Author Interviews, BMJ, Cost of Health Care, Education, Health Care Systems, University of Pittsburgh / 30.09.2015

Timothy Anderson, M.D. Chief medical resident University of Pittsburgh’s Department of Internal MedicineMedicalResearch.com Interview with: Timothy Anderson, M.D. Chief medical resident Department of Internal Medicine University of Pittsburgh Medical Research: What is the background for this study? What are the main findings? Dr. Anderson: My coauthors and I analyzed the public disclosures of all publicly traded U.S. health care companies listed on the NASDAQ exchange and New York Stock Exchange in January 2014 that specialized in pharmaceuticals, biotechnology, medical equipment and providing health care services.  Of the 442 companies with publicly accessible disclosures on boards of directors, 180 – or 41 percent – had one or more academically affiliated directors in 2013. These individuals included chief executive officers, vice presidents, presidents, provosts, chancellors, medical school deans, professors and trustees from 85 non-profit academic research and health care institutions. These individuals received compensation and stock shares from companies which far exceeds payment for other relationships such as consulting. In some cases compensation approaches or exceeds average professor and physician salaries. (more…)
Author Interviews, Cleveland Clinic, Cost of Health Care, Herpes Viruses, Vaccine Studies / 24.09.2015

Phuc Le, Ph.D., M.P.H. Center for Value-Based Care Research, Medicine Institute Cleveland, OHMedicalResearch.com Interview with: Phuc Le, Ph.D., M.P.H. Center for Value-Based Care Research, Medicine Institute Cleveland, OH  Medical Research: What is the background for this study? What are the main findings? Dr. Phuc Le: The live attenuated herpes zoster vaccine is approved by the FDA for persons aged 50 years and above. However, the Advisory Committee on Immunization Practices recommends it for only persons aged 60 years and older. Therefore, we aimed to analyze the vaccine’s cost-effectiveness among persons aged 50-59 years to see if ACIP’s recommendation is reasonable. We found that the vaccine is not cost-effective among people at aged 50 years, having an incremental costs of $323,000 per QALY gained, which is 3 times more than a commonly accepted threshold ($100,000/QALY). (more…)
Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, JAMA / 24.09.2015

Aaron L. Schwartz, PhD Department of Health Care Policy Harvard Medical School Boston, Massachusetts MedicalResearch.com Interview with: Aaron L. Schwartz, PhD Department of Health Care Policy Harvard Medical School Boston, Massachusetts   Medical Research: What is the background for this study? What are the main findings? Dr. Schwartz: It is widely believed that much health care spending is devoted to services that provide little or no health benefit to patients. In previous work, we demonstrated that low-value services were commonly delivered to the Medicare population. In this study, we examined whether a new form of paying physicians and hospitals was effective in discouraging the use of low-value services. The payment reform we studied was the Medicare Pioneer Accountable Care Organization (ACO)  Program, a feature of the Affordable Care Act. This program financially rewards health care provider groups who keep spending under a specified budget and achieve high performance on measures of quality of care. This voluntary program employs a similar ACO payment model that some private insurers have adopted.  The hope is that such models can encourage providers to be more efficient by allowing them to share in the savings generated by lower health care spending. In previous work, we demonstrated that the Pioneer ACO Program was associated with lower overall health care spending and steady or improved performance on health care quality measures. However, it was unclear whether providers were focusing on low-value services in their attempts to reduce spending. We examined  2009-2012 Medicare claims data and measured the use of, and spending on, 31 services often provided to patients that are known to provide minimal clinical benefit. We found that patients cared for in the ACO model experienced a greater reduction in the use of low-value services when compared to patients who were not served by ACOs. We attributed a 4.5 percent reduction in low-value service spending to the ACO program. Interestingly, this was a greater reduction than the 1.2 percent reduction in overall spending attributed to the program, which suggests that providers were targeting low-value services in their efforts to reduce spending. In addition, we found that providers with the greatest rate of low-value services prior to the ACO program showed the greatest reduction in these services. We also found similar reductions in service use between services that are more likely to be requested by patients (i.e. early imaging for lower-back pain) and other services. (more…)
Author Interviews, Cancer Research, Cost of Health Care / 21.09.2015

