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Mead M, Ibrahim AM. Over- and underreporting of prices: most hospitals are not compliant with the Hospital Price Transparency Rule. HEALTH AFFAIRS SCHOLAR 2024; 2:qxae099. [PMID: 39220579 PMCID: PMC11363865 DOI: 10.1093/haschl/qxae099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 07/17/2024] [Accepted: 08/15/2024] [Indexed: 09/04/2024]
Abstract
Concern has been raised about the effectiveness of the Hospital Price Transparency Rule to facilitate a clear understanding of health care prices due to poor reporting by hospitals. However, the relationship between what services the hospital provides and what prices they report is not clear. We assessed reported prices in the Turquoise Health database and compared them at the hospital level with the CMS Provider of Services File to identify if a shoppable service was provided at a hospital. We found significant mismatch between the hospital prices being reported and the services being provided. For example, 56% of hospitals providing at least 1 shoppable service that requires public price reporting did not report any prices. Of hospitals reporting prices, most hospitals (66%) reported prices for only a portion of the services they provide. In addition, 12% of hospitals reported prices for services they do not provide. Only 6% of hospitals had complete concordance with price reporting and services they actually provide. Current compliance enforcement and penalties do not appear to be adequate to achieve the goals of the Hospital Price Transparency Rule.
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Affiliation(s)
- Mitchell Mead
- Department of Surgery, University of Michigan, Ann Arbor, MI 48109, United States
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI 48109, United States
- Taubman College of Architecture and Urban Planning, University of Michigan, Ann Arbor, MI 48109, United States
| | - Andrew M Ibrahim
- Department of Surgery, University of Michigan, Ann Arbor, MI 48109, United States
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI 48109, United States
- Taubman College of Architecture and Urban Planning, University of Michigan, Ann Arbor, MI 48109, United States
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Lahey H, Shin H, Myers K, McBride KL. Longitudinal echocardiography in pediatric patients with hypermobile Ehlers-Danlos syndrome. Am J Med Genet A 2024:e63844. [PMID: 39148461 DOI: 10.1002/ajmg.a.63844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 07/26/2024] [Accepted: 07/31/2024] [Indexed: 08/17/2024]
Abstract
Vascular Ehlers-Danlos, Marfan and Loeys-Dietz syndromes have increased risk of aortic dilation and dissection. Previous early studies showed hypermobile Ehlers-Danlos syndrome (hEDS) may also have increased risk, with echocardiography screening recommended; subsequent studies have not confirmed the risk or recommended echocardiography. This pediatric-based study assessed aortic dilation prevalence in those with hEDS by serial echocardiographic examinations and assessed family history for aortic dissections. We retrospectively identified individuals with hEDS who had echocardiography studies from the electronic medical records at one pediatric center. Aortic root Z-scores >2.0 were found in 15/225 subjects (average age 12.9 years) on initial echocardiograms, with no Z-score >3.0. Subsequent studies (n = 68) found statistically significant decline in aortic root Z-scores. Repeat echocardiography in those with initial aortic root Z-score >2.0 (n = 10) demonstrated a decline in Z score <2.0 in seven. On final examination, 9/225 (4.0%) had a Z-score >2.0, not statistically different from the general population. No aortic dissection occurred in first- or second-degree relatives. In conclusion, aortic root dilation rate in hEDS is likely not different from the general population. We propose that in the absence of other cardiac findings or suspicion for another disorder, echocardiography is not required in hEDS.
