2011 Potpourri XXXXIII

The US Preventive Services Task Force has recommended against the use of prostate-specific antigen testing for prostate cancer.  The task force makes its recommendations based on a balance of benefits and harms and does not consider costs.  While in earlier decades, widespread screening for many conditions or diseases was recommended, increasingly research suggests that the number of false positives in particular end up causing significant patient harm through unnecessary followup testing and procedures and undue patient anxiety.  As many as 80% of positive results from this test are false, meaning there is no cancer and many of the true positives are for cancers which will never threaten the man’s health and are best left alone.    (USPTF Rec.)

Manhattan research periodically surveys the population regarding access to and use of health information.  Its recent Cybercitizen Health study estimates that about 56 million adult Americans have accessed their health information in an EHR and another 41 million would like to, but 140 million haven’t and aren’t interested in doing so.  Luddites!  The survey also found that about 26% of adults have used their mobile phone to access health information in the last year, which represents a doubling of the 2010 rate.  While searching for information is the most common health use, a growing number use the phone for specific tasks like medication refills.    (Manhattan Research Release)

An actuarial firm reports on medical costs for health plans.  The data, for 2010, was obtained from state insurance commissioner filings.  On a per member per month basis health costs rose about 8% annually from 2002 to 2008 but declined to a 4.9% increase in 2009 and 1.1% in 2010.  Insurers were spending about 86% of the premium dollar on medical costs in 2010.  The data may appear to conflict with recent reports on large premium rate increases, but those premiums are generally looking forward to 2011 and 2012 and most insurers are reporting an uptick in health utilization and costs.  It also needs to be remembered that these numbers only reflect what the insurers pay.  The actual medical trend is likely much higher because of continued cost-shifting to consumers in the form of larger deductibles and copays.    (Farah Release)

What to do about Medicare’s physician reimbursement system is a big, expensive issue.  The sustainable growth rate formula is widely viewed as dead, not really because it didn’t work but because of political pressure to override it.  So Congress is searching for an alternative, one that won’t be a huge budget buster.  The Medicare Payment Advisory Commission, in a letter to Congress, gives its recommendation, which is repeal of SGR and replacing it with a fixed ten year schedule of fee updates.  The total Medicare expenditures on physician fee-for-service claims would about double in ten years, but two-thirds of that growth would be related to increases in the number of beneficiaries.  Primary care physicians would be more protected than specialists under the recommendation and the Commission strongly encourages development of non-fee-for-service payment methods.  To pay for these changes MedPAC suggests cuts in other parts of the Medicare program.    (MedPAC Letter)

Some good news for the Medicare population is reflected in a Journal of the American Medical Association article which reports on heart failure hospitalizations and mortality from 1998 to 2008.  Heart failure is a frequently targeted condition in quality improvement programs, including CMS’ readmission efforts.  About 5.8 million Americans had heart failure in 2006 and it is estimated to cost over $40 billion in 2010.  The study found that the unadjusted rate of hospitalization had decreased from 2845 per 100,000 to 1957 and the adjusted rate from 2845 to 2007.  There was significant state variation in rates and in change in rates over the study period, with Oregon having the biggest decline.  The hospitalization rate was lowest in Vermont and highest in Wyoming.  There were only slight declines in either unadjusted or risk-adjusted mortality rates.    (JAMA Article)

Prescription medications often cost a lot but they also can reduce the use of other health services.  Adherence to prescriptions has become a central issue in improving care management and quality.  A new study based on over 400,000 prescriptions for patients covered by Caremark’s PBM found that about 24% of newly written prescriptions were never filled.  The advent of eprescribing facilitated the study.  Factors associated with non-filling included drugs that weren’t on the formulary, living in a low-income zip code and sending the prescription directly to the pharmacy as opposed to having the patient take it.  In addition, filling rate varied by drug, with hypertension and diabetes meds filled less often than antibiotics.  One potential missing piece is whether the prescription is generic and therefore might be fully paid for by the patient under his or her copay.  In these cases, the pharmacy often doesn’t file a claim with the PBM, so filling rates could actually be higher than this research suggests.   (Am. J. Med. Article)