Category Archives: Cost of care

Aug 21 2014
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RWJF Scholars in the News: Costs for blood tests, dentists testing for hypertension and HIV, fudging medical history, and more.

Around the country, print, broadcast, and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni, and grantees. Some recent examples:

A new study uncovers vast variation in pricing for common blood tests by California hospitals, reports the Washington Post. Renee Hsia, MD, MSc, an RWJF Physician Faculty Scholars program alumna, says she was “very surprised” to see such variation among more than 160 hospitals studied. Hsia’s research found that during 2011, some hospitals charged as little as $10 and others as much as $10,169 for a basic cholesterol test. The study found no clear explanation for the price differences for what Hsia categorized as ten “simple and standard” tests in which blood samples are inserted into a machine that performs the analysis. Time magazine, the Boston Globe and Kaiser Health News also cover Hsia’s research.

Dentists could offer a variety of medical tests in the future, including diagnostic tests for health problems such as diabetes, hypertension and HIV, Harold Pollack, PhD, tells Ozy.com. The mouth, Pollack says, “is the gateway to the human body.” He is an RWJF Investigator Award in Health Policy Research recipient.  

“There’s an overabundance of evidence that shows hospitals that have better staffing have better outcomes when we look at things like mortality,” Matthew McHugh, PhD, JD, MPH, FAAN, tells the Santa Fe New Mexican. In an article about nurse staffing ratios, McHugh, an RWJF Nurse Faculty Scholars program alumnus, says hospital readmissions, failure to rescue patients in distress, and patient satisfaction also correlate with increased staffing. “If you compare any two hospitals—one that’s good at staffing and one that has not as good staffing, but are similar in other factors—the hospital with better staffing is much less likely to be penalized” for bad patient outcomes by Medicare and Medicaid, McHugh notes. 

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Apr 29 2014
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How Can Health Systems Effectively Serve Minority Communities? Shift the Cost-Access-Quality Axis.

To mark National Minority Health Month, the Human Capital Blog asked several Robert Wood Johnson Foundation (RWJF) scholars to respond to questions about improving health care for all. In this post, Italo M. Brown, MPH, a rising fourth-year medical student at Meharry Medical College, responds to the question, “What are the challenges, needs, or opportunities for health systems to effectively serve minority communities?” Brown holds a BS from Morehouse College and an MPH from Boston University, School of Public Health. He is an alumnus of the Health Policy Scholars Program at the RWJF Center for Health Policy at Meharry Medical College.

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In our domestic health care system, we nurture the drive to improve patient outcomes, and apply evidence-based knowledge to solve contemporary health care challenges. Yet, studies have demonstrated that minorities are disproportionately affected by chronic conditions, and on average are less likely to receive ongoing care/management of their comorbidities. In addition, public health experts have asserted that social determinants of health (e.g., education level, family income, social capital) directly impact the minority community, and effectively convolute the pathway to care. 

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Apr 9 2014
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Heavy Workloads for Hospitalists Correlate to Longer Patient Stays

When workloads increase for hospitalists—the physicians who care exclusively for hospitalized patients—length of stay (LOS) and costs increase, too, according to a study published by JAMA Internal Medicine.

Researchers at Christiana Care Health System, a large academic community hospital system in Delaware, analyzed 20,241 inpatient admissions for 13,916 patients over a three-year period. Hospitalists had an average of 15.5 patient encounters per day, and LOS increased from 5.5 to 7.5 days as workloads increased at hospitals with occupancies under 75 percent.

Each additional patient seen by hospitalists increased costs by $262, although increasing workload did not affect outcomes such as mortality, 30-day readmission rates, and patient satisfaction.

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Feb 27 2014
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Human Capital News Roundup: Risk of increased ADHD labeling, unnecessary emergency department scans, food labeling, and more.

Around the country, print, broadcast, and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni, and grantees. Some recent examples:

In an op-ed for the New York Times, RWJF Investigator Award in Health Policy Research recipients Stephen Hinshaw, PhD, and Richard Scheffler, PhD, discuss how a major expansion of early childhood education could have an unintended consequence: a dramatic increase in the number of pre-school age children, particularly from low-income families, who are wrongly diagnosed with attention deficit hyperactivity disorder (ADHD). The writers recently authored a book, The ADHD Explosion: Myths, Medication, Money, and Today's Push for Performance. The Wall Street Journal also covered the book release, among other outlets.

