2011 Potpourri XXXXVIII

By December 16, 2011 Commentary

The NAIC recently asked HHS to exempt sales commissions from the MLR calculation.  HHS did not do that.  A Kaiser Foundation post finds great variation across states in how much of premium goes for individual or small group commissions.  Overall, broker commissions were 6% of individual premium, or $12 per covered person per month, and 5% or $15 per covered person per month in the small group market.  In the individual market, broker commissions were as low as 1% in Hawaii and Vermont and as high as 10% in South Carolina and Delaware.  For small group, the range was 1% in Alabama and North Dakota to 7% in Utah and California.  In some states insurers are much more likely to use direct sales, which accounts for much of the variation, since direct sales forces cost significantly less.   (KFF Post)

The focus on hospital readmissions and hospital-acquired conditions has greatly increased the importance of an obscure coding item called the present-on-admission indicator.  This is used to identify what diseases, conditions and issues a patient had at the time he or she arrived for a hospital stay.  An Agency for Healthcare Research and Quality report examines use of the indicator.  The indicator may also be used for risk-adjusted payments and other purposes.  As with other coding issues that have reimbursement effects, one can expect significant efforts by hospitals to “maximize” their position, which may mean there is a little too much enthusiasm for use of the POA indicator.  It also could be that the indicator raises costs by encouraging extensive testing and examination at the time of admission to ensure that all conditions are identified.   (AHRQ Report)

Many things can affect the outcome of a performance measurement program.  One of them is how patients are selected to be included.  A study in Medical Care finds that different methods of determining which patients are included in a measurement can have a substantial effect on the results.  The researchers looked at two different ways of assigning patients to be included in a Medicare measure regarding diabetes care.  Both methods are in common use.  Over 25% fewer patients were selected by one algorithm compared to the other.  The group with the fewer patients had as much as a 9% better performance on the diabetes measures.   (Medical Care Article)

The “nocebo” effect is an interesting corollary to the placebo effect in health care.  It occurs when patients actually have a negative expectation about a particular treatment and that expectation results in worse outcomes.  An article in Psychosomatic Medicine describes the effect and how it should be taken into account in routine medical practice.  A common example is describing potential negative effects of a particular treatment or procedure; when this is done, those adverse effects are more likely to occur.  Nocebo effects can lower quality of life and therapy adherence.  How information is presented can be important in minimizing the effect and obviously physicians and other providers need training in how to avoid undue likelihood of nocebo effect while still giving patients full disclosure.    (Psych. Med. Article) 

Another shocking health care statistic:  doctors too are only human and tend to do more unnecessary imaging when they own the equipment on which the imaging they order is done.  Hard to believe, we know, and next someone will tell us there is no Santa Claus.   The study looked at rates of unnecessary imaging when non-radiologist physicians had a financial interest in the imaging center and equipment to which they referred patients.  There were 86% more unnecessary scans when the ordering physician had a financial interest compared to when they didn’t.  (RSNA Release)

Medscape conducted a survey of physicians about their relationships with payers.  About 10,200 responded.  Asked to name the best payer they worked with, 29% said the Blues, 10% said Aetna and 9% said UHG.  Asked to name the worst, 14% said UHG, 10% said the Blues and 8% said Aetna.  Factors in how they regarded a payer included level of payment, 54%, and ease of doing business, 15%.  The fastest reimbursement was said to come from the Blues by 20% and from UHG or Aetna by 8%.  The most claims denials come from UHG and the Blues.  Eighty percent of doctors deal with 6 or more insurers.  The worst experience is in regard to denials and authorizations, followed by low reimbursement.  Many physicians have dropped at least one payer in the last year, with the Blues leading the way.   (Medscape Survey)

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