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2011 Potpourri IX

By February 25, 2011Commentary

A study reported in the Annals of Internal Medicine reports on the link between volume of cases of congestive heart failure and performance on various process of care and quality outcomes.  As might be expected, the hospitals with higher volumes have better outcomes on both process of care and quality, but also have higher costs.  It is unclear to what extent smaller hospitals don’t have the resources to pay close attention to reporting on some of the measures.  In regard to cost, the higher volume hospitals are likely in urban areas and probably have more intensive practice styles.  It would be nice to think that higher quality lowers overall costs, but that might depend on other market factors.   (Annals Article)

Research published in the Journal of the American Medical Association looks at interventions to improve health professionals’ adherence to better quality care initiatives.   The trial was specifically aimed at increasing six ICU practices associated with better quality outcomes.  The intervention was a video conference-based educational process and use of algorithms.  There was a clear improvement in adherence to the desired practices, particularly those that had low adherence to begin with.    (JAMA Article)

A Perspective in the New England Journal of Medicine discusses the need for an individual mandate to create healthy insurance markets.   The author also discusses the need for subsidies to induce healthy individuals to participate rather than pay the penalty.  The underlying premise of this whole discussion, however, is flawed.  The assumption is that we have to subsidize people to get into the market so they in turn can subsidize people with high health spending.  As long as people are insulated from the consequences of their health behaviors, they have no incentive to stay healthy and lower their spending and people who do engage in healthy behaviors are unfairly penalized by paying more to support those who are irresponsible.  Only people whose high health spending is caused by factors beyond their control, such as genetic disease, should be entitled to a subsidy.  Otherwise people should understand that poor health behaviors will mean they pay more.  (NEJM Perspective)

Research in Health Affairs examined starting pay for physicians in New York State, finding that male physicians were being paid about $16,000 more than female ones.  Although a gender-based pay gap has been noted in the past, the usual explanation has been more women choosing lower-paid primary care positions or choosing to work fewer hours.  The new research finds the pay difference even after adjusting for these factors.  The authors don’t believe that discrimination is at work, but some unexplained difference in practice characteristics.  The salary data were self-reported; it could just be that men have an ego need to assign themselves higher salaries than they actually received.   (Health Affairs Article)

It hasn’t been good lately for proponents of the health reform law.  Public opinion is still not strongly in favor of it, some courts have found it unconstitutional, health insurance premiums have continued to rise rapidly, the opposite of what proponents predicted, and now the head of the Congressional Budget Office acknowledges that in the long run the law will reduce employment by 800,000.  And to top it off, HHS says it will require college-sponsored health plans for students to meet all the requirements of other insurance coverage under the law.  It seems these people are determined to make health insurance very expensive for everyone.  College students are generally very healthy, and exactly the kind of population that a more limited, tailored, cheap coverage would be perfect for.  Politically, however, it will be impossible to change this terrible piece of legislation unless the Supreme Court upholds the unconstitutionality ruling or we have change after the 2012 elections.

Finally, the General Accounting Office noted in a report that HHS has created inconsistencies in some of the its requirements related to electronic medical record use.  (GAO Report) The department had an electronic prescribing incentive program in place and then added the EHR incentive program, which includes e-prescribing as a functionality for meaningful use.  GAO notes that the e-prescribing incentive program did not certify systems, whereas the EHR one does, leaving physicians with potential uncertainty about whether they will be eligible under both programs.  GAO also found that there were duplicate reporting requirements, which are obviously burdensome.  Interestingly, only 8% of physicians qualified for e-prescribing incentives in 2009.

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