Last week would have been Jim Henson’s 75th birthday. In his honor, the New America Foundation blog has created a Muppets edition of the Health Wonk Review. Check it out.
You are currently browsing the monthly archive for September 2011.
Tags: HWR
President Obama released a proposal last week to jump start the economy and reduce the deficit. The proposal includes many cuts to Medicare and increased cost sharing. Senators Coburn and Lieberman are supporting these cuts.
Increased cost sharing is a common theme in Medicare, Medicaid, but also for other programs as well. For instance, the proposal includes increases to TRICARE pharmacy benefit co-payments to be fall more in line with the most popular Federal employee health plan
The proposal, however, also has some interesting provisions. For instance, it would require providers to secure prior authorization to perform advanced imaging. This is one of the first moves away from the fee-for-service free-for-all towards managed care (read: rationing).
A pro-competition rule would prohibit ‘pay-for-delay’ where brand drug companies pay off other drug makers to delay their introduction of a generic into the market. The FTC is charged with enforcing this requirement. The proposal also would reduce the exclusive period of generic biologics. Weakening patent protection, for this authors perspective, is likely a good idea.
Specific changes under consideration which are related to medicare are highlighted below (with potential savings per year in parentheses):
Tags: Home Health, Long Term Care, Medicaid, Medicare, TRICARE
- Premiums for family coverage top $15,000/year.
- Women being disruptive.
- Elective procedure rates: all over the map in Cali.
- Neat presentation software.
- Spare the knife, keep the rod.
Tags: Links
In The New Republic, Peter Orzag argues that to fix our budget mess, we need less democracy. Specifically, he argues that implementing the following four recommendations more consistently would improve the budget situation.
- Progressive tax code
- Permanently link taxes to the unemployment rate
- Backstop rules
- Independent institutions
I have my doubts…
Tags: Comission, Commission, Debt, Deficit, IPAB, OMB, Orzag, Taxes, TNR
Does having a specialist as your usual source of care (USOC) increase costs?
“Among high-cost beneficiaries, the 27.8 percent attributed to a medical specialist as their USOCphysician had U.S.$1,839 greater costs than those attributed to primary care physicians, representing roughly 4 percent of the mean cost of care. Although this may reflect unmeasured patient preferences and health status differences, research provides mixed results whether management by specialists leads to better outcomes or lower costs (Donohoe 1998; Hartz and James 2006; Smetana et al. 2007)”
Likely, this evidence is based on correlation rather than causation. Patient with severe illnesses which require significant specialist treatment are more likely to visit specialists. Thus, going to a primary care provider in addition to these required specialist visit has a smaller marginal benefit. Healthier patients who do not need to visit specialists, on the other hand, will visit their PCP. Thus, observing that patients with a specialist as the USOC is more likely due to the fact that having a specialist as one’s USOC is an indicator of health status and only partially due to the fact that specialists may be worse at coordinating care for complex patients.
Source:
- Reschovsky, J. D., Hadley, J., Saiontz-Martinez, C. B. and Boukus, E. R. (2011), Following the Money: Factors Associated with the Cost of Treating High-Cost Medicare Beneficiaries. Health Services Research, 46: 997–1021. doi: 10.1111/j.1475-6773.2011.01242.x
Tags: complex patients, Medicare Spending, PCP, Primary Care, Usual Source of Care
Are you a genius? Probably not. But I know some people who are…
Tags: Genius, MacArthur Foundation
Big news today is that China has experienced a polio outbreak. The disease apparently made its way to China via Pakistan. This is the first polio outbreak in China since 1999. A disease that was once thought completely eradicated has now reared its ugly head.
Here are some other news of note:
- A $20 million stent study stopped
- Breast implant registry.
- Job training or below-minimum wage labor?
- Is Social Security a Ponzi Scheme?
- Should health insurers be mandated to cover IVF?
Also, do not forget to visit Disease Management Care Blog’s edition of the Cavalcade of Risk, featuring terrorism, cyberWar, floods, bad mortgages, robberies, investment losses and disease.
You’re a researcher. You just came up with a new medical treatment that is far superior to the previous treatment. How do you get physicians to adopt your method/technology?
Most researchers believe that providing the physician with evidence of the new treatment superiority is the number one factor driving adoption. In a presentation at this year’s AHRQ’s 2011 Annual Conference, I found out this is not the case at all. Evidence is important. Physicians, however, are much more likely to adopt a new technique/innovation if it has three characteristics:
- Low cost
- Simplicity
- Compatibility
In reality, all three of these factors deal with cost. The first examines the acquisition cost, the second deals with the time cost to learn to use the new procedure, and the third describes the cost of integrating the new technique within existing operations. These costs generally can be accurately estimated for most innovations.
On the other hand, most evidence cites benefits for patients or other stakeholders. Even if an innovation claims to be cost-effective from the provider’s perspective, physicians must risk that these promises will not come to pass.
The seminal technology adoption study examines the spread of hybrid corn in Iowa. Although there was significant evidence that hybrid corn was better than the status quo, there was still significant risk to the farmer since the hybrid corn was much more expensive than regular corn. It took the adoption of a thought leader for hybrid corn adoption to truly spread. This is why pharmaceutical companies spend so much money to get respected docs to endorse their products; it leads to more rapid spread of their drug than can even be accomplished by direct-to-consumer advertising.
Tags: Dissemination, Technology Adoption
The History of Medicine: A Very Short Introduction
September 30, 2011 in Books, Contagious Disease, Medical Studies | 1 comment
I recently finished reading a great book by William Bynum called The History of Medicine: A Very Short Introduction. The book does just what it says: provides a great introduction to the history of medicine. It is concise and interesting throughout. The contents are divided into six chapters:
This chart explains the differences between the first five kinds of medicine.
There are many interesting nuggets of information from this book and picking out a few is difficult. I’ll settle for two which discuss the unintended consequences of the invention of anesthesia and antibiotics:
“Giving surgeons more time to operate made conserving tissues easier, but the longer exposure of the open wounds to the air also increased the possibility of post-operative infection. Consequently, anaesthesia enlarged the range of operations surgeons could perform, but not necessarily the changes of a patient’s surviving the ordeal.”
“The causative agents of malaria, tuberculosis, and HIV have all developed resistance to many of their conventional treatments, complicating these major world diseases. The hospital has not ’caused’ this phenomenon; human agency has. But drug-resistant pathogens are now so common that modern hospitals sometimes lose their desired epithet, as ‘houses of healing,’ and revert to that old one, ‘gateways to death.’”
Here is Amazon’s summary of the book:
Taking a thematic rather than strictly chronological approach, W.F. Bynum, explores the key turning points in the history of Western medicine-such as the first surgical procedures, the advent of hospitals, the introduction of anesthesia, X-Rays, vaccinations, and many other innovations, as well as the rise of experimental medicine. The book also explores Western medicine’s encounters with Chinese and Indian medicine, as well as nontraditional treatments such as homeopathy, chiropractic, and other alternative medicines.
Tags: Books, History, Medicine