How Much Non-Invasive Testing Is Necessary In ER To Rule Out Heart Attack?

MedicalResearch.com Interview with:

David L. Brown, MD, FACC Professor of Medicine Cardiovascular Division Washington University School of Medicine St. Louis, MO 63110

Dr. Brown

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.

Continue reading

HIV PreExposure Prophylaxis -PrEP- For MSM Found To Be Effective and Cost Saving

MedicalResearch.com Interview with:

Dr Valentina Cambiano PhD Institute for Global Health University College London London UK

Dr. Cambiano

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.

Continue reading

Maryland All-Payer Model Produced Outpatient and ER Medicare Savings

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.

Continue reading

Low-Cost, High-Volume Services Add Billions To US Health Care Tab

MedicalResearch.com Interview with:

John N. Mafi 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

Dr. Mafi

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.

Continue reading

Financial Incentives to Physicians Did Not Increase Hospital Discharge Follow-Up Visits

MedicalResearch.com Interview with:

Dr. Lauren Lapointe-Shaw, MD Physician at University Health Network Department of Medicine University of Toronto 

Dr. Lapointe-Shaw

Dr. Lauren Lapointe-Shaw, MD
Physician at University Health Network
Department of Medicine
University of Toronto 

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

Response: Readmissions after hospital discharge are common and costly. We would like to reduce these as much as possible. Early physician follow-up post hospital discharge is one possible strategy to reduce readmissions. To this end, incentives to outpatient physicians for early follow-up have been introduced in the U.S. and Canada. We studied the effect of such an incentive, introduced to Ontario, Canada, in 2006.

Continue reading

Participation in SNAP Food Assistance Linked To Lower Health Care Costs

MedicalResearch.com Interview with:

Seth A. Berkowitz, MD, MPH Division of General Internal Medicine Diabetes Population Health Unit Harvard Medical School Massachusetts General Hospital, Boston

Dr. Berkowitz

Seth A. Berkowitz, MD, MPH
Division of General Internal Medicine
Diabetes Population Health Unit
Harvard Medical School
Massachusetts General Hospital, Boston

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

Response: There is ever growing pressure to contain healthcare costs in the US. Increasingly, attention is turning to programs that address social determinants of health–that is, those factors which affect health but lie outside the realm of clinical medicine.

Prior research has highlighted food insecurity as having a clear association with poor health and higher healthcare costs. SNAP is the nation’s largest program to combat food insecurity. However, we did not know whether SNAP participation would be associated with any difference in healthcare costs, compared with eligible non-participants.

This study found that participating in SNAP was associated with approximately $1400 lower healthcare expenditures per year in low-income adults.

Continue reading

Global Budget in Maryland Saved Medicare Money By Limiting Hospital Costs

MedicalResearch.com Interview with:
RTI
Susan G. Haber, Sc.D. 
Director, Health Coverage for Low-Income and Uninsured Populations
RTI International
Waltham, MA 02452-8413

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

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.

Continue reading

Morbidity and Financial Costs of Atrial Fibrillation High and Likely to Grow

MedicalResearch.com Interview with:

Sandra L. Jackson, PhD National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention Chamblee GA

Dr. Sandra  Jackson

Sandra L. Jackson, PhD
National Center for Chronic Disease Prevention and Health Promotion
Centers for Disease Control and Prevention
Chamblee GA

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

Response: People who have atrial fibrillation are at increased risk for having a heart attack or stroke. While we know that the percentage of the population with atrial fibrillation is increasing in the US, there is no national surveillance system to track the burden of emergency department visits, hospitalizations and deaths related to atrial fibrillation across all ages and health insurance provider types. This study combined data from the Healthcare Cost and Utilization Project and the National Vital Statistics System to provide national estimates for atrial fibrillation-related healthcare service use and deaths from 2006-2014.

Continue reading

Oropharyngeal Cancer Rising In Incidence and Costs to Over $140,000

MedicalResearch.com Interview with:

David R. Lairson, PhD Professor of Health Economics Division of Management Policy and Community Health Co-Director, Center for Health Services Research School of Public Health The University of Texas Health Science Center at Houston (UTHealth)

Dr. Lairson

David R. Lairson, PhD
Professor of health economics
Department of Management, Policy, and Community Health
The University of Texas Health Science Center at Houston (UTHealth) School of Public Health

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

Response: The study of oropharyngeal cancer treatment cost was initiated by the Head and Neck Cancer Surgery Department at the University of Texas MD Anderson Cancer Center as part of a larger study of the economic and health consequences of human papillomavirus (HPV) related conditions in Texas.  State specific information is required for policy-makers to consider future investments in cancer prevention based on HPV immunization and cancer screening.  The cost estimates at $140,000 per case for the first two years of treatment are substantially higher than previous estimates.  They indicate the potential savings associated with cancer prevention and partially justify increased investment in immunization efforts.

Continue reading

Even After Rebates, Use of PCSK9 Inhibitor Would Still Cost Over $5 Million To Prevent One Stroke

MedicalResearch.com Interview with:

Inmaculada Hernandez, PharmD, PhD Assistant Professor of Pharmacy and Therapeutics University of Pittsburgh School of Pharmacy Pittsburgh, PA 1526

Dr. Hernandez

Inmaculada Hernandez, PharmD, PhD
Assistant Professor of Pharmacy and Therapeutics
University of Pittsburgh School of Pharmacy
Pittsburgh, PA 1526

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

Response: A few months ago, the results of the FOURIER trial were published. This trial was the first one to evaluate the efficacy of PCSK9 inhibitors in the prevention of cardiovascular events, since the approval of these agents was based on trials that evaluated their efficacy in reducing levels of LDL-C. The results of the FOURIER trial did not meet the expectations generated by prior studies that had simulated how much the risk of cardiovascular events should decrease based on the observed reduction in LDL-C levels. A few hours after the publication of the results of the FOURIER trial, Amgen (evolocumab´s manufacturer) announced that it would be willing to engage in contracts where the cost of evolocumab would be refunded for those patients who suffer a heart attack or a stroke while using the drug.

