“[Introduction] Hip and knee replacements are the most common inpatient surgical procedures for Medicare beneficiaries in the US, with substantial cost and variability in care during the hospitalization and through postacute care. Most hospitals are participating in a bundled payment program for hip or knee replacement surgery, such as the comprehensive care for joint replacement model, with the goal of reducing unnecessary postacute care and rehospitalizations. Patients discharged from hospitals to facilities have higher costs and not necessarily improved outcomes, and payment policies have not resulted in substantially reduced rehospitalizations. [..] Behavioral science has revealed that humans have predictable biases … Read More
All posts by Anupam
Here is this week’s refresh of the excess mortality count from the CDC (last updated December 16). The federal agency identified over 367,000 excess deaths across the country since the start of this year (about 21 thousand more than last week’s estimate). The overall excess mortality rate rose from 11.6% last week to 12.0% this week. Data from CDC’s National Center of Health Statistics, updated December 16, 2020
“The QPP [Medicare Quality Payment Program] has 2 tracks: (1) the Merit-Based Incentive Payment System (MIPS), which is the default track, and (2) the advanced alternative payment models track, which includes novel payment models like accountable care organizations (ACOs). Both tracks reward or penalize clinicians based on their performance on cost and quality measures. The initial results on the MIPS, which accounted for 95.7% of participating clinicians in the first year (2019), were disappointing from a social equity and quality improvement perspective. Studies that examined publicly reported data from Centers for Medicare & Medicaid Services (CMS) showed that clinicians who … Read More
“Studies of excess deaths in the United States, as well as analyses published by the media, have calculated the absolute excess number of deaths by using data from the Centers for Disease Control and Prevention (CDC) on total deaths, by week, in 2020 compared with deaths during the same week in recent years (2014/2015 to 2019). These estimates did not account for population changes during the comparison period, although the U.S. population is in the midst of a major transition driven by aging of the Baby Boomers (that is, the 1945 to 1965 birth cohorts). Of importance, the population aged … Read More
Here is this week’s refresh of the excess mortality count from the CDC (last updated December 9). The federal agency identified over 346,000 excess deaths across the country since the start of this year (about eleven thousand more than last week’s estimate). The overall excess mortality rate rose slightly from 11.5% last week to 11.6% this week. Data from CDC’s National Center of Health Statistics, updated December 9, 2020
“[Introduction] [..] There are a total of 761 Medicare Severity–DRGs [Diagnosis Related Group], which are organized into families (eg, heart failure) with 2 or 3 levels, most commonly with a base Medicare Severity–DRG (hereafter referred to as DRG) and 1 or 2 higher-complexity DRGs. Assignment to these latter DRGs occurs if 1 or more complications or comorbidities (CC) or major complications or comorbidities (MCC) are present. Of importance, hospital payment for DRGs with CCs or MCCs is often substantially greater. For example, payment for DRG 291 (heart failure and shock with MCC) is approximately twice that for DRG 293 (heart … Read More
“Physician-assisted death (PAD) is now legal in 9 US states and the District of Columbia and is under consideration in 17 more. Legalization generally follows ballot, as opposed to legislative, initiatives in the setting of extensive marketing efforts by advocacy groups focused on convincing the public that they face a future of unbearable suffering if PAD is not available. Whereas fear of unbearable suffering at the end of life is a commonly expressed concern, most Americans should be able to expect reliable and expert relief of suffering as a result of medical advances in geriatrics and palliative care. The fact … Read More
Here is this week’s refresh of the excess mortality count from the CDC (last updated December 2). The federal agency identified over 335,000 excess deaths across the country since the start of this year (about three thousand more than last week’s estimate). The overall excess mortality rate dropped slightly from 11.6% last week to 11.5% this week. Data from CDC’s National Center of Health Statistics, updated December 2, 2020
“the what-I-wish-I-knew list about caring for my aging parents, medically and otherwise. [..] If you have the feeling that something may be an issue for your aging parents, it is almost definitely an issue. Do not put off something because it is likely to resolve itself; it will likely get worse, not better. As a pediatrician, I find myself frequently recommending to many of my patients and their parents to monitor their current condition and let me know if things change or get worse. This is in general the wrong approach for aging parents. It is better to deal with … Read More
“The standard curative treatment for sickle cell disease is allogeneic hematopoietic stem-cell transplantation. Matched sibling donor transplantation is curative in more than 90% of patients, but limitations include a higher risk of complications in older patients, a risk of severe graft-versus-host disease (GVHD), and lack of an available matched sibling in approximately 80% of cases. [..] In utero and during infancy, the abnormal HbS protein is produced at very low levels because the erythrocytes have not yet shifted from expression of the γ-globin gene (HBG), which encodes the developmentally regulated component of HbF, to expression of the HBB gene, a … Read More