Steven L. D'Amato, BSPharm, BCOP President and Executive Director New England Cancer Specialists Scarborough, Maine Association of Community Cancer CenteMedicalResearch.com Interview with: Steven L. D'Amato, BSPharm, BCOP President and Executive Director New England Cancer Specialists Scarborough, Maine Association of Community Cancer Centers Medical Research: What is the background for this study? What are the main findings? Response: The Trends in Cancer Programs annual survey, which began in 2009, provides key insight into nationwide developments in the business of cancer care. It’s a joint project between the Association of Community Cancer Centers and Lilly Oncology.  The goals of the survey are to:
  • Provide ACCC with information to help guide its education and advocacy mission
  • Assist member organizations to understand nationwide developments in the business of cancer care
  • Assist members in evaluating their own cancer program’s performance relative to similar organizations through a consistent and meaningful benchmark.
This year’s key findings show that patient-centered services – like nurse navigation, psychological counseling, survivorship care and palliative care – are continuing to grow in U.S. cancer programs. However, the biggest challenge facing cancer centers is reimbursement for these types of services. Additionally, mirroring what we are seeing in the industry in general, measurement is becoming more and more important. More cancer programs are now using quality metrics to show payers the value of care provided. More information about our findings can be viewed here: http://www.accc-cancer.org/surveys/pdf/Trends-in-Cancer-Programs-2015.pdf. (more…)
Author Interviews, Cost of Health Care, Flu - Influenza, Geriatrics, Lancet, Vaccine Studies / 20.09.2015

Dr Ayman Chit PhD Sanofi Pasteur Swiftwater, PA 18370MedicalResearch.com Interview with: Dr Ayman Chit PhD Sanofi Pasteur Swiftwater, PA 18370 Medical Research: What is the background for this study? What are the main findings? Dr. Chit: Our analysis used data from a large-scale, multi-center efficacy trial, in which a higher-dose split-virus inactivated influenza vaccine (IIV-HD, Fluzone® High-Dose vaccine, Sanofi Pasteur) was compared to a standard-dose split-virus inactivated influenza vaccine (IIV-SD, Fluzone vaccine, Sanofi Pasteur) in persons 65 years of age and older.  These data were supplemented with US healthcare cost data. In the efficacy trial, a total of 31,989 adults 65 years of age and older were randomly assigned in a 1:1 ratio to receive either IIV-HD or IIV-SD and followed for six to eight months post-vaccination for the occurrence of influenza, serious adverse events, and medical encounters. Healthcare utilization (HCU) data were captured for all participants through a surveillance program that covered each influenza season, including the following events occurring within 30 days after any respiratory illness: use of prescription and non-prescription medications (limited to antipyretics/analgesics/non-steroidal anti-inflammatory drugs, antivirals and antibiotics), emergency room visits, non-routine or urgent care visits, and hospitalizations. In addition, all hospitalizations were captured for participants for the entire duration of the study. The primary results from the efficacy trial were published in The New England Journal of Medicine, which reported that IIV-HD was 24.2% (95% confidence interval [CI], 9.7% to 36.5%) more effective in preventing laboratory-confirmed influenza-like illness compared to IIV-SD.1 In the current supplemental analysis of the trial, we used US healthcare cost data to evaluate economic impacts of using IIV-HD compared to IIV-SD within the efficacy trial participants. In this analysis, total healthcare payer costs (the combined costs of study vaccine, prescription drugs, emergency room visits, non-routine and urgent-care visits, and hospital admissions) were about $116 less per person.
  1. DiazGranados et al, NEJM, 2014;14;371(7):635-45 
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Author Interviews, Cost of Health Care, Primary Care / 17.09.2015

Michael K. Magill, MD Professor and Chairman, Family and Preventive Medicine University of Utah School of Medicine Salt Lake City, UT 84108MedicalResearch.com Interview with: Michael K. Magill, MD Professor and Chairman, Family and Preventive Medicine University of Utah School of Medicine Salt Lake City, UT  84108   Medical Research: What is the background for this study? What are the main findings? Dr. Magill: The Patient Centered Medical Home (PCMH) model of primary care is becoming more common. The model focuses on team delivery of care with other medical staff joining the primary care provider/clinician to provide for all patients’ healthcare needs.  However, the cost of sustaining PCMH functions is not well understood. This  study assessed direct personnel cost of delivering PCMH services in 20 diverse primary care practices in Utah and Colorado. The main finding is that PCMH services cost on average around $105,000 per clinician FTE per year, or around $4.00 per member per month for an imputed panel size of 2000 patients per FTE clinician.  (more…)
Author Interviews, Cleveland Clinic, Cost of Health Care, Heart Disease, JAMA, Radiology / 16.09.2015

Wael A. Jaber, MD FACC, FAHA Professor of Medicine Cleveland Clinic Lerner College of Medicine Fuad Jubran Endowed Chair in Cardiovascular Medicine Heart and Vascular Institute Cleveland Clinic Cleveland, OH MedicalResearch.com Interview with: Wael A. Jaber, MD FACC, FAHA Professor of Medicine Cleveland Clinic Lerner College of Medicine Fuad Jubran Endowed Chair in Cardiovascular Medicine Heart and Vascular Institute Cleveland Clinic  Cleveland, OH Medical Research: What is the background for this study? What are the main findings? Prof. Jaber: Risk stratification of patients presenting with atrial fibrillation often includes a non-invasive evaluation for coronary artery disease. However, the yield of such testing in patients without angina or anginal-equivalent symptoms is uncertain. That is, how often do we find silent myocardial ischemia? In our cohort of 1700 consecutive patients with atrial fibrillation, less than 5% had ischemia on nuclear stress testing, even though comorbidities were prevalent. Moreover, in patients with ischemia that had invasive coronary angiography, less than half had obstructive coronary artery disease. (more…)
Author Interviews, Cost of Health Care, JAMA / 08.09.2015

