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2.
Ann Intern Med ; 174(8): 1101-1109, 2021 08.
Article in English | MEDLINE | ID: covidwho-1368019

ABSTRACT

BACKGROUND: New cases of COVID-19 continue to occur daily in the United States, and the need for medical treatments continues to grow. Knowledge of the direct medical costs of COVID-19 treatments is limited. OBJECTIVE: To examine the characteristics of older adults with COVID-19 and their costs for COVID-19-related medical care. DESIGN: Retrospective observational study. SETTING: Medical claims for Medicare fee-for-service (FFS) beneficiaries. PATIENTS: Medicare FFS beneficiaries aged 65 years or older who had a COVID-19-related medical encounter during April through December 2020. MEASUREMENTS: Patient characteristics and direct medical costs of COVID-19-related hospitalizations and outpatient visits. RESULTS: Among 28.1 million Medicare FFS beneficiaries, 1 181 127 (4.2%) sought COVID-19-related medical care. Among these patients, 23.0% had an inpatient stay and 4.2% died during hospitalization. The majority of the patients were female (57.0%), non-Hispanic White (79.6%), and residents of an urban county (77.2%). Medicare FFS costs for COVID-19-related medical care were $6.3 billion; 92.6% of costs were for hospitalizations. The mean hospitalization cost was $21 752, and the mean length of stay was 9.2 days; hospitalization cost and length of stay were higher if the patient needed a ventilator ($49 441 and 17.1 days) or died ($32 015 and 11.3 days). The mean cost per outpatient visit was $164. Patients aged 75 years or older were more likely to be hospitalized, but their hospitalizations were associated with lower costs than for younger patients. Male sex and non-White race/ethnicity were associated with higher probability of being hospitalized and higher medical costs. LIMITATION: Results are based on Medicare FFS patients. CONCLUSION: The COVID-19 pandemic has resulted in substantial disease and economic burden among older Americans, particularly those of non-White race/ethnicity. PRIMARY FUNDING SOURCE: None.


Subject(s)
Ambulatory Care/economics , COVID-19/economics , Direct Service Costs , Hospital Costs , Hospitalization/economics , Medicare/economics , Aged , Aged, 80 and over , Direct Service Costs/trends , Fee-for-Service Plans , Female , Hospital Costs/trends , Humans , Male , Pandemics , Retrospective Studies , SARS-CoV-2 , United States
3.
JAMA Netw Open ; 4(3): e212618, 2021 03 01.
Article in English | MEDLINE | ID: covidwho-1146714

ABSTRACT

Importance: This study assesses the role of telehealth in the delivery of care at the start of the COVID-19 pandemic. Objectives: To document patterns and costs of ambulatory care in the US before and during the initial stage of the pandemic and to assess how patient, practitioner, community, and COVID-19-related factors are associated with telehealth adoption. Design, Setting, and Participants: This is a cohort study of working-age persons continuously enrolled in private health plans from March 2019 through June 2020. The comparison periods were March to June in 2019 and 2020. Claims data files were provided by Blue Health Intelligence, an independent licensee of the Blue Cross and Blue Shield Association. Data analysis was performed from June to October 2020. Main Outcomes and Measures: Ambulatory encounters (in-person and telehealth) and allowed charges, stratified by characteristics derived from enrollment files, practitioner claims, and community characteristics linked to the enrollee's zip code. Results: A total of 36 568 010 individuals (mean [SD] age, 35.71 [18.77] years; 18 466 557 female individuals [50.5%]) were included in the analysis. In-person contacts decreased by 37% (from 1.63 to 1.02 contacts per enrollee) from 2019 to 2020. During 2020, telehealth visits (0.32 visit per person) accounted for 23.6% of all interactions compared with 0.3% of contacts in 2019. When these virtual contacts were added, the overall COVID-19 era patient and practitioner visit rate was 18% lower than that in 2019 (1.34 vs 1.64 visits per person). Behavioral health encounters were far more likely than medical contacts to take place virtually (46.1% vs 22.1%). COVID-19 prevalence in an area was associated with higher use of telehealth; patients from areas within the top quintile of COVID-19 prevalence during the week of their encounter were 1.34 times more likely to have a telehealth visit compared with those in the lowest quintile (the reference category). Persons living in areas with limited social resources were less likely to use telehealth (most vs least socially advantaged neighborhoods, 27.4% vs 19.9% usage rates). Per enrollee medical care costs decreased by 15% between 2019 and 2020 (from $358.32 to $306.04 per person per month). During 2020, those with 1 or more COVID-19-related service (1 470 721 members) had more than 3 times the medical costs ($1701 vs $544 per member per month) than those without COVID-19-related services. Persons with 1 or more telehealth visits in 2020 had considerably higher costs than persons having only in-person ambulatory contacts ($2214.10 vs $1337.78 for the COVID-19-related subgroup and $735.87 vs $456.41 for the non-COVID-19 subgroup). Conclusions and Relevance: This study of a large cohort of patients enrolled in US health plans documented patterns of care at the onset of COVID-19. The findings are relevant to policy makers, payers, and practitioners as they manage the use of telehealth during the pandemic and afterward.


