In a recently released report, Dobson | DaVanzo discusses the role generic medicines play in decreasing the rate of increase in drug expenditures. Apart from unique and innovative introductions to the drug market, a conversion to generics has consistently reduced inflationary pressures in the U.S. drug marketplace.
In a study for the Federation of American Hospitals and the American Hospital Association, Al Dobson, Joan DaVanzo, Randy Haught and Phap-Hoa Luu estimated that the cumulative federal payment to hospitals between 2010 and 2028 would exceed $218 billion. The authors identified regulatory changes made by CMS as well as eleven legislative acts passed by Congress that have and will continue to result in these reductions over the specified time period. The study can be accessed here.
MedPAC recently released their June 2018 Report to Congress in which they have acknowledged Al Dobson as a contributor. The Commission publishes two annual reports advising Congress on issues affecting the Medicare program. The latest report can be found here.
In the January 2018 issue of Value in Health, Joan DaVanzo and Randy Haught coauthored an article that presents findings from the first comprehensive study of Medicare spending on wound care. The study found that close to 15% of Medicare beneficiaries had at least one type of wound or infection and estimated the cost of wound care for Medicare beneficiaries to be nearly $32 billion. This study has broad implications given that Medicare expenditures related to wound care are much higher than previously thought, and lays the foundation for future research and the development of more appropriate quality measures and reimbursement models. The article can be accessed here, and the Alliance of Wound Care Stakeholders’ press release about the study can be found here.
Sarmistha Pal (lead author) and Joan DaVanzo co-authored a December 2017 article in Surgery Technology International on the impact of Neuromuscular Electrical Stimulation (NMES) on episode costs and post-acute care utilization in total knee replacement patients with disuse atrophy. NMES is a complement to conventional forms of physical therapy. NMES involves the application of low-level electrical currents to targeted muscles which helps to strengthen the quadriceps muscle, thereby improving surgical outcomes and decreasing complications. The authors found that patients who used NMES had lower costs and a lower probability of readmission. The article can be accessed here.
In a study for The Commonwealth Fund, Al Dobson, Joan DaVanzo, Randy Haught and Phap-Hoa Luu examined how the Affordable Care Act’s Medicaid expansion affected the financial status of safety-net hospitals. Using Medicare Hospital Cost Report data for federal fiscal years 2012 and 2015, the authors analyzed changes in Medicaid inpatient days as a percentage of total inpatient days, Medicaid revenues as a percentage of total net patient revenues, uncompensated care costs as a percentage of total operating costs, and hospital operating margins. The authors found that the operating margins of safety-net hospitals in expansion states improved (in large part due to increased Medicaid revenues and reduced uncompensated care costs) while the operating margins of safety-net hospitals in non-expansion states declined. The study can be accessed here.
A Dobson | DaVanzo report entitled, "Access to Home Medical Equipment: Survey of Beneficiary, Case Manager, and Supplier Experiences", was released on October 12, 2017.
The analysis was based on a social media survey of beneficiaries, case managers/discharge planners, and suppliers. Over 1,000 responses were gathered in a 6-week time frame, indicating the power of social media to gather relatively large amounts of information in a short period of time. The report found that the Medicare Competitive Bidding (CB) process may require mid-course corrections in order to improve the beneficiary experience under CB. The report is available here.
Al Dobson presented at the American Orthopedic and Prosthetic Association’s Centennial Celebration and World Congress on Saturday, September 9. Al’s presentation, “The Economic Value of Orthotics and Prosthetics Care to the Medicare Program: 2011 – 2014 Update” summarized Dobson | DaVanzo’s recent research on the financial benefit to government and private payers when a person with spinal injury or lower limb loss or impairment attains restored mobility through receipt of orthotic and prosthetic services. This research, which confirmed the findings of an initial study that used earlier years of data, suggested that the receipt of orthotic and prosthetic services leads to a reduction in health care utilization that equals or exceeds the cost of the services, thus increasing quality of life for the patient and reducing the cost to Medicare. To view the presentation, click here.
