Author Interviews, CDC, Cost of Health Care, Geriatrics / 04.04.2018

MedicalResearch.com Interview with: Curtis Florence, PhD Division of Analysis, Research and Practice Integration CDC’s Injury Center MedicalResearch.com: What is the background for this study? Response: The estimates in this study provide a more robust indicator of the economic impact falls have on the U.S. economy.  Previous studies focused on Medicare spending. This study includes Medicare, Medicaid and out-of-pocket spending. MedicalResearch.com: What are the main findings?  Response: Our study found that older adult (65 years and over) falls impose a large economic burden on the U.S. healthcare system. In 2015, with a total medical cost $50 billion for non-fatal and fatal falls.  About three-quarters of the total cost was paid by government-funded programs.  Medicare paid nearly $29 billion for non-fatal falls, Medicaid $8.7 billion, and $12 billion was paid for by Private/Out-of-pocket expenses.  For fatal falls, $754 million was spent in 2015. (more…)
Author Interviews, Cost of Health Care, Pediatrics, Sexual Health / 02.04.2018

MedicalResearch.com Interview with: Dr. Xiangming Fang, PhD Associate professor of Health Management and Policy School of Public Health Georgia State University MedicalResearch.com: What is the background for this study? Response: Child sexual abuse is a serious public health problem in the United States. The estimated prevalence rates of exposure to child sexual abuse by 18 years old are 26.6 percent for U.S. girls and 5.1 percent for U.S. boys. The effects of child sexual abuse include increased risk for development of severe mental, physical and behavioral health disorders; sexually transmitted diseases; self-inflicted injury, substance abuse and violence; and subsequent victimization and criminal offending. (more…)
Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, Heart Disease, Medicare / 15.03.2018

MedicalResearch.com Interview with: Dr. Rishi K. Wadhera MD Clinical Fellow in Medicine Brigham and Women's Hospital  MedicalResearch.com: What is the background for this study?   Response: The Hospital Value Based Purchasing program, in which over 3,000 hospitals participate, is a Centers for Medicare and Medicaid Services (CMS) pay-for-performance program that links hospital fee per service reimbursement to performance, through measures like 30-day mortality rates after an acute myocardial infarction (a heart attack), and other measures such as average spending for an episode of care for Medicare beneficiaries. Hospitals that perform poorly on these measures are financially penalized by CMS. (more…)
Author Interviews, Cost of Health Care / 12.03.2018

MedicalResearch.com Interview with: Dr. Samuel Cho, MD Associate Professor of Orthopaedics Icahn School of Medicine at Mount Sinai   MedicalResearch.com: What is the background for this study? What are the main findings? Response: Anterior cervical discectomy and fusion (ACDF), first implemented in 1957, has been considered the “gold standard” for decades for the treatment of cervical degenerative disc disease after conservative options have been exhausted. For patients presenting with neck and radiating arm pain, motor weakness, and sensory loss due to cervical disc herniation or compressive pathologies, ACDF has been shown to be generally well-tolerated and associated with a high clinical success rate. Despite the proven long-term radiographic and clinical success of ACDF, however, our literature has shown the procedure to be associated with certain drawbacks including neurological complications, rapid development of adjacent segment disease, and decreased range of motion owing to solid bony arthrodesis. More recently, cervical disc replacement (CDR) has also become an acceptable surgical option for similar cervical spine pathologies as ACDF. CDR was developed as a motion-sparing alternative to ACDF with purported advantages including minimization of adjacent segment disease and obviation of pseudoarthrosis. Multiple large investigational device exemption (IDE) studies showing the non-inferiority of cervical disc replacement, the cost-effectiveness of this procedure has increasingly become a topic of interest. For this reason, we sought to determine the seven-year cost-effectiveness of single level ACDF versus CDR for the treatment of cervical disc degeneration. (more…)
Author Interviews, Cost of Health Care, JAMA, Surgical Research / 28.02.2018

