2011 Potpourri II

How well do physicians understand patients’ health values and beliefs?  Not very, according to a recent study in the Journal of General Internal Medicine.  The research compared patients’ beliefs with what physicians thought they heard the patients saying those beliefs were.  The physicians were off most of the time and tended to hear beliefs that were close to the physicians’ beliefs.   One thing that appears to help is having patients be more active in communicating with and making decisions with their physician.  (JGIM Article)

The federal Health & Human Services department has released its “Strategic Framework” for treating patients with multiple chronic conditions.  According to the document, about one fourth of Americans have multiple chronic conditions and they account for 66% of total health spending.  The Framework sets out HHS’ vision for how it, as a large research funder and health care payer, can lead the way in improving health care for these persons.  Priorities include identifying keyobjectives, payment reforms, use of IT, and maximizing use of self-care and self-management.  Ho-hum.  (HHS Info)

The New England Journal of Medicine carried an article regarding the use of collaborative care for patients with chronic diseases who are also depressed.   The study compared usual care versus a nurse-led team following care guidelines for 214 randomized patients at 14 primary care clinics.  The intervention group had significantly lower hemoglobin levels, cholesterol levels, blood pressure and depression scores, and had greater quality of life and satisfaction with care.  No information, however, was given on the cost of the intervention and the net savings, if any, although one would suspect that at least in the medium and long-run the program would reduce spending.   (NEJM Article)

The Office of Inspector General is widely feared by health care providers, for good reason.  It released its 2011 work plan, which sets out its priorities for the year.  As in past years, and as might be expected, most of the effort goes to where the money is, Medicare inpatient and outpatient services.  OIG will also look at some other key areas for CMS, such as quality reporting, hospital acquired conditions and hospital readmissions.  Diagnostic tests will get enhanced scrutiny, as will payments for DME and supplies.  Drug pricing has long been a focus for the OIG and with the demise of AWP, audits in that area will be stepped up, particularly in the Medicaid program.  (OIG Work Plan)

British-based private insurer and health company BUPA commissioned a survey by the London School of Economics on use of online health resources.  The survey covered 12,000 people in 12 countries.  It found significant use of the web for health information in every country.  Unfortunately it also found that misinformation abounds, which can have serious negative effects on readers, particularly since many respondents indicated that they use the internet to self-diagnose.  BUPA has prepared a guide for consumers to use in evaluating what they see online.   (BUPA Survey)

Medical tourism seems to have cooled as a health topic but a number of people are still going abroad for high cost conditions or treatments.   An article in the Journal of General Internal Medicine surveyed medical tourism companies and found that in 2008 about 13,500 patients traveled overseas for medical procedures.  The cost savings were significant and few quality issues were apparent.  (JGIM Article)