Al Dobson, Kennan Murray and Joan DaVanzo recently co-authored a report for 340B Health summarizing an analysis that assessed the financial impact of 340B discounts on drug manufacturers and evaluated the plausibility of claims that the 340B Program is a cause of pharmaceutical price increases, cost shifting, and reductions in private sector research and medical discovery. The analysis found that the 340B Program cannot plausibly be a major driver of U.S. drug spending or a major cause of cost shifting by drug manufacturers to make up for 340B discounts. The results of this analysis were published on the 340B Health website to view click here.
Al Dobson, Kennan Murray and Joan DaVanzo recently co-authored a report for 340B Health which evaluated the financial challenges faced by disproportionate share hospitals participating in the 340B drug discount program due to their characteristics as safety net hospitals and their unique patient populations. The study analyzed whether 340B DSH hospitals incur higher drug spending than non-340B hospitals because they treat high levels of low-income patients and operate as safety net facilities. The analysis found that 340B DSH hospitals incur higher drug spending than non-340B hospitals due to the low-income patients they treat and the nature of the safety net facilities they operate. Read the report here.
Dobson | DaVanzo's study of the MedPAC site-neutral post-acute care payment system prototype was published in a letter from the American Hospital Association (AHA). The letter, "Recommendations on the Development of a Post-Acute Care Prospective Payment System”, discusses AHA’s concerns with the MedPAC prototype, and makes several recommendations. The concerns and recommendations follow from the Dobson | DaVanzo's report, which examined the prototype payment system data sources, econometric approach, and policy implications. To view the letter which includes the report click here.
Dobson | DaVanzo co-authors “Addressing the Risk of Bacterial Contamination in Platelets: A Hospital Economic Perspective,” an article published in the Transfusion Journal which is currently posted on Wiley OnlineOpen. The article, commissioned by Verax Biomedical, Incorporated, discussed the comparative study on the economic value of Platelet PGD test and that of pathogen reduction technology (PRT). In comparison to platelets treated by PRT, platelets tested by the PGD test have extended shelf-life, accrue significantly lower cost, and thus generate savings for hospitals. To read the article click here.
Dobson | DaVanzo's AAHomecare Study was mentioned in an article featured on HME Business. The article, "AAHomecare Prioritizes Payer Relations" discusses how Laura Willard, Vice President of Payer Relations, enhances relations with various payers beyond Medicare, using resources such as Dobson | DaVanzo's study, which analyzed the full operational costs plus cost of goods against the current Medicare reimbursement environment. To read the article click here.
In a June 2017 study for The Commonwealth Fund, Al Dobson, Randy Haught and Joan DaVanzo estimated the financial impact of the Medicaid provisions in the American Health Care Act (AHCA) on safety-net hospitals. Using the Dobson | DaVanzo Hospital Finance Simulation Model, Medicare Hospital Cost Report data, and assumptions on how states would respond to the AHCA Medicaid provisions, the authors found that beginning in 2020, the financial status of safety-net hospitals could deteriorate as Medicaid coverage is reduced and the per-capita spending limits proposed in the AHCA grow. In addition, the authors found that small rural safety-net hospitals and safety net hospitals treating large proportions of low-income patients could be hurt the most. Ultimately, the study shows the strain that would be placed on safety net hospitals due to Medicaid provisions in the AHCA, and indicates that unintended consequences such as hospital closures, cost shifts to Medicare and private insurers and reduced provider payments may be a byproduct of the proposed legislation. The study can be accessed here.
Al Dobson, Randy Haught, and Joan DaVanzo co-authored “How the American Health Care Act’s Changes to Medicaid Will Affect Hospital Finances in Every State”, a report which was recently released by The Commonwealth Fund. The report provides a state-by-state look at the impact of the AHCA Medicaid provisions on hospitals. Specifically, changes in uncompensated care, Medicaid payments, and hospital financial margins over the next ten years. To read the report click here.