Kevin A Kerber

University of Michigan, Ann Arbor, Michigan, United States

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Publications (71)357.31 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: To evaluate longitudinal patient-oriented outcomes in peripheral neuropathy over a 14-year time period including time before and after diagnosis. The 1996-2007 Health and Retirement Study (HRS)-Medicare Claims linked database identified incident peripheral neuropathy cases (ICD-9 codes) in patients ≥65 years. Using detailed demographic information from the HRS and Medicare claims, a propensity score method identified a matched control group without neuropathy. Patient-oriented outcomes, with an emphasis on self-reported falls, pain, and self-rated health (HRS interview), were determined before and after neuropathy diagnosis. Generalized estimating equations were used to assess differences in longitudinal outcomes between cases and controls. We identified 953 peripheral neuropathy cases and 953 propensity-matched controls. The mean (SD) age was 77.4 (6.7) years for cases, 76.9 (6.6) years for controls, and 42.1% had diabetes. Differences were detected in falls 3.0 years before neuropathy diagnosis (case vs control; 32% vs 25%, p = 0.008), 5.0 years for pain (36% vs 27%, p = 0.002), and 5.0 years for good to excellent self-rated health (61% vs 74%, p < 0.0001). Over time, the proportion of fallers increased more rapidly in neuropathy cases compared to controls (p = 0.002), but no differences in pain (p = 0.08) or self-rated health (p = 0.9) were observed. In older persons, differences in falls, pain, and self-rated health can be detected 3-5 years prior to peripheral neuropathy diagnosis, but only falls deteriorates more rapidly over time in neuropathy cases compared to controls. Interventions to improve early peripheral neuropathy detection are needed, and future clinical trials should incorporate falls as a key patient-oriented outcome. © 2015 American Academy of Neurology.
    Neurology 05/2015; DOI:10.1212/WNL.0000000000001714 · 8.30 Impact Factor
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    ABSTRACT: Little is known about how neurology payments vary by service type (i.e., evaluation and management [E/M] vs tests/treatments) and compare to other specialties, yet this information is necessary to help neurology define its position on proposed payment reform. Medicare Provider Utilization and Payment Data from 2012 were used. These data included all direct payments to providers who care for fee-for-service Medicare recipients. Total payment was determined by medical specialty and for various services (e.g., E/M, EEG, electromyography/nerve conduction studies, polysomnography) within neurology. Payment and proportion of services were then calculated across neurologists' payment categories. Neurologists comprised 1.5% (12,317) of individual providers who received Medicare payments and were paid $1.15 billion by Medicare in 2012. Sixty percent ($686 million) of the Medicare payment to neurologists was for E/M, which was a lower proportion than primary providers (approximately 85%) and higher than surgical subspecialties (range 9%-51%). The median neurologist received nearly 75% of their payments from E/M. Two-thirds of neurologists received 60% or more of their payment from E/M services and over 20% received all of their payment from E/M services. Neurologists in the highest payment category performed more services, of which a lower proportion were E/M, and performed at a facility, compared to neurologists in lower payment categories. E/M is the dominant source of payment to the majority of neurologists and should be prioritized by neurology in payment restructuring efforts. © 2015 American Academy of Neurology.
    Neurology 04/2015; 84(17). DOI:10.1212/WNL.0000000000001515 · 8.30 Impact Factor
  • Kevin A. Kerber
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    ABSTRACT: Benign paroxysmal positional vertigo (BPPV) presentations are unique opportunities to simultaneously improve the effectiveness and efficiency of care. The test and treatment for BPPV-the Dix-Hallpike test (DHT) and the canalith repositioning maneuver (CRM), respectively-are supported by two evidence-based guidelines (American Academy of Otolaryngology-Head and Neck Surgery and American Academy of Neurology). With these processes, patients can be readily identified and treated at the bedside, quickly and without expensive tests. Patients randomized to the CRM have a cure rate of 80% at 24 h, compared to only 10% of controls. Despite this large effect size, less than 10% of affected patients receive the treatment, which shows that the management of BPPV in routine care is suboptimal. Future research is necessary to disseminate and implement the DHT and the CRM into routine practice. © 2015 New York Academy of Sciences.
