Healthcare utilization and costs among high-need and frail Mexican American Medicare beneficiaries

Objectives To examine Medicare health care spending and health services utilization among high-need population segments in older Mexican Americans, and to examine the association of frailty on health care spending and utilization. Methods Retrospective cohort study of the innovative linkage of Medicare data with the Hispanic Established Populations for the Epidemiologic Study of the Elderly (H-EPESE) were used. There were 863 participants, which contributed 1,629 person years of information. Frailty, cognition, and social risk factors were identified from the H-EPESE, and chronic conditions were identified from the Medicare file. The Cost and Use file was used to calculate four categories of Medicare spending on: hospital services, physician services, post-acute care services, and other services. Generalized estimating equations (GEE) with a log link gamma distribution and first order autoregressive, correlation matrix was used to estimate cost ratios (CR) of population segments, and GEE with a logit link binomial distribution was applied to estimate odds ratios (OR) of healthcare use. Results Participants in the major complex chronic illness segment who were also pre-frail or frail had higher total costs and utilization compared to the healthy segment. The CR for total Medicare spending was 3.05 (95% CI, 2.48–3.75). Similarly, this group had higher odds of being classified in the high-cost category 5.86 (95% CI, 3.35–10.25), nursing home care utilization 11.32 (95% CI, 3.88–33.02), hospitalizations 4.12 (95% CI, 2.88–5.90) and emergency room admissions 4.24 (95% CI, 3.04–5.91). Discussion Our findings highlight that frailty assessment is an important consideration when identifying high-need and high-cost patients.

Direct Costs of Healthcare for Children with Type 1 Diabetes Using a CGM System: A Health Economic Analysis of the VIDIKI Telemedicine Study in a German Setting

Aims The Virtual Diabetes Outpatient Clinic for Children and Adolescents (VIDIKI) study was a 6-month quasi-randomized, multicentre study followed by an extension phase to evaluate the effects of monthly video consultations in addition to regular care. A health economic analysis was conducted to assess the direct costs. Methods The cost data of 240 study participants (1–16 years of age) with type 1 diabetes who were already using a continuous glucose monitoring system were collected in the first 6 months of the study. The intervention group (IG) received monthly video consultations plus regular care, and the waiting control group (WG) received only regular care. Cost data were collected for a comparable anonymized group of children from the participating health insurance companies during the 6-month period before the study started (aggregated data group [AG]). Results Cost data were analysed for the AG (N=840) 6 months before study initiation and those for the study participants (N=225/240). Hospital treatment was the highest cost category in the AG. There was a cost shift and cost increase in the IG and WG, whereby diabetes supplies were the highest cost category. The mean direct diabetes-associated 6-month costs were € 4,702 (IG) and € 4,936 (WG). Conclusion The cost development within the cost collection period over two years possibly reflects the switch to higher-priced medical supplies. Video consultation as an add-on service resulted in a small but nonsignificant reduction in the overall costs.

Effectiveness Of A Staff Training Program To Stimulate Physical Activity In Homecare: A Cluster RCT

Reablement encourages older adults to do things themselves rather than having things done for them. To implement reablement in practice homecare staff needs the right knowledge, attitude, skills and support. This study evaluated the effectiveness of the “Stay Active at Home” reablement training program. A 12-month cluster-RCT was conducted, involving staff (n=313) and clients (n=264) from 10 homecare teams, five of which were trained. Effects were evaluated using data from accelerometers, physical performance tests, questionnaires and electronic patient records. No beneficial effects were observed in older adults for sedentary behavior; daily, physical, and psychological functioning; and falls. In homecare staff there were no statistically significant differences between study groups for self-efficacy and outcome expectations scores except for higher self-efficacy scores in more compliant staff (adjusted mean difference: 1.9 [95% CI 0.1, 3.7]). No differences were observed for any cost category except for domestic help costs in the intervention group (adjusted mean difference: €-173 [95% CI -299, -50]). The probability that “Stay Active at Home” is cost-effective compared to usual care at a willingness-to-pay of €20,000 was 19.7%/ daily minute of sedentary time averted, 19.2%/ percent of sedentary time averted as proportion of wake/wear time, and 5.9%/QALY gained, respectively. The reablement training program needs further development based on the lessons learned before wider implementation.