A study by RWJF Clinical Scholars alumnus, Jeremiah Schurr, MD, MHS, identifies five tests commonly performed in emergency departments that are unnecessary for some patients. In an article in Long Island Newsday, Schurr explains that curtailing their use for patients who do not exhibit specific symptoms could reduce health care costs. Schurr’s research shows that the information gleaned from the tests—CT scans and MRIs for certain patients and blood tests for others—can be derived just as effectively through less expensive procedures.

MedPage Today interviews Jason Karlawish, MD, an RWJF Investigator Award recipient, on the treatment of Alzheimer’s disease. Karlawish emphasizes the importance of accurate diagnosis, proper medication, and family involvement and education. Read more about Karlawish’s work on Alzheimer’s disease on the Human Capital Blog.

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Jan 23 2014
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Human Capital News Roundup: Cost of childbirth, underuse of nurse practitioners, obesity through economic lens, and more.

Around the country, print, broadcast, and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni, and grantees. Some recent examples:

Recent progress in preventing and treating cancer is not fully reflected in declining death rates from the disease, because improving survival rates for other diseases have resulted in longer lifespans, giving people more years during which cancer may strike. This is the key finding from a study by RWJF Health & Society Scholars alumnus Samir Soneji, PhD. HealthDay reports on Soneji’s research.

A study by Renee Hsia, MD, an RWJF Physician Faculty Scholars program alumna, examines childbirth costs at hospitals throughout California. Hsia found that costs for vaginal deliveries without complications range from $3,296 to $37,277. “The market doesn’t work and the system doesn’t regulate it, so hospitals can charge what they want,” she told the Boston Globe.

Having an incarcerated family member could lead to negative health outcomes, especially for women, according to a study carried by Medpage Today. RWJF Health & Society Scholars program alumna Hedwig Lee, PhD, found that for women, having an incarcerated family member was associated with an increased likelihood of self-reported diabetes, hypertension, heart attack or stroke, obesity, and fair or poor health.

Many health care providers are not making full use of nurse practitioners (NPs), partly due to the limitations of electronic health records (EHRs) and billing software, according a study from Lusine Poghosyan, PhD, MPH, RN, reports EHR Intelligence. Poghosyan, an RWJF Nurse Faculty Scholar, concluded that because such software fails to recognize NPs as providers of record, it restricts their access to patient data and does not accurately reflect their role in patient care.

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Jan 2 2014
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Cost-Conscious Care Training: A Missing Ingredient in Many Residency Programs

Given near-universal concern over rising health care costs, are new physicians being taught to keep costs in check?

Not enough of them, according to a research letter published in JAMA Internal Medicine in December. Lead author Mitesh Patel, MD, MBA, a Robert Wood Johnson Foundation (RWJF) Clinical Scholar at the University of Pennsylvania, and his research team analyzed survey responses from nearly 300 U.S. internal medicine residency programs. They found that fewer than 15 percent have curricula designed to teach residents to be more cost-conscious.

“Evidence shows that physicians who recently completed residency training practice medicine at a higher cost than more experienced physicians,” Patel and his team wrote. Among 295 programs that responded to a questionnaire on cost-conscious care in a 2012 survey from the Association of Program Directors in Internal Medicine, 14.9 percent indicated that they had a formal curriculum in cost-conscious care; another 49.8 percent responded that they did not, but were working on it.

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Nov 22 2013
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The Imperative to Improve Gallbladder Disease Treatment and Outcomes for Men

SreyRam Kuy, MD, MHS, is an alumna of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars program, and a vascular surgery fellow at the Medical College of Wisconsin.

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Gallbladder disease, and specifically gallstones, can present as pain in the upper abdomen, usually after eating fatty foods.  More severely, gallstones can progress to an inflammation and infection called cholecystitis or cholangitis, both of which require prompt surgical treatment.  Gallbladder disease is an important medical problem as it accounts for $650 billion in health care costs annually in the United States[i], making it the second most costly digestive disease in the country.[ii] With more than 700,000 cholecystectomies (surgeries to remove the gallbladder) performed annually in the United States, gallbladder disease is the number one reason for abdominal surgery in the nation.[i]  Cholecystectomies can be done with traditional surgery (open cholecystectomy) or performed minimally invasively (laparoscopic cholecystectomy).

The National Health and Nutrition Examination Survey estimates 6.3 million men and 14.2 million women in the United States have gallbladder disease.[iii]  It occurs two times more frequently in women than in men.[i][iv] However, during the reproductive years, women have a four-fold higher prevalence of gallstones than men.[iii] As a result of its disproportionate burden on women, gallbladder disease is a critically important topic in women’s health.

