Ateev Mehrotra’s research while affiliated with University of Rhode Island and other places

This cross-sectional study examines the association between April 20th cannabis celebrations and rates of cannabis-related emergency department visits in the US.

Objective: This study sought to evaluate how the recent increase in use of online meetings has influenced participant experiences with peer-based mutual support groups for problematic drinking. Methods: The authors conducted semistructured interviews in June and July 2024 with 20 adults who participated in online mutual support meetings for problematic drinking. Participants were recruited from a nationwide online research panel. The authors conducted an ideal-type analysis to compare the experiences of individuals who differed in their modality (online vs. in person) preferences and motivations for using online meetings. Results: The authors identified four distinct types of online meeting users, who varied in their perceptions about the advantages of online meetings. Meeting maximizers valued flexibility and convenience and used online meetings to supplement in-person participation. Strategists viewed online meetings as a source of new ideas and urgent support and used a mix of both modalities to capitalize on the perceived distinct advantages of each. Online enthusiasts preferred online meetings because they afforded increased anonymity and control and reduced social pressure. Finally, compliance seekers preferred online meetings for their efficiency in facilitating compliance with legal requirements. Participants of all types reported technological barriers, inconsistent quality, and greater potential for disruptions as disadvantages of online meetings. Conclusions: Online meetings offer distinct advantages for individuals with differing motivations for engaging in peer-based mutual support groups, functioning as a gateway support for some people and as an essential supplement to ongoing in-person support for others.

Importance Under certain circumstances, advance practice clinicians (APCs), such as physician assistants and nurse practitioners, can bill Medicare directly or indirectly (ie, incident to the services of a physician). With indirect billing, the submitted claim states the care was provided by the physician, and the reimbursement is higher. Objective To quantify volume and spending on office-based encounters billed indirectly in the Medicare program. Design, Setting, and Participants This cohort study used Medicare fee-for-service and Medicare Advantage claims data to identify indirectly billed APC services. To do so, office-based Medicare Part B claims (ie, clinician services) were linked to Part D claims for prescription drug fills. Because the latter contains the prescribing clinician’s unique identifier, this linkage distinguished between directly and indirectly billed services provided by APCs. In this way, the fraction of encounters and component services billed indirectly by APCs and physicians were quantified. Main Outcomes and Measures Share of fee-for-service and Medicare Advantage office encounters provided by APCs and billed indirectly. Share of a physician’s billed claims actually provided by an APC and billed indirectly. Results In 2022, of all office encounters provided by an APC, 38.9% were billed indirectly. Conversely, for the median physician in 2022, indirect billing on behalf of APCs represented 11.1% of all billed encounters. Billing for care delivered by APCs was most common among surgical specialists (29.7% of encounters) and least common for primary care physicians (3.9%). If all indirectly billed APC-provided care was billed directly by the APC, Medicare would have saved $270 million in 2022. Conclusions and Relevance The results of this cohort study suggest that APCs provide a substantial fraction of office-based care received by Medicare beneficiaries. Identifying indirectly billed APC-provided care is integral to understanding who serves Medicare beneficiaries.

