(Press-News.org) The California Public Employees' Retirement System (CalPERS) saved $7 million on spending for colonoscopy two years after it implemented a reference payment initiative that offered full insurance coverage at low-priced facilities but required substantial cost sharing if patients picked a high-priced alternative, according to an article published online by JAMA Internal Medicine.
Some employers are experimenting with payment methods that seek to counter high health care prices while upholding consumer access to valuable services. Employers, insurers and consumers face varying prices for the same procedures within the same local communities, including screening tests such as colonoscopy.
James C. Robinson, Ph.D., of the University of California-Berkley, and coauthors obtained data on 21,644 CalPERS enrollees who underwent colonoscopy in the three years prior to implementation of the reference payment initiative in 2012 and data on 13,551 patients in the two years after implementation. Data for a control group were obtained on 258,616 Anthem Blue Cross enrollees who underwent colonoscopy and who were not subject to reference payment initiatives during the five-year period.
Under its reference payment initiative, CalPERS paid the facility's negotiated price, without consumer cost sharing, if the patient selected an ambulatory surgery center. However, it limited its payment contribution to $1,500 for patients who selected hospital-based outpatient departments. Patients were exempt from the initiative if their physician presented a clinical case for services at a hospital-based outpatient department or if a patient lived more than 30 miles from an ambulatory surgery center, according to background information in the study.
The authors report that utilization of low-priced facilities for CalPERS members increased from 68.6 percent in 2009 to 90.5 percent in 2013 after the reference payment was implemented. The average price paid for colonscopy in the CalPERS population increased from $1,587 in 2009 to $1,716 in 2011 and then decreased to $1,508 in 2013 for patients subject to the reference payment. The reference payment also was associated with a small and statistically insignificant decline in procedural complications from 2.1 percent in 2009 to 2 percent in 2013, according to the results.
"As reported in this study, the implementation of reference payments for colonoscopy accelerated the shift in patient choice toward lower-priced facilities. This led to substantial reduction in the mean price paid for the procedure, without any observed reduction in safety. In the first two years after implementation, CalPERS saved $7 million (28 percent) compared with what it would have spent on colonoscopy in the absence of a reference payment initiative," the authors conclude.
(JAMA Intern Med. Published online September 8, 2015. doi:10.1001/jamainternmed.2015.4588. Available pre-embargo to the media at http://media.jamanetwork.com.)
Editor's Note: Support for this research was obtained from the California Public Employees' Retirement System (CalPERS) and from the U.S. Agency for Healthcare Research and Quality. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures.
Commentary: New Approaches to Controlling Health Care Costs
In a related commentary, David Lieberman, M.D., Oregon Health and Science University, Portland, and John Allen, M.D., Yale University School of Medicine, New Haven, Conn., write: "Although the findings of Robinson et al support the value of reference pricing for reducing costs of colonoscopy, several key issues require further study. ... Regardless of whether the discussion is about reference or bundled pricing for colonoscopy, knee or hip replacements or other procedures, public reporting of cost information, as well as meaningful quality benchmarks, should be required. Patients selecting lower-cost centers require assurances that they are receiving high-quality care."
"We are encouraged by the increasing evidence that new approaches to payment, such as bundling and reference pricing, can bend the cost curve for procedures such as colonoscopy, while maintaining access and quality. But there are many unknowns and continued study and monitoring is essential as these approaches become more widely used. We should continue to seek improved payment models that ensure that patients have incentives, not disincentives, to obtain important and high-quality preventive care."
(JAMA Intern Med. Published online September 8, 2015. doi:10.1001/jamainternmed.2015.4594. Available pre-embargo to the media at http://media.jamanetwork.com.)
Editor's Note: Authors made conflict of interest disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures
INFORMATION:
Media Advisory: To contact study corresponding author James C. Robinson, Ph.D., call Sarah Yang at 510-643-7741 or email scyang@berkeley.edu. To contact commentary author David Lieberman, M.D., call Amanda Gibbs or Elisa Williams at 503-494-8231 or email gibbam@ohsu.edu or willieli@ohsu.edu. An author audio interview will be available when the embargo lifts on the JAMA Internal Medicine website: http://bit.ly/1x0ZkrG
To place an electronic embedded link in your story: Links will be live at the embargo time: http://archinte.jamanetwork.com/article.aspx?doi=10.1001/jamainternmed.2015.4588
http://archinte.jamanetwork.com/article.aspx?doi=10.1001/jamainternmed.2015.4594
In 2011-2012, the estimated prevalence of diabetes among U.S. adults was 12 percent to 14 percent and the prevalence of prediabetes was 37 percent to 38 percent, indicating that about half of the U.S. adult population has either diabetes or prediabetes, according to a study in the September 8 issue of JAMA. Though data from recent years suggests that the increasing prevalence of diabetes may be leveling off.
