2010 Potpourri XXV

Aon and Hewitt are merging their companies.  This is probably a reaction in part to the Towers Perrin/Watson Wyatt merger earlier this year.  (Aon Release) The merger will create a significant global benefit consulting firm.  These benefit consulting firm mergers may in part be driven by uncertainty under the new health law–will employers spend as much on consulting?

There has been a trend for several years of consumers seeking more convenient and less expense methods of accessing health care.  A Newsweek story discusses the use of mobile health care vans, which bring health professionals and some equipment into neighborhoods, usually areas with limited local health care resources.  While the savings are probably exaggerated, such mobile vans do make it likely that some people receive care they would otherwise skip.   (Newsweek Story)

PMSI put out its annual report on workers’ compensation drug cost trends.  The company finds that average pharmacy spend per injured worker rose 6.5% in 2009, driven by unit price increases of 4.7% and utilization changes of 1.7%.  The unit price change was largely caused by AWP rises and the utilization change by a longer average supply of drugs being obtained.  Greater use of mail order muted the price increases.  Pain medications continue to be far and away the largest class of workers’ comp drugs.   (PMSI WC Drug Trends)

More research on geographic variation in care and spending is presented in a Journal of the American Medical Association article regarding  treatment of end-stage renal disease.  (JAMA Article) The researchers found that high-spending areas had more nephrologists, vascular surgeons and hospital beds, but interestingly in those high-spending areas patients were less likely to have been under the care of a nephrologist before starting dialysis.  There was a significantly higher intensity of care prior to death as well.

A letter to the New England Journal of Medicine offers further caution on CMS’  upcoming program to penalize unnecessary readmissions.   The letter suggests that readmissions may in fact be a sign of good hospital care, because often patients who are readmitted might have died in the hospital if they had gotten poor care.  Hospitals that have the best mortality rates often have high readmissions for just this reason.   (NEJM Letter)