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EHRs, EHRs, EHRs

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With the stimulus money and Medicare incentives, electronic health record vendors are riding high. But many, many questions remain regarding the implementation, use and value of these systems in reducing cost and improving quality.

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Drugs, Drugs, Drugs

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While spending on prescription drugs has stabilized over the last few years, it remains a major category of health cost and pharmaceuticals are a critical and effective treatment option for many diseases, especially chronic ones. Several recent articles discuss aspects of drugs and the prescribing process.

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National Broadband Plan and Health Care

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Communications and information technology has an increasingly critical role in health care and in the future vision of health care delivery and administration. The FCC has been tasked with facilitating the broadband infrastructure for these communication and information technology needs and has set forth its recommendations in the recently released National Broadband Plan.

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More Imaging Issues

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Use of imaging services has become the poster child for health care spending problems, even though excessive imaging may have been rather rapidly controlled by private sector use of imaging benefit managers. New research pours salt on the wounds.

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Health Care Reform Status

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We may or may not be nearing the end game of health care reform, at least as currently proposed by the Administration. Whether it passes or not, the problems of cost, access and quality will remain and private, not government, action is most likely to be the source of solutions to those problems.

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Hospital Costs and Quality

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Following up on similar research, an article delves into the relationship between hospital costs and quality, finding inconsistent associations between high cost and better quality. It does not appear that low-cost hospitals have higher readmission rates and greater downstream costs.

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2010 Potpourri VIII

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The Food & Drug Administration and the National Institutes of Health have announced an initiative to collaborate on speeding significant research findings into products and clinical use.  (FDA/NIH Announcement) Among other things the collaboration will create a leadership council to facilitate reaching its objectives.   They also will award $6.75 million for the study of new regulatory methods to better assess efficacy and safety of products submitted to the FDA for marketing approval.  With all due respect, don’t expect anything important to come out of this.  The objectives are worthy–there are many products being created that could provide significant clinical improvements and may even save money by being curative or helping avoid expensive health services like hospitalizations.  But the FDA is risk-averse and bureaucratic and doesn’t appear to have any real incentive to help manufacturers figure out how best to develop their products and get them reviewed quickly.

Towers Watson released findings from the 15th Annual Business Group on Health Survey.  (Towers Survey) Employers believe that health reform, if enacted, will raise costs and lessen benefits.  The annual median increase in health costs for these employers was 6% in 2008, 7% in 2009 and they expect a 6.5% rise in 2010.   In trying to control health costs, the three biggest challenges these firms identified were employees’ poor health habits, high catastrophic and end-of-life care and under use of preventive services.  Lack of employee engagement and insufficient financial incentives to encourage participation in programs, which seem linked, were cited as obstacles to changing employing behavior.  Most are not very satisfied with the performance of their medical management vendors.

The American Academy of Family Physicians has decided that it really, really doesn’t like retail health clinics.  The reason–why concerns over quality of course, couldn’t be anything else, could it, like maybe much higher cost physicians might lose some business.  The cause for the shift in policy is the supposed expansion of the clinics into chronic disease care and other areas.  (AAFP Statement) Fairly credible research has not suggested any significant quality issues with retail clinics.  Consumers obviously like them because they are convenient and less expensive and appear to be satisfied with quality or they wouldn’t keep using them.  They are a market success.  Maybe the AAFP should spend a little more time trying to figure out how to lower the cost of physician services, increase consumer satisfaction and improve quality, which research does indicate could use some attention.

The Wall Street Journal has an article on the growth of peer-influenced marketing.  Using social network capabilities, many patients have been connecting to share health care experiences.  Product providers, especially drug companies, are working to tap into or even create this social networking to boost sales of their products.  Much of this peer-influenced work is traditional TV advertising with real patients, but much is also internet-based.  The FDA has expressed concerns about drug companies’ activities in this area, and more regulation might be expected.  (WSJ Article)

The Wall Street Journal published an op-ed which discusses a better way to reform health care.  (WSJ Op-Ed) The authors note that the critical problem is rising costs and the current bills do little to address that problem. Duh.  They promote policies that would restore individual awareness of the cost of, and responsibility for payment for, health care services, and increasing competition among health insurers and providers, including eliminating the tax deduction for employment-based insurance, allowing sale of insurance policies across state lines, without regard to states’ benefit mandates and changing malpractice laws.  All laudable, all not likely to pass in the current Congress.  And one big problem in this individual responsibility approach, which we generally favor, is that a whole lot of health care spending is for elderly, chronically ill patients who are hardly capable of making decisions about their health care.

A new survey claims that defensive medicine is responsible for one of every four dollars spent on health care in the United States.  (Jackson/Gallup Survey) (Survey Summary) Gallup surveyed 462 practicing physicians.  Seventy three percent said they had practiced some form of defensive medicine in the last 12 months and they attributed 26% of overall health spending to defensive medicine and the physicians said they avoid practices and procedures that might increase medical malpractice insurance premiums.  Based on this survey, Jackson Healthcare, the sponsor, suggests that over $650 billion of health spending could be avoided annually by removing the practice of defensive medicine.  Not sure about that, since most other credible research doesn’t come up with a number close to that.  Also pretty sure that even if physicians had no possibility of being sued they would not give up $650 billion of income, or their share of that spending.

And finally, the fun item of the week.  The current issue of the Harvard Business Review has a brief summary of work by Kathleen Vohs, looking at the impact of literal hard cash on people’s feelings and actions.  (HBR Article) In a recent study she had some people count money and some slips of paper.  The she dipped their hands in very hot water.  The people who counted money felt less pain.  The article gives several other examples of the research.  Cold, hard cash appears to have a number of demonstrable effects on people’s behavior.  The applications to health care are obvious.  For patients, if they are in pain, give them some cash.  Want people to take better care of their health, give them actual cash immediately after good actions, or better yet, let them handle some cash first, take it away from them and tell them they can have it after they have completed the good health behavior.  For providers and staff, similar approaches could be used.

CDC Health Status Report

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The Centers for Disease Control issues a massive compendium of health facts and information called Health United States 2009. In addition to basic information regarding health care, it has some description and analysis of particular issues such as use of medical technology.

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