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Fewer Kidney Failure Patients Rely on Medicare for Dialysis
MedicalResearch.com Interview with: Lead and Senior coauthors contributing to this interview:
Abby Hoffman Abby Hoffman, BA is a Pre-Doctoral Fellow in Population Health Sciences at Duke University and a PhD Candidate in Health Policy and Management University of North Carolina at Chapel Hill.
Dr. Virginia Wang Virginia Wang, PhD, MSPH is an Associate Professor in the Department of Population Health Sciences, Associate Director of the Center for Health Innovation and Outcomes Research, and Core Faculty Margolis Center for Health Policy at Duke University and Investigator Durham VA HSR&D Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT). MedicalResearch.com: What is the background for this study? Response: It is well established that healthcare providers are sensitive to changes in price, though their behavioral response varies. Dialysis facilities are particularly responsive to changes in Medicare reimbursement. Many dialysis patients are eligible for Medicare regardless of age, but dialysis facilities generally receive significantly higher reimbursement from private insurers than from Medicare. In 2011, Medicare implemented a new prospective bundled payment for dialysis that was expected to decrease Medicare payment and reduce overall revenues flowing into facilities. Then the Affordable Care Act (ACA) rules against refusing to insure patients for preexisting conditions and the 2014 ACA Marketplace provided an additional avenue for patients to purchase private insurance. As a result of these policies, dialysis facilities had a strong motivation and opportunity to increase the share of patients with private insurance coverage. We were interested in understanding whether dialysis facilities were shifting their payer mix away from Medicare, possibly in response to these policy changes. MedicalResearch.com: What are the main findings? How has the change in Medicare enrollment affected the viability of for-profit dialysis units? Response: We used data from annual facility surveys on the numbers of their patients by Medicare enrollment status (enrolled, in the process of applying for Medicare, or neither enrolled nor in the process of applying for Medicare). We found a facility-level movement away from a Medicare payer mix and towards a non-Medicare payer mix beginning in 2011 and continuing through 2016. For example, from 2005 to 2011, on average, non-Medicare patients made up only about 4% of a dialysis facility’s payer mix. By 2016, non-Medicare patients made up 34% of a facility’s payer mix, on average. This movement was more pronounced in facilities that were part of large chains and facilities that were for-profit. These results point to potentially increasing revenues and profits for most facilities. Though it is important to note that our data are not clear on exactly what types of insurance (or lack of insurance) are supplanting Medicare coverage. We can infer that, because most dialysis patients are eligible for Medicare, patients are receiving private insurance coverage rather than remaining uninsured. MedicalResearch.com: What should readers take away from your report? Response: We empirically show a signal that facilities are potentially responding to changes in Medicare and ACA policies, in part by shifting away from Medicare. MedicalResearch.com: What recommendations do you have for future research as a result of this work? Response: This was a descriptive observational study and further investigation is needed to assess the impact facilities’ shift in payer mix has on patients and on the healthcare system more broadly. We see movement away from Medicare coverage at the facility-level, but, with the data in this study, we cannot determine what is happening at the patient-level. Is the patient-level movement away from Medicare as stark as the facility-level data make it appear? What is replacing Medicare for dialysis patients now? How? What benefits and harms are associated with diminished Medicare reliance? We have no new disclosures to add since the publication was accepted and printed for publication. Citation: Hoffman A, Sloan CE, Maciejewski ML, Wang V. Medicare Enrollment Among Patients With End-Stage Kidney Disease Receiving Dialysis in Outpatient Facilities Between 2005 and 2016. JAMA. 2020;323(13):1314–1316. doi:10.1001/jama.2020.0704 https://jamanetwork.com/journals/jama/article-abstract/2764171 The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website. Read the full article
Where Did the Day Go? Why Time Flies As We Age
MedicalResearch.com Interview with:
