Dobson | DaVanzo Publishes a Study in Advances in Wound Care

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.

Seung Ouk Kim, PhD, Joins Dobson | DaVanzo as a Senior Research Scientist

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 Welcomes Elaine Cheng as a Data Associate

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's Litigation and Arbitration Support Services

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 Welcomes Alex Wallace as an Associate

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.

Dobson | DaVanzo's Observations on COVID-19 and Health Care Data

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

Brian Hedgeman, MPH, MBA, DrPH, JD, Joins Dobson | DaVanzo as an Associate

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.

NaToya Mitchell, MA, Joins Dobson | DaVanzo as a Senior Manager

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. 

Paige Lambert, MPH, Joins Dobson | DaVanzo as a Research Analyst

Dobson | DaVanzo welcomed Paige Lambert in the role of Research Analyst. Prior to joining our firm, Paige served as a Regulatory Analyst in the Public Health Division for the Town of Needham in Massachusetts. She received her Bachelor of Science at the College of William and Mary and her Master of Public Health from Boston University.

American Physical Therapy Association and American Occupational Therapy Association Publishes a Dobson | DaVanzo's Therapy Outcomes in Post-Acute Care Settings Study Summary

The American Physical Therapy Association (APTA) and American Occupational Therapy Association (AOTA) have published summary materials of the Dobson DaVanzo & Associates Therapy Outcomes in Post-Acute Care Settings (TOPS) study. This study examined the relationship of physical and occupational therapy to measured changes in reported functional independence and readmissions. Overall, we found that therapy intensity is directly and positively related to improvements in functional ability and post-discharge readmission rates.

The TOPS study used Medicare claims and post-acute care assessment data (OASIS, IRF-PAI and MDS) to assess the amount of therapy received during a stay and functional impairment of core activities of daily living and mobility at admission and discharge. This allowed us to measure functional improvement while controlling for important beneficiary health and service use factors. Post-acute care (PAC) settings studied – Inpatient Rehabilitation Facilities, Skilled Nursing Facilities, and Home Health Agencies – differed substantially in their approaches to care provision as well as measurement of key functional status items. While we were able to compensate for this in the study, these differences precluded direct comparison across studies, with strong implications for the future of a unified PAC payment system.  

Summary TOPS study materials are available from APTA:

Dobson | DaVanzo Releases Analysis on Potential Medicare and Medicaid Savings for an Alzheimer’s Disease Therapy over 10 years

In 2020, 5.8 million Americans aged 65 and older (11% of the total population in this age group as of 2019) were diagnosed with Alzheimer’s Disease (AD) [1]. To determine Medicare and Medicaid expenditures for beneficiaries and total societal expenditures associated with the clinical introduction of a potential AD treatment for Medicare beneficiaries, we used the 2020-2021 total AD population over 65 as a baseline. Using a step-down approach and factoring in a take-up rate, we determined the target population that would benefit from the potential AD treatment to be 80,248, or approximately 1.4% of the initial population, gradually increasing each year to 205,153 by 2031. In addition, the analysis focuses on a 10-year time frame (2022-2031) and, specifically, on the Medicare population over 65. Our estimated 10-year cost savings assume the introduction of a novel AD medication that delays disease progression by six months for year 1 (2022), twelve months for year 2 (2023), eighteen months for year 3 (2024), and twenty-four months for all following years until 2031. A delay of this length represents a dramatic roll back in the progression of the disease where the costs are significantly higher than in the earlier stages of the disease. We assumed an aggressive take-up rate of the novel AD medication, starting at 25% in 2022 and gradually increasing to 50% in 2031. This analysis estimates our total 10-Year Savings as: $1.24 billion for Medicare (including beneficiary copayments), $26.42 billion for Medicaid and Non-Medicaid Nursing Home Costs, and $11.86 billion for Informal Care and Support Costs for a total of $39.52 billion. You can read an executive summary of the analysis and download the full report here.

Potential Medicare savings are limited because the study only focuses on those costs associated with Medicare spending that are directly associated with AD or ~11% of the total Medicare expenditures for AD patients [2]. For Medicaid savings, the analysis specifically focuses on costs and savings generated from Nursing Home (NH) Care for Medicare beneficiaries. It is estimated that close to two thirds of nursing home residents in the US have some type of cognitive impairment like AD [3]. The informal caregiving cost estimates account for both a population that enrolls in nursing home care and a population that never enrolls in nursing homes. Greater savings are achieved through reductions in broader societal expenditure burden like formal Medicaid long-term care expenditures and informal caregiving and support expenditures than from Medicare and Medicare Copayments.

