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Journal Cover JAMA The Journal of the American Medical Association
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     ISSN (Print) 0098-7484 - ISSN (Online) 1538-3598
     Published by American Medical Association Homepage  [11 journals]   [SJR: 4.843]   [H-I: 456]
  • Total Expenditures per Patient in Hospital-Owned and Physician-Owned
           Physician Organizations in California
    • Authors: Robinson JC; Miller K.
      Abstract: ImportanceHospitals are rapidly acquiring medical groups and physician practices. This consolidation may foster cooperation and thereby reduce expenditures, but also may lead to higher expenditures through greater use of hospital-based ambulatory services and through greater hospital pricing leverage against health insurers.ObjectiveTo determine whether total expenditures per patient were higher in physician organizations (integrated medical groups and independent practice associations) owned by local hospitals or multihospital systems compared with groups owned by participating physicians.Design and SettingData were obtained on total expenditures for the care provided to 4.5 million patients treated by integrated medical groups and independent practice associations in California between 2009 and 2012. The patients were covered by commercial health maintenance organization (HMO) insurance and the data did not include patients covered by commercial preferred provider organization (PPO) insurance, Medicare, or Medicaid.Main Outcomes and MeasuresTotal expenditures per patient annually, measured in terms of what insurers paid to the physician organizations for professional services, to hospitals for inpatient and outpatient procedures, to clinical laboratories for diagnostic tests, and to pharmaceutical manufacturers for drugs and biologics.ExposuresAnnual expenditures per patient were compared after adjusting for patient illness burden, geographic input costs, and organizational characteristics.ResultsOf the 158 organizations, 118 physician organizations (75%) were physician-owned and provided care for 3 065 551 patients, 19 organizations (12%) were owned by local hospitals and provided care for 728 608 patients, and 21 organizations (13%) were owned by multihospital systems and provided care for 693 254 patients. In 2012, physician-owned physician organizations had mean expenditures of $3066 per patient (95% CI, $2892 to $3240), hospital-owned physician organizations had mean expenditures of $4312 per patient (95% CI, $3768 to $4857), and physician organizations owned by multihospital systems had mean expenditures of $4776 (95% CI, $4349 to $5202) per patient. After adjusting for patient severity and other factors over the period, local hospital–owned physician organizations incurred expenditures per patient 10.3% (95% CI, 1.7% to 19.7%) higher than did physician-owned organizations (adjusted difference, $435 [95% CI, $105 to $766], P = .02). Organizations owned by multihospital systems incurred expenditures 19.8% (95% CI, 13.9% to 26.0%) higher (adjusted difference, $704 [95% CI,$512 to $895], P 
      PubDate: Wed, 22 Oct 2014 00:00:00 GMT
  • Physician Practice Competition and Prices Paid by Private Insurers for
           Office Visits
    • Authors: Baker LC; Bundorf M, Royalty AB, et al.
      Abstract: ImportancePhysician practice consolidation could promote higher-quality care but may also create greater economic market power that could lead to higher prices for physician services.ObjectiveTo assess the relationship between physician competition and prices paid by private preferred provider organizations (PPOs) for 10 types of office visits in 10 prominent specialties.Design and SettingRetrospective study in 1058 US counties in urbanized areas, representing all 50 states, examining the relationship between measured physician competition and prices paid for office visits in 2010 and the relationship between changes in competition and prices between 2003 and 2010, using regression analysis to control for possible confounding factors.ExposuresVariation in the mean Hirschman-Herfindahl Index (HHI) of physician practices within a county by specialty (HHIs range from 0, representing maximally competitive markets, to 10 000 in markets served by a single [monopoly] practice).Main Outcomes and MeasuresMean price paid by county to physicians in each specialty by private PPOs for intermediate office visits with established patients (Current Procedural Terminology [CPT] code 99213) and a price index measuring the county-weighted mean price for 10 types of office visits with new and established patients (CPT codes 99201-99205, 99211-99215) relative to national mean prices.ResultsIn 2010, across all specialties studied, HHIs were 3 to 4 times higher in the 90th-percentile county than the 10th-percentile county (eg, for family practice: 10th percentile HHI = 1023 and 90th percentile HHI = 3629). Depending on specialty, mean price for a CPT code 99213 visit was between $70 and $75. After adjustment for potential confounders, depending on specialty, prices at the 90th-percentile HHI were between $5.85 (orthopedics; 95% CI, $3.46-$8.24) and $11.67 (internal medicine; 95% CI, $9.13-$14.21) higher than at the 10th percentile. Including all types of office visits, price indexes at the 90th-percentile HHI were 8.3% (orthopedics; 95% CI, 5.0%-11.6%) to 16.1% (internal medicine; 95% CI, 12.8%-19.5%) higher. Between 2003 and 2010, there were larger price increases in areas that were less competitive in 2002 than in initially more competitive areas.Conclusions and RelevanceMore competition among physicians is related to lower prices paid by private PPOs for office visits. These results may inform work on policies that influence practice competition.
