Tag Archives: JAMA Network

Medical Podcasts: A Clinical Review Of “The Pritikin Diet” (JAMA)

JAMA Clinical Reviews LogoNathan Pritikin was a college dropout who became an entrepreneur. While doing research for the government during World War II, he observed that populations that had extremely limited food availability because of the war had substantially reduced mortality from cardiovascular disease—something unexpected at a time when cardiovascular disease was thought to be due to stress. 

After the war when food became more available CVD death rates went back up, resulting in Pritikin concluding that CVD was related to diet. Pritikin devised his own very low-fat diet that bears his name and the diet is still in use 65 years later.

Medicine: “Relentless Prescription Drug Price Increases” (JAMA Podcast)

JAMA Network NewsDrug Pricing Theme Issue: Is Pharma Earning Too Much?, R&D Costs Required to Bring a New Drug to Market, Probiotic Safety, and more

One in 4 people in the US has difficulty paying the cost of their prescription medications. This stark fact was recently reported in a 2019 Kaiser Family Foundation public opinion poll among a nationally representative random sample of 1205 adults.1 Persons who reported having the greatest difficulty affording their prescription drugs were those who most needed them, including those who took 4 or more prescription drugs, spent $100 or more per month on their drugs, and reported being in fair or poor health.

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Medical Podcasts: “2020 U.S. Influenza Epidemic” – Very Serious Year-To-Date

JAMA Clinical Reviews logoAlthough coronavirus disease 2019 (COVID-19) dominates the news in early 2020, it affects few people in the US. In contrast, at the same time the US is experiencing a severe influenza epidemic, which has caused an estimated 250 000 hospitalizations and 14 000 deaths. 

Timothy Uyeki, MD, lead for the CDC’s 2019 novel coronavirus response team and Chief Medical Officer of CDC’s influenza division, discusses influenza in the US, how it compares to coronavirus, and what both patients and clinicians should know about this year’s flu season.

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Study: 20% Of Surgery Patients Get “Surprise” Out-Of-Network Bills Averaging Over $2000

From a JAMA Network online study (February 11, 2020):

JAMA Network NewsIn this analysis of commercially insured patients who had undergone elective surgery with an in-network surgeon at an in-network facility, approximately 1 in 5 received an out-of-network bill, with a mean potential balance bill of $2011.

In this retrospective analysis of 347 356 surgical episodes among commercially insured patients who had undergone elective surgery with in-network primary surgeons and facilities, 20% of episodes involved out-of-network charges.

The patterns of out-of-network bills varied with the clinical scenario. Simpler ambulatory procedures that tend to involve 1 surgeon (arthroscopic meniscal repair, breast lumpectomy) had fewer out-of-network bills (13%-15% of cases), whereas inpatient procedures (hysterectomy, knee replacement, colectomy, CABG surgery) had more frequent out-of-network bills (24%-33% of cases). These more complex procedures were also associated with larger potential balance bills, in the range of $2000 to $4000.

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High, Non-Transparent Prices And Aggressive Collection Tactics Erode Trust In Healthcare (JAMA)

From a JAMA Network online article (February 4, 2020):

Billing Quality is Medical Quality JAMA Network ViewpointHigh medical prices and billing practices may reduce public trust in the medical profession and can result in the avoidance of care. In a survey of 1000 patients, 64% reported that they delayed or neglected seeking medical care in the past year because of concern about high medical bills. The field of quality science in health care has developed measures of medical complications; however, there are no standardized metrics of billing quality.

JAMA NetworkA recent study found that only 53 of 101 hospitals were able to provide a price for standard coronary artery bypass graft surgery. Notably, among the hospitals that provided a price, the price ranged from approximately $44 000 and $448 000 and was not associated with quality of care as measured by risk-adjusted outcomes and the Society of Thoracic Surgeons composite quality score.

Possible metrics of assessing billing quality JAMA

In the same way that there is wide variation in pricing, aggressive collection tactics also can be highly variable by institution. In a recent analysis, 36% (48/135) of hospitals in Virginia garnished wages of patients with unpaid medical bills, and 5 hospitals accounted for 4690 garnishment cases in 2017, representing 51% of all cases.7 In total, 20 054 lawsuits were filed in Virginia against patients for unpaid debt. For many hospitals that sue patients, legal action follows multiple attempts to contact patients through letters and calls, and some hospitals may offer to set up payment plans or even negotiate charges.

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Physician Profiles: Best-Selling Author Abraham Verghese MD (JAMA Video)

My Own Country A Doctor's Storey Abraham Verghese MD bookIn this video, best-selling author Abraham Verghese, MD, discusses the origins of the study he coauthored identifying 5 practices that foster meaningful connections between physicians and patients.