Author Interviews, Cancer Research, Cost of Health Care, JAMA, University of Pennsylvania / 13.02.2015

Ezekiel Jonathan Emanuel MD PhD Department of Medical Ethics and Health Policy Perelman School of Medicine and Department of Health Care Management The Wharton School University of Pennsylvania Philadelphia, PAMedicalResearch.com Interview with: Ezekiel Jonathan Emanuel MD PhD Department of Medical Ethics and Health Policy Perelman School of Medicine and Department of Health Care Management The Wharton School University of Pennsylvania Philadelphia, PA Editor’s note: Dr. Emanuel is a medical oncologist as well as director of the department of Medical Ethics and Health Policy at the University of Pennsylvania. Dr. Emanuel was kind enough to answer several questions regarding his most recent study, published in the new JAMA Oncology journal, Patient Demands and Requests for Cancer Tests and Treatments. Medical Research: What is the background for this study? What are the main findings? Dr. Emanuel: The genesis for this study is twofold. One, the first referenced article, by John Tilbert1 discussed how physicians explain US health care costs. In this study, physicians felt patients, insurance companies, drug companies, government regulations and malpractice lawyers...all were more to blame than doctors themselves for the high cost of US health care. Secondly, I give lots of presentations to doctors who offer two explanations for escalating health care costs: fear of malpractice litigation, and demanding patients, who request extensive testing and drugs. We decided to see whether the impression doctors frequently held of patients’ demands driving up health care costs, had been previously investigated. We could find no article to substantiate this belief. In addition, demanding patients were not common in my medical experience. In our study we included 5050 patient encounters. We asked the clinician coming out of the encounter, did the patient make a demand or request? (By asking immediately after the doctor left the examination room, there was little risk of inaccurate recall of the specifics of visit). In 8.7% there was a patient request and of these, over 70% were deemed clinically appropriate as determined by the physician (i.e. a request for pain medication, palliative care or imaging to address a new symptom or finding). In only 1% of all encounters (50/5050) was a clinically inappropriate request made as determined by the doctor, and the doctors hardly filled any of these inappropriate requests (total of 7 of 5050 encounters). We concluded that it is pretty rare for patients to make demands or requests, at least in this oncology setting, and even less common for the demands to be complied with by the doctor. Therefore it seems unlikely to us that health care costs are significantly driven by inappropriate patient requests. It is possible that there are more or different patient demands in other health care settings but we were very surprised to find no difference in patient requests based on patient-income, i.e. wealthier, more educated patients made no more demands than patients of lesser means. (more…)
Author Interviews, CDC, Cost of Health Care, HIV / 05.02.2015

MedicalResearch.com Interview with: Ya-lin (Aileen) Huang, PhD. Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention Atlanta, GA, 30329 Medical Research: What is the background for this study? What are the main findings? Dr. Huang: With an estimated 50,000 new HIV infections each year in this country, and no vaccine or cure available yet, prevention is critical. Maximizing the impact of all available prevention strategies could significantly reduce new infections in this country. The purpose of this study is to provide evidence for the cost effectiveness of the interventions recommended under the funding announcement and to highlight where more cost-effectiveness studies may be needed. We limited our scope to the four interventions required under the health department funding announcement, including HIV testing, prevention with HIV-positives and their partners, condom distribution and efforts to align policies with optimal HIV prevention, care and treatment. Our review provides an updated summary of the published evidence of cost-effectiveness of four key HIV prevention interventions recommended by CDC: HIV testing, prevention with HIV-positives and their partners, condom distribution and policy initiatives. Models suggest that more than 350,000 HIV infections have been avoided because of the nation’s HIV prevention efforts. In addition to lives saved, HIV prevention has also generated substantial economic benefits. For every HIV infection that is prevented, an estimated $402,000 (http://www.ncbi.nlm.nih.gov/pubmed/23615000) is saved in the cost of providing lifetime HIV treatment. It is estimated that HIV prevention efforts have averted more than $125 billion in medical costs since the beginning of the epidemic. (more…)
Accidents & Violence, Author Interviews, CDC, Cost of Health Care / 04.02.2015

Judy A. Stevens PhD National Center for Injury Prevention and Control Centers for Disease Control and Prevention Atlanta GA 30341MedicalResearch.com Interview with: Dr. Judy Stevens PhD National Center for Injury Prevention and Control Centers for Disease Control and Prevention, Atlanta, GA 30341, USA Medical Research: What is the background for this study? What are the main findings? Dr. Stevens: Falls among people aged 65 and older are a serious, costly, and growing public health problem. As our population ages, falls will continue to increase unless we implement effective prevention strategies that are also cost-effective. This study found that three evidence-based fall prevention programs, the Otago Exercise Program, Tai Chi: Moving for Better Balance, and Stepping On, were not only practical and effective but also provided a positive return on investment (ROI) or net benefit.  An ROI of 150% means for each $1 spent on implementing the program, you can expect a net benefit of $1.50. The analysis found that the cost of implementing each of these fall prevention programs was considerably less than the potential medical costs needed to care for someone injured from a fall. These research findings can help community organizations and policymakers identify and use programs that can both save lives and reduce costs. (more…)
Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, HIV, NEJM / 30.01.2015

