Can’t Get Over Overuse

January 28, 2012

In the movie Casablanca, Police Captain Renault announces with feigned surprise that he “shocked” to find out that gambling is going on at Rick’s Casino.

If you needed proof that yes, overuse of health services is going on here in the U.S., it comes in a new study out last week.  It reports with alarm that over overuse of therapeutic procedures accounts for as much as 30% of healthcare spending in our nation.

The article, published in the current issue of the Archives of Internal Medicine, reported on a review of 241 separate studies of overuse published between 1978 and 2009. Overuse was defined as interventions in which negative consequences, including unnecessary costs, outweighed the benefits of care.

The 4 most common health services examined in the studies included in the review were antibiotics for upper respiratory infections, coronary angiography, carotid endarterectomy, and coronary artery bypass grafting and revascularization.

One healthcare service that appeared to be significantly overused was follow-up screening colonoscopies, with up to a 60.8% rate of overuse; also hysterectomy, at up to 70.0% overuse.

“Despite broad acknowledgment that overuse is common and costly, overuse research has been underemphasized compared with research on underuse of health services,” the authors write.

Captain Renault attempted to deal with the gambling “problem” by closing Rick’s Casino for one night, thus averting a fight between the Free French citizens and Major Strasser and her evil Nazi thugs.

Here in the U.S., one attempt to quantify and reduce overuse is the new Patient-Centered Outcomes Research Institute (PCORI) which issued its much anticipated first report on national priorities on January 23.

The 22-page report stopped short of specifying any diseases or conditions that would be targeted for comparative effectiveness research.

Instead it made a series of general statements, intended to “define the boundaries” and “define the types of questions that we want to invest in,” said one panel member.

In Casablanca, Humphrey Bogart was forced to abandon the girl (Ingrid Bergman) and along with Claude Rains (Captain Renault), was forced to flee the city, heading for a French army camp deep in the North African desert. An initial setback for the two men, but “the beginning of a beautiful friendship,” said Bogart.

Let us hope the PCORI panel members maintain their sense of optimism as they begin a long struggle against the huge problem of overuse which may generate opposition from some entrenched interests.

Best Buy Offers Aetna Products

January 16, 2012

Best Buy has started selling “wellness plans” from Aetna, reports MobileHealthNews.  According to the article,

“Three Best Buy stores in the suburban Chicago area are now selling four wellness programs offered by Aetna focused on fitness, weight management, smoking cessation, and stress management. Shoppers can buy hanging cards that explain each of the online programs that they can then access online. Each program costs $19.99.”

The article doesn’t define exactly what the consumer gets for $19.99, although it must be guidance or online advice, not actual health insurance. My first reaction, as someone who spent a decade working for a health insurance company, is that this marks the rehabilitation of the HMOs. At the height of the managed care hatred, 1995-2005, Best But would never have wanted to be associated with Aetna or any other health insurer. At one point, health insurers vied with tobacco companies as the most hated corporations.

According to the news article, Best Buy has created “health departments” in some of its stores and is selling “health devices like Withings’ blood pressure cuff, iHealth’s weight scale, the Basis B1 Band, Fitbit Ultra, or Jawbone’s UP.”

The article reported that an Aetna spokesperson said

“If shoppers are at Best Buy to purchase a pedometer or blood pressure cuff, they might also be interested in a program that helps them achieve health goals associated with the device. Best Buy employees at these three particular stores have been trained specifically to help shoppers in the health department sections.”

Will the new effort succeed?

The report points out that in 2004, Best Buy attempted to launch a new chain of retail stores, called Eq-Life, which “which aimed to help women shoppers buy technology and resources to manage their family’s health.”

The idea never gained traction and was quietly folded.

I don’t know if the having Aetna products will make money for Best Buy, but I know it is a winner for the health insurers. This is a major marketing coup. They are displayed on Best Buy’s shelves along with Apple, Microsoft, HP, Samsung, Symantec and many other highly respected consumer brands.

The New Bottom Line: Data

January 6, 2012

For hospitals and medical groups, data is the new bottom line, according to a report from AHIMA.

CMS  will begin its value-based purchasing initiative in October 2012. This is just one step in the long march healthcare is taking from claims-based reimbursement to pay based on quality measurement. The targets for delivering quality care are almost entirely based on data.

The AHIMA report, available here, notes that “the more accurate and managed a facility’s data, the better their reimbursement potential.” This assumes the hospital is hitting the targets for high-quality care.If you’re facility is providing poor care and patients are dying right and left, high quality data reporting is not going to be in your best interest (at least for Medicare payments).

According to one AHIMA executive,

“People are going to have to leverage the data and use what they have available. That is what’s going to make the difference between success and failure.”

The report says that as senior executives at hospitals start analyzing data, they will learn something AHIMA has been warning about for years, that  data integrity “isn’t what it should be.”

For example, integrating information from different facilities raises information management challenges when multiple terms are used for the same items.

The AHIMA report cites this example

“A hospital has a psychology division that participates in an ACO. The division sends a record named ‘treatment plan’ to another facility, which assumes it is a general health treatment plan and fails to provide the record with the advanced security that behavioral health records require.”

The report adds that because of these issues

“work will be done to leverage metadata tags to manage patient identity, patient privacy and security, and health data provenance.”

Editorial note: data is a plural noun and normally takes plural verbs. However, when a unit of data is referred to (” the data is sound”) it becomes a collective noun and takes a singular verb.