2011 Potpourri III

The Annals of Internal Medicine has a study on the use of messaging to improve cancer screening rates.  The study randomized over 1100 patients to an intervention of single electronic message indicating they were overdue for a colon cancer screening.  The rate of screening was higher in the intervention group after one month than in the control group, but dropped to the same rate after four months.  The results would indicate that for text or email messaging to be effective, it may have to be repeated frequently.  Interestingly, half the patients didn’t even view the message, even though it came from their primary care physician.   (AIM Article)

Walmart strikes again.  The inventor of the $4 generic has brought more low-price services to health care.  Partnering with US Preventive Medicine, the company’s Sam’s Club division will offer a $99 package of heath assessment, blood test and coaching to help people identify health issues and achieve greater wellness.  For Walmart’s clientele, this is certainly a good deal.  As long as the provider community doesn’t get regulators too stirred up, firms like Walmart will come up with innovations that make health care cheaper while maintaining or even improving quality.  If federal policymakers had any sense they would use Medicare and Medicaid dollars to encourage these developments.  (USPM Release)

Benefit advisory firm Buck Consultants, a unit of ACS which is a unit of Xerox, released its fourth annual survey on wellness covering 1200 organizations in 47 countries.  The survey indicates that most US employers have a wellness strategy but less than half of those firms measure results.  The companies that do measure ROI self-reported reductions in cost trend of 2-5%.  Improving productivity is the top US wellness goal, in other countries it is reducing workplace stress.   Only 11% of employers spend more than $500 on wellness in the US, and technology tools are the fastest growing area.   (Buck Survey)

From the US Press you might think Americans are the least satisfied people in the world with their health system, but citizens of other countries have a lot of concerns as well.  A recent report on the views of Canadians in regard to their universal health care system reflects this.   Canadians have difficulty accessing care, particularly at other than regular working hours, so much so that they are the highest users of emergency room services in the developed world.  They also perceive that they waste a lot of time waiting for services.  And although they have universal coverage with very modest cost-sharing, a number of Canadians report that cost, particularly for some drugs, prevented them from getting some care recommended for them.   (Canadian Survey)

In one of a series of recent articles on Medicare’s problems in ensuring it is only paying for appropriate services; the Wall Street Journal on its own was able to identify some apparently very abusive providers.  We love to beat a dead horse and we have made this point repeatedly.  CMS is hindered by politically driven interference from doing physician and other provider profiling; profiling which would clearly identify physicians practicing outside of any reasonable norms.  CMS should be mandated to profile every physician’s practice against peers and against objective standards of care and should hold outliers to account.  That is where a lot of money could be saved and it is what every major private health plan already does.   (WSJ Article)

CBO has issued a preliminary analysis of the effects of a repeal of the “reform” law.  (CBO Analysis) According to that analysis, repeal would increase the deficit by $230 billion over the next ten years.  No point in rehashing the same issues (although see dead horses above), but the reform law was only projected to reduce the deficit in the first place because of a mismatch over the next ten years between taxes becoming effective much faster than the coverage expansions and because CBO uses a much more optimistic assumption about the medical cost reducing effects of the legislation than does CMS’ Office of the Actuary, for example.  We have already seen the real world effects of parts of this bill in what has happened to private insurance rates.  It is simply ludicrous to ever have believed that it was going to reduce the deficit.  But it is all moot, since a full repeal isn’t going to happen any time soon.