The VA Home Based Primary Care (HBPC) program provides comprehensive primary care to veterans in their homes through an interdisciplinary team approach. It serves veterans who are too ill to access regular clinic-based care and has grown significantly since 2000. Studies show HBPC reduces hospitalizations, nursing home stays, and costs of care while improving quality of life for veterans and their caregivers compared to usual care. HBPC may also reduce total costs for the VA and Medicare combined through lower utilization. Veterans report that the personalized care of HBPC helps them avoid emergency room visits and improves their daily lives.
This document presents data on average facility labor and birth charges in various US states from 2008-2010, broken down by site of birth (hospital vs birth center) and method of birth (vaginal with/without complications or cesarean with/without complications). The data shows that average charges were consistently highest for hospital cesarean births with complications and lowest for vaginal births at birth centers. Charges generally increased over the three year period for all categories. The document provides important information about trends in the cost of childbirth by location and method of delivery.
New York City Health & Hospitals Corporationlponssa
This document summarizes the transformation of the supply chain management at NYC Health and Hospitals Corporation (HHC). HHC is the largest municipal healthcare system in the US, serving 1.3 million patients annually. It was facing a $1 billion budget shortfall and needed to restructure its supply chain to reduce costs. The transformation established pillars like strategic sourcing, vendor management, and performance management to standardize processes and leverage the system's size. The results included over $8 million in supply savings in the first year and a projected $21.46 million in total annual savings from various initiatives. Key metrics were also implemented to track progress. The transformation of the supply chain was a critical part of HHC's "Road A
1) The document discusses the cost-effectiveness of drug-eluting stents (DES) compared to bare-metal stents (BMS) based on clinical trial data from 2003 and 2009.
2) While practice patterns have changed, DES remain cost-effective compared to BMS for patients with a predicted BMS target vessel revascularization rate of over 10-11%.
3) The most promising ways to further improve the cost-effectiveness of DES are to reduce stent thrombosis risks or decrease the duration of mandatory dual antiplatelet therapy.
The document summarizes the 3-year outcomes of the SYNTAX clinical trial for patients with left main coronary artery disease. The SYNTAX trial randomized patients with complex coronary artery disease to either coronary artery bypass grafting (CABG) or percutaneous coronary intervention with paclitaxel-eluting stents (PCI). For the 705 patients in the left main subgroup, the rates of all-cause death at 3 years were similar between CABG (8.4%) and PCI (7.3%). However, the rate of stroke was significantly higher in the CABG group (4.0%) compared to the PCI group (1.2%).
Diabetes Mellitus & Multi vessel disease-part 1cardiositeindia
This document discusses diabetes and multivessel coronary artery disease. It summarizes data from the BARI and ARTS trials comparing outcomes of coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) in patients with diabetes and multivessel disease. The BARI and ARTS trials found that CABG resulted in better long-term outcomes compared to PCI with bare-metal stents in diabetic patients with multivessel disease. However, subsequent analyses found no difference in outcomes between CABG and PCI with drug-eluting stents in this patient population.
XXVII Reunión anual de la sección de Hemodinámica y Cardiología Intervencionista
16 y 17 de junio de 2016 León
http://secardiologia.es/xxvii-reunion-anual-de-la-seccion-de-hemodinamica-y-cardiologia-intervencionista
Registro 3D
Rafael Romaguera
Coronary revascularization in diabetes mellitus and multivessel cadSatyam Rajvanshi
This document summarizes the FREEDOM trial which compared coronary artery bypass grafting (CABG) to percutaneous coronary intervention (PCI) with drug-eluting stents in 1900 patients with diabetes and multivessel coronary artery disease. The primary outcome of death, heart attack, or stroke occurred in fewer patients treated with CABG compared to PCI over 5 years. CABG was also associated with less need for repeat procedures compared to PCI. However, CABG was linked to more bleeding and acute kidney injury within 30 days. The trial provides evidence that CABG may have longer-term benefits over PCI for patients with diabetes and multiple blocked heart arteries, but also carries higher early risks.
