Commentary Archives for August 2012
Physician Survey on Payers
A survey from Revive Health examined hospital perceptions of payers, and other issues. Wellpoint is rated worst, many independent Blue Cross plans do poorly as well and UnitedHealth Group, while not highly ranked, is showing improvement. Hospitals are pessimistic about reform but undertaking a number of incented initiatives like ACOs and greater use of HIT.
Financial Incentives for Providers
Are financial incentives for providers a good thing? A review in the British Medical Journal examines when financial incentives can be helpful in improving care and when they might actually lead to worse outcomes. The authors created a checklist designed to provide easy guidance on design and implementation of pay for performance type programs.
EHR Adoption
A report from the Centers for Disease Control updates information on rates of electronic health record adoption. Given the incentives from the federal government, adoption seems surprisingly slow and meaningful use lags even further behind. Most doctors report being satisfied with their system.
AON Employer Survey
AONHewitt has released its 2012 Health Care Survey, which largely reviews employer attitudes and actions toward health care coverage. The impacts of the health reform law are obviously foremost on companies’ agendas, with cost increases being the biggest challenge and one that is really unaddressed by the reform law.
2012 Potpourri XXVII
Yet another brilliant collection of health care data points, including use of gene profiling tests to guide breast cancer care, 30-day mortality models for stroke performance, hospital medication administration errors, the costs of the Medicare physician payment fix and patient-sharing networks among physicians.
Early Hospital Readmission Experience
The first year of experience with Medicare’s readmission program is in and Kaiser has done an initial analysis of the results. A large number of hospitals will be penalized, mostly those who can least afford it, and the program continues to show how poorly designed it is and what severe unintended consequences will ensue from its implementation.
Designing Internet Health Applications
Research published in the Journal of Medical Internet Research focuses on whether and why the use of online health applications improves patient empowerment and knowledge and if such improvement leads to better health outcomes.
Hospitals and ACOs
The Commonwealth Fund releases an Issue Brief describing the readiness or lack thereof among hospitals participating in accountable care organizations. As might be expected, handling financial risk is one of the biggest shortcomings, along with necessary information system infrastructure.
Retail Clinic Growth
An article from Rand Corporation researchers published in Health Affairs details the continued growth and use of retail clinics. These facilities offer a convenient and inexpensive method for consumers to access health care and offer an increasing menu of services.
2012 Potpourri XXVI
Another sunny Potpourri, brightening your day with rays of data on hospital at home; Medicare care coordination programs; an employer survey on impacts of the reform law; a survey on health habits and employee productivity; first quarter health plan results and ER use and end-of-life care.
Physician Participation in Government Health Plans
Health Affairs contains a survey regarding physicians’ acceptance of new Medicaid patients, which reveals that a significant fraction won’t accept new ones, largely because of low fees. The reform act attempts to ameliorate the issue, but likely will exacerbate it in the longer term.
KPMG on Health Care Transformation
KPMG releases a report on the ongoing transformation of the United States’ health care system, which affects payers, providers and patients. The firm gives its perspective on the forces driving the transformation and on what responses are needed by participants if they are to continue to be successful.
PWC on Health Care Customers’ Experience
The “consumer” is all the rage in health care and a new report form PWC examines the customer experience and how to improve it, based on expectations in other industries and surveys of health care patients. Simple things like friendliness, speed and convenience may be keys to building loyalty and managing retention.
Will Employers Drop Coverage as 2014 Approaches?
A study from Truven Health Analytics looks at likely outcomes from the reform law’s provide insurance or pay a penalty provisions, suggesting that few employers would likely drop coverage, but some assumptions in the model appear to have flaws.
2012 Potpourri XXV
Another wonderful Potpourri, as lovely as a summer day, with information on small physician practices, medication adherence in Medicaid, access to care in Massachusetts, plan loyalty and PHRs, a survey regarding onsite health centers and hospital productivity in Massachusetts after reform.
Current Physician Issues and Attitudes
A new survey from Jackson Healthcare gives a snapshot of current views of many physicians. Physicians are perhaps the most important part of the health care system and they appear stressed, concerned and discouraged about the future and about many of the health care programs they work with.
The Concentration of Health Care Spending
It is well known that a relatively few people account for a very large proportion of American health spending, a fact reinforced by a recent brief from the National Institute for Health Care Management. What is most interesting is how much this fact is routinely ignored in reform discussions.
Wellness Incentive Guidelines
A group of health care organizations has produced a guidance for employer-sponsored wellness programs with incentives, published in the Journal of Occupational and Environmental Medicine. The statement is supportive of these programs, although expressing some reservations about incentive use.
More Primary Care Doesn’t Necessarily Lower Hospital Use
Research published by the National Bureau of Economic Research uses experience from an HRA plan to examine what happens when people presumably have better access to outpatient care. The primary finding is that as there is more outpatient spending, there is a higher likelihood of an inpatient admission and greater inpatient spending, largely for more discretionary treatments.
2012 Potpourri XXIV
The length of the summer day begins to decline, but not the quality of our Potpourri, this week including patient decision-making, the effect of genetic tests on overall health care use, an employee survey on health benefits, the growing market power of hospital systems, making decision aids more user friendly and physician compensation.
Wall Street Journal
Restaurants and retailers face some of the toughest changes now that the Supreme Court has kept the overhaul in place. These industries historically are among the least likely to provide insurance to workers.
Characteristics of Home Health Care Episodes
The Alliance for Home Health Quality and Innovation sponsored a useful report on characteristics of home health care and other post-acute care services by Medicare beneficiaries, with a focus on those surrounding hospital readmissions, a significant current issue for hospitals.
Imaging Utilization Slows
Imaging has been a poster boy for alleged excessive and inappropriate utilization, resulting in higher than necessary spending. A study reported in Health Affairs finds that, for Medicare and commercial insurers, imaging growth has slowed, and the researchers explore why this may be so.