2011 Potpourri XXXV

The National Human Genome Research Institute has given $25 million to researchers in the Electronic Medical Records and Genomics network to test putting more patient genetic information in medical records.  The genetic information can then be used with other information about disease characteristics and symptoms to help guide diagnosis and treatment decisions.  The research network has already used such information to create new links between genetic variation and disease.  This work is an important step in trying to ensure that genomic information has real clinical utility.   (NHGRI Release)

Beth Israel Deaconess Medical Center is giving a one-page list of common medical services and tests with prices to each of its physicians.  Availability of the list appears to have increased the doctors’ sensitivity to the price ramifications of what they order for a patient.  When they understand what some services cost, and the minimal benefit they offer, physicians are more inclined to limit their ordering, which also saves patients money in an era when most of them are under substantial cost-sharing obligations.  (Price List Story)

The Journal American Health & Drug Benefits reports on a study of the benefits of using a community-based health information exchange to help treat emergency room patients.  The study was a matched cohort observational study of a group in which an HIE query was used to gather medical information about a patient versus a group in which it was not.  The study group had an average savings of $29 per visit, largely due to lower use of imaging procedures and other diagnostic tests.  The study shows that giving doctors the ability to access especially prior test results can avoid redundant tests and speed treatment by not having to wait for new test results.   (AHDBR Story)

An article by Robert Kaplan and Michael Porter, two noted business strategists, in the Harvard Business Review, posits possible solutions to the cost crisis in health care.  As they point out, a provider’s underlying costs are one prominent driver of pricing and very little has been done to systematically address lowering providers’ costs of providing services.  It is fairly well understood that hospitals and other health care providers in the United States are generally poorly managed.  The authors believe that helping hospitals to better capture the actual costs of delivering care to a patient and comparing those costs to outcomes could help to lower spending.  They are right, but good luck applying smart business principles to health care providers.   (HBR Article)

A study reported in the Journal of the American Medical Association addresses the problem of medication consistency when a patient is hospitalized.  Many of these patients are on regular medications and apparently when they go into the hospital their supply of and adherence to these prescriptions can be interrupted.  The research was conducted in Canada and examined the likelihood that a patient in the hospital, and a subset in the ICU, would fail to renew a chronic disease medication after discharge.  The study found that there was a significantly greater likelihood that a patient who had been hospitalized would fail to renew a prescription as compared to an unhospitalized control group, and an even greater risk that patients in the ICU would fail to renew.   (JAMA Article)

A New England Journal of Medicine Perspective discusses episode-based payments, one of the reimbursement methods being tested as a way to rein in health spending growth.  The notion sounds good, but requires that methods be developed to assign an episode of care, usually to multiple providers, and to assign items of care to the episode, and finally, to figure out how the providers will divide the payment.  Medicare has attempted episode of care payments before, and while they have shown promise, hospitals in particular have been reluctant to see them expanded.  The adequacy of software tools to create episodes and administer payments is uncertain as well.  The concept has promise, but needs work to see widespread use.   (NEJM Perspective)