Author Interviews, Colon Cancer, Cost of Health Care / 25.10.2014

Dr. Christine Marie Veenstra MD Department of Internal Medicine, Division of Hematology/Oncology Division of Colorectal Surgery Center for Healthcare Outcomes and Policy Division of General Medicine Cancer Surveillance and Outcomes Research Team University of Michigan, Ann ArborMedicalResearch.com Interview with: Dr. Christine Marie Veenstra MD Department of Internal Medicine, Division of Hematology/Oncology Division of Colorectal Surgery Center for Healthcare Outcomes and Policy Division of General Medicine Cancer Surveillance and Outcomes Research Team University of Michigan, Ann Arbor Medical Research: What is the background for this study? Dr. Veenstra: Nearly 50,000 patients are diagnosed with stage III colorectal cancer each year. Chemotherapy is known to increase survival by up to 20% and is the standard recommendation for these patients after surgery. However, use of chemotherapy may be associated with financial strain. In order to better understand the financial burden and worry associated with colorectal cancer treatment, we surveyed 956 patients being treated for stage III colorectal cancer. We asked patients to answer questions about financial burden such as whether they had used savings, borrowed money, skipped credit card payments, or cut back on spending for food, clothing or recreational activities because of their cancer treatment. We also asked patients how much they worry about financial problems because of their cancer or its treatment. (more…)
AHA Journals, Author Interviews, Cost of Health Care, Stroke / 24.10.2014

A/Prof Dominique Cadilhac, MPH PhD Head: Translational Public Health Division Stroke and Ageing Research Centre (STARC) Department of Medicine, School of Clinical Sciences at Monash Health, Monash University Melbourne, AustraliaMedicalResearch.com Interview with: A/Prof Dominique Cadilhac, MPH PhD Head: Translational Public Health Division Stroke and Ageing Research Centre (STARC) Department of Medicine, School of Clinical Sciences at Monash Health, Monash University Melbourne, Australia Medical Research: What are the main findings of the study? Dr. Cadilhac: Our results provide important information for health policy and planning, by providing a better understanding of the long-term costs of ischemic stroke (IS) and intracerebral hemorrhage stroke (ICH). 243 patients who experienced an ischemic stroke– the most common type of stroke, and 43 patients with intracerebral hemorrhage stroke who went on to survive for 10 years or more were interviewed to calculate annual costs as part of the North East Melbourne Stroke Incidence Study. Average annual healthcare costs 10 years after an ischemic stroke were $5,418 (AUD) – broadly similar to costs estimated between 3 and 5 years ($5,545). Whereas previous estimates for annual healthcare costs for intracerebral hemorrhage stroke ten years after stroke onset were $6,101, Professor Cadilhac’s team found the true cost was $9,032 far higher than costs calculated at 3 to 5 years ($6,101) because of a greater need for aged care facilities 10 years on. The high lifetime costs per stroke for both subtypes for first-ever events emphasize the significant economic implications of stroke (ischemic stroke AUD103,566 [USD 68,769] and intracerebral hemorrhage stroke AUD82,764 [USD54,956]). The study also provides evidence of the importance of updating cost estimates when population demography patterns change or if new information on incidence rates, or case-fatality rates, are available. We found a much larger number of intracerebral hemorrhage stroke would be expected than from earlier estimates because a) there are a larger number of people in the age groups 45 to 84 years living in Australia in 2010; and b) we applied new information on incidence rates from a larger geographical region than what was found from using the original NEMESIS pilot study region. In the online supplement we also provide an estimate of health loss reported as quality adjusted Life years (QALYs) lost to highlight how many years of healthy life is lost from a first-ever stroke event. (more…)
Author Interviews, Cost of Health Care, JAMA, University of Pennsylvania / 22.10.2014

