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2012 Potpourri XVII

By May 11, 2012Commentary

Yet another report on regional variation in health spending, this one from the Center for Healthcare Research and Transformation, looking at variation in interventional cardiac care in Michigan.  The use of the two main procedures, PCI and CABG, declined from 1997 to 2008, but regional variation increased from a 1.8 times difference to a 2.4 times in that period.  About 40% of PCI procedures could be considered elective, and the regions with the highest use of PCI generally did more elective procedures.  Higher rates appeared associated with more cardiac cath labs, but not with more physicians doing those procedures.  Health status and behavior did not seem to be related to the variation.  (CHRT Report)

Shared decision-making, a method of involving patients in their care, sometimes is promoted as potentially reducing health spending.  Whether it does or not, it seems like the right thing to do, but physicians are often not trained in the technique and patients are often unaware of the importance of asserting their values and preferences and asking for all relevant information.  A study in the journal Health Affairs is based on focus group work with 48 patients, so has limited statistical validity, but finds that even well-educated, well-off patients are often fearful of being assertive; that most patients feel a need to defer to physicians, who often seem authoritarian and the patients are concerned they may be classified as difficult if they are too assertive.   (HA Article)

Health care research of all types is extremely important to provide solid, credible information to guide payers, policymakers, providers and patients.  Research that examines the validity or or issues with various types of research or research techniques is doubly important to help ensure that research results are credible.  A Viewpoint in the Journal of the American Medical Association examines response rates in survey-based research.  The authors discuss the need for a standardized method of calculating response rates, that the response rate has generally declined in recent years and that identifying potential differences between responders and non-responders may be more important than the actual nonresponse rate.    (JAMA Viewpoint)

Disease management programs continue to struggle to prove their value.  Most recently a study in the Journal of Managed Care Pharmacy reports on a diabetes management program instituted by Blue Cross Blue Shield of Rhode Island in which patients got lower drug copays if they participated in a program that included care coordination, regular testing and personalized support.  These patients did not, however, end up with any more recommended care than non-study participants, their drug costs were slightly higher and their overall medical costs about the same.  One of the issues here is that the care for most patients may be so good already that it is hard for a program to show a difference.   (JMCP)

And finally, yet one more article about hospital costs contributing to rising health spending.  Kaiser Health News carries a story about CMS’ effort to identify high-cost hospitals, encourage them to change and ultimately probably penalize them.  CMS is looking both at how hospitals’ costs for basically identical patients vary and also whether a hospital can show better cost control over time.  As expected, CMS’ analysis shows wide variance across regions, but also between hospitals that are relatively close to each other, sometimes as much as 50% more for the same case and care.  CMS has tried to carefully adjust the data, but some hospitals will undoubtedly complain about that.  While some of the differences are regional–every hospital in Las Vegas is high cost–some seem more due to poor management or even market power at a particular hospital.   (KFF Article)

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