MedicalResearch.com Interview with: Dr. Chris Childers, M.D. Division of General Surgery David Geffen School of Medicine at UCLA Los Angeles, CA 90095 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Over 20 million Americans undergo a surgical procedure each year with a price tag over $1 trillion.  The operating room (OR) is a particularly resource dense environment, yet little is known about the actual costs of running an OR.  Most previous efforts focusing on OR costs have come from single-site studies with little detail about the drivers of OR costs. Using financial statements from all California hospitals we estimated that the average cost to the hospital for one minute of OR time was between $36 and $37. Perhaps more notable was the composition of these costs.  Almost two-thirds ($20-21) was attributable to “direct costs” - those generated by the OR itself - including $14 for the wages and benefits of staff, $2.50-3.50 for surgical supplies, and $3 for “other” costs such as equipment repair and depreciation. Interestingly, the remainder ($14-16) was dedicated to “indirect costs” such as the costs associated with hospital security and parking.  While these indirect costs are necessary for a hospital to run, they are not under the purview of the operating room. Finally, we also learned that OR costs have increased quickly over the past 10 years – faster than other sectors of healthcare as well as the rest of the economy. (more…)
Author Interviews, Cost of Health Care, Critical Care - Intensive Care - ICUs, JAMA, Kidney Disease / 26.02.2018

MedicalResearch.com Interview with: Rodrigo F. Alban, MD FACS Associate Director Performance Improvement Associate Residency Program Director NSQIP Surgeon Champion Department of Surgery Cedars-Sinai Medical Center  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Continuous Renal Replacement Therapy (CRRT) is a modality of hemodialysis commonly used to manage renal failure in critically ill patients who have significant hemodynamic compromise.  However, it is also resource-intensive and costly and its usage is highly variable and lacks standardization. Our institution organized a multidisciplinary task force to target high value care in critically ill patients requiring CRRT by standardizing its process flow, promoting cross-disciplinary discussions with patients and family members, and increasing visibility/awareness of CRRT use.  After our interventions, the mean duration of CRRT decreased by 11.3% from 7.43 to 6.59 days per patient.  We also saw a 9.8% decrease in the mean direct cost of CRRT from $11642 to $10506 per patient.  Finally, we also saw a decrease in the proportion of patients expiring on CRRT, and an increase in the proportion of patients transitioning to comfort care. (more…)
Author Interviews, Cost of Health Care, Duke, Electronic Records, JAMA / 21.02.2018

MedicalResearch.com Interview with: Barak Richman JD, PhD Bartlett Professor of Law and Business Administration Duke University  MedicalResearch.com: What is the background for this study? What are the main findings?  Response: The US not only has the highest health care costs in the world, we have the highest administrative costs in the world. If we can reduce non-value added costs like the ones we document, we can make substantial changes in the affordability of health care without having to resort to more draconian policy solutions. Our paper finds that administrative costs remain high, even after the adoption of electronic health records.  Billing costs, for example, constituted 25.2% of professional revenue for ED departments and 14.5% of revenue for primary care visits.  The other numbers are captured below. (more…)
Aging, Author Interviews, BMJ, Cost of Health Care, Global Health / 11.02.2018

MedicalResearch.com Interview with: Dr Grace Sum Chi-En National University of Singapore MedicalResearch.com: What is the background for this study? Response: Chronic diseases are conditions that are not infectious and are usually long-term, such as diabetes, hypertension, cancer, chronic lung disease, asthma, arthritis, stroke, obesity, and depression. They are also known as non-communicable diseases (NCDs). Multimorbidity, is a term we use in our field, to mean the presence of two or more NCDs. Multimorbidity is a costly and complex challenge for health systems globally. With the ageing population, more people in the world will suffer from multiple chronic diseases. Patients with multimorbidity tend to need many medicines, and this incurs high levels of out-of-pocket expenditures, simply known as cost not covered by insurance. Even the United Nations and World Health organisation are recognising NCDs as being an important issue. Governments will meet in New York for the United Nations 3rd high-level meeting on chronic diseases in 2018. Global leaders need to work towards reducing the burden of having multiple chronic conditions and providing financial protection to those suffering multimorbidity. Our research aimed to conduct a high-quality systematic review on multimorbidity and out-of-pocket expenditure on medicines.  (more…)
Author Interviews, Cannabis, Cost of Health Care, Opiods / 07.02.2018

