Danny R. Hughes

Professor, Dir. Health Economics Analytics Lab

Member Of:
  • School of Economics
  • Health Economics and Analytics Lab

Overview

Dr. Hughes is a Professor in the School of Economics and Director of Georgia Tech’s Health Economics and Analytics Lab (HEAL). He also serves as an Adjunct Professor in Emory University School of Medicine's Department of Radiology and Imaging Sciences. His research focuses on the roles of technology, innovation, and incentives in the delivery and usage of health care services – with a specific focus on the economics of medical imaging. His externally funded research has focused on exploiting large scale data to explore contemporary health policy issues. He has published over 100 articles in leading journals across economics, health services research, and operations research.

Prior to Georgia Tech, Dr. Hughes served as Executive Director of the Harvey L. Neiman Health Policy Institute. He has held previous academic appointments at George Mason University, the University of Oklahoma, and the University of South Alabama. Dr. Hughes has also held research and management positions at the American College of Radiology, Logistics Management Institute, and Tecolote Research. Prior to his undergraduate studies, he served as a Nuclear, Biological, and Chemical Operations Specialist in the United States Army.

 

 

Education:
  • Ph.D. Economics, University of Georgia
  • B.S. Economics, Georgia Institute of Technology
Research Fields:
  • Applied Econometrics
  • Applied Microeconomics
  • Health Economics
  • Industrial Organization
Courses Taught:
  • ECON-6140: Probability & Statistics
  • ECON-6150: Cost Benefit Analysis
  • ECON-6510: Health Economics

Selected Publications

Journal Articles

  • Nationwide Trends in Utilization of Catheter-Directed Therapy of Pulmonary Embolism Among Medicare Beneficiaries from 2004-2016
    In: Journal of Vascular and Interventional Radiology [Peer Reviewed]
    Date: June 2019

    Purpose: To evaluate changes in the use of catheter-directed therapy (CDT) for pulmonary embolism (PE) treatment with attention to primary operator specialty in the Medicare population. 

    Methods: Using a 5% national sample of Medicare claims data from 2004 to 2016, all claims associated with PE were identified. The annual volume of 2 billable CDT services--arterial mechanical thrombectomy and transcatheter arterial infusion for thrombolysis-- were determined to evaluate changes in CDT use and primary CDT operator specialty over time. 

    Results: The total number of CDT procedures increased over the course of the study period, representing 0.457 and 5.057 service counts per 100,000 Medicare beneficiaries in 2004 and 2016, respectively. The proportion of PEs treated with CDT increased 10-fold from 2004 to 2016, increasing from 0.1% to 1.0%. Interventional radiologists performed most CDT therapies each year, with the exception of 2010 when vascular surgeons performed more. In 2016, interventional radiologists performed 3.54 CDT services for PE per 100,000 Medicare beneficiaries, which was 70% of total CDT for PE procedures, followed by interventional cardiologists and vascular surgeons performing 0.92 services (18%) and 0.60 services (12%), respectively.

    Conclusions: CDT is an increasingly used treatment for PE, with a 10-fold increase from 2004 to 2016. Interventional radiologists are the dominant providers of these services, followed by interventional cardiologists and vascular surgeons.

    View All Details about Nationwide Trends in Utilization of Catheter-Directed Therapy of Pulmonary Embolism Among Medicare Beneficiaries from 2004-2016

  • Bundled Payment Models for Breast Cancer Screening Including Tomosynthesis
    In: Journal of the American College of Radiology [Peer Reviewed]
    Date: January 2019

    Purpose: Bundled payments have been touted as mechanisms to optimize quality and costs. A recent feasibility study evaluating bundled payments for screening mammography episodes predated widespread adoption of digital breast tomosynthesis (DBT). We explore a similar model reflecting emerging acceptance of DBT in breast cancer screening.

    Methods: Using 4-year data for 59,094 screening episodes from two large facilities within a large academic health system, we utilized published methodology to calibrate Medicare national allowable reference prices for women undergoing screening mammography before and after practice-wide implementation of DBT.

