Today's News and Commentary

About health insurance

The High Cost of Avoidable Hospital Emergency Department Visits: This study by United Health Group found that “the average cost of treating common primary care treatable conditions at a hospital ED is $2,032…, 12 times higher than visiting a physician office ($167) and 10 times higher than traveling to an urgent care center ($193) to treat those same conditions. In other words, visiting either a physician’s office or an urgent care facility instead of a hospital would save an average of more than $1,800 per visit – creating a $32 billion annual savings opportunity systemwide.” The main extra cost is the hospitals’ facility charge.

Politicians Tackle Surprise Bills, but Not the Biggest Source of Them: Ambulances: 51% of out-of- network surprise bills are from ambulance services; yet these charges are not addressed by current legislative proposals.

About the public’s health

U.S. Global Health Legislation Tracker: “This tracker provides a listing of global health-related legislation introduced in the 116th Congress. Currently, there are more than 30 pieces of legislation related to global health. They address topics ranging from global health security to neglected tropical diseases (NTDs) and reproductive health.” This site is a great source for keeping up with public policy proposals in Congress.

Recent trends in the age at diagnosis of colorectal cancer in the US National Cancer Data Base, 2004‐2015: “The proportion of persons diagnosed with CRC at an age younger than 50 years in the United States has continued to increase over the past decade, and younger adults present with more advanced disease. These data should be considered in the ongoing discussion of screening guidelines.” Should guidelines be revised to lower the first age of screening?

Use of Antibiotics Without a Prescription in the U.S. Population: A Scoping Review: One of the causes of bacterial resistance is use of unprescribed antibiotics. These drugs can be obtained over the counter in some foreign countries, “saving pills” from a previous prescription, or “borrowing” from others. This article reviews this often overlooked problem.

Firearm Ownership and Domestic Versus Nondomestic Homicide in the U.S.: The anti-gun lobby wants more controls on firearms in order to reduce homicides. But is such ownership correlated with these deaths? Yes and no. According to these researchers: “State-level firearm ownership rates are related to rates of domestic but not nondomestic firearm homicide.”

Mortality Trends by Race and Ethnicity Among Adults Aged 25 and over: United States, 2000–2017: The CDC released this report today. Hispanics fared best in all age categories (see the charts for quick information). The over-65 age group had declining mortality rates. From 2012-2017, the 25-44 age group had increasing mortality rates. In all categories, the rates were highest for non-Hispanic blacks.

A Unified Welfare Analysis of Government Policies: This paper is from two Harvard economists working with the National Bureaus of Economic Research and is to be presented at a conference there on Thursday. The authors looked at which public policies paid back their investments. No surprise that the answer was childhood-related programs; the reason is the time over which to recoup the spending is longer than in older persons. For example, for every dollar spent on children’s health programs, the system recoups about $1.47. For adult health programs every dollar spent loses an additional sixty cents. Obviously the issues of equity are not considered.

About healthcare quality and safety

Adverse Events in Long-term Care Residents Transitioning From Hospital Back to Nursing Home: Transitions in processes create frequent opportunities for errors. In transition from hospital back to long term care facilities patients in this study experienced a 40% chance of an adverse event. “…pressure ulcers, skin tears, and falls with injury representing the most common types of events in this category. Health care–acquired infections… and adverse drug events… were the next most common…Most were preventable or ameliorable.” The authors call for better information transmission between sites. But person-to-person communication, and even provider continuity, would be better.

About healthcare IT

Groups host congressional briefing to support lifting patient ID ban: As almost every other country has discovered, you cannot have completely useful interoperability of medical information without the ability to link individual patient data. That linkage requires unique patient identifiers. The identifiers were part of the original HIPAA legislation but, subsequently, Section 510 of a Labor-HHS Appropriations bill prohibited federal spending to set up them up. Professional IT groups are now lobbying to reinstate this unique designation.

Health system boards don't do enough IT oversight, report shows: A new study by Black Book Research finds some significant problems with health system boards' knowledge about healthcare IT. For example: “4% of survey respondents said they have direct technology experience relevant to the healthcare industry, and nearly eight in 10 said they don’t get enough feedback or actual data regarding the technology challenges their health system faces… 88% said they had no knowledge of healthcare cybersecurity risks, with just 7% claiming they were ‘somewhat knowledgeable’ of the risks.” Clearly some education and/or board recruiting improvements need to be made immediately.

Anthem launching new app offering personalized health information, texting with doctors: Usually patient-physician communication is driven by the software at the provider site. This app is interesting because it is payer- sponsored. The platform is from K Health, a company that built its platform by using anonymized electronic health records of over 2 million patients from Maccabi Health Services in Israel from the past 20 years. That data, which includes 2 billion health events, was used to train artificial intelligence algorithms to recognize symptoms and diagnoses…” Humana announced a communication app with primary care physicians in April.