2012 Potpourri V

A study in Health Affairs looked at diabetes interventions that were modeled on the Diabetes Prevention Program, which was a clinical trial aimed at seeing if structured lifestyle interventions could help reduce development of diabetes in at-risk patients.  Since the trial, a number of these interventions have been adopted in real-life settings by various organizations.  Across all these interventions, patients achieved clinically significant weight loss, which they maintained through a follow-up period.  Some of these intervention programs used lay staff, which lowers the cost of the intervention significantly, without losing the good outcomes.   (HA Article)

A study conducted by the Centre for Market and Public Organisation in England examined the effects of hospital mergers in that country.  Because many hospitals in the country were deemed to be poor performers, between 1997 and 2006 almost half the short-term general hospitals were involved in a merger.  The authors analyzed a wide variety of performance measures and found that there appeared to be no gain in quality and no cost savings, other than some small drop in overall activity.  They suggest that mergers may not be the best way to help poorly performing hospitals.   (CMPO Paper)

A report from the Mercom Capital Group looks at health care information technology funding and mergers and acquisitions activity in 2011.   Due of course in large part to government largess, which typically gets handed out without regard to merit or outcomes, the health information sector has boomed.  Consequently there was a great deal of venture investing, almost half a billion dollars, double the amount for 2010.  Similarly, mergers and acquisition activity was high, with 104 transactions worth about $6 billion, up from $4 billion in 85 deals in 2010. Expectations are that 2012 will continue the trend.   (Mercom Report)

An article in the Archives of Internal Medicine attempts to identify and quantify actual examples of the supposed tremendous amount of overuse of health services in the United States.  The authors did an extensive survey to try to find research which specifically identified overuse.  They found 172 studies; 53 on therapeutic procedures, 38 on diagnostic tests and 81 on medications, but only a relative handful of services and diagnostics were studied, for example, 59 studies were on antibiotic use for upper respiratory infections.  In total, the existing evidence for overuse does not amount to even a small portion of annual health care spending.  Overuse may exist, but it is hard to stop it if we can’t even identify where it exists.  Again, the evidence really shows that unit prices are much more of an issue than utilization.   (Archives Article)

The Medical Group Management Association conducts regular surveys of its members on various issues.  A recently released report explores what makes a better performing organization in regard to profitability and cost management; productivity, capacity and staffing; accounts receivable and collections and patient satisfaction.  The best performers are able to have excellent financial performance while also having strong patient satisfaction scores.  The best groups focus on avoiding bad debt, collecting copays at time of service and using non-physician professionals widely in the practice; while frequently collecting and using the data from patient satisfaction surveys to improve operations.   (MGMA Release)

Another article in Health Affairs examines the effect of Medicare Advantage Special Needs Plans on diabetes patients and their care.  The patients enrolled in these plans, especially the non-white ones, had lower rates of hospitalization and readmissions than their peers in fee-for-service Medicare.  At the same time, these enrollees had higher rates of physician office visits.  Although a formal cost analysis was not completed, the research strongly suggests that these plans create a net saving.  What is very clear once again is that patients in Medicare Advantage plans get better care and have better outcomes than those left floundering in the fee-for-service system.    (HA Article)