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2010 Potpourri XXVIII

By August 7, 2010Commentary

The Annals of Internal Medicine has an article regarding the possibility of physicians sharing visit notes with patients and describing a demonstration project called “Open Notes” designed to promote such sharing.  While consistent with the notion of greater transparency, greater patient involvement in care and shared decision-making, both physicians and patients have concerns about the idea.  Doctors are concerned about demands on their time and on patients’ misunderstanding the information in the notes.    Patients were concerned about privacy, learning something regarding their medical condition they would just as soon not know or something that undermined their trust in the physician.  (Annals Article)

Many specialties have found ways to take advantage of computer and communication technology in seeing patients by telemedicine.  Dermatology is one such specialty and a recent study conducted in England indicated that remote evaluation of skin lesion images by experts worked as well as in-person examination and cut costs in half.  Patients also appeared satisfied by the process.  (JTT Article)

More research suggests the potential dangers of widespread screening for certain cancers, in this case prostate cancer.  Such screening often detects non-malignant or relatively harmless tumors that should probably be left alone.  The screening also has a number of false positives.  But once a screening test indicates a potential problem, more cost is incurred in further testing; cancers that could be left alone are treated, often with serious side effects such as incontinence or impotence and patients suffer significant anxiety.  The solution ultimately is better, more precise tests.   (Prostate Study)

Another telehealth article suggested that use of self-service kiosks in physician waiting rooms may have substantial benefits for doctors and patients.  The article describes the use of kiosks which allow patients to do blood pressure checks, answer basic questions on symptoms and health behaviors, weigh themselves and potentially check oxygen levels.  The kiosks save patients time otherwise used to wait for an in-person visit with a provider and often provide more accurate information.  They also allow for more efficient use of providers’ time.  (JTT Article)

The Wall Street Journal published a story suggesting that perhaps consumers have cut back on their use of medical services.  The story relied on statements about utilization from the earnings reports and conferences of a number of publicly-held health care companies.   (WSJ Story) The article attributes the cutback, if it exists, to consumers having to bear more of the cost of care, through higher deductibles, copays and coinsurance.  While the trend, if real, could help constrain insurance premium increases, it is unclear whether consumers make the best decisions when cutting back on care for cost reasons.  They may put off needed as well as discretionary care.

One final telehealth note; General Electric and Intel announced that they would form a joint venture to provide equipment and services for chronic disease management and particularly to focus on keeping these patients living independently.  (Intel Release) (NYTimes Story) The companies have each been interested in this market and had been working together.  They will now create a new 50/50 company to which each will contribute assets and cash.

Milliman is estimating that premium increases will average about 9% for HMO-type plans and about 11% for PPO plans in 2011.  One reason for the increases may be cost-shifting due to increased Medicare and Medicaid enrollment.  Another may be greater utilization by people who fear losing their jobs and health care coverage, as the economy continues to remain weak.  The changes in benefit plans forced by the recent health legislation and the mental health parity bill also undoubtedly play a role.  (Milliman Release)

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