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2012 Potpourri XXXV

By November 16, 2012Commentary

More research suggests that performance on various quality measures has little to do with hospital readmission rates, this time through a study published in the Journal of General Internal Medicine.  The researchers examined the relationship between Medicare  30 day readmission rates for heart failure, pneumonia and heart attack and performance on the CMS Hospital Compare measures.  The study found no meaningful difference in readmission rates among the best-performing and worst-performing hospitals on the quality measure and found that such performance explained only around 1% of the difference in readmission rates.  (JGIM Article)

A short Kaiser Family Foundation analysis looks at trends in deductibles for employment-based health insurance.  In general over the past decade there has been a continued growth of employee cost-sharing through both premium contributions and higher deductibles, coinsurance and copayments.  In 2006 only about half of employees had an annual deductible; in 2012 over 70% did.  In addition, the amount of the deductible has grown over time, from about $584 on average in 2006 to $1097 in 2012.  An increasing number of employees have annual deductibles of $2000 or more.  It used to be that small firms were more likely to have deductibles; that is no longer true, but the deductible tends to be larger at these companies.  (KFF Analysis)

An analysis from Mark Farrah Associates examines enrollment growth for health plans in the United States.  It finds that the big are getting bigger.  For the seven top health insurers, enrollment grew to 131.1 million in June 2012 from 129.4 million at the start of the year.   Growth was strongest in Medicare, and self-funded business also showed good increases, while the number of fully-insured members dropped.  UnitedHealth Group added 1.3 million members and Cigna added 1.136, largely from acquisitions.  Aetna lost 430,000 members and Wellpoint over 700,000.  Kaiser had slight membership losses, but is expanding its facilities in several states.  Margins were relatively stable to slightly declining.   (MFA Analysis)

The Altarum Institute conducts a regular analysis of health prices for America’s Health Insurance Plans.  In its latest release of this data, health care prices in August 2012 were 2.4% higher than in August 2011, continuing a trend of accelerating unit price growth.  Hospital prices rose 3.6% and prescription drugs 4.0%.  Since the beginning of the recession in December 2007, health care prices have increased by almost 12%, while general inflation has gone up only 8%.  It is a marker of substantial market power that prices can continue to rise in a recession and at a rate above general inflation.  (AHIP Summary)

An Accenture survey suggests that trends of physicians becoming employees instead of independent practitioners will continue.  The survey finds that operating costs and other aspects of running a business are the main reason doctors are turning to employment.  Of doctors who will remain in independent practice, many are looking to concierge-type models, which provide more predictable revenues and cost much less to operate.  These trends will likely exacerbate access concerns, as doctors in concierge models tend to service fewer patients and will probably also worsen the health spending rise, as consolidation of physicians in hospitals and elsewhere allows for more pricing power.   (Accenture Survey)

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