Author Interviews, Cost of Health Care / 23.07.2018

MedicalResearch.com Interview with: Jonathan Gruber PhD Department of Economics, E52-434 MIT Cambridge, MA 02139 MedicalResearch.com: What is the background for this study? What are the main findings?  Response: There is a large literature trying to estimate the extent of 'defensive  medicine' by looking at what happens when it gets harder to sue and/or  you can win less money. But there have been no studies of what happens if you just get rid of the right to sue.  That's what we have with active duty patients treated on a military base. The main finding is that when patients can't sue they are treated about  5% less intensively.  Much of the effect appears to arise from fewer diagnostic tests.
Author Interviews, Cost of Health Care, JAMA, Pediatrics / 19.07.2018

MedicalResearch.com Interview with: [caption id="attachment_43292" align="alignleft" width="142"]Julie L. Hudson, PhD Center for Financing, Access, and Cost Trends Agency for Healthcare Research and Quality Rockville, Maryland Dr. Hudson[/caption] Julie L. Hudson, PhD Center for Financing, Access, and Cost Trends Agency for Healthcare Research and Quality Rockville, Maryland MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Since 2013, public coverage has increased not only among low-income adults newly eligible for Medicaid but also among children and adults who were previously eligible for Medicaid or the Children’s Health Insurance Program (CHIP). Recent research has shown that growth in public coverage varied by state-level policy choices. In this paper we study the growth in public coverage (Medicaid/CHIP) for three population samples living in Medicaid Expansion states between 2013 and 2015: previously eligible children, previously eligible parents, and newly eligible parents by state-level marketplace policies (Note: eligibility refers to eligible for Medicaid/CHIP, eligibility for marketplace subsidized coverage). All marketplaces are required to assess each applicants’ eligibility for both the marketplace and for Medicaid/CHIP. States running state-based marketplaces are required to enroll Medicaid-/CHIP-eligible applicants directly into public coverage (Medicaid or CHIP), but states using federally-facilitated marketplaces can opt to require their marketplace to forward these cases to state Medicaid/CHIP authorities for final eligibility determination and enrollment. We study the impact of marketplace policies on public coverage by observing changes in the probability Medicaid-/CHIP-eligible children and parents are enrolled in public coverage across three marketplace structures: state-based marketplaces that are required to enroll Medicaid-/CHIP-eligible applicants directly into public coverage, federally-facilitated marketplaces in states that enroll Medicaid-/CHIP-eligible applicants directly into public coverage, and federally-facilitated marketplaces with no authority to enroll Medicaid-/CHIP-eligible applicants into public coverage. Supporting the existing literature, we find that public coverage grew between 2013-2015 for all three of our samples of Medicaid-/CHIP-eligible children and parents living in Medicaid expansion states. However, we show that growth in public coverage was smallest in expansion states that adopted a federally-facilitated marketplace and gave no authority to the marketplace to enroll Medicaid-/CHIP-eligible applicants directly into public coverage. Additionally, once we account for enrollment authority, we found no differences in growth of public coverage for eligible children and parents living in expansion states that adopted a state-based marketplace versus those in states that adopted a federally-facilitated marketplaces with the authority to directly enroll Medicaid-/CHIP-eligible applicants
Author Interviews, Cost of Health Care, Geriatrics / 07.07.2018

MedicalResearch.com Interview with: Jonathan H. Watanabe, PharmD, PhD, BCGP Associate Professor of Clinical Pharmacy National Academy of Medicine Anniversary Fellow in Pharmacy Division of Clinical Pharmacy | Skaggs School of Pharmacy and Pharmaceutical Sciences | University of California San Diego La Jolla, CA  Jonathan H. Watanabe, PharmD, PhD, BCGP Associate Professor of Clinical Pharmacy National Academy of Medicine Anniversary Fellow in Pharmacy Division of Clinical Pharmacy | Skaggs School of Pharmacy and Pharmaceutical Sciences | University of California San Diego La Jolla, CA MedicalResearch.com: What is the background for this study? What are the main findings?  Response: As a clinician in older adult care and as a health economist, I’ve been following the news and research studies on older patients unable to pay for their medications and consequently not getting the treatment they require. Our goal was to measure how spending on the medications Part D spends the most on, has been increasing over time and to figure out what prices patients are facing out-of-pocket to get these medications. In 2015 US dollars, Medicare Part D spent on the ten highest spend medications increased from $21.5 billion in 2011 to $28.4 billion in 2015.  The number of patients that received one of the ten highest spend medications dropped from 12,913,003 in 2011 to 8,818,471--- a 32% drop in that period. A trend of spending more tax dollars on fewer patients already presents societal challenges, but more troubling is that older adults are spending much more of their own money out-of-pocket on these medications.  For patients without a federal low income subsidy, the average out-of-pocket cost share for one of the ten highest spend medications increased from $375 in 2011 to $1,366 in 2015.  This represented a 264% increase and an average 66% increase per year.  For patients receiving the low income subsidy, the average out-of-pocket cost share grew from $29 in 2011 to $44 in 2015 an increase of 51% and an average increase of 12.7% per year.  This may not sound like much, but for those living close to the federal poverty level this can be the difference between foregoing necessities to afford your medications or choosing not to take your medications.  
Author Interviews, Breast Cancer, Cancer Research, Cost of Health Care, JAMA / 06.07.2018

