2011 Potpourri XXXXIV

The “reform” law is such an easy target that people just keep taking shots at it.  One of the recent ones is a report prepared for America’s Health Insurance Plans by the actuarial firm of Oliver Wyman.  The report looked at the effect on premiums of the law’s insurance tax, which is levied on all fully-insured health plans to help pay for the cost of subsidies to individuals and the Medicaid expansion.  The tax obviously is going to get passed on to customers and the report says it will increase premiums by about 2% in 2014 and over 3% in 2023.  This likely will be paid by consumers, as employers just continue to shift premium cost to them.  It also may lead to more self-funding and have other unpleasant consequences.  (AHIP Report)

And here is another shot at the law, coming from the National Foundation of Independent Business.  It looked specifically at the effect of the health insurance premium tax on small business.  The report relies on work such as the Oliver Wyman report above in finding that the increased premium cost will be passed on to consumers.  Since small businesses cannot self-insure, they will bear the brunt of the tax.  This will likely lead to less hiring, and NFIB says it may reduce employment by up 250,000 jobs by 2021.  Who knows how accurate the model is, but it stands to reason that the more small businesses pay for health insurance, the more cost they pass on to employees, the fewer employees they hire and they even begun to stop providing health benefits at all.  (NFIB Report)

According to a survey from Wolters Kluwer Health, 88% of physicians feel a conflict between making money and being efficient and providing quality care.  About 40% of physicians believe the efficiency of health care hasn’t improved in the last two years and 37% think quality hasn’t increased.  Most doctors want more time with patients and over 90% believe that greater access to online medical information has improved care.  Many, however, believe that much more needs to be done in regard to tools to provide and analyse information.  Barriers to technology use include cost, too much unusable data, and difficulty in learning how to use tools, particularly at the point of care.   (WK Release)

Does collaborative care really improve outcomes?  That was addressed by a recent study reported in the Archives of Internal Medicine.  In a randomized prospective trial of patients with heart disease, a collaborative team approach was used for some of the patients.  Compliance with care guidelines improved 4.5% more among the intervention group patients and providers implemented almost 92% of care recommendations made by the team.  Nonetheless, there was no improvement in angina symptoms or in self-perceived health among these intervention patients.  Because many of the intervention group recommendations involved more use of drugs or testing, it seems unlikely that spending was reduced.   (Archives Article)

A recent study highlights the lack of good evidence underlying many medical treatments which are prevalent and often costly.  One possible treatment for stroke is extracranial-intracranial bypass surgery.  A randomized trial showed that this surgery provides no additional long-term benefit as compared to typical medical treatment, and obviously surgery has risks.  This surgery undoubtedly adds to overall spending and provides financial rewards to the physicians performing it, which likely explains why notwithstanding the lack of solid evidence for long-term benefit, it became widely performed.   (JAMA Article)

A study of a pay-for-performance program related to surgeries at a consortium of New York hospitals found that there was little difference in outcomes before and after implementation of the program, which the authors took as a positive, because the incentive program didn’t affect quality.  A number of outcomes for the eight types of surgeries were examined.  In some cases there were slight increases or decreases in complications or in mortality, but none of the variation was significant.  In addition, the case mix index was the same before and after the program, so cherrypicking of patients didn’t appear to be occurring.  What puzzles us is how this can be defined to be a success when quality didn’t improve, which is supposedly the whole point of pay-for-performance.  The authors appear to have this backward and the program should be deemed to be a failure.   (ACS Release)