The VA Home Based Primary Care (HBPC) program provides comprehensive primary care to veterans in their homes through an interdisciplinary team approach. It serves veterans who are too ill to access regular clinic-based care and has grown significantly since 2000. Studies show HBPC reduces hospitalizations, nursing home stays, and costs of care while improving quality of life for veterans and their caregivers compared to usual care. HBPC may also reduce total costs for the VA and Medicare combined through lower utilization. Veterans report that the personalized care of HBPC helps them avoid emergency room visits and improves their daily lives.
This document presents data on average facility labor and birth charges in various US states from 2008-2010, broken down by site of birth (hospital vs birth center) and method of birth (vaginal with/without complications or cesarean with/without complications). The data shows that average charges were consistently highest for hospital cesarean births with complications and lowest for vaginal births at birth centers. Charges generally increased over the three year period for all categories. The document provides important information about trends in the cost of childbirth by location and method of delivery.
New York City Health & Hospitals Corporationlponssa
This document summarizes the transformation of the supply chain management at NYC Health and Hospitals Corporation (HHC). HHC is the largest municipal healthcare system in the US, serving 1.3 million patients annually. It was facing a $1 billion budget shortfall and needed to restructure its supply chain to reduce costs. The transformation established pillars like strategic sourcing, vendor management, and performance management to standardize processes and leverage the system's size. The results included over $8 million in supply savings in the first year and a projected $21.46 million in total annual savings from various initiatives. Key metrics were also implemented to track progress. The transformation of the supply chain was a critical part of HHC's "Road A
1) The document discusses the cost-effectiveness of drug-eluting stents (DES) compared to bare-metal stents (BMS) based on clinical trial data from 2003 and 2009.
2) While practice patterns have changed, DES remain cost-effective compared to BMS for patients with a predicted BMS target vessel revascularization rate of over 10-11%.
3) The most promising ways to further improve the cost-effectiveness of DES are to reduce stent thrombosis risks or decrease the duration of mandatory dual antiplatelet therapy.
The document summarizes the 3-year outcomes of the SYNTAX clinical trial for patients with left main coronary artery disease. The SYNTAX trial randomized patients with complex coronary artery disease to either coronary artery bypass grafting (CABG) or percutaneous coronary intervention with paclitaxel-eluting stents (PCI). For the 705 patients in the left main subgroup, the rates of all-cause death at 3 years were similar between CABG (8.4%) and PCI (7.3%). However, the rate of stroke was significantly higher in the CABG group (4.0%) compared to the PCI group (1.2%).
Diabetes Mellitus & Multi vessel disease-part 1cardiositeindia
This document discusses diabetes and multivessel coronary artery disease. It summarizes data from the BARI and ARTS trials comparing outcomes of coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) in patients with diabetes and multivessel disease. The BARI and ARTS trials found that CABG resulted in better long-term outcomes compared to PCI with bare-metal stents in diabetic patients with multivessel disease. However, subsequent analyses found no difference in outcomes between CABG and PCI with drug-eluting stents in this patient population.
XXVII Reunión anual de la sección de Hemodinámica y Cardiología Intervencionista
16 y 17 de junio de 2016 León
http://secardiologia.es/xxvii-reunion-anual-de-la-seccion-de-hemodinamica-y-cardiologia-intervencionista
Registro 3D
Rafael Romaguera
Coronary revascularization in diabetes mellitus and multivessel cadSatyam Rajvanshi
This document summarizes the FREEDOM trial which compared coronary artery bypass grafting (CABG) to percutaneous coronary intervention (PCI) with drug-eluting stents in 1900 patients with diabetes and multivessel coronary artery disease. The primary outcome of death, heart attack, or stroke occurred in fewer patients treated with CABG compared to PCI over 5 years. CABG was also associated with less need for repeat procedures compared to PCI. However, CABG was linked to more bleeding and acute kidney injury within 30 days. The trial provides evidence that CABG may have longer-term benefits over PCI for patients with diabetes and multiple blocked heart arteries, but also carries higher early risks.
