2012 Potpourri XV

A randomized controlled trial of telemonitoring in connection with frail, elderly adults conducted at Mayo Clinic and Purdue University showed no better outcomes, although mortality was higher.  The telemonitoring included daily biometrics, symptom reporting and teleconferencing and was compared to usual patient care.  There was no different in hospitalizations or emergency room use either compared with usual care or comparing the pre and post-enrollment periods.  Telemonitoring makes sense, but has had difficulty demonstrating either lower costs or better quality.   (Archives Article)

We have been consistent critics of the CMS, and similar, readmissions penalty program.  A recent article bolsters the view that many of these programs are poorly designed.  Researchers at the UCSF Medical Center found that calculating hospital readmission rates on administrative databases can lead to inaccurate calculations.  They looked at over 5800 spine-related admissions from 2007 to 2011.  About 5.8% were readmitted within 30 days of initial discharge.  They found the readmission rate to be too high when chart review was done, since almost 16% of the readmissions were planned or were unrelated to the initial admission.  The study once again shows the need to review each readmission to determine if it was appropriate.  (UCSF Study)

AISHealth has an article on early successes from accountable care organizations.  Several are reporting that they have been able to reduce hospitalizations by as much as 10% and emergency room visits by over 5%.  The article notes the potential conflicts that occur when hospitals are involved in the ACO and the reductions in utilization may leave idle capacity and lost revenue.  But a properly structured global-type payment mechanism which is allocated appropriately among the providers in the ACO may help ease these conflicts.  Acquiring the right management skills is also important to ensure success.   (AIS Story)

Despite concern about the potential for abuse when physicians have an interest in services or products they may order or prescribe, federal law contains a number of exceptions that allow the practice.  Research in Health Affairs demonstrates the danger in allowing this self-referral.  The researchers found urologists who had an interest in a pathology lab ordered almost 72% more specimens than did those physicians who were referring to an independent lab.  But they found less prostate cancer, suggesting that they were simply ordering more biopsies on men who were unlikely to benefit.  One way to deal with over-utilization is to completely disallow any physician self-referral.   (HA Article)

The Journal of the American Medical Association has an article purporting to identify how to eliminate waste in US health care spending, by two prominent authors.  It is a compendium of the usual ideas, eliminate bad care, coordinate care better, stop over-treatment, administrative simplification, get rid of fraud and abuse and rationalize prices.  No specific tactics discussed, and the fact that these have been addressed forever, with little impact on spending or spending growth, undermines the credibility of the article.  More important, the authors ignore the fact that there appears to be as much under as over-treatment, which would add to costs.   (JAMA Article)