Ezekiel J. Emanuel

You are viewing 30 posts with the tag Health Care

Apr 5

Next Phase in Effective Cost Control in Health Care

Glickman A, DiMagno SSP, Emanuel EJ.

JAMA, March 2019.

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Categories: Academic Writing

Apr 5

Effect of Financial Bonus Size, Loss Aversion, and Increased Social Pressure on Physician Pay-For-Performance: A Randomized Clinical Trial and Cohort Study

Navathe AS, Volpp KG, Caldarella KL, Bond A, Troxel AB, Zhu J, Matloubieh S, Lyon Z, Mishra A, Sacks L, Nelson C, Patel P, Shea J, Calcagno D, Vittore S, Sokol K, Weng K, McDowald N, Crawford P, Small D, Emanuel EJ. 

JAMA Network, February 2019.

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Categories: Academic Writing

Apr 5

National Representativeness of Hospitals and Markets in Medicare's Mandatory Bundled Payment Program

Liao JM, Emanuel EJ, Polsky DE, Huang Q, Shah Y, Zhu J, Lyon ZM, Dykstra SE, Dinh CT, Counsins DS, Navathe AS. 

Health Affairs, January 2019.

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Categories: Academic Writing

Apr 5

Pricing a Year of Progression-Free Survival: When is the Cost of Cancer Drugs Unreasonable?

DiMagno SSP, Emanuel EJ.

JAMA Dermatology, December 2018.

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Categories: Opinions , Academic Writing

Apr 5

Pitfalls and Potential in Medicare's Move Toward Outpatient Care Episodes

Navathe AS, Emanuel EJ, Liao JM.

Annals of Internal Medicine, December 2018.

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Categories: Academic Writing

Apr 5

Outcomes for Individuals Turned Down for Living Kidney Donation

Reese PP, Allen MB, Carney C, Leidy D, Levsky S, Pendse R, Mussell AS, Bermudez F, Keddem S, Thiessen C, Rodrigue JR, Emanuel EJ. 

Clinical Transplantation, December 2018.

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Categories: Academic Writing
Tags: Health Care

Apr 5

Aligning Patient and Physician Incentives

Navathe AS, Emanuel EJ, Volpp KG.

JAMA, October 2018.

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Categories: Academic Writing
Tags: Health Care

Apr 5

Association of Hospital Participation in a Medicare Bundled Payment Program with Volume and Case Mix of Lower Extremity Joint Replacement Episodes

Navathe AS, Liao JM, Dykstra SE, Wang E, Lyon ZM, Shah Y, Martinez J, Small DS, Werner RM, Dinh C, Ma X, Emanuel EJ. 

JAMA, September 2018.

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Categories: Academic Writing

Mar 29

The Status of End-of-Life Care in the United States: The Glass is Half Full

JAMA, July 2018.

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Categories: Academic Writing

Mar 29

Redesigning Provider Payment: Opportunities and Challenges From the Hawaii Experience

Volpp KG, Navathe AS, Lee EO, Mugishii M, Troxel AB, Caldarella K, Hodlofski A, Bernheim S, Drye E, Yoshimoto J, Takata K, Stollar MB, Emanuel EJ.

Healthcare (Amsterdam, Netherlands), September 2018.

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    Abstract

    Objectives

    To describe the process of developing a new physician payment system based on value and transitioning away from a fee-for-service payment system

    Study design

    Descriptive. This paper describes a recent initiative involving redesign of primary care provider payment in the State of Hawaii. While there has been extensive discussion about switching payment from volume to value in recent years, much of this change has happened at the organizational level and this initiative focused on changing the incentives for individual providers.

    Methods

    Descriptive paper. In this paper we discuss the approach taken to shift incentives from fee-for-service towards value using behavioral economics as a conceptual framework for program design. We summarize the new payment system, challenges in its design, and our approach to piloting of different behavioral economic strategies to improve performance.

    Results

    None.

    Conclusions

    This paper will provide useful guidance to health plans or health delivery systems considering shifting primary care payment away from fee-for-service towards value highlighting some of the design challenges and necessary compromises in implementing such a system at scale.

     
    Categories: Academic Writing

    Mar 27

    Comparison of Hospitals Participating in Medicare's Voluntary and Mandatory Orthopedic Bundle Programs

    Navathe AS, Liao JM, Polsky D, Shah Y, Huang Q, Zhu J, Lyon ZM, Wang R, Rolnick J, Martinez JR, Emanuel EJ. 

    Health Affairs June 2018.

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    ABSTRACT

    We analyzed data from Medicare and the American Hospital Association Annual Survey to compare characteristics and baseline performance among hospitals in Medicare’s voluntary (Bundled Payments for Care Improvement initiative, or BPCI) and mandatory (Comprehensive Care for Joint Replacement Model, or CJR) joint replacement bundled payment programs. BPCI hospitals had higher mean patient volume and were larger and more teaching intensive than were CJR hospitals, but the two groups had similar risk exposure and baseline episode quality and cost. BPCI hospitals also had higher cost attributable to institutional postacute care, largely driven by inpatient rehabilitation facility cost. These findings suggest that while both voluntary and mandatory approaches can play a role in engaging hospitals in bundled payment, mandatory programs can produce more robust, generalizable evidence. Either mandatory or additional targeted voluntary programs may be required to engage more hospitals in bundled payment programs.

    Categories: Academic Writing

    Mar 12

    Incorporating Value Into Physician Payment and Patient Cost Sharing

    Song Z, Navathe AS, Emanuel EJ, Volpp KG. 

