Ethnic and Racial Disparities in Medicare Annual Wellness Visit Utilization

MedicalResearch.com Interview with:

Kim Lind, PhD, MPH Research Fellow Centre for Health Systems and Safety Research Australian Institute of Health Innovation Macquarie University, NSW 

Dr. Lind

Kim Lind, PhD, MPH
Research Fellow
Centre for Health Systems and Safety Research
Australian Institute of Health Innovation
Macquarie University, NSW

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The Medicare Annual Wellness Visit (AWV) is a preventive care visit that was introduced in 2011 as part of the Patient Protection and Affordable Care Act. Prior to this, the only preventive care exam covered by Medicare was the Welcome to Medicare Visit, which is only available for people in their first year of Medicare enrolment. The AWV is available each year to beneficiaries without co-payment to people who are past their first year of Medicare enrolment. The AWV focuses on prevention and early detection of disease.

Racial disparities in healthcare utilization and health outcomes have been well documented in the US. Prior expansions of Medicare coverage have had varied effects on reducing disparities. For example, in 2001 Medicare began to cover colorectal cancer screening which reduced racial disparities for some minority groups with respect to screening rates and improved early detection.

Expanding coverage of preventive care for people on Medicare may help reduce disparities in health outcomes, but we first needed to know if people were using the Medicare Annual Wellness Visit. Our goal was to assess AWV utilization rates and determine if utilization differed by race or ethnicity. We analyzed a nationally representative database of Medicare beneficiaries (the Medicare Current Beneficiary Survey) that included self-reported race, ethnicity, income and education, linked to Medicare claims.

We found that Medicare Annual Wellness Visit use was low but increased from 2011 to 2013. We also found that people on Medicare who self-identified as belonging to a racial or ethnic minority group had lower AWV utilization rates than non-Hispanic white people. People with lower income or education, and people living in rural areas had lower Medicare Annual Wellness Visit utilization.  Continue reading

Decreased Cost-Sharing Increased Patient Adherence

MedicalResearch.com Interview with:

A. Mark Fendrick, M.D. Professor, Division of General Medicine, Department of Internal Medicine and Department of Health Management and Policy Director, University of Michigan Center for Value-Based Insurance Design Ann Arbor, Michigan 48109-2800

Dr. Fendrick

A. Mark Fendrick, M.D.
Professor, Division of General Medicine, Department of Internal Medicine and Department of Health Management and Policy
Director, University of Michigan Center for Value-Based Insurance Design
Ann Arbor, Michigan 48109-2800

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: As Americans are being asked to pay more for the medical care, in terms of copayments and deductibles, one in four Americans reports having difficulty paying for their prescription drugs. One potential solution is “value-based insurance design,” or V-BID. V-BID, is built on the principle of lowering or removing financial barriers to essential, high-value clinical services. V-BID plans align patients’ out-of-pocket costs, such as copayments and deductibles, with the value of services to the patient. They are designed with the tenet of “clinical nuance” in mind— in that the clinical benefit derived from a specific service depends on the consumer using it, as well as when, where, and by whom the service is provided.

According to a literature review published in the July 2018 issue of Health Affairs,  The researchers found that value-based insurance design programs which reduced consumer cost-sharing for clinically indicated medications resulted in increased adherence at no change in total spending. In other words, decreasing consumer cost-sharing meant better medication adherence for the same total cost to the insurer. Continue reading

Single-Payer Option Feasible For New York – With $139 Billion in New Taxes

MedicalResearch.com Interview with:

Jodi L. Liu, PhD Associate policy researcher RAND Corporation

Dr. Liu

Jodi L. Liu, PhD
Associate policy researcher
RAND Corporation

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The New York Health Act (NYHA) would create a state-based single-payer plan called New York Health.

The NYHA has been proposed in the New York State Assembly for many years. New York Health would provide all residents with comprehensive health benefits with no cost sharing and create new taxes to help fund the program.

In this study, we used microsimulation modeling to analyze the impact of the NYHA on outcomes such as health care utilization and costs. We estimate that total health care spending could be similar or slightly lower if administrative costs and provider payment rates are reduced. The program would require substantial new taxes and would shift the types of payments people make for health care.

After the presumed redirection of federal and state health care outlays to New York Health, we estimate that the new taxes revenue needed to finance the program in 2022 would be $139 billion.