Importance Low-value care is a persistent problem with direct and cascading harms. Telemedicine is now commonly used and may reduce low-value testing by introducing barriers to completing tests at a given visit or expand opportunities for low-value testing by contributing to higher visit volumes. Objective To quantify the association between telemedicine adoption and low-value testing among fee-for-service Medicare beneficiaries. Design, Setting, and Participants In this cohort study using 100% fee-for-service Medicare claims data, US health systems were divided into quartiles based on 2020 telemedicine adoption. Beneficiary-level linear regression in difference-in-differences (DiD) analyses was used to compare beneficiaries who were continuously enrolled from 2019 through 2022 and were attributed before telemedicine adoption (2019) to high telemedicine–adopting (top quartile) vs low telemedicine–adopting (bottom quartile) health systems on low-value test and visit outcomes in 2022 vs 2019. Data were analyzed from October 2023 to December 2024. Exposure Health system telemedicine adoption. Main Outcomes and Measures Receipt of, and spending on, 20 low-value screening, preoperative, chronic condition management, and acute diagnostic tests, as well as total visits (in person and virtual). Results The sample included 1 382 033 beneficiaries who were attributed to high-telemedicine systems (mean [SD] age, 71.6 [10.5] years; 58.8% female) and 999 051 beneficiaries who were attributed to low-telemedicine systems (mean [SD] age, 71.8 [10.0] years; 57.0% female). From 2019 to 2022, those in high-telemedicine systems had a small differential rise in visits (DiD visits per beneficiary, 0.12; 95% CI, 0.03 to 0.21) and differential decreases in use of 7 of 20 low-value tests: cervical cancer screening (DiD, −0.45 percentage points [pp]; 95% CI, −0.72 to −0.17 pp), screening electrocardiograms (DiD, −1.30 pp; 95% CI, −1.96 to −0.65 pp), screening metabolic panels (DiD, −1.84 pp; 95% CI, −2.87 to −0.80 pp), preoperative complete blood cell counts (DiD, −0.64 pp; 95% CI, −1.06 to −0.22 pp), preoperative metabolic panels (DiD, −1.35 pp; −1.91 to −0.80 pp), total or free T3 (triiodothyronine) level testing for hypothyroidism (DiD, −0.90 pp; 95% CI, −1.38 to −0.41 pp), and imaging for uncomplicated low back pain (DiD, −1.66 pp; 95% CI, −2.35 to −0.98 pp). There were no statistically significant differences in other tests. Those in high-telemedicine systems saw statistically significant differential decreases in spending on visits per beneficiary (−$47.87; 95$86.85 to −$8.88) and on 2 of 20 low-value tests, but no differences in low-value spending overall. Conclusions and Relevance In this cohort study, telemedicine adoption was associated with modestly lower use of 7 of 20 examined low-value tests (most point-of-care) and no changes in use of other low-value tests, despite a small rise in total visits that might offer more testing opportunities. Results suggest possible benefits of telemedicine and mitigate concerns about telemedicine contributing to increased spending.

Although apps are widely available and have several advantages as a tool to support alcohol reduction and recovery, little is known about how individuals are using them. In 2024, we conducted an exploratory sequential mixed-methods study that coupled in-depth interviews with 22 app users and a nationally representative survey of 2002 adults. We explored experiences with and perceptions of alcohol reduction apps. Approximately six percent of U.S. adults in the sample reported using alcohol reduction apps, and for most, it was the only support to address problematic drinking. In interviews, some users viewed apps as an alternative to traditional services and a way to independently address alcohol use; however, apps were seen as disconnected from care even by those who also used other supports. App users accessed a variety of features, with the most common being motivational content, tracking alcohol consumption, and educational content. Findings suggest that there are opportunities to not only introduce apps to individuals receiving healthcare services or participating in mutual support groups, but to reference and embed them in those settings. New approaches to regulation and reimbursement may support adoption as well as integration into healthcare services.

Importance There are substantial disparities in breastfeeding rates by race and ethnicity. Telelactation services that connect parents to lactation consultants via video are increasingly available and may reduce inequities in breastfeeding support; however, there is limited evidence on effectiveness. Objective To assess the impact of video telelactation services on breastfeeding duration and exclusivity across a racially and ethnically diverse population of parents. Design, Setting, and Participants This digital randomized clinical trial was conducted across 39 states. Eligible participants were aged 18 years or older, were in their third trimester of pregnancy with their first child, and intended to breastfeed. Participants were recruited through pregnancy apps from July 2021 to December 2022 and followed up through 24 weeks post partum. Analyses were completed from December 2023 to June 2024. Intervention Pregnant individuals were randomized 1:1 to the treatment arm, which received access to a smartphone app with on-demand access to lactation consultants 24 hours a day via video visits, or to the control arm, which received an infant care e-book. Main Outcomes and Measures Any breastfeeding and any infant formula use at 24 weeks post partum and time to breastfeeding cessation. The intention-to-treat analysis used regression models to estimate unadjusted effects and effects adjusted for baseline characteristics. Results A total of 2108 participants were randomized, and 1911 were analyzed for primary outcomes. The mean (SD) age at the time of recruitment was 29.61 (5.37) years, and 707 participants (37.0%) had a household income of less than $55 000. In all, 611 participants (32.0%) identified as Black, 678 (35.5%) as Latinx, and 622 (32.5%) as races and/or ethnicities other than Black or Latinx. Among treatment arm participants, 466 (48.8%) used telelactation services. In intention-to-treat analyses, the proportion of all participants who reported any breastfeeding at 24 weeks was 674 (70.6%) in the treatment group and 639 (66.8%) in the control group (adjusted difference, 3.6 percentage points; 95% CI, −0.5 to 7.6 percentage points; P = .08), and the proportion with exclusive breastfeeding at 24 weeks was 447 (46.9%) in the treatment arm and 421 (44.1%) in the control arm (adjusted difference, 2.4 percentage points; 95% CI, −1.9 to 6.8 percentage points; P = .28). Differences were significant among Black participants. The proportion of Black participants who reported any breastfeeding at 24 weeks was 196 of 301 (65.1%) in the treatment arm and 178 of 310 (57.4%) in the control arm (adjusted difference, 7.5 percentage points; 95% CI, 0.2-14.8 percentage points; P = .045) and who reported breastfeeding exclusively at 24 weeks was 128 of 300 (42.7%) in the treatment arm and 105 of 310 (33.9%) in the control arm (adjusted difference, 9.2 percentage points; 95% CI, 1.4-16.9 percentage points; P = .02). Conclusions and Relevance In this randomized clinical trial, telelactation services had no significant effect on breastfeeding rates among participants overall, but significant improvements were found among Black individuals. The results suggest that telelactation services could be a component of a comprehensive strategy to reduce racial disparities in breastfeeding rates. Trial Registration ClinicalTrials.gov Identifier: NCT04856163

