Medicare has an impending value-based purchasing program for hospitals. Payments would be based on performance against quality standards. Some hospitals ability to improve performance may be limited by the economic and workforce characteristics of their location, according to new research.
Three recent articles provide some additional insight into pay-for-performance programs. Research has generally shown inconsistent results, so there is great benefit in understanding what features may make a program most successful in improving quality and outcomes.
One more Saturday….morning. And another potpourri of health care news. This one includes health information technology, consumer directed health plans, guidelines, support group functioning, end-of-life care and telemedicine.
Quality measurement and pay-for-performance programs continue to spread, in the belief that they will improve health care quality. A new study looks at the costs these programs impose on physician practices, finding that any financial incentives are usually lower than the costs.
More health care snippets, including hospital costs, wireless health in 2009, genetic testing, caring for the elderly and pay-for-performance programs. Bon Apetit!
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)
A study suggests that hospital report cards on cardiac care in Canada did not result in significant performance improvement. Even less clear is whether they lead to better health outcomes.
Another dose of weekend tidbits, covering PAP screenings, health insurer consolidation, Part D plan satisfaction, Rand’s look at the best methods to reduce health care costs, geographic variations in health spending and coughing into cell phones–yes you heard me right.