Minimization of resource utilization data collected within cost-effectiveness analyses conducted alongside Canadian Cancer Trials Group phase III trials

Background Cost-effectiveness analyses embedded within randomized trials allow for evaluation of value alongside conventional efficacy outcomes; however, collection of resource utilization data can require considerable trial resources. Methods We re-analyzed the results from four phase III Canadian Cancer Trials Group trials that embedded cost-effectiveness analyses to determine the impact of minimizing potential cost categories on the incremental cost-effectiveness ratios. For each trial, we disaggregated total costs into component incremental cost categories and recalculated incremental cost-effectiveness ratios using (1) only the top 3 cost categories, (2) the top 5 cost categories, and (3) all cost components. Using individual trial-level data, confidence intervals for each incremental cost-effectiveness ratio simulation were generated by bootstrapping and descriptively presented with the original confidence intervals (and incremental cost-effectiveness ratios) from the publications. Results Drug acquisition costs represented the highest incremental cost category in three trials, while hospitalization costs represented the other consistent cost driver and the top incremental cost category in the fourth trial. Recalculated incremental cost-effectiveness ratios based on fewer cost components (top 3 and top 5) did not differ meaningfully from the original published results. Based on conventional willingness-to-pay thresholds (US$50,000–US$100,000 per quality-adjusted life-year), none of the re-analyses would have changed the original perception of whether the experimental therapies were considered cost-effective. Conclusions These results suggest that the collection of resource utilization data within cancer trials could be narrowed. Omission of certain cost categories that have minimal impact on incremental cost-effectiveness ratio, such as routine laboratory investigations, could reduce the costs and undue burden associated with the collection of data required for cancer trial cost-effectiveness analyses.

Knowledge and Expectations of Hearing Aid Applications: A Cross-sectional Survey of Smartphone Users and Hearing Professionals (Preprint)

BACKGROUND Despite the increasing prevalence of hearing loss, the cost and psychological barriers to use of hearing aids may prevent individuals with hearing loss from using these aids. Hearing loss patients can benefit from smartphone-based hearing aid applications (SHAAs), which are smartphone applications that use a mobile device as sound amplifier. OBJECTIVE The aims of this study were to determine how ear, nose and throat (ENT) outpatients perceived SHAAs, analyze factors that affected this, and estimate costs of annual subscription to an application through a self-administered questionnaire survey of smartphone users and hearing specialists. METHODS The study employed cross-sectional, multi-center survey of both ENT outpatients and hearing specialists. The questionnaire was designed to collect personal information about the respondents as well as responses to 18 questions concerning SHAAs in 5 domains: knowledge, needs, cost, expectations, and information. Questions about the expected cost of SHAAs were included in the questionnaire distributed to hearing experts. RESULTS Among 219 smartphone users and 42 hearing specialists, only eight respondents (3.7%) recognized SHAAs, while 47 of 261 respondents (21.5%) reported considering using an assistive device to improve their hearing capacities. Average perception score was 2.81 (95% CI 2.65-2.97), lower than the grade point average of 3. Among factors that shaped perceptions of SHAAs, the needs category received the lowest scores (2.02, 95% CI 1.83-2.20) whereas the cost category received the highest scores (3.29, 95% CI 3.14-3.44). Age was correlated with the information domain (P = .000) and an increased level of hearing impairment resulted in significantly higher points in the needs category (P = .000). Patients expected the cost of an annual application subscription to an SHAA to be about 86 USD, and predicted cost was associated with economic status (P = .200) and was noticeably higher than the prices expected by hearing specialists (P < .001). CONCLUSIONS Outpatients expected SHAAs to cost more than hearing specialists. However, SHAA perception was relatively low. In this regard, enhanced awareness of SHAAs is required to popularize SHAAs. CLINICALTRIAL None

