From the US Agency for Healthcare Research and Quality
AHRQ Stats: Per-Person Health Care Expenses
Among the U.S. noninstitutionalized population in 2013, the 1 percent of Americans with the highest health care expenses accounted for nearly 22 percent of the nation’s total health care expenditures. Members of that group had annual average expenses of $95,200. (Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey Statistical Brief #480: Differentials in the Concentration of Health Expenditures across Population Subgroups in the U.S., 2013.)
ancer, all by itself, is bad enough. Although cancer treatment, especially chemotherapy, has become much gentler than it was a decade ago, most interventions still carry significant risks and side effects.
Recently, many physicians have focused on a different sort of hazard that they call “financial toxicity.” Along with the distress of a cancer diagnosis and the discomforts of treatment, patients increasingly have to deal with the cost, anxiety and loss of confidence inspired by large, unpredictable expenses, often compounded by decreased ability to work.
A team led by Jonas de Souza, MD, a head-and-neck cancer specialist at the University of Chicago Medicine, has developed the first patient-oriented website devoted to helping cancer patients understand and cope with financial toxicity (FT). Their goal is to increase awareness of this side effect prior to and during medical treatment so patients know what to expect and can better understand how costs impact them and their families.
When writing about transparency in health care prices and quality, journalists should expose the myths that health care providers promote. That’s the advice Francois de Brantes gave during a session on price and quality transparency at Health Journalism 2015 last month.
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Providers promote the false ideas that gathering accurate price and quality data is difficult, if not impossible, and that variations in price result from the severity of illness in populations, de Brantes explained. By debunking these myths, journalists would inform policymakers and the public that there are ways to calculate the prices of medical episodes of care accurately, and that price variation can be controlled. “Price varies because of the way physicians practice,” he said.
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Among those myths:
Price is a trade secret
Disclosing prices would impede the ability of health plans, hospitals and physicians to compete effectively
Revealing prices enables collusion and thus violates antitrust law
Publishing prices leads to higher health care costs.
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Both Quincy and Suzanne Delbanco (@SuzanneDelbanco), executive director of the Catalyst for Payment Reform, made the point that price and quality transparency are similar in that both seem simple but are in fact extremely complex topics to cover. Most consumers, for example, are unaware of such quality measures as hospital infection rates and the CAHPS Hospital Survey from the federal Agency for Healthcare Research and Quality, Quincy said.
The intersection between rising consumerism and a growing retail orientation in the health care sector presents challenges, some unprecedented, for existing players. We explore three shifts that health industry players should respond to, and that can set the scene for greater consumer involvement.
Matching a buyer with a seller. On Angie’s List it’s simple: Consumers search, select, and schedule the services that fit their needs.
Could it ever be that easy in health care?
The cost of health care is high and rising. For the past 10 years, health care costs have exceeded US economic growth by an average 2.5 percent annually. The anticipated average annual growth rate of health care costs is 5.7 percent per year through 2023, well above gross domestic product (GDP), average wages, and productivity gains.1 Improving economic conditions, the impact of the ACA’s insurance coverage expansions, and an aging population are expected to drive health care expenditure growth.2 Average annual growth of out-of-pocket health care expenditure is projected to rise to 5.5 percent by 2023 from 3.2 percent in 2013.3
The health care system in the United States is edging toward a recalibration. Existing business models are being challenged to find and deliver new sources of value and to develop innovative approaches to make health care less complicated, and to improve outcomes:
Health care is moving toward value, not volume, as a central organizing principle. That impacts how patients are cared for, how physicians and hospitals are paid, and how life sciences companies approach the market.
Those paying the bills—employers, government, health plans, and increasingly, individuals—are looking for better value and better outcomes.
Entrepreneurs, retail organizations, and communications and technology companies see opportunity in the large and growing health care market. Taking advantage of developing trends, they are slipping across the industry’s increasingly permeable boundaries.
From the 29 January 2015 post at The Health Care Blog
By PAUL KECKLEY
Unnecessary care that’s not evidence-based—usually associated with excess testing, surgical procedures or over-prescribing—accounts for up to 30% of what is spent in healthcare. In recent months, enforcement actions against physicians and hospitals have gained increased attention. But unnecessary care and over-utilization is not a new story or one that’s easy to understand.
Background
Medical necessity means something slightly different in every part of the healthcare industry. Varied definitions and interpretations are used by providers, physicians, courts, pharmacy benefits managers, government insurers, private insurers, and consumers. Perhaps the two most important are from the largest and most influential payer, Medicare, and the industry’s most important clinical authority, the American Medical Association (AMA).
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The AMA defines medical necessity as: “Healthcare services or products that a prudent physician would provide to a patient for the purpose of preventing, diagnosing or treating an illness, injury, disease or its symptoms in a manner that is: (a) in accordance with generally accepted standards of medical practice; (b) clinically appropriate in terms of type, frequency, extent, site, and duration; and (c) not primarily for the economic benefit of the health plans and purchasers or for the convenience of the patient, treating physician, or other healthcare provider.” “Statement of the American Medical Association to the Institute of Medicine’s Committee on Determination of Essential Health Benefits,” American Medical Association, January 14, 2011
So based on these definitions, the application of “medical necessity” leaves lots of room for variation in how doctors and hospitals determine what’s done, and how payers (Medicare, Medicaid, employers, individuals) assess the appropriateness of their activities and costs. Therein is the conundrum about medical necessity and unnecessary care and the need for fresh thinking about the issue.
The basic facts:
Over-utilization and unnecessary care is prevalent and costly: Several reputable studies point to systemic over-utilization costing the U.S. system up to 30% more than what’s necessary (Exhibit A). The U.S. health system is the world’s most expensive, and health costs, per the Congressional Budget Office, will continue to increase at least 2-3% faster than the overall economy for the next decade. The costs associated with unnecessary care (a.k.a. medical necessity) are significant and growing. “The 2014 Long-Term Budget Outlook,” Congressional Budget Office, July 2014.
The government is cracking down on unnecessary care: Hospitals are increasingly being held accountable for the practice patterns of the physicians on their medical staff via the False Claims Act. Enforcement actions against both are on the rise and financial penalties harsh (see Exhibit B for recent cases).
Media attention is sparking public attention to unnecessary care: The Wall Street Journal calls its series, “Secrets of the System.” National broadcast and print news organizations have increased coverage of healthcare including its tendencies around medical necessity and unnecessary care. And social media is a hotbed for anecdotal assessments of “medical necessity”—some supported with objective data, most supported by personal experience, and a few judiciously studied and reported.
So if health costs are a looming problem in U.S. healthcare, and lack of consistency around the delivery of medically-necessary care is a systemic challenge that’s increasingly transparent, why isn’t more done? Most industry insiders offer these reasons:
The body of scientific evidence about what works best is expanding and changes fast. There are 20,000 medical journals. Keeping track of the latest innovations is almost impossible without using a clinical knowledge management software program that captures and filters relevant information useful to making patient diagnostic treatment decisions.
