Cost of Health Care

15 Aug

Posted at 17:14h in Medical Billing
[caption id="attachment_62854" align="alignleft" width="300"]medical-billing_pexels-karolina-grabowska-7195369 Image Source[/caption] Once upon a time, outsourcing physician medical billing services was seen as a novel concept. Many physicians initially viewed it as an unnecessary expense, believing it only benefited larger institutions like hospitals, clinics, and group practices. However, in recent years, it has increasingly become a standard practice. Even independent solo practitioners are now considering outsourcing for their medical billing and coding needs. If you are a solo practitioner finding healthcare billing and coding challenging, you are not alone. Many in the field struggle to deal with the complexities of coding and billing, often failing to maximize revenue in medical billing services for solo practices. It's important to recognize that the healthcare market is changing, with regulations and rules for medical billing and coding constantly developing. Implementing an effective medical billing and coding system is therefore crucial for physicians seeking a strategic advantage. Outsourcing medical billing services is no longer just about cutting costs; it has become a vital tool that provides numerous benefits to practicing physicians. Moreover, these advancements can be incorporated into oncology medical billing systems to ensure precise and efficient billing for cancer treatments and diagnostics.

06 Aug

Posted at 16:10h in Abuse and Neglect, Cost of Health Care, Race/Ethnic Diversity
MedicalResearch.com Interview with: [caption id="attachment_62764" align="alignleft" width="200"]Benjamin Ukert PhDAssistant Professor Department of Health Policy and Management Texas A&M University, School of Public Health Texas 77843-1266 Dr. Ukert[/caption] Benjamin Ukert PhD Assistant Professor Department of Health Policy and Management Texas A&M University, School of Public Health Texas 77843-1266 MedicalResearch.com: What is the background for this study? Response: The Affordable Care Act (ACA) was enacted in March 2010 with one major goal to increase access to insurance coverage. This was done through the expansion of the Medicaid program for low income individuals and the establishment of formal health insurance marketplaces for individuals without access to employer sponsored insurance. Texas did not expand Medicaid for low income individuals, but the health insurance marketplace should have led to increases in insurance coverage, due to generous federal subsidies that cover a large share of the health insurance premium. Gaining insurance coverage can affect providers, such as hospitals, who treat a large share of uninsured individuals. We focused on the inpatient setting and evaluated whether the ACA led to changes in demand for hospital care, and whether the ACA led to reduction in the share of uninsured individuals treated by hospitals.

23 Jul

Posted at 20:02h in Medicare, Primary Care
Navigating the complexities of Medicare can be challenging, especially when it comes to finding and choosing the right primary care doctor. This guide will help you understand the different parts of Medicare, how it covers primary care services, and provide actionable steps to find and evaluate primary care doctors that accept Medicare.

Understanding Medicare and Its Different Parts

Medicare is a federal health insurance program primarily for individuals aged 65 and older, though it also covers certain younger people with disabilities. Medicare consists of four parts:
  1. Medicare Part A: Covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
  2. Medicare Part B: Covers certain doctors' services, outpatient care, medical supplies, and preventive services.
  3. Medicare Part C (Medicare Advantage): An alternative to Original Medicare that offers all Part A and Part B services through private insurance companies. These plans often include additional benefits like vision, dental, and prescription drug coverage.
  4. Medicare Part D: Covers prescription drugs.

09 Jul

Posted at 18:12h in Author Interviews, Cost of Health Care, Telemedicine
The United States currently has a doctor-patient ratio of 2.6 in 1000, and although it is above the recommended 1:1000, medical practitioners are still having a hard time finding the right system to balance administrative tasks and patient care. Healthcare providers are struggling to keep up with the ever-increasing demands of their patients. That is why there is now a fast-growing demand for Virtual Patient Coordinators. Virtual Patient Coordinators are skilled individuals who work remotely to assist medical practices in managing their patients' needs. They are responsible for a wide range of tasks, including scheduling appointments, coordinating referrals, and organizing medical records. By utilizing advanced technology and secure communication platforms, virtual patient coordinators are able to efficiently handle these tasks from anywhere in the world, ensuring that patients receive the care they need in a timely manner. Let’s find out the ways they are changing the game for busy medical practices.

04 Jul

Posted at 13:34h in Cost of Health Care, Medical Billing
Patient insurance coverage frequently changes, which can lead to missed details when tracked manually. This often results in claim denials and subsequent reimbursement issues. This article explores the benefits and effectiveness of automated eligibility coverage tracking platforms designed to address these challenges effectively.

