2012 Potpourri VII

An article in Journal of Medical Internet Research describes use of a virtual coach to encourage exercise in overweight  adults.  Over 60 adults were randomized to the intervention or a control group.  All participants wore a pedometer that tracked steps and sent the information wirelessly to a database.  The intervention group used a virtual coach which monitored their progress and individualized messages to encourage them to keep up their activity and exercise levels.  Although the trial size is small and the outcomes were not significant by some measures, it appeared that the virtual coach group kept up a higher level of activity.  Virtual coaching is a relatively inexpensive method to encourage wellness.    (Coaching Article)

A study reported in Benefits magazine looked at the effect of integrating pharmacy and medical benefits.  The study was conducted among members of Independence Blue Cross.  The study compared people with pharmacy benefits managed by an external PBM with those whose drug benefit was managed by the plan along with medical benefits.  Over three years the average saving on medical costs for those with an integrated plan was almost $20 a person a month, or $240 a year.  Most of these savings were in outpatient costs, but integrated plan members also had fewer hospital admissions and ER visits.  In addition there appeared to be greater adherence to prescriptions.   (Drug Benefit Article)

Malpractice liability’s effects on medical costs are controversial, with a wide-range of estimates.  The biggest bucket is not the liability expense itself, but is likely the changes in medical practice to try and avoid liability exposure.  An article in the American Journal of Orthopedics looks at orthopedic surgeons reactions to potential liability.  Orthopedics is one of the areas with very high malpractice premiums.  In a survey in which about 1200 surgeons responded to web-based questions, almost all said they had at some time ordered imaging, lab tests, referrals or hospital admissions mainly to avoid potential lawsuits.  About 24% of ordered tests were for defensive medicines.  The authors estimated that among orthopedic surgeons alone, about $2 billion in unnecessary spending a year occurred due to malpractice fears.    (Malpractice Article)

Medicaid costs are killing the states and the federal reform law is only making it worse.  The states are desperate to get this spending under control and Washington state has decided it will stop paying for ER visits that are unnecessary.  Medicaid recipients are heavy abusers of ERs, whether through ignorance, lack of access to other care sites or just because they think they can do it.  Providers aren’t happy because it puts pressure on them to tell patients to go elsewhere when they don’t have a real emergency and that may create liability issues for the ERs.  But ERs have only themselves to blame as anywhere you go in the country you seem them advertising ER wait times and encouraging patients to come in, partly because the hospitals and other ER vendors are getting well paid.     (Medicaid Article)

A column in the Wall Street Journal discusses how physicians handle their own end-of-life care.  They tend to use less intensive care and be more likely to focus on the quality of their remaining life than to engage in heroic but usually futile efforts.  This is probably because they are realistic about what the likelihood of the benefits of intensive care is.  Other research has shown that doctors tend to pull their punches with patients who are likely terminal, but it appears physicians should be willing to share with patients what the doctor would do if he or she was in the patient’s shoes.   (WSJ Column)