This document summarizes a presentation about a new colorectal cancer screening test called ColoRTTM. It begins by outlining the problems with current CRC screening methods and then describes the ColoRTTM solution, which uses a patented oncoprotein and rapid vertical flow technology. Validation studies with NIH funding showed high accuracy. The test has advantages for patients, doctors, and payers by being convenient and reducing costs. Financial projections estimate growing sales and profitability. The company is pursuing FDA clearance and international expansion.
Transradial PCI is increasing in the US as it provides value by reducing costs through lower bleeding rates and shorter length of stays. The author's hospital implemented several strategies to increase value, including increased use of transradial PCI, a same-day discharge program, and a patient-centered approach focusing on individualized risk assessment. These strategies led to lower costs, improved outcomes, and increased patient satisfaction while maintaining the ability to treat high-risk patients. The hospital estimates annual savings of over $3 million from these strategies along with improved revenue from quality programs.
This document summarizes data from studies comparing percutaneous coronary intervention (PCI) using drug-eluting stents to coronary artery bypass grafting (CABG) for treating left main coronary artery disease. Some key findings from meta-analyses of randomized trials presented are that 1-year rates of death and myocardial infarction were similar for PCI and CABG, while 1-year rates of major adverse cardiac and cerebrovascular events (MACCE) were also similar. Subgroup analyses found the risk of MACCE was lower for PCI compared to CABG in patients with less complex coronary artery disease involvement. The document concludes that based on these studies, guidelines recommending CABG over PCI for left main disease should be revised to provide a
1. A hospitalist is considering job offers in Nebraska and New York City and wants to compare potential Medicare collections at each location.
2. The procedure coded would be CPT 99223 for a complex full admission. Medicare conversion factors and geographic practice cost indices differ between the two states and would impact reimbursement.
3. An audit of Medicare payments for cataract procedures with and without intraocular lenses (IOL) at a hospital found some payment calculations did not match what Medicare actually paid. The audit aims to verify the computer system's calculations using procedure codes, conversion factors, relative weights, wage indices and cost to charge ratios provided.
This document discusses left main coronary artery (LMCA) bifurcation percutaneous coronary intervention (PCI). It provides an overview of studies comparing outcomes of PCI versus coronary artery bypass grafting (CABG) for LMCA revascularization. Key points include:
1) Large trials and meta-analyses have found no difference in mortality between PCI and CABG for LMCA disease.
2) PCI for distal LMCA bifurcation lesions has better outcomes than non-distal lesions and is now treated more routinely.
3) Ongoing studies are providing new insights into optimal techniques for LMCA bifurcation PCI, including the DK-Crush versus provisional approach.
The document discusses the rising costs of healthcare and actions that have been taken to control costs. It notes that everyone who sponsors a healthcare plan faces a cost problem as average annual costs have increased significantly from 2000 to 2010. The document discusses various actions that plans and employers have taken to try to bring healthcare costs under control, such as wellness programs, pre-certification, and care management programs. However, costs continue to rise significantly each year. The document suggests examining provider reimbursements and charges, as there is a large variance in what different providers charge for the same services. Addressing rising provider costs may be one way to help control overall healthcare costs.
Badger Meter provides a table of contents for an analysis of the company. Key sections include relative valuation comparisons to industry averages, a DCF summary projecting revenues and cash flows through 2013, a Porter's Five Forces analysis of the water meter industry, a SWOT analysis, and discussions of management, recent surveys of water utilities, municipal bond issues, competitors, and various financial statements.
This document summarizes catheterization metrics, procedures, costs, charges, and reimbursement for a 300 bed teaching hospital using the DirectVision catheterization system. It finds that using DirectVision for 10 procedures per month generates $1,940 in direct incremental gain each month or $23,276 per year from additional charges and professional fees, despite $2,660 in additional costs per month. Physicians and mid-levels can bill for their DirectVision services. The analysis only considers direct financial impacts and not total costs of patient care.
