Health Policy News and Views
Compiled by Benita M. Dodd
Much ado about nothing: A new paper identifies five overused medical treatments and offers proposals to prevent their overuse, which the report defines as use of a treatment that confers zero or negative benefits to a patient. The paper, by the Joint Commission and the American Medical Association-Convened Physician Consortium for Performance Improvement, cites antibiotics for viral upper respiratory infections; over-transfusion of red blood cells; tympanostomy tubes for brief middle ear effusion (fluid); early-term, non-medically indicated elective delivery, and elective angioplasty.
The $69 million machine that goes “ping:” In health care, “self-referral” is when providers refer patients to facilities or services in which they or their family members have a financial interest. One such is anatomic pathology – the preparation and examination of tissue samples to diagnose disease. A report released Monday by the Government Accountability Office found that the number of such services self-referred increased at a faster rate than non-self-referred services from 2004 to 2010. In fact, they more than doubled, growing from 1.06 million services to about 2.26 million services, while non-self-referred services grew about 38 percent, from about 5.64 million services to about 7.77 million services.The GAO estimates that, self-referring providers probably referred over 918,000 more anatomic pathology services in 2010 than if they had performed them at the same rate as non-self-referring providers, at a cost to Medicare of about $69 million. “To the extent that these additional referrals were unnecessary, avoiding them could result in savings to Medicare and beneficiaries, as they share in the cost of services.”
OPM: The Veterans Health Administration’s (VHA) medical centers administer a Beneficiary Travel Program, designed to encourage eligible veterans to seek medical care by reducing travel costs to medical appointments. Veterans can be reimbursed for some travel expenses, such as mileage. The VA Office of Inspector General has identified “issues with inadequate management and oversight,” the GAO reports. The VHA has identified the program as “susceptible to significant improper payments and has estimated $71 million in improper payments for fiscal year 2012.”
The ObamaCare honor system: Benjamin Domenech of the Heartland Institute says the government’s inability to build a system that interfaces with states and takes the necessary steps to check for eligibility has led the Obama administration to just throw in the towel for at least the first year. “And this serves its aims in multiple ways: first, it makes it much easier to sign as many people up as possible to avoid rate shock, which is what the administration is worried about; second, it means the administration’s allies can target their sign-up efforts on the 16 states where no verification is necessary; and third, it creates as significant a subsidy constituency as possible prior to the problems we’re likely to see during rollout. Of course, the incentives it creates are completely warped. A modest lie about your income can push people who would’ve been on Medicaid, most of whom don’t file tax returns, to the far more generous exchange subsidies. The resemblance to the “Liar’s Loans” approach to the housing market collapse is uncanny.“
Shopping online for surgery: An Oklahoma City surgery center is offering a new kind of price transparency, posting guaranteed, all-inclusive surgery prices online. The move is revolutionizing medical billing in Oklahoma and around the world. Surgery Center of Oklahoma, founded 15 years ago, started posting its prices online about four years ago. The facility accepts private insurance, but not Medicaid or Medicare, thus avoiding government regulation and control.
Oklahoma City’s News Channel 4 obtained bills from the metro’s three largest medical centers: Mercy Medical Center, Integris Baptist Medical Center and OU Medical Center. It found that Mercy Hospital charged $16,244 for a breast biopsy; the procedure costs $3,500 at Surgery Center of Oklahoma. OU Medical Center billed $20,456 for the open repair of a fracture; the procedure costs $4,855 at Surgery Center of Oklahoma. OU Medical Center billed $21,556 for a gall bladder removal surgery; the procedure costs $5,865 at Surgery Center of Oklahoma. OU Medical Center billed $23,934 for an ankle arthroscopy; the procedure costs $3,740 at Surgery Center of Oklahoma. Integris Baptist billed $37,174 for a hysterectomy; the surgery costs $8,000 at Surgery Center of Oklahoma. Now, according to the report, prospective patients are demanding price matches before going under the knife.
