Posts Tagged “Health Care Costs”
ShowHide 3rd Party PapersOracle: Achieving Clinical and Operational Excellence: How to Establish Healthcare Service Line Costs
Robert Wood Johnson: Cost-sharing Effects on spending and outcomes
Health Affairs: How Health Insurance Design Affects Access To Care and Costs, By Income, In Eleven Countries
Kaiser Family Foundation: Medicare Spending and Use of Medical Services for Beneficiaries in Nursing Homes and Other Long‐Term Care Facilities
National Center for Policy Analysis: The new health care law enacted last spring will be devastating for the elderly and the disabled because of draconian cuts in payments to doctors and hospitals
McKinsey Quarterly: A provider that creates a best-practice IT platform can generate significant operating efficiencies.
AHIP: The Value of Provider Networks and the Role of Out-of-Network Charges in Risking Health Care Costs
Commonwealth Fund: Based on analysis of OECD health data from 2008, the United States continues to differ markedly from other countries on a number of health system measures.
Archives of Internal Medicine: Improving follow-up appointments is often considered one of the key strategies for reducing costly hospital readmissions, but a new study suggests that better discharge processes don’t reduce 30-day readmission rates at all.
Thomson Reuters: A Path To Eliminating $3.6 Trillion In Wasteful Healthcare Spending
CMS ONC: Estimated Financial Effects of the “Patient Protection and Affordable Care Act,” as Amended
BU Public School of Health: This report documents and investigates the excess in Massachusetts hospital
costs per person above the average for the United States
Urban Institute: In 2040, half of adults age 65 and older will spend at least 19 percent of their incomes on health care, up from 10 percent in 2010
MetLife Study: New Insights and Innovations for Reducing Health Care Costs for Employers
MA Attorney General: AGO releases this preliminary report based on its ongoing investigation of health care cost trends and cost drivers
CBO January 2010: The Budget and Economic Outlook: Fiscal Years 2010 to 2020
ShowHide Commentary
Implications of a Health Spending Growth Slowdown
by Kevin Roche on Monday, May 20, 2013
Another study published in the Health Affairs health cost issue examines the financial implications of a slowdown in the growth rate of national health spending.
Tags: Health Care Costs
The World According to Physicians and Nurse Practitioners
by Kevin Roche on Friday, May 17, 2013
A survey published in the New England Journal of Medicine finds that physicians and nurse practitioners have different perspectives on their respective value to and place in the health system.
Tags: Health Care Costs, Physicians
Has the Cost Curve Bent?
by Kevin Roche on Thursday, May 16, 2013
A new analysis published in Health Affairs suggests that the recent slowdown in national health spending growth may persist, as it appears to be due to factors other than just the economic downturn.
Tags: Health Care Costs
Rand Research on the Benefits of Integrated Care.
by Kevin Roche on Tuesday, May 14, 2013
A new paper from Rand looks at the effect of integrated care on a variety of outcomes, including provider and patient satisfaction, quality and costs.
Tags: Care Management, Health Care Costs, Health Care Quality, Physicians
How Much Does Socioeconomic Status Affect Medical Costs?
by Kevin Roche on Friday, May 10, 2013
An analysis of claims and other data from three Massachusetts health plans reveals that socioeconomic status seems to have little to do with relative physician costs of care.
Tags: Health Care Costs, Physicians
The Oregon Medicaid Lottery
by Kevin Roche on Monday, May 6, 2013
Proponents of health care coverage for years have suggested that people literally died without it. New research in regard to the Oregon Medicaid lottery suggests that is highly unlikely to be true and that insurance coverage has little to do with real health outcomes.
Tags: Health Care Costs, Health Care Quality, Health Insurance, Medicaid
Kaiser Analysis of Spending Slowdown
by Kevin Roche on Thursday, April 25, 2013
The growth in per capita health spending in the United States has slowed in recent years. A Kaiser Family Foundation brief analyzes why the slowdown has occurred and how long it might persist.
Tags: Health Care Costs
Massachusetts and Consumer Costs
by Kevin Roche on Tuesday, April 23, 2013
Health Reform hasn’t turned out quite as advertised in Massachusetts, with continuing issues about access and cost. A recent study in Health Affairs indicates that many families are still facing significant out-of-pocket costs.
2013 MedPAC Report to Congress, Part I
by Kevin Roche on Tuesday, April 16, 2013
This is the first of several posts on the Medicare Payment Advisory Commissions 2013 Annual Report to Congress, which covers a variety of provider types and other issues. In this post we cover the introduction and some of the specific provider payment recommendations in regard to hospitals.
Universal Considerations for Lowering Health Care Spending
by Kevin Roche on Wednesday, April 10, 2013
An article in the current Health Affairs discusses the worldwide issue of how to limit health spending while at the same time improving people’s health and the health care they receive. Seems difficult, but the authors suggest the key is lowering labor costs.
InstaMed Price Report
by Kevin Roche on Thursday, April 4, 2013
Health care payment technology firm InstaMed puts out a report on 2012 trends in health care payments.
Tags: Health Care Costs
IOM Report on Geographic Variation in Spending
by Kevin Roche on Wednesday, April 3, 2013
Congress asked the Institute of Medicine to look into the issue of geographic variation in spending and what that variation might say about the value of health care. The IOM has issued its Interim Report on the subject.
Tags: Health Care Costs
The Economic Effects of EHRs
by Kevin Roche on Tuesday, April 2, 2013
There is a heated debate about whether electronic medical records will save the health system money or improve quality and what their economic impact on health care providers will be. A survey reported in Health Affairs suggests that results may be mixed.
Tags: EHRs, Health Care Costs, HIT
State Variation in Spending
by Kevin Roche on Monday, April 1, 2013
Continuing the great interest in explaining the geographic variation in health care spending, the National Center for Policy Analysis issues a report finding that there is variation but it may not be linked to care appropriateness.
Tags: Health Care Costs
The International Federal of Health Plans Price Report
by Kevin Roche on Friday, March 29, 2013
The International Federation of Health Plans releases its latest comparison of prices for various services around the world, revealing as expected, that the US has the highest prices by far.
Tags: Health Care Costs
Society of Actuaries Weighs in on Rising Health Care Costs Under Reform
by Kevin Roche on Thursday, March 28, 2013
There has a been a flurry of similar reports recently, but none should have more credibility than the one from the Society of Actuaries stating that yes, claim costs and therefore insurance premiums will rise dramatically in the individual market in 2014.
Tags: Health Care Costs, Health Care Reform, Health Insurance
Inpatient Hospital Prices
by Kevin Roche on Friday, March 22, 2013
The latest salvo in the hospital pricing war is found in the American Journal of Managed Care, which reveals significant above general inflation increases in the costs of hospital services.
Tags: Health Care Costs, Hospital
Effect of Wellness Programs
by Kevin Roche on Thursday, March 21, 2013
The most recent issue of Health Affairs focuses on health and wellness. One of the programs reported found that in a health system’s employee population, hospitalizations were reduced but not overall costs.
Tags: Consumers, Health Care Costs, Health Care Quality, Wellness and Prevention
iCore Specialty Drug Report
by Kevin Roche on Wednesday, March 20, 2013
iCore, a unit of Magellan, presents its third Medical Pharmacy & Oncology Trend Report, which indicates that specialty pharmacy costs continue to grow very rapidly, despite increased management attention from payers.
Tags: Drugs, Health Care Costs
How Much Will Premiums Go Up?
by Kevin Roche on Tuesday, March 19, 2013
When the reform law was being sold to a dubious public, we were told that premiums would actually be lower. That is obviously not going to be the case, but how much higher they will be is still a matter of debate.
Tags: Health Care Costs, Health Care Reform, Health Insurance
An Alternative Method for Engaging Patients
by Kevin Roche on Monday, March 18, 2013
An article in Health Affairs discusses an alternative to patient engagement on health care decisions–using the findings of behavioral economics and pyschology to encourage patients to adopt a desired path or care alternative.
GAO on Medicare Advantage Payments
by Kevin Roche on Thursday, March 14, 2013
Adding to the controversy about Medicare Advantage payments, a Government Accounting Office report suggests that diagnoses coding excesses may be inflating payments.
Tags: Health Care Costs, Medicare
Patient Engagement and Decision-Making
by Kevin Roche on Wednesday, March 13, 2013
Several studies in Health Affairs focus on consumer decision-making in health care and how to “improve” that decision-making, which often seems to mean how to get the patient to agree to do what the doctor or a payer or a policy-maker thinks they should do.
Use of Non-Physician Care Providers
by Kevin Roche on Monday, March 11, 2013
Physicians have battled for decades to keep other types of licensed providers from having an expanded scope of practice. With the advent of health reform and concerns about access and cost, these restrictions are harder to justify. They are explored in a new report from the National Institute for Health Care Reform.
Medicaid Cost-Sharing
by Kevin Roche on Friday, March 8, 2013
Medicaid costs are driving states crazy and although the federal government is picking up most of the expansion spending, states continue to be at budgetary risk and are exploring methods of controlling spending. A brief from the Kaiser Family Foundation looks at beneficiary cost-sharing as one such method.
Tags: Health Care Costs, Medicaid
Use of Online Clinic Visits
by Kevin Roche on Thursday, March 7, 2013
New methods for delivering care in a more convenient method continue to evolve, including use of online visits. A study in Health Affairs reports on results of one health plan’s use of an online model for treating some conditions.
Tags: Care Management, Health Care Costs, HIT
The Effect of Medicare Advantage Payment Cuts
by Kevin Roche on Wednesday, March 6, 2013
The Centers for Medicare and Medicaid Services recently released its initial cut at Medicare Advantage payment rates for 2014, indicating a likely low to mid-single digit decrease in reimbursement for most plans. A report sponsored by America’s Health Insurance Plans suggests that such a reimbursement cut would have untoward effects.
Consumer Engagement in Health
by Kevin Roche on Tuesday, March 5, 2013
Consumer engagement in health is one of the themes of the current issue of Health Affairs. Two of the articles summarize findings regarding the effects of more engaged consumers on spending and health.
GAO on the Effect of the PPACA
by Kevin Roche on Monday, March 4, 2013
The Government Accounting Office performed a more current analysis of the likely budgetary effects of the federal health reform law, finding that its cost containment provisions are unlikely to provide sustainable benefits in the long-term and that the law will cause federal spending to rise more than it otherwise would without the law.
Health Spending and Mortality
by Kevin Roche on Friday, March 1, 2013
More spending, higher quality? More spending, lower quality? Less spending, higher quality? Less spending, lower quality? Theories and research abound, the latest a study of acute care hospitals in The American Journal of Managed Care.
Robot Assisted Surgery and Wasting Money
by Kevin Roche on Thursday, February 28, 2013
Can technology be a significant driver of health spending? You betya, look at robotically-assisted surgery. A new study in the Journal of the American Medical Association indicates that in the case of hysterectomy, robotic surgery has increased greatly, with no improvement in health outcomes and higher spending.
Tags: Health Care Costs, Health Care Quality, Medical Devices
Economic Impact of HIT
by Kevin Roche on Wednesday, February 27, 2013
There is substantial controversy about the benefits of health information technology and whether those benefits outweigh the costs. A meta-study in the Journal of the American Medical Informatics Association takes a fresh look at this question.
Tags: Health Care Costs, Health Care Quality, HIT, HITECH
Illness Adjustment Issues
by Kevin Roche on Monday, February 25, 2013
Several methods are commonly used to adjust health data for the illness burden of the patients’ information that is being used. A new study in the British Medical Journal suggests these are seriously flawed by not recognizing differences caused by variation in the use of health care services by the patients.
Tags: Health Care Costs, Health Care Quality, Research Methods
Hospital Costs in 2010
by Kevin Roche on Friday, February 22, 2013
While hospitalizations have dropped on a per capita basis in recent years, hospital spending remains the single largest bucket of overall health care costs. An Agency for Healthcare Research and Quality brief examines the details on hospital costs in 2010.
Tags: Health Care Costs, Hospital
An Abused Drug Discount Program
by Kevin Roche on Thursday, February 21, 2013
The 340B program was designed to allowed non-profit health care providers to obtain prescription medications cheaply in an effort to lower overall costs for poor people. A recent paper suggests that the program has expanded beyond its intended uses.
Tags: Drugs, Health Care Costs
Where is Medical Cost Trend Going?
by Kevin Roche on Monday, February 18, 2013
Medical spending growth has been relatively quiescent for the last few years. Especially as full implementation of the reform law nears, there is great anxiety about whether that slow growth can or will continue. A Mark Farrah Associates report gives some insight on the question.
Another View on How to Reduce Health Spending
by Kevin Roche on Thursday, February 14, 2013
The Commonwealth Fund Commission on a High Performance Health System issued a report called “Confronting Costs, Stabilizing U.S. Health Spending While Moving Toward a High Performance Health Care System”, which just about says it all!
Tags: Health Care Costs
ADP Survey of Large Employers
by Kevin Roche on Wednesday, February 13, 2013
Many large employers may consider shifting more employees to part-time status as a result of the implementation of the reform law, according to a survey by ADP, and they may take other actions to minimize their costs under the law.
Tags: Employers, Health Care Costs, Health Care Reform, Health Insurance
End-of-Life Care and Place of Death
by Kevin Roche on Tuesday, February 12, 2013
Most people want to die at home, but few do. A study published in the Journal of the American Medical Association examines changes in place of death and use of hospice care over the last decade for Medicare beneficiaries.
Tags: End-of-Life Care, Health Care Costs, Health Care Quality, Medicare
Concierge Care Effects
by Kevin Roche on Friday, February 8, 2013
A study in the American Journal of Managed Care looks at the effect on hospital utilization for patients who were care for in one of the country’s leading concierge practices.
Tags: Care Management, Concierge Medicine, Health Care Costs, Hospital, Physicians
Medicare Advantage Disenrollees
by Kevin Roche on Thursday, February 7, 2013
A study from the Centers for Medicare and Medicaid Services Office of the Actuary looks at characteristics of Medicare beneficiaries who disenroll from Medicare Advantage and their spending patterns following disenrollment.
AHIP on Out-of-Network Charges
by Kevin Roche on Monday, February 4, 2013
A new report from America’s Health Insurance Plans exposes the unbelievable ripoff charges that many providers place on out-of-network services. Much of these charges is paid by the insured person. Where are the regulators now!!
New Paper on Regional Health Spending Variations
by Kevin Roche on Sunday, February 3, 2013
A draft working paper from the Federal Reserve Staff is the latest salvo in the ongoing exploration of any link between more health spending and better quality or vice versa. The paper suggests that geographic variation in spending is not likely highly correlated with quality.
Tags: Geographic Variation, Health Care Costs, Health Care Quality
Hospital Consolidation and Pricing
by Kevin Roche on Friday, February 1, 2013
Actuarial consultants Alvarez & Marsal issue a brief summarizing increasing issues with cost increases caused by hospital acquisition of physician practices and other outpatient services.
Tags: Health Care Costs, Hospital
The Relationship Between Cost and Quality
by Kevin Roche on Monday, January 28, 2013
The relationship between cost and quality is tricky in health care, as it is with many services and products. A new study published in the Annals of Internal Medicine conducts a meta-review of the research on the issue, finding very mixed and inconclusive results.
A Review of the Benefits of Wellness Programs
by Kevin Roche on Friday, January 25, 2013
Do wellness programs improve quality and cost outcomes? Despite their popularity, from a research perspective the answer remains unclear, but a new review published in the Journal of Occupational and Environmental Medicine takes a fresh look, which concludes that the evidence remains inconclusive.
Tags: Health Care Costs, Health Care Quality, Wellness and Prevention
MedPAC and Medicare Physician Reimbursement
by Kevin Roche on Thursday, January 24, 2013
At its annual meeting in January, the Medicare Payment Advisory Commission explores issues regarding payment for various providers, beneficiary access to care and quality. This January’s presentation on physician issues has some interesting data.
Tags: Health Care Costs, Medicare, Physicians
EHRs Not Doing the Job Yet
by Kevin Roche on Wednesday, January 23, 2013
An article by Rand Corp researchers published in Health Affairs indicates that electronic health records and other aspects of health information technology are not fulfilling their promise, whatever that was. The authors give reasons for the disappointing performance and suggest remedies.
Tags: EHRs, Health Care Costs, Health Care Quality, HIT
Managed Care Digest Part II
by Kevin Roche on Tuesday, January 22, 2013
Today is the second part of our review of this year’s Sanofi Managed Care Digest, with information of drug coverage and other aspects of health benefits.
Tags: Drugs, Health Care Costs, Health Insurance
Managed Care Digest Part I
by Kevin Roche on Monday, January 21, 2013
Sanofi sponsors the Managed Care Digest Series and just released the 2012-13 edition, which contains a plethora of data on HMOs, PPOs and their use and management of prescription drugs.
Federal Pharmacy Report
by Kevin Roche on Friday, January 18, 2013
Allow drug spending growth has slowed, it is still a significant category of cost and adding drug benefits to Medicare and Medicaid has caused concern about how those drugs are paid for. A report to the Centers for Medicare and Medicaid Services discusses new methods for reimbursing for drugs.
Tags: Drugs, Government, Health Care Costs
Truven on 2013 Medical Costs
by Kevin Roche on Monday, January 14, 2013
Everyone is kind of on tiptoes, waiting to see if medical cost growth is going to stay relatively stable as it has for the last few years, or begin to increase more rapidly. A report from Truven Health Analytics projects modest growth for the coming year.
Impact of Reform Law on Age-Based Premiums
by Kevin Roche on Thursday, January 10, 2013
One of the things the new reform law does is limit the ability to adjust health insurance premiums on the basis of age. A study from Oliver Wyman examines the likely effect on premiums for younger people, who will be mandated to buy insurance. Not a pretty picture.
2011 United States Health Spending
by Kevin Roche on Tuesday, January 8, 2013
An article in Health Affairs summarizes the latest from the Office of the Actuary on national health spending in 2011, demonstrating that while spending growth remained relatively quiescent, it appears poised to grow more rapidly.
Tags: Health Care Costs
The Effect of Smoking Bans
by Kevin Roche on Friday, January 4, 2013
Many states and local governments have enacted prohibitions on smoking in certain public places, including restaurants and bars. These bans are founded on public health concerns due to inhalation of second-hand smoke. A new study in Health Affairs finds that the smoking bans are associated with fewer hospitalizations for certain conditions.
Readmissions and Safety Net Hospitals
by Kevin Roche on Thursday, January 3, 2013
One of the biggest problems with the Center for Medicare and Medicaid Services’ hospital readmissions program is that it likely unfairly and disproportionately hurts hospitals which treat larger numbers of poor patients. A brief from the Commonwealth Fund explores this issue and potential solutions.
Tags: Health Care Costs, Health Care Quality, Hospital, Hospital Readmissions
CDHP and Preventive Care
by Kevin Roche on Wednesday, January 2, 2013
A study published in Health Affairs examined consumers’ awareness of preventive care benefits in their high-deductible insurance plans, finding that many were unaware that these services were available without charge.
Tags: Consumer Directed Health, Consumers, Health Care Costs, Health Insurance, Wellness and Prevention
Health Insurance and Health Behavior
by Kevin Roche on Monday, December 31, 2012
A new paper from the National Bureau of Health Economics suggests that not allowing insurers to vary rates based on health status reduces incentives to be healthy, leading to an overall decline in population health, and, guess what, that leads to an increase in health spending.
2012 Potpourri XL
by Kevin Roche on Friday, December 28, 2012
Our last Potpourri for 2012 is the ultimate in health information, containing not lumps of coal but tasty nuggets of holiday goodies, including transition care from hospital to primary care, how to control health spending growth, use of market incentives to improve the health system, building a good health insurance exchange and Massachusetts’ experience with the uninsured after reform.
Tags: Care Management, Health Care Costs, Health Care Quality, Health Care Reform, Health Insurance, Health Insurance Exchange, Hospital Readmissions, Transitional Care
Review of Medical Home Evidence
by Kevin Roche on Thursday, December 27, 2012
Patient-centered medical homes, accountable care organizations, who can keep all the delivery innovations straight! Research summarized in an Annals of Internal Medicine article reviews the state of the evidence on the use of medical homes. So far, not great, small gains in quality and no showing of overall cost savings.