Douglas B. Jacobs B.S., MD/MPH Candidate Harvard T.H. Chan School of Public HealthMedicalResearch.com Interview with: Douglas B. Jacobs B.S., MD/MPH Candidate Harvard T.H. Chan School of Public Health Medical Research: What is the background for this study? Response: In May 2014, a formal complaint submitted to the Department of Health and Human Services contended that four Florida insurers were structuring their formularies in a way that discouraged enrollment from HIV positive beneficiaries. These insurers placed all HIV drugs, including generics, on the highest cost-sharing tiers. This formal complaint served as the impetus for this research. We wanted to discover if this was a phenomenon that was isolated to Florida, or if it was national in scope, and what the implications would be for HIV positive beneficiaries. As such, we analyzed what we called “adverse tiering”—in which all drugs for certain conditions are placed in the highest cost sharing tiers—in 12 states in the federal marketplace. We compared cost-sharing for a commonly prescribed class of HIV medication, called Nucleoside Reverse Transcriptase Inhibitors, or NRTIs. (more…)
Author Interviews, CDC, Cost of Health Care / 30.01.2015

MedicalResearch.com Interview with: Robin A. Cohen, Ph.D Medical Research: What is the background for this study? Dr. Cohen: Estimates are based on data collected from the 2013 National Health Interview Survey (NHIS). The NHIS is a survey conducted by the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics. NHIS collects information about health and health care of the civilian noninstitutionalized population of the United States. In 2013, questions about strategies used to reduce prescription drug cost were asked of more than 34,000 adults aged 18 and over. Medical Research: What are the main findings? Dr. Cohen: To save money, almost 8% of U.S. adults (7.8%) did not take their medication as prescribed, 15.1% asked a doctor for a lower-cost medication, 1.6% bought prescription drugs from another country, and 4.2% used alternative therapies. Adults aged 18–64 (8.5%) were nearly twice as likely as adults aged 65 and over (4.4%) to have not taken their medication as prescribed to save money. Among adults aged 18–64, uninsured adults (14.0%) were more likely than those with Medicaid (10.4%) or private coverage (6.1%) to have not taken their medication as prescribed to save money. The poorest adults—those with incomes below 139% of the federal poverty level—were the most likely to not take medication as prescribed to save money. Among adults aged 65 and over, those living with incomes in the 139-400% FPL range were more likely than adults living in lower or higher income thresholds to have asked their provider for a lower cost prescription to save money. (more…)
Author Interviews, Blood Pressure - Hypertension, Cost of Health Care, NEJM / 29.01.2015

Andrew Moran, MD, MPH Herbert Irving Assistant Professor of Medicine Columbia University Division of General Medicine Presbyterian Hospital 9th floor East room 105 New York, NY 10032MedicalResearch.com Interview with: Andrew Moran, MD, MPH Herbert Irving Assistant Professor of Medicine Columbia University Division of General Medicine Presbyterian Hospital  New York, NY 10032 Medical Research: What is the background for this study? What are the main findings? Response: In 2014, a panel appointed by the Eighth Joint National Committee on the Detection, Evaluation and Treatment of High Blood Pressure (JNC 8) recommended new guidelines for high blood pressure (hypertension ) treatment in U.S. adults.  The guidelines made sweeping changes to the prior guidelines and stirred up controversy among hypertension and public health experts.  Essentially, the panel recommended more conservative treatment targets that narrowed the population eligible for treatment with blood pressure-lowering medications.  Nonetheless, about 28 million U.S. adults have uncontrolled hypertension even under the new more conservative guidelines.  We asked the question:  are the new guidelines cost-effective? That is, does treating this common condition with the available medicines add more health and reduce medical costs?  It is surprising that this question has rarely been answered before. (more…)
Author Interviews, Cost of Health Care, Heart Disease / 28.01.2015

Andre Lamy MD MHSc COMPASS (CABG sub-group PI) CORONARY Principal Investigator Professor, Dept Surgery, Division Cardiac Surgery Associate Member, Dept Clinical Epidemiology & Biostatistics McMaster University Hamilton General Hospital Hamilton, ON, CanadaMedicalResearch.com Interview with: Andre Lamy MD MHSc COMPASS (CABG sub-group PI) CORONARY Principal Investigator Professor, Dept Surgery, Division Cardiac Surgery Associate Member, Dept Clinical Epidemiology & Biostatistics McMaster University Hamilton General Hospital Hamilton, ON, Canada Medical Research: What is the background for this study? Dr. Lamy: The Canadian healthcare system operates in an environment that must constantly find new ways to make healthcare delivery more efficient. In the TIMACS clinical led by Dr. Shamir Mehta, it was found that the primary outcome was similar for an early invasive procedure within 24 hours and a delayed approach of after 36 hours in outcomes. However, because of the inherent shorter length of stay associated with early invasive procedures within 24 hours there will be definite cost-savings from an early invasive strategy. Dr. Andre Lamy et al looked at the cost implications of this shorter length of stay in the TIMACS trial and explored the impact of the use of a catheterization lab on days when they are normally not in use (i.e. weekends), which may negate the savings of early intervention. Medical Research: What are the main findings? Dr. Lamy: The main findings of our study were that early invasive strategy was cost-saving for Canadian NTSE-ACS patients due to significant savings from the shorter length of stay. These savings were present even if as many as 50% of TIMACS patients were assumed to be weekend cases. Given many high-risk NSTE-ACS patients receive delayed intervention due to weekend catheterization lab status, these findings support operating catheterization labs on weekends to facilitate the use of early invasive intervention. (more…)
AHRQ, Author Interviews, Cost of Health Care / 28.01.2015

