Cost Of Physician Services Research Articles

Healthcare Costs for Medicare Patients With Hepatocellular Carcinoma in the United States

Hepatocellular carcinoma (HCC) has an increasing mortality in the United States and is a leading cause of morbidity and mortality in patients with cirrhosis. We aimed to estimate the financial burden related to HCC in a large nationally representative United States cohort. We used the Surveillance, Epidemiology, and End Results program (SEER)-Medicare database to identify 4525 adult patients who were diagnosed with HCC between 2011 and 2015. We generated a 1:1 propensity score-matched cohort of patients with cirrhosis but no HCC as a comparator group to define incremental HCC-specific costs beyond costs related to underlying cirrhosis. Our main outcomes were patient liabilities and Medicare payments in the first year after HCC diagnosis. Compared with patients with cirrhosis, those with HCC had higher incremental patient liabilities (median+$7166; interquartile range, $2401-$16,099) and Medicare payments (+$50,110; interquartile range, $142,42-$136,239; P < .001 for both) in the first year after diagnosis. Patients with HCC had significantly higher inpatient, outpatient, and physician service costs compared with the matched cohort with cirrhosis (P < .001 for all). Patients with early-stage HCC had lower incremental patient liabilities (median, $4195 vs $8238; P < .001) and Medicare payments (median, $28,207 vs $59,509; P < .001) than those with larger tumor burden. In multivariable median regression analysis, incremental patient liabilities and Medicare payments were significantly associated with the National Cancer Institute comorbidity index, nonalcoholic fatty liver disease etiology, presence of ascites, and presence of hepatic encephalopathy. Patients with HCC suffer from cancer-related financial burden, highlighting a need for policy interventions and financial support systems.

Trends in paediatric inflammatory bowel disease-attributable direct costs: a population-based analysis.

In addition to its morbidities, inflammatory bowel disease (IBD) has a major financial burden on patients and healthcare systems. However, there is a paucity of evidence on IBD-attributable costs in children. To determine the trends of IBD-attributable direct costs over time using a population-based analysis. Data were extracted from Manitoba Health Provider Claims and other population registry datasets from 1995 to 2017. Children with IBD were matched by age, sex and location with children without IBD. IBD-attributable direct costs were calculated using utilization counts from the administrative data and cost estimates from different sources. Inpatient hospitalisation and outpatient procedure costs were estimated using the resource intensity weight (RIW) that is attached to each record in the data. Costs were expressed in Canadian dollars. We included 733 (428 with Crohn's disease) prevalent cases who were diagnosed with IBD before the age of 18years and were followed for 2450 person-years. A matched control group of 6763 persons who were followed for 21558 person-years was included. The median annual costs of physician services billed per patient increased from $381 (IQR 215-1064) in 1995 to $936 (IQR 579-1932) in 2017 (P<0.001). The annual medication costs per patient increased from a median of $270 in 1995 to $7944 in 2017 (P<0.0001). The median annual direct cost per patient was $1810 in 2004 as compared to $14791 (P<0.0001) in 2017. Over two decades, there was a significant increase in the paediatric IBD-attributable direct costs mainly driven by medication costs.

HIV/AIDS treatment funding system to support the people affected by HIV/AIDS in Surakarta, Indonesia

