Cost of Health Care
02 Apr Economic Evaluation of a Home-Based Age-Related Macular Degeneration Monitoring System
Posted at 13:17h
in Author Interviews, Cost of Health Care, JAMA, Macular Degeneration, Ophthalmology, Telemedicine
MedicalResearch.com Interview with:
John Wittenborn
Senior research scientist
NORC's Public Health Analytics
University of Chicago
MedicalResearch.com: What is the background for this study? What are the main findings?
Response:The emergence of anti-VEGF treatment for wet-form AMD (choroidal neovascularization) has had a dramatic impact on preserving vision for many Americans. However, community-based studies show that most patients are not diagnosed with wet-form AMD until they have already lost a significant, and largely unrecoverable amount of their vision. Early detection of wet-form AMD is key to effective treatment and the preservation of vision. The ForeseeHome telemonitoring technology provides patients with a means to check their own eyes on a daily basis to detect the earliest signs of vision loss from wet-form AMD.
This is a novel technology that has the potential to improve visual health outcomes for AMD patients. A prior clinical trial (the AREDS-2 HOME study) demonstrated that this technology can detect wet-form AMD earlier, and with less vision loss than standard care alone. However, that is exactly where that study ended as it reported no cost information nor follow-up. Since the end of this study, the device has been cleared by the FDA and approved for reimbursement by Medicare for certain higher risk patients, but no study has yet considered the long-term implications of adoption of this technology.
In our analysis, we use a computer simulation model to essentially estimate what will come next, after patients realize earlier detection of wet-form AMD by utilizing home monitoring. Basically, we follow simulated patients from the time they begin monitoring for the rest of their lives, recording the likely impacts of home monitoring on patients’ long term outcomes including visual status, costs and quality of life.
We find that home telemonitoring among the population indicated for reimbursement by Medicare would cost $35,663 per quality adjusted life year (QALY) gained. Medicare would expect to incur $1,312 in net budgetary costs over 10 years for each patient who initiates monitoring. However, Medicare patients may expect to achieve lifetime net savings when accounting for the chance of avoided vision loss and its associated costs later in life.
29 Mar Knee Replacement Would Be More Cost Effective If Limited To Those With Severe Symptoms
MedicalResearch.com Interview with: [caption id="attachment_33519" align="alignleft" width="130"]
Dr. Bart Ferket[/caption]
Bart S Ferket, MD, PhD
Assistant Professor, Population Health Science and Policy
Icahn School of Medicine at Mount Sinai
MedicalResearch.com: What is the background for this study?
Response: The annual rate of total knee replacement in the US has doubled since 2000, and especially in those aged 45-65 utilization of this procedure has increased. The increase in practice cannot fully be explained by an increase in the prevalence of osteoarthritis and population growth, and has been partly attributed to expansion to people with less severe symptoms. The total number of procedures performed each year now exceeds 640,000. The evidence for the benefit of total knee replacement has been based on studies without a comparison group of no total knee replacement, and so far only one randomized clinical trial has been published. Although the published literature shows large improvements of pain, physical functioning and overall quality of life following the procedure, patients included in these studies generally had severe preoperative symptoms. A number of studies have suggested, however, that up to a third of recipients of total knee replacement show no benefit, and that those with poor physical functioning before surgery may show larger improvements. Therefore, the current US patient population undergoing total knee replacement might show less significant improvement in symptoms on average as compared with a hypothetical scenario in which eligibility is limited to those with more severe symptoms.
29 Mar Women With Health Insurance for IVF More Likely To Have Successful Live Birth
MedicalResearch.com Interview with: [caption id="attachment_33423" align="alignleft" width="133"]
Dr. Jungheim[/caption]
Emily S. Jungheim, MD, MSCI
Assistant Professor, Obstetrics and Gynecology
Division of Reproductive Endocrinology and Infertility
Washington University
St. Louis, Missouri
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Many women with health insurance lack coverage for fertility treatment so they end up being self-pay for fertility treatments which can be expensive and limit access to care.
