“Hypertension affects 46% of the adult population in the United States and is a leading risk factor for disability, cardiovascular morbidity, and mortality. Although treatment reduces morbidity and mortality, approximately 17% to 20% of patients using antihypertensive medications have apparent treatment-resistant hypertension, defined as inadequately controlled blood pressure (BP) with 3 antihypertensive medications, including a diuretic, or a requirement for at least 4 antihypertensive medications to achieve adequate control. Compared with patients who require fewer antihypertensive agents, those with apparent treatment-resistant hypertension are at increased risk for cardiovascular and all-cause mortality, independent of BP control. High-quality evidence supports the use … Read More
All posts by Anupam
Here is this week’s refresh of the excess mortality count from the CDC (last updated December 23). The federal agency identified over 387,000 excess deaths across the country since the start of this year (about 20 thousand more than last week’s estimate). The overall excess mortality rate rose from 12.0% last week to 12.3% this week. Data from CDC’s National Center of Health Statistics, updated December 23, 2020
“[Introduction] In this study, we aim to build on the existing research by analyzing the association of the adoption of EPCS [electronic prescribing of controlled substances] with opioid prescribing across the United States. We specifically examine trends in the adoption and use of EPCS and 2 measures of opioid prescribing across the United States from 2010 to 2018. In doing so, we aim to provide policy makers, prescribers, and patients with evidence of the association of the use of EPCS with the opioid epidemic. [..] [Methods] [..] We used data from annual reports published by Surescripts, a near-monopoly supplier of … Read More
“[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
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