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2010 Potpourri XII

By April 10, 2010Commentary

In a case that had implications for telehealth, the D.C. Circuit Court of Appeals ruled that the Federal Communications Commission had no authority to issue “net neutrality” rules which block broadband providers from treating sources of internet traffic differently.  (Net Neutrality Ruling) Telemedicine users were concerned that they may need the carriers to be able to prioritize their transmissions, especially for critical medical needs, so they were not happy with the net neutrality notion and probably are cheering the ruling.  The FCC’s response will likely be to find some other way to achieve the same end, but it is not clear Congress is on board.

Sermo and Athenahealth issued the results of a survey of 1000 physicians on various issues.  The survey is a first in a series designed to create a Physician Sentiment Index.  (Press Release) (Sentiment Index) (Registration Required)  According to this version of the survey, over half feel government involvement in health care is not helpful and that the quality of medicine will decline in the next five years.  They also feel their financial situation will worsen.  They have very negative perceptions of their reimbursement interactions with payers.   They are favorable regarding EHR potential, but view most current solutions as not working that well.  They feel they are more adequately reimbursed by private payers than government programs like Medicaid or Medicare.  One caveat, other than the usual methodological issues with surveys, is that the respondents are mostly from relatively smaller practices, who may be more disenchanted than the average physician.

In an earlier post we briefly mentioned a survey on how much revenue physicians generate for hospitals versus what they cost, but didn’t have a link to the full survey.  Here is a link to that survey, which again demonstrates why physicians are so eager to employ or otherwise closely affiliate with physicians and how a hospital with many close physician ties can aggregate substantial market power.  (Merritt Hawkins Survey)

Aetna issued the results of its updated review of members covered by a consumer directed health plan versus a traditional one.  The data indicates that for a full-replacement CDHP with an HSA or HRA, about $18 million in medical costs was saved per 10,000 members.  That is a lot of savings.  On a million people, it would be about $2 billion.  The CDHP members spend more on preventive care and less on physician care and emergency room visits.  They have greater use of generic drugs and they use online tools to help track and manage their health more.  They take health assessments much more often than other members.  (Aetna Release) (Aetna Study) Too bad the powers that be didn’t seem to think this was a direction worth encouraging in the new federal health act.  If everyone was covered by a policy like this, it seems they would be more engaged in managing their health and health costs and their health would be as good, if not better.

As feared by many physicians, retail and work-site clinics are beginning to expand the services they offer.  MinuteClinic, owned by CVS, announced that it would provide ongoing monitoring for patients with chronic diseases such as diabetes, asthma, high cholesterol and high blood pressure.  The service includes taking a history and checking care against that recommended by guidelines.  The results are sent to the patient’s physician, or if the patient doesn’t have a regular provider overseeing their care, the clinic can help them identify one.  (MinuteClinic Announcement) While these retail clinics have not always made a lot of money for their owners, they are well-accepted by customers and by payers and they represent one way in which patient care is evolving.

In a bridge story between retail clinics and telehealth, a vendor has begun offering a system which is designed to facilitate the clinics ability to offer a fuller set of services by remote connection to physicians or other providers.  The system is a combination of software and hardware which is described as a “mobile clinic on wheels.”  (Telemedicine Story)

Getting patients to fill prescriptions and take the medication as prescribed is important for good care of most chronic diseases.  A recent study by Express Scripts suggests that diabetes patients are more likely to be adherent to medication regimens if they use mail-order versus retail pharmacies.  The determination of adherence is somewhat indirect, as it measures possession of an adequate amount of the drug, not actual use.  The reasons why adherence might be better include lower cost, longer supply and more convenience.  (Express Scripts Study)

The uses for communication technology in health care are exploding.  Another innovation is the ability to remotely monitor a patient’s use of a CPAP machine that treats sleep apnea and ensure that they are compliant with therapy, which also facilitates meeting requirements for Medicare reimbursement.  (Sleep Apnea App) This is another example of the value of real-time, continuous access to data; a value which is created by the spread of wireless and internet capabilities.

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