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Transitional Care Services from Hospital to Home Underutilized, Can Save Money and Readmissions

MedicalResearch.com Interview with:

Andrew B. Bindman, MD Professor of Medicine PRL- Institute for Health Policy Studies University of California San Francisco

Dr. Bindman


Andrew B. Bindman, MD

Professor of Medicine
PRL- Institute for Health Policy Studies
University of California San Francisco

MedicalResearch.com: What is the background for this study?  


Response:
The purpose of this study was to evaluate the use and impact of a payment code for transitional care management services which was implemented by Medicare in.

The transition of patients from hospitals or skilled nursing facilities back to the community often involves a change in a patient’s health care provider and introduces risks in communication which can contribute to lapses in health care quality and safety. Transitional care management services include contacting the patient within 2 business days after discharge and seeing the patient in the office within 7-14 days. Medicare implemented payment for transitional care management services with the hope that this would increase the delivery of these services believing that they could reduce readmissions, reduce costs and improve health outcomes.

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Effects of Breast Density Notification Laws Vary By State

MedicalResearch.com Interview with:

Michal Horný PhD Assistant Professor Emory University School of Medicine, Department of Radiology and Imaging Sciences Emory University Rollins School of Public Health Department of Health Policy and Management Atlanta, GA 30322

Dr. Horný

Michal Horný PhD
Assistant Professor
Emory University School of Medicine, Department of Radiology and Imaging Sciences
Emory University Rollins School of Public Health
Department of Health Policy and Management
Atlanta, GA 30322

MedicalResearch.com: What is the background for this study?

Response: Increased breast tissue density is a common finding at screening mammography. Approximately 30-50% of women have so-called “dense breasts” but many of them are not aware of it. The problem is that the increased tissue density can potentially mask early cancers. In other words, if there is cancer hiding in dense breast tissue, it could be difficult to spot it.

To improve the awareness of breast tissue density, a patient group called Are You Dense Advocacy, Inc., started lobbying state and federal policymakers to pass laws mandating health care providers to notify women about their breast density assessments. As a result, 31 states have already enacted some form of legislation regarding dense breast tissue.

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Lay Health Workers Reduce Costs and Improve Cancer Patients’ Satisfaction

MedicalResearch.com Interview with:

Manali Patel MD MPH Assistant Professor of Medicine, Oncology Stanford Palo Alto Veterans Affairs Health Care System 

Dr. Patel

Manali Patel MD MPH
Assistant Professor of Medicine, Oncology
Stanford
Palo Alto Veterans Affairs Health Care System  

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: In prior work, many patients with advanced stages of cancer report a lack of understanding of their prognosis and receipt of care that differs from their preferences.

These gaps in care delivery along with the unsustainable rise in healthcare spending at the end-of-life and professional healthcare provider shortages led our team to consider new ways to deliver cancer care for patients.  Based on input from focus groups with patients, caregivers, oncology care providers and healthcare payers, we designed a novel model of cancer care to address these gaps in care delivery.  The intervention consisted of a well-trained lay health worker to assist patients with understanding and communicating their goals of care with their oncology providers and caregivers.

We found that patients who received the six-month intervention reported greater satisfaction with the care they received and their decision-making, had higher rates of hospice use, lower acute care use, and 95% lower total healthcare expenditures in the last month of life.  The intervention resulted in nearly $3 million dollars in healthcare savings.

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Defensive Medicine is Real and Raises Health Care Costs

MedicalResearch.com Interview with:
Jonathan Gruber PhD
Department of Economics, E52-434
MIT
Cambridge, MA 02139

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: There is a large literature trying to estimate the extent of ‘defensive  medicine’ by looking at what happens when it gets harder to sue and/or  you can win less money. But there have been no studies of what happens if you just get rid of the right to sue.  That’s what we have with active duty patients treated on a military base.

The main finding is that when patients can’t sue they are treated about  5% less intensively.  Much of the effect appears to arise from fewer diagnostic tests.

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Both State and Federal Marketplaces Expanded Medicaid/Chip Coverage to Eligible Patients

MedicalResearch.com Interview with:

Julie L. Hudson, PhD Center for Financing, Access, and Cost Trends Agency for Healthcare Research and Quality Rockville, Maryland

Dr. Hudson

Julie L. Hudson, PhD
Center for Financing, Access, and Cost Trends
Agency for Healthcare Research and Quality
Rockville, Maryland

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Since 2013, public coverage has increased not only among low-income adults newly eligible for Medicaid but also among children and adults who were previously eligible for Medicaid or the Children’s Health Insurance Program (CHIP). Recent research has shown that growth in public coverage varied by state-level policy choices.