James C. Robinson PhD MPH Leonard D. Schaeffer Professor of Health Economics Director, Berkeley Center for Health Technology Head, Division of Health Policy & Management School of Public Health, University of California– Berkeley University Hall, Berkeley, CA MedicalResearch.com Interview with: James C. Robinson PhD MPH Leonard D. Schaeffer Professor of Health Economics Director, Berkeley Center for Health Technology Head, Division of Health Policy & Management School of Public Health, University of California– Berkeley University Hall, Berkeley, CA   Medical Research: What is the background for this study? What are the main findings? Dr. Robinson: Employers and insurers face wide variation in the prices of similar tests and procedures within the same local communities, resulting from the indifference to price on the part of well-insured patients.  They are raising deductibles to increase price sensitivity, but deductibles mostly target low-cost primary care services whereas their concerns often center on high-cost specialty and facility services.  Some are adopting reference pricing, which sets a maximum insurer contribution for a particular type of test or procedure and then requires consumers selecting more expensive options to pay the difference themselves.  The insurers contribution limit typically is set at the median or other midpoint in the market distribution of prices. We studied the implementation of reference pricing for colonoscopy, using data from the California Public Employees Retirement System (CalPERS) from 2009-13, with a control group from Blue Cross of California.  Our data include detailed claims from almost 300,000 colonoscopy procedures and patients.  We find that patients who must pay the extra fees themselves are much more likely to select cheaper ambulatory facilities for their colonoscopies, compared to consumers who do not face reference pricing.  This leads to lower prices being paid by the employer and significant savings.  Detailed analyses of gastroenterological and cardiovascular complications of the colonoscopy procedures found no adverse effect of reference pricing on quality. (more…)
Author Interviews, Cost of Health Care, Infections, JAMA, Pharmacology / 19.08.2015

Jerome A. Leis, MD MSc FRCPC Division of Infectious Diseases, Sunnybrook Health Sciences Centre Physician Lead, Antimicrobial Stewardship Team Faculty Quality Improvement Advisor, Centre for QuIPS Assistant Professor, Department of Medicine, University of Toronto Sunnybrook Health Sciences Centre Toronto, OntarioMedicalResearch.com Interview with: Jerome A. Leis, MD MSc FRCPC Division of Infectious Diseases Sunnybrook Health Sciences Centre Physician Lead, Antimicrobial Stewardship Team Faculty Quality Improvement Advisor, Centre for QuIPS Assistant Professor, Department of Medicine University of Toronto Sunnybrook Health Sciences Centre Toronto, Ontario Medical Research: What is the background for this study? What are the main findings? Dr. Leis: We know that urinary tract infections are frequently diagnosed among general medicine patients who lack symptoms of this infection.  We wondered whether urinalysis ordering practices in the Emergency Department influence diagnosis and treatment for urinary tract infection among these asymptomatic patients.  We found that over half of patients admitted to the general medicine service underwent a urinalysis in the Emergency Department of which over 80% lacked a clinical indication for this test.  Urinalysis results among these asymptomatic patients did influence diagnosis as patients with incidental positive results were more likely to undergo urine cultures and treatment with antibiotics for urinary tract infection.  The study suggests that unnecessary urinalysis ordering contributes to over-diagnosis and treatment of urinary tract infection among patients admitted to general medicine service. (more…)
Cost of Health Care / 13.08.2015

Noam Y. Kirson, Ph.D. Vice President Analysis Group, Inc. Economic, Financial, and Strategy Consulting Boston, MA 02199MedicalResearch.com Interview with: Noam Y. Kirson, Ph.D.  Vice President Analysis Group, Inc. Economic, Financial, and Strategy Consulting Boston, MA 02199 Medical Research: What is the background for this study? What are the main findings? Dr. Kirson: Developments in diagnostic technology now support ruling out Alzheimer’s disease (AD) among patients presenting with symptoms of cognitive decline, possibly facilitating earlier and more accurate diagnosis of non-Alzheimer’s dementias. Our study assessed potential economic benefits of timely rule out of Alzheimer’s disease among U.S. Medicare beneficiaries eventually diagnosed with vascular dementia (VD) or Parkinson’s disease (PD) by estimating excess medical costs among those previously misdiagnosed withAlzheimer’s. We found that approximately one in six beneficiaries with VD and one in twelve beneficiaries with PD had a prior Alzheimer’s disease diagnosis. Further, we found that VD and PD patients previously diagnosed with Alzheimer’s disease incurred substantially higher medical costs in periods leading up to and including their VD/PD diagnoses, compared with matched counterparts with no prior AD diagnosis during the same timeframe. Perhaps most interestingly, excess costs declined – and eventually dissipated – following the confirmed VD/PD diagnoses. (more…)
Author Interviews, Heart Disease, Medicare, Outcomes & Safety / 05.08.2015