      PubDate: Wed, 22 Oct 2014 00:00:00 GMT
  • Treatment of Generalized War-Related Health Concerns Placing TBI and PTSD
           in Context
    • Authors: Hoge CW; Castro CA.
      Abstract: JAMA PsychiatryAssociation Between Traumatic Brain Injury and Risk of Posttraumatic Stress Disorder in Active-Duty MarinesKate A. Yurgil, PhD; Donald A. Barkauskas, PhD; Jennifer J. Vasterling, PhD; Caroline M. Nievergelt, PhD; Gerald E. Larson, PhD; Nicholas J. Schork, PhD; Brett T. Litz, PhD; William P. Nash, MD; Dewleen G. Baker, MD; for the Marine Resiliency Study Team Importance Whether traumatic brain injury (TBI) is a risk factor for posttraumatic stress disorder (PTSD) has been difficult to determine because of the prevalence of comorbid conditions, overlapping symptoms, and cross-sectional samples.Objective To examine the extent to which self-reported predeployment and deployment-related TBI confers increased risk of PTSD when accounting for combat intensity and predeployment mental health symptoms.Design, Setting, and Participants As part of the prospective, longitudinal Marine Resiliency Study (June 2008 to May 2012), structured clinical interviews and self-report assessments were administered approximately 1 month before a 7-month deployment to Iraq or Afghanistan and again 3 to 6 months after deployment. The study was conducted at training areas on a Marine Corps base in southern California or at Veterans Affairs San Diego Medical Center. Participants for the final analytic sample were 1648 active-duty Marine and Navy servicemen who completed predeployment and postdeployment assessments. Reasons for exclusions were nondeployment (n = 34), missing data (n = 181), and rank of noncommissioned and commissioned officers (n = 66).Main Outcomes and Measures The primary outcome was the total score on the Clinician-Administered PTSD Scale (CAPS) 3 months after deployment.Results At the predeployment assessment, 56.8% of the participants reported prior TBI; at postdeployment assessment, 19.8% reported sustaining TBI between predeployment and postdeployment assessments (ie, deployment-related TBI). Approximately 87.2% of deployment-related TBIs were mild; 250 of 287 participants (87.1%) who reported posttraumatic amnesia reported less than 24 hours of posttraumatic amnesia (37 reported ≥24 hours), and 111 of 117 of those who lost consciousness (94.9%) reported less than 30 minutes of unconsciousness. Predeployment CAPS score and combat intensity score raised predicted 3-month postdeployment CAPS scores by factors of 1.02 (P 
      PubDate: Wed, 22 Oct 2014 00:00:00 GMT
  • Diagnosis and Management of Urinary Tract Infections in the Outpatient
           Setting A Review
    • Authors: Grigoryan L; Trautner BW, Gupta K.
      Abstract: ImportanceUrinary tract infection is among the most common reasons for an outpatient visit and antibiotic use in adult populations. The increasing prevalence of antibacterial resistance among community uropathogens affects the diagnosis and management of this clinical syndrome.ObjectivesTo define the optimal approach for treating acute cystitis in young healthy women and in women with diabetes and men and to define the optimal approach for diagnosing acute cystitis in the outpatient setting.Evidence ReviewEvidence for optimal treatment regimens was obtained by searching PubMed and the Cochrane database for English-language studies published up to July 21, 2014.FindingsTwenty-seven randomized clinical trials (6463 patients), 6 systematic reviews, and 11 observational studies (252 934 patients) were included in our review. Acute uncomplicated cystitis in women can be diagnosed without an office visit or urine culture. Trimethoprim-sulfamethoxazole (160/800 mg twice daily for 3 days), nitrofurantoin monohydrate/macrocrystals (100 mg twice daily for 5-7 days), and fosfomycin trometamol (3 g in a single dose) are all appropriate first-line therapies for uncomplicated cystitis. Fluoroquinolones are effective for clinical outcomes but should be reserved for more invasive infections. β-Lactam agents (amoxicillin-clavulanate and cefpodoxime-proxetil) are not as effective as empirical first-line therapies. Immediate antimicrobial therapy is recommended rather than delayed treatment or symptom management with ibuprofen alone. Limited observational studies support 7 to 14 days of therapy for acute urinary tract infection in men. Based on 1 observational study and our expert opinion, women with diabetes without voiding abnormalities presenting with acute cystitis should be treated similarly to women without diabetes.Conclusions and RelevanceImmediate antimicrobial therapy with trimethoprim-sulfamethoxazole, nitrofurantoin, or fosfomycin is indicated for acute cystitis in adult women. Increasing resistance rates among uropathogens have complicated treatment of acute cystitis. Individualized assessment of risk factors for resistance and regimen tolerability is needed to choose the optimum empirical regimen.
