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Biomedical subjects

D W Garnick

Publications and source records attributed to D W Garnick.

49 records · Page 3Linked to original sources
PubMed1987

Market and regulatory influences on the availability of coronary angioplasty and bypass surgery in U.S. hospitals.

Using 1983 data on 3720 nonfederal short-term hospitals, we analyzed the influence of local market competition and state regulatory programs on the availability of percutaneous transluminal coronary angioplasty and coronary-artery bypass surgery. The degree of competition for patients with heart disease was measured in terms of the number of hospitals in the local market area that maintained a cardiac catheterization laboratory or facility for open-heart surgery. When the patient case mix and the hospital's teaching role were controlled for, institutions with more than 20 competitors in the local area were 166 percent more likely to offer coronary angioplasty (P less than 0.0001) and 147 percent more likely to offer bypass surgery (P less than 0.0001) than hospitals with no competitors in the local market. Four fifths of the hospitals performing bypass surgery whose annual volume was less than 200 had one or more neighboring hospitals with a facility for open-heart surgery. State rate-regulation programs in New York, New Jersey, Connecticut, Massachusetts, and Maryland significantly reduced the availability of both procedures, with the greatest regulatory effects being observed in the most competitive hospital markets. We conclude that in the period under consideration, competition encouraged and regulation discouraged the proliferation of these cardiac services.

Angioplasty, Balloon↗
PubMed1987

Association of volume with outcome of coronary artery bypass graft surgery. Scheduled vs nonscheduled operations.

Empirical evidence suggests that mortality rates for coronary artery bypass graft (CABG) surgery are lower in hospitals that perform a higher volume of the procedure. In recent years, the criteria for CABG surgery have been expanded to include patients with a wide variety of co-morbidities. To address the question of whether the volume-outcome relationship continues to exist for this new group of patients, discharge abstracts for 18,986 CABG operations at 77 hospitals in California in 1983 were analyzed using multiple-regression techniques. Higher-volume hospitals had lower in-hospital mortality (adjusted for case mix); this effect was greatest in patients who might be characterized as having "non-scheduled" CABG surgery. Higher-volume hospitals also had shorter average postoperative lengths of stay and fewer patients with extremely long stays. The results of this study suggest that the greatest improvement in average outcomes for CABG surgery would result from the closure of low-volume surgery units.

California↗
PubMed1987

Changes in patient characteristics and surgical outcomes for coronary artery bypass surgery 1972-82.

Data from a national sample of hospitals were used to explore reasons for improved in-hospital survival rate for coronary artery bypass graft (CABG) surgery between 1972 and 1982. Increases in annual volumes of surgery explain a large fraction of the decline in death rates. The residual can be attributed to improved techniques, experience, and other factors, even though more operations were done on older patients and women in 1982 than 1972.

Age Factors↗
PubMed1987

Episode-of-care physician payment: a study of coronary artery bypass graft surgery.

Paying physicians for an episode of care is a possible alternative to current fee-for-service payment. We studied physician billing patterns for 512 Medicare beneficiaries who received coronary artery bypass graft (CABG) surgery in 1983. Relatively elaborate decision rules had to be created to exclude services that were not part of a routine CABG. We found that 72% of charges for an episode were associated with services provided on the day of surgery. Forty-seven percent of charges were by the primary surgeon, 15% by the assistant surgeon(s), and 9% by the anesthesiologist. Our results suggest that episode-of-care payment is a complex, and somewhat costly, alternative to other methods of prospective payment to physicians, although selective contracting by a health insurer for an episode of care for certain procedures might both reduce costs and improve quality.

California↗
PubMed1987

Appropriate measures of hospital market areas.

As public and private policymakers turn to market-oriented strategies to control hospital prices, it is necessary to understand the conceptual underpinnings of hospital market area measurement. This article provides a framework for evaluating which definitions of hospital market areas are suitable for various types of analyses. Hospital market areas can be defined from two perspectives: an individual hospital perspective and that of the overall market. From each perspective, empirical definitions can be based on geopolitical boundaries, distance between hospitals, and patient-origin data. In this article, market areas are compared based on various descriptions using data on California hospitals and patient discharge abstracts.