In this paper we study the growth in public coverage (Medicaid/CHIP) for three population samples living in Medicaid Expansion states between 2013 and 2015: previously eligible children, previously eligible parents, and newly eligible parents by state-level marketplace policies (Note: eligibility refers to eligible for Medicaid/CHIP, eligibility for marketplace subsidized coverage). All marketplaces are required to assess each applicants’ eligibility for both the marketplace and for Medicaid/CHIP. States running state-based marketplaces are required to enroll Medicaid-/CHIP-eligible applicants directly into public coverage (Medicaid or CHIP), but states using federally-facilitated marketplaces can opt to require their marketplace to forward these cases to state Medicaid/CHIP authorities for final eligibility determination and enrollment. We study the impact of marketplace policies on public coverage by observing changes in the probability Medicaid-/CHIP-eligible children and parents are enrolled in public coverage across three marketplace structures: state-based marketplaces that are required to enroll Medicaid-/CHIP-eligible applicants directly into public coverage, federally-facilitated marketplaces in states that enroll Medicaid-/CHIP-eligible applicants directly into public coverage, and federally-facilitated marketplaces with no authority to enroll Medicaid-/CHIP-eligible applicants into public coverage.

Supporting the existing literature, we find that public coverage grew between 2013-2015 for all three of our samples of Medicaid-/CHIP-eligible children and parents living in Medicaid expansion states. However, we show that growth in public coverage was smallest in expansion states that adopted a federally-facilitated marketplace and gave no authority to the marketplace to enroll Medicaid-/CHIP-eligible applicants directly into public coverage. Additionally, once we account for enrollment authority, we found no differences in growth of public coverage for eligible children and parents living in expansion states that adopted a state-based marketplace versus those in states that adopted a federally-facilitated marketplaces with the authority to directly enroll Medicaid-/CHIP-eligible applicants Continue reading

With Aging Comes Increasing Cost of Life-Extending Medications

MedicalResearch.com Interview with:

Jonathan H. Watanabe, PharmD, PhD, BCGP Associate Professor of Clinical Pharmacy National Academy of Medicine Anniversary Fellow in Pharmacy Division of Clinical Pharmacy | Skaggs School of Pharmacy and Pharmaceutical Sciences | University of California San Diego La Jolla, CA 

Jonathan H. Watanabe, PharmD, PhD, BCGP
Associate Professor of Clinical Pharmacy
National Academy of Medicine Anniversary Fellow in Pharmacy
Division of Clinical Pharmacy | Skaggs School of Pharmacy and Pharmaceutical Sciences | University of California San Diego
La Jolla, CA

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: As a clinician in older adult care and as a health economist, I’ve been following the news and research studies on older patients unable to pay for their medications and consequently not getting the treatment they require. Our goal was to measure how spending on the medications Part D spends the most on, has been increasing over time and to figure out what prices patients are facing out-of-pocket to get these medications.

In 2015 US dollars, Medicare Part D spent on the ten highest spend medications increased from $21.5 billion in 2011 to $28.4 billion in 2015.  The number of patients that received one of the ten highest spend medications dropped from 12,913,003 in 2011 to 8,818,471— a 32% drop in that period.

A trend of spending more tax dollars on fewer patients already presents societal challenges, but more troubling is that older adults are spending much more of their own money out-of-pocket on these medications.  For patients without a federal low income subsidy, the average out-of-pocket cost share for one of the ten highest spend medications increased from $375 in 2011 to $1,366 in 2015.  This represented a 264% increase and an average 66% increase per year.  For patients receiving the low income subsidy, the average out-of-pocket cost share grew from $29 in 2011 to $44 in 2015 an increase of 51% and an average increase of 12.7% per year.  This may not sound like much, but for those living close to the federal poverty level this can be the difference between foregoing necessities to afford your medications or choosing not to take your medications.   Continue reading

Targeting Breast Cancer Screening To Higher Risk Patients Reduces Overdiagnosis, Costs and Side Effects

MedicalResearch.com Interview with:

Dr Nora Pashayan PhD Clinical Reader in Applied Health Research University College London Dept of Applied Health Research London 

Dr. Pashayan

Dr Nora Pashayan PhD

Clinical Reader in Applied Health Research

University College London

Dept of Applied Health Research

London 

MedicalResearch.com:  What is the background for this study?