    Annals of the New York Academy of Sciences 03/2015; 1343(1). DOI:10.1111/nyas.12721 · 4.31 Impact Factor
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    ABSTRACT: The aim of this article is to determine the patient-level factors associated with headache neuroimaging in outpatient practice. Using data from the 2007-2010 National Ambulatory Medical Care Surveys (NAMCS), we estimated headache neuroimaging utilization (cross-sectional). Multivariable logistic regression was used to explore associations between patient-level factors and neuroimaging utilization. A Markov model with Monte Carlo simulation was used to estimate neuroimaging utilization over time at the individual patient level. Migraine diagnoses (OR = 0.6, 95% CI 0.4-0.9) and chronic headaches (routine, chronic OR = 0.3, 95% CI 0.2-0.6; flare-up, chronic OR = 0.5, 95% CI 0.3-0.96) were associated with lower utilization, but even in these populations neuroimaging was ordered frequently. Red flags for intracranial pathology did not increase use of neuroimaging studies (OR = 1.4, 95% CI 0.95-2.2). Neurologist visits (OR = 1.7, 95% CI 0.99-2.9) and first visits to a practice (OR = 3.2, 95% CI 1.4-7.4) were associated with increased imaging. A patient with new migraine headaches has a 39% (95% CI 24-54%) chance of receiving a neuroimaging study after five years and a patient with a flare-up of chronic headaches has a 51% (32-68%) chance. Neuroimaging is routinely ordered in outpatient headache patients including populations where guidelines specifically recommend against their use (migraines, chronic headaches, no red flags). © International Headache Society 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.
    Cephalalgia 02/2015; DOI:10.1177/0333102415572918 · 4.12 Impact Factor
  • Brian C Callaghan, Kevin A Kerber, James F Burke
    JAMA Internal Medicine 02/2015; 175(2):313-4. DOI:10.1001/jamainternmed.2014.7014 · 13.25 Impact Factor
  • Journal of Neurology Neurosurgery & Psychiatry 01/2015; DOI:10.1136/jnnp-2014-307575 · 5.58 Impact Factor
  • 43rd Annual Meeting of the Child-Neurology-Society; 10/2014
  • 43rd Annual Meeting of the Child-Neurology-Society; 10/2014
  • 43rd Annual Meeting of the Child-Neurology-Society; 10/2014
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    ABSTRACT: Objectives: To determine whether the Centers for Medicare & Medicaid Services (CMS) Physician Fee Schedule confers higher value for physician work in procedure and test codes than in Evaluation and Management (E/M) codes. Background: Medicare Payment Advisory Commission previously demonstrated that time for medical services is the dominant element in valuing physician work in the CMS Physician Fee Schedule. In contrast, a more recent analysis suggests that more relative value units (RVUs) per unit time are issued for work in procedure codes than in E/M codes. Both prior analyses had important limitations for evaluating a possible systematic differential valuation of medical services. Methods: Data regarding RVUs, physician work times (minutes), and claims were obtained for all active level I Current Procedural Terminology (CPT) codes from 2011 CMS files. Linear regression was used to assess the associations of work time components and CPT category with work RVUs, including a model that weighted codes by the number of claims. Results: Included in the analysis were 6522 CPT codes (87 E/M codes, 6435 procedure/test codes). Compared with E/M codes, procedure/test codes did not have a significant difference in work RVUs adjusting for time (-0.631; 95% confidence interval, -1.427 to 0.166). The analysis also did not indicate a work RVU advantage specifically for Surgical CPT codes compared with E/M adjusting for time (-0.760; 95% confidence interval, -1.560 to 0.040). This pattern was not altered after weighting codes by the number of claims, indicating that an increase in RVUs per minute was not concentrated in a small number of highly utilized procedure codes. Conclusions: We did not find evidence of a systematic higher valuation of physician work in procedure /test codes than in E/M codes in the CMS RVU system.
