Presenter:  Mark A. Hlatky, MD
“Incorporating Cost-Effectiveness into Clinical Guidelines”
Health Research and Policy

RSVP required.  Please RSVP here.

All research in progress seminars are off-the-record unless otherwise noted. Any information about methodology and/or results are embargoed until publication.

Presenter:  Michelle Mello, JD, PhD
“Patients’ Experiences of Medical Error Disclosure and Reconciliation”
Health Research and Policy

RSVP required.  Please RSVP here.

All research in progress seminars are off-the-record unless otherwise noted. Any information about methodology and/or results are embargoed until publication.

The misery of the medical malpractice litigation process for all involved has led some hospitals to develop alternative ways to resolve medical injuries with patients.  In communication-and-resolution programs (CRPs), for example, hospitals disclose errors and adverse events, apologize and explain what happened, and where appropriate, proactively offer compensation.  Patients’ perceptions of these processes are not well understood. This presentation will report on an empirical study of patients’ experiences with disclosure and compensation offers, using interview data collected in 3 hospital systems.

Presenter:  Eric Sun, MD, PhD
“Billing Irregularities by Health Care Providers: Evidence from Anesthesia”
Anesthesiology, Pain and Perioperative Medicine

RSVP required.  Please RSVP here.

All research in progress seminars are off-the-record unless otherwise noted. Any information about methodology and/or results are embargoed until publication.

In the United States, physicians exercise tremendous discretion in choosing billing details that determine payment for their services.  While understanding the degree to which physicians inappropriately use this discretion has implications for setting payment policies, separating inappropriate discretion from actual differences in patient complexity is empirically challenging.  In anesthesia, providers are compensated by self-reported length of time (“anesthesia time”) spent on a case. Therefore, anomalous patterns in a practitioner’s reported times—e.g., an excess number of cases with an anesthesia time ending in five (e.g., 65 minutes)—can objectively identify inappropriate billing when those reported times are also longer than expected. Using a national database of over 6.5 million anesthesia cases from 5,755 anesthesia providers, we found that anomalous patterns are common—nearly one-quarter of providers report an unusually large number of cases with anesthesia times ending in 5 or zero.  Providers who were particularly anomalous—those in the top 5^th percentile in terms of anesthesia times ending in 5 or zero—also tended to report anesthesia times that were 22 minutes longer than expected, which would net an additional $34 to $98 per case, depending on payer.  While inappropriate practices seem confined to a minority of anesthesia providers, our results provide some impetus for ongoing policy efforts aimed at reducing the amount of discretion given to physicians.

Presenters:
Kate Bundorf, PhD, MBA, MPH; Health Research and Policy
Maria Polyakova, PhD; Health Research and Policy
Cheryl Stults, PhD; Palo Alto Medical Foundation Research Institute
Ming Tai-Seale, PhD, MPH; Palo Alto Medical Foundation’s Research Institute

RSVP required.  Please RSVP here.

All research in progress seminars are off-the-record unless otherwise noted. Any information about methodology and/or results are embargoed until publication.

Medicare beneficiaries consistently report difficulty choosing a Medicare Part D plan, rarely change their plans and are often not enrolled in the plan providing the most generous coverage for their medications. In this project, we test whether providing personalized information on the financial implications of enrolling in different plans, both with and without expert recommendations, improves decision outcomes for Medicare Part D enrollees relative to directing them to the Medicare.gov website. We describe and report the results of a randomized, controlled trial of the effects of using a patient-centered Medicare Part D decision tool during 2017 open enrollment (October 15 through December 7, 2016) among patients who are members of a large multispecialty group practice.

Presenter:  Joshua Salomon, PhD

“Prospects for Tuberculosis Elimination in the US and Globally”

Elimination of tuberculosis in the United States has been an explicit public health policy goal since the 1980s. Globally, the World Health Organization has established ambitious targets to reduce deaths from tuberculosis by 95% before 2035. In this seminar we will explore results from TB epidemic simulation models to shed light on the potential short-term and long-term trajectories of TB in the US under a range of different policy scenarios, and will consider relevant epidemiological and policy trends in global TB control. We will describe ongoing work to translate models into decision tools for US state-level TB planners, and to model key interdependencies between US and global TB control.

RSVP required.  Please RSVP here.

All research in progress seminars are off-the-record unless otherwise noted. Any information about methodology and/or results are embargoed until publication.

Presenters:  David Chan MD, PhD & David Studdert LLB, ScD, MPH

“Accuracy of Time Measures Used to Value Surgical Procedures in the Medicare Physician Fee Schedule”

The American Medical Association’s Relative Value Scale Update Committee (RUC) has been called “the most important health care group you’ve never heard of”.  It plays a central role in determining how much public and private insurers pay physicians for services.  The RUC’s role and performance have been heavily criticized, but subjected to very little empirical evaluation.  In a sample of the most common surgical procedures, we assessed the accuracy of a key ingredient of RUC valuations: procedure duration.  We identify inaccuracies, and find that they have substantial distributional effects on payments to surgeons. On the other hand, we find that revaluations by the RUC tend to partially correct these inaccuracies, and detect no evidence of bias in the RUC’s choices of procedures to review.

RSVP required.  Please RSVP here.

All research in progress seminars are off-the-record unless otherwise noted. Any information about methodology and/or results are embargoed until publication.

Presenters:  Michelle Mello, JD, PhD

“Making Prescription Drugs Affordable: The National Academies of Sciences, Engineering and Medicine’s Report”

In a recent poll, Americans ranked prescription drug prices as the most important domestic issue for Congress to tackle.  Prescription drugs now account for 17% of national health care expenditures, and 1 in 4 Americans reports that they or a family member has decided not to fill a prescription or to skip or reduce doses in the past year because of cost worries.  To investigate the causes of high drug costs and potential policy interventions, the National Academies of Sciences, Engineering and Medicine convened a committee of experts, which recently released its report.  Dr. Mello, a member of the committee, will review the key findings and discuss factors that make the affordability of medicines such a difficult problem to solve.

RSVP required.  Please RSVP here.

All research in progress seminars are off-the-record unless otherwise noted. Any information about methodology and/or results are embargoed until publication.

Presenters:  Jason Wang, MD, PhD

“Follow-up and Prevention of Preterm Birth Using a Mobile Strategy”

Preterm birth (PTB), delivery prior to 37-week gestation, accounts for 35% of infant deaths in the first year of life [minority populations], and substantial short- and long-term morbidity in survivors. Despite rigorous efforts to understand and mitigate PTB, it remains a significant clinical and financial burden for families and society [$26.2 billion in the US in 2005]. Although the causes of preterm birth are likely multifactorial, one major risk factor is known: women who have delivered a preterm infant have an increased risk of preterm birth in subsequent pregnancies. The risk of recurrent PTB is directly proportional to the number of prior PTBs, and is inversely proportional to the gestational age of the previous PTB. To date, many prematurity prevention initiatives focus on general education approaches targeting broad populations of pregnant women. We propose to supplement these broad-scale initiatives with targeted prevention approaches focused on high-risk women who have had a preterm birth. Dr. Wang will discuss the development and testing of a mobile app to help mothers of preterm infants take care of their children; the app will also educate, engage and empower mothers in preventing preterm births in future pregnancies.

RSVP required.  Please RSVP here.

All research in progress seminars are off-the-record unless otherwise noted. Any information about methodology and/or results are embargoed until publication.

Presenter: Rachel Hess, MD, MS

Chief, Division of Health System Innovation and Research

University of Utah