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Disease Burden News, Research & Data Analysis

Texas Institute for Surgery, North Central Surgical Center, and Texas Health Harris Methodist Hospital have the Lowest MSPB Costs for Hip & Knee Replacement Surgeries in Dallas Area

In Orthopedics

By: Yosh Thomas  Nov. 06, 2020

Dexur analyzed Medicare Claims data to calculate the Medicare Spending per Beneficiary (MSPB) cost for hospitals in the Dallas metro area for Hip and Knee Replacement surgeries and ranked the hospitals based on cost outcomes. MSPB weighs 25% in the CMS Value-Based Purchasing (VBP) program and is the only measure under the Efficiency and Cost domain. Hospitals have to wait more than a year to get aggregate MSPB numbers with no insight into DRG or service line specific costs. Dexur replicates CMS algorithms to update DRG and service line MSPB costs on a quarterly basis and with only a 5-6 month delay. For the analysis, Dexur considered hospitals in the Dallas area that record more than 11 episodes of DRG 470 during the calendar year 2019.

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MSPB Costs for Spine Surgeries show wide disparities among Hospitals in the New York Tri-State Area

In Spine

By: Yosh Thomas  Oct. 27, 2020

Dexur analyzed Medicare Claims data to calculate the Medicare Spending per Beneficiary (MSPB) cost for hospitals in the New York tri-state area for Spine surgery and found a wide disparity among hospitals in each sub-area such as Manhattan, Long Island, New Jersey, and Connecticut. MSPB is 25% of the weighting for the CMS Value-Based Purchasing (VBP) programs.

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McKenzie-Willamette Medical Center and Sacred Heart Medical Center at Riverbend have the best value outcomes for Sepsis in Springfield, Oregon

In Sepsis

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By: Parvathy Rajagopal  Aug. 31, 2020

Dexur’s analysis of Medicare claims of hospitals within a 10-mile radius of Springfield, Oregon showed that McKenzie-Willamette Medical Center and Sacred Heart Medical Center at Riverbend had the best value outcomes over a 90-day episode for Sepsis. Dexur’s value analysis tracks a patient’s episode of care from the date of admission for 90 days, including the index hospitalizations, rehospitalization, home health, nursing home, and ED costs. The total cost of care data helps patients make appropriate choices and helps local ACOs make appropriate referrals choices. The analysis was risk-adjusted, for alive and non-hospice patients and was done at the DRG level, specifically DRG 871: Septicemia or Severe Sepsis without MV >96 Hours with Major Complication or Comorbidity, to adjust for complications and comorbidities.

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Penn Highlands Dubois has the best value outcomes for Heart Failure in DuBois, PA

In Heart Failure

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By: Barsha Nandy  Aug. 10, 2020

Dexur’s analysis of Medicare claims of hospitals within a 50-mile radius of Du Bois, PA, showed that Penn Highlands DuBois had the best value outcomes over a 90 day episode for Heart Failure, followed by UPMC Altoona. Dexur’s value analysis tracks a patient’s episode of care from the date of admission for 90 days and includes the index hospitalizations, rehospitalization, home health, nursing home, and ED costs. Total cost of care data helps patients make appropriate choices and helps local ACOs make appropriate referral choices. The analysis was risk-adjusted, for alive and non-hospice patients and was done at the DRG level, specifically DRG 291: Heart Failure and Shock with Major Complication or Comorbidity, to adjust for complications and comorbidities.

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Aultman Hospital has the best value outcomes for COPD in Canton, OH

In Chronic Obstructive Pulmonary Disease (COPD)

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By: Neha Thomas  Jul. 30, 2020

Dexur’s analysis of medicare claims of hospitals within a 10-mile radius of Canton, Ohio, showed that Aultman Hospital had the best value outcomes over a 90 day episode for COPD, followed by Mercy Medical Center. Dexur’s value analysis tracks a patient’s episode of care from the date of admission for 90 days and includes the index hospitalizations, rehospitalization, home health, nursing home, and ED costs. Total cost of care data helps patients make appropriate choices and helps local ACOs, such as Integrated Health Collaborative, LLC, make appropriate referral choices. The analysis was risk-adjusted, for alive and non-hospice patients and was done at the DRG level, specifically DRG 190: Chronic Obstructive Pulmonary Disease with Major Complication or Comorbidity (MCC), to adjust for complications and comorbidities.

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Retained Blood Syndrome in Cardiac Surgeries is associated with higher costs over a 90-day Episode of Care at Three Top Hospitals

In Cardiovascular

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By: Neha Thomas  Jun. 29, 2020

Retained blood syndrome (RBS) occurs when drainage systems fail to adequately evacuate blood during recovery from cardiothoracic surgery. Dexur analyzed RBS related complications at three top hospitals to understand value outcomes over a 90-day episode of care. Hospitals, ACOs & Payors benefit from value outcomes and cost of care outcomes data to help manage overall population health. Patients benefit from this data as they can make informed choices regarding the facilities that will provide them the best care for specific conditions with the best value. Value outcomes are also closely aligned to bundled payment initiatives by CMS and other payors.

