Medical payments affect heart attack outcomes

Researchers from Beth Israel Deaconess Medical Center (BIDMC) analyzed if medical payments for acute myocardial infarction affects treatment outcomes for patients. Findings of this research are published in journal Circulation.

To cut down healthcare expenditure there has been a growing trend towards providing incentives to reduce cost at the same time maintaining acceptable outcomes. Hospital Value-Based Purchasing Program administered by the Centers for Medicare and Medicaid Services (CMS) is one such effort to reduce the cost of care. This program makes payments based on quality outcome measures for conditions such as acute myocardial infarction. Hospitals that perform poorly in these measures receive a reduced payment.

Researchers used national Medicare claims data and examined more than 640,000 hospitalizations involving patients 65 years or older hospitalized for heart attack and found that higher 30-day spending to care for Medicare beneficiaries with acute myocardial infarction was associated with a modest reduction inpatient mortality.

“Recent policy efforts have focused on improving the value of care, both in terms of total spending and patient outcomes,” said corresponding senior author Robert W. Yeh, MD, MSc, Director of the Smith Center for Outcomes Research in Cardiology at Beth Israel Deaconess Medical Center. “We need to understand whether programs like the Hospital Value-Based Purchasing Program are able to globally reduce spending and improve outcomes for acute conditions like acute myocardial infarction, or whether the strong incentive to reduce hospital spending has unintended adverse consequences.”

“These findings have important implications for patient care,” said first author Rishi K. Wadhera, MD, MPhil, an investigator at the Smith Center at Beth Israel Deaconess Medical Center and a cardiology fellow at Brigham and Women’s Hospital.Wadhera. “While this study found that increased spending was associated with better outcomes, not all spending is of equal value and further research is needed to find out why higher-spending hospitals have better outcomes.”

Citation: Wadhera, Rishi K., Karen E. Joynt Maddox, Yun Wang, Changyu Shen, Deepak L. Bhatt, and Robert W. Yeh. “Association Between 30-Day Episode Payments and Acute Myocardial Infarction Outcomes Among Medicare Beneficiaries.” Circulation: Cardiovascular Quality and Outcomes 11, no. 3 (2018). doi:10.1161/circoutcomes.117.004397.

Research funding: National Institute of Health

Adapted from press release by Beth Israel Deaconess Medical Center.

Cost of care for falls in elderly population

Researchers estimated medical costs attributable to both fatal and nonfatal falls in the elderly population and found that approximately 50 billion dollars were spent in 2015. These findings are published in the Journal of the American Geriatrics Society.

Researchers utilized population data from the National Vital Statistics System (NVSS) and cost estimates from the Web-based Injury Statistics Query and Reporting System (WISQARS) for fatal falls, quasi-experimental regression analysis of data from the Medicare Current Beneficiaries Survey (MCBS) for nonfatal falls.

For nonfatal falls in adults aged 65 and older, Medicare paid approximately $28.9 billion, Medicaid $8.7 billion and private and other payers $12.0 billion. Overall medical spending for fatal falls was estimated to be $754 million.

Study authors felt that”Preventive strategies that reduce falls among older adults could lead to a substantial reduction in health care spending.”

Citation: Florence, Curtis S., Gwen Bergen, Adam Atherly, Elizabeth Burns, Judy Stevens, and Cynthia Drake. “Medical Costs of Fatal and Nonfatal Falls in Older Adults.” Journal of the American Geriatrics Society, 2018. doi:10.1111/jgs.15304.

Research funding: CDC

Adapted from press release by Wiley publications.

Price tag for cardiovascular disease to reach 1 trillion dollars by 2035

A new study projects that by 2035, cardiovascular disease, the most costly and prevalent killer, if left unchecked, will place a crushing economic and health burden on the nation’s financial and health care systems. According to the study, in the next two decades, the number of Americans with cardiovascular disease will rise to 131.2 million – 45 percent of the total U.S. population – with costs expected to reach $1.1 trillion.

The new projections are an update of those made by the association in 2011 that estimated around 100 million Americans would suffer from cardiovascular disease by 2030. In addition to the staggering human toll it takes on Americans’ lives and health, cardiovascular disease wreaks havoc on our economy.

Currently, cardiovascular disease is the costliest disease in our nation, with a price tag of $555 billion in 2016. Today’s study suggests that the economic burden of cardiovascular disease will only get worse. Specifically, the total cardiovascular disease costs across all conditions are projected to more than triple among those age 80 and more than double among those ages 65-79.

Direct medical costs related to cardiovascular disease will continue to rise, with costs expected to triple over the next 20 years for Hispanics, more than double among Blacks and be higher for women than men. Expenses associated with cardiovascular disease are expected to surpass medical cost estimates for other chronic diseases, such as diabetes and Alzheimer’s.

Indirect costs due to cardiovascular disease, or the costs related to lost productivity in the workplace and at home, are projected to be the highest for individuals age 45-64. On average, an employee with cardiovascular disease costs his or her employer nearly 60 hours and over $1,100 more in lost productivity per year than an employee without cardiovascular disease.

