Medical Interventions

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

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 Treatments

• 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)

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)

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)

Acute Care

Observation Stays

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

Physician Office Visit

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

Post-Acute Care

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)

Medical Intervention Efficacy

Adverse Outcomes

• OIG report: 30% of rehab hospital patients experience harm (7/21/16)
• About one-third of patients over 70 years old and more than half of patients over 85 leave the hospital more disabled than when they arrived (8/9/16)
• Medicare pays for nearly 500,000 hip and knee replacement surgeries each year. Approximately 25,000 patients undergo procedures to remove and replace a previous artificial joint. Medicare program is unable to identify product failures, patient safety problems or performance of medical devices. (6/29/16)
• If Patients Only Knew How Often Treatments Could Harm Them (3/2/15)

Cancer Treatments

• One In Three Women With Breast Cancer Treated Unnecessarily, Study Concludes (1/9/17)
• At a median of 10 years, prostate-cancer–specific mortality was low irrespective of the treatment assigned, with no significant difference among treatments. (10/13/16)

Low-Value Care

• 18 'low-value' tests cost Minnesota patients $54.9M, Mayo and state study finds (6/2/17)
• Roughly 93 percent of quality measures and initiatives have focused on underuse. Choosing Wisely focuses on the overuse that impacts quality and safety (12/3/15)
• Medicare spent $8.5 billion on 26 measures of low-value care (7/2014)

Medical Intervention Efficacy

• For every woman in whom mammography detected a breast cancer that was destined to become large and potentially life-threatening, about four are diagnosed with one that would never have threatened their health (10/12/16)

Medical Errors

• Physicians prescribe wrong antibiotic half of the time (10/25/16)
• Medical errors may kill 250,000 a year, but problem not being tracked (5/4/16)
• Medical errors officially the third leading cause of death in U.S., study finds (5/3/16)
• Medication errors or unintended drug side effects occurred in about half of all surgeries done at Boston's Massachusetts General Hospital (10/26/15)
• Study: Medical Error Deaths 4.5 Times More Likely Than IOM Estimate 9/20/13)Medical Decisions'
  

Physician Preference Sensitive Treatments

• Physician Characteristics Strongly Predict Patient Enrollment In Hospice (6/2015)

Surgeries

• A review of 13 studies, involving nearly 1,700 patients, found that arthroscopic surgery for patients with degenerative knee problems did not provide lasting pain relief or improve function. (5/10/17)
• Total knee replacement of patients with knee osteoarthritis had minimal effects on quality of life. If procedure were restricted to more severely affected patients, its effectiveness would rise, with practice becoming economically more attractive than its current use. (3/28/17)
• 400,000 middle-aged and older Americans undergo meniscus surgery. Studies have concluded that meniscus surgery offers no additional benefits regular exercise could not. (8/5/16)
• For 99 percent of people in America, when they go in to have surgery, the outcome of that operation is not measured (5/3/15)
• One-third of knee replacements in the U.S. may be inappropriate (6/30/14)

Unnecessary Care

• Professional Athletes And Back Surgery: A Teachable Moment On Overuse In Health Care? (8/1/17)
• OVERKILL: An avalanche of unnecessary medical care is harming patients physically and financially. What can we do about it? (5/11/15)
• Choosing Wisely: In addition to wasting valuable resources, the unnecessary use of medical tests, treatments, and procedures can sometimes harm patients (1/20/15)
• Study of 4,215 orders shows $226 spent per patient on unnecessary care (9/16/14)

Diagnosis

Misdiagnosis

• How 4 types of cognitive bias contribute to physician diagnostic errors — and how to overcome them (6/9/17)
• More than 20% of patients misdiagnosed by primary care providers, Mayo Clinic study finds (4/4/17)
• As many as 1 in 3 adults diagnosed with asthma may not actually have the disease, according to research published in the Journal of the American Medical Association. (1/17/17)
• Institute of Medicine: Most patients will experience a misdiagnosis in their lifetime (9/22/15)
• 1 in 20 patients misdiagnosed each year, survey finds (9/4/14)
• Doctors Wrongly Prescribed Antibiotics in 30% of 2013 Flu Cases, Stays Study (7/17/14)
• 2 Million U.S. Adults Misdiagnosed Every Year (4/17/14)

Un-diagnosed Conditions

• Crowdsourcing is being used to help diagnose those patients who have doctors stumped (8/19/15)
• A survey by HealthMine revealed that 46% of the people who discovered they had a previously undiagnosed chronic condition received the diagnosis through their employer wellness program. (7/11/15)