Tags: Care Management, Health Care Costs, Health Care Quality, Medical Homes, Physicians
Employer Based Insurance Costs
by Kevin Roche on Wednesday, December 26, 2012
A Kaiser Family Foundation snapshot examines cost-sharing between employers and employees based on data from the KFF 2012 health benefit survey. In general public employees are getting a much better health benefit deal than are employees at private firms.
Private Health Insurance Facts
by Kevin Roche on Monday, December 24, 2012
The latest brief from the National Institute for Health Care Management describes facts about private health insurance, with a focus on what goes into the premiums charged by these companies. Another study that shows that rising health insurance premiums are driven by higher payments to providers, largely resulting from higher unit costs.
2012 Potpourri XXXIX
by Kevin Roche on Friday, December 21, 2012
Our penultimate Potpourri for 2012 is a festive blend of health data, including avoidance of health care due to costs, rates of expected spending increases in 2013, costs for younger versus older physicians, internet versus print health interventions, medical home results and poor health behaviors and health spending.
Tags: Consumers, Health Care Costs, Health Insurance, HIT, Medical Homes, Physicians, Wellness and Prevention
AHIP on Insurance Tax Hit
by Kevin Roche on Tuesday, December 18, 2012
The reform law begins to really kick in for 2013, with many new taxes and regulations. Unpleasant surprises abound and an Oliver Wyman report for America’s Health Insurance Plans examines the likely effect of the new health care coverage tax.
Tags: Health Care Costs, Health Care Reform, Health Insurance
Physician Compensation
by Kevin Roche on Monday, December 17, 2012
A new 2012 physicians compensation survey reveals interesting data about how much doctors work, what they are paid, what kinds of practices they are in and how they feel about their work. Many doctors feel overworked and undercompensated.
Tags: Health Care Costs, Physicians
2012 Potpourri XXXVIII
by Kevin Roche on Friday, December 14, 2012
In this holiday season, it is a time for giving presents and our latest Potpourri presents you with many gifts of health information, including some positive news about an ACO program, some cautions for the success of ACOs, an apparently successful disease management program, lung cancer screening, earnings growth for physicians and other health professionals and lessons in bundled payments.
Tags: ACO, Bundled Payments, Disease Management, Health Care Costs, Physicians, Providers, Wellness and Prevention
Medicare and Medicaid Cost Projections
by Kevin Roche on Thursday, December 13, 2012
The Congressional Budget Office releases a presentation on how it calculates long-term projections fro Medicare and Medicaid spending. More than a little frightening, and the absence of serious bipartisan discussion about reducing this spending is disturbing in its economic implications.
Tags: Government, Health Care Costs, Medicare
Medicare Advantage and Traditional Medicare
by Kevin Roche on Wednesday, December 12, 2012
For reasons that are truly mysterious, the Medicare Advantage program has been controversial. New research published in Health Affairs shows that the program has better utilization and spending control than traditional Medicare and does not have significant favorable selection.
CBO on Drug/Medical Cost Interaction
by Kevin Roche on Monday, December 10, 2012
One of the selling points for prescription drugs has been that their use often prevents use of more costly services, like hospitalizations. A new brief from the Congressional Budget Office explores the extent to which that might be true for Medicare beneficiaries.
Tags: Drugs, Health Care Costs, Medicare
2012 Potpourri XXXVII
by Kevin Roche on Friday, December 7, 2012
Our latest Potpourri captures the excitement of the holidays with scintillating items on certificate of need program effects on utilization, the public’s views on health care costs and government’s role in health care, the cost of developing new drugs and a survey on physician compensation.
Tags: Drugs, Health Care Costs, Health Care Reform, Health Insurance, Physicians, Regulation
The Cost of Medication Non-Adherence
by Kevin Roche on Thursday, December 6, 2012
Medication non-adherence has many causes and is likely a serious quality issue. Capgemini, the consulting group, has released a report claiming that such non-adherence adds hundreds of billions of dollars to our health care spending, and costs drug companies a similarly large amount of revenue.
Tags: Care Management, Consumers, Drugs, Health Care Costs, Health Care Quality
Medicare Payment Policies and Their Consequences
by Kevin Roche on Monday, December 3, 2012
The Centers for Medicare and Medicaid Services is forever tinkering with reimbursement for various providers, usually not getting exactly the results it seeks. An example of this is given in research published in the Archives of Internal Medicine regarding changes for primary care and specialty physician office visits.
Tags: Health Care Costs, Medicare, Physicians, Reimbursement
2012 Potpourri XXXVI
by Kevin Roche on Friday, November 30, 2012
Another in our series of Potpourris, tasty, succulent morsels of health data food, including this week the effect of mammography screening, improving health and health costs, state costs to run health insurance exchanges, family caregiving and the costs of fixing Medicare’s physician reimbursement.
Tags: Elder Care, Health Care Costs, Health Care Quality, Health Care Reform, Health Insurance Exchange, Medicare, Wellness and Prevention, Workplace
New Paper on Provider Pricing Power
by Kevin Roche on Wednesday, November 28, 2012
Another extensive research paper details the effects of provider consolidation and consequent market power on the health care industry in the United States, and specifically on the growth of health spending. Not a pretty picture, and the effect of the reform law is to exacerbate the problem.
Tags: Health Care Costs, Hospital, Providers
2012 Potpourri XXXV
by Kevin Roche on Friday, November 16, 2012
Thanks be given for our last Potpourri before Thanksgiving, a table spread with delectable bites of information on hospital readmissions and quality measure performance, health plan enrollment growth, health price rises, use of deductibles in employer-based health insurance and trends in employment of physicians.
Tags: Consumers, Health Care Costs, Health Care Quality, Health Insurance, Hospital Readmissions, Medicare, Pay For Performance, Physicians
Health Care Spending and the Deficit
by Kevin Roche on Thursday, November 15, 2012
The “fiscal cliff” deficits, and debt are very much in the news these days. A Congressional Budget Office report indicates how much of our spending difficulty is attributable to health care and lays out alternative scenarios for coping with that spending and its effect on the debt.
Tags: Health Care Costs, Medicare
More on End-of-Life Care
by Kevin Roche on Wednesday, November 14, 2012
A substantial amount of Medicare and overall health spending is incurred in the last few months of patients’ lives. Much of this spending is due to intensive care that obviously is rather superfluous at that point. A new article in the Journal of Clinical Oncology reports on research regarding end-of-life discussions and resulting care.
Tags: Care Management, End-of-Life Care, Health Care Costs, Health Care Quality
Limits on Use of Nurse Practitioners
by Kevin Roche on Tuesday, November 13, 2012
Everyone is concerned about health spending growth, the primary cause of which is unit price increases. So why are obvious methods to reduce unit price of services, like substituting less-expensive providers, ignored? An article in Health Affairs looks at limitations of use of nurse practitioners.
Tags: Health Care Costs, Health Care Quality, Physicians, Regulation
2012 Potpourri XXXIV
by Kevin Roche on Friday, November 9, 2012
Thank God the election is finally over, but our Potpourri is never-ending, this week bringing you the latest on why comparative effectiveness research results don’t translate to practice, innovations to reduce health spending, the value of medication adherence, factors related to end-of-life quality and MedPAC on new quality measures for avoidable hospital and ER use.
Tags: Comparative Effectiveness, Drugs, End-of-Life Care, Health Care Costs, Health Care Quality, Hospital, Medicare
KPMG Report on Health System Change
by Kevin Roche on Wednesday, November 7, 2012
Another consultant’s report on the American health system, this one from KPMG and focusing on the supposed transformation from a volume-based system to one founded on value. While leaders of health care system participants recognize the likelihood of significant change, they also seem determined not to let their share of health system spending drop.
Tags: Drugs, Health Care Costs, Health Care Reform, Health Insurance Exchange, Providers
The Latest Salvo From the Dartmouth Atlas Project
by Kevin Roche on Monday, November 5, 2012
The Dartmouth Atlas project has made its name by studying regional variations in health care utilization, spending and quality, with a core finding that substantial variation exists which does not appear to be correlated with quality. Its latest report, which has sketchy logic, examines variation in care at academic medical centers, which is where most physicians learn their craft.
2012 Potpourri XXXIII
by Kevin Roche on Friday, November 2, 2012
Another installment of our non-award winning (are there any potential awards?) Potpourri, this one examining drug costs for conditions of aging, self-referral in imaging, in home palliative care at the end-of-life, more on hospital readmissions and retail clinic utilization.
Tags: Care Management, Drugs, End-of-Life Care, Health Care Costs, Hospital Readmissions, Physicians, Retail Clinics
Kaiser Foundation Report on Health Spending History
by Kevin Roche on Thursday, November 1, 2012
Our last episode for the week of health spending is a useful report from the Kaiser Family Foundation, which provides an analysis of health expenditures in the United States, focusing on all the dimensions, including the impact on individuals and employers.
Tags: Health Care Costs
Another Analysis of Health Spending Growth
by Kevin Roche on Wednesday, October 31, 2012
Today’s report relating to American health expenditures comes from the Bipartisan Policy Center and looks at the drivers for our health care spending growth. All the usual suspects are rounded up and tabulated in a pro forma way.
Tags: Health Care Costs
Health Spending Trends Prior to Health Reform
by Kevin Roche on Tuesday, October 30, 2012
The Urban Institute issued a report examining health care spending trends in the United States prior to the passage of the federal health care reform using MEPS data from 2001 to 2009 on the non-elderly by spending category, finding most of the increase is due to unit price growth.
Tags: Health Care Costs
CHCF Report on Spending
by Kevin Roche on Monday, October 29, 2012
This week will be health care spending week, as we have collected several reports relating to spending trends, starting with a California HealthCare Foundation report examining components of health care costs and trends and drivers for each.
Tags: Health Care Costs
2012 Potpourri XXXII
by Kevin Roche on Friday, October 26, 2012
The light fades but not our evanescent Potpourri, this week featuring stories on computerized point of entry ordering, the presence of large treatment effects in research, characteristics of patients with readmissions, a survey on Medicare physician reimbursement and a study on family caregivers.
Tags: Care Management, Health Care Costs, Health Care Quality, Health Care Research, HIT, Hospital Readmissions, Medicare, Physicians
And One More Thing About Pay-for-Performance
by Kevin Roche on Thursday, October 25, 2012
In yet another piece evaluating the effectiveness to-date of pay-for-performance programs, Health Affairs carries a review of research on the topic, finding that results are mixed. Some seem to have improved quality, but others did not and providers caring for poorer and sicker patients may be disadvantaged.
Tags: Health Care Costs, Health Care Quality, Pay For Performance
ACA Impact on Business
by Kevin Roche on Wednesday, October 24, 2012
A new report from the Urban Institute examines the controversial issue of the impact of the Patient Protection Act on businesses of various sizes, showing that for small businesses it may reduce cost, it likely increases the cost for mid-sized ones and is neutral to large companies.
Tags: Employers, Health Care Costs, Health Care Reform, Health Insurance
2012 Potpourri XXXI
by Kevin Roche on Friday, October 19, 2012
It is cooling down across most of the country, but our Potpourri remains red-hot, with nuggets on the moderation in health spending over the last few years, how to change automatic health behaviors, EHRs and diabetes care, a medical home pilot in Colorado and an ACO demonstration in Maine.
Tags: ACO, Care Management, EHRs, Health Care Costs, Health Care Quality, medical home, Wellness and Prevention
Does Health Insurance Cost Sharing Lower Productivity?
by Kevin Roche on Wednesday, October 17, 2012
A new paper from the National Bureau of Economic Research explores whether increased cost-sharing in health care coverage has affected the productivity of employees subject to this greater out-of-pocket spending for health care. They find that workers with higher cost-sharing have more absenteeism but not more short-term disability stays.
Tags: Consumers, Health Care Costs, Workplace
2012 Potpourri XXX
by Kevin Roche on Friday, October 12, 2012
Another luminescent Potpourri, focusing on the ACA’s high-risk pool plan; controlling health spending in Massachusetts; what components of EHRs and HIEs may control costs; another survey of employers and dealing with hospital pricing power.
Tags: EHRs, Employers, Health Care Costs, Health Care Quality, Health Care Reform, Health Insurance, HIT, Hospital
2012 Potpourri XXIX
by Kevin Roche on Friday, October 5, 2012
Our first Potpourri in a while is as diverse and flamboyant as the fall colors, including items on the effectiveness of telemonitoring, the history of health “reform” in the United States, mortality and Medicaid eligibility expansions, continued issues with cost affecting access in Massachusetts and methods to help control imaging use.
Tags: Care Management, Health Care Costs, Health Care Quality, Health Care Reform, Medicaid, Medicare, Telemedicine
CMS’ Physician Group Practice Demo Results
by Kevin Roche on Wednesday, October 3, 2012
The Physician Group Practice Demonstration conducted by Medicare has largely wrapped up , to be supplanted by the accountable care organization programs. The PGP demo appears to have led to slightly improved quality and has led to slightly lower cost savings over traditional fee-for-service Medicare.
Tags: Care Management, Disease Management, Health Care Costs, Health Care Quality, Medicare, Physicians
New Health Care Spending Breakdown
by Kevin Roche on Tuesday, October 2, 2012
The Health Care Cost Institute releases a report on spending and utilization in the employer-based health care coverage market for 2011. Spending continues to rise faster than inflation or economic growth and is largely driven by higher prices charged by providers, not by increases in utilization.
Tags: Health Care Costs, Providers
Providers Using EHRs to UpCode–Shocking, Just Shocking
by Kevin Roche on Monday, October 1, 2012
The Center for Public Integrity has pointed out what was an obvious unintended consequence of greater use of electronic health records–providers will use the additional clinical information to feed billing systems that use the data to maximize coding for reimbursement. Medicare is already feeling the effects and other payers are likely to do so also.
Tags: EHRs, Health Care Costs, HIT, Medicare
AHRQ on Bundled Payments
by Kevin Roche on Thursday, September 27, 2012
Bundled payments are designed to change the incentives for providers so that they manage patient care in a more cost-effective manner, hopefully without negatively affecting quality. A report from the Agency for Healthcare Research and Quality examines the research evidence to date on the effect of bundled payment approaches, finding that spending and utilization are probably lower, with an uncertain effect on quality.
Tags: Bundled Payments, Health Care Costs, Health Care Quality, Providers
Kaiser Health News
by Vita Advisors on Friday, September 21, 2012
Bipartisan Report Focuses On Issues Driving Up Health Care Costs
Tags: Health Care Costs
MedPAC on Readmissions
by Kevin Roche on Wednesday, September 19, 2012
We, among many others, have been harsh critics of Medicare’s misguided hospital readmissions penalty program, which begins this year. MedPAC has weighed in with its views on how to “refine” the program, but its recommendations will only exacerbate the flaws in the current regulations.
Tags: Health Care Costs, Health Care Quality, Hospital Readmissions, Medicare
The Kaiser Family Foundation Report on Health Care Coverage
by Kevin Roche on Monday, September 17, 2012
The Kaiser Family Foundation published its annual survey on Employer Health Benefits. While the rate of growth in both single and family health insurance premiums has slowed, it is still well above inflation, wage growth or GDP growth and while employee cost-sharing is relatively flat, the amount spent on health insurance by the average employee continues to grow far faster than income.
Tags: Consumers, Health Care Costs, Health Insurance, Workplace
2012 Potpourri XXVIII
by Kevin Roche on Friday, September 14, 2012
Another brilliant edition of our Potpourri, focusing on individual health insurance rate reform, variation in traumatic care costs, genetic counseling and diabetes, small business and health care costs and savings from wellness programs.
Tags: Consumers, Health Care Costs, Health Care Reform, Health Insurance, Regulation, Wellness and Prevention
Variation in Episode Cost in a Commercial Health Plan
by Kevin Roche on Thursday, September 13, 2012
Research based on data from UnitedHealth Group’s commercial health plans finds wide variation in episode of care costs across both selected procedures and chronic diseases. The research also showed that for care provided by physicians meeting certain quality and efficiency benchmarks, episode of care costs were generally lower than for care provided by other physicians.
Tags: Health Care Costs, Health Care Quality, Health Insurance, Providers
Institute of Medicine Report
by Kevin Roche on Monday, September 10, 2012
The Institute of Medicine released a report regarding supposed unnecessary spending on health care in the United States and potential ways to remedy that problem, largely through use of health information technology.
Tags: Health Care Costs, Health Care Quality, Health Care Reform
AON Employer Survey
by Kevin Roche on Monday, August 27, 2012
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
by Kevin Roche on Friday, August 24, 2012
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.
Tags: Drugs, Genomics, Health Care Costs, Health Care Quality, Hospital, Medicare, Physicians
Retail Clinic Growth
by Kevin Roche on Monday, August 20, 2012
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.
Tags: Consumers, Health Care Costs, Health Care Quality, Retail Clinics
2012 Potpourri XXVI
by Kevin Roche on Friday, August 17, 2012
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.
Tags: Care Management, End-of-Life Care, Health Care Costs, Health Care Reform, Health Insurance, Hospital, Medicare, Wellness and Prevention, Workplace
Physician Participation in Government Health Plans
by Kevin Roche on Thursday, August 16, 2012
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.
Tags: Health Care Costs, Health Care Quality, Medicaid, Physicians
2012 Potpourri XXV
by Kevin Roche on Friday, August 10, 2012
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.
Tags: Consumers, Drugs, Health Care Costs, Health Care Quality, Health Care Reform, Health Insurance, HIT, Medicaid, Physicians
The Concentration of Health Care Spending
by Kevin Roche on Wednesday, August 8, 2012
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.
Tags: Health Care Costs, Health Care Reform, Health Insurance
More Primary Care Doesn’t Necessarily Lower Hospital Use
by Kevin Roche on Monday, August 6, 2012
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.
Tags: Health Care Costs, Health Care Reform, Hospital, Physicians
2012 Potpourri XXIV
by Kevin Roche on Friday, August 3, 2012
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.
Tags: Care Management, Health Care Costs, HIT, Hospital, Physicians
Characteristics of Home Health Care Episodes
by Kevin Roche on Thursday, August 2, 2012
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.
Tags: Health Care Costs, HomeCare, Hospital Readmissions, Medicare
Imaging Utilization Slows
by Kevin Roche on Wednesday, August 1, 2012
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.
Tags: Health Care Costs, Medicare
2012 Potpourri XXIII
by Kevin Roche on Friday, July 27, 2012
At the height of the summer, with dryness across the land, there is no drought of information in our Potpourri, this week including use of an interactive health record to increase preventive care, Medicare and Medicaid geographical variation, shared decision-making, readmissions for heart attacks and Japan’s all-payer rate setting system.
Tags: Consumers, Health Care Costs, Health Care Quality, HIT, Hospital, Hospital Readmissions, Medicaid, Medicare, Physicians, Wellness and Prevention
Hospital Executive Compensation
by Kevin Roche on Monday, July 23, 2012
Hospital costs are the major contributor to national health spending growth. A report from the New Hampshire Center for Public Policy examines executive compensation at the state’s non-profit hospitals, which is quite substantial and bears no relation to quality.
2012 Potpourri XXII
by Kevin Roche on Friday, July 20, 2012
Our Potpourri finally returns, including items on duplicate payments in federal health programs, EHR use and malpractice claims, venture capital statistics, consumer use of online self-service applications, and a new statistical method for predictive modeling.
Tags: Consumers, Financings, Government, Health Care Costs, Health Care Quality, Malpractice
Rand on CDHP
by Kevin Roche on Wednesday, July 18, 2012
No matter how controversial they may be, consumer-directed health plans with their higher cost-sharing continue to spread rapidly. A Rand Corporation brief examines the evidence on the effect of these plans on the cost and use of health care.
Tags: Consumer Directed Health, Health Care Costs, Health Care Quality, Health Insurance
Hospital Consolidation Costs Us All
by Kevin Roche on Monday, July 16, 2012
The Robert Wood Johnson Foundation summarizes and follows up research on the contribution of hospitals to spending increases and in particular the effects of hospital consolidation. Not good news for hospitals, especially large systems in non-competitive areas.
Tags: Health Care Costs, Hospital
Deloitte Consumer Survey
by Kevin Roche on Friday, July 13, 2012
Deloitte publishes its fifth annual survey of consumers on the performance of the American health system and the effects of health reform. The health reform law isn’t positively viewed, but people seem satisfied with their own care.
Tags: Consumers, Health Care Costs, Health Care Quality, Health Care Reform
Medicaid ER Usage
by Kevin Roche on Wednesday, July 11, 2012
Emergency room use tends to be expensive, and may reflect difficulty accessing other sources of primary care. Medicaid recipients are often identified as frequent inappropriate users of emergency rooms, but a new report from the Center for Studying Health System Change attempts to rebut that notion.
