FOR PROFIT HEALTHCARE

Higher costs limit attendance for life changing cardiac rehab

Cost of initial cardiac rehab session was the strongest predictor of lower attendance

Michigan Medicine - University of Michigan

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Despite the success cardiac rehabilitation has shown at reducing heart-related deaths and hospital readmissions, higher out-of-pocket costs may prevent patients from participating in the program, a Michigan Medicine study suggests.

In a national study of over 40,000 people with Medicare and commercial insurance, 81.6% of patients did not have to pay for their initial cardiac rehabilitation session.

The medically supervised program lasts up to 36 sessions, which are often recommended for patients recovering from many conditions and procedures.

Among those with insurance coverage that involved sharing the costs of cardiac rehab, patients with higher out-of-pocket costs attended fewer sessions and had lower odds of completing more than 24 sessions.

Results are published in the American Journal of Managed Care.

“Cardiac rehabilitation is a proven method of improving outcomes for patients with recent cardiovascular events, and our results show that lower out-of-pocket costs are associated with increased participation,” said Michael Thompson, Ph.D., co-author of the study and associate professor of cardiac surgery at University of Michigan Medical School. 

“In order ensure cardiac rehab is utilized more often by those who need it, the barrier of cost must be addressed.”

Cardiac rehab is recommended as a standard of care for many cardiovascular conditions and procedures, including heart attack, heart bypass surgery, and minimally invasive coronary angioplasty and stenting. 

A past U-M study found that people who participate in cardiac rehab have a decreased risk of death years after heart bypass, with those who attended more sessions achieving better outcomes. Another found that the program reduces the risk of hospital readmission by nearly 20%. 

In this study, cost for the initial cardiac rehab session was the strongest predictor of lower attendance. For every additional $10 spent out of pocket, patients attended .41 fewer sessions on average. 

Researchers note that cost is not the only barrier to participation. 

While most cardiac rehab attendees had zero out-of-pocket costs for their first session, participants who paid up to $25 for the initial session — the lowest of those with cost sharing — had higher rates of future attendance than patients who paid nothing.

The group with no out-of-pocket costs, however, may have been less healthy and utilized more health care services, meeting their deductible prior to enrolling in cardiac rehabilitation.

“Out-of-pocket costs are one of many factors associated with adherence to cardiac rehab, and we hope this research spurs further investigations and quality improvement initiatives to improve cardiac rehab by mitigating financial barriers,” said Devraj Sukul, M.D., M.Sc., a cardiologist at U-M Health at the time the research was conducted.

The study results, researchers conclude, support quality improvement initiatives to limit cost sharing hurdles for cardiac rehab services.

Such efforts are promoted by the Million Hearts Cardiac Rehabilitation Change Package, a collaboration between the Centers for Disease Control and Prevention and the American Association of Cardiovascular and Pulmonary Rehabilitation. 

“Health care systems must seek ways to offset expenses for cardiac rehab for those who are underinsured, which may improve participation for patients with less comprehensive health plans and reduce disparities in cardiovascular care,” said Alexandra I. Mansour, M.D., resident physician and graduate of U-M Medical School.

“Future payment reform policy should also focus on developing payment models that reduce patient costs for cost-effective interventions such as cardiac rehab."

Additional authors: Ushapoorna Nuliyalu, M.P.H., of University of Michigan and Steven Keteyian, Ph.D., of Henry Ford Health.

Paper cited: “Out-of-Pocket Spending for Cardiac Rehabilitation and Adherence Among US Adults,” American Journal of Managed Care. DOI: 10.37765/ajmc.2024.89637 

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Journal

The American Journal of Managed Care

DOI

10.37765/ajmc.2024.89637 

Method of Research

Observational study

Subject of Research

People

Article Title

Out-of-Pocket Spending for Cardiac Rehabilitation and Adherence Among US Adults

U of M Medical School study highlights financial burden of medical equipment on cancer survivors

University of Minnesota Medical School

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MINNEAPOLIS/ST. PAUL (1/23/2025) — Published in JAMA Network Open, a University of Minnesota Medical School research team examined the financial burden of different medical services — including outpatient care, inpatient care, prescription drugs and physical therapy — on cancer survivors. Of all these medical services, the research team found medical equipment results in the highest percentage of out-of-pocket costs, including wheelchairs, canes, hearing aids and oxygen equipment, among other items. 