MedicalResearch.com Interview with: Philip G. Cotterill PhD Centers for Medicare & Medicaid Services Baltimore, MD Medical Research: What is the background for this study? What are the main findings? Dr. Cotterill: Chest pain is one of those elusive complaints where patients can seem initially low-risk based on symptoms or risk factors, and subsequently have an acute myocardial infarction (AMI) or die in a short period of time. Using combinations of history and physical examination findings to discriminate patients with serious causes of chest pain is often not possible. In our study, we demonstrated wide variation in the decision to hospitalize Medicare beneficiaries with chest pain – nearly two fold between the lowest (38%) and highest (81%) quintile of hospitals – and that patients treated in hospitals with higher admission rates for chest pain are less likely to have an acute myocardial infarction within 30-days of the index event and less likely to die. While the findings were statistically significant – differences in outcomes were small: 4 fewer AMIs and 3 fewer deaths per 1,000 patients comparing the highest and lowest admission quintiles. Stated differently, these numbers suggest that if low admitting hospitals were to behave more like high admitting hospitals, 250 patients would need to be admitted to prevent one AMI and 333 cases to prevent one death. (more…)
Author Interviews, CDC, Cost of Health Care / 30.07.2015

Jared Fox, PhD CDC Office of the Associate Director for PolicyMedicalResearch.com Interview with: Jared Fox, PhD CDC Office of the Associate Director for Policy Medical Research: What is the background for this study? What are the main findings? Dr. Fox:  Increasing the number of people who get preventive care is important to keep people healthier, avoid complications from illnesses, reduce long-term health care costs, and prevent premature deaths. By one estimate, over 100,000 lives could be saved each year if more people got their recommended preventive care. By providing access to affordable insurance coverage and eliminating out-of-pocket costs for recommended preventive care in most health plans, the Affordable Care Act has reduced cost as a barrier to preventive care. This report could serve as a baseline for tracking the effects of some of the ACA’s preventive care provisions that might occur after 2012. The services in this study are recommended by the US Preventive Services Task Force and the Advisory Committee for Immunization Practices. The nine preventive services that were part of this study were:  screenings for blood pressure, breast cancer, cervical cancer, cholesterol, colon cancer, and diabetes; healthy diet counseling; and vaccination for hepatitis A and B. The data is from the 2011 and 2012 National Health Interview Survey. In 2011 and 2012, people with health insurance received needed preventive care at up to three times the rate of those without insurance. People with higher household incomes also got more recommended preventive care than those with lower incomes. (more…)
Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, JAMA / 28.07.2015

Benjamin D. Sommers, MD, PhD Assistant Professor of Health Policy & Economics Harvard T. H. Chan School of Public Health / Brigham & Women's Hospital Boston, MA 02115MedicalResearch.com Interview with: Benjamin D. Sommers, MD, PhD Assistant Professor of Health Policy & Economics Harvard T. H. Chan School of Public Health / Brigham & Women's Hospital Boston, MA 02115 Medical Research: What is the background for this study? What are the main findings? Response: The Affordable Care Act (ACA) expanded insurance options for millions of adults, via an expansion of Medicaid and the new health insurance Marketplaces, which had their first open enrollment period beginning in October 2013.  We used a large national survey to assess the changes in health insurance, access to care, and self-reported health since these expansions began.  What we found is that the beginning of the ACA’s open enrollment period in 2013 was associated with significant improvements in the trends of insurance coverage, access to primary care and medications, affordability of care, and self-reported health.  Among low-income adults in Medicaid expansion states, the ACA was associated with improvements in coverage and access to care, compared to non-expansion states. Gains in coverage and access to medicines were largest among racial and ethnic minorities. (more…)
Aging, Author Interviews, Cost of Health Care, Electronic Records, Geriatrics / 27.07.2015

MedicalResearch.com Interview with: Nisha C. Hazra MSc Department of Primary Care and Public Health Sciences, King's College London, London, UK Medical Research: What is the background for this study? What are the main findings? Response: Our study was motivated by limited evidence about the health status of very old people, the fastest growing group of the UK population with significant implications for future NHS health-care costs. Our findings indicated an increasing number of people reaching the age of 100 years, with the increase being higher among women comparing to men (a ratio of 4 to 1). Another interesting finding was that men reaching 100 years tended to be healthier than their female counterparts. In particular, women were more likely to present multiple chronic diseases compared to men and tended to be more frail, experiencing more falls, fractures, incontinence and hearing/visual impairments. (more…)
Author Interviews, Cost of Health Care, Social Issues / 27.07.2015

