Cost of Health Care

10 Jul Hospital ‘Observation Care’ – Different in the Real World than in CMS Definition

Posted at 05:22h in Author Interviews, Cost of Health Care, JAMA

MedicalResearch.com Interview with: Ann M. Sheehy, M.D., M.S. Associate Professor Division Head, Hospital Medicine University of Wisconsin Department of Medicine Ann M. Sheehy, M.D., M.S. Associate Professor Division Head, Hospital Medicine University of Wisconsin Department of Medicine MedicalResearch.com: What are the main findings of the study? Dr. Sheehy: There were three main findings of our study. First, we found that observation in clinical practice is very different from the CMS definition of observation. CMS states that observation should rarely last longer than 48 hours, yet 16.5% of our observation encounters lasted longer than 48 hours. CMS also states that observation care is “well-defined”. We found there were 1141 distinct observation codes for our 4578 observation encounters, indicating that observation care is not well defined. Second, we found that observation care disproportionately affects the general medicine population, as over half of our observation encounters were on the general medicine services. These patients also had longer length of stay, were older, more likely to be female, were more likely to need discharge to a skilled facility, and were more likely to have government insurance as compared to patients on other services. This indicates that observation care adversely affects the adult general medicine population more than other patients on other types of services. Finally, we found that observation cost was greater than reimbursement, resulting in a net negative financial margin.

03 Jul Coronary Heart Disease : What Correlates with Repeat Lipid Testing?

Posted at 12:43h in Author Interviews, Baylor College of Medicine Houston, Cost of Health Care, Heart Disease, JAMA

MedicalResearch.com Interview with Salim S. Virani, MD, PhD Health Policy and Quality Program, Michael E. DeBakey Veterans Affairs Medical Center Health Services Research and Development Center of Excellence, and Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, and Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, Texas MedicalResearch.com: What are the main findings of the study? Dr. Virani: The main findings of the study are that despite having cholesterol levels at goal (LDL cholesterol <100 mg/dL), about one-third of patients (9200 out of 27947) with coronary heart disease had repeat cholesterol testing in 11 months from their last lipid panel. As expected, no intervention was performed as a response to these lipid panels. Collectively, 12686 additional lipid panels were performed in these patients. Among 13,114 patients who met the optional treatment target of LDL-C<70 mg/dL, repeat lipid testing was performed in 8,177 (62.3% of those with LDL-C<70) during 11 months of follow-up. Patients with a history of diabetes mellitus (odds ratio [OR], 1.16; 95% CI, 1.10-1.22), a history of hypertension (OR, 1.21; 95%CI, 1.13-1.30), higher illness burden (OR, 1.39; 95%CI, 1.23-1.57), and more frequent primary care visits (OR, 1.32; 95%CI, 1.25-1.39) were more likely to undergo repeat testing, whereas patients receiving care at a teaching facility (OR, 0.74; 95%CI, 0.69-0.80) or from a physician provider (OR, 0.93; 95%CI, 0.88-0.98) and those with a medication possession ratio of 0.8 or higher (OR, 0.75; 95%CI, 0.71-0.80) were less likely to undergo repeat testing.

28 Jun Study finds ACA- Eligible Uninsured Adults have fewer Chronic Health Conditions

Posted at 16:48h in Cost of Health Care, JAMA

MedicalResearch.com Interview with Genevieve Kenney Ph.D Senior Fellow and Co-Director, Health Policy Center The Urban Institute 2100 M Street NW Washington DC 20037 MedicalResearch.com: What are the main findings of the study? Dr. Kenney: Our study is the first published analysis that draws on physical examinations, laboratory tests, and patient reports to assess the health needs and health risks of uninsured adults who could be eligible for Medicaid coverage under the Affordable Care Act relative to the adults who are already enrolled in Medicaid. Our main findings are that the uninsured adults who could enroll under the ACA are less likely than the adults with Medicaid coverage to be obese and to have functional limitations and chronic health problems, such as hypertension, hypercholesterolemia, or diabetes, but that the uninsured adults with these chronic conditions are less likely to be aware that they have them and less likely to have the condition under control. In comparison to the Medicaid population, the uninsured adults in our study were also less likely to have seen a health professional in the prior year and to have a routine place for care. The rates of undiagnosed and uncontrolled chronic health care problems found in our study indicate that millions of low-income uninsured adults are currently at risk of premature mortality and other significant health issues. These findings provide new evidence of the potential health benefits associated with the Medicaid expansion under the Affordable Care Act.