The economic challenges faced by patients with cancer due to health care costs are well-documented, but most prior work focused on high drug costs. This study, however, examines the patterns of use and costs of medical equipment among cancer survivors in the U.S., underscoring the prevalence of equipment use and the significant out-of-pocket expenses associated with it.

“As the number of cancer survivors continues to rise, so do their unmet needs for medical equipment. This research highlights critical gaps in access and affordability, which must be addressed to improve cancer survivorship care,” said Arjun Gupta, MBBS, assistant professor at the U of M Medical School, gastrointestinal oncologist with M Health Fairview, and member of the Masonic Cancer Center. 

Key findings include: 

• The absolute number of cancer survivors using medical equipment increased 2.5-fold between 1999 and 2018, with prevalence rising from 6.6% to 8.6%.
• The out-of-pocket cost-sharing responsibility — the proportion of total cost paid for by the patient — for medical equipment (39%) is the highest among medical services, exceeding that for prescription drugs (9%), outpatient care (4%) and hospitalizations (1%).

The financial strain associated with medical equipment presents cancer survivors with a serious barrier. According to the research team, accessing affordable medical equipment is challenging due to limited insurance coverage and onerous administrative burdens. Streamlining payer coverage and authorization processes, reducing cost-sharing responsibility and addressing affordability are key policy priorities to ensure equitable access to essential medical equipment.

This research was funded by the Pancreatic Cancer Action Network. 

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About the University of Minnesota Medical School
The University of Minnesota Medical School is at the forefront of learning and discovery, transforming medical care and educating the next generation of physicians. Our graduates and faculty produce high-impact biomedical research and advance the practice of medicine. We acknowledge that the U of M Medical School is located on traditional, ancestral and contemporary lands of the Dakota and the Ojibwe, and scores of other Indigenous people, and we affirm our commitment to tribal communities and their sovereignty as we seek to improve and strengthen our relations with tribal nations. For more information about the U of M Medical School, please visit med.umn.edu.

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Journal

JAMA Network Open

DOI

10.1001/jamanetworkopen.2024.55941 

Method of Research

Data/statistical analysis

Subject of Research

People

Article Title

Use and Spending on Medical Equipment Among US Cancer Survivors

Article Publication Date

22-Jan-2025

DEI 

Disability often neglected in medical school curricula, new study finds

‘Doctors do not know how to care for people with disabilities because they never learned’

Northwestern UniversityFacebook

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• Disability often framed as a ‘problem’ in medical school curriculum for doctors to diagnose, treat

• Negative ideas about disability have a direct, negative effect on workforce diversity in medicine

• Some faculty, trainees create disability-related curriculum on their own or in affinity groups

• Northwestern is addressing critical gaps in curricula

CHICAGO --- Doctors in the U.S. have reported feeling unprepared to care for people with disabilities and have revealed significant negative bias about this population, according to previous research. A new Northwestern Medicine study has found much of this could be rooted in their medical school training. 

Medical school curricula often view disability as a problem, leading medical trainees to make negative assumptions about people with disabilities’ health and quality of life, the study found. A lack of sufficient medical school training about disabilities and disability-related care across settings perpetuates ableism and leaves medical trainees inadequately prepared, said corresponding author Carol Haywood, assistant professor of medical social sciences at Northwestern University Feinberg School of Medicine.

“Doctors do not know how to care for people with disabilities because they never learned,” Haywood said. “Ultimately, our work reveals how medical education may be playing a critical role in creating and perpetuating ideas that people with disabilities are uncommon and unworthy in health care.”

The study was published today (Jan. 15) in the Journal of General Internal Medicine.

Negative attitudes, inaccessible exam rooms

More than one in four U.S. adults have some type of disability, according to the U.S. Centers for Disease Control and Prevention. People with disabilities experience significant disparities in their health care quality, access and outcomes, such as negative attitudes from physicians, inaccessible exam rooms and a lack of appropriate communication methods.

“Often, physicians think of disability as something important to certain specialties (e.g., physical medicine and rehabilitation), but if this isn’t their specialty, they assume they do not have to think about disability access and quality of care for their patient panel,” Haywood said.

“While we have known about physician bias and discrimination against people with disabilities in health care for some years now, this new work emphasizes the need for medical schools and regulating bodies such as the ACGME (Accreditation Council for Graduate Medical Education) and LCME (Liaison Committee on Medical Education) to take on the responsibility of educating future physicians about the care of people with disabilities,” said co-author Dr. Tara Lagu, adjunct professor of medicine and medical social sciences at Feinberg.