MedicalResearch.com Interview with: David Powell PhD Economist; Core Faculty, Pardee RAND Graduate School RAND, Santa Monica MedicalResearch.com: What is the background for this study? What are the main findings? Response: There has been some research suggesting that the adoption of state medical marijuana laws leads to reductions in prescriptions for opioid analgesics among certain populations and opioid-related overdoses overall. However, medical marijuana laws are very different across states and they have changed over time as well. We wanted to understand what components of a medical marijuana law could potentially lead to reductions in overdoses and substance abuse. We focused specifically on the role of dispensaries, given their importance in providing access to medical marijuana, and tested for different effects in states with and without legally-protected and operational dispensaries. We found that dispensaries are critical to reduce opioid-related overdoses and substance abuse. We also found evidence that more recently-adopting states have experienced smaller reductions in overdoses and opioid substance abuse, potentially because the more recent adopters tend to enforce more stringent guidelines for dispensaries than the early adopters. (more…)
Author Interviews, Cost of Health Care, JAMA, Ophthalmology, Surgical Research, UCSF / 23.01.2018

MedicalResearch.com Interview with: Catherine L. Chen, MD, MPH Assistant Professor UCSF Department of Anesthesia & Perioperative Care MedicalResearch.com: What is the background for this study? What are the main findings? Response: Routine preoperative medical testing (such as common laboratory tests looking at a patient's blood cell counts and kidney function, or cardiac tests like an EKG) are not recommended in patients undergoing cataract surgery, but these tests still occur quite frequently among Medicare cataract surgery patients because these patients tend to be older and sicker than the general population. In the past, researchers have used a 30-day window counting backwards from the date of surgery to determine whether a given test should be categorized as a routine preoperative test. However, we know that testing often takes place outside this window and therefore, the frequency and cost of routine preoperative medical testing has generally been underreported. In our study, we used a new method to figure out how to determine the start of the routine preoperative testing period. In cataract patients, ocular biometry is a diagnostic test that is performed in anticipation of cataract surgery, and this test is only performed in cataract patients who will be having cataract surgery in the near future. For each patient, we calculated the elapsed time between the ocular biometry and cataract surgery dates to get a better idea of when to start looking for unnecessary routine preoperative testing. Our goal was to identify all the routine preoperative medical testing that occurs once the decision has been made to operate and better estimate the cost to Medicare of this unnecessary testing. In a previous study that we published in the New England Journal of Medicine, we reported a significant spike in the rate of routine preoperative medical testing that occurs in the 30 days before surgery compared to the baseline rate of testing. In our current study, we discovered that there is a second spike in testing that occurs in the 30 days after ocular biometry. In fact, even if you exclude the testing that takes place during the 30 days before surgery, there is still a 41% increase in testing rates during the interval between ocular biometry and cataract surgery over the baseline rate of testing. In addition, we found that the cost of routine preoperative testing was 47% higher when looking at the entire biometry to surgery timeframe compared to testing that occurs just in the 30 days before surgery. We estimate that the cost to Medicare of all of this unnecessary testing approaches $45.4 million annually. (more…)
Author Interviews, Cost of Health Care, JAMA / 05.01.2018