The Problem: Manual Tracking Just Doesn't Cut It Anymore

Determining a patient’s status as well as his or her insurance is a crucial but time-consuming process in the billing department. Previously, it included calling insurance companies, verifying the data in different systems, and entering the information into spreadsheets. Since patient details are dynamic and various claims need to be addressed every week, it becomes impossible to manage information updates through traditional methods. Some of the problems include:
  • Time-Consuming Process - Verifying coverage manually can take up to 30 minutes per patient. For large billing companies, this may translate into big time losses.
  • Human Error - Manually compiling and updating records inevitably leads to inaccurate or outdated information falling through the cracks.
  • Claim Denials - Incorrect policy details lead to higher denial rates, payment delays and lost revenue.
  • Lack of Visibility - With records scattered across systems and spreadsheets, billing teams lack clear visibility into coverage changes.
Traditional ways of checking eligibility can't keep up with increasing patient numbers and complexity. Billing teams handling medical billing denials and solutions urgently require automation support to manage this crucial data.

01 Jul

Posted at 14:50h in Author Interviews, Cost of Health Care, JAMA, Kidney Disease, Transplantation
MedicalResearch.com Interview with: [caption id="attachment_62111" align="alignleft" width="200"]Amal Trivedi, MD, MPHProfessor of Health Services, Policy & Practice Brown University School of Public Health Prof. Trivedi[/caption] Amal Trivedi, MD, MPH Professor of Health Services, Policy & Practice Brown University School of Public Health MedicalResearch.com: What is the background for this study? Response: On January 1st, 2021, the Centers for Medicare & Medicaid Services (CMS) launched the mandatory End-Stage Renal Disease Treatment Choices (ETC) Model, which randomly assigned approximately 30% of U.S. dialysis facilities and managing clinicians to financial incentives to increase the use of home dialysis and kidney transplantation. The program is set to run through 2027, with financial incentives and penalties increasing as the model progresses. Our study sought to assess the ETC’s effect on these outcomes of interest in the first two years, as well as to examine outcome changes by race, ethnicity and socioeconomic status.

20 May

Posted at 13:29h in Author Interviews, Cost of Health Care, Gastrointestinal Disease, Health Care Systems
MedicalResearch.com Interview with: [caption id="attachment_61735" align="alignleft" width="183"]Laura Targownik, MDLead author and Clinician-Investigator Mount Sinai Hospital in Toronto Departmental Division Director, Gastroenterology and Hepatology University of Toronto Dr. Targownik[/caption] Laura Targownik, MD Lead author and Clinician-Investigator Mount Sinai Hospital in Toronto Departmental Division Director, Gastroenterology and Hepatology University of Toronto MedicalResearch.com: What is the background for this study? Was there a difference in the types of patients or need for surgery seen by the female/male physicians? Response: The background for this study is that there is an emerging body of literature that having a female physician leads to better patient outcomes in many health care settings, especially amongst patients undergoing surgery or being admitted to hospital.  However, this has not previously been evaluated in gastroenterology.  Female and male gastroenterologists may have different styles of practice on average, and this potentially could lead to differences in how patients engage with the health care system following an initial assessment.

11 Jan

Posted at 19:00h in Author Interviews, Cost of Health Care, JAMA, Kidney Disease, Medicare
MedicalResearch.com Interview with: [caption id="attachment_61226" align="alignleft" width="134"]Kalli Koukounas, MPHPh.D. Student, Health Services Research Brown University School of Public Health Providence, RI Kalli Koukounas[/caption] Kalli Koukounas, MPH Ph.D. Student, Health Services Research Brown University School of Public Health Providence, RI MedicalResearch.com: What is the background for this study? Response:  On Jan. 1st, 2021, the Centers for Medicare and Medicaid Services (CMS) implemented the End-Stage Renal Disease Treatment Choices (ETC) Model, one of the largest randomized tests of pay-for-performance incentives ever conducted in the US. The goal of the model was to enhance the use of home dialysis and kidney transplant or waitlisting among kidney failure patients in traditional Medicare. The model randomly assigned approximately 30% of US dialysis facilities and nephrologists to receive financial incentives, ranging from bonuses of 4% to penalties of 5%, based on their patients’ use of home dialysis and kidney transplant/waitlisiting. The payment adjustments apply to all Medicare-based reimbursement for dialysis services. Prior research has demonstrated that dialysis facilities that disproportionately serve populations with high social risk have lower use of home dialysis and kidney transplant, raising concerns that these sites may fare poorly in the payment model. Using data released by CMS, we examined the first year of ETC model performance and financial penalties across dialysis facilities, stratified by the measured social risk of the facilities’ incident patients.