2012 MedPAC Report
by Kevin Roche on Monday, July 9, 2012
The Medicare Payment Advisory Commission delivers an annual report to Congress on what it views as the pressing issues for the Medicare program. This year’s report touches on several issues, which have relevance for health care in general.
Tags: Government, Health Care Costs, Medicare
Retirement and Health
by Kevin Roche on Monday, July 2, 2012
One of the biggest issues facing retirees is health care costs, notwithstanding the availability of Medicare for many retirees when they retire and for all eventually. Stress over finances can also have a detrimental effect on retiree health. The Employee Benefits Research Institute issues a periodic survey on retirement-related trends which includes health questions. The [...]
Oregon’s Early Experience With Insuring the Uninsured
by Kevin Roche on Friday, June 29, 2012
The alleged primary spur for passage of the federal reform law was providing insurance for the uninsured, which supposedly would save money in the long run. An Oregon initiative has created an opportunity to see results from a similar effort and a report gives first year outcomes.
Tags: Health Care Costs, Health Care Quality, Health Care Reform, Medicaid
ER Crowding
by Kevin Roche on Monday, June 25, 2012
Use of emergency rooms is monitored as a potential indicator of access and quality problems. A recent study from the American College of Emergency Room Physicians analyses trends in both emergency room use and crowding.
2012 Potpourri XXI
by Kevin Roche on Friday, June 22, 2012
It is officially the start of summer and our Potpourri is hot, hot, hot, but not steamy! This week we cover why health care IT doesn’t seem to create productivity gains, the use of whole-genome sequencing, the consequences on failure to comply with prescribed drug regimens and the rates of drug misuse and the potential savings for patients in CDHP plans.
Tags: Consumers, Drugs, Genomics, Health Care Costs, HIT
What Will Medicare Really Cost?
by Kevin Roche on Wednesday, June 20, 2012
When the Congressional Budget Office and the Board of Trustees of the Medicare trust funds make projections about future Medicare expenditures and revenues, they are required to utilize current law, even when everyone knows it doesn’t reflect likely reality. A memo from the Office of the Actuary presents an alternative, probably more accurate, set of Medicare projections.
Tags: Health Care Costs, Medicare
2012 Potpourri XX
by Kevin Roche on Friday, June 15, 2012
Our Potpourri resumes, with information on consumer trust of insurers and providers, consumer use of online health information, price transparency in health care, imaging rates in integrated health care systems and effectiveness of telephonic depression therapy.
Tags: Care Management, Consumers, Health Care Costs, Health Care Quality, HIT, Physicians, Telemedicine
National Health Spending Projections
by Kevin Roche on Thursday, June 14, 2012
The latest projection on national health spending from the CMS Office of the Actuary is out and published in Health Affairs. It suggests that the very modest reduction in growth rate in the last couple of years is going to end and growth in spending will re-accelerate in the coming years.
Wellness Lessons From Germany
by Kevin Roche on Wednesday, June 13, 2012
Germany has encouraged wellness programs in a manner similar to the US. A new report from the Commonwealth Fund discusses results from the country’s efforts and draws lessons that may be applicable to the United States.
Tags: Health Care Costs, Health Care Quality, Wellness and Prevention
PWC 2013 Cost Projections
by Kevin Roche on Monday, June 11, 2012
PWC’s Health Research Institute is projecting that overall medical cost trend for employment-based health care coverage will be around 7.5% for 2013, which is identical to the number it currently estimates for 2012 and close to the 2011 and 2010 actuals.
Components of Hospital Cost Increases
by Kevin Roche on Friday, June 8, 2012
A new Agency for HealthCare Research and Quality Statistical Brief decomposes the sources of inpatient hospital cost increases from 1997 to 2008, which is important to understand given that hospital spending is the single largest contributor to overall per capital health spending growth.
Tags: Health Care Costs, Hospital
Medscape Survey on Physician Compensation
by Kevin Roche on Monday, June 4, 2012
A Medscape survey of physicians gives statistics on compensation and compensation trend and reveals doctors’ attitudes regarding their pay. While “healthy”, physician compensation is not generally lavish and growth in physician spending is not nearly the problem that growth in hospital costs are.
Tags: Health Care Costs, Physicians
2012 Potpourri XIX
by Kevin Roche on Friday, June 1, 2012
Summer is heating up and our Potpourri is smoking too, with nuggets on a silly provision in the final MLR rule; research on causes of readmissions, some within hospital control, some not; why are some hospitals more costly in treating heart failure than others and an unintended consequence of a change in dialysis drug reimbursement.
Tags: Care Management, Health Care Costs, Health Care Quality, Health Care Reform, Health Insurance, Hospital, Medicare, Physicians, Readmissions, Reimbursement
How to Counter Hospital Pricing Power
by Kevin Roche on Monday, May 28, 2012
Hospital unit prices appear to be the single largest cause of increased health spending, according to several lines of research. In a new report, the National Institute for Health Care Reform examines whether state rate regulation could help address the problem.
Tags: Health Care Costs, Hospital, Regulation
2012 Potpourri XVIII
by Kevin Roche on Friday, May 25, 2012
We are on the road, but our Potpourri remains, in this issue covering malpractice claims against doctors, wellness program outcomes, the effect of drinking coffee, do EHRs help improve care and a wellness survey of employers.
Tags: Consumers, EHRs, Health Care Costs, HIT, Malpractice, Physicians, Wellness and Prevention, Workplace
More on Specialty Drug Spending
by Kevin Roche on Wednesday, May 23, 2012
Another report that looks at specialty drug spending is issued by the Center for Studying Health System Change. Due to different characteristics of this category, the authors are pessimistic about near-term opportunities to limit spending growth.
Tags: Drugs, Health Care Costs
Milliman on 2012 Health Care Costs
by Kevin Roche on Thursday, May 17, 2012
Milliman tracks the average cost of health care for a family and issues an annual report. The 2012 version is out, showing that average family costs are over $20,000 for the first time. That reform law sure is working well to hold down costs.
Tags: Health Care Costs, Health Care Reform, Health Insurance
Medicare Part D Spending
by Kevin Roche on Wednesday, May 16, 2012
Among government health care programs, the Part D prescription drug benefit in Medicare has been extremely successful, costing less than projected. Beneficiaries also are satisfied with the program, which consists of all private plans. A Kaiser report examines Part D spending trends.
Tags: Drugs, Health Care Costs, Medicare
CDH Plans
by Kevin Roche on Tuesday, May 15, 2012
Consumer-directed or high-deductible insurance plans continue to grow in popularity and an article in Health Affairs suggests that they could save over $50 billion annually if most people were covered under them.
Tags: Consumers, Health Care Costs, HIT
DME Competitive Bidding
by Kevin Roche on Monday, May 14, 2012
The Government Accounting Office reports on initial results from the Medicare competitive bidding program for durable medical equipment, finding that it appeared to have succeeded in reducing spending, while not unduly affecting beneficiary access.
Tags: Devices, Health Care Costs, Medicare
2012 Potpourri XVII
by Kevin Roche on Friday, May 11, 2012
This week’s Potpourri contains tasty morsels of health care nutrition, including geographic variation in cardiac procedures, barriers to shared decision-making, issues in the credibility of survey-based research, the value of a diabetes disease management program, and differences in hospital costs.
Tags: Disease Management, Health Care Costs, Health Care Quality, Hospital
Differences in Health Care Spending and Status Across Countries
by Kevin Roche on Thursday, May 10, 2012
The Commonwealth Fund puts out yet another report decrying the sorry American health system, which has by far the highest per capita costs and supposedly no better outcomes. It is unclear, however, that Americans don’t actually by and large get more total value for their dollars and the higher spending is largely due to unit prices.
Tags: Health Care Costs, Health Care Quality, international health systems
2012 Potpourri XV
by Kevin Roche on Friday, April 27, 2012
Another tremendous edition of our Potpourri, featuring accountable care organization results, waste in our health system, self-referral costs, calculating hospital readmission rates and the benefits, if any, of telemonitoring frail seniors.
Tags: ACO, Care Management, Disease Management, Health Care Costs, Hospital Readmissions, Medicare, Physicians, Regulation, Telemedicine
Prostate Cancer Imaging Rates
by Kevin Roche on Thursday, April 26, 2012
An article in Health Affairs examines imaging rates for prostate cancer patients, adding a new viewpoint to the geographic variation in care debate by finding that low imaging areas have low rates of both appropriate and inappropriate imaging and vice versa.
Tags: Health Care Costs, Physicians
PMSI Drug Trend Report
by Kevin Roche on Wednesday, April 25, 2012
PMSI has released its 2012 Drug Trend Report for workers’ compensation business. Medical costs are an increasing portion of workers’ compensation payouts and drug spending, particularly for pain medications, has become an area of greater focus to prevent abuse.
Tags: Drugs, Health Care Costs, Workplace
GAO on Medicare Advantage
by Kevin Roche on Tuesday, April 24, 2012
A report from the Government Accounting Office trashes the Administration’s Medicare Advantage bonus “demonstration”, suggesting it was a thinly-veiled subterfuge, wasn’t likely saving money and wasn’t likely to improve quality.
Tags: Health Care Costs, Medicare
2012 Potpourri XIV
by Kevin Roche on Friday, April 20, 2012
More delightful health facts for your edification in our most recent Potpourri, including the cost of obesity, an employer survey on wellness programs, opportunities for hospitals to reduce costs, an employer survey on cost expectations in the coming year, Massachusetts’ and health spending control and incentives in health care.
Tags: Consumers, Health Care Costs, Health Care Reform, Health Insurance, Hospital, Wellness and Prevention, Workplace
A Primary Care Program That Reduced Spending
by Kevin Roche on Thursday, April 19, 2012
Improving primary care is viewed as a method to lower health spending while maintaining or even improving quality. A Health Affairs article reports on a Virginia program that appears to have successfully used primary care reforms to meet these objectives.
Dual Eligible Data
by Kevin Roche on Wednesday, April 18, 2012
The segment of the population which is elderly and poor, thus often eligible for both Medicare and Medicaid coverage, is often not in good health and has very high expenses. The travails of this population and how Medicare might be able to control spending for this group are explored in a new Kaiser Foundation Report.
Tags: Health Care Costs, Medicaid, Medicare
Hospital Spending and Quality
by Kevin Roche on Tuesday, April 17, 2012
All the focus on quality and the effect of spending on quality of care has led to some creative research approaches to understanding what that relationship may be. A new paper from the National Bureau of Economic Research looks at ambulance to hospital patterns to see what can be gleaned there.
2012 Potpourri XIII
by Kevin Roche on Friday, April 13, 2012
Our latest Potpourri features the comparative cost of cancer care in the US and elsewhere, the effect of genomics on spending, international practice guidelines, state Medicaid waivers, unintended consequences from patient satisfaction efforts and county health rankings.
Tags: Comparative Effectiveness, Consumers, Health Care Costs, Health Care Quality, Medicaid, Medical Care, Pay For Performance
Drug Use in the United States in 2011
by Kevin Roche on Thursday, April 12, 2012
The IMS Institute for Healthcare Informatics has released a wonderful report on use of prescription drugs in the United States in 2011. A great deal of detailed information on therapeutic category, cost sharing and source of prescription dispensing is presented, along with trend information.
Tags: Drugs, Health Care Costs
Coding and Outcomes Measurements
by Kevin Roche on Wednesday, April 11, 2012
In an era of multiple programs measuring outcomes and costs by provider and by disease or condition, the importance of consistent coding in the data used to do the measurement cannot be overstated, yet it appears that coding, and coding changes may have a substantial influence in results, according to a new JAMA study.
Tags: Health Care Costs, Health Care Quality, Pay For Performance
Insurance Changes and ER Use
by Kevin Roche on Tuesday, April 10, 2012
One of the surprises of the expansion of health coverage in Massachusetts is that it seems to have increased emergency room use. A new study shows that this phenomenon might occur in all insurance changes and if the reform law is fully implemented, ERs may be overwhelmed.
Tags: Emergency rooms, Health Care Costs, HIT
Chemotherapy Costs
by Kevin Roche on Monday, April 9, 2012
In general, lower drug costs have helped decrease health spending growth, but specialty drug prices and use, often for cancer, have increased rapidly. New reports show these cost increases are exacerbated by a sift in treatment from physician offices to hospital settings.
Tags: Drugs, Health Care Costs, Hospital, Physicians
Physicians on Inappropriate Medical Care
by Kevin Roche on Thursday, April 5, 2012
Physicians are as aware as anyone of the need to control health spending. Several physician specialty associations have released lists of procedures or treatments that consumers and doctors should question before using. This hopefully reflects a trend of physicians being more engaged in delivering only needed care.
Tags: Care Management, Consumers, Health Care Costs, Physicians
Variation in Spending and Quality
by Kevin Roche on Tuesday, April 3, 2012
One of the theories behind geographic variation in health spending analysis is that there are areas where high rates of inappropriate care delivery exist, leading to higher spending. A new systematic review of research on the topic of inappropriate use in the journal Medical Care finds little evidence to support this theory.
Tags: Health Care Costs
2012 Potpourri XI
by Kevin Roche on Friday, March 30, 2012
Welcome to another Potpourri of health information, focusing on workers’ comp medical prices, cost-sharing on asthma meds, the Medicare Advantage program, doctors’ experience of quality improvement programs, a review of the last 60 years in health economics and the value of teledermatology.
Tags: Care Management, Consumers, Drugs, Health Care Costs, Health Care Quality, Medicare, Physicians, Telemedicine, Workplace
2012 MedPAC Report
by Kevin Roche on Thursday, March 29, 2012
Every year the Medicare Payment Advisory Commission puts out a report on its views on the current state of Medicare, its major issues and recommendations to Congress and the Centers for Medicare and Medicaid Services about how to improve the program. The 2012 report is out with a plethora of useful information.
Tags: Health Care Costs, Medicare
Surrogate Decision-makers and End-of-Life Care
by Kevin Roche on Wednesday, March 28, 2012
End-of-life care accounts for a large fraction of health spending. Often decisions regarding such care are made by surrogates and new research published in the Annals of Internal Medicine suggest that analytical biases lead these surrogates to misinterpret information provided by physicians.
Local Health System Performance Report
by Kevin Roche on Monday, March 26, 2012
A new report from the Commonwealth Fund tracks performance of local health care systems across the United States, finding as much as a two to three times variation across the 306 regions, as measured on several dimensions of access and quality.
2012 Potpourri X
by Kevin Roche on Sunday, March 25, 2012
Spring is in the air but take a few minutes to refresh with our latest Potpourri, which includes the Congressional Budget Office’s latest health reform projections, ER use by those with Medicaid or private insurance coverage, the effect of selective outcomes reporting in research, an AonHewitt survey of employers on exchange use, another CBO report on employer incentives for use of TriCare and physician costs to comply with quality mandates.
Tags: Care Management, Comparative Effectiveness, Consumers, Employers, Health Care Costs, Health Care Quality, Health Care Reform, Health Insurance Exchanges, Medicaid, Physicians
Medical Home Research
by Kevin Roche on Thursday, March 22, 2012
A review article in the American Journal of Managed Care summarizes the evidence to date on medical homes. The results look modestly promising, with evidence of improving quality of care, some signs of cost control, but other evidence that suggests net cost increases.
Tags: Care Management, Health Care Costs, Health Care Quality, Medical Homes
Spending and Quality
by Kevin Roche on Tuesday, March 20, 2012
We would all like to believe that spending more on health care means we would have better outcomes and healthier people. Most research on the topic to date has suggested that this is not true, but a new study from Canada indicates that perhaps spending more is associated with better treatment outcomes.
So Maybe HIT Won’t Save Lots of Money?
by Kevin Roche on Thursday, March 15, 2012
A new study published in Health Affairs looks at one of the claimed benefits for broader use of health information technology, that it will reduce redundant test ordering, and finds that it appears to have the opposite effect. Once again, it pays to be very leery about the remedial claims of all these great new health care advances.
Tags: Health Care Costs, HIT
Personalized Medicine
by Kevin Roche on Wednesday, March 14, 2012
Years after it was initially predicted to do so, medical care based on individual genetic findings is becoming more pervasive. A new report from UnitedHealth Group examines trends and impacts over the next few years from this more personalized version of medicine.
Tags: Disease Management, Genomics, Health Care Costs, Health Care Quality
More on Specialty Drugs
by Kevin Roche on Monday, March 12, 2012
Specialty drug costs are growing very rapidly and in a few years may constitute half of all pharmaceutical spending. A new report from the Pharmacy Benefit Management Institute highlights trends in utilization and costs in this health care category.
Tags: Drugs, Health Care Costs
2012 Potpourri IX
by Kevin Roche on Friday, March 9, 2012
Another outstanding collection of summaries from the health research literature, including this week, physicians’ difficulty in understanding the benefits of screening tests, physicians’ feelings about health information technology, AARP’s latest report on prices paid by seniors for commonly used drugs, the real cost of health reform, variation in outcomes and costs of knee replacements and shared decision-making in two common clinical situations.
Tags: Consumers, Drugs, Elder Care, Health Care Costs, Health Care Reform, HIT, Physicians, Wellness and Prevention
Comparative World Health Spending
by Kevin Roche on Wednesday, March 7, 2012
A report from the International Federation of Health Plans compares prices for some common services and drugs across several developed countries. In all categories, physician services, hospital care and drugs, the United States pays average commercial plan prices that are much higher than any other country for almost every service.
High-Risk Insurance
by Kevin Roche on Monday, March 5, 2012
A small percent of the population accounts for a large percent of overall health spending. These people have often had difficulty getting health insurance and the reform law fixes that, but at a cost which is apparently far higher than what was originally projected by the Administration, according to its own analysis.
Managed Care Medicare Plan Hospital Readmission Rates
by Kevin Roche on Thursday, March 1, 2012
The CMS program to reduce, or at least penalize hospitals for, unnecessary readmissions is in full swing this year. A new study looks at how Medicare Advantage plans do in regard to readmissions for their beneficiaries and compares this performance to that for fee-for-service beneficiaries.
Tags: Health Care Costs, Health Care Quality, Hospital, Hospital Readmissions, Medicare
Price Transparency and Health Spending
by Kevin Roche on Wednesday, February 29, 2012
According to a new report from Thomson Reuters, $36 billion a year could be saved in health care spending if provider prices were more transparent to consumers. There is a little faulty reasoning in the report, but there is no doubt that it is extremely difficult for consumers to find, understand and compare the price of health care.
Tags: Consumers, Health Care Costs
Variation in Health Spending Again
by Kevin Roche on Tuesday, February 28, 2012
Yet another missive for the debate on the sources of variation in health spending, this time from the Center for Studying Health System Change, which looked at autoworker claims across the country, finding that people’s health status and hospital prices were the major factor in geographic spending differences.
Tags: Health Care Costs, Hospital
2012 Potpourri VII
by Kevin Roche on Friday, February 24, 2012
Our latest Potpourri, a week late and we apologize, covers virtual coaching, the integration of drug and medical benefit management, how doctors chose to handle their own end-of-life care, Medicaid and ER visits, and malpractice and orthopedics.
Tags: Drugs, End-of-Life Care, Health Care Costs, HIT, Hospital, Malpractice, Medicaid, Physicians, Telemedicine, Wellness and Prevention
Reform’s Effect on Health Insurance Premiums
by Kevin Roche on Tuesday, February 14, 2012
President Obama, his administration and Congressional Democrats sold the health “reform” law in large part by claiming it would reduce health insurance premiums for average Americans, by $2000 they said, and they persuaded “experts” to write papers supporting those claims. Now one of those experts has admitted his previous paid-for analysis was wrong.
Tags: Health Care Costs, Health Care Reform, Health Insurance
Regional Variation in Drug Spending
by Kevin Roche on Monday, February 13, 2012
Geographic variation in health care spending is an ongoing controversial topic primarily because the most significant implication is that many physicians have practice patterns that unnecessarily raise costs and changing those patterns could save significant dollars. A New England Journal of Medicine article discusses variation in Medicare drug spending.
Tags: Drugs, Health Care Costs, Medicare
2012 Potpourri VI
by Kevin Roche on Friday, February 10, 2012
This week’s Potpourri focuses on the cost of robotic surgery, the benefits of aspirin compared to more expensive drugs, the benefits of fitness club use, what states and specialties are responsible for the SGR overrun, and the performance of safety-net hospitals on ER quality measures.
