Prescription drugs accounted for 11% of Medicare spending in 2010, but are expected to account for 20% of this budget by 2020. The purpose of this subproject is to advance our understanding of the use and efficiency of prescription drugs among Medicare beneficiaries. First, we characterize the use of pharmaceutical drugs in the U.S. Medicare population at the level of the region or physician-hospital network (PHN) into four categories depending on efficiency or effectiveness - that is, value per dollar spent. These range from the first category, highly effective, to the fourth category, drugs which could lead to adverse effects on health. In this and subsequent analyses, we will consider factors that may affect the efficiency of pharmaceutical use, such as care fragmentation, academic affiliation, health information technology adoption, market structure, and for some physicians, board scores from the American Board of Internal Medicine examinations. These measures can also be used across other subproject analyses, for example for PHNs in subproject 1 and regions in subproject 4. Second, we focus on pharmaceutical treatments for specific cohorts: myocardial infarction survivors, hip fracture survivors, and incident cases of chronic pulmonary disease. This focus allows us to adjust more easily for patient level factors and identify clearly effective treatments (e.g., clopidogrel following a drug-eluting stent). In later years, data will permit assessment of the impact of payment structure such as shared savings and partial capitation on prescription use measures. Third, we use the cohorts developed in the previous subsection to measure substitution effects, the extent to which spending wisely on highly effective pharmaceuticals may have positive effects on downstream healthcare costs, and conversely for those drugs with little known value (or even negative value). To adjust for differences across areas in underlying risk, we will draw on Project 5's risk adjustment measures. Finally, we describe differences in prescription drug use in population subgroups. Early work shows substantial differences in use of some effective medications among Medicare subgroups (e.g. Black, older, poor) compared to the population overall. In addition, we intend to study the under-65 Medicare population (largely those receiving Social Security Disability Insurance) where pharmaceutical treatment for mental illness is likely to be common.
This subproject seeks to understand how variations across physician-hospital networks (PHNs) affect the health, quality of care, and health costs of the Medicare population. These findings could have first-order implications for measuring and improving pharmaceutical care across PHNs, as well as providing a better understanding of how drugs are used in actual clinical practice for, say, younger patients with mental illness or the very old, rather than those patients typically selected for randomized trials.
|Bekelis, Kimon; Gottlieb, Dan; Labropoulos, Nicos et al. (2017) The impact of hybrid neurosurgeons on the outcomes of endovascular coiling for unruptured cerebral aneurysms. J Neurosurg 126:29-35|
|Nyweide, David J; Bynum, Julie P W (2017) Relationship Between Continuity of Ambulatory Care and Risk of Emergency Department Episodes Among Older Adults. Ann Emerg Med 69:407-415.e3|
|Chandra, Amitabh; Frakes, Michael; Malani, Anup (2017) Challenges To Reducing Discrimination And Health Inequity Through Existing Civil Rights Laws. Health Aff (Millwood) 36:1041-1047|
|Bekelis, Kimon; Skinner, Jonathan; Gottlieb, Daniel et al. (2017) De-adoption and exnovation in the use of carotid revascularization: retrospective cohort study. BMJ 359:j4695|
|Bekelis, Kimon; Gottlieb, Daniel J; Su, Yin et al. (2017) Comparison of clipping and coiling in elderly patients with unruptured cerebral aneurysms. J Neurosurg 126:811-818|
|Bekelis, Kimon; Missios, Symeon; MacKenzie, Todd A et al. (2017) Does Objective Quality of Physicians Correlate with Patient Satisfaction Measured by Hospital Compare Metrics in New York State? World Neurosurg 103:852-858.e1|
|Bekelis, Kimon; Missios, Symeon; Coy, Shannon et al. (2017) Association of Hospital Teaching Status with Neurosurgical Outcomes: An Instrumental Variable Analysis. World Neurosurg :|
|Norton, Edward C; Li, Jun; Das, Anup et al. (2017) Moneyball in Medicare. J Health Econ :|
|Regenbogen, Scott E; Cain-Nielsen, Anne H; Norton, Edward C et al. (2017) Costs and Consequences of Early Hospital Discharge After Major Inpatient Surgery in Older Adults. JAMA Surg 152:e170123|
|Missios, Symeon; Bekelis, Kimon (2017) Association of Hospitalization for Neurosurgical Operations in Magnet Hospitals With Mortality and Length of Stay. Neurosurgery :|
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