Continue reading

Higher Cost Sharing For Mental Health Services Could Increase Downstream Costs

MedicalResearch.com Interview with:

Bastian Ravesteijn PhD Department of Health Care Policy Harvard Medical School

Dr. Ravesteijn

Bastian Ravesteijn PhD
Department of Health Care Policy
Harvard Medical School 

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

Response: We find that higher out-of-pocket costs for mental health care could have the unintended consequence of increasing the use of acute and involuntary mental health care among those suffering from the most debilitating disorders. Continue reading

EKGs of Low Risk Patients Remain Common and Associated With More Cardiac Testing

MedicalResearch.com Interview with:
Sacha Bhatia, MD, MBA, FRCPC
Scientist, Women’s College Research Institute
Director, Women’s College Hospital Institute for Health System Solutions and Virtual Care
Cardiologist, Women’s College Hospital and University Health Network
Canada

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

Response: The USPSTF recommends against screening with resting electrocardiography (ECG) for the prediction of coronary heart disease (CHD) events in asymptomatic adults at low risk for CHD events. We conducted a retrospective cohort study of the frequency of resting ECGs in low risk patients within 30 days of an annual health exam. We found that 21.5% of low risk patients in Ontario, Canada had a ECG, with significant variation among primary care physicians (1.8% to 76.1%). Moreover, low risk patients who had a ECG were five times more likely to receive another cardiac test or cardiology consultation than those that did not receive an ECG. At one year the rate of mortality, cardiac hospitalizations and revascularization was <0.5% in each group.

Continue reading

Optimization of Medication Use Critical to Success of ACOs

MedicalResearch.com Interview with:
Kimberly Westrich, MA
Vice President, Health Services Research, National Pharmaceutical Council, and
Kristina Lunner
Principal, Leavitt Partners

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

Response: With the advent of accountable care organizations (ACOs) following passage of the Affordable Care Act in 2010, it became important to understand how success in an ACO world is different from success in a capitated environment, where the focus is only on managing costs. In an ACO, providers are responsible for the quality of care they provide for a defined population in addition to having at least some financial responsibility. We wanted to explore how an ACO can succeed in this environment of dual responsibility for costs and quality, and more specifically, how pharmaceuticals fit into this success.

To address these questions, the National Pharmaceutical Council worked with the American Medical Group Association (AMGA), Premier, Inc., and a group of seven leading ACOs to develop a conceptual framework for considering the role of pharmaceuticals in ACOs. This framework shows how optimizing medication use in a value-based healthcare environment, such as an ACO, can help the organization achieve its cost and quality benchmarks.

We evaluated ACO readiness to optimize medication use in 2014 and again with our most recent study, published in June 2017 online ahead of print in the Journal of Managed Care & Specialty Pharmacy. For our 2017 study, we worked with Leavitt Partners to survey and interview ACOs to understand how they optimize medication use, determine if there is an association between efforts to optimize medication use and achievement on financial and quality metrics, ascertain organizational factors that correlate with optimized medication use, and identify barriers to optimized medication use.
Continue reading

Head-to-Head Study Compares All Costs Associated With New Anticoagulants in Non-Valvular AFib

MedicalResearch.com Interview with:

Sabine Luik, M.D.</strong> Senior vice president, Medicine & Regulatory Affairs Boehringer Ingelheim Pharmaceuticals, Inc.

Sabine Luik

Sabine Luik, M.D.
Senior vice president, Medicine & Regulatory Affairs
Boehringer Ingelheim Pharmaceuticals, Inc.

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

Response: This study is the first real-world, matched head-to-head study comparing all cause healthcare costs and healthcare resource utilization (HCRU) among novel oral anticoagulants (NOACs).

The study analyzed claims data from 70,898 newly-diagnosed NVAF patients who were newly treated with Pradaxa, rivaroxaban or apixaban.

The analysis found that Pradaxa was associated with lower all-cause costs and HCRU compared to rivaroxaban. Compared to apixaban, Pradaxa was associated with similar all-cause costs and hospitalizations, but higher all-cause outpatient and pharmacy HCRU.

Continue reading

Costs of Bike Accidents Skyrocket

MedicalResearch.com Interview with:

Tom Gaither, MD, MAS Department of Urology San Francisco, CA 94143

Dr. Gaither

Tom Gaither, MD, MAS
Department of Urology
San Francisco, CA 94143

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

Response: Admission to the hospital because of bicycle crashes has increased over the past 15 years. We aimed to estimate the costs due to these bicycle crashes.

From 1999 to 2013, the total costs due to these injuries (direct medical costs, work loss costs, and pain and suffering) were $209 billion dollars. Costs due to non-fatal injuries have increased by 137% over the study period. In 2013, the total direct and indirect costs were $24 billion dollars, which is approximately doubling the costs due to occupational injuries in the US.

Continue reading

Heart Disease, Trauma and Diabetes Incur Highest Cost Per Person Medical Expenses

MedicalResearch.com Interview with:

Anita Soni, PhD, MBA Survey Analyst/Statistician Agency for Healthcare Research and Quality

Dr. Anita Soni

Anita Soni, PhD, MBA
Survey Analyst/Statistician
Agency for Healthcare Research and Quality

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

Response: This statistical brief uses the data from the Medical Expenditure Panel Survey (MEPS), which collects a broad range of data related to the health care of the U.S. civilian noninstitutionalized population including health insurance coverage, the number and types of health care events and the sources of payment and payment amounts for those events. The survey also gathers information on which medical conditions are associated with the reported health care events. Condition-specific health care expenditure information derived from MEPS data is useful for policy makers in determining where to focus health policies to improve the quality and efficiency of the health care system from the perspective of disease treatment and management.

This Statistical Brief presents data regarding medical expenditures for nine conditions for which an estimated 10 percent or more of the U.S. civilian noninstitutionalized population (individuals age 18 and older) received health care in 2013.

