“We used Elevance Health’s in-network pricing data and medical claims data. We focused on in-network prices because these are the prices negotiated by the payer, and out-of-network providers represent a small percentage of use for planned procedures. The formatting of the released data files follows the specifications provided by CMS. We limited our analysis to one state, Colorado, and one month, August 2022, to illustrate the concepts. [..] We split the prices into two components, the professional price and the facility price. Notably, these two components may not be the only costs associated with a procedure as there are often other … Read More
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“Introduction Although cancer screening has been shown to reduce cancer-related mortality and morbidity, there is increasing recognition that it can also be harmful and burdensome, especially for older adults. The benefits of cancer screening typically lag by 10 or more years for breast, colorectal, and prostate cancer screenings, whereas the harms and burdens of these screenings—which include complications from screening and follow-up tests, overdiagnosis and overtreatment of clinically unimportant cancers, psychological stress from false-positive results, diverted attention away from other health conditions—occur in the short term. Guidelines recommend against routine cancer screening for older adults for whom the harms outweigh the benefits, … Read More
“A new rulemaking by the Biden administration seeks to lessen the harmful effects of abortion bans by protecting certain health data from being used to prosecute both clinicians and patients. But in the current draft, the rulemaking is designed to reinforce the privacy of reproductive health in states where abortion is legal and does little for those seeking abortion in states where it is illegal. Further, some states, like Idaho, are implementing a law that makes it illegal to travel out of state for an abortion, effectively blocking its citizens from the potential benefits of this rulemaking. The draft Notice of Proposed Rulemaking, titled … Read More
“Transparency has always been seen as a hallmark of honesty and integrity. The logic is familiar: democracies aspire to be transparent, but dictatorships are opaque; faithful spouses are guileless, while philanderers lie; reputable businesses operate in the open, but shady operations literally draw the shades. Collectively, we’ve embraced Louis Brandeis’s dictum that sunlight is the best disinfectant. We demand transparency in government, charitable institutions, nutrition labels, and middle-school grading rubrics. The medical record should be no different. [..] In 2008, Ethan Bernstein, an associate professor at Harvard Business School, travelled with a team of students to a vast mobile-phone-manufacturing plant … Read More
“When Roe v. Wade was decided in 1973, a group of 100 U.S. professors of obstetrics and gynecology predicted that teaching hospitals would emerge as leaders in compassionate abortion care, creating outpatient clinics to meet the demand for legalized abortion. But most hospitals did not embrace abortion provision; many of them in fact adopted policies that were more restrictive than was legally required. Freestanding clinics instead emerged as the primary provider of abortion care, and this siloing was further reinforced by stigma, threats of violence, and the exclusion of abortion coverage by major health care payers. In 2020, hospitals accounted … Read More
“Some patient messages are unsolicited questions seeking medical advice, which also take more skill and time to answer than generic messages (eg, scheduling an appointment, accessing test results). Current approaches to decreasing these message burdens include limiting notifications, billing for responses, or delegating responses to less trained support staff. Unfortunately, these strategies can limit access to high-quality health care. For instance, when patients were told they might be billed for messaging, they sent fewer messages and had shorter back-and-forth exchanges with clinicians. Artificial intelligence (AI) assistants are an unexplored resource for addressing the burden of messages. While some proprietary AI assistants show … Read More
“Over several hours and multiple Zoom and phone calls in April, I spoke with Fauci about that: how he saw the full story of this historic public-health emergency and the role he played in it. At times, he was defensive, even combative, particularly when it came to episodes in which he felt that his own positions had been misconstrued and on the matter of gain-of-function research and the origins of the pandemic. But on the whole, he was reflective, even humble, especially about the way that Covid-19 exposed the limits of public health and, in his telling, kept surprising him … Read More
“Oral anticoagulation reduces thromboembolic events in patients with nonvalvular atrial fibrillation (AF); however, underuse of anticoagulation is a major issue in treating patients with nonvalvular AF at high stroke risk. Prior data from the American College of Cardiology’s (ACC) Practice Innovation and Clinical Excellence Registry (PINNACLE Registry) has found approximately 40% of patients are not receiving anticoagulants, with little change over time, despite the availability of the nonvitamin K antagonists. Studies examining the reasons for nonuse are sparse. Because underuse may relate to both physician prescribing and patient factors, some studies have looked at physician assessment of the risk of bleeding … Read More
The New England Journal of Medicine’s Lisa Rosenbaum speaks with University of Pennsylvania’s internal medicine physicians Paula Chatterjee (also a health services researcher) and Atheen Venkataramani (also a health economist and founder of Penn’s Opportunity for Health lab) about the role of values in health care, social determinants of health and what physicians can do to improve U.S. health care. An excerpt of the audio interview: [Rosenbaum] Atheen, I know that you also had a formative experience, I think when you were a resident at MGH. Can you talk a little bit about that and how that experience informed your … Read More
“we examine real-world data from a cohort based in a UK primary care clinic offering a low-carbohydrate approach to people with T2D [type 2 diabetes] from 2013 to 2021. The physiological mechanisms behind remission induced by dietary weight loss were first demonstrated in 2011. Since then the idea of drug-free T2D remission has gained international momentum. [..] Advice on lowering dietary carbohydrate was offered routinely by our team of nine specially trained GPs and three practice nurses to patients with T2D (defined as HbA1c >48 mmol/mol on two occasions) starting in March 2013. Our protocol includes important information around the deprescribing of … Read More