“As the toll from coronavirus disease 2019 (COVID-19) mounted in the pandemic’s early months, it soon became apparent that people with diabetes and hypertension, among other factors, were at heightened risk of severe disease. But obesity didn’t attract as much attention, according to nutrition scholar Barry Popkin, PhD, of the University of North Carolina (UNC) at Chapel Hill. [..] If you contract the novel coronavirus, “You have more than double the likelihood of going into the hospital if you’re obese and 50% more likelihood of dying,” Popkin said in a recent interview with JAMA. “Those 2 statistics really shook me.” … Read More
All posts by Anupam
“Sensible medicine is an approach to treatment that seeks a balance along the spectrum of the strength of evidence and the pace of knowledge translation. On one hand, a hawkish interventionist has little doubt about the effectiveness of a new treatment and rapidly adopts it into practice. There is a tendency to favor adoption of the new, acceptance of less rigor in research methods and results, and a glance away from subconscious biases. This contrasts with the medical nihilist who is highly skeptical of new evidence and hopes to intervene even less. The medical nihilist is certain of the futility … Read More
“The Centers for Medicare & Medicaid Services recently announced a voluntary plan to cap out-of-pocket costs associated with insulin products in participating enhanced Part D plans. However, this model will not apply to other high-cost glucose-lowering medications such as sodium-glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide 1 (GLP-1) receptor agonists. These classes are increasingly used as second-line agents for patients with type 2 diabetes despite only a modest effect on glycemic control (approximately 0.8% to 1%) because of mounting evidence of cardiovascular benefits. We sought to examine contemporary coverage and out-of-pocket costs for beneficiaries filling either an SGLT2 inhibitor … Read More
“we report the two largest insurers’ commercial market shares and Herfindahl-Hirschman Indices (HHIs) for 384 metropolitan statistical areas (MSAs), the 50 states and the District of Columbia. Among the key findings in this year’s update is that, based on the DOJ/FTC Horizontal Merger Guidelines, 74% of MSA-level markets were highly concentrated (HHI>2500). The average market was also highly concentrated, with an HHI of 3473. Other findings are that in 92% of MSA-level markets, at least one insurer had a commercial market share of 30% or greater, and in 48% of markets, a single insurer’s share was at least 50%. We … Read More
“In the United States, the Centers for Medicare and Medicaid Services (CMS) have implemented value-based programs that compare the performance of hospitals using risk-standardized outcome measures (eg, readmission, mortality). A critically important characteristic of these measures is that they are point estimates with a margin of error. The CMS use the point estimates to compare hospitals, but the margin of error around each estimate may affect the CMS’s ability to accurately evaluate and distinguish performance. [..] The hospital-level 30-day RSRR [risk-standardized readmission rate] measure used by the CMS is a point estimate based on a finite number of discharges and, … Read More
“There has not been a single year since the founding of the United States when Black people in this country have not been sicker and died younger than White people.[..] Though the racial gap in life expectancy has narrowed, Black Americans continue to die 4 years earlier, on average, than White Americans. The divides on other U.S. mortality measures are starker: Black mothers are three times as likely as White mothers to die from pregnancy-related causes; Black infants are more than twice as likely as White infants to die in their first year, according to the Centers for Disease Control … Read More
“As health care expenditures continue to increase, with surgery accounting for approximately one-third of all health care spending, there is a need to identify strategies to decrease expenditures without compromising care quality. [..] the purpose of this study was to perform a population-based analysis of complication rates of minor hand procedures performed in different operative settings. In addition, we sought to investigate differences in total cost and OOP [out-of-pocket] spending across different operative settings. [..] We performed a retrospective cohort study using data from the IBM MarketScan Research databases between 2009 and 2017. These databases contain information from more than … Read More
“We believe the U.S. health care system should embrace this moment as an opportunity to shift the locus of preventive care from face-to-face annual exams to a strategy that focuses on population health: clinical registries that readily identify all preventive services for which a patient is due; annual prevention kits for patients that facilitate widespread deployment of home-based testing, shared decision making, and self-scheduling of preventive screening tests and procedures in more convenient and approachable community settings; and robust community-based strategies involving navigators to overcome health disparities in underserved populations. The first step in this strategy is developing a robust, … Read More
“Our study of the quality of end-of-life care in MA [Medicare Advantage] plans comes as the Centers for Medicare & Medicaid Services is set to start testing a “carve-in” of hospice services in 2021, meaning that hospice will be a covered benefit within MA and therefore MA plans will take a more active role in hospice services. Currently, the hospice benefit is “carved out” from MA, although MA plans are still involved in the care of hospice enrollees through several mechanisms. Older adults in MA are more likely to receive hospice services, potentially through direct care coordination or by contracting … Read More
“Health care delivery organizations have faced a myriad of important management challenges during the Covid-19 pandemic. Some of the challenges are idiosyncratic to the individual organization; others, however, are broadly faced by almost every health care delivery organization and are likely to be faced in any major disaster. The first key challenge is the lack of adequate capacity to handle the surging patient volume. [..] A second challenge is the need for real-time redesign of care models for patients. Given the highly contagious nature and severity of the infection, it is necessary for physicians, nurses, and other clinicians to discover … Read More