Response: Not all women have the same risk of developing breast cancer and not all women have the same potential to benefit from screening.

 

If the screening programme takes into account the individual variation in risk, then evidence from different studies indicate that this could improve the efficiency of the screening programme. However, questions remain on what is the best risk-stratified screening strategy, does risk-stratified screening add value for money, and what are benefit and harm trade-offs.

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Predicting Death is Difficult, Making it Difficult To Save Money on End of Life Care

MedicalResearch.com Interview with:

Amy Finkelstein PhD John & Jennie S. MacDonald Professor of Economics MIT Department of Economics National Bureau of Economic Research Cambridge MA 02139 

Dr. Finkelstein

Amy Finkelstein PhD
John & Jennie S. MacDonald Professor of Economics
MIT Department of Economics
National Bureau of Economic Research
Cambridge MA 02139 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Although only 5% of Medicare beneficiaries die in a given year, they account for almost 25% of Medciare spending.

This fact about high end of life spending has been constantly used to refer to inefficiency of the US healthcare system. A natural observation is that the fact is retrospective, and it motivated us to explore a prospective analog, which would take as an input the probability of someone dying in a given year rather than her realized outcome. We therefore used machine learning techniques to predict death, and somewhat to our surprise we found that at least using standardized and detailed claims-level data, predicting death is difficult, and there are only a tiny fraction of Medicare beneficiaries for whom we can predict death (within a year) with near certainty.

Those who end up dying are obviously sicker, and our study finds that up to half of the higher spending on those who die could be attributed to the fact that those who die are sicker and sick individuals are associated with higher spending.   Continue reading

Coding Changes Limited Penalty Impact From CMS Hospital-Acquired Conditions Policy

MedicalResearch.com Interview with:

Michael S. Calderwood, MD, MPH, FIDSA Regional Hospital Epidemiologist Assistant Professor of Medicine Infectious Disease & International Health

Dr. Calderwood

Michael S. Calderwood, MD, MPH, FIDSA
Regional Hospital Epidemiologist
Assistant Professor of Medicine
Infectious Disease & International Health

MedicalResearch.com: What is the background for this study?  

Response: Prior work by Lee et al. (N Engl J Med 2012;367:1428–1437) found that the 2008 CMS Hospital-Acquired Conditions (HAC) policy did not impact already declining national rates of central line-associated bloodstream infections (CLABSIs) or catheter-associated urinary tract infections (CAUTIs). We studied why this policy did not have its intended impact by looking at coding practices and the impact of the policy on the diagnosis-related group (DRG) assignment for Medicare hospitalizations. The DRG assignment determines reimbursement for inpatient hospitalizations.

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Voluntary Bundled Payment Program For Care After Acute Hospitalization Unable to Achieve Broad Participation

MedicalResearch.com Interview with:

A Jay Holmgren Doctoral Student, Health Policy and Management Harvard Business School

A Jay Holmgren

A Jay Holmgren
Doctoral Student, Health Policy and Management
Harvard Business School

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Post-acute care, care that is delivered following an acute care hospitalization, is one of the largest drivers of variation in US health care spending.

To address this, Medicare has created several payment reform systems targeting post-acute care, including a voluntary bundled payment program known as the Model 3 of the Bundled Payment for Care Improvement (BPCI) Initiative for post-acute care providers such as skilled nursing facilities, long-term care hospitals, or inpatient rehabilitation facilities. Participants are given a target price for an episode of care which is then reconciled against actual spending; providers who spend under the target price retain some of the savings, while those who spend more must reimburse Medicare for some of the difference.

Our study sought to evaluate the level of participation in this program and identify what providers were more likely to participate. We found that fewer than 4% of eligible post-acute care providers ever participated in the program, and over 40% of those who did participate dropped out. The providers more likely to remain in the program were skilled nursing facilities that were higher quality, for-profit, and were part of a multi-facility organization.

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Study Compares Hospitals Enrolled in Medicare’s Voluntary vs Mandatory Bundled Payment Programs

MedicalResearch.com Interview with:

Amol Navathe, MD, PhD Assistant Professor, Health Policy and Medicine Perelman School of Medicine University of Pennsylvania

Dr. Navathe

Amol Navathe, MD, PhD
Assistant Professor, Health Policy and Medicine
Perelman School of Medicine
University of Pennsylvania

MedicalResearch.com: What is the background for this study?