09 Dec

Posted at 18:15h in Author Interviews, Cost of Health Care, Pharmacology
MedicalResearch.com Interview with: [caption id="attachment_61125" align="alignleft" width="125"]Joseph T. DiPiro, Pharm.DAssociate Vice President, Faculty Affairs Virginia Commonwealth University Dr. DiPiro[/caption] Joseph T. DiPiro, Pharm.D Associate Vice President, Faculty Affairs Virginia Commonwealth University Dr. DiPiro is an editor for Pharmacotherapy: A Pathophysiologic Approach MedicalResearch.com: What is the background for this study? Response: The ASHP/ASHP Foundation Pharmacy Forecast Report is constructed from a survey of health-system pharmacy leaders who were asked to rate the likelihood of events, scenarios, and trends occurring in the next five years. The purpose is for health-system pharmacists and pharmacy leaders to inform their strategic planning efforts. The Pharmacy Forecast is not intended to predict future events. Rather, the report is intended to be a provocative stimulant for the thinking, discussion, and planning that must take place in every health system. Leaders must be informed of potential developments to help position their organizations to care for patients, enhance population health, and improve medication outcomes.

17 Nov

Posted at 11:17h in Author Interviews, Cancer Research, Cost of Health Care, JAMA, Pharmacology
MedicalResearch.com Interview with: Lisa-Marie Smale, PharmD PhD Candidate Clinical Pharmacy Radboud University Medical Center Department of Pharmacy Nijmegen, the Netherlands Lisa-Marie Smale, PharmDPhD Candidate Clinical PharmacyRadboud University Medical CenterDepartment of PharmacyNijmegen, the Netherlands   MedicalResearch.com: What is the background for this study? Response: Cancer drugs are not always fully used by patients, while these drugs are mostly expensive and environmentally damaging, both in production and (waste) disposal. Therefore we investigated whether unused drugs of patients can be collected, verified of quality by a pharmacy, to be redispensed to other patients instead of being disposed of. We were interested whether such an approach ultimately leads to lower environmental impacts and costs.

20 May

Posted at 16:43h in Alzheimer's - Dementia, Author Interviews, Cost of Health Care, JAMA, UCLA
MedicalResearch.com Interview with: [caption id="attachment_60418" align="alignleft" width="100"]Julia Cave ArbanasProject Manager and Julia Cave Arbanas[/caption] Julia Cave Arbanas Project Manager and     John N. Mafi, MD, MPH Associate Professor of Medicine General Internal Medicine & Health Services Research David Geffen School of Medicine at UCLAJohn N. Mafi, MD, MPH Associate Professor of Medicine General Internal Medicine & Health Services Research David Geffen School of Medicine at UCLA   MedicalResearch.com: What is the background for this study? What is lecanemab used for and how well does it work? Response: Lecanemab is a treatment for mild cognitive impairment and mild dementia that was approved in January 2023 as part of the Food and Drug Administration’s (FDA) accelerated approval program. The results from a recent phase 3 clinical trial show a modest clinical benefit: the rate of cognitive decline by 27% in an 18-month study involving participants experiencing the early stage of Alzheimer’s, with an 0.45-point absolute difference in cognitive testing scores. However, due to the risk of brain swelling and bleeding (also known as amyloid-related imaging abnormalities), treatment with lecanemab involves frequent MRIs and neurology or geriatrics appointments to monitor for these abnormalities, which can be life threatening. So far, three patient deaths have potentially been tied to lecanemab. It is likely that the FDA will grant is lecanemab traditional approval later this year, prompting Medicare to reconsider its current coverage restrictions and potentially enabling widespread use.

26 Feb

Posted at 11:25h in Author Interviews, Cost of Health Care, Heart Disease, JACC
MedicalResearch.com Interview with: [caption id="attachment_60080" align="alignleft" width="150"]Rishi K. Wadhera, MD, MPP, MPhilSection Head, Health Policy and Equity, Richard A. and Susan F. Smith Center for Outcomes Research Associate Program Director, Cardiovascular Medicine Fellowship at Beth Israel Deaconess Medical Center Assistant Professor of Medicine, Harvard Medical School Dr. Wadhera[/caption] Rishi K. Wadhera, MD, MPP, MPhil Section Head, Health Policy and Equity, Richard A. and Susan F. Smith Center for Outcomes Research Associate Program Director Cardiovascular Medicine Fellowship at Beth Israel Deaconess Medical Center Assistant Professor of Medicine, Harvard Medical School @rkwadhera MedicalResearch.com: What is the background for this study? Response: High and rising prescription drug costs in the United States contribute to medication non-adherence and financial strain among adults with cardiovascular risk factors or disease. As a result, addressing prescription drug costs in patients with chronic conditions has become a national priority. In response to these growing concerns, federal policymakers passed the Inflation Reduction Act on August 16, 2022, which aims to address high out-of-pocket drug costs for adults enrolled in Medicare Part D, by placing a $2000 annual cap on out-of-pocket prescription drug costs and expanding eligibility for full low-income subsidies to individuals that reduce deductible costs and prescription copayments (among several other provisions). It is unclear how these provisions will affect Medicare beneficiaries with cardiovascular risk factors and/or conditions.

