Outpatient red blood cell transfusion payments among patients on chronic dialysis.

BACKGROUND: Payments for red blood cell (RBC) transfusions are separate from US Medicare bundled payments for dialysis-related services and medications. Our objective was to examine the economic burden for payers when chronic dialysis patients receive outpatient RBC transfusions. METHODS: Using Truven Health MarketScan® data (1/1/02-10/31/10) in this retrospective micro-costing economic analysis, we analyzed data from chronic dialysis patients who underwent at least 1 outpatient RBC transfusion who had at least 6 months of continuous enrollment prior to initial dialysis claim and at least 30 days post-transfusion follow-up. A conceptual model of transfusion-associated resource use based on current literature was employed to estimate outpatient RBC transfusion payments. Total payments per RBC transfusion episode included screening/monitoring (within 3 days), blood acquisition/administration (within 2 days), and associated complications (within 3 days for acute events; up to 45 days for chronic events). RESULTS: A total of 3283 patient transfusion episodes were included; 56.4% were men and 40.9% had Medicare supplemental insurance. Mean (standard deviation [SD]) age was 60.9 (15.0) years, and mean Charlson comorbidity index was 4.3 (2.5). During a mean (SD) follow-up of 495 (474) days, patients had a mean of 2.2 (3.8) outpatient RBC transfusion episodes. Mean/median (SD) total payment per RBC transfusion episode was $854/$427 ($2,060) with 72.1% attributable to blood acquisition and administration payments. Complication payments ranged from mean (SD) $213 ($168) for delayed hemolytic transfusion reaction to $19,466 ($15,424) for congestive heart failure. CONCLUSIONS: Payments for outpatient RBC transfusion episodes were driven by blood acquisition and administration payments. While infrequent, transfusion complications increased payments substantially when they occurred.

Hospital purchasing alliances: utilization, services, and performance.

BACKGROUND: Hospital purchasing alliances are voluntary consortia of hospitals that aggregate their contractual purchases of supplies from manufacturers. Purchasing groups thus represent pooling alliances rather than trading alliances (e.g., joint ventures). Pooling alliances have been discussed in the health care management literature for years but have never received much empirical investigation. They represent a potentially important source of economies of scale for hospitals. PURPOSES: This study represents the first national survey of hospital purchasing alliances. The survey analyzes alliance utilization, services, and performance from the perspective of the hospital executive in charge of materials management. This study extends research on pooling alliances, develops national benchmark statistics, and answers important issues raised recently about pooling alliances. METHODOLOGY/APPROACH: The investigators surveyed hospital members in the seven largest purchasing alliances (that account for 93% of all hospital purchases) and individual members of the Association of Healthcare Resource & Materials Management. The concatenated database yielded an approximate population of all hospital materials managers numbering 5,014. FINDINGS: Hospital purchasing group alliances succeed in reducing health care costs by lowering product prices, particularly for commodity and pharmaceutical items. Alliances also reduce transaction costs through commonly negotiated contracts and increase hospital revenues via rebates and dividends. Thus, alliances may achieve purchasing economies of scale. Hospitals report additional value as evidenced by their long tenure and the large share of purchases routed through the alliances. Alliances appear to be less successful, however, in providing other services of importance and value to hospitals and in mediating the purchase of expensive physician preference items. There is little evidence that alliances exclude new innovative firms from the marketplace or restrict hospital access to desired products. PRACTICE IMPLICATIONS: Pooling alliances appear successful in purchasing commodity and pharmaceutical products. Pooling alliances face the same issues as trading alliances in their efforts to work with physicians and the supply items they prefer.

Surgeon evaluation of suture and endo-mechanical products.

BACKGROUND: Surgeons select medical instruments without comparative performance data. This analysis seeks to determine if suture and endo-mechanical products made by different vendors have equivalent performance profiles or are clearly distinguished by physicians on different dimensions. MATERIALS AND METHODS: A sample of 45 surgeons evaluated eight vendors of five categories of suture and endo-mechanical products: clip appliers, staplers, trocars, needles and sutures, and endoscopic specimen retrieval devices. Surgeons rated each vendor's products in each category on multiple performance dimensions at six animal laboratories at academic medical centers around the U.S. between April and September 2005. Performance dimensions included the product's clinical acceptability, ergonomics, functionality, overall performance, and relative rank-order preference. RESULTS: Physician evaluations of vendor performance vary widely. Vendors rated as clinically equivalent on a given product received different performance ratings by physicians. Ethicon's products (Somerville, NJ) were rated consistently high by physicians across product categories. This suggests the presence of some superior brand performance. Nevertheless, within some categories, there were alternative vendors (U.S. Surgical [Mansfield, MA], Applied Medical [Rancho Margarita, CA]) whose products are rated similar to the brand leader. This suggests there are often multiple vendors from which to choose. There was also evidence of idiosyncratic physician preference, especially due to the physician's gender, height, and glove size. CONCLUSIONS: Suture and endo-mechanical products made by different vendors do not have equivalent performance profiles. Specific brand seems to be the most important determinant of physician evaluations of the different vendors' products. These results suggest the value and importance of conducting head-to-head comparisons of multiple vendors of the same product.

Assessment of medical devices: how to conduct comparative technology evaluations of product performance.

OBJECTIVES: U.S. expenditures on medical devices (US dollars 70 billion in 2003) are one of the fastest growing components of hospital costs. Physicians' selection of medical devices lacks an evidence base on the comparative clinical effectiveness of these products. Comparative studies (e.g., vendor 1 versus vendor 2, technology A versus technology B) are increasingly promoted in the public sector as a means of cost containment, value-based purchasing, and quality improvement. This study illustrates how hospitals and physicians can conduct comparative technology assessments of product performance. METHODS: Surgeons evaluated comparable medical devices manufactured by eight different vendors in standardized surgical procedures. Devices included sutures and endomechanical products, which account for US dollars 2.5 billion of total device spending. Evaluations covered multiple performance dimensions, including ergonomics, functionality, clinical acceptability, and vendor preference. RESULTS: One vendor's products garnered consistently high ratings from surgeons, while two other vendors garnered consistently low ratings. Differences in ratings were statistically significant and persist when controlling for physician background characteristics and prior experience. Study results were used by a large hospital group purchasing organization to select which vendors to contract with for these products. CONCLUSIONS: Comparative technology evaluations assist physicians and hospitals in making cost-effective purchases of devices. These evaluations provide robust information on the performance of products routinely used by clinicians. Such evaluations can be carefully designed to have scientific rigor and clinical credibility.