California↗
PubMed1986

Office visit patterns in physician group practices.

In summary, this study provides evidence that with as few as five diagnosis it is possible to identify some physician group practices that consistently treat patients with more or fewer visits, on average. However, even among group practices that vary considerably in size, location, and organizational structure, there is little deviation from the norm in terms of office visits. A study of more than 30 patients per site using data from both office records and insurance claims is needed, however, to examine the entire spectrum of treatment, including lab tests, special procedures, medications, and hospitalization. Such future studies may exploit the possibilities and avoid the pitfalls describes here to better characterize physicians' practice patterns.

Asthma↗
PubMed1986

The role of specialized clinical services in competition among hospitals.

Because duplication of services among hospitals can be costly, it is important to understand the circumstances under which duplication occurs among hospitals within a region. In this sample of 3,584 community hospitals surveyed in 1972, we analyzed the impact of competition on the availability of specialized clinical services, with special focus on mammography, emergency services, cobalt therapy, heart surgery, and cardiac catheterization. We found that the presence of nearby institutions and services increases the availability of most of these services in neighboring hospitals. This supports the hypothesis that competition among hospitals within an open-ended reimbursement environment takes the form of nonprice competition for community-based physicians through the acquisition of expensive clinical facilities.

Cardiac Catheterization↗
PubMed1986

Imaging the heart: cardiac scintigraphy and echocardiography in U.S. hospitals (1983).

The rapid growth of cardiac catheterization has raised questions about the availability of less costly, "noninvasive" tests such as cardiac scintigraphy and echocardiography. To assess their availability and rates of use, we surveyed 3,778 non-federal short-term U.S. hospitals in June, 1983. Overall, 2,605 hospitals (69%) offered 201Tl myocardial perfusion scans, 2,580 (68%) 99mTc equilibrium gated blood pool scans, and 2,483 (67%) cardiac shunt scans; 1,679 hospitals (44%) offered M-mode and/or 2-dimensional echocardiography, and 768 (20%) pulsed Doppler echocardiography. Volumes of procedures varied enormously among hospitals capable of performing them. High volumes of both scintigraphy and echocardiography were performed in a small number of hospitals. Larger, voluntary, and teaching hospitals performed higher volumes of both procedures. Despite widespread availability of these "noninvasive" technologies, high volumes of both cardiac scintigraphy and echocardiography procedures are concentrated in a small number of U.S. hospitals.

Data Collection↗
PubMedDate not supplied

Do individuals with substance abuse diagnoses incur higher charges than individuals with other chronic conditions?

Concerns about high costs have led to limits on the services covered by most insurance plans for substance abuse treatment. But, the commonly used comparison group for cost analyses, all enrollees in a health-care plan, may not be appropriate because addiction is a chronic condition. Therefore, to determine whether substance abusers incur higher charges than patients with other serious chronic conditions, we used health insurance information for employees and dependents over 3 years (1989 to 1991) for two firms with a total of almost 40,000 employees to do alternate comparisons. We compared average annual charges for patients with the following diagnoses: substance abuse, substance abuse with mental illness, arthritis, asthma, and diabetes. Patients who undergo treatment for abusing alcohol, drugs, or both often (but not always) incur higher charges than people with other chronic conditions. Clear differences in average charges emerge between patients with and without mental health claims.

Adult↗
PubMedDate not supplied

Insurance agents: ignored players in health insurance reform.

In this paper we use the reforms to the individual health insurance market in New Jersey to illustrate the intricate interaction between insurance agents and insurance reform initiatives. Until recently, policymakers who designed reforms to the health insurance market largely ignored the role of agents in selling individual health insurance policies. These reforms have the potential to overturn the agent's traditional role, and agents can influence how the reforms are implemented.

Chi-Square Distribution↗