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Low back pain (LBP) is the most common type of pain experienced in the United States, with 25 percent of the U.S. population reporting at least one full day of [...], Objective. To compare differences in opioid prescription, health care utilization, and costs among patients with low back pain (LBP) who saw a physical therapist (PT) at the first point of care, at any time during the episode or not at all.Data Sources. Commercial health insurance claims data, 2009-2013.Study Design. Retrospective analyses using two-stage residual inclusion instrumental variable models to estimate rates for opioid prescriptions, imaging services, emergency department visits, hospitalization, and health care costs.Data Extraction. Patients aged 18-64 years with a new primary diagnosis of LBP, living in die northwest United States, were observed over a 1-year period.Principal Findings. Compared to patients who saw a PT later or never, patients who saw a PT first had lower probability of having an opioid prescription (89.4 percent), any advanced imaging services (27.9 percent), and an Emergency Department visit (14.7 percent), yet 19.3 percent higher probability of hospitalization (all p < .001). These patients also had significantly lower out-of-pocket costs, and costs appeared to shift away from outpatient and pharmacy toward provider settings.Conclusions. When LBP patients saw a PT first, there was lower utilization of highcost medical services as well as lower opioid use, and cost shifts reflecting the change in utilization.Key Words. Physical therapy, imaging, opioid, insurance claims, health care costs

Along with rising health care costs and sustained disparities in health care access and health outcomes, out-of-pocket expenditure (OOPE), the amount typically spent for health care service use (Chen et [...], Objective. To assess the effects of longitudinal patterns of health insurance and poverty on out-of-pocket expenditures among low-income late middle-aged adults.Data Sources/Study Setting. Six waves (2002-2012) of the Health and Retirement Study, in combination with RAND Center for the Study of Aging data, were used.Study Design. A random coefficient regression analysis was conducted in a multilevel growth curve framework to estimate the impact of health insurance and poverty on out-of-pocket expenditures.Principal Findings. At baseline, individuals with private insurance or unstable coverage were more likely to have out-of-pocket expenditures and financial burdens than public insurance holders. Over time, the poor who had no insurance, unstable coverage, or insurance type change had higher out-of-pocket expenditures; private coverage holders had higher odds of financial burden.Conclusions. Unstable insurance coverage had a discernible effect on the long-term, out-of-pocket expenditures among low-income adults. Findings have an important policy implication to protect poor late middle-aged population; as this population enters old age, the high financial burden it faces may exacerbate persistent socioeconomic health disparity among older people with unstable insurance coverage.Key Words. Health insurance coverage change, poverty, out-of-pocket expenditure change, out-of-pocket burden, late middle age

As the nation's changing healthcare environment continues to challenge even the most advanced and progressive-minded healthcare providers, the financial viability of every provider will depend on its response to these [...]

Coordination of care is challenging for patients who use multiple settings of care, such as outpatient, inpatient, and postacute care (Boyd et al. 2005; Anderson 2010; Boult and Wieland 2010). [...], Objective. To examine the extent to which accountable care organizations (ACOs) formally incorporate postacute care providers. Data Sources. The National Survey of ACOs (N = 269, response rate 66 percent). Study Design. We report statistics on ACOs&apos; formal inclusion of postacute care providers and the organizational characteristics and clinical capabilities of ACOs that have postacute care. Principal Findings. Half of ACOs formally include at least one postacute service, with inclusion at higher rates in ACOs with commercial (64 percent) and Medicaid contracts (70 percent) compared to ACOs with Medicare contracts only (45 percent). ACOs that have a formal relationship with a postacute provider are more likely to have advanced transition management, end of life planning, readmission prevention, and care management capabilities. Conclusions. Many ACOs have not formally engaged postacute care, which may leave room to improve service integration and care management. Key Words. Accountable care organizations, postacute care, health care reform

In this article ... Express clinics, mobile apps, online tools, video visits and even house calls are reshaping the way health care is delivered by some cutting-edge systems across the [...]

As healthcare organizations prepare for payers' increased focus on value-based purchasing, comprehensive and accurate cost analysis will become necessary to optimize value. Such cost analysis is straightforward in procedure-based specialties, [...]

With the ongoing reduction in payment and narrowing margins, health systems may be facing increased denials and associated administrative write-offs. When Ochsner Health System in Jefferson, La., was facing these [...]

In 2012, Bronx-Lebanon Hospital Center in New York began preparing for the shift to a value-based payment system by performing a complete review of its operations. This internal organizational review [...]

ABSTRACT The number of people enrolled in consumer-directed health plans (CDHPs) has increased dramatically over the last decade. We review the empirical literature on the effects of CDHPs, which is [...]

