2011 Potpourri XXI

The NCCI gave its annual presentation on the status of the workers’ comp industry.  Premiums were basically flat from 2009 to 2010, declining to $33.8 billion, which is slower than declines for the previous few years.  Workers comp is now only 1.6% of an employer’s total compensation costs.  Overall results for insurers are worsening, as reserves shrink and premiums are projected to decline this year in most states.  Lost time claim frequency was up, but overall claim costs down, and severity declined somewhat.  Medical costs continue to rise and become more of the total payouts.   (NCCI Presentation)

The year 2000 provided a lot of opportunity for health IT vendors to make money revising software and consulting on the changeover.  The coding switch from ICD-9 to ICD-10 looks like an even better opportunity.  The International Classification of Diseases new version will go into effect in the United States on October 1, 2013.  The will be 69,000 diagnostic codes, up from 14,000 and 72,000 procedure codes, up from 3,800.  Any chance, given the AMA’s lobbying muscle, that the ICD procedure codes will replace CPTs?  Many providers and payers are worried they won’t be ready on time and are concerned about the costs, estimates of which range from about $3 billion to $30 billion.  AHIP believes health plans will spend $2-3 billion alone.  The MGMA thinks a three doctor practice will spend about $83,000, a ten doctor group $285,000 and a 100 physician group $2.7 million.  Hospitals may spend $10-20 million each.  Retrospective research will be harder, with the disjoint in data sets.   (Health Affairs Article)

The Government Accounting Office looked into strategies used to reduce hospital emergency department use, dealing with a complex subject that has frustrated many of the health care industry’s brightest minds in just 16 pages, some of which were filler.  To be sure, they did single space the report.  I think the GAO probably gets tired of Congresspeople asking it to do stupid investigations, which this was.  In any event, GAO found that hospitals were seeking to reduce ED use by educating patients about appropriate use of ERs, so they don’t go in the first place; by having better care coordination for frequent ED users, so they have less need to go to the ER and by increasing availability of non-ER services, such as having more evening and weekend hours.  (GAO Report)

A case in the United States District Court has ruled on whether an employer’s premium surcharge for employees who fail to participate in health risk assessments and biometric screenings violates the ADA.  The surcharge was $20 every two weeks.  The court said the wellness components were clearly part of a benefit plan and were a part of risk classification and administration.  The case is particularly notable because the judge ruled on summary judgment, which means the court did not believe the suit could be won on any interpretation of the claims and evidence before the court.   (Seth Case)

Thomson Reuters has an index of consumer healthcare sentiment, which we have reported on before.  The latest reading, from April, shows a decline from 98 to 95, which is the lowest on record.  Consumers said they had the greatest difficulty in the history of the index in paying for health care in the last three months, and they have the greatest expectation that they will have difficulty paying for it in the next three months.  A greater percentage of respondents said they lost or had a reduction in health care coverage and more than ever before said they therefore had delayed or cancelled health care treatment or not filled prescriptions.   (TR Survey)

A New England Journal of Medicine Perspective discusses pragmatic trials, which in contrast to randomized trials attempt to mimic real world clinical environments, to better have a sense of how a treatment will work in everyday practice.  Pragmatic trials are a form of comparative effectiveness research.  They tend to have broad eligibility criteria, mimicking the real world population that may get the treatments and there is no blinding of assignment arms.  While there are drawbacks to these trials, including the need for large samples and potential large loss of patients in the course of the trial, they provide valuable information not found in randomized trials, which often deal with a highly selected population and whose results sometimes mislead on potential adverse events or benefits associated with a treatment.   (NEJM Perspective)