2010 Potpourri XL

The Agency for HealthCare Quality and Research does a lot of really good work, including reviewing various health care treatments.  A recent review looked at the use of complementary and alternative therapies, such as acupuncture and spine manipulation to treat back and neck pain.  These are frequent complaints, and prior research has suggested that in many cases, just waiting for the condition to resolve itself is best.  In general, the review found some modest short-term benefit from some alternative therapies, but those benefits quickly faded.  The overall state of the research is insufficient to suggest benefit from encouraging use of these therapies, which may be less expensive than traditional medical care, but may not be helping patients.   (AHRQ Review)

The head of the Congressional Budget Office gave a presentation on likely effects of the health reform law.  He suggested that some goals of the law would be met and others may not.  For example, the expansion of coverage goals will likely be achieved.  He was very dubious, however, that “unnecessary” spending would be curbed.  He also seemed to share the Office of the Actuary’s doubts that the proposed Medicare cuts can be sustained.  (CBO Presentation)

The Annals of Internal Medicine carries research on use of reciprocal peer interactions to help management diabetes.  The study compared this method with nurse care management.  Patients in the peer arm were paired up to help each other with diabetes issues, primarily through phone communication.  The patients in the peer support arm achieved better blood glucose control levels than those in the nurse-led care management group.  Obviously this method uses fewer professional health resources and should cost less.  An approach worthy of consideration for a number of chronic conditions.   (Annals Article)

The Centers for Disease Control is projecting a massive increase in diabetes prevalence in the United States, linked to the growth in obesity.  While diabetes isn’t the most expensive chronic disease, it does have substantial costs associated with the core disease and with complications and comorbidities.  CDC believes that as many as one in three Americans could have the disease by 2050, if nothing changes in current trends.  An aging, overweight population is the primary driver.   (CDC Release)

We are always nostalgic for Massachusetts and search eagerly for any new developments.  The Massachusetts Medical Society has obliged us by issuing a report on the physician workforce in the state in the wake of reform.  Alas, all continues to not be well in the fair Commonwealth.  The shortage of physicians in a number of specialties is rated severe or critical, including two primary care areas–family practice and internal medicine.  Hospitals and medical groups are having increasing difficulty recruiting new physicians and physicians are more dissatisfied with their jobs.  A majority of primary care doctors are not accepting new patients.   (MMS Study)

The National Committee for Quality Assurance has released draft criteria for Accountable Care Organization accreditation.  The criteria are available for public comment and are quite extensive.  The criteria are grouped into seven key areas:  program structure operations; access and availability; primary care; care management; care coordination and transitions; patient rights and responsibilities and performance reporting.  NCQA criteria for organizations have a way of becoming in essence mandatory.  It is expensive to meet and maintain accreditation and that expense isn’t going to lower health care costs.   (NCQA ACO Criteria)

An article in the Annals of Internal Medicine discusses some inherent problems with clinical trials.  The author finds that there is a persistent bias toward finding a favorable outcome and describes some specific examples of approaches that tend to lead to this bias and how researchers can help to avoid it.  This is very important work as policymakers and almost everyone involved in health care seek solid research-based information to guide decision-making.   (Annals Study)

The New England Journal of Medicine carries a brief commentary on the effect of the health law on employment-based health insurance coverage.  The authors are from Rand and using its model they find that more people will actually be covered by health insurance at the workplace, primarily because the individual penalties will cause employees to demand coverage and the exchanges will cause there to be less-expensive options for small employers.  This finding is contrary to what most experts expect and what most employers are saying.  The economic trade-off that makes more sense is for small firms, who don’t have a penalty, to drop coverage and pay what they were paying for insurance to employees as additional wages.   (NEJM Commentary)