2019 APR 13 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Researchers detail new data in Autoimmune Diseases and Conditions - Multiple Sclerosis. [...]

Although perennially relevant, investigation of the effect of Medicare hospital payment changes on hospital and health system performance has heightened salience today. The 2010 Patient Protection and Affordable Care Act [...]

Hospitals and health systems that contemplate an investment in new equipment or technology typically estimate procedure volume, payment rates, and the useful life of the equipment to determine how long [...]

The laboratory represents only about three percent of healthcare costs, but when it is used properly, it can impact downstream costs far beyond the cost of performing lab tests. As [...]

In this article ... Explore on physician's idea for having primary care physicians return to their roots. Physicians and surgeons held about 633,000 jobs in 2006; approximately 15 percent were [...]

Relative to health care, retail and other large industries such as hardware, automotive, and grocery seem to have their act together when it comes to product identification down to the [...]

Studies of health care cost at the national level routinely demonstrate that cost rises with increases in per capita income. Belgium spends more on medical care than Bangladesh because it [...], Objective. This study evaluated the extent to which the causes of variation in health care costs differ by the level at which observations are made. Methods. More than 40 U.S. and international studies providing empirical estimates of the sources of variation in health care costs were reviewed and arrayed by size of observational units. A simplified graphical analysis demonstrating how estimated correlation coefficients change with the level and type of aggregation is presented. Results. As the unit of observation becomes larger, association between health care costs and health status/morbidity becomes weaker and smaller in magnitude, while correlation with income (per capita GDP) becomes stronger and larger. Individual expenditure variation within a particular health care system is largely due to differences in health status, but across systems, morbidity has almost no effect on costs. For nations, differences in per capita income explain over 90 percent of the variation in both time series and cross section. Conclusions. Units of observation used for analysis of health care costs must be matched to the units at which decision making occurs. The observed pattern of empirical results is consistent with a multilevel allocative model incorporating aggregate capacity constraints. To the extent that macro constraints determine total budgets at the national level, policy interventions at the micro level (substitution of genetic pharmaceuticals, use of CEA for allocation of treatments, controls on construction and technology, etc.) can act to improve efficiency, equity and average health status, but will not usually reduce aggregate average per capita costs of medical care. Key Words. Health expenditures, multilevel analysis, aggregation, costs, units of observation

They say knowledge is power. To that end, we recently hosted a National Hospital Price Transparency Conference in Indianapolis to arm employers with necessary information on hospital prices in their [...]

The new administration, Congressional leaders, payers, and providers are eager to transform the nation's health care system to curb unnecessary spending and make coverage more fair and efficient. The main [...]

Amid increased uncertainty, strategic capital planning allows hospitals to quantify how much money, regardless of source, their organization needs to achieve its strategic objectives overlaid on financial performance into the [...]

Healthcare thinking is evolving across multiple levels simultaneously--in health systems, health plans, physician practices, policymakers, and member associations, to name a few. Healthcare providers should not be blindsided by changes [...]

I am going to do something treacherous in this column. Like a member of a bomb squad approaching a suspicious package, I'm going to tiptoe, ever so slowly and no [...]

In 2005, the overall cost of patients' time spent on cancer care, including waiting for and traveling to appointments, in the first year after diagnosis was $2.3 billion, according to [...]

'No one knows what they pay for their health care services. No one knows cost or quality ... We don't have any reason to care financially.' - HHS Secretary Mike [...]

Value-based purchasing. Consumerism. Mergers and acquisitions. Transformative innovation. There has been tremendous attention in health care focused on market trends in these four areas--and for good reason. These trends are [...]

Hospitals' charges for services, supplies and drags often don't reflect actual costs, a new study maintains. Further, the gap between charges and costs raise concerns about the accuracy of Medicare's [...]

Washington--While it is still unclear whether and how Congress will reform the Medicare sustainable growth rate (SGR) formula in time to avoid a 25% payment cut beginning in January, many [...]

'At least for the near future, I expect to see: (1) in the scientific area, more advances in molecular diagnostics but still slow acceptance due to costs and lack of [...]

WASHINGTON -- The inability of market forces to control rising health care costs is causing some to call for a larger role for the government, according to a study published [...]

WASHINGTON, D.C.--Innovative medical procedures and equipment can improve patient diagnosis and care, but also add millions of dollars to annual healthcare costs, according to an analysis sponsored by the Blue [...]

Managed care marches on: New Wilkerson forecast What will the health-care delivery system look like in 1995? Managed care--whether under the umbrella of a health maintenance organization (HMO), preferred provider [...]