Patients who suffer a heart attack on weekends and off hours are more likely to die than those stricken during working hours, according to a study in BMJ (formerly the British Medical Journal).

Researchers conducted a metaanalysis of nearly 50 studies done from 2001 to 2013 and including about 2 million patients. Portions of the patient cohort stretch back to 1987.

The authors discuss ST-elevation myocardial infarction (STEMI) and door-to-balloon time—that is, the time between presentation and receiving percutaneous coronary inter­vention. The door-to-balloon time should be 90 minutes or less.

“Patients who presented during off-hours were less likely to receive percutaneous coronary intervention within 90 minutes than were those who presented during regular hours,” states the study (“Off-Hour Presentation and Outcomes in Patients With Acute Myocardial Infarction: Systemic Review and Meta-Analysis”).

The study notes that “higher mortality during off-hours was seen for both in-hospital and 30-day mortality.”

The research was done in the United States, Canada, and Europe. One in 20 in-hospital deaths, or 1 in 29 deaths within 30 days after admission, could be prevented if the higher mortality during off-hours was resolved, the authors contend.

They add that “the 15-minute increase in door-to-balloon time observed during off-hours could increase mortality by as much as 10%–25%, assuming linearity between door-to-balloon time and mortality.”

The difference in outcomes “is likely associated with availability of cardiologists, support staff for the cardiac catheterization laboratory, or both,” the study says.

In addition, 24-hour-a-day cardiology service isn’t available everywhere. Many hospitals have to assemble on-call staff to get cardiac units up and running during off hours.

Managed Care’s Top Ten Articles of 2016

There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?

The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.

Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
Competition among manufacturers, industry consolidation, and capitalization on me-too drugs are cranking up generic and branded drug prices. This increase has compelled PBMs, health plan sponsors, and retail pharmacies to find novel ways to turn a profit, often at the expense of the consumer.
The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.

Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.