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J A Lamphere

Publications and source records attributed to J A Lamphere.

8 recordsLinked to original sources
PubMed2000

Promises unfulfilled: implementation of expanded coverage for the elderly poor.

OBJECTIVE: To examine implementation of the Qualified Medicare Beneficiary (QMB) and Specified Low-Income Medicare Beneficiary (SLMB) programs, enacted in 1988. The article summarizes the origin of the QMB and SLMB programs, describes what we have learned about QMB and SLMB enrollment in state Medicaid programs and, despite some encouraging news on the federal front, identifies policy issues that remain in assuring access to health care for the low-income elderly. SOURCE: Based in part on research that assessed state variations in Medicaid QMB and SLMB enrollment of low-income Medicare beneficiaries and identified best practices among states in administration of the QMB and SLMB programs. STUDY DESIGN: Telephone interviews were conducted with officials in ten states to elicit qualitative information about how state Medicaid programs have implemented federal protections for low-income Medicare beneficiaries. PRINCIPAL FINDINGS: The QMB and SLMB programs fail to reach a sizable proportion of potentially eligible individuals in most states. Fragmentation of Medicare and Medicaid benefits, complex Medicaid eligibility and income verification processes, and rigid federal and state administrative and data systems, impede efforts to achieve promised protection for low-income elderly persons. CONCLUSIONS: For low-income Medicare beneficiaries, obtaining financial protection against their high out-of-pocket health care costs remains an important issue. The complexities associated with aligning Medicare and Medicaid to deliver health benefits to low-income older persons makes improved coordination across federal and state agencies uncertain.

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PubMed1996

Cost reduction by combined carotid endarterectomy and coronary artery bypass grafting.

A significant cost reduction is likely if patients who require coronary artery bypass grafting with significant carotid stenosis have simultaneous carotid endarterectomy and bypass grafting, provided risk is not increased. To investigate this issue, we retrospectively identified cases from February 1977 to May 1994 with first-time isolated carotid endarterectomy, coronary bypass, or combined procedures. In the isolated carotid endarterectomy population, median age was 69 years and 58% (85/146) were male, as compared with 68 years and 68% (68/100) male in the combined group; median age of the coronary bypass cohort was 65 years and 76% (381/500) male. A significantly higher percentage of patients in the coronary bypass versus combined group were in New York Heart Association functional class IV. In the combined group there was a significantly higher incidence of older age, diabetes, hypertension, hyperlipidemia, renal failure, and congestive heart failure. There was no difference among the three groups with respect to hospital mortality (0%, 3.4%, and 4.0%, respectively) and permanent stroke (0.7%, 1.2%, and 0%, respectively). Hospital costs were $4,896, $10,959 and $11,089, respectively, with a savings of $4,766 (30%), and Medicare hospital reimbursement was $8,575, $23,071, and $23,071, respectively, with a savings of $10,077 (25.3%). Thus, in appropriate patients, a combined procedure is cost effective, eliminating a second surgical procedure and the cost of the postoperative stay (3.7 +/- 2.4 days) associated with isolated carotid endarterectomy. Risk of permanent stroke or death is not increased.

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PubMed1995

New technique for lesser saphenous vein harvesting.

A new technique using the Thompson self-retaining retractor system (Thompson Surgical Instruments, Inc, Traverse City, MI) to harvest lesser saphenous veins is presented. This modification, used in 10 patients undergoing redo myocardial revascularization, provided a rapid, comfortable, and convenient method for harvesting lesser saphenous veins.

Coronary Artery Bypass↗
PubMed1995

Risk selection in the health care market: a workshop overview.

In a voluntary health insurance market, risk selection poses serious and increasing problems. Responding to this concern, the Robert Wood Johnson Foundation sponsored an invitational meeting for public and private decision makers to understand the incentives for risk selection in the health insurance market and to discuss options for reducing risk selection practices. The meeting, held October 6, 1994, provided a framework for exploring this timely issue and served as a vehicle for understanding how health care reforms, such as insurance market regulation and risk adjustment mechanisms, both can reduce and exacerbate incentives for risk selection. This article sets the context for the three commissioned papers that follow; it summarizes the ideas presented and issues identified for future consideration. Failure to address risk selection will continue to have serious consequences both for access to care for vulnerable populations and for the financial viability of health plans.

Actuarial Analysis↗
PubMed1994

Effect of prophylactic epsilon-aminocaproic acid on blood loss and transfusion requirements in patients undergoing first-time coronary artery bypass grafting. A randomized, prospective, double-blind study.

The prophylactic use of aprotinin has recently been reported to be associated with a significant decrease in blood loss in patients undergoing cardiopulmonary bypass procedures. One of the primary effects of aprotinin is prevention of plasmin degradation of platelet function. Because aprotinin is commercially unavailable in the United States at this time, we evaluated epsilon-aminocaproic acid with respect to decreased perioperative blood loss. We prospectively randomized 40 patients undergoing first-time coronary artery bypass grafting without prior sternotomy into two groups: one group (n = 21) received prophylactic and preincision epsilon-aminocaproic acid and the other (n = 19) received a placebo. No significant differences existed between patient groups with respect to age, body surface area, cardiopulmonary bypass time, and aortic crossclamp time. Cumulative blood loss at 4, 8, 12, and 24 hours after chest closure was significantly less in the epsilon-aminocaproic acid group (426 +/- 242 ml versus 634 +/- 224 ml, p = 0.002, at 12 hours). Only one patient receiving epsilon-aminocaproic acid was given blood or blood components compared to five patients in the placebo group (p < 0.02). D-dimers and fibrin split products were significantly less prevalent in the epsilon-aminocaproic acid group (at 4 hours: 0/20 versus 7/16, p < 0.002 and 5/20 versus 12/19, p < 0.05, respectively). None of the patients had a perioperative myocardial infarction or cerebrovascular accident. The prophylactic administration of epsilon-aminocaproic acid results in a significant decrease in blood loss in patients undergoing first-time coronary artery bypass grafting, and blood transfusion requirements are significantly less. It may be important to administer epsilon-aminocaproic acid before skin incision to be optimally effective.

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