More delightful health facts for your edification in our most recent Potpourri, including the cost of obesity, an employer survey on wellness programs, opportunities for hospitals to reduce costs, an employer survey on cost expectations in the coming year, Massachusetts’ and health spending control and incentives in health care.
An early spring for much of the country and our latest Potpourri is in full bloom, with nuggets on health information exchanges, genetic testing guidelines, an employer survey on reform, EMRs and lab test ordering and the relationship between clinical quality and patient satisfaction.
Welcome to another Potpourri of health information, focusing on workers’ comp medical prices, cost-sharing on asthma meds, the Medicare Advantage program, doctors’ experience of quality improvement programs, a review of the last 60 years in health economics and the value of teledermatology.
Our latest Potpourri reveals details about causes of workplace injuries, the effect of raising the Medicare eligibility age, benefit levels in existing health policies, false claims prosecutions and off-label drug use, ICU staff perceptions of the appropriateness of care, and malpractice liability from clinical decision support systems.
The latest Towers Watson survey of employer intentions regarding health benefits indicates that significant changes may occur in the next two to three years, but the biggest danger may be firms’ willingness to play follow-the-leader when it comes to reactions to reform.
The annual Kaiser Foundation report on employment-based health coverage finds a rapid growth in per person and per family costs in 2009, but relative stability in the number of persons who have access to health insurance at the workplace. High-deductible plans continue to show rapid enrollment increases.
A dazzling review of recent research and other health related nuggets is presented in this latest Potpourri, including potential problems with evidence-based medicine, physician dilemmas in controlling cost, workers’ compensation medical costs, reducing hospital infections, improving heart attack care and the growth of CDHPs.
Summer begins to wane but our Potpourri remains hot, with items on large employers benefit intentions for 2012, Australia’s project to create a unified patient medical record, hospital collections at the point-of-service, physician compensation, trends in per capita medical costs and how to avoid issues in accountable care organizations.
Towers Watson and the National Business Group on Health released their latest Employer Survey on Purchasing Value in Health, which delineates actions being taken by many employers to try to limit health spending, while ensuring that employees receive good quality care.
Mercer issued a release on its survey of employers regarding issues relating to the reform law. Among the findings are that employers have already seen a 2% enrollment jump due to having to cover children up to age 26, and that over 40% of employers expect the full implementation of the law to raise their costs an additional 3% or more. So much for reducing insurance premiums. Eight percent said they were likely or very likely to terminate their coverage after the exchanges are operational, which is a smaller number than the McKinsey survey indicated but still a lot of employers. Employers say they are relying primarily on making employees more health conscious as a way to control spending. A number of employers are considering defined contribution-type strategies. (Mercer Survey)
The Kaiser Foundation issued a brief describing variation in individual health insurance premiums across the country. The average per month premium was $215, but the range was from over $400 to a low of $136. Massachusetts, Vermont, Rhode Island, New York and New Jersey were the highest states and Alabama, California, Arkansas, Idaho and Delaware were the lowest. These numbers are unadjusted for either benefit structure or health status of the enrollees. As might be expected all the high premium states have enacted “reform” laws which force insurers to take all applicants at basically the same price. This raises costs and consequently premiums and results in a death spiral where healthier people don’t see the benefit of paying for expensive coverage so they drop out, leaving the average cost of the people in the pool higher, premiums therefore go up, rinse and repeat. Really great reforms that price people out of the market! (Kaiser Brief)
The Centers for Medicare and Medicaid Services announced the latest results for its Physician Group Practice demonstration. Ten physician practices have participated in the demo and this was the fifth year of results. Seven of the groups hit all of the performance measure targets, and the remaining three hit at least 30 out of the 32 measures. The practices have shown continuing improvement in each year of the demonstration. All the groups are continuing to participate in a two-year add-on to the demonstration. Four of the groups will receive incentives totaling $29.4 million because they not only met the quality benchmarks but also showed an ability to control the amount Medicare spent on the beneficiaries they cared for. (CMS Announcement)
The Government Accountability Office issued yet another statement on Medicare’s improper payments. As previously reported, Medicare had at least $48 billion in improper payments in 2010. GAO’s current statement reviews its past recommendations to CMS on how to reduce these improper payments and CMS’ progress in implementing these recommendations. GAO’s primary recommendations include strengthening provider enrollment processes, improving prepayment reviews, focusing on known areas of vulnerability, like home health care or durable medical equipment and improving oversight of contractors, like the Part D plans. On the whole, GAO finds that CMS has not made a lot of progress on the recommendations, which is stating the obvious when one looks at the size of that $48 billion number. (GAO Report)
For decades physicians have waged war to prevent other health professionals from being able to deliver services that physicians do, or to do so without active physician oversight. The physicians are gradually losing the war, which has the potential to lower costs, and it appears that quality will not suffer. A recent article in Nursing Economics reviewed outcomes for services delivered by nurse practitioners. The research was a systematic review of studies over an 18 year period. Looking at over 100 studies, for outcomes like patient satisfaction, functional status and length of stay, there was a high level of evidence demonstrating that care by nurse practitioners was at least equivalent to physician care and in some cases had better outcomes. (Nursing Article)
Our final drug report post discusses releases from Express Scripts, the Pharmacy Benefit Management Institute and ESI’s PMSI division, which focuses on workers’ compensation pharmacy. Express Scripts emphasizes behavioral aspects of trend management and the PBMI report examines drug benefits from the employer perspective.