22 Jan

Posted at 14:42h in Author Interviews, Cost of Health Care, JAMA, Pharmaceutical Companies, Yale
MedicalResearch.com Interview with: [caption id="attachment_59948" align="alignleft" width="150"]Neeraj PatelMedical Student (MS-2), Yale School of Medicine New Haven, CT Neeraj Patel[/caption] Neeraj Patel Medical Student (MS-2), Yale School of Medicine New Haven, CT MedicalResearch.com: What is the background for this study? Response: Direct-to-consumer pharmaceutical advertising has been increasing in popularity for the past two decades or so, particularly via television. But it’s highly controversial. Only two high-income countries (the U.S. and New Zealand) widely permit this type of advertising for prescription drugs. Critics have pointed to a growing body of literature that suggests that direct-to-consumer advertising for prescription drugs can be misleading, lead to inappropriate prescribing, and inflate healthcare costs. Proponents have argued that it improves public health by promoting clinically beneficial prescribing.

19 Dec

Posted at 18:59h in Author Interviews, Cost of Health Care, JAMA
MedicalResearch.com Interview with: [caption id="attachment_59851" align="alignleft" width="125"]MedicalResearch.com Interview with:Anna L Goldman, MD, MPH, MPA Assistant Professor of Medicine Boston Medical Center MedicalResearch.com: What is the background for this study? Response: Experts on the healthcare labor market have long debated the existence and magnitude of a physician shortage. Physician work hours are a major contributor to physician supply issues, but little research is available on recent trends in work hours by physicians. In addition, no available studies have rigorously estimated changes in the physician workforce size during the pandemic. MedicalResearch.com: What are the main findings? Were there gender differences in hours worked? Response: The average hours worked per week by physicians decreased 7.6% in the two decades between 2001 and 2021. On average, physicians worked 52.6 hours per week in 2001-2003 and 48.6 hours per week in 2019-2021. This decrease did not appear to be caused by the COVID-19 pandemic, as the trend continued on the same steady trajectory that was present prior to the pandemic. The observed decreases were driven by reduced work hours among male physicians, full-time physicians, and younger physicians. Male physicians decreased work hours twice as much as female physicians. Physician mothers were the only group to increase weekly work hours, with a 3% increase over 20 years. Physician fathers, by contract, decreased work hours by 12%. The number of part-time physicians remained flat throughout the study period. Broadly decreasing trends in work hours were similarly present among non-physician holders of doctoral degrees, suggesting a broader trend among highly-educated professionals in their approach to work hours. The physician workforce grew by 32.9% over two decades, but then fell by 6.7% during the COVID-19 pandemic, or a drop of 1 in 14 physicians. The physicians who left the workforce during the pandemic were disproportionately white and from rural areas. Work hours generated by the physician workforce, as a whole, grew 7% over the study period, which was about half the rate of population growth in the same period (16.6%). This sluggish growth in physician workforce hours was entirely offset by large increases in the work hours contributed by nurse practitioners and physician assistants. When the clinician workforce was assessed as a whole (combining hours from physicians, nurse practitioners, and physician assistants), growth in total workforce hours was 21.4%, exceeding the population growth rate. MedicalResearch.com: What should readers take away from your report? • Physician weekly work hours fell 8% from 2001-2021, with a particularly large drop for physician fathers (-12%) vs. a small increase for physician mothers (+3%). • Because of this decline in hours, total weekly hours contributed by the physician workforce lagged far behind US population growth, an increase of 7% in work hours vs. 16.6% increase in US population. This gap was entirely offset by a large increase in nurse practitioner and physician assistant hours. • From 2019 to 2021, the physician workforce fell by 7%, which represents 1 in 14 physicians leaving the workforce during the COVID-19 pandemic. MedicalResearch.com: What recommendations do you have for future research as a results of this study? Response: Research on work hours in individual physician specialties is needed to better understand the distribution of work hour changes across the spectrum of physician types. Measurement of these trends can help predict burnout in specialties where hours may be lengthening vs. shortages in fields with rapidly decreasing work hours. MedicalResearch.com: Is there anything else you would like to add? Any disclosures? Response: Our findings may shed light on the high rates of burnout that has been identified among physician-mothers in other research. While increasing work hours among mothers may indicate progress on gender parity in terms of career engagement, this change may not have been sufficiently offset by a reduction in domestic responsibility. Further research should examine the balance of household duties as physician mothers spend an increasing amount of time at work. No disclosures. Citation: Changes in Physician Work Hours and Implications for Workforce Capacity and Work-Life Balance, 2001-2021 The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website. Dr. Goldman[/caption] Anna L. Goldman, M.D., M.P.A., M.P.H Assistant Professor of Medicine General Internal Medicine Boston University Chobanian & Avedisian School of Medicine   MedicalResearch.com: What is the background for this study? Response: Experts on the healthcare labor market have long debated the existence and magnitude of a physician shortage. Physician work hours are a major contributor to physician supply issues, but little research is available on recent trends in work hours by physicians.  In addition, no available studies have rigorously estimated changes in the physician workforce size during the pandemic.