Raynard E. Washington, PhD, MPH Center for Delivery, Organization, and Markets Agency for Healthcare Research and Quality Rockville, MD 20850MedicalResearch.com Interview with: Raynard E. Washington, PhD, MPH Center for Delivery, Organization, and Markets Agency for Healthcare Research and Quality Rockville, MD 20850 Medical Research: What is the background for this study? What are the main findings? Dr. Washington: Many individuals with low income who require a hospital stay are uninsured or covered by Medicaid, a joint Federal-State health insurance program for eligible individuals and families with low income. The difference in hospital utilization among patients covered by Medicaid and those who are uninsured may reflect differences in the characteristics of these populations and their level of access to health care. This HCUP Statistical Brief describes 2012 hospital stays with a primary expected payer of Medicaid and stays that were uninsured. Of the 36.5 million total hospital inpatient stays in 2012, 20.9 percent had an expected primary payer of Medicaid and 5.6 percent were uninsured; 30.6 percent were covered by private insurance. Patients covered by Medicaid were on average younger and more likely to live in low-income areas than were patients with private insurance. Patients who were uninsured were more likely to be male and to live in low-income communities than were patients with private insurance. The majority of the top 10 diagnoses for Medicaid hospitalizations were ambulatory care sensitive conditions. Cholecystectomy (gall bladder removal) was the most common operating room procedure for Medicaid and uninsured stays. (more…)
Author Interviews, Cost of Health Care, NEJM, University of Pennsylvania / 26.01.2015

Daniel Polsky PhD Executive Director, Leonard Davis Institute of Health Economics Professor of Medicine and Health Care Management Perelman School of Medicine and the Wharton School University of PennsylvaniaMedicalResearch.com Interview with: Daniel Polsky PhD Executive Director, Leonard Davis Institute of Health Economics Professor of Medicine and Health Care Management Perelman School of Medicine and the Wharton School University of Pennsylvania Medical Research: What is the background for this study? What are the main findings? Dr. Polsky: The Medicaid Fee bump, a provision of the Affordable Care Act (ACA), raised Medicaid payments to Medicare levels in 2013 and 2014 for selected services and providers expired on January 1, 2015 before policymakers had much empirical evidence about its effects.   The federally funded increase in reimbursements was aimed at expanding access to primary care for the growing number of Medicaid enrollees. The reimbursement increase expired at the end of 2014 in most states.  We found that this policy worked to increase the number of providers offering primary care appointments to Medicaid patients.  The Medicaid pay bump was associated with a 7.7 percentage points increase in new patient appointment availability without longer wait times.   This increase in availability was largest in the states where primary care physicians received the largest increase in their Medicaid reimbursements. (more…)
Author Interviews, Cost of Health Care, Heart Disease, JACC, Outcomes & Safety / 19.01.2015

Dr. P. Michael Ho, MD PhD Denver Veteran Affairs Medical Center, University of Colorado, Denver, Section of Cardiology Denver, Colorado 80220.MedicalResearch.com Interview with: Dr. P. Michael Ho, MD PhD Denver Veteran Affairs Medical Center, University of Colorado, Denver, Section of Cardiology Denver, Colorado 80220. Medical Research: What is the background for this study? What are the main findings? Dr. Ho: There is increasing interest in measuring health care value, particularly as the healthcare system moves towards accountable care. Value in health care focuses on measuring outcomes achieved relative to costs for a cycle of care. Attaining high value care - good clinical outcomes at low costs - is of interest to patients, providers, health systems, and payers. To date, value assessments have not been operationalized and applied to specific patient populations. We focused on percutaneous coronary intervention (PCI) because it is an important aspect of care for patients with ischemic heart disease, is commonly performed and is a costly procedure. In this study, we evaluated 1-year risk-adjusted mortality and 1-year risk-standardized costs of care for all patients who underwent PCI in the VA healthcare system from 2008 to 2010. We found that median one-year unadjusted hospital mortality rate was 6.13% (interquartile range 4.51% to 7.34% across hospitals). Four hospitals were significantly above the one-year risk standardized median mortality rate, with median mortality ratios ranging from 1.23 to 1.28; no hospitals were significantly below median mortality. Median 1-year total unadjusted hospital costs were $46,302 (IQR of $37,291 to $57,886) per patient. There were 16 hospitals above and 19 hospitals below the risk standardized average cost, with risk standardized ratios ranging from 0.45 to 2.09 reflecting much larger magnitude of variability in costs compared to mortality. These findings suggest that there are opportunities to improve PCI healthcare by reducing costs without compromising outcomes. This approach of evaluating outcomes and costs together may be a model for other health systems and accountable care organizations interested in operationalizing value measurement. (more…)
Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, JAMA, Medicare, Mental Health Research, Pharmacology / 16.01.2015

