JustCare

Tag: Data

  • Coronavirus: Lack of timely data jeopardizes public health

    Coronavirus: Lack of timely data jeopardizes public health

    In a new report, Sins of Omission: How Government Failures to Track Covid-19 Data Have Led to More Than 1,700 Health Care Worker Deaths and Jeopardize Public Health, National Nurses United (NNU) underscores the need to reform our health care system. Federal and state governments do not have systems in place to protect  the health and well-being of Americans, much less our nation’s nurses and other health care workers.

    NNU reports that more than 1,700 health care workers have tested positive for COVID-19. Of those, at least 213 registered nurses have died unnecessarily. The federal government does not have the systems in place to keep health care workers safe in a pandemic. Hospitals and other health care companies are not reporting infection rates or deaths accurately or in real time. Workplaces have not been safe.

    Without reliable and timely information, there is no way to respond effectively to the novel coronavirus pandemic. We need to know where the virus is, we need the resources to protect people in those areas, and we need to know what is working to contain the spread of the virus. The NNU report explains that rather than tracking this data, federal and state governments are hiding it or ignoring it. They are also playing with available data to mislead the public.

    Federal and state governments are not requiring health care facilities to turn over mortality or infection rate data. Of course, these facilities have no interest in so doing. It could tarnish their images.

    Fewer than one in three states are providing infection data for health care workers. Without good data, there is no way to understand the breadth of the pandemic. There is no way to respond to it as warranted.

    The Centers for Medicare and Medicaid Services (CMS) has only required nursing homes to provide mortality and infection rate data for health care workers. That data is publicly available on its web site. Hospitals are not required to collect this data.

    The Trump administration has kept a lot of the COVID-19 data hidden at the department of Health and Human Services (HHS). It has traditionally been kept by the CDC, but the administration transferred it to HHS. The Trump administration is interfering in scientific work and failing to release accurate public health information. To be sure, it is not coming up with a strong national plan to keep the novel coronavirus from spreading.

    The CDC must be charged with tracking this data and given the resources and tools to do the job that is needed. Data should be independent and not played with for political or business reasons.

    Specifically, NNU calls for:

    • Daily reporting of data (as well as cumulative totals) on diagnostic testing and case counts at national, state, and county/local levels.
    • Daily reporting and cumulative totals of data on health care worker infections and deaths at an establishment level, such as the specific hospital or business.
    • Data on symptomatic cases must be reported at national, state, and county/local levels (influenza-like illness and Covid-like illness).
    • Daily reporting of data on hospitalizations and deaths must be reported at national, state, and county/local levels.
    • Hospital capacity data must be reported at national, state, and county/local levels; must be updated in real time; and must include total and available hospital beds by type (e.g., ICU, medical/surgical, telemetry, etc.), staffing, health care worker exposures and infections, and nosocomial (hospital-acquired) patient infections.
    • Data on the stock and supply chain of essential personal protective equipment (PPE) and other supplies must be reported at national, state, and county/local levels.

    Here’s more from Just Care:

  • 2020: What you might not know about Medicare Advantage plans

    2020: What you might not know about Medicare Advantage plans

    The Kaiser Family Foundation has a new report on Medicare Advantage plans–private health plans that offer Medicare benefits–in 2020. Here’s what you might not know, including the latest data:

