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2010 Potpourri XXXII

By September 4, 2010Commentary

Physician cost and quality profiling would seem to be an obvious strategy to address misuse of health care resources, so naturally physicians have been opposed to it.  There are some serious issues about how to attribute what cost and other outcomes to which doctors.  An article in Health Affairs discusses some possible methods, including whether individual physicians or groups should be the unit of analysis.  (Health Affairs Article) Group analysis generally is more “reliable” in that it has larger sample sizes which make the statistics more accurate.  But using a group may mask differences between physicians in the group.  What is clear is that some physicians use more resources than others in treating patients with the same characteristics.

Here is another idea to save some health care dollars–stop letting non-profit hospital and health plan CEOs and other managers get ridiculous salaries.  The Baltimore Sun reports on the CEOs of non-profit hospitals who are getting million dollar-plus salaries, very rich benefits and perks like yacht trips, country club memberships and, of course, the obligatory rich payoff when they retire or leave, whether they did a good job or got fired.  Lets see, say there are about 2000 non-profit hospitals in the country.  If you paid them just half a million each in total, you might save $2 billion a year.  That is not chump change and its just the savings from overpaid CEOs.  It doesn’t matter how hard the job is, you can’t justify paying non-profit managers that much.  (Baltimore Sun Article)

Yet another article looked at whether variations in health care spending are correlated with better outcomes.  This time the researchers looked at 122 hospitals’ performance on mortality rates for seven common diagnoses for the time period 2000 to 2004.    Costs generally increased for all the diagnoses and mortality fell in most.  But the cost per life year saved varied dramatically and there was not a clear relationship between increased cost and better mortality rates.   (Health Affairs Article)

In a great victory for consumers, California regulators have approved rates for individual policies from Anthem and Blue Shield that average 14% and 19% respectively and go as high as 20% and 29%.  I am sure the policyholders are relieved that these are reduced from even higher initial proposed rate increases.  This at a time when inflation is close to zero.  The reason is obvious–continuing rapid growth in health care pricing from hospitals, physicians and other providers and a worsening of the insured pool as healthier people drop coverage.  Expect many more great success stories as health reform continues to be implemented!  (LA Times Story)

Health Affairs carries an article analyzing possible effects of proposed reforms in how health care is paid for, including episode of care bundling and accountable care organization capitation.  The article explores the history of similar payment methods and identifies issues and opportunities within each.  This is a useful primer, which makes it clear that any change will not only be fraught with uncertainty, but be politically difficult.   (Health Affairs Article)

The opportunity for greater economic rewards and a shortage of physicians has led many graduates of international medical schools to work in the US.  Research examines comparative quality among non-US citizen graduates of foreign medical schools, US citizen graduates of such schools and graduates of US medical schools.  Based on admissions to Pennsylvania hospitals, non-US citizen graduates of international schools had lower mortality than US medical school graduates.  US citizens from foreign medical schools had the worst performance. (Health Affairs Article)

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