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Affiliation(s)
- Hannah Lahey
- Quinnipiac University, Frank H. Netter MD School of Medicine, North Haven, Connecticut, USA
- Division of Genetic and Genomic Medicine, Center for Cardiovascular Research, Nationwide Children's Hospital, Columbus, Ohio, USA
- Department of Pediatrics, Ohio State University, Columbus, Ohio, USA
| | - Haewon Shin
- Division of Genetic and Genomic Medicine, Center for Cardiovascular Research, Nationwide Children's Hospital, Columbus, Ohio, USA
- Department of Pediatrics, Ohio State University, Columbus, Ohio, USA
| | - Katherine Myers
- Division of Genetic and Genomic Medicine, Center for Cardiovascular Research, Nationwide Children's Hospital, Columbus, Ohio, USA
- Department of Pediatrics, Ohio State University, Columbus, Ohio, USA
| | - Kim L McBride
- Division of Genetic and Genomic Medicine, Center for Cardiovascular Research, Nationwide Children's Hospital, Columbus, Ohio, USA
- Department of Pediatrics, Ohio State University, Columbus, Ohio, USA
- Department of Medical Genetics, Cumming School of Medicine, University of Calgary and Section of Medical Genetics, Alberta Children's Hospital, Calgary, AB, Canada
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Ke DYJ, Tso M, Johri AM. The Application of Point of Care Ultrasound to Screen for Pulmonary Hypertension: A Narrative Review. POCUS JOURNAL 2024; 9:109-116. [PMID: 38681162 PMCID: PMC11044931 DOI: 10.24908/pocus.v9i1.17494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
BACKGROUND Pulmonary Hypertension (PH) is a condition with several cardiopulmonary etiologies that has the potential of progressing to right heart failure without proper intervention. After a history, physical exam, and investigations, cases of suspected PH typically undergo imaging via a transthoracic echocardiogram (TTE). This is a resource-intensive procedure that is less accessible in remote communities. However, point of care ultrasound (POCUS), a portable ultrasound administered at the bedside, has potential to aid in the diagnostic process of PH. METHODS The MEDLINE, Embase, and CENTRAL databases were searched to screen the intersection of POCUS and PH. Studies involved adult patients, and only English articles were accepted. Reviews, case reports, unfinished research, and conference abstracts were excluded. Our aim was to identify primary studies that correlated POCUS scan results and additional clinical findings related to PH. RESULTS Nine studies were included after our search. In these studies, POCUS was effective in identifying dilatation of inferior vena cava (IVC); internal jugular vein (IJV); and hepatic, portal, and intrarenal veins in patients with PH. The presence of pericardial effusion, pleural effusion, or b-lines on POCUS are also associated with PH. CONCLUSIONS This review suggests important potential for the use of POCUS in the initial screening of PH. IVC and basic cardiopulmonary POCUS exams are key for PH screening in patients with dyspnea. Right-heart dilatation can be visualized, and peripheral veins may be scanned based on clinical suspicion. POCUS offers screening as an extension of a physical exam, with direct visualization of cardiac morphology. However, more studies are required to develop a statistically validated POCUS exam for PH diagnosis. More studies should also be conducted at the primary-care level to evaluate the value of screening using POCUS for PH in less-differentiated patients.
