2012 Potpourri XXXIII

An Agency for Healthcare Research and Quality innovations profile discusses use of in-home palliative care for end-of-life patients.  Kaiser Permanente developed the program which uses a team that includes health care professionals, a social worker and a chaplain.  Research has shown that patients generally have better quality of life at home and prefer palliative care to being in a hospital, but their are few resources or initiatives to ensure that patients can get adequate care at home at the end-of-life.  Patients have much higher satisfaction ratings and costs are significantly lower in these palliative care at home programs.   (AHRQ Report)

Express Scripts and other major PBMs often do research related to use of prescription drugs.  Express Scripts recently released findings from a study of drug use, showing that treatments for normal conditions of aging are accounting for more drug spending than treatment of chronic diseases.  These conditions, which include mental alertness, sexual dysfunction, menopause, hair loss and aging skin, are increasing in prevalence as the population ages and because current generations are less accepting of the changes that come with getting older.  The use of drugs for these conditions was up 18.5% and costs rose nearly 46% in the five-year period from 2006 to 2011.   (Express Scripts Release)

If we didn’t know it already, a Government Accounting Office report finds that self-referral to imaging facilities likely drives up use and spending.  Self-referral occurs when a referring provider has a financial interest in the imaging center to which the referral is made.  GAO looked at the relative trend in utilization and costs for self-referring and non-self-referring imaging.  It pains and shocks us to reveal that according to GAO, and very mystifyingly so, since we are constantly reassured that physicians are never motivated by economic considerations, there was greater growth in both utilization and spending in self-referred imaging than in non-self-referred.  We shall be depressed all weekend considering this rude blow.   (GAO Report)

Research published in the Journal of General Internal Medicine examines retail clinic utilization and how it affects use of primary care.  The study examined commercial insurance claims to ascertain whether patients who went to a retail clinic disrupted their use of primary care or continuity of care.  The researchers found that people who went to a retail clinic for a new condition were less likely to see a primary care physician for the condition and, by one measure, had less continuity of care.  Their receipt of preventive care and diabetes care, however, was no different from that of other patients.  While physicians may not like patients going to retail clinics first, this research suggests that retail clinics are doing a good job of lowering cost with no real quality effects.  (JGIM Article)

Researchers at the Loyola University Health System have reported finding significant flaws in how hospital readmission rates are calculated, at least in regard to spine patients.  According to these researchers 25% of readmissions had nothing to do with poor quality of care, such as infections, surgical complications or hardware failures.  Readmissions which don’t reflect on quality of care but are often included in a readmission rate include planned readmissions for a staged procedure, readmissions unrelated to the spine surgery and readmission following cancellation or postponement of the original surgery date, for example because while in the hospital the patient has an irregular heartbeat.     (Loyola Release)