Tags: Devices, Drugs, Health Care Costs, Health Care Quality, Hospital, Physicians
CMS’ Latest Foray Into Drug Pricing
by Kevin Roche on Thursday, February 9, 2012
CMS has issued its latest proposal rule on Medicaid drug pricing and rebates. The proposal doesn’t clear up all areas of uncertainty and will add administrative costs for manufacturers. It will also likely influence the continued shift in how payers reimburse pharmacies.
Tags: Drugs, Health Care Costs, Medicaid
Massachusetts Update
by Kevin Roche on Wednesday, February 8, 2012
The Massachusetts reform rolls on, with the state’s residents generally still okay with the changes, although cost continues to be a problem. An article in Health Affairs sums up the current state of affairs.
Tags: Health Care Costs, Health Care Quality, Health Care Reform
Medical Devices and Hospitals
by Kevin Roche on Tuesday, February 7, 2012
The Government Accountability Office issues a report on use of implantable medical devices in hospitals, finding that they pay widely varying prices, suggesting that it is often too much, some of which ends getting paid by taxpayers.
Tags: Devices, Health Care Costs, Hospital
2012 Potpourri V
by Kevin Roche on Friday, February 3, 2012
Another Potpourri brimming with doses of useful information that you eagerly await each week, including Medicare special needs plans and patients with diabetes, health information technology venture capital funding and M & A, identifying overuse in health care, what makes a better medical group, does merging weak hospitals help them and interventions that appear to work to prevent development of diabetes.
Tags: Care Management, Chronic Disease, Financings, Health Care Costs, Hospital, M&A, Medicare, Physicians
CBO on Medicare’s Value-Based Payment Demos
by Kevin Roche on Thursday, February 2, 2012
Another excellent paper from the Congressional Budget Office is issued, this one on Medicare’s demonstration projects on value-based payments to providers. Once again, the demonstrations had very mixed results, with only one demonstration generating savings for the Medicare program.
Tags: Bundled Payments, Health Care Costs, Health Care Quality, Pay For Performance, Providers
2012 Potpourri IV
by Kevin Roche on Friday, January 27, 2012
Another zinger of a Potpourri, with nuggets on a GAO audit of NQF work, use of web tools for diabetes management, the Healthways well-being index, the problem with federal health spending, hospital job losses from reimbursement cuts, and reducing unnecessary testing.
Tags: Care Management, Health Care Costs, Health Care Quality, HIT, Hospital, Physicians, Wellness and Prevention
AHA Guidelines on Hospital Ownership Changes
by Kevin Roche on Wednesday, January 25, 2012
The American Hospital Association releases its Principles and Guidelines for Changes in Hospital Ownership, which recognize and attempt to ameliorate the public concerns about the effects of hospital consolidation or for-profit conversions of hospitals.
Tags: Health Care Costs, Hospital
CBO on Medicare’s Care Management Demos
by Kevin Roche on Tuesday, January 24, 2012
The Centers for Medicare and Medicaid Services has engaged in a number of care management demonstrations over the years. The Congressional Budget Office adds its assessment to the body of research examining the outcomes of those demostrations.
Tags: Care Management, Chronic Disease, Disease Management, Health Care Costs, Health Care Quality, Medicare
Reinhardt on US Health Spending Trends
by Kevin Roche on Monday, January 23, 2012
A noted health economist discusses the recent release of national health spending and spending growth for 2010, finding that while expenditures appear to have slowed, we are a long way from being able to reach that conclusion.
Tags: Health Care Costs
2012 Potpourri III
by Kevin Roche on Friday, January 20, 2012
Winter is getting long and tedious by now, but our Potpourri offers a welcome respite, with refreshing tidbits on hospital uncompensated care, teledermatology, Medicaid controls of antipsychotic use, Medicare cuts to osteoporosis testing payments, the relationship between primary care access and mortality risk, and where the United States will find cost-savings.
Tags: Drugs, Health Care Costs, Health Care Quality, Hospital, Medicaid, Medicare, Telemedicine
Hospital Readmissions
by Kevin Roche on Thursday, January 19, 2012
Researchers have published a study in the Journal of the American Medical Association which examines hospital readmission rates for heart attack patients in multiple countries. The United States has higher absolute rates of readmissions, but the lowest lengths of stay and the two circumstances appear to be linked.
Tags: Health Care Costs, Health Care Quality, Hospital, Readmissions
High Cost Patients
by Kevin Roche on Wednesday, January 18, 2012
An astoundingly small number of patients account for a very high percentage of overall national health expenditures and an equally astounding large number of patients account for a very small amount of that spending. A new brief from AHRQ gives details.
Tags: Health Care Costs
Coverage of the Young and Spending by the Old
by Kevin Roche on Monday, January 16, 2012
The Employee Benefit Research Institute provides a quick look at two interesting topics. The new reform law requires that employer health plans provide coverage for adult children up to the age of 26. Early evidence suggests that the number of uninsured adults in the 19-25 age group has declined. Older Americans are also found to often make changes in health spending in response to financial distress.
Tags: Elder Care, Health Care Costs, Health Insurance Exchange
Health Spending Growth and Trend
by Kevin Roche on Thursday, January 12, 2012
The official report on national health spending for 2010 has been finalized by the Office of the Actuary at the Centers for Medicare and Medicaid Services. The increase over 2009 was quite low, driven mostly by reductions in utilization as individuals had to pay out-of-pocket for care.
Tags: Health Care Costs
Specialty Drug Trend
by Kevin Roche on Tuesday, January 10, 2012
A new report from Magellan subsidiary iCore provides information on trends in specialty drugs covered under a plan’s medical benefit, indicating that these compounds’ use and cost continues to rise rapidly, providing strong challenges for payers, who often lack good data and tools to manage this pharmaceutical category.
Tags: Drugs, Health Care Costs, Physicians
Chronic Disease Management Savings
by Kevin Roche on Monday, January 9, 2012
A report from the Urban Institute projects what savings might be available from greater use of intensive care management for persons with serious, multiple chronic diseases.
Tags: Care Management, Chronic Disease, Disease Management, Health Care Costs
Health Care Spending and Prices
by Kevin Roche on Wednesday, January 4, 2012
We appear to be in the midst of a hiatus in rapid health spending growth and health price inflation, a view reinforced by two recent reports from the Altarum Institute. Declines in per capita utilization may be the major cause, which might be a concern if needed care is being delayed.
Tags: Health Care Costs
End-of-Life Care
by Kevin Roche on Tuesday, January 3, 2012
A draft evidence report from AHRQ looks at end-of-life and hospice care. End-of-life care is often fingered as one of the causes of increasing health spending. The report finds moderate evidence supporting beneficial effects from many of the studied interventions.
Tags: End-of-Life Care, Health Care Costs, Health Care Quality, Medicare
2011 Wrapup
by Kevin Roche on Friday, December 30, 2011
Our final commentary of 2011 reflects on developments in health care for the year. Notably, support for the health reform law continues to be weak and health care cost growth continues to outpace both GDP and inflation.
Tags: Health Care Costs, Health Care Reform, Health Insurance
Insurance Premium Trends
by Kevin Roche on Thursday, December 29, 2011
One reason given for the need for the reform law was the growth in health insurance costs, although it is yet unclear whether the law reduces or increases those costs in the long run. A Commonwealth Fund brief looks at state-by-state trends in premiums and consumer costs.
Tags: Health Care Costs, HIT
Medical Homes
by Kevin Roche on Wednesday, December 28, 2011
Another one of the concepts being counted on to help improve health care quality and lower costs in the wake of reform is the “medical home.” An AHRQ draft review finds little evidence on quality effects or cost savings, but also suggests there is promise in the approach.
Tags: Health Care Costs, Health Care Quality, Medical Care, medical home, Physicians
Health Spending by State
by Kevin Roche on Tuesday, December 27, 2011
How much does health spending per person vary across the fifty states and does that variance occur equally in the commercially insured population, Medicaid eligibles and Medicare beneficiaries? These and other questions are answered in research published in the Medicare and Medicaid Research Review.
Tags: Health Care Costs, Medicaid, Medicare
Commercial and Medicare Spending Variation
by Kevin Roche on Thursday, December 22, 2011
A study reported in the American Journal of Managed Care follows up on the comparative geographic variation in spending on Medicare patients and commercially insured ones in Texas, finding that the pattern of variation is similar for the two groups.
Physician Views of Health Care
by Kevin Roche on Wednesday, December 21, 2011
Physicians have felt under assault for decades, with managed care restrictions, low reimbursement and malpractice concerns leading the charge. A new survey from Deloitte’s Center for Health Solutions give doctors’ perspectives on health care reform and their profession.
Tags: Health Care Costs, Health Care Quality, Health Care Reform, Health Insurance, Physicians
More on Hospital Readmissions
by Kevin Roche on Monday, December 19, 2011
The latest research on hospital readmissions, published in the NEJM, finds that the largest single factor associated with readmission rates for heart failure and pneumonia is the underlying rate of overall hospitalizations, suggesting that to reduce readmissions, you need to reduce the general predeliction to hospitalize.
Tags: Health Care Costs, Health Care Quality, Hospital, Hospital Readmissions
2011 Potpourri XXXXVIII
by Kevin Roche on Friday, December 16, 2011
The holiday season is in full swing, as is the time for bad weather, but nothing can deter the delivery of our Potpourri of health stories, including this week the nocebo effect, use of imaging when a financial interest in the equipment is present, broker commissions and the MLR, present-on-admission indicators, selecting patients for use in performance measuring, and physicians views of health insurers.
Tags: Health Care Costs, Health Care Quality, Health Insurance, Hospital, Medical Care, Pay For Performance, Physicians
Hospital Cost Components
by Kevin Roche on Wednesday, December 14, 2011
Inpatient hospital costs are the largest single category of health care costs and account for much of the last decade’s rapid annual rise in health care spending. A statistical brief from the HCUP project examines components of hospital costs to ascertain sources of growth. Cost per stay is the largest single cause of rising hospital inpatient costs.
Tags: Health Care Costs, Hospital
Bundled Payments
by Kevin Roche on Tuesday, December 13, 2011
Another excellent draft report from the Agency for Healthcare Research and Quality reviews the evidence related to the effects of bundled payments to providers on quality and costs. The evidence, while weak, suggests that utilization and costs decline and quality is not notably affected in either direction.
Tags: Bundled Payments, Comparative Effectiveness, Health Care Costs, Health Care Quality
Disease Registries
by Kevin Roche on Monday, December 12, 2011
Disease registries are used to track a number of patients with a common condition to determine factors which affect their outcomes and to help guide their treatment. An article in Health Affairs reviews a number of disease registries in several countries, finding that they have a high potential to improve overall quality.
Tags: Care Management, Chronic Disease, Health Care Costs, Health Care Quality
2011 Potpourri XXXXVII
by Kevin Roche on Friday, December 9, 2011
Another scintillating Potpourri, focused on the effect of copayments on prescription adherence, use of PHRs in the FEHBP plans, doctors use of cancer drugs after a Medicare reimbursement change, visiting physicians after a hospital discharge, consumers expectations regarding health insurance and early experience with bundled payments.
Tags: Consumers, Health Care Costs, Health Care Quality, Health Insurance, HIT, Hospital, Physicians, Readmissions
Hospital in the Home Analysis
by Kevin Roche on Thursday, December 8, 2011
An intriguing concept is explored in a paper from Deloitte: would it be possible to move some services typically delivered in a hospital to the patient’s home. Based on pilot’s in Australia, the paper suggests that savings can be achieved, with no apparent threat to quality or patient safety.
Tags: Health Care Costs, HomeCare, Hospital
What Works in Financial Incentives
by Kevin Roche on Monday, December 5, 2011
Both providers and consumers are increasingly subjected to positive and negative inducements to behave in certain ways. An article in the International Journal of Behavioral Medicine explores some possible behavioral and ethical rules for the design of patient-oriented incentive programs.
Tags: Consumers, Health Care Costs, Health Care Quality, Incentives
2011 Potpourri XXXXVI
by Kevin Roche on Friday, December 2, 2011
The holiday shopping season is in full swing but our Potpourri is free, filled with useful data on high-deductible health plans and utilization, Medicare Advantage plan Stars bonuses, drug complications and hospitalizations, physician office visit trends, premium increases, and patient expectations.
Tags: Consumer Directed Health, Drugs, Health Care Costs, Health Care Quality, Health Care Reform, Health Insurance, Medicare, Patient Satisfaction, Physicians
Medicare Cost-Sharing
by Kevin Roche on Thursday, December 1, 2011
The Kaiser Foundation looks at proposals to revamp Medicare’s cost-sharing design, including possible changes to Medigap benefits, finding that changes could save billions for the program and reduce costs for many beneficiaries.
Tags: Consumers, Health Care Costs, Medicare
OIG and Drug Pricing
by Kevin Roche on Tuesday, November 29, 2011
Pricing for drugs is an arcane world. The Office of Inspector General has attempted to shed light on pricing benchmarks and methodologies and in a new report tries to provide guidance to state Medicaid programs on how to minimize what they pay for drugs used by the programs’ beneficiaries.
Tags: Drugs, Health Care Costs
Technology and Health Costs
by Kevin Roche on Wednesday, November 23, 2011
A new paper at the National Bureau of Economic Research examines the relationship between technology and spending growth in health care. While no firm conclusions are reached, a country’s willingness to spend on health may drive technology development and use rather than vice versa.
Tags: Devices, Drugs, Health Care Costs
The Efficacy of Rehospitalization Interventions
by Kevin Roche on Monday, November 21, 2011
The Annals of Internal Medicine carries a study on the effectiveness of interventions to reduce the 30-day readmissions rate. This meta-review found little consistent evidence to support the value of any particular intervention, which should give further pause to the notion that most readmissions could be avoided or that hospitals should be penalized when they can’t be told how to reliably reduce readmissions.
Tags: Health Care Costs, Health Care Quality, Hospital, Readmisssions
2011 Potpourri XXXXV
by Kevin Roche on Friday, November 18, 2011
No Potpourri next week due to the holiday, so enjoy this festive collection of health care nuggets, including pay-for-performance in large physician groups, employer views on the effect of the reform law, the effect of physician financial interest in cardiac testing, experience with high deductible plans, medical homes and quality improvement and for-profit and non-for-profit hospital treatment of the uninsured.
Tags: ACO, Care Management, Consumer Directed Health, Health Care Costs, Health Care Quality, Health Care Reform, Health Insurance, Hospital, medical home, Pay For Performance, Physicians
Medicare Disease Management Pilots
by Kevin Roche on Wednesday, November 16, 2011
A final summary of Medicare’s disease management pilots gives a bleak picture of the value of the efforts. While there are design and methodological critiques of the Medicare program that may make the results not generalizable, the outcomes do suggest that if disease management is to show value, design and execution need to be improved.
Tags: Disease Management, Health Care Costs, Health Care Quality, Medicare
Massachusetts’ Cost Dilemma
by Kevin Roche on Tuesday, November 15, 2011
Massachusetts Special Commission on Provider Price Reform has released its momentous report on how to address the surging health care costs in the state, which appear to be largely caused by “excessive” provider prices and price increases. Someday regulators might learn that the more you regulate, the more you regulate.
Tags: Government, Health Care Costs, Health Care Reform, Providers
Drug Manufacturer Copay Assistance Programs
by Kevin Roche on Monday, November 14, 2011
Drug manufacturers have a new trick up their sleeve to get consumers to use their expensive branded products instead of cheaper alternatives–copay coupon programs. These programs significantly raise spending with no offsetting gain in quality or other benefits. Unfortunately, regulation is probably needed to ban the programs.
Tags: Drugs, Health Care Costs
Cost-Shifting and Care
by Kevin Roche on Tuesday, November 8, 2011
Research reported in Health Affairs examines the Mayo Clinic’s experience after increasing cost-sharing for its employees. Reductions in the use of many discretionary services seem to have been sustained over a multi-year period, leading to overall spending restraint.
Tags: Consumer Directed Health, Consumers, Health Care Costs, Health Care Quality, Health Insurance
GAO on Price Transparency
by Kevin Roche on Monday, November 7, 2011
A significant trend affecting all of health care in the last decade is consumerism, specifically the effort to engage consumers in managing their health and health care and to make care more patient-centered. A new report from GAO shows how hard these efforts can be when data, in this case data on provider prices, is hard to obtain and give to consumers.
Tags: Consumers, Health Care Costs, HIT, Providers
2011 Potpourri XXXXIII
by Kevin Roche on Friday, November 4, 2011
Winter nears but our Potpourri will distract you from the cold breezes, providing compelling nuggets on prostate screening recommendations, consumer use of technology for health, insurer medical cost trends, what to do about Medicare’s physician payments, heart failure hospitalization and mortality rates and rates of non-filling of new prescriptions.
Tags: Chronic Disease, Disease Management, Drugs, Health Care Costs, Health Insurance, HIT, Hospital, Medicare, Physicians, Telemedicine, Wellness and Prevention
More Trashing of the US Health System
by Kevin Roche on Wednesday, November 2, 2011
From the Commonwealth Fund comes another in a series of reports bemoaning the woeful inadequacy of the American health system, especially compared to those in other developed countries. Whatever our faults, this type of analysis is filled with its own flaws and provides little useful guidance for addressing our issues.
Tags: Health Care Costs, Health Care Quality, Health Care Reform
Specialty Pharmacy
by Kevin Roche on Tuesday, November 1, 2011
Specialty drugs have gotten the attention of all payers, with multiple efforts underway to manage the exploding costs associated with this category. A new paper from URAC summarizes the issues and sets out the value of using an accredited specialty pharmacy.
2011 Potpourri XXXXII
by Kevin Roche on Friday, October 28, 2011
Another brilliant Potpourri, with scintillating health care gems, including revising the FDA’s 510(k) process, the essential benefits package for health exchanges, the future of Medicare Advantage, the lack of labor productivity in health care, variation in elective procedure rates and the OIG’s work plan.
Tags: Care Management, Devices, FDA, Government, Health Care Costs, Health Care Reform, Health Insurance, Medical Care, Medicare, Physicians
Care Coordination for the Dual Eligible Population
by Kevin Roche on Wednesday, October 26, 2011
Medicare/Medicaid dual eligibles are relatively poor, elderly or disabled persons who have very high health spending. A report from America’s Health Insurance Plans discusses how care coordination programs can achieve significant savings for the programs and better health outcomes for the patients.
Tags: Care Management, Chronic Disease, Health Care Costs, Medicaid, Medicare
Controlling Health Spending
by Kevin Roche on Tuesday, October 25, 2011
An Urban Institute report looks at the seemingly unsolvable problem of US health care spending growth, identifying four key potential causes and several solutions which might in total reduce spending by an average of about 5% to 10% a year through 2023.
Tags: Health Care Costs
Insurance Market Competitiveness
by Kevin Roche on Monday, October 24, 2011
The Kaiser Foundation takes a look at the competitiveness of individual and small group health insurance markets on a state-by-state basis, finding that most are relatively concentrated. The report also examines the implications of this concentration for aspects of the reform law, particularly the exchanges and rate review.
Tags: Health Care Costs, Health Care Reform, Health Insurance
Deloitte’s Latest Consumer Survey
by Kevin Roche on Thursday, October 20, 2011
The Deloitte Center for Health Solutions releases the latest edition of its annual survey of consumers on health issues and health care use. Americans are anxious about the financial effects of health care and think our system is not good, but are generally happy with the care they actually receive.
Tags: Consumer Directed Health, Health Care Costs, Health Insurance
AHA Report on Hospital Readmissions
by Kevin Roche on Wednesday, October 19, 2011
The American Hospital Association weighs in on the hospital readmission reduction incentive program with a well-thought out program that identifies the complexities involved in identifying inappropriate readmissions and designing initiatives to reduce those readmissions.
Tags: Health Care Costs, Health Care Quality, Hospital, Readmissions
2011 Potpourri XXXX
by Kevin Roche on Friday, October 14, 2011
The leaves fall but not the quality of our Potpourri, this week covering beneficiaries’ use of Medicare Star ratings, quality of care guidelines and older patients, compassionate care, asthma care guidelines and outcomes, infection control in hospitals and informal caregivers in California.