    1. Enrollment in Medicare Advantage plans is now just over 24 million or about 40 percent of the Medicare population. In some counties, only 1 percent of people are enrolled in Medicare Advantage; in others, it’s as many as 60 percent.
    2. Average annual out-of-pocket costs for in-network care in HMOs and PPOs is $4,925; the average out-of-pocket cap for the combination of in-network and out-of-network care in PPOs is $8,828. Drug costs are not included in these caps.
    3. Virtually everyone enrolled in a Medicare Advantage plan must get prior approval before receiving most costly medical services; preventive care services generally do not require prior authorization.
    4. If you are hospitalized for more than five days and enrolled in a Medicare Advantage plan, your out-of-pocket costs are likely to be higher than in traditional Medicare (without supplemental coverage).
    5. Six in ten people in Medicare Advantage plans pay no additional premium, and they generally get prescription drug coverage. Nine in ten Medicare Advantage plans offer prescription drug coverage. The average premium for the 40 percent of enrollees who pay a premium is $63 a month.
    6. Of people enrolled in Medicare Advantage, about 20 percent have retirees benefits from employers or unions who require them to join in order to get their retiree wrap-around benefits. In some states, more than three in ten Medicare Advantage enrollees get retiree wrap-around coverage. And, in New Jersey, West Virginia and Michigan, four in ten Medicare Advantage enrollees or more get retiree wrap-around coverage.
    7. United Healthcare, Humana and BlueCross BlueShield have the greatest number of Medicare Advantage enrollees. More than one in four (26 percent) are enrolled in United Healthcare, nearly one in five (18 percent) are enrolled in Humana and more than one in seven (15 percent) are enrolled in BlueCross BlueShield.

    Here’s more from Just Care:

  • Half of health care spending goes to doctors and hospitals

    Half of health care spending goes to doctors and hospitals

    A recent Peterson-KFF health tracking report shows that spending on hospitals and doctors has been increasing faster than inflation. Today, half of health care spending goes to doctors and hospitals.

    In 2018, about one-third of overall health care spending went to hospitals. Another 20 percent of spending went to physicians and health clinics. And, another nine percent of spending went for prescription drugs. The rate of increase in health care spending for doctors, hospitals and prescription drugs has slowed down some recently.

    Over the last nearly 50 years, spending on health care has grown significantly. In 1970, we spent $74.6 billion (6.9 percent of GDP) on health care. Thirty years later, total health spending was $1.4 trillion. In 2018, health care spending more than doubled to $3.6 trillion (17.7 percent of GDP.)

    Per person spending on health care in the US was 31 times higher in 2018 than in 1970. It grew from $355 a person to $11,172. In 2018 dollars, per person spending grew six times from $1,832 in 1970 to $11,172.

    Not surprisingly, out-of-pocket health care costs also have grown considerably since 1970. They totaled an average of $119 in 1970 ($613 in 2018 dollars) and $1,150 in 2018. These costs do not include premium costs.

    Public and private health insurance premiums have also grown. One-third of all health care spending is for private health insurance. In 1970, 21 percent of total health spending went towards private insurance. Public insurance represents 41 percent of total spending, up from 22 percent in 1970. When you include spending on public health and research, the government is responsible for almost half (45 percent) of total spending.

    Notably, private insurers have not been able to rein in health care spending as well as Medicare and Medicaid. In addition to having high administrative costs, private health insurers have not been able to rein in provider rates. Private insurer per person spending grew 52.6 percent in the ten years between 2008 and 2018. In stark contrast, Medicare per person spending grew 21.5 percent, and Medicaid per person spending grew 12.5 percent.

    Administrative costs grew quicker in 2018 than in the previous ten years. They represented 7.9 percent of overall spending (excluding provider administrative costs). That’s up from 2.8 percent in 1970.

    Here’s more from Just Care:

  • People with Medicare still spend an average of $5,500 on health care

    People with Medicare still spend an average of $5,500 on health care

    Medicare is a blessing for people over 65 and people with disabilities. But, it only covers about half of a typical person’s health care costs. A new Kaiser Family Foundation study finds that people with Medicare still spend an average of almost $5,500 on health care.

    Nearly two years ago, Kaiser reported data from 2013 showing that people with Medicare spent an average of $5,500 on health care six years ago. Kaiser’s new report looks at 2016 data to arrive at about the same finding, $5,460.

    Different Medicare subpopulations spend more than others. Nearly $1,000 of those out-of-pocket costs are for institutionalized long-term care services, which only one in 20 people with Medicare use. People living in the community spent an average of $4,519 out-of-pocket on health care costs.