Continue reading

Fixed-Dose Blood Pressure Medications Save Money In The Long Run

MedicalResearch.com Interview with:

Kalyani B. Sonawane, PhD Assistant Professor/ PhD Program Director Department of Health Services Research, Management and Policy College of Public Health and Health Professions University of Florida Gainesville, FL 32610

Dr. Sonawane

Kalyani B. Sonawane, PhD
Assistant Professor/ PhD Program Director
Department of Health Services Research, Management and Policy
College of Public Health and Health Professions
University of Florida
Gainesville, FL 32610

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

Response: Almost one-third of Americans have high blood pressure. Of those patients who are prescribed medication to control their blood pressure, about 30 percent have problems with side effects and nearly 50 percent will not have their blood pressure controlled within the first year of taking medication. In such scenarios, physicians have the option to either add a medication, such as fixed-dose combination, to the patient’s regimen or gradually increase a patient’s dose of their current drug to achieve blood pressure control; and gradually decrease the dose of their current drug or switch to a different drug to resolve side effects. Using healthcare claims data, we compared the economic impact of these alternative treatment modification strategies.

Continue reading

Worsening Kidney Function Associated With Significantly Higher Medical Costs

MedicalResearch.com Interview with:

Shaum Kabadi</strong> HEOR Director at AstraZeneca

Shaum Kabadi

Shaum Kabadi
HEOR Director at AstraZeneca

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

Response: More than 20 million adults – roughly 1 in 10 adults – in the US are estimated to have chronic kidney disease (CKD), and this population is expected to grow as the US population ages. Patients with CKD are at high risk for progression to end-stage renal disease (ESRD), a condition requiring dialysis or kidney transplantation to maintain patients’ long-term survival. The cost of treating ESRD patients was over $40 billion in public and private funds in 2009. Prior research shows per-person annual Medicare expenses attributable to CKD were $1,700 for Stage 2, $3,500 for Stage 3, and $12,700 for Stage 4. Additional research is required to understand the economic burden of CKD by stage in a contemporary cohort of commercially insured patients with non-dialysis-dependent (NDD)-CKD.

This retrospective cohort study utilized data from the HealthCore Integrated Research Environment, which contained medical and pharmacy administrative claims integrated with laboratory result values from 14 regionally dispersed Anthem health plans in the US.

Of 16,030 patients identified with CKD, the mean (SD) estimated glomerular filtration rate (eGFR) (all in mL/min/1.73 m2) in 2014 was 44.3 (±18.7), and the breakdown by eGFR levels was: Stage 1 (≥90) 3%, Stage 2 (60–89) 13%, Stage 3a (45–59) 27%, Stage 3b (30–44) 35%, Stage 4 (15–29) 19%, and Stage 5 (<15) 3%. Mean age across all stages was 67.4 years, and 47% were women. Hospitalization rate (%) and number of outpatient encounters (visits per patient per year) by stage were: Stage 1 (11.6%, 19.8), Stage 2 (14.9%, 22.5), Stage 3a (16.2%, 23.6), Stage 3b (23.7%, 29.5), Stage 4 (30.7%, 36.3), and Stage 5 (30.8%, 61.7) (p-trend).

Continue reading

Younger Breast Cancer Patients Have More Later-Stage Disease and Higher Financial Costs

MedicalResearch.com Interview with:

Benjamin Allaire MS RTI International Research Triangle Park Durham, NC, 27709

Benjamin Allaire

Benjamin Allaire MS
RTI International
Research Triangle Park
Durham, NC, 27709

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

Response: More than 22,000 women younger than 45 years of age were diagnosed with breast cancer in 2013. Although less than 10 percent of all breast cancers are diagnosed among women younger than age 45, the types of breast cancer these younger women face are typically more aggressive, are diagnosed at more advanced stages, and result in poorer survival compared to breast cancer in older women. Younger women may also require more intense treatment, exhibit cancers that are less responsive to treatment, and have distinct and more prevalent side effects from treatment than older women. These side effects can include poorer quality of life, fertility problems, and depression.

As a result, breast cancer treatment for younger women is expensive, making them vulnerable to financial hardship. Recent research has shown that 31.8 percent of cancer survivors are likely to have cancer treatment-induced financial troubles, with higher rates among younger cancer patients. These financial difficulties cause some survivors to forego or delay necessary medical treatments.

Continue reading

Family and Individuals Directly Pay Less Than 14% of US Health Care Expenditures

MedicalResearch.com Interview with:
Marie Stagnitti, M.P.A.

Agency for Healthcare Research and Quality
Medical Expenditure Panel Survey Household Component Project Officer/Senior Survey Statistician

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

Response: The Medical Expenditure Panel Survey (MEPS) – Household Component (HC) which began in 1996 and is administered annually collects data from a sample of families and individuals in selected communities across the United States, and is drawn from a nationally representative subsample of households that participated in the prior year’s National Health Interview Survey (conducted by the National Center for Health Statistics).

During the household interviews, MEPS collects detailed information for each person in the household on the following: demographic characteristics, health conditions, health status, use of medical services, charges and source of payments, access to care, satisfaction with care, health insurance coverage, income, and employment.

The panel design of the survey, which features several rounds of interviews covering two full calendar years, makes it possible to determine how changes in respondents’ health status, income, employment, eligibility for public and private insurance coverage, use of services, and payment for care are related. Continue reading

Medicare Has Cut Radiology Payments To Physicians by 33% Over Ten Years

MedicalResearch.com Interview with:
David C. Levin, MD

Department of Radiology
Thomas Jefferson University Hospital
Philadelphia, PA 19107.

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

Response: Radiology had been previously identified as the most rapidly growing of all physician services in the Medicare program during the early years of the 2000-2009 decade. But there have been deep cuts in imaging reimbursement since then. We wanted to determine how these cuts have affected total Medicare payments for imaging.

Our main findings were that since 2006, payments to physicians for imaging under the Medicare Physician Fee schedule have dropped by $4 billion per year, or about 33%.

