January 10th, 2011 by Richard Cooper, M.D. in Better Health Network, Health Policy, News, Opinion, Research
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MedPAC has released another report in which they have tried to explain variation in healthcare utilization among metropolitan statistical areas (MSAs), of which there are approximately 400. MSAs more-or-less correspond to Dartmouth’s 306 hospital referral regions (HRRs), and the conclusions reached by the Dartmouth folks and MedPAC tend to correspond. In commenting about MedPAC’s last report, issued in December 2009, I noted that the major variation was caused by high Medicare expenditures in seven southern states, where patients are poorer and sicker and use much more care.
In their new report, MedPAC went a step beyond measuring expenditures, which they adjusted for prices and other factors in their last report, to measuring the actual units of service, a far better way to assess the healthcare system. MedPAC’s new findings on the distribution of service use in MSAs are graphed below:
Based on this new approach, MedPAC concluded: “Although service use varies less than spending, the amount of service provided to beneficiaries still varies substantially. Specifically, service use in higher use areas (90th percentile) is 30 percent greater than in lower use areas (10th percentile); the analogous figure for spending is about 55 percent. What policies should be pursued in light of these findings is beyond the scope of this paper, which is meant only to inform policymakers on the nature and extent of regional variation in Medicare service use. However, we do note that at the extremes, there is nearly a two-fold difference between the MSA with the greatest service use and the MSA with the least.” Read more »
*This blog post was originally published at PHYSICIANS and HEALTH CARE REFORM Commentaries and Controversies*
December 24th, 2010 by DrRob in Better Health Network, Opinion
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Every day I go to work and spend time with suffering people. They come to me for help and for comfort. They open up to me with problems that they would not tell anyone else. They put trust in me — even if I am not able to fix their problems. I serve as a source of healing, but I also am a source of hope.
Christmas is a moving season for many of the same reasons. No, I am not talking about the giving of gifts or the time spent with family. I am not talking about traditions, church services, or singing carols. I am not even talking about what many see as thereal meaning of Christmas: Mary, Joseph, shepherds, wise men, and baby Jesus. The Christmas story most of us see in pictures or read about in story books is a far cry from the Biblical account. The story we see and hear is sanctified, clean, and safe.
Before I go on, I want to assure my readers that I am in no way trying to persuade them to become Christians. I am a Christian, but whether or not you believe the actual truth of the story, there is much to be learned from it. I find it terribly hard to see the real Christmas story here in a country where the season is filled with so much else — much of it very good. It is far easier to just be happy with family, friends, giving gifts, singing songs, and maybe even going to church, than it is to contemplate the Christmas story. I think the Christians in our culture have gotten way off base on this — much to our shame.
Christmas is not about prosperity and comfort. It is about help to the hopeless. Read more »
*This blog post was originally published at Musings of a Distractible Mind*
November 17th, 2010 by Richard Cooper, M.D. in Better Health Network, Health Policy, News, Opinion, Research
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It is an article of faith that, in Barbara Starfield’s words, adults whose regular source of care is a primary care physician rather than a specialist have lower mortality, even after accounting for differences in income, and she draws upon studies at both the county and state levels to prove it. Now a new paper in JAMA about England’s Primary Care Trusts refocuses the discussion on poverty.
While Starfield’s county-level studies are often cited as evidence that more primary care physicians and fewer specialists lead to lower mortality, they actually showed virtually no differences at all. And when repeated by Ricketts, the small differences noted were not consistent throughout various regions of the U.S. On the other hand, “counties with high income-inequality experienced much higher mortality.” So, in reality, the county studies demonstrated the strong impact of poverty and the marginal impact (if any) of primary care. Read more »
*This blog post was originally published at PHYSICIANS and HEALTH CARE REFORM Commentaries and Controversies*
November 10th, 2010 by Richard Cooper, M.D. in Better Health Network, Health Policy, News, Opinion
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In a high-profile paper in the September issue of Health Affairs, Thorson and coworkers showed that the care at St. Mary’s Hospital in Grand Junction, CO was superior to that of 20 other unnamed hospitals. Grand Junction is, of course the smal town in SW Colorado that became famous when President Obama visited there during the health care reform debates during the summer of 2009, and here’s what he said:
“Hello, Grand Junction! It’s great to be back in Southwest Colorado. Here in Grand Junction, you know that lowering costs is possible if you put in place smarter incentives; if you think about how to treat people, not just illnesses. That’s what the medical community in this city did; now you are getting better results while wasting less money.”
So, Grand Junction, a town of 58,000 people located in SE Colorado, where there are virtually no blacks and fewer Native Americans but where family practice rules, is supposed to be the model for the nation. Read more »
*This blog post was originally published at PHYSICIANS and HEALTH CARE REFORM Commentaries and Controversies*
June 9th, 2010 by Richard Cooper, M.D. in Better Health Network, Health Policy, News, Opinion, Research
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In a recent blog posting, I described Group Health’s medical home for 8,000 patients. It proved to be a boon for primary care physicians, who were able to reduce the size of their patient panels, see fewer patients per day, refer more patients to specialists, and maintain or increase their incomes.
Patients liked it, too. And Group Health was happy because expenditures per patient were 2 percent lower. But poor patients had trouble getting through the front door of the medical home, so based on demographic differences alone, expenditures should have been lower by 10 percent or more. Nonetheless, they declared victory.
Now news filters south from Ontario’s eight-year experiment with medical homes for 8,000,000 patients, and the news is similar. Participation is skewed to healthier and wealthier patients who, in the absence of risk adjustment, yield profitable capitation for primary care physicians. Incomes have soared an average of 25 percent. Read more »
*This blog post was originally published at PHYSICIANS and HEALTH CARE REFORM Commentaries and Controversies*