    Annals of Surgery 09/2014; DOI:10.1097/SLA.0000000000000990 · 7.19 Impact Factor
  • Annals of Neurology 09/2014; DOI:10.1002/ana.24280 · 11.91 Impact Factor
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    ABSTRACT: Background and Purpose-Mexican Americans (MAs) were previously found to have lower mortality after ischemic stroke than non-Hispanic whites. We studied mortality trends in a population-based design. Methods-Active and passive surveillance were used to find all ischemic stroke cases from January 2000 to December 2011 in Nueces County, TX. Deaths were ascertained from the Texas Department of Health through December 31, 2012. Cumulative 30-day and 1-year mortality adjusted for covariates was estimated using log-binomial models with a linear term for year of stroke onset used to model time trends. Models used data from the entire study period to estimate adjusted mortality among stroke cases in 2000 and 2011 and to calculate projected ethnic differences. Results-There were 1974 ischemic strokes among non-Hispanic whites and 2439 among MAs. Between 2000 and 2011, model estimated mortality declined among non-Hispanic whites at 30 days (7.6% to 5.6%; P=0.24) and 1 year (20.8% to 15.5%; P=0.02). Among MAs, 30-day model estimated mortality remained stagnant at 5.1% to 5.2% (P=0.92), and a slight decline from 17.4% to 15.3% was observed for 1-year mortality (P=0.26). Although ethnic differences in 30-day (P=0.01) and 1-year (P=0.06) mortality were apparent in 2000, they were not so in 2011 (30-day mortality, P=0.63; 1-year mortality, P=0.92). Conclusions-Overall, mortality after ischemic stroke has declined in the past decade, although significant declines were only observed for non-Hispanic whites and not MAs at 1 year. The survival advantage previously documented among MAs vanished by 2011. Renewed stroke prevention and treatment efforts for MAs are needed.
    Stroke 07/2014; 45(9). DOI:10.1161/STROKEAHA.114.005429 · 6.02 Impact Factor
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    ABSTRACT: Distal symmetric polyneuropathy (DSP) is a prevalent condition that results in high costs from diagnostic testing. However, the role of neurologists and diagnostic tests in patient care is unknown.
    JAMA Neurology 07/2014; 71(9). DOI:10.1001/jamaneurol.2014.1279 · 7.01 Impact Factor
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    ABSTRACT: Background and Purpose-Poststroke rehabilitation is associated with improved outcomes. Medicaid coverage of inpatient rehabilitation facility (IRF) admissions varies by state. We explored the role of state Medicaid IRF coverage on IRF utilization among patients with stroke. Methods-Working age ischemic stroke patients with Medicaid were identified from the 2010 Nationwide Inpatient Sample. Medicaid coverage of IRFs (yes versus no) was ascertained. Primary outcome was discharge to IRF (versus other discharge destinations). We fit a logistic regression model that included patient demographics, Medicaid coverage, comorbidities, length of stay, tissue-type plasminogen activator use, state Medicaid IRF coverage, and the interaction between patient Medicaid status and state Medicaid IRF coverage while accounting for hospital clustering. Results-Medicaid did not cover IRFs in 4 (TN, TX, SC, WV) of 42 states. The impact of State Medicaid IRF coverage was limited to Medicaid stroke patients (P for interaction <0.01). Compared with Medicaid stroke patients in states with Medicaid IRF coverage, Medicaid stroke patients hospitalized in states without Medicaid IRF coverage were less likely to be discharged to an IRF of 11.6% (95% confidence interval, 8.5%-14.7%) versus 19.5% (95% confidence interval, 18.3%-20.8%), P<0.01 after full adjustment. Conclusions-State Medicaid coverage of IRFs is associated with IRF utilization among stroke patients with Medicaid. Given the increasing stroke incidence among the working age and Medicaid expansion under the Affordable Care Act, careful attention to state Medicaid policy for poststroke rehabilitation and analysis of its effects on stroke outcome disparities are warranted.
