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2010 Potpourri III

By January 23, 2010Commentary

The Washington Post has another article on the growth of concierge medicine, under which patients pay an annual retainer and receive more personalized attention.  (Wa. Post Article) The attraction to physicians is seeing fewer patients but being able to devote more time to them, while maintaining or even increasing their income and reducing the hassles of interacting with payers.  Because the physicians typically see fewer patients, there are concerns that the growth of these practices could exacerbate primary care shortages.  Others are worried that it may lead to a two-tier system of care, since many people can not afford the annual fee on top of insurance premiums, copays and deductibles.  But this clearly is a more satisfying method of delivering and receiving care for both patients and physicians.

One bright spot in the recession has been that health care-related hiring has held up fairly well and may be a source of growth in any recovery.   In particular, there will be a need for more physicians and staff in physician offices.   (Med. News Article) To some extent this is driven by the aging of the population and projected greater demand for health care services.  Concerns have been raised about whether there will be enough physicians, nurses and health professionals to meet the demand.  While health care costs are a problem for many people, health care has also been an economic bright spot for many years.

A recent study indicates that at least in some hospitals in New York, patients with coronary heart disease do not often receive   treatment considered most appropriate under national guidelines.  (Heart Treatment Article) In particular, patients frequently were sent for angioplasties when CABG surgery was recommended by the guidelines.  There were suggestions that this occurs more frequently in hospitals with angioplasty capabilities in-house.

While electronic medical records are all the rage, there is still significant paper in the administrative side of health care.   Cigna and MD Online announced a relationship to help physicians submit claims electronically instead of on paper.  (MD Online Release) It would have been a better use of taxpayer money to focus first on getting all the paper out of the billing, claims and administrative aspects of the system, then worry about electronic medical records, which are much more disruptive to workflow and have dubious paybacks.  A national goal could have been set to eliminate paper in two years and that might have been achievable and would, by most estimates, save at least $10-20 billion annually.

Molina, which is largely a Medicaid health plan company, announced it is buying Unisys’ Medicaid information system business.  (Molina Release) We could expect to see more Medicaid-related transactions, since most reform plans create a substantial expansion of Medicaid enrollment.  On the other hand, if major reform does not occur, given the funding woes of most states and the federal government, there may not be nearly as much Medicaid growth as people are hoping for.

Guided care is one of the approaches to care management for persons with serious chronic illnesses.  A recent study finds that patients being treated with this approach have a higher level of satisfaction with their care.  (Guided Care Study Abstract) This team-based method, which relies on specially trained nurses as a key component, is becoming more widespread.  While the outcome was only patient rating of their care, other studies have shown improvements in health outcomes as well.  And viewing your care as better quality probably helps patients achieve a higher health status.

Access DNA is one of the consumer-facing genetics companies.  It has partnered with Informed Medical Decisions to have access to a network of genetics counselors.  (AccessDNA Release) While genetics and personalized medicine have a bright future in reshaping medical diagnosis and treatment, the speed with which companies have gone for the direct-to-consumer market has caused confusion and uncertainty among patients.  The information has little value if it doesn’t have a direct relationship to clinical decisions.  Counselors may be able to help consumers find more utility in test results.

In more good news for EMR vendors, an article reveals frustrations surrounding the University of Iowa medical system’s implementation of an Epic system.  (UIHC Story) The story lists the usual issues of some tasks actually taking more time, difficulty in getting good support from the vendor and missing information; but also notes that most staff anticipate significant benefits in the longer term.  It is appropriate to be patient and take a long view, because most research indicates that it takes several years for at least the financial benefits of an EMR to be realized.

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