Registry versus claims-based index dates for studies of cancer diagnosis in administrative data.

Purpose: Studies of healthcare encounters leading to cancer diagnosis have increased over recent years. While some studies examine healthcare utilization before the cancer registry date of diagnosis, relevant pre-diagnosis interactions are not always immediately prior to this date due to date abstraction guidelines. We evaluated agreement of a registry date with a claims-based index and examined Emergency Department (ED) involvement in cancer diagnosis as an example of possible pre-diagnostic healthcare misclassification that could arise from improper date choice.

Riluzole is associated with reduced risk of heart failure.

Background: Reduction of intracellular Na accumulation through late Na current inhibition has been recognized as a target for cardiac Ca handling which underlies myocardial contractility and relaxation in heart failure (HF). Riluzole, an Na channel blocker with enhancement of Ca-activated K channel function, used for management of amyotrophic lateral sclerosis (ALS), is effective in suppressing Ca leak and therefore may improve cardiac function.

Objectives: The study aim was to investigate whether riluzole lowers HF incidence.

A Combination of Fruit Rind and Seed Extracts Enhances Sexual Function in Aging Males in a Randomized, Double-blind, Placebo-controlled Study.

LN18178 is a standardized, synergistic combination of fruit rind and seed extracts, which has been reported to increase serum testosterone levels in young and aging males. The present 84-day randomized, double-blind, placebo-controlled study assessed the efficacy of LN18178 on the sexual function of aging male volunteers (age: 40-70 years; serum total testosterone: ≥ 300 ng/dL). The subjects with mild to moderate erectile dysfunction [5-item version of the International Index of Erectile Function (IIEF-5) scores 17-25] and low sexual desire (score < 3 on items 11 and 12 of IIEF) participated in this investigation.

Examining Lung Cancer Screening Uptake in the United States: Recent Research and Limitations of Public-Use Data.

Eligibility criteria for lung cancer screening (LCS) were updated by the Centers for Medicare & Medicaid Services in 2022 following an updated recommendation from the United States Preventive Services Task Force. Recently, research has examined LCS use in the United States following this change, which centered on lowering the age to begin screening from 55 to 50 years and the smoking history threshold from 30 to 20 pack-years. These studies, including the accompanying article from Gudina and colleagues, have used the 2022 Behavioral Risk Factors Surveillance System data, which are publicly available and nationally representative.

Crises in Antimicrobial Stewardship: Misuse of Clarithromycin for Therapy.

is a class I carcinogen that infects more than 100 million individuals in the United States. Antimicrobial therapy for has typically been prescribed empirically rather than based on susceptibility testing. Until recently, therapeutic recommendations have generally ignored the principles of antibiotic stewardship.

Industry Payments and Branded Glatiramer Acetate Prescribing in the US Medicare Program.

Background And Objectives: Generic formulations of glatiramer acetate have been available since 2015 yet remain underprescribed relative to the branded product. We sought to characterize the association between branded glatiramer prescribing in the Medicare program and financial payments from the manufacturer (Teva Pharmaceuticals).

Methods: Using publicly available Medicare Part D and Open Payments data from the Centers for Medicare and Medicaid Services, we evaluated overall utilization from 2012 to 2021 and compared the prevalence, frequency, and magnitude of financial payments made in 2019 to neurologists who prescribed branded and generic versions of glatiramer in 2020.

Infant mental health integration into OB care leads to increased connection to services during the perinatal period.

We compared referrals and connection to care between perinatal patients: 90 receiving OB/GYN care in clinics with integrated behavioral health consultants with infant mental health specialization (IMH-BHC), and 68 receiving traditional care, in the United States. Participants identified as: Native American/Alaskan native, 1.90%; Asian, .

Measuring the Impact of Healthcare Provider Availability on Quality of Care and Disease Burden in Ohio: A Cross-Sectional Study.

Background: Chronic lower respiratory disease, heart disease, and diabetes have a higher prevalence in rural areas. Previous studies raise concerns that a lower supply of physicians is associated with negative outcomes.

Objective: To assess disease burden across the 88 counties in Ohio, including Appalachian and non-Appalachian counties, and examine associations with the number of healthcare providers.

Medicare Part D: Major Shifts With the Inflation Reduction Act and a Way Forward.

The Inflation Reduction Act (IRA) of 2022 introduced major changes in the Part D benefit that aim to improve medication access and correct several of the financial misalignments in the current Part D benefit. The changes address financial obligations of Medicare beneficiaries, the federal government, Part D plan sponsors (i.e.

Oral cavity and oropharyngeal cancers in Texas: examining incidence rates in dental health professional shortage areas.

Purpose: Oral cavity (OC) and oropharyngeal (OP) cancer rates have increased annually rising in the U.S. and Texas.

Comparing the cost of cirrhosis to other common chronic diseases: A longitudinal study in a large national insurance database.

Background Aims: Cirrhosis prevalence is increasing, yet costs associated with its chronic, complex care are poorly understood. The aim was to characterize the costs of care for patients with cirrhosis and compare them to other chronic diseases such as heart failure (HF) and chronic obstructive pulmonary disease (COPD), for which the public health burden is better recognized.

Approach: Patients enrolled in Medicare Advantage plans from a large national insurer between 2011-2020 with cirrhosis, HF, and COPD were identified by ICD-9/-10 codes.

Direct oral anticoagulants or warfarin in patients with left ventricular thrombus after ST-elevation myocardial infarction: a pilot trial and a prespecified meta-analysis of randomised trials.

