Dobson | DaVanzo staff are pleased to announce a recently accepted study in Respiratory Medicine, titled, "Early Initiation of non-invasive ventilation at home improves survival and reduces healthcare costs in COPD patients with chronic hypercapnic respiratory failure: A retrospective cohort study".

Some highlights include:

• Multi-year retrospective cohort study of patients with COPD-CRF receiving Non-invasive Ventilation at Home (NIVH) using 100% Medicare claims
• Econometric IPTW matching methodology – Cox proportional hazard models for time-to-event outcomes and generalized least square model for Medicare expenditure outcomes.
• Findings are that hypercapnic patients benefited in reduced mortality risk from NIVH applied within the first week after index; hypoxic patients did not reduce their risk of mortality.
• Medicare expenditures for hypercapnic patients were lower in the 12 months after treatment than expenditures for either hypoxic or unspecified phenotypes.

 We are pleased to announce that Dobson | DaVanzo was recently awarded the State Data Resource Center (SDRC) contract with the Centers for Medicare and Medicaid Services (CMS) under our General Services Administration (GSA) Multiple Award Schedule (MAS).

 A key aim of this work is to support states as they obtain and use Medicare data for their dually eligible beneficiaries. These data, combined with the states' Medicaid data, allow the states and territories to gain a full picture of the care provided to this population, including beneficiaries' access to care, and the areas for care coordination.

Dobson | DaVanzo, together with our subcontractor, Acumen, LLC, look forward to supporting CMS and states in this important work through hands-on data assistance, webinar content creation and facilitation, and data validation tasks.

Want to learn more about our claims data expertise or collaborate on a project? Get in touch with us.

Dobson | DaVanzo welcomed Michael Beins as an Associate in June. Michael has earned an M.S. in Global and International Education from Drexel University, and a B.A. in both Secondary Education and English from the University of Maryland. He previously served as an English Language Development coordinator at Denver Public Schools and occupied positions in Istanbul, Turkey and Ukraine. Throughout his career in education, he focused on using research-backed approaches to modernize educational teaching methods, contributing to critical theory methodologies, student-centered practices, and restorative approaches in the field. With over a decade of academic editing experience and expertise in qualitative research methods, Mr. Beins uses his knowledge to diversify the research capabilities of Dobson | DaVanzo.

Dobson | DaVanzo welcomed Gage Grispino as a Research Assistant in June. Gage holds a B.S. in Biochemistry and Political Science with a certificate in American Constitutional Democracy from the University of Missouri. He has previously interned at the Cancer Support Community's DC Headquarters and was also selected as a Kinder Scholar from the Kinder Institute on Constitutional Democracy. Gage brings experience in financial analysis, project management, and producing policy proposals and budgets.

Dobson | DaVanzo welcomed Sky Gonzalez as a Research Assistant this month. Sky holds a B.S. in Public Health and Health Administration with a Certificate in Public Health Management from the Edward J. Bloustein School of Planning and Public Policy at Rutgers University. She is currently pursuing an MPH degree with a concentration in health policy from George Washington University. Her previous experience includes managing and serving as a medical assistant at a healthcare practice. Sky views healthcare from both clinical and public health perspectives. She has experience producing research in healthcare, specializing in reproductive health, insurance programs, and healthcare disparities.

Dobson | DaVanzo attended the Wound Care Evidence Summit from May 19^th - May 20^th 2022, organized by the Alliance of Wound Care Stakeholders.

The summit convened a multi-disciplinary group of wound care stakeholders including payers, federal regulators such as the FDA, researchers, clinicians, and manufacturers to collaboratively discuss the challenges in wound care research, clinical care, and coverage. Specifically, stakeholder discussions focused on understanding the quantity and type of evidence payers need to make a coverage determination for wound care products and services, and how that evidence fulfills the requirements of federal regulators concerning safety and efficacy.

During the two-day meeting, attendees reflected on the drawbacks of evidence from clinical trials that are often designed with stringent inclusion criteria - limiting the generalizability of these studies to the actual patients with wound seen in a clinical practice in a hospital or a clinic. Panelists and attendees also discussed the opportunities for using Real World Evidence (RWE) obtained from Real World Data (RWD), including Electronic Health Records (EHRs), administrative claims, registries, and patient-generated data, to support Federal regulatory approvals and payer coverage decisions.

