Medicaid Expansion Improved Access to Cardiac Care Without Diminishing Outcomes

MedicalResearch.com Interview with:

Donald Likosky, Ph.D., M.S. Associate Professor Head of the Section of Health Services Research and Quality Department of Cardiac Surgery. University of Michigan

Dr. Likosky

Donald Likosky, Ph.D., M.S.
Associate Professor
Head of the Section of Health Services Research and Quality
Department of Cardiac Surgery.
University of Michigan

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

Response: Michigan was one of several states to expand Medicaid. Current evaluations of the Michigan Medicaid expansion program have noted increases in primary care services and health risk assessments, but less work has evaluated its role within a specialty service line. There has been concern among some that Medicaid patients, who have traditionally lacked access to preventive services, may be at high risk for poor clinical outcomes if provided increased access to cardiovascular interventions.

Using data from two physician-led quality collaboratives, we evaluated the volume and outcomes of percutaneous coronary interventions and coronary artery bypass grafting 24mos before and 24mos after expansion. We noted large-scale increased access to both percutaneous coronary interventions (44.5% increase) and coronary artery bypass grafting (103.8% increase) among patients with Medicaid insurance. There was a decrease in access for patients with private insurance in both cohorts. Nonetheless, outcomes (clinical and resource utilization) were not adversely impacted by expansion.  Continue reading

Readmissions After Stent Surgery Common and Often Due to Co-Morbid Disease

MedicalResearch.com Interview with:

“Open Stent” by Lenore Edman is licensed under CC BY 2.0

Example of Open Cardiac Stent

Chun Shing Kwok, MBBS, MSc, BSc, MRCP(UK)
Clinical Lecturer in Cardiology and Specialist Registrar in Cardiology
Keele University & Royal Stoke University Hospital Guy Hilton Research 

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

Response: Percutaneous coronary intervention (PCI) is a common revascularization modality in the treatment for coronary heart disease and the mortality rate after this procedure is low. Improved survival after PCI procedures has led to a growing population at risk of readmissions.  Early unplanned readmissions are important because they are a burden to patients, the local health care economy and it also serves as a quality of care indicator.

MedicalResearch.com: What are the main findings?

Response: Our analysis of 833,344 PCI procedures in the United States demonstrates that unplanned readmissions within 30 days of the index PCI are common (9.3%). The mean total hospital cost was higher for patients who were readmitted compared with those not readmitted ($37,524 vs $23,211). The majority of readmissions within 30 days are noncardiac (56%), with female sex, chronic kidney disease, liver failure, atrial fibrillation, increasing comorbidity burden, and discharge location among the strongest predictors of unplanned 30-day readmission. Patients who experienced an unplanned readmission for noncardiac reasons tended to be younger, with more comorbidities, including alcohol misuse, cancer, and dementia, whereas patients who are readmitted for cardiac reasons are more likely to have in-hospital complications at their index PCI event. 

MedicalResearch.com: What should readers take away from your report?

Response: Our results suggest that 30-day readmissions in the United States is common and comorbid illnesses and places of discharge are important factors that influence readmissions. There are important financial consequences of such readmissions, and further strategies to reduce the prevalence should be explored. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: Future work should explore if optimization of the management of any comorbid condition during a patient’s index admission for PCI and outreach programs to patients discharged to short-term hospitals, other institutions, and care homes may reduce early readmissions. 

Disclosures: Financial support was provided by the North Staffs Heart Committee. This work was conducted as a part of Dr. Kwok’s PhD research, which was supported by Biosensors International. 

Citations: 

Kwok CS, Rao SV, Potts JE, et al. Burden of 30-day readmissions after percutaneous coronary intervention in 833,344 patients in the United States: predictors, causes, and cost insights from the Nationwide Readmission Database. J Am Coll Cardiol Intv. 2018;Epub ahead of print.

Kalra A, Shishehbor MH, Simon DI. Percutaneous coronary intervention readmissions: where are the solutions? J Am Coll Cardiol Intv. 2018;Epub ahead of print.

 

 

 

 

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.

 

Readmissions After LVAD For Heart Failure High, Mostly For Non-Cardiac Causes

MedicalResearch.com Interview with:
Dr. Sahil Agrawal, MBBS MD

Division of Cardiology, St. Luke’s University Health Network, Bethlehem, PA
Dr Lohit Garg MD
Division of Cardiology
Lehigh Valley Health Network, Allentown 

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

Response: Readmissions among advanced heart failure patients are common and contribute significantly to heath care related costs. Rates and causes of readmissions, and their associated costs among patients after durable left ventricular assist device (LVAD) implantation have not been studied in a contemporary multi-institutional setting. We studied the incidence, predictors, causes, and costs of 30-day readmissions after LVAD implantation using Nationwide Readmissions Database (NRD) in our recently published study.