MedicalResearch.com Interview with: “Doctors” by Tele Jane is licensed under CC BY 2.0Kathryn R. Tringale, MAS Department of Radiation Medicine and Applied Sciences University of California San Diego, La Jolla MedicalResearch.com: What is the background for this study? What are the main findings? Response: Financial relationships between biomedical industry and physicians are common, and previous work has investigated the potential conflicts of interest that can arise from these interactions. Data show that even small payments in the form of industry sponsored lunches can influence physician prescribing patterns. Given the concern for the potential influence of biomedical industry over practice patterns and potentially patient care, the Open Payments program was implemented under the Affordable Care Act to shed light on these interactions and make reports of these financial transactions publicly available. We recently published a paper in JAMA on industry payments to physicians that found that men received a higher value and greater number of payments than women physicians and were more likely to receive royalty or licensing payments when grouped by type of specialty (surgeons, primary care, specialists, interventionalists). The purpose of the Research Letter discussed here was to further examine differences in the value of payments received by male and female physicians within each individual specialty. The main takeaway from this study is that male physicians, across almost every specialty, are receive more money from biomedical industry compared to female physicians. At first glance, this finding can be interpreted as merely another example of gender disparities in the workplace, which we have seen before with gender gaps in physician salaries and research funding. Indeed, this gender gap may be a product of industry bias leading to unequal opportunity for women to engage in these profitable relationships. Alternatively, these data may be more representative of gender differences in physician decision-making. Previous data has shown that industry engagement can lead to changes in practice patterns, so maybe female physicians acknowledge these conflicts of interest and actively choose not to engage with industry. Unfortunately, we cannot tease out these subtleties from our results, but our paper does reveal a remarkable gender difference among physician engagement with industry. With this being said, whether male or female, everyone needs a bit of help sometimes. The use of loans is a possibility for many people who need a little financial assistance. Regardless of whether men are getting paid a little more than women, they may all need help just as equally. The type of loans that would be worth looking into if this is your current situation is physician loans, which basically allows medical professionals to purchase a home with a low/little down payment while avoiding mortgage insurance. A little bit of help goes a long way, especially when it involves your future. (more…)
Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, Outcomes & Safety / 04.01.2018

MedicalResearch.com Interview with: Dr. Igna Bonfrer PhD Post-Doctoral Research Fellow Harvard T.H. Chan School of Public Health   MedicalResearch.com: What is the background for this study? What are the main findings? Response: One of the two main elements of the Affordable Care Act, generally known as Obama Care, is the implementation of value based payments through so called “pay-for-performance” initiatives. The aim of pay-for-performance (P4P) is to reward health care providers for high-quality care and to penalize them for low-quality care. We studied the effects of the P4P program in US hospitals and found that the impact of the program as currently implemented has been limited. (more…)
Author Interviews, Cost of Health Care, OBGYNE / 29.12.2017

MedicalResearch.com Interview with: Laura R. Wherry, Ph.D. Division of General Internal Medicine and Health Services Research David Geffen School of Medicine at UCLA Los Angeles, CA 90024  MedicalResearch.com: What is the background for this study? Response: All states provide Medicaid coverage to pregnant women, but many low-income women do not qualify for the program when they are not pregnant. However, state decisions to expand Medicaid coverage to low-income parents and adults allow low-income women to have Medicaid coverage prior to, and between, their pregnancies. Increased health insurance coverage for low-income women during these non-pregnancy periods may help improve their preconception health and their planning of pregnancies, ultimately leading to healthier pregnancies and infants. This study examines how state expansions in Medicaid coverage for low-income parents before the Affordable Care Act affected the health insurance status of mothers prior to additional pregnancies (i.e. their pre-pregnancy health insurance status). I also examine whether there are changes in pregnancy intention (i.e. whether the pregnancy was mistimed or unwanted), as better access to pre-pregnancy insurance coverage could increase contraception utilization and improve the planning of pregnancies. Finally, I examine whether there were changes in insurance coverage during pregnancy and in the utilization of prenatal care, since women who have pre-pregnancy insurance coverage may experience fewer barriers to establishing care during their pregnancies. (more…)
Author Interviews, Cost of Health Care, Pediatrics / 27.12.2017