The strength of evidence about what works best and why is often weak. As more information about a patient’s signs, symptoms, risk factors and co-morbidities are factored into a treatment determination, the less likely it is that a clear “medical necessity” directive is found. Ironically, the more information (data) a clinician has about a specific patient, the less likely it is that a “medically necessary service” is dictated through a clinical algorithm or guideline.
Most consumers assume everything recommended is “medically necessary.” The majority of consumers assume that what their physician recommends is evidence-based, and few feel confident to challenge their view. Therefore, consumers want MORE not less in the majority of cases. And social media and media coverage is complicating matters as treatments-de jour become more widely known to consumers searching the latest and best treatments. The burden to stay abreast about traditional and nontraditional methods for diagnosing and treating is daunting, especially if reimbursements are cutting into time spent with patients.
Most providers necessarily err on the side of over-treatment. The majority of physicians and the institutions that credential them to practice tend to over-treat fearing liability exposure or the possibility of an inaccurate diagnosis. It’s precautionary and a business imperative (discounting it can be lucrative at the same time).
The health information technology tools that allow for real-time, accurate matching of a patient’s signs, symptoms, risk factors and co-morbidities to the latest and best evidence don’t exist or are too expensive. The integration of smart medical record systems shared by clinically-integrated networks and with their patients is still aspirational in most communities. These systems are expensive. Clinicians doubt that these systems will pay for themselves in improved efficiency (less paperwork), nor do they trust that payers will pay them more if they make the investment. And most consumers aren’t demanding them to make the investment. Instead, basic access, convenient locations and an assuring experience with doctor are of higher importance.
These views provide a defensible rationale as to why medical necessity and unnecessary care is a systemic challenge in our system, but in coming months, they may be seen more as lame excuses. The spotlight on unnecessary care and medical necessity is likely to shine brighter because:
Unnecessary care contributes significantly to the impressive profitability in many parts of the health system.
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Unnecessary care can be harmful to consumers.
The data and sophisticated analytic tools upon which determinations of medical necessity and unnecessary care are increasingly available. Defaults that “my patients are different” and “we don’t have the data” will fall on deaf ears.
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What does it mean?
Documentation is key. Accurate clinical documentation across sites and systems of care is table stakes.
Transparency about medical necessity and unnecessary care is assured. Data about the performance of every practitioner, hospital, and health system will be widely accessible. And the evidence supporting coverage and denial decisions by insurers, formulary design by Pharmacy Business Managers (PBMs) and benefits managers, and the justification for narrow networks will be equally available.
1Patricia Neuman (tneuman@kff.org) is senior vice president and director of the Program on Medicare Policy at the Henry J. Kaiser Family Foundation, in Washington, D.C.
2Juliette Cubanski is associate director of the Program on Medicare Policy at the Henry J. Kaiser Family Foundation.
3Anthony Damico is an independent consultant in Bethesda, Maryland.
Abstract
Medicare per capita spending for beneficiaries with traditional Medicare over age 65 peaks among beneficiaries in their mid-90s and then declines, and it varies by type of service with advancing age. Between 2000 and 2011 the peak age for Medicare per capita spending increased from 92 to 96. In contrast, among decedents, Medicare per capita spending declines with age.
As the US population ages and more people on Medicare live into their 80s, 90s, and beyond, analysts and policy makers are examining the impact of these trends on the federal budget and the Medicare program. At the same time, geriatricians and other providers who care for older patients are paying greater attention to the question of how best to meet the needs of an aging population. By 2050 the number of people on Medicare ages 80 and older will nearly triple; the number of people in their 90s and 100s will quadruple.1⇓–3
To inform discussions about Medicare’s role in providing coverage for an aging population and to assess the relationship between Medicare spending and advancing age, this article presents findings from an analysis of Medicare per capita spending among beneficiaries over age 65 in traditional Medicare, by age and type of service.4Our main findings are shown in Exhibit 1 and discussed in detail below.
Exhibit 1
Medicare Per Capita Spending For Traditional Medicare Beneficiaries Over Age 65, By Age And Survival Status, 2011
SOURCE Authors’ analysis of a 5 percent sample of Medicare claims for 2011 from the Chronic Conditions Data Warehouse of the Centers for Medicare and Medicaid Services. NOTES Average per capita spending in 2011 for all traditional Medicare beneficiaries over age 65 (“all beneficiaries”) was $9,839; for the subset of those beneficiaries who were still alive at the end of 2011 (“full-year survivors”), it was $8,647. The analysis excluded beneficiaries with Medicare Advantage. The analysis also excluded traditional Medicare beneficiaries age 65 because some of these beneficiaries are enrolled for less than a full year; therefore, a full year of Medicare spending data is not available for all people at this age.
Previous studies have reported an increase by age in Medicare per capita spending,5,6beneficiaries’ out-of-pocket spending,7 and Medicaid spending.8 However, they have not examined Medicare per capita spending in depth, categorizing it by beneficiaries’ age and type of service and including trends over time.
We examine the following questions: What is the trajectory of Medicare per capita spending by age, at what age does spending peak, and has the peak age changed over time? How does Medicare per capita spending by age vary for specific Medicare-covered services? What is the pattern of per capita spending by age among decedents?
From the 24 November 2014 Robert Woods Foundation report
Recent years have brought numerous efforts to educate and engage Americans in what “quality” health care is, how to find it and how they can get better value for their dollars. To better understand the latest trends, the Robert Wood Johnson Foundation funded the AP-NORC Center for Public Affairs Research at the University of Chicago to conduct three surveys through the summer and fall of 2014.
The surveys each individually examined how consumers and employers, as purchasers, perceive health care quality and how they use quality information and performance data on health plans and providers. Learn more about the research and access links to the full reports with accompanying materials.
A number of initiatives in recent years have aimed at engaging consumers in making informed health care decisions, including empowering patients and their caregivers with data on provider quality, performance, cost and value. The first in the series of surveys looks at the inroads these efforts have made.
Thirty-seven percent of respondents don’t believe that higher health care costs correlate with better quality care—but 48 percent think they do. The poll also found that more than two-thirds say finding a doctor or hospital that offers the highest quality at the lowest possible cost is important to them. The survey also showed getting Americans to find quality information and use it in their health care decisions remains a challenge, with only 11 percent of Americans reporting they have done so.
As more provisions of the Affordable Care Act (ACA) are implemented over the next decade, the government projects that approximately 12 million additional people younger than 65 will enter the private insurance market. The second in the series of surveys looks at consumer opinions on health care costs and coverage, and how it impacts their decision-making.
It shows that nearly a fifth of insured Americans report skipping a trip to the doctor when they’re sick or injured to save money, and only 36 percent are confident they can pay for a major, unexpected medical expense. Those enrolled in health plans with high deductibles are greatly impacted by the out-of-pocket cost of health care—they are concerned with the uncertainty of major expenses, skip necessary medical treatment, and experience real financial burden when obtaining health care.
As a group, employers represent the largest purchaser of care in the United States. Given this, it is critical that they demand good value for the money they spend, ensuring that the plans offered to employees be high quality. The third and final report in the series of surveys looks at the opinions of private sector employers, including small-, medium- and large-sized businesses.