Continue reading

Hospital Based Primary Care Practices Provide More Low Value Services

MedicalResearch.com Interview with:

John N. Mafi, MD, MPH Assistant Professor of Medicine Division of General Internal Medicine and Health Services Research UCLA David Geffen School of Medicine Los Angeles, CA 90024 Affiliated Natural Scientist in Health Policy RAND Corporation 1776 Main St, Santa Monica, CA 90401

Dr. John Mafi

John N. Mafi, MD, MPH
Assistant Professor of Medicine
Division of General Internal Medicine and Health Services Research
UCLA David Geffen School of Medicine
Los Angeles, CA 90024
Affiliated Natural Scientist in Health Policy
RAND Corporation
1776 Main St, Santa Monica, CA 90401

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

Response: Between 10-30% of healthcare costs are due to low value care, or patient care that provides little to no benefit to patients, and can sometimes cause harm (e.g., radiation exposure from diagnostic imaging tests). In this study, we found that hospital-based primary care practice provide more low value care than community-based primary care practices across the United States. Understanding where and why low value care occurs is going to be essential if we want to get serious about eliminating it.

Continue reading

Women With Health Insurance for IVF More Likely To Have Successful Live Birth

MedicalResearch.com Interview with:

Emily S. Jungheim, MD, MSCI Assistant Professor, Obstetrics and Gynecology Division of Reproductive Endocrinology and Infertility Washington University St. Louis, Missouri

Dr. Jungheim

Emily S. Jungheim, MD, MSCI
Assistant Professor, Obstetrics and Gynecology
Division of Reproductive Endocrinology and Infertility
Washington University
St. Louis, Missouri

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

Response: Many women with health insurance lack coverage for fertility treatment so they end up being self-pay for fertility treatments which can be expensive and limit access to care.

15 states have responded with mandates for employers to include fertility coverage in their employee insurance benefits, and 5 of these have comprehensive mandates that include IVF. Illinois is one of these states. Washington University is located on the border between Illinois and Missouri so our fertility center treats a number of women with coverage for fertility treatment and a large number of women who are self-pay for fertility treatment. We suspected that women requiring IVF to conceive were more likely to follow through with treatments if they had coverage so we decided to look at our data.

Ultimately we confirmed our suspicions. Women with coverage were more likely to come back for additional cycles of IVF if they didn’t conceive. Ultimately this ability to come back for additional treatment cycles led to a higher chance of live birth.

Continue reading

Poorly Controlled Atopic Dermatitis Causes Significant Inpatient Financial Burden

MedicalResearch.com Interview with:

Dr. Jonathan L. Silverberg MD PhD MPH Assistant Professor in Dermatology Medical Social Sciences and Preventive Medicine Northwestern University, Chicago, Illinois

Dr. Jonathan Silverberg

Dr. Jonathan L. Silverberg MD PhD MPH
Assistant Professor in Dermatology
Medical Social Sciences and Preventive Medicine
Northwestern University, Chicago, Illinois 

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

Response: Atopic dermatitis (AD) is associated with considerable morbidity and quality of life impairment. AD patients may require hospitalization for acute treatment of serious flares and/or inadequately controlled chronic disease.

We examined data from the 2002-2012 National Inpatient Sample, which contains a representative 20% sample of all hospitalizations in the United States. We found that there were substantial numbers of children and adults hospitalized in the United States for AD. Hospitalization rates for atopic dermatitis were highest in the northeast during the winter likely due to cold and dry weather and south during the summer likely due to heat and humidity. Further, hospitalization rates for AD significantly increased in adults between 2002 and 2012. The costs per individual hospitalization were lower in children and adults with AD compared to those without  atopic dermatitis. However, the high prevalence of hospitalization resulted in total inpatient costs of >$8 and >$3 million per-year for adults and children, respectively.

Continue reading

Gunshot Injuries Cost US Taxpayers Billions

MedicalResearch.com Interview with:
Sarabeth Spitzer

MD Candidate | MS2
Stanford University School of Medicine

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

Response: While firearm homicides make headlines, they cause many more injuries than deaths.[1] No one had performed any recent analysis on the costs of hospitalizations for firearm-related injuries. Stanford is a Level One trauma center, and we care for patients injured by firearms. We wanted to know how much it costs the health system to treat these patients.

Continue reading

Buprenorphine Prescriptions for Opioid Use Disorder Rise With Medicaid Expansion

MedicalResearch.com Interview with:

Hefei Wen, PhD Assistant Professor, Department of Health Management & Policy University of Kentucky College of Public Health

Dr.Hefei Wen

Hefei Wen, PhD
Assistant Professor, Department of Health Management & Policy
University of Kentucky College of Public Health

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

Response: Buprenorphine has been proven effective in treating opioid use disorder. However, the high cost of buprenorphine and the limited prescribing capacity may restrict access to this effective medication-assisted treatment (MAT) for opioid use disorder.

We found a 70% increase in Medicaid-covered buprenorphine prescriptions and a 50% increase in buprenorphine spending associated with the implementation of Medicaid expansions in 26 states during 2014. Physician prescribing capacity was also associated with increased buprenorphine prescriptions and spending.

Continue reading

Number Of Epipen Prescriptions for Kids Skyrockets

MedicalResearch.com Interview with:
Lavanya Diwakar, FRCPath

Honorary consultant in immunology
Queen Elizabeth Hospital, Birmingham, and
Research fellow in health economic
University of Birmingham
Birmingham UK

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

Response: The rate of anaphylaxis (serious, potentially life threatening manifestation of allergy) has increased in the last decade. There have been some reports from other countries about an increase in the number of adrenaline autoinjectors being prescribed in children, but this has not been systematically examined in the UK.
We looked at a database of patient records from over 500 general practices, THIN (the Health Improvement Network), between 2000 and 2012. We found nearly 24,000 children who had been identified as being at risk of anaphylaxis by General Practitioners and prescribed epipens.

Continue reading

Increased Physician Spending On Hospital Care Does Not Improve Outcomes

MedicalResearch.com Interview with:
Yusuke Tsugawa, research associate

Department of Health Policy and Management
Harvard T H Chan School of Public
Division of General Internal Medicine and Primary Care
Brigham and Women’s Hospital, Boston, MA     

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

Response: It is well known that health spending varies substantially across geographical regions, and yet regions that spend more on health care dot not achieve better health outcomes. These findings has led to many to conclude that at least 20% of U.S. health care spending could be reduced without compromising quality of care. However, while physicians play a critical role in health care decision making, little is known as to how much health care spending varies between physicians, and its implications for patient outcomes.

