New paper led by Joel Mantilla and Laura Burke shows massive growth in urgent care use among older adults, now more than 1 visit for every 10 older adults. 1 in 15 visits was by an older adult with ADRD. doi.org/10.1001/jamanetworkopen.2025.55345
Thank you, Liz! I’m so grateful for this incredible organization that has supported my research and connected me with an amazing network of successful researchers like you. I hope to give back and support its mission.
Thanks Rachel! Re: ESR/CRP, I think we need for more evidence to guide when they are helpful/sufficient to rule out the disease (this is especially important for circumstances when MRI is not readily available).
It has been a privilege to work on this topic with an incredible team of health services researchers!
While the percentage of admissions preceded by a potential diagnostic error in the ED was relatively low for most conditions, admissions preceded by a potential diagnostic error had modestly higher mortality and Healthy Days at Home at 30 days for several conditions.
I am excited to share our AHRQ-funded study examining rates of potential diagnostic error for high-risk emergency admissions among Medicare beneficiaries.
Also, as a side note, the indicators for the legend in Figure 1 were misplaced and a corrected version will be published shortly. The attached picture has the correctly labeled trend lines.
Mom & Dad at Fenway Park.
This trend matters for all VA enrollees, not just those enrolled in Medicare. Shout-out to my favorite dual Medicare/VA enrollee, my Dad, and the Brockton VA that he raves about
An outstanding editorial by Dr. Kenneth Kizer jamanetwork.com/journals/jam... the policy implications of this payer shift. In brief, this trend threatens the financial viability of this critical safety net for our nation’s veterans and is likely enriching MA plans at the expense of the VA.
The % of ED visits occurring at VA EDs changed very little, suggesting that there hasn’t been an exodus of ED visits outside the VA system, but rather that the VA is now picking up the tab (instead of Medicare) to the tune of about $2b annually for veterans who were already using community EDs.
In this study of veterans dually enrolled in Medicare/ the VA, we examined national trends in ED visits. We found that the % of community ED visits among this population paid by the VA increased sharply after MISSION Act implementation, while the % of Medicare visits declined.
I have been very fortunate join the collaboration between PEPrEC www.peprec.research.va.gov and HQO hsph.harvard.edu/research/hea... studying the impact of the MISSION Act on emergency care delivery for our nation’s veterans. @joefigs.bsky.social
A robust body of work by Dr. Anita Vashi and colleagues jamanetwork.com/journals/jam... documented this rise in community ED spending and also uncovered the payer shifting phenomenon in the immediate post-MISSION Act period in New York state pubmed.ncbi.nlm.nih.gov/37076113/.
The MISSION Act of 2018 was intended to expand veterans’ access to emergency care at community EDs. After its implementation, VA spending on community ED visits rose markedly generating concern about the impact on the VA delivery system.
I’m delighted to share our recent work t.co/VGpLro9Kmo suggesting that much of the growth in VA spending on ED visits to non-VA (“community”) EDs is due a shift in payer for ED visits from Medicare to the VA, rather than a large change in where veterans are seeking emergency care.
