Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #105699

A. James Lee, PhD, Schneider Institute for Health Policy, Brandeis University, 415 South Street, Waltham, MA 02454, 978-937-7711, jimlee@brandeis.edu, D. S. Shepard, PhD, Schneider Institute for Health Policy, Heller School, Brandeis University, 415 South Street, MS 035, Waltham, MA 02454-9110, Sarita Malik Bhalotra, MD, PhD, Schneider Institute for Health Policy, Heller School, Brandeis University, 415 South Street, MS 035, Waltham, MA 02454, and William B. Stason, MD, Schneider Institute for Health Policy, Heller School for Social Policy and Management, Brandeis University, MS 035, 415 South Street, Waltham, MA 02454.

The Centers for Medicare & Medicaid Services (CMS) contracted with Brandeis University to evaluate the Medicare Lifestyle Modification Program Demonstration consisting of Dr. Dean Ornish's Program for Reversing Heart Disease (Ornish) and Dr. Herb Benson's Mind/Body Medical Institute (MB). In evaluating these programs, we are concerned not only with health status changes and possible cost offsets, but also with measuring the costs of the interventions themselves. Whatever the program benefits, if the Medicare reimbursement level is not adequate to pay the “steady state” program costs, the programs themselves may not prove viable in the long run.

We sought to measure or estimate what the programs would cost when reasonably mature. Since some Demonstration programs were operating below capacity, we sought to model or simulate the program costs when operated at planned enrollment levels.

We have developed resource cost models for five program sites: two Ornish programs and three MB programs. One of the Ornish sites also operated a traditional cardiac rehabilitation program (CR) and we analogously developed a resource cost model for this program.

The pattern of site-specific estimates strongly suggests that Ornish programs are inherently more costly than MB programs. We estimate that the Ornish program, when operated at capacity, costs almost three times as much per beneficiary as the MB program—an average of $10,353 per beneficiary (including overhead) in the two Ornish programs, compared to an average of just $3,656 per beneficiary in the three MB programs. The cost per class-hour are actually quite similar across most programs—$50 and $49 per class-hour in the two Ornish programs, compared to$45 and $48 per class-hour in two of the three MB programs. The Ornish program costs substantially more due to its higher number of classes per participant and longer class length—a total of 200 class-hours per participant in the Ornish program vs. 93 class-hours in the MB program.

We estimate that the one hospital's traditional CR program costs just $1,359 per Medicare beneficiary, compared to $10,710 per beneficiary for the hospital's Ornish program. Thus, for what it costs to send one beneficiary through its Ornish program, Medicare could pay for nearly eight beneficiaries to go through the same hospital's traditional CR program.

Our findings underscore the importance of determining the comparative benefits and costs of the innovative, more comprehensive approaches to lifestyle modification being tested in this Demonstration.

Learning Objectives:

• Discuss the comparative efficacy of alternative cardiac rehabilitation approaches, and recognize the value of resource cost modeling.

Keywords: Cost Issues, Cardiorespiratory

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.

Recorded presentation