15 states have responded with mandates for employers to include fertility coverage in their employee insurance benefits, and 5 of these have comprehensive mandates that include IVF. Illinois is one of these states. Washington University is located on the border between Illinois and Missouri so our fertility center treats a number of women with coverage for fertility treatment and a large number of women who are self-pay for fertility treatment. We suspected that women requiring IVF to conceive were more likely to follow through with treatments if they had coverage so we decided to look at our data.
Ultimately we confirmed our suspicions. Women with coverage were more likely to come back for additional cycles of IVF if they didn't conceive. Ultimately this ability to come back for additional treatment cycles led to a higher chance of live birth.
29 Mar Early Findings on Care Coordination in Capitated Medicare-Medicaid Plans under the Financial Alignment Initiative
MedicalResearch.com Interview with: Angela Greene Deputy director of Aging, Disability and Long Term Care Program RTI International MedicalResearch.com: What is the background for this study? What are the main findings? Response: The Medicare-Medicaid Coordination Office and the Innovation Center at the Centers for Medicare & Medicaid Services created the Financial Alignment Initiative to test integrated...
26 Mar Poorly Controlled Atopic Dermatitis Causes Significant Inpatient Financial Burden
MedicalResearch.com Interview with: [caption id="attachment_24142" align="alignleft" width="128"]
Dr. Jonathan Silverberg[/caption]
Dr. Jonathan L. Silverberg MD PhD MPH
Assistant Professor in Dermatology
Medical Social Sciences and Preventive Medicine
Northwestern University, Chicago, Illinois
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Atopic dermatitis (AD) is associated with considerable morbidity and quality of life impairment. AD patients may require hospitalization for acute treatment of serious flares and/or inadequately controlled chronic disease.
We examined data from the 2002-2012 National Inpatient Sample, which contains a representative 20% sample of all hospitalizations in the United States. We found that there were substantial numbers of children and adults hospitalized in the United States for AD. Hospitalization rates for atopic dermatitis were highest in the northeast during the winter likely due to cold and dry weather and south during the summer likely due to heat and humidity. Further, hospitalization rates for AD significantly increased in adults between 2002 and 2012. The costs per individual hospitalization were lower in children and adults with AD compared to those without atopic dermatitis. However, the high prevalence of hospitalization resulted in total inpatient costs of >$8 and >$3 million per-year for adults and children, respectively.
25 Mar Home Health Care Providers Increase, But Geographic Variability Persists
MedicalResearch.com Interview with: Sheila Eckenrode RN, CPHQ Quality Improvement Consultant The New England QIN-QIO Qualidigm, Wethersfield, Connecticut MedicalResearch.com: What is the background for this study? Response: Post-acute care has become a focus for improving quality and cost effectiveness of healthcare in the United States. Changes in Medicare payment systems such as bundled payments and the emergence of Affordable Healthcare Organizations will most likely lead to expansion of post-acute care services and decrease in acute care hospitalizations. Approximately 30% of hospitalized Medicare beneficiaries were referred to home health care at discharge in 2012. In 2013, home health agencies served 3.5 million beneficiaries with Medicare paying $18 billion for these services. Home health care has been emphasized under the Improving Medicare Post-Acute Care Transformation Act of 2014 to provide and improve care at individual patient and community levels. In anticipation of increasing utilization of home care services, our study aimed to demonstrate the overall growth in home care availability as well as identify geographical variation and potential gaps in service.23 Mar Gunshot Injuries Cost US Taxpayers Billions
MedicalResearch.com Interview with: Sarabeth Spitzer MD Candidate | MS2 Stanford University School of Medicine MedicalResearch.com: What is the background for this study? Response: While firearm homicides make headlines, they cause many more injuries than deaths.[1] No one had performed any recent analysis on the costs of hospitalizations for firearm-related injuries. Stanford is a Level One trauma center, and we care for patients injured by firearms. We wanted to know how much it costs the health system to treat these patients.17 Mar Buprenorphine Prescriptions for Opioid Use Disorder Rise With Medicaid Expansion
MedicalResearch.com Interview with: [caption id="attachment_33049" align="alignleft" width="125"]
Dr.Hefei Wen[/caption]
Hefei Wen, PhD
Assistant Professor, Department of Health Management & Policy
University of Kentucky College of Public Health
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Buprenorphine has been proven effective in treating opioid use disorder. However, the high cost of buprenorphine and the limited prescribing capacity may restrict access to this effective medication-assisted treatment (MAT) for opioid use disorder.
