“In the United States, Medicare beneficiaries represent 70% to 80% of all patients hospitalized with heart failure (HF) each year. The Medicare population has also experienced substantial changes in the epidemiology of HF, with progressively fewer Medicare beneficiaries being diagnosed as having HF each year over the last decade after several decades of increasing incidence. However, the epidemiological mechanisms underlying the observed decline in the incidence of HF are not well understood. [..] We used a national 5% sample of all fee-for-service Medicare beneficiaries with no prior HF followed up from 2011 to 2016, accessing data on all of the … Read More
“Neighborhood socioeconomic status (nSES) variables have been reported to improve predictions in some cases but not others. For instance, Molshatzki et al found that nSES variables improved the prediction of long-term mortality after myocardial infarction but Bhavsar et al found that an nSES index did not improve prediction of a variety of health care use measures within a 3-year window. Another study suggests that neighborhood-level indicators are not predictive above and beyond individual-level indicators. Whether these predictors are useful for risk stratification, and, if so, in what contexts remains unclear. [..] We assess the addition of diverse nSES predictors to … Read More
“Available guidance documents typically instruct schools to gain access to testing by contacting local public health departments, and few schools appear to have solidified a strategy — especially one that extends beyond testing of symptomatic persons. [..] Most reopening plans instead focus on screening for Covid-19 symptoms. Yet recent research indicates that symptom screening alone will not enable schools to contain Covid-19 outbreaks. Because an estimated 40% of Covid-19 cases are asymptomatic and 50% of transmissions occur from asymptomatic persons, we believe that screening testing is critical. [..] SARS-CoV-2 testing presents at least three challenges for schools. The first is … Read More
“I learned that the Centers for Medicare and Medicaid Services (CMS) had previously allowed codes for “adult failure to thrive” to qualify people for hospice and that in states that had legalized physician-assisted dying less recently than New Jersey had, those codes had been used to confer eligibility. But CMS recently removed those codes from hospice eligibility, and in any event, I could not find a New Jersey physician willing or sufficiently experienced to provide this service. I described another option to Grandpa: he could voluntarily stop eating and drinking. He’d never considered this possibility (which reminded me again how … Read More
“On February 4, 2020, the U.S. secretary of health and human services declared that emergency use of diagnostics for SARS-CoV-2 was justified, triggering emergency authority for the Food and Drug Administration (FDA) to grant an emergency use authorization (EUA) for a device if it reasonably believes that it may be effective, rather than waiting to grant full approval when it has reasonable assurance that the device is safe and effective. This mechanism expedites access to accurate diagnostic tests during emergencies, when information gaps and false results may adversely affect patient care and public health decision making. The EUA process enabled … Read More
“As the country reopens, it’s important to assess how we can be better prepared to stave off such enormous economic losses during the next wave or the next epidemic. In my view, a few key policy changes will be critical. First, expertise on pandemic-related policy and strategy should be located closer to the center of power. I believe that the type of pandemic-preparedness office (the Office of Pandemics and Emerging Threats) that now resides only in the Department of Health and Human Services (HHS) also needs to be reestablished as part of the National Security Council (NSC). [..] Since the … Read More
“Masks have become a flash point in our culture wars: as a symbol of either a commitment to public health or an infringement on basic liberties, the mask encapsulates the politicization of science. But since human behavior — including wearing or shunning masks — will determine the pandemic’s ultimate toll, communication strategies that bridge our partisan divide over science may prove as important as any novel therapeutic. Beyond the near complete failure of U.S. federal leadership in combating the pandemic, one significant problem, according to Harvard epidemiologist Marc Lipsitch, has been the absence of consistent communication from nonpartisan experts. During … Read More
“At HealthPartners, we envisioned a middle ground between curbside and face-to-face consultation in which referring clinicians and patients could access specialty advice in a timely manner that would be documented and billable, but at a rate lower than for a face-to-face visit. We decided to adopt the e-consult model and use it as an option rather than a requirement for all involved: patients, referring clinicians, and specialists. Referring clinicians could decide when ordering: do they want a face-to-face consultation or could the need be met with an e-consult? Patients could see a specialist in person if they preferred but would … Read More
“Recessions feed on themselves. Workers not at work have less to spend, and thus subsequent business revenue declines. The federal government offset much of the initial loss owing to the shutdown, which has averted what would likely have been a new Great Depression. But the virus is ongoing, and thus full recovery is not expected until well into the future. The Congressional Budget Office projects a total of $7.6 trillion in lost output during the next decade. [..] To date, approximately 200,000 deaths have been directly attributable to COVID-19; many more will doubtless occur. In the US, approximately 5000 COVID-19 … Read More
“In 2017, we find that helicopter air ambulance carriers owned by two private equity firms, who together make up 64% of the Medicare market, had a standardized average charge of $48,250 (7.2 times what Medicare would have paid). This is markedly higher than the $28,800 (4.3 times what Medicare would have paid) standardized average charge for the same service by air ambulance carriers that are not part of a private equity-owned or publicly-traded company. [..] one study found that nearly 80% of helicopter air ambulance transports for commercially-insured patients are out-of-network and that for half of these out-of-network transports, the … Read More