ABSTRACT People Living with HIV/AIDS (PLWHA's) quality of life (QoL) is determined by the lifetime treatment sustainability. Republic of Indonesia Minister of Health's Decree Number 328 of 2003 stated that government subsidies the PLWHA's medication and treatment, despite not covering entire medication and treatment cost. The objective of research was to analyse the cost assumed by PLWHA in accessing HIV/AIDS treatment service in Surakarta, Indonesia. The target group in this case study was PLWHAs, and related stakeholders of medical treatment in one of Public Health Centers and a Public Hospital in Surakarta; AIDS Commission of Surakarta City; Solo Plus Peer Support Group and AIDS-Care NGO selected purposively. Data collection was carried out using observation, in-depth interview, and documentation. Method and data source triangulations were used to validate data that was then analysed using Grossman's Demand for Health Capital theory. The result of research showed that the sources of HIV/AIDS treatment cost were self-income, Social Insurance Administration Organization (BPJS) fund and Local Government subsidy. Admission and physican services are given for free to PLWHA because it has been paid by BPJS Fund or has been subsidied by Local Government. Otherwise, they should pay registration cost of IDR 50,000, in Public Hospital and IDR 75,000 in Private Hospital. Physician service costs IDR 50,000–IDR 200,000. VCT Counsellor costs IDR 35,000-IDR 150,000. Non-Subsidy ARV costs IDR 687,000. 1 bottle containing 60 TB meningitis drug capsules costs IDR 145,000 for 10–20 d use and maximally IDR 210,000, while herpes drug costs IDR 295,000. CD4 examination costs IDR 126,000-IDR 297,000, RNA Viral load IDR 1,275,000–IDR 1,471,000, Haematology IDR 60,000-IRD 90,000, Cholesterol and triglyceride IDR 100,000-IDR 250,000, and SGOT/SGPT IDR 100,000–IDR 200,000. There is monthly non-medical cost the patient should spend, including transportation cost to go to health centre, and food, beverage, and newspaper cost while waiting for the service. BPJS fund and local government subsidy relieved health economic burden of PLWHAs, so that the average HIV/AIDS treatment cost in PLWHAs was relatively low, less than 10% of expense. National Insurance System including BPJS fund and local government subsidy as the answer to the integration of HIV/AIDS treatment funding management into national insurance system had provided PLWHA a funding access involving prevention, care, support, and treatment, and mitigated the effect despite less optimum.

Healthcare utilization costs of emerging adults with mood and anxiety disorders in an early intervention treatment program compared to a matched cohort.

The First Episode Mood and Anxiety Disorder Program (FEMAP) provides treatment to emerging adults with mood and anxiety disorders in an accessible, youth-friendly environment. We sought to investigate FEMAP's impact on the costs of care. We conducted a retrospective observational study of one-year health service costs using linked administrative datasets to compare emerging adults treated at FEMAP (FEMAP users) to propensity-score matched controls (non-users). Costs from the perspective of the Ontario Ministry of Health and Long-Term Care, included drug benefit claims, inpatient, physician and ambulatory care services. We used bootstrapping to perform unadjusted comparisons between FEMAP users and non-users, by cost category and overall. We performed risk-adjusted comparison of overall costs using generalized estimating equations. FEMAP users (n = 366) incurred significantly lower costs compared to non-users (n = 660), for inpatient services (-$784, 95% confidence interval [CI] -$1765, -$28), ambulatory care services (-$90, 95% CI -$175, -$14) and drug benefit claims (-$47, 95% CI -$115,-$4) and significantly higher physician services costs ($435, 95% CI $276, $581) over 1 year. The unadjusted difference in overall costs was not significant (-$853, 95% CI -$2048, $142). Following adjustment for age, sex and age at first mental health diagnosis, the difference of -$914 (95% CI (-$2747, $919)) was also not significant. FEMAP was associated with significantly lower costs of inpatient and ambulatory care services, and higher costs of physician services, however we are unable to conclude that FEMAP is cost-saving overall.

Physician Service Costs: Is there Blame to Share Around?

The rising portion of national income devoted to healthcare in general and the portion allocated to physician services have been a focus of the health policy literature for some time. Greater recognition should be given to the fact that the observed trends in physician service expenditures are the product of the interaction between physicians and provincial governments. Improving the productivity of healthcare systems in the delivery of high-quality primary care will require moving beyond simple oversight to deeper engagement with physicians as partners in system improvement.

The association between pediatric chronic pain clinic attendance and health care utilization: A retrospective analysis

