gregmh-blog

[gregmh-blog]

The Future of Medicares Coverage with Evidence Development Policy

The Future of Medicare’s Coverage with Evidence Development Policy https://ift.tt/6PwAm0K That is the title of an interesting panel from USC Schaeffer Center on Coverage with Evidence Development (CED). It includes an interview with Tamara Syrek Jensen, Director, of the Coverage & Analysis Group within the Centers for Medicare & Medicaid Services. After the interview, there is a panel discussion with Darius Lakdawalla of USC, Peter Neumann of Tufts University, and Joshua Makower of Stanford University. What do you think of CMS’s approach to Coverage with Evidence Development? via Healthcare Economist https://ift.tt/pR3j5TF October 21, 2024 at 08:16PM

[gregmh-blog]

Employers Havent a Clue How Their Drug Benefits Are Managed

‘Employers Haven’t a Clue How Their Drug Benefits Are Managed’ https://ift.tt/kWsZECX That is the title of a KFF article published last week. The results are based on KFF’s 2024 Employer Health Benefits Survey. They write: For KFF’s survey of 2,142 randomly selected companies, officials from those with 500 or more employees were asked how much of the rebates negotiated by [pharmacy benefit managers] PBMs returned to the company as savings. About 19% said they received most of the rebates, 27% said some, and 16% said little. Thirty-seven percent of the respondents didn’t know. While a larger percentage of officials from the largest companies said they got most or some of the rebates, the answers — and their contrast with the testimony of PBM leaders — reflect the confusion or ignorance of employers about what their drug benefit managers do, said survey leader Gary Claxton, a senior vice president at KFF, a health information nonprofit that includes KFF Health News. “I don’t think they can ever know all the ways the money moves around because there are so many layers, between the wholesalers and the pharmacies and the manufacturers,” he said… “Employers are generally frustrated by the lack of transparency into all the prices out there,” Claxton said. “They can’t actually know what’s true.” https://ift.tt/MygGO67 Do you think PBMs lead to higher or lower pharmacy cost? via Healthcare Economist https://ift.tt/mpi8udL October 20, 2024 at 05:18PM

[gregmh-blog]

Will ICERs shared savings approach decrease value-based prices most for the most severe diseases?

Will ICER’s ‘shared savings’ approach decrease value-based prices most for the most severe diseases? https://ift.tt/HB8Qc3X That is the title of a paper recently accepted for publication by Value in Health with co-authors Shanshan Wang, Khounish Sharma, Kathryn Spurrier, Robert J. Nordyke. The abstract is below. Objectives To identify the types of disease most likely to be impacted by the Institute for Clinical and Economic Review’s (ICER) shared savings assumptions. Methods For diseases with treatments that were FDA-approved between 2019 and 2023, annual direct and indirect economic burden and characteristics of each disease were extracted from peer-reviewed literature. ICER’s shared savings methodology was applied two ways: 50/50 shared savings and $150,000 cost-offset cap. The primary outcome was the difference in eligible cost savings provided by a hypothetical disease cure under ICER’s 2 shared savings methods. Characteristics of diseases most impacted by these 2 methods were evaluated descriptively. Results FDA approved 260 therapies for 89 unique diseases between 2019 and 2023. Shared savings reduced value of a hypothetical cure for hemophilia A most (50/50 method: -$367,670 per year; cap method: -$585,340 per year), followed by acute hepatic porphyria (50/50 method: -$333,948; cap method: -$517,896) and paroxysmal nocturnal hemoglobinuria (50/50 method: -$291,997; cap method: -$433,993). Compared to diseases with annual burdens

[gregmh-blog]