    Results: Excluding DBT, Medicare-normalized bundled prices for traditional breast imaging 364 days downstream to screening mammography are extremely similar pre- and post-DBT implementation ($182.86 in 2013; $182.68 in 2015). The addition of DBT increased a DBT-inclusive bundled price by $53.16 (an amount lower than the $56.13 Medicare allowable fee for screening DBT) but was associated with significantly reduced recall rates (13.0% versus 9.4%; P < .0001). Without or with DBT, screening episode bundled prices remained sensitive to bundle-included services and varied little by patient age, race, or insurance status.

    Conclusions: Prior non-DBT approaches to bundled payment models for breast cancer screening remain viable as DBT becomes the standard of care, with bundle prices varying little by patient age, race, or insurance status. Higher DBT-inclusive bundled prices, however, highlight the need to explore societal costs more broadly (eg, reduced time away from work from fewer recalls) as bundled payment models evolve.

    View All Details about Bundled Payment Models for Breast Cancer Screening Including Tomosynthesis

  • Increasing Utilization of Chest Imaging in United States Emergency Departments from 1994 to 2015
    In: Journal of the American College of Radiology [Peer Reviewed]
    Date: January 2019

    Purpose: The aim of this study was to assess national and state-specific changes in emergency department (ED) chest imaging utilization from 1994 to 2015.

    Methods: Using aggregate 100% Medicare Physician/Supplier Procedure Summary Master Files for 1994 to 2015, the annual frequency of chest imaging in Medicare Part B beneficiaries in the ED setting was identified, and utilization was normalized to annual Medicare enrollment as well as annual ED visits. Using individual Medicare beneficiary 5% research-identifiable files, similar determinations were performed for each state.

    Results: Between 1994 and 2015, per 1,000 beneficiaries, ED utilization of chest radiography and CT increased by 173% (compound annual growth rate [CAGR] 4.9%) and 5,941.8% (CAGR 21.6%). Per 1,000 ED visits, utilization increased by 81% (CAGR 2.9%) and 3,915.4% (CAGR 19.2%), respectively. Across states, utilization was highly variable, with 2015 radiography utilization per 1,000 ED visits ranging from 82 (Wyoming) to 731 (Hawaii) and CT utilization ranging from 18 (Wyoming) to 76 (Hawaii). Between 2004 and 2015, most states demonstrated increases in the utilization of both radiography (maximal increase of CAGR 11.0% in Vermont) and CT (maximal increase of CAGR 21.0% in Maine). Nonetheless, utilization of radiography declined in four states and utilization of CT in a single state.

    Conclusions: Over the past two decades, ED utilization of chest imaging has increased. This was related not only to an increasing frequency of ED visits but also to increasing utilization per ED visit. Across states, utilization is highly variable, but with radiography and CT both increasing, the use of CT seems additive to, rather than replacing, radiography.

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  • Invasive Procedural vs. Diagnostic Imaging and Clinical Services Rendered by Radiology Trainees Over Two Decades
    In: Journal of the American College of Radiology [Peer Reviewed]
    Date: 2019

    Purpose: To characterize evolving radiology trainee exposure to invasive procedures.

    Methods: Using Physician/Supplier Procedure Summary Master Files from 1997 to 2016, we identified Medicare services performed by radiology trainees in approved programs by extracting information on services billed by diagnostic and interventional radiologists reported with "GC" modifiers. Services were categorized as (1) invasive procedures, (2) noninvasive diagnostic imaging services, or (3) clinical evaluation and management (E&M) services. Relative category trainee work effort was estimated using service-level work relative value units.

    Results: Nationally from 1997 to 2016, invasive procedures declined from 34.2% to 14.3% of relative work effort for all Medicare-billed radiology trainee services. Radiology trainees' noninvasive diagnostic imaging services increased from 65.1% to 85.4%. Clinical E&M services remained uniformly low (0.7%-0.3%). Diagnostic radiology (DR) and interventional radiology (IR) faculty-supervised 81.0% and 19.0%, respectively, of all trainee invasive procedures in 1997, versus 68.3% and 31.7%, respectively, in 2016. Despite declining relative procedural work, trainees were exposed to a wide range of both basic and complex invasive procedures in both 1997 and 2016. Over this period, trainee noninvasive diagnostic imaging services shifted away from radiography to CT and MRI.

    Conclusion: Radiology trainees' relative invasive procedural work effort has declined over time as their work increasingly focuses on CT and MRI. As DR and IR-DR residency curricula begin to diverge, it is critical that both DR and IR residents receive robust training in basic image-guided procedures to ensure broad patient access to these services.

