Difference between revisions of "Medical Interventions"

Revision as of 17:44, 18 February 2019

Medical Interventions are treatments and services that are typically reimbursed by healthcare insurance companies.

• See more on how Medical Interventions impact Health Status
• See more on how Medical Interventions impact Health Outcomes

Most health plans are based on Medicare fee schedules, so they typically reimburse for the same or similar services.

• Part A (hospital/facility interventions),
• Part B (physician interventions),
• Part C (Medicare Advantage Health Plans),
• Part D (medication interventions).

See Medical Intervention Determinants

Medical Interventions Activities Insight

Insights into Medical Interventions Determinants that can decisively affect a patient's overall health and well-being.

Access to Medical Care

• High-need adults faced significant barriers accessing needed care in many states. In Alabama, Georgia, Idaho, North Carolina, and South Carolina, for example, 40 percent or more of high-need adults reported not seeing a doctor when needed or not filling a prescription because of cost. (8/7/17)
• In a survey of high-need patients (2 or more major chronic conditions like heart failure, stroke or diabetes requiring insulin, among other factors), 19% used the ED instead of a physician's office or a clinic, 44% delayed care in the past year because of inhibited access. 22% reported a lack of transportation as a reason for delaying care. 95% have a regular physician or place of care, only 35% said it was somewhat or very easy to get medical care after hours without visiting an ED, compared to 53% of other adults (12/9/16)
• Access to medical care in the evenings and on weekends. 32% of doctors say they see patients in person and only 58% say they provide advice by telephone 24/7. Only 38% of patients say they can obtain medical advice by telephone during off-hours. 2% of patients are able to engage in a video visit with their physicians. (7/7/16)

Behavioral Health Access

• Shortage of Psychiatrists Leads Patients to Costly ER, Hospitalization (5/23/17)
• Suicide rate in America has risen by 24% in the last 15 years associated with a significant reduction in the numbers of psychiatric beds available. (12/28/16)
• Scarcity Of Mental Health Care Means Patients — Especially Kids — Land In ER (10/17/16)
• Suicidal patients often wait hours for hospital beds (9/20/16)
• Number of psychiatric beds in US down 13% from 2010. (8/2/16)
• Population Of US Practicing Psychiatrists Declined, 2003–13, Which May Help Explain Poor Access To Mental Health Care (7/2016)
• The troubling deficiencies in our mental health system (7/4/14)
• 4 Ways to Reach Out for Mental Health Help Anonymously (5/1/14)

Behavioral Health Treatment

• More than half of mentally ill U.S. adults get no treatment (10/19/16)
• Most Americans who screen positive for depression don’t receive treatment — while most who did receive treatment don’t actually have the condition. (8/29/16)
• Over 80% of individuals who had an emergency department visit for self-harm did not receive treatment from a specialty behavioral health provider in the 90 days before their emergency department visit. (8/10/16)
• In fighting an opiod epidemic, medication-assisted treatment is effective but underused (6/2016)
• More than half of people with mental illnesses and 90 percent of people with substance use disorders do not get specialty care services. (2016)
• 80% of people who are dependent on heroin or painkillers are not getting treatment (10/13/15)
• Approximately one in five Americans—including children, teens, college youth, and adults—has a mental health problem. Majority of children with mental health conditions are not identified and lack access to treatment. Barriers include: Stigma, Inadequate screening by primary care providers, Trouble finding treatment, Failure to implement evidence-based therapies, Slow implementation of research findings (10/1/15)

Emergency Room

• 10k patients die each year within 7 days of leaving a hospital ER, study finds. (2/1/17)
• 10 common conditions represent more than 2 million annual visits to NY State hospital ERs at an estimated cost of about $1.3 billion, and 9 out of 10 of them could have been avoided or treated elsewhere (4/6/16).
• Most 2012 Minnesota ED visits were unnecessary. The more than 1 million ED visits may have been prevented (7/23/15)
• ER Revisit Rates Higher Than Previously Thought, Often More Costly Than Initial Visits (6/1/15)

Medications

• 10 most popular prescription drugs for 2017 (7/24/17)
• Study: Prolonged opioid use is the most common postsurgical complication (4/12/17)
• Study of Medicare recipients found about 15% were prescribed an opioid when they were discharged from the hospital; three months later, 42% were still taking the pain medicine. (12/20/16)
• Study found a failure by cardiologists to correctly recognize which of their patients were nonadherent with medications (7/2016)
• 575,000 Americans used at least $50,000 in prescription medicines last year, about 139,000 used at least $100,000 worth of medication (5/13/15)
• ‘America’s other drug problem’: Giving the elderly too many prescriptions. 74-year-old woman with a long history of health problems was in the hospital with pneumonia and difficulty breathing. Her medical records showed she was on 36 medications. (8/15/16)

Observation Stays

• 1 in 5 Medicare patients return to hospital after an observation stay (6/21/17)

Opioid Treatment

• Between 2009 and 2015, the average cost of care per opioid admission increased from $58,500 to $92,400 (8/11/17)
• Addiction treatment hard to find, even as overdose deaths soar (5/24/15)

Physician Visit

• CDC report: 34% of American adults did not see, talk to a physician last year (5/5/16)

Post-Acute Care

• IOM finds regional health spending differences linked to post-hospital care, provider charges (8/5/13)

Readmission to Hospitals

• 28% of patients offered home health care when they’re being discharged from a hospital — mostly older adults — say “no” to those service. (6/15/17)
• Centura Health Shares Strategies for Reducing Readmissions in Bundled Payment Arrangementsfor total hip arthroplasty (THA) and total knee arthroplasty (TKA) (6/9/17)
• 1 in 5 hospital patients discharged with unstable vital signs--a likely cause of deaths, readmissions (8/10/16)
• The government will punish more than half of the nation’s hospitals — a total of 2,597 — having more patients than expected return within a month. (8/2/16)
• One in five elderly patients is back in the hospital within 30 days of leaving (11/2013)

Virtual Visits

• Study shows telehealth increased office visits, had minimal health benefits (8/16/17)
• Survey: More than half of patients prefer telehealth visits to in-person care (7/17/17)
• Rural telehealth use for mental illness sees uptick of 45% yearly (5/2/17)
• Online Psychotherapy Gains Fans And Raises Privacy Concerns (6/30/14)
• 41% of Organizations Are Not Reimbursed for Telehealth Services (11/13/14)