Dr. Jeanne Madden PhD Instructor, Department of Population Medicine Harvard Medical SchoolMedicalResearch.com Interview with: Dr. Jeanne Madden PhD Instructor, Department of Population Medicine Harvard Medical School   Medical Research: What is the background for this study? What are the main findings? Dr. Madden: When Medicare Prescription Drug Coverage started in 2006, many experts voiced concerns about disabled patients with serious mental illness making the transition from state Medicaid coverage to Medicare.  Our study is one of the first to examine the impact of the transition in mentally ill populations.  People living with schizophrenia and bipolar disorder are at high risk of relapse and hospitalization and are especially vulnerable to disruptions in access to their treatments. We found that the effects of transitioning from Medicaid to Medicare Part D depended on where patients lived.  Transition to Part D in states that put limits on Medicaid drug coverage resulted in fewer patients going without treatment. By contrast, in states with more generous drug coverage, we saw reductions in use, of antipsychotics in particular, after patients shifted to Medicare Part D.  This may have been due to new cost controls used within many private Medicare drug plans.  Given that most states in the US are in this latter category, with the relatively generous Medicaid drug coverage, we also found reductions in antipsychotic use nation-wide. Although a very large group of people made that transition from Medicaid to Medicare in 2006, thousands more still transition every year because when disabled people qualify for Medicare, they must wait 2 years for their benefits kick in.  Also, many other disabled patients are on Medicaid only and don’t qualify for Medicare.  They are of course affected by restrictions on Medicaid coverage, which vary from state to state. (more…)
Author Interviews, Cost of Health Care, JAMA, Pediatrics / 24.12.2014

Dr. Ricardo Mosquera MD Assistant professor of Pediatrics at The University of Texas Health Science Center at Houston Medical School Clinic Director, UT Physicians, of the UTHealth Medical School.MedicalResearch.com Interview with: Dr. Ricardo Mosquera MD Assistant professor of Pediatrics at The University of Texas Health Science Center at Houston Medical School Clinic Director, UT Physicians, of the UTHealth Medical School. Medical Research: What is the background for this study? What are the main findings? Dr. Mosquera: There is not strong scientific evidence to support the use of medical homes.  Medical homes have not been demonstrated to decrease adverse outcomes or costs in children. Such benefits are most likely for high-risk children with chronic illness.  We conducted a rigorous and well designed, randomized controlled trial to determine if an enhanced medical home providing comprehensive care decreases serious illness  (death, prolonged hospitalization>7 days, or intensive care unit admissions) and/or cost among high-risk chronically ill children. An enhanced medical home decreased both adverse outcomes (decreased serious illness, hospitalizations, PICU admissions, and serious illness by ~50%) and cost (~$10.000 less per child/year). (more…)
Author Interviews, CDC, Cost of Health Care, Smoking / 17.12.2014

MedicalResearch.com Interview with: Xin Xu, Ph.D. Senior Economist Office on Smoking and Health and Darryl Konter Health Communications Specialist McNeal Professional Services Centers for Disease Control and Prevention Office on Smoking and Health Atlanta, GA 30341 Medical Research: What is the background for this study? What are the main findings? Response: Tips From Former Smokers (Tips), the first federally funded national mass media antismoking campaign, launched by the CDC, provides a unique opportunity to assess the cost effectiveness of a nationwide public health intervention that meets the ad exposure recommendation in CDC’s 2014 Best Practices for Comprehensive Tobacco Control Programs.  The 2012 campaign spent $393 per year of life saved—far less than the $50,000 per year of life saved figure used as a common threshold for cost-effectiveness. The campaign  added about 179,000 healthy life years, at $268 per healthy year gained. The campaign spent about $480 per smoker who quit. The campaign averted more than 17,000 premature deaths, at a cost of about $2,200 per premature death averted. (more…)
Author Interviews, Cost of Health Care, Smoking / 14.12.2014

MedicalResearch.com Interview with: Darryl Konter Health Communications Specialist McNeal Professional Services Centers for Disease Control and Prevention Office on Smoking and Health Atlanta, GA 30341 Medical Research: What is the background for this study? What are the main findings? Darryl Konter:         Fifty years after the first Surgeon General’s report, tobacco use remains the nation’s leading preventable cause of death and disease, despite declines in adult cigarette smoking prevalence. Smoking-attributable healthcare spending is an important part of overall smoking attributable costs in the U.S.         Data came from the 2006–2010 Medical Expenditure Panel Survey (MEPS) linked to the 2004–2009 National Health Interview Survey (NHIS). The MEPS is a nationally representative survey of civilian non-institutionalized families and individuals, their medical providers, and employers that collects information on individual healthcare utilization and medical expenditures.         By 2010, 8.7% of annual healthcare spending in the U.S. could be attributed to cigarette smoking, amounting to as much as $170 billion per year.  More than 60% of the attributable spending was paid by public programs, including Medicare, other federally-sponsored programs, or Medicaid. (more…)
Author Interviews, Cost of Health Care, Geriatrics, Nursing / 11.12.2014