      PubDate: Wed, 22 Oct 2014 00:00:00 GMT
  • Association Between Availability of Health Service Prices and Payments for
           These Services
    • Authors: Whaley C; Schneider Chafen J, Pinkard S, et al.
      Abstract: ImportanceRecent governmental and private initiatives have sought to reduce health care costs by making health care prices more transparent.ObjectiveTo determine whether the use of an employer-sponsored private price transparency platform was associated with lower claims payments for 3 common medical services.DesignPayments for clinical services provided were compared between patients who searched a pricing website before using the service with patients who had not researched prior to receiving this service. Multivariable generalized linear model regressions with propensity score adjustment controlled for demographic, geographic, and procedure differences. To test for selection bias, payments for individuals who used the platform to search for services (searchers) were compared with those who did not use the platform to search for services (nonsearchers) in the period before the platform was available. The exposure was the use of the price transparency platform to search for laboratory tests, advanced imaging services, or clinician office visits before receiving care for that service.Setting and ParticipantsMedical claims from 2010-2013 of 502 949 patients who were insured in the United States by 18 employers who provided a price transparency platform to their employees.Main Outcomes and MeasuresThe primary outcome was total claims payments (the sum of employer and employee spending for each claim) for laboratory tests, advanced imaging services, and clinician office visits.ResultsFollowing access to the platform, 5.9% of 2 988 663 laboratory test claims, 6.9% of 76 768 advanced imaging claims, and 26.8% of 2 653 227 clinician office visit claims were associated with a prior search on the price transparency platform. Before having access to the price transparency platform, searchers had higher claims payments than nonsearchers for laboratory tests (4.11%; 95% CI, 1.87%-6.41%), higher payments for advanced imaging services (5.57%; 95% CI, 1.83%-9.44%), and no difference in payments for clinician office visits (0.26%; 95% CI; 0.53%-0.005%). Following access to the price transparency platform, relative claim payments for searchers were lower for searchers than nonsearchers by 13.93% (95% CI, 10.28%-17.43%) for laboratory tests, 13.15% (95% CI, 9.49%-16.66%) for advanced imaging, and 1.02% (95% CI, 0.57%-1.47%) for clinician office visits. The absolute payment differences were $3.45 (95% CI, $1.78-$5.12) for laboratory tests, $124.74 (95% CI, $83.06-$166.42) for advanced imaging services, and $1.18 (95% CI, $0.66-$1.70) for clinician office visits.Conclusions and RelevanceUse of price transparency information was associated with lower total claims payments for common medical services. The magnitude of the difference was largest for advanced imaging services and smallest for clinical office visits. Patient access to pricing information before obtaining clinical services may result in lower overall payments made for clinical care.
      PubDate: Wed, 22 Oct 2014 00:00:00 GMT
  • What Gets Measured Gets (Micro)managed
    • Authors: Ranji SR.
      Abstract: When I became an attending physician in 2002, the rules were unwritten but clear: The residents ran the service, and I knew where I stood—in the background. I was to get involved only when necessary, usually meaning if a consultant was being particularly unhelpful, if there was a thorny goals-of-care discussion, or if a patient directly asked for the attending’s opinion. Anything else would result in receiving the worst label you could get as an attending: “micromanager.”
      PubDate: Wed, 22 Oct 2014 00:00:00 GMT
  • Who Benefits From Health System Change'
    • Authors: Cutler DM.