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Physicians Passage of MOC Exam Linked to Fewer State Disciplinary Actions

MedicalResearch.com Interview with:

Dr. Furman S. McDonald MD MPH Lead author of the research and  Senior Vice President for Academic and Medical Affairs American Board of Internal Medicine (ABIM)

Dr. McDonald

Dr. Furman S. McDonald MD MPH
Lead author of the research and
Senior Vice President for Academic and Medical Affairs
American Board of Internal Medicine (ABIM)

MedicalResearch.com: What is the background for this study? Would you briefly explain how the MOC examination works?

Response: To earn Board Certification from the American Board of Internal Medicine (ABIM), doctors take an exam after completing a medical education training program accredited by the Accreditation Council for Graduate Medical Education to demonstrate they have the knowledge to practice in a specialty. Previously, ABIM conducted research that showed that physicians who passed a certification exam were five times less likely to be disciplined by a state licensing board than those who do not become certified.

After becoming board certified, physicians can participate in ABIM’s Maintenance of Certification (MOC) program, which involves periodic assessments and learning activities to support doctors in staying current with medical knowledge through their careers. ABIM has been in conversations across the medical community and many people have expressed interest in whether performance on the MOC exams doctors take is also associated with important outcomes relevant to patients.

For this study, my ABIM colleagues and I studied whether there was any association between Internal Medicine MOC exam performance and disciplinary actions by state licensing boards. We studied MOC exam results and any reported disciplinary actions for nearly 48,000 general internists who initially certified between 1990 and 2003.  Continue reading

Frail Patients More Likely To Be Readmitted After Surgery

MedicalResearch.com Interview with:
Rachel Khadaroo, MD, PhD, FRCSC
Associate Professor of Surgery
Department of Surgery & Division of Critical Care Medicine
University of Alberta

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

Response: The elderly are the fastest growing population in North America. There are very few studies that have examined the impact of frailty and age on outcomes following abdominal surgery. Readmissions are expensive have been considered an important quality indicator for surgical care. This study examined 308 patients 65 years and older who were admitted for emergency abdominal surgery in two hospitals in Alberta and followed them for 6 months for readmission or death. Patients were classified into 3 categories: Well, pre-frail (no apparent disability), and frail. Continue reading

Clinical Pharmacist Intervention Can Reduce ED Visits and Hospital Readmissions

MedicalResearch.com Interview with:
Lene Vestergaard Ravn-Nielsen, MSc(Pharm) Hospital Pharmacy of Funen Clinical Pharmacy Department Odense University Hospital Odense, Denmark
Lene Vestergaard RavnNielsenMSc(Pharm)
Hospital Pharmacy of Funen
Clinical Pharmacy Department
Odense University Hospital
Odense, Denmark

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

Response: Hospital readmissions are common among patients receiving multiple medication, with considerable costs to the patients and society.

MedicalResearch.com: What are the main findings? 

Response: A multifaceted clinical pharmacist intervention can reduce ED visits and hospital readmissions.  Continue reading

Medicaid Expansion Led To Better, More Timely Surgical Care

MedicalResearch.com Interview with:

Andrew Phillip Loehrer MD MPH Fellow in Surgical Oncology Department The University of Texas MD Anderson Cancer Center

Dr. Loehrer

Andrew Phillip Loehrer MD MPH
Fellow in Surgical Oncology Department
The University of Texas MD Anderson Cancer Center

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

Response: A growing number of studies have examined the effects of the Affordable Care Act’s Medicaid expansion.  But none to date have looked at effects on surgical conditions, which are both expensive and potentially life-threatening.  We examined data for nearly 300,000 patients who presented to hospitals with common and serious surgical conditions such as appendicitis and aortic aneurysms.

We found that expansion of Medicaid coverage was linked to increased insurance coverage for these patients, but even more importantly, Medicaid expansion led patients to come to the hospital earlier before complications set in, and they also received better surgical care once they got there.

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Survival From In-Hospital Cardiac Arrest Improves But Still Worse on Nights and Weekends

MedicalResearch.com Interview with:

Uchenna Ofoma, MD, MS Associate, Critical Care Medicine Assistant Professor of Medicine, Temple University Director of Critical Care Fellowship Research Geisinger Medical Center

Dr. Ofoma

Uchenna Ofoma, MD, MS
Associate, Critical Care Medicine
Assistant Professor of Medicine, Temple University
Director of Critical Care Fellowship Research
Geisinger Medical Center

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

Response: Patients who suffer in-hospital cardiac arrest at nights and during weekends (off-hours) are known to have lower rates of survival to hospital discharge, compared to their counterparts who have cardiac arrest during the daytime on weekdays (on-hours). Since overall survival to hospital discharge has improved over the past decade for the approximately 200,000 patients who experience in-hospital cardiac arrest annually, our study sought to determine whether survival differences between off-hours and on-hours arrest has changed over time.

