Michal Horný

• PhD, MSc
• Assistant Professor at University of Massachusetts Amherst

Health care price transparency aims to empower patients to make better-informed purchasing decisions. However, the prospective availability of patients’ out-of-pocket costs may lead to an increased rate of forgone care. The objective of this study was to examine whether obtaining a prospective out-of-pocket cost estimate is associated with the like...

Importance The Patient Protection and Affordable Care Act (ACA) eliminated out-of-pocket cost-sharing for recommended preventive care for most privately insured patients. However, patients seeking preventive care continue to face cost-sharing and administrative hurdles, including claim denials, which may exacerbate inequitable access to care. Obje...

Medical imaging, identified as a potential driver of unsustainable US health care spending growth, was subject to policies to reduce prices and use in low-value settings. Meanwhile, the Affordable Care Act increased access to preventive services—many involving imaging—for employer-sponsored insurance (ESI) beneficiaries. We used a large insurance c...

This Viewpoint proposes episode-based cost sharing as a way to prospectively guarantee out-of-pocket costs for patients while also preventing insurers from absorbing cost differentials created by unexpected complications of care.

Background Few studies have comprehensively compared health-related quality of life (HRQoL) between metastatic prostate cancer survivors, survivors with non-metastatic disease, and men without a cancer history. Methods We used the Surveillance, Epidemiology, and End Results-Medicare Health Outcomes Survey (SEER-MHOS) data linkage to identify men a...

Healthcare price transparency is an effort to inform patient decision-making, but also to decrease prices and their variation across healthcare systems for equivalent medical services. The initiative is meaningful only for medical services that are shoppable-such as imaging examinations-for which patients incur out-of-pocket costs. Therefore, sever...

Background: Shared decision-making is mandated for patients receiving primary prevention implantable cardioverter defibrillators (ICDs). Less attention has been paid to generator exchange decisions, although at the time of generator exchange, patients' risk of sudden cardiac death, risk of procedural complications, quality of life, or prognosis ma...

Objective: To determine the health care costs and utilization burden of pediatric feeding disorder after congenital heart surgery. Study design: A retrospective, population-based cohort study using claims data (2009-2018) was performed. Participants include patients aged 0-18 years who had undergone congenital heart surgery and were included in...

Background Recent advancements in the clinical management of metastatic prostate cancer include several costly therapies and diagnostic tests. The objective of this study was to provide updated information on the cost to payers attributable to metastatic prostate cancer among men aged 18 to 64 years with employer‐sponsored health plans and men aged...

The term “headache” is used for pain of the head. Pain can vary in location, frequency, severity, onset, associated symptoms, and response to treatment [1].

Objective Recent price transparency initiatives have considerable limitations notably due to the complexity of healthcare products. A single care encounter often consists of several services that may be performed by numerous clinicians and health care facilities that bill independently. Our objective was to describe the complexity in billing for no...

Background: Shared decision-making (SDM) is mandated for patients receiving primary prevention implantable cardioverter-defibrillators (ICD). Less attention has been paid to ICD generator exchange (GE) decisions. At the time of GE, patients’ risk of sudden cardiac death (SCD), risk of procedural complications, quality of life, or prognosis may have...

This cross-sectional study assesses how much monthly cost-sharing limits, as opposed to annual limits, could reduce out-of-pocket costs for commercially insured patients in the US.

Background: Recent increases in utilization of CT in patients presenting with trauma have raised concern of inappropriate imaging. The evolving utilization of CT for trauma evaluation may be impacted by injury severity. Objective: To explore patterns in utilization of chest and abdominopelvic CT among trauma-related emergency department (ED) visits...

30-day hospital readmission is a long standing medical problem that affects patients' morbidity and mortality and costs billions of dollars annually. Recently, machine learning models have been created to predict risk of inpatient readmission for patients with specific diseases, however no model exists to predict this risk across all patients. We d...

Demographic changes in the population are an understudied driving force of imaging utilization and associated spending. This study uses national databases to characterize variations in spending on medical imaging among individuals with primary or secondary employer-sponsored insurance. Spending on imaging generally increased with age until approxim...

Given the integral role of CT in patient care, the current global contrast media shortage creates profound and manifold patient care implications. We used a large insurance dataset to highlight examinations (abdominopelvic and chest CT), delivery settings (emergency department and outpatient hospital), and clinical indications (acute abdominopelvic...

Importance To improve health care price transparency and promote cost-conscious selection of health care organizations and practitioners, the Centers for Medicare & Medicaid Services (CMS) required that hospitals share payer-specific negotiated prices for selected shoppable health services by January 2021. While this regulation improves price trans...

Research Objective Despite the Affordable Care Act increasing access to health insurance for millions of previously uninsured Americans, underinsurance is a persistent problem. A key contributor to underinsurance is growing enrollment in high deductible health plans for those on the health insurance exchanges and in employer-sponsored health plans....

BACKGROUND. The volume of emergency department (ED) visits and the number of neuroimaging examinations have increased since the start of the century. Little is known about this growth in the commercially insured and Medicare Advantage populations. OBJECTIVE. The purpose of our study was to evaluate changing ED utilization of neuroimaging from 2007...

Purpose Clinical practice guidelines intended to reduce unnecessary cervical spine imaging have yielded mixed results. We aimed to assess evolving emergency department (ED) cervical spine imaging utilization in patients with trauma by injury severity. Methods Using 2009 to 2018 IBM MarketScan Commercial Databases, we identified ED trauma encounter...

Introduction The Affordable Care Act of 2010 mandated private health plans to fully cover the services recommended by the U.S. Preventive Services Task Force. In June 2016, the Task Force added computed tomography colonography to its list of recommended tests for colorectal cancer screening. This study evaluates the association among the updated re...