There is currently a lack of consensus on whether a patient’s gender affects how soon they get surgery for cholecystitis, what type of surgery they get (open versus laparoscopic cholecystectomy), and how they do after surgery.  My prior work and that of my colleagues has clearly shown that older age negatively impacts how patients do following cholecystectomy.[v] Therefore, to determine whether gender, independent of other factors, affects outcome, we examined a national group of patients hospitalized with cholecystitis over an eight-year period, age-matched to account for the effect of age, and identified gender-based differences in patients hospitalized with cholecystitis. We measured outcomes of women compared with men who underwent cholecystectomy during that admission for cholecystitis, and identified factors associated with outcome.

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Nov 7 2013
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Human Capital News Roundup: Cost of care, cash for clunkers, secure housing, and more.

Around the country, print, broadcast, and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni, and grantees. Some recent examples:

In a New York Times op-ed, Peter Ubel, MD, examines the need for physicians to incorporate the cost of care into treatment conversations with patients. Ubel is an RWJF Generalist Physician Faculty Scholar and an RWJF Investigator Award in Health Policy Research recipient. “[T]he financial burden of paying for medical care can cause more distress in patients’ lives than many medical side effects,” he writes. Read more about Ubel’s views.

In lieu of expanding Medicaid under the Affordable Care Act, Pennsylvania Governor Tom Corbett proposes to direct low-income residents to insurance marketplaces to purchase state-subsidized private plans. In a Philly.com op-ed, David Grande, MD, MPA, discusses whether the plan will cost more than traditional Medicaid. Grande is the associate director of the RWJF Clinical Scholars program and an alumnus of the RWJF Health & Society Scholars program.

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Oct 24 2013
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Human Capital News Roundup: Out-of-pocket medical costs, whooping cough vaccinations, hand sanitizer, and more.

Around the country, print, broadcast, and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni, and grantees. Some recent examples:

RWJF Senior Adviser for Nursing Susan B. Hassmiller, PhD, RN, FAAN, has been elected to the Institute of Medicine, which is “widely held to be one of the highest individual honors in the fields of health and medicine,” Advance for Nurses reports. Read more about Hassmiller’s honor.

Physicians should talk to patients about their potential out-of-pocket medical costs, Peter Ubel, MD, and colleagues urge in a perspective piece in the New England Journal of Medicine. Such potentially avoidable costs "may impair patients’ well-being," Medpage Today reports, and the authors lay out the benefits of discussing this often uncomfortable topic. Ubel is an alumnus of the RWJF Generalist Physician Faculty Scholars program and a recipient of an RWJF Investigator Award in Health Policy Research. Read more about Ubel's argument for cost discussions.

In a study of unintentional fatal drug overdoses in New York City boroughs, RWJF Health & Society Scholars alumna Magdalena Cerda, PhD, MPH, and colleagues found that while heroin overdoses are common in predominantly low-income, high-crime  neighborhoods, fatal overdoses of prescription painkillers are increasingly common in neighborhoods that are largely working-class. NPR and Health Canal are among the outlets to report on the findings.

A 2006 recommendation from the Centers for Disease Control and Prevention that adolescents be vaccinated against pertussis (whooping cough) led not only to a significant increase in vaccination rates among teens, but to a reduction in severe pertussis-related hospitalizations among infants, who often catch the disease from adolescents, Medscape reports. The study was led by RWJF Clinical Scholars alumna Katherine Auger, MD.

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Sep 10 2013
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Consistency and Cost: Why Reducing Variability in Health Care Matters

Mark I. Neuman, MD, MPH, is director of fellowship research and research education for the division of emergency medicine at Boston Children’s Hospital, and an assistant professor of pediatrics at Harvard Medical School. The following blog, adapted from a commentary he co-authored in Pediatrics, originally appeared on Vector, the science and innovation blog of Boston Children's Hospital.

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It’s no secret that the U.S. health care system is in the midst of a financial crisis. As a nation, we spend nearly 18 percent of our Gross Domestic Product on health care, and health care costs remain the largest contributor to the national debt. In 2011 alone, the cost of maintaining the nation’s 5,700 hospitals exceeded $770 billion.

If ever there was a time for a societal mandate to reduce health care costs, that time is now.

It’s widely accepted that one of the first steps to reining in runaway health care costs is reducing variability in the manner in which care is delivered. Well-defined and well-disseminated best practice guidelines can improve the reproducibility and standardization of care. In time, these guidelines may reduce costly and unnecessary tests and hospitalizations, while providing a platform on which to measure and enhance quality. More consistency may also allow providers to be more efficient with their time, space and personnel.

If it’s so costly, why is health care variability so abundant?

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