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2012 Potpourri VI

By February 10, 2012Commentary

Use of robots in surgery is promoted by the manufacturers as leading to less complications, etc. but the machines are expensive and surgeries using them are more costly for payers.  For example a robotic hysterectomy costs over $1500 more than a laparoscopic one.  Research in the Journal of Clinical Oncology also finds that among 2464 women there was no difference in intraoperative complications, surgical site complications, medical complications or prolonged hospitalizations.  In other words, you get to pay more for no additional quality benefit.  But the doctors and manufacturers make more money.   (JCO Article)

Aspirin is cheap and does a lot of good things.  But physicians often persist in using other drugs which cost more and cause more problems.  A study presented at the  International Stroke Conference finds that aspirin and warfarin have similar results in preventing deaths and strokes in heart failure patients.  Warfarin is a dangerous drug with serious complication potential if not closely monitored and the monitoring and the drug add to expense.  In this study death, ischemic stroke and intracerebral hemorrhage had similar rates for patients on either aspirin or warfarin.  However, the warfarin patients had twice as many incidents of serious bleeding.    (Aspirin Release)

More on aspirin in another study reported at the International Stroke Conference which compared aspirin alone and aspirin plus Plavix, an expensive commonly used drug which is soon to go generic.  In regard to subcortical strokes, which affect 150,000 Americans a year, the study found that the risk of bleeding nearly doubled when Plavix was added to the patient’s drug treatment, and the risk of death from aspirin alone was 1.4% but when Plavix was added it rose to 2.1%.  There was no difference in stroke recurrence.     Now we will see if doctors pay attention and stop misusing the drug in this way.   (Aspirin Release 2)

Many health plans have taken steps to encourage their members to use fitness clubs, including providing financial incentives.  Health Care Service Corporation is one such health plan and it examined the claims history of 5000 members using a fitness club benefit.  For those members, claim costs decreased a total $1 million from the year before they were members to the year they were.  Meanwhile claims costs rose 5% for those not in the program.  For those who worked out once a week, costs were 8% lower, twice a week workouts were associated with 28% lower costs and more than three visits to a club with 44% lower costs.  Employees report feeling better and being more productive as well.  Of course, we can’t tell from the release what the prior health of these people was or if the cohorts were matched.   (HCSC Story)

An interesting perspective in the New England Journal of Medicine looks at where the overrun in physician expenses that led to the Sustainable Growth Rate formula came from, geographically by state and by physician specialty.  The SGR cuts would fall on all physicians equally but the analysis by the authors finds that doctors in some states contributed much more to the problem, for example in New York, Florida and TExas.  Similarly, cardiologists, internal medicine doctors, emergency medicine doctors and radiation oncologists were major contributors to the overrun, while general and thoracic surgeons and psychiatrists actually under-contributed.    (NEJM Article)

An article in the Journal of the American Medical Association examines emergency department performance at safety net hospitals compared to others.  These measures are proposed for use by CMS in its pay-for-performance and value-based purchasing initiatives.  The research found no significant differences in length of stay in the ER, time to discharge, time to admission, time to admission for observation and time to transfer.  The results are encouraging because they suggest that hospitals which care for a disproportionate share of poor or uninsured patients won’t be disadvantaged by adoption of the measures.   (JAMA Article)

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