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Biomedical subjects

R T Burge

Publications and source records attributed to R T Burge.

8 recordsLinked to original sources
PubMed2005

Fracture Reduction Affects Medicare Economics (FRAME): impact of increased osteoporosis diagnosis and treatment.

Osteoporosis is a common, debilitating disease affecting US Medicare beneficiaries, yet diagnosis and treatment lag behind medical advances. We estimated the cost of fractures to the Medicare program and the impact of increasing osteoporosis diagnosis and treatment. A Markov model was used to predict fracture incidence and costs in postmenopausal women aged 65 years and older, over 3 years (2001-2003). Only 1.80 million women were estimated to receive a Medicare-reimbursed bone mineral density (BMD) test in 2001. We evaluated the budget impact of testing an additional 1 million women from Medicare and patient perspectives. These women were stratified into high-risk (osteoporotic with prevalent vertebral fracture) and moderate-risk (without prevalent vertebral fracture) groups. During 2001-2003, an estimated 2.39 million fractures occurred among the 5.11 million women aged 65+ with osteoporosis, at a cost to Medicare of 12.96 billion dollars. We projected that BMD testing of an additional 1 million women in 2001 would result in treatment of 440,000 new patients with a bone-specific medication, preventing over 35,000 fractures over the 3 years. The decrease in fractures would produce a net discounted savings to the Medicare budget of 77.86 million dollars. Medicare's hospital inpatient cost would decrease by 115.41 million dollars and long-term care cost by 43.51 million dollars, more than offsetting incremental outpatient cost of 81.07 million dollars. Patients would benefit from fracture avoidance, but their out-of-pocket medical costs would increase by 63.49 million dollars during 2001-2003, or 1,771 dollars per fracture avoided. Sensitivity analyses showed that savings to the Medicare program varied in proportion to the unit cost of fractures, fracture risk of the populations tested, treatment rate, and adherence to therapy. Increased osteoporosis diagnosis may produce savings for the Medicare program if interventions are targeted to women at elevated risk for fracture and may be budget neutral if all older women are screened.

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PubMed2004

One year outcomes and costs following a vertebral fracture.

Vertebral fractures are believed to be important predictors for future vertebral and other fractures, leading to at least a 4- to 5-fold increase in the risk of subsequent fractures. However, little is known about their associated near-term costs. The purpose of this study was to quantify the subsequent fracture and cost outcomes emanating from patients with an incident vertebral fracture. A probabilistic decision analysis model was developed to estimate the expected cost of all subsequent fractures. We ran Kaplan-Meier time-to-event models on placebo patients in risedronate's pivotal phase III clinical trial data to determine the cumulative incidence or probabilities of all fractures within one year of an incident vertebral fracture. Unit costs for health care payers in the USA and Sweden for vertebral, hip, other, and forearm/wrist fractures were multiplied by fracture probabilities to generate the expected costs of new fractures within one year of incident vertebral fractures. Our analysis found that that 26.1% of vertebral fracture patients with a mean age of 74 years refractured within 1 year (vertebral 17.4%; hip 3.6%; "other" 3.5%; forearm/wrist 1.6%). The calculated medical costs for those patients who refracture within 1 year was $5906 and 3670 euros for the USA and Sweden, respectively, while the weighted average cost across all patients (refracture and non-fracture) within a year of their incident fracture was $1541 (USA) and 958 euros (Sweden). These results suggest that therapies with proven, rapid efficacy may offer important economic value to healthcare payers, providers and patients.

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PubMed2003

Hospital care of osteoporosis-related vertebral fractures.