Implications of the transfer ami trial for clinical practiceTrimed Media Group
The document discusses implications of the TRANSFER AMI trial for clinical practice based on a presentation. It summarizes that PCI centers should perform PCI in a timely manner (<90 minutes) and that short distance transfer patients should receive PCI within 120 minutes. For patients with expected delays, a pharmacoinvasive PCI strategy is an excellent option. However, the ideal regimen and timing remain unclear based on limitations of previous trials. Overall, reperfusion strategies should aim to restore flow in a timely fashion, as delays are associated with worse outcomes.
The document contains information about two carbon offset projects. The first project involves capturing methane from the manure of 2,500 cows. It estimates the costs and revenues from selling 8,750 carbon reduction tons (CRTs) per year over 10 years. The second project involves preventing emissions from 40,000 tons of eligible food waste per year. It also estimates costs and revenues from selling 20,000 CRTs per year over 10 years. Both projects estimate a positive net present value (NPV) from selling the CRTs.
Presentation delivered by Dr. DingXin Cheng, Director of the California Pavement Preservation Center at CSU Chico to the CalAPA Fall Asphalt Pavement Conference, Oct. 24-25, 2018 in Sacramento.
This document discusses the costs of transradial PCI (percutaneous coronary intervention) procedures in the United States. It finds that PCI procedures can vary widely in cost between hospitals, with radial procedures on average costing $830 less than femoral procedures. Same-day discharge PCI procedures have been shown to further lower costs by $3,600 on average compared to traditional overnight stays. Hospitals that convert 1,000 elective PCIs annually from traditional to radial same-day discharge procedures could save costs substantially. Patient satisfaction also remains high with same-day discharge approaches.
If your company is self-funded then you can have proton therapy coverage added to your policy. Research shows that proton therapy can actually result in decreased overall medical costs for cancer patients.
This document summarizes the results of a randomized trial comparing outcomes of PCI performed at hospitals with and without on-site cardiac surgery. It found that at 6 weeks and 9 months, rates of death, heart attack, bleeding, stroke and other complications were similar between the two hospital types. However, PCI failure and use of bare-metal stents were higher, and staged procedures and catheterization lab visits were more frequent, at hospitals without on-site surgery.
Evaluation of transition scenarios for breast cancer screeningin France to ...HTAi Bilbao 2012
This document evaluates transition scenarios to increase participation in breast cancer screening in France for women aged 50 to 74. It analyzes switching the full population to an organized screening program (OS) compared to the current mix of OS and opportunistic screening (OPPS). Five transition scenarios are modeled: stopping OPPS coverage, adding OPPS quality controls, changing OS operations, adjusting fees, and providing incentives to healthcare practitioners. Full conversion to OS could detect an additional 283 cancers at a lower total cost compared to current practice but relies on high patient transfer rates and low withdrawal rates from screening. Combining incentives for practitioners with stopping OPPS coverage may be most effective if behavioral assumptions can be validated. Further research is needed on patient behaviors, OP
The hospital had previously contracted an outside service to handle physician assistant (PAT) billing but was not recovering costs. PAT Services was asked to review the PAT practice and make suggestions. PAT Services was then asked to manage the physician and provide billing services. By retraining the physician in documentation and billing codes, and conducting chart audits, PAT Services increased the hospital's annual PAT collections from $142,502 to $289,584, transforming the department from a cost center to a revenue generator.
The document discusses upgrading a hospital's systems through implementing the TiC101 intelligent healthcare system. It describes the system's key concepts of connection, instinct, and security which are realized through features like smart contacts, templates, and RFID identification. It also analyzes Asia's EMR adoption model and stages of EMR implementation. Finally, it presents CIS Note's business model, market assumptions, and projected profit and loss statements which estimate achieving profitability by 2017.
