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2010 Potpourri IV

By February 6, 2010Commentary

The Agency for HealthCare Research and Quality has released another draft paper related to pharmacogenetics, this time regarding cancer drugs.  (AHRQ Paper) The Agency specifically looked at whether genetic tests in regard to three types of cancer predicted therapy response, affected therapeutic choices and what were the benefits or harms of the testing for patients.  In general, the Agency found a paucity of good research on these questions, particularly on impacts on therapy decisions and overall benefits and harms of testing.  It identified several methodological issues that should be addressed to make future studies more useful.

The Department of Health and Human Services announced that it has awarded a contract to Avalere Health to study creation of an all-payor, all claims database that would facilitate comparative effectiveness research.   (HHS Announcement) A number of private payors have large claims databases that they use to identify health cost and quality issues.  The Medicare and Medicaid databases also provide useful information.  Having a comprehensive database that covered almost all health services in the United States, however, would be an enormously powerful tool.  Being able to profile providers across all lines of business would be extremely helpful in identifying inappropriate utilization and failure to comply with best-practice guidelines.

Buck Consultants, a unit of ACS, soon to become a unit of Xerox, released some results from an annual survey of the costs of private health care coverage.  (Buck Survey) The survey shows that double digit increases are expected for most forms of employer based coverage, including HMOs, PPOs and even high deductible plans.  Among the cost concerns expressed by employers are concerns over mental health parity and continued high COBRA enrollment.  Other than the continued rapid cost increases, the most notable finding may be that apparently high deductible plans have lost their ability to limit rising costs.  Perhaps their effect was a one-time phenomenon.

The ECRI Institute, which provides information for payers and others on the value of medical devices and other technology, has issued a guide to help hospitals approach implementation of EMRs in compliance with the HITECH Act.  ECRI also is collecting  data on issues hospitals are having with particular systems.  The goal is to help identify common problems and help avoid them in the future.  (ECRI Info.)

The Wall Street Journal has an article on how the new genetic discrimination law is making it more difficult for companies to design and implement wellness programs and accompanying incentives.  (WSJ Article) This at a time when evidence is mounting that wellness and prevention programs in the workplace can have a significant effect on costs and on employee health status.  As is often the case, it is government action which inhibits the ability to effectively address health system issues.

A story in the SunTimes discusses a physician who uses telemedicine technology to extend his practice.  HomeCare Physicians is based in Wheaton, Illinois and Dr. Tom Cornwell used technology to care for as many as 5,000 patients.  He uses wireless monitoring to track patients’ condition and believes he has successfully avoided many emergency room and hospital visits.    (SunTimes Story) Treating patients at home also tends to enhance their quality of life.

A study finds that the number of hours doctors work is influenced by changes in malpractice laws and risk.  (Malpractice Story) The research compared changes in malpractice laws in various states with physician survey results regarding work hours.  When laws increased malpractice risk, physicians worked fewer hours and the reverse was also true.  Doctors over 55 and those owning their practice were the most sensitive to changes.  If the results of the study are accurate, higher malpractice risk reduces the overall physician capacity at a time when there is concern about the adequacy of the physician workforce to meet patient demand, especially if that demand is enhanced by coverage expansions.

Here is another innovative use of wireless technology in health.  A company has devised a system to remind hospital employees to wash their hands.  Hospital acquired infections have become a significant concern and simple measures like good hand-washing can be helpful.  Proventix’ system has a badge with wireless capability that notes when a nurse or other health care worker goes in a patient room and if the worker washes their hands when they go in and when they leave.  People who don’t comply with the hand-washing regiment can be sent an email or a text message.    (NPR Story)

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