Resource implications of hospitalization for osteoporosis-related vertebral fracture are sparsely documented. This study utilized data abstracted from a national sample of hospitalized patients to identify characteristics of patients who are hospitalized with vertebral fracture and their patterns of resource utilization. These were compared with patterns observed for hip fracture hospitalizations. Data from the Nationwide Inpatient Sample (NIS) for 1997 were used to identify men and women age 45 years and above who had a primary diagnosis of vertebral fracture. After patients whose fractures might have been due to metastatic cancer or severe trauma were excluded, 68,901 individuals hospitalized for vertebral fracture were identified. Seventy-seven percent of these were women, most were white, 75 years and older, and had multiple comorbid diagnoses. Total charges averaged 8000-10,000 US dollars per hospitalization and were higher in men. Mean length of stay was just under 6 days and more than 50% of discharged patients required some form of continuing care. Hospitalizations for vertebral fracture occurred at only one-fourth the rate of those for hip fracture, and created only half the hospital charges per admission. Vertebral fracture accounted for over 400,000 total hospital days and generated charges in excess of 500 million US dollars. This resource impact is considerably higher than has been described in prior studies.

Age Distribution↗
PubMed1994

Diffusion of Medicare's RBRVS and related physician payment policies.

In 1992, Medicare reformed its physician payment method by implementing the Medicare fee schedule (MFS), of which the resource-based relative value scale (RBRVS) is a major component. Using a recent survey and case studies, we examine the diffusion of Medicare's RBRVS to non-Medicare payers and how those payers use and perceive the RBRVS and MFS policies. We find that approximately one-third of payers that participated in the survey have adopted RBRVS-based payment systems in varying degrees while another 40 percent were seriously considering its adoption. Prospects for expanded use of Medicare's RBRVS appear favorable.

Cost-Benefit Analysis↗
PubMed1993

Allocating practice expense under the Medicare fee schedule.

Currently, relative value units for practice expense are determined under the Medicare fee schedule (MFS) using historical physician charges. This seems inconsistent with the goal of a resource-based fee schedule. A specialty resource-based method of determining practice expense payments is presented and simulated here. The method assumes that, for each service, the payment for practice expense should be the same proportion of the total payment as actual physician practice expenses are of total practice revenues. A comparison with the approach developed by the Physician Payment Review Commission (PPRC) shows similar fees, but the specialty-based method proposed here requires no data beyond what is already employed in the MFS.

Computer Simulation↗
PubMed1992

Inefficiencies in physician practices.

Explosive growth in spending on physician services in the 1980s has focussed the attention of policymakers and researchers on inefficiencies in physician practices. This chapter surveys the recent literature on inefficiencies in physician practices and provides a review, critique, and synthesis of empirical findings. The major emphasis is on measurement and estimates of economies of scale in physician practices. The paper concludes with a discussion of limitations of current knowledge and methods, and directions for future research.

Costs and Cost Analysis↗
PubMedDate not supplied

Resource-based relative-value scale expansion: implications for performance and quality of care.

OBJECTIVE: To assess the impact on the delivery of physician services from expanded use of Medicare's Resource-Based Relative-Value Scale (RBRVS) by multiple payers. DESIGN: A 1993 survey of insurers and targeted case studies of payers. RESULTS: Approximately one third of surveyed payers were using RBRVS in some fashion to pay for physician services, while another 40% were considering its adoption. The RBRVS is spreading to many types of payers--both public and private--and to health insurance product lines. Penetration of RBRVS is most prevalent within managed-care arrangements, accounting for 75% of all RBRVS-based products among payers. Many payers were found to be modifying aspects of the RBRVS and applying payment policies tailored to their specific needs. Most payers expect to achieve cost control, and several may be using RBRVS to profile physician service utilization. CONCLUSIONS: The diffusion or RBRVS to multiple payers may have a profound impact on the distribution of services provided, how these services are delivered, and the quality of care provided. Providers may respond to RBRVS by reducing some types of services, while increasing others, and using new resource combinations. Managed-care payers are likely to continue using RBRVS for negotiating fee schedules or for allocating payments for bundled service packages and capitation and sub-capitation products among physicians. As larger shares of physicians' incomes are driven by RBRVS, the underlying incentives become more critical. Nevertheless, RBRVS will remain an important payment approach in the future. The impact on quality and delivery of physician services from broader use of RBRVS cannot be measured adequately until future empirical studies are undertaken.

Data Collection↗