2010 Potpourri XXIX

UnitedHealth Group is planning to acquire Executive Health Resources and add it to the lineup of Ingenix’ services.  Ingenix appears to be rapidly expanding its capabilities in the hospital marketplace, both in administrative and clinical areas.  EHR primarily assists hospitals in obtaining reimbursement from Medicare and Medicaid, by facilitating appropriate documentation to justify whatever is coded on the bill.  It also helps hospitals with commercial insurer claim denials, so you have to wonder how that will work out if a UHG plan is the denier.  The rumored price appears quite rich, particularly since CMS is very focused on upcoding and its basis or lack of basis in clinical reality.   (EHR Release)

The National Association of Chain Drug Stores released data on prescriptions filled.  Total prescription sales were about $269 billion in 2009, up 5.8% from 2008.  Total prescriptions were 3.61 billion, an increase of around 3% from 2008.  The average prescription price in 2009 was $76.94, compared to $72.87 in 2008.  Brand name prescriptions have an average cost 4 times greater than that of generics.  The average brand name prescription increased 9.6% in 2009 over 2008 but generics also rose at about the same rate.   Out of that average cost, the manufacturer receives about 80%, the wholesaler 3% and the retailer 17%.   (NACDS Data)

The Harris Poll regularly looks at Americans’ use of online health resources.  In the latest poll results, 175 million people say they have looked for health information via the internet and 32% say they do so often.  This is up from 154 million people and 22% last year.   Almost all these users are satisfied with the information they find.  Over half discuss the information with their doctors and about half look for information after having a discussion with their physician.   It is clear that the internet has become a very common method for people to gather data about health and health care.   (Harris Poll)

There is more conflict coming on workers’ compensation rates in California.  The Workers’ Compensation Insurance Rating Bureau will recommend a 30% increase in premiums for 2011.  A 20% plus increase had been proposed for 2010 but rejected by the California Insurance Commissioner because he believed the insurers could do more to control health care costs.  No reason to think there won’t be another fight along the same lines this year.  Whatever happens, there does appear to be upward pressure on health costs for workers’ comp insurers.  (Calif. WC)

The New York Times carries an article on the increasing use of monitoring equipment that helps children keep track of their parents.  The equipment not only may track medication use and other health matters, but can include sensors to identify the parent’s movements around their living space.  While some parents resent the intrusions and the implications that they are unable to care for themselves, others appreciate the communication capability and the security of knowing that someone may be aware if they do have a problem.  Studies show that older people accept the use of such technology if they have control over who sees the information and how it is used.  Some research suggests that the people with access to the information often don’t look at it frequently, which may limit the benefits.   (NY Times Story)

In the world of telemedicine, there is real time patient/provider or provider/provider interaction and there is asynchronous or store and forward interaction, in which information, including video, may be captured and forwarded to a provider for review and action.  A study looked at the use of store and forward technology to assess the psychological state of patients.  Primary care providers videotaped a structured interview with the patients and sent it to a consulting psychiatrist.  The psychiatrists were able to make good diagnoses and recommend treatment actions.  Satisfaction was high, timeliness was higher than in-person interaction would be and there were likely cost-savings.  (Science Daily Story)

Another psychiatric use of telemedicine was examined in research on rural collaborative telemedicine care for depression.  Patients at several Veterans Administration clinics were the subjects of the study.  While the intervention was as effective at treating depression as usual care, it was relatively expensive and had a QALY cost of over $100,000.   (Archives Psych. Abstract)