The Whole System Demonstrator is a program started by the Department of Health in Britain and designed to look at use of telemonitoring equipment to improve care and lessen costs for certain chronic disease patients. It was structured as a randomized control trial, covering 238 physician practices and almost 6200 patients. Early findings for patients with at least 12 months of data were released and they indicate that there were significant utilization reductions, including around 15% fewer hospital days, and about 8% lower costs. This was accompanied by a 45% reduction in mortality. Full analysis will be published later. (UK Report)
SureScripts runs the nation’s largest network for sending prescriptions from physicians to pharmacies and conducting other pharmacy-related health information exchange. According to the company, research has indicated that when a eprescription is written, patients actually pick up the prescription 76.5% of the time, as opposed to only about 70% when paper, phone and fax is used. About one-third of all prescriptions are now electronic and over 70% of physicians are eprescribers. It is unclear why the traditional method has a lower fill rate, but either way the loss of revenue to manufacturers is staggering and this could represent a significant quality issue. (WSJ Blog Post)
Imaging is expensive. Do the results actually make a difference in either patient/provider decision-making or outcomes? An article in the Archives of Internal Medicine suggests that they have only a minor effect on decision-making and no effect on outcomes. Low back pain is a large area of expense and one for which imaging often appears to be overused. This study targeted the use of MRI for this diagnosis. All patients got MRIs but in one group the physician was blinded to the results. The physicians who looked at the MRI were slightly more likely to recommend a particular treatment, but the ultimate outcomes between the two groups were no different. (Archives Article)
Health information technology is often put forward as the solution to many health care problems and one aspect of it is use by consumers to improve awareness and management of health. A report from the National Academies of Science describes issues relating to use of such technologies in the home, particularly for disease management and related purposes. (NAP Report) The report intends to be a guide listing factors for designers of HIT to be used in the home to consider when making products. Given that many of the users have serious diseases and often some level of cognitive deficit, designers need to take that into consideration. As providers and payers rely more on telemonitoring and self-management, the data provided must be credible and accurate, and easy to take action on.
The Medicare Payment Advisory Commission gave its somewhat high-level analysis of how to fix the SGR formula for physician reimbursement. In a letter to Congress, the Commission said the formula should be junked (let’s be real, the formula was dropped several years ago when Congress started overriding it every time there was supposed to be a reduction) and replaced with a ten-year schedule of fixed updates for the physician fee schedule. In essence there would not be a formula, just set fee schedules for the next decade. The proposed fee schedule would shrink actual fees, although less than the current scheduled reduction, but overall physician spending in Medicare would double over the period due to more beneficiaries and more per beneficiary service use. (MedPAC)
And now for something very obtruse, a study reported in Science magazine examines the effects of the structure of a social network on changing health behaviors, in this case weight management. In this case the authors experimentally manipulated network composition on the internet to see if a network of similar individuals had more impact on health behavior than did a more heterogenous one. There was much greater adoption and awareness of a particular diet in the network of similar people, up to three times as much. This increased adoption applied both to obese and non-obese members of the network. The results provide important guidance for those seeking to improve patient engagement and indicate that especially for unhealthy people, the composition of their social network can very significantly affect healthy behavior change. (Science Article)