Critical shortfalls in medical education

Interviews with faculty and students from medical schools across the U.S. between September 2021 and February 2022 revealed the following prominent themes related to critical shortfalls in medical education:

1. Disability is often neglected in medical education curricula. Participants said disability was only mentioned in select lectures across all years of medical school, and/or disability was incorporated only into elective coursework, largely relegating the essential training to students or faculty who already had familiarity and/or interest in disability. A faculty participant said, “The fact that [disability training is not required, and it’s not seen as a core part of the medical school curriculum … reinforces the idea that these aren’t really your patients or they’re not important enough for you to learn about.”
2. Disability being framed as a “problem” within individuals. Most medical schools define disability as a condition within an individual to be diagnosed and treated, rather than something rooted in physical barriers, social bias and stigmatization. One student said, “Just seeing how biases can be sort of continued on through generations of doctors … whether that means that thinking of disability as a tragedy or … a medical condition.” 
3. Negative ideas about disability have a direct, negative effect on workforce diversity in medicine. Participants described a neglect of disability training and a reduction of disability to pathology as being part of a “hidden curriculum” in medical education that ultimately teaches medical students that disability does not belong in society. By extension, trainees with disabilities are often viewed as weak or incapable of excelling in their medical practice. One participant said: “We're just sending the message from the get-go that you’re not welcome, which is so damaging in every possible way.”
4. Overreliance on ad hoc, faculty and student-led efforts to cultivate curricular change. When their own training fell short, faculty and students sought personal mentorship and communities of practice to discuss and understand disability-related health care. One student said, “It’s hard to be mad at physicians …. Because they weren’t taught how to do it or taught to ask the questions, or it wasn’t emphasized. That’s why it comes back to this medical education piece.”

How Northwestern is addressing these gaps in curricula

Advancing disability-related medical education will require systemic reform, the scientists said. There has increasingly been a push for “disability-competent” and “ableism-aware” medical education. 

At Feinberg, Dr. Leslie Rydberg, associate professor of physician medicine and rehabilitation and of medical education, has been charged with transforming how medical trainees learn about disability. 

For example, medical students elicit a history from individuals with a disability, focusing on asking about the patient’s disability and their function; learn directly from guest speakers who are individuals with a disability who share their journey in the medical system; learn from various rehabilitation team members including a physical therapist, occupational therapist and speech language pathologist, who discuss their roles in the assessment and treatment of people with disabilities; and work with an inpatient rehabilitation team and participate in the medical care of people with disabilities, including inpatient rounds, physical exams, clinical decision making, documentation in the medical record and more.  

The study is titled “‘The forgotten minority:’ Perpetuation of ableism in medical education.” 

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Journal

Journal of General Internal Medicine

Article Title

“‘The forgotten minority:’ Perpetuation of ableism in medical education

Article Publication Date

15-Jan-2025

Partnership gives community college students path to BS in Public Health

A transfer pathway to the Zuckerman College of Public Health will enable Tohono O’odham Community College students to expand their career potential

University of Arizona Health Sciences

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At Tohono O’odham Community College, students can earn certificates or an Associate of Arts in Life Science – Community and Public Health before transferring to the U of A Mel and Enid Zuckerman College of Public Health.

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Credit: Photo courtesy of Tohono O’odham Community College

A new partnership between the University of Arizona Mel and Enid Zuckerman College of Public Health and Tohono O’odham Community College will provide a direct transfer pathway for students to start their college careers at the community college and finish a Bachelor of Science in Public Health at the U of A in preparation for health services careers.

“By bridging our programs, we aim to empower students from Tohono O’odham Community College to become the next generation of Indigenous public health leaders who will make meaningful impacts in our communities and beyond,” said John Ehiri, PhD, MPH, a professor and the senior associate dean for academic and faculty affairs at the Zuckerman College of Public Health. 

“This collaboration reflects our commitment to expanding educational opportunities and supporting our diverse communities,” Ehiri added. “We are thrilled to partner with Tohono O’odham Community College to establish this transfer pathway for students pursuing careers in public health.” 

At Tohono O’odham Community College, students can earn certificates or an Associate of Arts in Life Science – Community and Public Health before transferring to the U of A. The associate degree program meets students’ general education requirements and provides opportunities for hands-on experiences while exploring health careers, relevant topics in health and wellness, and the fields of community health and public health. 

