Policy

Could transparency in healthcare pricing decrease the disparity of costs in routine procedures?

Ongoing shortages of common oncology chemotherapies have compelled physicians to substitute more expensive drugs, delay or suspend clinical trials, or even skip doses of chemotherapy, according to survey results gathered by a team from the University of Pennsylvania.

Michael Kolodziej, MD, National Medical Director for Oncology Strategies, Aetna, says that in regard to payers impacting the use of immunotherapies, most payers have decided they will respect the judgment of the Food and Drug Administration, Centers for Medicare & Medicaid Services and the National Comprehensive Cancer Network.

As the future of healthcare reform is considered, many discussions seem to center around the concept of shared decision-making, specifically in regards to the patient's role in managing their own healthcare choices. However, in light of new research, the notion of patient participation is being questioned.

The panel at the American Thoracic Society 2013 International Conference continued discussions that suggested high rates of hospital readmissions may be an indicator of poor initial treatment, or failure to coordinate care. Further, these rates, which varied dramatically from hospital to hospital, were often excessively expensive.

Scott Halpern, MD, PhD, discussed the Choosing Wisely campaign with his opening presentation on The History of and Rationale for the Choosing Wisely Campaign. As most healthcare providers know, healthcare spending per capita in the United States is significantly higher than most other countries.

David H. Au, MD, MS, kicked off the Hospital Readmissions session at the American Thoracic Society 2013 conference with his presentation on Defining the Role of the Practitioner, Scientist and Policymaker. In the presentation, Dr Au says that it is important for all stakeholders in the healthcare industry to focus on hospital readmission rates.

David Weidig, MD, System Director of Hospital Medicine, Aurora Medical Group, Milwaukee, WI, says that readmissions are not necessarily a failure of medical treatment, but a failure of psycologic and social support systems for the patient that are not addressed while the patient is hospitalized.

Paul Ginsburg, PhD, President, Center for Studying Health System Change, says that consolidation plays a role in healthcare costs regarding the shift in hospital and provider market power.

Even experienced providers say prescribing has become too complex and time consuming with Medicare Part D plans, which differ in formularies and prior authorization processes.

In a cohort of 449 patients with colorectal cancer in the VA health system, diagnostic resource use varied with facility, patient age, and patient presentation.

One of the most talked about subjects at the SCAI 2013 meeting was the Appropriate Use Criteria (AUC). There are great economic and potential implications associated with the designations of appropriate or inappropriate for specific diagnostic procedures and treatments.

Predictive modeling can be used to identify disabled Medicaid beneficiaries at high risk of future hospitalizations who could benefit from appropriate interventions.

Integrated health systems are often portrayed as the most effective in providing high-quality care at lower costs. This systematic review assesses the empirical evidence.

Manesh Patel, MD, an interventional cardiologist at Duke University began by presenting a talk entitled, Appropriate Use Criteria: The Reasons, Methods, Intended, and Unintended Consequences. He first pointed out that Medicare expenditures on imaging have doubled between 2000 and 2006.

As payment reform models continue to evolve, practitioners must determine which strategy makes the most sense for their practice. Although the idea behind bundled payments may be worth considering, there are some concerns that this system could causes disruptions in oncology practices.

Patrick Gleason, PharmD, Director of Health Outcomes, Prime Therapeutics, says benefit design trends in specialty pharmacy show that the preferred specialty tier is generally a cost share of around one hundred dollars for a 30-day supply.