Cost of Health Care
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.
09 Jan ACA: Screening Disparities Fall For Mammograms But Not Colonoscopies
Posted at 13:02h
in Author Interviews, Breast Cancer, Cancer Research, Colon Cancer, Cost of Health Care, Mammograms, Medical Imaging, Race/Ethnic Diversity, Radiology
MedicalResearch.com Interview with:
[caption id="attachment_31020" align="alignleft" width="133"]
Dr. Gregory Cooper[/caption]
Dr. Gregory Cooper, MD
Program Director, Gastroenterology
UH Cleveland Medical Center
Co-Program Leader for Cancer Prevention and Control, UH Cleveland Medical Center
Professor, Medicine, CWRU School of Medicine
Co-Program Leader for Cancer Prevention and Control
UH Seidman Cancer Center
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The Affordable Care Act, among other features, removed out of pocket expenses for approved preventive services, and this may have served as a barrier to cancer screening in socioeconomically disadvantaged individuals. If so, then the gap in screening between socioeconomic groups should narrow following the ACA.
The main findings of the study were that although in the pre-ACA era, there were disparities in screening, they narrowed only for mammography and not colonoscopy.
08 Jan Economic Effects of Medicaid Expansion in Michigan
MedicalResearch.com Interview with: [caption id="attachment_31066" align="alignleft" width="142"]
Dr. John Z. Ayanian[/caption]
John Z. Ayanian, MD, MPP
Director of the Institute for Healthcare Policy and Innovation and
Alice Hamilton Professor of Medicine
University of Michigan
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Our study assessed the broad economic impact of Medicaid expansion in Michigan – one of several Republican-led states that have chosen to expand Medicaid under the Affordable Care Act. About 600,000 low-income adults in Michigan are covered through the program, known as the Healthy Michigan Plan, which began in April 2014.
Using an economic modeling tool that is also used to advise the state government for fiscal planning, we found that federal funding for the Healthy Michigan Plan is associated with over 30,000 additional jobs, about $2.3 billion in increased personal income in Michigan, and about $150 million in additional state tax revenue annually. One third of the new jobs are in health care, and 85 percent are in the private sector. The state is also saving $235 million annually that it would have spent on other safety net programs if Medicaid had not been expanded.
Thus, the total economic impact of the Healthy Michigan Plan is generating more than enough funds for the state budget to cover the state’s cost of the program from 2017 through 2021. Beginning in 2017, states are required to cover 5 percent of the costs of care for Medicaid expansion enrollees, and the state share of these costs will rise to 10 percent in 2020. The remaining costs are covered by federal funding.
06 Jan Bundled Payment For Joint Replacements Saved Hospitals and CMS Money
Posted at 13:22h
in Author Interviews, Cost of Health Care, JAMA, Medicare, Orthopedics, University of Pennsylvania
MedicalResearch.com Interview with:
[caption id="attachment_30994" align="alignleft" width="180"]
Dr. Amol Navathe[/caption]
Amol Navathe, MD PhD
University of Pennsylvania
Staff Physician, CHERP,
Philadelphia VA Medical Center
Assistant Professor of Medicine and Health Policy, Perelman School of Medicine
Senior Fellow, Leonard Davis Institute of Health Economics, The Wharton School
Co-Editor-in-Chief, HealthCare: the Journal of Delivery Science and Innovation
MedicalResearch.com: What is the background for this study?
Response: Bundled payments pay a fixed price for an episode of services that starts at hospital admission (in this case for joint replacement surgery) and extends 30-90 days post discharge (30 days in this study). This includes physician fees, other provider services (e.g. physical therapy), and additional acute hospital care (hospital admissions) in that 30 day window.
05 Jan Diabetes Most Expensive Health Care Condition in US
MedicalResearch.com Interview with: [caption id="attachment_30753" align="alignleft" width="125"]
Dr. Joseph Dieleman[/caption]
Joseph Dieleman, PhD
Institute for Health Metrics and Evaluation
University of Washington
Seattle, WA 98121
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The objective of this study was to provide a estimate of total health care spending in the United States for an exhaustive list of health conditions, over an extended period of time – from 1996 to 2013. The study primarily focuses on personal health spending, which includes both individual out-of-pocket costs as well as spending by private and government insurance programs on care provided in inpatient and outpatient facilities, emergency departments, nursing care facilities, dentist offices, and also on pharmaceuticals. There were 155 conditions included in the analysis, and spending was also disaggregated by type of care, and age and sex of the patient.