In this study, we found that the variation in spending across physicians is slightly larger than the variation across hospitals. More importantly, higher spending by physicians did not lead to lower patient mortality or readmission rates, within the same hospital.

Continue reading

Diabetes Prevention Program Reduced Health Care Costs In First Year

MedicalResearch.com Interview with:

Maria L. Alva, DPhil Public Health Economics Program RTI International 701 13 Street, NW, Suite 750 Washington, DC 20005

Dr. Maria Alva

Maria L. Alva, DPhil
Public Health Economics Program
RTI International
701 13 Street, NW, Suite 750
Washington, DC 20005 

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

Response:  Diabetes affects more than 25 percent of Americans over 65. The estimated economic cost of diagnosed diabetes is $245 billion a year. In spite of this we have almost no evidence of the impact of programs geared to stave off the cost of diabetes.

The Y-USA received a Health Care Innovation Award of $11.8 million from the Centers for Medicare & Medicaid Services to offer a diabetes prevention program to individuals 65 and over with prediabetes. The goal of the Y-USA model is to get participants to lose 5 percent or more of their body weight and gradually increase their physical activity to 150 minutes per week.  The program lasts a year. The curriculum comprises sixteen weekly core sessions about healthy eating, exercise and motivation followed by eight monthly maintenance sessions.

Epidemiological data from other studies have shown that the risk of diabetes increases with increased levels of BMI. There is mounting evidence that it is possible to prevent or delay diabetes through life-style intervention. It is unclear, however, whether weight-loss interventions can yield reductions in medical spending.

The objective of our analysis was to establish whether the -USA Diabetes Prevention Program reduces health care spending and utilization among fee-for-service Medicare beneficiaries.

Continue reading

Pediatric Asthma Costs Over $5 Billion Per Year In Health Care Expenses

MedicalResearch.com Interview with:

Patrick W. Sullivan, Ph.D. Professor Regis University School of Pharmacy Denver, CO 80221

Dr. Sullivan

Patrick W. Sullivan, Ph.D.
Professor
Regis University School of Pharmacy
Denver, CO 80221

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

Response: Asthma is one of the most common chronic disorders among children. It affects 7.1 million children in the U.S. Of these, 4.1 million children suffered an asthma attack in 2011. An asthma attack is an acute period of extreme difficulty breathing. It can be life threatening and is always very frightening for children. Because asthma can be dangerous and frightening, it ends up costing a lot because patients need to go the doctor, hospital or take medications to try to control it.

Asthma also has a negative effect on the patient’s health and outlook about their health – both mentally and physically. Previous studies have focused on adults with asthma and have found that it is very expensive – it costs $18 billion in the U.S. to manage adults with asthma. Those studies also showed that adults with asthma have lower quality of life. However, there is not a lot of good evidence on the burden of asthma in children. This study was designed to quantify the cost and mental and physical health of children with asthma in the U.S.

Continue reading

Tool Can Help Avoid Overtesting in Evaluation of Chest Pain

MedicalResearch.com Interview with:

James E. Udelson, MD Chief, Division of Cardiology Director, Nuclear Cardiology Laboratory Professor, Tufts University School of Medicine

Dr. James Udelson

James E. Udelson, MD
Chief, Division of Cardiology
Director, Nuclear Cardiology Laboratory
Professor, Tufts University School of Medicine  

MedicalResearch.com: What is the background for this study? What are the main findings?
Response: There are millions of stress tests done every year in the United States and many of them are normal,” said James Udelson, MD, Chief of the Division of Cardiology at Tufts Medical Center and the senior investigator on the study. “We thought that if we could predict the outcome of these tests by using information we already had from the patient before the test, we could potentially save the health care system money and save our patients time and worry.”   We were able to get a strong prediction of the possibility of having entirely normal testing and no clinical events such as a heart attack, by developing a risk prediction tool using ten clinical variables that are commonly available to a physician during an evaluation”

Continue reading

Non-Dialysis Chronic Kidney Disease Expenses On Par With Cancer and Stroke

MedicalResearch.com Interview with:

Talar W. Markossian PhD MPH Assistant Professor of Health Policy Loyola University Chicago 2160 S. First Ave, CTRE 554 Maywood, IL 60153

Dr. Talar Markossian

Talar W. Markossian PhD MPH
Assistant Professor of Health Policy
Loyola University Chicago
2160 S. First Ave, CTRE 554
Maywood, IL 60153

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

Response: Approximately 10% of U.S. adults currently have non-dialysis dependent chronic kidney disease (CKD), while dialysis dependent CKD accounts for only 0.5% of the U.S. population. The escalation in healthcare expenditures associated with CKD starts prior to requirement for dialysis, and treatment costs escalate as non-dialysis dependent CKD progresses.

We examined the total healthcare expenditures including out-of-pocket costs for non-dialysis dependent chronic kidney disease and compared these expenditures with those incurred for cancer and stroke in the U.S. adult population. After adjusting for demographics and comorbidities, the adjusted difference in total direct healthcare expenditures was $4746 (95% CI $1775-$7718) for CKD, $8608 (95% CI $6167-$11,049) for cancer and $5992 (95% CI $4208-$7775) for stroke vs. group without CKD, cancer or stroke. Adjusted difference in out-of-pocket healthcare expenditures was highest for adults with CKD ($760; 95% CI 0-$1745) and was larger than difference noted for cancer ($419; 95% CI 158–679) or stroke ($246; 95% CI 87–406) relative to group without CKD, cancer or stroke. Continue reading

ACA Medicare Changes Increased Diagnosis of Early-Stage Colorectal Cancer Among Seniors.

MedicalResearch.com Interview with:

Nengliang “Aaron” Yao PhD Assistant professor Department of Public Health Sciences University of Virginia

Dr. Nengliang Yao

Nengliang “Aaron” Yao PhD
Assistant professor
Department of Public Health Sciences
University of Virginia

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

Response: The ACA made several changes in Medicare that could increase the use of cancer screening and thus lead to more early cancer diagnoses. This includes waiving patient cost-sharing for screening, waiving patient cost-sharing for one wellness visit per year, and paying bonuses to physicians for doing more work in a primary care setting.

