Inoue, Kosuke, Michael Liu, and Rishi K Wadhera. (2025) 2025. “Prevalence and Control of Diabetes Among US Adults-Reply.”. JAMA 334 (5): 453-54. https://doi.org/10.1001/jama.2025.6308.
Publications
2025
Liu, Michael, and Rishi K Wadhera. (2025) 2025. “The United States Faces a Healthcare Affordability Crisis.”. BMJ (Clinical Research Ed.) 390: r1702. https://doi.org/10.1136/bmj.r1702.
Lassen, Mats C Højbjerg, Frederikke Held Berg, and Rishi K Wadhera. (2025) 2025. “Hospitalization Rates Alone Do Not Define Health Systems-Reply.”. JAMA Cardiology 10 (10): 1076-77. https://doi.org/10.1001/jamacardio.2025.2539.
Aggarwal, Rahul, Rishi K Wadhera, Nicholas Chiu, Michael Szarek, and Deepak L Bhatt. (2025) 2025. “Cardiovascular Risk Factor and Disease Mortality Among Asian Indian, Chinese, and Filipino Adults in the United States, 2018 to 2023.”. Annals of Internal Medicine 178 (10): 1523-25. https://doi.org/10.7326/ANNALS-25-00108.
Liu, Michael, Kosuke Inoue, Azariah Boyd, Rahul Aggarwal, Lucas X Marinacci, and Rishi K Wadhera. (2025) 2025. “Obesity Prevalence Among Children and Adolescents in the United States, 2011 to 2023.”. Annals of Internal Medicine 178 (10): 1517-20. https://doi.org/10.7326/ANNALS-25-00389.
Shanab, Bassel M, David A Bunn, Andrew S Oseran, Rishi K Wadhera, Jessica Phelan, John Orav, and Jose F Figueroa. (2025) 2025. “Insurance Coverage and Plan Choice Complexity for Medicare Beneficiaries With Cardiovascular Disease.”. The American Journal of Cardiology 257: 12-15. https://doi.org/10.1016/j.amjcard.2025.07.026.
Medicare beneficiaries with cardiovascular disease are increasingly enrolling in Medicare Advantage and other managed care plans, raising concern for plan choice complexity and subsequent detrimental plan selection. In this repeated cross-sectional observational study, between 2016 and 2022, plan choice complexity for Medicare beneficiaries with cardiovascular disease has worsened substantially, especially for the medically complex and socially vulnerable beneficiaries dual-eligible for Medicare and Medicaid. These findings raise substantial concern for the health and well-being of Medicare beneficiaries given that plan choice complexity has previously been shown to negatively impact decision-making and outcomes for people with cardiovascular disease.
Liu, Michael, Kushal T Kadakia, Stephen A Mein, and Rishi K Wadhera. (2025) 2025. “Patient Healthcare Spending After the No Surprises Act: Quasi-Experimental Difference-in-Differences Study.”. BMJ (Clinical Research Ed.) 390: e084803. https://doi.org/10.1136/bmj-2025-084803.
OBJECTIVE: To estimate changes in healthcare spending in the US after implementation of the No Surprises Act (NSA) in 2022 among adults with direct purchase private insurance.
DESIGN: Quasi-experimental difference-in-differences study.
SETTING: 24 US states.
PARTICIPANTS: Adults aged 19-64 years with direct purchase private insurance who participated in the Annual Social and Economic Supplement of the Current Population Survey 2019-24 and resided in states that gained NSA surprise billing protections (intervention states) or in states with comprehensive protections already in place (control states).
MAIN OUTCOME MEASURES: Inflation adjusted out-of-pocket spending, insurance premium spending, and high burden medical spending (defined as spending >10% of total family income on both out-of-pocket and premium costs).
