Unbiased Analysis of Today's Healthcare Issues
Do patients prefer AI or physician responses to their questions. Based on a study in JAMA Internal Medicine by Ayers et al (2023), the answer is AI: Of the 195 questions and responses, evaluators preferred chatbot responses to physician responses in 78.6% (95% CI, 75.0%-81.8%) of the 585 evaluations… Chatbot responses were rated of significantly…
Hospital admissions are typically paid largely based on DRGs. DRGs account for the type of admission (e.g., heart failure, hip fracture, COPD) and some measure of patient characteristics and disease severity. However, should hospital structural factures be incorporated into reimbursement? On the one hand, if the structural factor is a cause of less efficient care,…
In 2020, spending on specialty drugs was $265 billion; this constituted 49.6% of total prescription drug expenditure. To combat rising costs, payers have turned to white, brown and clear bagging as well as approaches to restrict the site of care where patients receive specialty drugs. What are these “bagging” policies, what are the pros and…
A commentary from Sheehy et al. (2023) argues that the hospital readmissions reduction program has been a disappointment. “If you can’t measure it, you can’t improve it”—a quote featured prominently on the Centers for Medicare & Medicaid Services (CMS) Measures Management website.3 But like any initiative intended to improve quality, evaluation, and iteration is key…
A paper by Brady et al. (2023) aims to measure this relationship in the US. They use data from the 1997-2019 Panel Study of Income Dynamics (PSID) data merged with the Cross-National Equivalent File. The data were validated with information from the National Death Index. The authors adjust for self-reported health, demographics, comorbidities and a…
That is the topic of a Health Affairs Forefront article (Sullivan et al. 2021) out today which is addresses the topic. The issue is particularly relevant as the Inflation Reduction Act (IRA)’s has a de facto ban on QALYs for use in setting a drug’s maximum fair price (MFP). The authors discuss some alternatives: The…
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Human Genome Project: twenty years later ICER’s UPI protocol. Cross-market hospital mergers. UnitedHealth 1Q profits: $5.8 billion. Cancer vaccine in the works.
That is the questions Peter Neumann and David Kim (2023) answer in their JAMA research letter published today. They use 1990-2021 data from the Tufts Medical Center CEA Registry. The results are summarized in the graphs below. First, we see the use of a explicit cost effectiveness threshold increasing over time, from only 45% of…
Let’s say that you want to predict the impact of some policy intervention. Let us also assume that there is a randomized controlled trial (RCT) examining the impact of said policy on some outcome of interest. To predict the best model fit, at first glance, one would use all the data in the RCT to…