ABSTRACT Background Pediatric chronic pain is common, disabling, and costly. Children with chronic pain have high health care utilization in that they are seen by multiple health care providers, have frequent emergency room visits, and require many diagnostic tests. Pediatric health care utilization relating to direct health care services and associated costs of attendance at chronic pain clinics in Canada has not been well described. Aim The purpose of this project was to analyze the cost of physician services for individuals attending an interprofessional pediatric chronic pain clinic over an 8-year span including years before, during, and after treatment. Methods Physician claims were extracted from the Ontario Health Insurance Plan (OHIP) Claims History Database and retrospectively reviewed over 8 fiscal years for 100 new patients seen at the Chronic Pain Clinic at the Hospital for Sick Children. The utilization metrics analyzed included physician consultations and follow-up appointments, emergency room visits, lab tests, and diagnostic imaging. These data reflected 2 years prior to the first chronic pain clinic appointment, year of initial appointment, and five subsequent years. Results Health care utilization based on OHIP claims related to physician services and cost analysis showed an increase during the 2 years prior to first chronic pain clinic appointment, a decrease during the year of initial appointment, and a further decrease over the subsequent 5 years. Conclusions Further prospective research is required to establish whether attendance at the chronic pain clinic caused the reduction in health care services and costs and, if so, to identify the effective components of treatment.

Estimating the Cost of Cancer Care in British Columbia and Ontario: A Canadian Inter-Provincial Comparison

Costing studies are useful to measure the economic burden of cancer. Comparing costs between healthcare systems can inform evaluation, development or modification of cancer care policies. To estimate and compare cancer costs in British Columbia and Ontario from the payers' perspectives. Using linked cancer registry and administrative data, and standardized costing methodology and analyses, we estimated costs for 21 cancer sites by phase of care to determine potential differences between provinces. Overall, costs were higher in Ontario. Costs were highest in the initial post-diagnosis and pre-death phases and lowest in the pre-diagnosis and continuing phases, and generally higher for brain cancer and multiple myeloma, and lower for melanoma. Hospitalization was the major cost category. Costs for physician services and diagnostic tests differed the most between provinces. The standardization of data and costing methodology is challenging, but it enables interprovincial and international comparative costing analyses.

MACRA, Alternative Payment Models, and the Physician-Focused Payment Model: Implications for Radiology

The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 describes alternative payment models (APMs) as new approaches to health care payment that incentivize higher quality and value. MACRA incentivizes increasing APM participation by all physician specialties over the coming years. Some APMs will be deemed Advanced APMs; clinicians who are a Qualifying Participant in an Advanced APM will receive substantial benefits under MACRA including an automatic 5% payment bonus, regardless of their performance and savings within the APM, and a larger payment rate increase beginning in 2026. Existing APMs are most relevant to primary care physicians, and opportunities for radiologists to participate in Advanced APMs fulfilling Qualified Participant requirements are limited. Physician-Focused Payment Models (PFPMs), as described in MACRA, are APMs that target physicians’ Medicare payments based on quality and cost of physician services. PFPMs must address a new issue or specialty compared with existing APMs and will thus foster a more diverse range of APMs encompassing a wider range of specialties. The PFPM Technical Advisory Committee is a new independent agency that will review proposals for new PFPMs and provide recommendations to CMS regarding their approval. The PFPM Technical Advisory Committee comprises largely primary care physicians and health policy experts and is not required to consult clinical experts when reviewing new specialist-proposed PFPMs. As PFPMs provide a compelling opportunity for radiologists to demonstrate and be rewarded for their unique contributions toward patient care, radiologists should embrace this new model and actively partner with other stakeholders in developing radiology-relevant PFPMs.

The Economic Impact of Changing Levothyroxine Formulations in Difficult-to-Treat Hypothyroid Patients: An Evidence-Based Model

Objective: To determine the budget impact of incorporating levothyroxine gel caps in the treatment plan of patients diagnosed with hypothyroidism who experience multiple levothyroxine dose or formulation changes annually due to inadequate efficacy or tolerability. Methods: Cost estimates of levothyroxine formulations were obtained. Estimated utilization patterns and costs of physician services, laboratory tests, ancillary healthcare services, and lost productivity were quantified based on published literature and government/public sources. The patient population was based on epidemiology reports and estimates from the American Association of Clinical Endocrinology and the American Thyroid Association. All calculations of economic outcomes were determined using a budget impact model constructed in a MS Excel platform. Results: The economic model demonstrated for a population of 500,000 persons, there are 23,000 (4.6%) people with hypothyroidism, of which 18,400 (80.0%) receive pharmacologic treatment, including 17,480 (95.0%) that receive levothyroxine. The proportion of patients requiring ≥ 1 dosage changes annually is 31.4%, producing 5,489 “hard-to-treat” patients. Similarly, the proportion of patients requiring ≥ 2 dosage changes annually is 8.0% or 1,398 “harder-to-treat” patients. Using evidence-based data of the tolerability and absorption characteristics of levothyroxine gel caps, changing 20.0% of the target cohort to the gel cap formulation produced annual net cost savings of $542,901 in direct medical costs and $564,650 in lost productivity for “hard-to-treat” patients and savings of $409,107 in direct medical costs and $441,926 in lost productivity for “harder-to-treat” patients. Conclusions: Consideration of switching levothyroxine product from a tablet to a gel cap formulation is justified on an economic and therapeutic basis for hypothyroid patients at risk of sub adequate drug efficacy or tolerability as measured by the need for one or more annual levothyroxine dosage or formulation adjustments.

