2012 Potpourri XXIV

Merritt Hawkins does regular surveys of physician compensation and has released its 2012 review of recruiting incentives.  Family physicians and general internists were the most recruited physician specialties, followed by psychiatrists and general surgeons.  Demand for radiologists and anesthesiologists has dropped.  Hospital employment of physicians continues to rise rapidly, with salaries the most common compensation model.  Production bonuses, usually based on relative value units are common, but quality-based bonuses are being used more often.  Housing allowances are also increasing.   (MH Survey)

Everyone wants patients and providers to do more online, but having applications that are easy and intuitive to use is critical to that goal.  The journal Ergonomics carries research on making decision support  aids user-friendly.  Participants in the study engaged in diabetes self-management tasks with an anthropomorphic aid or without one.  The anthropomorphic aid (one with person-like characteristics) appeared to foster greater trust and dependence in both older and younger adults.  The anthropomorphic aid, however, did no better than a normal one in improving performance, although both did better than having no aid.   (Ergonomics Article)

The National Business Group on Health surveyed 1545 employees about health benefits.  About 79% of employees said good benefits were important to job satisfaction, up from 74% in 2007.  Health coverage is viewed as the most important benefit.  A good percent of employees were willing to have health benefits reduced to get a higher salary.  A slight majority prefer low premium costs to either reduced cost-sharing or less plan choice.  Almost all employees have little confidence in their ability to estimate how much their health care coverage costs the employer.  Over 60% are very satisfied with their health plan.  Most employees don’t think they could get as good health coverage on their own.  Most accept employers implementing wellness programs.  Strongly engaged employees are more satisfied with their health coverage.   (NBGH Survey)

An article in the Journal of General Internal Medicine explored patient decision-making in regard to coronary artery stenting or prostate cancer surgery.   The study surveyed Medicare beneficiaries about the decision-making process.  About 64% of prostate cancer patients said they were presented with options other than surgery, 33% said no treatment was discussed as an option, 95% said the reasons for surgery were discussed, 63% reported conversations about why not to do surgery, 76% said their doctor asked them what they wanted to do and 58% went on the internet for information.  For stenting the results were very different.  Only 10% said an alternative was discussed and only 19% said the doctor gave reasons why not to have the stent placed, only 16% were asked what they wanted and only 14% went to the internet for information.  Obviously a lot more needs to be done to involve patients and perhaps this should be a focus of the ubiquitous value-based purchasing programs.   (JGIM Article)

Genetics in Medicine reports on research regarding whether genetic testing increases health care use among patients 25 to 40 years old.  The test was a multiplex panel that indicated risk for eight common health problems.  In comparing a group of patients who had the test done with a group that did not, those who had the test used slightly more physician visits before testing but there was no significant difference in use of services after the test was performed.  This would indicate that fears that genetic testing could lead to a lot of follow-on services may be unfounded.   (Gene Test Article)

Finally, in relation to one of our favorite topics, a commentary in Health Affairs finds that many hospital systems have dominant market power that is leading to steep reimbursement increases in many areas, increases that inevitably raise the cost of health care coverage.  The authors conducted interviews in twelve communities.  Areas vary in whether they have dominant, “must have” health systems, and also whether they have dominant health plans that may be able to resist demands for excessive  price increases.  However, health plans negotiating leverage is often limited by employer demands for broad provider networks, to avoid employee discontent and dominant health systems often insist that they must be included in all of a health plan’s offerings.    (HA Article)