Tag: 5/9/22

Categories : Ethics and Law Medical IndustryTags :

Private Equity Firms Acquire Medical Practices and Squeeze Them for Profit

On By ModernMedia
Photo by Marek Studzinski on Unsplash

New research has found that private equity firms that acquire physician-owned medical practices seem to be imposing measures to squeeze out more profits. After their acquisition by private equity firms, the clinics saw more patients and billed more for visits among a large, commercially insured population, according to a study published in JAMA Health Forum.

Researchers from Oregon Health & Science University and other institutions examined a total of 578 US physician practices specialising in dermatology, gastroenterology and ophthalmology that were acquired by private equity firms from 2016 to 2020.

“The reason this is of concern to patients and policymakers is that private equity is often driven by profit margins of 20% or more,” said senior author Jane M. Zhu, MD, assistant professor of medicine in the OHSU School of Medicine. “To do that, they have to generate higher revenues or reduce costs. Increasing private equity in these physician practices may be a symptom of the continuing corporatisation of health care.”

While it is unclear whether these practices hurt clinical outcomes for patients, the findings raise concerning parallels with the rapid growth of private equity acquisition of nursing homes and hospital systems.

“Private equity investment in nursing homes has been associated with an increase in short-term mortality and changes to staffing,” the authors wrote, citing previous research.

In the new study, researchers found an increase in the overall number of patients seen in these clinics. The study also reviewed commercial insurance claims data that showed an increased share of visits longer than 30 minutes, even though the complexity of cases remained similar to cases prior to being bought out.

“These billing patterns could mean more efficient documentation of services provided, or it could mean upcoding or up-charging insurance companies to make more money,” Asst Prof Zhu said.

She believes more evidence is needed about how private equity impacts practice patterns.

Recently, the same study team found that ~5% of US physicians are currently employed by private equity-owned practices. Researchers cited quality of care and patient satisfaction as key areas for future research as this trend continues.

“Private equity ownership of physician practices has added a distinctly private and market-driven influence to the broader trends in corporate consolidation of physicians by health systems and insurers,” they concluded. “This study contributes evidence for potential overutilisation and higher spending of care that will be important for policymakers to monitor.”

Source: Oregon Health & Science University

Categories : Diseases, Syndromes and ConditionsTags :

Fixing The Protein Behind Huntington Disease

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Genetics
Image source: Pixabay

An international research effort has developed a new strategy to treat Huntington disease, which demonstrated that converting the disease-causing protein to its disease-free form results in it still retaining its original function. This discovery, published in the Journal of Clinical Investigation Insight, provides new avenues to approach Huntington disease.

Huntington disease is a rare neurodegenerative disorder with a worldwide prevalence of 2.7 per 100 000. Huntington’s disease is a dominantly inherited neurodegenerative disease and is caused by a mutation in a protein called ‘huntingtin’, which adds a distinctive feature of an expanded stretch of glutamine amino acids called polyglutamine to the protein. The patients would suffer a decade of regression before death, and, thus far, there is no known cure for the disease.

The cleavage near the stretched polyglutamine in mutated huntingtin is known to be the cause of the Huntington disease. However, as huntingtin protein is required for the development and normal function of the brain, it is critical to specifically eliminate the disease-causing protein while maintaining the ones that are still normally functioning. The research team showed that huntingtin delta 12 – the converted form of huntingtin that is resistant to developing cleavages at the ends of the protein, known to be the cause of Huntington disease – alleviated the disease’s symptoms while maintaining the functions of normal huntingtin.

Source: The Korea Advanced Institute of Science and Technology (KAIST)

Categories : Cardiovascular Disease GenderTags :

New Guidelines for CVD Rehabilitation for Women

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Photo by Stephen Andrews on Unsplash

All over the world, women with cardiovascular disease (CVD) generally experience worse outcomes and are less likely to attend prevention and rehabilitation programmes than men. An expert panel has developed a clinical practice guideline endorsed by 24 clinical societies worldwide to provide guidance to the cardiac rehabilitation community on how to deliver more effective women-focused programming. The guideline appears in the Canadian Journal of Cardiology.

“It has long been established that women are significantly less likely to access and complete cardiac rehab (CR), and that their outcomes are often poorer, despite greater need than men,” explained lead author Sherry L. Grace, PhD, a professor at the University of Toronto. “Accordingly, ‘women-focused’ models of CR have been developed to better engage women and optimise their outcomes. There is now sufficient evidence on women-focused CR to make recommendations to the CR community.”