Over the next few weeks, Dobson | DaVanzo will prepare and publish conference proceedings that will include key lessons learned as well as actionable next steps that wound care stakeholders can take to address the challenges discussed.

Dobson | DaVanzo has extensive experience applying rigorous statistical and econometric methodologies to Medicare FFS Claims to infer causal relationships between interventions (such as drugs or services) and outcomes. For instance, in a recently published journal article, we used a two-stage inverse probability treatment weighting model to compare the outcomes for Medicare patients with diabetic foot ulcer(s) (DFU) receiving cryopreserved placental membrane containing viable cells (vCPM) to other Cellular- and Tissue-Based Products (CTPs).

Want to learn more about our claims data expertise or collaborate on a project? Get in touch with us.

Dobson | DaVanzo welcomed Enaas Ahmad as a Research Assistant this month. Enaas holds a Bachelor of Arts in Medical Anthropology from the University of Virginia. Her previous experience includes introducing technology to ease the patient care system in a small-scale healthcare facility in urban Pakistan. She is skilled in clinical comprehension and has experience producing research in healthcare, specializing in indigenous health and biopolitics.

Dobson | DaVanzo staff are pleased to announce a recently accepted study in Advances in Wound Care, titled, "Cryopreserved placental membrane allograft reduces the likelihood of developing a new or recurring foot ulcer and all-cause mortality in diabetic patients, when compared to other cellular- and tissue-based products". This study examines differences in ulcer occurrence and mortality for Medicare Diabetic Foot Ulcer (DFU) patients receiving cryopreserved placental membrane containing viable cells and other cellular and tissue-based products. The study's strict DFU definition which excludes beneficiaries without foot ulcer with demonstrated diabetes etiology makes it an innovative study. Suggested citation: DaVanzo J, Hartzman A, Surfield C, Dobson A. Cryopreserved placental membrane allograft reduces the likelihood of developing a new or recurring foot ulcer and all-cause mortality in diabetic patients, when compared to other cellular- and tissue-based products. Adv Wound Care (New Rochelle). 2022 Mar 9. doi: 10.1089/wound.2021.0123. Epub ahead of print. PMID: 35262428.

Dobson | DaVanzo welcomed Dr. Seung Kim as a Senior Research Scientist. Dr. Kim holds a PhD in Health Systems and Health Economics from Johns Hopkins Bloomberg School of Public Health. He has more than 12 years of experience in the health services research and healthcare data science fields, including working with federal, state, or international agencies, as well as commercial and pharmaceutical companies. Dr. Kim’s expertise includes health economics, outcomes research, program evaluation, resource use and quality measures development and testing, case-mix risk adjustment, and statistical modeling.

Dobson | DaVanzo is pleased to welcome Elaine Cheng to our team of SAS Programmers. Elaine brings more than fifteen years of experience performing business and statistical analyses in the healthcare sector. She holds a Bachelors degree in Sociology and Statistics from North Carolina State University, and her repertoire of data sets includes working with Medicare, Medicaid, and Managed Care systems.

Dobson | DaVanzo principals and staff members have over three decades of dispute resolution experience on behalf of clients. An early successful application of the firm's econometric expertise in litigation support was work on behalf of the Washington State Hospital Association to recoup Medicaid underpayments from the state under the Boren Amendment in 1991. More recently, the Dobson | DaVanzo team helped a small local law firm achieve success against the unfair business practices of a large corporate entity that had financially harmed many community members.

Our litigation and arbitration support activities have been a mainstay for the firm over nearly fifteen years. We currently support a number of efforts to resolve several large and complex disputes. These efforts enable Dobson | DaVanzo analysts to apply econometric expertise gained through policy and financial analyses to "real world" conflicts. Furthermore, our work products are vetted through the intense scrutiny of legal experts and validated by courts and arbiters.

We are meticulous in our data gathering, processing, and econometric analyses. We are equally meticulous in selecting the engagements for which our expertise can best support resolution activities, including class action and qui tam cases.