RESULTS: The study population included 17 351 privately insured adults, with 8204 residing in the 18 intervention states and 9147 in the six control states. After implementation of the NSA, out-of-pocket spending showed a decline among privately insured adults in intervention states (from $3674 (£2776; €3214) to $2922, relative percentage change -16.5%, 95% confidence interval (CI) -27.9% to -3.2%), but not among privately insured adults in control states ($2704 to $2550, 1.9%, -11.6% to 17.4%). A significant differential reduction was observed in out-of-pocket spending among privately insured adults in intervention states compared with control states after the NSA (relative percentage change -18.0%, -30.2% to -3.7%; absolute change -$567, 95% CI -$1031 to -$102; P=0.02). In contrast, no differential changes were observed in premium spending (relative percentage change 1.9%, -13.9% to 20.7%; absolute change $93, -$737 to $924; P=0.82) and in high burden medical spending (absolute percentage point change -1.0%, 95% CI -5.2% to 3.1%, P=0.62) between the two groups. These findings were consistent across sociodemographic characteristics, including sex, race/ethnicity, poverty status, education level, and employment status.
CONCLUSIONS: Substantial declines occurred in out-of-pocket spending among direct purchase privately insured adults who gained NSA surprise billing protections. In contrast, premium spending and high burden medical spending did not change. Additional policy efforts are needed to reduce healthcare related financial strain in the US.
Liu, Michael, Kushal T Kadakia, and Rishi K Wadhera. (2025) 2025. “Proliferation of Prior Authorization in Traditional Medicare - None the WISeR?”. The New England Journal of Medicine 393 (15): 1457-59. https://doi.org/10.1056/NEJMp2510451.
Liu, Michael, and Rishi K Wadhera. (2025) 2025. “High-Risk Areas-The Trees in the Forest-Reply.”. JAMA Cardiology. https://doi.org/10.1001/jamacardio.2025.2957.
Lalani, Christina, Ravi K Sharma, Jonathan Sevilla-Cazes, Kevin Kennedy, Neel M Butala, Eric A Secemsky, Duane Pinto, et al. (2025) 2025. “Outcomes of Percutaneous Coronary Interventions Following Transcatheter Aortic Valve Replacement: Insights From the CathPCI Registry.”. The American Journal of Cardiology 251: 18-24. https://doi.org/10.1016/j.amjcard.2025.05.006.
Although transcatheter aortic valve replacement (TAVR) devices can impair coronary access, there are limited real-world data comparing outcomes of percutaneous coronary intervention (PCI) in post-TAVR versus non-TAVR patients. In this study, we compare procedural characteristics and outcomes between patients with versus without a history of TAVR who undergo PCI. We used claims data for the Medicare population to evaluate the incidence of PCI after TAVR between 2011 and 2017. Then, using the CathPCI Registry, we compared PCI outcomes between patients with a history of TAVR versus propensity score-matched non-TAVR patients. Of the 52,780 Medicare patients who underwent TAVR between 2011 and 2017, the incidence of acute myocardial infarction (AMI) was 10.2% and of PCI was 5.1% at 5 years. At 5 years, the incidence of stroke was 5.0% and of death was 64.0%. In the CathPCI Registry, procedural success for PCI was similar between 1,309 post-TAVR patients versus 5,236 propensity-score matched patients without prior TAVR. However, post-TAVR patients required greater fluoroscopic time (21.9 vs 17.7 minutes, p <0.001) and had higher rates of post-procedural stroke (0.8% vs 0.4%, p = 0.02) and bleeding (5.1% vs 2.9%, p <0.001). Post-TAVR patients were more likely to have repeat PCI in the 3 years post-PCI (HR: 1.36, 95% C.I: 1.09, 1.70) and had higher rates of stroke (HR: 1.65, C.I.: 1.07 to 2.56, p = 0.023) and death (HR: 1.23, C.I.: 1.11-1.38, p <0.001) compared to non-TAVR patients. In conclusion, in the CathPCI Registry, patients with a history of TAVR appeared to have similar procedural success but longer fluoroscopic times, more frequent post-procedural bleeding and stroke, and a higher likelihood of a repeat PCI compared with matched patients without a history of TAVR.