ACA Medicaid Expansion Linked To Decrease in Uninsured Cancer Patients

MedicalResearch.com Interview with:

Aparna Soni, MA Department of Business Economics and Public Policy Kelley School of Business Indiana University, Bloomington

Aparna Soni

Aparna Soni, MA
Department of Business Economics and Public Policy
Kelley School of Business
Indiana University, Bloomington

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

Response: Cancer is the leading cause of death among the non-elderly population in the United States. Unfortunately, uninsured people are less likely to get screened for cancer, and treatment is often unaffordable for those who are uninsured.

One of the key objectives of the Affordable Care Act (ACA) was to improve outcomes for cancer patients. Our objective in this study was therefore to assess changes under the ACA in insurance coverage among patients newly diagnosed with cancer.

Our main finding is that uninsurance among patients with newly diagnosed cancer fell by one-third in 2014.

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Maryland All-Payer Model Produced Outpatient and ER Medicare Savings

MedicalResearch.com Interview with:
Susan G. Haber, Sc.D.

Director, Health Coverage for Low-Income and Uninsured Populations
RTI International
Waltham, MA

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

Response: In 2014, the state of Maryland and the federal Centers for Medicare and Medicaid Services (CMS) began testing an alternative payment structure for inpatient and outpatient hospital services. Known as the All-Payer Model, the new system limits hospitals’ revenues from Medicare, Medicaid, and private insurers to a global budget for the year. This builds on Maryland’s hospital rate-setting system that had operated since the 1970s, where all payers pay the same rates. CMS wanted to test whether global budgets could help Maryland limit cost growth and reduce avoidable hospital use. The goal of the model is to limit per capita total hospital cost growth for both Medicare and all payers and to generate $330 million in Medicare savings over 5 years.

RTI researchers studied the impact of hospital global budgets on Medicare beneficiary expenditures and utilization, using Medicare claims data to compare changes in Maryland before and after adoption of global budgets with changes in matched comparison areas outside of the state. Our report found Maryland has reduced total Medicare expenditures by approximately $293 million and total hospital expenditures by about $200 million in its first two years of operation. The reduction in overall expenditures indicates that “squeezing the balloon” on hospital expenditures did not simply produce a cost-shift to other health care sectors. Hospital expenditure savings for Medicare were achieved by reducing expenditures for outpatient emergency department and other hospital outpatient department services. Although inpatient admissions declined, there were no savings in Medicare expenditures for inpatient hospital services because the payment per admission increased. Maryland hospitals reduced avoidable utilization, including admissions for ambulatory care sensitive conditions, and readmissions and emergency department visits following hospital discharge. Despite the success in reducing expenditures, interviews with senior leaders at Maryland hospitals and focus group discussions with physicians and nurses suggest that many hospitals had not yet made fundamental changes in how they operate or developed partnerships with community physicians to divert care from the hospital, although there was variation in how hospitals responded.

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CMV Infections Increase Complications and Costs After Stem Cell Transplantation

MedicalResearch.com Interview with:

Dr. Jonathan Schelfhout, PhD Director, Outcomes Research Merck & Co. Inc. North Wales, PA

Dr. Schelfhout

Dr. Jonathan Schelfhout, PhD
Director, Outcomes Research
Merck & Co. Inc.
North Wales, PA

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

Response: The cost of hematopoietic stem cell transplantation has received increased attention after it was identified as a top 10 contributor to increasing healthcare costs in an AHRQ 2016 report. Many recent studies have explored the cost of HSCT but additional research is needed on the costly complications that can follow the transplant procedure. This research is particularly relevant for inpatient decision makers, as most transplant centers receive one bundled payment for the transplant and the treatment of any complications over the first 100 days.

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Low-Cost, High-Volume Services Add Billions To US Health Care Tab

MedicalResearch.com Interview with:

John N. Mafi MPH Assistant Professor of Medicine David Geffen School of Medicine University of California, Los Angeles Natural scientist in Health Policy RAND Corporation Santa Monica, California

Dr. Mafi

John N. Mafi MD MPH
Assistant Professor of Medicine
David Geffen School of Medicine
University of California, Los Angeles
Natural scientist in Health Policy
RAND Corporation
Santa Monica, California

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

Response: Of the 3 trillion dollars the U.S. spends annually on health care, an estimated 10-30% consists of “low-value care”, or patient care that provides no net benefit in specific clinical scenarios (think antibiotics given for the common cold virus). Determining where and why this waste occurs is critical to efforts to safely reducing healthcare spending. Little is known, however, about the distribution of costs among such “low-value” services. In this context, we used the Virginia All Payer Claims Database in order to assess the quantity and total costs of 44 low-value services in 2014 among 5.5 million beneficiaries.

