2011 Potpourri XXVI

MetLife, through its Mature Market Institute, conducts research on aspects of health and aging.  A new report looks at the effect of informal caregiving.  About a quarter of adult children currently provide personal care or financial assistance to parents.  The study estimated that spending time on this caregiving costs these caregivers a total of around $3 trillion in lost wages, lost social security benefits and lost pensions.  The data was drawn from about 1100 respondents in the government’s Health and Retirement Study, so its quality may be questioned, but probably is directionally accurate.  In addition to financial costs, these informal caregivers report significant stress and poorer health themselves.   (MetLife Study)

The Commonwealth Fund issued a report on the state of California’s effort to establish a health insurance exchange and what lessons that may hold for other states.  California is often a “leader” on issues, but what it leads to is often disaster, witness its recent budget travails.  California set up its health insurance exchange to be an active purchaser and took steps to avoid adverse selection, by requiring insurers to sell all their products on the exchanges.  The exchange will actually be run as a state agency, which should ensure lots of bureaucracy and political interference.  On the plus side, it will have the authority to negotiate with and even exclude insurers, which should maximize competition.   (Commonwealth Report)

The Medical Group Management Association gave out some information from its most recent annual survey of trends in physician compensation, reflecting changes from 2009 to 2010.  Radiologists, while earning a healthy median of $471,253, saw a 1.58% decrease in their compensation; while internal medicine doctors earned “only” $205,379 but had an increase of 4.21%.  Gastroenterologists and anesthesiologists also had decrease in compensation; while psychiatrists, dermatologists, neurologists and general surgeons had increases.  Doctors in the south had the highest median pay while those in the east had the lowest.   (MGMA Release)

HIMSS and McKesson conducted a survey of 175 individuals working in provider settings, mostly hospitals, on their access to and use of data on clinical performance.  About half of the organizations are working on getting a comprehensive EHR in place.  The great majority, however, currently rely on manual chart review to get data for performance measures.  A variety of analytic tools are used, but typically are not integrated with the EHR or other systems.  Most feel their organization is committed to quality improvement, but lacks staff resources or good data collection and analysis tools.  Most organizations are using the data and tools not just for quality improvement but to help control costs and increase revenues.   (HIMSS Survey)

America’s Health Insurance Plans, a health plan trade group, released a study on hospital concentration and its likely effects on prices.  This is part of AHIP’s broader assault on the possibility, indeed, the likelihood, that the accountable care organization rules will likely result in hospitals having even more market power.  The analysis finds that in almost every major metropolitan area the hospital market is highly concentrated and has grown more so in the last ten years.  In 2009, the HHI, a measure of concentration used by antitrust enforcement agencies, was an average of 4700, when 2500 is considered highly concentrated.  We have seen repeatedly in recent research that hospital unit price increases are the single largest factor in health spending growth.  Think there might be a relationship?   (AHIP Study)

A study in the Journal of Aging & Health looked at the effect of adopting a comprehensive HIT system in a nursing home on residents’ outcomes and satisfaction.  Ten nursing homes and over 750 residents in the New York City greater metropolitan area were examined.  While health care overall is slow to use IT, nursing homes have been even slower, probably because of the costs in an industry with very low margins.  Only about half the residents were aware of the HIT introduction; those who were thought it improved care and there was no overall negative impact on resident satisfaction.  Outcomes also appeared unchanged, although more disruptive resident behavior was observed in facilities with the new HIT system.  The study took the perspective that using a comprehensive HIT system did not seem to make things worse; given all the hype, what is disturbing is that it didn’t seem to make things better.   (HIT Article)

A study in the Journal Telemedicine and eHealth looks at what makes teens with chronic illness start using and keep using health information websites.  Getting teens to visit a website was difficult but once they did, they were more likely to continue using it.  Sites that were oriented toward teens, had frequent updates and were easy to use were more likely to see repeat visits.  Teens who did not use the internet for health said they didn’t have time, didn’t have an interest, didn’t perceive any medical need or didn’t have easy internet access.  Neither health literacy nor demographics was associated with the level of use of health websites.   (Tel. & eHealth Article)