2012 Potpourri XI

The Workers’ Compensation Research Institute issued a report on prices for medical treatment in workers’ compensation systems.  Over the last decade, medical care has become the largest part of workers’ comp payouts.  The report covers 25 large states over the last ten years and creates an index to help monitor trends in prices paid in each state and across states.  As might be expected, the report shows that states with fee schedules had lower prices and lower price growth.  States without fee schedules had prices as much as 25-50% higher than those with them, which adds a lot of cost to employers.  Even states with fee schedules saw faster growth in prices for services not covered by fee schedules.   The report strongly suggests that fee schedules are a valuable tool to keep workers’ comp medical costs under control.   (WCRI Study)

A study reported in the Journal of the American Medical Association finds that higher cost-sharing for asthma meds results in slightly less use of prescribed drugs and higher rates of hospitalization for children over 5 with the condition, but not for younger children.  The study involved about 8800 children over a ten year period.  Asthma medications can be expensive and cost-sharing on drugs has risen substantially, with general concerns about the impact on compliance.  The effect here is very small, but it is worrisome if higher cost-sharing does deter appropriate use of helpful medications.   (JAMA Article)

The New England Journal of Medicine carried a couple of perspectives on the Medicare Advantage program, which has been very popular among seniors.  One of the perspectives suggests that Medicare Advantage is too expensive and hasn’t demonstrated that is producing value, but the other one points out that it is the design of the program’s reimbursement that makes costs appear higher than fee-for-service Medicare; the actual bids by plans would usually provide lower costs.  Medicare Advantage has also shown better improvement in care quality than the fee-for-service program.  The right solution is to encourage everyone to use Medicare Advantage, force the plans to rely solely on competitive bidding to set the benchmark for payments and allow the private insurance market to work.   (NEJM Article)

The Journal of the American Medical Association has an article discussing how primary care physicians are trying to cope with the onslaught of various quality improvement programs.    The commentary suggests that as we have moved from a system where many primary care doctors practiced solo or in small groups to one in which large numbers of doctors work for hospitals or large groups, the focus on population-based quality improvement may have slighted patients’ care and little attention has been paid to patients’ experience of care as a result of these changes.  It is also uncertain that the new quality improvement programs are actually creating better outcomes, but they are creating more work for doctors and more expense.   (JAMA Article)

The New England Journal of Medicine has a commentary by well-regarded health economist Victor Fuchs on major trends in the health economy over the last 60 years.  The author notes the rise in health expenditures as a portion of GDP in this time period, fueled by medical technology and the growth of third-party payment.  He also notes changes in hospital use and in physician practice structure and work.  The rise of managed care crimped costs for a short period, before regulations emasculated its effectiveness.  While the author recognizes, along with almost every other economist, that growing health expenditures are responsible for wage stagnation and probably have a negative effect on GDP, he seems to have little hope that we will get our spending under control any time soon.   (NEJM Article)

A study reported in the Archives of Dermatology finds that use of live interactive teledermatology consults improves clinical outcomes.  The study looked at 1500 patients evaluated from 2003 to 2005, discovering that in the majority of cases, there was a change in diagnosis and in treatment management.  These changes resulted in clinical improvements for over two-thirds of the patients referred for the teledermatology consult.  This again demonstrates the value of telemedicine to bring high-quality resources to patient care, often at a lower cost.   (Archives Article)