2011 Potpourri XXXVII

Some better news for pay-for-performance programs is found in an American Journal of Medical Quality article.  The impact of a pay-for-performance program on the quality of care and outcomes for cardiovascular patients was examined using commercial plan data from 1999-2006.  Patients treated by physicians participating in the program were more likely to have appropriate lipid monitoring and lipid control treatment than patients treated by non-participants and those patients receiving better quality care were less likely to have coronary events, be hospitalized or have uncontrolled lipid levels.   (AJMQ Article)

An article in the journal Medical Care examines physician work intensity across various medical specialties, including family physicians, general internists, neurologists and surgeons, all located in Kansas, Kentucky, Maryland, Ohio and Virginia.   Using generalized work intensity survey instruments, the researchers concluded that, generally, work intensity seems to be similar across the specialties. Family physicians have the highest level of time intensity and surgeons of task engagement, which makes sense.  Overall the results seem to undercut a justification for higher payments to specialists.   (Medical Care Article)

One of the most controversial areas of the minimum loss ratio regulations was the potential effect on broker commissions.  A General Accounting Office report examined early possible effects of the MLR rule and one finding was that most insurers are concerned about the effect of commissions on MLR calculations and intend to reduce commissions to increase their MLR.  Other items contributing to business changes or concerns in regard to MLRs are the treatment of taxes and fees and of the costs of quality improvement programs.  Some insurers indicated that the new formula might affect where they decide to do business.   (GAO Report)

Another American Journal of Medical Quality article has bad news for EHR proponents.  The authors examined one potential benefit of such systems–the ability to more easily keep and share comprehensive records of health history and of treatments.  Comparing primary care practices which used an electronic medical record with those still using paper-based records, the researchers found no difference between the two groups in rates of health history documentation or of delivery of preventive service recording.  A practice can have an EMR, but if they don’t take advantage of its features, it isn’t going to provided the supposed benefits.   (Quality Article)

Another study published in the American Journal of Medical Quality looked at hospital readmissions, a very timely topic.  In fact the researchers were looking at how the timing of followup after discharge might affect 30 day readmission rates.  Looking at 1044 patients discharged to home from an academic medical center, they compared patients who had scheduled followup within 14 days with those who had such followup set for more than 14 days and those who had no followup scheduled.  There was no statistical difference among the groups, indicating that followup scheduling may not be as significant factor in readmission rates as has been suggested.   (AJMQ Article)

Another hot topic for hospitals is the avoidance of hospital acquired infections.  One particularly dangerous form of these is central-line associated blood stream infections, a preventable harm that has significant mortality outcomes and very high treatment costs.  A group of children’s hospitals has succeeded over five years in reducing their rates of these infections, saving an estimated $100 million and 355 lives.  The basic intervention that appears to have caused the reductions is just a very simple better daily maintenance of the line to reduce bacteria.   (Infection Release)