Differences in Cancer Care Expenditures and Utilization for Surgery by Hospital Type Among Patients With Private Insurance.

Importance: With rising expenditures on cancer care outpacing other sectors of the US health system, national attention has focused on insurer spending, particularly for patients with private insurance, for whom price transparency has historically been lacking. The type of hospital at which cancer care is delivered may be an important factor associated with insurer spending for patients with private insurance.

Objective: To examine differences in spending and utilization for patients with private insurance undergoing common cancer surgery at National Cancer Institute (NCI) centers vs community hospitals.

Cardiac intervention rates for older patients with acute myocardial infarction in the United States and Ontario, 2003-2013: a retrospective cohort study.

Background: Previous work showed lower cardiac intervention rates for patients with acute myocardial infarction (AMI) in Ontario than in the United States. We assessed whether Ontario's efforts to improve access to rapid percutaneous coronary intervention (PCI) for AMI were associated with improved timeliness of care and whether this closed the gap between the 2 jurisdictions.

Methods: In this retrospective cohort study, we followed adults aged 66-99 years in the US and Ontario for 30 days after admission for incident AMI between 2003 and 2013 using health administrative data from both countries.

An Insurer's Program To Incentivize Generic Oncology Drugs Did Not Alter Treatment Patterns Or Spending On Care.

The high and rising costs of anticancer drugs have received national attention. The prices of brand-name anticancer drugs often dwarf those of established generic drugs with similar efficacy. In 2007-16 UnitedHealthcare sought to encourage the use of several common low-cost generic anticancer drugs by offering providers a voluntary incentivized fee schedule with substantially higher generic drug payments (and profit margins), thereby increasing financial equivalence for providers in the choice between generic and brand-name drugs and regimens.

Relation Between Narrow Networks and Providers of Cancer Care.

Purpose Health insurers offer plans covering a narrow subset of providers in an attempt to lower premiums and compete for consumers. However, narrow networks may limit access to high-quality providers, particularly those caring for patients with cancer. Methods We examined provider networks offered on the 2014 individual health insurance exchanges, assessing oncologist supply and network participation in areas that do and do not contain one of 69 National Cancer Institute (NCI)-Designated Cancer Centers.

Physicians' Participation In ACOs Is Lower In Places With Vulnerable Populations Than In More Affluent Communities.

Early evidence suggested that accountable care organizations (ACOs) could improve health care quality while constraining costs, and ACOs are expanding throughout the United States. However, if disadvantaged patients have unequal access to physicians who participate in ACOs, that expansion may exacerbate health care disparities. We examined the relationship between physicians' participation in both Medicare and commercial ACOs across the country and the sociodemographic characteristics of their likely patient populations.

Comparison of estimation methods for creating small area rates of acute myocardial infarction among Medicare beneficiaries in California.

Creating local population health measures from administrative data would be useful for health policy and public health monitoring purposes. While a wide range of options--from simple spatial smoothers to model-based methods--for estimating such rates exists, there are relatively few side-by-side comparisons, especially not with real-world data. In this paper, we compare methods for creating local estimates of acute myocardial infarction rates from Medicare claims data.

Comparison of self-reported and Medicare claims-identified acute myocardial infarction.

Background: Cardiovascular disease is often studied through patient self-report and administrative data. However, these 2 sources provide different information, and few studies have compared them.

Methods And Results: We compared data from a longitudinal, nationally representative survey of older Americans with matched Medicare claims.

Local population characteristics and hemoglobin A1c testing rates among diabetic medicare beneficiaries.

Background: Proposed payment reforms in the US healthcare system would hold providers accountable for the care delivered to an assigned patient population. Annual hemoglobin A1c (HbA1c) tests are recommended for all diabetics, but some patient populations may face barriers to high quality healthcare that are beyond providers' control. The magnitude of fine-grained variations in care for diabetic Medicare beneficiaries, and their associations with local population characteristics, are unknown.

Association between physician supply, local practice norms, and outpatient visit rates.

Background: There is considerable regional variation in Medicare outpatient visit rates; such variations may be the consequence of patient health, race/ethnicity differences, patient preferences, or physician supply and beliefs about the efficacy of frequently scheduled visits.

Objective: The objective of the study was to test associations between varying regional Medicare outpatient visit rates and beneficiaries' health, race/ethnicity, preferences, and physician practice norms and supply.

Methods: We used Medicare claims from 2006 and 2007 and data from national surveys of 3 different groups in 2005-Medicare beneficiaries, cardiologists, and primary care physicians.

Healthcare intensity is associated with lower ratings of healthcare quality by younger adults.

Previous studies suggest a negative relationship between regional intensity of healthcare services and Medicare patients' perceptions of healthcare quality. However, no studies to date have examined the relationship across a broad age range of the population. We describe the responses of 64 088 respondents aged 19 to 69 years to an online interactive patient assessment and feedback system.

Hospital quality and intensity of spending: is there an association?

Numerous studies in the United States have examined the association between quality and spending at the regional level. In this paper we evaluate this relationship at the level of individual hospitals, which are a more natural unit of analysis for reporting on and improving accountability. For all of the quality indicators studied, the association with spending is either nil or negative.

ETV6-NTRK3 fusion oncogene initiates breast cancer from committed mammary progenitors via activation of AP1 complex.

To better understand the cellular origin of breast cancer, we developed a mouse model that recapitulates expression of the ETV6-NTRK3 (EN) fusion oncoprotein, the product of the t(12;15)(p13;q25) translocation characteristic of human secretory breast carcinoma. Activation of EN expression in mammary tissues by Wap-Cre leads to fully penetrant, multifocal malignant breast cancer with short latency. We provide genetic evidence that, in nulliparous Wap-Cre;EN females, committed alveolar bipotent or CD61(+) luminal progenitors are targets of tumorigenesis.