Opioid-Induced Constipation: Can Your Hospital Afford the Financial Burden?

MedicalResearch.com Interview with:

Howard Franklin, MD, MBAVice President of Medical Affairs and StrategySalix Pharmaceuticals

Dr. Franklin

Howard Franklin, MD, MBA
Vice President of Medical Affairs and Strategy
Salix Pharmaceuticals

MedicalResearch.com: What is opioid-induced constipation?

Response: Opioid-induced constipation (OIC) is a side effect in as many as 80 percent of chronic pain patients on opioids. OIC is unlikely to improve over time without treatment and can lead to suffering and discomfort. More importantly, the insufficient treatment of OIC can have negative implications for patients, both those on opioid therapy for chronic non-cancer pain as well as advanced illness, and for hospitals. 

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Hospital Costs For Maternity Care Vary Widely

Xiao Xu, Ph.D. Assistant Professor Department of Obstetrics, Gynecology & Reproductive Sciences Yale School of MedicineMedicalResearch.com Interview with:
Xiao Xu, Ph.D. Assistant Professor

Department of Obstetrics, Gynecology & Reproductive Sciences
Yale School of Medicine

Medical Research: What is the background for this study? What are the main findings?

Dr. Xiao Xu: While research has shown hospital variation in costs of care for other conditions, we know little about whether and how hospitals differ in costs of childbirth related care. With nearly 4 million births each year, childbirth is the most common reason for hospital admission in the U.S. Understanding the pattern and causes of variation in resource utilization during childbirth among hospitals can help inform strategies to reduce costs. Our study used data from 463 hospitals across the country and analyzed hospital costs of maternity care for low-risk births. We found that hospital varied widely in average facility costs per maternity stay. Continue reading

Malpractice Reform Did Not Change ER Doctor Habits or ER Costs

Daniel A. Waxman, MD, PhD Department of Emergency Medicine David Geffen School of Medicine University of California, Los Angeles RAND Corporation Santa Monica, CaliforniaMedicalResearch.com Interview with:
Daniel A. Waxman, MD, PhD
Department of Emergency Medicine
David Geffen School of Medicine
University of California, Los Angeles
RAND Corporation Santa Monica, California

Medical Research: What are the main findings of the study?

Dr. Waxman: About 10 years ago, three states (Texas, Georgia, and South Carolina) passed laws which made it much harder for doctors to be sued for malpractice related to emergency room care.   The goal of our research was to determine whether the lower risk of being sued translated into less costly care by emergency physicians.  To figure this out, we looked at the billing records of nearly 4 million Medicare patients and compared care before and after the laws took effect, and between states that passed reform and neighboring states that didn’t change their laws.   We found that these substantial legal protections didn’t cause ER doctors to admit fewer patients to the hospital, to order fewer CT or MRI scans, or to spend less for the overall ER visit.
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US Hospitals Spend At Least Double Other Countries on Billing and Administration

Steffie Woolhandler MD MPH Professor at the School of Public Health and Hunter College, CUNY; Professor of Medicine Harvard Medical School Cambridge HospitalMedicalResearch.com Interview with:
Steffie Woolhandler MD MPH
Professor School of Public Health and Hunter College, CUNY;
Professor of Medicine
Harvard Medical School Cambridge Hospital

Medical Research: What are the main findings of the study?

Dr. Woolhandler: In 2011, U.S. hospitals spent $215 billion on
billing and administration. Meanwhile, other
countries spent far less. None of the other
seven countries we studied spent even half as
much as the U.S., and they all have modern, high
quality hospitals. While we spent nearly
$700 per capita on hospital paperwork, Scotland
and Canada spent less than $200. This means
that if U.S. hospitals ran as efficiently as
Canada’s, the average family of four would save
$2,000 annually on health care.
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Implantable Defibrillators: Proper Programing Reduces Hospitalizations and Costs

Maurizio Gasparini, MDMedicalResearch Interview with:
Maurizio Gasparini MD
Humanitas Research Hospital
Rozzano, Italy


Medical Research: What are the main findings of the study?

