2012 Potpourri IV

The Government Accounting Office did a review of the work that the National Quality Forum is doing for Health and Human Services.  NQF is the primary source and developer of various quality and other performance measures that HHS is using in pay-for-reporting and pay-for-performance programs.  GAO found that NQF is often slow, which may not be totally its fault, but this slowness inhibits HHS in having the full set of measures it needs for various deadlines for its programs, such as the value-based purchasing initiative.  In addition to delays, there have also been significant cost overruns.  Welcome to government-run health care.   (GAO Report)

An article in the Journal of the American Medical Informatics Association reports on a systematic review of the use of web tools for diabetes management by providers and patients.  The authors looked at 57 studies, which included randomized trials as well as observational research.  They found inconsistent and at best moderate effects on either psychological or clinical outcomes.  Few of the studied web tools met criteria for effectiveness, usefulness, sustainability or usability.  The authors suggest the need for great improvement in web tool design, particularly to ensure that patients and providers actually use and continue to use the tools.   (JAMIA Article)

Healthways and Gallup released their latest index which purports to track the health and well-being of Americans.  Covering December, the index for the first time in four years did not show a holiday dip and found that Americans were feeling less stressed and less sad.  The healthy behavior index had a slight drop with an increase in smokers and less exercise.  The work environment index stayed very low, and in fact the last 10 months of that index are the lowest since the survey’s start.  In addition, the basic access index found that the lowest percent on record said they had enough money to buy food at all times during the month.  Welcome to Obamaland.     (Well-being Index)

A Congressional Budget Office Presentation gives yet another of its many warnings about what is going to happen if we don’t get government health care spending under control.  We are already running huge deficits that we can’t seem to reduce, running our total debt up to almost 100% of GDP.  If we don’t get especially health care spending down, that will rise to almost 200% by 2035, at which point debt service alone would be killing us.  Unless steps are taken, federal health care spending will be over 10% of GDP by then, and the states would be swamped.   These programs must simply be substantially cut back, reducing eligibility for Medicaid, raising the eligibility age for Medicare and ensuring that only people who can’t afford health care get any benefits from government programs.  (CBO Presentation)

The American Hospital Association is doing its job for its members, issuing a release warning of horrible employment consequences if reimbursement cuts for hospitals go ahead as planned.  The trade group claims that 278,000 jobs will be lost.  Currently hospitals employ 5.4 million persons, having added 89,000 jobs in 2011.  The lost jobs reflect both employment in hospitals and a ripple effect as laid off people purchase less, etc.  This is very phony accounting.  Hospital inefficiency and cost increases have been sucking the life out of other economic sectors for decades.  If they finally had to get efficient, whatever jobs they lost would more than be made up in other industries who were paying less for health care, in taxes and were less crowded out for debt capital by governments borrowing money to pay health bills.  (AHA Release)

An article in the Annals of Internal Medicine suggests that doctors need to take a lead role in identifying appropriate use of screening and diagnostic tests, which are one of the drivers of increasing medical spending.  The article is based on work by a group of practicing physicians who were asked to identify commonly overused tests, resulting in a list of 37 tests.   General principles recommended for physicians included not doing tests if the results won’t change how the patient’s care is managed; not doing tests when the probability of disease is low, since false positives are very likely in that scenario; and the need to take into account all the downstream costs which occur because the test was performed.  (Annals Article)