Karen Dorman Marek, PhD, MBA, RN, FAAN Bernita 'B' Steffl Professor of Geriatric Nursing Arizona State University College of Nursing & Health Innovation Phoenix, AZ 85004-0696MedicalResearch.com Interview with: Karen Dorman Marek, PhD, MBA, RN, FAAN Bernita 'B' Steffl Professor of Geriatric Nursing Arizona State University College of Nursing & Health Innovation Phoenix, AZ 85004-0696 Medical Research: What is the background for this study? What are the main findings? Response: For many older adults, self-management of chronic illness is an overwhelming task, especially for those with mild cognitive impairment or complex medication regimens. The purpose of this study was to evaluate cost outcomes of a home-based program that included both nurse care coordination and technology to support self-management of chronic illness, with as an emphasis on medications in frail older adults. A total of 414 older adults, identified as having difficulty self-managing their medications, were recruited at discharge from three Medicare-certified home health care agencies in a large Midwestern urban area. A prospective, randomized, controlled, three-arm, longitudinal design was used. A team consisting of both Advanced Practice Nurses (APNs) and Registered Nurses (RNs) coordinated care to two groups: home-based nurse care coordination (NCC) plus mediplanner group and NCC plus the MD.2 medication-dispensing machine group. Major findings were:
  • Total Medicare costs were $447 per month lower in the NCC + mediplanner group (p=0.11) when compared to the control group.
  • For participants in the study at least 3 months, total Medicare costs were $491 lower per month in the NCC + mediplanner group (p=0.06) compared to the control group.
  • The cost of the NCC intervention was $151 per month, yielding a net savings of $296 per month or $3552 per year for the NCC + mediplanner group.
  • Participants who received the nurse care coordination intervention scored significantly better than the control group in depression (p < 0.001), functional status (p < 0.001), cognition (p < 0.001), and quality of life (p < 0.001) than participants in the control group.
(more…)
Author Interviews, BMJ, Cost of Health Care, Pediatrics / 05.12.2014

MedicalResearch.com Interview with Rosemary Dodds Senior Policy Adviser NCT (formerly National Childbirth Trust), London, UK Medical Research: What is the background for this study? What are the main findings? Response: The study, which was commissioned by UNICEF UK, was designed to take an in-depth look at how raising breastfeeding rates might save money for the health service through reducing illness. It found that low breastfeeding rates in the UK are costing the health service millions of pounds.  We calculated that from reducing rates of illnesses, where the evidence is strongest, moderate increases in breastfeeding could see potential annual savings to the health service of around £40m per year. It should be noted however, that this figure is likely to be only the tip of the iceberg when the full range of conditions affected by breastfeeding are taken into account. Economic models around five illnesses (breast cancer in the mother, and gastroenteritis, respiratory infections, middle ear infections and necrotising enterocolitis (NEC) in the baby), show that moderate increases in breastfeeding would translate into the following cost savings for the NHS:
  •  If half those mothers who currently do not breastfeed were to do so for up to 18 months over their life, there would be:
-      865 fewer cases of breast cancer -      With cost savings to the NHS of over £21million -      Improved quality of life equating to more than £10million[1] Over the lifetime of each annual cohort of first-time mothers.
  • If 45% of babies were exclusively breastfed for four months, and if 75% of babies in neonatal units were breastfeeding at discharge, each year there would be:
-      3,285 fewer babies hospitalised with gastroenteritis and 10,637 fewer GP consultations, saving more than £3.6million -      5,916 fewer babies hospitalised with respiratory illness, and 22,248 fewer GP consultations, saving around £6.7million -      21,045 fewer GP visits for ear infection, saving £750,000 -      361 fewer cases of the potentially fatal disease necrotising enterocolitis, saving more than £6million (more…)
Author Interviews, Cost of Health Care / 02.12.2014

Dr. John Romley PhD Schaeffer Center for Health Policy and Economics Sol Price School of Public Policy, University of Southern California Los Angeles, CAMedicalResearch.com Interview with: Dr. John Romley PhD Schaeffer Center for Health Policy and Economics Sol Price School of Public Policy, University of Southern California Los Angeles, CA MedicalResearch: What is the background for this study? What are the main findings? Dr. Romley: We've known for a long time now that there is tremendous variation in how much Medicare spends across the country, and that these differences are not necessarily related to quality of care.  Researchers have devoted great time, energy and intellect to understanding the drivers of Medicare spending.  While progress has been made, our understanding remains limited.  We also have had less insight into how private health care varies across the country. We used new information on how much private health plans pay health care providers over and above cost, and found that areas with low private payment levels tended to have substantially higher Medicare spending and utilization. (more…)
Author Interviews, Cost of Health Care, Heart Disease, UCLA / 18.11.2014