Summary of landmark CTO clinical trials and highlights from registries AhmedElBorae1
This document summarizes information from registries and trials on coronary chronic total occlusions (CTO). It discusses CTO lesion analysis scores, access choices, success rates and complications. It reviews several randomized controlled trials comparing CTO percutaneous coronary intervention (PCI) to medical therapy that had modest sample sizes and open-label designs. It also discusses observational data from large registries on temporal trends in CTO PCI procedures, techniques, success rates and complications. The key takeaway message is that adoption of modern CTO techniques has led to increased success rates with lower complications, and RCTs showed improved quality of life while observational data suggests successful CTO revascularization may improve long-term prognosis.
Estudio presentado por el Dr. Andre Lamy en el último ACC.2013, realizado en San Francisco, Estados Unidos, los días 9, 10 y 11 de Marzo. Más presentaciones de este evento en www.solaci.org/es/coberturas.php
- This study randomized 542 high-risk patients with non-ST elevation ACS to either immediate (<12 hours) or delayed (>48 hours) angiography and revascularization.
- The primary endpoint of death, myocardial infarction, or recurrent ischemia at 30 days was not significantly different between the immediate and delayed groups.
- However, hospital stay was significantly shorter in the immediate group. Subgroup analysis found that patients treated in non-PCI centers may benefit more from early intervention.
- While underpowered, results were consistent with prior trials showing early intervention reduces recurrent ischemia but not a clear benefit on other outcomes.
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Badger Meter provides a table of contents for an analysis of the company. Key sections include relative valuation comparisons to industry averages, a DCF summary projecting revenues and cash flows through 2013, a Porter's Five Forces analysis of the water meter industry, a SWOT analysis, and discussions of management, recent surveys of water utilities, municipal bond issues, competitors, and various financial statements.
This document summarizes catheterization metrics, procedures, costs, charges, and reimbursement for a 300 bed teaching hospital using the DirectVision catheterization system. It finds that using DirectVision for 10 procedures per month generates $1,940 in direct incremental gain each month or $23,276 per year from additional charges and professional fees, despite $2,660 in additional costs per month. Physicians and mid-levels can bill for their DirectVision services. The analysis only considers direct financial impacts and not total costs of patient care.
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The document discusses implications of the TRANSFER AMI trial for clinical practice based on a presentation. It summarizes that PCI centers should perform PCI in a timely manner (<90 minutes) and that short distance transfer patients should receive PCI within 120 minutes. For patients with expected delays, a pharmacoinvasive PCI strategy is an excellent option. However, the ideal regimen and timing remain unclear based on limitations of previous trials. Overall, reperfusion strategies should aim to restore flow in a timely fashion, as delays are associated with worse outcomes.
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Cangrelor compared with clopidogrel improves efficiency without increasing bl...
Cost-Effectiveness of PCI with Drug Eluting…
1. Cost-Effectiveness of PCI with Drug Eluting
Stents vs. Bypass Surgery for Patients with
Diabetes and Multivessel CAD:
Results from the FREEDOM Trial
Elizabeth A. Magnuson, Valentin Fuster, Michael E. Farkouh,
Kaijun Wang, Katherine Vilain, Haiyan Li, Jaime Appelwick,
Victoria Muratov, Lynn A. Sleeper, Mouin Abdallah, David J. Cohen
Saint Luke’s Mid America Heart Institute
University of Missouri-Kansas City
Kansas City, Missouri
2. Disclosures
• FREEDOM was supported by U01 grants
#01HL071988 and #01HL092989 from the National
Heart Lung and Blood Institute
Other support
Drug eluting stents were provided by Cordis, Johnson and