01 Dec

Posted at 14:57h in Author Interviews, Cost of Health Care, Rheumatology, University of Pittsburgh
MedicalResearch.com Interview with: Raisa Silva, M.D. Resident physician in Internal medicine University of Pittsburgh Medical Center MedicalResearch.com: What is the background for this study? Response: Systemic lupus erythematosus (lupus for short) is a complex disease that significantly affects patients’ lives. Adherence to medications for lupus is known to be suboptimal (it can be as low as 15% in some studies). Multiple social factors may affect treatment adherence. For example, costs of medications (including copayments, deductibles, co-sharing), polypharmacy (patients with lupus often have comorbid diseases that also need medications), and potential side effects are some of the reasons why patients may have difficulty in taking medications for lupus every day. The costs of insurance copayment may represent a major obstacle to adherence. The lack of adherence to lupus medications is associated with poor control of disease, more symptoms, and worse disease outcomes, such as more hospitalizations and more severe disease. In our study, we examined the association between lupus medications copayment and adherence to these medications (some of the most commonly used medications for lupus).

05 Oct

Posted at 20:19h in Author Interviews, CDC, Cost of Health Care, Hepatitis - Liver Disease
MedicalResearch.com Interview with: William W. Thompson, Ph.D. Epidemiologist Division of Viral Hepatitis CDC MedicalResearch.com: What is the background for this study? Response: Prior to this analysis, we knew only an estimated 1.2 million persons initiated hepatitis C treatment with DAA agents in the United States during 2014–2020, far below the number needed to achieve national hepatitis C elimination goals. Further, the number of persons treated was highest in 2015 and declined to its lowest level in 2020. This analysis used a large national health care claims database to assess the level and timing of hepatitis C treatment among persons with diagnosed HCV infection with breakdowns by sex, age, race, insurance type (i.e., private, Medicaid, and Medicare), and by state.

26 Sep

Posted at 12:41h in Author Interviews, Cost of Health Care, COVID -19 Coronavirus, JAMA
MedicalResearch.com Interview with:

Allison Witman PhD Assistant Professor of Economics Economics & Finance Cameron School of Business University of North Carolina, Wilmington

Yu Wang PhD Assistant Professor Congdon School of Supply Chain, Business Analytics, & Information Systems Cameron School of Business University of North Carolina Wilmington David Cho PhD Assistant Professor of Management California State University, Fullerton

MedicalResearch.com: What is the background for this study? Response: The COVID-19 pandemic placed tremendous financial pressure on hospitals. Beginning in March of 2020, hospitals cancelled outpatient and elective procedures to accommodate surges in demand from COVID-19 patients. As these procedures account for more than 60% of an average hospital’s revenue, cancellation posed serious challenges to the financial health of hospitals. Revenue from COVID-19 patients may have partially offset these effects, but the American Hospital Association estimated a total loss of $202.6 billion by American hospitals between March and June 2020. In response, the U.S. government created large federal assistance programs aimed to stabilize hospitals’ financial situation as their ability to maintain operations was critical to the health of the nation. Due to differences in hospital characteristics, certain hospitals such as rural hospitals and those serving a higher share of Medicaid and uninsured patients (e.g., safety net hospitals) may have been more financially susceptible to the effects of the pandemic. These hospitals that serve vulnerable patient populations historically have had lower profit margins and were candidates for targeted COVID relief funding (e.g., Safety Net Hospitals Payments, a $10 billion component of the Provider Relief Fund).

08 Sep

Posted at 10:54h in Author Interviews, Cost of Health Care, Dermatology, JAMA
MedicalResearch.com Interview with: [caption id="attachment_59485" align="alignleft" width="150"]Jane M. Zhu, M.D., M.P.P., M.S.H.P. Assistant Professor of Medicine Division of General Internal Medicine and Geriatrics School of Medicine Oregon Health & Science University Portland, Oregon Dr. Zhu[/caption] Jane M. Zhu, M.D., M.P.P., M.S.H.P. Assistant Professor of Medicine Division of General Internal Medicine and Geriatrics School of Medicine Oregon Health & Science University Portland, Oregon MedicalResearch.com: What is the background for this study? Response: Private equity (PE) acquisitions of physician practices are accelerating across many specialties, but there is still little robust evidence on the effects of these acquisitions. Concerns about PE involvement is predicated on the fact that these firms expect high annual returns, which require either reducing costs or increasing revenue, or both. Using PE acquisition data from 2016-2020, linked to commercial claims data, we sought to understand what common mechanisms of revenue generation were being adopted after private equity acquisition of physician practices.