Tags: Consumer Directed Health, Elder Care, evidence based medicine, Health Care Costs, Health Care Quality, Hospital, Medicare, Pay For Performance
Telehealth Care Management
by Kevin Roche on Thursday, October 13, 2011
The effect of telehealth tools on the health spending of Medicare beneficiaries with chronic disease has been controversial, with a number of studies finding no or very limited savings. New research published in Health Affairs suggests that at least one such tool may contribute to savings in a care management program for common chronic diseases.
Tags: Care Management, Disease Management, Health Care Costs, Medicare, Telehealth
Advance Directives and End-of-Life Spending
by Kevin Roche on Wednesday, October 12, 2011
End-of-life care is a significant contributor to overall health expenditures. New research in the Journal of the American Medical Association probes the effect of advance directives on end-of-life spending, with a particular focus on geographic variations both in the use of directives and care.
Tags: Elder Care, End-of-Life Care, Health Care Costs, Health Care Quality, Medicare
Hospital Quality and Community Demographics
by Kevin Roche on Tuesday, October 11, 2011
Increasingly hospitals are being judged on their “quality” based on process and outcome measures and on their cost. New research examines the characteristics of hospitals which fall in various quartiles based on quality and costs, finding that many hospitals serving poorer patients are judged low quality and high cost, but whether those hospitals are being fairly evaluated is an open question.
Shared Decision Making
by Kevin Roche on Monday, October 10, 2011
A new paper discusses the state of shared decision-making, illuminating progress and barriers to use by patients and providers. This approach results in higher-quality care, because it is consistent with patient values and with truly informed patient consent and it may also help reduce spending.
Tags: Comparative Effectiveness, Consumers, Health Care Costs, Health Care Quality, Physicians, shared decision-making
Dartmouth Atlas on Hospital Readmissions
by Kevin Roche on Thursday, October 6, 2011
In another piece of research related to hospital readmissions, the Dartmouth Atlas project released a report on variations in readmission patterns across the country and among academic medical centers. Possible reasons for the variation are explored as is the longitudinal trend, which shows no improvement.
Tags: Health Care Costs, Health Care Quality, Hospital, Hospital Readmissions
Kaiser Health Insurance Survey Part III
by Kevin Roche on Wednesday, October 5, 2011
The final look at the Kaiser employer health benefit survey examines findings on prescription drug coverage, wellness programs, retiree health plans, funding mechanisms and the effect of health care reform.
Tags: Consumers, Health Care Costs, Health Insurance, Workplace
Kaiser Health Insurance Survey II
by Kevin Roche on Tuesday, October 4, 2011
The second part of our review of the Kaiser employer health benefits survey discusses employee contributions to premiums and employee cost-sharing trends, along with developments in high-deductible plans with savings accounts.
Tags: Consumers, Health Care Costs, Health Insurance, Workplace
Kaiser Health Insurance Survey I
by Kevin Roche on Monday, October 3, 2011
The annual Kaiser Foundation report on employment-based health coverage finds a rapid growth in per person and per family costs in 2009, but relative stability in the number of persons who have access to health insurance at the workplace. High-deductible plans continue to show rapid enrollment increases.
Tags: Consumers, Health Care Costs, Health Insurance, Workplace
2011 Potpourri XXXVIII
by Kevin Roche on Friday, September 30, 2011
We enter the year’s home stretch with a great Potpourri, focusing on comparison friction in Part D plan shopping, a Harris poll on health-related internet use, the effect of aging populations on health costs, creation of a data repository by major insurers, Mercer’s survey of employers on 2012 expected health benefit costs and AHRQ’s site on unintended EHR consequences.
Tags: Consumers, Drugs, EHRs, Health Care Costs, HIT
Consumerism and Employer-Provided Health Care
by Kevin Roche on Thursday, September 29, 2011
A new Rand report explores the use of health information technology to assist consumers in managing their health and making decisions about health care coverage. As health care coverage changes, these tools are more important, but their utility is unproven.
Tags: Consumers, Health Care Costs, Health Care Quality, HIT
Unit Cost Versus Prevalence or Utilization as a Health Spending Driver
by Kevin Roche on Tuesday, September 27, 2011
Increased disease prevalence has been hypothesized to be behind much of the growth in health spending. New research published in Health Affairs finds that prevalence growth accounts for little of the rise in spending, with most of it due to increases in treatment cost.
Tags: Chronic Disease, Health Care Costs
Maryland’s Hospital Payment System
by Kevin Roche on Monday, September 26, 2011
Maryland is unique among the states in having an all-payer hospital rate regulation system. The most recent report on the system’s performance shows that it is continuing to constrain the grow of hospital spending. Payers, hospitals and patients seem happy with the system.
Tags: Health Care Costs, Hospital, Regulation
Medicaid Managed Care
by Kevin Roche on Thursday, September 22, 2011
A Kaiser Family Foundation report surveys state managed care Medicaid programs, finding a surge in utilization of health plans and addition of eligibility categories to the plans. A great variety of features are used in different states, but the trend toward more managed care is clear.
Tags: Government, Health Care Costs, Health Care Reform, Medicaid
Hospital Readmissions
by Kevin Roche on Wednesday, September 21, 2011
A paper prepared by Mathematica for the New York State Health Foundation discussions readmissions in the state and evaluates proposed methods of reducing those readmissions. Just in New York, billions of dollars could potentially be saved by effective interventions.
Tags: Health Care Costs, Hospital, Readmissions
Health Plan and Hospital Market Concentration
by Kevin Roche on Tuesday, September 20, 2011
Hospitals and other providers have expressed concern that health plan consolidation jeopardizes the adequacy of reimbursement to providers but a new piece of research indicates that hospital consolidation is a much greater threat to attempts to control health spending.
Tags: Health Care Costs, Hospital
2011 Potpourri XXXVI
by Kevin Roche on Friday, September 16, 2011
The leaves begin to fall but not the quality of our Potpourri, this week including useful data on hospital readmissions in the VA system, what makes top hospitals successful, the accuracy of mortality ratings for children’s hospitals, the use of mortality rankings to identify the best hospitals, advertising by health care providers and the quality effects of the annual changeover of trainees in hospitals.
Tags: Health Care Costs, Health Care Quality, Hospital, Physicians, Readmissions
Physician Fees and National Health Spending
by Kevin Roche on Tuesday, September 13, 2011
The evidence continues to pile up that higher provider unit costs in the United States are the primary driver of our much higher than average per capita national health spending. Research published in Health Affairs indicates that our physician costs are higher because physicians charge more than in other countries.
Tags: Health Care Costs, Physicians
Search Costs in the Health Insurance Market
by Kevin Roche on Monday, September 12, 2011
A new paper from the National Bureau of Economics focuses on whether there are aspects of the health insurance market that add to premiums by creating significant inefficiencies in finding the best policy and whether a public insurance option may reduce those inefficiencies.
Tags: Consumers, Health Care Costs, HIT
2011 Potpourri XXXV
by Kevin Roche on Friday, September 9, 2011
Fall looms and brings the football season. Our Potpourri scores with nutritious bites of health information, including getting more genetic data into medical records, giving doctors price lists, the value of HIEs, reducing hospital costs, medication continuation after hospitalization and use of episode-based payments.
Tags: Genomics, Health Care Costs, HIT, Hospital, Personalized Medicine, Physicians, Reimbursement
Use of Cancer Drugs in Medicare
by Kevin Roche on Wednesday, August 31, 2011
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.
Tags: Drugs, Health Care Costs, Medicare
2011 Potpourri XXXIII
by Kevin Roche on Friday, August 26, 2011
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.
Tags: ACO, EHRs, Health Care Costs, HIT, Physicians, Workplace
Hospital Employment of Physicians
by Kevin Roche on Wednesday, August 24, 2011
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.
Tags: Health Care Costs, Hospital, Physicians
2011 Potpourri XXXII
by Kevin Roche on Friday, August 19, 2011
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.
Tags: Care Management, Health Care Costs, Health Care Quality, Hospital, Malpractice, Medicare, Wellness and Prevention
PPACA Projection Accuracy
by Kevin Roche on Tuesday, August 16, 2011
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.
Tags: Health Care Costs, Health Care Reform, Health Insurance
GAO on CMS’ Physician Feedback Reports
by Kevin Roche on Monday, August 15, 2011
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.
Tags: Health Care Costs, Medicare, Physicians
2011 Potpourri XXXI
by Kevin Roche on Friday, August 12, 2011
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 [...]
Tags: Health Care Costs, Health Insurance, Medicare, Physicians, Workplace
Geographic Variation in Commercial Health Spending
by Kevin Roche on Thursday, August 11, 2011
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
by Kevin Roche on Wednesday, August 10, 2011
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.
Tags: Health Care Costs, Medicare
Physician Administrative Costs
by Kevin Roche on Tuesday, August 9, 2011
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
by Kevin Roche on Monday, August 8, 2011
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.
Tags: Health Care Costs, Health Insurance, Hospital, Medicare
2011 Potpourri XXX
by Kevin Roche on Friday, August 5, 2011
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.
Tags: Consumers, EHRs, Health Care Costs, Health Care Quality, Health Insurance, HITECH, Hospital, Malpractice, Medicare, Physicians
Part D’s Effect on Overall Spending
by Kevin Roche on Thursday, August 4, 2011
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.
Tags: Drugs, Health Care Costs, Medicare
GAO on the Value of Health Spending
by Kevin Roche on Wednesday, August 3, 2011
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.
Tags: Care Management, Health Care Costs, Health Care Quality
Latest National Health Spending Projections
by Kevin Roche on Tuesday, August 2, 2011
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.
Tags: Health Care Costs
Risk-Bearing by Providers
by Kevin Roche on Monday, August 1, 2011
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.
Tags: ACO, Care Management, Health Care Costs, Health Insurance, Physicians
National Variations in Medicaid Spending
by Kevin Roche on Wednesday, July 27, 2011
A lot of the work on geographic variation in spending has been done on the Medicare population. New research published in Health Affairs examines variation in Medicaid spending for the disabled population and finds significant differences based on both volume and unit prices.
Tags: Health Care Costs, Medicaid
Early Massachusetts Experience With Global Payment
by Kevin Roche on Tuesday, July 26, 2011
Research published in the New England Journal of Medicine examines early results from the Massachusetts Blue Cross plan’s global budgeting program, finding very modest health spending reductions and small changes in quality.
Tags: ACO, Health Care Costs, Health Care Quality, Health Insurance, Physicians
Most Costly Conditions
by Kevin Roche on Wednesday, July 20, 2011
An AHRQ Statistical Brief looks at the most costly health conditions for 2008. They are about what you would expect, with heart disease and cancer leading the way. Women and men have the same top ten expensive conditions, but in slightly different order.
Tags: Health Care Costs
Analysis of US Health Spending
by Kevin Roche on Tuesday, July 19, 2011
A recent report from the NIHCM details national spending, showing that a few patients account for a lot of costs and that hospitals are the largest source of spending growth. Unit price increases are more important than utilization in explaining spending rises. Insurance administrative costs have actually declined as a percent of spending.
Tags: Health Care Costs
2011 Potpourri XXVII
by Kevin Roche on Friday, July 15, 2011
A mid-summer’s evening (or weekend) Potpourri, but no heated discussion here, just soothing nuggets of knowledge, including use and misuse of PCI, how to measure blood pressure, CMS and telemedicine, preventing falls, copying and pasting EHR notes, and physicians attitude to work and compensation.
Tags: EHRs, Health Care Costs, Health Care Quality, Medical Care, Medicare, Physicians, Telemedicine
Drug Week–Reports Part IV
by Kevin Roche on Thursday, July 14, 2011
Our final drug report post discusses releases from Express Scripts, the Pharmacy Benefit Management Institute and ESI’s PMSI division, which focuses on workers’ compensation pharmacy. Express Scripts emphasizes behavioral aspects of trend management and the PBMI report examines drug benefits from the employer perspective.
Tags: Drugs, Health Care Costs, Health Insurance, Workplace
Drug Week–Reports Part III
by Kevin Roche on Wednesday, July 13, 2011
Today’s drug trend reports come from Medco and CVS Caremark, two of the largest pharmacy benefit managers. Both experienced relatively low overall trends and both anticipate specialty drug management being the primary challenge in the years ahead.
Tags: Drugs, Health Care Costs
Drug Week–Reports Part II
by Kevin Roche on Tuesday, July 12, 2011
Our next set of drug reports deals with specialty drugs, the most expensive and fastest growing category, and one which has bedeviled payers but many of the drugs are covered under medical benefits. The reports detail usage trends and describe payer management strategies in detail.
Tags: Drugs, Health Care Costs, Health Insurance
2011 Potpourri XXVI
by Kevin Roche on Friday, July 8, 2011
Our current Potpourri features Google’s dropping of its PHR, the AMA’s report on insurer claims paying, the role of health advocacy groups, employer’s intentions in regard to offering health coverage, drug approval in the US versus Europe and the use of a checklist to improve quality in the ICU.
Tags: Drugs, FDA, Health Care Costs, Health Care Quality, Health Insurance, HIT, Physicians
Savings from Home Health Use
by Kevin Roche on Wednesday, July 6, 2011
A study finds that using home health care after a hospital admission for Medicare beneficiaries with certain chronic illnesses reduces Medicare Part A spending and readmissions compared to a beneficiary group that used other post-discharge services.
Tags: Elder Care, Health Care Costs, HomeCare, Hospital, Medicare
Deloitte Consumer Surveys
by Kevin Roche on Tuesday, July 5, 2011
Deloitte issues the results of a global and a United States consumer survey on perceptions of health and health care system. Most Americans have a gloomy outlook, but so do the citizens of most of the surveyed countries.
Tags: Consumers, Government, Health Care Costs, Health Care Quality
2011 Potpourri XXVI
by Kevin Roche on Friday, July 1, 2011
Fireworks galore for the Fourth of July Potpourri, including dynamite excerpts on the effects of parent caregiving on caregivers’ financial status; health insurance exchanges; physician compensation; provider performance data gathering and use; hospital market concentration; use of HIT in nursing homes and teen use of health websites.
Tags: Consumers, Elder Care, Health Care Costs, Health Care Reform, Health Insurance, HIT, Hospital, Meaningful Use, Pay For Performance, Physicians, Telemedicine
Massachusetts Report on Effect of Global Payments
by Kevin Roche on Thursday, June 30, 2011
The second annual report by the Massachusetts AG on health care spending trends continues to find that provider market power is a major factor and that using a risk-based payment methodology does not reduce payment variation or lower medical spending or utilization.
Tags: ACO, Health Care Costs, Health Care Reform, Providers
How England’s NICE Works
by Kevin Roche on Wednesday, June 29, 2011
Two articles describe in detail how Britain’s NICE operates in creating guidelines and conducting cost-effectiveness reviews. The process is highly transparent and professional, and while the institution has taken criticism for some of its decisions, its role is extremely important.
Tags: Comparative Effectiveness, Health Care Costs, Health Care Quality
2011 Potpourri XXV
by Kevin Roche on Friday, June 24, 2011
Summer waxes but no heat-induced torpor can stop us from producing our Potpourri of health snapshots, including the health care and health care coverage of young adults; malpractice incidence; Massachusetts health spending; online provider ratings; access to specialty care for children in public programs and options for dealing with the SGR mess.
Tags: Access, Consumers, Health Care Costs, Health Insurance, Malpractice, Medicaid, Medicare, Physicians
2011 Potpourri XXIV
by Kevin Roche on Friday, June 17, 2011
The week’s Potpourri continues the tradition of presenting excellent nuggets of health information, including EHR use in the VA system, the effect of making surrogate care decisions, screening for ovarian cancer, gaps in health among socioeconomic groups, cancer care guideline compliance, and ER visits in Massachusetts.
Tags: Care Management, EHRs, Elder Care, End-of-Life Care, Health Care Costs, Health Care Reform, HIT, Wellness and Prevention
CMS’ Review of Physician Reimbursement Methodology
by Kevin Roche on Thursday, June 16, 2011
CMS issued a proposed notice regarding its regular review of relative value units for physician reimbursement under Medicare. The notice gives you a sense of the impossibility of understanding what is going on there and the outsized influence of physicians in the process.
Tags: Health Care Costs, Medicare, Physicians
2011 Potpourri XXIII
by Kevin Roche on Friday, June 10, 2011
Another scintillating menu of health care tidbits, including provider reaction to the proposed Accountable Care Organization rule; end-of-life care in the US and Canada; hospital volume and outcomes for difficult surgeries; hospital marketing of robotic surgery; and cutting lab test costs.
Tags: ACO, Elder Care, End-of-Life Care, Health Care Costs, Hospital
More Data Available from CMS
by Kevin Roche on Thursday, June 9, 2011
CMS has proposed a rule to implement a PPACA provision allowing access to extracts of provider-level Medicare data to evaluate performance, primarily on quality measures. This is a good first step, but just a first step in being able to completely profile physician practice patterns.
Tags: Comparative Effectiveness, Health Care Costs, Health Care Quality, Medicaid, Medicare, Providers
Massachusetts Provider Price Variation
by Kevin Roche on Wednesday, June 8, 2011
A new report on prices paid by commercial insurers in Massachusetts shows great variation, which appears unrelated to providers’ costs or to the quality of care delivered. While the specific causes of the variation aren’t analyzed, a large opportunity to limit spending by reducing high-end payments is apparent.
Tags: Health Care Costs, Health Insurance, Hospital, Physicians
New Ideas to Control Spending
by Kevin Roche on Monday, June 6, 2011
Responding to a challenge for each medical specialty to find methods for reducing inappropriate care and spending in that specialty, two oncologists identify a number of steps that could easily be adopted and are supported by research findings.
2011 Potpourri XXII
by Kevin Roche on Friday, June 3, 2011
Another round of health tidbits, including the association between primary care workforce and Medicare outcomes, comparisons of Type 2 diabetes drugs, effects of limiting DTC drug advertising, health information exchange sustainability, the effect of the Irish workplace smoking ban and barriers to diffusion of cost-effective care.
Tags: Care Management, Drugs, Elder Care, Health Care Costs, Health Care Reform, HIT, Medicare, Physicians, Wellness and Prevention, Workplace
Variation in Medicare Spending–The Search for Causes Continues
by Kevin Roche on Wednesday, June 1, 2011
The latest paper on geographic variation in Medicare spending uses a different design and statistical tool to demonstrate that higher spending on health care is associated with better health in this population, which upends the traditional analysis and should lead to more careful policymaking.
Tags: Health Care Costs, Medicare
2011 Potpourri XXI
by Kevin Roche on Friday, May 27, 2011
Our Memorial Day Potpourri, celebrating health information such as the growth of high-deductible plans, physician starting salaries, benefit design for high-cost conditions, why emergency room physicians order tests, the use of telehealth for heart failure patients and sources of physician pay.
Tags: Care Management, Chronic Disease, Health Care Costs, Health Insurance, Malpractice, Physicians, Telemedicine
Medicare Trust Funds Alternative Scenario
by Kevin Roche on Thursday, May 26, 2011
As noted in yesterday’s post, the Trustees of the Medicare Hospital and Supplementary Funds recognized the inadequacy of the official projections of Medicare’s financial condition, and therefore had an alternative, and bleaker, scenario prepared.
Tags: Health Care Costs, Medicare
Medicare Trustees Report
by Kevin Roche on Wednesday, May 25, 2011
The Medicare Trustees have released the 2011 report on the status of the Medicare funds, indicating that they will be exhausted sooner than anticipated, due both to the recession and higher spending.
Tags: Health Care Costs, Medicare
Health Care Spending Index
by Kevin Roche on Tuesday, May 24, 2011
An index that tracks medical spending shows that while per capita spending continues to rise, the rate of growth has slowed, particularly for Medicare. Hospital spending continues to be the fastest growing category.
2011 Potpourri XXI
by Kevin Roche on Friday, May 20, 2011
Once more into the world of health care to find nuggets of useful information, this week including the legality of wellness programs, the switch to ICD-10, pragmatic trials, the status of the workers’ comp industry, consumer health care sentiment, and hospital ER strategies.
Tags: Comparative Effectiveness, Consumers, Health Care Costs, HIT, Hospital, Wellness and Prevention, Workplace
Do Doctors Always Act in Patients’ Best Interest?
by Kevin Roche on Thursday, May 19, 2011
Notwithstanding clear research demonstrating the percutaneous coronary intervention has no significant outcomes advantages over medical therapy, almost no change in practice patterns has been observed, suggesting that doctors are seeking to maintain their incomes.
