Economic Stimulus Legislation Will Incentivize Use of HIT

Both the House of Representatives and the Senate last week unveiled legislative proposals to address the ailing economy in a number of ways. (Source: AMGA) Click Here to Read Full Story

HIGHER DEDUCTIBLES MAY RESULT IN SICKER PATIENTS

Last year, the median deductible required by employers for individual coverage in PPOs - which cover about 69 percent of all covered employees nationwide - rose to $1,000 from $500, according to the recently released National Survey of Employer-Sponsored Health Plans conducted each year by Mercer, a benefits consulting firm. The number of employers that impose a deductible for PPO coverage has risen from about half in 2000, when the median deductible for individual coverage was just $250, to about 80 percent today, according to the Mercer report. But some observers fear the current economy could result in more people putting off necessary medical care. The trend also could mean less revenue for cash-strapped hospitals, doctors and other providers as the national economy slows down. "One thing this taught us is that hospitals aren't immune to a lack of consumer confidence. If they won't buy a car, they won't take an elective surgery either. They don't want to pay the co-pay," said said Craig Becker, president of the Tennessee Hospital Association.
(Source: The Tennessean, January 21)

HSACONNECT PUMPS UP WEB SITE WITH NEW FEATURES

HSAConnect, an online resource for information and services relating to Health Savings Accounts and HSA-qualified, High Deductible Health Plans, has rolled out a new Web site with added content, new features and additional resources. Among the Web site's newest features are 400 pages of continually updated information along with tools and resources, including a searchable database of over 350 financial institutions that offer HSAs. There also is access to a variety of real-time quotes and HSA Health Insurance plan summaries from all the major insurance carriers throughout the nation. Finally, the website includes a complete library of IRS and U.S. Treasury Department publications on HSAs.
(Source: PRWEB, January 26)

DELOITTE ESTIMATES ITS PLAN CAN SAVE HEALTHCARE $530B

Consulting firm Deloitte LLP said that U.S. healthcare spending could be cut by half a trillion dollars over 10 years if the industry would adopt changes such as using electronic prescriptions and relying on drugs and procedures proven to work best. Deloitte proposed $220 billion in new spending upfront over three years on efforts such as getting doctors to use e-prescribing and electronic medical records, as well as better coordination of patient care through primary-care doctors. The savings, it said, could be $530 billion within 10 years. "We're including improving health status and improving quality and not just taking an ax to costs,"
Paul Keckley, executive director of the Deloitte Center for Health Solutions, said.
(Source: Reuters, January 15)

PROFITS DIVE AT UNITEDHEALTH GROUP

UnitedHealth Group said fourth-quarter net income dropped by 40 percent thanks to litigation charges and premium rates that didn't keep up with medical costs. The nation's second-largest insurer still met analysts'
targets and UnitedHealth also maintained its 2009 profit forecast. Revenue grew by 9.6 percent to $20.5 billion. The company's medical loss ratio worsened from 79.9 percent to 80.8 percent as premium increases failed to match rising medical costs. Overall enrollment finished the year with 32.9 million members, gaining 95,000 in the fourth quarter alone.
(Source: Reuters, January 22)

Improving the Quality of Health Care

Suboptimal health care quality is an urgent national concern.1 Recently, policy makers have sought to improve quality by providing bonus dollars to physicians whose patients achieve certain health goals.2 The privatized US health care system has engendered decentralized quality improvement approaches3 and an unintended consequence has been ambiguity regarding who is responsible for quality and the scope of stakeholders' obligations. For example, some pay-for-performance arrangements effectively pay physicians less if their patients with diabetes miss appointments and fail to take prescribed medications.4-5 Pay-for-performance also does not typically assess diagnostic skills or clinician empathy,3 traits that patients value highly.6 These measurement flaws have frustrated physicians5, 7 and a backlash could derail potentially valuable improvement efforts.

In this Commentary, the stakeholders responsible for improving health care quality are identified and their shared and unique obligations are outlined. The resulting framework may . . .Click here for the full article

Transparency Standards for Diabetes Performance Measures

Regardless of the direction US health care reform takes, performance measurement, public reporting, and accountability will play major roles. Presently, a number of entities have staked out business models for developing, collecting, and disseminating operational data about performance at the hospital, health plan, and clinician levels. Critical to such a system are valid measures that permit fair comparisons. Indeed, generalization of randomized controlled trials to larger populations for performance measurement is a complex process that invariably involves judgment of the health benefit of the proposed measure as well as technical issues. Such factors include importance, scientific evidence, reproducibility, validity, precision, specification (including inclusion and exclusion criteria for the measure denominator), and feasibility in practice. The validity of methods measurement development, and adoption must be transparent. Transparency has been defined as "a process by which information about existing conditions, decisions and actions is . . .Click here for full text article

Quality reports for hospitals inconsistent...

Article from American Medical News
By Kevin B. O'Reilly, AMNews staff. Posted Jan. 12, 2009.

The promise of public quality reporting is undermined by competing sources of information that use different metrics, methodologies and data sources, yielding contradictory and confusing data for patients to sort through, says a study in the November/December 2008, Health Affairs.

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Postmarket Drug Safety Information for Patients and Providers

In accordance with Section 915 of the Food and Drug Administration Amendments Act of 2007 (FDAAA), this website contains links to postmarket drug safety information to improve transparency and communication to patients and healthcare providers.

Click here for the FDA list of Drug Information.

Benchmarking Physician Performance: Reliability of Individual and Composite Measures

Objective: To examine the reliability of quality measures to assess physician performance, which are increasingly used as the basis for quality improvement efforts, contracting decisions, and financial incentives, despite concerns about the methodological challenges.

Study Design: Evaluation of health plan administrative claims and enrollment data.

Methods: The study used administrative data from 9 health plans representing more than 11 million patients. The number of quality events (patients eligible for a quality measure), mean performance, and reliability estimates were calculated for 27 quality measures. Composite scores for preventive, chronic, acute, and overall care were calculated as the weighted mean of the standardized scores. Reliability was estimated by calculating the physician-to-physician variance divided by the sum of the physician-to-physician variance plus the measurement variance, and 0.70 was considered adequate.

Results: Ten quality measures had reliability estimates above 0.70 at a minimum of 50 quality events. For other quality measures, reliability was low even when physicians had 50 quality events. The largest proportion of physicians who could be reliably evaluated on a single quality measure was 8% for colorectal cancer screening and 2% for nephropathy screening among patients with diabetes mellitus. More physicians could be reliably evaluated using composite scores =17% for preventive care, >7% for chronic care, and 15%-20% for an overall composite).

Conclusions: In typical health plan administrative data, most physicians do not have adequate numbers of quality events to support reliable quality measurement. The reliability of quality measures should be taken into account when quality information is used for public reporting and accountability. Efforts to improve data available for physician profiling are also needed.

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