MedicalResearch.com Interview with: “Babies at Brunch!” by TJ DeGroat is licensed under CC BY 2.0Kandice A. Kapinos, Ph.D. Economist Professor RAND Corporation Pardee RAND Graduate School MedicalResearch.com: What is the background for this study? Response: In the U.S., we have relatively high rates of breastfeeding initiation – about 80% of mothers will attempt breastfeeding, but rates drop off precipitously in the first few months of an infant’s life. There are tremendous health benefits for both the mother and child from breastfeeding and estimates of significant cost savings from diseases prevented from breastfeeding. However, breastfeeding can be difficult, especially when you need to return to work or school. The American Academy of Pediatrics recommends exclusive breastfeeding for 6 months, but only 22% of mothers breastfeed exclusively for 6 months. My coauthors, Tami Gurley-Calvez and Lindsey Bullinger, and I were interested in evaluating provisions in recent healthcare legislation (the Affordable Care Act) that required private insurers to cover lactation support services, including breast pumps and visits with lactation consultants, without cost-sharing. (more…)
Author Interviews, Cost of Health Care, JAMA / 12.12.2017

MedicalResearch.com Interview with: Renuka Tipirneni, MD, MSc Clinical Lecturer in Internal Medicine University of Michigan Department of Internal Medicine, Division of General Medicine, and Institute for Healthcare Policy & Innovation Ann Arbor, MI MedicalResearch.com: What is the background for this study? What are the main findings? Response: Several states have submitted proposals to require Medicaid expansion enrollees to work, actively seek work or volunteer, or risk losing Medicaid coverage. The current federal administration has signaled a willingness to approve the waivers states need to enact such requirements. In our survey of over 4000 Medicaid expansion enrollees in Michigan, we found that nearly half of enrollees have jobs, another 11 percent can’t work, likely due to serious physical or mental health conditions, and another 27% are out of work but also are much more likely to be in poor health. (more…)
Author Interviews, Cost of Health Care, Social Issues / 06.12.2017

MedicalResearch.com Interview with: “Homeless” by Sonny Abesamis is licensed under CC BY 2.0Sarah Hunter, PhD Senior Behavioral Scientist, RAND Corporation Professor, Pardee RAND Graduate School Santa Monica, CA 90401-3028 MedicalResearch.com: What is the background for this study? Response: In 2014, RAND was contracted by Brilliant Corners in collaboration with the Conrad N. Hilton Foundation and Los Angeles County Department of Health Services to conduct an evaluation of the Los Angeles County Department of Health Services’ Housing for Health (HFH) program.  The HFH program began in 2012 with the goal of providing permanent supportive housing for frequent utilizers of county health services who were experiencing homelessness.  (more…)
Author Interviews, Cost of Health Care, Health Care Systems, JAMA / 05.12.2017

MedicalResearch.com Interview with: Allison Kratka MD Candidate 2018 Duke University School of Medicine MedicalResearch.com: What is the background for this study? Response: As there are increasing numbers of high-deductible plans and those with high rates of co-insurance, patients are increasingly expected to help contain the cost of their health care by being savvy health care consumers. We set out to determine how easy or hard it is to find healthcare prices online. (more…)
Author Interviews, Cost of Health Care, Hematology / 28.11.2017

MedicalResearch.com Interview with: Carol Mansfield, PhD, Senior Research Economist Health Preference Assessment RTI Health Solutions www.rtihs.org  MedicalResearch.com: What is the background for this study? Response: As the most prevalent form of leukemia, chronic lymphocytic leukemia (CLL) affects approximately 130,000 people in the United States. More than 20,000 new cases are diagnosed each year. In recent years, more treatment options–each with its own associated benefits, side effects, and price tag–have been approved. This leaves patients and physicians with a variety of factors they must consider when choosing a treatment plan. While every patient wants the most effective drug with the fewest side effects, most people don’t have that option available. By asking patients to make tradeoffs and rank their preferences, we can form an understanding of how patients approach their treatment. This study showed that patients with CLL value medicines that provide the longest progression-free survival, but are willing to trade some benefits for a lower risk of serious adverse events. Additionally, we found that cost clearly has an impact on which treatment a patient would choose. When patients get prescribed something they can’t afford, they are forced to make very difficult choices. (more…)
Author Interviews, Cost of Health Care, Dermatology, JAMA, Medicare / 22.11.2017