We studied how effective those changes were in facilitating more early diagnoses of breast and colorectal cancers. We found that the changes had no effect on early breast cancer diagnoses (likely because costs and other access barriers for mammograms were already low), but increased the number of early colorectal cancer diagnoses by 8 percent.

Continue reading

When Patients Can’t Choose: Out-of-Network Care Can Be Costly

MedicalResearch.com Interview with:

Ge Bai, PhD, CPA Assistant Professor The Johns Hopkins Carey Business School Washington, DC 20036

Dr. Ge Bai

Ge Bai, PhD, CPA
Assistant Professor
The Johns Hopkins Carey Business School
Washington, DC 20036 

MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The average anesthesiologist, emergency physician, pathologist and radiologist charge more than four times what Medicare pays for similar services, often leaving privately-insured out-of-network patients stuck with surprise medical bills that are much higher than they anticipated.

The average physician charged roughly 2.5 times what Medicare pays for the same service. There are also regional differences in excess charges. Doctors in Wisconsin, for example, have almost twice the markups of doctors in Michigan (3.8 vs. two).

Continue reading

Little Evidence Pay-For-Performance Improves Patient Outcomes

MedicalResearch.com Interview with:

Devan Kansagara MD, MCR Associate Professor of Medicine, Oregon Health and Science University Director, Evidence-based Synthesis Program, Portland VA Medical Center Staff Physician, Portland VA Medical Center

Dr. Devan Kansagara

Devan Kansagara MD, MCR
Associate Professor of Medicine
Oregon Health and Science University
Director, Evidence-based Synthesis Program, Portland VA Medical Center
Staff Physician, Portland VA Medical Center

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

Response: Historically, the US health care system has been dominated by a fee-for-service payment structure in which health care providers are paid for discrete procedures and visits regardless of care quality. Pay for performance programs are part of the move towards value-based care. They tie a portion of payments to individual health care providers, institutions, or health care systems to performance on a discrete set of measures of health care quality.

In theory, these programs are meant to encourage the right care at the right time and thereby improve the health of the patient population. Over the last decade, many studies in and outside the US have examined whether or not, in fact, these programs do result in improved care, reduced cost, and improved patient health. Our study is a systematic review of this literature.

Continue reading

Economic Effects of Medicaid Expansion in Michigan

MedicalResearch.com Interview with:

John Z. Ayanian, MD, MPP</strong> Director of the Institute for Healthcare Policy and Innovation and Alice Hamilton Professor of Medicine University of Michigan

Dr. John Z. Ayanian

John Z. Ayanian, MD, MPP
Director of the Institute for Healthcare Policy and Innovation and
Alice Hamilton Professor of Medicine
University of Michigan

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

Response: Our study assessed the broad economic impact of Medicaid expansion in Michigan – one of several Republican-led states that have chosen to expand Medicaid under the Affordable Care Act. About 600,000 low-income adults in Michigan are covered through the program, known as the Healthy Michigan Plan, which began in April 2014.

Using an economic modeling tool that is also used to advise the state government for fiscal planning, we found that federal funding for the Healthy Michigan Plan is associated with over 30,000 additional jobs, about $2.3 billion in increased personal income in Michigan, and about $150 million in additional state tax revenue annually. One third of the new jobs are in health care, and 85 percent are in the private sector. The state is also saving $235 million annually that it would have spent on other safety net programs if Medicaid had not been expanded.

Thus, the total economic impact of the Healthy Michigan Plan is generating more than enough funds for the state budget to cover the state’s cost of the program from 2017 through 2021. Beginning in 2017, states are required to cover 5 percent of the costs of care for Medicaid expansion enrollees, and the state share of these costs will rise to 10 percent in 2020. The remaining costs are covered by federal funding.

Continue reading

Bundled Payment For Joint Replacements Saved Hospitals and CMS Money

MedicalResearch.com Interview with:

MedicalResearch.com Interview with: Amol Navathe, MD PhD University of Pennsylvania Staff Physician, CHERP, Philadelphia VA Medical Center Assistant Professor of Medicine and Health Policy, Perelman School of Medicine Senior Fellow, Leonard Davis Institute of Health Economics, The Wharton School Co-Editor-in-Chief, HealthCare: the Journal of Delivery Science and Innovatio

Dr. Amol Navathe


Amol Navathe, MD PhD

University of Pennsylvania
Staff Physician, CHERP,
Philadelphia VA Medical Center
Assistant Professor of Medicine and Health Policy, Perelman School of Medicine
Senior Fellow, Leonard Davis Institute of Health Economics, The Wharton School
Co-Editor-in-Chief, HealthCare: the Journal of Delivery Science and Innovation

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

Response: Bundled payments pay a fixed price for an episode of services that starts at hospital admission (in this case for joint replacement surgery) and extends 30-90 days post discharge (30 days in this study). This includes physician fees, other provider services (e.g. physical therapy), and additional acute hospital care (hospital admissions) in that 30 day window.

Continue reading

Expensive Intensive Care Units Often Overutilized

MedicalResearch.com Interview with:

Dr. Dong W. Chang, MD MS</strong> Division of Respiratory and Critical Care Physiology and Medicine Los Angeles Biomed Research Institute at Harbor-University of California Los Angeles, Medical Center Torrance California

Dr. Dong Chang

Dr. Dong W. Chang, MD MS
Division of Respiratory and Critical Care Physiology and Medicine
Los Angeles Biomed Research Institute at Harbor-University of California
Los Angeles, Medical Center
Torrance California

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

Response: The study was based on our overall impression that ICU care is often delivered to patients who are unlikely to derive long-term benefit (based on their co-morbidities/severity of illness, etc.). However, what surprised us was the magnitude of this problem. Our study found more than half the patients in ICU at a major metropolitan acute-care hospital could have been cared for in less expensive and invasive settings.

