“To help establish ACOs in more areas of the country, the Centers for Medicare and Medicaid Services (CMS) developed the ACO Investment Model (AIM) to provide participating ACOs with up-front and ongoing monthly payments over 24 months to fund ACO infrastructure investments and staffing. As part of the Medicare Shared Savings Program (SSP), the payments were to be recouped through any shared savings earned by the ACOs that sufficiently decreased costs relative to a financial benchmark, as specified by SSP regulations. Forty-one new SSP ACOs, primarily located in rural and underserved health care markets, joined AIM in 2016. [..] A … Read More
All posts by Anupam
“Skin cancers represent the most common malignant neoplasms in the United States and account for more than $8 billion of health expenditure annually. Because the US population is aging, the incidence of skin cancers is increasing. In addition to topical chemotherapy, procedural treatments for skin cancers include Mohs micrographic surgery (MMS), simple surgical excision, and shave excision as well as destructive modalities including laser surgery, electrosurgery, and cryosurgery. [Results] From 2012 to 2017, MMS services had the highest mean payment ($378.71; range, $41.24-$466.93) and shave excisions had the lowest ($70.99; range, $15.58-$135.24). During this period, payment rates declined for each … Read More
“If public health officials want to get people to wear masks to curb the spread of Covid-19, they might take a lesson what is now a widely accepted aspect of American life: buckling up. [..] Fred Rivara, an injuries expert and professor of pediatrics at the University of Washington, remembers an unsubstantiated claim that any positive effects would be cancelled out by people dying when they couldn’t escape fiery cars. [..] After years of pressure, President Johnson signed legislation in 1966 that required seat belts in all passenger vehicles and created a national traffic safety agency. Rivara credits science for … Read More
This week’s refresh of the excess mortality count from the CDC (last updated November 4). The federal agency identified over 298,000 excess deaths across the country since the start of this year (about 4,000 more than last week’s estimate). The overall excess mortality rate decreased from 11.3% last week to 11.2% this week. Data from CDC’s National Center for Health Statistics, updated November 4, 2020
“In their 2019 book, The Misinformation Age, Cailin O’Connor and James Owen Weatherall explain how false beliefs persist and spread. They emphasise the social character of fake news. The connections between us in groups or networks enable the propagation of misleading evidence as well as true beliefs. Models of communication show the importance of trust in shaping the spread of beliefs. The greater the distrust among those with different views, the greater the risk of permanent polarisation. We are also prey to conformity bias—a desire to agree with others and to trust the judgments of others. Our predilection to conformity … Read More
“We assessed the clinical effectiveness and cost-effectiveness of a brief falls-risk screening questionnaire, sent by mail, followed by an exercise program or a multifactorial intervention targeted to persons at increased risk for falls, as compared with no screening in community-dwelling older people. All participants received advice by mail. [Methods] [..] This was a three-group, pragmatic, cluster-randomized, controlled trial with parallel economic evaluation that included 63 general practices in seven rural and urban regions in England. Drawing from their patient registries, general practices contacted community-dwelling persons 70 years of age or older who were living in their own homes. Residents of … Read More
“Cardiac rehabilitation integrates patient education, behavior modification, and exercise. The traditional in-person, center-based cardiac rehabilitation model has been shown to reduce all-cause hospital readmissions by 31% and all-cause mortality by 24% over 1 to 3 years. For patients with a recent acute myocardial infarction, coronary revascularization, or acute heart failure exacerbation, cardiac rehabilitation reduces spending on future hospitalizations by approximately $900 per patient over 21 months. Yet uptake has been disappointing. Even before COVID-19, less than a third of eligible patients attended a single session. Supply-and-demand challenges have impeded uptake, and both must be addressed to expand this life-saving therapy. … Read More
“In 2017, approximately 47,600 individuals in the US died from an opioid overdose, and morbidity and mortality from the opioid epidemic continues to accrue. [..] To fully estimate the epidemic’s scope and the impact of interventions to address it, it is essential to consider differences in individuals using prescription opioids vs heroin or illicit fentanyl, the increased risk of second overdose in people who have experienced an initial overdose, and the evolving time-dependent nature of the epidemic. Despite the contributions of prior models of the epidemic, most have not incorporated these elements, nor have they accounted for the more than … Read More
On October 27th, the United States Preventive Services Task Force (USPSTF) issued a draft recommendation to extend colorectal cancer screening to individuals 45-49 years of age (Grade B recommendation). Assuming the public comment period does not uncover any surprises, the recommendation will be finalized by the end of the year. The recommendation includes the group’s modeling of benefits and harms with the proposed screening strategy. Compared to our current screening recommendations (screening individuals 50-75 years of age), the new recommendation will add 22-27 additional life-years at a cost of 0.2-2 additional gastrointestinal and cardiovascular complications per 1000 individuals screened. Given … Read More
“Population health management is a team-based approach in which nonclinical staff members identify and reach out (typically outside face-to-face visits) to specific groups of patients with unmet preventive and chronic condition care needs. Population health management has been increasing across primary care and is associated with improved outcomes, but to our knowledge, it has not previously been used for patients with overweight or obesity. The purpose of this trial was to examine whether integrating an online weight management program with population health management support would enhance its effectiveness and lead to greater weight loss at 12 months among primary care … Read More