MedicalResearch.com Interview with: Adewole Adamson, MD, MPP Department of Dermatology UNC – Chapel Hill North Carolina  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Nurses practitioners and physician assistants, collectively known as non-physician clinicians (NPCs), provide many dermatology services, some which are billed for independently. Little is known about the types of these services provided. Even less is known about where these independently billed services are provided. Given that there is a purported shortage of dermatologists in the United States (US),  NPCs have been suggested as way to fill in the gap. In this study, we found that NPCs independently billed for many different types of dermatology associated procedures, including surgical treatment of skin cancer, flaps, grafts, and billing for pathology. Most of these NPCs worked with dermatologists. Much like dermatologists, NPCs were unevenly distributed across the US, concentrating mostly in non-rural areas. (more…)
Author Interviews, Cost of Health Care, Emergency Care, Heart Disease, JAMA / 16.11.2017

MedicalResearch.com Interview with: David L. Brown, MD, FACC Professor of Medicine Cardiovascular Division Washington University School of Medicine St. Louis, MO 63110 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Approximately 10 million patients present to emergency rooms in the US annually for evaluation of acute chest pain. The goal of that evaluation is to rule out the diagnosis of an acute heart attack. Imaging with coronary CT angiography and stress testing are not part of the diagnostic algorithm for acute heart attack.  Nevertheless many chest pain patients undergo some form of noninvasive cardiac testing in the ER. We found that CCTA or stress testing adding nothing to the care of chest pain patients beyond what is achieved by a history, physical examination, ECG and troponin test. (more…)
Author Interviews, Cost of Health Care, Education, JAMA / 14.11.2017

MedicalResearch.com Interview with: Victoria Valencia, MPH Assistant Director for Healthcare Value Dell Medical SchoolThe University of Texas at Austin MedicalResearch.com: What is the background for this study? What are the main findings? Response: We were surprised to find that despite the common anecdote that resident physicians in teaching environments order more lab tests, there was a lack of empirical data to support the claim that more lab tests are ordered for patients at teaching hospitals than at non-teaching hospitals. Our study of 43,329 patients with pneumonia or cellulitis across 96 hospitals  in the state of Texas found that major teaching hospitals order significantly more lab tests than non-teaching hospitals.  We found this to be true no matter how we looked at the data, including when restricting to the least sick patients in our dataset. We also found that major teaching hospitals that ordered more labs for pneumonia tended to also more labs for cellulitis, indicating there is some effect from the environment of the teaching hospital that affects lab ordering overall. (more…)
Author Interviews, Cost of Health Care, Health Care Systems / 14.11.2017

MedicalResearch.com Interview with: Barbara L. McAneny MD, CEO New Mexico Oncology Hematology Consultants, Ltd. Albuquerque, NM 87109  MedicalResearch.com:   What is the meant by value-based care? Response: There are a lot of people using this term to mean a variety of things, confusion is not surprising.  Generally it means a move to pay more for better patient outcomes and less for worse patient outcomes.  Currently in our Fee for Service system, there are a lot of services for which there are no fees. That deficiency keeps physicians from looking at non face-to-face delivery methods or the use of other health professionals to augment the care they give, because we can’t afford to give services that we aren’t paid to give. (more…)
Author Interviews, Cost of Health Care, Primary Care, University of Pennsylvania / 14.11.2017