It shows that American firms are hesitant to say they would pay more for higher quality care, and when it comes to measuring quality, 90 percent don’t know or don’t use independent quality information when deciding on what plans to offer employees. And while many employers are indeed providing wellness programs to benefit their employees’ health, relatively few are actively promoting those programs or offering incentives for participation.
From the US Health and Human Services press release
Hospital-acquired conditions decline by 17 percent over a three-year period
A report released by the Department of Health and Human Services today shows an estimated 50,000 fewer patients died in hospitals and approximately $12 billion in health care costs were saved as a result of a reduction in hospital-acquired conditions from 2010 to 2013. This progress toward a safer health care system occurred during a period of concerted attention by hospitals throughout the country to reduce adverse events. The efforts were due in part to provisions of the Affordable Care Act such as Medicare payment incentives to improve the quality of care and the HHS Partnership for Patients initiative. Preliminary estimates show that in total, hospital patients experienced 1.3 million fewer hospital-acquired conditions from 2010 to 2013. This translates to a 17 percent decline in hospital-acquired conditions over the three-year period.
“Today’s results are welcome news for patients and their families,” said HHS Secretary Sylvia M. Burwell. “These data represent significant progress in improving the quality of care that patients receive while spending our health care dollars more wisely. HHS will work with partners across the country to continue to build on this progress.”
Today’s data represent demonstrable progress over a three-year period to improve patient safety in the hospital setting, with the most significant gains occurring in 2012 and 2013. According to preliminary estimates, in 2013 alone, almost 35,000 fewer patients died in hospitals, and approximately 800,000 fewer incidents of harm occurred, saving approximately $8 billion.
Hospital-acquired conditions include adverse drug events, catheter-associated urinary tract infections, central line associated bloodstream infections, pressure ulcers, and surgical site infections, among others. HHS’ Agency for Healthcare Research and Quality (AHRQ) analyzed the incidence of a number of avoidable hospital-acquired conditions compared to 2010 rates and used as a baseline estimate of deaths and excess health care costs that were developed when the Partnership for Patients was launched. The results update the data showing improvement for 2012 that were released in May.
“Never before have we been able to bring so many hospitals, clinicians and experts together to share in a common goal – improving patient care,” said Rich Umbdenstock, president and CEO of the American Hospital Association. “We have built an ‘infrastructure of improvement’ that will aid hospitals and the health care field for years to come and has spurred the results you see today. We applaud HHS for having the vision to support these efforts and look forward to our continued partnership to keep patients safe and healthy.”
From the 24 November 2014
That headline appeared in the Minneapolis Star Tribune print edition yesterday. The focus of the article was how difficult it is to obtain medical cost data despite a state law and other efforts to increase transparency.item at HealthNewsReview.org
The same newspaper had a brief column the previous day about open enrollment season for workplace medical benefits, but that column’s final line seemed to conflict with the point of the longer story mentioned above. The shorter column quoted the executive director of the MN Community Measurement group saying that the group’s rankings – “rating doctors on whether they provide optimal care to patients with diabetes, depression and other conditions….can help consumers make informed choices.” The exec said consumers can now ask, “Is there much difference in quality, given the difference you might be asked to pay in price?”
Meantime, it was great to see a JAMA Internal Medicine article about a great piece of journalism on this same topic. The article, by Lisa Aliferis of KQED radio in San Francisco, was entitled, “Variation in Prices for Common Medical Tests and Procedures.” It gives details about the PriceCheck project of KQED, KPPC, and the excellent ClearHealthCosts.com effort run by Jeanne Pinder. Aliferis concludes the article:
“The window is cracked open on health cost transparency. We have been here before—with car sales, with airline tickets. Now, technology in combination with transparency can do the same for health care.
And yes, we have been asked whether people should “shop” for medical treatment in the same way they shop for a new car. If there were a correlation between cost and quality, this might be a reasonable question. Instead, in American health care, money is spent on unnecessary or unproven treatments much too often, and there’s widespread variation in price. People are waking up to these facts.
The money conversation makes the practice of medicine very complicated: the “gotcha” bill and the medication that is not covered challenge the physician-patient relationship. It is time to take off the blindfold and embrace transparency in pricing for medical care and services.”
Despite recent advances in health care policy, American households continue to struggle with medical debt, and it’s only getting worse. Americans are putting more of their take-home pay toward medical costs than ever before.
NerdWallet Health has found that Americans pay three times more in third-party collections of medical debt each year than they pay for bank and credit card debt combined. In 2014, roughly one in five American adults will be contacted by a debt collection agency about medical bills, but they may be overpaying – NerdWallet found rampant hospital billing errors resulting in overcharges of up to 26%.
NerdWallet found 63% of American adults indicate they have received medical bills that cost more than they expected. At the same time, 73% of consumers agree they could make better health decisions if they knew the cost of medical care before receiving it.
Between 2010 and 2013, American households lost $2,300 in median income, but their health care expenses increased by $1,814.[1]Out-of-pocket spending is expected to accelerate to a 5.5% annual growth rate by 2023 – double the growth of real GDP.
In a follow-up to last year’s study that found medical debt is the largest cause of personal bankruptcy, NerdWallet Health investigated the mounting financial obstacles facing the American patient.
As a nation, we only spend 9% of national health expenditures in embracing healthy behavior. On the other hand, only 6% of health determinates are related to access to services, although 90% of national health expenditures is spent on medical services.
[1]
Therefore, presumably, providing primary care providers the tools and the means to change and educate patients about their health determinate will have a significant impact on overall spending on medical services.
From the 25 January 2014 post at The Health Care Blog
By William H. Frist, MD
Here’s a point most of us can agree on. Tackling ballooning health care costs requires more than insurance reform because the charge and cost structure for health services in the U.S. is inconsistent and irrational. The same quality CT scan that costs $500 at one outpatient facility costs $2,000 at a nearby teaching hospital.
Obamacare’s typical high-deductible insurance plans encourage many cost-conscious consumers to shop around for low-ticket items below their deductible — and that is good. However, the bulk of health care spending is attributable to patients who rapidly blow through their deductible, after which they have no incentive to shop for value. Those 5 percent of people — who spend a whopping 50 percent of the nation’s health care dollars — have little incentive to consider price. With the cost of multiple medications, frequent doctors visits, use of specialists and one or more hospitalizations a year, these 5 percent will exceed even the highest deductible in the first few months of each year.
So what might be the single most powerful tool to slow the seemingly intractable yet unsustainable increases in health spending affecting practically every family in America? “Referenced-based” pricing for health services encourages patients — most significantly, those with the highest costs — to act as smart consumers by seeking the most cost-effective care, even after they have exceeded their deductible.
Here’s how it works. Insurance companies or employers set a limit they are willing to pay for a specified service of excellent quality — say, $1,000 for a CT scan — and communicate that reference price clearly to consumers. If patients choose a location where the charge is below the maximum set reimbursement rate, they pay nothing. If they choose a provider where the charge is higher, they pay the difference.
As patient-consumers shop around for the best price and quality services, competition in the market pushes prices down and value up.