Boback Ziaeian MD Cardiology Fellow, UCLA Division of Cardiology PhD Candidate, UCLA Fielding School of Public HealthMedicalResearch.com Interview with: Boback Ziaeian MD Cardiology Fellow, UCLA Division of Cardiology PhD Candidate, UCLA Fielding School of Public Health Medical Research: What is the background for this study? What are the main findings? Dr. Ziaeian: Heart failure is projected to increase dramatically over the coming decade due to an aging population improved medical therapies that prolong heart failure survival. Spending for heart failure is projected to increase from $20.9 billion in 2012 to $53.1 billion in 2030.  Despite the magnitude of the impact of heart failure on the US population and economy, our understanding of the factors associated with the highest cost heart failure hospitalizations is limited. Our study provides a descriptive analysis of how certain patient and hospital factors are associated with increased medical costs nationally. The top 20% of heart failure hospitalizations average $28,500 per hospitalization compared to $3,000 for the lowest 20%. Overall, patients with more medical conditions (such as obesity, lung disease, and peripheral vascular disease) have much higher costs associated with hospital care. As expected, sicker patients receiving more invasive procedures such mechanical ventilation or blood transfusions incurred higher costs. Certain hospital characteristics were also associated with higher costs. Hospitals in urban centers were higher cost compared to more rural hospitals. Hospitals in the Northeast and West Coast of the US were higher in cost compared to the Midwest and South. The reasons for this disparity in medical costs requires further research to better understand. (more…)
Annals Internal Medicine, Author Interviews, Cost of Health Care, McGill / 18.11.2014

MedicalResearch.com Interview with: Todd Lee MD MPH FRCPC Consultant in Internal Medicine and Infectious Diseases Assistant Professor of Medicine, McGill University Director, General Internal Medicine Consultation Service, Chief of Service, 6 Medical Clinical Teaching Unit, McGill University Health Centre Medical Research: What is the background for this study? What are the main findings? Dr. Lee: Antibiotics are often misused and overused in hospitalized patients leading to harms in terms of side effects, infections due to Clostridium dificile, the development of antibiotic resistance, and increased health care costs.  Antimicrobial stewardship is a set of processes which are employed to improve antibiotic use.  Through various techniques, stewardship seeks to ensure the patient receives the right drug, at the right dose, by the right route, for the right duration of therapy.  Sometimes this means that no antibiotics should be given. In implementing antimicrobial stewardship programs, some of the major challenges larger health care centers face include limitations in the availability of trained human resources to perform stewardship interventions and the costs of purchasing or developing information technology solutions. Faced with these same challenges, we hypothesized that for one major area of our hospital, our medical clinical teaching units, we could use our existing resources, namely resident and attending physicians, to perform "antimicrobial self-stewardship".  This concept tied the CDCs concept of antibiotic "time outs" (periodic reassessments of antibiotics) to a twice weekly audit using a locally developed checklist.  These audits were performed by our senior resident physicians in the context of providing their routine clinical care.  We also provided local antibiotic guidelines and regular educational sessions once a rotation. We demonstrated a significant reduction in antibiotic costs as well as improvement in two of the four major classes of antibiotics we targeted as high priority.  We estimated we saved between $140 and $640 in antibiotic expenses per hour of clinician time invested. Anecdotally, trainees felt the process to be highly valuable and believed they better understood the antibiotic use for their patients. (more…)
Aging, Author Interviews, Cost of Health Care / 06.11.2014

MedicalResearch.com Interview with: Dr. Amalavoyal Chari PhD Department of Economics, University of Sussex Brighton UK Medical Research: What is the background for this study? What are the main findings? Dr. Chari: It is well-known that in the United States, informal (unpaid) caregiving by family members and friends is the primary source of long-term care for the elderly population: Recent estimates indicate that nearly 1 in 5 adults in the United States provides care to an elderly relative or friend over the age of 50. Informal care is not really “free”: Rather, it diverts caregivers’ effort from other productive activities, and the value of these displaced activities is the opportunity cost of informal elder-care. Estimates of this cost have been limited by the lack of nationally representative data with detailed information to allow an assessment of the value that caregivers attach to time and time spent providing care. Our study utilizes new and unique data from the American Time Use Survey (ATUS) to remedy this deficit, and to provide careful, up-to-date estimates of the opportunity costs of informal eldercare in the United States. We find that informal care is mainly provided by working-age adults, who consequently bear most of the economic burden in terms of opportunity costs. We find that the price tag for informal caregiving of elderly people by friends and relatives in the United States comes to $522 billion a year. Replacing that care with unskilled paid care at minimum wage would cost $221 billion, while replacing it with skilled nursing care would cost $642 billion annually. (more…)
Author Interviews, Cost of Health Care, Health Care Systems / 28.10.2014

Luís A. Nunes Amaral PhD HHMI Early Career Scientist Professor of Chemical & Biological Eng. Professor of Medicine Howard Hughes Medical Institute Northwestern University, Evanston, IllinoisMedicalResearch.com Interview with: Luís A. Nunes Amaral PhD HHMI Early Career Scientist Professor of Chemical & Biological Eng. Professor of Medicine Howard Hughes Medical Institute Northwestern University, Evanston, Illinois