MedicalResearch.com Interview with: Molly Candon, PhD Postdoctoral Fellow Leonard Davis Institute of Health Economics Center for Mental Health Policy and Services Research University of Pennsylvania MedicalResearch.com: What is the background for this study? What are the main findings? Response: We conducted a secret shopper study in 2012, 2014, and 2016 in which simulated Medicaid patients called primary care practices and attempted to schedule an appointment. When Medicaid fees were increased to Medicare levels in 2013 and 2014, primary care appointment availability increased. Once the federally-funded program ended in 2015, most states returned to lower fees. As expected, provider participation in Medicaid declined as well. (more…)
Author Interviews, Cost of Health Care, HIV, Lancet / 13.11.2017

MedicalResearch.com Interview with: Dr Valentina Cambiano PhD Institute for Global Health University College London London UK MedicalResearch.com: What is the background for this study? Response: Pre-Exposure Prophylaxis (PrEP) which involves the use of drugs, which are used to treat HIV, in people without HIV to prevent them from getting is a critical new advance in HIV prevention. It has been shown to reduce the risk of HIV infection by 86% and the benefits heavily out-weigh any concerns. However, introducing this intervention has a cost. When we started working on this study the National Health Services was discussing whether to introduce PrEP and if so for which populations. Unfortunately, at the moment NHS England is not providing Pre-exposure prophylaxis. However, a large study, the PrEP impact trial, funded by the NHS, has just started and this will provide PrEP to 10,000 people. (more…)
Aging, Author Interviews, BMJ, Cost of Health Care, Exercise - Fitness, Social Issues / 27.10.2017

MedicalResearch.com Interview with: Dr. Scarlett McNally Consultant Orthopaedic Surgeo Eastbourne D.G.H. MedicalResearch.com: What is the background for this study? What are the main findings? Response: There are vast differences between older people in their abilities and their number of medical conditions. Many people confuse ageing with loss of fitness. Ageing has specific effects (reduction in hearing and skin elasticity for example) but the loss of fitness is not inevitable. Genetics contributes only 20% to diseases. There is abundant evidence that adults who take up physical activity improve their fitness up to the level of someone a decade younger, with improvements in ‘up and go’ times. Physical activity can reduce the severity of most conditions, such as heart disease or the risk of onset or recurrence of many cancers. Inactivity is one of the top four risk factors for most long-term conditions. There is a dose-effect curve. Dementia, disability and frailty can be prevented, reduced or delayed. The need for social care is based on an individual’s abilities; for example, being unable to get to the toilet in time may increase the need for care from twice daily care givers to needing residential care or live-in care, which increases costs five-fold. Hospitals contribute to people reducing their mobility, with the ‘deconditioning syndrome’ of bed rest, with 60% of in-patients reducing their mobility. The total cost of social care in the UK is up to £100 billion, so even modest changes would reduce the cost of social care by several billion pounds a year. (more…)
Author Interviews, Cancer Research, Cost of Health Care, JAMA / 20.10.2017

MedicalResearch.com Interview with: Aparna Soni, MA Department of Business Economics and Public Policy Kelley School of Business Indiana University, Bloomington MedicalResearch.com: What is the background for this study? What are the main findings? Response: Cancer is the leading cause of death among the non-elderly population in the United States. Unfortunately, uninsured people are less likely to get screened for cancer, and treatment is often unaffordable for those who are uninsured. One of the key objectives of the Affordable Care Act (ACA) was to improve outcomes for cancer patients. Our objective in this study was therefore to assess changes under the ACA in insurance coverage among patients newly diagnosed with cancer. Our main finding is that uninsurance among patients with newly diagnosed cancer fell by one-third in 2014. (more…)
Author Interviews, Cost of Health Care, Medicare / 19.10.2017