    The oldest people with Medicare, people who were hospitalized, and people in poor health, spent more on health care than others. People between 65 and 74, on average, spent less than half as much out of pocket as people 85 and older, $5,021 as compared to $10,307. The difference is largely attributable to the costs of institutionalized care.

    People who were hospitalized at least once during the year spent almost $2,500 more than people who were not hospitalized, $7,613 as compared to $5,044.

    Curiously, women spent somewhat more out of pocket, on average, than men, $5,748 as compared to $5,104. And, even though extra help is available for people with low incomes to pay for their health care, people with Medicaid and Medicare still spent an average of $2,665.

    Understandably people with multiple chronic conditions spent more on average than people in better health. People with five or more chronic conditions spent $1,065 on prescription drugs as compared to $416 for people with one or two chronic conditions. People with cancer, hepatitis C, rheumatoid arthritis and multiple sclerosis spend thousands of dollars out of pocket each year even with the Part D drug benefit.

    Dental services, which Medicare does not cover, cost people with Medicare an average of $449.

    Kaiser was only able to analyze traditional Medicare data as the Medicare Advantage plans, private health plans that contract with Medicare, do not disclose this data. What are they hiding? More important, with Medicare for All, older adults and people with disabilities would save an average of $5,500 on health care costs.

    Here’s more from Just Care:

  • How do you choose a hospital?

    How do you choose a hospital?

    All hospitals are not created equal. In fact, there are some with records suggesting you may leave in worse health than you arrived. Many factors contribute to whether a hospital will provide you with the care you need and not jeopardize your health. So, how do you choose a hospital?

    CMS updated its Overall Hospital Quality Star Ratings in February. It gave only 293 hospitals out of more than 4,500 a five-star rating.

    CMS’ Hospital Compare website reports on quality measures that go into its star ratings. Medicare has been collecting data on hospitals and rating them on Hospital Compare for several years, based on 62 independent ratings.

    On Hospital Compare, you can learn about hospitals with high readmission rates and hospitals that CMS has penalized, hospitals which you might want to avoid. You can also learn about hospitals with high rates of hospital-acquired infections.

    Questions that are factored into the star-rating system include:

    • How frequently do patients get an infection after surgery?
    • The average wait patients have in the Emergency Department before seeing a doctor?
    • How often do patients develop complications after hip replacement surgery?
    • Chances of patients being readmitted to the hospital after a heart attack?
    • The number of times patients receive CT scans or MRI’s?

    Medicare star ratings do not tell the whole story about the quality of a hospital, and you should not rely exclusively upon them.

    If you are choosing a hospital, you should also visit the Informed Patient Institute, a non-profit that grades the different entities rating hospitals in each state. Right now, the IPI gives Medicare’s Hospital Compare a B grade because there is a lot of missing data. Medicare has not collected information on several measures.

    Here’s more from Just Care:

  • PPIs found to increase risk of kidney failure

    PPIs found to increase risk of kidney failure

    Routine use of proton pump inhibitors, common over-the-counter medications used to treat acid reflux, can increase the risk of kidney failure four-fold.

    Researchers examined health data on more than 190,000 patients over a 15-year period in a retrospective study. None of the patients had existing kidney disease at the start. Researchers compared patients who were eventually given a PPI and those who weren’t ever given one. Common PPIs include Prevacid (lansoprazole), Prilosec (omeprazole) and Nexium (esomeprazole).

    Results, published in Pharmacotherapy, found that those on a PPI had a 20% increased risk of chronic kidney disease compared with those not on the drug. In addition, those on a PPI were four times as likely to experience kidney failure. The study authors noted that the risks were highest in those 65 and older.

    Although PPIs are only meant for short-term use, overuse of the medications are as high as 70% of patients.

    Lead author David Jacobs, PharmD, PhD, assistant professor of pharmacy practice at the University of Buffalo School of Pharmacy and Pharmaceutical Sciences, noted that doctors need to be educated on the dangers of overuse of PPIs and deprescribing initiatives developed.

    Last month, a study that analyzed adverse events reports sent to the FDA found that PPIs were associated with an increased risk of kidney disease.

