2011 Potpourri XXIX

An article in the journal Cancer reports on research finding that hospitals in Wisconsin who purchased robotic surgery equipment had over twice the rate of prostate cancer surgery as those hospitals that did not.  Robotic surgery in general has not been shown to have better health outcomes, in some cases it has worse, and it costs much more than non-robotic surgery or than alternatives other than surgery as a treatment for prostate cancer.  Patients may also be a greater risk in such surgeries.  But they make money for doctors and hospitals.  So much for informed patient preference.  Health plans and other payers, especially Medicare, really need to push back on this trend.   (Cancer Article)

The American Action Forum released a report claiming that if Medicare’s Part D drug coverage required drug manufacturers to provide rebates equivalent to those in the Medicaid program, out-fo-pocket costs in the form of premiums would actually increase for Part D enrollees.  Today, Part D is a completely managed care program and relies on the plans to maximize rebates so that they can lower their price to enrollees.  This appears to have worked fairly well.  A mandated rebate would make it harder for plans to get additional rebates and might lead to higher nominal prices by drug companies to all purchasers, since the rebates are typically based on selling prices.  According to the report, seniors might see a 20-40% increase in their premiums, but the analysis looks a little theoretical, as opposed to based on real-life experience.   (Rebate Report)

The Food & Drug Administration issued a draft guidance on when device manufacturers need to submit a 510(k) application for modifications to an existing approved device.  The two primary criteria are whether the change might significantly affect the device’s safety or effectiveness and whether there is a major change in the intended use of a device.  Changes could include manufacturing process changes, label changes, technology or performance specification changes or material changes.  To make a decision about whether submission of a new 510(k) is needed, the manufacturer must compare the modified device to the most recent cleared version of that device.  Comparisons to other devices cannot be used.  All changes must be considered as a whole, not evaluated singly.  The Agency advises paying particular attention to labeling changes and to patient/user interfaces.   (FDA Guidance)

The HHS Office of Inspector General issued a preliminary report regarding state programs to provide incentives for use of EHR’s for Medicaid patients, in particular the integrity plans to ensure that providers were entitled to payments that they claimed.   Reviewing 13 state programs, OIG found that many states were only checking a few elements of eligibility and that even those states that were checking requirements often lacked the data to do so effectively.  Over the next eight years about $13.4 billion will be spent on Medicaid EHR incentives, so this is not a trivial issue.  No state is checking all eligibility requirements, and in some cases they aren’t checking basic things like actual adoption of an EHR or provider Medicaid volume.  The opportunity for fraud and abuse seems pretty apparent.   (OIG Report)

The ability of patients to understand health information is an important topic.  One issue is how to communicate to patients the risks and benefits of particular treatments when there are clinical trial results that are important to consider.  Results could be given as a percent, a natural frequency or in another format.  Currently experts believe using a natural frequency is the easiest for people to understand, but research reported in the Annals of Internal Medicine suggests this is incorrect.  The study used information about the risks and benefits of certain drugs in an online trial with a large number of participants.  They reviewed the data in various formats and then were tested for comprehension.  Using percents led to the highest comprehension.  The alarming result was that under any method, about a third of the patients had limited understanding of the data.   (Annals Article)

Research reported in Health Affairs indicates that Medicaid patients seen at federally qualified health centers use less hospital services than do those seen by private providers.  After adjustment for certain demographic variables, rates of emergency room use, inpatient hospitalization, hospital readmissions within 90 days and preventable hospital admissions were all better for patients whose usual care was a FQHC as opposed to a private provider, although on an unadjusted basis the rates were all higher.  It should be noted that the study was limited to Colorado, and has no case mix or health status adjustment, which is a significant flaw.  Also, by law FHQCs are actually paid more than private payers under Medicaid, so it is not clear that there are net savings.   (HA Article)