Greatest economic burden shouldered by African-American and Hispanic men
African-American men incurred $341.8 billion in excess medical costs due to health inequalities between 2006 and 2009, and Hispanic men incurred an additional $115 billion over the four-year period, according to a new study by researchers at the Johns Hopkins Bloomberg School of Public Health. The study, published this week in the International Journal of Men’s Health, looks at the direct and indirect costs associated with health inequalities and projects the potential cost savings of eliminating these disparities for minority men in the U.S.
“Health disparities have a devastating impact on individuals and families, and they also affect society as a whole,” said Roland J. Thorpe, Jr., PhD, lead author of the study and Assistant Professor at the Johns Hopkins Bloomberg School of Public Health and Director of the Program for Research on Men’s Health in the Johns Hopkins Center for Health Disparities Solutions. “Quantifying the economic impact of health inequalities among men highlights how enormous a societal problem this is.”
Researchers used data from the Agency for Health Care Research and Quality’s 2006-2009 Medical Expenditure Panel Survey (MEPS) to determine the prevalence of a variety of health statuses and conditions (for example, fair/poor health, obesity, diabetes, heart disease) among each racial/ethnic group (African American, Asian, Hispanic and white). This information was incorporated in statistical models to estimate the total direct medical costs and the proportion of costs incurred due to health disparities for each group. The direct medical expenditures for African-American men over the four-year period totaled $447.6 billion; and 5.4 percent, or $24.2 billion, were excess costs attributed to health disparities. There were no excess direct costs due to health disparities for the other racial/ethnic groups over the four year period.
The indirect costs of lower worker productivity due to illness and premature death were calculated using data from MEPS and the CDC’s National Vital Statistics System. Over the four-year period, these factors cost the economy a total of $436.3 billion—lower worker productivity due to illness contributed $28 billion in excess costs, and premature death contributed $408.3 billion. Of the total indirect costs, African-American men accounted for $317.6 billion, or 72 percent; indirect costs totaled $115 billion for Hispanic men and $3.6 billion for Asian men.
“These stark findings underscore the fact that we can’t afford to overlook men’s health disparities that exist in this country,” added Thorpe. “The cost to society—both moral and economic—is staggering.”
Greatest economic burden shouldered by African-American and Hispanic men
African-American men incurred $341.8 billion in excess medical costs due to health inequalities between 2006 and 2009, and Hispanic men incurred an additional $115 billion over the four-year period, according to a new study by researchers at the Johns Hopkins Bloomberg School of Public Health. The study, published this week in the International Journal of Men’s Health, looks at the direct and indirect costs associated with health inequalities and projects the potential cost savings of eliminating these disparities for minority men in the U.S.
“Health disparities have a devastating impact on individuals and families, and they also affect society as a whole,” said Roland J. Thorpe, Jr., PhD, lead author of the study and Assistant Professor at the Johns Hopkins Bloomberg School of Public Health and Director of the Program for Research on Men’s Health in the Johns Hopkins Center for Health Disparities Solutions. “Quantifying the economic impact of health inequalities among men highlights how enormous a societal problem this is.”
Researchers used data from the Agency for Health Care Research and Quality’s 2006-2009 Medical Expenditure Panel Survey (MEPS) to determine the prevalence of a variety of health statuses and conditions (for example, fair/poor health, obesity, diabetes, heart disease) among each racial/ethnic group (African American, Asian, Hispanic and white). This information was incorporated in statistical models to estimate the total direct medical costs and the proportion of costs incurred due to health disparities for each group. The direct medical expenditures for African-American men over the four-year period totaled $447.6 billion; and 5.4 percent, or $24.2 billion, were excess costs attributed to health disparities. There were no excess direct costs due to health disparities for the other racial/ethnic groups over the four year period.
The indirect costs of lower worker productivity due to illness and premature death were calculated using data from MEPS and the CDC’s National Vital Statistics System. Over the four-year period, these factors cost the economy a total of $436.3 billion—lower worker productivity due to illness contributed $28 billion in excess costs, and premature death contributed $408.3 billion. Of the total indirect costs, African-American men accounted for $317.6 billion, or 72 percent; indirect costs totaled $115 billion for Hispanic men and $3.6 billion for Asian men.
“These stark findings underscore the fact that we can’t afford to overlook men’s health disparities that exist in this country,” added Thorpe. “The cost to society—both moral and economic—is staggering.”
Health care access, affordability, and quality are problems all around the world and large numbers of individuals do not receive the quality care that they need. Mobile technology offers ways to help with these challenges. Through mobile health applications, sensors, medical devices, and remote patient monitoring products, there are avenues through which health care delivery can be improved. These technologies can help lower costs by facilitating the delivery of care, and connecting people to their health care providers. Applications allow both patients and providers to have access to reference materials, lab tests, and medical records using mobile devices.
Complex mobile health applications help in areas such as training for health care workers, the management of chronic disease, and monitoring of critical health indicators. They enable easy to use access to tools like calorie counters, prescription reminders, appointment notices, medical references, and physician or hospital locators. These applications empower patients and health providers proactively to address medical conditions, through near real-time monitoring and treatment, no matter the location of the patient or health provider.
In this paper, part of the Mobile Economy Project, Darrell West looks at specific applications and inventions, and discuss how mobile is transforming health care in the United States and around the world. He argues that mobile health helps frontline health workers and health care providers extend their reach and interactions – enabling them to be more efficient and effective in their provision of medical assistance. And in the conclusion, West recommends several steps that will speed the adoption of mobile technology in health care.
Policymakers should encourage the use of mobile devices for health care. Moving to electronic systems for service delivery will save money, improve access, and provide higher levels of quality in both developed and developing nations.
Nearly three-quarters of medical expenditures takes place on a small number of chronic illnesses including cardiovascular disease, cancer, diabetes, and asthma. We should encourage the use of mobile systems that monitor patient symptoms and provide real-time advice on treatment and medication because they have the potential to control costs, reduce errors, and improve patients’ experiences.
We should work to remove barriers to adoption of mobile applications that aid in chronic disease management and make these tools much more widely available.
With growing knowledge about diseases, genetics, and pharmaceutical products, the practice of medicine has become far more complicated. Health providers need access to as much accurate data as they can get on how to treat various ailments.
One of the barriers to cost containment and quality service delivery has been the continued reliance in many locales on paper-based medical systems. In a digital world, one cannot imagine a costlier way to run a health care system.
On the issue of government regulation, the FDA has finalized its guidance on how mobile applications and regulated mobile medical devices are to be treated in an effort to clarify some of the ambiguities and help further innovation. Having clear rules that encourage desirable behavior is the best way to move forward in mobile health.
Flashback— About 20 years ago I was in an urgent care center around 11 pm with a severe migraine. The doctor was getting ready to give me a shot with appropriate medication. At the time I was unemployed with little money. So I asked him if I could get a prescription for capsules/tablets instead, and how much the shot would be. He looked a bit startled, but looked up the information for me. I opted for the capsules/ tablets. My mother, bless her, drove me to a nearby hospital so I could get the prescription filled. Was very grateful the medication kicked in within 10 minutes or so. Will never forget the compassionate professionalism of that physician.