Dr. Harald Schmidt, MA, PhD Assistant Professor, Department of Medical Ethics and Health Policy Research Associate, Center for Health Incentives and Behavioral Economics Perelman School of Medicine University of Pennsylvania Philadelphia, PA 19104-3308MedicalResearch.com Interview with Dr. Harald Schmidt, MA, PhD Assistant Professor, Department of Medical Ethics and Health Policy , Research Associate, Center for Health Incentives and Behavioral Economics, Perelman School of Medicine University of Pennsylvania Philadelphia, PA 19104-3308 Medical Research: What are the main findings of the study? Dr. Schmidt: We reviewed currently available policies for aligning cost and quality of care. We focused on interventions are similar in their clinical effectiveness, have modest differences in convenience, but pose substantial cost differences to the healthcare system and patients. To control health care costs while ensuring patient convenience and physician burden, reference pricing would be the most desirable policy. But it is currently politically unfeasible. Alternatives therefore need to be explored. We propose the novel concept of Inclusive Shared Savings, in which physicians, the healthcare system, and, crucially, patients, benefit financially in moving more patients to lower cost but guideline concordant and therapeutically equivalent interventions. (more…)
Cost of Health Care, MRSA / 08.10.2014

https://medicalresearch.com/cost-of-health-care/id_week_14_universal_mrsa_screening_may_be_too_expensive_to_implement/8166/Medical Research’s Interview with: James A. McKinnell, MD Los Angeles Biomedical Research Institute   Medical Research: What are the main findings of the study? Dr. McKinnell: Numerous experts and policy makers have called for hospitals to screen patients for methicillin-resistant Staphylococcus aureus (MRSA) infections and isolate anyone testing positive to prevent the spread of these so-called “Superbugs” in healthcare settings. Several states have enacted laws requiring patients be screened for MRSA upon admission. We conducted two studies, both of which were presented as abstracts at IDWeek, the annual scientific meeting for infectious disease specialists, which found universal MRSA screening and isolation of high-risk patients will help prevent MRSA infections but may be too economically burdensome for an individual hospital to adopt. Researchers at Los Angeles Biomedical Research Institute, the University of California, Irvine and John Hopkins University examined the cost of a hospital infection prevention strategy that tested all patients for MRSA and then took precautions to avoid contact with potential carriers. We found that using the traditional method of testing for MRSA in the nose, or nares surveillance, and then isolating MRSA carriers prevented nearly three MRSA infections. But it cost the hospital $103,000 per 10,000 hospital admissions. More extensive screening, through the use of other testing methods, which included PCR-based screening, prevented more infections, but increased the cost. In the second study, we also evaluated the cost of a hospital infection prevention strategy that targeted high-risk patients. Again, we found the costs of the program exceeded the potential savings to the hospital that would be generated by preventing MRSA infections. We found nares screening and isolation of high-risk patients prevented fewer than one infection (0.6) per 1,000 high-risk admissions to the hospital and created a financial loss of $36,899 for the hospitals. Using more extensive MRSA screening – which included nares, pharynx and inguinal folds screening – prevented slightly more infections (0.8 infections per 1,000 high-risk admissions), according to the study. But our abstract reported an even larger financial loss of $51,478 with the more extensive screening. (more…)
Author Interviews, Cost of Health Care, General Medicine, Heart Disease / 10.07.2014

Jeff Trost, MD Assistant Professor of Medicine Johns Hopkins MedicineMedicalResearch.com Interview with: Jeff Trost, MD Assistant Professor of Medicine Johns Hopkins Medicine Medical Research: What are the main findings of the study? Dr. Trost: In our study, we reported the use of two relatively simple tactics to significantly reduce the number of unnecessary blood tests to assess symptoms of heart attack and chest pain and to achieve a large decrease in patient charges. Specifically, we
  • 1) Provided information and education to physicians about proven testing guidelines and
  • 2) Made changes to the computerized provider order entry system at the medical center, part of the Johns Hopkins Health System. The guidelines call for more limited use of blood tests for so-called cardiac biomarkers. A year after implementation, our intervention led to an estimated $1.25 million reduction in laboratory charges.
(more…)
Author Interviews, Cost of Health Care / 07.06.2014