While white Americans face the highest indirect costs, the report stresses that Hispanics are expected to experience the largest relative increase in costs due to cardiovascular disease over the next 20 years.

To address the escalating burden highlighted in this report, the association recommends the following specific changes in federal policies: Increased funding for heart and stroke research by the National Institutes of Health Enhanced focus on prevention to improve and preserve population health from birth to old age Preservation and expansion of access to high-quality affordable health care Even though heart disease and stroke account for 23 percent and 4 percent of all deaths respectively, the NIH invests a meager 4 percent of its budget on heart disease research, a mere 1 percent on stroke research and only 2 percent on other cardiovascular disease research.

Prevention programs under the Affordable Care Act have enabled insured patients to obtain blood pressure and cholesterol screenings, smoking cessation services, behavioral counseling for obesity, as well as improved access to primary care and medications needed to help manage their diseases and reduce their risks. Retaining this emphasis on prevention and investments in it will be key to reducing health care costs moving forward. Finally, protections for patients with pre-existing conditions are vitally important for Americans who have or will develop cardiovascular disease.

“While we have made tremendous progress in fighting cardiovascular disease, recently reported death rates and these projections reinforce that now is not the time to relax,” said American Heart Association President Steven Houser, Ph.D., FAHA. “We must continue to be vigilant, because if these projections become reality, a serious health and economic crisis is on the horizon. The association welcomes the opportunity to work with Congress and the new administration to find ways to wipe out the burden of cardiovascular disease and build an improved culture of health in our country.”

Citation: Cardiovascular disease: a costly burden for America – projections through 2035. American Heart association CVD burden report. http://www.heart.org/idc/groups/heart-public/@wcm/@adv/documents/downloadable/ucm_491543.pdf Accessed on 2017-2-14
Adapted from press release by RTI international.

Cost of sleep deprivation

A lack of sleep among the U.S. working population is costing the economy up to $411 billion a year, which is 2.28 percent of the country’s GDP, a new report finds. According to researchers at the not-for-profit research organisation RAND Europe, part of the RAND Corporation, sleep deprivation leads to a higher mortality risk and lower productivity levels among the workforce, putting a significant damper on a nation’s economy.

Effects of sleep deprivation.
Credit: Mikael Häggström & Wikipedia
A person who sleeps on average less than six hours a night has a 13 percent higher mortality risk than someone sleeping between seven and nine hours, researchers found, while those sleeping between six and seven hours a day have a 7 percent higher mortality risk. Sleeping between seven and nine hours per night is described as the “healthy daily sleep range”.
In total, the U.S. loses just over 1.2 million working days a year due to sleep deprivation among its working population. Productivity losses at work occur through a combination of absenteeism, employees not being at work, and presenteeism, where employees are at work but working at a sub-optimal level.

The study – ‘Why Sleep Matters – The Economic Costs of Insufficient Sleep’- is the first of its kind to quantify the economic losses due to lack of sleep among workers in five different countries – the U.S, UK, Canada, Germany, and Japan. The study uses a large employer-employee dataset and data on sleep duration from the five countries to quantify the predicted economic effects from a lack of sleep among its workforce.

Marco Hafner, a research leader at RAND Europe and the report’s main author, says: “Our study shows that the effects from a lack of sleep are massive. Sleep deprivation not only influences an individual’s health and wellbeing but has a significant impact on a nation’s economy, with lower productivity levels and a higher mortality risk among workers.”

He continues: “Improving individual sleep habits and duration has huge implications, with our research showing that simple changes can make a big difference. For example, if those who sleep under six hours a night increase their sleep to between six and seven hours a night, this could add $226.4 billion to the U.S. economy.”

The U.S. has the biggest financial losses (up to $411 billion, which is 2.28 percent of its GDP) and most working days lost (1.2 million) due to sleep deprivation among its workforce. This was closely followed by Japan (up to $138 billion, which is 2.92 percent of its GDP, and around 600,000 working days lost).

Germany (up to $60 billion, which is 1.56 percent of its GDP, and just over 200,000 working days lost) and the U.K (up to $50 billion, which is 1.86 percent of its GDP, and just over 200,000 working days lost) have similar losses. Canada was the nation with the best sleep outcomes, but still has significant financial and productivity losses (up to $21.4 billion, which is around 1.35 percent of its GDP, and just under 80,000 working days lost).

To improve sleep outcomes, the report outlines a number of recommendations for individuals, employers and public authorities:

Individuals – Set consistent wake-up times; limit the use of electronic items before bedtime; and physical exercise during the day.

Employers – Recognise the importance of sleep and the employer’s role in its promotion; design and build brighter workspaces with facilities for daytime naps; combat workplace psychosocial risks; and discourage the extended use of electronic devices after working hours.

Public authorities – Support health professionals in providing sleep-related help; encourage employers to pay attention to sleep issues; and introduce later school starting times.

Citation: Hafner, Marco, Martin Stepanek, Jirka Taylor, Wendy M. Troxel and Christian van Stolk. Why sleep matters — the economic costs of insufficient sleep: A cross-country comparative analysis. Santa Monica, CA: RAND Corporation, 2016. Link
DOI: 10.7249/RR1791
Adapted from press release by RAND Corporation.