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Healthcare Spending: Slowest Growth Since The Great Depression

Healthcare spending grew in 2009 at its slowest rate since 1938, according to a report published in Health Affairs.

The last time America saw such a slow growth rate on health spending it was still emerging from the Great Depression and hadn’t yet entered World War II. The most recent recession is also the cause for the health spending figures, according to the annual report, released by the Centers for Medicare and Medicaid Services.

The report shows that the recession left a deeper impact than previous ones.

Healthcare spending grew 4 percent to $2.5 trillion, outpacing the rest of the still recovering economy. Authors wrote that the recession contributed to slower growth in private health insurance spending and out-of-pocket spending by consumers, as well as a reduction in capital investments by health care providers. Enrollment in private health insurance fell by 6.3 million people.

That’s still 17.6 percent of the U.S. economy in 2009, which reflects the effects of the recession on the economy and the effects of more Medicaid spending, which rose nearly 22 percent last year as part of the economic stimulus and to cover state deficits. (Health Affairs, Washington Post, New York Times, Wall Street Journal)

*This blog post was originally published at ACP Internist*

Making 2011 “Meaningful”

Today, $27 billion in incentives begin for using electronic medical records, as office- and hospital-based providers begin to register for meaningful use criteria.

Providers must use a certified system according to Centers for Medicare and Medicaid meaningful-use guidelines for 90 consecutive days within the first year of the program to qualify. Eligible professionals can receive up to $44,000 over five years under the program. There’s an additional incentive for eligible professionals who provide services in a Health Professional Shortage Area. To get the most money, Medicare-eligible professionals must begin by 2012. By 2015, Medicare-eligible professionals and hospitals that do not demonstrate meaningful use get punished. Read more »

*This blog post was originally published at ACP Internist*

The Business Of Anticoagulation

This is a guest post by Dr. Juliet Mavromatis:

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The emergence of a new generation of anticoagulants, including the direct thrombin inhibitor, dabigatran and the factor Xa inhibitor, rivaroxaban, has the potential to significantly change the business of thinning blood in the United States. For years warfarin has been the main therapeutic option for patients with health conditions such as atrial fibrillation, venous thrombosis, artificial heart valves and pulmonary embolus, which are associated with excess clotting risk that may cause adverse outcomes, including stroke and death. However, warfarin therapy is fraught with risk and liability. The drug interacts with food and many drugs and requires careful monitoring of the prothrombin time (PT) and international normalized ratio (INR).

Recently, when I applied for credentialing as solo practioner, I was asked by my medical malpractice insurer to detail my protocol for monitoring patients on anticoagulation therapy with warfarin. When I worked in group practice at the Emory Clinic in Atlanta I referred my patients to Emory’s Anticoagulation Management Service (AMS), which I found to be a wonderful resource. In fact, “disease management” clinics for anticoagulation are common amongst group practices because of the significant liability issues. Protocol based therapy and dedicated management teams improve outcomes for patients on anticoagulation with warfarin. Read more »

*This blog post was originally published at ACP Hospitalist*

Reassuring Patients About CT Scans And Radiation Risks

Emergency patients with acute abdominal pain feel more confident about medical diagnoses when a doctor has ordered a computed tomography (CT) scan, and nearly three-quarters of patients underestimate the radiation risk posed by this test, reports the Annals of Emergency Medicine.

“Patients with abdominal pain are four times more confident in an exam that includes imaging than in an exam that has no testing,” said the paper’s lead author. “Most of the patients in our study had little understanding of the amount of radiation delivered by one CT scan, never mind several over the course of a lifetime. Many of the patients did not recall earlier CT scans, even though they were listed in electronic medical records.”

Researchers surveyed 1,168 patients with non-traumatic abdominal pain. Confidence in medical evaluations with increasing levels of laboratory testing and imaging was rated on a 100-point scale. Then, to assess cancer risk knowledge, participants rated their agreement with these factual statements: “Approximately two to three abdominal CTs give the same radiation exposure as experienced by Hiroshima survivors,” and “Two to three abdominal CTs over a person’s lifetime can increase cancer risk.” Read more »

*This blog post was originally published at ACP Internist*

Leading Healthcare Systems Collaborate On Best Practices For Common Conditions

Six of the nation’s leading healthcare systems will collaborate on outcomes, quality, and costs across eight common conditions or procedures in an effort to share best practices and reduce costs with the entire healthcare system.

Cleveland Clinic, Dartmouth-Hitchcock, Denver Health, Geisinger Health System, Intermountain Healthcare, and Mayo Clinic will to share data among their 10 million patients with The Dartmouth Institute, which will analyze the data and report back to the collaborative and the rest of the country, according to a press release.

The collaborative will focus on eight conditions and treatments for which costs have been increasing rapidly and for which there are wide variations in quality and outcomes across the country. The first three conditions to be studies are knee replacement, diabetes, and heart failure. They will be followed by asthma, weight loss surgery, labor and delivery, spine surgery, and depression.

*This blog post was originally published at ACP Internist*

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