MedicalResearch.com Interview with:

[caption id="attachment_42920" align="alignleft" width="150"]Dr Nora Pashayan PhD Clinical Reader in Applied Health Research University College London Dept of Applied Health Research London  Dr. Pashayan[/caption]

Dr Nora Pashayan PhD

Clinical Reader in Applied Health Research

University College London

Dept of Applied Health Research

London 

MedicalResearch.com:  What is the background for this study?

Response: Not all women have the same risk of developing breast cancer and not all women have the same potential to benefit from screening.

 

If the screening programme takes into account the individual variation in risk, then evidence from different studies indicate that this could improve the efficiency of the screening programme. However, questions remain on what is the best risk-stratified screening strategy, does risk-stratified screening add value for money, and what are benefit and harm trade-offs.

Author Interviews, Cost of Health Care, End of Life Care, Medicare, Science / 06.07.2018

MedicalResearch.com Interview with: [caption id="attachment_42957" align="alignleft" width="200"]Amy Finkelstein PhD John & Jennie S. MacDonald Professor of Economics MIT Department of Economics National Bureau of Economic Research Cambridge MA 02139  Dr. Finkelstein[/caption] Amy Finkelstein PhD John & Jennie S. MacDonald Professor of Economics MIT Department of Economics National Bureau of Economic Research Cambridge MA 02139  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Although only 5% of Medicare beneficiaries die in a given year, they account for almost 25% of Medciare spending. This fact about high end of life spending has been constantly used to refer to inefficiency of the US healthcare system. A natural observation is that the fact is retrospective, and it motivated us to explore a prospective analog, which would take as an input the probability of someone dying in a given year rather than her realized outcome. We therefore used machine learning techniques to predict death, and somewhat to our surprise we found that at least using standardized and detailed claims-level data, predicting death is difficult, and there are only a tiny fraction of Medicare beneficiaries for whom we can predict death (within a year) with near certainty. Those who end up dying are obviously sicker, and our study finds that up to half of the higher spending on those who die could be attributed to the fact that those who die are sicker and sick individuals are associated with higher spending.  
Author Interviews, Cost of Health Care, Hospital Acquired, Medicare / 02.07.2018

MedicalResearch.com Interview with: [caption id="attachment_42878" align="alignleft" width="200"]Michael S. Calderwood, MD, MPH, FIDSA Regional Hospital Epidemiologist Assistant Professor of Medicine Infectious Disease & International Health Dr. Calderwood[/caption] Michael S. Calderwood, MD, MPH, FIDSA Regional Hospital Epidemiologist Assistant Professor of Medicine Infectious Disease & International Health MedicalResearch.com: What is the background for this study?   Response: Prior work by Lee et al. (N Engl J Med 2012;367:1428–1437) found that the 2008 CMS Hospital-Acquired Conditions (HAC) policy did not impact already declining national rates of central line-associated bloodstream infections (CLABSIs) or catheter-associated urinary tract infections (CAUTIs). We studied why this policy did not have its intended impact by looking at coding practices and the impact of the policy on the diagnosis-related group (DRG) assignment for Medicare hospitalizations. The DRG assignment determines reimbursement for inpatient hospitalizations.
Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, Health Care Systems, JAMA / 26.06.2018

