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2010 Potpourri X

By March 20, 2010Commentary

One of the most interesting developments regarding technology in health care is the use of robots to aid in various health services or procedures, including very delicate procedures.  In theory, robots could make fewer errors.  A recent article looked at use of robot-assisted prostate cancer surgery, finding that use of the robots did not compromise outcomes.  (BJUI Article) The surgeons tended to use visual cues more than tactile ones when using the robot.  Eventually robots may operate on their own.  They already can allow a surgeon to operate remotely.  Access to scarce expertise may be improved and quality appears to be as good, but careful research is necessary to validate the increasing use of this technology.

Continuing the streak of articles regarding provider pricing, the Boston Globe reports on information released by a large Massachusetts health plan about its payments to hospitals.  The information was released in advance of hearings on the source of cost increases in the state.  Those hearings should be fascinating and may shift the discussion of pricing issues from insurers to providers, where it probably more appropriately belongs.  (Boston Globe Story) The story indicates that some hospitals and physicians got paid as much as three times more than others for the same services.  How can that ever be justified?  The health plan said provider leverage was the explanation.

Venture capital funding for health care companies remains alive, according to a VentureDeal report.  (VentureDeal Report) A total of $1.9 billion was invested in biotech, medical device and pharmaceutical companies in the fourth quarter of 2009, about the same as the third quarter.  Biotech investments increased signficantly, while medical device and pharmaceutical ones were down slightly.  Sixty-nine biotech companies got $871 million, while 78 medical device firms received $572 million.  A lot of money being pumped into innovations that the current Administration doesn’t seem that eager to pay for.

The Office of Inspector General attempts to ferret out fraud, waste and cost savings opportunities for Medicare, Medicaid and other public health programs.  It issues a number of reports every year identifying these opportunities.  It also periodically reports on whether its recommendations have been taken up by the appropriate agencies or Congress.  The most recently issued report suggests that there is a lot of room for improvement.  (OIG Report) Even a cursory look at the report indicates that there are probably tens of billions of dollars in annual savings in those recommendations that have basically been ignored.  A lot of this is undoubtedly due to political pressure on Congress and HHS by those who would lose revenue if the recommendations were adopted, but when cost is such a concern it is hard to understand not following up on the OIG’s spending reduction ideas.

Medco and the Mayo Clinic released results of research utilizing a genetic test to aid in prescribing warfarin, a blood thinner whose use often leads to adverse events. (Press Release) Warfarin use is associated with many emergency room visits and hospitalizations.  Use of a genetic test to help guide dosing and identify at-risk patients led to thirty percent fewer hospitalizations.  A follow-up study will generate explicit cost-benefit information.

Telemonitoring has great promise for improving chronic disease patients’ care, but its cost saving potential is not always self-evident, particularly since some remote monitoring equipment can be quite expensive.  A cheaper, web-based monitoring method was discussed in a Telemedicine and e-Health article.  (Telemonitoring Study) (Abstract Only)  CHF patients were monitored at home through use of information they posted on a website.  Patients and caregivers were satisfied with the program and it appeared to improve health status and outcomes.

Another telemedicine article reports on observational research into a home-based care management program for recently discharged elderly persons with chronic disease.  (CMTM Article) (Abstract Only)  While the study did not have a control group and does not report the cost of the intervention, clinical outcomes appeared to be good and the rehospitalization rate and utilization of emergency room visits were both well below national norms.  Low mortality was also observed.  As hospitals are now subject to penalties for readmissions in some cases, programs like this can be expected to spread.

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