Flashback II – About 25 years ago I had rather painful wrists (not carpal tunnel) and went to a doctor. (From a temp job, basically keyboarding for hours at end.) Again, I was uninsured with little money.. Went to the doctor with a book from the library with exercises to relieve pain in the wrists. Asked the doctor what he thought about them. Told him I was uninsured and didn’t have much money. The doctor didn’t say much. Just directed me down the hall to a physical (occupational?) therapist. The therapist gave me several pages of exercises and went over them with me. I asked her what the additional charge for her services was. She said nothing. Again, the doctor showed compassionate professionalism. Such a “business” where the staff communicated well and worked with each other for the customer’s benefit! Oh, and the exercises worked, and I keyboarded with better ergonomics as outlined in the handouts given.
by David Pittman, Washington Correspondent, MedPage Today
Oct 16, 2013 – Physicians need to broach discussions about out-of-pocket costs with patients the same way they discuss a treatment’s side effects, public policy professors wrote.
“Admittedly, out-of-pocket costs are difficult to predict, but so are many medical outcomes that are nevertheless included in clinical discussions,” Peter Ubel, MD, of Duke University’s School of Public Policy, and colleagues wrote.
They noted in a New England Journal of Medicine perspective published Wednesday that patients can experience considerable financial strain from out-of-pocket costs, with little or no discussion beforehand about potentially avoidable health-related bills.
“Because treatments can be ‘financially toxic,’ imposing out-of-pocket costs that may impair patients’ well-being, we contend that physicians need to disclose the financial consequences of treatment alternatives just as they inform patients about treatments’ side effects,” the authors wrote.
They gave the example of a colon cancer patient who receives bevacizumab (Avastin), which can help prolong life by 5 months over chemotherapy alone.
Many providers don’t mention that the drug can cost $44,000 for 10 months of therapy, Ubel and others wrote. A Medicare patient responsible for 20% of the cost can expect $8,800 in out-of-pocket costs on top of other treatment costs, doctor’s fees, and diagnostic tests. The out-of-pocket costs can be even higher for patients with high-deductible insurance plans.
“Most physicians insist on discussing the 2% risk of adverse cardiovascular effects associated with bevacizumab, but few would mention the drug’s potential financial toxicity,” the authors noted.
More than one in five patients covered only by Medicare (20.9%) reported some kind of financial burden, according to the National Center for Health Statistics data the authors cited. Even 30.4% of privately insured patients under age 65 reported some financial burden from medical care.
The authors suggested that taking the time to discuss what can be an uncomfortable topic may:
Enable patients to choose lower-cost treatments when available
Help patients who are willing to trade medical benefit for financial distress
Enable patients to seek financial assistance earlier and avoid duress
In addition, evidence suggests that considering costs as part of clinical decision-making might reduce long-term costs to society, the authors noted. For example, some physicians feel it’s their responsibility to provide the best care regardless of costs, and patients worry that inquiring about prices will pit them against doctor’s orders and open them to subpar treatment.
Physicians lack training in this area, and may feel uncomfortable or may not know what a patient’s costs will be since it depends on what health insurance plan they have. “It is often difficult to determine a patient’s out-of-pocket costs for any given intervention,” Ubel and colleagues wrote.
But insurance companies are developing ways to better estimate patients’ costs, the perspective stated. Furthermore, policymakers need to push for greater price transparency, especially when it comes to prices borne by patients.
“We can no longer afford to divorce costs from our discussion of patients’ treatment alternatives,” they wrote.
BenefitsCheckUp, a service of the National Council on Aging, can help you find public and private programs that may be able to help pay for your prescription drugs.
Non-profit information resource devoted to helping people in need find assistance programs to help them afford their medications and costs related to health care. Includes coverage gap programs.
A way to receive discounts on prescription drugs at participting pharmacies.
Printable coupon at Web site
Contact by email or phone (1-888-412-0869). FAQ page here.
How it Works
Use FreeRxPlus® Bin and Group numbers for FREE access to savings on prescriptions, lab tests, and imaging services.
For access to Lab Test savings: Locate a lab or order your test call toll-free 1-888-412-0869
For access to Imaging Savings: Locate an imaging center or order your service call toll-free 1-888-412-0869
For access to Prescription Savings: Click HERE and locate a participating pharmacy or search for medication pricing. Then simply present your FreeRxPlus® card to the pharmacist for immediate saving
PatientAssistance.com is a free resource designed to help connect patients who can’t afford their prescription medications with patient assistance programs. Generally for the uninsured and underinsured.
The PAF helps to solve health insurance and access problems. The website has information on resources, programs, and provides personal help. PAF offers assistance to patients with specific issues they are facing with their insurer, employer and/or creditor regarding insurance, job retention and/or debt crisis matters relative to their diagnosis of life threatening or debilitating diseases.
CINV (chemotherapy-induced nausea and vomiting) CareLine is a patient hotline designed to provide case management assistance to patients diagnosed with cancer and experiencing chemotherapy-induced nausea and vomiting who are seeking education and access to care.
The Co-Pay Relief Program currently provides direct financial support to insured patients, including Medicare Part D beneficiaries, who must financially and medically qualify to access pharmaceutical co-payment assistance. The program offers personal service to all patients through the use of call counselors; personally guiding patients through the enrollment process
RxAssist is a website with information, news, and a database that are all designed to help you find out about ways to get affordable, or free, medications. The database includes information on the pharmaceutical companies’ patient assistance programs, or programs that provide free medication to low-income patients. RxAssist was created by Volunteers in Health Care, a national, nonprofit resource center for health care programs working with the uninsured.
The wellness emphasis in the Affordable Care Act is built around the Centers for Disease Control and Prevention’s (CDC) 2009 call to action about chronic disease: The Power to Prevent, the Call to Control. On the summary page we learn some shocking statistics:
“Chronic diseases cause 7 in 10 deaths each year in the United States.”
“About 133 million Americans—nearly 1 in 2 adults—live with at least one chronic illness.”
“More than 75% of health care costs are due to chronic conditions.”
Shocking, that is, in how misleading or even false they are. Take the statement that “chronic diseases cause 7 in 10 deaths,” for example. We have to die of something. Would it be better to die of accidents? Suicides and homicides? Mercury poisoning? Infectious diseases? As compared to the alternatives, it is much easier to make the argument that the first statistic is a good thing rather than a bad thing.
The second statistic is a head-scratcher. Only 223 million Americans were old enough to drink in 2009, meaning that 60% of adults, not “nearly 1 in 2 adults,” live with at least one chronic illness — if their language is to be taken literally. Our suspicion is that their “133-million Americans” figure includes children, and the CDC meant to say “133-millon Americans, including nearly 1 in 2 adults, live with at least one chronic illness.” Sloppy wording is not uncommon at the CDC, as elsewhere they say almost 1 in 5 youth has a BMI > the 95th percentile, which of course is mathematically impossible.
More importantly, the second statistic begs the question, how are they defining “chronic disease” so broadly that half of us have at least one? Are they counting back pain? Tooth decay? Dandruff? Ring around the collar?
There were a few charts that made the radar this year. In some cases, the data is older than 2012, but all too often, the data hasn’t really changed or improved with age…
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The Kaiser Family Foundation also provided a comparison of cumulative increases in health insurance premiums – relative to Workers’ Contributions, Inflation and Workers’ Earnings (from 2000 to 2012).