“Tohono O’odham Community College students bring a wealth of life experiences and Indigenous ways of knowing and competence to their studies, particularly for service fields such as community and public health,” said Laura Sujo-Montes, PhD, dean of academics at Tohono O’odham Community College. “We are excited to join in this partnership with the Zuckerman College of Public Health to create a pathway that will facilitate Native American students moving forward in public health careers and benefitting their local communities.”

At the Zuckerman College of Public Health, the Bachelor of Science in Public Health offers students the opportunity to develop the knowledge, skills, ethics and cultural competencies needed to build healthier communities, develop safer workplace environments and improve regional health programs. Students can choose from one of seven degree tracks: public health practice, global health, health promotion, One Health, environmental and occupational health, quantitative methods in public health, and health systems theory and practice.

Graduates go on to build health services programs, change policies, improve health equity across communities and make the world a better place.

Tohono O’odham Community College is located about 50 miles west of Tucson along Arizona 86. Approximately 1,200 students, about 96% of whom are American Indian or Alaskan Native, are enrolled at the college, which is open to learners of all backgrounds.

  

Parental favoritism isn't a myth

Daughters, responsible kids more likely to be favored, study finds

American Psychological Association

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WASHINGTON -- If you’ve ever wondered whether your parents secretly had a favorite child, they might have. Parents may be more inclined to confer the “favorite child award” to daughters and children who are agreeable and conscientious, according to research published by the American Psychological Association.

“For decades, researchers have known that differential treatment from parents can have lasting consequences for children,” said lead author Alexander Jensen, PhD, an associate professor at Brigham Young University. “This study helps us understand which children are more likely to be on the receiving end of favoritism, which can be both positive and negative.”

The research was published in the journal Psychological Bulletin.

The study examined the link between children's characteristics and differences in how their parents treat them, while considering potential moderators such as child age, parent gender and measurement methods.

The researchers conducted a meta-analysis of 30 peer-reviewed journal articles and dissertations/theses, along with 14 databases, encompassing a total of 19,469 participants. They examined how birth order, gender, temperament and personality traits (extraversion, agreeableness, openness, conscientiousness and neuroticism) were linked to parental favoritism.

Parents can show favoritism in numerous ways, including how they interact with their children, how much money they spend on them and how much control they exert over them, the researchers said. Altogether, they looked at five domains: overall treatment, positive interactions, negative interactions, resource allocation and control.

The researchers initially thought that mothers would tend to favor daughters and fathers would favor sons. However, the study found that both mothers and fathers were more likely to favor daughters.

Of the personality traits evaluated, children who were conscientious -- meaning they were responsible and organized -- also appeared to receive more favorable treatment. This suggests that parents may find these children easier to manage and may respond more positively. Jensen said he was surprised that extraversion was not associated with favoritism.

 “Americans seem to particularly value extraverted people, but within families it may matter less,” he said.

When it came to birth order, parents were more likely to give older siblings greater autonomy, possibly because they were more mature, according to Jensen.

The researchers also examined whether parent-child relationships were influenced by other factors, such as the child's age, the parent's gender, or how favoritism was measured. They found that these factors might play a role, but if they did it was minimal, highlighting the complexity of parental favoritism.

Siblings who receive less favored treatment tend to have poorer mental health and more strained family relationships, according to Jensen.

“Understanding these nuances can help parents and clinicians recognize potentially damaging family patterns,” he said. “It is crucial to ensure all children feel loved and supported.”

The researchers said they hope their findings will encourage parents to be more aware of their biases and strive to treat all their children fairly.

 “It is important to note that this research is correlational, so it doesn't tell us why parents favor certain children,” Jensen said. “However, it does highlight potential areas where parents may need to be more mindful of their interactions with their children.”

“So, the next time you're left wondering whether your sibling is the golden child, remember there is likely more going on behind the scenes than just a preference for the eldest or youngest. It might be about responsibility, temperament or just how easy or hard you are to deal with,” he said.

Article: “Parents Favor Daughters: A Meta-Analysis of Gender and Other Predictors of Parental Differential Treatment,” by Alexander Jensen, PhD, Brigham Young University and McKell Jorgensen-Wells, MS, Western University. Psychological Bulletin, published online Jan. 16, 2025.

