2012 Potpourri II

One concern about the increasing use of information technology in health care is whether it might raise new or expanded malpractice liability concerns.  A commentary in Health Affairs suggests that in regard to clinical decision support, such concerns may be legitimate, but could be minimized.  Clinical decision support systems have been criticized by providers for creating alert fatigue that limits utility, but the vendors fear their own exposure if they limit alerts.  The authors suggest a middle ground but also recognize that legislation may be needed to protect both vendors and physicians relying on the systems.   (HA Article)

An article in the Journal of the American Medical Association discusses perceptions of intensive care unit workers about the appropriateness of care they provide.  The units surveyed were in Europe and Israel.  About 1650 staff were surveyed and about 25% of nurses and 32% of doctors reported at least one instance of what they thought was inappropriate care, including too much care for the patient and doing things for a patient when other patients would benefit more from application of resources.  Greater perception of inappropriate care was associated with factors indicating poor teamwork.   (JAMA Article)

Off-label drug use obviously benefits drug manufacturers and may at times benefit patients, but government health care programs have been concerned about improper marketing that may inappropriately raise health costs.  The feds have used false claim prosecutions to try to discourage the practice.  One example discussed in health affairs relates to neurontin, which was the subject of a $430 million settlement with its maker in 2004.  The authors found that up until the settlement, the prosecution of the case had no effect on off-label prescribing rates.  This drug actually had higher rates of off-label use than on-label, which continued up to settlement of the complaint, and got to as much as five times more off-lable use.  Even after the public, including physicians, knew about the prosecution of the manufacturer, very heavy off-label prescribing continued.  After settlement, all uses of the drug declined, including on-label ones.  The authors suggest that something more than initiation of a case is needed to prevent inappropriate off-label use, since that alone does not appear to deter doctors from such uses.  (HA Article)

The Congressional Budget Office looked at the effect of raising the Medicare (and Social Security) eligibility age.  The Medicare eligibility age is currently 65 and raising it just to 67 would save about $148 billion in the next ten years and would reduce spending 5% by 2035.  In addition, people would probably work longer, raising economic output and government tax revenue.  Life expectancy has increased dramatically since Social Security and even Medicare were enacted.  What should really happen is that the eligibility age for both programs should be reset to adjust for the increase in life expectancy and should be automatically adjusted in the future for such increases.  That would mean at least a 7 or 8 year increase in eligibility age, which depending on over what period of time it was implemented, would be enough of a change to fully restore the programs to long-term health.     (CBO Report)

The National Association of Health Underwriters weighed in on the adequacy of benefits in employer-based health insurance.  The reform law calls for mandated benefit levels to be set by the federal government and the Institute of Medicine has urged that affordability be a major concern.  Mandated benefits and providers have caused a significant portion of the rise in insurance premiums over the last two or three decades.  The NAHU conducted surveys of more than 11oo of its members in regard to the benefits in both large and small group plans.  The survey revealed that almost all plans, large and small group, already cover most basic care, including prescriptions, maternity care, organ transplants, rehab and hospice care.    (NAHU Release)

Liberty Mutual released its latest index of activities leading to workplace injuries and workers’ compensation claims.  The causes are amazingly basic things and the top five activities led to 72% of total costs related to workplace injuries.  Number one was overexertion, which includes lifting, pushing, carrying, etc. and cost about $13 billion in 2009.  Number two and three are falls, either on the same level or to a lower level, costing about $13 billion in total.  The fourth leading cause was bodily reaction, which means tripping, slipping, bending, reaching, etc., which cost over $5 billion.  And the fifth category was struck by object.  Seems like it shouldn’t be that hard to make such common activities a little safer.   (Lib. Mut. Index)