A population-based analysis of incentive payments to primary care physicians for the care of patients with complex disease.

In 2007, the province of British Columbia implemented incentive payments to primary care physicians for the provision of comprehensive, continuous, guideline-informed care for patients with 2 or more chronic conditions. We examined the impact of this program on primary care access and continuity, rates of hospital admission and costs. We analyzed all BC patients who qualified for the incentive based on their diagnostic profile. We tracked primary care contacts and continuity, hospital admissions (total, via the emergency department and for targeted conditions), and cost of physician services, hospital care and pharmaceuticals, for 24 months before and 24 months after the intervention. Of 155 754 eligible patients, 63.7% had at least 1 incentive payment billed. Incentive payments had no impact on primary care contacts (change in contacts per patient per month: 0.016, 95% confidence interval [CI] -0.047 to 0.078) or continuity of care (mean monthly change: 0.012, 95% CI -0.001 to 0.024) and were associated with increased total rates of hospital admission (change in hospital admissions per 1000 patients per month: 1.46, 95% CI 0.04 to 2.89), relative to preintervention trends. Annual costs per patient did not decline (mean change: $455.81, 95% CI -$2.44 to $914.08). British Columbia's $240-million investment in this program improved compensation for physicians doing the important work of caring for complex patients, but did not appear to improve primary care access or continuity, or constrain resource use elsewhere in the health care system. Policymakers should consider other strategies to improve care for this patient population.

The excess health care costs of KardioPro, an integrated care program for coronary heart disease prevention

Coronary heart disease (CHD) is a major cause of death and important driver of health care costs. Recent German health care reforms have promoted integrated care contracts allowing statutory health insurance providers more room to organize health care provision. One provider offers KardioPro, an integrated primary care-based CHD prevention program. As insurance providers should be aware of the financial consequences when developing optional programs, this study aims to analyze the costs associated with KardioPro participation. 13,264 KardioPro participants were compared with a propensity score-matched control group. Post-enrollment health care costs were calculated based on routine data over a follow-up period of up to 4 years. For those people who incurred costs, KardioPro participation was significantly associated with increased physician costs (by 33%), reduced hospital costs (by 19%), and reduced pharmaceutical costs (by 16%). Overall costs were increased by 4%, but this was not significant. Total excess costs per observation year were €131 per person (95% confidence interval: [€−36.5; €296]). Overall, KardioPro likely affected treatment as the program increased costs of physician services and reduced costs of hospital services. Further effects of substituting potential inpatient care with increased outpatient care might become fully apparent only over a longer time horizon.

Direct Medical Cost of Influenza-Related Hospitalizations among Severe Acute Respiratory Infections Cases in Three Provinces in China