MedicalResearch.com Interview with: [caption id="attachment_42726" align="alignleft" width="140"]A Jay Holmgren Doctoral Student, Health Policy and Management Harvard Business School A Jay Holmgren[/caption] A Jay Holmgren Doctoral Student, Health Policy and Management Harvard Business School MedicalResearch.com: What is the background for this study? What are the main findings? Response: Post-acute care, care that is delivered following an acute care hospitalization, is one of the largest drivers of variation in US health care spending. To address this, Medicare has created several payment reform systems targeting post-acute care, including a voluntary bundled payment program known as the Model 3 of the Bundled Payment for Care Improvement (BPCI) Initiative for post-acute care providers such as skilled nursing facilities, long-term care hospitals, or inpatient rehabilitation facilities. Participants are given a target price for an episode of care which is then reconciled against actual spending; providers who spend under the target price retain some of the savings, while those who spend more must reimburse Medicare for some of the difference. Our study sought to evaluate the level of participation in this program and identify what providers were more likely to participate. We found that fewer than 4% of eligible post-acute care providers ever participated in the program, and over 40% of those who did participate dropped out. The providers more likely to remain in the program were skilled nursing facilities that were higher quality, for-profit, and were part of a multi-facility organization.
Author Interviews, Cost of Health Care, Medicare, Orthopedics / 12.06.2018

MedicalResearch.com Interview with: [caption id="attachment_42352" align="alignleft" width="200"]Amol Navathe, MD, PhD Assistant Professor, Health Policy and Medicine Perelman School of Medicine University of Pennsylvania Dr. Navathe[/caption] Amol Navathe, MD, PhD Assistant Professor, Health Policy and Medicine Perelman School of Medicine University of Pennsylvania MedicalResearch.com: What is the background for this study? Response: Bundled payment is a key Medicare Alternative Payment Model (APM) developed by the Centers for Medicare and Medicaid Services (CMS) to increase health care value by holding health care organizations accountable for spending across an episode of care. The model provides financial incentives to maintain quality and contain spending below a predefined benchmark. In 2013, CMS launched the Bundled Payments for Care Improvement (BPCI) initiative to expand bundled payment nationwide. BPCI’s bundled payment design formed the basis for CMS’s Comprehensive Care for Joint Replacement (CJR) Model beginning in 2016. While the programs are similar in design, BPCI is voluntary while CJR is mandatory for hospitals in selected markets. Moreover, CJR is narrower in scope, focusing only on lower extremity joint replacement (LEJR) and limiting participation to hospitals.
Author Interviews, CMAJ, Cost of Health Care, Health Care Systems, Hip Fractures, Surgical Research / 12.06.2018

MedicalResearch.com Interview with: [caption id="attachment_42321" align="alignleft" width="108"]Daniel Pincus MD Department of Surgery Institute for Clinical Evaluative Sciences University of Toronto Dr. Pincus[/caption] Daniel Pincus MD Department of Surgery Institute for Clinical Evaluative Sciences University of Toronto MedicalResearch.com: What is the background for this study? What are the main findings? Response: We chose to look at hip fractures because is the most common reason for urgent surgery complications have be tied to wait times (and in particular wait times greater than 24 hours).
Author Interviews, Cost of Health Care, Critical Care - Intensive Care - ICUs, End of Life Care, NEJM, University of Pittsburgh / 30.05.2018

MedicalResearch.com Interview with: [caption id="attachment_42024" align="alignleft" width="160"]Douglas B. White, M.D., M.A.S. Director of the Clinical Research Investigation and Systems Modeling of Acute Illness (CRISMA) Center’s Program on Ethics and Decision Making in  Department of Critical Care Medicine University of Pittsburgh  Dr. White[/caption] Douglas B. White, M.D., M.A.S. Director of the Clinical Research Investigation and Systems Modeling of Acute Illness (CRISMA) Center’s Program on Ethics and Decision Making in  Department of Critical Care Medicine University of Pittsburgh  MedicalResearch.com: What is the background for this study?  Response: We set out to test the effectiveness of PARTNER (PAiring Re-engineered ICU Teams with Nurse-driven Emotional Support and Relationship-building). PARTNER is delivered by the interprofessional team in the ICU, consisting of nurses, physicians, spiritual care providers, social workers and others who play a part in patient care. The program is overseen by nurse-leaders in each ICU who receive 12 hours of advanced communication skills training to support families. The nurses meet with the families daily and arrange interdisciplinary clinician-family meetings within 48 hours of a patient coming to the ICU. A quality improvement specialist helps to incorporate the family support intervention into the clinicians’ workflow. PARTNER was rolled out at five UPMC ICUs with different patient populations and staffing. It was implemented in a staggered fashion so that every participating ICU would eventually get PARTNER. Before receiving PARTNER, the ICUs continued their usual methods of supporting families of hospitalized patients. None of the ICUs had a set approach to family communication or required family meetings at regular intervals before receiving PARTNER. A total of 1,420 adult patients were enrolled in the trial, and 1,106 of these patients’ family members agreed to be a part of the study and its six-month follow-up surveys. The patients were very sick, with about 60 percent dying within six months of hospitalization and less than 1 percent living independently at home at that point.
Author Interviews, Cost of Health Care, End of Life Care, Geriatrics, JAMA, Medicare / 23.05.2018