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Stepped Care Case-Finding Intervention Can Provide Cost Effective Care For PTSD After a Disaster

MedicalResearch.com Interview with:

Dr-Gregory-H-Cohen.jpg 

Dr. Cohen

Gregory H. Cohen, MPhil, MSW
Statistical Analyst
Department of Epidemiology
School of Public Health
Boston University 

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

Response: We simulated a stepped care case-finding approach to the treatment of posttraumatic stress in New York City, in the aftermath of Hurricane Sandy.

Stepped care includes an initial triage screening step which identifies whether a presenting individual is in need of Cognitive Behavioral Therapy, or can be adequately treated at a lower level of care.

Our simulation suggests that a stepped care approach to treating symptoms of posttraumatic stress in the aftermath of a hurricane is superior to care as usual in terms of reach and treatment-effectiveness, while being cost-effective. Continue reading

Employer Health Plans Spend At Least $6 Billion Per Year On Preterm Infant Care

MedicalResearch.com Interview with:

Scott D. Grosse, PhD National Center on Birth Defects and Developmental Disabilities CDC 

Dr. Scott Grosse

Scott D. Grosse, PhD
National Center on Birth Defects and Developmental Disabilities
CDC 

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

Response: The U.S. Institute of Medicine (IOM) in 2007 published estimates of the economic costs associated with preterm birth. That report is publicly available: https://www.ncbi.nlm.nih.gov/pubmed/20669423. The total societal cost over a lifetime of a single year’s cohort of infants born preterm was estimated as $26 billion in 2005 US dollars. The study in Pediatrics sought to provide more current estimates of one component of those costs: medical care between birth and 12 months and to answer two additional questions:

  1. What costs are specifically incurred by employer-sponsored private health plans?
  2. How much of the overall cost burden of prematurity is attributable to infants born preterm with major birth defects (congenital malformations and chromosome abnormalities)?

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Almost $3 Billion Spent Per Year On Injuries From Firearms

MedicalResearch.com Interview with:
Faiz Gani MD
Postdoctoral research fellow
Department of Surgery
Johns Hopkins University School of Medicine
Baltimore, Maryland

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

Response: The current study sought to evaluate epidemiological trend in emergency department (ED) visits for firearm-related injuries in the US.

In our study, we observed that 25.3 patients per 100,000 presented to the ED for a firearm-related injury. This translated to over 78,000 ED visits per year.

Over time, while firearm injuries decreased from 2006-2013, an increase in the incidence of firearm-related injuries was observed in 2014.

Additionally, over time injuries among older patients and those injured in an unintentional firearm injury increased. Injuries due to an assault decreased over time.

The average ED and inpatient charges were $5,254 and $95,887, respectively, resulting in an overall financial burden of approximately $25 billion over the study or an annual $2.8 billion in ED and inpatients charges.

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Coordination Program Reduced ER Visits and Readmissions in Medicaid Population

MedicalResearch.com Interview with:

Roberta Capp MD Assistant Professor Director for Care Transitions in the Department of Emergency Medicine University of Colorado School of Medicine Medical Director of Colorado Access Medicaid Aurora Colorado

Dr. Capp

Roberta Capp MD
Assistant Professor
Director for Care Transitions in the Department of Emergency Medicine
University of Colorado School of Medicine
Medical Director of Colorado Access Medicaid
Aurora Colorado

 

 

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

Response: Medicaid clients are at highest risk for utilizing the hospital system due to barriers in accessing outpatient services and social determinants.

We have found that providing care management services improves primary care utilization, which leads to better chronic disease management and reductions in emergency department use and hospital admissions.

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Does Brand Name 17P Work Better Than Generic In Reducing Preterm Births?

MedicalResearch.com Interview with:

Andrew L. Beam, PhD Instructor in Biomedical Informatics Department of Biomedical Informatics Harvard Medical School

Dr. Beam

Andrew L. Beam, PhD
Instructor in Biomedical Informatics
Department of Biomedical Informatics
Harvard Medical School

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

Response: This study is one piece of a larger story regarding the use of 17-alpha-hydroxyprogesterone caproate (17P) to treat recurrent preterm birth. This drug was originally only available in a compounded form, but since receiving an orphan drug designation in 2011, a branded and manufactured form was marketed under the name “Makena”. This branded form was then sold for a much higher price than the compounded version, but a study that provided concrete data on pricing and outcomes had not been done.
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Financial Incentives to Physicians Did Not Increase Hospital Discharge Follow-Up Visits

MedicalResearch.com Interview with:

Dr. Lauren Lapointe-Shaw, MD Physician at University Health Network Department of Medicine University of Toronto 

Dr. Lapointe-Shaw

Dr. Lauren Lapointe-Shaw, MD
Physician at University Health Network
Department of Medicine
University of Toronto 

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

Response: Readmissions after hospital discharge are common and costly. We would like to reduce these as much as possible. Early physician follow-up post hospital discharge is one possible strategy to reduce readmissions. To this end, incentives to outpatient physicians for early follow-up have been introduced in the U.S. and Canada. We studied the effect of such an incentive, introduced to Ontario, Canada, in 2006.

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