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CHI St. Vincent Hot Springs and Baptist Health Medical Center were among the most affordable hospitals for Pneumonia patients in Central Arkansas

In Pneumonia

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By: Neha Thomas  May. 13, 2020

Dexur’s analysis of medicare claims of hospitals in Central Arkansas showed that CHI St. Vincent Hot Springs, Baptist Health Medical Center, and Baptist Health Medical Center - Little Rock had the lowest cost of care over a 90 day episode for Pneumonia. The episode of care tracks a patient journey from the date of admission for 90 days includes the index hospitalizations, rehospitalization, home health, nursing home and ED costs. Total cost of care helps patients make appropriate choices and helps local ACOs such as Arkansas Health Network and Baptist Health/UAMS Accountable Care Alliance make appropriate referrals choices. The analysis was risk adjusted and was done at the DRG level, specifically

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Patients with Atrial Fibrillation are a big contributor to Hospital Readmissions for Skilled Nursing Facilities (SNFs)

In Atrial fibrillation (AFib)

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By: Avinash Kumar  May. 10, 2019

CMS recently instituted a program to evaluate and incentivize skilled nursing facilities (SNF) based on Hospital 30 day readmissions. For example, if a patient is discharged from a hospital to a SNF on Jan 15th 2019 and is readmitted back to a hospital on Jan 27 2019, then this would be counted as part of the measure for SNF Hospital 30 Day readmissions. Dexur analyzed Medicare claims (Oct 2015 to Mar 2018) for three separate skilled nursing facilities to understand the role of Atrial Fibrillation (AFib) on the overall readmissions for these SNFs.

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RNS System is associated with lower 30 Day readmission rates in DRG 026

In Epilepsy

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By: Raj Kumar  May. 08, 2019

RNS system (Neurostimulator system)’s ICD 10 Procedure code 00H00MZ used by Hospitals to get additional payment under NTAP program from CMS. NTAP(New Technology Add-on payment) payment is an additional payment over and above the DRG allowed payment amount.

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What are major Oncology combination therapies based on claims data?

In Oncology

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By: Avinash Kumar  May. 01, 2019

Dexur analyzed Medicare claims data based on a 5% sample for the time period of Jan 2016 to June 2018, to understand the prevalence of oncology combination therapies. This methodology checked for relevant J codes of HCPCS code set in the claim files across the patient’s history. If a patient used a base drug, it was then checked to see what other drugs were used on the same patient.

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In-Hospital Quality Outcomes for Hepatocellular Carcinoma with Gastrointestinal Hemorrhage

In Hepatocellular Carcinoma (HCC)

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By: James Pitt  Dec. 19, 2018

Gastrointestinal hemorrhage contributed to 3% of hospitalizations and 2.35% of in-hospital deaths among patients with hepatocellular carcinoma as a primary or secondary diagnosis, according to a Dexur analysis of 2013-2017 Medicare claims data.

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Doppler Ultrasound Devices Like Deltex CardioQ Could Help Address Excess Length of Stay in Bowel Surgery Patients With Major Complications

In Fluid Imbalance

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By: James Pitt  Oct. 22, 2018

In goal-directed fluid therapy (GDT or GDFT), physicians use hemodynamic variables such as stroke volume (the amount of fluid the heart moves with each beat) to estimate the amount of fluid in circulation. Physicians provide fluid as needed to keep these hemodynamics variables near target values.

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How to Evaluate the Impact of Venous Thromboembolism (VTE): Part 2: Incidence

In Venous Thromboembolism (VTE)

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By: James Pitt  Aug. 13, 2018

Hospitalized patients are at greater risk of venous thromboembolism than the general population, in part because immobility increases VTE risk. According to the CDC report on healthcare-associated VTE, up to 70% of HA-VTE cases are preventable.

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Chicago’s Wide Variance in Fracture Readmission Rates Indicates Opportunities for Osteoporosis Treatment

In Osteoporosis

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By: James Pitt  Jul. 30, 2018

Osteoporosis is a common disease of aging, associated with weakened bones. Bone fractures are associated with higher subsequent mortality. According to University of Washington Medicine, “The one-year mortality following a hip fracture is 12 to 24%. It is estimated that 14% of deaths following a hip or pelvic fracture in previously ambulatory women were caused or hastened by the fracture.”