Cost as Calculation Category

The article considers the possibility of calculating indicators of the theoretical cost category using modern inter-industry interregional tools for forecasting economic development. The principles of displaying production relationships implemented in them and the resulting calculated indicators in the cost dimension do not contradict the categories of classical political economy. In parallel, the concept of redistribution of nominal value by means of Finance between interconnected producers and consumers was introduced when applying the intersectoral approach. The paper provides an example of calculations. The usual financial statements are used as an instrumental basis, but the number of employees is set as an input measure of all costs. As a result, all calculated data: prices (aggregated prices), indices of their changes in dynamics, current financial flows are recalculated in labor costs. The tables below represent the corresponding indicators aggregated by region. Despite the proximity of the financial and cost categories, the use of cost characteristics in financial instruments to calculate them affects the quantitative results to a certain extent. In particular, comparison of indicators of forecasts of financial and cost statements of tasks connected with one initial base of tasks of material composition shows the following. The dynamics of changes in the total income of the population, budgets, volume of loans, etc. for indicators in value units are overwhelmingly lower than the corresponding values of the mentioned purely financial task. This suggests that the rates calculated in current prices (the financial task) have a greater inflationary impact than similar indicators calculated in value units. Or, regional differentiation of calculated units of product value above the corresponding indices of consolidated prices of purely financial statements. To a certain extent, this is due to the fact that the task adopted assumptions for a certain alignment of economic activity conditions by region due to the differentiation of Federal taxes.

Reasons and ways to manipulate financial statements

Subject. The article considers the reasons and tools for manipulation of financial statements and ways to identify it. Objectives. The purpose of the study is to reveal preconditions and the main instruments of misstatements of financial reporting. Methods. The study employs empirical and logical constructions, analysis and synthesis, generalization, systems approach, methods of comparative analysis. Results. I show the main ways of misstatements of financial reporting and formulate mechanisms to detect them. The findings can be useful for enhancing the financial accounting standards, as well as for all interested stakeholders of enterprises that use financial statements. Conclusions. The absence of adequate responsibility of auditors and appraisers involved in the preparation and confirmation of reporting contributes to the practice of misrepresentation of financial statements. On the one hand, a company hires appraisers or auditors and pays for their services, and the latter have no motivation to engage in any confrontation with the company that manipulates its financial statements. On the other hand, companies, pursuing various goals (meeting the KPIs by managers or in the run-up to the M&A transaction), apply window dressing and manipulate their financial statements, using a wide range of tools, like revenues reposting, provisions for impairment, reclassification of costs from the operating cost to capital cost category, etc.

Producing Standardized Country-Level Immunization Delivery Unit Cost Estimates

Background To plan for the financial sustainability of immunization programs and make informed decisions to improve immunization coverage and equity, decision-makers need to know how much these programs cost beyond the cost of the vaccine. Non-vaccine delivery cost estimates can significantly influence the cost-effectiveness estimates used to allocate resources at the country level. However, many low- and middle-income countries (LMICs) do not have immunization delivery unit cost estimates available, or have estimates that are uncertain, unreliable, or old. We undertook a Bayesian evidence synthesis to generate country-level estimates of immunization delivery unit costs for LMICs. Methods From a database of empirical immunization costing studies, we extracted estimates of the delivery cost per dose for routine childhood immunization services, excluding vaccine costs. A Bayesian meta-regression model was used to regress delivery cost per dose estimates, stratified by cost category, against a set of predictor variables including country-level [gross domestic product per capita, reported diphtheria-tetanus-pertussis third dose coverage (DTP3), population, and number of doses in the routine vaccination schedule] and study-level (study year, single antigen or programmatic cost per dose, and financial or economic cost) predictors. The fitted prediction model was used to generate standardized estimates of the routine immunization delivery cost per dose for each LMIC for 2009–2018. Alternative regression models were specified in sensitivity analyses. Results We estimated the prediction model using the results from 29 individual studies, covering 24 countries. The predicted economic cost per dose for routine delivery of childhood vaccines (2018 US dollars), not including the price of the vaccine, was $1.87 (95% uncertainty interval $0.64–4.38) across all LMICs. By individual cost category, the programmatic economic cost per dose for routine delivery of childhood vaccines was $0.74 ($0.26–1.70) for labor, $0.26 ($0.08–0.67) for supply chain, $0.22 ($0.06–0.57) for capital, and $0.65 ($0.20–1.66) for other service delivery costs. Conclusions Accurate immunization delivery costs are necessary for assessing the cost-effectiveness and strategic planning needs of immunization programs. The cost estimates from this analysis provide a broad indication of immunization delivery costs that may be useful when accurate local data are unavailable.