We found a 70% increase in Medicaid-covered buprenorphine prescriptions and a 50% increase in buprenorphine spending associated with the implementation of Medicaid expansions in 26 states during 2014. Physician prescribing capacity was also associated with increased buprenorphine prescriptions and spending.
17 Mar Number Of Epipen Prescriptions for Kids Skyrockets
MedicalResearch.com Interview with: Lavanya Diwakar, FRCPath Honorary consultant in immunology Queen Elizabeth Hospital, Birmingham, and Research fellow in health economic University of Birmingham Birmingham UK MedicalResearch.com: What is the background for this study? Response: The rate of anaphylaxis (serious, potentially life threatening manifestation of allergy) has increased in the last decade. There have been some reports from other countries about an increase in the number of adrenaline autoinjectors being prescribed in children, but this has not been systematically examined in the UK. We looked at a database of patient records from over 500 general practices, THIN (the Health Improvement Network), between 2000 and 2012. We found nearly 24,000 children who had been identified as being at risk of anaphylaxis by General Practitioners and prescribed epipens.15 Mar Out-of-Pocket Expenditures for Adults with Multiple Chronic Conditions
MedicalResearch.com Interview with: Anita Soni, PhD, MBA Survey Analyst/Statistician Agency for Healthcare Research and Quality Rockville, MD MedicalResearch.com: What is the background for this study? Response: This statistical brief uses the data from the Medical Expenditure Panel Survey (MEPS), which is a nationally representative survey of the U.S. civilian noninstitutionalized population that collects data on the demographic characteristics, health conditions, health status, use of medical care services, charges and payments, access to care, satisfaction with care, health insurance coverage, income, and employment of Americans. This brief focuses on adults 18 and older who received some medical care in 2014. Persons who have multiple chronic conditions—those who were treated for two or more conditions considered to be chronic during 2014 -- are compared to those who, while they had medical care, reported use associated with only one or no chronic conditions.13 Mar Increased Physician Spending On Hospital Care Does Not Improve Outcomes
MedicalResearch.com Interview with: Yusuke Tsugawa, research associate Department of Health Policy and Management Harvard T H Chan School of Public Division of General Internal Medicine and Primary Care Brigham and Women’s Hospital, Boston, MA MedicalResearch.com: What is the background for this study? What are the main findings? Response: It is well known that health spending varies substantially across geographical regions, and yet regions that spend more on health care dot not achieve better health outcomes. These findings has led to many to conclude that at least 20% of U.S. health care spending could be reduced without compromising quality of care. However, while physicians play a critical role in health care decision making, little is known as to how much health care spending varies between physicians, and its implications for patient outcomes. In this study, we found that the variation in spending across physicians is slightly larger than the variation across hospitals. More importantly, higher spending by physicians did not lead to lower patient mortality or readmission rates, within the same hospital.07 Mar Diabetes Prevention Program Reduced Health Care Costs In First Year
MedicalResearch.com Interview with: [caption id="attachment_32757" align="alignleft" width="118"]
Dr. Maria Alva[/caption]
Maria L. Alva, DPhil
Public Health Economics Program
RTI International
701 13 Street, NW, Suite 750
Washington, DC 20005
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Diabetes affects more than 25 percent of Americans over 65. The estimated economic cost of diagnosed diabetes is $245 billion a year. In spite of this we have almost no evidence of the impact of programs geared to stave off the cost of diabetes.
The Y-USA received a Health Care Innovation Award of $11.8 million from the Centers for Medicare & Medicaid Services to offer a diabetes prevention program to individuals 65 and over with prediabetes. The goal of the Y-USA model is to get participants to lose 5 percent or more of their body weight and gradually increase their physical activity to 150 minutes per week. The program lasts a year. The curriculum comprises sixteen weekly core sessions about healthy eating, exercise and motivation followed by eight monthly maintenance sessions.