ISPORs 2024 HEOR Awards

ISPOR’s 2024 HEOR Awards https://ift.tt/9nIc4hx Who won the ISPOR’s 2024 HEOR awards? The list is below. Avedis Donabedian Lifetime Achievement Award: C. Daniel Mullins, PhD; Professor of Practice, Sciences, and Health Outcomes Research and Executive Director of The PATIENTS Program; University of Maryland School of Pharmacy; Baltimore, MD, USA Marilyn Dix Smith Leadership Award: Deborah Marshall, PhD; Professor and Svare Chair in Health Economics, Value, and Impact; University of Calgary; Calgary, Alberta, CA  Bernie O’Brien New Investigator Award: Natalia Kunst, PhD; Senior Research Fellow (Associate Professor); Centre for Health Economics; University of York; York, England, UK Low- and Middle Income Country (LMIC) Health Economics and Outcomes Research Excellence Award: Nelson Rafael Alvis-Guzman, MD, PhD; Professor, Universidad of Cartagena; Cartagena, Colombia Award for Excellence in Health Economics and Outcomes Research Methodology: William Padula, PhD; Assistant Professor, University of Southern California; Los Angeles, CA, USA for the article, “Predicting pressure injury risk in hospitalised patients using machine learning with electronic health records: a US multilevel cohort study;” [BMJ Open. 2024;14(4): e082540.] Award for Excellence in Health Economics and Outcomes Research Application: Inmaculada Hernandez, PhD; Professor, University of California San Diego; San Diego, CA, USA for the article, ”Changes In net prices and spending for pharmaceuticals after the introduction of new therapeutic competition.” [Health Aff (Millwood). 2023;42(8):1062-1070.] Value in Health Paper of the Year Award: Aurélie A. Meunier, MSc; Director, Modelling, HEOR, Putnam; London, England, UK for the article, “Distributional cost-effectiveness analysis of health technologies: data requirements and challenges.” [Value Health. 2023;26(1):60-63.] Value in Health Regional Issues Excellent Article Award: Carleigh B. Krubiner, PhD; Bioethics Lead, Wellcome; London, England, UK for the article, “The value of explicit, deliberative, and context-specified ethics analysis for health technology assessment: evidence from a novel approach piloted in South Africa.” [Value Health Reg Issues. 2023;34:23-30] Congratulations to all the winners! via Healthcare Economist https://ift.tt/SdVGYC2 October 17, 2024 at 01:04AM

[gregmh-blog]

FTC erects additional administrative barriers to hospital mergers

FTC erects additional administrative barriers to hospital mergers https://ift.tt/BKmeq1r Last week, the Federal Trade Commission (FTC) increased their required premerger reporting requirements for any healthcare providers such as hospitals. Healthcare Dive reports: Thursday’s update marks the first time the FTC has revised its Hart-Scott-Rodino Act premerger notification form in nearly 50 years. The law is intended to alert officials of companies’ intent to merge and offer them a short window to determine whether to conduct a more extensive antitrust review. The FTC proposedincreasing documentation for the premerger notification process in June 2023. At the time, the FTC said it was necessary to glean a “basic understanding of key facts” as mergers becameincreasingly complex. Both the FTC and AHA said the final rule, which is set to go into effect 90 days after publication in the Federal Register, is less aggressive compared to the proposed rule. However, the FTC estimates companies will still need to log 105 hours per response to comply with the final rule — an increase of 68 hours compared to current averages. In June, the agency estimated its proposal would require approximately 107 hours per response. Provider groups said the new documentation load would unnecessarily burden companies looking to merge.  Unsurprisingly, the American Hospital Association does not like the rule. Fierce Healthcare reports: The American Hospital Association immediately pushed back on the proposal…saying the increased paperwork would comprise “more information than the agencies could feasibly review in 30 days” and would “function as little more than a tax on mergers.” The full final rule–weighing in at 460 pages–can be found here. What do you think about the FTC’s final rule? via Healthcare Economist https://ift.tt/X8ImoR9 October 16, 2024 at 12:59AM

[gregmh-blog]

Daron Acemoglu Simon Johnson and James Robinson win 2024 Nobel Prize in Economics