Laura Rosella, PhD MHSc Assistant Professor, Dalla Lana School of Public Health, University of Toronto Scientist, Public Health Ontario Adjunct Scientist, Institute for Clinical Evaluative Sciences Toronto, OntarioMedicalResearch.com Interview with: Laura Rosella, PhD MHSc Assistant Professor, Dalla Lana School of Public Health, University of Toronto Scientist, Public Health Ontario Adjunct Scientist, Institute for Clinical Evaluative Sciences Toronto, Ontario Medical Research: What is the background for this study? What are the main findings? Response: High-cost users of health care generally refer to the top five per cent of health care users. They are a small portion of the population who consume a disproportionately high share of health care resources. We undertook a study to explore the social and economic determinants that were associated with future, high cost users. That is, the characteristics of these individuals before they proceed on a trajectory of high health care utilization. By understanding these associations we can better understand the role that socio-economic factors play in future health care utilizations and costs. (more…)
Author Interviews, CDC, Cost of Health Care, Tobacco Research / 24.07.2015

healtMedicalResearch.com Interview with: Sajal Chattopadhyay, Ph.D. Economic Advisor, The Community Guide Branch Division of Public Health Information Dissemination Center for Surveillance, Epidemiology, and Laboratory Services Office of Public Health Scientific Services Centers for Disease Control and Prevention Medical Research: What is the background for this study? What are the main findings? Dr. Chattopadhyay: Based on an updated review of all of the available scientific studies, the Community Preventive Services Task Force (CPSTF) reiterated its recommendation for tobacco price increases based on strong evidence of their effectiveness in reducing tobacco use and its harmful consequences. This study expands on the conclusions on effectiveness of price increases by systematically reviewing the evidence on the economic impact of policies that raise the unit price of tobacco products in the U.S. and other high-income countries, primarily through taxation. The findings indicate that tobacco price increases generate substantial healthcare cost savings and can generate additional gains from improved workplace productivity. (more…)
AHRQ, Author Interviews, Cost of Health Care / 17.07.2015

  H. Joanna Jiang, Ph.D. Agency for Healthcare Research and QualityMedicalResearch.com Interview with: H. Joanna Jiang, Ph.D. Agency for Healthcare Research and Quality MedicalResearch: What is the background for this study? What are the main findings? Dr. Jiang: A large proportion of health care resources in the United States are consumed by a relatively small number of individuals, who have been dubbed super-utilizers. Approximately 25% of U.S. health care expenses are incurred by 1% of the U.S. population, and 50% of expenses are incurred by 5% of the population. Our study found that across all types of payers of medical care (Medicare, Medicaid, and private insurance), super-utilizers on average had approximately 4 times as many hospital stays as other patients, and the 30-day hospital readmission rate for super-utilizers was 4 to 8 times higher than for other patients. Among Medicaid and privately insured patients, super-utilizers had longer hospital stays and higher average hospital costs than other patients. We also found that patients with multiple chronic conditions, such as diabetes, hypertension, and congestive heart failure, accounted for a greater share of hospital stays among super-utilizers than among other hospitalized patients. Mental health and substance use disorders were among the top 10 principal diagnoses for super-utilizers aged 1 to 64 years regardless of payer. (more…)
Author Interviews, Compliance, Cost of Health Care, Emergency Care, Primary Care, UCSD / 15.07.2015

Nadereh Pourat, PhD Professor, Department of Health Policy and Management, UCLA Fielding School of Public Health Adjunct Professor, UCLA School of Dentistry Director of Research, UCLA Center for Health Policy ResearchMedicalResearch.com Interview with: Nadereh Pourat, PhD Professor, Department of Health Policy and Management, UCLA Fielding School of Public Health Adjunct Professor, UCLA School of Dentistry Director of Research, UCLA Center for Health Policy Research Medical Research: What is the background for this study? What are the main findings? Dr. Pourat: We have succeeded to insure most of the uninsured population in the U.S., but now have to figure out how to reduce costs while improving health. We had the opportunity to examine the role of continuity with a primary care provider, which is one of the pathways that looked promising in improving health and reducing costs. We were evaluating a major demonstration program in California called the Health Care Coverage Initiative (HCCI) and one of the participating counties implemented a policy to increase adherence by only paying for visits if patients went to their assigned providers. We examined what happened to patients who always or sometimes adhered to their provider versus those who never adhered. We found that adherence or continuity reduced emergency department use and hospitalizations. This would lead to savings because of the high costs of these services. Medical Research: What should clinicians and patients take away from your report? Dr. Pourat: The study shows that both patients and clinicians would benefit from continuity with the primary care provider. Clinicians can actually make a difference in helping patients: they can teach patients about self-care and help them manage their conditions better. Patients would benefit from following through with treatment plans and experience less medical error and duplication of services which are potentially harmful. Continuity fosters rapport and trust between patients and providers and can be beneficial to both. (more…)
Author Interviews, Cost of Health Care, OBGYNE, Pharmacology / 14.07.2015