In 2013, we accounted for $2.1 trillion in personal health spending in the U.S. It was discovered that just 20 health conditions made up more than half of all dollars spent on health care in the U.S. in 2013, and spending for each condition varied by age, sex and type of care. Diabetes was the most expensive condition, totaling $101 billion in diagnoses and treatments, growing at an alarmingly rate – a 6.5% increase per year on average.
Ischemic heart disease, the number one killer in the U.S., ranked the second most expensive at $88.1 billion, followed by low back and neck pain at $87.6, treatment of hypertension at $83.9 billion, and injury from falls at $76.3.
Women aged 85 and older spent the most per person in 2013, at more than $31,000 per person. More than half of this spending (58%) occurred in nursing facilities, while 20% was expended on cardiovascular diseases, 10% on Alzheimer’s disease, and 7% on falls. Men ages 85 and older spent $24,000 per person in 2013, with only 37% on nursing facilities, largely because women live longer and men more often have a partner at home to provide care.
28 Dec Is Skin Cancer Screening Cost Effective?
MedicalResearch.com Interview with: Isabelle Hoorens, MD, PhD Department of Dermatology Ghent University Hospital Ghent, Belgium MedicalResearch.com: What is the background for this study? What are the main findings? Response: In this study we questioned whether a population-based screening for skin cancer is cost-effective. In addition we compared the cost-effectiveness of two specific screening techniques. The first technique, a lesion-directed screening being a free-of-charge skin cancer check of a specific lesion meeting 1 or more of the following criteria: ABCD rule (asymmetry, border irregularity, color variation, and diameter >6 mm), “ugly duckling” sign, new lesion lasting longer than 4 weeks, or red nonhealing lesions. The second screening technique consisted of a systematic total body examination in asymptomatic patients. A clinical screening study was performed in Belgium in 2014.28 Dec Patients Who Understand Their Medical Condition Less Likely To Opt For Aggressive Care
MedicalResearch.com Interview with: [caption id="attachment_30823" align="alignleft" width="200"]
Dr. Joseph A. Ladapo[/caption]
Joseph A. Ladapo, MD, PhD
David Geffen School of Medicine at UCLA
Department of Medicine, Division of General Internal Medicine and Health Services Research
Los Angeles, California
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Four million stable patients in the US undergo testing for suspected ischemic heart disease (IHD) annually. There is substantial variation in how these patients are managed by physicians, and both clinical and economic factors have been used to explain this variation. However, it is unknown whether patients’ beliefs and preferences influence management decisions, and we aimed to answer this question. Based on interviews of 351 stable patients at Geisinger Health System newly referred for cardiac stress testing/coronary computed tomographic angiography (CTA) for suspected IHD, we found that patients with an accurate understanding of their initial test result were less likely to undergo follow-up tests/procedures if the initial test was negative and more likely to undergo follow-up tests/procedures if the initial test was positive.
27 Dec Expensive Intensive Care Units Often Overutilized
Posted at 19:27h
in Author Interviews, Cost of Health Care, Critical Care - Intensive Care - ICUs, JAMA
MedicalResearch.com Interview with:
[caption id="attachment_30798" align="alignleft" width="133"]
Dr. Dong Chang[/caption]
Dr. Dong W. Chang, MD MS
Division of Respiratory and Critical Care Physiology and Medicine
Los Angeles Biomed Research Institute at Harbor-University of California
Los Angeles, Medical Center
Torrance California
MedicalResearch.com: What is the background for this study?
Response: The study was based on our overall impression that ICU care is often delivered to patients who are unlikely to derive long-term benefit (based on their co-morbidities/severity of illness, etc.). However, what surprised us was the magnitude of this problem. Our study found more than half the patients in ICU at a major metropolitan acute-care hospital could have been cared for in less expensive and invasive settings.
