Present-On-Admission Indicators

The Centers for Medicare & Medicaid Services (CMS) has proposed expanding the list of conditions for which it will no longer pay at a higher rate if the patient acquires them during a hospital stay. This research brief includes a section on measuring impact, including which types of facilities will feel the greatest effects, and recommendations for provider organizations to establish clear policies and procedures for present-on-admission indicator assignment.

High and Rising Health Care Costs: Demystifying U.S. Health Care Spending

This report by HSC president Paul B. Ginsburg, Ph.D. synthesizes current research on health care costs. Some of the key findings from this report are:

• Health insurance is becoming increasingly difficult for workers-and their employers-to afford. Premiums increased 114 percent between 1999 and 2007, while workers' earnings increased only 27 percent.
• U.S. spending on health care (as a percentage of Gross Domestic Product) is more than six percentage points higher than the average for other developed countries.
• Technology-not demographics or medical malpractice-is the key driver of health spending, accounting for an estimated half to two-thirds of spending growth.
• Other important drivers of health care spending include health status (particularly obesity) and low productivity gains in the health care sector.

These data are particularly important for health policy experts to consider when determining what steps can be taken to expand insurance coverage while keeping costs down.

Frequency of Stress Testing to Document Ischemia Prior to Elective Percutaneous Coronary Intervention

A study of Medicare beneficiaries undergoing elective percutaneous coronary intervention (PCI) for stable coronary artery disease (CAD) indicates that more than half did not first undergo a guideline-recommended stress test to confirm that the intervention was necessary. The study was a retrospective observational cohort study using claims data. The findings, following the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial results, imply that patients may be getting higher-risk treatment than warranted and also that Medicare is spending more on invasive therapies without knowing whether an interventional approach is needed.

National Trends in Treatment of Type 2 Diabetes Mellitus, 1994–2007

Over the last six years, the cost of diabetes medicine in the U.S. has nearly doubled, from $6.7 billion in 2001 to $12.5 billion in 2007. According to this study, this has often been due to the use of newer, more expensive drugs over traditional, less expensive treatments. Despite innovations in therapy, little is known about patterns and costs of drug treatment. This study shows that increasingly complex and costly diabetes treatments are being applied to an increasing population, but the magnitude of these rapid changes raises concerns about whether these more costly therapies will result in proportionately improved outcomes.