    Stroke 07/2014; 45(8). DOI:10.1161/STROKEAHA.114.005882 · 6.02 Impact Factor
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    ABSTRACT: Studies suggest that dying at home is a more favorable experience. This study investigated where amyotrophic lateral sclerosis (ALS) patients die and the patient demographics associated with dying in an acute care facility or nursing home compared to home or hospice. Centers for Disease Control and Prevention Multiple Cause Mortality Files from 2005 to 2010 were used to identify ALS patients and to classify place of death. Multinomial logistic regression was used to determine the association between patient demographics and place of death. Between 2005 and 2010, 40,911 patients died of ALS in the United States. Place of death was as follows: home or hospice facility 20,231 (50%), acute care facility (25%), and nursing home (20%). African Americans (adjusted multinomial odds ratio (aMOR) 2.56, CI 2.32-2.83), Hispanics (aMOR 1.44, CI 1.30-1.62), and Asians (aMOR 1.87, CI 1.57-2.22) were more likely to die in an acute care facility, whereas females (aMOR 0.76, CI 0.72-0.80) and married individuals were less likely. Hispanics (aMOR 0.68, CI 0.58-0.79) and married individuals were less likely to die in a nursing home. In conclusion, minorities, men, and unmarried individuals are more likely to die in an acute care facility. Further studies are needed to better understand place of death preferences.
    Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration 06/2014; 15(5-6):1-4. DOI:10.3109/21678421.2014.924143 · 2.59 Impact Factor
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    ABSTRACT: Background: Association between cerebral infarction site and poststroke sleep-disordered breathing (SDB) has important implications for SDB screening and the pathophysiology of poststroke SDB. Within a large, population-based study, we assessed whether brainstem infarction location is associated with SDB presence and severity. Methods: Cross-sectional study was conducted on ischemic stroke patients in the Brain Attack Surveillance in Corpus Christi (BASIC) project. Subjects underwent SDB screening (median 13 days after stroke) with a well-validated cardiopulmonary sleep apnea-testing device (n = 355). Acute infarction location was determined based on review of radiology reports and dichotomized into brainstem involvement or none. Logistic and linear regression models were used to test the associations between brainstem involvement and SDB or apnea/hypopnea index (AHI) in unadjusted and adjusted models. Results: A total of 38 participants (11%) had acute infarction involving the brainstem. Of those without brainstem infarction, 59% had significant SDB (AHI >= 10); the median AHI was 13 (interquartile range (IQR) 6,26). Of those with brainstem infarction, 84% had SDB; median AHI was 20 (IQR 11,38). In unadjusted analysis, brainstem involvement was associated with over three times the odds of SDB (odds ratio (OR) 3.71 (95% confidence interval (Cl): 1.52, 9.13)). In a multivariable model, adjusted for demographics, body mass index (BMI), hypertension, diabetes, coronary artery disease, atrial fibrillation, prior stroke/transient ischemic attack (TIA), and stroke severity, results were similar (OR 3.76 (95% CI: 1.44, 9.81)). Brainstem infarction was also associated with AHI (continuous) in unadjusted (p = 0.004) and adjusted models (p = 0.004). Conclusions: Data from this population-based stroke study show that acute infarction involving the brainstem is associated with both presence and severity of SDB.
