High Cost of Hospitalization Rates of LTC Medicare Beneficiaries

A new Kaiser Family Foundation report provided insight into another method for reducing Medicare costs – reducing hospitalization among patients in nursing homes and other long-term care (LTC) facilities. The report estimated that a 15% reduction in hospitalization rates in Medicare LTC beneficiaries could potentially save Medicare $1.3 billion dollars in 2010. It is estimated that hospitalization rates for long-term care facility residents can be reduced by 30-67% since a lot of the hospitalizations are preventable if the appropriate interventions are given.

I think this is a wonderful potential source for reducing public health care expenditures. However, I wonder what methods CMS can use to attack the high hospitalization rate in this patient population besides not paying for “never events” and “preventable readmissions.” Can Medicare coordinate with Medicaid to restructure LTC payments to provide incentives for facilities to provide better care and reduce hospitalization rates for their residents? What are your thoughts on how to reduce this area of wasteful Medicare spending?

The report can be found here.

$200 million in Medi-Cal Cuts: Follow up from Today's Class

I came across this article briefly outlining where the cuts will be made to the Medi-Cal program by the Governor's line item veto. It looks like they will come from:

- Rate freeze on fee-for-service hospital payments ($84 million)
- Shifting mental health services for students from the counties to the school districts ($133 million)
- Cuts to community clinics, although the specific cuts are unclear

If I come across more detail I will post it, but it seems there will be efforts to challenge the veto. Here is the post from the California Healthline: http://www.californiahealthline.org/articles/2010/10/13/health-cuts-in-budget-package-could-face-legal-challenges.aspx

There's a lot to bend...

In preparation for Friday's talk on Cost-Sharing, and in response to constant conversation re: "bending the cost curve," I thought this graphic was interesting, because it shows our US cost curve as compared to the 31 other OECD countries. Technically, it shows total health spending as a percentage of GDP - but still, the way the US curve stands out from the pack is striking.

http://theincidentaleconomist.com/wordpress/why-its-time-to-panic/

Accountable care organizations friend or foe?

ACOs seem to be the next great hopeful for health care cost containment, but I have yet to read anything very optimistic about them. Writing them into Healthcare reform without actually defining them seems to be leaving a great deal of opportunity for the entire sector to spin it's wheels on ways to cope with it.

http://www.kaiserhealthnews.org/Stories/2010/October/11/health-care-interests-ACOS.aspx

Medical Student Distress and the Risk of Doctor Suicide

http://www.nytimes.com/2010/10/07/health/views/07chen.html

I saw this thought-provoking piece in the New York Times last week and wanted to share it with you. It sheds light on the high rate of suicide and unaddressed mental illness among the U.S. physician community, a truly under-examined problem within our hospitals and medical schools. The article noted that physicians have a far higher suicide rate than their peers (40 percent for men and a jaw-dropping 130 percent for women), an unhappy commonality that physicians share with other health care workers such as dentists and psychiatrists. Apart from the expected workplace stressors that we might assume would contribute to the problem, social pressures and worries about career advancement seem to provide powerful disincentives for seeking treatment and may drive doctors to cope with mental illness through substance abuse and other "dysfunctional behaviors."

Disproportionate rates of untreated mental illness among the physician community reaches far beyond their social circles. They present serious implications for quality and efficiency of patient care, and establish an unhealthy precedent for future physicians to follow. As future managers, policymakers and administrators within the healthcare system, we will likely inherit the challenge of dealing with a physician culture that discourages healthy coping mechanisms for its most vulnerable members. How can we develop policies and intra-hospital programs that foster a more treatment-friendly mentality that can cope with the frequent--and inevitable--workplace stressors facing the physician community?

Food Stamps and Obesity

For the policy-oriented people, something to ponder other than health care reform.

No Food Stamps for Soda - NYT (This article was circulated by GSPP's econ professor Steve Raphael)

New York City and State asked the USDA to prohibit food stamps from being used to buy sodas and other sugary drinks because they have low nutritional value and contribute to a growing obesity problem in New York.

This made me think about the conversations we've had in class addressing conservative attacks on "obamacare" and the government being "too paternalistic." There was also an article in SF Chronicle a couple weeks ago about a resolution they were considering that would limit the giving away of toys with foods that are unhealthy (i.e. happy meals from McDonalds). I'm all for encouraging people to make healthy choices, but is this the way?

We learn from economics that our choices are heavily influenced by our budget constraints, but how, or even should, our food consumption choices also be constrained by public policy? Is it OK to limit the choices of the poor (on food stamps) and not okay to limit the choices of the rich (because they make their choices with their own money)?

Where do we draw the bright line? Or, should we?

Healthcare's Lost Weekend - NYTimes

Healthcare's Lost Weekend - NYTimes 10/3/2010

This article addresses two areas in which NYC hospitals are attempting to improve quality and reduce cost: (1) More services on the weekends, (2) Quality assessments.

The article highlights that making physicians work weekends is both a necessity and a convenience, because it will improve quality and reduce cost, while also giving people the ability to see a physician more easily on the weekends. Also highlighted is the use of quality assessment and management to allow health providers to be more efficient and therefore reduce costs.

This article brings to mind a few questions:

In regards to expanding the physician's role to the weekend...

1. What types of physicians would this impact the most? Are we talking only emergency physicians available, or extending primary care services to the weekends? If so, is there enough physicians to meet these needs?

2. Does expanding the hours of healthcare provider add additional administrative costs that will then outweigh the cost savings?

3. Is this model encouraging more overall use of healthcare?

Thoughts????