Health Care Systems
23 Oct Physicians Frustrated By Administrative Burdens of Medical Practice
MedicalResearch.com Interview with:
Dr. Steffie Woolhandler MD MPH
Professor of Public Health and City University of
New York, Lecturer (formerly Professor of
Medicine) at Harvard Medical School
Primary Care Physician Practicing in the South Bronx
Medical Research: What is the background for this study?
Dr. Woolhandler: Physicians like myself are extremely frustrated
by the administrative burdens of medical
practice. Many hours of physicians’ time each
week go to administrative work completely
unrelated to good patient care, but mandated by
private insurers and other payers. Colleagues
often tell me that they love seeing patients but
are getting burned out by the paperwork.
05 Aug Bundled Payment Orthopedic Pilot Program A Bust In California
MedicalResearch.com: Interview with:
M. Susan Ridgely, JD
Senior Policy Analyst
RAND Corporation
Santa Monica, California
Medical Research: What are the main findings of the study?
Answer: We evaluated a three-year effort, coordinated by the Integrated Healthcare Association, to determine whether bundled payment could be an effective payment model for California. The pilot focused on bundled payment for orthopedic procedures for commercially insured adults under age 65. Bundled payment is a much-touted strategy that pays doctors and hospitals one fee for performing a procedure or caring for an illness. The strategy is seen as one of the most-promising ways to curb health care spending. Unfortunately, the project failed to meet its goals, succumbing to recruitment challenges, regulatory uncertainty, administrative burden and concerns about financial risk.
At the outset of the project, participants included six of the state’s largest health plans, eight hospitals and an independent practice association. Eventually, two insurers dropped out because they believed the bundled payment model in this project would not lead to a redesign of care or lower costs. Another decided that bundled payment was incompatible with its primary type of business (health maintenance organization). Just two hospitals eventually signed contracts with the three remaining health plans to use bundled payments. Hospitals that dropped out cited concerns about the time and effort involved.
The project was hurt by a lack of consensus about what types of cases to include and which services belonged in the bundle. In the end, most stakeholders agreed that the bundle definitions were probably too narrow to capture enough procedures to make bundled payment viable.
09 Jul Diabetes, Age and Obesity Drive Demand for Endocrinologists
MedicalResearch.com Interview with:
Robert A. Vigersky, MD
Walter Reed National Military Medical Center
Bethesda, MD
Medical Research: What type of patients do endocrinologists typically treat and why is the demand for their services anticipated to grow?
Dr. Vigersky: Endocrinologists are physicians trained in managing, diagnosing, and treating disorders of the endocrine system: thyroid, parathyroid, adrenal glands, hypophyseal and hypothalamic axes, ovaries, testes, and pancreas. Their role involves controlling diabetes mellitus, menopause, hyperthyroidism and other conditions involving metabolism.
A major factor affecting the anticipated demand for health care services is the aging population. In 2010, there were 37.5 million people age 65 or over, constituting about 12.7 percent of the total population, and by 2025 the population age 65 or over will number 62.5 million (17.9 percent of the population). Due to the greater prevalence of many of the diseases in older age groups, like osteoporosis, diabetes, obesity, and thyroid nodules, the growth in the population age 65 or over will exert a major influence on the demand for endocrine services.
Diabetes, by itself, is a major driver of demand. The incidence of Type 2 diabetes rises dramatically with age, and with obesity. In an increasingly overweight population an estimated 22.3 million people in the U.S. are diagnosed with diabetes as of 2012, representing about 7 percent of the population. This estimate is higher than but consistent with those published by the CDC for 2010. The percentage of the population with diagnosed diabetes continues to rise, with one study projecting that as many as one in three U.S. adults could have diabetes by 2050 if current trends continue.
13 May Neighborhood Socioeconomic Status Impact On Medicare Rating for Heart Failure
Posted at 21:48h
in AHA Journals, Author Interviews, Health Care Systems, Hospital Readmissions, Medicare
MedicalResearch.com Interview with:
Alex Blum, MD MPH FAAP
Chief Medical Officer
Evergreen Health, Baltimore MD 21211
MedicalResearch.com: What are the main findings of the study?
Dr. Blum: Accounting for the social risk of patients using a measure of neighborhood socioeconomic status (SES), did not alter the hospital rankings for congestive heart failure (CHF) readmission rates.
07 May Mortality Dropped After Massachusetts Health Care Reform
Posted at 10:28h
in Annals Internal Medicine, Author Interviews, Cost of Health Care, Health Care Systems
MedicalResearch.com Interview with:
Benjamin D. Sommers, MD, PhD
Assistant Professor of Health Policy & Economics
Harvard School of Public Health / Brigham & Women's Hospital
Boston, MA 02115
MedicalResearch.com: What are the main findings of the study?