Dr. Bejan Adrian Bejan PhD ( MIT 1971, 1972, 1975 ) J.A. Jones Distinguished Professor Duke University MedicalResearch.com: What is the background for this study? What are the main findings? Response: Among the most common human perceptions is that time passes faster as an individual becomes older. The days become shorter, and so do the years. We all have stories of this kind, from the long days of childhood and the never-ending class hours in elementary school, to days, months and years that now pass in a blur. Why does it feel that the time passes faster as we get older? What is the physical basis for the impression that some days are slower than others? Why do we tend to focus on the unusual (the surprise), not on the ever present? This new article unveils the physics basis for these common observations. The reason is that the measurable ‘clock time’ is not the same as the time perceived by the human mind. The ‘mind time’ is a sequence of images, i.e. reflections of nature that are fed by stimuli from sensory organs. The rate at which changes in mental images are perceived decreases with age, because of several physical features that change with age: saccades frequency, body size, pathways degradation, etc. The misalignment between mental-image time and clock time serves to unite the voluminous observations of this phenomenon in the literature with the constructal law of evolution everywhere, as physics. MedicalResearch.com: What should clinicians and patients take away from your report? Response: More subtle, and worth questioning is the impression that some days appear to pass more slowly than others. The ‘ slower’ days are full of productivity, events, and memories of what happened. Productive days happen when the body and mind are rested, after periods of regular sleep, when in the morning you look in the mirror and you see a younger you, not a tired you. Athletes learn the hard way the correlation between good rest and the speed of the passing time. Lack of rest makes you miss plays, unable to anticipate, unable to see the ball before it arrives. While sleep walking, the game is over before you know it. Young students learn the same physical truth while taking exams during a fixed time interval. The rested mind has more time to go through the problems, to find mistakes, to go back to the beginning, and try again. Lack of sleep, due to cramming the night before the exam, makes the time pass faster during the exam period. Cramming does not pay, but rest does, which is why the good coach rests the team before the big game. Here is why this is important to you, the reader: Today, many young people experience time distortion because they spend too much time on social media. This has serious consequences, ranging from sleep deprivation to mood changes and mental disorder. This is why an understanding of the physics basis of how humans perceive the passing of time is essential. MedicalResearch.com: Is there anything else you would like to add? This work is the latest discovery in the new field of life and evolution as 'physics'. Response: Recommended reading are the books The Physics of Life (2016) and Design in Nature (2012) MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community. Citation: Bejan, A. (n.d.). Why the Days Seem Shorter as We Get Older. European Review, 1-8. doi:10.1017/S1062798718000741 Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions. Read the full article
One year ago today the young baller we now know as ZiOn broke Clemson fans hearts when he committed to #DukeBasketball!! He’s been a more complete player than most of us dreamed of! I love that he speaks highly of Coach K, embraces learning all he can in his season at Duke, and is an unselfish teammate! Thank you @zionlw10 for choosing #DukeU!! #SI6HTS 🔵😈💙 https://www.instagram.com/p/Bs4C8l4Fv-n/?utm_source=ig_tumblr_share&igshid=req5wx0xptxf
Duke U CRAZIES
After an early morning at North Carolina Central University, we arrived at Duke University and were instantly encapsulated by the beautiful, newly renovated Duke Chapel. Many of our colleagues commented on the Hogwarts feel of the campus.
We were greeted by the Vice President for Student Affairs, Larry Moneta, who gave us an incredible tour of West Campus, Cameron Indoor Stadium, and the Duke Hall of Fame. The Duke houses were equally beautiful and unique to the campus culture. Duke requires students to live on campus for three years, creating quite the student experience on their campus. One of the long-standing traditions at Duke is bench-burning after NCAA championship games.
As we continued our tour into their sport facilities, it was apparent that athletics, specifically basketball, play a huge role in the campus culture. We observed many students wearing Duke apparel, giving us a clue into how much pride the students have for their institution.
Although athletics is very apparent in their culture, it appears that Duke ensures academics is the first priority, as students are students first and athletes second. The honor roll featured in the Duke Hall of Fame further asserts this concept.
