2011 Potpourri XXXIX

Research published in the Archives of Internal Medicine gives results of a survey of 627 primary care physicians regarding the receipt of unnecessary care by their patients.  Forty-two percent of the doctors said patients in their own practice were getting too much care; only 6% said they didn’t get enough care.  Factors cited for delivering unnecessary care included fears of malpractice, clinical performance measures and inadequate time with patients.  The physicians also said financial incentives led to excessive testing.  Finally, the doctors believe there is significant variation in care for identical patients.   (Archives Article)

Benefits consultant Segal releases a trend report for 2012, based on interviews with managed care companies, health insurers, TPAs and PBMs.  The expectation are that overall trend will be around 10%, with HMOs seeing a slightly lower trend.  This is down about a point from the 2011 trend expectations.  Actual trends tend to be 2-4% less than the projected ones.  Actual trends were the lowest in ten years.  Drug trends are projected to be around 7% for 2012 and Medicare Advantage plan trend is at 6.6%.  So far, the respondents believe that the reform law has added about 1% to trend and they don’t expect the MLR requirement to do anything to effect trend.   (Segal Survey)

A CMS notice indicates that it has awarded the multi-payor claims database project to Ingenix, a division of UnitedHealth Group.  Similar to the voluntary effort begun by some large payors, including UnitedHealth, this database will collect information from as many payers as possible and provide access particularly for comparative effectiveness research.  While a worthy effort, as we have pointed out before, if the data can’t be used to profile providers, it loses much of its value.  (CMS Notice)

Talking to patients about their end-of-life care and arranging for advance directives does not appear to have an impact on survival rates, according to a study published in the Journal of Hospital Medicine.  Over 350 patients at low or medium risk of dying were followed for six years.  The “death panel” scare implied that having a conversation with patients about end-of-life care would lead to the patient being abandoned to die early.  The research shows no difference in survival rates for the group of patients who had an end-of-life care discussion versus those who did not, nor was there any difference for patients who went further and created an advance directive.   (Hospital Journal Article)

The mHealth Regulatory Coalition is an industry group working with the FDA to create greater certainty about the regulation of certain mobile and wireless devices and software which are used for health care related purposes.  The FDA has been confused about software in general forever and the mobile health movement has added a further level of complexity.  The group issued a draft of its suggested guidance for FDA.  The guidance attempts to set forth a risk assessment model and to define what claims a manufacturer can make and not be regulated and a clearer process for when a manufacturer does need approval for health-related claims.   (Proposed Guidance)

One of the many CMS demonstration projects related to reform is the Comprehensive Primary Care Initiative, which seeks to enlist payers other than Medicare or Medicaid in a common effort to transform primary care practices to “medical home” type entities.  The initiative is premised on the probably realistic recognition that  any one payer may not have enough influence to change a physician practice.  The initiative’s primary goal is greater continuity and coordination of care, buttressed by payment reforms to be adopted by all participating payers.  Five to seven markets will be targeted, with up to 75 practices involved in each market.  The new Center for Innovation will manage the initiative.   (CMS Demo Project)