26 Jun High-Cost Medicare Patients: What is the Contribution of Preventable Acute Care Spending to Total Spending?

Posted at 14:04h in Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, JAMA, Medical Research Centers

Dr. Karen E. Joynt, MD MPH Cardiovascular Division Brigham and Women's Hospital and VA Boston Healthcare System Department of Health Policy and Management, Harvard School of Public Health

MedicalResearch.com Interview with Dr. Karen E. Joynt, MD MPH Cardiovascular Division Brigham and Women's Hospital and VA Boston Healthcare System Department of Health Policy and Management, Harvard School of Public Health MedicalResearch.com: What are the main findings of the study? Dr. Joynt: The main findings of the study were two-fold. First, high-cost patients in Medicare (the top decile of spenders) are responsible for about 80% of inpatient spending in the Medicare program, so understanding more about these patients' patterns of care is really important. Second, we found that only about 10% of acute-care spending for these high-cost Medicare patients were for causes that we generally think of as preventable in the short term, like uncontrolled diabetes, COPD, or heart failure. The rest of the spending was for acute conditions that we generally don't think of as preventable (at least in the short term), such as orthopedic procedures, sepsis, and cancer.

04 Jun Medicare: Potential Cost & Quality Gains Using Cost-Effectiveness Evidence to Reallocate Expenditures

Posted at 15:54h in Author Interviews, Cost of Health Care, Outcomes & Safety

James D. Chambers, PhD, MPharm Assistant Professor The Center for the Evaluation of Value and Risk in Health Institute for Clinical Research and Health Policy Studies TuftsMedicalCenter www.cearegistry.org MedicalResearch.com: What are the main findings of the study? Dr. Epstein: Using cost-effectiveness evidence to help inform the allocation of expenditures for medical interventions in Medicare has the potential to generate substantial aggregate health gains for the Medicare population with no increases in spending. Reallocating expenditures for interventions in Medicare using cost-effectiveness evidence led to an estimated aggregate health gain of 1.8 million quality-adjusted life years (QALYs), a measure of health gain that accounts for both quality and quantity of life.

27 Apr Cost-Effectiveness of Helicopter Versus Ground Emergency Medical Services for Trauma Scene Transport in the US

Posted at 11:53h in Cost of Health Care, Emergency Care, Stanford

MedicalResearch.com eInterview with: M. Kit Degado, MD, MS Instructor, Emergency Medicine Affiliated Faculty, Centers for Health Policy/Primary Care and Outcomes Research Stanford University School of Medicine kdelgado@stanford.edu MedicalResearch.com: What are the main findings of the study? Dr. Degado:

We found that if an additional 1.6% of patients flown by helicopter survive or if there is any improvement in disability outcomes, then helicopter EMS should be considered cost-effective over transporting patients by ground EMS.

15 Mar Regional Variation in Spending and Survival for Older Adults With Advanced Cancer

Posted at 00:59h in Author Interviews, Cancer Research, Cost of Health Care, JNCI

MedicalResearch.com Interview with Gabriel Brooks MD Fellow, Medical Oncology Dana-Farber Cancer Institute MedicalResearch.com: What are the main findings of the study? Dr. Brooks: First, we found that there is substantial regional variation in Medicare spending for patients with advanced cancer. For patients with a new diagnosis of advanced stage cancer, spending in the six months following diagnosis varied by 32% between regions in the highest and lowest quintiles of spending. And for patients who died from cancer, spending in the last six months of life varied by 41% between the highest and lowest spending regions. Second, we tested the association between area-level spending and survival from the time of advanced cancer diagnosis. We found that there was no consistent association between increasing spending and survival for any of the five cancer sites included in our study (non-small cell lung cancer, colorectal cancer, pancreas cancer, breast cancer and prostate cancer).

09 Mar Researchers reveal ways to make personalized cancer therapies more cost effective

Posted at 22:21h in Cancer Research, Cost of Health Care

AURORA, Colo. -- As scientists continue making breakthroughs in personalized cancer treatment, delivering those therapies in the most cost effective manner has become increasingly important. Now researchers at the University of Colorado School of Medicine have identified new ways of doing just that, allowing more patients to benefit from this...