Epidemiological data from other studies have shown that the risk of diabetes increases with increased levels of BMI. There is mounting evidence that it is possible to prevent or delay diabetes through life-style intervention. It is unclear, however, whether weight-loss interventions can yield reductions in medical spending.
The objective of our analysis was to establish whether the -USA Diabetes Prevention Program reduces health care spending and utilization among fee-for-service Medicare beneficiaries.
07 Mar Over-the-Counter Hearing Aids Had Similar Outcomes to More Expensive Devices
MedicalResearch.com Interview with: [caption id="attachment_32744" align="alignleft" width="182"]
Dr. Larry Humes[/caption]
Larry Humes, PhD, CCC-A
Department of Speech and Hearing Sciences
Indiana University Bloomington
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: About 40% of adults over the age of 60 have significant hearing loss, yet only about 20% of these older Americans seek help and eventually purchase hearing aids. There have been several national calls for improvements in the accessibility and affordability of hearing health care for adults, especially older adults, including a 2015 report by the President’s Council of Advisors in Science and Technology and a 2016 report by the National Academies of Science, Engineering and Medicine. One strategy in common to both of these recent reports is to make hearing aids available directly to the consumer via over-the-counter service delivery.
This study was a double-blind placebo-controlled randomized clinical trial investigating two different service-delivery approaches, best-practices and over-the-counter, and two different purchase prices for the hearing aids ($600/pair, $3600/pair). For the most part, purchase price had no influence on outcomes. Hearing aids delivered via the best-practices service-delivery model were confirmed to be efficacious, but almost identical positive outcomes were obtained via the over-the-counter service-delivery approach.
07 Mar Most Patients Do Not Know Their Doctors Receive Industry Payments
MedicalResearch.com Interview with: [caption id="attachment_32691" align="alignleft" width="140"]
Dr. Kanter[/caption]
Genevieve Kanter, PhD Assistant Professor
Department of Health Management and Policy
Drexel University Dornsife School of Public Health
Philadelphia, PA
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: We were interested in the exposure of patients to doctors who accept industry payments. Previous research on physician payments has focused on the percentage of doctors who accepted payments, but these estimates can give a partial or misleading picture of the reach of industry payments in relation to the typical patient. No studies had previously taken a population-based approach to estimate the reach of industry payments.
We conducted a nationally representative survey of 3542 Americans. We asked respondents about their awareness of industry payments and if they knew whether their own doctor had received an industry payment. We also asked them to identify the doctor they had visited most frequently in the previous 12 months and linked this information to Open Payments, a government website that reports payments made to doctors by prescription drug and device manufacturers.
We found that 65%, or almost two-thirds, of patients had seen--in the past 12 months--a physician who had received an industry payment. For some specialties, patient contact with doctors who had industry contact was much higher; 77% of patients who saw an obstetrician/gynecologist visited a doctor who had accepted payments, and 85% of patients who saw an orthopedic surgeon visited a doctor who had accepted payments.
At the same time, very few people knew whether their own doctor had received payments; only 5% of respondents reported knowing whether their doctor had received an industry payment.
06 Mar Without Paid Sick Leave Workers Less Likely To Get Flu Shots and Preventive Care
MedicalResearch.com Interview with: Dr. LeaAnne DeRigne Associate Professor School of Social Work Florida Atlantic University Boca Raton, FL 33431 MedicalResearch.com: What is the background for this study? What are the main findings? Response: “Compared to 22 similarly developed countries, the United States is the only one that does not mandate employers to provide paid sick leave benefits or include paid sick leave in a universal social insurance plan,” said LeaAnne DeRigne, Ph.D., lead author and an associate professor in the School of Social Work within FAU’s College for Design and Social Inquiry. For the study, DeRigne and collaborators used cross-sectional data from a sample of 13,545 adults aged 18-64 with current paid employment from the 2015 National Health Interview Survey (NHIS). They examined the relationship between having paid sick leave and obtaining eight preventive care services: blood pressure check; cholesterol check; fasting blood sugar check; getting a flu shot; being seen by a medical doctor or health care provider; getting a Pap test (females only); getting a mammogram (females only); and getting tested for colon cancer. The analysis controlled for demographic and other important predictor variables including gender, marital status, education, race/ethnicity, full time work, insurance coverage, health status, limiting health conditions, family income, age, and family size.04 Mar Pediatric Asthma Costs Over $5 Billion Per Year In Health Care Expenses
MedicalResearch.com Interview with: [caption id="attachment_32645" align="alignleft" width="132"]
Dr. Sullivan[/caption]
Patrick W. Sullivan, Ph.D.