http://www.ncbi.nlm.nih.gov/pubmed/24889948?dopt=AbstractMedicalResearch.com Interview with Katherine Neuhausen, MD, MPH Director of Delivery System Transformation, Office of Health Innovation Clinical Assistant Professor, Department of Family Medicine and Population Health Virginia Commonwealth University MedicalResearch: What are the main findings of the study? Dr. Neuhausen: Medicaid Disproportionate Share Hospital (DSH) payments keep safety-net hospitals financially viable because these hospitals play such a critical role caring for the uninsured and Medicaid patients, providing trauma care and other vital community services, and training future health providers.  The Affordable Care Act (ACA) reduces these DSH payments because the ACA's authors assumed that safety-net hospitals would receive increased revenue from Medicaid expansion and therefore, have less need for DSH payments.  However, we found that California’s DSH need will actually increase because of medical cost inflation, low Medicaid payment rates, and the high number of people who will remain uninsured.  As a result, the DSH reductions will create funding gaps that must be filled to ensure the financial stability of safety-net hospitals.  The financial outlook for California’s safety-net hospitals is still much better under ACA than it would have been without the ACA.  In the absence of the ACA, California’s public hospitals would have had an additional $1.5 billion in costs for uncompensated care for the uninsured and would be facing a financial crisis. (more…)
Author Interviews, Cost of Health Care / 15.05.2014

MedicalResearch.com Interview with: David Lassman Statistician in the National Health Statistics Group, Office of the Actuary Centers for Medicare and Medicaid Services (CMS) Baltimore, Maryland. MedicalResearch: What types of health care spending are included in this report?  Answer: In the past, the CMS Office of the Actuary provided periodic updates of health care spending by age and more recently by gender. This report, for the first time, provides a time series of spending by age (five categories – 0-18, 19-44, 45-64, 65-84, and 85+) and gender. We also show spending by three major age categories – children (0-18), working age adults (19-64), and the elderly (age 65 and over). We present data for personal health care only which consists of all the medical goods and services used to treat or prevent a specific disease or condition in a specific person. We provide estimates for the even years between 2002 and 2010. These age and gender estimates are controlled to the most recent Historical National Health Expenditure Accounts. (more…)
Author Interviews, CMAJ, Cost of Health Care, Prostate Cancer / 26.04.2014

MedicalResearch.com Interview with: Alice Dragomir, MSc, PhD Assistant Professor, Urology/Surgery, McGill University Scientist, RI-MUHC MedicalResearch.com: What are the main findings of the study? Authors’ response: Our study demonstrates that for eligible patients, active surveillance could offer not only the known clinical advantages from the patient’s perspective, but also economic benefits from the health care system’s perspective. At the national level, the cost savings of an annual cohort of incident prostate cancers managed with active surveillance over a first year and 5 years of follow-up could be substantial. These are estimated at $96 million. (more…)
Author Interviews, Cost of Health Care, JAMA, Pain Research, Pharmacology, Radiology, University of Michigan / 17.03.2014

Dr. Brian C. Callaghan MD Department of Neurology University of Michigan Health System, Ann ArborMedicalResearch.com Interview Invitation with: Dr. Brian C. Callaghan MD Department of Neurology University of Michigan Health System, Ann Arbor MedicalResearch.com: What are the main findings of the study? Dr. Callaghan:  The main findings are that we order headache neuroimaging (MRIs and CTs) frequently, this accounts for approximately $1 billion dollars annually, and the number of tests ordered is only increasing with time. (more…)
Author Interviews, Cost of Health Care, General Medicine, JAMA, OBGYNE / 26.11.2013

dr_Deanna-KepkaMedicalResearch.com Interview with Deanna Kepka, PhD, MPH   Assistant Professor College of Nursing & Huntsman Cancer Institute University of Utah MedicalResearch.com: What are the main findings of the study? Dr. Kepka: Nearly two-thirds, 64.8% (95% CI: 62.2% - 67.3%) of women reporting a hysterectomy also reported a recent Pap test since their hysterectomy and more than half,  58.4% (95% CI: 55.3% - 61.4%)  of women age 65 years and older without a hysterectomy reported a Pap test in the past three years.  Together, this represents approximately 14 million in the United States. (more…)
Author Interviews, Cost of Health Care, Heart Disease / 11.10.2013