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This next one was orignally assembled by Carnegie Mellon University professor Paul Fischbeck – and reported by Mark Roth of the Pittsburgh Post-Gazette (December, 2009) – and highlights our Per Capita Healthcare Costs by Age as compared to four other countries (Germany, the U.K., Sweden and Spain).
In New England Journal of Medicine, Weill Cornell researchers advocate the development and implementation of criteria for elective procedures, with joint replacement surgery as an example
Many of the most common inpatient surgeries in the United States are performed electively. These surgeries are expected to significantly increase with the enactment of the Affordable Care Act. In a new perspectives article, published in the Dec. 27 edition of The New England Journal of Medicine, a team of Weill Cornell Medical College researchers are recommending the nation’s health care leaders and medical community join forces to establish evidence-based appropriateness criteria to determine which patients are most in need of elective procedures, such as joint replacement surgery, to slow the projected surge in demand and rising costs. Currently, there are no appropriateness criteria for most of the common elective procedures.
Total joint replacement surgeries — such as hip and knee replacements — are among the most common inpatient surgeries in the United States and are used as a prime example of elective surgeries that could benefit from implementing appropriateness criteria. Patients requesting joint replacement surgery vary from those disabled by their joint arthritis to those who do so to maintain an active lifestyle without pain. Total joint replacement surgeries are expected to quadruple over the next two decades in the United States, contributing to the rise in health care costs and increasing the risk of medical complications.
“The purpose behind establishing criteria is to use evidence-based metrics to prioritize patients most in need,” says lead author Dr. Hassan M.K. Ghomrawi, assistant professor of public health at Weill Cornell and an outcomes research scientist at Hospital for Special Surgery. “We don’t want to sacrifice necessary care when thinking of cost-containment.”..
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Current cost-containment proposals focus primarily on payment reforms, such as pay-for-performance and bundled payments. But in their perspective, titled “Appropriateness Criteria and Elective Procedures — Total Joint Arthroplasty,” the authors posit that developing and implementing evidence-supported criteria that identifies the appropriate patients who are most likely to benefit from surgery will also slow the growing costs of these procedures.
“Identifying patients who are likely to benefit the most from these procedures could help to combat increasing health care costs while enhancing access and quality,” says senior author Dr. Alvin I. Mushlin,…
References for “What is Possible for Health Care” Infographic
Stremikis, K., C. Schoen, and A. K. Fryer. 2011. A call for change: The 2011 Commonwealth Fund survey of public views of the U.S. health system. New York: Commonwealth Fund.
Stremikis, K., C. Schoen, and A. K. Fryer. 2011. A call for change: The 2011 Commonwealth Fund survey of public views of the U.S. health system. New York: Commonwealth Fund.
Donchin, Y., D. Gopher, M. Olin, Y. Badihi, M. Biesky, C. L. Sprung, R. Pizov, and S. Cotev. 2003. A look into the nature and causes of human errors in the intensive care unit. Quality & Safety in Health Care 12(2):143-147.
Pham, H. H., A. S. O’Malley, P. B. Bach, C. Saiontz-Martinez, and D. Schrag. 2009. Primary care physicians’ links to other physicians through Medicare patients: The scope of care coordination. Annals of Internal Medicine 150(4):236-242.
Classen, D. C., R. Resar, F. Griffin, F. Federico, T. Frankel, N. Kimmel, J. C. Whittington, A. Frankel, A. Seger, and B. C. James. 2011. ‘Global trigger tool’ shows that adverse events in hospitals may be ten times greater than previously measured. Health Affairs (Millwood) 30(4):581-589; Landrigan, C. P., G. J. Parry, C. B. Bones, A. D. Hackbarth, D. A. Goldmann, and P. J. Sharek. 2010. Temporal trends in rates of patient harm resulting from medical care. New England Journal of Medicine 363(22):2124-2134; Levinson, D. R. 2010. Adverse events in hospitals: National incidence among Medicare beneficiaries. Washington, DC: U.S. Department of Health and Human Services, Office of Inspector General.
Jencks, S. F., M. V. Williams, and E. A. Coleman. 2009. Rehospitalizations among patients in the Medicare fee-for-service program. New England Journal of Medicine 360(14):1418-1428.
Goodman, J. C., 2006. Transparency in Health Care. Washington, DC: National Center for Policy Analysis.
Goodman, J. C., 2006. Transparency in Health Care. Washington, DC: National Center for Policy Analysis.
Stremikis, K., C. Schoen, and A. K. Fryer. 2011. A call for change: The 2011 Commonwealth Fund survey of public views of the U.S. health system. New York: Commonwealth Fund.
Stremikis, K., C. Schoen, and A. K. Fryer. 2011. A call for change: The 2011 Commonwealth Fund survey of public views of the U.S. health system. New York: Commonwealth Fund.
Degner, L. F., L. J. Kristjanson, D. Bowman, J. A. Sloan, K. C. Carriere, J. O’Neil, B. Bilodeau,
P. Watson, and B. Mueller. 1997. Information needs and decisional preferences in women with breast cancer. Journal of the American Medical Association 277(18):1485-1492; Fagerlin, A., K. R. Sepucha, M. P. Couper, C. A. Levin, E. Singer, and B. J. Zikmund-Fisher. 2010. Patients’ knowledge about 9 common health conditions: The decisions survey. Medical Decision Making 30(Suppl. 5):S35-S52; IOM. 2011. Patients charting the course: Citizen engagement in the learning health system (a workshop summary). Washington, DC: The National Academies Press; Lee, C. N., J. Belkora, Y. Chang, B. Moy, A. Partridge, and K. Sepucha. 2011. Are patients making high-quality decisions about breast reconstruction after mastectomy? Plastic and Reconstructive Surgery 127(1):18-26; Lee, C. N., Y. Chang, N. Adimorah, J. K. Belkora, B. Moy, A. H. Partridge, D. W. Ollila, and K. R. Sepucha. 2012. Decision making about surgery for early- stage breast cancer. Journal of the American College of Surgeons 214(1):1-10; Sepucha, K. R., A. Fagerlin, M. P. Couper, C. A. Levin, E. Singer, and B. J. Zikmund-Fisher. 2010. How does feeling informed relate to being informed? The decisions survey. Medical Decision Making 30(Suppl. 5):S77-S84.
Degner, L. F., L. J. Kristjanson, D. Bowman, J. A. Sloan, K. C. Carriere, J. O’Neil, B. Bilodeau,
P. Watson, and B. Mueller. 1997. Information needs and decisional preferences in women with breast cancer. Journal of the American Medical Association 277(18):1485-1492; Fagerlin, A., K. R. Sepucha, M. P. Couper, C. A. Levin, E. Singer, and B. J. Zikmund-Fisher. 2010. Patients’ knowledge about 9 common health conditions: The decisions survey. Medical Decision Making 30(Suppl. 5):S35-S52; IOM. 2011. Patients charting the course: Citizen engagement in the learning health system (a workshop summary). Washington, DC: The National Academies Press; Lee, C. N., J. Belkora, Y. Chang, B. Moy, A. Partridge, and K. Sepucha. 2011. Are patients making high-quality decisions about breast reconstruction after mastectomy? Plastic and Reconstructive Surgery 127(1):18-26; Lee, C. N., Y. Chang, N. Adimorah, J. K. Belkora, B. Moy, A. H. Partridge, D. W. Ollila, and K. R. Sepucha. 2012. Decision making about surgery for early-stage breast cancer. Journal of the American College of Surgeons 214(1):1-10; Sepucha, K. R., A. Fagerlin, M. P. Couper, C. A. Levin, E. Singer, and B. J. Zikmund- Fisher. 2010. How does feeling informed relate to being informed? The decisions survey. Medical Decision Making 30(Suppl. 5):S77-S84.
