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  • Explaining Hospital Charge Variation for Members of America’s Essential Hospitals: The Role of Mark-ups and Underlying Costs

    In a changing healthcare environment in which providers are under increasing demands to demonstrate their value, providers with above-average prices are likely to face increased scrutiny.  In this study, we examined three research questions: How do the average charges for patients at America’s Essential Hospitals (AEH) member hospitals compare to other hospitals?; To what extent are these charge differences driven by differences in underlying costs?; What factors cause cost differences between AEH hospitals and other hospitals and among AEH member hospitals? We found that higher charges among AEH member hospitals are explained by higher costs, which in turn are explained by the intensive services these facilities provide and the environment in which they provide them.  If other hospitals operated under similar circumstances, the data suggests the costs would be similar, and the charges would be even higher than the current average charges among AEH members.

    Services : Advanced Data Analytics Expertise: , ,

    In a changing healthcare environment in which providers are under increasing demands to demonstrate their value, providers with above-average prices are likely to face increased scrutiny.  In this study, we examined three research questions: How do the average charges for patients at America’s Essential Hospitals (AEH) member hospitals compare to other hospitals?; To what extent

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  • Diagnosing Certain Conditions with Ultrasound over Other Technologies Can Save Money

    For certain types of conditions, different imaging technologies may serve as substitutes for one another. Rotator cuff tears, for example, can be diagnosed with ultrasound or magnetic resonance imaging (MRI).  Because both imaging technologies have been shown to be effective in diagnosing this type of injury, relative cost becomes an important consideration.  KNG Health conducted two studies to examine the potential cost savings to the Medicare program from the substitution of ultrasound for MRI and computed tomography (CT) in diagnosing certain musculoskeletal (MSK) conditions and renal colic. Cost-saving estimates were developed using Medicare claims data and assumptions relating to the use of diagnostic ultrasound, MRI, and CT in the Medicare population.  The studies found that using ultrasound over CT and MRI in diagnosing MSK conditions and renal colic would result in significant cost savings.

    Services : Advanced Data Analytics Expertise:

    For certain types of conditions, different imaging technologies may serve as substitutes for one another. Rotator cuff tears, for example, can be diagnosed with ultrasound or magnetic resonance imaging (MRI).  Because both imaging technologies have been shown to be effective in diagnosing this type of injury, relative cost becomes an important consideration.  KNG Health conducted

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  • Characteristics and Cost Drivers of High-Cost Hospitals

    A 2008 report produced by the Medicare Payment Advisory Commission (MedPAC) found that 20% of hospitals had consistently higher costs than other hospitals.  KNG Health identified key characteristics and cost drivers for those hospitals classified by MedPAC as high-cost hospitals.  The study compared low and high-cost hospitals across a number of dimensions, including hospital-wide and Medicare-specific cost factors, quality measures, and overall Medicare spending per beneficiary.  The study shows that, generally, high-cost hospitals have higher costs across multiple factors, but performed better on process-of-care quality measures than low-cost hospitals.

    Services : Advanced Data Analytics Expertise:

    A 2008 report produced by the Medicare Payment Advisory Commission (MedPAC) found that 20% of hospitals had consistently higher costs than other hospitals.  KNG Health identified key characteristics and cost drivers for those hospitals classified by MedPAC as high-cost hospitals.  The study compared low and high-cost hospitals across a number of dimensions, including hospital-wide and

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  • Patterns in the Use and Cost of Medical Care for Osteoarthritis Prior to Total Knee Arthroplasty: An Analysis of the Osteoarthritis Initiative and Medicare Data

    In this paper, we examined patterns in the use and costs of treatments for osteoarthritis (OA) of the knee in the years prior to total knee arthroplasty (TKA) and how these patterns differ between elderly and younger populations.  We examined treatments from one to five years prior to surgery for a cohort of individuals with osteoarthritis who received a TKA.    Using data from the Osteoarthritis Initiative and Medicare, we assessed the use of medications, corticosteroid and hyaluronic acid injections, arthroscopy, durable medical equipment, and office visits.  We found that the use and spending for services related to knee OA increased every year leading up to total knee arthroplasty, increasing almost 9 fold between one year prior to TKA and five years prior to TKA. Patients in our sample generated more spending on hyaluronic acid and corticosteroid injections than any other treatment category. The injections represented between 28.7% (five years prior to TKA) and 44.9% (two years prior to TKA) of the Medicare spending related to knee OA.  Nevertheless, use rates for most services remained relatively low, with the exception of pain-relieving medications.

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    In this paper, we examined patterns in the use and costs of treatments for osteoarthritis (OA) of the knee in the years prior to total knee arthroplasty (TKA) and how these patterns differ between elderly and younger populations.  We examined treatments from one to five years prior to surgery for a cohort of individuals with

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  • Health and Spending Consequences of Bisphosphonate Treatment for Osteoporosis: A Markov Model Approach

    Osteoporosis-related hip fractures are a major source of avoidable disability and generate significant healthcare costs.  Although bisphosphonates use has been shown to prevent osteoporotic fractures, utilization has been low. This study assessed the value of bisphosphonates to patients and payers by estimating the health and spending consequences of treatment.  We ran Markov models to assess the effects of bisphosphonate treatment on hip fractures, long-term-care facility admissions, life years, and medical and custodial care spending for females aged 65 and 75 with mild, moderate, and severe osteoporosis. Assumptions were developed using 2011-2013 Medicare claims, a mixed-effect meta-analysis of prior clinical studies, and literature review.

    Services : Health Economics & Outcomes Research Expertise:

    Osteoporosis-related hip fractures are a major source of avoidable disability and generate significant healthcare costs.  Although bisphosphonates use has been shown to prevent osteoporotic fractures, utilization has been low. This study assessed the value of bisphosphonates to patients and payers by estimating the health and spending consequences of treatment.  We ran Markov models to assess

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  • Assessing the Value of Surgical Treatment for Select Musculoskeletal Conditions

    Increasingly, policy makers and payers are focusing on value, defined as the health outcome achieved per dollar spent, to increase the return on health care expenditures.  KNG Health led a series of studies examining the societal and economic value of musculoskeletal (MSK) care for selected MSK conditions.  Using regression and Markov modeling techniques, the KNG Health Team developed a Musculoskeletal Care Value Model® (MSK-VM®) that uses functional limitations associated with MSK conditions to estimate clinical and non-clinical outcomes (e.g., ability to work).  The study findings, which focused on healthcare spending, productivity, and quality-adjusted life years, demonstrate that treatment for the selected conditions is cost effective and highlight the importance of considering the benefits to society, in terms of increased earnings, avoided nursing home costs, and other indirect-cost factors, when assessing the full benefit of medical treatment.

    Links: Hip Fracture Publication, Lumbar Discectomy Publication, Rotator Cuff Publication, ACL Publication, Hip Replacement Publication, Knee Replacement Publication

    Services : Health Economics & Outcomes Research Expertise:

    Increasingly, policy makers and payers are focusing on value, defined as the health outcome achieved per dollar spent, to increase the return on health care expenditures.  KNG Health led a series of studies examining the societal and economic value of musculoskeletal (MSK) care for selected MSK conditions.  Using regression and Markov modeling techniques, the KNG

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