Nora V. Becker MD/PhD candidate Department of Health Care Management and Economics Wharton School, University of Pennsylvania, in Philadelphia. MedicalResearch.com Interview with: Nora V. Becker MD/PhD candidate Department of Health Care Management and Economics Wharton School, University of Pennsylvania, in Philadelphia. Medical Research: What is the background for this study? What are the main findings? Response: The Affordable Care Act mandates that private health insurance plans cover prescription contraceptives with no consumer cost sharing. The positive financial impact of this new provision on consumers who purchase contraceptives could be substantial, but it has not yet been estimated. Using a large administrative claims data set from a national insurer, we estimated out-of-pocket spending before and after the mandate. We found that mean and median per prescription out-of-pocket expenses have decreased for almost all reversible contraceptive methods on the market. The average percentages of out-of-pocket spending for oral contraceptive pill prescriptions and intrauterine device (IUD) insertions by women using those methods both dropped by 20 percentage points after implementation of the ACA mandate. We estimated average out-of-pocket savings per contraceptive user to be $248 for the IUD and $255 annually for the oral contraceptive pill. (more…)
Author Interviews, Cost of Health Care, Heart Disease / 13.07.2015

MedicalResearch.com Interview with: Azfar B. Sheikh, M.D. Internal Medicine Resident Physician Staten Island University Hospital New York Medical Research: What is the background for this study? Dr. Sheikh: The background of this review article circles around the impact of atrial fibrillation on epidemiology, trends in hospitalizations, costs associated with hospitalization and outpatient care, in the United States. This article also describes the benefits of newer treatment modalities compared to the standard of care with regards to symptomatic improvement and prevention of thromboembolism. These findings are supported by several cost-utility analyses. Medical Research: What are the main findings? Dr. Sheikh:  The main findings of the study are:
  • The cost of hospitalization is three times higher for patients with atrial fibrillation than those without atrial fibrillation.
  • 5 million new cases are being reported annually.
  • The incidence of atrial fibrillation is projected to increase from 1.2 million cases in 2010 to 2.6 million cases by 2030. Due to this increase in incidence, the prevalence of atrial fibrillation is projected to increase from 5.2 million cases to 12.1 million cases by 2030.
  • The most common co-moribidites associated with atrial fibrillation were hypertension, diabetes mellitus, and chronic obstructive lung disease.
  • According to the NIS database, the atrial fibrillation. hospitalization rate has increased from 1552 to 1812 per one million US residents per year from 2000 to 2010 (relative increase 14.4%).
  • According to the NIS database, the mortality associated with atrial fibrillation hospitalizations has decreased significantly from 1.2% in 2000 to 0.9% in 2010 (relative decrease 29.2%).
  • The median length of stay in the hospital is 3 days and increases proportionally with a rise in CHADS2 score.
  • The largest source of direct healthcare costs associated with atrial fibrillation is hospitalization. According to the NIS database, the mean cost of inpatient atrial fibrillation hospitalization increased significantly from $6401 in 2001 to $8439 in 2010 (relative increase 24.0%). The mean cost of atrial fibrillation hospitalization also increases proportionally with a rise in CHADS2 score.
  • In the outpatient setting, the highest costs were associated with physician office visits in comparison to emergency room and urgent care visits.
  • With regards to prevention of thromboembolism, the new oral anticoagulant agents (dabigatran, rivaroxaban, and apixaban) have been found to be more cost-effective compared to warfarin.
  • Left atrial catheter ablation is more effective than rate control and rhythm control. It is more cost-effective in younger patients who are moderate risk for stroke.
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Author Interviews, Cost of Health Care, OBGYNE, Yale / 10.07.2015

Xiao Xu, Ph.D. Assistant Professor Department of Obstetrics, Gynecology & Reproductive Sciences Yale School of MedicineMedicalResearch.com Interview with: Xiao Xu, Ph.D. Assistant Professor Department of Obstetrics, Gynecology & Reproductive Sciences Yale School of Medicine Medical Research: What is the background for this study? What are the main findings? Dr. Xiao Xu: While research has shown hospital variation in costs of care for other conditions, we know little about whether and how hospitals differ in costs of childbirth related care. With nearly 4 million births each year, childbirth is the most common reason for hospital admission in the U.S. Understanding the pattern and causes of variation in resource utilization during childbirth among hospitals can help inform strategies to reduce costs. Our study used data from 463 hospitals across the country and analyzed hospital costs of maternity care for low-risk births. We found that hospital varied widely in average facility costs per maternity stay. (more…)
Author Interviews, BMJ, Cost of Health Care, Medicare / 06.07.2015