Dr. Sommers: We find that over the first four years since Massachusetts' 2006 comprehensive health reform law, all-cause mortality in the state fell by 2.9%, compared to a similar population of adults living in counties outside Massachusetts that did not expand insurance during this period. We also found that the law reduced the number of adults in Massachusetts without insurance, reduced cost-related barriers to care, increased use of outpatient visits, and led to improvement in self-reported health. Overall, we estimate that the health reform law prevented over 320 deaths per year in the state - or one life saved per 830 adults gaining health insurance. Mortality rates declined primarily due to fewer deaths from causes amenable to health care, such as cancer, infections, and heart disease. We also found that the health benefits were largest for people living in poor counties in the state, areas with higher percentage of uninsured adults before the law was passed, and for minorities.
01 Apr Hospital Readmissions Increased In Massachusetts After Health Care Reform
MedicalResearch.com Interview with:
Karen E Lasser, MD MPH
Associate Professor of Medicine
Boston University School of Medicine, Boston, MA
MedicalResearch.com: What are the main findings of the study?
Dr. Lasser: After controlling for variables that could affect the risk of readmission, we found that:
- There was a slightly increased risk of all-cause readmission in Massachusetts (MA) relative to control states (New York and New Jersey) post-reform.
- Racial and ethnic disparities in all-cause readmission rates did not change in MA relative to control states.
- However, both blacks and whites in counties with the highest uninsurance rates had a decreased risk of readmission following MA health reform relative to blacks and whites in counties with lower uninsurance rates.
12 Mar Massachusetts Health Care Reform and the Working Poor
MedicalResearch.com Interview with: Liane J. Tinsley, MPH Associate Research Scientist Department of Epidemiology New England Research Institutes, Inc. Watertown, MA 02472 MedicalResearch.com: What are the main findings of the study? Answer: For this study, we analyzed health insurance data from a cohort of community-dwelling individuals between the ages of 30-79 at baseline, in Boston, MA. Massachusetts health care reform legislation, including the expansion of Medicaid, resulted in substantial overall gains in coverage in our study population. Despite being targeted by the law, the working poor (those currently working for pay, either part- or full-time and earning less than 200% of the US federal poverty threshold for household size) continued to report lower rates of insurance coverage following reform (13.3% without insurance), compared to the both non-working poor (4.7% without insurance) and the not poor (5.0% without insurance).04 Mar Hospital Mortality: Association With Nurses’ Work Load and Education
Posted at 00:25h
in Author Interviews, Health Care Systems, Lancet, Nursing, University of Pennsylvania
MedicalResearch.com Interview with:
Professor Linda H Aiken PhD, FAAN, FRCN, RN
Claire M. Fagin Leadership Professor in Nursing, Professor of Sociology
Director of the Center for Health Outcomes and Policy Research
Center for Health Outcomes and Policy Research
University of Pennsylvania School of Nursing
MedicalResearch.com: Austerity measures and health-system redesign to minimise hospital expenditures risk adversely affecting patient outcomes. Against that backdrop, can you start by letting us know the background of the study?
Prof. Aiken: European Surgical Outcomes Study in 28 countries showed higher than necessary deaths after surgery.
A comparable study in the US showed that despite the nation spending hundreds of millions of dollars on improving patient safety, there were no improvements in adverse outcomes after surgery in US hospitals between 2000 and 2009. Clearly it is time to consider new solutions to improving hospital care for surgical patients, who make up a large proportion of all hospital admissions. Our study was designed to determine whether there are risks for patients of reducing hospital nurse staffing, and what, if any, are the benefits to patients of moving to a more educated nurse workforce.
18 Feb Expanded Health Insurance: Hospital Services Use by Young Adults with Behavioral Diagnoses
Posted at 21:53h
in Cost of Health Care, Dartmouth, Health Care Systems, Mental Health Research, Yale
MedicalResearch.com Interview with:
Ellen R. Meara
Associate Professor of The Dartmouth Institute
Adjunct Associate Professor in Economics & Nelson A. Rockefeller Center for Public Policy, Dartmouth College
MedicalResearch.com: What are the main findings of this study?
Answer: When insurance coverage for young adults rose by over 15 percentage points following Massachusetts' 2006 health reform, use of inpatient care for mental illness and substance use disorders fell and emergency department visits for these conditions grew more slowly for 19 to 25 year olds in Massachusetts relative to other states. Also, their care was much more likely to be paid for by private or public insurance insurers.
26 Jan Underserved Patients: Minority Physicians’ Role
MedicalResearch.com Interview with:
Dr. Lyndonna Marrast MD
Fellow in General Internal Medicine
Cambridge Health Alliance
Cambridge, MA 02139
MedicalResearch.com: What are the main findings of the study?