Medical Research: What is the background for this study? What are the main findings? Dr. Amaral: There is a well known difficulty in promoting the rapid adoption of best practices by physicians.  Because of their work load and because of the inability to figure out when some result is a true advance or just hype, doctors tend to stick to what they believe works. Unfortunately, as a 15 year old Institute of Medicine study shows, this lack of adoption of best practices costs society hundreds of thousands of lives a year in the US alone. The typical process for informing doctors of what best practices are (such as continual medical education and other broadcasting approaches) do not work well. We believe that a weakness of typical approaches is that they have a one talking to the many style, and they are out of a medical practice context.  Our hypothesis was that by seeding a few doctors with desired knowledge, one could have spread of the adoption through one-on-one contacts between physicians in the context of treating patients.  We found that this approach has the potential to be very effective. (more…)
Author Interviews, Colon Cancer, Cost of Health Care / 25.10.2014

Dr. Christine Marie Veenstra MD Department of Internal Medicine, Division of Hematology/Oncology Division of Colorectal Surgery Center for Healthcare Outcomes and Policy Division of General Medicine Cancer Surveillance and Outcomes Research Team University of Michigan, Ann ArborMedicalResearch.com Interview with: Dr. Christine Marie Veenstra MD Department of Internal Medicine, Division of Hematology/Oncology Division of Colorectal Surgery Center for Healthcare Outcomes and Policy Division of General Medicine Cancer Surveillance and Outcomes Research Team University of Michigan, Ann Arbor Medical Research: What is the background for this study? Dr. Veenstra: Nearly 50,000 patients are diagnosed with stage III colorectal cancer each year. Chemotherapy is known to increase survival by up to 20% and is the standard recommendation for these patients after surgery. However, use of chemotherapy may be associated with financial strain. In order to better understand the financial burden and worry associated with colorectal cancer treatment, we surveyed 956 patients being treated for stage III colorectal cancer. We asked patients to answer questions about financial burden such as whether they had used savings, borrowed money, skipped credit card payments, or cut back on spending for food, clothing or recreational activities because of their cancer treatment. We also asked patients how much they worry about financial problems because of their cancer or its treatment. (more…)
AHA Journals, Author Interviews, Cost of Health Care, Stroke / 24.10.2014

A/Prof Dominique Cadilhac, MPH PhD Head: Translational Public Health Division Stroke and Ageing Research Centre (STARC) Department of Medicine, School of Clinical Sciences at Monash Health, Monash University Melbourne, AustraliaMedicalResearch.com Interview with: A/Prof Dominique Cadilhac, MPH PhD Head: Translational Public Health Division Stroke and Ageing Research Centre (STARC) Department of Medicine, School of Clinical Sciences at Monash Health, Monash University Melbourne, Australia Medical Research: What are the main findings of the study? Dr. Cadilhac: Our results provide important information for health policy and planning, by providing a better understanding of the long-term costs of ischemic stroke (IS) and intracerebral hemorrhage stroke (ICH). 243 patients who experienced an ischemic stroke– the most common type of stroke, and 43 patients with intracerebral hemorrhage stroke who went on to survive for 10 years or more were interviewed to calculate annual costs as part of the North East Melbourne Stroke Incidence Study. Average annual healthcare costs 10 years after an ischemic stroke were $5,418 (AUD) – broadly similar to costs estimated between 3 and 5 years ($5,545). Whereas previous estimates for annual healthcare costs for intracerebral hemorrhage stroke ten years after stroke onset were $6,101, Professor Cadilhac’s team found the true cost was $9,032 far higher than costs calculated at 3 to 5 years ($6,101) because of a greater need for aged care facilities 10 years on. The high lifetime costs per stroke for both subtypes for first-ever events emphasize the significant economic implications of stroke (ischemic stroke AUD103,566 [USD 68,769] and intracerebral hemorrhage stroke AUD82,764 [USD54,956]). The study also provides evidence of the importance of updating cost estimates when population demography patterns change or if new information on incidence rates, or case-fatality rates, are available. We found a much larger number of intracerebral hemorrhage stroke would be expected than from earlier estimates because a) there are a larger number of people in the age groups 45 to 84 years living in Australia in 2010; and b) we applied new information on incidence rates from a larger geographical region than what was found from using the original NEMESIS pilot study region. In the online supplement we also provide an estimate of health loss reported as quality adjusted Life years (QALYs) lost to highlight how many years of healthy life is lost from a first-ever stroke event. (more…)
Author Interviews, Cost of Health Care, JAMA, University of Pennsylvania / 22.10.2014