Joshua P. Cohen Ph.D Research Associate Professor Tufts Center for the Study of Drug Development Boston, MassachusettsMedicalResearch.com Interview with: Joshua P. Cohen Ph.D Research Associate Professor Tufts Center for the Study of Drug Development Boston, Massachusetts Medical Research: What is the background for this study? Dr. Cohen: Florbetapir 18F was the first radioactive diagnostic agent approved by the US Food and Drug Administration for positron emission tomography imaging of the brain to evaluate amyloid â neuritic plaque density. Medical Research: What are the main findings? Dr. Cohen: Medicare has restricted coverage of florbetapir in the US, whereas conspicuously the UK NHS decided to reimburse the radiopharmaceutical. Note, the British NHS is generally more restrictive with regard to coverage of new technologies than the Centers for Medicare and Medicaid Services. Historically Medicare has rejected coverage of 25% of diagnostics approved by the FDA, but covers all FDA approved drugs administered in the physician’s office. Furthermore, Medicare has subjected labeled use of diagnostics, including a half-dozen Alzheimer's diagnostics, to its coverage with evidence development program while not subjecting any labeled uses of drugs to coverage with evidence development. In sum, diagnostics are subject to a level of scrutiny by Medicare that is rarely given Medicare Part B drugs (physician-administered). (more…)
Author Interviews, BMJ, Cost of Health Care / 04.07.2015

Igho Onakpoya MD MSc Clarendon Scholar University of Oxford Centre for Evidence-Based Medicine Nuffield Department of Primary Care Health Sciences Oxford UKMedicalResearch.com Interview with: Igho Onakpoya MD MSc Clarendon Scholar University of Oxford Centre for Evidence-Based Medicine Nuffield Department of Primary Care Health Sciences Oxford UK MedicalResearch: What is the background for this study? What are the main findings? Dr. Onakpoya: Several orphan drugs have been approved for use in Europe. However, the drugs are costly, and evidence for their clinical effectiveness are often sparse at the time of their approval. We found inconsistencies in the quality of the evidence for approved orphan drugs. We could not identify a clear mechanism through which their prices drugs are determined. In addition, the costs of the branded drugs are much higher than their generic or unlicensed versions. MedicalResearch: What should clinicians and patients take away from your report? Dr. Onakpoya: Because of inconsistencies in the evidence regarding the benefit-to-harm balance of orphan medicines, coupled with their high prices, clinicians and patients should assess whether the orphan drugs provide real value for money before making a decision about their use for a medical condition. (more…)
Author Interviews, Cost of Health Care, Education, Johns Hopkins, Primary Care / 15.06.2015

MedicalResearch.com Interview with: Eric T. Roberts and Darrell Gaskin Johns Hopkins University Bloomberg School of Public Health Baltimore, MD Medical Research: What is the background for this study? What are the main findings? Response: This study looked at the implications of the Affordable Care Act’s expansion of Medicaid on the need for additional physicians working in primary care. Since 2014, 11 million low-income adults have signed up for Medicaid, and this figure will likely increase as more states participate in the expansion. Many new Medicaid enrollees lacked comprehensive health insurance before, and will be in need of primary and preventive care when their Medicaid coverage begins. In light of these questions, in this study, we projected the number of primary care providers that are needed to provide care for newly-enrolled adults. We forecast that, if all states expand Medicaid, newly-enrolled adults will make 6.1 million additional provider visits per year. This translates into a need for 2,100 additional full time-equivalent primary care providers. We conclude that this need for additional providers is manageable, particularly if Congress fully funds key primary care workforce training programs, such as the National Health Service Corps. (more…)
Author Interviews, Cost of Health Care, Endocrinology, OBGYNE, Yale / 12.06.2015