Daron Acemoglu, Simon Johnson and James Robinson win 2024 Nobel Prize in Economics https://ift.tt/76BIwSH The Nobel Prize committee summarizes their contributions as follows: Some countries become trapped in a situation with extractive institutions and low economic growth. The introduction of inclusive institutions would create long-term benefits for everyone, but extractive institutions provide short-term gains for the people in power. As long as the political system guarantees they will remain in control, no one will trust their promises of future economic reforms. According to the laureates, this is why no improvement occurs. However, this inability to make credible promises of positive change can also explain why democratisation sometimes occurs. When there is a threat of revolution, the people in power face a dilemma. They would prefer to remain in power and try to placate the masses by promising economic reforms, but the population are unlikely to believe that they will not return to the old system as soon as the situation settles down. In the end, the only option may be to transfer power and establish democracy. One book of interest (one I just ordered) is Why Nations Fail: The Origins of Power, Prosperity, and Poverty by Acemoglu and Robinson. Alex Tabarrok of Marginal Revolution called Acemoglu: …the Wilt Chamberlin of economics, an absolute monster of productivity, who racks up the papers and the citations at nearly unprecedented rates. According to Google Scholar he has 247,440 citations and an H-index of 175, which means 175 papers each with more than 175 citations. The authors cite the importance of institutions looking at North and South Korea and also cities, like Nogales, than span an international border. The N.Y. Times writes: As an example, Dr. Acemoglu and Dr. Robinson point to the city of Nogales, which straddles the border between Mexico and Arizona. Northern Nogales is more affluent than its southern portion, despite a shared culture and location. The driver of differences, the economists argue, is the institutions governing the two halves of the city. It’s interesting what different media outlines choose to highlight for this award. Some focus on the research. Some focus on the value the researchers placed on democracy. Another article focused the fact the all three laureates are immigrants to the US. See more coverage here: NPR, WSJ, Marginal Revolution, Nobel. via Healthcare Economist https://ift.tt/SVKXMmH October 14, 2024 at 03:54PM

[gregmh-blog]

What is microRNA and why did its discovery merit this years Nobel Prize for Medicine?

What is microRNA and why did its discovery merit this year’s Nobel Prize for Medicine? https://ift.tt/qbXOzJF This year, the Nobel Prize in medicine went to Victor Ambros, currently a Professor of Natural Science at the University of Massachusetts Medical School, and Gary Ruvkun, a Professor of Genetics at Harvard Medical School. The two men won the award for their discovery of microRNA. One of the key questions of science is figuring how how can we have such differentiated cells–brain cells, muscle, bone, nerve–when all cells have the same DNA. The key is gene regulation where each cell only selects the DNA instructions which are relevant to its particular function. A key question is how this gene regulation takes place. Victor Ambros and Gary Ruvkun were interested in how different cell types develop. They discovered microRNA, a new class of tiny RNA molecules that play a crucial role in gene regulation. Their groundbreaking discovery revealed a completely new principle of gene regulation that turned out to be essential for multicellular organisms, including humans. It is now known that the human genome codes for over one thousand microRNAs. Their surprising discovery revealed an entirely new dimension to gene regulation. MicroRNAs are proving to be fundamentally important for how organisms develop and function… Many of the initial discoveries around microRNA were made through research on a 1 mm long roundworm known as C. elegans. They found that very small sections of RNA–now known as microRNA–don’t code for specific proteins but rather inhibit production of specific proteins. The implications of microRNA in the real world are vast. We know from genetic research that cells and tissues do not develop normally without microRNAs. Abnormal regulation by microRNA can contribute to cancer, and mutations in genes coding for microRNAs have been found in humans, causing conditions such as congenital hearing loss, eye and skeletal disorders. You can read more about microRNA as well as Nobel laureates Ambros and Ruvken here. via Healthcare Economist https://ift.tt/CSRHWkX October 12, 2024 at 12:41AM

[gregmh-blog]

How long does it take for new pharmaceuticals to reach low and middle-income countries?

How long does it take for new pharmaceuticals to reach low and middle-income countries? https://ift.tt/1uCmHyL That is the question considered by Wouters and Kuha (2024) in a recent Health Affairs article. The authors use IQVIA data between 1982 and 2024 on the timing of drug launches and estimate median delay times using a Kaplan Meier estimates. They find that: From the first launch globally, the median time to availability was 2.7 years for high-income countries, 4.5 years for upper-middle-income countries, 6.9 years for lower-middle-income countries, and 8.0 years for low-income countries. The gap between richer (high- and upper-middle-income) and poorer (lower-middle- and low-income) countries remained largely unchanged over time. Moreover, the authors also find that about three-quarters (74%) of first launches occurred in eight countries with most first launches occurring (in order) in: US, Netherlands, Sweden, Switzerland, UK, France, Germany, and Japan. You can read the full article here. via Healthcare Economist https://ift.tt/IF3XiLd October 10, 2024 at 09:10PM

[gregmh-blog]