MedicalResearch.com Interview with: Susan G. Haber, Sc.D. Director, Health Coverage for Low-Income and Uninsured Populations RTI International Waltham, MA MedicalResearch.com: What is the background for this study? What are the main findings? Response: In 2014, the state of Maryland and the federal Centers for Medicare and Medicaid Services (CMS) began testing an alternative payment structure for inpatient and outpatient hospital services. Known as the All-Payer Model, the new system limits hospitals’ revenues from Medicare, Medicaid, and private insurers to a global budget for the year. This builds on Maryland’s hospital rate-setting system that had operated since the 1970s, where all payers pay the same rates. CMS wanted to test whether global budgets could help Maryland limit cost growth and reduce avoidable hospital use. The goal of the model is to limit per capita total hospital cost growth for both Medicare and all payers and to generate $330 million in Medicare savings over 5 years. RTI researchers studied the impact of hospital global budgets on Medicare beneficiary expenditures and utilization, using Medicare claims data to compare changes in Maryland before and after adoption of global budgets with changes in matched comparison areas outside of the state. Our report found Maryland has reduced total Medicare expenditures by approximately $293 million and total hospital expenditures by about $200 million in its first two years of operation. The reduction in overall expenditures indicates that “squeezing the balloon” on hospital expenditures did not simply produce a cost-shift to other health care sectors. Hospital expenditure savings for Medicare were achieved by reducing expenditures for outpatient emergency department and other hospital outpatient department services. Although inpatient admissions declined, there were no savings in Medicare expenditures for inpatient hospital services because the payment per admission increased. Maryland hospitals reduced avoidable utilization, including admissions for ambulatory care sensitive conditions, and readmissions and emergency department visits following hospital discharge. Despite the success in reducing expenditures, interviews with senior leaders at Maryland hospitals and focus group discussions with physicians and nurses suggest that many hospitals had not yet made fundamental changes in how they operate or developed partnerships with community physicians to divert care from the hospital, although there was variation in how hospitals responded. (more…)
Author Interviews, Cost of Health Care, Infections, Merck, Stem Cells, Transplantation / 12.10.2017

MedicalResearch.com Interview with: Dr. Jonathan Schelfhout, PhD Director, Outcomes Research Merck & Co. Inc. North Wales, PA MedicalResearch.com: What is the background for this study? What are the main findings? Response: The cost of hematopoietic stem cell transplantation has received increased attention after it was identified as a top 10 contributor to increasing healthcare costs in an AHRQ 2016 report. Many recent studies have explored the cost of HSCT but additional research is needed on the costly complications that can follow the transplant procedure. This research is particularly relevant for inpatient decision makers, as most transplant centers receive one bundled payment for the transplant and the treatment of any complications over the first 100 days. (more…)
Author Interviews, Cost of Health Care / 09.10.2017

MedicalResearch.com Interview with: John N. Mafi MD MPH Assistant Professor of Medicine David Geffen School of Medicine University of California, Los Angeles Natural scientist in Health Policy RAND Corporation Santa Monica, California MedicalResearch.com: What is the background for this study? What are the main findings? Response: Of the 3 trillion dollars the U.S. spends annually on health care, an estimated 10-30% consists of “low-value care”, or patient care that provides no net benefit in specific clinical scenarios (think antibiotics given for the common cold virus). Determining where and why this waste occurs is critical to efforts to safely reducing healthcare spending. Little is known, however, about the distribution of costs among such “low-value” services. In this context, we used the Virginia All Payer Claims Database in order to assess the quantity and total costs of 44 low-value services in 2014 among 5.5 million beneficiaries. (more…)
Author Interviews, Cost of Health Care, JAMA, PTSD / 06.10.2017

MedicalResearch.com Interview with: Gregory H. Cohen, MPhil, MSW Statistical Analyst Department of Epidemiology School of Public Health Boston University  MedicalResearch.com: What is the background for this study? What are the main findings? Response: We simulated a stepped care case-finding approach to the treatment of posttraumatic stress in New York City, in the aftermath of Hurricane Sandy. Stepped care includes an initial triage screening step which identifies whether a presenting individual is in need of Cognitive Behavioral Therapy, or can be adequately treated at a lower level of care. Our simulation suggests that a stepped care approach to treating symptoms of posttraumatic stress in the aftermath of a hurricane is superior to care as usual in terms of reach and treatment-effectiveness, while being cost-effective. (more…)