Johnson and Boston Scientific
Abciximab and an unrestricted research grant were provided
by Eli Lilly and Company
Clopidogrel was provided by Sanofi Aventis and Bristol-
Myers Squibb
3. Background
Time to Death/MI/Stroke
PCI/DES
30 CABG
Death/Stroke/MI, %
Logrank P=0.005
20 PCI/DES
CABG
10
5-Year Event Rates: 26.6% vs. 18.7%
0
0 1 2 3 4 5
Years post-randomization
4. Patient Flow
1900 patients randomized
947 assigned to 953 assigned to PCI
CABG
36 no
procedure 9 no procedure
(withdrawn) (withdrawn)
911 underwent 944 underwent
revascularization revascularization
893 initial 18 initial 939 initial 5 initial
CABG PCI PCI CABG
Median follow-up duration: 47 months
5. Economic Study Analysis Plan
Primary Endpoint:
• Incremental cost-effectiveness ratio expressed as
cost per quality-adjusted life year (QALY) gained
» Costs and QALYs were discounted at 3% annually
General Approach – 2 Stages:
• In-trial analysis based on observed survival, health
state utility (EQ-5D), and costs derived from reported
health care resource use during the trial period
• Lifetime analysis based on projections of survival,
quality-adjusted survival and costs beyond the trial
period
6. Costing Methods
PCI and CABG Procedures:
• Cath lab and CABG-related procedure costs based on
measured resource utilization (procedure duration,
balloons, stents, wires, etc.) and current unit costs
DES cost = $1500/stent
• Ancillary hospital costs based on regression models
developed from 2010 MedPAR data for FREEDOM-
eligible patients
Clinical events and complications rather than LOS were used
as key predictors to avoid distortions due to marked differences
in LOS across different countries/health care systems
Additional costs: CV and non-CV rehospitalizations, MD fees,
outpatient CV care/testing and medications, cardiac rehabilitation
and nursing home stays
10. Annual and Cumulative Costs: Years 1- 5
Annual
$25,000 Cumulative
$70,000
$60,000
$20,000 Δ costs = $7878
$50,000
$15,000
Δ costs = $3641 $40,000
$30,000
$10,000
$20,000
$5,000
$10,000
$0 $0
Year 1 Year 2 Year 3 Year 4 Year 5
CABG Annual Cost PCI Annual Cost CABG Cumulative Cost PCI Cumulative Cost
11. Annual Differences in Life Years and QALYs
Time Since
Δ Life Years Δ QALYs
Randomization
(CABG-PCI) (CABG-PCI)
(Years)
1 -0.008 -0.033
2 -0.010 -0.034
3 -0.0006 -0.029
4 +0.015 -0.004
5 +0.053 +0.031
12. Markov Model
For the Projection of Post-Trial Life Years, QALYs and Costs
• Monthly risk of death based on age, sex and race-
matched data from US life tables calibrated to the
observed 5 year mortality for the PCI population
CABG effect based on a landmark analysis for years 2-5:
mortality hazard ratio for CABG vs. PCI = 0.60
• Base case: Gradual attenuation of CABG effect
Mortality hazard ratio increases from 0.60 to 1 in a linear
fashion between 5 and 10 years; no impact of CABG beyond
10 years
• Long-term costs and utility weights obtained from
regression models developed from trial data
13. In-Trial and Projected Survival
1 0.053 life years
CABG
0.8 PCI
0.6 1.266 total life years
Survival
gained with CABG
(0.794 when discounted at 3% annually)
0.4
0.2
0
0 5 10 15 20 25 30 35
Years post-randomization
18. Summary (1)
• CABG is associated with initial costs ≈ $9,000/patient
higher than PCI
• Partially offset by lower costs associated with repeat
revascularization and to a lesser extent cardiac meds
• At 5 years, CABG improved quality-adjusted life
expectancy by ~ 0.03 years while increasing total
costs by ~ $3,600/patient
• Over a lifetime horizon, CABG associated with 0.66
QALYs gained and ~$5,400/patient higher costs
yielding an ICER of $8,132/QALY gained
19. Summary (2)
• Results were robust to a broad range of
sensitivity analyses regarding the duration of
the CABG effect on both survival and costs
• Results were also consistent across a wide
range of subgroups
20. Conclusions
• For patients with diabetes and multivessel
CAD, CABG provides not only better long-
term clinical outcomes than DES-PCI but
these benefits are achieved at an overall cost
that represents an attractive use of societal
health care resources
• These findings provide additional support for
existing guidelines that recommend CABG for
diabetic patients with multivessel CAD