Family-Friendly Destinations: Fun Adventures for All Ages

Family-Friendly Destinations: Fun Adventures for All Ages https://ift.tt/Mq4Rp1T Family vacations are an opportunity to create lasting memories and bond with loved ones while exploring new destinations together. From theme parks to natural wonders, family-friendly destinations offer a wide range of fun adventures suitable for all ages. Here’s a look at some of the top family-friendly destinations around the world: Disneyland Resort: As the quintessential family destination, Disneyland Resort in California offers a magical experience for visitors of all ages. From thrilling rides and enchanting shows to character meet-and-greets and immersive themed lands, Disneyland Resort promises endless fun and excitement for the whole family. Orlando, Florida: Known as the “Theme Park Capital of the World,” Orlando is home to a plethora of family-friendly attractions, including Walt Disney World Resort, Universal Orlando Resort, and SeaWorld Orlando. With thrilling roller coasters, interactive exhibits, and live entertainment, Orlando offers something for everyone in the family to enjoy. Yellowstone National Park: For families who love the great outdoors, Yellowstone National Park in Wyoming, Montana, and Idaho is the perfect destination. Home to geothermal wonders, towering waterfalls, and abundant wildlife, Yellowstone offers endless opportunities for hiking, wildlife watching, and exploring the natural beauty of the American West. Grand Canyon National Park: Marvel at the awe-inspiring beauty of one of the world’s most iconic natural wonders at Grand Canyon National Park in Arizona. Families can hike along scenic trails, take a helicopter tour over the canyon, or embark on a river rafting adventure down the Colorado River for an unforgettable experience. London, England: With its rich history, iconic landmarks, and family-friendly attractions, London is an ideal destination for families looking to explore Europe. From visiting the Tower of London and Buckingham Palace to riding the London Eye and exploring the Harry Potter Studio Tour, London offers a wealth of cultural experiences and adventures for all ages. Tokyo, Japan: Immerse yourself in the vibrant culture and endless entertainment options of Tokyo, Japan’s bustling capital city. From exploring the historic temples of Asakusa and shopping in the trendy neighborhoods of Shibuya and Harajuku to visiting iconic attractions like Tokyo Disneyland and Tokyo DisneySea, Tokyo offers a perfect blend of traditional and modern experiences for families. Costa Rica: For families seeking adventure in a tropical paradise, Costa Rica offers an abundance of outdoor activities and eco-friendly attractions. From zip lining through the rainforest canopy and surfing on pristine beaches to exploring wildlife-rich national parks and soaking in natural hot springs, Costa Rica provides an unforgettable adventure for families of all ages. Paris, France: Experience the magic of the City of Light with a family vacation to Paris, France. Explore iconic landmarks like the Eiffel Tower, Notre-Dame Cathedral, and Louvre Museum, and indulge in delicious pastries and cuisine at charming cafes and bistros. With its charming neighborhoods, beautiful parks, and world-class museums, Paris offers endless opportunities for family-friendly fun and adventure. From thrilling theme parks to natural wonders and cultural attractions, family-friendly destinations around the world offer a wide range of adventures for all ages to enjoy. Whether exploring the great outdoors, immersing in vibrant cultures, or embarking on thrilling adventures, family vacations provide an opportunity for bonding and creating cherished memories that will last a lifetime.     via Greg Harmeling | Travel https://ift.tt/mMkyKtT October 09, 2024 at 07:20AM

[gregmh-blog]