Response: Bundled payment is a key Medicare Alternative Payment Model (APM) developed by the Centers for Medicare and Medicaid Services (CMS) to increase health care value by holding health care organizations accountable for spending across an episode of care. The model provides financial incentives to maintain quality and contain spending below a predefined benchmark.

In 2013, CMS launched the Bundled Payments for Care Improvement (BPCI) initiative to expand bundled payment nationwide. BPCI’s bundled payment design formed the basis for CMS’s Comprehensive Care for Joint Replacement (CJR) Model beginning in 2016. While the programs are similar in design, BPCI is voluntary while CJR is mandatory for hospitals in selected markets. Moreover, CJR is narrower in scope, focusing only on lower extremity joint replacement (LEJR) and limiting participation to hospitals.

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2/3 Canadians Do Not Receive Timely Surgery for Hip Fractures

MedicalResearch.com Interview with:

Daniel Pincus MD Department of Surgery Institute for Clinical Evaluative Sciences University of Toronto

Dr. Pincus

Daniel Pincus MD
Department of Surgery
Institute for Clinical Evaluative Sciences
University of Toronto

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We chose to look at hip fractures because is the most common reason for urgent surgery complications have be tied to wait times (and in particular wait times greater than 24 hours).

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Family-Support Intervention in ICUs Increased Patient Comfort and Reduced Costs

MedicalResearch.com Interview with:

Douglas B. White, M.D., M.A.S. Director of the Clinical Research Investigation and Systems Modeling of Acute Illness (CRISMA) Center’s Program on  Ethics and Decision Making in  Department of Critical Care Medicine University of Pittsburgh 

Dr. White

Douglas B. White, M.D., M.A.S.
Director of the Clinical Research Investigation and Systems Modeling of Acute Illness (CRISMA) Center’s Program on
Ethics and Decision Making in  Department of Critical Care Medicine
University of Pittsburgh 

MedicalResearch.com: What is the background for this study? 

Response: We set out to test the effectiveness of PARTNER (PAiring Re-engineered ICU Teams with Nurse-driven Emotional Support and Relationship-building). PARTNER is delivered by the interprofessional team in the ICU, consisting of nurses, physicians, spiritual care providers, social workers and others who play a part in patient care. The program is overseen by nurse-leaders in each ICU who receive 12 hours of advanced communication skills training to support families. The nurses meet with the families daily and arrange interdisciplinary clinician-family meetings within 48 hours of a patient coming to the ICU. A quality improvement specialist helps to incorporate the family support intervention into the clinicians’ workflow.

PARTNER was rolled out at five UPMC ICUs with different patient populations and staffing. It was implemented in a staggered fashion so that every participating ICU would eventually get PARTNER. Before receiving PARTNER, the ICUs continued their usual methods of supporting families of hospitalized patients. None of the ICUs had a set approach to family communication or required family meetings at regular intervals before receiving PARTNER. A total of 1,420 adult patients were enrolled in the trial, and 1,106 of these patients’ family members agreed to be a part of the study and its six-month follow-up surveys. The patients were very sick, with about 60 percent dying within six months of hospitalization and less than 1 percent living independently at home at that point.

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Rate of End-of-Life Medicare Spending Falls

MedicalResearch.com Interview with:

William B Weeks, MD, PhD, MBA The Dartmouth Institute

Dr. Weeks

William B Weeks, MD, PhD, MBA
The Dartmouth Institute

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The background for the study is that a common narrative is that end-of-life healthcare costs are driving overall healthcare cost growth.  Growth in end-of-life care has been shown, in research studies through the mid 2000’s, to be attributable to increasing intensity of care at the end-of-life (i.e., more hospitalizations and more use of ICUs).

The main findings of our study are that indeed there have been substantial increases in per-capita end-of-life care costs within the Medicare fee-for-service population between 2004-2009, but those per-capita costs dropped pretty substantially between 2009-2014.  Further, the drop in per-capita costs attributable to Medicare patients who died (and were, therefore, at the end-of-life) accounts for much of the mitigation in cost growth that has been found since 2009 in the overall Medicare fee-for-service population.

