2011 Potpourri XXI

A heart failure program at a health system in Duluth has successfully used remote monitoring to greatly reduce readmissions and improve the quality of life for patients.  The program employs a scale which records patient weight, asks questions and transmits the information to a cardiac nurse, who then tracks and adjusts treatment on a daily basis.  The system claims the program has reduced 6 month readmission rates to around 5%, compared to a national average of 40-50%.  The system also said that a study with Blue Cross of Minnesota found $1.25 million in savings for just 29 patients in a six month period.   (Telehealth Article)

Jackson Healthcare issued results of a survey of over 1500 physicians regarding sources of income.  The survey looked at fixed compensation, such as salary, that does not vary with productivity, and variable pay that was depended on bonuses, incentives, profits from ownership.  About 35% of doctors said their pay was from fixed sources only.  Twelve percent said they had some variable compensation based on productivity and 8% reported variable pay from practice ownership.  Eighty-two percent reported no compensation based on number of prescriptions, lab tests, imaging, hospital admissions or facility fees.  (Jackson Survey)

The Medical Group Management Association has a survey available for purchase on starting salaries for physicians.  According to a release about the survey, first year compensation for specialty doctors is higher in multi-specialty than in single-specialty practices, at $258,677 versus $240,596.  Primary care physicians see the opposite, with compensation at $165,000 in multi-specialty groups and $172,400 in single-specialty ones.  Primary care physicians tended to have similar first-year compensation across the country.  Specialists saw more variation, with higher payments in the South and West and lower in the Midwest and East.   (MGMA Release)

A report from Milliman discusses benefit designs for expensive diseases.    The report was commissioned by Genentech, a biotech company which has some very costly therapeutic products.  It looks at what happens when a benefit plan has very high coinsurance or copays with no or a very high total out-of-pocket limit.  About 19% of covered employees are in plans with no out-of-pocket limit.  Looking at 8 conditions which can be high cost, the report finds that about 1% of a plan’s members will have such conditions and most will incur annual expenses of more than $20,000, which could lead to cost-sharing of thousands of dollars.  Truly catastrophic cases, with more than $100,000 in annual health spending, can be financially burdensome if there is uncapped cost-sharing.  (Milliman Report)

The American College of Emergency Physicians conducted a survey of over 1750 physicians.  They found that almost every one had patients who had been referred to the emergency room by a primary care doctor on a daily basis.  The great majority also had seen Medicaid patients daily who could not get an appointment with a physician.  Respondents identified fear of lawsuits as the single biggest obstacle to cutting ER costs and 53% said such fears were the primary reason for the number of tests run on a patient.  Most believe health reform will increase use of the ER.   (ACEP Survey)

The American Association of PPOs released a survey of consumer-directed health plans.  The organization estimates that CDHP enrollment rose from 23 million people in 2009 to 28 million in 2010.  Seventeen percent of all employers offered such a plan in 2010, up from 15% in 2009.  Large and very large employers, who account for much of the actual employee count, had much higher rates, with 27% of large employers offering a CDHP and 54% of very large employers.  More employers indicate they are very likely to offer such plans in the future.  More employers also offer a health savings account with the CDHP than a health reimbursement account.   (AAPPO Survey)