Coping with Stress: Strategies for Better Mental Health

Coping with Stress: Strategies for Better Mental Health https://ift.tt/BtRj73s In today’s fast-paced world, stress has become an inevitable part of daily life for many people. Whether it’s work-related pressure, family responsibilities, or personal challenges, managing stress is essential for maintaining good mental health. Coping with stress effectively can help prevent a range of mental health issues, including anxiety and depression. Here are some strategies for better mental health: Identify Triggers: The first step in coping with stress is to identify the triggers that contribute to your feelings of stress and anxiety. Keep a journal to track your stressors and note how you react to them. Work deadlines, relationship conflicts, financial worries, and health concerns are common stressors. Once you identify your triggers, you can develop strategies to manage them more effectively. Practice Relaxation Techniques: Relaxation techniques such as deep breathing, meditation, and progressive muscle relaxation can help calm the mind and body and reduce feelings of stress. Make time for relaxation each day, even if it’s just a few minutes of deep breathing exercises or a short meditation session. These techniques can help you feel more centered and grounded, even in the midst of a stressful situation. Stay Active: Regular physical activity is one of the most effective ways to reduce stress and improve mental health. Exercise releases endorphins, chemicals in the brain that act as natural painkillers and mood elevators. Aim for at least 30 minutes of moderate exercise most days of the week. Activities such as walking, swimming, cycling, and yoga are excellent choices for reducing stress and improving overall well-being. Maintain a Healthy Lifestyle: Eating a balanced diet, getting enough sleep, and avoiding excessive alcohol and caffeine consumption are important factors in managing stress and maintaining good mental health. Make healthy food choices, prioritize sleep, and limit your intake of stimulants and depressants to support your body’s ability to cope with stress. Seek Social Support: When you’re feeling overwhelmed, don’t hesitate to reach out to friends, family members, or mental health professionals for support. Talking to someone you trust about your feelings can help alleviate stress and provide perspective on your situation. Joining a support group or participating in community activities can also help you feel connected and supported during difficult times. Set Boundaries: Learn to say no to activities and commitments that add unnecessary stress to your life. Setting boundaries and prioritizing your own needs is essential for protecting your mental health. Practice assertiveness skills and communicate your limits to others in a respectful but firm manner. Practice Self-Care: Make self-care a priority in your daily routine. Engage in activities that bring you joy and relaxation, whether it’s reading a book, taking a bubble bath, or spending time in nature. Taking care of yourself physically, emotionally, and spiritually is essential for coping with stress and maintaining overall well-being. In conclusion, coping with stress is an essential skill for maintaining good mental health in today’s busy world. By identifying your stress triggers, practicing relaxation techniques, staying active, maintaining a healthy lifestyle, seeking social support, setting boundaries, and practicing self-care, you can effectively manage stress and improve your overall quality of life. Remember that it’s okay to ask for help when you need it, and prioritize your own well-being above all else.   via Greg Harmeling | Healthcare & Medicine https://ift.tt/6QyN4Op October 09, 2024 at 06:51AM

[gregmh-blog]

Links

Links https://ift.tt/Wg1YCLe When Interest Rates Go Low, Should Public Debt Go High? ROI for SDOH interventions. Consumption responses to sweetened beverage taxes. Do health care quality improvement policies work for all? “Provider respondents reported spending time equivalent of more than 100 000 full-time registered nurses per year on prior authorization. ” via Healthcare Economist https://ift.tt/xW8fhPp October 09, 2024 at 12:38AM

[gregmh-blog]

Do wait times for breast cancer surgery in the UK vary by socioeconomic status?

Do wait times for breast cancer surgery in the UK vary by socioeconomic status? https://ift.tt/9UrSXN6 One of the key benefits of the UK health system is that everyone has access to care. However, is care provided equally to all people? A paper by Matias et al. (2024) examines whether or not there are any inequalities in waiting times by socioeconomic status for women diagnosed with breast cancer in England and who require either a mastectomy or breast conserving surgery.  The authors use data from Hospital Episode Statistics (HES) between 2015 and 2022 to measure wait time between a specialist’s diagnosis and time to surgery. Inequalities are measured based on income deprivation by geographic area [specifically, the Lower Super Output Area (LSOA)]. The analysis controls for a variety of patient characteristics as well as hospital fixed effects. Using this approach, they find that: In the pre-COVID-19 period, we do not find statistically significant associations between income deprivation in the patient’s area of residence and waiting times for surgery. In the COVID-19 period, we find that patients living in the most deprived areas have longer waiting times by 0.7 days (given a mean waiting time of 20.6 days). While we do see inequalities appear in the post-COVID period, the difference is fairly modest (about 1 day). Further, other studies (e.g., Saito et al. 2021) found little difference in cancer surgery wait times by socio-economic status (although this was pre-COVID levels). In short, NHS still appears to be highly egalitarian, but there are the beginnings of some worrying trends. via Healthcare Economist https://ift.tt/xW8fhPp October 08, 2024 at 01:44AM

[gregmh-blog]

When should we trust AI more than physicians?

