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2010 Potpourri XLI

By November 13, 2010Commentary

UnitedHealth Group put out a paper on possible savings from extending best practice managed care approaches to the Medicaid and Medicare programs.  The underlying assumption has to be understood as the ability to fully apply those approaches to these populations with the same results currently obtained in the best of these managed care programs.  The first option was to provide coordinated care to all Medicaid-only beneficiaries, which would save $580 billion over 25 years; the second would use managed care for Medicaid/Medicare dual eligibles which would save $1.62 trillion over that time span and option three would provide more care management to traditional Medicare enrollees at a savings of $1.9 trillion over 25 years.  We will never get near those numbers, but any implementation of these techniques by these government programs would save the taxpayers a fair amount of money.   (UHG Report)

A Medical Group Management Association survey suggests that physician practices utilizing EHRs have a higher net revenue per physician than do those that are still relying on paper.  EHR practices averaged $350,000 per year and paper ones $300,000.  Both revenue and costs were higher for the EHR practices.  This was true for both independent practices and those owned by hospitals or systems.  There was no indication, however, that the results were adjusted for other characteristics of the practices which might account for the difference.   (MGMA Survey)

Another MGMA survey indicates that physicians won’t take kindly to allowing the Medicare SGR payment cuts to kick in.  This ongoing drama has seen several delays to implementation in recent years so that the current reimbursement reduction, if allowed to occur on December 1, 2010, would be over 30%.  The survey indicates that about 67% of practices would limit the number of new Medicare patients and 50% said they wouldn’t take any new patients.  Around 27% said they would stop seeing even existing Medicare patients.  The practices also would plan to take actions like reducing staff and equipment purchases.   (MGMA Survey)

A study from UCLA’s Center for Health Policy Research profiled characteristics of California’s health plan enrollees.  Most insured Californians are in some form of managed care plan, including Medicaid and Medicare beneficiaries.  A significant minority of enrollees are overweight or smoke and a number have had mental health issues.  Preventive care receipt is high.  The most notable finding was the increase in enrollment in high-deductible plans and its possible relationship to delays in accessing care.   Twelve percent of HMO and 23% of PPO members have deductibles over $1000.  About 15-20% of these people reported delays in care-seeking.   (UCLA Study)

The Congressional Budget Office looked at the likely effect of the reform law on prescription drug prices.  Drug pricing is very complex, full of parallel relationships and special rebates and discounts.  It is very hard to figure out the final net cost of a drug to a pharmacy or a patient.  The CBO anticipated that the overall effect of the law will be to raise prices paid by pharmacies about 1% for drugs covered by Part D of Medicare.  For Medicaid, new drugs will likely see an increase in cost for pharmacies of 4%, but drug stores probably will pay less for existing drugs.  Little change in pricing will be likely in the private insurance world.   (CBO Paper)

CareFirst, the Maryland Blues plan, announced that it will allow nurse practitioners to be independent primary care providers in its networks and will allow them to participate in its patient-centered medical home panels.  This is an important step, because creating additional, lower-cost competition for physicians is a significant way to lower overall health costs.  While physician organizations oppose these moves, there is no evidence to suggest that nurse practitioners provide worse quality care.   (CareFirst Announcement)

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