Physician Cost Profiling — Reliability and Risk of Misclassification

Insurance products that include incentives for patients to choose physicians classified as offering lower-cost care on the basis of cost-profiling tools are increasingly common. The objective of this study was to determine whether these tools can accurately distinguish higher-cost physicians from lower-cost physician.  The researchers constructed clinically homogeneous episodes of care (e.g., treatment of diabetes, heart attack, or urinary tract infection), assigned each episode to a physician, and created a summary profile of resource use (i.e., cost) for each physician on the basis of all assigned episodes. The researchers estimated the reliability of each physician's cost-profile score on a scale of 0 to 1, with 0 indicating that all differences in physicians' cost profiles are due to a lack of precision in the measure  and 1 indicating that all differences are due to real variation in costs of services. They used the reliability results to estimate the proportion of physicians in each specialty whose cost performance would be classified inaccurately in a two-tiered insurance product in which the physicians with cost profiles in the lowest quartile were labeled as "lower cost."

The study found that overall, 59 percent of physicians had cost-profile scores with reliabilities of less than 0.70, a commonly used marker of suboptimal reliability. Using these reliability results, the researchers estimated that 22 percent of physicians would be misclassified in a two-tiered system. The researchers conclude that the current methods for profiling physicians with respect to costs of services may produce misleading results.

For Consumers, Clarity on Health Care Changes

This article from the New York Times summarizes how the recently-enacted health reform legislation will impact those who currently have insurance and those who do not, concluding with a specific look at how the legislation will impact household budgets. 

How the Health Care Bill Will Affect You

The Patient Protection and Affordable Care Act includes more than a dozen key provisions scheduled to take effect in 2010, including the creation of a national high-risk pool for people with preexisting conditions that can’t buy insurance on their own, tax credits for small businesses that obtain health coverage for their workers, and assistance for Medicare beneficiaries with high drug costs who get hit by the drug benefit’s coverage gap or “doughnut hole;” changes continue through 2014, when the major reforms to expand access to health coverage are fully implemented. This interactive graphic, published by the New York Times, is designed to explain how the new law will affect people in all walks of life.

Overweight, Obesity, and Depression

The objective of the study described in this article was to conduct a systematic review and metaanalysis of the longitudinal relationship between depression,overweight, and obesity, and to identify possible influencing factors. The authors conducted a literature review that summarizes available prospective cohort studies and examines whether depression is predictive of the development of overweight and obesity - and, in turn, whether overweight and obesity are predictive of the development of depression. They authors conlcude that overall, there is a reciprocal link between depression and obesity. Obesity was found to increase the risk of depression,most pronounced among Americans and for clinically diagnosed depression. In addition, depression was found to be predictive of developing obesity. Obese persons had a 55 percent increased risk of developing depression over time, whereas depressed persons had a 58 percent increased risk of becoming obese. The association between depression and obesity was stronger than the association between depression and overweight, which reflects a dose-response gradient. While there have been many studies that have examined this relationships, this article is of particular interest because it is the first meta analysis to examine this association.

National, State, And Local Disparities In Childhood Obesity

Growing evidence suggests that childhood obesity is associated with negative near-term health and cost impacts as well as longer-term impacts on adult health and health care costs. This paper uses data from the 2007 National Survey of Children’s Health to update national- and state-level findings on the prevalence and disparities in childhood overweight and obesity from the earlier fielding of this survey in 2003.17–19. In addition, for the first time the authors examine important contextual factors at the state level, independent from socioeconomic status, such as the child’s neighborhood and the impact of overweight/obesity on school-related outcomes.

The percentage of children ages 10–17 who are overweight (body mass index in the eighty-fifth to ninety-fourth percentiles) remained stable, while the national prevalence of obesity (BMI in the ninety-fifth percentile and higher) grew significantly, from 14.8 percent in 2003 to 16.4 percent in 2007. This increase in obesity accounted for the entire increase in the combined prevalence of overweight and obesity between 2003 and 2007 (from 30.6 percent to 31.6 percent). An estimated 10.58 million children, or nearly one in three children ages 10–17, were overweight or obese in 2007. Our findings suggest that the obesity epidemic among children may not yet have reached its plateau for some groups of children. The data also reveal persistent and highly variable disparities in childhood overweight and obesity within and among states, associated with socioeconomic status, school outcomes, neighborhoods, type of health insurance, and quality of care. The authors conclude that these results require policy makers’ attention nationally and within states.

Geographic Variations in Public Health Spending: Correlates and Consequences

Geographic variation in medical care spending has long been a source of policy concern because it implies inefficiencies and inequities in resource use and availability. The Robert Wood Johnson Foundation (RWJF) and Trust for America's Health (TFAH) has released the fifth annual Shortchanging America’s Health: A State-By-State Look at How Public Health Dollars Are Spent. The report found that federal spending for public health has been flat for nearly five years, while states around the country cut more than $392 million for public health programs in the past year, leaving communities around the country struggling to deliver basic disease prevention and emergency health preparedness services.

States in the Midwest received the least federal funding support for disease prevention at public health, at only $16.50 per person in fiscal year (FY) 2009, according to the analysis. This is $3.30 less per person than the Northeastern states, which receive the highest amount, at $19.80 per person. Western states receive $19.22 per person, while Southern states receive $19.75 per person.

The authors point out that as Congress, the Administration and eventually state and local governments move forward in reforming this nation’s health system, it is critical that reform examines both sides of the system—delivery and prevention. The contend that by measuring spending levels in specific programmatic areas, such as tobacco control, obesity prevention and communicable disease control, policy-makers and public health officials will be able to identify exactly how funding is being used and the value of each type of investment.

Radiation Risks Prompt Push to Curb CT Scans

For millions of patients, a CT scan can mean the difference between life and death - detecting a brain tumor, blood clot or burst appendix in seconds. But federal regulators, radiology groups, and hospitals are launching efforts to scale back use of the scans - also called CAT scans - amid growing evidence that they are exposing millions of patients to radiation that may elevate the risk of cancer in the future. A third or more of scans may be unnecessary or repetitive, studies show, and in scans that are medically appropriate, radiation doses could be dramatically reduced without hurting the quality of images. Experts say that the best way to reduce the use of CT scans is to encourage doctors to follow guidelines developed by the American College of Radiology and others. This article provides information to health care consumers and others about the uses and risks of high technology scans.