Diabetes is a major cause of illness and death in the United States, costing an estimated $245 billion in 2012 due to increased use of health resources and lost productivity. ...
Over the last 20 years, complications have decreased and survival has improved for extremely preterm infants, according to a study in the September 8 issue of JAMA.
Advances in medicine over the past 2 decades have changed care for mothers in preterm labor and for extremely preterm infants. Evaluation of current in-hospital complications and mortality data among extremely preterm infants is important in counseling families and considering new interventions to improve outcomes. Barbara J. Stoll, M.D., of the Emory University School of Medicine, Atlanta, and colleagues ...
Among women in a malaria-endemic region in Kenya, daily iron supplementation during pregnancy did not result in an increased risk of malaria, according to a study in the September 8 issue of JAMA. Iron supplementation did result in increased birth weight, gestational duration, neonatal length, and a decreased risk of low birth weight and prematurity.
Anemia in pregnancy is a moderate or severe health problem in more than 80 percent of countries worldwide, but particularly in Africa, where it affects 57 percent of pregnant women. Iron deficiency is the most common cause, ...
The lack of adherence to usability testing standards among several widely used electronic health record (EHR) products that were certified as having met these requirements may be a major factor contributing to the poor usability of EHRs, according to a study in the September 8 issue of JAMA.
Many EHRs have poor usability, leading to user frustration and safety risks. The U.S. Department of Health and Human Services' Office of the National Coordinator for Health Information Technology (ONC) has established certification requirements to promote usability practices by EHR ...
Banning smoking in the workplace and increasing taxes on cigarettes have discouraged teens and young adults from taking up smoking, according to a study by researchers at UC San Francisco and UC Merced.
The study, published today (Sept. 8, 2015) in JAMA Pediatrics, used data on the smoking habits of a group of 12- to 18-year-olds living throughout the country in 1997. They were tracked for 11 years as they transitioned to young adults.
The researchers found that a 100 percent smoke-free environment reduced the odds of taking up smoking by one third and that the number ...
Poor mental health, self-harm and suicide attempts are common among children and adolescents who have been trafficked for forced labour or sexual exploitation, according to a new study published in JAMA Pediatrics.
The research was led by the London School of Hygiene & Tropical Medicine, in collaboration with the International Organization for Migration, and included interviews with 387 children and adolescents aged 10 to 17 years in post-trafficking services in Cambodia, Thailand and Vietnam.
Researchers found that one third of boys and girls surveyed had experienced ...
A study of extremely preterm infants born at U.S academic medical centers over the last 20 years found changes in maternal and infant care practices, resulting in modest increases in survival and reductions in several neonatal complications.
The study will be published in the September 8 issue of JAMA.
Overall survival increased most significantly in infants born at 23-24 weeks, but survival without major health problems identified prior to hospital discharge increased most in infants 25-28 weeks. The study found an increase in one complication of prematurity, however ...
ANN ARBOR--Solar cells capture up to 40 percent more energy when they can track the sun across the sky, but conventional, motorized trackers are too heavy and bulky for pitched rooftops and vehicle surfaces.
Now, by borrowing from kirigami, the ancient Japanese art of paper cutting, researchers at the University of Michigan have developed solar cells that can have it both ways.
"The design takes what a large tracking solar panel does and condenses it into something that is essentially flat," said Aaron Lamoureux, a doctoral student in materials science and engineering ...
(SACRAMENTO, Calif.) - Clostridium difficile is a common cause of infection and diarrhea in hospitalized patients, but a new study by UC Davis pathologists suggests that many patients are mistakenly diagnosed and do not need antibiotic treatment. As a result, patients are likely being over-diagnosed and over-treated, adding to concerns about antibiotic resistance, damage to the "good" bacteria that live in people's intestines, and increased health-care costs.
"It all depends on the type of test doctors use to diagnose patients," said Christopher R. Polage, associate ...
Forensic biomedical scientists from KU Leuven, Belgium, have developed a test to predict individuals' age on the basis of blood or teeth samples. This test may be particularly useful for the police, as it can help track down criminals or identify human remains.
When forensic examiners find traces of blood at a crime scene, they can try to identify the perpetrator on the basis of DNA. From now on, the blood samples can also be used to predict the criminal's age. This is also the case for deceased individuals: when traditional methods do not lead to identification, the ...
