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
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