Professor
Regis University School of Pharmacy
Denver, CO 80221
MedicalResearch.com: What is the background for this study?
Response: Asthma is one of the most common chronic disorders among children. It affects 7.1 million children in the U.S. Of these, 4.1 million children suffered an asthma attack in 2011. An asthma attack is an acute period of extreme difficulty breathing. It can be life threatening and is always very frightening for children. Because asthma can be dangerous and frightening, it ends up costing a lot because patients need to go the doctor, hospital or take medications to try to control it.
Asthma also has a negative effect on the patient’s health and outlook about their health – both mentally and physically. Previous studies have focused on adults with asthma and have found that it is very expensive – it costs $18 billion in the U.S. to manage adults with asthma. Those studies also showed that adults with asthma have lower quality of life. However, there is not a lot of good evidence on the burden of asthma in children. This study was designed to quantify the cost and mental and physical health of children with asthma in the U.S.
28 Feb Primary Care Wait Times For Medicaid Patients Increased Modestly Under Affordable Care Act
MedicalResearch.com Interview with: [caption id="attachment_32467" align="alignleft" width="192"]
Dr. Molly Candon[/caption]
Molly Candon, PhD
Fellow
Leonard Davis Institute of Health Economics, The Wharton School
Center for Mental Health Policy and Services Research, Perelman School of Medicine
University of Pennsylvania
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Primary care practices are less likely to schedule appointments with Medicaid patients compared to the privately insured, largely due to lower reimbursement rates for providers. Given the gap in access, concerns have been raised that Medicaid enrollees may struggle to translate their coverage into care. Despite the substantial increase in demand for care resulting from provisions in the Affordable Care Act (ACA), our 10-state audit study recently published in JAMA Internal Medicine finds that primary care appointment availability for new patients with Medicaid increased 5.4 percentage points between 2012 and 2016, while appointment availability for patients with private coverage did not change.
Over the same time period, both Medicaid patients and the privately insured experienced slight increases in wait times.
17 Feb Tool Can Help Avoid Overtesting in Evaluation of Chest Pain
MedicalResearch.com Interview with: [caption id="attachment_32148" align="alignleft" width="142"]
Dr. James Udelson[/caption]
James E. Udelson, MD
Chief, Division of Cardiology
Director, Nuclear Cardiology Laboratory
Professor, Tufts University School of Medicine
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: There are millions of stress tests done every year in the United States and many of them are normal,” said James Udelson, MD, Chief of the Division of Cardiology at Tufts Medical Center and the senior investigator on the study. “We thought that if we could predict the outcome of these tests by using information we already had from the patient before the test, we could potentially save the health care system money and save our patients time and worry.” We were able to get a strong prediction of the possibility of having entirely normal testing and no clinical events such as a heart attack, by developing a risk prediction tool using ten clinical variables that are commonly available to a physician during an evaluation”
15 Feb Heart Disease Costs Expected To Top $1Trillion Per Year By 2035
MedicalResearch.com Interview with: [caption id="attachment_32066" align="alignleft" width="200"]
Olga Khavjou[/caption]
Olga Khavjou
RTI International
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Cardiovascular disease (CVD) is the leading cause of death in the United States and is one of the costliest chronic diseases. As the population ages, CVD costs are expected to increase substantially. To improve cardiovascular health and control health care costs, we must understand future prevalence and costs of CVD.