When should we trust AI more than physicians? https://ift.tt/vJzCkSI The time may be fast approaching. A paper by Goh et al. 2024 sampled 50 physicians and examined which was better: physicians alone, physicians with access to GPT-4, or GPT-4 alone. The primary outcome was how well each group diagnosed the case (i.e., diagnostic reasoning score). The authors found that: The median diagnostic reasoning score per case was 76.3 percent (IQR 65.8 to 86.8) for the GPT-4 group and 73.7 percent (IQR 63.2 to 84.2) for the conventional resources group, with an adjusted difference of 1.6 percentage points (95% CI −4.4 to 7.6; p=0.60). The median time spent on cases for the GPT-4 group was 519 seconds (IQR 371 to 668 seconds), compared to 565 seconds (IQR 456 to 788 seconds) for the conventional resources group, with a time difference of −82 seconds (95% CI −195 to 31; p=0.20). GPT-4 alone scored 15.5 percentage points (95% CI 1.5 to 29, p=0.03) higher than the conventional resources group. Conclusions and Relevance: So not only was GPT-4 faster, and better than physicians alone, it was also better than physicians when they had access to GPT-4. The authors summarize as follows: In a clinical vignette-based study, the availability of GPT-4 to physicians as a diagnostic aid did not significantly improve clinical reasoning compared to conventional resources, although it may improve components of clinical reasoning such as efficiency. GPT-4 alone demonstrated higher performance than both physician groups, suggesting opportunities for further improvement in physician-AI collaboration in clinical practice. HT: To Ethan Mollick. via Healthcare Economist https://ift.tt/L2HuhEW October 02, 2024 at 07:05PM

[gregmh-blog]

Why arent people using Paxlovid?

Why aren’t people using Paxlovid? https://ift.tt/myJ9iAe Paxlovid (nirmatrelvir-ritonavir) is effective at preventing hospitalization and death from COVID-19, but few people use it. A paper by SteelFisher et al. (2024) surveyed 1,430 American adults to find out why. Their survey revealed patients had a lack of awareness of the treatment as well as misinformation about the treatment (among those who were aware of it). Specifically: A majority of respondents (85 percent) had no or low awareness of Paxlovid, including 31 percent who had never heard of it. Even among those who were aware of the drug, many held misperceptions about its effectiveness (39 percent), adverse effects (86 percent), and requisite timing (61 percent) that could lead to underuse. Lower awareness and misperceptions were more common among medically vulnerable and disadvantaged populations who might benefit most from Paxlovid access, including adults unvaccinated against COVID-19, those with lower levels of education, and Black and Hispanic or Latino adults. https://ift.tt/NqrWc3z You can read the full paper here. via Healthcare Economist https://ift.tt/d40H1Pz October 01, 2024 at 01:55AM

[gregmh-blog]

Links

Links https://ift.tt/rgvb1je Tyler Cowen on the price of Ozempic. Problems with the OMB’s social welfare function. Link between alcohol and cancer. Disparities in the rural-urban life expectancy. Why will Part D plans “…move drugs that are selected for [MFP] negotiation into a higher cost-sharing tier”? via Healthcare Economist https://ift.tt/Uu6dtiE September 27, 2024 at 06:41PM

[gregmh-blog]

What are the new CMS Star Ratings Measures for 2025?