Wired: Six Georgia hospitals made the 2013 list of Healthcare’s Most Wired in Hospitals and Health Network’s 15th annual survey, designed to measure the level of information technology adoption in U.S. hospitals and health systems:
Emory Healthcare, Atlanta www.emoryhealthcare.org (five hospitals, 1,420 beds)
Piedmont Fayette Hospital, Fayetteville, Ga. www.piedmontfayette.org (one hospital, 157 beds)
Piedmont Hospital, Atlanta http://piedmont.org/locations/pah-home.aspx (one hospital, 529 beds)
Piedmont Mountainside Hospital, Jasper www.piedmontmountainsidehospital.org (one hospital, 42 beds)
Grady Health System, Atlanta www.gradyhealth.org (one hospital, 660 beds)
Piedmont Newnan Hospital, http://piedmont.org/locations/pnh-home.aspx (one hospital, 136 beds)
Bioengineered HIV treats genetic diseases: Italian researchers reported they effectively eliminated the symptoms of children with two rare genetic diseases using gene therapy that involved a modified HIV-derived virus. The two clinical trials, published in the journal Science, focused on three children who were born with metachromatic leukodystrophy and three others with Wiskott-Aldrich syndrome. Both diseases are caused by inherited genetic mutations that disrupt the body’s ability to produce crucial enzymes. In each trial, researchers took the normal form of the faulty gene and attached it to a virus derived from HIV that had been modified so that it could no longer cause AIDS. It was then delivered to bone marrow stem cells that were transfused into the patients. Source: Los Angeles Times
Whistleblower lawsuit settled: Doctors Hospital of Augusta (Ga.) has agreed to pay a $1.02 million settlement in a lawsuit alleging the hospital submitted or caused the submission of false claims to Medicare and Tricare, according to an Augusta Chronicle report. The lawsuit alleged the hospital submitted claims for certain radiation oncology procedures that were allegedly performed without proper physician supervision, according to the report. The suit was filed under the whistleblower provisions of the False Claims Act, according to the report.
Nanotech improving medications: A new nanotechnology has been developed to precisely control the size, shape and composition of drug particles, coupled with an innovative spray system, that may allow for more precise and targeted delivery of drugs and biologic medications, according to researchers at the University of North Carolina. The combination of nanoparticles with the new coating process provides “control and reproducibility,” researchers say. Source: In-Pharma
Who to follow on Twitter: Aside from me (@benitadodd) and the Georgia Public Policy Foundation (@gppf), according to Becker’s Hospital Review Kevin Brown (@KBrown_Piedmont) is one of the 20 health care leaders you should follow. The President and CEO of Piedmont Healthcare, a nonprofit, five-hospital system, Brown tweets from conferences and regularly posts health care news.
What health care reform? Half of patients have yet to hear their regular physician discuss health care reform or the Patient Protection and Affordable Care Act at appointments, according to a new survey from HealthPocket, a technology company that compares health plans.
How’s your doctor? Nearly 40 percent of the nation’s physicians are experiencing at least one symptom of burnout, according to Medscape’s Physician Lifestyle Report 2013. The survey defined “burnout” as a loss of enthusiasm for work, feelings of cynicism and a low sense of personal accomplishment. The 12 specialties with the highest percentage of burnout were:
1. Emergency medicine
2. Critical care
3. Family medicine
4. Obstetrics, gynecology and women’s health
5. Internal medicine
7. General Surgery
11. HIV and infectious diseases
Costly slip-ups: Accidents involving slips, trips and falls send 9 million people to the hospital each year and are a leading cause of workers’ compensation claims, costing an average of $20,000 per accident. Did you know that 95 million workdays per year are lost due to slip-and-fall injuries? Source: EHS Today
My mother used to tell me I had “sweet blood,” and that’s what drew mosquitoes to me. It doesn’t help that I’m highly allergic to the little bloodsuckers, too! But according to a recent article in the Wall Street Journal, “Mosquitoes find their mammalian prey through sensing the heat and carbon dioxide mammals emit. Pregnant women and larger people are sometimes the victim of multiple attacks, since they exert more energy than the average person.” There are ways to ward off mosquitoes, according to the article, but it’s not by eating garlic. Hint: Try an electric fan or mosquito repellant.
Quotes of Note
“A half-educated physician is not valuable. He thinks he can cure everything.” – Mark Twain’s Notebook
“An aging human body is all too much like an aging automobile. This week the carburetor needs repair, next week the transmission starts acting up, then the spark plugs need replacing. And then, even after everything is taken care of, the acceleration is never the same as it once was.” – Thomas Sowell