Ankur Pandya PhD Assistant Professor of Public Health in the Division of Health Policy Department of Public Health at Weill Cornell Medical CollegeMedicalResearch.com Interview with: Ankur Pandya PhD Assistant Professor of Public Health in the Division of Health Policy Department of Public Health at Weill Cornell Medical College MedicalResearch.com: What are the main findings of the study? Dr. Pandya: Our study looked at the impact of some of the future risk factors for cardiovascular disease in the United States.  Using nine National Health and Nutrition Examination Survey waves from 1973 to 2010 we forecasted disease risk and prevalence from 2015 to 2030. We found that despite continued improvements in the disease’s treatment and declining smoking rates, increasing obesity rates, the aging population, and declining mortality from the disease should cause a rise in health care costs, disability, and reductions in the quality of life associated with increased disease prevalence. (more…)
AHA Journals, Author Interviews, Cost of Health Care, Diabetes / 23.08.2013

MedicalResearch.com Interview with: Xiaohui Zhuo PhD Health economist Division of Diabetes Translation National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention MedicalResearch.com: What are the main findings of the study? First, someone diagnosed with type 2 diabetes may pay an average of about $85,500 treating the disease over his or her lifetime. Lifetime cost is higher for women, and for patients who developed the disease earlier in life. Second, treating diabetic complications account for more than half of lifetime costs, and a majority of which is attributed by damage to large blood vessels, which can lead to coronary heart disease and stroke. (more…)
Author Interviews, Cost of Health Care, JAMA, Mayo Clinic / 24.07.2013

Jon C. Tilburt, MD, MPH Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota Biomedical Ethics Program, Mayo Clinic Knowledge & Evaluation Research Unit, Mayo Clinic Healthcare Delivery Research Program, Center for the Science of Healthcare Delivery Division of Health Care Policy and Research, Mayo ClinicMedicalResearch.com Interview with: Jon C. Tilburt, MD, MPH Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota Biomedical Ethics Program, Mayo Clinic Knowledge & Evaluation Research Unit, Mayo Clinic Healthcare Delivery Research Program, Center for the Science of Healthcare Delivery Division of Health Care Policy and Research, Mayo Clinic What did you set out to find, what was your objective in this study?
  • We wanted to know physicians perceived roles and responsibilities in addressing health care costs as well as their enthusiasm for proposed strategies to contain health care spending.
Who did you study and what did you look at?
  • Practicing US physicians under age 65, we randomly selected 3900 physicians representing all specialties and mailed them an 8-page survey entitled “Physicians, Health Care Costs, and  Society.” We received 2,556 completed surveys (65% response rate). (more…)
Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, JAMA, Medical Research Centers / 26.06.2013

Dr. Karen E. Joynt, MD MPH Cardiovascular Division Brigham and Women's Hospital and VA Boston Healthcare System Department of Health Policy and Management, Harvard School of Public HealthMedicalResearch.com Interview with Dr. Karen E. Joynt, MD MPH Cardiovascular Division Brigham and Women's Hospital and VA Boston Healthcare System Department of Health Policy and Management, Harvard School of Public Health MedicalResearch.com: What are the main findings of the study? Dr. Joynt:  The main findings of the study were two-fold. First, high-cost patients in Medicare (the top decile of spenders) are responsible for about 80% of inpatient spending in the Medicare program, so understanding more about these patients' patterns of care is really important. Second, we found that only about 10% of acute-care spending for these high-cost Medicare patients were for causes that we generally think of as preventable in the short term, like uncontrolled diabetes, COPD, or heart failure. The rest of the spending was for acute conditions that we generally don't think of as preventable (at least in the short term), such as orthopedic procedures, sepsis, and cancer. (more…)
Cost of Health Care, Emergency Care, Stanford / 27.04.2013

Sridhar Sri SeshadriMedicalResearch.com eInterview with: M. Kit Degado, MD, MS Instructor, Emergency Medicine Affiliated Faculty, Centers for Health Policy/Primary Care and Outcomes Research Stanford University School of Medicine [email protected] MedicalResearch.com: What are the main findings of the study? Dr. Degado:
  • We found that if an additional 1.6% of patients flown by helicopter survive or if there is any improvement in disability outcomes, then helicopter EMS should be considered cost-effective over transporting patients by ground EMS. (more…)