Dr. Gasparini: We found that a strategic programming of implantable cardioverter defibrillators which allows the non-sustained arrhythmias to self-terminate is associated with reductions in hospitalizations, length of hospital stay and cost per patient-year and an increase in the time to first hospitalization. These results were mainly driven by reduction in cardiovascular-related events.
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Hospital Weekend Rehabilitation Services Improve Outcomes and May Save Money

MedicalResearch.com Interview with:
Natasha K Brusco
Manager of Physiotherapy Services, Cabrini Health
PhD Candidate, Physiotherapy Department, Faculty of Health Science,
La Trobe University, Bundoora,
Victoria, Australia

MedicalResearch: What are the main findings of the study?

Answer: This economic evaluation reports that providing additional Saturday rehabilitation, compared to Monday to Friday rehabilitation alone, is likely to be cost saving per quality adjusted life year gained and for a minimal clinically important difference in functional independence. This builds on previous literature that reports that additional Saturday rehabilitation can improve functional independence and health related quality of life at discharge and may reduce patient length of stay.
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Hospital Costs, Length of Stay Increase with Workload of Hospitalists

 Daniel J. Elliott, M.D., MSCE, FACP Associate Chair of Research Department of Medicine and Research Scholar Value Institute, Christiana Care Health SystemMedicalResearch.com Interview with:
Daniel J. Elliott, M.D., MSCE, FACP
Associate Chair of Research
Department of Medicine and Research Scholar
Value Institute, Christiana Care Health System

MedicalResearch.com: What are the main findings of the study?

Dr. Elliott: The optimal workload for hospitalists has been a question since the earliest days of hospital medicine. However there has been very little empirical evidence to understand the relationship between workload and outcomes.

The objective of our study was to determine the association of daily workload for hospitalists on the efficiency, quality, and cost of care.  We analyzed data from a single private practice hospitalist group at a community-based health system between February 2008 and January 2011. Our research showed that both length of stay and cost increased for patients as hospitalist workload increased.

At the same time, our research showed that workload did not affect patient satisfaction as measured by HCAHPS scores or quality and safety outcomes including admissions, rapid response team activation and mortality.
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Threatened Preterm Labor : Cost of Hospital Admissions

MedicalResearch.com Interview with: Robert E. Garfield, PhD

Department of Perinatology, Division of Obstetrics and Gynecology
University Medical Centre Ljubljana, Slovenia

Costs of Unnecessary Admissions and Treatments for “Threatened Preterm Labor”

MedicalResearch.com :What are the main findings of the study?

Dr. Garfield: Unnecessary admissions and treatments for “threatened preterm labor” are still part of everyday clinical practice and contribute to exploding healthcare costs. This happens despite substantial evidence that measuring CL by trans-vaginal ultrasound can help to avoid needless interventions due to the high negative predictive values of this test.
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Hospital ‘Observation Care’ – Different in the Real World than in CMS Definition

MedicalResearch.com Interview with:
Ann M. Sheehy, M.D., M.S.
Associate Professor
Division Head, Hospital Medicine
University of Wisconsin Department of Medicine
Ann M. Sheehy, M.D., M.S.
Associate Professor
Division Head, Hospital Medicine
University of Wisconsin Department of Medicine

MedicalResearch.com: What are the main findings of the study?

Dr. Sheehy: There were three main findings of our study.

First, we found that observation in clinical practice is very different from the CMS definition of observation. CMS states that observation should rarely last longer than 48 hours, yet 16.5% of our observation encounters lasted longer than 48 hours. CMS also states that observation care is “well-defined”. We found there were 1141 distinct observation codes for our 4578 observation encounters, indicating that observation care is not well defined.

Second, we found that observation care disproportionately affects the general medicine population, as over half of our observation encounters were on the general medicine services. These patients also had longer length of stay, were older, more likely to be female, were more likely to need discharge to a skilled facility, and were more likely to have government insurance as compared to patients on other services. This indicates that observation care adversely affects the adult general medicine population more than other patients on other types of services.

Finally, we found that observation cost was greater than reimbursement, resulting in a net negative financial margin.
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