Continue reading

Choosing Primary Care Physicians Based On Low Office Visit Price Can Save Money for Patients With High Deductible Plans

MedicalResearch.com Interview with:

Dr. Ateev Mehrotra Associate professor, Department of Health Care Policy Harvard Medical School and a  hospitalist at Beth Israel Deaconess Medical Center Boston, Massachusetts

Dr. Ateev Mehrotra

Dr. Ateev Mehrotra MD
Associate professor, Department of Health Care Policy
Harvard Medical School and a
hospitalist at Beth Israel Deaconess Medical Center
Boston, Massachusetts

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

Response: More people in the US are using price transparency websites to shop for care. Some have wondered whether using the information on these websites to choose a doctor will help them actually save money. A relatively small difference in price for visits on the website translated into hundreds of dollars.

Continue reading

Health Care Spending Highly Concentrated Among a Small Group of People

MedicalResearch.com Interview with:

Emily Mitchell, Ph.D., Statistician Agency for Healthcare Research and Quality

Emily Mitchell,

Emily Mitchell, Ph.D., Statistician
Agency for Healthcare Research and Quality

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

Response: The data for this study come from the Household Component of the Medical Expenditure Panel Survey (MEPS-HC), a nationally representative survey that is conducted annually by the Agency for Healthcare Research and Quality (AHRQ). The survey collects detailed information on health care utilization and expenditures, health insurance, and health status, as well as a wide variety of social, demographic, and economic characteristics for the U.S. civilian non-institutionalized population.

Continue reading

Costs of Generic Drugs for Heart Failure Can Vary Widely

MedicalResearch.com Interview with:

Paul J. Hauptman, MD</strong> Professor Internal Medicine, Division of Cardiology Health Management & Policy, School of Public Health

Dr. Paul Hauptman

Paul J. Hauptman, MD
Professor Internal Medicine, Division of Cardiology
Health Management & Policy, School of Public Health

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

Response: We decided to evaluate the cost of generic heart failure medications after an uninsured patient of ours reported that he could not fill a prescription for digoxin because of the cost for a one month’s supply: $100. We called the pharmacy in question and confirmed the pricing. At that point we decided to explore this issue more closely.

We called 200 retail pharmacies in the bi-state, St. Louis metropolitan area, 175 of which provided us with drug prices for three generic heart failure medications: digoxin, carvedilol and lisinopril. We found significant variability in the cash price for these medications. Combined prices for the three drugs ranged from $12-$400 for 30 day supply and $30-$1,100 for 90 day supply.

The variability was completely random, not a function of pharmacy type, zip code, median annual income, region or state. In fact, pricing even varied among different retail stores of the same pharmacy chain.

Continue reading

Cancer Drugs, Survival and Ethics

MedicalResearch.com Interview with:

Peter Wise MD Charing Cross Hospital and Imperial College School of Medicine London, UK

Dr. Peter Wise

Peter Wise MD
Charing Cross Hospital and
Imperial College School of Medicine
London, UK

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

Response: As a medical ethicist, I wished to know how much patients with advanced – metastatic – cancer knew about the drugs that were being used to treat it. What were their perceptions of likely treatment success and how did that tally with our knowledge of what drugs could actually achieve – and at what cost to the body and to the pocket. Did patients actually have a choice – and how did the drugs get approved for use in the first place?

Continue reading

Canadian Limits on Glucose Strips Did Not Impair Diabetes Control

MedicalResearch.com Interview with:

Tara Gomes, MHSc Li Ka Shing Knowledge Institute, St Michael’s Hospital, The Institute for Clinical Evaluative Sciences Leslie Dan Faculty of Pharmacy Department of Health Policy, Management, and Evaluation University of Toronto, Toronto, Ontario, Canada

Tara Gomes

Tara Gomes, MHSc
Li Ka Shing Knowledge Institute, St Michael’s Hospital,
The Institute for Clinical Evaluative Sciences
Leslie Dan Faculty of Pharmacy
Department of Health Policy, Management, and Evaluation
University of Toronto, Toronto, Ontario, Canada

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

Response: In August 2013, the Ontario government introduced reimbursement limits for blood glucose test strips. Subsequent research has suggested that the provincial government saved $24 million in the first year after implementing this quantity limit policy. This study investigated whether these quantity limits led to any change in diabetes-related patient outcomes.

We found that limiting the number of blood glucose test strips reimbursed by the government to levels recommended by the Canadian Diabetes Association had to no change in diabetes control (measured as rates of emergency department visits for hypoglycemia or hyperglycemia, and mean HbA1c) in the 1.5 years after implementation. Similarly, there was no worsening of patient outcomes in a subgroup of individuals who had been frequent users of test strips prior to the policy being announced.

Continue reading

Expanding the Role of Hospitalist Physician Assistants May Save Money With Similar Outcomes

MedicalResearch.com Interview with:

Timothy M. Capstack, MD, FACP, SFHM Regional Medical Director, Physicians Inpatient Care Specialists, LLC (MDICS) Hanover MD

Dr. Timothy M. Capstack

Timothy M. Capstack, MD, FACP, SFHM
Regional Medical Director, Physicians Inpatient Care Specialists, LLC (MDICS)
Hanover MD

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

Response: Hospitalists—medical providers who provide medical care to hospital inpatients—have become a pervasive part of American medical care. Hospitalists with internal medicine training earn, on average, a little over twice as much as do physician assistants (PAs). The researchers studied the hospitalist staffing model of Physicians Inpatient Care Specialists (MDICS) hospitalists at a 384-bed community hospital in Annapolis, Maryland. MDICS used specifically trained and supported PAs working collaboratively with their physicians to see a large proportion of their patients rather than relying mainly or exclusively on physicians, as many groups do. MDICS believed that their model would provide equal quality of care while saving on salary costs.

The MDICS expanded-PA model was compared with a conventional group of hospitalists who used mostly physicians to care for their inpatients. 16,964 inpatient hospitalizations were identified for study; 6,612 expanded-PA and 10,352 conventional patients were seen by the groups over the 18 months that were included.