In 2015, 41.5% (more than 100 million people) of the U.S population was estimated to have some form of CVD. By 2035, the number of people with CVD is projected to increase to over 130 million people, representing a 30% increase in the number of people with CVD over the next 20 years. Between 2015 and 2035, real total direct medical costs of CVD are projected to more than double from $318 billion to $749 billion and real indirect costs (due to productivity losses) are projected to increase from $237 billion to $368 billion. Total costs (medical and indirect) are projected to more than double from $555 billion in 2015 to $1.1 trillion in 2035.
25 Jan Many CT Scans Can Be Avoided During ER Evaluation of Head Trauma
Posted at 23:13h
in Author Interviews, Brain Injury, Cost of Health Care, CT Scanning, Electronic Records, Emergency Care, Kaiser Permanente
MedicalResearch.com Interview with:
[caption id="attachment_31510" align="alignleft" width="156"]
Dr. Adam Sharp[/caption]
Adam L. Sharp MD MS
Research Scientist/Emergency Physician
Kaiser Permanente Southern California
Kaiser Permanente Research
Department of Research & Evaluation
Pasadena, CA 91101
MedicalResearch.com: What is the background for this study?
Response: Millions of head computed tomography (CT) scans are ordered annually in U.S. emergency Departments (EDs), but the extent of avoidable imaging is poorly defined. Ensuring appropriate use is important to ensure patient outcomes and limited resources are optimized. A large number of stake holders have highlighted the need to reduce “unnecessary” CT scanning as part of their recommendations for the Choosing Wisely campaign. However, despite calls for improved stewardship, the extent of avoidable CT use among adults with minor trauma in community EDs is not known.
The Canadian CT Head Rule (CCHR) is perhaps the most studied of many validated decision instruments designed to assist providers in evaluating patients with minor head trauma. This study aims to describe the scope of overuse of CT imaging by ED providers in cases where application of the CCHR could have avoided imaging.
Secondarily, we sought to describe the extent to which avoidable CTs, if averted, would have resulted in “missed” intracranial hemorrhages requiring a neurosurgical intervention.
23 Jan Non-Dialysis Chronic Kidney Disease Expenses On Par With Cancer and Stroke
MedicalResearch.com Interview with: [caption id="attachment_31437" align="alignleft" width="134"]
Dr. Talar Markossian[/caption]
Talar W. Markossian PhD MPH
Assistant Professor of Health Policy
Loyola University Chicago
2160 S. First Ave, CTRE 554
Maywood, IL 60153
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Approximately 10% of U.S. adults currently have non-dialysis dependent chronic kidney disease (CKD), while dialysis dependent CKD accounts for only 0.5% of the U.S. population. The escalation in healthcare expenditures associated with CKD starts prior to requirement for dialysis, and treatment costs escalate as non-dialysis dependent CKD progresses.
We examined the total healthcare expenditures including out-of-pocket costs for non-dialysis dependent and compared these expenditures with those incurred for cancer and stroke in the U.S. adult population. After adjusting for demographics and comorbidities, the adjusted difference in total direct healthcare expenditures was $4746 (95% CI $1775-$7718) for CKD, $8608 (95% CI $6167-$11,049) for cancer and $5992 (95% CI $4208-$7775) for stroke vs. group without CKD, cancer or stroke. Adjusted difference in out-of-pocket healthcare expenditures was highest for adults with CKD ($760; 95% CI 0-$1745) and was larger than difference noted for cancer ($419; 95% CI 158–679) or stroke ($246; 95% CI 87–406) relative to group without CKD, cancer or stroke.
23 Jan ACA Medicare Changes Increased Diagnosis of Early-Stage Colorectal Cancer Among Seniors.
MedicalResearch.com Interview with: [caption id="attachment_31434" align="alignleft" width="200"]
Dr. Nengliang Yao[/caption]
Nengliang “Aaron” Yao PhD
Assistant professor
Department of Public Health Sciences
University of Virginia
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The ACA made several changes in Medicare that could increase the use of cancer screening and thus lead to more early cancer diagnoses. This includes waiving patient cost-sharing for screening, waiving patient cost-sharing for one wellness visit per year, and paying bonuses to physicians for doing more work in a primary care setting.