Background: The role of direct oral anticoagulants (DOACs) in the treatment of left ventricular thrombus (LVT) after ST-elevation myocardial infarction (STEMI) remains uncertain.

Aims: We aimed to compare the effect of rivaroxaban versus warfarin in patients with STEMI complicated by LVT.

Methods: Adult patients with STEMI and two-dimensional transthoracic echocardiography showing LVT were assigned to rivaroxaban (15 mg once daily) or warfarin (international normalised ratio goal of 2.

Trends in Cervical Laminoplasty Incidence in the United States: A Comparison of Commercial Insurance, Medicare, and Device Manufacturer Databases.

Study Design: Retrospective database study.

Objective: To leverage a commercial insurance claims database to explore trends in laminoplasty utilization and reimbursement in the United States. Secondarily, volume estimates were compared with data from the industry and from the Centers for Medicare and Medicaid (CMS).

Contributors and Solutions to High Out-of-Pocket Costs for Heart Failure Medications: A State-of-the-Art Review.

As expensive therapeutics rise to the fore of heart failure management, out-of-pocket (OOP) medication costs have become increasingly relevant to patient care. Prescription medication costs influence medical decision-making and affect adherence. Yet, individualized cost estimates are seldom available during clinical encounters when prescription decisions are made.

Association Between Hospital Efficiency and Quality of Care Among Fee-for-Service Medicare Beneficiaries with Prostate Cancer: A Retrospective Cohort Study.

Background: Technical efficiency evaluates a hospital's economic performance and plays an important role in variations in quality of care and outcomes. The study objective was to examine the association between hospital efficiency and quality of care among fee-for-service Medicare beneficiaries with prostate cancer and to assess if race moderates this association.

Design: Retrospective study using Surveillance, Epidemiological, and End Results-Medicare (SEER-Medicare) data from 1998 to 2016 for prostate cancer patients aged ≥ 66.

Disparities in treatment delays among metastatic breast cancer patients: insights from nationwide electronic health records, 2011-2022.

Purpose: While previous research has highlighted treatment delay inequities in early-stage breast cancer and identified potential contributing factors, there is limited research on disparities in treatment delays for metastatic breast cancer (MBC). This study investigates these disparities in MBC treatment initiation, aiming to identify key factors crucial for improving timely access to care.

Method: Nationwide Flatiron Health electronic health records-derived deidentified database, including females aged 18+ diagnosed with either De novo or relapsed MBC in the U.

Assessing Medicare's Coverage With Evidence Development Program.

The Centers for Medicare and Medicaid Services (CMS) coverage with evidence development (CED) program provides coverage for items and services not meeting Medicare's "reasonable and necessary" standard while requiring participation in clinical studies. As additional evidence is available, CMS may reconsider CED decisions. Of twenty-six items and services in the CED program since its 2005 inception, CMS has reconsidered coverage for ten (38 percent).

Medicare Advantage Networks Include Few Black Or Hispanic Physicians, Making Concordant Care Inaccessible For Many.

Black and Hispanic patients who receive care from Black and Hispanic physicians have greater use of preventive care. However, receiving care from racially concordant physicians requires that such physicians are included in private insurance plan networks. Using data from 2019, we examined the extent to which racially concordant physicians are available in the Medicare Advantage (MA) program, which disproportionately enrolls Black and Hispanic Medicare beneficiaries, by linking MA physician networks to physician race and ethnicity to measure the diversity of in-network physicians.

After Risk-Adjustment Change, Dementia Diagnoses Increased In Medicare Advantage Relative To Traditional Medicare.

In 2020, the Centers for Medicare and Medicaid Services reintroduced Alzheimer's disease and related dementias to its risk-adjustment payment model for Medicare Advantage (MA) plans. Using 2017-20 data for 100 percent of community-dwelling beneficiaries enrolled in Medicare, we evaluated how the reintroduction of dementia to the risk-adjustment model affected rates of new (incident) dementia diagnoses among beneficiaries enrolled in MA relative to those enrolled in traditional Medicare. In response to the payment change, annual incident dementia diagnosis rates in MA increased by 11.

Are Fewer Diagnoses Better? Assessing A Proposal To Improve The Medicare Advantage Payment System.

Medicare Advantage (MA) plans report diagnoses more completely than they are reported in traditional Medicare. As a result, payment to MA plans is greater than it would be if coding patterns were identical in the two sectors. The Medicare Payment Advisory Commission estimates that the overpayment to MA attributable to differential coding was $50 billion in 2024.

Medicare Risk Adjustment: Goals, Reform Proposals, And New Frontiers.

Risk adjustment modifies payments to health insurers based on enrollee characteristics that are predictive of higher or lower medical spending. Risk-adjustment policy is a key ingredient for the success of regulated individual insurance markets in Medicare and beyond. Researchers have identified shortcomings of Medicare's current risk-adjustment system, illustrated the limits of coarse fixes, and proposed new strategies that improve the data and calculations used to generate beneficiary risk scores.

Cardiovascular Safety of Anti-CGRP Monoclonal Antibodies in Older Adults or Adults With Disability With Migraine.

Importance: Monoclonal antibodies (mAbs) targeting calcitonin gene-related peptide (CGRP) or its receptor (anti-CGRP mAbs) offer effective migraine-specific preventive treatment. However, concerns exist about their potential cardiovascular risks due to CGRP blockade.

Objective: To compare the incidence of cardiovascular disease (CVD) between Medicare beneficiaries with migraine who initiated anti-CGRP-mAbs vs onabotulinumtoxinA in the US.