On-hours was categorized as 7:00 a.m. to 10:59 p.m. Monday to Friday. Off-hours was categorized as 11:00 p.m. to 6:59 a.m. Monday to Friday or anytime on weekends. Among 151,071 adult patients in the GWTG-Resuscitation registry who experienced in-hospital cardiac arrest between January 2000 and December 2014, slightly over half (52%) suffered a cardiac arrest during off-hours. We found that survival to hospital discharge improved significantly in both groups over the study period — for on-hours: from 16.0% in 2000 to 25.2% in 2014; for off-hours: 11.9% in 2000 to 21.9% in 2014.

However, despite overall improvement in both groups, survival from in-hospital cardiac arrest at nights during off-hours remained significantly lower compared to on-hours by an absolute 3.8%.

MedicalResearch.com: What should readers take away from your report? 

Response: Survival to hospital discharge has improved in both groups of patients. This is reassuring and suggests that health care providers and hospital systems must be doing something right. However, the persistent survival disparities between on-hours and off-hours arrests remains concerning. To ensure that improved survival trends are sustained over time, narrowing this gap must be made an area of focus for quality improvement efforts. Data regarding mediator variables, such as physician and nurse staffing patterns and how they changed over the course of the study was not available for this study. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work? 

Response: Since timing of in-hospital cardiac arrest appears to impact survival outcomes, future research should aim at identifying factors that may be associated with these described survival discrepancies and care processes that mitigate against them.

Disclosures: The authors received research support from the Geisinger Health System Foundation and the National Institutes of Health. 

Citations:

Journal of the American College of Cardiology
Volume 71, Issue 4, January 2018
DOI: 10.1016/j.jacc.2017.11.043
Trends in Survival After In-Hospital Cardiac Arrest During Nights and Weekends
Uchenna R. Ofoma, Suresh Basnet, Andrea Berger, H. Lester Kirchner, Saket Girotra, for the American Heart Association Get With the Guidelines – Resuscitation Investigators, Benjamin Abella, Monique L. Anderson, Steven M. Bradley, Paul S. Chan, Dana P. Edelson, Matthew M. Churpek, Romergryko Geocadin, Zachary D. Goldberger, Patricia K. Howard, Michael C. Kurz, Vincent N. Mosesso Jr., Boulos Nassar, Joseph P. Ornato, Mary Ann Peberdy and Sarah M. Perman

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.

 

ACA Pay-For-Performance Programs Not Living Up To Expectations

MedicalResearch.com Interview with:

Dr. Igna Bonfrer PhD Post-Doctoral Research Fellow Harvard T.H. Chan School of Public Health 

Dr. Bonfrer

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.

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Penalties for Readmissions Widens Financial Losses At Delta Safety Net Hospitals

MedicalResearch.com Interview with:

Hsueh-Fen Chen, Ph.D. Associate Professor Department of Health Policy and Management College of Public Health University of Arkansas for Medical Sciences Little Rock, AR 72205

Dr. Chen

Hsueh-Fen Chen, Ph.D.
Associate Professor
Department of Health Policy and Management
College of Public Health
University of Arkansas for Medical Sciences
Little Rock, AR 72205

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

Response: The Centers for Medicare and Medicaid Services announced the Hospital Readmissions Reduction Program (HRRP) and Hospital Value-based Purchasing (HVBP) Program in 2011 and implemented the two programs in 2013. These two programs financially motivate hospitals to reduce readmission rates and improve quality of care, efficiency, and patient experience. The Mississippi Delta Region is one of the most impoverished areas in the country, with a high proportion of minorities occupying in the region.  Additionally, these hospitals are  safety-net resources for the poor. It was largely unknown what the financial performance for the hospitals in the Mississippi Delta Region was under the HRRP and HVBP programs.

Dr. Chen and colleagues in the Fay W. Boozman College of Public Health at the University of Arkansas for Medical Sciences compared the financial performance between Delta hospitals and non-Delta hospitals (namely, other hospitals in the nation) from 2008 through 2014 that were covered before and after the implementation of the HRRP and HVBP programs. The financial performance was measured by using the operating margin (profitability from patient care) and total margin (profitability from patient care and non-patient care)

Before the implementation of the HRRP and HVBP programs, Delta hospitals had weaker financial performance than non-Delta hospitals but their differences were not statistically significant. After the implementation of the HRRP and HVBP programs, the gap in financial performance between Delta and non-Delta hospitals became wider and significant. The unadjusted operating margin for Delta hospitals was about -4.0% in 2011 and continuously fell to -10.4% in 2014, while the unadjusted operating margin for non-Delta hospitals was about 0.1% in 2011 and dropped to -1.5% in 2014. The unadjusted total margin for Delta hospitals significantly fell from 3.6% in 2012 to 1.1% in 2013 and reached 0.2% in 2014, while the unadjusted total margin for non-Delta hospitals remained about 5.3% from 2012 through 2014. After adjusting hospital and community characteristics, the difference in financial performance between Delta and non-Delta remained significant.

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