Subject(s)
Ambulatory Care , COVID-19 , Practice Patterns, Physicians' , Telemedicine , Adult , Ambulatory Care/economics , Ambulatory Care/methods , Ambulatory Care/statistics & numerical data , COVID-19/epidemiology , COVID-19/prevention & control , Cohort Studies , Costs and Cost Analysis , Female , Humans , Infection Control/methods , Insurance, Health/statistics & numerical data , Male , Organizational Innovation/economics , Practice Patterns, Physicians'/economics , Practice Patterns, Physicians'/organization & administration , Practice Patterns, Physicians'/statistics & numerical data , SARS-CoV-2 , Telemedicine/economics , Telemedicine/organization & administration , Telemedicine/statistics & numerical data , United States/epidemiology
4.
Am J Manag Care ; 27(3): 91-92, 2021 03.
Article in English | MEDLINE | ID: covidwho-1134756

ABSTRACT

As the coronavirus disease 2019 (COVID-19) pandemic threatens to worsen the opioid crisis, payers must rapidly deploy policies to ensure care for individuals with opioid use disorder.


Subject(s)
Buprenorphine/therapeutic use , Health Services Accessibility/economics , Insurance, Health, Reimbursement , Opiate Substitution Treatment/economics , Opioid-Related Disorders/drug therapy , Ambulatory Care/economics , COVID-19 , Humans , Methadone/therapeutic use , Naltrexone/therapeutic use , Telemedicine/economics , United States/epidemiology
5.
J Investig Med ; 69(7): 1372-1376, 2021 10.
Article in English | MEDLINE | ID: covidwho-1133307

ABSTRACT

We performed a retrospective study of cardiology telemedicine visits at a large academic pediatric center between 2016 and 2019 (pre COVID-19). Telemedicine patient visits were matched to data from their previous in-person visits, to evaluate any significant differences in total charge, insurance compensation, patient payment, percent reimbursement and zero reimbursement. Miles were measured between patient's home and the address of previous visit. We found statistically significant differences in mean charges of telemedicine versus in-person visits (2019US$) (172.95 vs 218.27, p=0.0046), patient payment for telemedicine visits versus in-person visits (2019US$) (11.13 vs 62.83, p≤0.001), insurance reimbursement (2019US$) (65.18 vs 110.85, p≤0.001) and insurance reimbursement rate (43% vs 61%, p=0.0029). Rate of zero reimbursement was not different. Mean distance from cardiology clinic was 35 miles. No adverse outcomes were detected. This small retrospective study showed cost reduction and a decrease in travel time for families participating in telemedicine visits. Future work is needed to enhance compensation for telemedicine visits.


Subject(s)
Ambulatory Care , Cardiology Service, Hospital , Cardiovascular Diseases , Costs and Cost Analysis , Telemedicine , Ambulatory Care/economics , Ambulatory Care/methods , Ambulatory Care/organization & administration , COVID-19/epidemiology , Cardiology Service, Hospital/economics , Cardiology Service, Hospital/trends , Cardiovascular Diseases/economics , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/therapy , Child , Cost Savings/methods , Costs and Cost Analysis/methods , Costs and Cost Analysis/statistics & numerical data , Family Health , Female , Health Services Accessibility/economics , Heart Defects, Congenital/economics , Heart Defects, Congenital/epidemiology , Heart Defects, Congenital/therapy , Humans , Male , Retrospective Studies , SARS-CoV-2 , Telemedicine/economics , Telemedicine/organization & administration , Telemedicine/statistics & numerical data , United States/epidemiology
6.
J Med Internet Res ; 23(3): e26516, 2021 03 03.
Article in English | MEDLINE | ID: covidwho-1115367

ABSTRACT

BACKGROUND: The COVID-19 pandemic has caused patients to avoid seeking medical care. Provision of telemonitoring programs in addition to usual care has demonstrated improved effectiveness in managing patients with heart failure (HF). OBJECTIVE: We aimed to examine the potential clinical and health economic outcomes of a telemonitoring program for management of patients with HF during the COVID-19 pandemic from the perspective of health care providers in Hong Kong. METHODS: A Markov model was designed to compare the outcomes of a care under COVID-19 (CUC) group and a telemonitoring plus CUC group (telemonitoring group) in a hypothetical cohort of older patients with HF in Hong Kong. The model outcome measures were direct medical cost, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio. Sensitivity analyses were performed to examine the model assumptions and the robustness of the base-case results. RESULTS: In the base-case analysis, the telemonitoring group showed a higher QALY gain (1.9007) at a higher cost (US $15,888) compared to the CUC group (1.8345 QALYs at US $15,603). Adopting US $48,937/QALY (1 × the gross domestic product per capita of Hong Kong) as the willingness-to-pay threshold, telemonitoring was accepted as a highly cost-effective strategy, with an incremental cost-effective ratio of US $4292/QALY. No threshold value was identified in the deterministic sensitivity analysis. In the probabilistic sensitivity analysis, telemonitoring was accepted as cost-effective in 99.22% of 10,000 Monte Carlo simulations. CONCLUSIONS: Compared to the current outpatient care alone under the COVID-19 pandemic, the addition of telemonitoring-mediated management to the current care for patients with HF appears to be a highly cost-effective strategy from the perspective of health care providers in Hong Kong.


Subject(s)
Ambulatory Care , COVID-19/complications , Data Analysis , Heart Failure/epidemiology , Monte Carlo Method , Telemedicine/economics , Telemedicine/methods , Ambulatory Care/economics , Ambulatory Care/methods , COVID-19/epidemiology , Cohort Studies , Cost-Benefit Analysis , Hong Kong/epidemiology , Humans , Markov Chains , Pandemics , Quality-Adjusted Life Years , SARS-CoV-2
7.
JAMA Oncol ; 7(4): 597-602, 2021 04 01.
Article in English | MEDLINE | ID: covidwho-1012157

ABSTRACT

Importance: The coronavirus disease 2019 (COVID-19) pandemic has burdened health care resources and disrupted care of patients with cancer. Virtual care (VC) represents a potential solution. However, few quantitative data support its rapid implementation and positive associations with service capacity and quality. Objective: To examine the outcomes of a cancer center-wide virtual care program in response to the COVID-19 pandemic. Design, Setting, and Participants: This cohort study applied a hospitalwide agile service design to map gaps and develop a customized digital solution to enable at-scale VC across a publicly funded comprehensive cancer center. Data were collected from a high-volume cancer center in Ontario, Canada, from March 23 to May 22, 2020. Main Outcomes and Measures: Outcome measures were care delivery volumes, quality of care, patient and practitioner experiences, and cost savings to patients. Results: The VC solution was developed and launched 12 days after the declaration of the COVID-19 pandemic. A total of 22 085 VC visits (mean, 514 visits per day) were conducted, comprising 68.4% (range, 18.8%-100%) of daily visits compared with 0.8% before launch (P < .001). Ambulatory clinic volumes recovered a month after deployment (3714-4091 patients per week), whereas chemotherapy and radiotherapy caseloads (1943-2461 patients per week) remained stable throughout. No changes in institutional or provincial quality-of-care indexes were observed. A total of 3791 surveys (3507 patients and 284 practitioners) were completed; 2207 patients (82%) and 92 practitioners (72%) indicated overall satisfaction with VC. The direct cost of this initiative was CAD$ 202 537, and displacement-related cost savings to patients totaled CAD$ 3 155 946. Conclusions and Relevance: These findings suggest that implementation of VC at scale at a high-volume cancer center may be feasible. An agile service design approach was able to preserve outpatient caseloads and maintain care quality, while rendering high patient and practitioner satisfaction. These findings may help guide the transformation of telemedicine in the post COVID-19 era.


Subject(s)
Ambulatory Care/organization & administration , COVID-19 , Cancer Care Facilities/organization & administration , Delivery of Health Care, Integrated/organization & administration , Medical Oncology/organization & administration , Telemedicine/organization & administration , Tertiary Care Centers/organization & administration , Ambulatory Care/economics , Appointments and Schedules , Attitude of Health Personnel , Cancer Care Facilities/economics , Cost Savings , Cost-Benefit Analysis , Delivery of Health Care, Integrated/economics , Feasibility Studies , Health Care Costs , Health Expenditures , Humans , Medical Oncology/economics , Ontario , Patient Satisfaction , Program Development , Program Evaluation , Quality Indicators, Health Care/organization & administration , Telemedicine/economics , Tertiary Care Centers/economics , Time Factors , Workload
10.
J Vasc Surg ; 72(6): 1856-1863, 2020 12.
Article in English | MEDLINE | ID: covidwho-863661

ABSTRACT

Although the coronavirus disease 2019 (COVID-19) pandemic has created havoc with the U.S healthcare system and physicians, the financial and contractual implications for physicians are now beginning to come to the forefront. Financial assistance from the federal government has mainly been received by hospitals, which have borne the brunt of the COVID-19 illness. Some physician groups have, or are, receiving assistance through a few programs, although the accelerated and advance payments have been suspended. Employed surgeons are now being furloughed, terminated, or persuaded to agree to a significant cut in pay, forego bonuses, or take leave without pay as healthcare systems and some physician groups have started to experience the consequences of halting elective procedures. Newly hired surgeons might be forced in a few cases to agree to delays in starting their employment, new amendments, changes in employment status, and other terms for fear of losing their employment. In the present report, we have explained some agreement terminology and options available to allow physicians to understand the terms of their employment agreement and make their decisions after consulting with an expert healthcare attorney.


Subject(s)
COVID-19/economics , Employment/economics , Financing, Government/economics , Income , Insurance, Health, Reimbursement/economics , Surgeons/economics , Ambulatory Care/economics , COVID-19/legislation & jurisprudence , Employment/legislation & jurisprudence , Financing, Government/legislation & jurisprudence , Humans , Insurance, Health, Reimbursement/legislation & jurisprudence , Policy Making , Practice Management, Medical/economics , Surgeons/legislation & jurisprudence , Telemedicine/economics , Time Factors , United States
11.
Reg Anesth Pain Med ; 45(8): 579-585, 2020 08.
Article in English | MEDLINE | ID: covidwho-457168

ABSTRACT

The COVID-19 pandemic has resulted in significant clinical and economic consequences for medical practices of all specialties across the nation. Although the clinical implications are of the utmost importance, the economic consequences have also been serious and resulted in substantial damage to the US healthcare system, including pain practices. Outpatient pain practices have had to significantly change their clinical care pathways, including the incorporation of telemedicine. Elective medical and interventional care has been postponed. For the most part, ambulatory surgical centers have had to cease operations. As patient volumes have decreased for non-emergent elective care, the financial indicators have deteriorated. This review article will provide insight into solutions to mitigate the clinical and economic challenges induced by COVID-19. Undoubtedly, the COVID-19 pandemic will have short-term and long-term implications for all medical practices and facilities. In order to survive, medical practices will need dynamic, operational, and creative strategic plans to mitigate the disruption in medical care and pathways for successful reintegration of clinical and surgical practice.


Subject(s)
Ambulatory Care/economics , Coronavirus Infections/economics , Coronavirus Infections/therapy , Pain Management/methods , Pandemics/economics , Pneumonia, Viral/economics , Pneumonia, Viral/therapy , Ambulatory Care/statistics & numerical data , COVID-19 , Humans , Insurance, Health , Telemedicine , United States
12.
Diabetes Metab Syndr ; 14(5): 731-732, 2020.
Article in English | MEDLINE | ID: covidwho-305996

ABSTRACT

BACKGROUND AND AIMS: Diabetes mellitus (DM) is one of the most critical risk factors for complications and death in COVID-19 patients. The present study aims to highlight challenges in the management of diabetic patients during the COVID-19 outbreak in developing countries. METHODS: We reviewed the literature to obtain information about diabetic care during the Covid-19 crisis. We also seek opinions of clinicians working in undeveloped countries. RESULTS: Current challenges faced by clinicians in the management of diabetic patients in developing countries are as follows: lack of preventive measures, inadequate number of visits, loss of the traditional method of communication with the patient, shortage of medications, impaired routine diabetic care, and absence of telehealth services. CONCLUSIONS: Developing countries are faced with many challenges in diabetes management due to a lack of resources.


Subject(s)
Coronavirus Infections/epidemiology , Developing Countries , Diabetes Mellitus/epidemiology , Diabetes Mellitus/therapy , Pneumonia, Viral/epidemiology , Ambulatory Care/economics , Ambulatory Care/standards , Ambulatory Care/statistics & numerical data , Betacoronavirus/physiology , COVID-19 , Coronavirus Infections/complications , Developing Countries/economics , Developing Countries/statistics & numerical data , Diabetes Mellitus/economics , Health Services Accessibility/economics , Health Services Accessibility/standards , Health Services Accessibility/statistics & numerical data , Humans , Incidence , Pandemics , Pneumonia, Viral/complications , Risk Factors , SARS-CoV-2 , Telemedicine/economics , Telemedicine/methods
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