After the tour, we were given the opportunity to have discourse with many of the student affairs administrators. The following professionals were kind enough to take time out of their day to speak with us:
Larry Moneta, Vice President for Student Affairs Chris Heltne, Director of Communications for Student Affairs Zoila Airall, Associate Vice President, Campus Life Li-Chen Chin, Director Intercultural Programs David Pittman, Director of Student Life , University Activities and Events Chris Roby, Assistant Vice President and Executive Director, University Activities & Events Williams Wright-Swadel, Assistant Vice President, Fannie Mitchell and Executive Director, Career Center Rick Johnson, Associate Vice President, Housing, Dining and Residence Life Joe Gonzalez, Dean, Residence Life John Vaughn, Director, Student Health Libby Webb, Interim Director, Counseling and Psychological Services
We discussed a multitude of topics, highlighting campus expansion efforts to better meet the needs of students. These efforts include upgraded dining facilities, additional housing, and a revamp of historic campus. In addition, we discussed Duke’s approach to student affairs, campus culture, and their vision for Duke’s future. In light of recent legislature that has passed within North Carolina, they discussed continuing to provide a safe space for their students, and their commitment to diversity and inclusion. They also disclosed how dedicated their students are to academics and campus leadership involvement, and how the division is making intentional efforts to encourage practical application of these experiences and self-reflection.
As we reflect on our journey, we were honored to have the opportunity today to experience Duke University. It is apparent that the student affairs leadership team at Duke is not only committed to their students, but invested in the future generation of student affairs professionals.
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PONYO! Screening + Q&A, 11/3 7pm White Auditorium @dukeuniv @dukestudents
Summer 2015 Student Documentary - Duke in the Arab World
By Brandon Choi
Our Statement
On Sunday, March 22, 2015, around 2:30 AM, a group of white male students targeted and taunted a young black female student with the racist Sigma Alpha Epsilon chant.
The People of Color Caucus at Duke University understands that this is no isolated incident. This cannot be treated as singular nor spontaneous. We are cognizant of the ways in which the past is no fixed other-world but is instead something that we carry with us and reproduce in this present moment.
What happened to the young Black woman on Sunday, March 22, 2015, is intimately connected to the conditions that necessitated the takeover of the Allen Building on February 13, 1969, by Black students. What happened to the young Black woman on Sunday, March 22, 2015, is intimately connected to the the Kappa Sigma Fraternity’s Asia Prime / International Relations party in Spring 2013 that treated yellowface as an occasion of celebration. What happened to the young black woman is intimately connected to Duke’s Education Department participating in brownface and yellowface while claiming to be invested in serving black and brown youth in Durham. It is intimately tied to the dearth of faculty of color as well as the attrition rate of faculty of color. It is tied to the state-sanctioned extrajuridical killings and brutalization of black bodies: Trayvon Martin, Aiyana Jones, Rekia Boyd, Tanesha Anderson, Jesus Huerta, Pearlie Golden, Carlos Riley, Jr., Deshawnda Sanchez and countless others—tragedies which have only received glaring silence from the administration. In other words, the racist terror to which the young black woman was subjected is symptomatic of systematized racism.
The POC Caucus at Duke University understands that racism is not about individual behavior nor about being a “good” or “bad” person. Racism is a system of oppression that pervades our quotidian experiences through institutional, structural, and individual reproduction. It poisons the water that we drink, the food that we eat to sustain our bodies, and the air that we breathe.
We know that racism does not exist as a lone system of oppression. We know that what happened to the young black woman on March 22 is connected to the institution’s decision to include a LGTBQ box for high school students to check on admission applications without addressing the gay bashing, absence of gender neutral accommodations, and general psychological violence that LGBTQ people confront as students upon arrival. We know that the racism entrenched in the institution is connected to the institution’s failure to make accommodations of accessibility actually accessible as the institution often makes deliberate decisions to invisibilize people with disabilities, such as making ramps difficult to find by placing them in the back of buildings. We know that the institutionalized racism that we face is connected to the victim-blaming and other mechanisms of silence that further traumatize survivors of sexual assault. We know that the institution’s racism is connected to the university’s failure to financially support the Office of Access and Outreach that was supposedly formed out of a commitment to support first generation and low-income college students.