    Sleep Medicine 05/2014; 15(8). DOI:10.1016/j.sleep.2014.04.003 · 3.10 Impact Factor
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    ABSTRACT: Objective: Acute stroke is a serious concern in Emergency Department (ED) dizziness presentations. Prior studies, however, suggest that stroke is actually an unlikely cause of these presentations. Lacking are data on short- and long-term follow-up from population-based studies to establish stroke risk after presumed non-stroke ED dizziness presentations.Methods: From 5/8/2011 to 5/7/2012, patients ≥ 45 years of age presenting to EDs in Nueces County, Texas, with dizziness, vertigo, or imbalance were identified, excluding those with stroke as the initial diagnosis. Stroke events after the ED presentation up to 10/2/2012 were determined using the Brain Attack Surveillance in Corpus Christi (BASIC) study, which uses rigorous surveillance and neurologist validation. Cumulative stroke risk was calculated using Kaplan-Meier estimates.Results: 1,245 patients were followed for a median of 347 days (IQR 230- 436 days). Median age was 61.9 years (IQR, 53.8-74.0 years). After the ED visit, fifteen patients (1.2%) had a stroke. Stroke risk was 0.48% (95% CI, 0.22%-1.07%) at 2 days; 0.48% (95% CI, 0.22%-1.07%) at 7 days; 0.56% (95% CI, 0.27%-1.18%) at 30 days; 0.56% (95% CI, 0.27%-1.18%) at 90 days; and 1.42% (95% CI, 0.85%-2.36%) at 12 months.Interpretation: Using rigorous case ascertainment and outcome assessment in a population-based design, we found that the risk of stroke after presumed non-stroke ED dizziness presentations is very low, supporting a non-stroke etiology to the overwhelming majority of original events. High-risk subgroups likely exist, however, because most of the 90-day stroke risk occurred within 2-days. Vascular risk stratification was insufficient to identify these cases. ANN NEUROL 2014. © 2014 American Neurological Association
    Annals of Neurology 05/2014; 75(6). DOI:10.1002/ana.24172 · 11.91 Impact Factor
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    ABSTRACT: Objective: Dizziness is a common reason patients present to doctors, but effective diagnostic tests and treatments for dizziness are underused. The internet is a way to disseminate medical information and is emerging as an intervention platform. The objective of this study was to describe internet searches for dizziness terms to assess the possible consumer demand for internet-based dizziness diagnostic and treatment tools.Study Design/Methods: Google AdWords and Google Insights for Search were used for keyword search data on the following generic terms: vertigo, dizzy, dizziness, lightheaded, and lightheadedness. Data collected included keyword ideas (i.e., additional keywords identified by Google as being related search terms), global and US only monthly search frequencies, as well as trends in top searches related to dizziness terms from 2004 to 2012. Keywords suggestive of benign paroxysmal positional vertigo (BPPV) or BPPV processes were identified.Results: Of the five generic dizziness terms, vertigo had the most global searches per month (1.83 million) and lightheadedness had the least (90,500). Four BPPV-specific terms had more than 100,000 global searches per month. Three BPPV terms (“positional vertigo,” “benign vertigo,” and “benign positional vertigo”) have been in the list of top searches related to vertigo every quarter since 2004.Conclusion: Substantial demand exists for dizziness information via the internet. Future studies should seek to better characterize the population seeking this information. The magnitude of this potential demand suggests that validated and tested diagnostic and treatment tools could contribute to healthcare efficiencies and patient outcomes.
    Frontiers in Neurology 04/2014; 5:50. DOI:10.3389/fneur.2014.00050
  • JAMA Internal Medicine 03/2014; 174(5). DOI:10.1001/jamainternmed.2014.173 · 13.25 Impact Factor
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    ABSTRACT: <0.01). After adjustment for demographics, stroke severity, and stroke and mortality risk factors, the relationship between BMI and mortality was U shaped. The lowest mortality risk was observed among patients with an approximate BMI of 35 kg/m(2), whereas those with lower or higher BMI had higher mortality risk.Conclusions-Severe obesity is associated with increased poststroke mortality in middle-aged and older adults. Stroke patients with class 2 obesity had the lowest mortality risk. More research is needed to determine weight management goals among stroke survivors.
    Circulation Cardiovascular Quality and Outcomes 12/2013; 7(1). DOI:10.1161/CIRCOUTCOMES.113.000129 · 5.04 Impact Factor

Publication Stats

557 Citations
357.31 Total Impact Points

Institutions

  • 2006–2015
    • University of Michigan
      • • Department of Emergency Medicine
      • • Department of Health Management & Policy
      • • Department of Neurology
      Ann Arbor, Michigan, United States
  • 2014
    • Henry Ford Hospital
      Detroit, Michigan, United States
  • 2006–2014
    • Concordia University–Ann Arbor
      Ann Arbor, Michigan, United States
  • 2011
    • Universitätsklinikum Schleswig - Holstein
      Kiel, Schleswig-Holstein, Germany
  • 2005–2011
    • University of California, Los Angeles
      • • Department of Neurology
      • • Department of Head and Neck Surgery
      Los Ángeles, California, United States
  • 2005–2006
    • Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center
      • Department of Medicine
      Torrance, California, United States