31 Aug

Posted at 17:45h in Author Interviews, Cost of Health Care, JAMA, Pharmaceutical Companies
MedicalResearch.com Interview with: [caption id="attachment_59466" align="alignleft" width="200"]Prof. Katharina Blankart, PhD Faculty of Economics and Business Administration University of Duisburg-Essen Essen, Germany Prof. Blankart[/caption] Prof. Katharina Blankart, PhD Faculty of Economics and Business Administration University of Duisburg-Essen Essen, Germany MedicalResearch.com: What is the background for this study? Response: Given the high drug prices and policy discussions, we were interested whether the US may miss opportunities from medical innovation in availability of medicines compared to Germany. Since 2011, Germany has a unique way to determine value of new medicines after regulatory approval and to negotiate prices. We aimed to find out differences in availability of medicines in these two countries and timing of availability. We evaluated the differences in timing of availability and to characterize medicines not available to one of the two countries.

09 Jun

Posted at 18:46h in Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, JAMA
MedicalResearch.com Interview with: [caption id="attachment_59244" align="alignleft" width="150"]Benjamin N. Rome MD Instructor, Harvard Medical School Internal Medicine Division of Pharmacoepidemiology and Pharmacoeconomics Brigham and Women’s Hospital Dr. Rome[/caption] Benjamin N. Rome MD Instructor, Harvard Medical School Internal Medicine Division of Pharmacoepidemiology and Pharmacoeconomics Brigham and Women’s Hospital MedicalResearch.com:  What is the background for this study? What are the main findings?  Response: Manufacturers of brand-name drugs are granted periods, free from direct competition, during which they can set and raise prices as they choose. We found that the prices for newly marketed brand-name drugs increased by 20% per year from 2008 to 2021. In 2020 and 2021, nearly half of new drugs were launched at a price greater than $150,000 per year, compared with 9% of drugs in 2008-2013. These dramatic trends are only partly explained by changes in the types of drugs coming to market.

15 Feb

Posted at 19:20h in Author Interviews, Cost of Health Care, COVID -19 Coronavirus, JAMA
MedicalResearch.com Interview with: [caption id="attachment_54411" align="alignleft" width="148"]Kao-Ping Chua, M.D., Ph.D. Assistant Professor, Pediatrics, Medical School Susan B. Meister Child Health Evaluation and Research Center University of Michigan Dr. Kao-Ping Chua[/caption] Kao-Ping Chua, MD, PhD Assistant Professor, Department of Pediatrics Assistant Professor, Health Management and Policy School of Public Health University of Michigan MedicalResearch.com:  What is the background for this study? Response: In 2020, most insurers waived the cost of COVID-19 hospitalization for patients. In early 2021, many major insurers started to abandon those waivers. By August 2021, the vast majority of insurers had started billing patients for COVID-19 hospitalizations again.

09 Jan

Posted at 14:39h in ADHD, Author Interviews, Cost of Health Care, Eating Disorders, Pharmacology
MedicalResearch.com Interview with: [caption id="attachment_58622" align="alignleft" width="125"]MedicalResearch.com Interview with: Sneha Vaddadi, BS Department of Medical Education Geisinger Commonwealth School of Medicine Scranton, Pennsylvania Sneha Vaddadi[/caption] Sneha Vaddadi, BS Department of Medical Education Geisinger Commonwealth School of Medicine Scranton, Pennsylvania MedicalResearch.com: What is the background for this study? Response: The prescription stimulants methylphenidate, amphetamine, and lisdexamfetamine, classified as Schedule II substances, are sympathomimetic drugs with therapeutic use widely used in the US for Attention Deficit Hyperactivity Disorder. Changes in criteria for diagnosis of Attention Deficit Hyperactivity Disorder in 2013 and approval of lisdexamfetamine for binge eating disorder in 2015 may have impacted usage patterns. The goal of this study1 was to extend upon past research2 to compare the pharmacoepidemiology of these stimulants in the United States from 2010–2017, including consideration to variation within geographic regions, the Hispanic population, and the Medicaid population.