Tags: Health Care Costs, Medical Care, Physicians
Better Care for the Elderly
by Kevin Roche on Wednesday, May 18, 2011
A Health Affairs article discusses health care for elderly persons living in retirement communities and how various models might help improve care coordination and reduce spending.
Tags: Elder Care, Health Care Costs, HomeCare, Medicare
Milliman’s Annual Health Care Cost Report
by Kevin Roche on Monday, May 16, 2011
The 2011 Milliman Medical Index was released, showing a 7.3% increase for a family of four covered by an employer sponsored PPO plan. Premium share and other out-of-pocket payments continue to rise faster than overall cost and unit prices, especially for hospital services, are the main source of the continued higher spending.
2011 Potpourri XX
by Kevin Roche on Friday, May 13, 2011
Another Potpourri, this week delivering factoids on drug companies’ use of technology to reach physicians, waiting times in Massachusetts, use of atypical antipsychotics in nursing homes, unnecessary colonoscopies, EMRs and productivity, and a stupid FDA ruling.
Tags: Drugs, EHRs, Health Care Costs, Health Care Reform, HIT, Medicare, Physicians, Wellness and Prevention
Malpractice and Tort Reform
by Kevin Roche on Thursday, May 12, 2011
Malpractice reform is stymied at the federal level and state efforts appear to have run out of steam, despite the likelihood that reform would significantly reduce wasteful spending. New approaches are being tested but their effect is uncertain.
Tags: Health Care Costs, Malpractice, Providers
CMS Hospital Payment for 2012
by Kevin Roche on Wednesday, May 11, 2011
CMS’ proposed rule and explanations for hospital payments for 2012 are lengthy but as usual give a great background on the issues that go into the payment elements. Hospital payments are slated for at best a very modest increase.
Tags: Health Care Costs, Hospital, Medicare
Hospital Spending
by Kevin Roche on Monday, May 9, 2011
A brief from the Agency for Healthcare Research and Quality looks at hospital charges in the United States, which accounted for 31% of total health care expenditures. Spending by payer and condition are detailed.
Tags: Health Care Costs, Hospital
Comparative Health Spending
by Kevin Roche on Wednesday, May 4, 2011
A Kaiser Family Foundation report analyzes health care spending across a number of nations, confirming that we spend a lot more than most developed countries and that our growth rate for health expenses has been higher and continues to be higher than that of these other nations.
Tags: Health Care Costs
Controlling Health Spending
by Kevin Roche on Monday, May 2, 2011
A WSJ article examines the likelihood that the myriad of health care cost control measures embedded in the reform law will actually reduce costs, concluding that it is unlikely they will, based on history here and in other countries.
Tags: Health Care Costs
Outpatient Services
by Kevin Roche on Wednesday, April 27, 2011
The Agency for Healthcare Research & Quality released a Statistical Brief looking at physician visits, finding variance in cost and out-of-pocket expense, depending on the setting.
Tags: Health Care Costs, Hospital, Physicians
Off-Label Drug Use
by Kevin Roche on Monday, April 25, 2011
Two pieces of research discuss an example of extensive off-label use of a drug, finding that costs are being raised with little likelihood of an increase in quality of care.
GAO Reports on CHIPs Programs
by Kevin Roche on Thursday, April 14, 2011
Medicaid and the Childrens Health Insurance Programs provide coverage for a very substantial portion of the nation’s children. The GAO issues a report on the adequacy of some aspects of the care they receive.
Tags: Care Management, Government, Health Care Costs, Health Care Quality, Medicaid
2011 Potpourri XV
by Kevin Roche on Friday, April 8, 2011
Our Masters week Potpourri masterfully covers such items as EHR satisfaction, ICU telemedicine, effects of concierge care on Medicare, failure to fill prescriptions, percent of household spending on health care by seniors, and drug rep visits to physicians.
Tags: Drugs, EHRs, Health Care Costs, Health Care Quality, HIT, Medicare, Physicians, Telemedicine
Hospital-Employed Physicians
by Kevin Roche on Thursday, April 7, 2011
A NEJM article notes the increasing employment of doctors by hospitals, even though the hospitals usually lose money on the practice in the short-term. The effects of this trend on the costs and quality of care are explored.
Tags: Health Care Costs, Hospital, Physicians
2011 Potpourri XIII
by Kevin Roche on Friday, March 25, 2011
Another edition of the Potpourri, featuring results on the Guided Care program, bundled payment experience, academic physician compensation, end-of-life care, hospital prices and costs, and geographic variation in Medicare spending.
Tags: Care Management, Chronic Disease, Disease Management, Elder Care, Health Care Costs, Hospital, Physicians
Hidden Costs of Health Care
by Kevin Roche on Thursday, March 24, 2011
A Deloitte report focuses on health spending which may not be captured in official accounts, finding over $360 billion of it, all borne by consumers, but it is not clear that the fact that consumers are responsible for this spending is a bad thing.
Tags: Consumers, Health Care Costs
GAO Update on Drug Prices
by Kevin Roche on Tuesday, March 22, 2011
GAO issued its latest trend report on drug prices, which confirmed that for branded medications prices continue to rise well above the rate of either Medical CPI or general inflation, but generics hold down overall cost rises.
Tags: Drugs, Health Care Costs
2011 Potpourri XII
by Kevin Roche on Friday, March 18, 2011
Our Ides of March Potpourri, featuring two studies of the impact of wellness programs; the link between hospital spending and mortality outcomes; HHS waiving the MLR requirement for Maine; bills to have CMS disclose physician practice patterns; and research on smoking cessation techniques.
Tags: Care Management, Health Care Costs, Health Care Quality, Health Care Reform, Health Insurance, Hospital, Medicare, Wellness and Prevention, Wireless
New End-of-life Studies
by Kevin Roche on Thursday, March 17, 2011
Feeling blue, don’t read this post. It is collection of research reports related to death and end-of-life care. Mostly positive trends, not that it helps those who make up the statistics.
Price Transparency’s Consequences
by Kevin Roche on Wednesday, March 16, 2011
Is it always better for providers of health care to have to fully disclose their actual charges to various payers? A NEJM Perspective suggests that it may not be and that other forms of disclosure may be more useful.
Tags: Consumers, Health Care Costs, Hospital
Where is the Drug Money Going?
by Kevin Roche on Monday, March 14, 2011
An AHRQ Statistical Brief examines where drug spending went in 2008, finding that spending was concentrated in five therapeutic categories which accounted for about two-thirds of total outlays.
Tags: Drugs, Health Care Costs
Medical Spending in the Last Six Months of Life
by Kevin Roche on Thursday, March 10, 2011
End-of-life care accounts for a very substantial fraction of all health spending and appears to vary geographically, as does much other spending. Research looked at what may determine end-of-life spending and its variation around the country.
Tags: Elder Care, Health Care Costs, Medical Care
The Effects of HSAs
by Kevin Roche on Tuesday, March 8, 2011
High-deductible plans often have health savings accounts associated with them. New research looks at the effect of HSA-linked plans on utilization and spending, finding significant reductions, but concerns about use of preventive services.
Tags: Consumer Directed Health, Health Care Costs, Health Care Quality, Health Insurance
End-of-Life Expenditures
by Kevin Roche on Monday, March 7, 2011
A new report looks at the out-of-pocket health spending in the last year of life for Medicare beneficiaries. The spending is not only large but highly variable and undoubtedly puts a significant financial strain on most of these people.
Tags: Consumers, Elder Care, Health Care Costs
2011 Potpourri X
by Kevin Roche on Friday, March 4, 2011
Hopefully winter nears its end; it has been brutal where we are. This week’s Potpourri may offer a little diversion, covering defensive medicine, a pediatric tele-consultation service, home stroke rehabilitation, consumers’ ability to afford care, patient satisfaction and hospital readmission rates and a mobile phone app to improve medication adherence.
Tags: Care Management, Drugs, Health Care Costs, HomeCare, Hospital, Telehealth
Latest Dartmouth Atlas Work
by Kevin Roche on Thursday, March 3, 2011
The latest Dartmouth Atlas work looks at variation in elective surgery rates in the context of patient involvement in decision-making. The report highlights differences in treatment for a number of common conditions and provides good advice for patients.
Tags: Consumers, Health Care Costs, Health Care Quality, Medicare, Physicians
Rand on Payment Reform Methods
by Kevin Roche on Tuesday, March 1, 2011
A new report from the Rand Corporation reviews various proposals for changing payment methods to providers. The researchers categorize payment reforms into 11 models and review appropriate performance measures for each.
Health Status, Income and Use of Services in Canada
by Kevin Roche on Thursday, February 24, 2011
The leading reason advocates use for demanding universal coverage is that it will improve health and health outcomes for lower socioeconomic groups. New research from Canada indicates that this is not likely to be true.
Tags: Consumers, Health Care Costs, Health Care Reform, Health Insurance
Drug Trial Success Rates
by Kevin Roche on Wednesday, February 23, 2011
A BIO study looks at the success rates for pharmaceutical and biotech candidates over a multi-year period, finding a fairly low rate, which doesn’t vary much by type of drug or disease addressed.
Tags: Drugs, Health Care Costs
Yet More on Geography and Costs
by Kevin Roche on Tuesday, February 22, 2011
Yet another study has emerged on the factors responsible for apparent variation in costs of treating Medicare patients, this one focused on the high-cost quartile of beneficiaries and finding that health status accounts for much of the variation.
Tags: Elder Care, Health Care Costs, Medicare
Hospice Care By Ownership Type
by Kevin Roche on Tuesday, February 15, 2011
Researchers writing in JAMA looked at whether the ownership type of a hospice appeared to be correlated with profit-maximizing behavior under Medicare’s per diem payment scheme. They found only weak evidence which could have other explanations.
Tags: Elder Care, Health Care Costs, Medicare
CDC Report on Physician Usage
by Kevin Roche on Monday, February 14, 2011
One of the primary concerns regarding Medicare spending is the significant population bulge in the 45-64 bracket, a group that is beginning to become Medicare eligible. A CDC brief explores physician usage trends in this group and the over 65 set and looks at potential implications.
Tags: Health Care Costs, Physicians
Age and Gender Differences in Health Spending
by Kevin Roche on Thursday, February 10, 2011
As would be expected, new research verifies that there are significant spending differences by age and by gender. The implications of this are unclear, particularly since the reform legislation limits how much insurance premiums can vary by these factors.
PWC on Medical Device Development
by Kevin Roche on Wednesday, February 9, 2011
PWC issued a report assessing the status of innovation in medical devices, finding that the United States no longer has the lead in this area and that the types of devices currently being deemed “innovative” has changed.
Home Care and TeleCommunications
by Kevin Roche on Monday, January 31, 2011
An outstanding Rand report describes the potential for home care technologies, barriers to their use and changes needed to overcome those barriers. The report paints a compelling picture of how greater care at home can benefit patients and the health system.
Tags: Chronic Disease, Elder Care, Health Care Costs, HomeCare, Telemedicine
SOA on Obesity Costs
by Kevin Roche on Wednesday, January 26, 2011
Another group weighs in on the health care costs of obesity. The Society of Actuaries releases a report which suggests even higher mortality and morbidity costs related to the condition than did other research.
Tags: Chronic Disease, Health Care Costs
One Perspective on Health Care’s Future
by Kevin Roche on Wednesday, January 19, 2011
CSC put out a report giving its vision of the future of health care, with a particular focus on how emerging technologies may reshape wellness, prevention, early disease detection, treatment and how care is delivered.
Tags: Care Management, Health Care Costs, Health Care Quality, HIT, Medical Care, Wellness and Prevention
MedPAC Report on Regional Service Use Variation
by Kevin Roche on Tuesday, January 18, 2011
We have reported several times on geographic variation in health spending, primarily in regard to Medicare beneficiaries, MEdPAC released a new brief that focuses on variation in use as opposed to raw spending, showing variation but to a smaller degree.
Tags: Health Care Costs, Medicare
MedPAC’s Medicare Advantage Comments.
by Kevin Roche on Monday, January 17, 2011
MedPAC weighs in unasked on some proposed changes to the Medicare Advantage program; objecting to CMS’ intent to limit benefit design flexibility on home health care and to CMS’s proposed quality incentive “demonstration.”
Tags: Health Care Costs, HomeCare, Medicare
2009 Health Spending
by Kevin Roche on Thursday, January 13, 2011
The initial report on 2009 national health expenditures is profiled in Health Affairs. The recession had a notable impact in slowing utilization and overall spending, particularly for consumers paying out-of-pocket, but spending continues to increase at rates that probably can’t be sustained.
Tags: Health Care Costs
Cost-Sharing and Outcomes
by Kevin Roche on Tuesday, January 11, 2011
Cost-sharing by consumers is an issue of the greatest importance in an era of increasing premium share, high deductibles, and coinsurance. A new report looks at the potential health consequences but is not without its biases.
Medication Adherence Methods
by Kevin Roche on Thursday, January 6, 2011
The high prevalence of medications as the primary method of treatment especially for chronic diseases has led to focus on ensuring that patients take the drugs that are prescribed for them. A review article examines the outcome of research on various intervention programs to encourage adherence.
Tags: Consumers, Drugs, Health Care Costs, Health Care Quality
More on Hospital Pricing
by Kevin Roche on Thursday, December 30, 2010
America’s Health Insurance Plans piles on hospitals in regard to their pricing, using data from Oregon and California. The analysis might be more persuasive if it weren’t coming from a trade association, but it is further evidence of a major source of health care cost increases.
Physician Compensation Methods
by Kevin Roche on Monday, December 27, 2010
Researchers and policymakers keep searching for solutions to the problem of inappropriate utilization of services. Fee-for-service payment is often targeted as a key cause, but a recent survey suggests that productivity-based compensation may not be inconsistent with lower spending and better quality.
Tags: Health Care Costs, Physicians
Christmas Potpourri
by Kevin Roche on Friday, December 24, 2010
A very happy and relaxing Christmas Eve and Day to all our readers. To aid in the pursuit of that happiness and relaxation we offer up our scraps of enlightenment, this week covering EHR impact on productivity, e-prescribing systems, health insurance rate reviews, not-for-profit hospital executive compensation, Oregon’s state health plan and use of placebos to improve health.
Tags: Consumers, Drugs, Health Care Costs, Health Insurance, HIT, Hospital, Meaningful Use, Medicaid, Physicians
Disease Management Lessons from Germany
by Kevin Roche on Thursday, December 23, 2010
Attention to management of chronic diseases is a common feature of health systems around the world. Germany has implemented an approach which is focused through primary care physicians and has shown both quality improvement and cost savings.
Tags: Disease Management, Health Care Costs, Health Care Quality
Use and Misuse of Imaging
by Kevin Roche on Tuesday, December 21, 2010
Health Affairs carries several articles analyzing imaging use, particularly in regard to physician interests in imaging equipment. The findings support the idea that physicians are often driven by their own economic advantage when making decisions about patient treatment.
Tags: Care Management, Health Care Costs, Health Care Quality, Physicians
More on McAllen’s Costs
by Kevin Roche on Thursday, December 9, 2010
One of the premises of the movement to constrain health spending is that there is a lot of wasteful care in some geographic areas. A notable New Yorker article last year made McAllen Texas the poster child for this thesis, but new research suggests the issue may be more complex.
Tags: Health Care Costs, Medicare
Abandoned Prescriptions
by Kevin Roche on Wednesday, December 8, 2010
Prescriptions written by doctors and transmitted to pharmacies are not always picked up by patients. New research examines the factors that appear to be linked to, if not causative of, such prescription abandonment.
Tags: Consumers, Drugs, Health Care Costs, Health Care Quality
Health Care Prices
by Kevin Roche on Wednesday, December 1, 2010
A new survey of prices for common health care services in developed countries shows once again that unit prices in the United States are much higher than in other countries. Another report shows that there is significant variability in prices within the US as well.
Tags: Health Care Costs
New Evidence on Wellness Value
by Kevin Roche on Tuesday, November 30, 2010
Doubt continues to exist about whether wellness and prevention have net short or long-term cost savings. A new study indicates that a well-designed, comprehensive health program can save money, at least in the near term, and may lower longer term cost trajectories.
Tags: Care Management, Consumers, Health Care Costs, Wellness and Prevention
Turkey of a Potpourri
by Kevin Roche on Thursday, November 25, 2010
There you are, relaxing on a holiday and holiday weekend and for some reason you feel compelled to browse the internet and come across our Thanksgiving potpourri, hopefully not a turkey, but stuffed with edible data, including HHS’ final rule on MLRs; the AMAs survey on prior authorization; principles for ACOs, how to use research studies, Humana’s acquisition of Concentra and an explanation of why health care costs keep going up. Happy Thanksgiving!
Tags: Accountable Care Organization, Care Management, Health Care Costs, Health Insurance, HIT, M&A, MLR, Physicians, Workplace
2010 Potpourri XLII
by Kevin Roche on Saturday, November 20, 2010
Thanksgiving approaches and we are thankful for the continuing stream of news to fill our Potpourri, including the effect of malpractice liability on Illinois’ ability to retain physicians; the role of prices in health spending increases; comparative health and death rates in the US and England; employer health insurance costs; CBO review of a plan to reshape to Medicare; and end-of-life decision making.
Tags: Chronic Disease, Consumer Directed Health, Elder Care, Health Care Costs, Health Insurance, Malpractice, Medicare, Physicians
More on Hospital Pricing Power
by Kevin Roche on Saturday, November 20, 2010
Another study, this time from the Center for Studying Health System Change, suggests that hospital market power plays a substantial role in health care cost increases and discusses some possible options to address the problem.
Tags: Health Care Costs, Hospital
Reimbursement’s Impact on Medical Practice
by Kevin Roche on Wednesday, November 10, 2010
A New England Journal of Medicine article further solidifies the susceptibility of physicians to financial incentives to overuse care when it assists them economically. Removing those incentives does not seem to prevent continued delivery of the same care when it is needed.
Tags: Health Care Costs, Medicare, Physicians
End-of-Life Care
by Kevin Roche on Monday, November 8, 2010
New research covering aspects of end-of-life care in Canada and the US reveals that costs continue to be high, even though the use of palliative care in the United States has increased significantly.
Obesity Costs
by Kevin Roche on Friday, November 5, 2010
A new report from the National Bureau of Economics adds to the evidence that obesity is related to substantial health expenditures, but primarily concentrated in a few individuals.
Tags: Consumers, Health Care Costs, Medical Care
The Prevalence and Cost of Mandated Benefits
by Kevin Roche on Wednesday, November 3, 2010
The Council for Affordable Health Insurance puts out the latest in its series of reports on mandated benefits, looking at not just the number and type of mandates, but the incremental cost they add to insurance premiums; a cost which is ultimately borne by consumers.
The Most Costly Hospital Stays
by Kevin Roche on Monday, November 1, 2010
AHRQ released a report on high-cost hospitalizations, demonstrating the concentration of spending on a relatively few cases. The diagnoses are what would be expected and it is unclear how these hospitalizations might be avoided.
Tags: Health Care Costs, Hospital
2010 Potpourri XL
by Kevin Roche on Saturday, October 30, 2010
Is there anything scary about health care? Yes if you have to pay for it! Nothing scary about our Potpourri, just soothing health care nuggets, covering alternative therapies for back pain, CBO’s view on the reform law, peer interaction to help manage diabetes, diabetes prevalence, Massachusetts physician information, accountable care organizations, bias in clinical trial results and the effects of the health law on employer provided insurance.
Tags: Accountable Care Organization, Care Management, Chronic Disease, Disease Management, Health Care Costs, Health Care Reform, Health Insurance, Medical Care, Physicians, Workplace
Home Is Where the Care Is
by Kevin Roche on Thursday, October 28, 2010
The complexity and rate of change in health care sometimes makes spotting major trends difficult. One appears to be growth of home-based diagnostic and therapeutic care. An article in the New England Journal of Medicine discusses drivers for this trend.
Tags: Care Management, Consumers, Health Care Costs, Health Care Quality, HomeCare, Telemedicine
Nursing Home Resident Hospitalizations
by Kevin Roche on Tuesday, October 26, 2010
There is so much health spending in the United States that it is sometimes hard to isolate the big buckets. Nursing home residents have very high medical costs and many questionable hospitalizations. A KFF report examines reasons why.
Tags: Care Management, Elder Care, Health Care Costs, Physicians
Medicaid Health Plan Administrative Costs
by Kevin Roche on Tuesday, October 19, 2010
The reform debate and its aftermath focused a lot of attention on health plans’ administrative expenses, particularly whether they were devoting too much of total premium to profits. A new report looks at expense trends for Medicaid managed care plans.
