2018

Health Care Employment Growth and the Future of US Cost Containment

JAMA
Jonathan Skinner, PhD; Amitabh Chandra, PhD

In 2013, the growth rate in US health care spending of 3.6% was the lowest in 50 years. Health policy experts and the media viewed the “unprecedented” decline as demonstrating that growth in health care costs had finally slowed.1 However, one number that was not consistent with this popular narrative was employment growth in the health care sector. In 2013, health care jobs continued to increase by 1.4%, slightly below the annual average of 1.9% during the prior 5 years.

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Assessing Variation in Implantable Cardioverter Defibrillator Therapy Guideline Adherence With Physician and Hospital Patient-sharing Networks

Medical Care
Moen EL, Bynum JP, Austin AA, Skinner JS, Chakraborti G, O’Malley AJ

Implantable cardioverter defibrillator (ICD) therapy is used for primary prevention of death among people with heart failure, and new evidence in 2005 on its effectiveness changed practice guidelines in the United States. The objective of this study is to examine how the connectedness of physicians and hospitals, measured using network analysis, relates to guideline-consistent ICD implantation. We constructed physician and hospital networks for cardiovascular disease. Physicians were linked if they shared cardiovascular disease patients; these links were aggregated by hospital affiliation to construct a hospital network…

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Mandatory Medicare Bundled Payment Program for Lower Extremity Joint Replacement and Discharge to Institutional Postacute Care: Interim Analysis of the First Year of a 5-Year Randomized Trial

JAMA
Amy Finkelstein, PhD; Yunan Ji, BA; Neale Mahoney, PhD; Jonathan Skinner, PhD

As part of a 5-year, mandatory-participation randomized trial by the Centers for Medicare & Medicaid Services, eligible metropolitan statistical areas (MSAs) were randomized to the Comprehensive Care for Joint Replacement (CJR) bundled payment model for LEJR episodes or to a control group. In the first performance year, hospitals received bonus payments if Medicare spending for LEJR episodes was below the target price and hospitals met quality standards. This interim analysis reports first-year data on LEJR episodes starting April 1, 2016, with data collection through December 31, 2016.

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Big Ideas in Health Economics

Health Affairs
Jonathan S. Skinner

Health economics as a profession has grown exponentially in the past half-century, but not everyone agrees on what health economics is. Many physicians think that health economists spend their days tabulating prices for cost-effectiveness studies. I once was called by a large pharmaceutical company seeking to recruit a health economist. Puzzled as to why any profitable company would want to employ me, I asked what they meant by “health economics.” With a sigh, the recruiter responded: “To prepare a business case for marketing new drugs.”

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Validating Publicly Available Crosswalks for Translating ICD-9 to ICD-10 Diagnosis Codes for Cardiovascular Outcomes Research

Cardiovascular Quality and Outcomes
Jesse A. Columbo, Ravinder Kang, Spencer W. Trooboff, Kristen S. Jahn, Camilo J. Martinez, Kayla O. Moore, Andrea M. Austin, Nancy E. Morden, Corinne G. Brooks, Jonathan S. Skinner, Philip P. Goodney

We devised an 8-step process to derive and validate ICD10 codes from an existing set of ICD-9 codes representing outcomes across several body systems (Figure 1). This process was developed in an iterative fashion with input from all coauthors and shared with collaborators as part of an ongoing National Institute on Aging Program Project (P01-AG019783).

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ICD-10 Coding Will Challenge Researchers: Caution and Collaboration may Reduce Measurement Error and Improve Comparability Over Time

Medical Care
Alexander J. Mainor, JD, MPH, Nancy E. Morden, MD, MPH, Jeremy Smith, MPH, Stephanie Tomlin, MS, MPA, and Jonathan Skinner, PhD

Using an analysis of Medicare data before and after the switch, we illustrate potential pitfalls of these crosswalks. We test some available translations by measuring weekly frequencies of common conditions during the transition and reveal the discontinuity of measures temporally aligned with the adoption of ICD-10 (October 1, 2015, the first day of the fourth quarter of 2015). We then suggest addressing this problem by creating a public good for all researchers, using a web-based platform, “Dataverse” for sharing ICD-9 and comparable ICD-10 definitions, rate comparisons that quantify the discontinuity in diverse datasets (to allow adjustment for comparisons over time), and the programming code used to make the comparisons. Our exploration of inpatient diagnostic code discontinuity illustrates the problem and serves as a starting point for the envisioned shared resource that would include a broad range of datasets.

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Exnovation of Low Value Care: A Decade of Prostate-Specific Antigen Screening Practices

Journal of the American Geriatrics Society
Julie Bynum, MD, MPH, Honor Passow, PhD, Donald Carmichael, MDiv, and Jonathan Skinner, PhD

Using PSA screening, we aimed to understand which factors influence practice change during a period when a decline in service use would be expected. First, we focused on national PSA screening in men aged 68 and older with fee-for-service Medicare from 2003 to 2013 and examine the influence of guidelines by assessing changes in likelihood of screening associated with factors directly mentioned in guidelines. Second, we focused on practice change across U.S. hospital referral regions (HRRs) for men aged 75 and older – for whom guidelines have been in agreement – to test whether practice variation declines and what contextual factors are associated with greater decline. We hypothesized that guidelines and the practice environment would influence the degree to which practitioners and patients would reduce their use of an existing practice in the face of converging evidence regarding effectiveness.

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