    View All Details about Invasive Procedural vs. Diagnostic Imaging and Clinical Services Rendered by Radiology Trainees Over Two Decades

  • Management of Unruptured Intracranial Aneurysms in Older Adults: A Cost-Effectiveness Analysis
    In: Radiology [Peer Reviewed]
    Date: 2019

    Abstract: Routine treatment or frequent, indefinite imaging surveillance is not cost-effective in adults greater than 65 years old with unruptured intracranial aneurysms.

    Background: Unruptured intracranial aneurysms (UIAs) are relatively common and are being increasingly diagnosed, with a significant proportion in older patients (˃ 65 years old). Serial imaging is often performed to assess change in size or morphology of UIAs since growing aneurysms are known to be at high risk for rupture. However, the frequency and duration of surveillance imaging have not been established.

    Purpose: To evaluate the cost-effectiveness of routine treatment (aneurysm coil placement) versus four different strategies for imaging surveillance of UIAs in adults older than 65 years.

    Results: Imaging follow-up for the first 2 years after detection is the most cost-effective strategy (cost = $24 572, effectiveness = 13.73 QALYs), showing the lowest cost and highest effectiveness. The conclusion remains robust in probabilistic and one-way sensitivity analyses. Time-limited imaging follow-up remains the optimal strategy when the annual growth rate and rupture risk of growing aneurysms are varied. If annual rupture risk of nongrowing aneurysms is greater than 7.1%, coil placement should be performed directly.

    Conclusions: Routine preventive treatment or periodic, indefinite imaging follow-up is not a cost-effective strategy in all adults older than 65 years with unruptured intracranial aneurysms. More aggressive management strategies should be reserved for patients with high risk of rupture, such as those with aneurysms larger than 7 mm and those with aneurysms in the posterior circulation.

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  • State-Level Variation in Inferior Vena Cava Filter Utilization Across Medicare and Commercially Insured Populations
    In: American Journal of Roentgenology [Peer Reviewed]
    Date: 2019

    Objective: Recent research on inferior vena cava (IVC) filter utilization in the United States has largely focused on national aggregate Medicare datasets, showing recent declines. Whether these national Medicare trends are generalizable across regions and payer populations is unknown. We studied recent state-level variation in IVC filter utilization across both Medicare and private insurance populations.

    Results: Between 2009 and 2015, IVC filter utilization across the United States declined by 36.3% (from 177.9 to 113.3 procedures per 100,000 beneficiaries) in the Medicare population and by 26.6% (from 32.7 to 24.0 procedures per 100,000 beneficiaries) in the privately insured population. For the Medicare population, state-level utilization rates varied 5.2-fold, from 48.4 to 251.3 procedures per 100,000 beneficiaries in Alaska and New Jersey, respectively. For the private insurance population, rates varied 5.5-fold, from 10.8 to 59.5 procedures per 100,000 beneficiaries in Oregon and Michigan, respectively. Nationally, utilization in the Medicare population was 5.0 times higher than that in the private insurance population (range by state, from 2.0 times higher in Hawaii to 11.1 times higher in Utah). Despite the national decline, utilization in Medicare and private insurance populations increased in five and seven states, respectively. State-level IVC filter utilization rates for the Medicare population correlated strongly with those for the privately insured population (r = 0.74; p < 0.001). In both the Medicare and privately insured populations, utilization rates correlated moderately with beneficiary age (r = 0.44 and r = 0.50, respectively; p < 0.001 for both).

    Conclusion: IVC filter utilization rates vary dramatically by state and payer population, and they likely depend in part on the age of the covered population. To better identify demographic and socioeconomic drivers of utilization, future research should prioritize nonaggregate multipayer claims-level approaches.

     

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  • Transcatheter Dialysis Conduit Procedures: Changing National and State-Level Medicare Utilization Patterns Over 15 Years
    In: Journal of Vascular and Interventional Radiology [Peer Reviewed]
    Date: 2019

    Purpose: To evaluate the changing use of transcatheter hemodialysis conduit procedures.

    Methods: Multiple Centers for Medicare & Medicaid Services datasets were used to assess hemodialysis conduit angiography. Use was normalized per 100,000 beneficiaries and stratified by specialty and site of service.