Dr. Marrast: We found that disadvantaged patients (categorized as racial and ethnic minorities, non-English home language speakers, being low income, having Medicaid, or reporting fair or poor health) were more likely than other patients to be cared for by a minority physician.
A majority, 54%, of black, Hispanic and Asian patients received care from a minority doctor and the vast majority, 70%, of those who report not speaking English at home got care from a minority physician.
22 Jan Transfers of Hospitalized Patients and Insurance Status
Posted at 01:00h
in Annals Internal Medicine, Author Interviews, Cost of Health Care, Health Care Systems, University of Pittsburgh
MedicalResearch.com Interview with:
Janel Hanmer, MD, PhD
University of Pittsburgh Medical Center
Montefiore Hospital
Pittsburgh, PA 15213
MedicalResearch.com: What are the main findings of the study?
Dr. Hanmer: We used the National Inpatient Sample - a sample of about 20% of US community hospitals with all discharges from those hospitals - to examine if insurance status is associated with transfer from one hospital to another. We were looking at patients who were already admitted to the hospital, not the patients who presented to the Emergency Department. We selected the five most common general medicine admissions for adults aged 18 to 64. We found that uninsured patients were less likely to be transferred than privately insured patients in four of the five conditions (about 20-40% less likely). We also found that women were less likely than men to be transferred in five of the conditions (about 35 to 40% less likely).
17 Jan Safety Net Hospitals: Death Rates After Major Complications
Posted at 02:32h
in Author Interviews, Brigham & Women's - Harvard, Health Care Systems, JAMA, Medical Research Centers, Outcomes & Safety
MedicalResearch.com Interview with
Elliot Wakeam MD
Center for Surgery and Public Health
Brigham and Women's Hospital
Boston MA 02115
MedicalResearch.com: What are the main findings of the study?
Dr. Wakeam: Our study examined failure to rescue (FTR), or death after postoperative complications, in safety net hospitals. Prior work has shown that hospital clinical resources can improve rescue rates, however, despite having higher levels of technology and other clinical resources that should lead to better rates of patient rescue, safety net hospitals still had greater rates of death after major complications.
16 Nov Mental Illness: Elderly Patients and Healthcare Utilization
MedicalResearch.com Interview with:
Hugh C. Hendrie, MB ChB, DSc
Professor, Department of Psychiatry, Indiana University School of Medicine
Center Scientist, Indiana University Center for Aging Research
Research Scientist, Regenstrief Institute, Inc.
MedicalResearch.com: What are the main findings of the study?
Answer: Our findings of higher rates of emergency care, longer hospitalizations and increased frequency of falls, substance abuse and alcoholism suggest that seriously mentally ill older adults remain a vulnerable population.
12 Sep Value of a Hospitalists-Led, Post-Discharge Clinic
MedicalResearch.com Interview with:
Lauren Doctoroff, MD
Hospitalist, Hospital Medicine Program
Beth Israel Deaconess Medical Center
Medical Director, HCA Post Discharge Clinic and PACT Transitional Care Program
Instructor, Harvard Medical School
Boston, MA 02215
MedicalResearch.com What are the main findings of the study?
Dr. Doctoroff: A dedicated post discharge clinic, staffed by hospitalists, led to a shorter interval to a clinic visit for patients after discharge. Patients with resident primary care doctors and those who are African American were most likely to use the clinic. The care provided in the clinic, in terms of testing, was consistent with the remainder of the practice.
29 Aug Kaiser’s Hypertension Program Dramatically Improves Blood Pressure Control in Large Population
Posted at 11:27h
in Author Interviews, Blood Pressure - Hypertension, Health Care Systems, JAMA, UCSF
MedicalResearch.com Interview with:
Dr. Marc Jaffe, MD
Clinical Leader, Kaiser Northern California Cardiovascular Risk Reduction Program
Clinical Leader, Kaiser National Integrated Cardiovascular Health (ICVH) Guideline Development Group
Associate Clinical Professor of Medicine, UCSF
Endocrinology and Internal Medicine
Kaiser South San Francisco Medical Center
1200 El Camino Real
South San Francisco, California 94080
MedicalResearch.com: What are the main findings of the study?
Dr. Jaffe: In 2001, we set out to improve blood pressure control in among Kaiser Permanente (KP) members in Northern California, and we ended up creating one of the largest, community-based hypertension programs in the nation. The paper published in JAMA explores how we combined a number of innovations, including a patient registry, single-pill combination therapy drugs and more, to nearly double blood pressure control rates.
If you had told us at the onset that blood pressure control among members would be more than 80 percent, and it was actually almost 90 percent in 2011, we wouldn’t have believed you. These results are truly incredible. During the study period, hypertension control increased by more than 35 percent from 43.6 percent to 80.4 percent in Kaiser Permanente Northern California between 2001 and 2009. In contrast, the national mean control rate increased from 55.4 percent to 64.1 percent during that period.