2012 Potpourri XXXVI

One of the sleights of hand used to promote the health reform law as not adding costs was to ignore the cost of fixing the current Medicare physician reimbursement formula, the notorious Sustainable Growth Rate formula which Congress has prevented from being implemented every year for several years.  If it were implemented in 2013, doctors would see almost a 30% reimbursement decline.  That is not going to happen and the fix will cost at least $25 billion in additional Medicare spending each year.  That is a lot of money when Congress already can’t figure out how to make even the simplest of reductions in deficit growth.   (The Hill Article)

According to a Kaiser Health News story, our state of Minnesota is leading the way in the likely explosion of cost overruns related to implementation of the health care reform law.  The state is planning to run the required insurance exchange itself and the initial estimate for the operating cost in 2015 was $30-40 million.  Now the state is saying it will be $55 million and $64 million in 2016.  The state will have to basically tax users or find some other mechanism to fund the costs.  Minnesota is not that big a state and is very well run among states, comparatively speaking.  Just an example of the huge costs that this law is going to end up imposing, with no improvement in anything.   (KFF Article)

According to a release from a UnitedHealth Group subsidiary, family members who provide care to a Medicare beneficiary are very common and 70% are the primary caregiver and 66% have been providing care for five or more years.  Over half live in the same residence.  About 75% have an annual income under $25,000; meaning that the caregiving likely creates a financial as well as physical and emotional burden on these family caregivers.   Chronic conditions drive much of the need for the assistance for family caregivers, with diabetes a leading cause.  As other research has indicated, caregiving can be a health risk for the caregivers and they typically need support which is often not available.  (UHG Release)

A Journal of Environmental and Occupational Medicine article studied the relationship between health risk assessment changes and costs in an employer setting.  Employees at multiple companies who completed a health risk assessment in each of two consecutive years were categorized as either having reduced risks or higher risks.  For employees who had more health risks after the second health assessment, costs subsequently increased an average of $210 per year for each additional risk and for employees with fewer health risks, costs were lower by an average of $129 for each reduced risk.  These results applied to people with chronic conditions; similar results occurred for those without chronic conditions, but were of a lesser magnitude.   (JOEM Article)

Research published in the New England Journal of Medicine examines the effect of screening mammography over the last three decades.  Theoretically better screening should increase early cancer detection and reduce later stage discovery of cancers, leading to better overall survival.  And the number of early state cancers found each year has more than doubled, from 112 to 234 cases per 100,000 women.  But there has been a much smaller reduction in detection of late-stage breast cancer, from 102 to 94 cases per 100,000 women.  And relatively few, just over 5%, of the newly detected cancers would be expected to progress to advanced cancer, leading to likely overtreatment.  On the other hand, if you are one of the women whose life may have been saved by additional early detection, you are very happy there was more screening.   (NEJM Article)