    Results: From 2001 to 2015, hemodialysis angiography use increased from 385 to 1,045 per 100,000 beneficiaries (compound annual growth rate [CAGR], +7.4%)]. Thrombectomy use increased from 114 to 168 (CAGR, +2.8%). Angiography and thrombectomy changed, by specialty, +1.5% and -1.3% for radiologists, +18.4% and +14.4% for surgeons, and +24.0% and +17.7% for nephrologists, respectively. By site, angiography and thrombectomy changed +29.1% and +20.7% for office settings and +0.8% and -2.4% for hospital settings, respectively. Radiologists' angiography and thrombectomy market shares decreased from 81.5% to 37.0% and from 84.2% to 47.3%, respectively. Angiography use showed the greatest growth for nephrologists in the office (from 5 to 265) and the greatest decline for radiologists in the hospital (299 to 205). Across states in 2015, there was marked variation in the use of angiography (0 [Wyoming] to 1173 [Georgia]) and thrombectomy (0 [6 states] to 275 [Rhode Island]). Radiologists' angiography and thrombectomy market shares decreased in 48 and 31 states, respectively, in some instances dramatically (eg, angiography in Nevada from 100.0% to 6.7%).

    Conclusions: Dialysis conduit angiography use has grown substantially, more so than thrombectomy. This growth has been accompanied by a drastic market shift from radiologists in hospitals to nephrologists and surgeons in offices. Despite wide geographic variability nationally, radiologists market share has declined in most states.

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  • The Effect of Medicare's Annual Wellness Visit on Preventive Care for the Elderly
    In: Preventive Medicine [Peer Reviewed]
    Date: 2018

    The study aim was to assess the effect of receiving an Annual Wellness Visit (AWV) between 2011 and 2013 on the annual rate of eight preventive services recommended for the Medicare population following the AWV. We used retrospective Medicare claims from 2009 to 2014 for a 5% national sample of fee-for-service beneficiaries in the United States. Propensity score-adjusted logistic regressions were performed to estimate the log odds of the probability of receiving the preventive services between beneficiaries who received AWVs during 2011-13 and those who did not during the same period. The average marginal effect was also reported. Among 845,318 patients who met the inclusion and exclusion criteria, 23% had an AWV in 2011-2013. In a propensity-matched sample of 381,934 patients, AWV participants are more likely to undergo subsequent preventive services within a year (adjusted odds ratio ranges from 1.46 (95% CI, 1.44, 1.49) to 2.43 (95% CI, 2.38, 2.49). The findings are consistent using secondary outcomes or with subgroups defined by baseline primary care provider visits or baseline preventive services. These analyses showed that AWV is associated with a significant increase in all the preventive services examined. As Healthy People 2020 has established a target goal to increase the proportion of older adults who receive a core set of clinical preventive services by 10%, AWV represents a promising opportunity to facilitate the delivery of preventive care for the elderly and to advance our knowledge about effective strategies for healthy aging.

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  • Utilization and Cost of Actinic Keratosis Destruction in the Medicare Part B fee-for-Service Population, 2007-2015
    In: JAMA Dermatology [Peer Reviewed]
    Date: 2018

    Importance: Actinic keratosis is prevalent and has the potential to progress to keratinocyte carcinoma. Changes in the use and costs of actinic keratosis treatment are not well understood in the aging population.

    Objective: To evaluate trends in the use and costs of actinic keratosis destruction in Medicare patients.

    Results: More than 35.6 million actinic keratosis lesions were treated in 2015, increasing from 29.7 million in 2007. Treated actinic keratosis lesions per 1000 beneficiaries increased from 917 in 2007 to 1051 in 2015, while mean inflation-adjusted payments per 1000 patients decreased from $11 749 to $10 942 owing to reimbursement cuts. The proportion of actinic keratosis lesions treated by independently billing nurse practitioners and physician assistants increased from 4.0% in 2007 to 13.5% in 2015.

    Conclusions and Relevance: This study’s findings suggest that actinic keratosis imposes continuously increasing levels of treatment burden in the Medicare fee-for-service population. Reimbursement decreases have been used to control rising costs of actinic keratosis treatment. Critical research may be warranted to optimize access to actinic keratosis treatment and value for prevention of keratinocyte carcinoma.

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