MedicalResearch.com Interview with: [caption id="attachment_41835" align="alignleft" width="125"]William B Weeks, MD, PhD, MBA The Dartmouth Institute Dr. Weeks[/caption] William B Weeks, MD, PhD, MBA The Dartmouth Institute MedicalResearch.com: What is the background for this study? What are the main findings? Response: The background for the study is that a common narrative is that end-of-life healthcare costs are driving overall healthcare cost growth.  Growth in end-of-life care has been shown, in research studies through the mid 2000’s, to be attributable to increasing intensity of care at the end-of-life (i.e., more hospitalizations and more use of ICUs). The main findings of our study are that indeed there have been substantial increases in per-capita end-of-life care costs within the Medicare fee-for-service population between 2004-2009, but those per-capita costs dropped pretty substantially between 2009-2014.  Further, the drop in per-capita costs attributable to Medicare patients who died (and were, therefore, at the end-of-life) accounts for much of the mitigation in cost growth that has been found since 2009 in the overall Medicare fee-for-service population.
Annals Internal Medicine, Author Interviews, Cost of Health Care, Kidney Disease / 22.05.2018

MedicalResearch.com Interview with: [caption id="attachment_41937" align="alignleft" width="133"]Lilia Cervantes, M.D. Internal Medicine, Hospitalist Denver Health and Hospital Authority Assistant Professor, Division of General Internal Medicine Founder, Healthcare Interest Program and Health Equity Lecture Series at Denver Health University of Colorado Health Sciences Center Dr. Cervantes[/caption] Lilia Cervantes, M.D. Internal Medicine, Hospitalist Denver Health and Hospital Authority Assistant Professor, Division of General Internal Medicine Founder, Healthcare Interest Program and Health Equity Lecture Series at Denver Health University of Colorado Health Sciences Center MedicalResearch.com: What is the background for this study? What are the main findings?  Response:  For most undocumented immigrants with kidney failure in the U.S., access to hemodialysis is limited and they can only receive it when they are critically ill and near-death.  This type of “emergency-only” hemodialysis is already known to be nearly 4-fold more costly, has 14-fold higher mortality rate, and leads to debilitating physical and psychosocial distress for these patients compared to those receiving regular hemodialysis. This study shows that clinicians who are forced to provide this substandard care are also harmed.  They experience moral distress, emotional exhaustion, and several other drives of professional burnout due to witnessing needless suffering and high mortality. 
Author Interviews, Breast Cancer, Cancer Research, Cost of Health Care, Kaiser Permanente, Lung Cancer, Prostate Cancer / 02.05.2018

MedicalResearch.com Interview with: [caption id="attachment_41442" align="alignleft" width="149"]Matthew P. Banegas, PhD, MPH Center for Health Research Kaiser Permanente Dr. Banegas[/caption] Matthew P. Banegas, PhD, MPH Center for Health Research Kaiser Permanente MedicalResearch.com: What is the background for this study? Response: Despite a large body of research on cancer care costs, we observed a significant evidence gap. Namely, while about one-half of cancer diagnoses in the U.S. occur among people under age 65, it can be difficult to find good data on the costs of care for this population. That’s because most of the current literature on cancer care costs is based on SEER Medicare data, which are limited to Medicare fee-for-service beneficiaries. At a time of rising costs and an ever-increasing number of new therapies, we felt it was important to improve our understanding of cancer costs for U.S. adults of all ages. We examined medical care costs for the four most common types of cancer in the United States: breast, colorectal, lung, and prostate cancer.
Author Interviews, Cost of Health Care, End of Life Care, JAMA / 01.05.2018