Contact: Alexander Jensen, PhD, may be contacted via email at alexjensen@byu.edu.  

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Journal

Psychological Bulletin

Method of Research

Meta-analysis

Subject of Research

People

Article Title

Parents Favor Daughters: A Meta-Analysis of Gender and Other Predictors of Parental Differential Treatment

Article Publication Date

16-Jan-2025

Study finds gender gap with children when it comes to negotiating

Boys more likely than girls to ask for bigger bonuses—for the same work

New York University

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Studies have shown a persistent gender gap when it comes to wages—disparities that stretch over decades. Past analyses have pointed to various causes for this discrepancy, but often overlooked is how such divides may surface early in life.

In a related new study of boys and girls, a team of psychology researchers has found that despite holding similar views on the purpose and value of negotiation, boys ask for bigger bonuses than girls do for completing the same work. The findings, reported in the journal Developmental Psychology, indicate that these outcomes are linked, in part, to differences in perceptions of abilities: in a series of cognitive tasks, boys had a higher opinion of their abilities and therefore asked for higher bonuses—even though they performed no better than girls did in these tasks.

“Our findings suggest that boys tend to overestimate their abilities compared to girls—and relative to their actual performance,” says Sophie Arnold, a New York University doctoral student and the lead author of the paper. “This inflated self-perception may lead boys to feel more entitled to push the boundaries during negotiations.”

“These findings offer new perspectives on the possible origins of negotiation disparities that exist between adult men and women in professional settings,” concludes NYU Psychology Professor Andrei Cimpian, the paper’s senior author. 

The research, which also included Katherine McAuliffe, a professor of psychology and neuroscience at Boston College, consisted of a series of three experiments. The first two of these were used to ascertain if boys and girls had similar perceptions of negotiation. 

In a pair of hypothetical scenarios, boys and girls—aged six to nine—were introduced to situations in which they could negotiate a bonus with a teacher for completing classroom work or with a neighbor for completing neighborhood work. In these hypothetical scenarios, boys and girls revealed similar perceptions of negotiation: they thought other children were similarly likely to negotiate, that it was similarly permissible to negotiate, that they would receive similarly little backlash for negotiating, and that negotiating would lead to similar rewards. Furthermore, girls and boys reported that they would negotiate to a similar extent in these hypothetical situations.

Through a subsequent experiment that included more than 200 child participants, the researchers sought to understand how boys and girls would negotiate based on their performance and their perceptions of this performance. Here, the children were asked to quickly identify images on a computer screen. The boys and girls performed roughly the same.

After these cognitive tasks, all children—regardless of their performance—were told that because of how they did, they should receive a bonus: pictures of animals. The children were then asked how many pictures they thought they should receive for their achievement. 

Despite performing at approximately the same levels, there was a noticeable gender gap in how the participants responded to the question about the size of the bonus they thought they should receive:

• Despite having similar perceptions of negotiation, consistent with the findings from the hypothetical studies, boys asked for bigger bonuses than girls did for completing the same work. This difference was not trivial: the typical boy asked for more bonus pictures than about 65% of girls did.

• While girls and boys performed equally well in the cognitive task, their perceptions of their own competence differed: boys thought better of their performance than girls thought of theirs. This difference in perceived competence, the authors conclude, helped explain why boys asked for more than girls: boys believed they did better, and those boys were also more likely to negotiate for higher bonuses.

• Also notable among the findings was that the relationship between children’s perceptions of negotiation and their bonus requests differed by gender. Although girls’ and boys’ perceptions were similar on average, these perceptions only predicted boys’ requests, not girls’. For instance, among boys, those who thought negotiating was more permissible were also more likely to ask for higher bonuses. In contrast, perceptions of the permissibility of negotiation were not associated with request magnitude among girls. 

“Boys leveraged their perceptions of how common and permissible it is to ask for more, while girls did not,” explains McAuliffe. “This meant that, for example, when both girls and boys thought it was more common and more permissible to negotiate, boys negotiated more than girls did.”

The research was supported by a grant from the National Science Foundation (DGE-2234660).

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Journal

Developmental Psychology

DOI

10.1037/dev0001898 

Method of Research

Experimental study

Subject of Research

People

Article Title

Unraveling the Gender Gap in Negotiation: How Children’s Perceptions of Negotiation and of Themselves Relate to Their Bargaining Outcomes

Article Publication Date

16-Jan-2025