BackgroundInfluenza-related hospitalizations impose a considerable economic and social burden. This study aimed to better understand the economic burden of influenza-related hospitalizations among patients in China in different age and risk categories.MethodsLaboratory-confirmed influenza-related hospitalizations between December 2009 and June 2011 from three hospitals participating in the Chinese Severe Acute Respiratory Infections (SARI) sentinel surveillance system were included in this study. Hospital billing data were collected from each hospital’s Hospital Information System (HIS) and divided into five cost categories. Demographic and clinical information was collected from medical records. Mean (range) and median (interquartile range [IQR]) costs were calculated and compared among children (≤15 years), adults (16–64 years) and elderly (≥65 years) groups. Factors influencing cost were analyzed.ResultsA total of 106 laboratory-confirmed influenza-related hospitalizations were identified, 60% of which were children. The mean (range) direct medical cost was $1,797 ($80–$27,545) for all hospitalizations, and the median (IQR) direct medical cost was $231 ($164), $854 ($890), and $2,263 ($7,803) for children, adults, and elderly, respectively. Therapeutics and diagnostics were the two largest components of direct medical cost, comprising 57% and 23%, respectively. Cost of physician services was the lowest at less than 1%.ConclusionDirect medical cost of influenza-related hospitalizations imposes a heavy burden on patients and their families in China. Further study is needed to provide more comprehensive evidence on the economic burden of influenza. Our study highlights the need to increase vaccination rate and develop targeted national preventive strategies.

Bending the Medicare Cost Curve for Physicians’ Services: Lessons Learned from Canada

In 1997 Congress created the Sustainable Growth Rate (SGR) formula for the payment of physicians under Part B of Medicare. SGR established a target rate of growth for aggregate costs of physician services under Part B, linked to growth in overall GDP. If growth in aggregate Part B costs exceeds the target, the rate at which physicians are paid in the following year is to be reduced by a corresponding amount. In SGR, Congress and the U.S. medical profession jointly confront a policy dilemma with no clear solution. For several years running, Congress has elected to postpone cuts in payment to physicians required under SGR. Absent further Congressional action, in 2013 physicians' fees under Part B of Medicare will be reduced by more than 30 %. The historical roots of SGR suggest that a potential solution lies in shifting to regional expenditure targets-an approach applied successfully in Canada in the 1970s when Canadian Medicare confronted rising physician fees. The commission that created what was to become SGR was aware of the lessons learned in Canada, and recommended that they also be applied to U.S. Medicare.

Cost effectiveness analysis of playground surfacing at preventing arm fractures in a randomised study

BackgroundUpper extremity fractures resulting from playground falls are commonly seen in emergency departments. A 2-year randomised surfacing trial conducted in 19 schools in Toronto, Canada, found that the risk of...

Older Women: Work and Caregiving in Conflict? A Study of Four Countries

Caregiving issues are important for industrialized societies that have been undergoing population aging. In this article we consider caregiving as a factor in the outlook for midlife and older women with respect to economic security and economic advancement. We use demographic and economic data from the United States, France, Sweden, and the United Kingdom, in particular to document the importance of continued labor force participation for older women to make ends meet in an era of high household costs of physician services, prescription drugs, and other health-related services, and uncertainties about pensions. Data on employment status, industry, and occupation of economically active women in comparison with men indicate the extent of both gender gaps and progress affecting women's resources. The research of Dr. Myrna Lewis was a stimulus to the present exploration. Our conclusion discusses the implications for women's welfare of policy initiatives relating to care of elderly disabled, including improving services to family caregivers, assuring social financing of formal care, raising local provisions to a national standard, and supporting women's return to the labor force after a period of caregiving. In the context of population aging and longevity, such initiatives are responsive to women's need for earned income to attain retirement security.

Health care reform — need for less emotion and more science

Health care reform — need for less emotion and more science

Estimating the Economic Costs of Antidepressant Discontinuation during Pregnancy

Depression is a major public health concern that results in a wide range of economic costs to people, their families, and the health care system. Our study sought to determine the direct medical costs incurred by the Ontario government owing to cessation of antidepressant therapy during pregnancy. We conducted an economic evaluation by making assumptions based on data obtained from Statistics Canada, federal and provincial government reports, and relevant depression literature. The analysis included the number of pregnant women with depression residing in Ontario and, subsequently, the number of those women who experienced depressive relapse during pregnancy owing to discontinuation of antidepressant medication. The cost of physician services, hospitalizations, and the birth of preterm and low birth weight infants (2 adverse outcomes associated with untreated depression during pregnancy) were also taken into consideration. An estimated 2953 pregnant women with depression in Ontario annually discontinue antidepressant therapy and subsequently have a depressive relapse. An estimated $20 546 982 is spent annually in Ontario on untreated maternal depression in pregnancy; this is the total after subtracting the cost of risks associated with treated depression during pregnancy ($3 144 053). Safe treatment options for the management of depression during pregnancy should be actively explored as treated depression translates into cost savings for the Ontario government and society as a whole. Beyond this cost, depression interferes with the quality of childrearing, maternal responsiveness to infants, and other determinants essential for optimal child development.