      Abstract: The organization of medical care is changing more rapidly now than at any point in the last century. For decades, health care was a cottage industry: physicians practiced independently or in small groups and had arms-length relationships with hospitals, imaging and laboratory facilities, and other health care entities. Those organizations alternately competed and cooperated as part of an informal local health care system.
      PubDate: Wed, 22 Oct 2014 00:00:00 GMT
  • Health Care Price Transparency and Economic Theory
    • Authors: Reinhardt UE.
      Abstract: Citizens in most economically developed nations have health insurance coverage that results in only modest cost sharing at the time health care is used. Furthermore, physicians, hospitals, and other clinicians and entities that provide health care within most systems outside the United States are paid on common fee schedules uniformly applied to all clinicians, health care organizations, and insurers. That approach spares the insured the need to seek out lower-priced health care and obviates the need for transparency on the prices charged by individual clinicians and organizations that provide health care.
      PubDate: Wed, 22 Oct 2014 00:00:00 GMT
  • Tests for Urinary Tract Infection in Nursing Home Residents
    • Authors: Juthani-Mehta M; Datunashvili A, Tinetti M.
      PubDate: Wed, 22 Oct 2014 00:00:00 GMT
  • Presence of Banned Drugs in Dietary Supplements Following FDA Recalls
    • Authors: Cohen PA; Maller G, DeSouza R, et al.
      Abstract: The US Food and Drug Administration (FDA) initiates class I drug recalls when products have the reasonable possibility of causing serious adverse health consequences or death. Recently, the FDA has used class I drug recalls in an effort to remove dietary supplements adulterated with pharmaceutical ingredients from US markets. Approximately half of all FDA class I drug recalls since 2004 have involved dietary supplements adulterated with banned pharmaceutical ingredients.
      PubDate: Wed, 22 Oct 2014 00:00:00 GMT
  • Insulin vs Sulfonylureas for Second-Line Diabetes Treatment
    • Authors: Tasci I; Safer U.
      Abstract: To the Editor Dr Roumie and colleagues reported that compared with sulfonylureas the addition of insulin to metformin to improve glycemic control was associated with an increased risk of a composite of nonfatal cardiovascular outcomes and all-cause mortality in patients with diabetes mellitus. Although the results presented require verification in carefully designed clinical trials, we have some concerns about the current analyses.
      PubDate: Wed, 22 Oct 2014 00:00:00 GMT
  • Insulin vs Sulfonylureas for Second-Line Diabetes Treatment—Reply
    • Authors: Roumie CL; Greevy RA, Griffin MR.
      Abstract: In Reply We agree with Drs Tasci and Safer that the risk of metformin and insulin compared with metformin plus sulfonylurea as a second-line diabetes treatment after failure of metformin monotherapy may differ in certain populations. They point to eFigure 3 that shows a statistically significant increased risk in persons aged 65 years or older and no statistically significant increase in younger persons.
      PubDate: Wed, 22 Oct 2014 00:00:00 GMT
  • Insulin vs Sulfonylureas for Second-Line Diabetes Treatment
    • Authors: Roumie CL; Greevy RA, Griffin MR.
      Abstract: To the Editor In Dr Safford’s Editorial, she discussed our analyses that quantified how sensitive our conclusions were to unmeasured confounding and used as an example the degree of insulin resistance. We would like to provide a clarification to the explanation provided regarding unmeasured confounder imbalance.
      PubDate: Wed, 22 Oct 2014 00:00:00 GMT
  • Breast Cancer Screening With Tomosynthesis and Digital
    • Authors: Friedewald SM; Rafferty EA, Conant EF.
      Abstract: In Reply Drs Seidenwurm and Rosenberg correctly point out that the mean recall rate in our study with digital mammography alone (10.7%) was slightly higher than the ACR guidelines of 10% or less. This is not surprising given that prior analyses of performance benchmarks of mammographic interpretation in the United States have consistently acknowledged that recall rates in clinical practice commonly exceed these ACR guidelines.
      PubDate: Wed, 22 Oct 2014 00:00:00 GMT
  • Breast Cancer Screening With Tomosynthesis and Digital Mammography
    • Authors: Seidenwurm D; Rosenberg R.
      Abstract: To the Editor Dr Friedewald and colleagues demonstrated improved performance with both lower recall rates and improved invasive cancer detection by adding tomosynthesis to digital mammography. The report also documented the continued large variability of recall rates and cancer detection rates among sites. This variation may be even greater among individual radiologists.
