Health and Medical News and Resources

General interest items edited by Janice Flahiff

What Does the Dartmouth Atlas Have to Say About the Politics of the ACA?

From the 27 December 2012 article at The Health Care Blog by Anubhav Kaul, MD, Peter Bhandari, and Thom Walsh, PhD

…The Dartmouth Atlas Project is an online database which collects Medicare spending and utilization data from around the country. Information gathered from the database has shown immense variation in the way medical resources are utilized by even similar regions, communities, and health care organization. Evidence has repeatedly shown that, from a population perspective, areas that spend more on medical care do not consistently benefit from increased quality of care or patient wellbeing. Variation in the type of care delivered can be attributed to diverse incidence and prevalence of disease severity or the type of care a well- informed patient chooses. Variation in health care delivery is thus omnipresent and expected, because every patient is unique and medical innovation presents a growing number of care options to choose from….

[The interactive map may be found here]

The top ten Republican states have higher Medicare spending than the top ten Democratic states. The rate of hospitalization and surgical procedures are also higher for Republican states. If we investigate a procedure like percutaneous coronary interventions (PCI), the Republican states are performing more PCI procedures with equal mortality benefit compared to Democratic states. The evidence of variation in cost and utilization is a strong indication of inconsistency and inefficiency in the care delivery process. Are the Republican states providing better care by providing more care? We cannot find evidence of for such an assertion. Nor do we find evidence of harm occurring from a lack of utilization to individuals residing in democratic states. Six of the ten Republican states sued the federal government over the individual mandate and Medicaid expansion earlier this year (Utah, Alabama, Louisiana, Texas, Georgia, and Nebraska), compared to only one democratic majority state (Maine). Yet the Republican states have a higher average of uninsured people, thus inhibiting a greater percentage of their citizens from accessing preventive healthcare….

Read the entire article here

December 28, 2012 Posted by | health care | , , , , | Leave a comment

Doctors call for evidence-based appropriateness criteria for elective procedures

Hip-Joint, total Replacement, insertion withou...

From the 26 December 2012 EurkAlert article

In New England Journal of Medicine, Weill Cornell researchers advocate the development and implementation of criteria for elective procedures, with joint replacement surgery as an example

Many of the most common inpatient surgeries in the United States are performed electively. These surgeries are expected to significantly increase with the enactment of the Affordable Care Act. In a new perspectives article, published in the Dec. 27 edition of The New England Journal of Medicine, a team of Weill Cornell Medical College researchers are recommending the nation’s health care leaders and medical community join forces to establish evidence-based appropriateness criteria to determine which patients are most in need of elective procedures, such as joint replacement surgery, to slow the projected surge in demand and rising costs. Currently, there are no appropriateness criteria for most of the common elective procedures.

Total joint replacement surgeries — such as hip and knee replacements — are among the most common inpatient surgeries in the United States and are used as a prime example of elective surgeries that could benefit from implementing appropriateness criteria. Patients requesting joint replacement surgery vary from those disabled by their joint arthritis to those who do so to maintain an active lifestyle without pain. Total joint replacement surgeries are expected to quadruple over the next two decades in the United States, contributing to the rise in health care costs and increasing the risk of medical complications.

“The purpose behind establishing criteria is to use evidence-based metrics to prioritize patients most in need,” says lead author Dr. Hassan M.K. Ghomrawi, assistant professor of public health at Weill Cornell and an outcomes research scientist at Hospital for Special Surgery. “We don’t want to sacrifice necessary care when thinking of cost-containment.”..

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Current cost-containment proposals focus primarily on payment reforms, such as pay-for-performance and bundled payments. But in their perspective, titled “Appropriateness Criteria and Elective Procedures — Total Joint Arthroplasty,” the authors posit that developing and implementing evidence-supported criteria that identifies the appropriate patients who are most likely to benefit from surgery will also slow the growing costs of these procedures.

“Identifying patients who are likely to benefit the most from these procedures could help to combat increasing health care costs while enhancing access and quality,” says senior author Dr. Alvin I. Mushlin,…

Read the entire article here

December 28, 2012 Posted by | health care | , , | Leave a comment

   

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