The distribution of out-of-pocket spending throughout the year is an important determinant of health care affordability that has received little attention. We used 2017 data from a large database of US commercial insurance claims to study the distribution of patient-level out-of-pocket spending throughout the year, highlighting potential hardship d...

Objective The primary objectives of this investigation were to evaluate the use of screening CT colonography (CTC) examinations by age comparing individuals of Medicare-eligible age to younger cohorts and to determine if the association between use of CTC and Medicare-eligible age varies by race. Although the Affordable Care Act requires commercial...

Purpose The aim of this study was to explore state-level relationships between the incidence and payout amounts for medical malpractice claims and Medicare imaging utilization and spending across the United States. Methods Using claims data from a 5% sample of Medicare beneficiaries for 2004 to 2016, annual state population-adjusted rates of imagi...

Importance: The risk of hematoma formation after rhytidectomy is gender associated and can lead to postoperative complications. The literature to help explain and elucidate the mechanism behind this gender-associated risk is poorly developed and requires further investigation. Objective: The objective of this study was to compare facial skin micro-...

The year 2019 featured extensive debates on transforming the United States multipayer health care system into a single-payer system. At a time when reimbursement structures are in flux and potential changes in government may affect health care, it is important for neuroradiologists to remain informed on how emerging policies may impact their practi...

Objective To assess the geographic dispersion of CT colonography (CTC) as well as differences in CTC utilization in rural versus urban areas in individuals with commercial insurance. Methods Claims data from approximately 18.5 million commercially insured individuals across the United States were used to determine CTC utilization based on geograph...

Purpose The aim of this study was to evaluate the contemporary use of procedural interventions to treat symptomatic uterine fibroids and assess associated health care system costs. Methods Using the IBM Watson MarketScan Commercial Claims and Encounters database for 2009 to 2015 and relevant International Classification of Diseases diagnosis codes...

Rationale and objectives: To evaluate the clinical yield of routine chest radiography in identifying pneumothorax warranting chest tube decompression in patients undergoing ultrasound-guided thoracentesis. Materials and methods: All adult patients without pre-existing pneumothorax who underwent ultrasound-guided thoracentesis by a radiologist wi...

Objective: The objective was to develop a novel metric for quantifying patient-level utilization of emergency department (ED) imaging. Methods: Using 2009 to 2015 Truven Health MarketScan commercial claims and encounters database, all ED visits and associated imaging services were identified. To measure imaging resource intensity, total imaging...

The field of radiology has witnessed a burst of technological advances that improve diagnostic quality, reduce harm to patients, support clinical needs, and better serve larger more diverse patient populations. One of the critical challenges with these advances is proving that value outweighs the cost. The use of cutting-edge technology is often ex...

Objective: To investigate the value of co-formulated Tenofovir disoproxil fumarate and emtricitabine (TDF/FTC) for pre-exposure prophylaxis (PrEP) for conception in the U.S. and to identify scenarios in which "Undetectable = Untransmittable" (U = U) may not be adequate, and rather, PrEP or assisted reproduction would improve outcomes. Design: We...

Objective Otolaryngology residents face time‐management challenges between clinical duties and self‐directed learning. Mobile devices provide a new medium for education that could aid with educational efficiency. The objective of this study was to investigate whether spaced repetition mobile app use of an otolaryngology question bank was associated...

Background: Increased breast tissue density may mask cancer and thus decrease the diagnostic sensitivity of mammography. A patient group advocacy led to the implementation of laws to increase the awareness of breast tissue density and to improve access to supplemental imaging in many states. Given limited evidence about best practices, variation e...

Dense breast tissue is a common finding that decreases the sensitivity of mammography in detecting cancer. Many states have recently enacted dense breast notification (DBN) laws to provide patients with information to help them make better-informed decisions about their health. To test whether DBN legislation affected the probability of screening m...

Background/objective: The etiology and risk factors for angioedema remain poorly understood with causative triggers often going undiagnosed despite repeated reactions. The purpose of this study was to determine the relationship between inhalant allergen sensitization and angioedema. Methods: A retrospective review of patients who had in vitro in...

Background: Recent emphasis on value based care and population management, such as Accountable Care Organizations in the United States, promote patient navigation to improve the quality of care and reduce costs. Evidence supporting the efficacy of patient navigation for chronic disease care is limited. The objective of this study was to evaluate t...

Analysis of Dense Breast Tissue Notification Laws across states.

Objective: To assess what aspects of the breast density notification legislation impact the utilization of supplemental breast cancer testing via breast ultrasound and breast MRI. Conclusion: The breast density notification legislation increased the utilization of supplemental breast cancer testing, especially in states that mandated its insurance...

Objective: The aim of the study was to investigate whether the increase in utilization of advanced diagnostic imaging for privately insured patients in 2011 was the beginning of a new trend in imaging utilization growth, or an isolated deviation from the declining trend that began in 2008. Methods: We extracted outpatient and inpatient CT, diagn...

Although the value of interprofessional collaborative education has been promoted, it is unclear how teams of clinical and nonclinical learners perceive this experience. The authors studied an interprofessional quality improvement (QI) curriculum implemented in 2013 integrating internal medicine residents (n = 90) and Master of Public Health (MPH)...

To quantify changes in private insurance payments for and utilization of abdominal/pelvic computed tomography scans (CTs) after 2011 changes in CPT coding and Medicare reimbursement rates, which were designed to reduce costs stemming from misvalued procedures. TruvenHealth Analytics MarketScan Commercial Claims and Encounters database. We used diff...

Recent studies have reported that the rate of growth in utilization of noninvasive diagnostic imaging has slowed, with a concomitant reduction in total payments to providers in the Medicare Part B fee-for-service population. Utilization and payment growth trends in commercially insured populations, however, are not as well understood. We used the T...