We studied how effective those changes were in facilitating more early diagnoses of breast and colorectal cancers. We found that the changes had no effect on early breast cancer diagnoses (likely because costs and other access barriers for mammograms were already low), but increased the number of early colorectal cancer diagnoses by 8 percent.
19 Jan Do Financial Conflicts Influence CDC Guidelines For Prescription Opioids?
MedicalResearch.com Interview with: Dora Lin, MHS Sr. Research Assistant Johns Hopkins Bloomberg School of Public Health Center for Drug Safety and Effectiveness Baltimore, MD 21205 MedicalResearch.com: What is the background for this study? What are the main findings? Response: In response to the opioid epidemic and growing number of overdose deaths each year, the CDC released draft guidelines to improve the safe use of opioids in primary care. The draft guidelines were open to public comment, and many organizations, ranging from professional societies to consumer advocates to local governmental organizations, submitted comments regarding the guidelines. We examined the levels of support or non-support for the draft guidelines among the 158 organizations who submitted comments. We also examined each organization’s relationship to opioid manufacturers. Most organizations supported the guidelines, regardless of whether or not they had a financial relationship to a drug company. However, organizations receiving funding from opioid manufacturers were significantly more likely to be opposed to the guidelines than those who did not receive such funding.17 Jan Conflicts of Interest In Medical Guideline Committees Underreported
MedicalResearch.com Interview with: [caption id="attachment_31328" align="alignleft" width="200"] Dr. Akilah Jefferson[/caption] Akilah Jefferson, MD, MSc Postdoctoral Fellow, Clinical Center, Department of Bioethics Clinical Fellow, Allergy and Immunology National Institute of Allergy and Infectious Diseases National Institutes of Health MedicalResearch.com: What is the background for this study? What are the main findings? Response: The guidelines that we looked at in...
17 Jan When Patients Can’t Choose: Out-of-Network Care Can Be Costly
MedicalResearch.com Interview with: [caption id="attachment_31255" align="alignleft" width="150"]
Dr. Ge Bai[/caption]
Ge Bai, PhD, CPA
Assistant Professor
The Johns Hopkins Carey Business School
Washington, DC 20036
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The average anesthesiologist, emergency physician, pathologist and radiologist charge more than four times what Medicare pays for similar services, often leaving privately-insured out-of-network patients stuck with surprise medical bills that are much higher than they anticipated.
The average physician charged roughly 2.5 times what Medicare pays for the same service. There are also regional differences in excess charges. Doctors in Wisconsin, for example, have almost twice the markups of doctors in Michigan (3.8 vs. two).
11 Jan No Evidence Chronically Ill or Patients With High Deductibles Forego Medical Care
MedicalResearch.com Interview with: [caption id="attachment_31052" align="alignleft" width="131"]
Dr. Joel Segel[/caption]
Joel Segel, Ph.D.
Assistant Professor
Department of Health Policy and Administration
The Pennsylvania State University
University Park, PA 16802
MedicalResearch.com: What is the background for this study?
Response: Americans’ health insurance plans increasingly include deductibles, which require patients to pay a certain amount out-of-pocket before the health plan will cover most services. In addition, the levels of these deductibles have been increasing with more and more Americans enrolling in high-deductible health plans (HDHP’s), which in 2013 were plans with a deductible of $1,250 or more for an individual or $2,500 or more for a family. Furthermore, nearly 40% of those with private insurance have a HDHP including most of the bronze and silver plans on the federal Marketplace. This trend has many worried that patients are facing greater financial risk and may delay or forego necessary care because of costs. A population that may be most vulnerable to these problems are Americans with common chronic conditions.
11 Jan Little Evidence Pay-For-Performance Improves Patient Outcomes
MedicalResearch.com Interview with: [caption id="attachment_31055" align="alignleft" width="200"]
Dr. Devan Kansagara[/caption]
Devan Kansagara MD, MCR
Associate Professor of Medicine
Oregon Health and Science University
Director, Evidence-based Synthesis Program, Portland VA Medical Center
Staff Physician, Portland VA Medical Center
MedicalResearch.com: What is the background for this study?
