About costs of care:
Estimated Nonreimbursed Costs for Care Coordination for Children With Medical Complexity: While children with complex medical conditions are rare ( <1% of the pediatric patients), they account for more than a third of health care costs for this sector. Many specialists are involved in their care, but the cost for coordinating services falls on their primary care provider- the general pediatrician. This study “tracked time spent in practicably measured nonbilled care coordination efforts” and found that “ the adjusted median estimated cost of documented activities ranged from $145 to $210” per child per month. Similar financial burdens fall on primary care internists and family medicine physicians. In other words, those earning the lowest income in medical practice bear the highest unreimbursed costs of coordinating care. Quantifying these amounts highlights the need to better balance payments to cognitive and procedural specialists.
About insurance:
Consumer Engagement in Health Care: Findings From the 2018 EBRI/Greenwald & Associates Consumer Engagement in Health Care Survey: High deductible health plans are supposed to make patients more cost sensitive- encouraging them to shop for healthcare based on cost and quality. This study shows that persons who enroll in such plans do, indeed, engage more with their care decisions. However, the the population enrolling in these plans “ have higher income and higher education than those enrolled in more traditional health coverage;… are more likely than enrollees with more traditional health coverage to be employed full-time; and… were more likely than enrollees in more traditional health coverage to report being in very good health.” As with many other healthcare studies, sorting out the direction of causality is important before meaningful interpretation can be made.
About information technology:
Administrative Simplification: Rescinding the Adoption of the Standard Unique Health Plan Identifier and Other Entity Identifier: In an effort to simplify reporting requirements, HHS issued a proposed rule that would eliminate the HIPAA requirement for providers to list the patent’s health plan identifiers. The complaints about this requirement centered on the fact that providers gather insurance data by payer not specific health plan of that payer. The proposed rule is open for commentary but I cannot see who would oppose it.
Read the proposed rule in the Federal Register
Feasibility of Reidentifying Individuals in Large National Physical Activity Data Sets From Which Protected Health Information Has Been Removed With Use of Machine Learning: Just when you thought HIPAA was protecting your identity… This study analyzed physical activity data gathered from accelerometers and reported to the National Health and Nutrition Examination Survey (NHANES). Data was de-identified with traditional methods. Using machine learning, one algorithm “successfully reidentified the demographic and 20-minute aggregated PA data of 4478 adults (94.9%) and 2120 children (87.4%).” While this study was focused on one type of data, it calls attention to the ability to re-identify individuals using increasingly sophisticated software and the need for better “data scrubbing.”
About quality:
Variation in the Quality of Head and Neck Cancer Care in the United States: While this article is very specific in focus, its results highlight a more general topic in quality studies: volume-quality linkages. For many conditions, high institutional and/or physical volume predict better outcomes (such as lower mortality). But this association does not always hold. This study demonstrates a wide variation in quality among hospitals with different volume and other characteristics , such as academic and system affiliations as well as geographic locations. The reasons for these variations are to clear and the authors call for better identification of high performance centers based on as yet to be identified criteria.
Read the research (Subscription required)
Long-Term Survivorship Care After Cancer Treatment - Summary of a 2017 National Cancer Policy Forum Workshop: Speaking of cancer, the good news is that many diseases are now either curable or treatable, turning a death sentence into a chronic condition. But what happens to “survivors?” Providers of care tend to look at these patients as successes and then move on to others who need treatment. The results of this 2017 workshop were published in this month’s Journal of the National Cancer Institute. It provides an excellent summary of all dimensions of caring for these patients.
About the public’s health:
Screening for Syphilis Infection in Pregnant Women: This article is not from today’s news but made a top story list for the year. It is a reminder that we need to stay vigilant about re-emerging health threats. At one time, every US jurisdiction required a syphilis test to obtain a marriage license. Now none do. But syphilis has returned as a public health problem: ”After a steady decline from 2008 to 2012, cases of congenital syphilis markedly increased from 2012 to 2106, from 8.4 to 15.7 cases per 100 000 live births (an increase of 87%). At the same time, national rates of syphilis increased among women of reproductive age.” As a result, the US Preventive Task Force now issues its highest (A) recommendation that all pregnant women be screened early in pregnancy for this disease.