Aileen Gariepy, MD, MPH Assistant Professor Section of Family Planning Department of Obstetrics, Gynecology, and Reproductive Sciences Yale School of Medicine New Haven, CT 06510MedicalResearch.com Interview with: Aileen Gariepy, MD, MPH Assistant Professor Section of Family Planning Department of Obstetrics, Gynecology, and Reproductive Sciences Yale School of Medicine New Haven, CT Medical Research: What is the background for this study? What are the main findings? Dr. Gariepy: Women who have just given birth are often highly motivated to prevent a rapid, repeat pregnancy.  For women who desire the contraceptive implant, a highly effective reversible form of contraception that is placed in the arm and can last for 3 years, new research shows that it is more cost-effective to place the implant while women are still in the hospital after giving birth, compared to delaying insertion to the postpartum visit 6-8 weeks later which is currently the most common practice. When the costs associated with the implant insertion and the costs of unintended pregnancy are compared in women who receive immediate contraceptive implant insertion (while still in the hospital after giving birth) to women who are asked to come back in 6-8 weeks for the implant insertion (delayed insertion), immediate insertion is expected to save $1,263 per patient.  Based on these estimates, for every 1,000 women using postpartum implant, immediate placement is expected to avert 191 unintended pregnancies and save $1,263,000 compared with delayed insertion in the first year. Cost savings would continue to increase for the second and third year after insertion. In fact, over half of U.S. pregnancies are unintended.  Maternal and infant care costs for unintended pregnancies amount to $11.1 billion annually for public insurance programs alone. The immediate postpartum period (after delivery but before discharge home) provides an ideal opportunity for initiating contraceptives as patients are motivated and timing is convenient. However, the majority of insurance company policies do not provide coverage for insertion of the contraceptive implant when the new mother is still in the hospital.  This lack of reimbursement is the most significant barrier to providing this highly effective contraceptive method for women who have just delivered a baby.  Surprisingly, the reason most insurance companies do not offer reimbursement for immediate insertion is due to an outdated insurance protocol, “the global obstetric fee” which precludes separate reimbursement of individual procedures (like inserting the implant). The main reason that immediate insertion results in cost savings is because more women will get the implant compared to a strategy of delayed insertion.  Women can get pregnant again within 4 weeks of delivering a baby.  Starting contraception as soon as possible after giving birth is important because most women will resume sexual activity before their postpartum office visit and therefore will be at risk of pregnancy. And approximately 35% of women do not return for a postpartum visit. Even for women who want another pregnancy soon, the implant has benefits.  When women conceive and deliver a baby within 2 years of last giving birth, there is a significantly higher risk of poor maternal and neonatal outcomes, including preterm birth, low birth weight, and even early neonatal and maternal death.  Birth spacing is better for moms and babies. (more…)
Author Interviews, Cost of Health Care, JAMA, NYU, Surgical Research / 12.06.2015

Joseph A. Ladapo, MD, PhD Assistant Professor of Medicine Section on Value and Effectiveness Department of Population Health NYU School of MedicineMedicalResearch.com Interview with: Joseph A. Ladapo, MD, PhD Assistant Professor of Medicine Section on Value and Effectiveness Department of Population Health NYU Langone School of Medicine Medical Research: What is the background for this study? What are the main findings? Dr. Ladapo: Routine tests before elective surgery are largely considered to be of low value, and they may also increase costs.  In an attempt to discourage their use, two professional societies released guidance on use of routine preoperative testing in 2002. We sought to examine the long-term national effect of these guidelines from the American College of Cardiology/American Heart Association and the American Society of Anesthesiologists on physicians' use of routine preoperative testing. While we found that overall rates of routine testing declined across several categories over the 14-year study period, these changes were not significant after accounting for overall changes in physicians’ ordering practices. Our findings suggest that professional guidance aimed at improving quality and reducing waste has had little effect on physician or hospital practice. (more…)
Author Interviews, Cost of Health Care, Kaiser Permanente, Long Term Care, Medicare / 11.06.2015

Yan S. Kim, MD PhD Delivery Science Fellow Division of Research Kaiser Permanente Northern California Oakland, CA 94612MedicalResearch.com Interview with: Yan S. Kim, MD PhD Delivery Science Fellow Division of Research Kaiser Permanente Northern California Oakland, CA 94612 Medical Research: What is the background for this study? What are the main findings? Dr. Kim: Long-term care hospitals first emerged in the 1980s as an alternative to lengthy acute-care hospital stays for patients with complex medical problems who need prolonged hospital-level care.  In 2002, Medicare changed its payment method for these facilities from cost-based to a lump sum per admission based on the diagnosis.  Under this system, which is still in place, Medicare pays these hospitals a higher rate for patients who stay a minimum number of days based on the patient's condition.  Shorter stays are paid much less and longer stays do not necessary generate higher reimbursements. Using Medicare data, we analyzed a national sample of patients who required prolonged mechanical ventilation – the most common, and among the most costly, conditions for patients in long-term care hospitals – to examine whether this payment policy has created incentives to base discharge decisions on payments.  We found that in the years after the policy’s implementation there was a substantial spike in the percentage of discharges on and immediately after the minimum-stay threshold was met, while very few patients were discharged before the threshold. By contrast, prior to 2002, discharges were evenly distributed around the day that later became the short-stay threshold.  These findings confirm that the current payment policy has created unintended incentives for long-term care hospitals to base the timing of patient discharges on payments and highlight how responsive these hospitals are to payment incentives. (more…)