Tags: Health Care Costs, Medicaid
IOM’s Report on Nursing
by Kevin Roche on Monday, October 18, 2010
The Institute of Medicine’s report on The Future of Nursing discusses many issues, but one that catches the eye relates to the role of restrictions on nurse scope of practice in impeding better access and lower costs.
Tags: Health Care Costs, Health Care Quality, Physicians, Providers
2010 Potpourri XXXVIII
by Kevin Roche on Saturday, October 16, 2010
More health care tidbits in this week’s potpourri, including medication adherence; the benefits of workplace wellness programs; the costs to employers of obesity; hospital prices in Oregon; reimbursement methods for drugs and potential savings from health IT.
Tags: Drugs, Health Care Costs, HIT, Hospital, Providers, Wellness and Prevention
More Group Purchasing Organization News
by Kevin Roche on Thursday, October 14, 2010
A medical device manufacturers’ trade association publishes sponsored research on the effect of GPOs on costs, concluding that hospitals would be better off to buy directly from the manufacturers or to restructure how GPOs are paid.
Tags: Health Care Costs, Hospital
Why Do We Have Worse Survival Rates?
by Kevin Roche on Wednesday, October 13, 2010
Health spending is high in the United States compared to other industrial countries. Quality, based on health outcomes such as survival or mortality, appears to be worse. A new article probes the reasons why, but may have some flaws.
Health Affairs Articles on Malpractice
by Kevin Roche on Tuesday, October 12, 2010
Because of political considerations, medical malpractice and its health spending effects is a controversial topic. A recent issue of Health Affairs carried several articles on this topic.
Tags: Health Care Costs, Malpractice, Providers
Grand Junction’s Low Health Spending
by Kevin Roche on Monday, October 11, 2010
There appears to be significant variation in per capita health spending around the United States. The low-cost areas could provide valuable lessons to the rest of the country and a NEJM perspective examines the experience of Grand Junction.
Tags: Health Care Costs, Physicians
Uwe Reinhardt on Cost Control
by Kevin Roche on Tuesday, October 5, 2010
Uwe Reinhardt is one of the wise old men of health care economics and policy. The New York Times has a recent blog column by him in which he reviews the perennial issues blocking real change in regard to health cost control.
GAO Group Purchasing Organization Report
by Kevin Roche on Monday, October 4, 2010
Hospitals and other providers often use group purchasing organizations to facilitate obtaining goods and services at better prices and other terms. A GAO report looks at some of the business practices of these organizations.
Tags: Health Care Costs, Hospital, Regulation
2010 Potpourri XXXVI
by Kevin Roche on Saturday, October 2, 2010
The days shorten but the potpourri stays strong, this week including information on the safety of FDA-cleared devices; medication adherence; genetic tests; the FDA and CMS working together to review products; state all-payer databases and the increasing control of physician practices by hospital systems.
Tags: Care Management, Devices, Drugs, Health Care Costs, HIT, Hospital, Medicare, Personalized Medicine, Physicians, Regulation
CBO Report on Medicare and Generic Drugs
by Kevin Roche on Friday, October 1, 2010
A Congressional Budget Office Report finds that Medicare Part D and its beneficiaries have accrued very significant savings, about 55%, from use of generic drugs and that more savings may be available in the near future.
Tags: Drugs, Health Care Costs, Medicare
Telephone Care Management Support
by Kevin Roche on Wednesday, September 29, 2010
A study published in the New England Journal of Medicine gives heart to supporters of telephone-based care management programs. Largely because of reduced hospitalizations, patients in the intervention arm had lower monthly medical costs, for a modest price.
Tags: Care Management, Chronic Disease, Health Care Costs, Telemedicine
2010 Potpourri XXXV
by Kevin Roche on Saturday, September 25, 2010
The days are shortening and the light fades, but there is still enough to read our Potpourri, which this week includes two benefit consultants’ views on health care coverage costs for next year, hospice care at end-of-life, insurance premium hikes in Connecticut, Massachusetts health reform outcomes, and how patients’ characteristics affects doctors’ quality ratings.
Tags: Health Care Costs, Health Care Reform, HIT, Medical Care, Pay For Performance, Physicians, Workplace
At-risk Payments to Physicians
by Kevin Roche on Thursday, September 23, 2010
An article in Health Affairs looks at new proposals for paying physicians on an at-risk basis in light of the historical experience with capitation, which operated in a similar manner.
Tags: Health Care Costs, Physicians
Workers Compensation Trends
by Kevin Roche on Wednesday, September 22, 2010
The National Academy of Social Insurance tracks workers’ compensation trends, among other items, and has issued a report which confirms that medical costs are rising faster than indemnity costs.
CBO on Obesity
by Kevin Roche on Monday, September 20, 2010
Obesity has been fingered as one of the villains of health care cost increases. A CBO analysis verifies that obese persons appear to have significantly higher annual health care costs compared to non-obese persons.
Tags: Care Management, Chronic Disease, Consumers, Health Care Costs
Accessing Acute Care and Avoiding the ER
by Kevin Roche on Friday, September 17, 2010
Health Affairs publishes several studies addressing inappropriate use of the emergency room, finding that many visits could be dealt with in other settings, but that higher copays may not deter inappropriate use.
Tags: Access, Consumers, Health Care Costs, Hospital
Reform to Increase Health Spending!
by Kevin Roche on Monday, September 13, 2010
The Office of Actuary publishes its current estimate of national health spending in the wake of health reform. It finds that the law will slightly increase spending, but there is a big caveat because the projections assume Medicare payment cuts will stay in place.
2010 Potpourri XXXIII
by Kevin Roche on Saturday, September 11, 2010
Fall is a lovely time of year and what could be better than relaxing with a Potpourri, featuring health insurance increases, the true costs of EHRs, hospital pay-for-performance programs and quality, the impact of social networks on health behavior, and unenrolled Medicaid-eligible children.
Tags: Consumers, Government, Health Care Costs, Health Care Quality, HIT, Hospital, Medicaid, Pay For Performance, Workplace
Deloitte Global Health Consumer Survey
by Kevin Roche on Friday, September 10, 2010
Deloitte’s annual survey of consumers in six countries on health care issues provides some interesting insights on the citizens’ health behaviors, concerns and perceptions of their health system.
Tags: Consumers, Health Care Costs
CDHP Study by GAO
by Kevin Roche on Thursday, September 9, 2010
Fears have been expressed that increasing CDHP enrollment puts people at risk for skipping necessary health services. The GAO looked at this population and found healthier people enrolled and they spent less after enrollment than non-CDHP members.
Tags: Consumer Directed Health, Health Care Costs, Health Care Quality, Health Insurance
Using Nurses Instead of Doctors
by Kevin Roche on Wednesday, September 8, 2010
Research shows that allowing nurse anesthetists to do their jobs without physician supervision does not pose additional risk to patients. Regulations and laws which limit this ability should therefore be eliminated.
Tags: Health Care Costs, Health Care Quality, Medical Care, Regulation
2010 Potpourri XXXII
by Kevin Roche on Saturday, September 4, 2010
We have certainly labored over the Labor Day weekend version of the Potpourri, featuring relative performance of US and foreign medical school graduates, California health insurance hikes, non-for-profit hospital CEO pay, performance measures and outcome variation at hospitals related to cost, new reimbursement methods and physician cost profiling.
Tags: Health Care Costs, Health Care Quality, HIT, Hospital, Physicians
The Great MLR Calculation Debate
by Kevin Roche on Tuesday, August 31, 2010
The new health law attempts to dictate how much of insurance premiums insurers must spend on medical care, so of course there is now extensive haggling on defining the calculation. The NAIC has released its version, which now goes to HHS for review.
2010 Potpourri XXXI
by Kevin Roche on Saturday, August 28, 2010
Summer nears an end, but not our Potpourris. This one includes the costs of malpractice, an innovative provider error disclosure program, employer wellness paybacks, blood pressure medication issues, the cost of new technologies, provider pricing power and the mental health of Californians.
Tags: Care Management, Health Care Costs, Hospital, Malpractice, Personalized Medicine, Wellness and Prevention
Employer Health Plan Changes for 2011
by Kevin Roche on Friday, August 27, 2010
Everyone is anxious to see the early effects of the reform law on health care costs. Another survey of large employer groups regarding their 2010 and 2011 expectations indicates that those costs are continuing to go up, probably at a faster pace.
Emergency Room Use
by Kevin Roche on Tuesday, August 24, 2010
A study discusses trends in the use of emergency rooms. Medicaid beneficiaries are the vast majority of the increase in utilization, which may reflect poor access to primary care or inappropriate health care seeking behavior.
Tags: Health Care Costs, Hospital, Medicaid, Medical Care
The Cost of Medical Errors
by Kevin Roche on Thursday, August 19, 2010
Medical errors have received a lot of attention since the Institute of Medicine published a seminal report almost a decade ago. A new analysis from the Society of Actuaries suggests that such mistakes cost the country at least $20 billion a year and potentially a much greater sum.
Tags: Health Care Costs, Malpractice
State Variations in Health Insurance Costs
by Kevin Roche on Wednesday, August 18, 2010
AHRQ released a statistical brief looking at state differences in the cost of employment-based health insurance and how much of that cost is borne by employees. Follow-up research to understand factors contributing to the variation would be interesting.
Medicare’s Solvency Extended–Or Is It?
by Kevin Roche on Friday, August 13, 2010
In a sign that the media is less willing to accept some of the Administration’s misleading pronunciations about health care, when HHS claimed that the Medicare Trustee’s report showed the new health law extended Medicare solvency by several years, most sources noted that the CMS Actuary disagreed.
Tags: Government, Health Care Costs, Medicare
2010 Potpourri XXVIII
by Kevin Roche on Saturday, August 7, 2010
Summer begins to wane, but not our Potpourris. Another one full of useful data, including health insurance costs for 2011, a new telehealth joint venture, use of kiosks in physician offices, prostate cancer screening, health care use cutbacks, teledermatology and sharing of physician notes with patients.
Tags: Consumers, Health Care Costs, Health Insurance, Monitoring, Physicians, Telemedicine, Wellness and Prevention
End-of-Life Care
by Kevin Roche on Wednesday, August 4, 2010
The New Yorker carries an exceptional article by Atul Gawande on end-of-life care, highlighting irrational reimbursement policies and the difficult decisions that both patients and providers must make.
Tags: Health Care Costs, Health Care Quality, Medical Care, Physicians
Massachusetts Reports
by Kevin Roche on Tuesday, August 3, 2010
Although its reform effort appears to have gone amok, largely for cost reasons, the state of Massachusetts is producing a lot of useful data and research on medical service delivery, including three recent ones on avoidable emergency room and hospital use and the state of primary care services.
Tags: Health Care Costs, Health Care Reform, Hospital, Physicians
More Geographic Variation Research
by Kevin Roche on Monday, August 2, 2010
A study of diagnostic practices for Medicare beneficiaries reveals geographic variations. These variations not only may suggest either under or overuse of diagnostic tests but they can bias other research results and payment methods. A second study suggests that caution should be applied in analyzing regional variation to ensure that all possible sources of the differences are taken into account.
Tags: Health Care Costs, Medical Care, Medicare, Physicians
Medicare’s Physician Reimbursement Problem
by Kevin Roche on Friday, July 30, 2010
There has been no more gnarly health care problem for Congress than how to deal with physician reimbursement. At some point, as a Health Affairs article points out, it will have to come up with a better solution than the temporary fixes it has used for years.
Tags: Government, Health Care Costs, Medicare, Physicians
Workers’ Comp Medical Cost Increases
by Kevin Roche on Tuesday, July 27, 2010
Workers’ compensation health cost trends may provide some insight into underlying medical cost issues across the system and vice versa. An NCCI report looks at factors driving trends in medical cost increases for workers’ compensation.
2010 Potpourri XXV
by Kevin Roche on Saturday, July 17, 2010
Another week, another potpourri, this time with items on workers’ compensation drug spending, benefit consulting firm mergers, hospital readmissions, geographic variation in spending and use of mobile vans to deliver health care.
Tags: Drugs, Health Care Costs, Hospital, M&A, Medical Care, Workers Compensation
Creating New Health Conditions is Costly
by Kevin Roche on Wednesday, July 14, 2010
There are so many sources of the rapid increases in national health spending that it is hard to track them all. A recent article estimates the costs of “medicalization”, the process of turning problems into medical issues which end up incurring health costs.
Tags: Health Care Costs, Medical Care
Rhode Island Insurance Rates
by Kevin Roche on Tuesday, July 13, 2010
Struggling with the continuing rise in health insurance premiums, Rhode Island’s Insurance Commissioner takes some creative steps to attempt to slow the rise of hospital costs, which are a major contributor to the premium increases.
End-of-Life Care and Patients’ Preferences
by Kevin Roche on Monday, July 12, 2010
Medical care provided near the end of a patient’s life accounts for a significant portion of total national health spending and is often inconsistent with patient wishes. New research evaluates the effects of a more detailed set of physician advance orders for frail and elderly persons.
Fireworks Potpourri
by Kevin Roche on Saturday, July 3, 2010
We light up the sky with a scintillating selection of health care bombshells. Okay, maybe not that great, but some hopefully useful info on the VA’s health information system, MRIs and emergency cardiac care, business method and process patents, end-of-life care, actuaries’ views on how to control costs and, of course, more issues in Massachusetts.
Tags: Government, Health Care Costs, Health Care Reform, Health Insurance, Medical Care
The US Health System Stinks…Or Does It?
by Kevin Roche on Thursday, July 1, 2010
The Commonwealth Fund issues one of its regular reports designed to demonstrate how bad the US health system is compared to those of other developed countries. Unfortunately, the report is based almost exclusively on subjective survey data and fails to provide any adjustments to create a truer picture of the status of our system vis-a-vis others.
Tags: Government, Health Care Costs, Health Care Quality, Health Care Reform
Services With Increasing Costs
by Kevin Roche on Wednesday, June 30, 2010
Where does all that health spending go and what areas are incurring some of the largest increases? An AHRQ statistical brief looks at hospital costs from 2001 and 2007 and identifies the ten fastest growing diagnoses by cost in that period.
2010 Potpourri XXIII
by Kevin Roche on Saturday, June 26, 2010
Once more into the breach with the Saturday health care roundup, including medication adherence, monitoring patients’ health status in their homes, Massachusetts’ reform update and insurance costs, hospitals’ economic contribution, hospital cost shifting and consumers’ views on use of health IT.
Tags: Drugs, Health Care Costs, Health Care Reform, Health Insurance, HIT, HomeCare, Hospital, Monitoring, Telemedicine
Medical Innovation and the American Economy
by Kevin Roche on Wednesday, June 23, 2010
The Council for American Medical Innovation has released a report about the value of medical innovation to the United States’ economy. Concern is expressed about maintaining a vigorous medical product industry in the face of funding, reimbursement and regulatory challenges.
Tags: Devices, Health Care Costs, HIT
PWC Report on Employer Health Costs
by Kevin Roche on Tuesday, June 22, 2010
PriceWaterhouseCooper has a Health Research Institute which periodically looks at medical cost trends. Consistent with other recent publications, PWC believes that costs are continuing to increase at a rate well above that of inflation or GDP growth.
Geographic Variation in Drug Expenses
by Kevin Roche on Monday, June 21, 2010
Medicare’s Part D benefit covers most prescription drugs and has added significantly to the program’s cost, although not as much as originally projected. Now that the program has been in existence for a few years, researchers looked at whether the same geographic variation in spending exists for drugs as does for other Medicare services.
Tags: Drugs, Health Care Costs, Medicare
ThomsonReuters on Saving Health Dollars
by Kevin Roche on Friday, June 18, 2010
It is an oft repeated claim that there are hundreds of billions of dollars of waste in the health system, which if limited or removed would greatly relieve financial pressure on public budgets, companies and individuals. A Thomson Reuters report gives its view on where the waste is and how it can prevented.
Tags: Health Care Costs
Milliman Releases 2009 Health Cost Index
by Kevin Roche on Monday, June 14, 2010
Milliman issued its annual look at health care costs for a family of four, including employer payments and out-of-pocket. Costs continue to rise well-above the rate of inflation or GDP growth.
Will Reform Act Slow Health Costs?
by Kevin Roche on Thursday, June 10, 2010
Two federal budget experts examine CBO’s final analysis of the deficit effect of the health reform bill as passed and find that it is very likely that instead of a small amount of deficit reduction over the next decade, it will likely to add to an already desperate federal fiscal crisis.
Group Medical Visits
by Kevin Roche on Wednesday, June 9, 2010
As long as cost pressures continue, people will search for new and better ways to control them. One area of focus has been the cost of a physician interaction and group visits are an emerging approach to reduce that cost.
Big Effort Needed to Create Informed and Engaged Patients
by Kevin Roche on Tuesday, June 8, 2010
One theory for improving the health care system is to rely on more-informed and engaged consumers to help improve decision-making about treatment options. A recent Health Affairs article suggests there is a long way to go on this goal.
Tags: Consumers, Health Care Costs, Medical Care
Physician Cost Profiling
by Kevin Roche on Wednesday, June 2, 2010
Physicians control most of the spending in health care. Understanding their practice patterns can be useful. New research demonstrates the difficulty of accurately attributing care to specific physicians.
Tags: Health Care Costs, Physicians
Living Longer and Paying More for Health
by Kevin Roche on Tuesday, May 25, 2010
Boston College researchers have examined the expected remaining lifetime health costs for an average person at various ages and linked that expected spending to health status, finding that healthy people will actually end up spending more.
Tags: Consumers, Health Care Costs
Hospital Readmissions
by Kevin Roche on Monday, May 24, 2010
Hospital readmissions are one area of health spending being studied intensively to identify causes and possible solutions to inappropriate or avoidable rehospitalizations. A California agency issued a report on readmissions in that state.
Tags: Health Care Costs, Hospital
2010 Potpourri XVI
by Kevin Roche on Saturday, May 8, 2010
No mother’s day would be complete without some health care news to ruminate on. This week’s include psychiatric drugs, the cost of the SGR fix, home health care costs, telemedicine and using computers to aid in diagnosis.
Tags: Drugs, Health Care Costs, Health Care Reform, HIT, Medicare, Telemedicine
More Imaging-Related Studies
by Kevin Roche on Friday, May 7, 2010
Imaging services have been labeled one of the “bad boys” of health care, but a review of recently published studies shows that while there are negative aspects to use of imaging, it has benefits as well.
Tags: Diagnostics, Health Care Costs
Online Physician Visits
by Kevin Roche on Wednesday, May 5, 2010
Traditional telemedicine has expanded in recent years to include a variety of methods for patients to interact with physicians in real and delayed time, including email, secure messaging, and video over the computer. A study examines the effect of these interactions on health spending.
Tags: Health Care Costs, Physicians, Telemedicine
Self-Directed Care
by Kevin Roche on Friday, April 30, 2010
Here’s a novel idea–give patients a set amount of money to spend on health care needs and allow them to manage what services they use for that money. It is a notion that is spreading internationally and just represents an attempt to restore traditional economics to health care.
Tags: Care Management, Consumer Directed Health, Health Care Costs
Hospital Value
by Kevin Roche on Thursday, April 29, 2010
Milliman, Inc. is a very prominent and capable actuarial firm which does excellent research on health care issues. The firm released a report on high, and low, value hospital regions, focusing on spending as the indicia of value.
Tags: Health Care Costs, Hospital
Physician Ownership of SurgiCenters and Operation Rates
by Kevin Roche on Friday, April 23, 2010
Another item that falls in the “shocking, just shocking” category. Research reveals that physicians who have an ownership interest in ambulatory surgical centers tend to do more surgeries at that surgicenter and to send the easier cases there.
Tags: Health Care Costs, Physicians
Misleading VA Health Information System Numbers
by Kevin Roche on Thursday, April 22, 2010
EMRs are posited to provide enormous benefits to the health system. The Veteran’s Administration has one of the most comprehensive large EMR installations. An article in Health Affairs provides a very misleading picture of the supposed cost benefits of the system.
Tags: Health Care Costs, HIT
UnitedHealth Group’s Suggestions for Medicaid Savings
by Kevin Roche on Wednesday, April 21, 2010
The new health law greatly expands Medicaid and government spending. Figuring out how to keep that spending from breaking state budgets will be difficult. A large national health plan company provides suggestions on how to control Medicaid costs.
