Christmas Potpourri

Researchers at the University of California Davis examined the impact of EHR implementation across six outpatient sites of a large primary care network affiliated with an academic medical center.  The authors found that implementation of the system resulted in a 25-33% reduction in physician productivity in the first months.  Over time, some departments, such as internal medicine, adjusted and saw a return to prior productivity.  Other specialties, such as pediatricians and family practice, continued to experience slightly lower productivity.  The researchers suggested that different needs of different specialties should be taken into account and separate systems may be needed for each.    (UC Release)

HHS released its rule on how states should review health insurance rates–the same health insurance rates that are going up because of the ill-advised reform law giving HHS the power to release these rules.  For 2011, rate increases above 10% will have to be disclosed and justified.  After 2011, threshholds will be set by state.  How absurd is it that a reform effort that was justified in part by saying it was going to lower insurance rates is now basically acknowledging that rate increases of at least 10% should be expected and are okay.  That rate of increase is a killer–it is a multiple of either inflation or GDP growth.  Meanwhile, absolutely nothing is being done about the real primary cause of these rate increases–provider pricing power.  The Administration apparently has no shame, because this whole exercise in “reform” is a disgrace and they won’t acknowledge the problems being created.   (HHS Rule)

We are an equal opportunity basher, we even go after non-profits, or at least their executives, which may not be in the holiday spirit.  We just mentioned that providers are the real source of health spending increases, especially hospitals.  And what are they doing with all this money–giving a lot of it to management.  What for-profit companies do is largely their  and their shareholders business.  What not-for-profits do is the public’s concern.   And at least in Washington state, the public should be outraged.  Multiple millions of dollars in compensation for executives; perks like country club dues, paying for spouse travel, paying for cars or even housing.  This is inexcusable in light of resulting health insurance increases and loss of coverage and should be strictly limited.   Reducing this compensation to much more reasonable levels across the country would save tens of billions a year.   (Radio Transcript)

An article in Health Affairs suggests that physicians using electronic prescribing that is integrated into an electronic medical record got more benefits and were more satisfied than those using stand-alone systems.  These doctors are also more likely to qualify for meaningful use incentives.  Those using an integrated system more often checked the patient’s formulary and drug history when using the system, which likely improves quality and reduces administrative hassle.  (Health Affairs Article)

Continuing our holiday theme of dumping on the likely innocent, researchers examined what happened to enrollment in Oregon’s state-run health plan when premiums and cost-sharing were raised sharply.  As might be expected, enrollment dropped dramatically–by over 77%.  The researchers expressed concern that policymakers may not have understood what a terrible impact the changes had on the enrollees’ lives.  While some did find private insurance, many did not, and self-reported failure to obtain care for cost reasons also rose substantially.  We understand the issue, can’t help but think, though, that maybe the researchers should have noted that the reason for the changes was out-of-control costs placing an unsustainable burden on the state’s taxpayers.  Oregon already has some of the highest taxes in the country and can’t attract business or jobs, resulting in one of the highest unemployment rates in the country.  Policymakers are beginning to catch on that there simply isn’t some magical pot of money for every need that people may feel needs to be filled.   (HA Article)

Finally, on a cheerier note, researchers have noted that  even when people know that they are being given a placebo, they show improvement.  The researchers gave patients with irritable bowel syndrome a placebo and told them that is what they were doing and compared results with patients who got no treatment at all.  The researchers did tell the patients that the placebo pills had been shown in studies to produce mind-body self-healing processes.  And the patients on placebo reported doing better than those with no treatment.  So if something is bothering you, including headaches caused by all the distressing health care news, take a placebo and tell yourself everything will be better and it will be!  Better yet, have some Christmas spirits to augment your Christmas spirit.  (Placebo Article)

Ho, Ho, Ho; Merry Christmas!