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VALUE: Americans are lousy patients

Could the problem with America’s health-care system lie not only with the American system but with American patients?”

Americans do not take prescribed medications.  We make poor lifestyle choices.  We demand expensive tests and scans and procedures.  All of these factors contribute to making the American health care system costly while failing to produce very good outcomes, compared to other developed nations.

Source: Freedman, D.H. (2019, July). The worst patients in the world. The Atlantic, 324(1), 28-30.  Click here for text: https://www.theatlantic.com/magazine/archive/2019/07/american-health-care-spending/590623/  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

COST OF HEALTH CARE: Specialist visits to hospitalized Medicare patients cost over $1.3 billion in 2014

What is the cost to the nation to bring in specialists to consult on hospitalized Medicare patients?  This question was studied based on analysis of over 700,000 discharges from over 4500 U.S. hospitals in 2014.  Medicare Part B payment for consultative care was found to represent 41.3 percent of all physician visits during the hospital stays.  The total dollar amount was estimated to be $1.3 billion.  These figures are thought to be underestimates because the patients studied excluded surgical patients and because there was no analysis of downstream costs – such as additional diagnostic testing and follow-up visits.  Characteristics of hospitals which were found to be more likely to have higher rates of consultative visits included those in the Northeast, those in urban areas and teaching hospitals.

Source: Ryskina, K.L., Association of Medicare spending with subspecialty consultation for elderly hospitalized adults. JAMA Network Open, 2(4).  Click here for full text:  https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2729802 Posted by AHA Resource Center (312) 422-2050 rc@aha.org

OPERATING ROOMS: How much major surgery is infrequent? Is there an impact on costs?

Texas hospitals were studied to see how many inpatient major surgical procedures were not performed very often (once a month or less) at each hospital analyzed.  In this study of discharge data from 343 hospitals for the period late 2015 to early 2016, over half (54 percent)  of procedures were found to be uncommon (as defined above) for the hospital where they were performed.  These procedures accounted for 68 percent of inpatient costs.

Source: O’Neill, L. and others. (2017, September). Discharges with surgical procedures performed less often than once a month per hospital account for two-thirds of hospital costs of inpatient surgery. Journal of Clinical Anesthesia. 41, 99-103. Click here for publisher’s website: http://www.jcafulltextonline.com/article/S0952-8180(17)30659-1/fulltext   Posted by AHA Resource Center (312) 422-2050, rc@aha.org

FORECAST: Slowdown in hospital spending growth expected

Implementation of the Affordable Care Act (ACA) is intended to reduce the growth in hospital costs for Medicare patients directly, but this study analyzed the potential for associated decreases in costs due to the “spillover” effects related to lower utilization by non-elderly patients.  The analysis was based on data from 1995 to 2009.  Here is a nice brief summary of how Medicare reimbursement policy has affected costs over time.  This is a direct quote:

…Medicare, when first implemented, spurred broad increases in hospital capacity, with large spending spillovers among the nonelderly.  Our results describe a similar spillover but in reverse.  Medicare’s impact on the broader health system seems to depend on how Medicare pays providers.  In the 1960s and 1970s, Medicare paid hospitals very generously, and so the implementation of Medicare spurred spillover increases in spending and utilization among the nonelderly.  Over the period of our study, Medicare kept tight constraints on hospital payments, and those Medicare constraints appear to have contributed to falling inpatient hospital utilization rates among the nonelderly.  (pages 1592-1593)

The author, who is with RAND, concludes that the changes in Medicare due to the ACA will “slow the growth in hospital spending to a larger degree than has been projected.”

Source: White, C. (2014, October). Cutting Medicare hospital prices leads to a spillover reduction in hospital discharges for the nonelderly. HSR. Health Services Research. 49(5), 1578-1595.  Click here for access to article: http://onlinelibrary.wiley.com/doi/10.1111/1475-6773.12183/pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Physician-owned practices outperformed IDS-owned practices in Midwest study

This study, which I’m going to guess might have been conducted in the Twin Cities–although the location is identified only as a “large upper Midwest community”–surprised the authors.  But, it’s important to note that this study was not based on national data.  The authors examined data from 2008 and 2009 for a total of 273,000 enrollees covered by self-insured health plans.  The point was to compare the performance of medical group practices that were owned by an integrated delivery system (32 practices) versus those that were physician-owned (20 practices).

The findings were that the quality of care was pretty much the same regardless of whether the practices were part of an integrated delivery system or not.  However, the physician-owned practices often outperformed the IDS-owned practices as far as cost savings.  The authors comment that:

  • “This unexpected finding might result from difficulties encountered in creating a uniform culture in the large, complex health care delivery systems and the technology-intense culture of the hospital-based IDS practices.”

Source: Kralewski, J., Dowd, B., and others.  Do integrated health care systems provide lower-cost, high-quality care?  PEJ. Physician Executive.  40(2):14-18, Mar.-Apr. 2014.  Click here for access to this article:  http://www.acpe.org/docs/default-source/survey/do-integrated-health-care-systems-provide-lower-cost-higher-quality-care.pdf?sfvrsn=4  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

HOSPITAL COSTS: Supplies and devices drive up costs

Medical technology in the category “supplies and devices” was found to be the key driver in the increase in cost of inpatient hospital care in this study comparing 2001 and 2006 data from the Agency for Healthcare Research and Quality (AHRQ) Healthcare Cost and Utilization Project State Inpatient Databases.  This category alone accounted for 24.2 percent of the increase in average cost per discharge.  Changes in intensive care unit cost of care accounted for another 17.6 percent.

Source: Maeda, J.L.K., Raetzman, S.O., and Friedman, B.S.  What hospital inpatient services contributed the most to the 2001-2006 growth in the cost per case?  HSR. Health Services Research;47(5):1814-1835, Oct. 2012.  Click here for publisher’s website: http://onlinelibrary.wiley.com/doi/10.1111/hesr.2012.47.issue-5/issuetoc Posted by AHA Resource Center, (312) 422-2050, rc@aha.org