Tags: Health Care Costs, Medicaid
Patients’ Knowledge and Its Effect on Cost
by Kevin Roche on Monday, April 19, 2010
One theory of the consumer-directed health movement has been that educated and motivated patients will make better value-based decisions regarding their health care, helping to reduce overall costs. A recent study published in AJMC supports this theory.
Health Care, the Federal Deficit and Federal Debt
by Kevin Roche on Monday, April 12, 2010
A commentary in the New England Journal of Medicine reminds us that health care has been a major contributor to the federal deficit and consequently the national debt and that it is likely to continue to add to our financial woes, notwithstanding the recent health act.
What! Massachusetts Again? Yep, With a Side of Maine and New York
by Kevin Roche on Friday, April 9, 2010
States that supposedly led the way on health care reform are finding out it was the bleeding edge that they were on. Insurers are always the easy target, but bashing them won’t solve the underlying cost problem. If the federal bill actually is implemented, the experience of these states will likely be replicated nationally.
Tags: Government, Health Care Costs, Health Care Reform, Health Insurance
Socio-Economic Status and Health Behaviors
by Kevin Roche on Thursday, April 1, 2010
What is the link, if any, between socio-economic status, health behaviors and health status? Researchers have theorized and pondered whether there is correlation or causation and in which direction. A new study from England provides some additional thoughts on the topic.
Tags: Consumers, Health Care Costs
The Massachusetts Debacle
by Kevin Roche on Tuesday, March 30, 2010
The Massachusetts Attorney General’s final report on what is driving health care cost increases in Massachusetts confirms the preliminary version’s finding that most of the spending rise is due to nothing more than application of raw provider market power to extract high prices from private payers. Another report also examines hospitals’ pricing practices.
Tags: Health Care Costs, Health Care Reform, Hospital, Physicians
More on Hospital Costs and Pricing
by Kevin Roche on Monday, March 29, 2010
Health Affairs publishes a study with a creative approach to understanding hospital costs, hospital pricing, Medicare payments and market power. The authors’ conclusion is that profitable hospitals have higher expenses because they have more money to spend, and those higher expenses may make them look unprofitable in regard to Medicare payments.
Tags: Health Care Costs, Hospital
Relative Pay of Primary Care and Specialist Physicians
by Kevin Roche on Friday, March 26, 2010
MedPAC had outside researchers look at the effects of paying all physician services in the United States under the Medicare fee schedule. Changes in that schedule were supposed to be creating more equal pay between primary care and specialist physicians, but that does not appear to have happened.
Tags: Health Care Costs, Physicians
Towers Watson Employer Survey
by Kevin Roche on Monday, March 22, 2010
Towers Watson is a large employee benefits consulting firm which regularly surveys companies regarding their health plan and related offerings. The latest survey offers insights on trends in plan design and cost containment efforts.
Tags: Health Care Costs, Workplace
More Imaging Issues
by Kevin Roche on Tuesday, March 16, 2010
Use of imaging services has become the poster child for health care spending problems, even though excessive imaging may have been rather rapidly controlled by private sector use of imaging benefit managers. New research pours salt on the wounds.
Tags: Care Management, Health Care Costs
2010 Potpourri IX
by Kevin Roche on Saturday, March 13, 2010
One more sampling of health care news, covering provider reaction to the EHR meaningful use rule, telemedicine, people’s perceptions of their health status and insurance coverage and hospital costs and prices.
Tags: Health Care Costs, Health Insurance, HIT, Hospital
Hospital Costs and Quality
by Kevin Roche on Wednesday, March 10, 2010
Following up on similar research, an article delves into the relationship between hospital costs and quality, finding inconsistent associations between high cost and better quality. It does not appear that low-cost hospitals have higher readmission rates and greater downstream costs.
CDC Health Status Report
by Kevin Roche on Tuesday, March 2, 2010
The Centers for Disease Control issues a massive compendium of health facts and information called Health United States 2009. In addition to basic information regarding health care, it has some description and analysis of particular issues such as use of medical technology.
Tags: Devices, Government, Health Care Costs, Health Care Quality
Maybe It’s the Providers that Are the Cause of Spending Increases.
by Kevin Roche on Monday, March 1, 2010
Two more studies suggest that provider price increases, particularly those of hospitals, are the cause for overall spending rises and notes that there is little competitive check on providers’ ability to raise prices. When are policy-makers going to start paying attention?
2010 Potpourri VII
by Kevin Roche on Saturday, February 27, 2010
The latest in our regular amalgamation of health care news items, including telehealth, how many people really die from not having health insurance, silent PPOs, progress in automating claims processing and more on individual insurance policy price hikes.
Tags: Health Care Costs, Health Care Reform, Health Insurance, Telemedicine
Competition Leads to Lower Hospital Costs
by Kevin Roche on Friday, February 26, 2010
Research indicates that commercial health insurance, while it has geographic variation in spending, does not vary in the same way as Medicare. A primary factor explaining private health plan geographic spending variation appears to be the state of competition for hospital services in different locales.
Tags: Health Care Costs, Health Insurance, Hospital, Medicare
Sources of Medicare Spending Growth
by Kevin Roche on Wednesday, February 24, 2010
A Health Affairs article examines changes in the composition of Medicare spending over the last two decades, finding that chronic disease is now the primary driver of that spending and that the nature of service demand has shifted from inpatient to outpatient and prescription drugs.
Tags: Health Care Costs, Medicare
More on Regional Spending Variation
by Kevin Roche on Tuesday, February 23, 2010
The New England Journal of Medicine publishes dueling commentaries on geographic and provider spending variations. Having a clear understanding of whether there are providers who render more care with no better outcomes would help formulate reforms to change their behavior.
2009 Health Spending and Future Projections
by Kevin Roche on Wednesday, February 10, 2010
The Office of Actuary at CMS provides its estimate of 2009 health spending and projections for future years. Partly due to the recession, health spending grew rapidly as a per cent of GDP. Healthy, or unhealthy, growth over the next decade is also projected.
Tags: Health Care Costs
Prices Not Major Contributor to Medicare Spending Variation
by Kevin Roche on Friday, February 5, 2010
New research published in Health Affairs finds that geographic variation in Medicare spending is not strongly driven by price variation. Utilization differences appear to be the major cause of that variation.
Tags: Health Care Costs
CBO Looks at Republican Budget Proposal
by Kevin Roche on Tuesday, February 2, 2010
CBO analyzes a Republican proposal on federal spending, finding that the health care-related provisions would significantly reduce federal spending and national health expenditures, while increasing covered persons by an unspecified number.
Massachusetts Report on Provider Pricing Impact
by Kevin Roche on Monday, February 1, 2010
The Massachusetts Attorney General investigates and discovers that hospitals and some physicians have market power and consequently are able to demand high payments and those payments are the main cause of increases in the cost of health insurance, not utilization increases.
Tags: Health Care Costs, Hospital, Physicians
Variations in Hospital Payments in One State
by Kevin Roche on Friday, January 29, 2010
Rhode Island released a report on payments to hospitals from various sources and looked at factors accounting for significant differences in payment levels. The variation is likely entirely due to hospital bargaining power by large systems, which in turn is driving health insurance premium increases.
Tags: Health Care Costs, Hospital
More Breast Cancer Screening Controversy
by Kevin Roche on Thursday, January 28, 2010
The recommended schedule for mammography screenings to detect breast cancer is examined in a Cochrane report, which finds that the current recommendation probably leads to overdiagnosis and treatment and the women are not being properly presented with the overall risks and benefits.
Tags: Comparative Effectiveness, Health Care Costs, Health Care Quality, Wellness and Prevention
Older Employees and Workers’ Compensation
by Kevin Roche on Wednesday, January 27, 2010
While employees over 65 are a very small part of the work force, their numbers are growing and the recession likely will keep people working longer. These employees have some different characteristics in regard to workers’ compensation claims, according to a new NCCI report.
2010 Potpourri I
by Kevin Roche on Saturday, January 9, 2010
The tort lawyer lobby errand boys in Congress just don’t know when to stop. Even after Senator Rockefeller got his hand slapped for questioning CBOs analysis of potential savings from tort reform, Congressman Bruce Baley decided to go back for more. And sure enough, CBO gave him an even more detailed justification of the savings [...]
Tags: Health Care Costs, Health Insurance, Malpractice, Medicare, Personalized Medicine, Telemedicine
National Health Spending in 2008
by Kevin Roche on Wednesday, January 6, 2010
National health spending growth slowed in 2008, but still grew at a rate much faster than GDP, meaning health care continues to account for a greater share of total GDP. More alarming, the rate of federal spending on health care grew much faster than the overall spending increase.
Tags: Health Care Costs
New Year Potpourri
by Kevin Roche on Friday, January 1, 2010
Many thanks for your readership of the last year and here are a few health care predictions and observations about likely trends for 2010.
West Virginia Health Report Identifies Possible Savings
by Kevin Roche on Thursday, December 31, 2009
States have often been leaders in experimenting with different methods of delivering and financing health care. West Virginia commissioned a report to identify methods by which it might reduce costs, while increasing coverage and not harming quality.
Drug Advertising and Prices
by Kevin Roche on Monday, December 7, 2009
The CBO looks at the characteristics of drug promotion spending and activity. Another study reveals that direct-to-consumer advertising for Plavix did not appear to increase the number of prescriptions but was correlated with a sharp rise in the price of the drug.
Tags: Drugs, Health Care Costs
MedPac Analysis Finds Less Geographic Spending Variation
by Kevin Roche on Thursday, December 3, 2009
One of the supposed sources for cost reduction is eliminating inappropriate geographic variation in medical care; variation that is unassociated with better outcomes. A MedPac report suggests variation, while significant, may be less of an issue than other analyses have found.
Senate Begins Health Reform Debate
by Kevin Roche on Monday, November 30, 2009
The Senate takes up its version of the health reform bill, creating an opportune moment to revisit what the goals of reform are and whether this bill will actually widen access, lower cost or improve quality. The answer is likely not.
Costs of End-of-Life Hospitalizations
by Kevin Roche on Monday, November 23, 2009
AHRQ issues a statistical brief examining the costs of end-of-life care. About one-third of American’s who die do so in a hospital, at an average cost two-and-a-half times greater than that for patients discharged alive.
Tags: End of Life, Health Care Costs
ECRI Advises Plans on Top Technologies for 2010
by Kevin Roche on Thursday, November 19, 2009
The ECRI Institute released a report advising payers on technologies to watch for in 2010, including genetic testing, imaging technologies, orthopedic devices and EHRs and PHRs. Most are very expensive but their comparative benefits or risks have not been proven in clinical trials.
Office of the Actuary Strikes Again
by Kevin Roche on Tuesday, November 17, 2009
The CMS Office of the Actuary zings the House bill, finding it will likely increase total national health care spending, its proposed savings from cuts in payments to Medicare institutional providers are unlikely to be sustainable and may reduce beneficiaries’ access to services.
Few Innovations Lower Cost
by Kevin Roche on Thursday, November 12, 2009
A study reported in the Annals of Internal Medicine tried to find medical innovations that significantly lowered costs, with only minor reduction in quality or outcome. Very few were found, which is consistent with innovation, especially technologic innovation, being found to be a major health cost driver in other studies.
Tags: Health Care Costs, Medical Care
GAO Report on Medicare Use of Physician Profiling
by Kevin Roche on Thursday, November 5, 2009
The General Accounting Office gives its perspective on the viability of the per capita method of physician resource use profiling by Medicare and provides useful insight into the topic of variable physician practice patterns.
Tags: Health Care Costs, Physicians, Providers
Weekend Potpourri
by Kevin Roche on Saturday, October 24, 2009
A miscellany of interesting items for your weekend browsing pleasure.
Tags: Care Management, Government, Health Care Costs, Health Care Reform, Telemedicine
More Variation in Spending Research
by Kevin Roche on Monday, October 19, 2009
A study reported in Circulation indicates that California teaching hospitals that utilize more resources in treating heart failure had lower rates of mortality. The study results call into question the methods and findings of some Dartmouth Atlas research. Another report looks at supply and variation in MRI usage.
Tags: Care Management, Health Care Costs, Hospital, Medical Care, Providers
Concentration in Children’s Health Spending
by Kevin Roche on Thursday, October 1, 2009
A review of what money is spent on which children for Medicaid and CHIPS yields insights on possible cost-saving and quality improvement opportunities.
Clinical Preventive Care Summary
by Kevin Roche on Wednesday, September 30, 2009
The Robert Wood Johnson Foundation has published a review of the cost effects of clinical preventive care measures.
Tags: Health Care Costs, Medical Care, Wellness and Prevention
The Advantage of Medicare Advantage
by Kevin Roche on Friday, September 25, 2009
AHIP presents evidence on the value of Medicare Advantage plans in delivering more efficient and effective care.
Tags: Government, Health Care Costs, Health Care Reform, Health Insurance, Hospital
Are Our Health Costs High?
by Kevin Roche on Thursday, September 24, 2009
Researchers associated with the Dartmouth Atlas project reinforce their viewsg on high health costs in a NEJM Perspective.
The Health Care Version of NIMBY
by Kevin Roche on Thursday, September 17, 2009
Everybody says we need cost control and expanded access, but nobody wants to pony up.
Geographic Variation in Health Spending
by Kevin Roche on Monday, September 14, 2009
Geographic variation in health spending is hot, but the reasons for it are still murky.
Tags: Health Care Costs, Health Care Reform, Medical Care, Providers
Quality Improvement is Not Easy
by Kevin Roche on Thursday, August 27, 2009
A commentary on Medicare’s experience in attempting to improve the quality of heart failure care demonstrates just how hard it may be to get better outcomes and lower cost.
More Evidence of Continuing Cost Increases
by Kevin Roche on Tuesday, August 25, 2009
Aon has estimated that private insurers health costs will increase at over 10% next year.
And Now For Something Completely Different
by Kevin Roche on Saturday, August 22, 2009
An Op-ed suggests we spend too little on healthcare. That may depend on who is paying.
Tags: Health Care Costs, Medical Care
NEHI Study Estimates Cost of Medication Non-Compliance
by Kevin Roche on Wednesday, August 19, 2009
A recent report from NEHI states that medication therapy non-compliance leads to $290 billion in avoidable medical costs every year.
Tags: Care Management, Drugs, Health Care Costs, Pharmaceutical
Looking at Hospital Input Costs
by Kevin Roche on Friday, August 14, 2009
One relatively unexplored method for reducing health spending is lowering providers’ input costs. A New York Times article examines one category of hospital costs.
Tags: Health Care Costs, Hospital, Providers
AHIP Survey Illustrates Physician Fee Issues
by Kevin Roche on Wednesday, August 12, 2009
Insurers have been under sharp attack for causing many of the problems reform is designed to address. One response has been to shift the responsibility for these problems to other components of the health system; in this case physicians’ fees.
Tags: Health Care Costs, Health Insurance, Physicians, Providers
Obesity, Obesity
by Kevin Roche on Monday, August 3, 2009
A new study shows increasing amounts of US health care spending are caused by obesity.
Tags: Chronic Disease, Consumers, Health Care Costs, Wellness and Prevention
Health Care, Small Business and Jobs
by Kevin Roche on Tuesday, July 21, 2009
Health care costs can limit small business growth, stunting a major source of new jobs.
Tags: Employers, Health Care Costs, Workplace
Fraud and Abuse–Are We Doing Enough to Stop It?
by Kevin Roche on Wednesday, July 15, 2009
One of the most commonly identified areas for health cost savings is fraud and abuse, but has enough effort been devoted to stopping the practices?
Cost Sharing and Health Outcomes
by Kevin Roche on Tuesday, July 14, 2009
Patient cost sharing reduces utilization, but appears to limit use of appropriate as well as inappropriate care.
Tags: Consumers, Government, Health Care Costs, Incentives
Don’t Blame Drugs For Cost Issues
by Kevin Roche on Friday, July 10, 2009
The limiting of growth in drug spending is a health care success story.
Tags: Drugs, Health Care Costs, Pharmaceutical
More Innovation From the Private Sector
by Kevin Roche on Wednesday, July 8, 2009
A Company mandates that its employees check their health status.
UnitedHealth Proposes Administrative Cost Savings
by Kevin Roche on Wednesday, July 8, 2009
A new UnitedHealth Group report identifies $332 billion over ten years in administrative cost savings.
Tags: Administrative Costs, Government, Health Care Costs, Health Care Reform, Health Insurance
Health Plan Medical Expenses Keep Rising
by Kevin Roche on Tuesday, July 7, 2009
A consulting firm study indicates that medical expenses for commercial health plans continue to rise at a rate far above inflation.
Tags: Health Care Costs, Health Insurance, Payor
JAMA Commentary Gives Crux of Cost Control Issue
by Kevin Roche on Wednesday, July 1, 2009
A recent JAMA commentary gives a concise summary of the cost control problems.
Tags: Government, Health Care Costs, Health Care Reform, Medical Care
Study Looks At Part D Impact on Drug and Medical Spending
by Kevin Roche on Tuesday, June 30, 2009
A study reported in the current issue of NEJM indicates that enrollment in Part D significantly increased drug spending for those persons who previously had no or a low level of drug coverage, but also led to a lower level of medical spending.
Tags: Health Care Costs, Health Insurance, Medicare, Pharmaceutical
Dumping on the CBO
by Kevin Roche on Friday, June 26, 2009
Unhappy with its projections, Democrats have beginning disparaging the CBO’s estimates on health reform.
Tags: CBO, Government, Health Care Costs, Health Care Reform
Maybe We Should Focus on Cost Control First
by Kevin Roche on Wednesday, June 24, 2009
Reality appears to have hit the health reform train head-on in the form of the costs of expanding coverage. Maybe we should focus on getting costs under control and then coverage extensions would be affordable.
Tags: Government, Health Care Costs, Health Care Reform, Health Insurance, Legislation
Shared Decision Making
by Kevin Roche on Tuesday, June 23, 2009
Shared decision-making for preference-sensitive conditions has the potential to improve quality and control spending. States are exploring required use of the technique and it should be considered in federal reform efforts.
Tags: Care Management, Consumers, Health Care Costs, Health Care Quality, Health Insurance
More Required Reading from the CBO
by Kevin Roche on Monday, June 22, 2009
The CBO’s June 16th letter to Senator Conrad is an excellent summary of health reform and cost control ideas and implementation issues.
Tags: CBO, Comparative Effectiveness, Government, Health Care Costs, Health Care Reform, Health Insurance
One Reason Health Reform Will be Hard
by Kevin Roche on Tuesday, June 2, 2009
An interesting news report on Kaiser Health News gives an indication of why health reform that affects costs will be very difficult. The story details the fight in one New Jersey town over building a new hospital.
Tags: Health Care Costs, Medical Care
Room for Improvement in Preventing Hospital Admissions
by Kevin Roche on Friday, May 29, 2009
The Agency for Healthcare Research and Quality’s (“AHRQ”) Healthcare Cost and Utilization Project released a report in April 2009 outlining hospitalizations that might have been preventable had the patients been receiving appropriate ambulatory care.
Tags: Health Care Costs, Hospital, Medical Care
Cost/Quality Relationship Unclear
by Kevin Roche on Wednesday, May 27, 2009
A study reported in Health Affairs, vol. 28, page 897 (May/June 2009), provides a further input to the question of the relationship, if any, between costs and quality in health care.
Tags: Health Care Costs, Health Care Quality, Hospital, Medical Care, Medicare
More Coverage = More Physician Visits = Less Cost?
by Kevin Roche on Thursday, May 21, 2009
A recent story in the Boston Globe raises intriguing questions about the effect of health coverage expansions on physician visits and other services and consequently, costs.
An Opportunity for Birthing Quality and Cost Improvement
by Kevin Roche on Thursday, May 21, 2009
The Los Angeles Times ran an article on May 17, 2009, regarding Cesarean births. Birth services are a microcosm of the problems in the broader health system.
Tags: Government, Health Care Costs, Hospital
ShowHide Headlines
CBO Outlines ‘Key Features’ Of Ryan Budget Proposal: ‘Substantial’ Changes To Medicare, Medicaid
Washington Post: Federal and state programs will pay slightly more than half the tab for health care purchased in the United States by 2012
Atul Gawande: The health-care bill has no master plan for curbing costs. Is that a bad thing?
Unions pressure Democrats on health insurance tax