2011 Potpourri XXXXV

In yet another consultant survey of employers, Mercer contacted about 900 employers earlier this year to find out about their benefit plans and the impact of the reform law to date.  Many have seen an increase in covered individuals due to the requirement of extending coverage to older children.  Most employers expect that when the law kicks in fully in 2014 it will add to their costs, in many cases by 3% or more.  Only a small minority, about 8%, say they are actively considering terminating their health coverage.  Many employers are working to figure out how to avoid the excise tax, which overall is employers’ number one concern about the reform law.  A large minority of employers are also looking at a defined contribution approach.   (Mercer Survey)

Ah, the medical home, salvation for us all!  A study examined 21 primary care clinics in Minnesota which met the requirements to be a medical home and tracked their progress in improving quality and patient satisfaction.  Quality on process of care measures for several diseases improved by 2-7% a year and patient satisfaction by 1-3%, but this improvement in quality was no better than in non-medical home groups in the community, although patient satisfaction grew faster.  A medical home can be expensive to establish and operate, so it may not be the optimal method for improving quality.  There was no indication that costs, including the medical home costs, were lower.  As the authors said in regard to medical homes:  “Expectations for large and rapid change (in quality) are probably unrealistic.”    (AFM Article)

Another big concept, pay-for-performance, gets mixed reviews in a long-standing Medicare Physician Group Practice Demonstration.  In this, ten large, well-known multi-specialty groups participated for about 5 years in a project in which they were potentially paid more for improving quality and lowering costs.  As the author notes, the project took much longer than first thought to get underway and required revisions to keep the groups participating.  In general, the groups did well on the quality of care measures, although it is not clear how much more improvement, if any, they had than other physicians.  But the cost savings were harder to come by; only 5 of the groups met the rather modest threshhold savings of 2%.   There were patient attribution and data acquisition from CMS issues, which might be instructive for the ACO initiative.   (NEJM Perspective)

Benefit consultant Buck, now owned ultimately by Xerox, released results of a survey regarding consumers and health savings accounts.  The survey found that 77% of small employers believe that high deductible health plans coupled with health savings accounts are criical to controlling health costs.  Most account holders believe that the design allows them to have affordable health care.  People who have a health savings account say they are highly motivated to manage their health and 18% are engaging in healthier lifestyles, 18% using more preventive care and 28% look for lower cost drugs.  Both the companies that have these plans and the consumers using them seem fairly satisfied.   (Buck Survey)

It has long been alleged that for-profit hospitals minimize patient care to earn higher margins.  An article in the Annals of Family Medicine suggests that is unlikely to be true.  Looking at 850,000 hospitalizations the analysis compared for-profit, not-for-profit and government hospitals on a severity-adjusted basis for length-of-stay and morbidity for insured and uninsured patients.  On an adjusted basis, uninsured, or self-pay patients in for-profit hospitals had slightly lower lengths-of-stay compared to those with commercial insurance or Medicaid in non-profit hospitals.  While uninsured patients had a higher mortality risk than those with insurance, the difference between for-profit and not-for-profit hospitals was not significant.  Among other things, the results raise a question about whether patients with insurance are actually kept in the hospital too long.  (AFM Article)

Are physicians normal human beings who are influenced by their own financial well-being?  All the evidence certainly suggests so and a study reported in the Journal of the American Medical Association reinforces that notion.   (JAMA Article)   Treating heart disease is expensive and there are very costly diagnostic tests like nuclear stress and stress echocardiography.  The research examined whether physicians who billed for these tests were more likely to order them for their patients than were those doctors who did not do such billing.  In other words, if you made from money from ordering the tests were you more likely to order them.  The answer was a resounding yes.