Continue reading

Patients Greatly Underestimate Reimbursement For Orthopedic Procedures

MedicalResearch.com Interview with:

Kelechi Okoroha, M.D. Orthopaedic Surgery House Officer Henry Ford Health System

Dr. Kelechi Okoroha

Kelechi Okoroha, M.D.
Orthopaedic Surgery House Officer
Henry Ford Health System

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

Response: Historically, patient perceptions of surgeon reimbursement have been exaggerated compared with actual reimbursement. Currently there has been an increased focus or reducing health care cost, increasing access to health care and a shift to tie Medicare and insurance reimbursement to quality outcomes. Among these changes was the reduction in reimbursement payments for orthopedic surgeons. When we polled over 200 of our clinic patients, we found that most patients don’t think an orthopedic surgeon is overpaid but they greatly exaggerate how much a surgeon is reimbursed by Medicare for performing knee surgery. When told of the reimbursement payments, patients found them too be low and said they would be willing to pay more out-of-pocket costs. Patients also believe a surgeon should be compensated more for having fellowship training.

• Nearly 90 percent of patients say physicians are not overpaid and their salaries should not be cut.
• 61 percent of patients say a surgeon’s salary should not be tied to outcomes.
• 79 percent of patients say reimbursement to drug and device companies should be reduced.

Continue reading

Uninsured Kids More Likely To Be Transferred From Emergency Departments

MedicalResearch.com Interview with:

Yunru Huang Ph.D. Candidate in epidemiology Department of Pediatrics University of California Davis, Sacramento, CA

Yunru Huang and Dr. James Marcin (left)

Yunru Huang
Ph.D. Candidate in epidemiology
Department of Pediatrics
University of California
Davis, Sacramento, CA

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

Response: Each year, more than 27 million children seek care in emergency departments (EDs) in the United States. Many EDs, however, are not fully equipped with the recommended pediatric supplies and may not have access to the pediatric specialists and resources needed to provide definitive care. As a result, many children receiving treatment in EDs of hospitals with limited pediatric resources are transferred to another hospital’s ED or inpatient unit for admission.

The Emergency Medical Treatment and Active Labor Act (EMTALA) requires hospitals to make decisions on patient transfer and admission independent of insurance status. That is, the decision to transfer a patient to another hospital for admission should only depend upon clinical factors or the need for specialty services. However, patterns observed in the medical literatures have suggested that a child’s insurance status could be associated with transfer and admission decisions. These studies have been limited to single institutions and/or have been limited to specific conditions._ENREF_14 Whether or not transfer decisions among pediatric patients are related to insurance status has yet to be studied on a national level and across a variety of diagnoses.

We used Healthcare Cost and Utilization Project 2012 Nationwide Emergency Department Sample data and sought to investigate the relationships between insurance status and odds of transfer relative to local admission among pediatric patients receiving care in the ED.

Continue reading

Very Few Patients Take Advantage of Health Care Pricing Tools

MedicalResearch.com Interview with:

Anna D. Sinaiko, PhD, MPP Research Scientist Department of Health Policy & Management Harvard T.H. Chan School of Public Health Boston, MA 02115

Dr. Anna D. Sinaiko

Anna D. Sinaiko, PhD, MPP
Research Scientist
Department of Health Policy & Management
Harvard T.H. Chan School of Public Health
Boston, MA 02115

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

Response: One strategy for reducing health care spending in the U.S. is to increase transparency in health care pricing for patients. The idea is that patients can learn about and anticipate the prices they would pay for health care before they receive care, and incorporate that information into their choices about whether and where to receive care. When patients incorporate price information into their decisions, it gives providers an incentive to compete on price and quality.

There has been a dramatic increase in the availability of health care price information over the last few years for patients who have commercial health insurance, primarily through web-based tools. In this study, we examined the impact of this information on patient choice of health care facility.

We find that a small number of enrollees with commercial health insurance through Aetna, 3% overall, accessed price information through their transparency tool. Among users of the tool, patients who viewed price information for imaging services and for sleep studies before they had the service chose facilities with lower prices, and incurred lower spending (of 12%) for imaging services. We found no effect on patient choices for patients who viewed price information for 6 other health care services (carpal tunnel release, cataract/lens procedures, colonoscopy, echocardiogram, mammograms, and upper gastrointestinal endoscopy).

Continue reading

Both Men and Women Can Face Financial Barriers After Heart Attack

MedicalResearch.com Interview with:
Adam L. Beckman
Yale College, New Haven, CT (at the time this work was completed)
Erica S Spatz MD MHS
Assistant Professor, Section of Cardiovascular Medicine
Center for Outcomes Research and Evaluation
Yale-New Haven Hospital
Yale University School of Medicine

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

Beckman: Despite the expansion of insurance coverage, young adults face major challenges to obtaining affordable healthcare. We suspected women may experience greater challenges than men — they often have lower income and less complete medical coverage than men, and care for multiple generations of family, and that this may in part explain why young women have worse outcomes following a heart attack as compared with similarly-aged men.

Continue reading

Community Dental Program May Reduce Emergency Dental Admissions

MedicalResearch.com Interview with:
Jonathon P. Leider, PhD
Department of Health Policy and Management
Johns Hopkins University
Baltimore, MD

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

Response: The increasing utilization of Emergency Departments (ED) for the treatment of non-urgent and non-traumatic dental conditions among adults in the United States is an increasing policy issue. Research shows that seeking dental care in an ED is often more expensive and less effective when compared to a traditional dental office. Seeking care in the ED for non-traumatic dental conditions is more frequent among low income individuals and people in rural areas, who must often overcome insufficient dental coverage and access to receive office-based care.

Under the Affordable Care Act, there has been considerable expansion in state Medicaid dental coverage for adults. However, not all states are participating in the expansion or extension of dental benefits and dental professional shortage areas are fairly common– over 4,900 exist in the United States. Innovative programs are needed to effectively address the challenges low income individuals in rural areas encounter accessing care. Our study examined the expansion of a Community Dental Program (CDP) in rural Western Maryland and its impact on dental-related visits at a regional ED.

Continue reading