Joynt and colleagues examined clinical and economic outcomes associated with hospital conversions from not-for-profit to for-profit status in an analysis of 2002-2010 Medicare inpatient data from 237 hospitals that converted and 631 hospitals—matched on size, teaching status, and region—that remained not-for-profit (controls). The authors found that for-profit conversion was associated with improvements in financial margins but no differences in care quality or mortality rates or in the proportion of poor or minority patients receiving care. In an Editorial, Cutler discusses who benefits from organizational changes in medical care.
Editorial and Related Articles 1 and 2
Author Video Interview
In an analysis of nationally representative claims data from more than 49 million privately insured individuals, Baker and colleagues assessed the relationship between physician competition and prices paid (the “allowed amount”) by preferred provider organizations (PPOs) for office visits in 10 specialties. The authors found that greater competition between physicians was related to lower prices paid by private PPOs for physician office visits.
To examine whether total expenditures per patient are higher in physician organizations owned by local hospitals or multihospital systems than in medical groups owned by participating physicians, Robinson and Miller analyzed data from approximately 4.5 million California patients covered by commercial health maintenance organization insurance between 2009 and 2012. The authors report that from the perspective of insurers and patients, hospital-owned physician organizations incurred higher per-patient expenditures than physician-owned medical groups for professional, hospital, laboratory, pharmaceutical, and ancillary services.
In an analysis of medical claims from 502 949 patients who had employer-sponsored health insurance and access to personalized information on out-of-pocket prices for imaging studies, laboratory testing, or a clinician office visit, Whaley and colleagues found that patients who accessed the pricing information had lower claims payments for the services than patients who did not access the information. In an Editorial, Reinhardt discusses economic theory and practicalities of health care price transparency.
Increasing prevalence of antibiotic-resistant community-acquired uropathogens can influence the diagnosis and management of urinary tract infections (UTIs) in outpatient settings. Grigoryan and colleagues reviewed the evidence from 27 randomized trials, 6 reviews, and 11 observational studies to define an optimal approach to the diagnosis and treatment of UTIs in healthy women, women with diabetes, and men.
Continuing Medical Education
An article in JAMA Psychiatry reported that among military combat veterans, traumatic brain injury (TBI) during the most recent deployment was the strongest predictor of postdeployment posttraumatic stress disorder symptoms—even after accounting for predeployment symptoms, prior TBI, and combat intensity. In this From the JAMA Network article, Hoge and Castro discuss treatment of war-related health concerns.
This JAMA Diagnostic Test Interpretation article presents the case of a female nursing home resident who has been treated repeatedly for suspected urinary tract infection (UTI). Most recently, the patient reports voiding frequency without dysuria. On examination she is afebrile, with no abdominal, suprapubic, or flank tenderness. A catheterized urine specimen is obtained. How would you interpret the urinalysis and urine culture results?
Highlights. JAMA. 2014;312(16):1611-1613. doi:10.1001/jama.2013.279795