Response: Historically, the US health care system has been dominated by a fee-for-service payment structure in which health care providers are paid for discrete procedures and visits regardless of care quality. Pay for performance programs are part of the move towards value-based care. They tie a portion of payments to individual health care providers, institutions, or health care systems to performance on a discrete set of measures of health care quality.
In theory, these programs are meant to encourage the right care at the right time and thereby improve the health of the patient population. Over the last decade, many studies in and outside the US have examined whether or not, in fact, these programs do result in improved care, reduced cost, and improved patient health. Our study is a systematic review of this literature.
10 Jan Prostate Cancer Treatment Declines Sharply in General Population, But Not Among Diagnosed Men
MedicalResearch.com Interview with: Tudor Borza, MD, MS Urologic Oncology and Health Service Research Fellow Department of Urology, University of Michigan MedicalResearch.com: What is the background for this study? Response: Starting in the late 2000’s studies began to identify overdiagnosis and overtreatment in men with prostate cancer. Because of the indolent nature of some prostate cancers many men who ended up diagnosed and treated would have never had any consequences from their prostate cancer. This led national organizations (like the American Urological Association and the National Comprehensive Cancer Network) to call for decreased prostate cancer screening (using the serum PSA test) and eventually led to the US Preventive Services Task Force to recommend against routine PSA screening, citing that the harms from diagnosis and treatment outweighed the harms from the disease. Over the same specialists treating the disease began to report on the safety of surveillance strategies in select men with prostate cancer. Watchful waiting (delaying any treatment until men become symptomatic from their cancer and then offering palliative treatment) was found to be comparable to initial treatment in men with a limited life expectance, either from advanced age or multiple comorbidities. Similarly, active surveillance (a technique employing intense monitoring with PSA testing, digital rectal exams, repeat biopsies and possible use of MRI or other biomarkers) was introduced with the goal of delaying treatment in some men with low risk cancer until the cancer becomes more aggressive and was shown to have similar outcomes to initial treatment in carefully selected men. We wanted to study the trends in initial prostate cancer treatment in this context of recommendations for decreased screening and recognition of the feasibility of surveillance in certain patients with prostate cancer.09 Jan Do High-Deductible Insurance Plans Cause Patients To Delay Health Care?
Posted at 21:56h
in Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, Diabetes, JAMA
MedicalResearch.com Interview with:
J. Franklin Wharam MD MPH
Associate Professor, Harvard Medical School
Director, Division of Health Policy and Insurance Research
DPM Site Director, Harvard Medical School General Internal Medicine Fellowship
Harvard Medical School and HPHCI Department of Population Medicine
MedicalResearch.com: What is the background for this study?
Response: High-deductible health plans have been increasing over the last decade and are now the most common form of private health insurance. It also appears that high-deductible plans associated with health savings accounts will be the centerpiece of the new presidential administration’s plan to replace the Affordable Care Act.
In high-deductible plans, members pay more out-of-pocket for services such as specialist visits, emergency department visits, and hospitalizations, so patients might delay or skip needed care due to high costs.
The theory behind high-deductible insurance is that patients paying out-of-pocket for health care, sometimes called having “skin in the game,” will consider their health care use more carefully than if they are spending “someone else’s money.” It is hoped that this will motivate patients to receive only care they truly need rather than services that have not been shown to improve health, such as an MRI for uncomplicated low back pain. However, it could be challenging for patients to make this distinction, and those facing a high burden of costs might decide to take a chance and delay or skip care even if they think it would be beneficial.
We decided to examine how high-deductible health plans affect people with diabetes because these patients often need frequent, expensive health care services and no studies have examined adverse outcomes among chronically ill patients in high-deductible plans. Skipping or delaying needed diabetes care could cause patients to be sicker in the future and could therefore increase the need for more expensive or higher acuity care.
This study focused on whether high-deductible enrollment among people with diabetes changed outpatient visits and routine disease monitoring, and effects of such potential changes.