June 30, 2008

Healthcare Topics and Trends Update

CHRT's monthly online newsletter, providing convenient access to recently-published articles relating to healthcare quality, sustainability and access.

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General Interest Topics

Hospital Report Card to the House Appropriations Committee

Department of Veterans Affairs – June 16, 2008

This article describes the VA's "hospital report card," which includes data suggesting VA facilities may offer higher-quality care than the private sector on some measures, outperforming the privates on patient satisfaction, staffing levels, surgical volume, and other significant quality indicators. The VA report card is relevant not only to monitoring hospital quality trends, but also in the development of our own Michigan report card initiative.

Evidence-Informed Case Rates: Paying for Safer, More Reliable Care

Commonwealth Fund – June 16, 2008

This study reports on a new payment model based on evidence-informed case rates (ECRs) — a global fee derived from the costs of treating a patient across an entire episode of care. The report suggests that the model has the potential to improve quality, lower administrative burdens, enhance transparency, and support a patient-centered approach. The ECR payment model is an example of an incentive based payment system and is relevant and worth understanding as CHRT tests ideas around evidence based care delivery. Related video: Francois de Brantes: A New Payment Model for the U.S.

Obesity Costs US Employers $45 Billion A Year

New York Times – June 23, 2008

According research published by the Conference Board and RTI International, obesity costs U.S. employers an estimated $45 billion annually, but few employers are tackling the problem head on. About 14 percent of chief executives cite obesity as a top healthcare benefits concern, but the study finds industries may not realize a return on investments in employee weight loss programs. This article highlights the need for evaluation of these programs to test their effectiveness (clinical and/or financial) and is pertinent to CHRT's work in the area of smart benefit design.

The Evidence Gap – Weighing the Costs of a CT Scan's Look Inside the Heart

New York Times – June 29, 2009

This article is part of a New York Times series of articles that explores medical treatments in use despite scant proof they work. This article is particularly significant as it focuses on heart disease diagnosis and treatment that relates directly to CHRT's demonstration project to encourage the judicious and appropriate use of cardiac services for patients with stable CAD.

Special Interest Topics

Medicare Part B Imaging Services: Rapid Spending Growth and Shift to Physician Offices Indicate Need for CMS to Consider Additional Management Practices

U.S. Government Accountability Office – June 13, 2008

According to this GAO report, Medicare spending for imaging services paid for under the physician fee schedule more than doubled from 2000 to 2006, increasing to about $14 billion. The report says the shift in imaging services to physicians' offices could encourage overuse, given physicians' financial incentives to supplement lower fees for interpretation of imaging tests with higher fees for performance of the tests. Several private health care plans cited in the report attributed substantial drops in annual spending increases on imaging services to the use of prior authorization; their experience suggests that front-end management of these services could add to Medicare's prudent purchaser efforts. This article adds to the body of knowledge regarding the use of medical imaging, relating to the CHRT project Encouraging Appropriate and Judicious Use of High Technology Radiology for Patients with Low Back Pain.

Number of People with Diabetes Increases to 24 Million

Centers for Disease Control and Prevention – June 24, 2008

This release highlights a CDC report that provides current estimates and trends related to diagnoses of diabetes in the United States. The report estimates that nearly 8 percent of today's U.S. population has diabetes. Monitoring the prevalence and growth trend of diabetes is important as it relates to our benefit design work, particularly the Focus on Diabetes project.

Decision-making in percutaneous coronary intervention: a survey

BMC Medical Informatics and Decision Making – June 25, 2008

This survey explores the perceptions of physicians concerning their involvement in PCI decisions in cases they had referred to the cardiac catheterization laboratory of a major academic medical center. Both non-cardiologists and cardiologists felt that involving another decision-maker, either the referring physician or a non-interventional cardiologist, would be the best way to make PCI decisions. This article adds to the body of knowledge regarding the use of PCI for patients with stable CAD.

Effects Of Diagnostic Information, Per Se, On Patient Outcomes In Acute Radiculopathy And Low Back Pain

American Journal of Neuroradiology – June 29, 2008

This research assesses the effect of knowledge of diagnostic findings of spinal imaging on clinical outcome. The study concluded that patient knowledge of imaging findings do not alter outcome and are associated with a lesser sense of well-being. The results of this study add to the body of knowledge regarding the use of radiology and back pain which relates directly to CHRT's demonstration project to encourage the judicious and appropriate use of high technology radiology for patents with low back pain.

The Evolving Role Of Medical Therapy For Chronic Stable Angina

Current Cardiology Reports – July 10, 2008 (Subscription required to view full text)

This article highlights the need for a comprehensive approach to management that includes carefully identifying cardiac risk factors, using therapeutic lifestyle interventions, aggressive, multifaceted medical therapy, and judiciously using myocardial revascularization. This article adds to the body of knowledge regarding the use of PCI for patients with stable CAD.