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Pressure Ulcer Readmission Rates in Los Angeles Area Hospitals Range From 0.94% to 3.83%

In Pressure Ulcer

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By: James Pitt  Jul. 20, 2018

Pressure ulcers are wounds that develop due to reduced blood flow, typically in patients who lie in the same position for long periods. Elderly and critically ill patients are at particular risk. A study based on 2006-2007 Medicare data found that patients with pressure ulcers are more likely to die in-hospital (odds ratio 2.81); have more than double the average length of stay; and are more likely to be readmitted within 30 days of discharge (odds ratio 1.33).

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Bon Secours Hospital Treats the Most Surgical Patients with Iron Deficiency Anemia in Maryland

In Iron Deficiency Anemia (IDA)

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By: James Pitt  Jul. 04, 2018

Iron deficiency anemia (IDA) is a condition in which the body has too little iron to properly supply red blood cells, leading to fatigue and weakness. According to the Merck Manual, blood loss is the most common cause of IDA. About 70% of the body's iron is already in red blood cells, rather than stored in reserve, so patients may require iron supplementation after major blood loss.

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Mortality Rates Nearly Double with Hyperkalemia in California DRG 871 Sepsis Patients

In Hyperkalemia

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By: James Pitt  Jul. 03, 2018

Hyperkalemia, i.e. high potassium, is a common electrolyte imbalance. Like other forms of fluid imbalance, it may affect sepsis outcomes. Dexur has extensively reported on fluid imbalance in sepsis.

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In Southern Arizona Hospitals, DRG 640 Hyponatremia Rate Exceeds National Rate at All But One

In Hyponatremia

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By: James Pitt  Jun. 27, 2018

Hyponatremia, i.e. low blood sodium, is a common electrolyte imbalance. According to the Mayo Clinic, risk factors for hyponatremia include age, certain medications, kidney disease and heart failure (due to their effects on water excretion), and intensive physical activities like marathons.

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Jackson Health Hospitals Have Lower ABSSSI Incidence Than Miami-Dade County Average

In Acute Bacterial Skin and Skin Structure Infections (ABSSSI)

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By: James Pitt  Jun. 26, 2018

A June 4 Miami Herald investigation found that according to CMS data, Jackson Health System performed under the national benchmark on incidence of MRSA bloodstream infections, but at or above the national benchmark on five other types of infection. Dr. Lilian Abbo of Jackson Health attributed this to the case mix at Jackson Health and the high prevalence of MRSA in Miami-Dade County.

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Asthma is a Significant Contributor to 30 Day Readmissions in Mississippi

In Asthma

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By: James Pitt  Jun. 19, 2018

Asthma is a chronic lung disease which narrows the airways. It affects over 25 million people in the US, including 7 million children. Risk factors for developing asthma include air pollution, poverty, and tobacco smoke. Though asthma is often regarded as a childhood disease, 8.8% of adults had asthma as of 2011-2014.

Dexur analysts examined hospital-level data at the twenty hospitals in Mississippi with the most Medicare-eligible inpatient discharges for asthma in 2013-2016. The average readmission rate across these hospitals was close to Mississippi's state average, so they are a fair representation of the state.

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Florida Orlando Hospital Has Particularly Low Mortality, Length of Stay, & Readmission Rates for Interstitial Lung Disease With Major Complications

In Interstitial Lung Disease (ILD)

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By: James Pitt  May. 30, 2018

Interstitial lung diseases (ILD) are more than 300 different conditions with similar symptoms. According to the European Respiratory Society, “Only about one in three cases of interstitial lung disease has a known cause.” Different ILDs present very different risks: “Survival rates at 5 years range from 20% for idiopathic pulmonary fibrosis [IPF] to almost 100% for cryptogenic organizing pneumonia.”

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High Variation in Readmissions May Suggest Need For Better Lung Cancer Diagnostics in New York

In Lung Cancer

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By: James Pitt  May. 29, 2018

Lung cancer rates are falling, but it remains the leading cause of cancer deaths in the US. Detecting cancer early can improve survival. But in recent years, overdiagnosis became a concern. The only lung cancer screen the CDC recommends is low dose CT (LDCT). But even LDCT picks up many findings that may not be dangerous. A 2016 randomized clinical trial in The Lancet Oncology found that only 4% of new solid nodules detected on LDCT were lung cancer.

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Cigarette Use Data May Help Pinpoint Patients At Particular Risk of Malignant Hypertension in Kentucky; Louisville at Low Risk

In Hypertension

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By: James Pitt  May. 28, 2018

People in industrialized countries have an over 90% lifetime risk of developing hypertension, according to a 2007 review in The Lancet. Many diseases cause hypertension. Primary or “essential” hypertension is defined as hypertension with no such cause. This definition is misleading because diet, exercise, and several known genes affect the risk of primary hypertension.

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