Dr. Harald Schmidt, MA, PhD Assistant Professor, Department of Medical Ethics and Health Policy Research Associate, Center for Health Incentives and Behavioral Economics Perelman School of Medicine University of Pennsylvania Philadelphia, PA 19104-3308MedicalResearch.com Interview with Dr. Harald Schmidt, MA, PhD Assistant Professor, Department of Medical Ethics and Health Policy , Research Associate, Center for Health Incentives and Behavioral Economics, Perelman School of Medicine University of Pennsylvania Philadelphia, PA 19104-3308 Medical Research: What are the main findings of the study? Dr. Schmidt: We reviewed currently available policies for aligning cost and quality of care. We focused on interventions are similar in their clinical effectiveness, have modest differences in convenience, but pose substantial cost differences to the healthcare system and patients. To control health care costs while ensuring patient convenience and physician burden, reference pricing would be the most desirable policy. But it is currently politically unfeasible. Alternatives therefore need to be explored. We propose the novel concept of Inclusive Shared Savings, in which physicians, the healthcare system, and, crucially, patients, benefit financially in moving more patients to lower cost but guideline concordant and therapeutically equivalent interventions. (more…)
Author Interviews, Cost of Health Care, Emergency Care, NEJM, UCLA / 16.10.2014

Daniel A. Waxman, MD, PhD Department of Emergency Medicine David Geffen School of Medicine University of California, Los Angeles RAND Corporation Santa Monica, CaliforniaMedicalResearch.com Interview with: Daniel A. Waxman, MD, PhD Department of Emergency Medicine David Geffen School of Medicine University of California, Los Angeles RAND Corporation Santa Monica, California Medical Research: What are the main findings of the study? Dr. Waxman: About 10 years ago, three states (Texas, Georgia, and South Carolina) passed laws which made it much harder for doctors to be sued for malpractice related to emergency room care.   The goal of our research was to determine whether the lower risk of being sued translated into less costly care by emergency physicians.  To figure this out, we looked at the billing records of nearly 4 million Medicare patients and compared care before and after the laws took effect, and between states that passed reform and neighboring states that didn’t change their laws.   We found that these substantial legal protections didn’t cause ER doctors to admit fewer patients to the hospital, to order fewer CT or MRI scans, or to spend less for the overall ER visit. (more…)
Cost of Health Care, MRSA / 08.10.2014

https://medicalresearch.com/cost-of-health-care/id_week_14_universal_mrsa_screening_may_be_too_expensive_to_implement/8166/Medical Research’s Interview with: James A. McKinnell, MD Los Angeles Biomedical Research Institute   Medical Research: What are the main findings of the study? Dr. McKinnell: Numerous experts and policy makers have called for hospitals to screen patients for methicillin-resistant Staphylococcus aureus (MRSA) infections and isolate anyone testing positive to prevent the spread of these so-called “Superbugs” in healthcare settings. Several states have enacted laws requiring patients be screened for MRSA upon admission. We conducted two studies, both of which were presented as abstracts at IDWeek, the annual scientific meeting for infectious disease specialists, which found universal MRSA screening and isolation of high-risk patients will help prevent MRSA infections but may be too economically burdensome for an individual hospital to adopt. Researchers at Los Angeles Biomedical Research Institute, the University of California, Irvine and John Hopkins University examined the cost of a hospital infection prevention strategy that tested all patients for MRSA and then took precautions to avoid contact with potential carriers. We found that using the traditional method of testing for MRSA in the nose, or nares surveillance, and then isolating MRSA carriers prevented nearly three MRSA infections. But it cost the hospital $103,000 per 10,000 hospital admissions. More extensive screening, through the use of other testing methods, which included PCR-based screening, prevented more infections, but increased the cost. In the second study, we also evaluated the cost of a hospital infection prevention strategy that targeted high-risk patients. Again, we found the costs of the program exceeded the potential savings to the hospital that would be generated by preventing MRSA infections. We found nares screening and isolation of high-risk patients prevented fewer than one infection (0.6) per 1,000 high-risk admissions to the hospital and created a financial loss of $36,899 for the hospitals. Using more extensive MRSA screening – which included nares, pharynx and inguinal folds screening – prevented slightly more infections (0.8 infections per 1,000 high-risk admissions), according to the study. But our abstract reported an even larger financial loss of $51,478 with the more extensive screening. (more…)
Author Interviews, Cost of Health Care, JAMA, Pharmacology / 27.09.2014

Dr. Song Hee Hong PhD Associate Professor, Health Outcomes and Policy Research Dept. Clinical Pharmacy University of Tennessee Health Science Center Memphis, TN 38163MedicalResearch.com Interview with: Dr. Song Hee Hong PhD Associate Professor, Health Outcomes and Policy Research Dept. Clinical Pharmacy University of Tennessee Health Science Center Memphis, TN 38163 Medical Research: What are the main findings of the study? Dr. Hong: Use of GDDP (generic drug discount programs) increased to 23.1% in 2010 from 3.6% of patients receiving any prescription drugs in 2007. Generic drug discount programs were more valued among the elderly, sicker and uninsured populations. The lower use of Generic drug discount programs among racial/ethnic minorities observed when the program was deployed no longer existed when the program matured. (more…)
Author Interviews, Cost of Health Care, JAMA / 09.09.2014

Michael Johansen, MD MS Assistant Professor Dept of Family Medicine Ohio State UniversityMedicalResearch.com Interview with: Michael Johansen, MD MS Assistant Professor Dept of Family Medicine Ohio State University Medical Research: What are the main findings of the study? Dr. Johansen: Between 2007-2011, the United States spent $63.4 billion on high-cost proton pump inhibitors of which $47.1 billion was in excess of using generic omeprazole. (more…)