Thus, we understand that struggle against racism is connected to and reinforced by other systems of oppression such as sexism, heterosexism, cissexism, ableism, and classism. We cannot stand against racial injustice without acknowledging that all systems intersect to perpetrate violence against marginalized bodies. The same racial oppression that affects Black bodies is connected to the cis-heteropatriarchy that variably oppresses any and everyone whose masculinity is not fully accepted. The same racial oppression that affects Black bodies is connected to the systematic exclusion and invisibilization of non-able bodied or non-neurotypical peoples.The same racial oppression that affects Black bodies affects other minority bodies, including racial and religious minorities. The same racial oppression that affects Black bodies is connected to the displacement and erasure of queer and non-normative bodied people.
Why We Are Here
First and foremost, we are here to stand in support and in solidarity with the young woman. We acknowledge and honor her experiences. We are also here to equip ourselves with the necessary knowledge so that we may dismantle the oppressive institutions that have never served us and create ones that do, thereby transforming the spaces in which we find ourselves. We are here to boldly and unapologetically take up the space we need as not simply a means of survival but as a means of thriving. We are here because we refuse to be complacent with inclusion in the brochures that we receive as prospective students when we continue to face violent exclusion on a daily basis as actual students on this campus.
We are not interested in “restoring” the institutions nor restoring our faith in the institutions, which presumes that there has been a moment in which the institutions had our safety and interests in mind. We have not come together to negotiate with the administration behind closed doors on their territory. We are not interested in the administration asking us for solutions to institutional inequities that we did not create—especially, when we have time and time again provided them undue access to our mental and physical energies to right their wrongs.
As a community of marginalized peoples and allies, we will no longer ask the administration and the larger Duke community for a seat at the table with them. We are committed to doing the work to maintain a community in which all of our siblings in the struggle are seen as their whole selves and feel protected, affirmed, and loved. Indeed, we are compelled by the radical possibilities of love in a world that tries to convince us through an array of mechanisms of violence and silence that we are condemned as people who cannot be loved, who cannot love, who cannot matter, and who cannot breathe. In the face of our incredulous “peers,” more time is spent continually justifying our anger, hurt, and pain than caring and loving ourselves. We will no longer practice declaring humanity that is self-evident. We have exhausted all “respectable” avenues, and they have not served us. Therefore, we state the following:
We demand justice for our sister as well as change in the communities in which we live and work. We will not be treated as second-class students or people any longer. Our lives matter. They do not matter because we make Duke more “diverse”; they matter because we are human beings.
We will no longer remain silent about the oppression we face on this campus at the hands and mouths of other students and faculty/staff members.
We will no longer remain passive when we see a Duke student mistreat a non-academic employee. We will celebrate and support all employees as members of our community, rather than dismissing any as “other” or “underclass”.
We will no longer remain silent when the administration decides not to acknowledge the pain of its marginalized students. By not acknowledging our pain, they continue to delegitimize our humanity.
We propose to create spaces that celebrate our lives, our art, our experiences, our minds, and all other aspects of our identity. Through our radical dedication to loving ourselves and our community, we will advocate for change on our campus and in our world.
We will unapologetically live and act as free human beings while fighting to dismantle the systems that oppress us.
As a collective of students intent on dismantling the imperialist, colonialist, capitalist, white supremacist cis-heteropatriarchy, we will declare that we are loved, that we can love, that we matter, and that we will breathe. We will live!
The Duke POCC is a group of marginalized students who have come together to be in solidarity in struggles toward social justice while creating space to support and learn from each other. We acknowledge that while racism affects us all as people of color, it does so variably based on the ways in which we are racialized in society and has different manifestations dependent on other socially constructed categorizations.