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Lack of Dialysis Access for Undocumented Immigrants Stresses Patients and Providers

MedicalResearch.com Interview with:

Lilia Cervantes, M.D. Internal Medicine, Hospitalist Denver Health and Hospital Authority Assistant Professor, Division of General Internal Medicine Founder, Healthcare Interest Program and Health Equity Lecture Series at Denver Health University of Colorado Health Sciences Center

Dr. Cervantes

Lilia Cervantes, M.D.
Internal Medicine, Hospitalist
Denver Health and Hospital Authority
Assistant Professor, Division of General Internal Medicine
Founder, Healthcare Interest Program and Health Equity Lecture Series
at Denver Health
University of Colorado Health Sciences Center

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response:  For most undocumented immigrants with kidney failure in the U.S., access to hemodialysis is limited and they can only receive it when they are critically ill and near-death.  This type of “emergency-only” hemodialysis is already known to be nearly 4-fold more costly, has 14-fold higher mortality rate, and leads to debilitating physical and psychosocial distress for these patients compared to those receiving regular hemodialysis.

This study shows that clinicians who are forced to provide this substandard care are also harmed.  They experience moral distress, emotional exhaustion, and several other drives of professional burnout due to witnessing needless suffering and high mortality.  Continue reading

Which Cancers Cost The Most To Treat?

MedicalResearch.com Interview with:

Matthew P. Banegas, PhD, MPH Center for Health Research Kaiser Permanente

Dr. Banegas

Matthew P. Banegas, PhD, MPH
Center for Health Research
Kaiser Permanente

MedicalResearch.com: What is the background for this study?

Response: Despite a large body of research on cancer care costs, we observed a significant evidence gap. Namely, while about one-half of cancer diagnoses in the U.S. occur among people under age 65, it can be difficult to find good data on the costs of care for this population. That’s because most of the current literature on cancer care costs is based on SEER Medicare data, which are limited to Medicare fee-for-service beneficiaries.

At a time of rising costs and an ever-increasing number of new therapies, we felt it was important to improve our understanding of cancer costs for U.S. adults of all ages. We examined medical care costs for the four most common types of cancer in the United States: breast, colorectal, lung, and prostate cancer.

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Palliative Care of Sickest Patients Improves Quality of Life, But Does it Save Money?

MedicalResearch.com Interview with:

R. Sean Morrison, MD Ellen and Howard C. Katz Professor and Chair Brookdale Department of Geriatrics and Palliative Medicine Icahn School of Medicine at Mount Sinai New York, NY 10029

Dr. Morrison

R. Sean Morrison, MD
Ellen and Howard C. Katz Professor and Chair
Brookdale Department of Geriatrics and Palliative Medicine
Icahn School of Medicine at Mount Sinai
New York, NY 10029

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Palliative care is team based care that is focused on improving quality of life and reducing suffering for persons with serious illness and their families.  It can be provided at any age and in concert with all other appropriate medical treatments.  Palliative care has been shown to improve patient quality of life, patient and family satisfaction, and in diseases like cancer and heart failure, improve survival.  A number of individual studies have shown that palliative care can reduce costs by providing the right care to the right people at the right time.

This study pooled data from six existing studies to quantify the magnitude of savings that high quality palliative care provides.
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Does Drug Industry Money Affect Cancer Prescriptions?

MedicalResearch.com Interview with:

Aaron Mitchell, MD Division of Hematology/Oncology, Department of Medicine,  Lineberger Comprehensive Cancer Center The Cecil G. Sheps Center for Health Services Research The University of North Carolina at Chapel Hil

Dr. Mitchell

Aaron Mitchell, MD
Division of Hematology/Oncology, Department of Medicine,
Lineberger Comprehensive Cancer Center
The Cecil G. Sheps Center for Health Services Research
The University of North Carolina at Chapel Hill

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Financial relationships between physicians and the pharmaceutical industry are very common. However, we are just beginning to figure out whether these relationships may lead to potentially concerning changes in physician behavior – whether physicians tend to prescribe more of the drugs made by a company that has given them money. We decided to ask whether oncologists who receive money from drugmakers are more likely to use the cancer drugs made by companies that have given them money in the past.

In studying two specific groups of cancer drugs, one for kidney cancer and one for chronic myeloid leukemia (CML), we found that oncologists who had received payments such as meals, consulting fees, travel & lodging expenses from the manufacturer of one of these drugs tended to use that drug more. When looking at oncologists who received payments for research, we found increased prescribing among the kidney cancer drugs but not the CML drugs.