22 Dec Pembrolizumab Found to Be Cost-Effective in Advanced Melanoma
MedicalResearch.com Interview with: [caption id="attachment_30744" align="alignleft" width="141"]
Dr. Herbert Loong[/caption]
Herbert H F Loong
MBBS(HK), PDipMDPath(HK), MRCP(UK), FHKCP, FHKAM(Medicine)
Specialist in Medical Oncology
Clinical Assistant Professor, Department of Clinical Oncology
Deputy Medical Director, Phase 1 Clinical Trials Centre
The Chinese University of Hong Kong
Prince of Wales Hospital
Hong Kong SAR
MedicalResearch.com: What is the background for this study?
Response: Advanced melanoma have previously been known to be a disease with a dismal prognosis. Over the last few years, clinical trials data and real-world clinical experience of checkpoint inhibitors have significantly changed the treatment landscape for advanced melanoma patients. This was first demonstrated with the Anti-CTLA4 Ab Ipilimumab, and more recently with the Anti-PD1 Ab pembrolizumab. Whilst we have seen dramatic improvements in disease control with the use of these agents, the high costs of these drugs may be prohibitive to the average patient who has to pay out-of-pocket and potentially may place significant burdens on healthcare systems. There is a need to rationally assess the cost-effectiveness of these new agents, specifically addressing the potential benefits to the individual patient and to society, whilst balancing the costs that such a treatment may entail.
The assessment of cost-effectiveness of a particular treatment is extremely important in Hong Kong, as this has direct implications on drug reimbursement and accessibility of the particular drug in question at public hospitals in Hong Kong. The aim of the study is to assess the cost-effectiveness of pembrolizumab in patients with advanced melanoma used in the first-line setting in Hong Kong, and comparing it to (1) ipilimumab and (2) cytotoxic chemotherapy. Cytotoxic chemotherapy chosen for comparison were drugs commonly used in the first line setting in Hong Kong, which included dacarbazine, temozolomide and carboplatin+paclitaxel combination. It is important to note that whilst ipilimumab is registered for this indication in Hong Kong, there is no reimbursement of this drug by the Hospital Authority in Hong Kong and patients have to pay out-of-pocket. The cost of ipilimumab and the associated side effects has been prohibitive to most advanced melanoma patients in the public setting.
16 Dec Physicians Perceive Health Insurance as Barrier to Weight Management Efforts
MedicalResearch.com Interview with: Ruchi Doshi, MPH MD Candidate 2017 | Johns Hopkins University School of Medicine MedicalResearch.com: What is the background for this study? What are the main findings? Response: Current guidelines recommend that physicians collaborate with non-physician health professionals to deliver weight management care. While several studies have looked at barriers physicians face in providing these services, few studies have looked at the barriers that the non-physician health professionals face. Ultimately, we found that one quarter of these health professionals found insurance coverage to be a current challenge to providing weight management care, and that over half of them felt improved coverage would help facilitate weight loss. These findings were consistent regardless of the income level of the patient populations.16 Dec AARP: Retail Price of Brand Name Drugs Rising Sharply
MedicalResearch.com Interview with: [caption id="attachment_30552" align="alignleft" width="200"]
Leigh Purvis[/caption]
Leigh Purvis, MPA
AARP PPI Director of Health Services Research
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: This report is part of an ongoing series that AARP has been publishing since 2004. The report focuses on brand name prescription drugs that are widely used by older Americans and found that, on average, their retail prices increased almost 130 times faster than general inflation in 2015. The report also found that the average annual cost for one brand name medication used on a chronic basis was more than $5,800 in 2015, almost $1,000 higher than the average annual cost of therapy in 2014.
09 Dec Choosing Primary Care Physicians Based On Low Office Visit Price Can Save Money for Patients With High Deductible Plans
Posted at 03:10h
in Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, Primary Care
MedicalResearch.com Interview with:
[caption id="attachment_30342" align="alignleft" width="200"]
Dr. Ateev Mehrotra[/caption]
Dr. Ateev Mehrotra MD
Associate professor, Department of Health Care Policy
Harvard Medical School and a
hospitalist at Beth Israel Deaconess Medical Center
Boston, Massachusetts
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: More people in the US are using price transparency websites to shop for care. Some have wondered whether using the information on these websites to choose a doctor will help them actually save money. A relatively small difference in price for visits on the website translated into hundreds of dollars.