14 Dec

Posted at 23:06h in Author Interviews, Cost of Health Care, JAMA, Kidney Disease, Social Issues, Transplantation
MedicalResearch.com Interview with: [caption id="attachment_58511" align="alignleft" width="150"]Rebecca Thorsness, PhD Research Associate Department of Health Services, Policy, and Practice Brown University School of Public Health Dr. Thorsness[/caption] Rebecca Thorsness, PhD Research Associate Department of Health Services, Policy, and Practice Brown University School of Public Health  MedicalResearch.com: What is the background for this study? What are the main findings? Response: In 2019, the President signed the Advancing American Kidney Health executive order, which included provisions to increase the use of home dialysis and kidney transplant for Americans living with kidney failure. To carry out this vision, the Centers for Medicare & Medicaid Services (CMS) developed the ESRD Treatment Choices (ETC) payment model, which uses financial incentives and penalties to incentivize dialysis facilities to pursue home dialysis or kidney transplant for their patients. Transplant and home dialysis are optimal care for people with kidney failure, but there are social and clinical reasons that patients with high social risk (such as those exposed to racism, poverty, or housing instability) may not be candidates for these treatments. This means that facilities which serve a large number of patients with high social risk might be disproportionately penalized by this new payment model. Using data immediately prior to the implementation of the ETC model, we found that dialysis facilities that serve high proportions of patients with high social risk have lower rates of home dialysis and kidney transplantation than facilities that care for lower proportions of such patients.

12 Dec

Posted at 13:19h in Author Interviews, Cost of Health Care, JAMA, Medicare
MedicalResearch.com Interview with: [caption id="attachment_58508" align="alignleft" width="150"]Jeanne Madden, PhD Associate Professor Department of Pharmacy and Health Systems Sciences School of Pharmacy and Pharmaceutical Sciences Bouvé College of Health Science Northeastern University   Dr. Madden[/caption] Jeanne Madden, PhD Associate Professor Department of Pharmacy and Health Systems Sciences School of Pharmacy and Pharmaceutical Sciences Bouvé College of Health Science Northeastern University MedicalResearch.com: What is the background for this study? Response: Medicare is the US public insurance program mainly serving people 65 years and older, but also some younger adults who have long-term disabling conditions. As such, on average, the Medicare population bears a heavy burden of illness and has high health care needs, compared to the general US population. The under-65 group for the most part has quite low incomes, while the older group represents a wide spectrum, from poor to well-off. Medicare beneficiaries also differ a great deal in terms of whether they have access to supplemental insurance that can help with patient cost-sharing requirements. I’m referring to Medicaid assistance, or a self-purchased Medigap plan, or retiree health benefits, etc. The cost-sharing requirements in traditional Medicare are substantial — e.g., 20% for doctor visits — and there is no annual cap on patient out-of-pocket spending. That’s in contrast to commercial insurance and Medicare Advantage managed care plans — all of those have an annual cap on patient out-of-pocket costs. There’s a good amount of existing research on whether people in Medicare can afford their drugs, and on the affordability of medical care among younger groups such as working-aged uninsured people and those in ACA exchange plans. But there hasn’t been much research into medical care affordability among older Americans.

24 Oct

Posted at 20:32h in Author Interviews, Cost of Health Care, JAMA, Lung Cancer, Stanford, USPSTF
MedicalResearch.com Interview with: [caption id="attachment_58273" align="alignleft" width="200"]Dr. Summer Han Dr. Han[/caption] Summer S Han, PhD Assistant Professor Quantitative Sciences Unit Stanford Center for Biomedical Informatics Research (BMIR) Neurosurgery and Medicine Stanford University School of Medicine Stanford, CA 94304  MedicalResearch.com: What is the background for this study? Response: The US Preventive Services Task Force (USPSTF) issued their 2021 recommendation on lung cancer screening lowering the start age from 55 to 50 years and the minimum pack-year criterion from 30 to 20, relative to the 2013 recommendations. Although costs are expected to increase with the expanded screening eligibility, it is unknown if the new guidelines for lung cancer screening are cost-effective.

