2010 Potpourri XVI

The Congressional Budget Office has re-estimated the cost of likely Sustainable Growth Rate formula changes for Medicare’s physician payments, finding that the proposed fixes will add as much as $330 billion in spending over the next ten years.  For those of you keeping track, that is now around $500 billion in extra spending from the reform bill, not a reduction.  Stay tuned, more excess spending to come.  (CBO Estimate) Can you say Greece?

An engineer at UCLA has developed a miniscule microscope for use in telemedicine applications.  (UCLA Release) The microscope can examine blood and other samples placed on a chip and inserted under the lens.  The microscope is just one of an increasing number of devices which can be used at home or in areas with few medical resources, such as Africa, to remotely allow gathering of diagnostic information for medical personnel.

A computerized model of decision-making about children’s fevers and how they should be treated performed as well or better than physicians.  The result was based on a study of over 15,000 cases of children with fever in Australia.   (BMJ Article) The model was constructed with a list of 40 relevant circumstances and checked against past cases, then used prospectively.  The value is not in showing that physicians make mistakes; there are simply too many relevant factors and other information for a physician to consider, and too much variability in disease and patients, for physicians not too make errors; but in demonstrating that computer models can aid physicians in making important diagnostic determinations and treatment decisions.

Its funny how not a week seems to go by without some truly shocking revelation relating to health care.  This week’s is the story in the Wall Street Journal suggesting that home health care agencies may have gamed Medicare’s payment system.  (WSJ Article) While they all denied it and came up with various lame explanations, the data are irrefutable:  the home health agencies were ginning up just enough visits to get to the next increment of reimbursement.  This is possible in part because physicians aren’t paying any attention to whether the visits they order are really needed and tend to over-rely on what the home health care agencies suggest.  There might be a little funny business in there too.  Medicare probably needs to get tougher on the standards physicians are using to order the visits and perhaps even use financial incentives to ensure that the physicians are only ordering truly necessary visits.

More shocking news came from a Journal of the American Medical Association perspective on prescribing of antipsychotics.  (JAMA Perspective) These drugs continue to be very frequently used for non-FDA approved uses.  These drugs have serious side effects, which doctors are often not aware of and don’t monitor.  Billions of dollars are being spent on unapproved uses; in some cases as many as 50% of the prescriptions are not for an indicated use.  All those drug company marketing dollars are apparently working.  It is hard to understand how a conscientious physician could be writing these prescriptions when it not only contributes to our serious cost problems, but jeopardizes patients’ health.

More good news on depression drugs–doctors often don’t catch the side effects of these drugs either.  A study in the Journal of Clinical Psychiatry reports that patients have 2-3 times the number of serious side effects that are reflected in their charts and 20 times more overall side effects.  (Study) The psychiatrists are apparently not even bothering to inquire about most of these side effects.  The authors suggest the obvious remedy that all patients should be regularly asked to respond to specific checklists of possible side effects.