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Maryland’s Global Budget Plan Did Not Change Hospital or Primary Care Usage

MedicalResearch.com Interview with:

Eric T. Roberts, PhD Assistant Professor of Health Policy & Management University of Pittsburgh Graduate School of Public Health Pittsburgh, PA 15261

Dr. Roberts

Eric T. Roberts, PhD
Assistant Professor of Health Policy & Management
University of Pittsburgh Graduate School of Public Health
Pittsburgh, PA 15261

MedicalResearch.com: What is the background for this study?

Response: There is considerable interest nationally in reforming how we pay health care providers and in shifting from fee-for-service to value-based payment models, in which providers assume some economic risk for their patients’ costs and outcomes of care.  One new payment model that has garnered interest among policy makers is the global budget, which in 2010 Maryland adopted for rural hospitals.  Maryland subsequently expanded the model to urban and suburban hospitals in 2014.  Maryland’s global budget model encompasses payments to hospitals for inpatient, emergency department, and hospital outpatient department services from all payers, including Medicare, Medicaid, and commercial insurers.  The intuition behind this payment model is that, when a hospital is given a fixed budget to care for the entire population it serves, it will have an incentive to avoid costly admissions and focus on treating patients outside of the hospital (e.g., in primary care practices).  Until recently, there has been little rigorous evidence about whether Maryland’s hospital global budget model met policy makers’ goals of reducing hospital use and strengthening primary care.

Our Health Affairs study evaluated how the 2010 implementation of global budgets in rural Maryland hospitals affected hospital utilization among Medicare beneficiaries.  This study complements work our research group published in JAMA Internal Medicine (January 16, 2018) that examined the impact of the statewide program on hospital and primary care use, also among Medicare beneficiaries.

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Falls in Older Adults Cost US Over $50 Billion Dollars Annually

MedicalResearch.com Interview with:

Curtis Florence, PhD Division of Analysis, Research and Practice Integration  CDC’s Injury Center

Dr. Florence

Curtis Florence, PhD
Division of Analysis, Research and Practice Integration
CDC’s Injury Center

MedicalResearch.com: What is the background for this study?

Response: The estimates in this study provide a more robust indicator of the economic impact falls have on the U.S. economy.  Previous studies focused on Medicare spending. This study includes Medicare, Medicaid and out-of-pocket spending.

MedicalResearch.com: What are the main findings? 

Response: Our study found that older adult (65 years and over) falls impose a large economic burden on the U.S. healthcare system. In 2015, with a total medical cost $50 billion for non-fatal and fatal falls.  About three-quarters of the total cost was paid by government-funded programs.  Medicare paid nearly $29 billion for non-fatal falls, Medicaid $8.7 billion, and $12 billion was paid for by Private/Out-of-pocket expenses.  For fatal falls, $754 million was spent in 2015.

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The Economic Burden of Child Sexual Abuse is in the Billions

MedicalResearch.com Interview with:

Dr. Xiangming Fang, PhD Associate professor of Health Management and Policy School of Public Health Georgia State University

Dr. Xiangming Fang

Dr. Xiangming Fang, PhD
Associate professor of Health Management and Policy
School of Public Health
Georgia State University

MedicalResearch.com: What is the background for this study?

Response: Child sexual abuse is a serious public health problem in the United States. The estimated prevalence rates of exposure to child sexual abuse by 18 years old are 26.6 percent for U.S. girls and 5.1 percent for U.S. boys. The effects of child sexual abuse include increased risk for development of severe mental, physical and behavioral health disorders; sexually transmitted diseases; self-inflicted injury, substance abuse and violence; and subsequent victimization and criminal offending. Continue reading

Increased Hospital Spending After Heart Attack Linked To Modestly Lower Mortality

MedicalResearch.com Interview with:
Dr. Rishi K. Wadhera MD
Clinical Fellow in Medicine
Brigham and Women’s Hospital 

MedicalResearch.com: What is the background for this study?  

Response: The Hospital Value Based Purchasing program, in which over 3,000 hospitals participate, is a Centers for Medicare and Medicaid Services (CMS) pay-for-performance program that links hospital fee per service reimbursement to performance, through measures like 30-day mortality rates after an acute myocardial infarction (a heart attack), and other measures such as average spending for an episode of care for Medicare beneficiaries. Hospitals that perform poorly on these measures are financially penalized by CMS.

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