Farrell, D., E. Jensen, B. Kocher, N. Lovegrove, F. Melhem, L. Mendonca, and B. Parish. 2008. Accounting for the cost of US health care: A new look at why Americans spend more. Washington, DC: McKinsey Global Institute; IOM. 2010. The healthcare imperative: Lowering costs and improving outcomes: Workshop series summary, Learning health system series. Washington, DC: The National Academies Press; Wennberg, J. E., E. S. Fisher, and J. S. Skinner. 2002. Geography and the debate over Medicare reform. Health Affairs (Millwood) (Suppl. Web Exclusives):W96-114.
As imaging technology advances and medical devices improve, healthcare professionals are more inclined to use these state-of-the art scanners to look inside patients’ bodies. Computed tomography usage, for example, more than tripled between 1996 and 2010. Over the same period, MRI (magnetic resonance imaging) usage increased fourfold. It is not surprising, therefore, that patient radiation exposure has also risen.
An article in JAMA, published today, asks the question to see if this technological dependance is going too far or even putting patients in danger with too many scans. Some people are worried about raditation from mobile phones, so stepping inside a multi-million dollar machine that blasts the body with one type of electromagnetic resonance or another, is going to draw warranted safety questions…
..One of the main points made in the article is that there has never been a comprehensive study of how much use healthcare providers are making of imaging technology. The studies that have been done are usually based around private practices and done for insurance purposes, and in these cases, imaging is usually encouraged. Looking at a wider range of patients and facilities enables the authors to provide us with a clear picture.
The authors summarize the use of various imaging techniques:
Radiography and angiography/fluoroscopy rates were relatively stable over time: radiography increased 1.2 percent per year, and angiography/fluoroscopy decreased 1.3 percent per year.
Computed tomography examinations tripled (52/1000 enrollees in 1996 to 149/1000 in 2010, 7.8 percent annual growth)
MRIs quadrupled (17/1000 to 65/1000,10 percent annual growth)…
…while healthcare has obviously improved with the use of technology, given the high costs of imaging, some $100 Billion annually, combined with the cancer risks and other possible side effects, the benefits of sending patients for scans, should be balanced by weighing the medical needs against both financial and heath risks of the technology itself.
Choosing Wisely™ aims to get physicians, patients and other health care stakeholders thinking and talking about the overuse or misuse of medical tests and procedures that provide little benefit, and in some instances harm.
Includes tips,scenarios, and information to get the most out of doctor visits.
English: Osteoarthritis Initiative (OAI) researchers at Ohio State University look through the opening of an MRI machine, used to image the knees of patients. The OAI, a public-private partnership, led by NIAMS and the National Institute on Aging with additional support from five other Institutes and Centers, funds research and information sharing resources to aid in the identification of biological markers for osteoarthritis. (Photo credit: Wikipedia)
The biggest problem with health care delivery in the US is cost, which seems to have taken a back seat to other issues meant to be addressed by health care reform. We spend about $2.5 trillion dollarsa year on health care—that’s over eight thousand dollars a year for every man, woman, and child. What’s that getting you?
According to the government, about 30% goes to hospitals; 20% goes to doctors and other clinicians, 10% goes for prescriptions, and the other 40% or so goes for “other spending,” mostly administrative costs and haircuts for insurance executives. But it’s probably even worse than that: according to arecent JAMA study, about 20% of total healthcare expenditures are wasted dollars.
20% of 2.5 trillion dollars, by the way, is 500 billion dollars. Each year. The JAMA article breaks down the waste into several categories:..
Choose Wisely Campaign
Nine United States specialty societies representing 374,000 physicians developed lists of Five Things Physicians and Patients Should Question in recognition of the importance of physician and patient conversations to improve care and eliminate unnecessary tests and procedures.
These lists represent specific, evidence-based recommendations physicians and patients should discuss to help make wise decisions about the most appropriate care based on their individual situation. Each list provides information on when tests and procedures may be appropriate, as well as the methodology used in its creation.
A group of nine medical specialty societies recently announced the “Choose Wisely” campaign, targeting 45 commonly performed medical procedures and tests that offer little or no value in improving health. These interventions waste precious health care resources, lead to erroneous conclusions and/or false security, spur unwarranted additional interventions, and cause patient harm. Among the appropriately indicted procedures was cardiac stress testing of asymptomatic, low-risk patients. There is an old adage among savvy clinicians: “It is difficult to make an asymptomatic person feel better.” Attempting to do so can cause more harm than good.
One of the most common ideas in the whole healthcare financing discussion is a moral one. Why, people say, should my taxes and my healthcare premiums go to take care of the huge medical problems of people who don’t take care of themselves? As one commenter on THCB put it: “…self inflicted injuries to not be covered at all, ideally. If someone drinks their liver away I don’t think we should all have to buy them a new one. Same for smoking.”
This is a common idea, one that seems logical and right on the surface. But there are four assumptions built into it, all four of which have problems:…..
This image depicts the total health care services expenditure per capita, in U.S. dollars PPP-adjusted, for the nations of Australia, Canada, France, Germany, Japan, Switzerland, the United Kingdom, and the United States with the years 1995, 2000, 2005, and 2007 compared.
Relative risk of mortality by BMI in White US men who never smoked. Berrington de Gonzalez A,..
http://healthyamericans.org/newsroom/releases/?releaseid=255
The Trust for America’s Health (TFAH) has released a new report, Bending the Obesity Cost Curve, which finds that reducing the average body mass index by just five percent in the United States could lead to more than $29 billion in health care savings in just five years, due to reduced obesity-related costs.
“Your “healthy” weight cannot simply be calculated from a general source – people’s healthy weight, orideal weight, depends on several factors, including their age, sex, body type, bone density, muscle-fat-ratio, overall general health, and height.
Over the last few decades, using BMI (body mass index) was seen as an excellent means for calculating a person’s healthy weight. However, BMI, as you will see later on in this article, is at best, a ballpark calculation with several limitations…
…Health care professionals and sports scientists say measuring a person’s body fat percentage is the ideal way of gauging their level of fitness and general health, because it is the only one that includes the person’s true body composition. [my emphasis]
(Unfortunately, at this time, the only ways to measure body fat percentage are rather hi-tech according to this article. Three ways noted are based on air displacement, infrared rays, and X-rays)
At The Atlantic, a post by Alex Tabarrok, “The Innovation Nation vs. the Warfare-Welfare State“, has been making its way around the bloggysphere, in part due to the big shout out to science, as embodied by this figure:
Tabarrok:
We like to think of ourselves as an innovation nation, but our government is a warfare/welfare state. To build an economy for the 21st century we need to increase the rate of innovation and to do that we need to put innovation at the center of our national vision.