20 Oct

Posted at 11:17h in Author Interviews, Brigham & Women's - Harvard, Cancer Research, Cost of Health Care, JAMA
MedicalResearch.com Interview with: [caption id="attachment_58259" align="alignleft" width="200"]Anita Katharina Wagner, PharmD, MPH, DrPH Associate Professor of Population Medicine Director, Ethics Program, Point32Health (parent company of Harvard Pilgrim Health Care and Tufts Health Plan) Co-Director, HMS Fellowship in Health Policy and Insurance Research Co-Director, Center for Cancer Policy and Program Evaluation (CarPE) Department of Population Medicine Harvard Medical School and Harvard Pilgrim Health Care Institute Dr. Wagner[/caption] Anita Katharina Wagner, PharmD, MPH, DrPH Associate Professor of Population Medicine Director, Ethics Program, Point32Health (parent company of Harvard Pilgrim Health Care and Tufts Health Plan) Co-Director, HMS Fellowship in Health Policy and Insurance Research Co-Director, Center for Cancer Policy and Program Evaluation (CarPE) Department of Population Medicine Harvard Medical School and Harvard Pilgrim Health Care Institute MedicalResearch.com: What is the background for this study? What are the main findings? Response: The expectation for new cancer drugs is that they help patients live better longer. Increasingly more cancer drugs are approved without documented quality of life or overall survival benefits.   At the same time, cancer drug prices are rising.  We studied use of and spending on selected new cancer drugs among patients with employer-sponsored health insurance. We found that among 37348 patients who received one or more of 44 oral targeted cancer drugs, the proportion of patients who received a drug without documented overall survival benefit increased from 13% in 2011 to 59% in 2018.  By 2018, spending on drugs without documented overall survival benefit accounted for 52% of the $3.5 million spend on the 44 drugs since 2011.

07 Sep

Posted at 23:35h in Author Interviews, Cost of Health Care, JAMA, Surgical Research
MedicalResearch.com Interview with: [caption id="attachment_58033" align="alignleft" width="133"]Andrew P. Loehrer, MD, MPH Assistant Professor Department of Surgery, Division of Surgical Oncology Dartmouth-Hitchcock Dr. Loehrer[/caption] Andrew P. Loehrer, MD, MPH Assistant Professor Department of Surgery, Division of Surgical Oncology Dartmouth-Hitchcock MedicalResearch.com: What is the background for this study? Response: Patient cost sharing represents the portion of costs covered by insurance that individuals pay out of pocket, including deductibles, co-payment, and co-insurance. Cost sharing is increasingly common and also increasingly expensive for patients with commercial health insurance across the United States. While designed to increase patient responsibility for health care spending, prior work has shown that higher cost sharing is also associated with decreased use of health care overall, both needed and discretionary. However, little work has been done as to how high cost sharing may affect common and costly conditions like acute appendicitis and acute diverticulitis. 

18 Aug

Posted at 16:49h in Anesthesiology, Author Interviews, Cost of Health Care, JAMA
MedicalResearch.com Interview with: [caption id="attachment_57937" align="alignleft" width="165"]Ambar La Forgia, PhD Assistant Professor of Health Policy & Management Columbia University Mailman School of Public Health Dr. La Forgia[/caption] Ambar La Forgia, PhD Assistant Professor of Health Policy & Management Columbia University Mailman School of Public Health MedicalResearch.com: What is the background for this study? Response: Over the past few years, there has been mounting pressure to protect consumers from surprise medical bills, which occur when a patient unknowingly receives care from an out-of-network practitioner at an in-network facility. In 2018, only six states had passed comprehensive surprise billing legislation, and by 2020, 17 states had passed legislation. In addition to protecting patients from financial liability for surprise medical bills, states adopted different methods for determining payments made by a patient’s insurer to the out-of-network practitioner. For example, some states, such as California and Florida, developed a payment standard that tied provider payments to median in-network rates, Medicare rates, or the usual and customary provider charges. Other states, such as New York, developed an independent dispute resolution process, which uses a third-party arbiter to resolve payment disputes between insurers and practitioners. However, little is known about how state laws influence the prices paid to out-of-network practitioners and whether spillovers existed to in-network prices. In this study, my co-authors and I study the association between the passage of surprise billing legislation in California, Florida, and New York, and prices paid to anesthesiologists in hospital outpatient departments and ambulatory surgery centers using commercial claims data from 2012-2017. We focused on anesthesiology because it is one of the specialties with the highest proportion of potential surprise bills since patients do not usually choose their anesthesiologist.

22 Mar

Posted at 17:51h in Author Interviews, Cost of Health Care, Genetic Research, Hematology, JAMA
MedicalResearch.com Interview with: [caption id="attachment_57001" align="alignleft" width="150"]Patrick DeMartino MD Pediatric Hematology and Oncology Fellow Doernbecher Children's Hospital Oregon Health & Science University Dr. DeMartino[/caption] Patrick DeMartino MD Pediatric Hematology and Oncology Fellow Doernbecher Children's Hospital Oregon Health & Science University MedicalResearch.com: What is the background for this study? Response: Dozens of gene therapies are expected to be on the market within a decade or so. Much has been written about the high prices of the therapies currently on the market (exceeding $1 million). However, only a small number of patients are eligible for these existing therapies each year. Gene therapy for sickle cell disease (SCD) appears promising and would potentially apply to a relatively large number of individuals in the U.S. We sought to explore potential affordability challenges associated with a gene therapy for SCD.