Objective To evaluate the data consistency and quality of Medicaid claims data on opioid use disorder (OUD) treatment, benchmarking the Transformed Medicaid Statistical Information System Analytic Files (TAF) against metrics reported by the Medicaid Outcomes Distributed Research Network (MODRN), which analyzed data obtained directly from 11 state Medicaid agencies. Data Sources and Study Setting The primary data source was TAF claims for the years 2017 and 2018, limited to non‐dual, full‐benefit Medicaid beneficiaries aged 12–64 in one of the 11 states in our study sample. Study Design Using TAF data, we replicated performance on the following five OUD quality metrics reported by MODRN: number of enrollees receiving any OUD medication, receipt of behavioral health counseling, completion of urine drug screens, receipt of any opioid analgesic fill, and receipt of any benzodiazepine fill. Data Collection/Extraction Methods Access to TAF data was facilitated through the Chronic Conditions Warehouse. Principal Findings There were 11% fewer Medicaid enrollees with OUD in TAF compared to MODRN (912,478 vs. 1,034,412). Patient characteristics were largely similar across the two datasets, with the exception of more missing race information in TAF (20.9% vs. 7.1%). Across the 11 states, performance on the six quality measures was similar. For example, the rate of use of any OUD medication in 2018 was 57.1% in MODRN and 58.6% in TAF. However, there were important discrepancies in the TAF data in individual states for single years. Conclusions TAF data may undercount patients with OUD, but otherwise exhibited consistency with MODRN benchmarks, suggesting suitability of TAF for research on OUD treatment. Our results highlight several data quality issues with TAF that researchers who use these data should be aware of, including reporting of race and ethnicity.

Unlike most other Medicare fee schedules, the Medicare Physician Fee Schedule does not include an automatic inflation update. We describe the history of Physician Fee Schedule update systems and present paradigms for evaluating the merits of adding an inflation-based adjustment factor to the schedule's updating formulas. We adopt an incentive paradigm, which emphasizes how access to care and the consolidation of health care facilities are affected by fees. Although evidence suggests that the impact of fee changes on access has been small, it might not remain so. Moreover, the disparity in fees, and fee updates, between care delivered in an outpatient facility as opposed to a physician office may induce consolidation. Because existing evidence does not support the idea that there is a current access crisis in Medicare, we believe that a partial, inflation-based, across-the-board update (for example, inflation minus 1) would help sustain access into the future and potentially slow consolidation. This approach would be reasonably easy to implement and have better distributional properties than some alternatives, such as differential updates for the work and practice expense components of the Medicare Physician Fee Schedule.

Objective: The authors sought to understand patient experiences with group teletherapy to inform improvements in service delivery. Methods: From December 2022 to October 2023, semistructured interviews were conducted with 20 adults with depression or bipolar disorder who had received outpatient group teletherapy in the past 2 years. A rapid thematic analysis was conducted by using a matrix to identify patterns and synthesize data. A logic model from the patients' perspective was developed by extracting common themes related to elements of effective group teletherapy. Results: Telehealth allowed for more empowered engagement in group teletherapy and enabled better access and longitudinal attendance for many patients, compared with in-person group therapy. However, many patients reported a reduced sense of emotional intimacy and connectedness with telehealth, and some reported that technology challenges and distractions contributed to feelings of disconnection. Patients were divided in their modality preferences, but many expressed an interest in receiving at least some of their group therapy sessions by telehealth. Conclusions: Although group teletherapy has the potential to meet patients' needs and preferences, more work is needed to improve the quality of the experience for patients.