Innovation, however, is not a priority of our massive federal government. Nearly two-thirds of the U.S. federal budget, $2.2 trillion annually, is spent on the four biggest warfare and welfare programs, Medicaid, Medicare, Defense and Social Security. In contrast, the National Institutes of Health, which funds medical research, spends $31 billion annually, and the National Science Foundation spends just $7 billion.
I’m all for cutting back on the warfare state–that senitment is as old as the biblical prophets. And spending more money on non-military research is a good thing (and while we’re on the subject, go sign this petition). Regular readers will know I agree with that. But I’m not sure what’s wrong with the so-called welfare programs.
I’m all for controlling healthcare costs and figuring out ways of delivering care more effectively (who could possibly be against these things?).
Excerpt from the 13 January Stateline Daily article
Numerous studies have shown that investments in programs aimed at helping people quit smoking reap significant long-term reductions in health care costs. Even so, fiscal stress has caused states to dramatically reduce spending on anything that does not yield immediate returns.
Now new data suggests that states may not have to wait so long for the returns. According to astudy conducted by George Washington University, a Massachusetts Medicaid program saved $3 in Medicaid hospitalization expenses for every dollar it invested in a comprehensive smoking cessation counseling and treatment program — and the savings accrued in the first 16 months of the program.
While not all Medicaid patients who underwent the treatment were able to quit smoking permanently, the group as a whole had far fewer hospital admissions for cardiovascular problems than it did before entering the program. According to the report, the annual medical savings attributable to even a brief reduction in smoking was $571 per participant, far outweighing the $183-per-person cost of the program.
“The good news from a state budget perspective is that even if people stop smoking temporarily, there can be immediate savings,” says Leighton Ku, one of the study’s authors. “From a public health perspective we’d like to help people stop smoking for good,” Ku says. “But the study showed a rapid reduction in the number of people having heart attacks and other cardiovascular problems, and that led to immediate savings.”
Imagine what health care in the United States could look like if we devised a system that was based on sound medical practice and proven cost effectiveness. What if we put our brains, energies and passion behind designing the smartest health care system possible?
That was the question that kept poking through my train of thought as I read a study that appeared in the most recent issue of Pediatrics, the official journal of the American Academy of Pediatrics. Thestudy, out of UCLA, examined the association between length of well-child visits and quality of the visits, including things like developmental screening and anticipatory guidance. No big surprise that the longer the duration of the well child visit, the greater the likelihood that the content of the visit was aligned with recommended practice guidelines from the AAP. The discouraging news however is that one third of visits were reported as being less than 10 minutes in duration; these occurred to a greater degree in private practice. Longer visits of 20 minutes or more made up 20% of the encounters, and were more likely to occur in community health centers.
The big winners in the pinch for time? Guidance on immunizations and breastfeeding were offered in 80% of even the shortest visits. The biggest loser: developmental assessments, which don’t even achieve a mediocre occurrence of 70% until we pass the 20-minute mark for visit duration….
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Our fee for service approach to health care dictates that procedures and tests pay well while addressing a child’s emotional problem gets a doctor little more than a backed up waiting room. From the patient’s view, underinsured children have to rely too much on emergency rooms, while insured parents can only get basic child rearing advice from someone with a medical degree. Health insurance companies and the pharmaceutical industry shape medical practice – and our collective health – through their reimbursement policies, marketing and aggressive lobbying. So 25% of US children are on chronic medications, while half the children in pediatric practice are not receiving basic screening and advice. The obsolete business models that the health care industries rely on are like the tyrannosaurus-rex in the room, emphasizing expensive, short term quantity rather than cost-effective long term quality, while cognitive care – a high level of skill and expertise delivered face to face in a personal manner – is what is becoming extinct.
An international survey of adults living with health problems and complex care needs found that patients in the United States are much more likely than those in 10 other high-income countries to forgo needed care because of costs and to struggle with medical debt. In all the countries surveyed, patients who have a medical home reported better coordination of care, fewer medical errors, and greater satisfaction with care than those without one.
… Key Findings
Sicker adults in the U.S. stood out for having cost and access problems. More than one of four (27%) were unable to pay or encountered serious problems paying medical bills in the past year, compared with between 1 percent and 14 percent of adults in the other countries. In the U.S., 42 percent reported not visiting a doctor, not filling a prescription, or not getting recommended care. This is twice the rate for every other country but Australia, New Zealand, and Germany.
In the U.S., cost-related access problems and medical bill burdens were concentrated among adults under age 65. Compared with Medicare-aged adults 65 or older, adults under 65 were far more likely to go without care because of the cost or to have problems paying bills.
Adults with complex care needs who received care from a medical home—an accessible primary care practice that knows their medical history and helps coordinate care—were less likely to report experiencing medical errors, test duplication, and other care coordination failures. They were also more likely to report having arrangements for follow-up care after a hospitalization and more likely to rate their care highly.
Sicker adults in the U.K. and Switzerland were the most likely to have a medical home: nearly three-quarters were connected to practices that have medical home characteristics, compared with around half in most of the other countries.
“These tools are new ways CMS is making sure consumers have information about health care quality and important information they need to make the best decisions about where to receive high-quality care,” said Dr. Don Berwick, the CMS Administrator. “These efforts are designed to also encourage providers to deliver safe, patient-centered care that consumers can rely on and will motivate improvement across our health care system.”
The steps announced today include:
· A Quality Care Finder to provide consumers with one online destination to access all of Medicare’s Compare tools — comparison information on hospitals, nursing homes and plans: www.Medicare.gov/QualityCareFinder.
· An updated Hospital Compare website, which now includes data about how well hospitals protect outpatients from surgical infections and whether hospitals care for outpatients who are treated for suspected heart attacks with proven therapies that reduce death: www.hospitalcompare.hhs.gov
This blog presents a sampling of health and medical news and resources for all. Selected articles and resources will hopefully be of general interest but will also encourage further reading through posted references and other links. Currently I am focusing on public health, basic and applied research and very broadly on disease and healthy lifestyle topics.
Several times a month I will post items on international and global health issues. My Peace Corps Liberia experience (1980-81) has formed me as a global citizen in many ways and has challenged me to think of health and other topics in a more holistic manner.
Do you have an informational question in the health/medical area? Email me at jmflahiff@yahoo.com I will reply within 48 hours.
My professional work experience and education includes over 15 years experience as a medical librarian and a Master’s in Library Science. In my most recent position I enjoyed contributing to our library’s blog, performing in depth literature searches, and collaborating with faculty, staff, students, and the general public.
While I will never be be able to keep up with the universe of current health/medical news, I subscribe to the following to glean entries for this blog.
Unnecessary care that’s not evidence-based—usually associated with excess testing, surgical procedures or over-prescribing—accounts for up to 30% of what is spent in healthcare. In recent months, enforcement actions against physicians and hospitals have gained increased attention. But unnecessary care and over-utilization is not a new story or one that’s easy to understand.
Health and Medical News and Resources 