• Reflex: September 14, 2011

    Strict hand hygiene and other practices shortened stays and cut costs and mortality in a pediatric intensive care unit, reports a manuscript in Health Affairs“[O]n average patients admitted after the quality interventions were fully implemented spent 2.3 fewer days in the hospital, their hospitalization cost $12,136 less, and mortality was 2.3 percentage points lower, compared to patients admitted before the interventions. Aaron’s comment: The annual savings in one intensive care unit was projected to be $12 million! We can make light of it, but this is a serious problem and not hard to fix. We should do so.

    A new tax on health benefits is included in Obama’s jobs plan, reports Julian Pecquet (The Hill). “Currently, individuals and families in the 35 percent tax bracket receive $0.35 off their taxes for every $1 in tax deductions and exclusions, including employer contributions to health. This proposal would change the limit to $0.28, making the deduction more in line with what middle class families receive today. No individual earning less than $200,000 and family earning less than $250,000 would be affected by this proposal.” Austin’s comment: This is similar in spirit, though different to, the Cadillac tax, which will tax high-premium health plans beginning in 2018. The main difference is Obama’s proposal is more progressive, hitting only the wealthiest taxpayers. Among economists and policy wonks, it’s a well-regarded way to increase revenue. Will it survive the political gauntlet? (H/t Igor Volsky)

    The Healthcare Leadership Coucil will endorse raising the Medicare eligibility age, reports Janet Adamy (WSJ). The council, which “includes top executives from Pfizer Inc., Aetna Inc., the Mayo Clinic, [Johnson & Johnson, and Walgreens … is] expected to approve a proposal that would call for raising Medicare’s eligibility age and shifting the program toward private plans for beneficiaries. […] Austin’s comment: Any industry that would benefit from the higher payments offered by private insurers relative to Medicare is likely to be for this style of  Medicare retrenchment. Because Medicare’s drug benefit is entirely in the hands of private insurers, I don’t understand the support of drug manufacturers like Pfizer. For a run down of the consequences, see our FAQ entry. (H/t Brad Flansbaum)

    • I always have trouble interpreting studies like that first one in Health Affairs. Sure, hand washing is important, but do we really think it saves over $10,000 per patient ON AVERAGE? I might believe it from a better designed study, but a pre-post without any control groups? I am much more inclined to believe that this is due to a secular time trend in the hospital rather than the intervention itself

      Aaron and Austin, how do you interpret studies like these?

    • “We can make light of it, but this is a serious problem and not hard to fix. ”

      This is very hard to fix. I was involved in getting the central line protocol installed at our hospital, way before it was a Medicare requirement. There was incredible push back by other doctors and, especially, nurses. I could cite the studies. I brought in the studies. No one believed that you could reduce infections as much as claimed in the studies. No one wanted to bother with full body draping. We tried to do this with persuasion. We ended up making it mandatory policy. Hand washing is going the same way. Few believe it will make the difference shown in the studies. People dont want to told what to do. IMO, it will have to be made mandatory policy. (I only hope Purell isnt toxic.)