Today's News and Commentary

About Health Insurance

Groupons For Medical Treatment? Welcome To Today’s U.S. Health Care: Interesting article on how discount coupons are being used for a variety of medical services. The overall charges can be less than insurance company negotiated prices, but it is unclear if patients will get deductible “credit” for out of pocket expenses.

AMA Releases 2020 CPT® code set: ALL healthcare providers and payers need to review these changes. “There are 394 code changes in the 2020 CPT code set, including 248 new codes, 71 deletions, and 75 revisions…
Among this year’s important additions to CPT are new medical services sparked by novel digital communication tools, such as patient portalsthat allow health care professionals to more efficiently connect with patients at home and exchange information.” See, also, CPT® Overview.

Insurers Pitch New Ways to Pay for Million-Dollar Therapies (Wall Street Journal- subscription may be required): This article augments the previous post about one method for dealing with gene therapy drugs by omitting the patient’s out-of-pocket payment. Another method mentioned here is called a subscription model. However, it is not different from a pharma capitation scheme used decades ago with HMOs.

Administering Specialty Drugs Outside Hospitals Can Improve Care and Reduce Costs by $4 Billion Each Year: The headline and reporting in other media outlets is misleading. What the study shows is that it is cheaper to administer high-cost specialty drugs in settings that are not hospital affiliated rather than places that are owned by those facilities. (The headline erroneously implies inpatient versus outpatient costs.)

How much is the savings? $16,000-37,000 per patient per year, or $4 billion overall.

The Relative Value Scale Update Committee:Time for an Update: This article provides a nice analysis about why the relative value system needs updating. To what is in the article, I add two more reasons:
1. Cognitive services are undervalued compared to procedural services. This imbalance is the result of the composition of the committee that sets the relative values.
2. Geographic adjustments for work units never made sense and should be eliminated.

About the public’s health

Association of Race/Ethnicity With Emergency Department Destination of Emergency Medical Services Transport: Add one more item to health disparities in care provision. “This study found race/ethnicity variation in ED destination for patients using EMS transport, with black and Hispanic patients more likely to be transported to a safety-net hospital ED [instead of closest hospital ED] compared with white patients living in the same zip code.”

Emergency Department Closures And Openings: Spillover Effects On Patient Outcomes In Bystander Hospitals: ED closures in most urban areas do not affect quality of care, since travel times to the next facility are relatively short. Closing those EDs decreases access but saves money. But how far would you need to travel so that quality is affected? When heart attacks were studied, closure of an ED that resulted in a 30 minute or greater trip to the next closest high-occupancy ED resulted in a one-year mortality and thirty-day readmission rates increase of “2.39 and 2.00 percentage points, respectively, while the likelihood of receiving percutaneous coronary intervention (PCI) declined by 2.06 percentage points.”

Impact of Rural and Urban Hospital Closures on Inpatient Mortality: A similar question to the one above must be posed vis-a-vis closure of rural versus urban hospitals. “This paper examines the impact of California's hospital closures occurring from 1995-2011 on adjusted inpatient mortality for time-sensitive conditions: sepsis, stroke, asthma/chronic obstructive pulmonary disease (COPD) and acute myocardial infarction (AMI)…rural closures increase inpatient mortality by 0.46% points (an increase of 5.9%), whereas urban closures have no impact. Results differ across diagnostic conditions; the general effect of closures is to increase mortality for stroke patients by 3.1% and for AMI patients by 4.5%, and decrease mortality for asthma/COPD patients by 8.8%.”

Marijuana use by US college students up, highest in 35 years: “U.S. college students are using marijuana at the highest rates in 35 years, according to a report released Thursday.
About 43% of full-time college students said they used some form of pot at least once in the past year, up from 38%, a University of Michigan survey found. About 25% said they did so in the previous month, up from 21%.
The latest figures are the highest levels seen in the annual survey since 1983.”

2019 Update on Medical Overuse: This article reviews evidence for many commonly used diagnostics and treatments, and presents evidence-based recommendations to curb their overuse.

About healthcare IT

Physicians’ gender and their use of electronic health records [EHRs]: findings from a mixed-methods usability study: Usually age and prior IT experience are evaluated when EHR usability is evaluated. However, this article indicates gender may be an important factor as well. “ Overall task performance scores were similar for men (90% ± 9.3%) and women (92% ± 4.4%), with no statistically significant differences (P = .374). However, female physicians demonstrated higher efficiency in completion time (difference = 7.1 minutes; P = .207) and mouse clicks (difference = 54; P = .13). Overall, men reported significantly higher perceived EHR workload stress compared with women (difference = 17.5; P < .001). Men reported significantly higher levels of frustration with the EHR compared with women (difference = 33.15; P< .001). Women reported significantly higher satisfaction with the ease of use of the EHR interface than men (difference = 0.66; P =.03). The women’s perceived overall usability of the EHR is marginally higher than that of the men (difference = 10.31; P =.06).”

ONC awards The Sequoia Project coordinating responsibilities for TEFCA: “In a major step toward advancing its strategy for nationwide data sharing, the Office of the National Coordinator for Health IT (ONC) awarded The Sequoia Project a cooperative agreement to serve as the recognized coordinating entity (RCE) for the Trusted Exchange Framework and Common Agreement (TEFCA).

As the coordinating entity, The Sequoia Project—a nonprofit that advocates for nationwide health information exchange—will be responsible for developing, updating, implementing and maintaining the common agreement component of TEFCA.” See Chapter 8 of the text for detailed background of these organizations.