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Affiliation(s)
| | - Melissa Tso
- Queen's University School of MedicineKingston, ONCanada
- Kingston Health Sciences CentreKingston, ONCanada
| | - Amer M Johri
- Queen's University School of MedicineKingston, ONCanada
- Kingston Health Sciences CentreKingston, ONCanada
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Wei C, Paranjpe I, Sharma P, Milligan M, Lam M, Heidenreich PA, Kalwani N, Schulman K, Sandhu A. Assessment of Price Variation in Coronary Artery Bypass Surgery at US Hospitals. J Am Heart Assoc 2024; 13:e031982. [PMID: 38362880 PMCID: PMC11010067 DOI: 10.1161/jaha.123.031982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/08/2023] [Indexed: 02/17/2024]
Abstract
BACKGROUND Little is known about hospital pricing for coronary artery bypass grafting (CABG). Using new price transparency data, we assessed variation in CABG prices across US hospitals and the association between higher prices and hospital characteristics, including quality of care. METHODS AND RESULTS Prices for diagnosis related group code 236 were obtained from the Turquoise database and linked by Medicare Facility ID to publicly available hospital characteristics. Univariate and multivariable analyses were performed to assess factors predictive of higher prices. Across 544 hospitals, median commercial and self-pay rates were 2.01 and 2.64 times the Medicare rate ($57 240 and $75 047, respectively, versus $28 398). Within hospitals, the 90th percentile insurer-negotiated price was 1.83 times the 10th percentile price. Across hospitals, the 90th percentile commercial rate was 2.91 times the 10th percentile hospital rate. Regional median hospital prices ranged from $35 624 in the East South Central to $84 080 in the Pacific. In univariate analysis, higher inpatient revenue, greater annual discharges, and major teaching status were significantly associated with higher prices. In multivariable analysis, major teaching and investor-owned status were associated with significantly higher prices (+$8653 and +$12 200, respectively). CABG prices were not related to death, readmissions, patient ratings, or overall Centers for Medicare and Medicaid Services hospital rating. CONCLUSIONS There is significant variation in CABG pricing, with certain characteristics associated with higher rates, including major teaching status and investor ownership. Notably, higher CABG prices were not associated with better-quality care, suggesting a need for further investigation into drivers of pricing variation and the implications for health care spending and access.
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Affiliation(s)
- Chen Wei
- Department of MedicineStanford University School of MedicineStanfordCA
| | - Ishan Paranjpe
- Department of MedicineStanford University School of MedicineStanfordCA
| | | | | | | | - Paul A. Heidenreich
- Division of Cardiovascular Medicine, Department of MedicineStanford UniversityStanfordCA
- Palo Alto Veteran’s Affairs Healthcare SystemPalo AltoCA
| | - Neil Kalwani
- Division of Cardiovascular Medicine, Department of MedicineStanford UniversityStanfordCA
- Palo Alto Veteran’s Affairs Healthcare SystemPalo AltoCA
| | - Kevin Schulman
- Department of MedicineStanford University School of MedicineStanfordCA
- Clinical Excellence Research CenterStanford UniversityStanfordCA
- Operations, Information and Technology, Graduate School of BusinessStanford UniversityStanfordCA
| | - Alexander Sandhu
- Division of Cardiovascular Medicine, Department of MedicineStanford UniversityStanfordCA
- Center for Digital Health, Department of MedicineStanford UniversityStanfordCA
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Wei C, Heidenreich PA, Sandhu AT. The economics of heart failure care. Prog Cardiovasc Dis 2024; 82:90-101. [PMID: 38244828 PMCID: PMC11009372 DOI: 10.1016/j.pcad.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 01/13/2024] [Indexed: 01/22/2024]
Abstract
Heart failure (HF) poses a significant economic burden in the US, with costs projected to reach $70 billion by 2030. Cost-effectiveness analyses play a pivotal role in assessing the economic value of HF therapies. In this review, we overview the cost-effectiveness of HF therapies and discuss ways to improve patient access. Based on current costs, guideline directed medical therapies for HF with reduced ejection fraction provide high economic value except for sodium-glucose cotransporter-2 inhibitors, which provide intermediate economic value. Combining therapy with the four pillars of medical therapy also has intermediate economic value, with incremental cost-effectiveness ratios ranging from $73,000 to $98,500/ quality adjusted life-years. High economic value procedures include cardiac resynchronization devices, implantable cardioverter-defibrillators, and coronary artery bypass surgery. In contrast, advanced HF therapies have previously demonstrated intermediate to low economic value, but newer data appear more favorable. Given the affordability challenges of HF therapies, additional efforts are needed to ensure optimal care for patients. The recent Inflation Reduction Act contains provisions to reform policy pertaining to drug price negotiation and out-of-pocket spending, as well as measures to increase access to existing programs, including the Medicare low-income subsidy. On a patient level, it is also important to encourage patient and physician awareness and discussions surrounding medical costs. Overall, a broad approach to improving available therapies and access to care is needed to reduce the growing clinical and economic morbidity of HF.