MedicalResearch.com Interview with: [caption id="attachment_41387" align="alignleft" width="130"]R. Sean Morrison, MD Ellen and Howard C. Katz Professor and Chair Brookdale Department of Geriatrics and Palliative Medicine Icahn School of Medicine at Mount Sinai New York, NY 10029 Dr. Morrison[/caption] R. Sean Morrison, MD Ellen and Howard C. Katz Professor and Chair Brookdale Department of Geriatrics and Palliative Medicine Icahn School of Medicine at Mount Sinai New York, NY 10029 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Palliative care is team based care that is focused on improving quality of life and reducing suffering for persons with serious illness and their families.  It can be provided at any age and in concert with all other appropriate medical treatments.  Palliative care has been shown to improve patient quality of life, patient and family satisfaction, and in diseases like cancer and heart failure, improve survival.  A number of individual studies have shown that palliative care can reduce costs by providing the right care to the right people at the right time. This study pooled data from six existing studies to quantify the magnitude of savings that high quality palliative care provides.
Author Interviews, Cancer Research, Cost of Health Care, JAMA, Pharmaceutical Companies / 09.04.2018

MedicalResearch.com Interview with: [caption id="attachment_41105" align="alignleft" width="133"]Aaron Mitchell, MD Division of Hematology/Oncology, Department of Medicine,  Lineberger Comprehensive Cancer Center The Cecil G. Sheps Center for Health Services Research The University of North Carolina at Chapel Hil Dr. Mitchell[/caption] Aaron Mitchell, MD Division of Hematology/Oncology, Department of Medicine, Lineberger Comprehensive Cancer Center The Cecil G. Sheps Center for Health Services Research The University of North Carolina at Chapel Hill MedicalResearch.com: What is the background for this study? What are the main findings? Response: Financial relationships between physicians and the pharmaceutical industry are very common. However, we are just beginning to figure out whether these relationships may lead to potentially concerning changes in physician behavior - whether physicians tend to prescribe more of the drugs made by a company that has given them money. We decided to ask whether oncologists who receive money from drugmakers are more likely to use the cancer drugs made by companies that have given them money in the past. In studying two specific groups of cancer drugs, one for kidney cancer and one for chronic myeloid leukemia (CML), we found that oncologists who had received payments such as meals, consulting fees, travel & lodging expenses from the manufacturer of one of these drugs tended to use that drug more. When looking at oncologists who received payments for research, we found increased prescribing among the kidney cancer drugs but not the CML drugs.
Author Interviews, Cost of Health Care, University of Pennsylvania / 04.04.2018

MedicalResearch.com Interview with: [caption id="attachment_40996" align="alignleft" width="138"]Eric T. Roberts, PhD Assistant Professor of Health Policy & Management University of Pittsburgh Graduate School of Public Health Pittsburgh, PA 15261 Dr. Roberts[/caption] Eric T. Roberts, PhD Assistant Professor of Health Policy & Management University of Pittsburgh Graduate School of Public Health Pittsburgh, PA 15261 MedicalResearch.com: What is the background for this study? Response: There is considerable interest nationally in reforming how we pay health care providers and in shifting from fee-for-service to value-based payment models, in which providers assume some economic risk for their patients’ costs and outcomes of care.  One new payment model that has garnered interest among policy makers is the global budget, which in 2010 Maryland adopted for rural hospitals.  Maryland subsequently expanded the model to urban and suburban hospitals in 2014.  Maryland’s global budget model encompasses payments to hospitals for inpatient, emergency department, and hospital outpatient department services from all payers, including Medicare, Medicaid, and commercial insurers.  The intuition behind this payment model is that, when a hospital is given a fixed budget to care for the entire population it serves, it will have an incentive to avoid costly admissions and focus on treating patients outside of the hospital (e.g., in primary care practices).  Until recently, there has been little rigorous evidence about whether Maryland’s hospital global budget model met policy makers’ goals of reducing hospital use and strengthening primary care. Our Health Affairs study evaluated how the 2010 implementation of global budgets in rural Maryland hospitals affected hospital utilization among Medicare beneficiaries.  This study complements work our research group published in JAMA Internal Medicine (January 16, 2018) that examined the impact of the statewide program on hospital and primary care use, also among Medicare beneficiaries.
Author Interviews, CDC, Cost of Health Care, Geriatrics / 04.04.2018

MedicalResearch.com Interview with: [caption id="attachment_40978" align="alignleft" width="200"]Curtis Florence, PhD Division of Analysis, Research and Practice Integration  CDC’s Injury Center Dr. Florence[/caption] 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.
Author Interviews, Cost of Health Care, Pediatrics, Sexual Health / 02.04.2018