Our financial, policy, and regulatory analyses provide decision makers with frameworks to understand the unique conditions of healthcare financing and the practical details to inform dispute resolution efforts. We believe that our litigation and arbitration support services help to maintain efficiency within the healthcare marketplace day-to-day when market solutions are not evident or possible.

Dobson | DaVanzo is pleased to announce the addition of Alex Wallace as Associate to our team. Alex holds a Masters in Public Policy from the University of Virginia with a special emphasis on cost benefit analysis and applied policy analysis. Before joining Dobson | DaVanzo, Alex worked as a healthcare consultant primarily engaged in conducting community and health benefit projects with a focus on community health needs
assessments and health program implementation strategies.

As a Health Economics firm, we routinely perform a variety of analyses across multiple Medicare databases; in so doing, we have observed numerous occurrences of COVID-19's impacts. We learned quickly that monthly data were vital to understanding the volatility that COVID-19 introduced into the healthcare system. For instance, from March to April 2020, there was a marked decrease in activity in the healthcare sector. Even ED visits fell dramatically during this time period. In the subsequent months of 2020, monthly data showed lower utilization than observed in prior years, and sometimes unintuitive trends. At this point, due to lags in the data and continued monthly volatility, it is uncertain whether 2021 data reflect a return to normal, or still a decreased amount of activity in the healthcare industry.

In addition to overall changes in utilization, we observed changing relationships within the system. For instance, the portion of fee-for-service (FFS) patients obtaining Home Health care following their hospital discharge overtook the portion of FFS patients obtaining post-hospital care at a Skilled Nursing Facility (SNF), representing a reversal of pre-COVID relationships, as people became wary of SNF care given the infection rates in nursing homes. This reversal in market dominance between SNFs and Home Health care may have changed in late 2020 and early 2021 but we are not sure whether it's been maintained. Second, for Home Health and other settings telehealth changed the dynamics of health care provision. However, many of the Home Health telehealth visits were neither recorded nor costed, hence the extent to which telehealth replaced the in-person visits is unknown.

As we continue to evaluate 2021 data and prepare to conduct preliminary 2022 analyses, we will get a better understanding of the degree to which the healthcare system has returned to a "normal" post-COVID-19 state. A major effect has been that if we want to assess healthcare performance, 2019 data is still the most accurate. And if we want to assess COVID-19's upheaval on the system, we look at the 2020 and 2021 data. This means that the CMS rulemaking process (which typically relies on the most recent historical data for rate setting and other policy changes) has been somewhat disrupted.

Furthermore, it is difficult to ascertain whether recent observed trends were the result of COVID-19 or CMS policy making, which brought about significant payment system changes each of which caused unique impacts in the midst of COVID-19's upheaval. We have yet to determine whether 2021 data will represent a return to normal for the CMS rulemaking process

Dobson | DaVanzo welcomed Brian Hedgeman, MPH, MBA, DrPH, JD, is an Associate. Brian brings a broad range of experience in conducting program design and evaluations, survey design (quantitative and qualitative analyses), health policy analysis, and compliance and legal analysis to the firm. Before joining Dobson | DaVanzo, Dr. Hedgeman worked as a Law Clerk/Advisor at Epstein Becker & Green, PC, where he supported numerous healthcare and life science clients on regulatory and compliance issues specific to federal and state regulations. Dr. Hedgeman holds a Bachelor of Arts in Government from the University of Redlands, a Master of Business Administration and Master of Public Health from Claremont Graduate University, a Doctor of Public Health Degree from Loma Linda University, and a Juris Doctor from Howard University School of Law.

Dobson | DaVanzo is pleased to welcome NaToya Mitchell, MA, as Senior Manager. Prior to joining us, NaToya served as the Commissioner for Anne Arundel County (MD) Commission on Disability Issues. Committed to effective and equitable care, Ms. Mitchell is an Anne Arundel County, Maryland executive appointee and member of several commissions, boards, and workgroups. Formerly an administrator for the Maryland Department of Health, she led the Developmental Disabilities Administration delivery model for people self-directing home and community-based supports while actively managing a $235M portfolio of health services. Ms. Mitchell has earned a Master of Arts in International Studies, and a Bachelor of Arts in Political Science. She is currently pursuing a Doctor of Public Health from Morgan State University.