    American Journal of Managed Care, March 2018. 

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    ABSTRACT: 

    The United States is simultaneously moving toward value-based payments for populations and precision medicine for individuals. During this evolution, innovations in payment and delivery that enhance tailoring of treatments to individuals while improving the value of care are needed. We propose one such innovation that would allow physician payment and patient cost sharing to better reflect the value of care by allowing the appropriateness of a service for a given patient in a given clinical situation to play a more meaningful role in the design of such incentives. We introduce the idea of a payment modifier, based on indication and appropriateness, and discuss its advantages and challenges to implementation.

    Categories: Academic Writing

    Mar 12

    The Real Cost of the US Health Care System


    Mar 12

    Characteristics of Hospitals Earning Savings in the First Year of Mandatory Bundled Payment for Hip and Knee Surgery

    Navathe AS, Liao JM, Shah Y, Lyon Z, Chatterjee P, Polsky D, Emanuel EJ. 

    JAMA, March 2018.

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    Categories: Academic Writing

    Mar 12

    Volume Increases and Shared Decision-making in Joint Replacement Bundles

    Navathe AS, Liao SM, Emanuel EJ. 

    Annals of Surgery, January 2018.

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    Categories: Academic Writing

    Mar 12

    Reforming American Medical Education

    The Milbank Quarterly, December 2017

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    Categories: Academic Writing
    Tags: Health Care

    Mar 12

    Measuring the Burden of Health Care Costs on US Families: The Affordable Index

    Emanuel EJ, Glickman A, Johnson D. 

    JAMA, November 2017

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    This Viewpoint proposes a new Affordability Index measure, the ratio of the mean cost of an employer-sponsored family health insurance policy divided by median household income, to describe US families’ ability to pay for health care.

    Categories: Academic Writing

    Mar 11

    Phase 1 Healthy Volunteer Willingness to Participate and Enrollment Preferences

    Chen SC, Sinaii N, Bedarida G, Gregorio MA, Emanuel E, Grady C. 

    Clinical Trial, October 2017

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    Abstract

    BACKGROUND/AIMS:

    Healthy volunteers in phase 1 clinical trials contribute to the development of safe drugs and other biologics and accept risks and burdens without anticipated health benefits from participation. Although emerging data have shown that healthy volunteers are influenced by risk, some still worry that financial incentives lead them to take on unreasonable risk. Yet little is known about healthy volunteers' preferences and how they make choices about enrolling in research studies.

    METHODS:

    We surveyed 654 healthy volunteers at the end of their participation in a phase 1 Pfizer trial in the United States, Belgium, and Singapore to examine their reported willingness to enroll in studies of different types, with various procedures, and with possible side-effects.

    RESULTS:

    The majority of respondents were willing to join many kinds of studies, but fewer were willing to participate in first-in-human vaccine studies or studies of psychiatric drugs than in other study types. With regard to procedures, a substantial proportion were unwilling to participate in studies that involved invasive procedures, such as a lumbar puncture (45.4%) and bone marrow biopsy (42.3%), but willing to participate in studies with less invasive procedures such as a computed tomography scan of the heart (86.8%), magnetic resonance imaging (87.4%), and skin allergy testing (86.8%). Although there was some variation by gender and region, the majority were willing to participate in studies with side-effects like pain (80%) or nausea and vomiting (64%), but only a minority were willing to join if the research drug would result in their having a one in a million chance of death (34.4%), a small chance of kidney damage (16.7%), or influence how their mind works (23.2%; Figure 4).

    CONCLUSION:

    Our results suggest that healthy volunteers are willing to participate in a wide range of types of phase 1 clinical trials, and express preferences for low risk and familiar studies and study procedures, preferences which are partially affected by offers of payment.

    Categories: Academic Writing
    Tags: Health Care

    Mar 11

    Shortage or Surplus of Physicians in the United States - Reply

    Emanuel EJ, Gudbranson E. 

    JAMA, September 2017. 

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    Categories: Academic Writing
    Tags: Health Care

    Mar 11

    The Case for Resource Sensitivity: Why is it Ethical to Provide Cheaper, Less Effective Treatments in Global Health

    Persad GC, Emanuel EJ.

    Hastings Center Report, September 2017. 

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    Abstract

    When Dr. Hortense screens her patients in Chicago for cervical dysplasia and cancer, she conducts a pelvic exam, takes a sample of cervical cells, and sends them for Pap cytology and human papilloma virus DNA co-testing. But when she conducts cervical cancer screening in Botswana, she employs a much simpler diagnostic strategy. She applies acetic acid to highlight precancerous lesions and visually inspects the cervix-a technique known as the VIA (visual inspection with acetic acid) method. She treats suspicious lesions with cryotherapy. There are multiple reasons that Dr. Hortense uses VIA in developing countries. It requires no specialized laboratory facilities or highly trained personnel. With immediate results, there is no delay in diagnosis and treatment, ensuring that patients are not lost to follow-up. Most importantly, VIA is considerably cheaper than Pap and HPV co-testing. This difference in care between Chicago and Botswana presents an ethical dilemma in global health: is it ethically acceptable to provide some patients cheaper treatments that are less effective or more toxic than the treatments other patients receive? We argue that it is ethical to consider local resource constraints when deciding what interventions to provide. The provision of cheaper, less effective health care is frequently the most effective way of promoting health and realizing the ethical values of utility, equality, and priority to the worst off.

    Categories: Academic Writing