A drug that would delay AD disease progression by up to two years would increase quality of life by preserving and extending patients’ independence for a longer time, thus transforming the AD drug space. A drug that delays AD disease progression by two years also promises significant social returns relative to costly drugs that extend life for much shorter time frames. The most important benefit of the potential AD treatment is likely not monetary, but rather quality of life due to a delay in the debilitating neurodegenerative sequelae of AD. Biogen, Inc. commissioned Dobson DaVanzo & Associates, LLC, a health economics and policy consulting firm, to conduct this study.


[1] Alzheimer’s Association. (2020), 2020 Alzheimer's disease facts and figures. Alzheimer's Dement., 16: 391-460.

[2] Pyenson, B., Sawhney, T. G., Steffens, C., Rotter, D., Peschin, S., Scott, J., & Jenkins, E. (2019). The real-world medicare costs of alzheimer disease: considerations for policy and care. Journal of managed care & specialty pharmacy, 25(7), 800-809.

[3] Gaugler, J. E., Yu, F., Davila, H. W., & Shippee, T. (2014). Alzheimer’s disease and nursing homes. Health Affairs, 33(4), 650-657.


Dobson | DaVanzo Prepares for Submitting Publications to Peer Reviewed Journals

Dobson | DaVanzo routinely assists clients who wish to submit their studies to peer reviewed journals. Our analysts and data scientists help to develop the “story line,” and tailor the content and format to the requirements of the selected journal. Our studies range from econometric analyses of legislation or Medicare regulation to more clinically oriented retrospective longitudinal cohort studies of patient outcomes using Medicare claims. Recent examples are "Economic Value of Orthotic and Prosthetic Services Among Medicare Beneficiaries: A Claims-Based Retrospective Cohort Study, 2011–2014", appearing in the Journal of NeuroEngineering and Rehabilitation in 2018 and "An Economic Evaluation of the Impact, Cost, and Medicare Policy Implications of Chronic, Nonhealing Wounds", appearing in Value in Health in 2018. Other studies have been published in a wide variety of journals such as Health Economics, Health Affairs, The Milbank Quarterly, Surgical Technology International, Military Medicine, and Journal of Vascular Access. We are currently preparing three manuscripts for clients based on our analysis of the 100 percent Medicare files. 

Dobson | DaVanzo subcontracts with BAH for the Evaluation of Network of Quality Improvement and Innovation Contractors

Dobson | DaVanzo is pleased to announce its continued partnership over the next five years with Booz Allen Hamilton's (BAH) Independent Evaluation Center to evaluate hospital and clinician focused improvement initiatives related to large scale interventions in the fields of Behavioral Health, Chronic Disease Management, Patient Safety, Quality of Care Transitions, Long Term Care and response to the COVID-19 emergency and preparedness. As subcontractor to BAH, Dobson | DaVanzo will collaborate on technical aspects of the development and implementation of formative and impact evaluations as well as on innovative techniques to estimate a Return on Investment to CMS. This work is a continuation of Dobson | DaVanzo’s past subcontracting work for BAH, in which impact evaluation and ROI estimates were produced for CMS related to the Quality Innovation Network-Quality Improvement Organizations (QIN-QIOs) 11th Statement of Work.

Dobson | DaVanzo Hosts Webinars for Academic Centers and Hospitals to Understand FUS APC Payments

Dobson | DaVanzo has been helping manufacturers and service providers of focused ultrasound (FUS) devices in understanding how CMS sets Ambulatory Payment Classification (APC) payment amounts in the outpatient setting. The project entails tracking how providers bill Medicare for a code in relationship to the cost of delivering the service. The key is that the provider bills Medicare “charges.” Medicare then steps these charges down to costs using the hospital’s cost-to-charge ratio (CCR x charges = costs) and sets payments at these estimated costs. Through workshops and webinars, Dobson | DaVanzo has been able to discuss with a number of academic medical centers and their various financial departments how the decisions on Revenue Center selection, setting, and charge levels influence eventual CMS APC payments.

Dobson | DaVanzo Evaluates the Financial Impact of Medicare Coverage of Complex Rehabilitative Power Wheelchair Seat Elevation and Standing Systems

Dobson | DaVanzo was commissioned by the Independence Through Enhancement of Medicare and Medicaid (“ITEM”) Coalition to model the likely impact of establishing coverage for two accessories of complex rehabilitative power wheelchairs on Medicare spending over 10 years (2021-2030). In their findings, they provided cost estimates which will be incurred by Medicare in the event of coverage implementation of these wheelchairs.