A community oncology practice financial experience in oncology care model pilot (OCM).

e19379 Background: Oncology Division of Michigan Health Professionals (MHP) participates in OCM, which requires effort from all MHP OCM providers to coordinate care at same or lower cost to Medicare. Palliative Care, Care Management, and End of Life Care programs established by MHP, in collaboration with Premiere Hospice and Integra Connect, have shown cost and quality benefits in the OCM patients. Quality improvement initiatives included monthly OCM provider meetings to review OCM results, identify cost & quality opportunities, and to design training and education sessions. In order to assess the impact of such a concerted initiative, this study aims to evaluate MHP OCM provider impact in OCM total cost of care relative to historical period. Methods: Retrospective review of reconciliation results provided by Centers for Medicare and Medicaid Innovation (CMMI) for OCM performance periods 1-4 (pp1-4). Total cost of care (ACTUAL) and cost categories were the summarized and adjusted expenditures during 6-month OCM period as reported by CMMI. ACTUAL and cost category experience was compared by OCM performance period to the trended-mean of matched historical OCM-eligible patients (Baseline Episodes from CMMI). Patients were matched by cancer type, comorbidity count, age group, radiation, surgery, and low-intensity/-risk cancer sub-type for prostate, bladder and breast cancers. Results: The largest pp1-4 cost category reductions were acute inpatient ($2.2M), physician services excluding drug-cost, imaging and labs ($1.2M), skilled nursing facility ($0.5M), ancillary which consists of imaging and lab ($0.5M), inpatient rehab ($0.3M), home health agency ($0.3M), radiation oncology ($0.1M). The largest pp1-4 increase in OCM expense relative to historical was Part D Drugs ($1.7M). Conclusions: MHP decreased non-drug costs by $5.1M compared to historical cost for matched patients. OCM costs were lower in facility (hospital and SNF) and physician sites of care. Drug costs increased by $1.7M. Study was limited by OCM claims available as of December 2019. Results may be refreshed as more data becomes available. [Table: see text]

Cost stickiness behavior and financial crisis: Evidence from the UK chemical industry

The global financial crisis has created pessimism in terms of prospects of sales rebounding in the future. Therefore, this study aims to examine the stickiness behaviors of firm costs pre, during and post the period of the financial crisis. It uses a sample from the UK chemical industry over the period from 2001 to 2015. The ABJ sticky cost model is applied with the following cost categories: total costs, cost of goods sold, operating costs, selling, general and administrative costs, salaries and benefits, and finance costs. The ABJ sticky cost models are run separately for each cost category over pre (2001-2007), during (2007-2009) and post (2010-2015) the financial crisis. The study finds that total costs have behaved as sticky pre the financial crisis and anti-sticky during and post the financial crisis. Furthermore, cost of goods sold has changed from sticky (pre and during the financial crisis) to anti-sticky (post the financial crisis). Furthermore, salaries and benefits costs have changed from sticky (pre the financial crisis) to anti-sticky (during the financial crisis) and financing costs from sticky (pre the financial crisis) to anti-sticky (after the financial crisis). However, there is no variation in the behavior of selling, general and administrative costs pre and post the financial crisis