    This story first appeared on Medshadow.org.

    Here’s more from Just Care:

  • US health care system ranks last in meeting patient’s health care needs

    US health care system ranks last in meeting patient’s health care needs

    A report, published in Health Affairs, analyzes 2016 survey data on patients’ experiences with the health care system in 11 countries. It finds that the US health care system ranks last–at the bottom of the barrel–in meeting the needs of patients, when compared with health care systems in other wealthy countries. All of the other countries have universal health care.

    Of the people surveyed across 11 countries, people in the US are less healthy and more likely to face material hardship, because of the health care system. US health care is less affordable and does a worse job of getting people quick access to medical care, except specialty care.

    People in the United States struggle more than others to access care. One in three adults in the US, a higher percentage than in any other country, reported difficulty accessing care because of the cost. Every other country does a better job protecting residents from the costs of health care.

    The UK does the best job of ensuring health care is affordable for everyone. Germans were the least likely to face financial barriers to care. The Netherlands had the best health system based on overall survey results.

    No country did a great job of engaging patients or managing chronic care, particularly patients with low incomes. But, the US led the pack on social challenges that affected health. More than people in other countries, Americans reported being “always” or “usually” concerned about having money to buy meals and pay for their housing. Germans were least concerned.

    In other countries, people were more likely to have difficulty affording dental care. But, affordability of dental care presented the greatest issues for Americans. People in the Netherlands, the UK and Germany had the least problem accessing dental care.

    On the issue of quick access to care, again the US ranked below other countries. In the Netherlands and New Zealand, eight in ten people said they could see a doctor within a day or two. Only in the Netherlands could most people (75 percent) get health care at night and on the weekends without having to go to the emergency room.

    Canadians struggled most to get primary care. Three in ten Canadians needed to wait at least two months. Nearly as many adults in Norway also waited at least two months for primary care. In France, Germany, the Netherlands, Switzerland, and the United States, only about one in ten adults waited that long.

    Of note, the US performed best in one category–doctors engaging patients in discussions about exercise and good nutrition–staying healthy. The report authors suggest that the US could further improve. And, they suggested that it may be that the US performs better because relative to the other 10 countries in the study we have higher rates of obesity and lead less active lives.

    People surveyed lived in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the US.

    To improve health outcomes in the US, we need Medicare for All. Please sign this petition.

    Here’s more from Just Care:

  • Another study confirms, it’s the prices, stupid

    Another study confirms, it’s the prices, stupid

    Why do we spend so much more on health care than other countries? In 2003, Gerard Anderson and Uwe Reinhard et al. explained, It’s the prices stupid: Why the US is so different from other countries. But, some very intelligent people believe otherwise. A new international study on health care spending, by Irene Papanicolas, PhD, Liana Woskie, MSc and Ashish Jha, MD, MPH, confirms, it’s the prices, stupid.

    These researchers looked at health care services in other countries to better understand why the US spends about twice as much per capita as other countries. In a Vox interview, Jha explained that he was surprised by their findings. Contrary to what he had been telling people, excessive use of specialty care has not been responsible for high health care spending in the US. Indeed, the US has about the same mix of primary care and specialty care as other wealthy countries. And, health care in the US looks a lot like health care in other countries.

    Americans visit the doctor about as frequently as people in other comparable countries. Indeed, we go to the doctor and use the hospital slightly less on average than other wealthy countries. We do get more CAT scans and knee replacements than people in every other country. And, we get more MRIs than people in other countries, with the exception of Germany. But, we get significantly fewer hip replacements than the Swiss, the Germans, the Danes, the French and the Swedes.

    Rather than quantity of services, the data show that the big difference between the US and other countries is that we spend more on drugs, devices, labor and services. Jha also thinks Americans use too many services. But, so do people in peer countries. To look more like those countries, we need to address the prices we pay for our services and our administrative costs. Focusing on utilization will not rein in spending sufficiently.

