Commentary Archives for August 2011
Use of Cancer Drugs in Medicare
Two reports from the Agency for Healthcare Research & Quality detail the use of expensive cancer biologics for Medicare beneficiaries. As for other payers, Medicare expenditures on these compounds has increased rapidly, often for off-label use.
Physician Pay-for-Performance Programs
A paper from the National Bureau of Economic Research examines the effect of a physician pay-for-performance program in Canada. The study found very limited effects of the incentives in spurring greater delivery of the care which was incented.
Are Readmissions Really an Indicator of Poor Quality?
CMS currently intends to implement its readmissions penalty/incentive program in a manner that may not truly distinguish between good and poor quality at hospitals, according to recent research in Canada which finds no correlation between overall readmission rates and inappropriate readmissions.
2011 Potpourri XXXIII
Summer begins to wane but our Potpourri remains hot, with items on large employers benefit intentions for 2012, Australia’s project to create a unified patient medical record, hospital collections at the point-of-service, physician compensation, trends in per capita medical costs and how to avoid issues in accountable care organizations.
Kaiser Health News
On Tuesday, the Department of Health and Human Services unveiled a Medicare pilot program that will pay participating hospitals, doctors and other health providers one, “bundled,” payment to treat a patient for a single episode of care.
Shared Decision Making
A report from The King’s Fund articulates the benefits of shared decision-making and provides a detailed roadmap for how to effectively implement its use more widely. A great deal of work on creating decision aids and training providers needs to be done.
Hospital Employment of Physicians
An issue brief from the Center for Studying Health System Change reviews the potential effects of increasing employment of physicians by hospitals. While there may be benefits in terms of greater care integration, the trend also will likely drive up spending.
Socioeconomic Status and Health
It is often observed that more financially well-off persons tend to have better health than their poorer counterparts. Teasing out whether this is correlation or causality that runs in one direction or the other has been difficult. A new NBER paper attempts to answer this question.
Physician Malpractice Risk
Malpractice and tort reform are politically controversial and there is uncertainty about how much malpractice litigation there is and how it affects medical practice. An article in the New England Journal of Medicine attempts to shed further light on the subject.
2011 Potpourri XXXII
Our thirty-second Potpourri of the year brings fascinating health items such as how to design wellness incentives, how Medicare could save money, the complexities of improving care, the use of community health centers to save money, designing subjective survey questions and an intervention to reduce hospital readmissions.
Review of Care Management Research
The Agency for Healthcare Research & Quality released a report on the Comparative Effectiveness of Case Management for Adults with Medical Illness and Complex Care Needs. This metareview found limited evidence for positive effects of any care management intervention.
Towers Watson, NBGH Survey on Value in Health Spending
Towers Watson and the National Business Group on Health released their latest Employer Survey on Purchasing Value in Health, which delineates actions being taken by many employers to try to limit health spending, while ensuring that employees receive good quality care.
PPACA Projection Accuracy
An NBER paper analyzes the accuracy of the CBO projections of the enrollment, insurance cost and health spending effects of the PPACA, using the similar Massachusetts reforms as a case study. The paper concludes that the projections are likely conservative, but the author is not likely to be unbiased and he ignores the last two years of experience in Massachusetts.
GAO on CMS’ Physician Feedback Reports
In the last couple of years CMS has begun providing feedback reports to physicians treating Medicare beneficiaries. A Government Accounting Office Report underlines the challenges CMS has had implementing the program and making it likely to affect physician behavior.
2011 Potpourri XXXI
Mercer issued a release on its survey of employers regarding issues relating to the reform law. Among the findings are that employers have already seen a 2% enrollment jump due to having to cover children up to age 26, and that over 40% of employers expect the full implementation of the law to raise their [...]
Geographic Variation in Commercial Health Spending
A new report from Thomson Reuters examines geographic differences in health spending among a commercially insured population. While there is significant variation among areas, the pattern is different from that found by analyses based on the Medicare population and changes among regions based on type of spending and age.
Effect of Changes in Medigap Insurance
Most seniors tend to purchase Medigap or Medicare Supplement insurance, which mutes the effect of Medicare’s cost-sharing provisions, potentially increasing utilization and costs for the program. A Kaiser brief examines the effect of proposed changes in permissible Medigap benefit structures.
Physician Administrative Costs
A study reported in Health Affairs finds that American physicians spend much more time at a much higher cost interacting with insurers than do Canadian physicians, who only have to deal with a single-payer system. The data, however, is based on surveys and uses somewhat dated cost comparisons.
Hospital Pricing Behavior and Market Characteristics
Further evidence that hospitals with market power raise prices almost at will and disregard opportunities to cut costs is provided by research reported in Health Affairs. Hospitals in concentrated markets have enormous margins on their private insurers payments.
2011 Potpourri XXX
This week’s Potpourri features dropped malpractice claims, the quality benefits of EHRs, improper Medicare payments, health insurer customer satisfaction, the utilization and cost effects of using hospitalists, and determining if a patient has decision-making capacity.
Part D’s Effect on Overall Spending
Research published in the Journal of the American Medical Association finds that the onset of Part D prescription drug coverage helped reduce relative non-drug spending for those beneficiaries who previously had limited drug coverage.
GAO on the Value of Health Spending
The Government Accounting Office examined various interventions designed to improve the quality of health care and/or lower costs and analyzed the strength of the evidence supporting the effect of the intervention. In general, not many interventions have high-quality research results to support efficacy.
LA Times
Nearly 18 months after passage of the national healthcare overhaul, American employers say they are providing health benefits for growing numbers of people as they extend coverage to their workers’ adult children
HealthLeaders Media
Cogent HMG, the nation’s largest private hospitalist provider, announced that it has acquired The Intensivist Group, a Lake Zurich, IL-based provider of hospital critical care services.
Latest National Health Spending Projections
Projections of national health expenditures through 2010 show a continued relentless upward trend, at a rate faster than GDP growth; with spending reaching 20% of GDP by the end of the projection period and government accounting for half of the payments.
Risk-Bearing by Providers
A recent report from the Commonwealth Fund describes the status of plans to have accountable care organizations and other provider systems take on financial risk for their patients, finding that there is a gap between the plans and the providers capabilities to manage the risk.