What are the new CMS Star Ratings Measures for 2025? https://ift.tt/LDEhvl6 My FTI colleagues Mark Van Ert and Krunal Patel summarize some of the new quality measures that will be incorporated into the 2025 CMS Star Ratings that are used to evaluate Medicare Advantage (MA) plans. The CMS Star Ratings are very important as CMS payments to MA plans is expected to increase by 3.7% or $16 billion between 2024 and 2025. Van Ert and Patel describe the CMS ratings cycle as follows: Star ratings are determined through a four-year process. The first year is the measurement year (“MY”), in which plans collect performance data for various measures, though specific timing can vary — for instance, Consumer Assessment of Healthcare Providers and Systems (“CAHPS”) surveys are conducted at the start of the second year. During the second year — the reporting year (“RY”) — the CMS evaluates the previous year’s performance data. The third year is the Star Year (“SY”), which is when the Star Ratings are officially assigned. In the fourth year — the quality bonus payment (“QBP”) year.4 https://ift.tt/8lVhFWr Which are the new measures to be included for 2025? These include: Concurrent Use of Opioids and Benzodiazepines. Evaluates the simultaneous prescription of opioids and benzodiazepines, which significantly increases the risk of respiratory depression and fatal overdoses Use of Multiple Anticholinergic Medications in Older Adults. Measure focuses on the risks associated with older adults taking multiple anticholinergic medications concurrently, which can lead to cognitive decline. Kidney Health for Patients with Diabetes. Measures the percentage of members aged 18-85 with diabetes (type 1 and type 2) who received a kidney health evaluation, which includes evaluations of estimated glomerular filtration rate (eGFR) and a urine albumin-creatinine ratio (uACR). Improving/Maintaining Physical Health. Measures overall physical functioning based on the Medicare Health Outcomes Survey. Improving/Maintaining Mental Health. Evaluates self-reported beneficiary data regarding emotional well-being, such as the frequency of feelings of depression, anxiety and other mental health conditions based on the Medicare Health Outcomes Survey. Full technical specifications of all CMS Star Rating quality measures can be found here. via Healthcare Economist https://ift.tt/1sun32b September 26, 2024 at 05:25PM

[gregmh-blog]

What share of physicians are integrated within hospital systems?

What share of physicians are integrated within hospital systems? https://ift.tt/KjAbpZP This questions may be harder to answer than it may seem. While some physicians are fully independent, and others are full employees, other physicians can be affiliated with hospitals, without being hospital-employed. There are various approaches for measuring whether a physician is integrated within a hospital system: Basic TIN-based measure. The standard approach to identifying whether a physician is integrated into a hospital is to examine whether that physicians billed exclusively or primarily using a a tax identification number (TIN) that belongs to a hospital or a health system that operates hospitals (aka a “hospital-related TIN”)–those that are are deemed to be integrated. This approach is useful but relies on a comprehensive set of hospital TINs; without a comprehensive list, there are many false positives. Service location measure. A second approach uses examines how often outpatient services are performed in hospital-based outpatient departments versus physician offices. Physicians who perform all or most outpatient services in an hospital outpatient location are determined to be integrated. However, false positive can occur for nonintegrated physicians who use hospital outpatient facilities for selected procedures (e.g., surgeries); false negatives occur for integrated physicians who often provide outpatient services in a physician’s office. Affiliation based approaches. These approaches rely on the physicians affiliation rather than a billing based or place of service based approach to measure integration. Common data sources used to identify affiliation include a proprietary database from IQVIA (formerly SK&A); and the Compendium of U.S. Health Systems prepared by the Agency for Healthcare Research and Quality (AHRQ). “Advanced” TIN measure. This approach was proposed in a paper by Luo et al. (2024) and is similar to the Basic TIN-based measure as it relies on 3 steps: “(i) a multistep search for hospital-related TINs using multiple sources for these TINs ; (ii) using Medicare data to determine the TINs that physicians use to bill for services; and (iii) identifying as integrated those physicians who bill Medicare primarily (75% or more) or exclusively using hospital-related TINs.” The authors also examine whether hospitals have a controlling interest in the physician TIN (based on IRS data), which they call they “network” approach’; using data from AHA surveys to link hospitals and physicians (“indirect” approach). Using these approaches, Luo and co-authors find that the number of physicians who are integrated into hospitals is rising over time. The “Direct TIN match”–which is analogous to the Basic TIN-based measure describe above, shows that the share of physicians integrated into hospitals increased between 1999 and 2019. However, this figure peaks at just over 25%. If we bring in Luo et al.’s other methods for measuring physician vertical integration, we not only find that the share of physicians integrated into hospital-based systems is much higher, but the trend is much steeper. Specifically, the authors find that: There was a steady increase in percent of physicians integrated from 19.5% of physicians in 1999 to 24.6% in 2005 and 43.5% in 2019. https://ift.tt/DrwxRXN You can read more details on this study here. A methods summary figure is below. https://ift.tt/DrwxRXN The views expressed herein are those of the author and not necessarily the views of FTI Consulting, Inc., its management, its subsidiaries, its affiliates, or its other professionals. via Healthcare Economist https://ift.tt/1sun32b September 25, 2024 at 11:09PM