      PubDate: Wed, 22 Oct 2014 00:00:00 GMT
  • Insulin vs Sulfonylureas for Second-Line Diabetes Treatment—Reply
    • Authors: Safford MM.
      Abstract: In Reply Dr Roumie and colleagues have clarified the interpretation of their analysis of unmeasured confounder imbalance in their study. Because their analysis reported absolute differences, as they point out in their letter, the prevalence of unmeasured confounders would need to be quite high in the insulin-treated group with little or no prevalence in the sulfonylurea-treated group to explain the findings of their study.
      PubDate: Wed, 22 Oct 2014 00:00:00 GMT
  • Addressing the Trauma of Hospitalization
    • Authors: Davydow DS; Katon WJ.
      Abstract: To the Editor Drs Detsky and Krumholz highlighted an important problem facing hospitalized patients and their family members and suggested interventions to reduce the potential for traumatization by the experience of being hospitalized for a medical illness or surgical procedure. However, hospitalization is not inherently traumatizing for all patients, and interventions targeting posthospitalization syndrome should also consider premorbid patient characteristics.
      PubDate: Wed, 22 Oct 2014 00:00:00 GMT
  • Addressing the Trauma of Hospitalization—Reply
    • Authors: Detsky AS; Krumholz H.
      Abstract: In Reply We agree with Drs Davydow and Katon that there is a need to better integrate mental health concerns into the care of patients who are hospitalized primarily for nonmental health problems.
      PubDate: Wed, 22 Oct 2014 00:00:00 GMT
  • Analysis Reveals Large Increase in Hospitalizations in Recent Years Among
           Older Patients Prescribed Opioids
    • Authors: Rubin R.
      Abstract: A government “statistical brief” on opioid-related hospitalizations didn’t get much press coverage when it was posted in August, but at least a few findings merit a closer look.
      PubDate: Wed, 22 Oct 2014 00:00:00 GMT
  • CDC to Clinicians: Be Alert for Children With Poliolike Illness
    • Authors: Stephenson J.
      Abstract: Clinicians should be on alert for pediatric patients who present with an acute neurologic illness that features focal limb weakness and abnormalities of the spinal cord gray matter on magnetic resonance imaging (MRI), according to a health advisory issued September 26 by the Centers for Disease Control and Prevention (CDC).
      PubDate: Wed, 22 Oct 2014 00:00:00 GMT
  • Combined Therapy May Enhance Recovery Rates of Severe Depression
    • Authors: Slomski A.
      Abstract: Cognitive therapy combined with antidepressant medication improved recovery rates compared with medication alone, but only among patients with severe nonchronic depression, found a randomized trial of 452 adults with major depressive disorder (Hollon S et al. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2014.1054 [published online August 20, 2014]).
      PubDate: Wed, 22 Oct 2014 00:00:00 GMT
  • Mepolizumab May Substantially Reduce Asthma Exacerbations
    • Authors: Slomski A.
      Abstract: Mepolizumab, a humanized monoclonal antibody against interleukin-5, significantly reduced asthma exacerbations and improved quality of life among patients treated with inhaled glucocorticoids, according to a randomized, placebo-controlled trial with 576 participants (Ortega H et al. N Engl J Med. 2014;371[13]:1198-207).
      PubDate: Wed, 22 Oct 2014 00:00:00 GMT
  • Rivaroxaban Viable as Alternative Anticoagulant for Cardioversion
    • Authors: Slomski A.
      Abstract: The oral anticoagulant rivaroxaban appears to safely and effectively prevent the risk of stroke associated with cardioversion in patients with atrial fibrillation, according to a randomized trial of 1504 patients (Cappato R et al. Eur Heart J. doi:10.1093/eurheartj/ehu367 [published online September 2, 2014]). Rivaroxaban’s action in 2 to 4 hours also allowed for more rapid cardioversion than vitamin K antagonists.
      PubDate: Wed, 22 Oct 2014 00:00:00 GMT
  • Telephone Counseling May Sustain Safer Sex Practices in Teenaged Girls
    • Authors: Slomski A.
      Abstract: African American adolescent girls had fewer chlamydial and gonococcal infections and safer sex over 3 years while receiving 18 telephone counseling sessions that reinforced an initial behavioral intervention to prevent sexually transmitted infection (STI) and HIV, reported investigators for a randomized trial (DiClemente R et al. JAMA Pediatr. doi:10.1001/jamapediatrics.2014.1436 [published online August 25, 2014]).