Myocardial infarction following coronary artery bypass graft surgery increases healthcare resource utilization

To assess the health economic impact of perioperative myocardial infarction in a cohort of patients undergoing coronary artery bypass graft surgery. Retrospective cohort analysis using data from hospital bills and uniform billing forms. A total of 147 geographically diverse hospitals in the United States. The study population consisted of 2,102 coronary artery bypass graft surgery patients enrolled in the PRIMO-CABG trial at U.S. sites between January 2002 and February 2003. None. Resource utilization and costs during the index hospitalization and during a 6-month follow-up period were compared between patients who had a myocardial infarction by postoperative day 4 and those who did not. Linear regression was used to examine whether myocardial infarction by day 4 was associated with index hospitalization costs, after adjusting for baseline characteristics. Myocardial infarction occurred in 191 (9.1%) patients undergoing coronary artery bypass graft surgery. Myocardial infarction was associated with a doubling of intensive care unit time (3.5 days among patients with no myocardial infarction and 7.1 days among patients with myocardial infarction, p < .01) and a 48% increase in hospital length of stay. Myocardial infarction by day 4 was associated with a 43% increase in hospital costs, a 29% increase in physician service costs, a 41% increase in total costs during the index hospitalization, and a 38% increase in cumulative 6-month costs. After baseline adjustment, myocardial infarction continued to be associated with higher index hospitalization costs. Myocardial infarction following coronary artery bypass graft surgery was associated with a significant increase in intensive care unit time, hospital length of stay, and overall costs, which contributed to greater hospital and physician service costs. Healthcare resource utilization is increased in patients sustaining a myocardial infarction following coronary artery bypass graft surgery.

A Comparison of Intensive Care Unit Physician Staffing Costs at the 3 Mayo Clinic Sites

To determine the provider cost of administering intensive care unit (ICU) services, comparing 3 different staffing models for ICU coverage, and to compare the costs of using house staff vs nonphysician providers (NPPs). Data were collected on total staff composition and number of beds In ICUs from January 1, 2004, through December 31, 2004, at the 3 Mayo Clinic sites: Rochester, Minn; Jacksonville, Fla; and Scottsdale, Ariz. Institutional or national average staff salaries were used to determine total staffing costs per ICU bed per year at each site. Medicare medical education reimbursements were also taken into account. Costs per ICU bed for physician staffing were $18,630 in Rochester, $37,515 in Jacksonville, and $38,010 in Scottsdale. When NPPs were substituted for house staff, the costs per bed were $72,466 in Rochester, $61,291 in Jacksonville, and $49,909 in Scottsdale. Incremental costs per ICU bed using NPPs were $53,836 in Rochester, $23,776 in Jacksonville, and $11,899 in Scottsdale. Use of residents and fellows in ICU staffing at a major tertiary health center is more cost-efficient than use of NPPs. This finding could have Implications for the cost of physician services in nonteaching community hospitals and the methods by which care is provided.

Health care resource use for uterine fibroid tumors in the United States

The purpose of this study was to quantify the total direct cost to the US health care system for the management of uterine leiomyomas. We used Center for Disease Control heath care databases for estimates of inpatient care, ambulatory care, and outpatient care of leiomyomas. With International Classification of Diseases-9 codes for fibroid tumors and fibroid-related conditions, all fibroid-related care was identified in each database. Inpatient and ambulatory surgical cases were stratified by surgical procedure, and outpatient clinical cases were categorized by type of visit and health care provider. With the use of Medicare's RBRVU reimbursement rates for 2000 as a proxy for the cost of physician services and Medicare diagnostic-related group reimbursement as a proxy for facility costs, the total direct cost to the US health care system for the care of fibroid tumors was estimated. Total direct cost to treat uterine fibroid tumors was estimated at 2,151,484,847 dollars. Most of the cost was due to inpatient care, in particular, hysterectomy. Uterine fibroid tumors consume a significant amount of health care resources in the United States.