2011 Potpourri XXV

The latest Harris Interactive poll surveyed 1270 young adults, aged 18-26, on their health care.  The poll was skewed with female respondents.  Two-thirds have a regular place of care; for 62% of those it is a family physician and they get care at the doctor’s office.  Only 7% report being in poor or fair health.  Very high percentages utilize technical tools like online scheduling, e-mail with providers and e-prescribing.  Those who don’t have a regular doctor gave lack of health need and lack of insurance as the primary reason.  Almost 80%, however, said they do have a source of health coverage.   (Harris Poll)

The Congressional Budget Office once again takes a look at Medicare’s physician reimbursement conundrum.   The sustainable growth rate reductions which would have been implemented have been put off by Congress for almost a decade, resulting in a cumulative 30% cut needed for next year to put spending at the target.  Congress has played a variety of games to keep its actions from being reflected in CBO’s estimates of future years’ budget deficits.  The current brief looks at options to deal with the SGR, almost all of which result in very substantial additional spending.  The reality is that the options with the lower spending are not politically feasible.  The whole point of the SGR was to encourage physician control of inappropriate medical care delivery and stopping its implementation, with nothing to replace it, was foolish.  Our already huge deficits will be much worse than projected because it is extremely unlikely that any Congress will let the SGR reduction go forward.   (CBO Brief)

An article in the New England Journal of Medicine discusses access to specialty care for children covered by Medicaid or CHIPS programs.  More bad news for reform proponents.  There are access issues, which can only be expected to get worse as Medicaid expands and payments to physicians go down compared to what either Medicare or private plans pay.  The authors called 273 specialty clinics in Chicago, once for a privately insured patient and once for a Medicaid/CHIPS covered child.  An astounding 66% of the Medicaid/CHIPS calls were denied an appointment, compared to only 11% for private insurance.  The wait time when the Medicaid/CHIPS child did get an appointment was an average of 22 days longer than for a privately-covered child.  Other evidence suggests this is not a problem limited to Chicago.   (NEJM Article)

A paper to be presented at the Institute for Operations Research and the Management Sciences discusses patients’ online ratings of physicians.  Concerns have been expressed by physician groups that patients will tend to only rate negative experiences and by consumer groups that only more positive experiences will be reported.  The researchers found that patients were more likely to discuss doctors they had good views of and less likely to post about lower quality physicians.  The posters were also more likely to exaggerate than were people doing ratings offline.   (INFORMS Release)

Alas, poor Massachusetts health reform, we knew it all too well!  On the heels of the research showing that ER use has not been reduced by Massachusetts’ expansion of coverage, a new report from the Division of Health Care Finance and Policy reveals that health spending, particularly by private insurers, continues to rise faster than economic growth in the state and on a faster pace than in most of the rest of the country.  From 2008-2009, private payer spending per covered person rose 10.3%, while from 2007-2008 (the latest years available) for Medicare the rate was 4.8% and for Medicaid 2.8%.   The vast majority of the increase in per person spending was driven by price increases, not utilization growth.  For private insurers, inpatient grew 10.3%; hospital outpatient 13.2%, physician services 11.8% and drugs only 5.1%.  The rates were lower for Medicare and Medicaid, which dictate prices.  Cost-shifting is likely going on, as well as exercise of market-power by providers.  Whatever the cause, the Massachusetts reform has totally failed to help private insurers be able to control spending increases and has probably exacerbated the problem.  Don’t expect the federal result to be any different.   (Mass. Report)

Research published in the Journal of the American Medical Association looks at malpractice claims in various settings.  The authors profiled claims paid for alleged physician errors from 2005 to 2009.  Major injury and death were the two most common bases for the claims.  The claims were almost evenly split between inpatient and outpatient settings, with a trend toward more outpatient claims.  The largest source of claims was diagnostic procedures for outpatient settings and surgery for inpatient ones.  The mean payment for inpatient claims was substantially higher than for outpatient ones.   (JAMA Article)