The clinical practice guideline provided by the International Council of Cardiovascular Prevention and Rehabilitation (ICCPR) offers guidance to the CR community on how best to design programs for women with CVD, including stroke and peripheral arterial disease (PAD), and how to increase their engagement, with the goal of optimising women’s health outcomes. Cost, resource implications, feasibility, and patient preferences are foremost considerations in the recommendations.

The ICCPR identified women-focused CR researchers through a review of the scientific literature and programs offering women-focused CR around the world as identified through ICCPR’s Global Audit. Individuals and programs that consented to participate formed a writing and consensus panel including experts with diverse geographic representation who are multidisciplinary healthcare providers, a policymaker, and patient partners. This group drafted and reviewed the recommendations. The draft then underwent external review from CR societies internationally and was posted online for public comment before finalisation. One third of the studies identified in the review that formed the basis for the guideline came from Canada, which is considered to be a leader in women-focused CR.

The guideline presents 15 recommendations relating to referral (ie, automatic plus encouragement), setting (eg, choice of delivery mode, environment, tailoring, and staff training), and delivery (eg, session timing options, preferred form of exercise, psychosocial assessment and care, and education on women and heart disease). When adopted, these recommendations and the associated tools compiled can feasibly support some degree of women-focused CR as part of any program.

Key recommendations are:

  • Women should be systematically referred to CR to reduce bias and encouraged to attend before hospital discharge through two-way fulsome discussion to overcome gender-related barriers.
  • Particular considerations when developing a woman’s tailored rehab plan include considering their contextual and full clinical history, such as any mental health and psychosocial issues, menopausal status, frailty, cancer history, and concerns about urinary incontinence, falls risk/osteoporosis, as well as autoimmune conditions.
  • All programmes should offer women-focused programming, comprising as many of the definitional elements of women-focused CR as possible. Where resources are limited, this could include offering, for example, some women-only virtual education or exercise sessions or peer support programs.
  • Women should be given a choice in participating in a centre-based (clinical or community) or home-based setting, delivered in a women-friendly environment, and their needs/preferences should be taken into consideration when formulating their programs.
  • Programs should include a strong psychosocial component, choice of exercise modalities, as well as specific education on women and CVD. The psychosocial needs of women should be assessed and addressed in an evidence-based manner (eg, social support, relationship health, depression, anxiety, stress, socioeconomic issues, informal caregiving activities).

“For the first time, there are a consensus definition and recommendations for women-focused CR, so it is hoped now that many programmes will incorporate these elements into their programmes,” said Prof Grace. “If implemented, more women may engage in CR, and as a result have significantly greater quality and quantity of life.”

Source: Elsevier

Categories : Cancer Obstetrics & GynaecologyTags :

Possible Cancer Risk for Children Born from Frozen Embryos

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Photo by Pavel Danilyuk

A new study suggests the possibility that children born after use of a fertility procedure known as frozen-thawed embryo transfer may have a slightly higher risk of cancer than children born through other means. The researchers presented their findings in PLOS Medicine.

In assisted reproductive technology (ART) a doctor may immediately transfer a fertilised embryo to the uterus, or, in a practice that is increasing worldwide, the embryo might be frozen and later thawed before implantation. Prior research suggests that children born after frozen-thawed transfer may have higher short-term risk of certain medical issues than children born after fresh embryo transfer. However, potential long-term medical risks have been less clear.

To better understand these risks, Nona Sargisian of the University of Gothenburg, Sweden, and colleagues analysed medical data from nearly 8 million children in Denmark, Finland, Norway, and Sweden. Of these, 171 744 were born after the use of ART, and of these, 22 630 were born after frozen-thawed transfer.

Analysis showed that children born after frozen-thawed embryo transfer were at higher risk of cancer than children born after fresh embryo transfer and those without ART. When analysed as a single group (ie, those born after frozen-thawed transfer and fresh embryo transfer), however, the use of any type of ART did not have an increased risk of cancer. The most common types of cancer seen in this study were leukaemia and tumours of the central nervous system.

The researchers stress caution in interpreting the results due to the low number of cancer cases (48) in children born from frozen-thawed embryo transfer.

Nonetheless, the findings may raise concerns about frozen-thawed embryo transfer. Future research will be needed to confirm a possible link between the procedure and increased risk of cancer, as well as any biological mechanisms that may underlie such risk.

Coauthor Ulla-Britt Wennerholm added, “A higher risk of cancer in children born after frozen-thawed embryo transfer in assisted reproduction, a large study from the Nordic countries found. The individual risk was low, while at a population level it may have an impact due to the huge increase in frozen cycles after assisted reproduction. No increase in cancer was found among children born after assisted reproduction techniques overall.”

Source: EurekAlert!