    Here’s more from Just Care:

  • Risks of harm from surgery towards end of life often outweigh benefits

    Risks of harm from surgery towards end of life often outweigh benefits

    Medicare data reveals that almost one in three older adults have surgery in the year before they die. And one in four have surgery in the three months before they die. But, Liz Szabo reports for Kaiser Health News that the risks of harm from surgery often outweigh the benefits in people at the end of life. There may be no miracle cure, but you do have options.

    Dr. Rita Redberg, Director of Cardiovascular Care at the University 0f California–San Francisco Division of Cardiology, believes that doctors opt to operate rather than not because they often fail to appreciate what patients value most. They do not ask their patients. Yet, many patients at the end of life place a higher priority on quality of life than on a prolonged life in a nursing home.

    Doctors tend not to focus on the fact that older people fare far worse from surgery than younger people, for whom surgery can be lifesaving. Older people tend not to benefit in terms of longer lives or better quality of life. Indeed, functional decline is too often the consequence of surgery. The recovery rate for older adults is far slower than younger people, requiring them to spend twice as long in intensive care.

    One in five older adults die within a month of getting emergency abdominal surgery. But, surgeons may not want to, or know how to, communicate this information to older adults. Some are now using a best case/worst case framework for helping older adults share in decision-making about their care.

    The issue is extremely complex. It is easy to imagine that the surgery will not deliver the desired benefits. But, it is hard to turn it down if the doctor recommends it as an option. Maybe, you think, you will be lucky and the surgery will improve your condition. It is far more difficult to weigh the potential harms in the balance.

    Just the other day my 95-year old father went to the emergency room with a health care buddy after he took a fall. After waiting five hours for the brain imaging scan the ER staff claimed he needed, he called me for advice. He wanted to leave. I urged him to go home and get sleep. He was clearly of sound mind but totally exhausted. Instead, he spent the night in the ER, exposed to dozens of people in poor health and at risk of infection. His geriatrician discharged him the next day.

    My dad had tried to leave the ER after we spoke, but a doctor, not his treating physician, blocked his way. The doctor was adamant he stay for the test and for the night. And, though my dad is a retired doctor, neither he nor his health care buddy felt they could disregard the doctor’s instructions.

    Requiring people at the end of life to pay a portion of the surgery’s cost is not the solution. That simply rations care based on ability to pay rather than on need. It does nothing to move doctors to both help patients understand they have options and respect those options.

    Decision-support tools could be helpful for older patients to understand the risks of surgery, along with the best, worst and most likely outcomes. The mounting evidence suggests that fewer medical interventions and medicines often mean a longer and better life for older adults at the end of life–people need to understand that.

    Here’s more from Just Care:

  • Question your doctor before getting arthroscopic knee surgery

    Question your doctor before getting arthroscopic knee surgery

    If your doctor recommends you get arthroscopic knee surgery for a meniscal tear, do some homework before moving forward with the operation. A new Johns Hopkins study published in JAMA reveals that even though arthroscopic partial meniscectomies (APMs) have no benefit whatsoever for people over 65, surgeons perform these procedures routinely. And, as with much surgery, there are risks of infection and complications.

    Researchers studied Medicare data on 121,624 knee arthroscopies for meniscal tears that developed with age. It is one of the most common procedures for older adults, performed by 12,504 surgeons. Yet, many clinical trials have shown that the procedure unequivocally has no benefit in treating this degenerative disease in older adults.

    In general, the clinical trials reveal that routine exercise and physical therapy provide additional benefits for meniscal tears in older adults. Surgery, by comparison, offers no benefit. However, for acute traumatic meniscal tears, often resulting from engaging in sports, the APM can be beneficial.

    Notwithstanding the evidence against arthroscopic knee surgery for meniscal tears in older adults, thousands of surgeons continue to perform the procedure, jeopardizing people’s health and driving up health care spending unnecessarily. Perhaps, the surgeons have not seen the evidence or, perhaps, they choose to disregard it. Either way, the question is what is to be done about it.

    Here’s more from Just Care: