The Council of Economics Advisors (CEA), established in 1946, functions within the Executive Office of the President and is comprised of a chair, two members, and a staff of economics experts. Several HCFO grantees were selected to serve as staff members at the CEA under both the Bush and Obama administrations. They graciously shared some of their experiences and thoughts on how their HCFO-funded work and health services research generally helped inform their analysis at the CEA.

As policymakers continue to look for ways to bend the cost curve, many have pointed to the administrative costs of health care in the United States as one potential target for reform. Physicians’ interactions with health plans create an enormous cost burden on the system. In a HCFO-funded study led by Lawrence Casalino, M.D., Ph.D., at the University of Chicago (now at Cornell University), the research team used a survey of U.S. physicians and practice managers to develop a national estimate of the administrative costs for U.S. private physician practices generated by their interactions with multiple health plans. Building on his 2009 work, Casalino’s team and Canadian colleagues Dante Morra and Wendy Levinson at the University of Toronto implemented a similar survey in Canada to create a comparison between administrative costs in the United States and those of a single payer system like Canada.

Now Available: The 2009 Nationwide Emergency Department Sample (NEDS)

The Agency for Healthcare Research and Quality (AHRQ) is pleased to announce the release of the 2009 Nationwide Emergency Department Sample (NEDS). The NEDS is the largest all-payer emergency department (ED) database in the United States. The NEDS was created to enable analyses of ED utilization patterns and support public health professionals, administrators, policymakers, and clinicians in their understanding and decision-making regarding this critical source of health care.

The NEDS provides information on both "treat-and-release" ED visits and those in which the patient was admitted to the same hospital for further care. The 2009 NEDS contains data from nearly 29 million ED visits and encompasses all encounter data from more than 950 hospital-based EDs in 29 states. Weights are provided to calculate national estimates pertaining to the almost 130 million ED visits that took place in 2009.

The 2009 NEDS and other HCUP databases can be purchased through the HCUP Central Distributor. 

HCUP’s 2009 Facts and Figures Report Released

The Agency for Healthcare Research and Quality (AHRQ) is pleased to announce the release of the HCUP Facts and Figures: Statistics on Hospital-Based Care in the United States, 2009, available on the HCUP-US Website. The report is an update and expansion of the HCUP Facts and Figures, 2008 report and uses the Nationwide Inpatient Sample (NIS) to present information about hospital care in 2009 and trends in care between 1993 and 2009.

HCUP Facts and Figures contains an overview of hospital-related topics including general characteristics of U.S. hospitals and the patients treated; the most common diagnoses, conditions, and procedures associated with inpatient stays; the costs and charges associated with hospitalizations; and the payers for inpatient stays. This year’s report features a special chapter on women’s health.
 

Blood Infections Most Costly Hospital Care in 2009      

Septicemia, an illness caused by blood infections with bacteria such as E. coli and MRSA, was the single most expensive condition treated in U.S. hospitals at nearly $15.4 billion in 2009, according to a recent report from the Agency for Healthcare Research and Quality (AHRQ). Data include cases of septicemia acquired within the community and during hospital stays.

The Federal agency also found that:

• The number of hospital stays principally for septicemia more than doubled between 2000 and 2009 (337,100 admissions and 836,000 admissions, respectively), making it the sixth most common principal reason for hospitalization in 2009.

• Complication resulting from a device, implant, or graft was the most common reason for these hospitalizations, representing one of every five septicemia-related stays.

• The in-hospital death rate for septicemia was 16 percent in 2009—more than 8 times as high as for all other hospital stays.

• More than half of all patients hospitalized for septicemia were elderly; about 14 percent were 85 and older and nearly 40 percent were 65 to 84. Some 27 percent of cases were in patients age 45 to 64, nearly 11 percent were in patients age 18 to 44 and only 1.6 percent were in children age 1 to 17.

These findings are based on data described in Statistical Brief #122: Septicemia in U.S. Hospitals, 2009. The report uses data from the Nationwide Inpatient Sample (NIS).

For information about the NIS and other HCUP databases, go to www.ahrq.gov/data/hcup/datahcup.htm.

Hal Luft, Ph.D., is director of the Palo Alto Medical Foundation (PAMF) Research Institute, and a senior investigator and interim chair of PAMF’s Department of Health Policy Research. He is also Caldwell B. Esselstyn Professor Emeritus of Health Policy and Health Economics at the University of California San Francisco. Dr. Luft’s research has addressed a wide range of topics in health care including health maintenance organizations, medical care utilization, hospital market competition, and risk assessment and risk adjustment.

Mireille Jacobson, Ph.D., Craig C. Earle, M.D., and Joseph P. Newhouse, Ph.D. published “Geographic Variation in Physicians’ Responses to a Reimbursement Change,” November 2, 2011, in the New England Journal of Medicine.

J. Scott Ashwood, M.A., and colleagues published, “Trends in Retail Clinic Use Among the Commercially Insured,” November 2011, in the American Journal of Managed Care.

Grantees in the News

HCFO-funded research led by Mark Duggan, Ph.D., of the University of Maryland, was highlighted in his NBER working paper, "Has the Shift Toward Managed Care Reduced Medicaid Expenditures? Evidence from State and Local-Level Mandates" (subscription required). The national study described in the paper is an outgrowth of Duggan's earlier HCFO project.

HCFO grantee Donald Taylor, Ph.D., Duke University, blogs in The Incidental Economist about the Medicare hospice benefit, just one of the challenges facing the Super Committee and how its decisions are likely to impact on the ACA. Taylor’s HCFO-funded work and other research on the cost and quality of hospice and palliative care address key policy issues.

Recently published HCFO-funded research by Neal Wallace, Ph.D., was featured in Medscape News. The article, "Oregon Medicaid Dental Cuts Sent Patients to Emergency Department," (login required) details the study's finding that Oregon Medicaid patients who lost their dental benefits utilized medical facilities for their dental care and faced signficiant unmet dental health needs.

HCFO Webinar Archive Now Available

Getting and Using Medicare Data: What I Wish I Had Known Before I Started My Research

The HCFO program, in collaboration with AcademyHealth’s Methods Council, hosted a webinar on best practices for obtaining and using Medicare data for research on September 27, 2011. Two experienced HCFO researchers, Jack Hoadley, Ph.D. of Georgetown University and Jim Reschovsky, Ph.D. of the Center for Studying Health System Change, shared some of their accumulated wisdom in getting and working with Medicare data in their research. In addition, Barbara Frank, M.P.H., M.S., from the Research Data Assistance Center (ResDAC) at the University of Minnesota provided additional resources, tips, and best practices drawn from her organization’s role as a CMS contractor assisting researchers in obtaining and working with Medicare data.

The webinar recording and materials can be accessed online: http://www.academyhealth.org/Training/ResourceDetail.cfm?ItemNumber=7764

Registration is now open for the National Health Policy Conference. Register today and be among the first to learn to learn where health policy is headed in 2012.

NCHS/AcademyHealth Health Policy Fellowship Application Deadline: January 9, 2012

Register for Two Free Upcoming PHSR Webinars: An Introduction to Mixed Methods and Conducting Natural Experiments

Medical Care Research and Review (MCRR) Announces a Call for Review Papers