Trying to keep abreast of the latest in health services research, as presented in Health Affairs. The December issue had a focus on cancer drugs, medical debt and cybersecurity. We learn that drug companies are apparently developing new cancer drugs with a target of earlier disease state, which seems to be a good thing. We are told that having medical debt decreases the likelihood of getting certain cancer screenings. I think the real association is that people who have difficulty managing their finances also engage in poor health behaviors. These cancer screenings are generally free of charge to the patient.
An article examines the trend of more doctors to engage in concierge medicine and direct primary care. Doctors are pretty fed up with the regulatory garbage they face from CMS and from the states and with the administrative hassle of dealing with third-party payers. And they often don’t like practicing in the large health systems which dominate US health care. So they go to practice models that are more patient pay and more patient-focused. The number of practitioners in these models is growing rapidly.
Oregon capped hospital payments for services to state employees and saw little effect on hospitals but big savings for the state. The Netherlands implemented a bundled payment for maternity services, with a little reduction in spending and no change in health outcomes.
The January issue focussed on health spending and artificial intelligence. The lead article talks about the possible benefits and risks of using artificial intelligence for prior authorization and claims processes. Ideally AI would speed up processing of prior authorization requests and ensure consistent use of criteria, but it may also make it hard to take certain factors into account. Another article discusses the use of AI in regard to the Medicare physician fee schedule, which uses weights to value services. AI could help eliminate over-coding and other abusive practices. A third article talks about how to pay physicians who use AI to help with clinical tasks, to ensure that some cost savings are recognized while still paying for the value that may be delivered in terms of better outcomes. Yet another article talks about the health spending implications of AI use. I would guess it will mostly be used by providers to maximize reimbursement.
Another study finds that opioid prescription limnits caused a reduced number of opioid-related hospitalizations and ER visits. Medicare has begun negotiating lower prices for drugs paid for by the program. A study found that fewer clinical trials were being conducted in regard to drugs subject to the price limits. Research on use of independent medical reviews for claim denials found that about half the denials were overturned when an independent review occurred. Medicaid covers a number of persons with serious mental illness and substance abuse. Providing housing support for these people substantially increased use of ERs and other services and reduced mortality. Medicare home health care is often used with no prior hospitalization, particularly for those with cognitive impairment or dementias. (HA Site)