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Affiliation(s)
- Chen Wei
- Department of Medicine, Stanford University School of Medicine, United States of America
| | - Paul A Heidenreich
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, CA, United States of America; Palo Alto Veterans Affairs Healthcare System, Palo Alto, CA, United States of America
| | - Alexander T Sandhu
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, CA, United States of America; Palo Alto Veterans Affairs Healthcare System, Palo Alto, CA, United States of America.
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Tao M, Al-Sadawi M, Ahmed N, Dianati-Maleki N, Mann N, Kort S. The use of quality improvement interventions in reducing rarely appropriate echocardiograms: A systematic review and meta-analysis. Echocardiography 2023; 40:916-924. [PMID: 37464949 DOI: 10.1111/echo.15653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 06/18/2023] [Accepted: 07/07/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND The volume of cardiac imaging continues to increase, with many tests performed for rarely appropriate indications. Appropriate use criteria (AUC) documents were published by the American Society of Echocardiography and American College of Cardiology, with quality improvement (QI) interventions developed in various institutions. However, the effectiveness of these interventions has not been assessed in a systematic fashion. METHODS We searched Ovid MEDLINE, EMBASE, Scopus, Web of Science, Google Scholar, and EBSCO CINAHL for studies reporting association between cardiac imaging, AUC and QI. The search was not restricted to time or publication status. We selected studies assessing the effect of QI interventions on performance of rarely appropriate echocardiograms. The primary endpoint was reduction of rarely appropriate testing. RESULTS Nine studies with 22,070 patients met inclusion criteria. Mean follow up was 15 months (1-60 months). QI interventions resulted in statistically significant reduction in rarely appropriate tests (OR 0.52, 95% CI: .41-.66; p < .01). The effects of QI interventions were analyzed over both the short (<3 months) and long-term (>3 months) post intervention (OR 0.62, 95% CI: .49-.79; p < .01 in the short term, and OR 0.47, 95% CI: .35-.62; p < .01 in the long term). Subgroup analysis of the type of intervention, classified as education tools or decision support tools showed both significantly reduced rarely appropriate testing (OR 0.54, 95% CI: .41-.73; p < .01; OR .47, 95% CI: .36-.61; p < .01). Adding a feedback tool did not change the effect compared to not using a feedback tool (OR 0.49 vs. 0.57, 95% CI: .36-.68 vs. 39-.84; p > .05). CONCLUSION QI interventions are associated with a significant reduction in performance of rarely appropriate echocardiography testing, the effects of which persist over time. Both education and decision support tools were effective, while adding feedback tools did not result in further reduction of ordering rarely appropriate studies.
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Affiliation(s)
- Michael Tao
- Stony Brook University Hospital, 101 Nicolls Rd., Stony Brook, New York, USA
| | - Mohammed Al-Sadawi
- Stony Brook University Hospital, 101 Nicolls Rd., Stony Brook, New York, USA
| | - Navid Ahmed
- Stony Brook University Hospital, 101 Nicolls Rd., Stony Brook, New York, USA
| | - Neda Dianati-Maleki
- Stony Brook University Hospital, 101 Nicolls Rd., Stony Brook, New York, USA
| | - Noelle Mann
- Stony Brook University Hospital, 101 Nicolls Rd., Stony Brook, New York, USA
| | - Smadar Kort
- Stony Brook University Hospital, 101 Nicolls Rd., Stony Brook, New York, USA
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Oseran AS, Wadhera RK. Price Transparency and Cardiovascular Spending: An Important but Incomplete First Step. J Am Soc Echocardiogr 2023; 36:578-580. [PMID: 37002145 DOI: 10.1016/j.echo.2023.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 02/24/2023] [Accepted: 02/25/2023] [Indexed: 06/05/2023]
Affiliation(s)
- Andrew S Oseran
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Division of Cardiology, Massachusetts General Hospital, Boston Massachusetts.
| | - Rishi K Wadhera
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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