      PubDate: Wed, 22 Oct 2014 00:00:00 GMT
  • NIH Funds Creation of Database of Cellular Signatures
    • Authors: Hampton T.
      Abstract: Building on a successful 3-year pilot project, the National Institutes of Health (NIH) has awarded more than $64 million to 6 research institutions to create the Library of Integrated Network-based Cellular Signatures (LINCS), a database of human cellular responses to influences such as drugs, genetic factors, and environmental changes that can disrup cells (
      PubDate: Wed, 22 Oct 2014 00:00:00 GMT
  • Report Predicts Fewer Uninsured but More Growth in Health Spending
    • Authors: Hampton T.
      Abstract: In the coming years, the number of uninsured individuals will likely decline and the growth in health spending accelerate in the United States, predicts a new report from the Centers for Medicare & Medicaid Services (Sisko AM et al. Health Aff [Millwood]. doi:10.1377/hlthaff.2014.0560 [published online September 3, 2014]).
      PubDate: Wed, 22 Oct 2014 00:00:00 GMT
  • Teens’ Use of Drugs, Alcohol, and Tobacco Declines
    • Authors: Hampton T.
      Abstract: The percentage of US adolescents aged 12 to 17 years who reported using illicit drugs in the past month decreased from 11.6% in 2002 to 8.8% in 2013, and the proportion of youths with substance dependence or abuse problems decreased from 8.9% to 5.2%. The findings, reported by the Substance Abuse and Mental Health Services Administration, are from the latest National Survey on Drug Use and Health (, an annual survey of approximately 70 000 US individuals.
      PubDate: Wed, 22 Oct 2014 00:00:00 GMT
  • Tweaking Proposed Food Safety Rules
    • Authors: Hampton T.
      Abstract: The US Food and Drug Administration (FDA) has issued revisions to 4 proposed rules that will implement portions of the FDA Food Safety Modernization Act, which aims to ensure the US food supply is safe by shifting the focus from responding to contamination to preventing it (
      PubDate: Wed, 22 Oct 2014 00:00:00 GMT
  • Can Coupons Help Curb Obesity'
    • Abstract: Shoppers aren’t the only ones looking for grocery store coupons and discounts. Public health researchers hope to find ways to curb overweight and obesity rates by studying how price breaks on food affect consumer choices for high- and low-calorie foods.
      PubDate: Wed, 22 Oct 2014 00:00:00 GMT
  • Vaccine-Related Diseases Affect Young Immigrants
    • Abstract: Pediatricians can add one more spot to watch on their radar screens: vaccine-associated diseases in foreign-born children who live in the United States.
      PubDate: Wed, 22 Oct 2014 00:00:00 GMT
  • No Tomorrow Hath Nor Yesterday Ina Meares
    • Authors: Smith JM.
      Abstract: The scale of the endless sky and acres of ochre grain in Canada may make other locales look almost Lilliputian in comparison. For painter Ina Meares (1921-2000), who had emigrated from England with its more petite properties, Canada’s supersize scenery was likely awe-inducing. The shimmery reflective works by Meares that seem to symbolize hue and sweep of earth and sky may bring to mind Carl Sandburg’s Prairie wherein the reader is pressed, “Have you seen a red sunset drip over one of my cornfields, the shore of night stars, the wave lines of dawn up a wheat valley'”
      PubDate: Wed, 22 Oct 2014 00:00:00 GMT
  • Placebo
    • Authors: Skillman J.
      Abstract: I have taken the pill of dreamsunder winter’s dead-pan sky.
      PubDate: Wed, 22 Oct 2014 00:00:00 GMT
  • The Cost of Medical Care
    • Abstract: The interest of the public in the cost of medical care, apparently for many years dormant, seems now to be the topic of the hour. True, one may visit innumerable villages, cities and hamlets of the Middle West, the South, and even the New England states and find both the physicians and the general public little concerned in the current agitation; but in other communities it arouses burning argument and intense feeling. Much of this emotionalism is, of course, the result of propaganda and of personal issues which have little or nothing to do with the purely economic aspects of the question. Nevertheless, the work of the Committee on the Cost of Medical Care and the numerous investigations now being carried on under various auspices in new methods of medical practice make the situation one which the medical profession must consider. As has been said previously in these columns, regardless of the nature of medical practice in the future, physicians will have to do the practicing; and the success or failure of any experiment will depend on the extent to which physicians deliver what the public has been accustomed to expect from them in the way of prevention and cure of disease.