02 Dec Health Care Spending Highly Concentrated Among a Small Group of People
MedicalResearch.com Interview with: [caption id="attachment_30131" align="alignleft" width="200"]
Emily Mitchell,[/caption]
Emily Mitchell, Ph.D., Statistician
Agency for Healthcare Research and Quality
MedicalResearch.com: What is the background for this study?
Response: The data for this study come from the Household Component of the Medical Expenditure Panel Survey (MEPS-HC), a nationally representative survey that is conducted annually by the Agency for Healthcare Research and Quality (AHRQ). The survey collects detailed information on health care utilization and expenditures, health insurance, and health status, as well as a wide variety of social, demographic, and economic characteristics for the U.S. civilian non-institutionalized population.
02 Dec Cancer Can Mean High Out-of-Pocket Expenses For Seniors With Only Medicare
MedicalResearch.com Interview with: [caption id="attachment_29945" align="alignleft" width="80"]
Dr. Amol Narang[/caption]
Dr. Amol K. Narang, MD
Instructor of Radiation Oncology and Molecular Radiation Sciences
Johns Hopkins Sidney Kimmel Comprehensive Cancer Center
MedicalResearch.com: What is the background for this study?
Response: We know that cancer care is becoming increasingly expensive in the U.S., but the financial impact on patients in the form of out-of-pocket expenses is not well understood, in part because of the lack of data sources that track this information. As such, we used the Health and Retirement study, a national panel study that closely tracks the out-of-pocket medical expenditures of older Americans, to understand the level of financial strain that Medicare patients experience after a new diagnosis of cancer. We further investigated what factors were associated with high financial strain and what type of health services were driving high costs in this population.
21 Nov Patients Who Start Dialysis in Hospital Setting Have More Comorbidities
[caption id="attachment_16840" align="alignleft" width="124"]
Dr. Csaba P. Kovesdy[/caption]
MedicalResearch.com Interview with:
Dr. Csaba P. Kovesdy
Fred Hatch Professor of Medicine
Director, Clinical Outcomes and Clinical Trials Program
Division of Nephrology, University of Tennessee Health Science Center
Nephrology Section Chief, Memphis VA Medical Center
Memphis TN, 38163
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Many ESRD patients initiate dialysis in an inpatient setting. This practice is expensive, and carries potential risks (e.g. hospital associated infections, medication errors, etc.). There is very little information about the characteristics of patients who transition to ESRD (i.e. start dialysis) in an inpatient setting, and about their outcomes.
We examined a cohort of >50,000 US veterans who started dialysis during 2007-2011, and found that about half of them performed their first treatment in an inpatient setting. Compared to patients starting dialysis as outpatients, those who transitioned in an inpatient setting had a significantly higher prevalence of comorbid conditions, and were much less likely to have received pre-dialysis nephrology care, or to have a mature AV fistula or AV graft at the first hemodialysis treatment. Mortality was significantly higher in the inpatient start group, but the differences were attenuated by adjustment for comorbid conditions and vascular access.
20 Nov Cesarean Section Rates Vary Across US Hospitals
MedicalResearch.com Interview with: Kamila Mistry, PhD MPH AHRQ MedicalResearch.com: What is the background for this study? Response: Although the overall cesarean section (C-section) rate in the United States has declined slightly in recent years, nearly a third of all births continue to be delivered by C-section—higher than in many other industrialized countries. A number of medical as well as nonmedical factors may contribute to high C-section rates. C-section is the most common surgical procedure performed in the United States. This operation carries additional risks compared with vaginal delivery, such as infection and postoperative pain. A C-section also may make it more difficult for the mother to establish breastfeeding and may complicate subsequent pregnancies. Consensus guidelines from the American Congress of Obstetricians and Gynecologists and other national efforts to improve perinatal care have shown promise in reducing nonmedically indicated C-sections. However, recent research has found wide variation in hospital C-section rates even for low-risk deliveries.16 Nov Substituting Less Well Trained Assistants For Nurses Increased Hospital Mortality
Posted at 20:41h
in Author Interviews, BMJ, Cost of Health Care, Nursing, Outcomes & Safety, University of Pennsylvania
MedicalResearch.com Interview with:
[caption id="attachment_29710" align="alignleft" width="200"]
Dr Linda H Aiken[/caption]
Dr Linda H Aiken PhD, FAAN, FRCN, RN
Claire M. Fagin Leadership Professor in Nursing
Professor of Sociology, School of Arts & Sciences
Director, Center for Health Outcomes and Policy Research
University of Pennsylvania School of Nursing
Center for Health Outcomes and Policy Research
Philadelphia, PA 19104
MedicalResearch.com: What is the background for this study?
