Reflex: August 24, 2011

Association of ICU or hospital admission with unintentional discontinuation of medications for chronic diseases. study in JAMA showed that patients who were admitted to the hospital were significantly more likely to unintentionally stop medications. Patients admitted to an intensive care unit were more likely to have an additional risk of medical discontinuation in 4 of 5 medication groups. Aaron’s comment: Continuity of care is recognized as an important part of long-term care of chronic conditions. This study took place in Canada, so I’m not going to blame the US health care system. But it’s something to consider as a potential problem, especially as we transition to a more hospitalist/less primary care system of inpatient management. I wrote about other problems with this system of care last week.

Medicare announced a new bundled payment initiative, Julie Rovner reports. “Rather than paying hospitals, doctors, and post-hospital caregivers separately, Medicare would provide a single payment for, say, heart attack care. That would give all the providers involved an incentive to work more cooperatively. […] If providers can treat a patient for less than the specified payment, they can keep the extra money as profit. If it costs them more — for example, if the patient needs to be readmitted to the hospital — the providers will have to make up the difference.” Austin’s comment: The alignment of payment incentives and seat of information and decision-making is the fundamental theory behind much of the ACA. If physicians are making or highly influencing decisions, they should be at greater risk for the cost consequences, the theory goes.

Consumer driven health plans slightly bending the cost curve, according reporting by Joanne Wojcik. “The average cost increase for all CDHPs was 8.0% for 2011, slightly lower than the average of all plan types, which increased 8.2% this year, UBA found. The average increase across all plans was 8% in 2010 and 7.3% in 2009.” Austin’s comment: Whereas bundled payments redistribute cost risk to providers, CDHPs, which include high deductibles, shift it to patients. Though the ACA is focused on the former approach for Medicare, employers are more likely to try the latter. Because healthier people tend to choose them, evidence is mixed as to whether CDHPs really bend the cost curve. If they do, it isn’t a lot because most of health are spending is far above even what we call “high deductibles.” More on CDHPs here and here.

H/t: Igor Volsky.

Hidden information below


Email Address*