The American Hospital Association has released updated information on the amount of uncompensated care delivered by community hospitals and on the degree of underpayment of costs by Medicare and Medicaid.
Health care organizations of all types have stepped up their lobbying and campaign contributions, obviously hoping to influence reform. The amount of money spent on these activities suggests the country is only going to get what interest groups paid to get in the bill; malpractice reform is a good example.
Mercer surveyed employers to ascertain their reaction to the proposed tax on high value insurance coverage. The majority said they would reduce benefits to avoid the tax. Seven percent said they would outright terminate insurance coverage. Of those saying they would reduce benefits, most would do so by raising deductibles and copays. Employers also narrowly favor an individual mandate, although large employers tend to fairly strongly endorse the concept and small employers oppose it. (Mercer Release) The findings suggest that many employees are going to have worse coverage as a result of the “reform” and/or the government is going to get less revenue than it anticipated from the excise tax.
One of the early and primary uses for wireless technology in health care is in patient monitoring equipment. An article summarizes trends and market potential for patient monitoring equipment overall and for wireless equipment. (Wireless Monitoring) This is a relatively stable segment of the telemedicine industry, with relatively strong research support for better health outcomes and established reimbursement. Some suggest this could be an $8 billion market by 2013.
Associated Press has a story about the early results from the Center for Medicare Services Care Transitions program. The program is designed to avoid rehospitalizations, which cost Medicare $17 billion a year. Fourteen states are participating and so far rehospitalization rates have been creeping downward. Different hospitals are using different approaches to the problem, focusing on medication issues, difficulty in obtaining follow-up appointments, and reporting troublesome symptom changes quickly. (CMS Story)
ORC Guideline reports that a survey of consumers reveals their misunderstanding or failure to read drug information. The survey found that while most people say they understand how to take their medications, in fact 60% are not aware of potential interactions with other medicines. Twenty percent stopped taking a medication because they felt they did not have enough information about it. A large minority do not even read the information that comes with prescriptions. These responses, if accurate, help explain why there are so many adverse drug events each year and why those events cause a lot of unnecessary health spending. (ORC Report)
The same group of economists who earlier sent a letter to President Obama supporting health reform efforts has sent a letter to Senator Reid indicating some queasiness about the current Senate bill. In particular, they expressed concerns about limitations on the authority of the proposed Medicare Commission, too weak penalties on quality failures and too little use of bundling payments. (Economists’ Letter) What these economists should really be concerned about is the actual upward bend that this reform bill would cause for national health expenditures.
An article and editorial in JAMA gives further pause to the guideline and pay for performance movement. The article points out that many, perhaps a majority, physicians are in practices too small to generate appropriate sample sizes for valid statistical evaluation of their performance. Being able to measure and reward good medical care may be useful, but this study raises yet another practical barrier to widespread implementation. (JAMA Article) (JAMA Editorial)
The GAO looks at OSHA’s auditing of workplace injury reporting and finds that there may be under-reporting. To the extent this is true, the very real and significant decline in workers compensation claims may be reversed, making medical management efforts even more important.
Two groups have put out statements suggesting that the CBO is underestimating the effect of the Senate reform bill on private health insurance premiums, probably by quite a bit. The relatively weak penalty for not having health insurance is likely to cause significant adverse selection among those who choose to buy rather than pay the penalty.
The CBO looks at the characteristics of drug promotion spending and activity. Another study reveals that direct-to-consumer advertising for Plavix did not appear to increase the number of prescriptions but was correlated with a sharp rise in the price of the drug.
An NCCI report indicates that increasing time-off benefits in workers’ compensation insurance results in employees staying off the job for a longer period of time, incurring higher work comp costs for employers.
One of the supposed sources for cost reduction is eliminating inappropriate geographic variation in medical care; variation that is unassociated with better outcomes. A MedPac report suggests variation, while significant, may be less of an issue than other analyses have found.