Response: The idea that adding lower skilled and lower wage caregivers to hospitals instead of increasing the number of professional nurses could save money without adversely affecting care outcomes is intuitively appealing to mangers and policymakers but evidence is lacking on whether this strategy is safe or saves money.
16 Nov Costs of Generic Drugs for Heart Failure Can Vary Widely
MedicalResearch.com Interview with: [caption id="attachment_29573" align="alignleft" width="149"]
Dr. Paul Hauptman[/caption]
Paul J. Hauptman, MD
Professor Internal Medicine, Division of Cardiology
Health Management & Policy, School of Public Health
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: We decided to evaluate the cost of generic heart failure medications after an uninsured patient of ours reported that he could not fill a prescription for digoxin because of the cost for a one month's supply: $100. We called the pharmacy in question and confirmed the pricing. At that point we decided to explore this issue more closely.
We called 200 retail pharmacies in the bi-state, St. Louis metropolitan area, 175 of which provided us with drug prices for three generic heart failure medications: digoxin, carvedilol and lisinopril. We found significant variability in the cash price for these medications. Combined prices for the three drugs ranged from $12-$400 for 30 day supply and $30-$1,100 for 90 day supply.
The variability was completely random, not a function of pharmacy type, zip code, median annual income, region or state. In fact, pricing even varied among different retail stores of the same pharmacy chain.
11 Nov Cancer Drugs, Survival and Ethics
MedicalResearch.com Interview with: [caption id="attachment_29575" align="alignleft" width="200"]
Dr. Peter Wise[/caption]
Peter Wise MD
Charing Cross Hospital and
Imperial College School of Medicine
London, UK
MedicalResearch.com: What is the background for this analysis?
Response: As a medical ethicist, I wished to know how much patients with advanced – metastatic – cancer knew about the drugs that were being used to treat it. What were their perceptions of likely treatment success and how did that tally with our knowledge of what drugs could actually achieve – and at what cost to the body and to the pocket. Did patients actually have a choice – and how did the drugs get approved for use in the first place?
08 Nov Canadian Limits on Glucose Strips Did Not Impair Diabetes Control
MedicalResearch.com Interview with: [caption id="attachment_29503" align="alignleft" width="200"]
Tara Gomes[/caption]
Tara Gomes, MHSc
Li Ka Shing Knowledge Institute, St Michael’s Hospital,
The Institute for Clinical Evaluative Sciences
Leslie Dan Faculty of Pharmacy
Department of Health Policy, Management, and Evaluation
University of Toronto, Toronto, Ontario, Canada
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: In August 2013, the Ontario government introduced reimbursement limits for blood glucose test strips. Subsequent research has suggested that the provincial government saved $24 million in the first year after implementing this quantity limit policy. This study investigated whether these quantity limits led to any change in diabetes-related patient outcomes.
We found that limiting the number of blood glucose test strips reimbursed by the government to levels recommended by the Canadian Diabetes Association had to no change in diabetes control (measured as rates of emergency department visits for hypoglycemia or hyperglycemia, and mean HbA1c) in the 1.5 years after implementation. Similarly, there was no worsening of patient outcomes in a subgroup of individuals who had been frequent users of test strips prior to the policy being announced.
