A Study on the Economic Impact of Bariatric Surgery

This study concludes that insurers can recover the cost of laparoscopic surgery (approx. $17,000) within two years, and traditional bariatric surgery costs (approx. $26,000) within four years, by saving on other forms of medical care associated with obesity and related conditions.

The study included obese adults identified in an employer claims database of more than five million beneficiaries (1995-2005). Patients who underwent bariatric surgery during this period were matched to a control group who were morbidly obese and never underwent bariatric surgery. Bariatric surgery patients and controls were matched based on patient demographics, selected co-morbidities, and costs.

This study contributes to the small but growing body of and evidence on the economics of bariatric surgery. The study has relevance for benefit design, and may influence health plan coverage decisions, specifically in the context of obesity related conditions such as diabetes.

Approaching Health Disparities From a Population Perspective: The National Institutes of Health Centers for Population Health and Health Disparities

This report highlights collaborations among eight Centers for Population Health and Health Disparities (CPHHDs) across the country reflecting a new approach — the combining of population research, clinical research, and basic science — to explain the determinants of health disparities. This research explores the question of "how environment gets under the skin." Preliminary findings reveal that neighborhood context has a significant effect on individual risk, independent of individual characteristics.

Addressing health disparities has been a challenge for decades. The National Institutes of Health-sponsored Centers for Population Health and Health Disparities is the first federal initiative to support multi-level research, across disciplines, on the determinants of health disparities. The scientific findings of the centers are relevant to communities and contribute to reductions in health disparities.

Growing Popularity, Concerns Regarding CT Scans

This article describes the increase in CT scans and speculates why the growth in CT use been so steep. The authors cite decreasing prices of equipment as a primary factor. This has, in turn, led to growth in many private practices and independent imaging centers purchasing their own machines.

With the volume of CT scans increasing, there is a concern about the potential for a conflict of interest between cardiologists, orthopedic surgeons and other specialists — who provide their own scans — and radiologists, who rely on referrals. To address this issue, CMS has reduced Medicare payments for various medical scans, including CTs, and it is considering "how far to go in restricting doctors from referring scanning business to themselves." The rising popularity of CT scans has also raised concerns about excessive exposure to radiation, which may affect the health of patients.

The article touches on various market issues that surround the use of high tech radiology, and is relevant specifically to CHRT's demonstration project to reduce unnecessary high tech imaging for patients with low back pain.

Measuring the Medical Home Infrastructure in Large Medical Groups

This study concludes that large established physician groups are more likely to adopt medical home and preventive care strategies. The authors report that practices with more than 140 doctors and those owned by a hospital or HMO are most likely to support the medical home model. The study surveyed several large physician practices throughout the country, focusing on those that treat patients with chronic conditions including asthma, diabetes, congestive heart failure and depression.

The Patient Centered Medical Home (PCMH) is becoming increasingly popular and widely discussed in primary care forums as a new delivery model that provides comprehensive, coordinated care for patients. However, the extent to which physician practices have the infrastructure in place to function as medical homes is not known. This study is important as it highlights the value of CHRT's demonstration project to evaluate the PCMH in Michigan.

A House is Not a Home: Keeping Patients at the Center of Practice Redesign

Based on a literature review and interviews with practicing physicians, this study finds that medical home advocates and physicians have different expectations of what the medical home should accomplish — from greater responsiveness to the needs of all patients to increased focus on care management for patients with chronic conditions.

The authors suggest how medical homes might address deficiencies in patient-centered care, the challenges of chronic care, and relatively poor primary care compensation. The authors also describe the evolution of the medical home model from its roots in pediatrics, to primary care, to practice redesign. Finally, they list challenges of medical home adoption such as: practice culture and structure, practice size and scope, lack of agreement on patient populations served by the medical home, management challenges, and "unfettered" expectations.

The authors conclude that the patient-centered medical home could be a transformative innovation. But they also caution, as models are being developed and refined, not to emphasize redesign of practices at the expense of patient-centered care.

Neighborhood Income, Health Insurance, and Prehospital Delay for Myocardial Infarction

This study involved an analysis of more than 6,700 medical records of men and women who had heart attacks between 1993 and 2002. By cross-referencing patient addresses with census data, researchers were able to sort patients into low, medium, and high-income groups.

Overall, the study concludes that people with low incomes — including those with Medicaid coverage — often take much longer than more affluent people to get to the hospital when afflicted with a heart attack. Two key findings were (1) patients in low-income neighborhoods were 46 percent more likely to experience a long rather than short delay, and (2) patients on Medicaid were 87 percent more likely to wait a long time before having their symptoms addressed.

The results of this study add to the body of evidence on health disparities, and point to the critical need to reduce socioeconomic and insurance disparities and pre-hospital delay, all of which may interfere with effective care for heart attack.