MedicalResearch.com Interview with: [caption id="attachment_40905" align="alignleft" width="200"]Dr. Xiangming Fang, PhD Associate professor of Health Management and Policy School of Public Health Georgia State University Dr. Xiangming Fang[/caption] 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.
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.
Author Interviews, Cost of Health Care / 12.03.2018

MedicalResearch.com Interview with: [caption id="attachment_40395" align="alignleft" width="133"]Dr. Samuel Cho, MD Associate Professor of Orthopaedics Icahn School of Medicine at Mount Sinai   Dr. Cho[/caption] 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.
Author Interviews, Cost of Health Care, JAMA, Surgical Research / 28.02.2018

MedicalResearch.com Interview with: [caption id="attachment_40286" align="alignleft" width="201"]Dr. Chris Childers, M.D.  Division of General Surgery David Geffen School of Medicine at UCLA Los Angeles, CA 90095 Dr. Childers[/caption] 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.
Author Interviews, Cost of Health Care, Critical Care - Intensive Care - ICUs, JAMA, Kidney Disease / 26.02.2018

MedicalResearch.com Interview with: [caption id="attachment_40274" align="alignleft" width="143"]Rodrigo F. Alban, MD FACS Associate Director Performance Improvement Associate Residency Program Director NSQIP Surgeon Champion Department of Surgery Cedars-Sinai Medical Center Dr. Alban[/caption] 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.
Author Interviews, Cost of Health Care, Duke, Electronic Records, JAMA / 21.02.2018

[caption id="attachment_40182" align="alignleft" width="200"]Barak Richman JD, PhD Bartlett Professor of Law and Business Administration Duke University Prof. Barak Richman[/caption] 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. [caption id="attachment_40183" align="alignleft" width="680"]Administrative Costs Still High With EHRs Administrative Costs Still High With EHRs[/caption]
Aging, Author Interviews, BMJ, Cost of Health Care, Global Health / 11.02.2018

MedicalResearch.com Interview with: [caption id="attachment_39962" align="alignleft" width="147"]Dr Grace Sum Chi-En National University of Singapore Dr Grace Sum    Chi-En[/caption] 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. 
Author Interviews, Cannabis, Cost of Health Care, Opiods / 07.02.2018

MedicalResearch.com Interview with: [caption id="attachment_39890" align="alignleft" width="130"]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 <a href=michigan dispensaries and other dispensaries across America 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. MedicalResearch.com: What should readers take away from your report? Response: We find that the introduction of medical marijuana dispensaries has the potential to reduce opioid-related harms quite significantly. More broadly, it also suggests that, when we think about the opioid crisis, improving access to pain management alternatives may be a useful mechanism for reducing dependence on opioids. MedicalResearch.com: What recommendations do you have for future research as a result of this work? Response: During most of the time period that we studied, prescription opioids were driving the opioid crisis, but it has recently transitioned to the point where heroin and illicit synthetic opioids are playing more prominent roles. We are hesitant to suggest that medical marijuana access will have the same scope in a climate in which synthetic opioids and heroin are the primary substances of abuse. Future work could do more to explore the potential of different types of medical marijuana laws to reduce overdoses related to these substances. Citations: Do medical marijuana laws reduce addictions and deaths related to pain killers? ? •David Powella, , , • Rosalie Liccardo Paculaa, b, Mireille Jacobsonb RAND, Santa Monica, United States NBER Cambridge, MA, United StatesUniversity of California, Irvine, United States Received 14 November 2015, Revised 15 August 2017, Accepted 30 December 2017, Available online 3 February 2018 Journal of Health Economics Volume 58, March 2018, Pages 29–42 https://doi.org/10.1016/j.jhealeco.2017.12.007 [wysija_form id="3"] 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." width="130" height="150" /> Dr. Powell[/caption]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.
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.
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.
Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, Outcomes & Safety / 04.01.2018

MedicalResearch.com Interview with: [caption id="attachment_39170" align="alignleft" width="161"]Dr. Igna Bonfrer PhD Post-Doctoral Research Fellow Harvard T.H. Chan School of Public Health  Dr. Bonfrer[/caption] 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.
Author Interviews, Cost of Health Care, OBGYNE / 29.12.2017

MedicalResearch.com Interview with: [caption id="attachment_39102" align="alignleft" width="200"]Dr. Laura Wherry credit: UCLA Health Dr. Laura Wherry
credit: UCLA Health[/caption] 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.
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.