08 Nov Most Extra Tubes of Collected Blood Go Unused
MedicalResearch.com Interview with: Robert Humble, MS, MD Candidate, 2019 President, EQUAL Med Governmental Relations Chair, CCOM Student Government University Iowa Matthew D. Krasowski, MD, PhD Department of Pathology University of Iowa Hospitals and Clinics, Iowa City MedicalResearch.com: What is the background for this study? What are the main findings? Response: Laboratory testing is a critical tool in clinical decision-making. Clinical laboratories frequently receive “extra” tubes of blood. On collection, they have no testing associated with them. They are stored in the laboratory for a period of time for add-on testing. We sought to analyze patterns of extra tube collection at an academic medical center over an extended period of time, and determine patterns of add-on testing before and after implementation of new laboratory information system (LIS) software (Epic Beaker). Until this study, extra tube collection and utilization had not been quantified at our institution to this extent. We found that most extra tubes weren’t used for laboratory testing. After collection, the vast majority of these tubes were stored until disposal. Over the period of study our institution moved from a paper ordering protocol to a ‘paperless ordering’ system that printed labels only for tubes needed for testing ordered by providers. After implementation of Epic Beaker, we saw utilization practices improve, though there is still room for improvement. Overall, we’ve seen significant decreases in extra tube collection across the institution.08 Nov Prevent Cancer Foundation Tool Compares Screening Coverage By Major Health Insurers
MedicalResearch.com Interview with: [caption id="attachment_29479" align="alignleft" width="200"]
Carolyn R. Aldigé[/caption]
Carolyn R. Aldigé
President of the Prevent Cancer Foundation
MedicalResearch.com: What is the background for this tool? What types of cancers are covered under this comparison tool?
Response: The coverage tool compares screening coverage by the 30 largest health insurers in the U.S. Consumers can use the tool to see their insurance plans' policies on coverage of screening tests for breast, cervical, colorectal, lung and prostate cancers.
MedicalResearch.com: What are some of the differences in insurance coverage of screening tests?
Response: There is a sizable variation in what insurance plans cover, partly a result of differing screening guidelines from three leading organizations. Though insurance plans are required to cover screenings recommended by the United States Preventive Services Task Force (USPSTF) without a co-pay, many will choose to cover other screening tests as well—but which guidelines do they follow? This is confusing to both patients and providers.
Breast cancer screening is an area where we see big differences in insurance coverage. All 30 plans cover 2D mammography, but only 13 plans cover 3D mammography (tomosynthesis).
Colorectal cancer screening coverage also differs. While almost all plans cover colonoscopy, CT colonography, flexible sigmoidoscopy, and FIT and FOBT screening tests, there are differences in coverage of stool-based DNA tests.
31 Oct Expanding the Role of Hospitalist Physician Assistants May Save Money With Similar Outcomes
MedicalResearch.com Interview with: [caption id="attachment_29276" align="alignleft" width="131"]
Dr. Timothy M. Capstack[/caption]
Timothy M. Capstack, MD, FACP, SFHM
Regional Medical Director, Physicians Inpatient Care Specialists, LLC (MDICS)
Hanover MD
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Hospitalists—medical providers who provide medical care to hospital inpatients—have become a pervasive part of American medical care. Hospitalists with internal medicine training earn, on average, a little over twice as much as do physician assistants (PAs). The researchers studied the hospitalist staffing model of Physicians Inpatient Care Specialists (MDICS) hospitalists at a 384-bed community hospital in Annapolis, Maryland. MDICS used specifically trained and supported PAs working collaboratively with their physicians to see a large proportion of their patients rather than relying mainly or exclusively on physicians, as many groups do. MDICS believed that their model would provide equal quality of care while saving on salary costs.
The MDICS expanded-PA model was compared with a conventional group of hospitalists who used mostly physicians to care for their inpatients. 16,964 inpatient hospitalizations were identified for study; 6,612 expanded-PA and 10,352 conventional patients were seen by the groups over the 18 months that were included.
27 Oct Majority of US Adults Have At Least One Chronic Health Condition
MedicalResearch.com Interview with: [caption id="attachment_29223" align="alignleft" width="149"]
Dr. Elizabeth Walker[/caption]
Elizabeth Walker, PhD, MPH, MAT
Research Assistant Professor
Assistant Director of Evidence-based Learning
Department of Behavioral Sciences and Health Education
Rollins School of Public Health
Emory University
MedicalResearch.com: What is the background for this study?
Response: Previous research has shown that many adults in the United States have one or more chronic health condition; however, not much was known about multimorbidities – having multiple chronic conditions – among people with mental disorders. We used nationally representative data from the National Survey on Drug Use and Health to determine the patterns of co-occurrence of mental illness, substance abuse and/or dependence, and chronic medical conditions. We also examined the association between the cumulative burden of these conditions, as well as living in poverty, and self-rated health.