      PubDate: Wed, 22 Oct 2014 00:00:00 GMT
  • Crohn Disease
    • Authors: Cheifetz A.
      PubDate: Wed, 22 Oct 2014 00:00:00 GMT
  • JAMA
    • PubDate: Wed, 22 Oct 2014 00:00:00 GMT
  • Association Between Hospital Conversions to For-Profit Status and Clinical
           and Economic Outcomes
    • Authors: Joynt KE; Orav E, Jha AK.
      Abstract: ImportanceAn increasing number of hospitals have converted to for-profit status, prompting concerns that these hospitals will focus on payer mix and profits, avoiding disadvantaged patients and paying less attention to quality of care.ObjectiveTo examine characteristics of US acute care hospitals associated with conversion to for-profit status and changes following conversion.Design, Setting, and ParticipantsRetrospective cohort study conducted among 237 converting hospitals and 631 matched control hospitals. Participants were 1 843 764 Medicare fee-for-service beneficiaries at converting hospitals and 4 828 138 at control hospitals.ExposuresConversion to for-profit status, 2003-2010.Main Outcomes and MeasuresFinancial performance measures, quality process measures, mortality rates, Medicare volume, and patient population for the 2 years prior and the 2 years after conversion, excluding the conversion year, assessed using difference-in-difference models.ResultsHospitals that converted to for-profit status were more often small or medium in size, located in the south, in an urban or suburban location, and were less often teaching institutions. Converting hospitals improved their total margins (ratio of net income to net revenue plus other income) more than controls (2.2% vs 0.4% improvement; difference in differences, 1.8% [ 95% CI, 0.5% to 3.1%]; P = .007). Converting hospitals and controls both improved their process quality metrics (6.0% vs 5.6%; difference in differences, 0.4% [95% CI, −1.1% to 2.0%]; P = .59). Mortality rates did not change at converting hospitals relative to controls for Medicare patients overall (increase of 0.1% vs 0.2%; difference in differences, −0.2% [95% CI, −0.5% to 0.2%], P = .42) or for dual-eligible or disabled patients. There was no change in converting hospitals relative to controls in annual Medicare volume (−111 vs −74 patients; difference in differences, −37 [95% CI, −224 to 150]; P = .70), Disproportionate Share Hospital Index (1.7% vs 0.4%; difference in differences, 1.3% [95% CI, −0.9% to 3.4%], P = .26), the proportion of patients with Medicaid (−0.2% vs 0.4%; difference in differences, −0.6% [95% CI, −2.0% to 0.8%]; P = .38) or the proportion of patients who were black (−0.4% vs −0.1%; difference in differences, −0.3% [95% CI, −1.9% to 1.3%]; P = .72) or Hispanic (0.1% vs −0.1%; difference in differences, 0.2% [95% CI, −0.3% to 0.7%]; P = .50).Conclusions and RelevanceHospital conversion to for-profit status was associated with improvements in financial margins but not associated with differences in quality or mortality rates or with the proportion of poor or minority patients receiving care.
      PubDate: Wed, 22 Oct 2014 00:00:00 GMT
  • Structuring Payments to Patient-Centered Medical Homes
    • Authors: Landon BE.
      Abstract: This Viewpoint discusses the use of structured payments to patient-centered medical homes as a means of optimizing primary care reimbursement.
      PubDate: Wed, 22 Oct 2014 00:00:00 GMT
  • The Pioneer Accountable Care Organization Model Improving Quality and
           Lowering Costs
    • Authors: Pham HH; Cohen M, Conway PH.
      Abstract: This Viewpoint discusses the evolution of the Centers for Medicare & Medicaid Services’ Pioneer accountable care organization model.
      PubDate: Wed, 22 Oct 2014 00:00:00 GMT
  • Indication-Specific Pricing for Cancer Drugs
    • Authors: Bach PB.
      Abstract: This Viewpoint addresses the benefits and challenges of adopting indication-specific pricing for cancer drugs.
      PubDate: Wed, 22 Oct 2014 00:00:00 GMT
  • Highlights
    • PubDate: Wed, 22 Oct 2014 00:00:00 GMT
  • Providing Price Displays for Physicians Which Price Is Right'
    • Authors: Riggs KR; DeCamp M.
      Abstract: This Viewpoint discusses ethical issues related to use of price displays for physicians to help contain US health care costs.
      PubDate: Wed, 22 Oct 2014 00:00:00 GMT
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