2011 Potpourri XXII

The ehealth Initiative has released a report that details the health information exchanges currently in existence and attempts to analyze factors influencing sustainability.  A release describing the report says there are 234 active health information exchanges but only a small number are operational and sustainable.  A critical problem for HIEs is generating revenue and the report says fee models are needed, with subscription and transactional charges.  Sustainability is apparently enhanced by offering services that support meaningful use and value-added services, such as a lite EHR or quality reporting.  Offering administrative services such as claims processing or referral transactions apparently doesn’t help sustainability.   (eHealth Release)

Government mandates tend to grate on most of us, but some can have a clear effect on public health.  Smoking bans in public places or indoor facilities now have a respectable line of research indicating that they reduce health services utilization and cost.  Most recently a study suggested that a workplace smoking ban in Ireland had reduced emergency room admissions.  The ban was put in place in 2004 and data from two years after the ban compared to two years before suggests that there was a significant reduction in emergency admissions for cardiopulmonary reasons, as well as for asthma.  The reduction was most significant among 20-29 year-olds.   (Irish Smoking Ban)

A Perspective in the New England Journal of Medicine by prominent health economist Victor Fuchs addresses why our system does not spread cost-effective care methods more quickly.  Fuchs notes that there is a subset of providers that deliver care of equal or better quality at 20% less cost.  If the whole system performed this way, the savings would be $640 billion a year.  Fuchs then identifies reasons that each constituent of the system may oppose this uniform cost-effective way of delivering medical care, primarily financial reasons.  It should be noted that it is unrealistic to think that we will ever get to this vision, but if we got even a small way closer, the savings would be significant.   (NEJM Perspective)

The Congressional Budget Office reports on likely effects of a ban of direct-to-consumer advertising of drugs.  Drug companies spend an enormous amount of money on marketing and a lot of that goes to DTC channels, $4.7 billion in 2008, a fourth of all promotional spending, which probably increases utilization.  The CBO said a moratorium on DTC in the first two years after a drug’s introduction might reduce demand for some drugs, would shift promotional spending to other channels and would likely have a limited effect on prices.  It said there also could be an effect on public health because individuals might be unaware of a potentially beneficial drug, but it is up to physicians to identify and recommend potential therapies.  Eliminating DTC would likely reduce drug companies’ overall costs, which might lower prices and would certainly make doctors’ lives easier.   (CBO Report)

A report from the Agency for Healthcare Research & Quality finds that older drugs for Type 2 diabetes work as well as new ones and have fewer side effects.  The report updates an earlier study and focuses on specific comparisons of medications.  Because most of the overall drugs are available as generics, they have a significantly lower cost to patients and payers.  In addition, fewer side effects likely reduces overall health care spending.  This is the kind of finding that needs to be widely broadcast to physicians and enforced by payers, with protection from patient suits for following the findings.  (AHRQ Report)

The Journal of the American Medical Association published research results on the link between the primary care physician resources in an area and Medicare beneficiaries’ health outcomes.  The number of primary care physician FTEs per 100,000 beneficiaries has a wide geographic variation.  Areas with the highest FTEs had 5% lower mortality, 9% fewer ambulatory care sensitive condition hospital admissions, but on percent more total Medicare spending, but this association was not stepwise.   Proponents of the cost-saving benefits of primary care should note that it appears that more primary care actually increases overall spending, as higher physician costs outweigh lower hospital spending.   (JAMA Article)