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Fireworks Potpourri

By July 3, 2010Commentary

End-of-life care, particularly for the elderly or those suffering from incurable diseases such as terminal cancer, accounts for a great deal of health spending in the United States.  How much of that care is appropriate or even necessary has been controversial, and there are concerns that it often is not consistent with informed consumer wishes.  The Washington Post has an article looking at the experiences of several patients and discussing the issues.  (Post Story) It is very unfortunate that the recent health law did not include requirements for bettering informing patients about their choices and respecting their wishes.

The Supreme Court issued its much-anticipated opinion in the Bilski case.    (Court Opinion) Although not dealing with a health care patent, the ruling has clear relevance to many health care companies.  Unfortunately, the Supreme Court really didn’t provide much guidance.  Many inventors breathed a sigh of relief because the opinion did not accept the notion that a patent must be tied to a machine and involved in transforming an article.  The Court also, however, did not reinstate the notion that a process patent will be granted if it produced a useful, tangible and concrete result.  Processes and business methods can be patented but under what circumstances is still not clear and basically left to the federal patent court.

After imaging has taken so much abuse, a new study suggests that using MRI scans more often in emergency rooms for patients with cardiac symptoms could save money.   (Annals Article) In this randomized trial some patients received usual care, which typically meant being admitted as an inpatient for further testing and observation and others got an MRI and were observed.  Around $600 was saved per visit by using the MRI and there appears to be no difference in health outcomes.  Interestingly, of the 110 patients in the study, only 8 turned out to have acute coronary syndrome.

The Veterans Administration is often lauded for the quality of its health care and its health care IT.  The truth may be  less favorable.  Health IT projects at the VA often have significant cost overruns and are rarely delivered on time.  Modern Healthcare has a story about the VA’s scheduling system project.  The Government Accounting Office reviewed the project and found that $127 million had been spent over 9 years for basically no value and the agency needed to start over.  Your tax dollars at work.  ( I think I would rather have publicly funded fireworks displays.)  (VA Story)

Actuaries understand the dynamics behind health utilization and health costs as well or better than anyone, so they are usually worth listening to.  The Society of Actuaries released a survey of actuaries, and patients on some issues, about what might help reduce health spending.   (SOA Release) The actuaries favored making the prices and quality of medical care more visible to patients, as well as educating patients about the effectiveness of care.  Other suggestions were reducing medical errors and stopping fraud and abuse.  Some of the patients agreed that these items would help them control costs, but 39% felt there was nothing they could do to control their individual health costs.  Almost all consumers, however, did believe that financial incentives would help them make better choices and be healthier.

And what would any Potpourri be without a Massachusetts item to spice it up.  The state released the report it requested regarding the effect of individuals who may be purchasing insurance only when they need it.  Health plans have claimed this practice is costing them millions of dollars. The report finds that the number of individuals who are gaming the system has increased dramatically, but they are having a relatively nominal effect on overall cost increases, around 1-2% of premium.  Compared to what was projected before the Massachusetts reform bill, costs are higher because of the elimination of waiting periods and pre-existing condition limits.  Costs have suffered a double whammy, as the number of high-cost individuals terminating shortly after obtaining coverage is up and the number of low-cost individuals leaving early also has gone up.  The high-cost ones are presumably just getting coverage when they know they have a significant medical need and the low-cost members probably figured out that it was cheaper for them to pay the penalty than pay for insurance.  (Oliver Wyman Report)

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