obtain insurance from these sources, even after accounting for penalties (for nonprovision of insurance) and employee bonuses (to ensure the shif...

Over 9.6 million ED visits occur annually for abdominal pain in the US, but little is known about the medical outcomes of these patients based on demographics. We aimed to identify disparities in outcomes among children presenting to the ED with abdominal pain linked to race and SES. Data from 4.2 million pediatric encounters of abdominal pain were...