2010 Potpourri XXI

With the possible exception of health information technology, telemedicine is one of the most notable health care trends.  A New York Times article discusses the use of the capability to bring medical expertise to underserved areas.  (NY Times Article) Companies are using a variety of inexpensive and expensive equipment to facilitate telemedicine, from webcams to high definition video-conferencing with all manner of electronic diagnostics.

ABC News has a story about more medical care sometimes not being better care.  (ABC Story) The article gives some of the usual examples–too much radiation, too many cesarean’s, too many antibiotic prescriptions.  It is good to continue to have visibility on the issue, however, as it may help build public support for the notion of evidence-driven, conservative medicine, support which needs to be built, as one of our commentaries earlier in the week pointed out.

John Goodman writes in the Health Affairs Blog about the best way to have health care cost sharing.  (Goodman Blog) Contrary to most current insurance designs, he points out that it might make the most sense to have patients be responsible for the costs of care which are discretionary and third-party payment cover those which are not discretionary, such as strokes or ruptured appendix.  Much of the discretionary care is preventive or primary care.  In his view, the worst feature of the reform bill is its prohibition of copays on preventive and primary care and the acceptance of large deductibles and copays on hospital and other acute care, much of which is not discretionary.  One aspect Goodman seems to ignore is that even when some form of treatment is absolutely necessary, a heart attack for instance, a patient may be able to choose between options which have very different cost consequences, for example, bypass surgery versus a stent versus just drugs.

The Los Angeles Times published an article on the use of online technology for patient-physician interactions.  The e-visit phenomenon is receiving more and more attention.  (LA Times Story) While payment averages about $30 versus $75-100 for an office visit, the encounters can be shorter and have less cost like office space and staff associated with them.   Some experts say as many as 35% of medical interactions could be done online or in retail clinics.  Some foresee a future where an in-person visit is rare.

A couple of notable mergers this week.  One is Allscripts buying Eclipsys.  No area has been hotter this year than health information technology and the number of transactions is growing as firms scramble to broaden product lines and customer bases.  All the hype, however, means there is likely rampant overpayment and looming disappointment.  (Allscripts Release) The second acquisition was smaller but also interesting.  Cardinal Health is buying Healthcare Solutions, which provides a variety of  services related to specialty pharmaceuticals and other aspects of managing health care.  Cardinal had slimmed itself down by disposing of some major business segments in the last few years and this acquisition indicates it is now expanding again.  It is a little hard to tell the exact strategic direction they intend to take. (Cardinal Release)

Apparently at least one regulator in Massachusetts has the sense to realize that trying to pretend that rate increases aren’t necessary to cover increased health costs has implications for the solvency of health insurers.   (Globe Story) Of course, this employee was then apparently scolded for revealing these concerns in an internal email.  The administration in Massachusetts would prefer to pretend that it hasn’t created a huge mess through its “reform” program.  And in a related story, apparently the insurance department is worried about the solvency of insurers since earlier this year it sent letters to three of them saying it wanted to exercise closer oversight of their financial condition.  (Globe Story) The whole saga is soon to be repeated in a state theater near you and on the federal level.