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2010 Potpourri XV

By May 1, 2010Commentary

An article in the Annals of Internal Medicine reports that the rankings of hospitals in a popular magazine are driven more by reputation than by actual objective measures of quality or value.  (Annals Article) While this largely falls in the “shocking, just shocking” category for knowledgeable health industry participants, the general public is probably unaware that many of these ranking systems are nothing more than popularity contests.  It would probably be helpful to the public to have some controls on what is disseminated as a supposed “quality” rating.

In another item related to hospital rankings, a British Medical Journal piece suggests that using mortality rates is not an appropriate way to measure hospital quality.  (BMJ Article) The study points out the difficulties in assessing which deaths might have been avoidable and because those generally are a small percent of overall in-hospital deaths, the statistical analysis is easily confounded by a multitude of variables.  While the authors believe mortality rates can provide clues as to where the need for further investigation of quality may exist, they strongly caution against making judgments about the propriety of care until a thorough examination has been conducted.

Insurance premiums in Chicago are likely to go up 13% on average next year, an article reports.  (Crain Article) As we have noted before, there will be many more stories like this in the coming months.  The changes required by the new federal law, as well as other changes such as mental health parity, are going to raise costs.  The changes may be the right thing to do in terms of providing better insurance coverage, but they simply aren’t free.  And the public is not going to be happy when they see that instead of going down as promised, its share of premiums and other out-of-pocket costs are rising.

Mathematica issued an Issue Brief on the subject of the relationship between insurance coverage and health outcomes.  (Mathematica Paper) The paper suggests that there is conclusive evidence that it is the lack of insurance coverage that leads to the poor outcomes.  The brief is basically an advocacy piece and only in the footnotes do you find even a hint of the well-demonstrated fact that the research on this supposed connection has completely failed to account for the many confounding variables.  People without insurance generally are already in poorer health than those persons with it and have a number of other characteristics that account for their lesser health outcomes, quite aside from any insurance coverage.  This has been one of the worst arguments used in favor of reform laws that expand access.

The Centers for Disease Control issued a report examining emergency room visits by nursing home residents.  (CDC Report) The report found that these residents account for an increasing percent of total emergency room use and that a relatively high percent of them have had at least one visit in the past 90 days.  The researchers estimated that as many as 40% of these visits were potentially preventable.  The leading cause of preventable visits was falls.  Heart conditions and pneumonia also led to preventable emergency room visits.

The Georgia Department of Insurance has held that the state’s any willing provider law requires a Blue Cross plan to contract with providers.  At a  time when there is concern about rising insurance costs, which appear to be driven by increasing provider reimbursements, these any willing provider laws are an example of government actions which impede the private sectors ability to create networks of high quality, cost-effective providers.  As long as there are laws and regulations like these and like mandated benefits, it will difficult for insurers to hold price increases down.  (Georgia Ruling)

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