2010 Potpourri XLIV

Video games are not only fun, they are good for your health!  Okay, lets don’t get too carried away, but a study in the American Journal of Preventive Medicine does find, in a randomized trial, albeit small, that having children play a video game designed to improve knowledge of and lifestyle modification in regard to diabetes, had a positive effect on fruit and vegetable consumption, but not on exercise (too busy playing those games) or body composition. (Gaming Study)

High-deductible plans, especially if not accompanied by a health savings account, can significantly increase patient out-of-pocket costs.  A study in the Archives of Internal Medicine found that surveyed low-income HDHP members were more likely than higher-income families to report cost-related delayed or foregone care.  These patients were, however, just as likely to understand their plans and to seek information on the plan or health care.  Employers might consider ensuring that low-income employees have a funded health savings account or eliminating cost-sharing on truly beneficial care items.   (Archives Study)

CMS issued a press release discussing the results of several pay-for-quality demonstrations.  The demonstrations included hospitals, large physician practices and small ones.  All ten of the large practices in the demonstration met at least 29 of 32 measures, which focus on diabetes, heart failure, coronary disease and cancer.  CMS was less clear on how many of the small practices were eligible for payments but a number did qualify.  Interestingly only 26% of the practices used EHRs to report their performance. Similarly, it is not clear how many of the hospitals participating met the threshholds for payments, but 212 did get them.  (CMS Release)

As noted in another item above, concern is often expressed about whether the spread of high deductible health plans would limit access to beneficial care.  One method of limiting any potential harm is to exempt clearly needed and cost-effective services from the deductible.  Researchers examined the effect of high deductible coverage on well-child visits in a study published in the American Journal of Managed Care.  Looking at a large New England health plan to compare children who switched to high deductible coverage to those who did not, the results showed no difference at all in receipt of well-child visits.   While the deductible did not apply to the visit, there was a copay.   (AJMC Study)

Another article in the American Journal of Managed Care compared results on HEDIS measures for Medicare Advantage plans versus fee-for-service Medicare.  The study found that Medicare Advantage plans had much better performance on 8 of 11 measures, performance was the same on one and slightly worse on two.  The three measures on which performance was not better were newer, which suggests that it may take plans a while to either improve performance or measure compliance better.  In any event, it is clear that Medicare Advantage plans do a much better job than does traditional Medicare at ensuring compliance with these supposed good practices, which presumably means better health outcomes as well.  And yet the current administration seems determined to undermine the Medicare Advantage program, largely on what appear to be ideological grounds.   (AJMC Article)